Hospital Infection Control in Sweden

In Sweden the 23 counties are responsible for the medical care of their inhabitants. They own and run virtually all hospitals. This system facilitates a county-based hospital infection control system. The infection control team is based in the county hospital department of clinical bacteriology. It is headed by an MD clinical bacteriologist or, in some counties, by an infectious disease specialist. In the majority of cases this is a part-time job besides other duties in the department, but some ten hospital epidemiologists work full-time with infection control. Totally there are only some 50 full-time infection control nurse positions in Sweden. This means that on the average every infection control nurse is in charge of some 2,400 hospital beds, of which some 800 are somatic acute-care ones. These beds are situated in several hospitals, often at considerable distance from each other. The county-wise organization of hospitals facilitates infection control work. Medical and nursing procedures can be coordinated between the different hospitals within the county, and teaching is facilitated. However, the scarcity of infection control nurses makes it impossible to perform ongoing complete surveillance. Only surveillance based on laboratory reports can be performed routinely. In Swedish geriatric care there has been a strong movement not to accept incontinence as a reason for inserting and maintaining indwelling urinary catheters. This has greatly reduced urinary tract infections, and the rates of other infections as well. It has also reduced the costs in this type of medical care. In Sweden as well as in the US and Canada ongoing surveillance of postoperative wound infections has reduced the infection rate. The latest reported figures for clean wound infections average 2%, and for colorectal surgery 8%. The incidence of hepatitis B is nowadays very low in Swedish hospital staff and very near that of the general population.