Using flexible methods to determine risk factors for ventilator-associated pneumonia in the Netherlands.

Seven hospitals participated in the Dutch national surveillance for ventilator-associated pneumonia (VAP) and its risk factors. We analysed time-independent and time-dependent risk factors for VAP using the standard Cox regression and the flexible Weighted Cumulative Effects method (WCE) that evaluates both current and past exposures. The prospective surveillance of intensive care patients aged ≥16 years and ventilated ≥48 hours resulted in the inclusion of 940 primary ventilation periods, comprising 7872 ventilation days.

Adhering to a national surgical care bundle reduces the risk of surgical site infections.

Background: In 2008, a bundle of care to prevent Surgical Site Infections (SSIs) was introduced in the Netherlands. The bundle consisted of four elements: antibiotic prophylaxis according to local guidelines, no hair removal, normothermia and 'hygiene discipline' in the operating room (i.e.

Internal and External Validation of a Computer-Assisted Surveillance System for Hospital-Acquired Infections in a 754-Bed General Hospital in the Netherlands.

OBJECTIVE To evaluate a computer-assisted point-prevalence survey (CAPPS) for hospital-acquired infections (HAIs). DESIGN Validation cohort. SETTING A 754-bed teaching hospital in the Netherlands.

[Healthcare-associated infections on readmission: 1 in 3 is linked to previous hospital admission].

Objective: To gain insight into the prevalence of healthcare-associated (HAI) infections in hospital patients in the Netherlands, and their link with previous hospital admission.

Design: Cross-sectional study.

Method: This prevalence study was carried out in 36 hospitals at 42 locations in the Netherlands in March 2014.

Appropriate use of indwelling urethra catheters in hospitalized patients: results of a multicentre prevalence study.

Background: Although indwelling urethra catheterization is a medical intervention with well-defined risks, studies show that approximately 14-38% of the indwelling urethra catheters (IUCs) are placed without a specific medical indication. In this paper we describe the prevalence of IUCs, including their inappropriate use in the Netherlands. We also determine factors associated with inappropriate use of IUCs in hospitalized patients.

Urethral catheters: can we reduce use?

Background: Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection.

Methods: The efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals.

An evidence-based recommendation on bed head elevation for mechanically ventilated patients.

Introduction: A semi-upright position in ventilated patients is recommended to prevent ventilator-associated pneumonia (VAP) and is one of the components in the Ventilator Bundle of the Institute for Health Care Improvement. This recommendation, however, is not an evidence-based one.

Methods: A systematic review on the benefits and disadvantages of semi-upright position in ventilated patients was done according to PRISMA guidelines.

Surveillance and epidemiology of surgical site infections after cardiothoracic surgery in The Netherlands, 2002-2007.

Objective: Surgical site infections after cardiothoracic surgery substantially increase the risk for illness, mortality, and costs. Surveillance of surgical site infections might assist in the prevention of these infections. This study describes the Dutch surveillance methods and results of data collected between 2002 and 2007.

Trends in the incidence of surgical site infection in the Netherlands.

Objective: To evaluate the time trend in the surgical site infection (SSI) rate in relation to the duration of surveillance in The Netherlands.

Setting: Forty-two hospitals that participated in the the Dutch national nosocomial surveillance network, which is known as PREZIES (Preventie van Ziekenhuisinfecties door Surveillance), and that registered at least 1 of the following 5 frequently performed surgical procedures for at least 3 years during the period from 1996 through 2006: mastectomy, colectomy, replacement of the head of the femur, total hip arthroplasty, or knee arthroplasty.

Methods: Analyses were performed for each surgical procedure.

Associations between surgical site infection risk and hospital operation volume and surgeon operation volume among hospitals in the Dutch nosocomial infection surveillance network.

Objective: To examine the association between hospital operation volume and surgeon operation volume and the risk of surgical site infection (SSI).

Design: Prospective, multicenter cohort study based on surveillance data.

Methods: Data were obtained from the Dutch surveillance network for nosocomial infections (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]) on 9 different types of orthopedic surgery, general surgery, and gynecology procedures performed during 1996-2003.

Effect of optimized antibiotic prophylaxis on the incidence of surgical site infection.

Objective: To compare the rate of surgical site infection (SSI) before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented. To demonstrate that a more prudent, restrictive policy would not have a detrimental effect on patient outcomes.

Design: Before-after trial with prospective SSI surveillance in the Dutch nosocomial surveillance network (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), using the criteria of the Centers for Disease Control, including postdischarge surveillance for up to 1 year.

Improved risk adjustment for comparison of surgical site infection rates.

Objective: To develop prognostic models for improved risk adjustment in surgical site infection surveillance for 5 surgical procedures and to compare these models with the National Nosocomial Infection Surveillance system (NNIS) risk index.

Design: In a multicenter cohort study, prospective assessment of surgical site infection and risk factors was performed from 1996 to 2000. In addition, risk factors abstracted from patient files, available in a national medical register, were used.

Incidence and risk factors of device-associated infections and associated mortality at the intensive care in the Dutch surveillance system.

Objective: To examine the incidence of and risk factors for device-associated infections and associated mortality.

Design And Setting: Prospective surveillance-based study in ICUs of 19 hospitals in The Netherlands.

Patients: The study included 2,644 patients without infection at admission during 1997-2000, staying in the ICU for at least 48 h.

Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in The Netherlands.

Objective: To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important.

Design: Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record.

Quality improvement of surgical prophylaxis in Dutch hospitals: evaluation of a multi-site intervention by time series analysis.

Objectives: Misuse of antibiotics in surgical prophylaxis is still quite common. The objectives of this study were to reduce the quantity and improve the quality of surgical prophylaxis and to reduce costs.

Methods: Prospective multi-site study of elective procedures in 13 Dutch hospitals.

Hospital-related determinants for surgical-site infection following hip arthroplasty.

Objective: To determine hospital-related risk factors for surgical-site infection (SSI) following hip arthroplasty.

Design: Prospective, multicenter cohort study based on surveillance data and data collected through a structured telephone interview. With the use of multilevel logistic regression, the independent effect of hospital-related characteristics on SSI was assessed.

Promoting quality through surveillance of surgical site infections: five prevention success stories.

Background: Public reports of successful quality improvement efforts are useful, but seldom available. We present 5 successful efforts to prevent surgical site infections (SSIs) with the use of prospectively collected surveillance data.

Methods: Before-and-after intervention studies were conducted in 5 acute care public hospitals in the national surveillance network for SSI in The Netherlands from 1992 to 2000.