ECDC Programme on Antimicrobial
Resistance & Healthcare-Associated
Infections
Carl Suetens, Senior Expert, Deputy Programme Coordinator
European Centre for Disease Prevention and Control
Role of the European Centre for Disease
Prevention and Control (ECDC)
Identify, assess and communicate current and emerging health
threats to human health from communicable diseases.
— ECDC Founding Regulation (851/2004), Article 3
ECDC provides:
 EU-level surveillance of communicable diseases
 Scientific opinions and studies;
 Early Warning System and response;
 Technical assistance and training;
 Epidemic intelligence;
 Communication
– to the scientific community,
– to the public.
ECDC
Organisational
Chart
Marc Sprenger, Director
Office of the Director
Chief Scientist
June 2010
Scientific Advice
Unit
(SAU)
Communication
and Country
Cooperation Unit
(CCU)
Administrative
Services Unit
(ADMIN)
ARHAI Section (SUN)
ARHAI Section (SAU)
Knowledge and
Resource Centre on
Health
Communication
Legal and
Procurement Section
Epidemic Intelligence
and
Response Section
FWD Section (SUN)
FWD and EVD
Section (SAU)
Scientific
Communication
Section
Internal Control
Coordination
Training
Section
HASH Section (SUN)
HASH Section (SAU)
Public
Communication and
Media Section
Human Resources
Section
RTI Section (SUN),
incl. FLU and TB
subsections
RTI Section (SAU),
incl. FLU and TB
subsections
Web Services
Section
Finance
Section
VPD Section (SUN)
VPD Section (SAU)
Preparedness
and Response Unit
(PRU)
Surveillance
Unit
(SUN)
EOC and
Preparedness
Section
Unit
Data Management
and General
Surveillance Section
Section
SE
DSP
Special Entitiy under
Deputy Head of Unit
Core of Disease Specific Programme (DSP)
(supported by other units)
Future Threats and
Determinants
Section
Scientific and
Technical Advice
and Knowledge
Services
ICT and Project
Support Section
Missions, Meetings
and Logistics Section
Healthcare-associated infections, antimicrobial resistance: Overlapping, but not identical
Healthcareassociated
infections
Antimicrobial
resistance
Community-acquired
infections
Surveillance
of outcomes
Surveillance of
determinants
Ad-hoc studies
Guidance &
risk assessments
Coordination &
capacity building
Communication
Training
Infection
control
(IC)
Alcohol
hand rub
consumption
Healthcareassociated
infect. (HAI)
Antimicrobial
stewardship
Antimcirobial
consumtpion
Antimcirobial
resistance
(AMR)
Antimicrobial Resistance and HealthcareAssociated Infections (ARHAI) at ECDC
Surveillance
of outcomes
ESAC +
PPS
Indicators
Ad-hoc studies
C. difficile
survey
(ECDIS)
Guidance &
risk assessments
C. difficile,
MRSA,
KPC&XDR
Coordination &
capacity building
MRSA
typing
Communication
European Antibiotic Awareness Day
Training
Infection
control
(IC)
Alcohol
hand rub
consumption
Formerly
IPSE +
PPS
EARS-Net
Surveillance of
determinants
Healthcareassociated
infect. (HAI)
Antimicrobial
stewardship
Antimcirobial
consumtpion
Antimcirobial
resistance
(AMR)
Antimicrobial Resistance and HealthcareAssociated Infections (ARHAI) at ECDC
ECDC-EMA
Indicators
Review of national
hand hygiene campaigns
Joint
Report
Guidance on prevention and control of HAI
Guidance on antimicrobial stewardship
Meetings of National Focal Points & Country visits
Meetings of Surveillance Contact Points & Country visits (training)
Short course on prevention
and control of MDRO
Collaboration with WHO
on hand hygiene
Assessment of IC training needs
Short course on PPS
Short course on HAI epidemiology
European Antibiotic Awareness Day
2008
• Materials for general public
• 32 countries participated
2009
• Materials for primary care prescribers
• Website translated in all EU
languages
• TV spots developed
2010: Focus on hospital prescribers
• Match with Get Smart week in the
United States
For more information: Earnshaw S, et al. Euro Surveill 2009;14(30) & http://antibiotic.ecdc.europa.eu
Outpatient antibiotic (J01) use , 2008 (ESAC)
Antimicrobial Resistance and HealthcareAssociated Infections Team
Scientific Advice
– Dominique L. Monnet, Senior Expert AMR & HAI, Coordinator
– Marc Struelens , Senior Expert AMR & HAI
– Anna-Pelagia Magiorakos, Expert AMR & HAI
– Scientific Officer AMR & HAI
– J. Todd Weber, CDC liaison to ECDC (part time)
– Elmira Khazeva, Secretary (part time)
Surveillance Unit
– Carl Suetens, Senior Expert HAI, Deputy Coordinator
– Ole E. Heuer, Senior Expert AMR
– Klaus Weist, Seconded National Expert HAI
– Carlo Gagliotti, Expert AMR
– Jolanta Griškevičienė, Expert HAI
– Eva Liljestedt, Secretary (part time)
– Senior Expert Antimicrobial Consumption (2010)
Health Communication Unit
Preparedness and Response
- Sarah Earnshaw, Information Officer
Unit - Jas Mantero, Expert
(part time)
+ Carmen Valera, Vladimir P.
