The study parts relate to one example from the ICU component and one example from the SSI component of the HELICS European surveillance network:

1. ICU Component
• primary bloodstream infections per 1000 patient days / per 1000 CVC days
• primary MRSA bloodstream infections per 1000 patient days / per 1000 CVC days
2. SSI Component
• SSI per 100 HIP operations
• SSI due to MRSA per 100 HIP operations

For both examples a lot of infection control recommendations are not based on randomised controlled trials or other scientific evidence, most of the recommendations are only supported by some epidemiological studies a strong theoretical rationale or even less evidence.

From the participating hospitals of the participating countries individual anonymous ICU data about CVC associated bloodstream infections and / or SSI after HIP procedures for a one year period will be collected.

That means;

1. from each individual ICU
• the number of primary bloodstream infections and the total number of patient days / CVC days in the surveillance periodand also
• the number of MRSA bloodstream infections and the total number of patient days / CVC days has to be documented.
2. from each Orthopaedic or Trauma department
• the number of SSI after HIP operations and the total number HIP operations and also
• the number of SSI due to MRSA after HIP operations and the total number of HIP operations has to be documented.

HIP procedures are defined as procedures by the following ICD-9 CM Codes: 81.51-81.53 (ICD-9-CM Procedure Codes ver. 2001).

In addition, a questionnaire for individual hospitals will be distributed by the national surveillance centres in order to get information about patient care quality parameters. They have to be answered only once, and will spend no more than 10 minutes for the majority of ICUs/surgical departments. The collected data will be evaluated anonymously. Finally, a univariate and multivariate analysis will be carried out in order to identify risk factors. Chi square tests and Odds ratios were determined in the univariate analysis and logistic regression models in univariate and multiple analysis.

Each individual factor identified as significant by this analysis will be evaluated according to the literature to make the evidence transparent.

These results will be given as feedback to the individual countries in order to draw their own conclusions (e.g. modification of guidelines) and it is planned to publish this information. The person in charge for the contact with the individual hospitals of the surveillance networks participating is invited to serve as a co-author for publication.