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

1. ECDC ARHAI networks:
achievements in 2013-2014 and challenges
for 2015-2016
Dominique L. Monnet, Head of Programme
Antimicrobial Resistance & Healthcare-associated Infections (ARHAI)
Stockholm, 11-13 February 2015

2. Epidemic
Intelligence
and Response
Public Health
Training
External
Communication
Microbiology
Coordination
Scientific
Assessment
Epidemiological
methods
Surveillance
ARHAI

3. Antimicrobial Resistance and Healthcare-
Associated Infections (1)
Office of the Chief Scientist
. Disease Programme Section
– Dominique L. Monnet, Head of Disease Programme
– Barbara Albiger, Programme manager
– Elmira Khazeeva, Secretary
Surveillance and Response Support Unit
. Surveillance Section
– Ole E. Heuer, Senior Expert AMR surveillance, Group Leader
– Liselotte Diaz Högberg, Expert AMR surveillance
– Klaus Weist, Senior Expert Antimicrobial consumption surveillance
– Carl Suetens, Senior Expert HAI surveillance
– Jolanta Griškevičienė, Expert HAI surveillance
– Pete Kinross, Expert HAI surveillance
– To be recruited, Senior Expert AMR & HAI
. Scientific Assessment Section
– Anna-Pelagia Magiorakos, Senior Expert AMR & HAI
– Alessandro Cassini, Expert AMR & HAI
. Epidemic Intelligence and Response Section
– Diamantis Plachouras, Expert AMR & HAI

4. Surveillance and Response Support Unit (continued)
. Epidemiological Methods Section
– Daniel Palm, Senior Expert
– Karin Johansson, Expert
Public Health Capacity and Communication Unit
. Public Health Training Section
– Carmen Varela, Senior Expert and Group Leader, Training Network Strenghtening
– Vladimir Prikazsky, Expert
. External Communication Section
– Sarah Earnshaw, Group Leader, Press, Media and Information
– Giovanni Mancarella, Communciation Officer
– Andrea Mendez, Communication Specialist
– Karen Aimard, Communication Officer
– Andrea Würz, Communciation Officer
– Boyana Todorova, Communication Officer
Office of the Director, International Relations Section
– Nabil Safrany, International Relations Officer
Antimicrobial Resistance and Healthcare-
Associated Infections (2)

5. Austria
Federal Ministry of
Health
Greece
Hellenic Centre for Dis.
Control and Prev.
Norway
Norwegian Institute of
Public Health
Belgium
Scientific Institute of
Public Health
Hungary
National Center for
Epidemiology
Poland
Nat. Inst. of Public Health
– Nat. Inst. of Hygiene
Bulgaria
National Centre of
Infectious and
Parasitic Diseases
Iceland
Centre of Health
Security and Comm.
Disease Prevention
Portugal
Directorate General of
Health
Croatia
Croatian Nat. Inst.
of Public Health
Ireland
Health Protection
Surveillance Centre
Romania
National Institute of
Public Health
Cyprus
Directorate of
Medical and Public
Health Services
Italy Ministry of Health Slovakia
Public Health Authority of
the Slovak Republic
Czech
Republic
National Institute of
Public Health
Latvia
Centre for Disease Prev.
and Control
Slovenia
National Institute of
Public Health
Denmark
Danish Health and
Medicines Authority
Lichtenstein
Principality of
Liechtenstein
Spain
Ministry of Health, Social
Services and Equality
Estonia Health Board Lithuania Ministry of Health Sweden
Public Health Agency of
Sweden
Finland
National Institute for
Health and Welfare
Luxembourg Health Directorate
United
Kingdom
Public Health England
(Colindale)
France
Institute for Public
Health Surveillance
Malta
Superintendence of
Public Health
Germany
Robert Koch
Institute
Netherlands
National Institute for
Public Health and the
Environment
List of nominated
Coordinating Competent Bodies (CCBs)
Source: ECDC, 2015.

