1. ECDC point prevalence survey (PPS) 2016-2017
Facilitator notes:
Epidemiological methods for point prevalence surveys of healthcare-associated infections and antimicrobial use in acute care hospitals
ECDC point prevalence survey (PPS)
Version 2017
Revision: 2018

2. Objectives Specific objectives of this session:
Learn about the background to the ECDC PPS
Learn about the main results of the ECDC PPS
Learn about the aims of and participation in the ECDC PPS
Related to the course objectives:
Describe the aims and objectives of the ECDC PPS
Understand the reporting output from the ECDC PPS
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3. Outline This session consists of the following elements Background
Healthcare-associated infections in Europe
The role of ECDC in HAI surveillance?
Why carry out a European prevalence survey?
Prevalence of HAI in Europe
Results from the ECDC PPS
Aims and objectives of ECDC PPS
Inclusion/exclusion criteria
Explanation for inclusion of the participants’ hospital
Interpretation of the ECDC PPS results
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4. Background

5. (ECDC Founding Regulation (851/2004), Article 1)
What is the role of European Centre for Disease Prevention and Control (ECDC)?
Identify, assess & communicate current & emerging health threats to human health from communicable diseases
(ECDC Founding Regulation (851/2004), Article 1)
EU-level disease surveillance
Scientific opinions and studies
Early Warning System and Response
Technical assistance and training
Epidemic intelligence
Communication to scientific community
Communication to the public
Notes to trainer: the purpose of this slide is to familiarise the participants with ECDC as many will not be familiar with the Centre.

6. Source: ECDC, HAI-Net surveillance data 2013-2014
Surveillance of healthcare-associated infections (HAI) by ECDC in Europe
Ongoing HAI surveillance activities:
Surgical site infections
HAI in intensive care units
Note to trainer: these graphs are from and 2012 and participation may have changed since then
Source: ECDC, HAI-Net surveillance data

7. Surveillance of HAI in Europe (continued)
Further ongoing HAI surveillance activities:
HAI in long-term care facilities
Repeated Point Prevalence Surveys (PPS)
Clostridium difficile infection surveillance
Launched in the beginning of 2016
Structure and process indicators for infection control are integrated to each surveillance activity.
Note to trainer: PPSs in long term care facilities have been organized 2009, 2011, 2013 and will be organized again in

8. Surveillance of healthcare-associated infections and benchmarking contributes to control
Trends in cumulative incidence of surgical site infections (SSI) in hip prosthesis surgery (HPRO) by country,
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9. Why carry out an ECDC prevalence survey?
An external ECDC evaluation in 2008 recommended that:
“The European HAI surveillance needs to cover other types of nosocomial infections besides surgical site infections and ICU-acquired infections in order to estimate and monitor the complete HAI disease burden.”
“Since the implementation of an expanded continuous incidence surveillance is very resource demanding, hospital-wide prevalence surveys are efficient approaches to address it.”
Prevalence survey can be used to describe key structures and processes for the prevention of HAIs and antimicrobial resistance at the hospital and ward level in EU hospitals.
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10. Prevalence of HAI in Europe

11. Prevalence surveys in Europe, 1990-2008: need for harmonized methods
Notes to trainer: 21 documented PPS surveys have taken place in Europe in the last 15 years. The prevalence varied from <4% (Germany 1997) to almost 10% (Sweden 2003/4/6).
In 2008, ECDC reviewed the existing protocols from countries that carry out prevalence surveys and noted that these were not harmonised and therefore comparisons between countries was difficult. ECDC identified the need for a consistent European protocol should be developed to ensure that data were collected consistently across Europe and that inter-country comparisons could be made.
Mean HAI prevalence 7%
Mean HAI incidence 5%

12. Participation in the ECDC Point Prevalence Survey (PPS) 2011-2012
30 countries
Over hospitals
More than patients

13. ECDC Point Prevalence Survey 2011-2012

14. Healthcare-associated infections and antimicrobial use by country in the ECDC PPS 2011-2012

15. Objectives of ECDC PPS 2016-2017
To estimate the total burden (prevalence) of HAI & antimicrobial use
To describe patients, invasive procedures, infections (sites, microorganisms including markers of antimicrobial resistance) and antimicrobials prescribed (compounds, indications)
By type of patients, specialties or healthcare facilities
By EU-country, adjusted or stratified
To describe key structures and processes for the prevention of HAI and antimicrobial resistance at the hospital and ward level in EU hospitals
To disseminate results to those who need to know at local, regional, national and EU level
Raise awareness
Train and reinforce surveillance structures and skills
Identify common EU problems and set up priorities accordingly
Evaluate the effect of strategies and guide policies (repeated PPS)
To provide a standardised tool for hospitals to identify targets for quality improvement
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16. Included/Excluded? INCLUDED Hospitals Wards Patients EXCLUDED
All acute care hospitals / facilities
All sizes
Wards
All hospital wards, both acute and long-term care (including psychiatric wards & neonatal units)
Wards attached to Accident and Emergency (A&E) departments / Emergency Rooms (ER) where patients are monitored >24 hours
Patients
All admitted to ward before 8 AM and not discharged at the time of the survey
EXCLUDED
Hospitals
Long-term care facilities
Wards
Accident and Emergency departments
Patients
Day cases including: same day treatment or surgery, outpatient, or emergency room (A&E) episode, renal dialysis day attenders
 Notes to trainer: This slide shows which hospitals, wards and patient should be included in the survey and which should be excluded. 17

17. Why was your hospital selected?
The ECDC has designed a systematic sampling design.
In practice, countries with less than 25 hospitals include all hospitals.
Countries with more than 25 hospitals randomly select the appropriate number of hospitals (and also at this time randomly selected a reserve list).
You have been chosen because you were on that list and have accepted the invitation to participate.
Facilitator notes:
THIS SLIDE MAY NEED TO ALTERED BY YOUR COUNTRY DEPENDING ON HOW YOU SELECTED YOUR HOSPITAL

18. What results will the ECDC PPS 2016-2017 provide?
European Level
European prevalence can be calculated in all acute care hospitals in the EU.
National Level
National prevalence can be calculated, but may be less representative in countries which do not use a systematic sampling framework.
Hospital Level
Hospital prevalence can be calculated for included hospitals individually and by administrative hospital group.
Ward Level
Prevalence can be calculated for each ward including information on HAI types and antimicrobial use.
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19. 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