ECDC Healthcare-Associated Infection
Surveillance: overview of activities
Carl Suetens
Surveillance Unit
European Centre for Disease Prevention and Control
Burden of healthcare-associated infections
and multidrug-resistant bacteria in EU*
* (preliminary estimate)
 Healthcare-associated infections (HAI)
– approximately 4 million per year
– Directly attributable deaths: approx. 37,000 each year
– Extra hospital days: approx. 16 million each year
– Direct costs: approx. €5.5 billion per year (average €334 per day)
 Multidrug-resistant bacteria
– approximately 1/2 of the deaths attributable to HCAI are
due to the 7 most common multidrug-resistant bacteria ...
– ... and in the four main types of HCAI: bloodstream
infection, pneumonia, skin and soft tissue infection, urinary
tract infection
– "This is a very conservative estimate!"
Source: ECDC Annual Epidemiological Report 2008 and Monnet DL, ECDC (preliminary estimate)
http://ec.europa.eu/health/ph_threats/com/comm_legislation_en.htm
Decision 2119/98 of the European Parliament and Council, 24/09/1998:
network for epidemiological surveillance and control of communicable
diseases in Europe
IPSE
Languages of the European Union
Knowledge of English
English
German
French
Italian
Spanish
Polish
Russian
Dutch
Greek
Swedish
Czech
Portuguese
Hungarian
mother tongue
Slovak
% speaking language
Catalan
0%
10% 20% 30% 40% 50% 60%
Percentage of EU population
Source: Europeans and their language, 2005. Special Eurobarometer 243. European Commission, February 2006.
History of standardized surveillance of
healthcare-associated infections in the EU
 HELICS (Hospitals in Europe Link for
infection control through
surveillance) = collaboration of
national/regional surveillance
networks: first initiative in 1994,
funding discontinued
 1998: Decision 2119/98 EC:
epidemiological surveillance and
control of communicable diseases in
Europe
 2000-2004: Helics (EC DG-Sanco
funded project): surveillance of
Surgical Site Infections and ICUacquired infections
http://ipse.univ-lyon1.fr
 2005-2008: Continued Helics surveillance support as one of
workpackages of IPSE (Improving Patient Safety in Europe)
 1/7/2008: transition IPSE & HAI surveillance coordination to
ECDC Stockholm
IPSE
Basis for European Healthcare-Associated
Infection surveillance activities
• Decision 2119/98 of the European Parliament and
Council, 24/09/1998: network for epidemiological
surveillance in Europe
 ECDC Founding Regulation (851/2004)
 IPSE evaluation & transition plan
 Council Recommendation 2009/C 151/01 of 9 June
2009 on patient safety, including the prevention and
control of healthcare associated infections
 ECDC Advisory Forum, HAI surveillance Coordination
Group
IPSE
IPSE-ECDC transition overview
ECDC CfP HCAI
surveillance in
LTCF (HALT)
WP1
 IC training needs assessment
Infection Control
Training
 PPS training curriculum
WP7
WP2
HCAI in Nursing
Homes
Standards &
Indicators
IPSE
WP6
ICU tools
(molecular
typing)
ECDC CfT
MRSA typing
2 ECDC CfT:
WP5
WP4
CARE-ICU (AMR
& antibiotics)
HELICS-SSI &
HELICS-ICU
ECDC HCAI surveillance :
 1 ICU-module in TESSy
 SSI surveillance
+ HELICSwin support, TESSy training
ECDC - SPI
surveillance
WP3
Nosocomial
Event Warning
ECDC
EPIS
ECDC:
 EU PPS of HCAI (& AB
use) in hospitals
 Call concordance study
HAI case definitions
ECDC support to the Council
Recommendation on Patient Safety & HCAI
Council Recommendation
ECDC
Programme,
measures,
guidelines
• Guidance development
• Country visits
Surveillance
•
•
•
•
Infection Control Training
Patient information,
Research
EU PPS 2010-2012
Surveillance: SSI, ICU
Structure and process indicators
Epidemic Intelligence (EPIS)
• Needs assessment IC training & core
competencies (IPSE-WP1)
• Training modules: PPS, AMR control
• Annual Report, Web development
• E-bug, HH workshop at EU conference
http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2009:151:0001:0006:EN:PDF
The Council Recommendation recommends that
Member States …
– Establish/strengthen active surveillance systems
• National/regional level:
– Prevalence surveys at regular intervals, as appropriate
– Surveillance of targeted infection types + process/structure indicators
to evaluate strategy
– Timely detection/reporting alert organisms/clusters of HAIs
– Reporting of clusters/infection types of international relevance
• At level of healthcare institutions
– Surveillance of targeted infection types + process/structure indicators
to evaluate implementation of measures
– Surveillance for timely detection alert organisms/clusters of HAIs
– High quality microbiological documentation/patient records
• Use surveillance methods/indicators as recommended by ECDC and
case definitions agreed at Community level.
