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ECDC Programme on Antimicrobial Resistance & Healthcare-Associated Infections Carl Suetens, Senior Expert, Deputy Programme Coordinator European Centre.

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Presentation on theme: "ECDC Programme on Antimicrobial Resistance & Healthcare-Associated Infections Carl Suetens, Senior Expert, Deputy Programme Coordinator European Centre."— Presentation transcript:

1 ECDC Programme on Antimicrobial Resistance & Healthcare-Associated Infections Carl Suetens, Senior Expert, Deputy Programme Coordinator European Centre for Disease Prevention and Control

2 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

3 Organisational Chart June 2010 Office of the DirectorChief 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 Services Section 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 and Response Section Training Section Legal and Procurement Section Internal Control Coordination Human Resources Section Finance Section ICT and Project Support Section Missions, Meetings and Logistics Section Special Entitiy under Deputy Head of Unit SE 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, Director ECDC

4 Healthcare- associated infections Community-acquired infections Antimicrobial resistance Healthcare-associated infections, antimicro- bial resistance: Overlapping, but not identical Antimicrobial resistance

5 Surveillance of outcomes Guidance & risk assessments Ad-hoc studies Surveillance of determinants Coordination & capacity building Communication Training Antimicrobial Resistance and Healthcare- Associated Infections (ARHAI) at ECDC Infection control (IC) Alcohol hand rub consumption Healthcare- associated infect. (HAI) Antimcirobial resistance (AMR) Antimcirobial consumtpion Antimicrobial stewardship

6 Surveillance of outcomes Guidance & risk assessments Ad-hoc studies Surveillance of determinants Coordination & capacity building Communication Training Antimicrobial Resistance and Healthcare- Associated Infections (ARHAI) at ECDC Infection control (IC) Alcohol hand rub consumption Healthcare- associated infect. (HAI) Antimcirobial resistance (AMR) Antimcirobial consumtpion Antimicrobial stewardship EARS-Net Formerly IPSE + PPS ESAC + PPS C. difficile, MRSA, KPC&XDR European Antibiotic Awareness Day Collaboration with WHO on hand hygiene Assessment of IC training needs Short course on PPS Short course on HAI epidemiology Short course on prevention and control of MDRO C. difficile survey (ECDIS) ECDC-EMA Joint Report Indicators Review of national hand hygiene campaigns 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) MRSA typing

7 For more information: Earnshaw S, et al. Euro Surveill 2009;14(30) & 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

8 Outpatient antibiotic (J01) use, 2008 (ESAC)

9 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.

10 ECDC Healthcare-Associated Infection Surveillance: overview of activities Carl Suetens Surveillance Unit European Centre for Disease Prevention and Control

11 *(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)

12 Decision 2119/98 of the European Parliament and Council, 24/09/1998: network for epidemiological surveillance and control of communicable diseases in Europe

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14 Languages of the European Union Source: Europeans and their language, Special Eurobarometer 243. European Commission, February Knowledge of English

15 History of standardized surveillance of healthcare-associated infections in the EU : 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 : Helics (EC DG-Sanco funded project): surveillance of Surgical Site Infections and ICU- acquired infections

16 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

17 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 ECDC HCAI surveillance : 1 ICU-module in TESSy SSI surveillance + HELICSwin support, TESSy training ECDC EPIS ECDC - SPI surveillance 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

18 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 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

19 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.

20 Participation to HAI surveillance, status in 2010 NOIS SIRO RAISIN ISC III ENVIN ASR SPIN-UTI HELICS KISS NSIH PREZIES HPA SSHAIP HISC INST HYG ANIS NNSR NHS

21 EU HAI surveillance integrated in TESSy in October 2010 TESSy = The European Surveillance System = ECDCs online database, upload and reporting system for all communicable diseases under surveillance Integration of all dedicated surveillance networks June, : 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 Pre-TESSY

22 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 ( ): representative systematic sample of hospitals per country

23 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

24 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

25 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

26 Median % 3.8% (min. 0 - max. 26.7) Mean % 5 [95% CI: ] HALT: Pilot results of HAI in nursing homes

27 Surveillance of Clostridium difficile infections (CDI) 2006: ESGCD/ECDC case definitions on CDI 2007: ECDC launched the European C. difficile survey (ECDIS, ) (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.

28 Concordance study of HAI dase definitions

29 Concordance study: Results *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

30 The Council Recommendation recommends that Member States … (3) Adopt and implement a strategy, pursuing (contd): –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

31 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/ /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, June 2010: country representatives identified by Competent Bodies for training on ECDCs request

32 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)

33 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

34 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

35 Source: Thank you! Takk Tack Kiitos Tak Dank u Merci Gracias Takk Danke Obrigado Grazie Dziekuje Köszönöm Děkuji vám Dăkujem vám Ačiū Paldies Tänan Spasibo/ Спасибо Hvala Mulţumesc Blagodarya/Благодаря Efharisó/ ευχαριστώ Go raibh maith agaibh Grazzi


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