Surveillance of hospital-acquired infections: A model for settings with resource constraints Silvio Brusaferro, MD, a Laura Regattin, MD, a Alda Faruzzo, ICP, b Adriana Grasso, MD, a Marco Basile, MD, a Laura Calligaris, MD, a Luigia Scudeller, MD, c and Pierluigi Viale, MD c Udine, Italy Background: Surveillance activities have been considered of paramount importance for effective infection control programs in health care organizations. Objectives: Our objective was to design a capture system able to assure surveillance of hospital-acquired infections (HAI) in acute hospitals with few resources devoted to infection control. Methods: We performed 4 biweekly repeated prevalence studies to identify major HAI (urinary tract infections, surgical site infec- tions, lower respiratory tract infection, bloodstream infections) as defined by the Centers for Disease Control and Prevention (CDC) criteria in 3 large hospitals in northeastern Italy (6 internal medicine departments, 5 general surgery departments, 3 intensive care units, and 1 bone marrow transplant unit). Results: One thousand five hundred fifty-four patients were screened (63.9% in medical wards, 27.5% in surgical wards, and 8.5% in intensive care units and bone transplant unit). The overall prevalence of infection was 4.9% (77/1554); 4.5% (70/1554) of patients were infected. A capture system based on the presence of fever $38°C, antibiotic use, and presence of devices guarantees 100% sensitivity in detecting HAI but requires an assessment of 62% of the population. Using the presence of fever and devices as criteria guarantees a sensitivity of 98%, requiring an assessment of 41.4% of patients, whereas presence of fever and antibiotic use has the same sensitivity but requires an assessment of 50% of patients. Using nursing records, physician records, and direct patient examination as sources of documentation guarantees that all necessary data are collected while requiring a mean of 4 minutes and 42 seconds per patient (standard deviation, 1 minute and 30 seconds). Conclusion: A capture system based on biweekly repeated prevalence studies that select patients for the presence of fever, antibiotics, and medical devices ensures the detection of all HAI in a resource-limited environment. (Am J Infect Control 2006;34:362-6.) Since results from the Study On Efficacy Of Nosoco- mial Infection Control (SENIC) were published, surveil- lance activities have been considered of paramount importance for effective infection control programs in health care organizations. 1,2 Various surveillance methods have been recommended and validated. 3-5 In most cases, however, they apply to health care orga- nizations in which hospital-acquired infection (HAI) control is an established tradition and in which a fair amount of resources have been earmarked for the problem. Many health care organizations, however, are not in this optimal situation; surveillance, in these settings, although recommended, is not regularly performed. 6 Recent surveys on infection control in Ital- ian national health system (NHS) hospitals showed, among other critical points, a lack of surveillance activ- ities, financial constraints, and human resources limi- tations (particularly in infection control nurses and doctors). 7,8 This is particularly true in small and medium size hospitals (,500 beds), representing the majority of the health care organizations within the Italian NHS, in which the resources needed for the traditionally recommended surveillance methods are not readily available. 4,5 From this perspective, a matching of appropriate methods with available resources is therefore the key to implementing surveillance and effective infection control. 9-12 This study is aimed at defining a surveillance method able to detect the most frequent HAI in hospi- tals for acute patients in which resources invested in infection control are limited. In particular, our objective was to design a HAI capture system with the highest sensitivity, restricting consultation to a minimum set of relevant data sources and reducing the number of patients to be screened for HAI. From the Department of Experimental and Clinical Pathology and Medicine, a School of Medicine, University of Udine; Hospital Health Direction, APUGD Udine, b and Department of Medical and Morpho- logical Research, c School of Medicine, University of Udine, Udine, Italy. Reprint requests: Silvio Brusaferro, MD, Chair of Hygiene, Department of Experimental and Clinical Pathology and Medicine, University of Udine, Via Colugna 50, 33100 Udine, Italy. E-mail: s.brusaferro@med. uniud.it. 0196-6553/$32.00 Copyright ª 2006 by the Association for Professionals in Infection Control and Epidemiology, Inc. doi:10.1016/j.ajic.2006.03.002 362