6. Source: ECDC Management Board (MB23-16), 9-10 November 2011.

8. Disease Network Coordination Committees
(DNCCs), 2015-2018
• Results after elections, by alphabetical order
• Enter in function for Joint DNCC Meeting, 14-15 April 2015
• EARS-Net
José Campos, Tim Eckmanns, Vincent Jarlier, Alan Johnson,
Jos Monen, Annalisa Pantosti, Gunnar Skov Simonsen,
Alkiviadis Vatopoulos, Dorota Żabicka, Helena Žemličková
• ESAC-Net
Marcel Bruch, Philippe Cavalié, Herman Gossens, Jenny Hellman,
Susan Hopkins, Stephanie Natsch, Anna Olczak-Pieńkowska,
Ajay Oza, Arjana Tambić, Peter Zarb
• HAI-Net*
Aleksander Deptuła, Petra Gastmeier, Mayke Koek, Jana Kolman,
Outi Lyytikäinen, Maria Luisa Moro, Mercedes Palomar, Jacqui Reilly,
Anne Savey, Reinhild Strauss, Rolanda Valintėlienė
*Due to an equal number of votes, the HAI-Net CC is exceptionally composed of 11 (instead of 10) members.

9. Indicators
Epidemic intelligence
Coordination
Ongoing surveillance
Ad-hoc studies / projects
Point prevalence survey
Risk assessment : syst.
reviews and guidance
Communication
Training
ECDC Antimicrobial Resistance and Healthcare-
Associated Infections Programme, 2007-2015
EARS-Net ESAC-Net HAI-Net
EuSCAPE, LA-MRSA
Contribution to WHO
Hand Hygiene Day
European Antibiotic Awareness Day
Interactive database
& Reports
Point prevalence survey of HAI and antimicrobial use
in acute care hospitals (2nd PPS in 2016-2017)
Infection control
indicators (2015)
Antibiotic stewardship
indicators (2015)
HAI LTCFs, CDI surv.
Hosp. IPC prog.
Infection control
training (TRICE-IS)
Coord. Committee Coord. Committee
Joint Meetings of ARHAI Networks
Short course on prevention and control of MDROs
Periop. prophylaxis
EPIS AMR-HAIEPIS AMR-HAI
Interactive database
& Annual report
Interactive database
& Annual report
CPE, ESBL
Inter-agency report - JIACRA (2014)
Directory of online resources for infection prevention and control (2015)
Coord. Committee
Hosp. use (2015)
Burden of HAI & AMR(2015)
Source: ECDC, 2015.

10. Source: ECDC, 2015 (http://ecdc.europa.eu/en/activities/diseaseprogrammes/ARHAI/Pages/index.aspx).

11. 2013-2014
• EARS-Net: annual reports, updates of interactive database,
EQA exercise
• ESAC-Net: reports and updates of interactive database
• HAI-Net:
• Point prevalence survey of HAI and antimicrobial use, 2011-2012:
report and interactive database, trainings, validation in 4 countries
• Surgical site infections: 2010-2011 report
• HAI and antimicrobial use in long-term care facilities (HALT) reports,
2010 & 2013
• Feasibility study for EU surveillance of Clostridium difficile infection
• Support to standardisation of antimicrobial
susceptibility testing methods and clinical breakpoints
for surveillance of antimicrobial resistance
Surveillance activities (1)

12. 2015-2016
• EARS-Net: annual reports, updates of interactive database, EQA
• ESAC-Net: report 2013-2014, updates of interactive database,
start of hospital antimicrobial consumption surveillance
• HAI-Net:
- HAI in intensive care units: 2008-2012 report (2015, in press)
- Surgical site infections: 2012 & 2013 reports
- HAI and antimicrobial use in long-term care facilities (3rd PPS)
- Start of Clostridium difficile infection surveillance (2016)
- Prep. (2015), then start 2nd PPS in acute care hospitals (2016)
- Introduction of structure & process indicators: PPS, ICU
• Support to standardisation of antimicrobial
susceptibility testing methods and clinical breakpoints for
surveillance of antimicrobial resistance
Surveillance activities (2)

