1. Clinical audits Some practical considerations
The Swedish Society for
Infectious Disease Physicians (
Clinical audits
Some practical considerations
How accurate are the data we get…?
Per Follin, Linköping, Sweden

2. Swedish ID resources 21 counties ( 5-6 regions) 28 ID departments
820 ID beds*
395 single-bed (isolation) rooms (48%)
* Internal Medicin hospitalized ID patients not included

3. ID beds / Department

4. Swedish ID-departments
>40 beds
20-40 beds
15-20 beds

5. Swedish ID-departments
>40 beds
20-40 beds
15-20 beds

6. Swedish ID-departments
>40 beds
20-40 beds
15-20 beds

7. ID beds/1000 inhabitants

8. Previous problems (in the 2005 EUNID inventory)
Accuracy of numbers
Obtaining data from all the facilities in a country
Understanding what information is being asked for
Complicated answers
Silly computer errors

9. (preliminary results)
Swedish inventory 2005
(preliminary results)
I Rooms with controlled negative pressure?
>40 beds
20-40 beds
231
5-20 beds
1-5 beds
Are these numbers correct?
II Isolation rooms with ICU capacity?
(within ID ward or ICU)
57*
* Stockholm not included

10. EUNID 2005 definitions ** 54% of al single-bed rooms
Data from
Sweden
Negative pressure (  6 air changes per hour) +
anteroom
direct connection with lab area (HIU)
Negative pressure (  6 or not defined air changes per hour)
Negative pressure
( 6 air changes per hour)
(HIU without lab)
( 6 or not defined air changes per hour)
( 6 air changes per hour)
( 6 or not defined air changes per hour
Current Hospital 1 20
(13 verified*)
Hospital Beds 3 2
215**
(190 verified*)
** 54% of al single-bed rooms
* By telephone interviews / inquiries

11. What are the adequate standards we are asking for?
Negative pressure: To have a controlled negative P (to get a constant flow)
1-10, 25 or 50 Pa?
- certain problems with low/high negative pressure
- NB the influence of different weather conditions!
Easy to claim - but harder to prove..
Air change per hour: standards when building Swedish hospital is 4-6
(therefore al our rooms have < 6 changes/h)

12. Other aspects: Locked anteroom?
Single / double anterooms (separated entrance and exit)?
Exhaust air separate or in connection with other rooms?
HEPA filtered?
Sealed…verified that there is no leakage
(i.e. can a low negative pressure be reached?)
Verification by Instruments / Gauge / manometers / ascending pipes?
Does the anteroom have positive pressure compared to the corridor?

13. Clinical audits – practical problems
Standardized protocol
Sound facts (EB-infection control)
Bias (What we want, is not the same as,
What we got testing is required)
Long distances – hours of traveling required?
In old buildings – who has the information?
Should recourses be scattered or centralized?
Lowest standard – highest standard

14. Problems / experiences
More details – less reply
Relevant Q – (i e what EB-standards should we look for)
Inventory by questionnaire easiest
telephone inquiry
on site observations time consuming / costly
professionals (non-bias) - “ -
rotations / triangular visits…
2006 Independent examiner will perform an audit of the Swedish HIU,
initiated by The National Board of Health and Welfare.
(interviews, revision of SOP´s, economics, education, drills,
in -/ inter hospital cooperation, preparedness ets.)
Suggestion for future national agreements / priorities / improvements

15. Thank You!