title: Point-prevalence surveillance of healthcare-associated infections in Swedish hospitals, 2008-2014. Description of the method and reliability of results.
abstract: BACKGROUND
  In 2007 the Swedish Association of Local Authorities and Regions (SALAR) decided to establish a nationwide system for point-prevalence surveillance of healthcare-associated infections (HCAIs) among hospitalized patients. Surveillance started in 2008 and has since then been performed twice a year (April and October). The documentation of HCAIs is performed by regular clinical physicians and nurses on each hospital ward aided by oral and written instructions. All Swedish publicly financed hospitals (>95% of all hospitals) are included (25,862 beds in 2008 and 24,905 beds in 2013). A total of 88-92% of all inpatients has been covered in each survey. The overall prevalence of HCAI (including psychiatric inpatients) has ranged from 7.8% to 10.0%.
  
  
  OBJECTIVE
  In 2012 SALAR decided to assess the reliability of the prevalence data.
  
  
  METHODS
  In all, 1216 patients were assessed for HCAIs by both the regular surveillance teams and teams with expert knowledge on HCAI independently of each other.
  
  
  RESULTS
  The prevalence of HCAI was 8.3% (95% confidence interval: 6.7-9.9) according to the regular teams and 13.1% (11.2-15.0) according to the expert teams. The sensitivity of the regular point-prevalence surveillance was 47% and the specificity 97%.
  
  
  CONCLUSIONS
  The Swedish system for repeated nationwide point-prevalence surveillance of HCAI has had a high coverage of about 90% since it commenced. However, the surveys underestimate the true prevalence of HCAI.
authors.affiliation: Department of Medicine, Solna (MedS), Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden. Electronic address: ann.tammelin@sll.se.
authors.forename: A
authors.initials: A
authors.lastname: Tammelin
authors.affiliation: Lung Immunology Group, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Qvarfordt
mesh_terms: D003428:Cross Infection / Q000453:epidemiology*; D062665:Epidemiological Monitoring; D006761:Hospitals; D006801:Humans; D015995:Prevalence; D015203:Reproducibility of Results; D013548:Sweden / Q000453:epidemiology
keywords: Healthcare-associated infections; Prevalence; Reliability; Surveillance