[Monitoring, reporting, and preventing nosocomial infections in ophthalmology. Creation of the National Endophthalmitis Observation Database (ONDE)].
BACKGROUND
Fighting against nosocomial infections (NI) is one of the missions of every healthcare institution (Decree No. 99-1034, 6 December 1999 and circular No. DGS-DHOS-2600-645, 29 December 2000). Setting up epidemiological surveillance for NI is an essential factor in preventing such infection as well as operation-site infections (OSI). It forms one of the priorities defined by the National Technical Committee for Nosocomial Infections (CTIN). In this context, the National Observation Endophthalmitis Database (ONDE) was born under the auspices of the Académie d'Ophtalmologie to coordinate epidemiological surveillance of OSI in ophthalmology, principally after cataract surgery. In addition, recent legislation (Decree No. 2001-671 of 26 July 2001 and circular No. DHOS/E2-DGS/SD/5C no 2001-383 of 30 July 2001) introduced the obligatory reporting of certain NI through the coordination centers to fight nosocomial infections (CCLIN) and to the DDASS, with the aim of alerting and assisting medical institutions. The interaction between these professional initiatives and regulatory obligations remains to be defined.


METHODS
The ONDE project establishes surveillance of postoperative endophthalmitis by collecting information on cases of OSI and their circumstances of onset using a standardized, anonymous questionnaire. This questionnaire can be viewed online on the website . In conjunction, and as stipulated in Decree 671 dated 26.07.2001, it is essential to install the continuous reporting of endophthalmitis of infectious origin in every health care institution, thereby enabling transmission of these NI data in ophthalmology to various healthcare bodies (C-CLIN, DDASS, In Vs). This reporting does not replace the reporting obligations associated with safety monitoring. Patient information, another aspect of the regulatory device, is essential to the patient-healthcare professional confidence relationship.


RESULTS
The creation of ONDE and an explanation of its objectives were announced by mail at the beginning of 2003 to all French ophthalmologists: 424 answers were received, 346 (82%) ophthalmologists stating that they were ready to take part in this project. Despite the length of the questionnaire, the project coordinators hoped to recover a sufficient number of observations, thereby repeating the success of the first prospective national survey piloted by GEEP in 1991. This project was presented to the Network for Advancing and Investigating the Surveillance of Nosocomial Infections (RAISIN), which is an association of CCLIN and the Institute for Health Monitoring. The ONDE process was received with interest and RAISIN offered its methodological support. The potential synergism between the ONDE work and that of other RAISIN studies was highlighted. The results of the surveillance network for OSI identified an ophthalmological infection rate in surgery in 2002 of 0.27 OSI per 100 operative procedures. The endophthalmitis reports received since 2001 make up 3% of the reports received at InVs, making this a warning event and justifying specific studies and the need for a case-control study to better understand the risk factors for this type of infection: ONDE will be associated with the RAISIN working group on this subject.


CONCLUSIONS
Setting up a dialogue between ophthalmology professionals (surgeons, manufacturers of medical devices), and those in hygiene, and the surveillance of NI on regional and national scales, will help to increase the cooperation specifically required to introduce quality procedures and improve the understanding of the risk of infection in ophthalmology. Although sending data to ONDE cannot substitute for regulatory reporting, it will help to obtain additional information and to improve this knowledge. The American SENIC Project (Study of the Efficacy of Nosocomial Infection Control) in the 1970s found that the introduction of epidemiological surveillance could reduce NI by 30%.


CONCLUSIONS
The need to regularly update epidemiological data on NI in ophthalmological surgery justifies this new effort required from the profession and will enable it to perform part of a permanent evaluation process for the multifactorial risk of infection. Ophthalmologists have long shown their involvement in mobilizing forces to fight infection.
Salvanet-Bouccara
A
A
Service d'Ophtalmologie, CHI Villeneuve-St-Georges, 40, allée de la Source, 94195 Villeneuve-St-Georges Cedex, France.
Seegmuller
J-L
JL
D003428:Cross Infection / Q000517:prevention & control*; D016208:Databases, Factual; D009877:Endophthalmitis / Q000517:prevention & control; D015817:Eye Infections / Q000517:prevention & control*; D005602:France; D006801:Humans; D011159:Population Surveillance