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) Identify, assess and communicate current and emerging health threats to human health from communicable diseases.— ECDC Founding Regulation (851/2004), Article 3ECDC provides:EU-level surveillance of communicable diseasesScientific opinions and studies;Early Warning System and response;Technical assistance and training;Epidemic intelligence;Communicationto the scientific community,to the public.
3 Marc Sprenger, Director ECDCOrganisational ChartJune 2010Office of the DirectorChief ScientistPreparednessand Response Unit (PRU)Surveillance Unit (SUN)Scientific Advice Unit (SAU)Communication and Country Cooperation Unit (CCU)Administrative Services Unit (ADMIN)EOC and Preparedness SectionARHAI Section (SUN)ARHAI Section (SAU)Knowledge and Resource Centre on Health CommunicationLegal and Procurement SectionEpidemic Intelligence and Response SectionFWD Section (SUN)FWD and EVD Section (SAU)Scientific Communication SectionInternal Control CoordinationTraining SectionHASH Section (SUN)HASH Section (SAU)Public Communication and Media SectionHuman Resources SectionRTI Section (SUN), incl. FLU and TB subsectionsRTI Section (SAU), incl. FLU and TB subsectionsWeb Services SectionFinance SectionVPD Section (SUN)VPD Section (SAU)ICT and Project Support SectionData Management and General Surveillance SectionFuture Threats and Determinants SectionMissions, Meetingsand Logistics SectionUnitSectionScientific and Technical Advice and Knowledge ServicesSESpecial Entitiy under Deputy Head of UnitDSPCore of Disease Specific Programme (DSP) (supported by other units)3
4 Antimicrobial resistance Antimicrobial resistance Healthcare-associated infections, antimicro- bial resistance: Overlapping, but not identicalHealthcare- associated infectionsAntimicrobial resistanceAntimicrobial resistanceNosocomial infections and antimicrobial resistance are two special health issues listed in Annex 1 of Commission Decision 2000/96/EC.The term ”healthcare-associated infections” is now preferred to nosocomial infections because it includes not only infections acquired in hospitals, but also in other settings where healthcare is provided.Although, for historical and professional reasons, the issues of healthcare-associated infections and antimicrobial resistance are often dealt with together, they represent two separate, though overlapping issues.Healthcare-associated infections are often, but not always caused by resistant microorganismsConversely, antimicrobial resistance can affect microorganisms in hospitals, but also outside hospitals.PRESS SPACE BARSo far, the European Antibiotic Awareness Day that I mentioned previously addresses antimicrobials and antimicrobial resistance in patients outside hospitals- The topic chosen by the Czech Presidency of the EU, however, is patient safety, healthcare-associated infections as well as antimicrobial resistance issues in hospitals and other healthcare settings and my presentation will now focus on these issues.Community-acquired infections
5 Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) at ECDC Antimcirobial resistance (AMR)Healthcare-associated infect. (HAI)Alcohol hand rub consumptionAntimcirobial consumtpionAntimicrobial stewardshipInfection control (IC)Surveillance of outcomesGuidance & risk assessmentsAd-hoc studiesSurveillance of determinantsCoordination & capacity buildingCommunicationTraining
6 Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) at ECDC Antimcirobial resistance (AMR)Healthcare-associated infect. (HAI)Alcohol hand rub consumptionAntimcirobial consumtpionAntimicrobial stewardshipInfection control (IC)Surveillance of outcomesGuidance & risk assessmentsAd-hoc studiesSurveillance of determinantsCoordination & capacity buildingCommunicationTrainingEARS-NetFormerly IPSE + PPSESAC + PPSIndicatorsC. difficile survey (ECDIS)ECDC-EMA Joint ReportReview of national hand hygiene campaignsC. difficile, MRSA, KPC&XDRGuidance on prevention and control of HAI Guidance on antimicrobial stewardshipMeetings of National Focal Points & Country visitsMRSA typingMeetings of Surveillance Contact Points & Country visits (training)European Antibiotic Awareness DayCollaboration with WHO on hand hygieneShort course on prevention and control of MDROAssessment of IC training needs Short course on PPS Short course on HAI epidemiology
7 European Antibiotic Awareness Day 2008Materials for general public32 countries participated2009Materials for primary care prescribersWebsite translated in all EU languagesTV spots developedMatch with Get Smart week in the United States2010: Focus on hospital prescribersFinally, ECDC is coordinating an EU health initiative to promote prudent use of antibiotics and support Member States and other European countries in their efforts in this area.The European Antibiotic Awareness Day is a recurrent event that takes place throughout Europe on 18 November each year since 2008.In 2008,...THEN MAKE SENTENCES FROM BULLET POINTSFor more information: Earnshaw S, et al. Euro Surveill 2009;14(30) &
9 Antimicrobial Resistance and Healthcare-Associated Infections Team Scientific AdviceDominique L. Monnet, Senior Expert AMR & HAI, CoordinatorMarc Struelens , Senior Expert AMR & HAIAnna-Pelagia Magiorakos, Expert AMR & HAIScientific Officer AMR & HAIJ. Todd Weber, CDC liaison to ECDC (part time)Elmira Khazeva, Secretary (part time)Surveillance UnitCarl Suetens, Senior Expert HAI, Deputy CoordinatorOle E. Heuer, Senior Expert AMRKlaus Weist, Seconded National Expert HAICarlo Gagliotti, Expert AMRJolanta Griškevičienė, Expert HAIEva 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 SuetensSurveillance Unit European Centre for Disease Prevention and Control
11 Burden of healthcare-associated infections and multidrug-resistant bacteria in EU* (preliminary estimate)Healthcare-associated infections (HAI)approximately 4 million per yearDirectly attributable deaths: approx. 37,000 each yearExtra hospital days: approx. 16 million each yearDirect costs: approx. €5.5 billion per year (average €334 per day)Multidrug-resistant bacteriaapproximately 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)
12 Decision 2119/98 of the European Parliament and Council, 24/09/1998: network for epidemiological surveillance and control of communicable diseases in Europe
14 Languages of the European Union Knowledge of EnglishSource: Europeans and their language, Special Eurobarometer 243. European Commission, February 2006.