13. Source: ECDC, 2015 (http://www.ecdc.europa.eu/en/data-tools/atlas/Pages/atlas.aspx).

14. • Surveillance Atlas of Infectious Diseases:
integration of EARS-Net, ESAC-Net and HAI-Net data
• Link data across the three networks, at hospital level
• Burden (deaths and costs) of HAIs and AMR
updated estimates for the EU and by country
• Introduce structure and process indicators
• Improve country participation in HAI surveillance:
all EU/EEA Member States, validated data (PPS)
Surveillance activities (3)

15. 2013-2014
• Interim results from the European survey on
carbapenemase-producing Enterobacteriaceae (EuSCAPE)
project 2013
2015-2016
• EuSCAPE: final report (2015)
• Self-assessment and evaluation (post-EuSCAPE, 2015)
• Livestock-associated MRSA survey (2015)
• Survey on molecular typing of carbapenem-resistant
Enterobacteriaceae in Europe (preparatory work with
consultations of experts in 2015)
Ad-hoc studies/surveys

16. 2013-2014
• Epidemic Intelligence Information System (EPIS)
for AMR and HAI events
• Country visit to discuss AMR and HAI issues (Portugal)
2015-2016
• Open the EPIS platform to all members of EARS-Net,
ESAC-Net and HAI-Net, i.e. All nominated National Focal
Points and Operational Contact Points
• Country visits to discuss AMR and HAI issues
- Invitations from Spain and Cyprus
- Budget for 2-3 visits / year
• Unexpected requests
Epidemic intelligence and
response support activities

17. 2013-2014
• Perioperative antibiotic prophylaxis (systematic review and guidance)
• Triazole-resistant Aspergillus spp. (risk assessment)
• Infection control measures to prevent the transmission of
ESBL-producing Enterobacteriaceae and of carbapenemase-
producing Enterobacteriaceae (2 systematic reviews)
• Healthcare-associated MRSA (systematic review)
Köck R, et al. Euro Surveill 2014 Jul 24;19(29). pii: 20860.
2015-2016
• Organisation of hospital infection control programmes
Zingg W, et al. Lancet Infect Dis 2015; 15(2): 212-24.
• Precautions for patients being transferred between
healthcare institutions across borders (guidance)
• ECDC directory of online resources (& toolbox)
Systematic reviews and guidance
documents

18. Source: ECDC, 2015. http://www.ecdc.europa.eu/en/healthtopics/Healthcare-associated_infections/guidance-infection-prevention-
control/Pages/guidance-prevention-control-infections-caused-by-multidrug-resistant-bacteria-and-healthcare-associated-infections.aspx

19. Source: ECDC, 2015. http://www.ecdc.europa.eu/en/healthtopics/Healthcare-associated_infections/guidance-infection-prevention-
control/Pages/guidance-prevention-control-infections-caused-by-multidrug-resistant-bacteria-and-healthcare-associated-infections.aspx

20. 2013-2014
• Core competencies for infection control and hospital hygiene
professionals in the European Union
• Training infection control and hospital hygiene
professionals in Europe (2 articles)
Brusaferro S, et al. Euro Surveill. 2014 Dec 11;19(49). pii: 20985.
Brusaferro S, et al. J Hosp Infect 2015. In press.
2015-2016
• Short course on control of multidrug-resistant
organisms (MDROs) in healthcare settings (20-22 Jan. 2015)
• Evaluation of existing national courses against the
core competencies (2015)
• Field Epidemiology Manual Wiki for infection control and
hospital hygiene (2016)
Public health training activities

