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. HAI-Net surveillance of HAIs in intensive care units
(HAI-Net ICU): protocol changes - conclusions
Carl Suetens
Surveillance and Response Support Unit
European Centre for Disease Prevention and Control

2. HAI-Net ICU :
HAI prevention indicators
 1-2 weeks data collection & aggregated reporting per year/surveillance
period, Unit based (aggregated), at least 30 opportunities per indicator
 Current proposal:
– Hand hygiene: alcohol handrub consumption (L/1000 pt days) in ICU
– ICU staffing: registered nurses and nurse aides
– Antimicrobial stewardship: systematic review of AM after 48-72 hrs
– IAP prevention: cuff pressure control, oral decontamination, patient
position
– CR-BSI prevention: CVC maintenance – dressing observation and/or
clinical surveillance of insertion site (chart review)

3. HAI-Net ICU protocol changes: conclusions
 Prevention indicators: proposed selection agreed
 HAI-related mortality, direct measurement of relationship of HAI to
death:
– strong reserves about validity/feasibility
– concerns over negative effect on hospital participation/submission
data to ECDC (certainly with current Data Access policy), fear that
data would reach lawyers, press, etc.
– further develop methods in mortality working group (email to recruit
members)
– additional modelling using more advanced statistical methods
planned
 No objection against removal variables standard protocol: date of
hospital admission, coronary care, previous surgery site, parenteral
nutrition + new optional severity score variable
 Revision of AMR markers: discussion still ongoing, to be proposed for
pilot after meeting (updated proposal included in slides)

4. Forms: hospital/ICU data 1/2
Hospital data
Hospital Code Year:
Hospital Type: O primary O secondary O tertiary O specialised
ICU characteristics
ICU Id
ICU size Number of beds in the ICU
ICU specialty
Percentage of intubated patients in year (true or estimated %): %
HAI types included in surveillance: O Pneumonia (PN) O Bloodstream Infections (BSI)
O Urinary tract infections (UTI) O Catheter-related infections (CRI1+2+3)
ICU indicators and denominators (one sheet per surveillance period)
Start date
N of
admissions
N of patient-
days
N of
admissions
N of patient-
days
Recommended minimal surveillance period = 3 months, maximum 1 year; add one form for each period
O Mixed O Medical O Surgical O Coronary O Burns O Neurosurgical
O Pediatric O Neonatal O Other O Unknown
Surveillance Period Patients staying >2 days All Patients
European Surveillance of ICU-acquired infections
Hospital / ICU form (standard & light protocol)
Hospital size
(n of beds)
Unique identifier for each intensive care unit w ithin an hospital
End date

5. Forms: hospital/ICU data 2/2
STRUCTURE AND PROCESS INDICATORS
Alcohol hand rub consumption during the previous year: Litres
Number of patient days (all) in the previous year patient days
ICU staffing
Number of hours of nurses present in the ICU in 7 days nurse hours
Number of hours of nurses' aides present in the ICU in 7 days nurse hours
Number of patient days in these 7 days patient days
Practice evaluation Start date __ / __ / _____ End date __ / __ / _____
N of files /
observations
N
compliance
Intubation: Position of the patient not supine (observation)
CVC: Catheter site dressing is not damp, loose or visibly soiled
(observation)
Antimicrobial stewardship: Review antimicrobial therapy after 48-
72 hours (chart review)
Intubation: Endotracheal cuff pressure controlled and/or corrected
at least twice a day (chart review)
Intubation: Oral decontamination using oral antiseptics at least
twice a day (chart review)

