Prevention is better than cure

The ECDC’s Dr Andrea Ammon speaks to Portal about the threats posed by healthcare-associated infections

According to the World Health Organization (WHO), healthcare-associated infections (HAIs) represent the most frequent adverse event during care delivery, and no institution or country can claim to have solved the problem yet. Based on data from a number of countries, it adds, it can be estimated that each year, hundreds of millions of patients around the world are affected by them, with the burden of these infections being severalfold higher in low- and middle-income countries than in high-income ones.

The European Centre for Disease Prevention and Control (ECDC) highlights similar concerns, underlining the fact that approximately 4,100,000 patients are estimated to acquire a healthcare-associated infection in the EU each year. The number of deaths occurring as a direct consequence of these infections is estimated to be at least 37,000, and these infections are thought to contribute to an additional 110,000 deaths each year.

Portal asked the ECDC’s director, Dr Andrea Ammon, about the burden that HAIs pose and the action that can be taken to address them.

More than 18,000 healthcare facilities worldwide have joined the WHO’s SAVE LIVES: Clean Your Hands campaign since its launch in 2009. How, since then, have efforts to improve hand hygiene to reduce HAIs at the point of care been assessed?

The WHO’s SAVE LIVES: Clean Your Hands campaign is a very good initiative. It has managed to involve a great number of healthcare facilities and individuals, and has considerably increased the awareness about the importance of hand hygiene in healthcare. Good infection control measures, and especially good hand hygiene, are essential, together with prudent antibiotic use, to avoid the spread of resistant bacteria in hospitals and other healthcare facilities.

To what extent are governments and healthcare providers in Europe tackling HAIs a public health priority? Is there still a need for greater awareness raising? 

Many of these infections could be prevented by sustained and multifaceted actions. Such actions are outlined in the council recommendation of 9 June 2009 on patient safety, including: the prevention and control of healthcare-associated infections; implementing infection prevention and control programmes; ensuring adequate numbers of healthcare professionals specialised in infection control in hospitals and other healthcare institutions; providing regular training for these healthcare professionals; having surveillance systems for these infections in place at the national level to identify priorities, targets for intervention and evaluation; and, of course, increasing awareness amongst patients and healthcare professionals about proper hand hygiene, amongst others.

How important a tool is targeted surveillance in the control and prevention of HAIs?

One of the first steps for the prevention of healthcare-associated infections is to have surveillance systems in place at the national level. This is extremely important as it provides an overview of the specific national situation and comparisons between hospitals and wards with the same specialty. Upon having that information, hospitals and healthcare authorities can take measures efficiently.

In its work plan for 2016, the EU’s health programme announced an anticipated €4m funding commitment in response to HAIs and AMR – how are these funds best made use of?

It is important that funds are made available to support the work done at different levels to address healthcare-associated infections and antimicrobial resistance. The ECDC has identified three main strategies to address antibiotic resistance, and these could benefit from funding in the European Union:

n          The prudent use of antibiotics is the cornerstone of preventing the emergence and spread of resistance, since antibiotic resistance being reported across Europe is directly linked to antibiotic use;

n          The implementation of good infection control practices, including hand hygiene and the screening and isolation of infected patients in hospitals, is important in order to prevent the spread of resistant bacteria; and

n          The promotion of the development of new antibiotics with novel mechanisms of action is essential, as resistance inevitably builds over time.

Earlier this year, the ECDC concluded a visit to Romania on the subject of HAI detection, prevention and control. What lessons can other European countries learn from the ECDC’s findings there?

Based on the discussions and observations of the ECDC team that visited Romania, actions that could be considered were identified. These could be implemented by other countries looking to improve their situation in terms of HAIs, if not yet in place. The actions included:

n          Increasing awareness and promoting better understanding of HAIs and infection control measures, starting with hand hygiene, involving hospital staff, patients, their relatives, the general public and the media;

n          Fostering an environment where hospitals are not stigmatised for reporting HAIs, but encouraged and supported by the government, the media and other stakeholders to learn and to improve their situation;

n          Organising appropriate training for various categories of healthcare professionals working in the hospitals;

n          Implementing good integrated reporting systems (both epidemiology and microbiology) which can provide data for direct and immediate actions and their evaluation at hospital level, and would also allow for national trends and international comparisons at the ministry of health level;

n          Improving microbiology standards and protocols to monitor HAIs and ensuring a national reference microbiology function for the identification of unusual strains, confirmation of antibiotic susceptibility testing, and epidemiological typing of outbreak strains. This function would also support, train and provide external quality assurance services for local laboratories;

n          Cementing the role of functional multidisciplinary infection control committees in hospitals and at national levels where all relevant stakeholders are empowered to drive change; and

n          Proper funding for the infection control activities needs to be ensured, implemented properly, followed up and evaluated. Additional funding would likely result in a quick return of investments and savings from preventing HAIs.

Dr Andrea Ammon


European Centre for Disease Prevention and Control (ECDC)

This article first appeared in issue 13 of Horizon 2020 Projects: Portal, which is now available here.