Evidence shows that timely surveillance, targeted screening and focused interventions can reduce infections while helping hospitals use limited resources more effectively.
Ashleigh Myall
Introduction
Hospitals cannot act on infection risks they cannot see.
Yet the information needed to understand those risks is often spread across laboratory systems, patient records, bed movements and clinical notes. Infection Prevention and Control teams must bring that information together, often manually, to understand what has happened and decide where to intervene.
Effective surveillance changes this. It gives hospitals a clearer view of infection risk, helping teams detect possible cases earlier, investigate transmission faster and focus resources where they can have the greatest impact.
The Cost of Acting Too Late
Healthcare-associated infections cause avoidable harm, extend hospital stays and place additional pressure on already stretched services.
An estimated 136 million healthcare-associated infections involving antibiotic-resistant bacteria occur globally each year. In England, one large study found that patients who developed a healthcare-associated infection remained in hospital for an average of 7.8 additional days.
Many of these infections can be prevented. The World Health Organization estimates that effective Infection Prevention and Control programmes can reduce healthcare-associated infections by as much as 70%.
The question is not whether hospitals should invest in infection prevention. It is how they can identify risks earlier and direct limited time, isolation capacity, testing and protective equipment more precisely.
Surveillance is a fundamental part of the answer.
Surveillance Is More Than Counting Infections
Infection surveillance is sometimes understood as reporting how many infections have occurred. That is important, but it is only the starting point.
Good surveillance helps teams understand:
Which infections are occurring.
Where and when they are appearing.
Which patients may be at greater risk.
Whether cases could be connected.
Whether an intervention is working.
Where action may be needed next.
This requires consistent case definitions, reliable data, appropriate risk adjustment and timely feedback to the people responsible for acting on it. Networks such as the ECDC’s Healthcare-Associated Infections Surveillance Network have helped establish common approaches across hospitals and countries.
But collecting data is not enough. Surveillance creates value when information reaches the right team early enough to change what happens next.
What the Evidence Shows
The relationship between surveillance and infection reduction has been studied for decades.
The landmark SENIC study found that hospitals with organised surveillance and infection-control programmes achieved substantially greater reductions in healthcare-associated infections than hospitals without them.
More recent studies show how surveillance can support wider improvement programmes:
A national infection-control campaign in England, combining surveillance and feedback with other interventions, was associated with a 97% reduction in MRSA bloodstream infections in intensive care units.
National point-prevalence surveys in the United States identified a 16% reduction in healthcare-associated infection prevalence between 2011 and 2015.
A hospital-wide, real-time surveillance system in China was associated with a 21% reduction in infections involving multidrug-resistant organisms.
A collaborative programme across Brazilian intensive care units used standardised surveillance, feedback and targeted interventions to achieve a 43.5% reduction in central-line-associated bloodstream infections, with more than 5,000 infections estimated to have been prevented.
These results were not produced by surveillance alone. They came from surveillance being connected to action: better feedback, targeted precautions, clinical education and consistent infection-control practice.
That distinction matters. Data does not prevent infections. People do—but better information helps them act earlier and more precisely.
Targeted Screening Can Create More Value
Screening is another important part of hospital surveillance, but more screening is not always better.
A recent umbrella review of 24 systematic reviews and 101 economic analyses found that selective screening was frequently the most cost-effective approach. Universal screening may be justified in some high-risk settings, but its value depends on local prevalence, transmission patterns and the organism involved.
A targeted approach can help hospitals focus testing and contact precautions on patients most likely to benefit. It can also reduce unnecessary isolation, PPE use and clinical workload when the risk is low.
However, traditional risk-factor screening has limitations. Static rules may miss patients whose risk changes during their admission as they move between wards, undergo procedures or share environments with infectious patients.
More responsive surveillance should account for these changing exposures—not only what was known about a patient when they arrived.
Why Hospital Surveillance Still Falls Short
Many hospitals already collect large amounts of infection data. The problem is that it is often fragmented, retrospective and difficult to use.
Teams may spend hours moving between systems, reviewing spreadsheets and manually reconstructing patient journeys. By the time a possible cluster has been identified, opportunities for earlier intervention may have passed.
Some hospitals have developed local dashboards or surveillance tools. These can be valuable, but they are often dependent on a small number of technical staff, difficult to maintain and hard to extend across organisms, workflows or hospital sites.
Static alerts can create another problem. When systems generate too many low-value notifications, teams must spend more time deciding what can be ignored.
Better surveillance should reduce that burden. It should connect data automatically, prioritise meaningful risks and give Infection Prevention and Control teams a clearer place to begin their investigation.
From Surveillance to Infection Intelligence
Traditional surveillance helps hospitals understand what has already happened.
Infection Intelligence builds on this foundation. It brings together information from across the hospital to help teams identify possible infections and clusters earlier, understand shared exposures and anticipate where risks may be emerging next.
This does not replace clinical judgement. It gives Infection Prevention and Control teams a more complete and timely view, so their expertise can be focused where it is most needed.
NEX is being developed around this principle: giving hospitals the intelligence to act earlier.
By connecting surveillance automation, outbreak investigation and predictive insight, we aim to help hospitals move from reacting to infections after they occur towards identifying risks sooner and preventing avoidable harm.
Seeing Earlier Means Acting Earlier
The evidence does not simply show that hospitals need more infection data.
It shows that surveillance is most valuable when it turns data into timely, targeted action. Done well, it can support earlier intervention, reduce avoidable infections and help hospitals make better use of limited resources.
Hospitals cannot prevent what they cannot see. But seeing the risk early is what creates the opportunity to act.You can’t reduce what you don’t measure.
