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ECDC Programme on Antimicrobial Resistance & Healthcare-Associated InfectionsCarl Suetens, Senior Expert, Deputy Programme CoordinatorEuropean Centre for Disease Prevention and Control
Role of the European Centre for Disease Prevention and Control (ECDC)
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.
Identify, assess and communicate current and emerging health threats to human health from communicable diseases.
— ECDC Founding Regulation (851/2004), Article 3
OrganisationalChartJune 2010
Office of the Director Chief Scientist
Communication and Country Cooperation Unit (CCU)
Administrative Services Unit(ADMIN)
Knowledge and Resource Centre on Health Communication
Scientific Communication Section
Public Communication and Media Section
Web ServicesSection
Surveillance Unit (SUN)
Preparedness and Response Unit (PRU)
Data Management and General Surveillance Section
Future Threats and Determinants Section
Scientific and Technical Advice and Knowledge Services
EOC and Preparedness Section
Epidemic Intelligence andResponse Section
Training Section
Legal and Procurement Section
Internal Control Coordination
Human Resources Section
Finance Section
ICT and Project Support Section
Missions, Meetingsand Logistics Section
Special Entitiy underDeputy Head of UnitSE
DSP
Section
Unit
Core of Disease Specific Programme (DSP) (supported by other units)
ARHAI Section (SUN)
FWD Section (SUN)
HASH Section (SUN)
RTI Section (SUN), incl. FLU and TB subsections
VPD Section (SUN)
ARHAI Section (SAU)
FWD and EVD Section (SAU)
HASH Section (SAU)
RTI Section (SAU), incl. FLU and TB subsections
VPD Section (SAU)
Scientific Advice Unit (SAU)
Marc Sprenger, DirectorECDC
Healthcare-associated infections
Community-acquired
infections
Antimicrobial resistance
Healthcare-associated infections, antimicro-bial resistance: Overlapping, but not identical
Antimicrobial resistance
Surveillance of outcomes
Guidance & risk assessments
Ad-hoc studies
Surveillance ofdeterminants
Coordination &capacity building
Communication
Training
Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) at ECDC
Infe
ctio
nco
ntr
ol
(IC
)
Alc
oh
ol
ha
nd
ru
b
con
sum
ptio
n
He
alth
care
-a
sso
cia
ted
infe
ct.
(HA
I)
An
timci
rob
ial
resi
sta
nce
(AM
R)
An
timci
rob
ial
con
sum
tpio
n
An
timic
rob
ial
ste
wa
rdsh
ip
Surveillance of outcomes
Guidance & risk assessments
Ad-hoc studies
Surveillance ofdeterminants
Coordination &capacity building
Communication
Training
Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) at ECDC
Infe
ctio
nco
ntr
ol
(IC
)
Alc
oh
ol
ha
nd
ru
b
con
sum
ptio
n
He
alth
care
-a
sso
cia
ted
infe
ct.
(HA
I)
An
timci
rob
ial
resi
sta
nce
(AM
R)
An
timci
rob
ial
con
sum
tpio
n
An
timic
rob
ial
ste
wa
rdsh
ip
EARS-NetFormerlyIPSE +
PPS
ESAC + PPS
C. difficile,MRSA,
KPC&XDR
European Antibiotic Awareness Day Collaboration with WHO
on hand hygiene
Assessment of IC training needsShort course on PPS
Short course on HAI epidemiology
Short course on preventionand control of MDRO
C. difficilesurvey
(ECDIS)
ECDC-EMAJoint
Report
Review of national hand hygiene campaigns
Guidance on prevention and control of HAIGuidance on antimicrobial stewardship
Meetings of National Focal Points & Country visits
Meetings of Surveillance Contact Points & Country visits (training) MRSA typing
For more information: Earnshaw S, et al. Euro Surveill 2009;14(30) & http://antibiotic.ecdc.europa.eu
2008 • Materials for general public
• 32 countries participated
2009• Materials for primary care prescribers
• Website translated in all EU languages
• TV spots developed
• Match with Get Smart week in the United States
2010: Focus on hospital prescribers
European Antibiotic Awareness Day
Outpatient antibiotic (J01) use , 2008 (ESAC)
Antimicrobial Resistance and Healthcare-Associated 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 UnitEuropean Centre for Disease Prevention and Control
* (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!"
Burden of healthcare-associated infections and multidrug-resistant bacteria in EU*
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
IIPPSSEE
Languages of the European Union
Source: Europeans and their language, 2005. Special Eurobarometer 243. European Commission, February 2006.
