65-577 / 1. National Nosocomial Surveillance System (NNSR) 2. National Hand Hygiene Campaign

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
National Center for Epidemiology


Program on quality and safety
Quality indicators

GOP Description
Implementation level
Clinical settings
1.hospital setting

2. health care workers

1. Nosocomial infections continue to be an important cause of morbidity and mortality in hospitals, prolonging hospital stay, increasing antibiotic usage and hospital costs. Surveillance of hospital-acquired infections (HAI) remains an important tool in the reduction of nosocomial infection rates and has been internationally acknowledged as an important component of infection control programmes. It is increasingly recognised as the key to improving clinical outcomes. Nosocomial infection rates are considered as important indicators of the quality of patient care. Surveillance of nosocomial infection has been a fundamental component of infection control in the USA since the 1960s. The US National Nosocomial Infections Surveillance System (NNIS) was established in 1970 and periodically reports its findings. Many countries have developed their own national nosocomial surveillance systems based on NNIS and have published their findings. In 2005 there was a transition of healthcare-associated infection surveillance in the USA from NNIS to National Healthcare Safety Network (NHSN).

The National Nosocomial Surveillance System (NNRS) was established in 2004, as a result of public health demand for improving quality of care. NNSR is a standardised system based on international used and recognised above mentioned NNIS definitions and methodology.

NNSR is a secure web-based reporting system developed at the Hungarian National Center for Epidemiology (NCE). Training on case definitions, surveillance methodology, case finding and on software use has been provided by NCE on a regular basis.

Since 2004 NNSR is an ongoing surveillance system and provides yearly national aggregated data on infection rates caused by multidrug resistant organisms (MDRO), bloodstream infections, surgical site infections and device associated infection rates in intensive care units. NNSR is a flexible system, it can be completed.

2. Improving hand hygiene practice
National Hand Hygiene Campaign was launched in 2011,

–     making available in Hungarian WHO tools for improvement of hand hygiene (WHO Guidelines for hand hygiene in health care, slides for education, Guide to implementation of the WHO multimodal hand hygiene improvement strategy),
–    providing regular training for healthcare workers on the innovative WHO “My 5 Moments for Hand Hygiene” approach and „why, how, where”, as well as
–    design of posters and information leaflets on hand hygiene which can be downloaded form the campaign website.

Since 2011 every year on Hand Hygiene World Day we organise a scientific meeting where we share the new WHO tools for hand hygiene improvement: WHO Self Assessment Framework, monitoring and feedback, action plan for hand hygiene improvement.

1. hopsital patients

2. health care workers

1. NNSR is a standardized web-based system based on Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance System (NNIS) and National Healthcare Safety Network NHS definitions and methodology. It has the following components: surgical site infection (SSI), adult and neonatal intensive care unit (ICU) device associated infections, hospital-wide bloodstream infections, hospital-wide infections caused by MDROs and nosocomial outbreak reports.
2. WHO multimodal hand hygiene improvement strategy
Timeframe implementation
1 year
Implementation tools available
1. education, free software, feedback of results

1. education

Implementation cost
There is no information available on implementation costs.
Method used to measure the results
Surveillance system:
The following MDROs are under surveillance:
MRSA: meticillin resistant Staphylococcus aureus, MKLE: multiresistant Klebsiella, MACI: multiresistant Acinetobacter, MECO: multiresistant Escherichia coli, MPAE: multiresistant Pseudomonas; MENB: multiresistant Enterobacter, CRE: carbapenem resistant Enterobacter, CRKL: carbapenem resistant Klebsiella; CDI: Clostridium difficile infectionHand hygiene campaign: Alcohol hand rub consumption has been monitored in the majority of Hungarian hospitals, and many hospitals started to measure hand hygiene compliance.
The trend analysis of the SSI cumulative incidence showed a significant decreasing trend (p<0.05) for hip and knee prosthesis interventions between 2005 and 2010.

Significant reduction of CABSI rates between 2005 and 2010.

Analysis of the results
aggregated cumulative incidence (crude percentage of surgical intervention resulting in a SSI) and confidence interval by surgical procedure, trend analysis

Catheter associated bloodstream infection/1000 catheter day per hospital and yearly median rate

Implementation barriers
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Other information
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