Considerable efforts have been made to date to harmonise data on nosocomial infections (NI) and antibiotic resistance (AR) in Europe. As a result, large variability in preventive practices and outcomes across countries has become evident. Based on this experience, the IPSE project aimed at resolving these persisting differences through the following approaches:
To achieve these aims, an extended partnership has been created, including the European Union (EU), the World Health Organisation (WHO), the European Society for Clinical Microbiology (ESCMID), some major public health institutes and EU-supported networks. The project also addresses challenges facing the EU at this moment, such as the creation of the European Centre for Disease Prevention and Control (ECDC), development and production of health indicators and emerging concerns regarding patient mobility and quality/safety of healthcare.
Problem:
Considerable efforts have been made to date to harmonise data on healthcare-associated infections (HAI) and antimicrobial resistance (AMR) in Europe. As a result, large variability in preventive practices and outcomes across countries has become evident. HAI and AMR cause significant problems for patients and healthcare systems. To improve the situation, the harmonization of efforts in European countries leading to consistent standards for monitoring and therapy needs to be addressed.
Aim:
IPSE aimed to reduce significant differences that persist in the risks associated with HAI and AR in the healthcare of countries in Europe.
Expected and obtained results:
- Harmonisation and support for professional profiles and training for infection control practitioners
Training of infection control doctors and nurses does not meet common standards in European countries. The professional status of infection control staff is well defined in some countries (e.g. by law, with specific government funding) but remains unclear in others. These differences result in very heterogeneous capacities of healthcare institutions to deal with the prevention and control of HAI. This initiative has documented existing differences with regard to the professional status of infection control staff and defined a common core curriculum for the training of infection control staff in Europe.
- European standards and indicators for public health surveillance and guidelines for the control of HAI and AMR
Existing guidelines, standards and indicators from infection control programmes in European countries were reviewed. With the help of these findings guidance is proposed to establish minimum recommendations for a pool of surveillance methods and infection control measures which are considered the minimum standard to be achieved in each country in order to prevent and control HAI and AMR better, regardless of its level of development.
- Event warning and rapid exchange on NI and AMR
Even in countries with a national NI surveillance network, important nosocomial epidemics may remain undetected at the regional/national level due to the lack of a system for the rapid dissemination of information on unusual and/or potentially important nosocomial events. A standardised internet-based nosocomial event information system for the notification of nosocomial events that can be implemented at the national/regional level has been developed.
- Sustaining and extending HELICS NI surveillance in Europe
Surveillance of NI in European hospitals has already been established in some countries in Europe via the HELICS (Hospitals in Europe Link for Infection Control through Surveillance) programme.
In order to sustain the development NI surveillance, continuing technical assistance is being provided to countries implementing NI surveillance, yearly data has been collected from participating surveillance networks according to HELICS-defined procedures and data analysis at the European level of the minimal data set of NI defined in the HELICS protocols has been carried out and analysed. The technical assistance also includes further support of the HELICS software application for data entry at the hospital level as well as the data analysis tools for coordinating centres of national/regional surveillance networks.
- Improving surveillance and control of antibiotic resistance and hygienic precautions in the ICU
A web-based programme has been implemented for the coordinated collection of information on ICU structure, infection control practices, antibiotic policies and use and antibiotic resistance in participating ICUs with a view to establishing best practice with regard to antibiotic policy and hygiene interventions.
- " Understanding the interaction of antibiotic consumption, infections and resistance patterns in the ICU.
Presumptive reasoning for increased resistance rates in participating ICUs has been developed by the analysis of ICU-based genodiversity of respective resistant pathogen and antimicrobial consumption rates.
- Feasibility of surveillance of HAI in European nursing homes and home care.
The growing importance of nursing homes in European countries and their role in the international spread of healthcare associated - often multiresistant - pathogens, highlights the need of enhancing infection control efforts in this setting. Surveillance of HAI in European nursing homes is not widespread; moreover, no agreement exists at the European level regarding preferred methods for the surveillance of infections in this setting as well as the criteria to be used for defining infections. Some European countries have gained experience in this field recently by carrying out repeated prevalence surveys or audit programmess of infection control activities, but no European network covering member states, aimed at exchanging experiences and comparing results achieved, exists.
A report summarises the systems of care and infection control activities in European nursing homes and the existing experiences for the surveillance of HAI in nursing homes and their characteristics. A harmonised protocol for the surveillance of HAI in European nursing homes has been proposed.
Coordinator:
Prof. Jacques Fabry
Université Claude Bernard Lyon1
Laboratoire d'épidémiologie et Santé publique
8, avenue Rockefeller
69373 Lyon, France
Tel: +33/4-78.77.75.99
Fax: +33/4-78.00.93.86
helics@adm.univ-lyon1.fr
Partners:
Ms Ana Paula Coutinho
World Health Organisation,
Copenhagen, Denmark
Dr. Hajo Grundmann
National Institute for Public Health and the Environment
Bilthoven, Netherlands
Dr. Carl Suetens
L'Institut scientifique de Santé publique
Brussels, Belgium
Dr. Hakan Hanberger
Swedish Institute from Infectious Disease Control
Solna, Sweden
Prof. Uwe Frank
Universitätsklinikum Freiburg
Freiburg, Germany
Dr. Maria Luisa Moro
Regione Emilia-Romagna - Agenzia Sanitaria Regionale
Bologna, Italy
Dr. Andreas Voss
European Society of Clinical Microbiology and Infectious Diseases
Taufkirchen, Germany
Prof. Barry Cookson
Health Protection Agency
London, England, UK
