A national surveillance scheme for hospital associated infections in England

The Nosocomial Infection National Surveillance Scheme (NINSS) was established in 1996 by the Public Health Laboratory Service (PHLS) and the Department of Health (DH). The scheme is based upon the advice of the Hospital Infection Working Group of the DH and PHLS1 which recommended that ‘a voluntary national reporting system should be established, which will enable hospitals to compare their data against aggregated anonymized data from other hospitals. Investigation by the hospital of areas where it appeared to differ significantly from the norm would then be possible’. In addition, a previous project by the PHLS and the DH2 demonstrated the feasibility of a centrally organized surveillance scheme in the UK which, together with the increasing interest in quality assurance and audit in the Health Service, suggested that hospitals would like to participate in such a scheme. The NINSS also took into account the experience of the National Nosocomial Infections Surveillance System in the USA.3 The scheme is now available to acute hospitals in both the National Health Service and private sector in England. Participation is voluntary and confidential. Surveillance is targeted on specific infections, units or groups of patients and data collection is for one or more three-month surveillance periods. Where possible, selective methods are used to identify infections. This approach is particularly suitable for Infection Control Teams (ICTs) with limited resources. The scheme comprises a set of modules, for each of which a standard protocol has been developed. To date, three protocols have been developed that focus on specific infections – hospital-acquired bacteraemia, surgical site infection and catheter-associated urinary tract infection (UTI). Those for hospital-acquired bacteraemia and surgical site infections are fully implemented, and the pilot for catheter-associated UTI has just been completed. The modules were chosen with the help of ICTs and the protocols developed with the advice of a multidisciplinary group of colleagues with expertise in surveillance or practical day-to-day experience of hospital infection. For each module, a pilot study was carried out to test the methodology, evaluate the feasibility of the protocol, and to determine the time required for data collection, handling and analysis. Hospitals choose which modules they wish to follow. Regular workshops and annual meetings are held for participants. So far, 139 hospitals have participated in one or more of the three modules. Further modules may include units, such as intensive care, or particular groups of patients, such as burns patients. At the outset, it was realized that computer data entry might not be possible for all hospitals, so a paper-based system for data collection was chosen as the initial method. Forms for data collection were based upon an Optical Mark Recognition (OMR) system. Completed forms are returned to NINSS, where they are scanned through the OMR system and the data downloaded to an appropriate software package for analysis and report production. It is recognized that advances in information technology must be exploited to increase the efficiency and effectiveness of data collection, processing and reporting.