A three-year survey of nosocomial and community-acquired infections, antibiotic treatment and re-hospitalization in a Norwegian health region

In Norway, hospital-acquired infections (HAI) were analysed by repeated point prevalence studies (four each year) performed simultaneously at 14 hospitals in a health region (860 000 inhabitants) during the period 1996-1998. The study included 3200 beds and 121 000 discharged patients each year and was initiated by and co-ordinated from the regional university hospital; Ulleval University Hospital (UHH). An overall prevalence rate of HAI of 6.5% (interhospital variation 1.4-11.7%) was found for the 32 248 patients studied. The rate of HAI was reduced from 7.7% in 1996 to 5.9% in 1998. Smaller hospitals (<200 beds) generally had lower rates of HAI, community acquired infections (CAI), postoperative infections and use of antibacterial agents, than the large regional hospital (1200 beds). HAI was reduced in non-operated patients from 5.8% in 1996 to 4.4% in 1998 and in operated patients from 13.2% in 1996 to 10.5% in 1998. The risk of developing HAI was twice as high after surgery. From 1996 to 1998 there was as a reduction in: urinary tract infections from 2.4% to 1.7%, lower respiratory tract infections from 1.5% to 0.8% and postoperative wound infections from 5.7% to 4.3%, while septicaemia (from 0.5% to 0.4%) remained unchanged. Re-hospitalization because of HAI was registered in 0.6% (interhospital variation 0.3-1.1%) of patients. The CAI rate in hospitals increased from 8.3% in 1996 to 10.8% in 1998. Approximately 16% (variation:14.4-20.6%) of the patients had an infection. The total use of antibacterial agents was 19.9% in 1996, 16.6% in 1997 and 17.8% in 1998 (variation: 14.9-23%). (C) 2000 The Hospital Infection Society.