Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015

1. 3rd Joint Meeting of the Antimicrobial Resistance and
Healthcare-Associated Infections (ARHAI) Networks
Report from HAI-Net sessions
Rapporteur: Ana Budimir (Croatia)
Organised jointly with

2. HAI-Net ICU session 11/2/2015
1. HAI-Net ICU protocol changes agreed for piloting
• Indicators of staffing, hand hygiene, antimicrobial
stewardship, indicators of intubation care, CVC care;
attributable mortality needs more discussion
2. Presentation of HELICSWin.Net ICU software
3. Rationale for validation of ICU data
4. Expansion of surveillance of ICU-acquired infections to
more countries

3. Conclusions
ICU surveillance
HAI prevention indicators:
• Agreed: 1-2 weeks data collection of
• aggregated reporting per year /surveillance period,
• unit based at least 30 opportunities per indicator
• Attributable mortality
• direct measurement of relationship of HAI to death:
– Very strong reservations about the feasibility of
acquiring valid data, from national experience
– Concerns over negative effect on hospital
participation/submission data to ECDC , fear that data
would reach lawyers, press etc
• Further develop methods in mortality via working group
(email to recruit members)

4. 1. Presentation
• Overview of legal basis; Overview of agreements from
ECDC Management Board (EU countries, EC); Possibilities
to say no (“Article 4”); possible annual policy review
2. Discussion
• Very strong feeling from people, most were ICU people
• Not notifiable in some countries, so no legal basis to
share e.g. AT, SL.
• Deductive disclosure of hospitals, units, patients,
doctors is big fear.
• Broad acceptance that use of data good for public health
• HAI data acquired voluntarily based on trust for
limits.
Third party access to TESSy data

5. 1. Overview of PPS activities and changes to PPS protocol
2. US CDC presentation
• 2011 PPS, 2015 PPS; comparability of results with EU?
3. Indicators for PPS II protocol
• ‘SIGHT’ was ECDC systematic review of evidence base
• Includes: Hosp organization, management, structure for
prevention: key components and indicators for PPS
protocol
• Indicators of antimicrobial stewardship (TATFAR)
4. National and international PPS validation
5. PPS training and further planning
6. National PPS planning
HAI-Net PPS session 12-13/2

6. Conclusions
PPS PROTOCOL CHANGES
• Agreement of SIGHT-based structure and process indicators
• Antimicrobial stewardship and use:
• 2 TATFAR indicators
• Dosage to inform US/EU comparison
Few other changes : HAI association to ward, neonatal birth
weight, specialty for healthy babies…

7. Conclusions: PPS validation
• Significant differences were noted between the teams of data
collectors in terms of:
• Completeness of data
• Identifying patients who had undergone surgery in the
previous month,
• The number of HAI detected
• No internationally agreed standard/protocol?
• National validation-at the same time as the primary PPS
• Recommended: 750 in 25 hosp, minimum 250 in 5 hospitals
• International validation
• Validation of national validation teams
• Accompany national VT in 1-2 hospitals /country
• Who? Part of HA-Net support call for tender (published soon):
contractors +ECDC experts

8. Perspectives
1. HAI Net-ICU: new software, efforts to include more
countries in surveillance, duration of surveillance, pilot on
prevention indicators, mortality data…
2. 2nd PPS in 2016-new forms, changes in indicators
3. Pilot-PPS indicators based on SIGHT project findings
4. Participation in PPS II: almost all confirmed, 4 countries
uncertain, validation almost all