suited to monitor specific types of HAI and the associated risk factors in appropriate patient categories, e.g. surgery patients at risk for SSI, ventilated patients at risk for ventilator‐associated pneumonia (VAP), and patients with a CVC at risk for CRBSI. Incidence‐based surveillance of all hospital patients would be very time‐consuming and not very effective, as patients not included in SSI, VAP or CRBSI surveillance are generally at low risk to develop a HAI. An alternative is the point prevalence survey (PPS) in which a cross‐section of the hospital population is observed for one or more types of HAI at one time‐point only. These surveys are more suitable to assess all patients in the hospital than incidence‐based surveillance, as they do not include patient follow‐up. They can identify possible patient populations at increased risk and opportunities for intervention, but are less suitable to assess new risk factors. 1.3 HAI in the early 2000s: expansion of surveillance programmes (Part I) Following the SENIC study many industrialised countries have initiated regional or national HAI monitoring programmes , [5]. To allow interhospital comparisons and trend monitoring surveillance requires standardized criteria to define HAI. The US CDC were the first to establish such criteria [21], which form the basis for most other surveillance programmes [22]. In 1996 the Dutch Institute for Public Health and the Environment (RIVM) and the former Dutch Institute for Healthcare Improvement joined to form one national surveillance programme: Prevention of Hospital infections by Interventions and Surveillance (PREventie van ZIEkenhuisinfecties door Surveillance, PREZIES) (https://www.rivm.nl/prezies). To this day PREZIES, in which hospitals and the RIVM participate, enables hospitals to monitor HAI according to a standardised protocol, including a limited set of relevant literature‐based risk factors; it also provides feedback and benchmarks. The first national surveillance initiative in the Netherlands targeted SSI, complemented in 1998 by a surveillance programme focussed on the intensive care unit (ICU), where patients are more at risk of acquiring HAI than in most other hospital wards. Lasting four years, this program monitored ICU‐acquired infections, including (device‐ associated) pneumonia, BSI and UTI, and patient mortality. Chapter 2 describes the incidence of these device‐associated infections, but the data were also used to quantify the recorded risk factors, including device use, for both infection and mortality. Evaluation of the ICU‐programme led to the development of two more targeted programmes, one aimed at VAP and one at CRBSI, with more detailed patient and device‐ specific data to improve case mix correction, increase insight and provide more specific leads for interventions. Both outcome and time at risk (device‐use days) were recorded to calculate incidence densities. The first results of these two programmes are presented 12 Chapter 1
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