ECDC Releases First Point Prevalence Survey on HAIs

The European Center for Disease Prevention and Control (ECDC) has released the results of its first point prevalence survey (PPS) on healthcare-associated infections (HAIs) and antimicrobial use in European hospitals.

Based on findings from this survey, ECDC estimates that on any given day, one in 18 patients in European hospitals has at least one healthcare-associated infection. The report also presents data on the most commonly reported infections, which microorganisms are most commonly reported as causing them, how often antimicrobial drugs are being used to treat these infections and data on infection control structure and processes in the hospitals. More than 1,000 hospitals in 30 European countries participated in this first Europe-wide PPS.

HAIs are those acquired by patients during their stay in a hospital or other healthcare setting. Although some of these infections can be treated easily, others may more seriously affect a patients health, increasing their stay in the hospital, requiring further surgical intervention or prolonged treatment with antimicrobials and causing considerable distress to these patients.

Through the ECDC PPS, a major step has been made towards increasing the skills for surveillance of healthcare-associated infections and antimicrobial use, and raising awareness of healthcare-associated infections among thousands of healthcare workers across Europe. The survey provides the most comprehensive database on healthcare-associated infections and antimicrobial use in European acute care hospitals to date, and based on these results ECDC has made recommendations that should be further developed and implemented across Europe.

Marc Sprenger, ECDC director, says, The survey confirms that healthcare-associated infections pose a major public health problem and a threat to European patients: ECDC estimates that on any given day, about 80,000 patients, i.e. 1 in 18 patients, in European hospitals have at least one healthcare-associated infection. Overall, this amounts to an estimated total of 3.2 million patients (95 percent confidence interval: from 1.9 to 5.2 million) each year. He adds, Many of these infections could be prevented by sustained, multifaceted infection prevention and control programs, including surveillance of healthcare-associated infections. Such programs, as well as prudent use of antibiotics, will help all actors involved to protect the patients of European hospitals."

Paola Testori Coggi, director general of DG Health and Consumers, European Commission, notes, This survey represents an important milestone in monitoring healthcare-associated infections across Europe. Their prevalence is worrying and increased efforts are needed at local, national and European level to prevent such infections, for the safety of patients. Such efforts are also needed to fight against the development of antimicrobial resistance. The European Commission is actively monitoring the situation with the support of the European Center for Disease Prevention and Control, and works in cooperation with the Member States to implement the 2009 Council Recommendation on Patient Safety.

The prevalence of HAIs was the highest among patients admitted to intensive care units (ICUs) in these hospitals, where 19.5 percent of patients had at least one. The most common types of HAI in these ICUs were respiratory tract infections and bloodstream infections. Overall, of a total of 15 000 reported healthcare-associated infections, the most commonly reported types were respiratory tract infections (pneumonia, 19.4 percent; lower respiratory tract infections, 4.1 percent), surgical site infections (19.6 percent) and urinary tract infections (19.0 percent).

The survey also confirms that a large proportion of patients receive antimicrobial agents while being hospitalized. ECDC estimates that more than 400 000 patients, i.e. one in three patients, receive at least one antimicrobial agent on any given day in European hospitals. The following areas for improvement were identified: limiting the use of broad-spectrum antimicrobials, reducing the unnecessary prolongation of surgical prophylaxis, promoting earlier change from parenteral to oral administration of antimicrobials, and improving the documentation of the reason for the antimicrobial use in the patients charts.

ECDC will organize a second Europe-wide point prevalence survey in all member states in 2016-2017 and will continue supporting the organization, data collection, validation and analysis of national surveys during the period 2013-2015.

Other findings:

- About half (54.1 percent) of the healthcare-associated infections were reported with microbiological results on the day of the survey. Among these, the 10 most commonly isolated microorganisms in HAIs were Escherichia coli (15.9 percent), Staphylococcus aureus (12.3 percent), Enterococcus species (9.6 percent), Pseudomonas aeruginosa (8.9 percent) Klebsiella species (8.7 percent), coagulase-negative staphylococci (7.5 percent), Candida species (6.1 percent), Clostridium difficile (5.4 percent), Enterobacter species (4.2 percent), Proteus species (3.8 percent) and Acinetobacter species (3.6 percent).

- Among all Staphylococcus aureus isolates with known results from antimicrobial susceptibility testing , 41.2 percent were reported as resistant to meticillin (i.e. were MRSA). Among all isolates of Enterococcus species with known results, 10.2 percent were reported as resistant to vancomycin. Among all isolates of Enterobacteriaceae with known results, 33.4 percent and 7.6 percent were reported as resistant to third-generation cephalosporins and to carbapenems, respectively.

Source:  European Center for Disease Prevention and Control (ECDC)