There are oft-quoted studies which advise that between 1% and 10% of healthcare-associated infections (HAIs) present as healthcare-associated outbreaks (HAOs). Examination of these studies showed they lacked validity due to a low sensitivity to detect HAO, and because they pre-date both advanced healthcare systems and the emergence of recent nosocomial pathogen challenges. The accepted inference: that as there are so few HAOs the focus of surveillance programmes should be on endemic and not epidemic infections (outbreaks), is therefore called into question.
Current estimates of HAI burden are derived from Point Prevalence Surveys (PPS) which are neither designed to nor are capable of detecting HAOs. We considered the extensive Infection Prevention and Control Team (IPCT) work to prevent and prepare for perennial and novel HAOs and suggest that at present this endeavour is largely unseen, underestimated and undervalued.
Any HAI burden estimate needs to comprise a more complete HAI summary than PPS data. This can only be done with a more inclusive surveillance system that has a wider focus than just prevalent infections. There is a real risk of redirection of the IPCT resource from outbreak prevention and preparedness work towards HAI that are counted: such a change could only further increase HAO risks.
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References
1.
BeckU (2002) Risk society and the provident state. In: LashSSzerzynskiSWynneB (eds). Risk, Environment and Modernity: Towards a New Ecology. London: Sage.
2.
BenneyanJC (1998a) Statistical quality control methods in infection control and hospital epidemiology, part I: Introduction and basic theory. Infection Control & Hospital Epidemiology19(3): 194–214.
3.
BenneyanJC (1998b) Statistical quality control methods in infection control and hospital epidemiology, Part II: Chart use, statistical properties, and research issues. Infection Control & Hospital Epidemiology19(4): 265–283.
4.
BukhariSSSandersonPJRichardsonDMKaufmanMEAuckenHMCooksonBD (1993) Endemic cross-infection in an acute medical ward. Journal of Hospital Infection24(4): 261–271.
5.
CurranET (2013) Outbreak Column 10: What causes outbreaks - questions of attribution. Journal of Infection Prevention14(5): 182–187.
6.
CurranET (2014a) Outbreak Column 12: Nosocomial Outbreaks of Staphylococcus aureus (part 1). Journal of Infection Prevention15(1): 36–40.
7.
CurranET (2014b) Outbreak Column 14: Staphylococcus aureus – new outbreaks of old infections. Journal of Infection Prevention15(4): 148–153.
8.
CurranETBenneyanJCHoodJ (2002) Controlling methicillin-resistant Staphylococcus aureus: a feedback approach using annotated statistical process control charts. Infection Control & Hospital Epidemiology23(1): 13–18.
9.
DanialJCepedaJACameronFCloyKWishartDTempletonKE (2011) Epidemiology and costs associated with norovirus outbreaks in NHS Lothian, Scotland 2007–2009. Journal of Hospital Infection79(4): 354–358.
10.
DobelliR (2013) The Art of Thinking Clearly. London: Hodder & Stoughton.
11.
European Centre for Disease Prevention and Control (2012) European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals - protocol version 4.3. Stockohlm: ECDC, 2012.
12.
European Centre for Disease Prevention and Control (2013) European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare associated infections and antimicrobial use in european acute care hospitals. Stockholm: ECDC, 2013.
13.
GaynesRRichardsCEdwardsJEmoriTGHoranTAlonso-EchanoveJFridkinSLawtonRPeavyGTolsonJ (2001) Feeding back surveillance data to prevent hospital-acquired infections. Emerging Infectious Diseases7: 295–298.
14.
GuptaAKhannaS (2014) Community-acquired Clostridium difficile infection: an increasing public health threat. Infection and Drug Resistance7(2): 63–72.
15.
HaleyRWTenneyJHLindseyJOGarnerJSBennettJV (1985) How frequent are outbreaks of nosocomial infection in community hospitals?Infection Control6(6): 233–236.
16.
HallerSEckmannsTBenzlerJTolksdorfKClausHGilsdorfASinMA (2014) Results from the first 12 months of the national surveillance of healthcare associated outbreaks in Germany, 2011/2012. PLoS One9(5): e98100.
17.
Healthcare Commission (2007) Investigation into outbreaks of Clostridium difficile at Maidstone and Tunbridge Wells NHS Trust. London: Healthcare Commission.
18.
Health Protection Scotland (2014) Surveillance of Helathcare Associated Infections in Scottish Intensive Care Units. Annual report of data from January - December 2013. Glasgow: Health Protection Scotland.
JennerEAMackintoshCScottGM (1999) Infection control–evidence into practice. Journal of Hospital Infecttion42: 91–104.
22.
KahnemanD (2011) Thinking Fast and Slow. New York: Farrar, Straus and Giroux.
23.
KambhampatiAKoopmansMLopmanBA (2015) Burden of norovirus in healthcare facilities and strategies for outbreak control. Journal of Hospital Infection89: 296–301.
24.
KhannaSPardiDSAronsonSLKammerPPOrensteinRSt SauverJLHarmsenWSZinsmeisterAR (2012) The epidemiology of community-acquired Clostridium difficile infection: a population-based study. American Journal of Gastroenterology107(1): 89–95.
25.
KolaAPieningBPapeUFVeltzke-SchliekerWKaaseMGeffersCWiedenmannBGastmeierP (2015) An outbreak of carbapenem-resistant OXA-48 - producing Klebsiella pneumonia associated to duodenoscopy. Antimicrobial Resistance and Infection Control4: 8.
26.
LefflerDALamontJT (2012) Editorial: not so nosocomial anymore: the growing threat of community-acquired Clostridium difficile. American Journal of Gastroenterology107(1): 96–98.
27.
MacielALde AssisDBMadalossoGPadovezeMC (2014) Evaluating the quality of outbreak reports on health care-associated infections in Sao Paulo, Brazil, during 2000–2010 using the ORION statement findings and recommendations. American Journal of Infection Control42(4): e47–e53.
28.
MuscarellaLF (2014) Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy. World Journal of Gastrointestinal Endoscopy6(10): 457–474.
29.
Public Health England (2014) Surveillance of Surgical Site Infections in NHS Hospitals in England 2013/14. London: Public Health England.
30.
Public Health England (2015) Norovirus and rotavirus: summary of surveillance. London: Public Health England.
31.
ReidJ (2004) Bloodborne MRSA infection rates to be halved by 2008. London: Department of Health.
32.
ReillyJCairnsSFlemingSHewittDLawderRRobertsonCMalcolmWNathwaniDWilliamsC (2012) Results from the second Scottish national prevalence survey: the changing epidemiology of healthcare-associated infection in Scotland. Journal of Hospital Infection82(3): 170–174.
33.
RichardsCLJarvisWR (1999) Lessons from recent nosocomial epidemics. Current Opinion in Infectious Diseases12: 327–334.
34.
StammWEWeinsteinRADixonRE (1981) Comparison of endemic and epidemic nosocomial infections. American Journal of Medicine70(2): 393–397.
35.
SukhrieFHBeersmaMFWongAvan dVVennemaHBogermanJKoopmansM (2011) Using molecular epidemiology to trace transmission of nosocomial norovirus infection. Journal of Clinical Microbiology49(2): 602–606.
36.
WenzelRPThompsonRLLandrySMRussellBSMillerPJPonce deLSMillerGBJr (1983) Hospital-acquired infections in intensive care unit patients: an overview with emphasis on epidemics. Infection Control4(5): 371–375.
