French national program for prevention of healthcare-associated infections and antimicrobial resistance, 1992-2008: positive trends, but perseverance needed.
OBJECTIVE
To describe the French program for the prevention of healthcare-associated infections and antibiotic resistance and provide results for some of the indicators available to evaluate the program. In addition to structures and process indicators, the 2 outcome indicators selected were the rate of surgical site infection and the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates among the S. aureus isolates recovered.


METHODS
Descriptive study of the evolution of the national structures for control of healthcare-associated infections since 1992. Through national surveillance networks, process indicators were available from 1993 to 2006, surgical site infection rates were available from 1999 to 2005, and prevalence rates for MRSA infection were available from 2001 to 2007.


RESULTS
A comprehensive national program has gradually been set up in France during the period from 1993 to 2004, which included strengthening of organized infection control activities at the local, regional, and national levels and developing large networks for surveillance of specific infections and antibiotic resistance. These achievements were complemented by instituting mandatory notification for unusual nosocomial events, especially outbreaks. The second phase of the program involved the implementation of 5 national quality indicators with public reporting. Surgical site infection rates decreased by 25% over a 6-year period. In France, the median proportion of MRSA among S. aureus isolates recovered from patients with bacteremia decreased from 33.4% to 25.7% during the period from 2001 to 2007, whereas this proportion increased in many other European countries.


CONCLUSIONS
Very few national programs have been evaluated since the Study on the Efficacy of Nosocomial Infection Control. Although continuing efforts are required, the French program appears to have been effective at reducing infection rates.
Carlet
Jean
J
French National Authority for Health, Haute Autorité Santé, Saint-Denis, France. j.carlet@has-sante.fr
Astagneau
Pascal
P
Brun-Buisson
Christian
C
Coignard
Bruno
B
Salomon
Valérie
V
Tran
Béatrice
B
Desenclos
Jean-Claude
JC
Jarlier
Vincent
V
Schlemmer
Benoît
B
Parneix
Pierre
P
Regnier
Bernard
B
Fabry
Jacques
J
D016009:Chi-Square Distribution; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D005602:France / Q000453:epidemiology; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards / Q000639:trends*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification* / Q000472:pathogenicity; D009313:National Health Programs / Q000592:standards / Q000639:trends; D015397:Program Evaluation; D018571:Sentinel Surveillance; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*