Participation to HAI surveillance, status in
2010
SIRO
NOIS
HISC
SSHAIP
NHS HPA
INST HYG
PREZIES
NSIH
KISS
ANIS NNSR
RAISIN
ASR
HELICS
ISC III ENVIN
SPIN-UTI
Surgical Site Infection only
Intensive care only
ICU or SSI pilot
Both SSI and ICU
Does not participate
EU HAI surveillance integrated in TESSy in
October 2010
Pre-TESSY
MS
 TESSy = “The European Surveillance System”
= ECDC’s online database, upload and
reporting system for all communicable
diseases under surveillance
DSN
MS
DSN
MS
DSN
MS
DSN
MS
 Integration of all dedicated surveillance
networks
MS
DSN
MS
DSN
MS
DSN
MS
DSN
MS
DSN
MS
DSN
MS
Country
National institute
Country
Disease expert
Country
General public
Country
Country
Country
Country
Country
Country
Country
Country
Country
Country
TESSy
Data access
 October (4-8/10): HAI TESSy training for
national surveillance coordinators and data
managers
DSN
MS
Data upload and access
 June, 7-9 2010: 2nd annual HAI surveillance
meeting, final adjustments to SSI and ICU
protocols
AF member
MB member
…
…
…
…
…
Data users
EU-PPS for HAI/Antimicrobial use in acute
care hospitals
 Pilot PPS: June-September
2010: 25 countries
subscribed (at least 1
hospital per country)
 2 levels: full (patient-based +
risk factors), light
(aggregated denominators
for each ward)
 Full PPS (2011-...):
representative systematic
sample of 20-35 hospitals per
country
ECDC support to Point Prevalence Survey
 Training: Outsourced (HPA, UK) development of standardized training
material for Point Prevalence Survey (Jan-Nov 2010):
– 1-day training for large audience
– 5-day course in-depth epidemiological concepts and PPS data
analysis
– Training of trainers
 Pilot PPS support project (Univ of Antwerp, BE, InVS, FR, IPH, BXL):
– Helpdesk during pilot
– Feasibility analysis
– WebPPS tool test
– Full collaboration with ECDC ARHAI team
 Software (HELICSwin or adapted ESAC WebPPS)
 Helpdesk
 On-site workshops
Infection control structure- and process
indicators (SPIs)
 Integrated in Point Prevalence Survey
(hospital and national level), ICU
surveillance (integration IPSE WP5) and SSI
surveillance (no separate protocol)
 Will be further developed as a function of
development of ECDC guidance on
healthcare-associated infections and
antimicrobial stewardship
 Survey of SPIs currently in place in Member
States in 2010
Healthcare-Associated infections in
European LongTerm care facilities (HALT)
 Follow-up of WP7 of IPSE
 Outsourced (Jan 2009 – Feb 2011) to
consortium coordinated by former IPSE
hub (Lyon, Univ Claude Bernard) + exIPSE WP7 + Esac-nursing homes
 Repeated prevalence surveys
 Integration HAI, SPIs, AMR markers and
antimicrobial use through collaboration
ESAC
 Discussed at ECDC Advisory Forum (Feb
2010) => light and full protocol
 Future: one HALT PPS month/year
 http://halt.wiv-isp.be
HALT: Pilot results of HAI in nursing homes
Median %
3.8% (min. 0 - max.
