Survey of Clostridium difficile infection surveillance systems in Europe, 2011.

To develop a European surveillance protocol for Clostridium difficile infection (CDI), existing national CDI surveillance systems were assessed in 2011. A web-based electronic form was provided for all national coordinators of the European CDI Surveillance Network (ECDIS-Net). Of 35 national coordinators approached, 33 from 31 European countries replied. Surveillance of CDI was in place in 14 of the 31 countries, comprising 18 different nationwide systems. Three of 14 countries with CDI surveillance used public health notification of cases as the route of reporting, and in another three, reporting was limited to public health notification of cases of severe CDI. The CDI definitions published by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the European Centre for Disease Prevention and Control (ECDC) were widely used, but there were differing definitions to distinguish between community- and healthcare-associated cases. All CDI surveillance systems except one reported annual national CDI rates (calculated as number of cases per patient-days). Only four surveillance systems regularly integrated microbiological data (typing and susceptibility testing results). Surveillance methods varied considerably between countries, which emphasises the need for a harmonised European protocol to allow consistent monitoring of the CDI epidemiology at European level. The results of this survey were used to develop a harmonised EU-wide hospital-based CDI surveillance protocol.

Impact of department volume on surgical site infections following arthroscopy, knee replacement or hip replacement.

OBJECTIVE: To examine the association between surgical department volume and the risk of surgical site infections (SSI) after orthopaedic procedures. BACKGROUND: A minimum volume regulation of at least 50 knee replacements per year was implemented in 2006 in German surgical departments. METHODS: SSI rates were obtained from Krankenhaus-Infektions-Surveillance-System, the German national nosocomial infections surveillance system (January 2003-June 2008). The authors analysed the data by linear regression models. The adjusted ORs were estimated based on general estimating equation models to assess the independent effect of department volume (low, ie, ≤ 50, medium, ie, >50 and ≤ 100, and high, ie, >100 procedures annually). RESULTS: A total of 206 surgical departments performed 14,339 arthroscopies, 63,045 knee replacements and 43,180 hip replacements during the 5.5-year study period. SSI rates were significantly higher in departments with a procedure volume of ≤ 50 arthroscopies and knee replacements. A higher threshold of 100 procedures per year did lead to a significant decrease in SSI rates for all three procedures in the univariate analysis. The multivariate analysis showed that the risk of SSI in low volume departments was sevenfold higher for arthroscopies and twofold higher for knee replacement than in medium volume departments. SSI risk after hip replacement was significantly lower in high volume centres. CONCLUSION: The authors' findings offer some support for recommendations to concentrate arthroscopy and knee replacement in surgical departments with more than 50 procedures and hip replacement in departments with more than 100 procedures per year in order to reduce SSI.