ECDC Programme on Antimicrobial Resistance & Healthcare-Associated InfectionsCarl Suetens, Senior Expert, Deputy Programme CoordinatorEuropean Centre for Disease Prevention and Control

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

OrganisationalChartJune 2010

Office of the Director Chief 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 ServicesSection

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 andResponse Section

Training Section

Legal and Procurement Section

Internal Control Coordination

Human Resources Section

Finance Section

ICT and Project Support Section

Missions, Meetingsand Logistics Section

Special Entitiy underDeputy Head of UnitSE

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, DirectorECDC

Healthcare-associated infections

Community-acquired

infections

Antimicrobial resistance

Healthcare-associated infections, antimicro-bial resistance: Overlapping, but not identical

Antimicrobial resistance

Surveillance of outcomes

Guidance & risk assessments

Ad-hoc studies

Surveillance ofdeterminants

Coordination &capacity building

Communication

Training

Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) at ECDC

Infe

ctio

nco

ntr

ol

(IC

)

Alc

oh

ol

ha

nd

ru

b

con

sum

ptio

n

He

alth

care

-a

sso

cia

ted

infe

ct.

(HA

I)

An

timci

rob

ial

resi

sta

nce

(AM

R)

An

timci

rob

ial

con

sum

tpio

n

An

timic

rob

ial

ste

wa

rdsh

ip

Surveillance of outcomes

Guidance & risk assessments

Ad-hoc studies

Surveillance ofdeterminants

Coordination &capacity building

Communication

Training

Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) at ECDC

Infe

ctio

nco

ntr

ol

(IC

)

Alc

oh

ol

ha

nd

ru

b

con

sum

ptio

n

He

alth

care

-a

sso

cia

ted

infe

ct.

(HA

I)

An

timci

rob

ial

resi

sta

nce

(AM

R)

An

timci

rob

ial

con

sum

tpio

n

An

timic

rob

ial

ste

wa

rdsh

ip

EARS-NetFormerlyIPSE +

PPS

ESAC + PPS

C. difficile,MRSA,

KPC&XDR

European Antibiotic Awareness Day Collaboration with WHO

on hand hygiene

Assessment of IC training needsShort course on PPS

Short course on HAI epidemiology

Short course on preventionand control of MDRO

C. difficilesurvey

(ECDIS)

ECDC-EMAJoint

Report

Review of national hand hygiene campaigns

Guidance on prevention and control of HAIGuidance on antimicrobial stewardship

Meetings of National Focal Points & Country visits

Meetings of Surveillance Contact Points & Country visits (training) MRSA typing

For more information: Earnshaw S, et al. Euro Surveill 2009;14(30) & http://antibiotic.ecdc.europa.eu

2008 • 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

Outpatient antibiotic (J01) use , 2008 (ESAC)

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.

ECDC Healthcare-Associated Infection Surveillance: overview of activities

Carl Suetens

Surveillance UnitEuropean Centre for Disease Prevention and Control

* (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)

http://ec.europa.eu/health/ph_threats/com/comm_legislation_en.htm

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

IIPPSSEE

Languages of the European Union

Source: Europeans and their language, 2005. Special Eurobarometer 243. European Commission, February 2006.

0% 10% 20% 30% 40% 50% 60%

Catalan

Slovak

Hungarian

Portuguese

Czech

Swedish

Greek

Dutch

Russian

Polish

Spanish

Italian

French

German

English

Percentage of EU population

mother tongue

% speaking language

Knowledge of English

History of standardized surveillance of healthcare-associated infections in the EU

2005-2008: 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

2000-2004: Helics (EC DG-Sanco funded project): surveillance of Surgical Site Infections and ICU-acquired infections

http://ipse.univ-lyon1.fr

IIPPSSEE

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

IIPPSSEE

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

IIPPSSEE

ECDC HCAI surveillance :

1 ICU-module in TESSy

SSI surveillance

+ HELICSwin support, TESSy training

ECDC EPIS

ECDC - SPI surveillanc

e

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

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 2010-2012• 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

http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2009:151:0001:0006:EN:PDF

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.

Participation to HAI surveillance, status in 2010

Surgical Site Infection onlyIntensive care onlyBoth SSI and ICU

ICU or SSI pilotDoes not participate

NOISNOISSIROSIRO

RAISINRAISIN

ISC IIIISC III ENVINENVIN

ASRASR

SPIN-UTISPIN-UTIHELICSHELICS

KISSKISSNSIHNSIH

PREZIESPREZIESHPAHPA

SSHAIPSSHAIPHISCHISC INST HYGINST HYG

ANISANIS NNSRNNSR

NHSNHS

EU HAI surveillance integrated in TESSy in October 2010

TESSy = “The European Surveillance System” = ECDC’s online database, upload and reporting system for all communicable diseases under surveillance

Integration of all dedicated surveillance networks

June, 7-9 2010: 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

MS

MS

MS

MS

MS

MS

MS

MS

MS

MS

MS

MS

MS

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

MS

MS

MS

MS

MS

MS

MS

MS

MS

MS

MS

MS

MS

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

DSN

Pre-TESSY

Country

Country

Country

Country

Country

Country

Country

Country

Country

Country

Country

Country

Country

National institute

Disease expert

General public

AF member

MB member

…

…

…

…

…

TESSy

Dat

a up

load

and

acc

ess

Data access

Data users

Country

Country

Country

Country

Country

Country

Country

Country

Country

Country

Country

Country

Country

National institute

Disease expert

General public

AF member

MB member

…

…

…

…

…

TESSy

Dat

a up

load

and

acc

ess

Data access

Data users

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 (2011-...): representative systematic sample of 20-35 hospitals per country

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

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

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 http://halt.wiv-isp.be

Median % 3.8% (min. 0 - max. 26.7)Mean % 5 [95% CI: 4.1-5.9]

HALT: Pilot results of HAI in nursing homes

Surveillance of Clostridium difficile infections (CDI)

2006: ESGCD/ECDC case definitions on CDI 2007: ECDC launched the European C. difficile survey

(ECDIS, 2008-2010) (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.

Concordance study of HAI dase definitions

Concordance study: Results

Cases HELICS+CDC+

HELICS+CDC-

HELICS-CDC+

HELICS-CDC-

Cohen’s kappa

Pneumonia, all 180 177 1 2 6326 0.99 (0.98;1.00)

Clinical Pneumonia* 127 102 23 2 6379 0.89 (0.85;0.93)

Microbiological Pneumonia**

65 37 16 12 6441 0.72 (0.63;0.82)

Key term „ICU-acquired pneumonia”

147 130 0 17 28 0.71 (0.58;0.84)

Key term „mechanical ventilation”

136 134 2 0 42 0.97 (0.93;1.00)

BSI, all 123 72 51 0 6383 0.73 (0.66;0.80)

Primary BSI*** 72 72 0 0 51 1

Key term „ICU-acquired BSI”

98 93 0 5 22 0.87 (0.76;0.98)

*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”

The Council Recommendation recommends that Member States … (3) Adopt and implement a strategy, pursuing (cont’d):

– 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

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): 12/2009-10/2010 (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, 21-22 June 2010: country representatives identified by Competent Bodies for training on ECDC’s request

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) TRaining

InfectionControl

Europe

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

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

Source: http://en.wikipedia.org/wiki/Eurolinguistics

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

HvalaMulţumesc

Blagodarya/Благодаря

Efharisó/ευχαριστώ

Go raibh maith agaibh

Grazzi