Adhering to a national surgical care bundle reduces the risk of surgical site infections.

BACKGROUND: In 2008, a bundle of care to prevent Surgical Site Infections (SSIs) was introduced in the Netherlands. The bundle consisted of four elements: antibiotic prophylaxis according to local guidelines, no hair removal, normothermia and 'hygiene discipline' in the operating room (i.e. number of door movements). Dutch hospitals were advised to implement the bundle and to measure the outcome. This study's goal was to assess how effective the bundle was in reducing SSI risk. METHODS: Hospitals assessed whether their staff complied with each of the bundle elements and voluntary reported compliance data to the national SSI surveillance network (PREZIES). From PREZIES data, we selected data from 2009 to 2014 relating to 13 types of surgical procedures. We excluded surgeries with missing (non)compliance data, and calculated for each remaining surgery with reported (non)compliance data the level of compliance with the bundle (that is, being compliant with 0, 1, 2, 3, or 4 of the elements). Subsequently, we used this level of compliance to assess the effect of bundle compliance on the SSI risk, using multilevel logistic regression techniques. RESULTS: 217 489 surgeries were included, of which 62 486 surgeries (29%) had complete bundle reporting. Within this group, the SSI risk was significantly lower for surgeries with complete bundle compliance compared to surgeries with lower compliance levels. Odds ratios ranged from 0.63 to 0.86 (risk reduction of 14% to 37%), while a 13% risk reduction was demonstrated for each point increase in compliance-level. Sensitivity analysis indicated that due to analysing reported bundles only, we probably underestimated the total effect of implementing the bundle. CONCLUSIONS: This study demonstrated that adhering to a surgical care bundle significantly reduced the risk of SSIs. Reporting of and compliance with the bundle compliance can, however, still be improved. Therefore an even greater effect might be achieved.

Chlamydia test results were associated with sexual risk behavior change among participants of the Chlamydia screening implementation in The Netherlands.

OBJECTIVE: To examine the effect of a laboratory-confirmed Chlamydia trachomatis (Ct) test result on subsequent sexual risk behavior in a large population-based screening program. METHODS: The study population consisted of 16- to 29-year-old participants of the Chlamydia Screening Implementation who completed Ct testing and questionnaires in 2 or more rounds. The influence of a Ct test result on sexual behavior was analyzed by generalized estimating equation models, in which the Ct test result of the previous round was the independent variable and 1 of the 8 sexual risk behavior indicators was the dependent variable, adjusted for covariates. RESULTS: Of 48,910 Chlamydia Screening Implementation participants with completed questionnaires and test results, 14.1% (n = 6802) and 2.6% (n = 1272) completed 2 and 3 rounds, respectively, and were included in this study. Analysis showed that Ct positives less often reported to "never" use condoms with a casual partner (%change pretest/posttest = -5.7% [-10.3 to -0.9]), whereas Ct negatives less often reported to "always" use condoms with a casual partner (-4.6% [-6.4 to -2.8]; odds ratio [95% confidence interval], 1.75 [1.09 to 2.80]). Ct positives also had more sexual partners in the subsequent round than did participants with a Ct-negative test result (relative risk [95% confidence interval], 1.14 [1.01 to 1.29]). CONCLUSIONS: Ct test results were associated with subsequent sexual risk behavior. In general, Ct positives were more likely to change their behavior after a Ct test result in a more positive and protective direction than Ct negatives, who were more likely to change their behavior toward more risky behavior. Effects over time after a Ct test should be investigated further, especially in the Ct negatives.

Ongoing transmission of hepatitis B virus in rural parts of the Netherlands, 2009-2013.

BACKGROUND: Reported acute hepatitis B incidence in the Netherlands reached its nadir in 2013. However, regional signals about increased number of hepatitis B cases raised the question how hepatitis B incidence was distributed over the country. In this study, regional differences in hepatitis B epidemiology were investigated using epidemiological and molecular data. METHODS: Acute hepatitis B virus (HBV) infections, reported between 2009-2013, were included. If serum was available, a fragment of S and C gene of the HBV was amplified and sequenced. Regional differences in incidence were studied by geographical mapping of cases and cluster analysis. Regional differences in transmission were studied by constructing regional maximum parsimony trees based on the C gene to assess genetic clustering of cases. RESULTS: Between 2009 and 2013, 881 cases were notified, of which respectively 431 and 400 cases had serum available for S and C gene sequencing. Geographical mapping of notified cases revealed that incidences in rural border areas of the Netherlands were highest. Cluster analysis identified two significant clusters (p<0.000) in the South-western and North-eastern regions. Genetic cluster analysis showed that rural border areas had relatively large clusters of cases with indistinguishable sequences, while other regions showed more single introductions. CONCLUSION: This study showed that regional differences in HBV epidemiology were present in the Netherlands. Rural border regions showed higher incidences and more ongoing transmission, mainly among MSM, than the more urban inland areas. Therefore, preventive measures should be enhanced in these regions.