Interpretation of local, national and European level results Facilitator notes: Epidemiological methods for point prevalence surveys of healthcare-associated infections and antimicrobial use in acute care hospitals Interpretation of local, national and European level results Version 2017 Revision: 2018

Objectives Specific objectives of this session: Learn about the interpretation of the ECDC PPS results at various levels Learn how to interpret hospital feedback reports Learn how to interpret starndardised ratios based on observed and expected ECDC PPS results Related to the course objectives: A. Understand the reporting outputs from the ECDC PPS Facilitator notes:

Outline This session consists of the following elements Interpreting local, national and European level results Interpreting prevalence of HAI and distribution of infection types Antimicrobial prescribing Invasive devices Interpretation of reporting template with pilot data Data for action: using the results from PPS Facilitator notes:

Interpreting local, national and European level results Local results 100% of included wards surveyed Representative of prevalence in hospital at the time of survey Also including results by wards National results Sample of hospitals in the country are included (determined by sampling strategy) Theoretically representative of country-wide prevalence (more representative in larger countries) Reduced precision in smaller countries European results Representative of acute care hospitals in the EU Facilitator notes:

Interpreting HAI prevalence Calculation described in „PPS epidemiology” lecture Interpretation of examples from the local, national and European pilot data (will not be representative, but will illustrate the point) Facilitator notes:

Distribution of HAI prevalence by country Patients with HAI: 6 Distribution of HAI prevalence by country Patients with HAI: 6.0% (95% CI: 5.7–6.3%)

Sample hospital report for HAI prevalence: HAI types and prevalence by type   N pts Pr% (95%CI) N HAI Rel% Total 10 2.7% (1.3-5.0) 100% Pneumonia (PN1-PN5) 2 0.5% (0.1-2.0) 20.0% Surgical site infections 3 0.8% (0.2-2.4) 30.0% Urinary tract infections 1 0.3% (0.0-1.5) 10.0% UTI-B Bloodstream infections BSI, other than CRI3 Gastro-intestinal system infections Skin and soft tissue infections Facilitator notes: N: number, pts: patients, Pr: prevalence, CI: confidence interval, HAI: healthcare-associated infection, Rel: relative

Sample hospital report for AM prevalence: Total, indication and route for AM   N pts Pr% (95%CI) N AM Rel% Total 104 28.1% (23.0-34.1) 172 100.0% Indication for antimicrobial use Treatment intention 77 20.8% (16.4-26.0) 137 79.7% Community infection (CI) 59 15.9% (12.1-20.6) 107 62.2% Hospital infection (HI) 18 4.9% (2.9-7.7) 29 16.9% Other HAI, e.g. long-term care (LI) 1 0.3% (0.0-1.5) 0.6% Surgical prophylaxis 5 1.4% (0.4-3.2) 2.9% Medical prophylaxis 2 0.5% (0.1-2.0) 4 2.3% Unknown 22 5.9% (3.7-9.0) 26 15.1% Route of administration Parenteral 52 14.1% (10.5-18.4) 82 47.7% Oral 69 18.6% (14.5-23.6) 90 52.3% Other/unknown 0.0% (0.0-1.0) 0.0% N: number, pts: patients, Pr: prevalence, CI: confidence interval, AM: antimicrobial, Rel: relative

Observed and expected prevalence of HAI: pilot data Interpretation of examples from the local, national and EU pilot data (will not be representative but will illustrate the point)

Observed and expected prevalence of HAI: pilot data

Standardized HAI ratio (SIR): pilot data Facilitator notes: SIR: standardized infection ratio, O: observed, E: expected, CI: confidence interval, P: percentile

Standardized HAI ratio (SIR): pilot data Facilitator notes: SIR: standardized infection ratio, O: observed, E: expected, CI: confidence interval, P: percentile

Standardized HAI ratio (SIR): pilot data Facilitator notes: SIR: standardized infection ratio, O: observed, E: expected, CI: confidence interval, P: percentile

Observed and expected prevalence of antimicrobial use: pilot data AU, antimicrobial use, CI: confidence interval, P: percentile

Observed and expected prevalence of antimicrobial use: pilot data SAUR: standardized antimicrobial use ratio, O: observed, E: expected, CI: confidence interval, P: percentile

Data for action: using the results from local, national and European level Raise awareness Monitor all HAI types Monitor antimicrobial prescribing Set priorities for interventions and surveillance programmes Guide policy decisions Identify targets for quality improvement Measure progress towards targets (repeated PPS) Evaluate the effect of prevention strategies (repeated PPS) Evaluate effect of interventions (repeated PPS) Facilitator notes:

In summary List of learning points in this session: The results from PPS can be used locally, nationally and in the EU/EEA to: Measure the burden of HAI inclusive of all HAI types Measure the burden of antimicrobial prescribing Set priorities for the prevention and control of HAI locally, nationally and in the EU/EEA Set priorities for prudent antimicrobial prescribing locally, nationally and in the EU/EEA Robust collection and interpretation of these data is essential to maximise the benefits of conducting a Europe-wide survey Facilitator notes:

Facilitator notes: Acknowledgements The creation of this training material was commissioned in 2010 by ECDC to Health Protection Agency (UK) with the direct involvement of Dr. S. Hopkins, Prof. J. Reilly, S. Cairns, Dr. E. Sheridan, Dr. G. Hughes, Prof. B. Cookson, Dr. A. Charlett, G. Kafatos, B. Muller Pebody, F. Cowan, and Y. Sueiro. The revision and update of this training material was commissioned in 2017 by ECDC to Transmissible (NL) with the direct involvement of Dr. Arnold Bosman and Dr. Ágnes Hajdu