6. Forms: patients/HAIs
European Surveillance of ICU-acquired infections
Patient-based risk factor form (standard protocol)
Hospital code Date of admission in hospital: ___ / ___ / _______
ICU code (abbr name) Patient Counter
Patient data
Age in years: ____ yrs Gender: M F UNK Date of admission in ICU: ___ / ___ / _______
Date of ICU discharge ___ / ___ / _______ Outcome at ICU discharge: Alive Dead UNK
Origin of the patient O Ward this/oth hosp O Other ICU O Community O LTCF O Other O UNK
SAPS II score: Other severity score name*:
Other severity score value:
Type of admission: O medical O scheduled surgical O unscheduled surgical O UNK
Trauma: O Yes O No O UNK Impaired immunity: O Yes O No O UNK
Antimicrobial treatment +/- 48 Hrs around admission: O Yes O No O UNK
*Other severity score name: APACHE II, APACHE III, APACHE IV, SAPS 3, MPM II, MPM III, McCabe score
Exposure to invasive devices in the ICU
Central vascular catheter in ICU: O Yes O No O Unk
If Yes: Start Date 1 : ___ / ___ / _______ End Date 1: ___ / ___ / _______
Start Date 2 : ___ / ___ / _______ End Date 2: ___ / ___ / _______
Intubation in ICU: O Yes O No O Unk
If Yes: Start Date 1 : ___ / ___ / _______ End Date 1: ___ / ___ / _______
Start Date 2 : ___ / ___ / _______ End Date 2: ___ / ___ / _______
Urinary catheter in ICU: O Yes O No O Unk
If Yes: Start Date 1 : ___ / ___ / _______ End Date 1: ___ / ___ / _______
Start Date 2 : ___ / ___ / _______ End Date 2: ___ / ___ / _______
Patient received antimicrobial(s) during ICU stay O Yes O No O Unkown
Antimicrobial (generic or brand name) or ATC5 Indication
Patient had at least one ICU-acquired infection included in surveillance O Yes O No O Unknown
(if yes, fill out HAI form)
Indication: P: prophylaxis E: empiric treatment M: documented treatment S: SDD (Selective Digestive
Decontamination)
Start Date End Date
Patient Counter
Case definition code
Relevant device in
situ before onset*
Date of onset
BSI: source of BSI***
Micro-organism 1
Micro-organism 2
Micro-organism 3
Patient ICU outcome: O discharged alive O death, HAI definitely contributed to death
O death, HAI possibly contributed to death O death, no relation to HAI O death, relationship to HAI unknown
HAI1: AB1 SIR1 AB2 SIR2 AB3 SIR3 AB4 SIR4 PDR
Staphylococcus aureus OXA GLY
Enterococcus spp. AMP GLY
Enterobacteriaceae AMC C3G CAR COL
AMC C3G CAR COL
P.aeruginosa PIP CAZ CAR COL
Acinetobacter spp. CAZ CAR COL SUL
HAI2: AB1 SIR1 AB2 SIR2 AB3 SIR3 AB4 SIR4 PDR
Staphylococcus aureus OXA GLY
Enterococcus spp. AMP GLY
Enterobacteriaceae AMC C3G CAR COL
AMC C3G CAR COL
P.aeruginosa PIP CAZ CAR COL
Acinetobacter spp. CAZ CAR COL SUL
HAI3: AB1 SIR1 AB2 SIR2 AB3 SIR3 AB4 SIR4 PDR
Staphylococcus aureus OXA GLY
Enterococcus spp. AMP GLY
Enterobacteriaceae AMC C3G CAR COL
AMC C3G CAR COL
P.aeruginosa PIP CAZ CAR COL
Acinetobacter spp. CAZ CAR COL SUL
Bold=minimal resistance data (as in PPS); SIR: S susceptible, I intermediate resistance, R resistant, U unknow n
Antibiotic codes: AMC: amoxicillin/clavulanate, AMP: ampicillin, C3G: cephalosporins of third generation (cefotaxim/
cetriaxone/ceftazidim), CAR: carbapenems (imipenem/meropenem/doripenem), CAZ: ceftazidim, COL: colistin,
GLY: glycopeptides (vancomycin, teicoplanin), OXA: oxacillin, SUL: Sulbactam; PIP: piperacillin/ticarcillin w ith or w ithout
enzyme inhibitor; PDR: pandrug resistance, No PDR =N (susceptible to at least 1 antimicrobial), Possible PDR = P
(I/R to all antimicrobials tested in hospital), Confirmed PDR = C (I/R to all antimicrobials confirmed by reflab), U=Unknow n
SIR: S,I,R or U; PDR: N,P,C or U
SIR: S,I,R or U; PDR: N,P,C or U
SIR: S,I,R or U; PDR: N,P,C or U
MO-Code
European Surveillance of ICU-acquired infections
HAI and AMR form, standard protocol
MO-Code
MO-Code
*relevant device use (intubation for PN, CVC for BSI, urinary catheter for UTI) in 48 hours before onset of infection (even
intermittent use), 7 days for UTI; ** C-CVC, C-PER, C-ART, S-PUL, S-UTI, S-DIG, S-SSI, S-SST, S-OTH, UNK
MO-code MO-code MO-code
___ / ___ / ______
ICU-acquired infections
O Yes O No
O Unknown
___ / ___ / ______ ___ / ___ / ______
O Yes O No
O Unknown
O Yes O No
O Unknown
Target antimicrobial resistance data in ICU-acquired infections
HAI 1 HAI 2 HAI 3

7. HAI-Net ICU surveillance pilot
 Two weeks data collection:
– piloting of structure and process indicators
– testing methodology mortality review in HAI patients
 Period: April-September 2015
 Min 1 ICU/ country…
 Recruitment countries by email