15 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 discontinued1998: 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: 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
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 EuropeECDC Founding Regulation (851/2004)IPSE evaluation & transition planCouncil Recommendation 2009/C 151/01 of 9 June 2009 on patient safety, including the prevention and control of healthcare associated infectionsECDC Advisory Forum, HAI surveillance Coordination Group
17 IPSE-ECDC transition overview WP1Infection Control TrainingWP2Standards & IndicatorsWP3Nosocomial Event WarningWP4HELICS-SSI & HELICS-ICUWP5CARE-ICU (AMR & antibiotics)WP6ICU tools (molecular typing)WP7HCAI in Nursing HomesECDC HCAI surveillance :1 ICU-module in TESSySSI surveillance+ HELICSwin support, TESSy trainingECDC EPISECDC - SPI surveillanceECDC CfT MRSA typing2 ECDC CfT:IC training needs assessmentPPS training curriculumECDC CfP HCAI surveillance in LTCF (HALT)ECDC:EU PPS of HCAI (& AB use) in hospitalsCall concordance study HAI case definitions
18 ECDC support to the Council Recommendation on Patient Safety & HCAI Programme, measures, guidelinesGuidance developmentCountry visitsEU PPSSurveillance: SSI, ICUStructure and process indicatorsEpidemic Intelligence (EPIS)SurveillanceNeeds assessment IC training & core competencies (IPSE-WP1)Training modules: PPS, AMR controlInfection Control TrainingPatient information, ResearchAnnual Report, Web developmentE-bug, HH workshop at EU conference
19 The Council Recommendation recommends that Member States … Establish/strengthen active surveillance systemsNational/regional level:Prevalence surveys at regular intervals, as appropriateSurveillance of targeted infection types + process/structure indicators to evaluate strategyTimely detection/reporting alert organisms/clusters of HAIsReporting of clusters/infection types of international relevanceAt level of healthcare institutionsSurveillance of targeted infection types + process/structure indicators to evaluate implementation of measuresSurveillance for timely detection alert organisms/clusters of HAIsHigh quality microbiological documentation/patient recordsUse surveillance methods/indicators as recommended by ECDC and case definitions agreed at Community level.
20 Participation to HAI surveillance, status in 2010 SIRONOISSSHAIPINST HYGHISCPREZIESNHSHPANSIHKISSANISRAISINNNSRASRENVINISC IIIHELICSSPIN-UTI
21 EU HAI surveillance integrated in TESSy in October 2010 Pre-TESSYTESSy = “The European Surveillance System” = ECDC’s online database, upload and reporting system for all communicable diseases under surveillanceIntegration of all dedicated surveillance networksJune, : 2nd annual HAI surveillance meeting, final adjustments to SSI and ICU protocolsOctober (4-8/10): HAI TESSy training for national surveillance coordinators and data managers
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 audience5-day course in-depth epidemiological concepts and PPS data analysisTraining of trainersPilot PPS support project (Univ of Antwerp, BE, InVS, FR, IPH, BXL):Helpdesk during pilotFeasibility analysisWebPPS tool testFull collaboration with ECDC ARHAI teamSoftware (HELICSwin or adapted ESAC WebPPS)HelpdeskOn-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 stewardshipSurvey 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 IPSEOutsourced (Jan 2009 – Feb 2011) to consortium coordinated by former IPSE hub (Lyon, Univ Claude Bernard) + ex-IPSE WP7 + Esac-nursing homesRepeated prevalence surveysIntegration HAI, SPIs, AMR markers and antimicrobial use through collaboration ESACDiscussed at ECDC Advisory Forum (Feb 2010) => light and full protocolFuture: one HALT PPS month/year
26 HALT: Pilot results of HAI in nursing homes Median % % (min. 0 - max. 26.7)Mean % [95% CI: ]
27 Surveillance of Clostridium difficile infections (CDI) 2006: ESGCD/ECDC case definitions on CDI2007: ECDC launched the European C. difficile survey (ECDIS, ) (Scientific Advice Unit)2008: Guidance on measures to limit spread of CDISep 2009: ECDC CDI expert meeting, Advisory Forum discussion2010: Call for Tender “Laboratory support for CDI surveillance”:Enhance the laboratory capacity for surveillance, and maintenance of a ribotyping nomenclature reference database for Clostridium difficileDevelopment of a European enhanced CDI surveillance protocol with case-based epidemiological data.
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 (cont’d):Foster education and training of healthcare workersNational/regional level:Specialised infection control training/education programmesEducation on prevention and control of HCAIs for all healthcare workersAt level of healthcare institutionsRegular training for all healthcare personnelRegular advanced training for specialised infection control staff
31 Needs assessment of (hospital) infection control training in EU (TRICE) Follow-up of IPSE WP1Call 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 documentTo propose future EU and national activities in the area of infection control trainingMeeting in Udine, June 2010: country representatives identified by Competent Bodies for training on ECDC’s request
32 Presence of National Curriculum or Programme for training IC/HH Nurses Yes (at national or professional level)NoNot respondent(IPSE 2006)(TRICE 2010)54.8%(17/31)63.6% (21/33)
33 Other ECDC ARHAI training activities, 2010 On-site HAI surveillance workshops:Technical support visit, 2 x ½ day workshopIncluding 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 10/9/2010HAI surveillance workshop, Sofia, Nov 2009
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 surveillanceSurveillance/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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