ECDC tools: surveillance is essential to prevent and control healthcare-associated infections

5 May 2017

Today, ECDC’s Healthcare-associated Infections Surveillance Network (HAI-Net) publishes two updated protocols for the surveillance of healthcare-associated infections (HAIs): one for surgical site infections (SSIs) and prevention indicators, and another one for HAIs and prevention indicators in intensive care units (ICUs), both to be used by European hospitals. An update of the protocol for the surveillance of Clostridium difficile infections (CDIs) was published on 21 April.

The main objective of these protocols is to ensure standardisation of definitions, data collection and reporting procedures for hospitals participating in the national/regional surveillance of HAIs across Europe, and to contribute to improve the quality of care in European hospitals. An additional objective of the updated HAI-Net SSI and ICU protocols is to compare and follow-up the implementation of key measures for the prevention of SSIs and HAIs in ICUs (especially device-associated pneumonia and bloodstream infections).

Furthermore, a new version of the free surveillance software application now including the HAI-Net ICU and HAI-Net CDI modules (HelicsWin.Net v2.3.7) is also published today on the ECDC website. The HAI-Net SSI module will be made available in this software application by the end of 2017.

SSIs are among the most common HAIs and are associated with longer post-operative hospital stays, additional surgical procedures, treatment in an ICU, and higher mortality.

Patients admitted to ICUs are at 5 to 10 times higher risk of acquiring a HAI due to both intrinsic (e.g. immune system depression) and extrinsic (e.g. mechanical ventilation) risk factors. Moreover, ICUs often are the epicentres of emerging problems of antimicrobial resistance in hospitals. Antimicrobial resistance complicates the treatment of severe infections such as ventilator-associated pneumonia and bloodstream infections in ICUs because limited options for treatment of these HAIs are available.

The burden of CDIs has increased in hospitals worldwide with the appearance and spread of new hypervirulent strains such as PCR ribotype 027. CDIs affect in particular the frail elderly patients in healthcare institutions and the early detection of outbreaks is crucial to guide specific prevention and control measures.

The HAI-Net surveillance modules target HAI types that cause a high burden in European hospitals and need special attention in terms of prevention. ECDC recently estimated the number of attributable deaths per year at 16 049 (confidence interval (CI): 15 249 – 16 893) for surgical site infections, at 26 972 (CI: 21 859 – 32 541) for healthcare-associated pneumonia, at 24 284 (CI: 20 824 – 27 755) for healthcare-associated primary bloodstream infections, and at 8 382 (CI: 6 034 – 11 152) for healthcare-associated CDIs.

All European hospitals can take part in HAI-Net surveillance, by contacting the national HAI surveillance coordinating centre in their country or by contacting ECDC HAI-Net at, which will put them in contact with their national HAI surveillance coordinating centre.