10.3 HAI surveillance in the Netherlands: the future One might wonder whether national surveillance of HAI is still necessary. The benefit for hospitals with low HAI rates is small; the discriminatory possibilities decrease, and the current level of detail may not be necessary from the viewpoint of national monitoring. In Dutch surveillance, low CRBSI incidence densities are a reason for some hospitals to stop participating: the balance between the information gained and the work expended in data collection has tipped the other way. The individual infections are still scrutinised in these hospitals. By contrast, the physicians participating in the Redline focus group study considered CRBSI benchmarking to be important [22]. There are additional reasons to continue national surveillance. First of all to reveal further opportunities for improvement data from multiple hospitals are sometimes needed. For instance the risk of CRBSI associated with TPN was significantly higher in primary than in secondary hospitals[32], a finding which will not emerge in individual hospital data. Secondly, a national surveillance with sufficient participating hospitals, allows the government to have a finger on the pulse. Although hospitals are keen on keeping HAI at low levels, it is conceivable that this may not always be the case. Keeping HAI rates low benefits both patients and healthcare costs. Thirdly, a crisis such as the COVID‐19 pandemic affects organisation and practices of the care system, and therefore may have impact on HAI. National surveillance contributed to the insight in these effects: not only by the regular data collection, which was in fact delayed by the overwhelming influx of SARS‐CoV 2 patients to the ICU, but also because the surveillance organization acts as a central point that individual hospitals address to share and check observations. The rates of ICU‐acquired infections in SARS‐ CoV 2 patients was considerably higher than in the usual ICU population [33‐36]. In the Netherlands, the CRBSI incidence per 1000 CVC days in the ICU appeared 11 times higher with SARS‐CoV 2 patients than with the average ICU patient during the four years before [36]. SARS‐CoV 2 patients required long ICU stays, were treated with immunosuppressive drugs[37], and are often ventilated in a prone position, making it more difficult to access and care for their CVCs. The increased work pressure, assistance of staff from outside the ICU, and (anticipated) scarcity of materials may too have hampered infection prevention [38]. Other developments may also affect future HAI rates and thus warrant a national surveillance program, even with low incidence rates. E.g. in the coming decades, the Dutch population will continue to age. Older age per se is not an independent risk factor for each type of HAI (chapter 2‐4, 7 and 9) [39‐48], but the overall HAI prevalence is higher for elderly patients [8, 31]. Additionally hospital admissions increase with age [49] 242 Chapter 10
RkJQdWJsaXNoZXIy MTk4NDMw