1. 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

2. 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:

3. 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:

4. 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:

5. 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:

6. 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%)

7. Sample hospital report for HAI prevalence: HAI types and prevalence by type
N pts
Pr% (95%CI)
N HAI
Rel%
Total 10
2.7% ( )
100%
Pneumonia (PN1-PN5) 2
0.5% ( )
20.0%
Surgical site infections 3
0.8% ( )
30.0%
Urinary tract infections 1
0.3% ( )
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

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

9. 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)

10. Observed and expected prevalence of HAI: pilot data

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

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

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

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

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

16. 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)
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17. 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
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18. 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