Mean %
5 [95% CI: 4.1-5.9]
26.7)
Surveillance of Clostridium difficile
infections (CDI)
 2006: ESGCD/ECDC case definitions on CDI
 2007: ECDC launched the European C. difficile survey
(ECDIS, 2008-2010) (Scientific Advice Unit)
 2008: Guidance on measures to limit spread of CDI
 Sep 2009: ECDC CDI expert meeting, Advisory Forum
discussion
 2010: Call for Tender “Laboratory support for CDI
surveillance”:
– Enhance the laboratory capacity for surveillance, and
maintenance of a ribotyping nomenclature reference
database for Clostridium difficile
– Development of a European enhanced CDI surveillance
protocol with case-based epidemiological data.
Concordance study of HAI dase definitions
Concordance study: Results
Cases
Pneumonia, all
Clinical Pneumonia*
Microbiological
Pneumonia**
Key term „ICUacquired
pneumonia”
Key term
„mechanical
ventilation”
BSI, all
Primary BSI***
Key term „ICUacquired BSI”
HELICS+ HELICS+ HELICS- HELICS- Cohen’s kappa
CDC+
CDCCDC+
CDC-
180
127
65
177
102
37
1
23
16
2
2
12
6326
6379
6441
0.99 (0.98;1.00)
0.89 (0.85;0.93)
0.72 (0.63;0.82)
147
130
0
17
28
0.71 (0.58;0.84)
136
134
2
0
42
0.97 (0.93;1.00)
123
72
98
72
72
93
51
0
0
0
0
5
6383
51
22
0.73 (0.66;0.80)
1
0.87 (0.76;0.98)
*CDC/NHSN PNU1 and HELICS/IPSE PN2, PN4, PN5
**CDC/NHSN PNU2 and HELICS/IPSE PN1, PN3
***CDC/NHSN LCBI and HELICS/IPSE BSI-A with origin “Catheter” and origin “Unknown”
The Council Recommendation recommends that
Member States … (3)
 Adopt and implement a strategy, pursuing (cont’d):
– Foster education and training of healthcare workers
• National/regional level:
– Specialised infection control training/education
programmes
– Education on prevention and control of HCAIs for all
healthcare workers
• At level of healthcare institutions
– Regular training for all healthcare personnel
– Regular advanced training for specialised infection control
staff
Needs assessment of (hospital) infection
control training in EU (TRICE)
 Follow-up of IPSE WP1
 Call for Tender (June 2009)
 Awarded to University of Udine (Italy):
12/2009-10/2010 (TRICE project)
 Objectives:
– To assess current infection control capacities and infection control
training status in EU Member States (Questionnaire, update of IPSE
WP1 Q 2006)
– To define a procedure for endorsement of the IPSE core competency
document
– To propose future EU and national activities in the area of infection
control training
 Meeting in Udine, 21-22 June 2010: country representatives identified by
Competent Bodies for training on ECDC’s request
Presence of National Curriculum or Programme
for training IC/HH Nurses
Yes (at national or
professional level)
No
Not respondent
(IPSE 2006)
(TRICE 2010)
54.8%
(17/31)
63.6%
(21/33)
Other ECDC ARHAI training activities, 2010
 On-site HAI surveillance
workshops:
 Technical support visit, 2 x ½
day workshop
 Including case studies of HAI
case definitions and computer
exercises (HELICSwin)
 Call for Tender ”Curriculum and
training materials for the first
course on ‘Control of multidrugresistant micro-organisms in health
care settings’” –
deadline 10/9/2010
HAI surveillance workshop, Sofia, Nov 2009
Overview HAI surveillance workplan 2010
 Surveillance of Healthcare-Associated Infections (HAI): Surgical Site
Infections (SSI), ICU-acquired infections (ICU)
 European Point Prevalence Survey of HAI and Antimicrobial Use in acute
care hospitals (PPS)
 Structure and process indicators for infection control: integrated in Point
Prevalence Survey and ICU/SSI surveillance
 Surveillance/rPPS of HAI in long-term care facilities (outsourced)(HALT)
 Surveillance of Clostridium difficile infections (CDI) (Call for tender)
 Case definitions of HAI: Concordance Study (outsourced)
 Training (PRU/SUN/SAU):
– Needs Assessment of Infection Control Training in EU (outsourced)
– PPS training material (outsourced)
 Country support: HELICSwin support (outsourced), on-site HAI
surveillance training courses, PPS pilot support project (outsourced)
 EPIS: ARHAI alerts
Takk
Kiitos
Takk
Tack
Go raibh maith
agaibh
Tänan
Tak
Paldies
Thank you!
Ačiū
Spasibo/
Спасибо
Dank u
Dziekuje
Danke
Merci
Děkuji vám Dăkujem vám
Köszönöm
Hvala
Gracias
Grazie
Mulţumesc
Blagodarya/Благодаря
Obrigado
Source: http://en.wikipedia.org/wiki/Eurolinguistics
Grazzi
Efharisó/
ευχαριστώ