ECDC contribution to control of (Dominique Monnet)

ECDC contribution to control of healthcare‐associated infections
Dominique L. Monnet
Head of Disease Programme for the ECDC Antimicrobial Resistance and Healthcare‐
Associated Infections (ARHAI) Programme, ECDC What is the role of ECDC in its
Founding Regulation?
… to identify, assess and communicate current and emerging
health threats to human health from communicable diseases.
— ECDC Founding Regulation (851/2004), Article 3
• EU-level disease surveillance and
epidemic intelligence
• Scientific opinions and studies
• Early Warning System and response
• Technical assistance and training
• Communication to scientific
community
• Communication to the public
Antimicrobial Resistance and HealthcareAssociated Infections (ARHAI) Networks
 European Antimicrobial Resistance
Surveillance Network (EARS-Net)
(formerly EARSS, integrated in January 2010)
 European Surveillance of
Antimicrobial Consumption
Network (ESAC-Net)
(formerly ESAC, integrated in July 2011)
 Healthcare-Associated Infections
surveillance Network (HAI-Net)
(formerly HELICS / IPSE, integrated in July 2008)
http://www.ecdc.europa.eu/en/activities/diseaseprogrammes/ARHAI/Pages/surveillance_networks.aspx
http://ecdc.europa.eu/en/activities/diseaseprogrammes/ARHAI/Pages/index.aspx
Participation in surveillance networks
contributes to prevention of HAIs
Cholecysectomy
(CHOL)
Cholecysectomy
(CHOL)
Source: HAI-Net, ECDC, 2013.
Colon
surgery
(COLO)
Caesarean
section
(CSEC)
Hip
prosthesis
(KPRO)
http://www.ecdc.europa.eu/en/publications/Publications/SSI-in-europe-2010-2011.pdf
Knee
prosthesis
(KPRO)
Laminectomy
(LAM)
Healthcare-Associated Infections
surveillance Network (HAI-Net)
• Standardised methodology and protocols for surveillance
• HELICSwin.Net software for use in European hospitals
• Feed-back to Member States by hospital/ward (confidential code)
following reporting to ECDC/TESSy
• Reports and interactive databases
No. reporting
Year
EU/EEA
• Five components
countries
Point prevalence survey of HAI and antimicrobial use
30
2011-2012
Surgical site infections (in preparation, 2014)
16
2012
HAI in intensive care units (in preparation, 2014)
15
2012
HAI and antimicrobial use in long-term care facilities
17
2013
Clostridium difficile infections (pilot survey, 2015)
13
2013
http://www.ecdc.europa.eu/en/activities/surveillance/HAI/Pages/default.aspx
How are surveillance data collected?
EARS-Net
(antimicrobial resistance)
©Istockphoto/Sorapop
Electronically, from laboratory information
system (LIS)
ESAC-Net
(antimicrobial consumption)
©Istockphoto/Sorapop
Electronically, from medicines agencies /
pharmacies / national insurance system
HAI-Net
(healthcare-associated infections)
In the wards, at patient bed
ECDC point prevalence survey (PPS) in
European acute care hospitals, 2011-2012
•
•
•
•
28 EU Member States (incl. Croatia), Iceland and Norway
Approx. 2800 healthcare workers involved
Submitted to ECDC: 1 149 hospitals
Included in analysis: 947 hospitals, 231 459 patients
• Specific ECDC surveillance report, incl.country profiles
• Interactive database on ECDC website
Source: HAI-Net, ECDC, 2013.
http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf
ECDC PPS in European acute care hospitals,
2011-2012: comparing with other risks
Healthcare-associated infections:
on a given day, 1 /18 patients
(point prevalence survey, EU/EEA, 2011-2012)

Adapted from: Perl T, 2007. Source for healthcare-associated infections: HAI-Net, ECDC, 2013.
http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf
ECDC PPS in European acute care hospitals,
2011-2012: example of indicator
median
AA
Alcohol hand rub consumption (L / 1000 patient-days)
Source: HAI-Net, ECDC, 2013.
http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf
Healthcare-associated infections & antimicrobial resistance: overlapping, but not identical
Adverse events
Healthcareassociated
infections
Healthcareassociated,
antimicrobialresistant
infections
(selected
MDROs)
Communityacquired,
antimicrobialresistant
infections
Antimicrobial
resistance
Community-acquired
infections
Staphylococcus aureus: % of invasive
isolates with resistance to meticillin
(MRSA), EU/EEA, 2010 & 2013

2010






2013
Source: EARS-Net, 2014
The symbols  and  indicate a significant increasing or decreasing trend for the period 2010-2013, respectively.
These trends were calculated on laboratories that consistently reported during this period.
Klebsiella pneumoniae: % of invasive
isolates with combined resistance
(third-generation cephalosporins, fluoroquinolones and
aminoglycosides), EU/EEA, 2010 & 2013

2010










2013
Source: EARS-Net, 2014
The symbols  and  indicate a significant increasing or decreasing trend for the period 2010-2013, respectively.
These trends were calculated on laboratories that consistently reported during this period.
Mohammed
(United Kingdom)
https://storify.com/EAAD_EU/patient-stories
Klebsiella pneumoniae: % of invasive
isolates with resistance to carbapenems,
EU/EEA, 2010 & 2013

2010






2013
Source: EARS-Net, 2014
The symbols  and  indicate a significant increasing or decreasing trend for the period 2010-2013, respectively.
These trends were calculated on laboratories that consistently reported during this period.
Trends in consumption of antibacterials for
systemic use in the hospital sector (expressed
in DDD per 1000 inhabitants and per day), EU/EEA,
2009-2013
Total (J01)
Carbapenems (J01DH)
Polymyxins (J01XB)
Source: ESAC-Net, 2014. http://ecdc.europa.eu/en/eaad/Pages/antibiotics-data-reports.aspx
Carbapenem-resistant infections:
a challenge for appropriate patient therapy
Colistin resistance – options for
treatment are further reduced
Modern medicine: not possible
without effective antibiotics
Hip / knee replacement
Organ transplant
Cancer chemotherapy
Intensive care
Care of preterm babies
Conclusions - Perspectives
•
•
•
•
•
•
•
HAI-Net: improve participation of Member States
EARS-Net: improve reporting of HAI vs. community-acquired
Directory of online resources for HAI and AMR (2014-2015)
Revised estimates of the burden of HAI (2014-2015)
Integrate indicators in surveillance components
Surveillance of Clostridium difficile infections (2015 onwards)
2nd ECDC point prevalence survey in European acute care
hospitals, 2016-2017 (mandatory validation of data)
Thank you!
• ECDC Press office
press@ecdc.europa.eu
• Twitter
@ECDC_EU
• European Antibiotic Awareness Day,
18 November 2014
Website: http://antibiotic.ecdc.europa.eu
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