0% 10% 20% 30% 40% 50% 60%
Catalan
Slovak
Hungarian
Portuguese
Czech
Swedish
Greek
Dutch
Russian
Polish
Spanish
Italian
French
German
English
Percentage of EU population
mother tongue
% speaking language
Knowledge of English
History of standardized surveillance of healthcare-associated infections in the EU
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
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 ICU-acquired infections
http://ipse.univ-lyon1.fr
IIPPSSEE
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
IIPPSSEE
IPSE-ECDC transition overview
WP1
Infection Control Training
WP2
Standards & Indicators
WP3
Nosocomial Event
Warning
WP4
HELICS-SSI & HELICS-ICU
WP5
CARE-ICU (AMR &
antibiotics)
WP6
ICU tools (molecular
typing)
WP7
HCAI in Nursing Homes
IIPPSSEE
ECDC HCAI surveillance :
1 ICU-module in TESSy
SSI surveillance
+ HELICSwin support, TESSy training
ECDC EPIS
ECDC - SPI surveillanc
e
ECDC CfT MRSA typing
2 ECDC CfT:
IC training needs assessment
PPS training curriculum
ECDC CfP HCAI surveillance in LTCF (HALT)
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
• Guidance development• Country visits
Programme, measures, guidelines
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
Council Recommendation ECDC
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
Surgical Site Infection onlyIntensive care onlyBoth SSI and ICU
ICU or SSI pilotDoes not participate
NOISNOISSIROSIRO
RAISINRAISIN
ISC IIIISC III ENVINENVIN
ASRASR
SPIN-UTISPIN-UTIHELICSHELICS
KISSKISSNSIHNSIH
PREZIESPREZIESHPAHPA
SSHAIPSSHAIPHISCHISC INST HYGINST HYG
ANISANIS NNSRNNSR
NHSNHS
EU HAI surveillance integrated in TESSy in October 2010
TESSy = “The European Surveillance System” = ECDC’s online database, upload and reporting system for all communicable diseases under surveillance
Integration of all dedicated surveillance networks
June, 7-9 2010: 2nd annual HAI surveillance meeting, final adjustments to SSI and ICU protocols
October (4-8/10): HAI TESSy training for national surveillance coordinators and data managers
MS
MS
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MS
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DSN
DSN
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DSN
DSN
DSN
DSN
DSN
DSN
DSN
MS
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MS
MS
MS
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MS
MS
MS
MS
MS
MS
DSN
DSN
DSN
DSN
DSN
DSN
DSN
DSN
DSN
DSN
DSN
Pre-TESSY
Country
Country
Country
Country
Country
Country
Country
Country
Country
Country
Country
Country
Country
National institute
Disease expert
General public
AF member
MB member
…
…
…
…
…
TESSy
Dat
a up
load
and
acc
ess
Data access
Data users
Country
Country
Country
Country
Country
Country
Country
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Country
National institute
Disease expert
General public
AF member
MB member
…
…
…
…
…
TESSy
Dat
a up
load
and
acc
ess
Data access
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) + ex-IPSE 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
Median % 3.8% (min. 0 - max. 26.7)Mean % 5 [95% CI: 4.1-5.9]
HALT: Pilot results of HAI in nursing homes
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 HELICS+CDC+
HELICS+CDC-
HELICS-CDC+
HELICS-CDC-
Cohen’s kappa
Pneumonia, all 180 177 1 2 6326 0.99 (0.98;1.00)
Clinical Pneumonia* 127 102 23 2 6379 0.89 (0.85;0.93)
Microbiological Pneumonia**
65 37 16 12 6441 0.72 (0.63;0.82)
Key term „ICU-acquired pneumonia”
147 130 0 17 28 0.71 (0.58;0.84)
Key term „mechanical ventilation”
136 134 2 0 42 0.97 (0.93;1.00)
BSI, all 123 72 51 0 6383 0.73 (0.66;0.80)
Primary BSI*** 72 72 0 0 51 1
Key term „ICU-acquired BSI”
98 93 0 5 22 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
(IPSE 2006) (TRICE 2010)
Yes (at national or professional level)
No
Not respondent
54.8%(17/31)
63.6% (21/33) TRaining
InfectionControl
Europe
Other ECDC ARHAI training activities, 2010
HAI surveillance workshop, Sofia, Nov 2009
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 multidrug-resistant micro-organisms in health care settings’” – deadline 10/9/2010
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
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