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Point prevalence survey: Long-term care facilities

ECDC Point prevalence survey of healthcare-associated infections and antimicrobial use in European long-term care facilities

 

Overview

In Europe, most long-term care facilities (LTCFs) are for the elderly, including general nursing homes, residential homes and mixed facilities. In 2013, there were approximately 63 224 LTCFs for older adults in EU/EEA Member States with a capacity of approximately 3.6 million beds. The size of Europe’s LTCF population is increasing.
 
ECDC monitors the burden of healthcare-associated infections (HAIs) and antimicrobial use in LTCFs through repeated point prevalence surveys (PPSs) in EU/EEA Member States, using a standardised protocol. PPSs in May-September 2010 and April-May 2013 identified a crude prevalence of residents with at least one HAI in participating LTCFs of 2.4% and 3.3%, respectively. In 2013, ECDC estimated that on any given day there are more than 116 000 residents in European LTCFs with at least one HAI; the total number of HAIs occurring each year in European LTCFs was estimated at 4.2 million HAIs.
 
The risks of acquiring a HAI can be reduced by implementing infection prevention and control (IPC) structures and processes including antimicrobial stewardship. In the 2013 survey, the crude prevalence of residents receiving at least one antimicrobial agent was 4.4%. 
 

Objectives

The objectives of ECDC surveillance of HAIs and antimicrobial use in European LTCFs are: 
 
  • To provide EU/EEA Member States and LTCFs with a standardized tool to follow trends in HAIs and antimicrobial use;
  • To identify priorities for national and local intervention measures and evaluate their implementation in EU/EEA Member States and LTCFs;
  • To estimate and monitor the burden of HAIs and antimicrobial use in LTCFs at national and European level.

 

Methodology

 
History
  • In 2008, the coordination of surveillance of HAIs in Europe was transferred to the European Centre for Disease Prevention and Control (ECDC), which created the Healthcare-Associated Infections Surveillance Network (HAI-Net).
  • A feasibility study of surveillance of HAIs in European nursing homes had already been performed under the Improving Patient Safety in Europe (IPSE) project financed by the European Commission.
  • In December 2008, ECDC initiated surveillance of HAIs and antimicrobial use in European LTCFs under the Healthcare-Associated Infections in Long-Term Care Facilities (HALT) project.
    The HALT project integrated variables from the European Surveillance of Antimicrobial Consumption in Nursing Homes (ESAC-NH) subproject into a protocol for repeated PPS in LTCFs, thus providing an integrated methodology for continued assessment of the prevalence of HAIs and antimicrobial use in LTCFs. Data collection for the PPS as part of the HALT project took place in May-September 2010.
  • A second project (HALT-2) conducted a similar PPS in April-May 2013.
  • The next ECDC PPS of HAIs and antimicrobial use in European LTCFs under the HALT-3 project will take place in EU/EEA Member States and in EU enlargement countries in 2016 - 2017.

 

Protocols and tools
The main protocol provides the methodology, data collection forms and definitions of the variables for a PPS of HAIs and antimicrobial use in LTCFs. One form is used to collect data on each participating LTCF, including general characteristics of the LTCF and performance indicators for IPC and antimicrobial stewardship in the LTCF. A separate form is used to collect information on each resident with signs and symptoms of infection or receiving an antimicrobial on the day of the PPS. For each PPS in LTCFs, ECDC critically reviews its methodology, adapting the protocols and survey tools where necessary.
 
The protocol and materials for the PPS are presented at a train-the-trainer workshop for representatives of EU/EEA Member States, thus enabling these representatives to train other trainers and local survey staff. In 2013, staff from 1 072 LTCFs were trained in the use of the protocol using the provided materials.
 
A validation protocol provides the methodology, data collection forms and definitions of variables for a validation survey in at least one LTCF per EU/EEA Member State, performed by a national validation team on the same day as a primary survey, to estimate the sensitivity and specificity of data collection in that LTCF. These are used to adjust the estimates of the burden of HAIs in European LTCFs.
 
If an invitation is received by ECDC from a participating EU/EEA Member State, the Project Management Team will arrange a two-day onsite assessment visit together with the corresponding national team. The objectives of the visit are to support the completion of a questionnaire on national data and to accompany the national team during a validation survey. The questionnaire relates to national performance indicators of IPC, the effect of repeated PPSs in LTCFs at national and local level, and the collection of national denominator data. The Project Management Team accompany the national team on a validation survey, to aid completion of the national questionnaire and to qualitatively assess the comparability of the national validation surveys.
 
The outputs from the PPS of HAIs and antimicrobial use in European LTCFs include a European report as well as feedback reports for each participating LTCF, comparing their data to national and European results; both are distributed to national teams for onward distribution.
 

 PROTOCOL

 
 

 HAI-Net EXTRANET

 
 

 REPORTS

 
 

 SCIENTIFIC PUBLICATIONS

 
© European Centre for Disease Prevention and Control (ECDC) 2005 - 2017