21. Source: ECDC, 2015 (http://ecdc.europa.eu/en/EAAD/Pages/Home.aspx).

22. 2014
• European Antibiotic Awareness Day: a five-year perspective of Europe-
wide actions to promote prudent use of antibiotics.
Euro Surveill 2014 Oct 16;19(41). pii: 20928.
• 17 November: Event at ECDC, with the Public Health Agency of Sweden
• 18 November: >40 European countries, together with WHO/Europe
• 18 November: Global reach through collaboration with the U.S., Canada
and Australia and WHO Regional Offices
• #EAAD: >4000 tweets, 14 million impressions;
#AntibioticDay: >6000 tweets, 41 million impr.
2015-2016
• European Antibiotic Awareness Day, 18 Nov.
• Technical Advisory Committee + Meetings with experts
• New materials & toolkit (tbd)
• European event and social media activities
• Contribution to global awareness activities on 18 November
European Antibiotic Awareness Day

23. https://storify.com/EAAD_EU/patient-stories

24. Support to the Commission
2013-2014
• Regular teleconferences
• Contribution to 2nd report on the implementation
of Council Recommendation 2009/C 151/01
• Contribution to progress report on the
implementation of the Commission’s 5-year
action plan (in press)
2015-2016
• Regular teleconferences
• Support on the implementation of the
Commission’s 5-year action plan
• Evaluation of the implementation of Council
Recommendation 2002/77/EC
• Other actions in action plan

25. 2013-2014
• European Food Safety Authority (EFSA) & ECDC.
European Union Summary Report on antimicrobial resistance in
zoonotic and indicator bacteria from humans, animals and food
in 2012 http://www.ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-in-
zoonotic-and-indicator-bacteria-summary-report-2012.pdf
• European Medicines Agency (EMA) Antimicrobial Advice
Ad Hoc Expert Group (AMEG). Use of antibiotics in animals:
impact on public health and animal health. http://www.ema.europa.eu
(Regulatory > Veterinary medicines >
Antimicrobial resistance > Use of antibiotics in animals)
• EMA. Sales of veterinary antimicrobial agents in 26 EU/EEA
countries in 2012. Fourth ESVAC Report. http://www.ema.europa.eu
(Regulatory > Veterinary medicines > Antimicrobial resistance > European Surveillance of
Veterinary Antimicrobial Consumption)
• ECDC/EFSA/EMA. Joint Interagency Antimicrobial Consumption
and Resistance Analysis (JIACRA) Report (30 January 2015)
http://www.ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-JIACRA-report.pdf
Collaboration with other EU agencies

26. 2013-2014
• Contribution to Global report on surveillance of AMR
• Contribution to WHO/Europe´s strategic action plan on AMR
• See below
2015-2016
• Regular teleconferences
• Contribution to Global Action Plan on AMR
• Contribution to WHO “SAVE LIVES: Clean Your Hands”
campaign, 5 May
• Collaboration on surveillance of AMR
(meetings of WHO/Europe’s CAESAR, AGISAR, WHO/HQ expert
consultation) and antimicrobial consumption
• Collaboration on European Antibiotic Awareness Day
• Possible joint country visits
Collaboration with WHO

27. Source: CDC, 2015 (http://www.cdc.gov/drugresistance/tatfar/).
2015-2016
• Process for transatlantic communication
of critical events – new AMR trends
• Indicators for hospital antimicrobial
stewardship programmes
• Standards for measuring antimicrobial
use in hospitals

28. 3rd Joint Meeting of the ARHAI Networks,
Stockholm, 11-13 February 2015
• Network sessions
EARS-Net, ESAC-Net, HAI-Net
• Dinner at hotel (today 11/2)
• Plenary session organised
by the Public Health Agency
of Sweden (Thursday 12/2 pm)
• Dinner organised jointly with the
Swedish Ministry of Health and
Social Affairs (12/2)
• Final plenary session
(Friday 13/2, 11:30-13:30)
• Lunch & departure
• Slides (SlideShare) & evaluation

29. Thank
you!
Source: EARS-Net, 2014. Infographic: A. Haeger, ECDC.