explain the observed lower prevalence in October versus March. The prevalence of the different categories of infection was also comparable.1–3,5,6 In our study the use of devices was comparable or slightly higher than in other recent European studies.3,5 The antibiotic use was comparable to that found in Sweden (32.5– 34.9%), the UK and the Republic of Ireland (RoI) (32.1–33.1%).3,6,12 Microbiology The pathogens predominantly cultured are known to be a major cause for these infections.13,14 In The Netherlands, the prevalence of C. difcile was lower than that in the UK, RoI and Germany.6,15,16 C. difcile has caused outbreaks in several Dutch hospitals, following the introduction of polymerase chain reaction ribotype 027, but in general these were under control prior to 2007.17 Methodological considerations It is hard to draw conclusions on the relative position of Dutch hospitals because although all the cited studies were also point prevalence studies, there are other methodological differences that hamper comparison. These include the method of data collection (e.g. by hospital staff or by a visiting team), the characteristics of participating hospitals, the inclusion of patients admitted or discharged on the day of the survey, case denitions and the departments included. Issues that could belong to the past when a common protocol, like the one that is being developed by the European Centre for Disease Prevention and Control, is used. Since the surveillance was executed by hospital staff it is likely that there were some differences between hospitals in how the protocol was applied. In order to address this, workshops explaining the protocol were organised for all the participants. Further, from 2008 onwards hospitals were visited by a validation team that checked the survey procedure. Larger hospitals can be overrepresented in voluntary studies and this was the case in our study, where university medical centres were overrepresented and other larger hospitals slightly so (24% ≥800 beds vs 15% nationally).¹⁸,¹⁹ This can result in an overestimated NI prevalence – as larger hospitals usually have relatively more patients with severe underlying disease that is associated with an increased NI risk.¹⁸,²⁰ We compared our results only with those of recent studies. Previous data have limited value for comparison. For example, the average proportion of patients on antibiotics will have increased during the last decade because patients are now discharged earlier. From 1997 to 2006 the average use of antibiotics in Dutch hospitals increased from 47 to 62 dened daily doses per 100 patient‐days whereas hospital stay 98 Chapter 5
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