wards, checked the medical records and laboratory results of patients and discussed these with the relevant nursing and medical staff. Patients with infections and complex cases were discussed by the whole surveillance team. From 2008 onwards, ten hospitals a year were visited by two PREZIES staff members who validated the way the protocol was used. This was done by discussing the surveillance process and studying 20 patient records from prescribed specialties including at least five from patients with NI. Preliminary results of this validation showed a negative predictive value of 97.6% and a positive predictive value of 75%. Study design and data collection All inpatients one year and older, who had been admitted before the day of the survey, were included except for patients in psychiatric and day units, such as dialysis. The surveillance took place during one whole month (March and/or October) and all patients from one ward were surveyed on the same day. Initially, March was the only proposed survey month but October was added at the request of participants who were used to surveying twice a year. Demographic and additional details were collected from patients at the time of the survey and included: presence of NI on hospital admission (related to an earlier hospital stay; not included in the prevalence), surgery, and type, treating specialty, the presence of and category of NI on the survey day, risk factors and anti‐infective use (excluding antifungals and antivirals). Also, the presence of peripheral, central venous, arterial, urinary, suprapubic and epidural catheters, ventricular drains and invasive ventilation were also recorded. An NI was defined as an infection that occurred following hospital admission, without any evidence that the infection was present or had been incubating on admission. An infection was considered to be present or active as long as the patient was symptomatic or receiving antimicrobial or other therapy for the infection on the day of the survey. There is a national working party on antibiotic policy (SWAB: Stichting Werkgroep Antibioticabeleid) that issues guidelines and these serve as a starting point for hospital guidelines. All types of infections, according to the Centers for Disease Control and Prevention (CDC) criteria, were recorded. Adapted CDC criteria were used for SSI, CR‐ BSI and VAP (Table I). CR‐BSI, VAP and catheter‐related urinary tract infection (UTI) were deemed device‐associated when the devices had been present for at least 48h. Only symptomatic UTIs were recorded. Where necessary, results on cultures taken on or before the survey day were collected after the survey day. Data were collected in a web‐ based questionnaire. In order to increase data quality, checks for logical data sequence 92 Chapter 5
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