International comparison of results of infection surveillance: The Netherlands versus Belgium

To explore the potential benefit of comparing results from two national surveillance networks. Two prospective multicenter cohort studies of surgical wound infections (SWI). Thirty-five and 62 acute-care hospitals in The Netherlands (NL) and Belgium (B), respectively, from October 1, 1991, to June 30, 1992. The participation was equivalent in the two countries: 27% (NL) and 28% (B) of all acute-care hospitals. Marked differences emerged between the Dutch and Belgian crude infection rates and the specific rates by wound class and other risk factors. Because the case-mix in the countries is quite different, comparisons can be made only by specific surgical category. The results for inguinal hernia repair and for appendectomy are compared as an example. In herniorrhaphies, the difference in infection rate (0.4% [NL] versus 1.2% [B]) is not explained by differences in the distribution of risk factors. The shorter hospital stay in The Netherlands (4 days [NL] versus 6 days [B]), the more effective postdischarge surveillance in Belgium, and the fact that more than two thirds of the detected infections occurred after the first postoperative week probably can account for most of the difference. There was a striking difference in prophylaxis use (3.7% [NL] versus 41.9% [B]). In appendectomies, the Dutch patient population shows on average a higher risk profile, and surgery is urgent much more often in The Netherlands (78.3%) than in Belgium (49.2%). The infection rate is higher in The Netherlands, especially among the patients without prophylaxis, which again is employed less frequently there. We conclude that international comparisons yield interesting insights regarding quality of care, reaching beyond the field of nosocomial infection prevention. This is an argument in favor of more harmonization between surveillance networks