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. Overview of PPS activities and meeting
objectives
Carl Suetens
Surveillance section, surveillance and response support unit
European Centre for Disease Prevention and Control (ECDC)

3. ECDC PPS 2016-2017: timeline
 Sep 2013: evaluation meeting of PPS 2011-2012, discussion protocol
changes
 Feb 2014: first review hospital-wide structure-and process indicators
(SPIs) based on SIGHT project and TATFAR
 May 2014: second SPI review, HAI-Net coordination committee meeting
 Jul 2014-Jan 2015: 7 teleconferences ECDC PPS expert group
 February 2015: discussion PPS II protocol at joint ARHAI meeting
 April 2015: HAI-Net Coordination Committee meeting
 April-Aug 2015: SPI pilot
 May-Sep 2015: Adaptation PPS module in HelicsWin.Net
 October 2015: PPS II meeting / training workshop (incl. validation), 2
participants per country
 November 2015 - March 2016: start national training courses
 April-June 2016: first wave ECDC PPS II
 Following PPS waves: Sep-Nov 2016, Apr-June 2017, Sep-Nov 2017, 2018?

4. Objectives HAI-Net PPS meeting, 12-13
February 2015
 To review and discuss proposed changes to the ECDC PPS
protocol
 To agree planning for piloting new structure and process
indicators
 To review national plans for the second PPS in all EU/EEA MS
 To discuss national and international validation during the
second PPS

5. National and international validation
 National validation:
– Required for interpretation of HAI prevalence + burden
estimates
– At the same time as the primary PPS
– Recommended: re-examine 750 patients in 25 hospitals
– Minimum: 250 patients in 5 hospitals
– Support contracts with ECDC (10 000 EUR / country),
budget to be spread over (at least) 2 years (2016-2017)
 International validation:
– Validation of national validation teams (VT)
– Accompany national VTs in 1-2 hospitals/country
– Who?: Part of HAI-Net support call for tender (published
soon): contractors + ECDC experts

6. Hospital-wide indicators for second ECDC
PPS: based on SIGHT project
Source: W. Zingg et al. Lancet Infectious Diseases, Published online Nov 11 2014.
 Systematic review & expert opinion => 10 Key Components
and proposed indicators
 HAI-Net experts: further define indicators for implementation
in PPS II protocol (meeting and teleconferences)

7. Infection prevention and control indicators:
objectives
 Increase awareness for HAI/AMR prevention through
surveillance/repeated PPS
 Add local value to surveillance by inter-hospital comparison
and follow-up of key preventive measures (=> increase
participation to surveillance networks?)
 Inter-country comparison and follow-up of implementation of
key preventive measures in EU/EEA countries
 Follow-up of implementation of ECDC guidance and Council
Recommendation 2009/C 151/01
 At the longer term: linking evolution of prevention indicators
with outcome indicators trends

8. Indicators: criteria
 Should measure:
- Capacity/Preparedness
AND
- Behaviour/Practices
 Evidence-based
 Feasible
 Valid & reproducible
 Sufficient variability
 Allow change over time
 Limited number, best selection for EU-level surveillance
Infection Prevention and Control
Surveillance process
Antimicrobial Stewardship
Hospital denominator data

9. Common indicators for ARHAI surveillance
networks
EARS-Net
HAI-Net
Lab001
Lab002
ESAC-Net
Hospital-based
antimicrobial
consumption
PPS
ICU
SSI
CDI
Hosp12
Hosp34
Hosp56
Hosp78
Standardised
hospital
codes
Specific
indicators
Hospital indicators
and denominator data
(1 record per hospital and per
surveillande period/ year)

10. Antimicrobial Stewardship indicators

11. ECDC PPS in acute care hospitals, 2011-2012:
structure and process indicators
 Infection prevention and control indicators in 2011-2012:
single bed rooms, alcohol hand rub consumption
 Mapping leads to action: e.g. measures to improve AHR data
availability in UK-Scotland
Percentage of beds in single roomsAlcohol hand rub consumption
*Poor data representativeness; Source: ECDC PPS, 2011-2012. Report available from
http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf

12. ECDC PPS in acute care hospitals, 2011-2012:
structure and process indicators
 Two indicators of infection prevention and control staffing
 Mapping leads to action: e.g. Czech Republic: National HAI
Reference Centre (2012), new IPC guidance (2013)
IPC nurses (FTE/250 beds) IPC doctors (FTE/250 beds)

13. Overview of changes to the ECDC PPS
protocol
ECDC Point prevalence survey of healthcare-
associated infections and antimicrobial use in
acute care hospitals, 2016-2017
Forms V5.0

14. 08:30 – 10:30
Session 11: HAI-Net
Point prevalence survey (PPS) in acute care hospitals*
Moderators: Carl Suetens (ECDC), Walter Zingg (UK)
08:30 – 09:00
Welcome; Overview of PPS activities and
meeting objectives
Carl Suetens (ECDC)
09:00 – 09:30 Second PPS in the US Shelley Magill (CDC, Atlanta)
09:30 – 10:30
Hospital organisation, management, and
structure for prevention of HAI: key
components and indicators for PPS
protocol – part I
Discussion
Carl Suetens (ECDC),
Walter Zingg (UK)
All
10:30 – 11:00 Coffee break
11:00 – 12:30
Session 12: HAI-Net
Point prevalence survey (PPS) in acute care hospitals*
Moderators: Carl Suetens (ECDC), Walter Zingg (UK)
11:00 – 12:30
Hospital organisation, management, and
structure for prevention of HAI: key
components and indicators for PPS
protocol – part II
Indicators of antimicrobial stewardship
Discussion
Carl Suetens (ECDC),
Walter Zingg (UK)
All
12:30 – 14:00 Lunch break

15. Friday 13/2
09:00 – 11:00
Session 17: HAI-Net
Point Prevalence Survey (PPS)*
Moderators:
Pete Kinross (ECDC), Jacqui Reilly (UK)
09:00 – 10:00
Other changes to PPS protocol
Discussion
Carl Suetens (ECDC)
All
10:00 – 10:20 National and international PPS validation
Carl Suetens (ECDC),
Jacqui Reilly (UK-Scotland)
10:20 – 10:45
Roundtable discussion:
National PPS planning
All
10:45 – 11:00 PPS training and further planning Carl Suetens (ECDC)
11:00 – 11:30 Coffee break

16. Friday 13/2
11:30 – 13:30
Session 18: EARS-Net, ESAC-Net, HAI-Net
ARHAI networks:
Moderators: Mike Catchpole & Dominique L. Monnet (ECDC)
11:30 – 11:45
Report from EARS-Net sessions
Discussion
Rapporteur (tbd)
11:45 – 12:00
Report from ESAC-Net sessions
Discussion Peter Zarb (Malta)
12:00 – 12:15
Report from HAI-Net sessions
Discussion
Rapporteur (tbd)
12:15 – 12:30
EARS-Net, ESAC-Net and HAI-Net:
keeping specific objectives to achieve
a common goal
Dominique L. Monnet (ECDC)
12:30 – 13:15 Roundtable discussion All
13:15 – 13:30 Conclusions Dominique L. Monnet (ECDC)
13:30 – 15:00 Lunch