Healthcare-associated infections pose a major public health threat in long-term care facilities in Europe


​An EU-wide survey estimated that 4.2 million healthcare-associated infections occur every year in European long-term care facilities, compared to an estimated 3.5 million occurring in European acute care hospitals, and that on any given day, over 116 400 residents have at least one active healthcare-associated infection. Pete Kinross, an expert in surveillance of healthcare-associated infections at the European Centre for Disease Prevention and Control (ECDC), speaks about these findings during a session on antimicrobial resistance in these healthcare settings, at ECCMID 2017.

These data come from a project called HALT-2 that conducted a survey with information on 77 264 residents in 1 181 long-term care facilities in 19 European countries between April and May 2013. This project was developed by ECDC together with a consortium led by the Scientific Institute of Public Health in Brussels, through a framework contract for services with ECDC.

The survey also showed that on any given day, over 150 650 long-term care facilities’ residents received at least one antimicrobial agent to treat their infections. Over 85% of the healthcare-associated infections were urinary or respiratory track or skin infections. The majority of the facilities that took part in the study were general nursing homes (65%), mixed long-term care facilities (19%), rehabilitation centres (6%) and residential homes (5%).

Furthermore, 46% of the participating facilities had not implemented any of the ten key elements of good antimicrobial stewardship e.g. antimicrobial stewardship committees, annual training on appropriate prescribing of antimicrobial agents, a system that requires permission from designated staff to prescribe restricted antimicrobials, a mechanism to provide feedback on antimicrobial consumption to general practitioners, guidelines for appropriate antimicrobial use, or a therapeutic formulary, amongst others. One in ten centres did not have access to infection prevention and control advice or committee.

Pete Kinross said: “healthcare-associated infections pose a major public health threat in long-term care facilities in Europe. Strategies to prevent and control these infections, in addition to prudent use of antimicrobial agents, need to be in place to protect the health of the residents of these facilities. We hope that these results help national authorities and the participating facilities to target their interventions”. He added: “we are particularly grateful with the facilities that participated in the HALT-1 and HALT-2 surveys, as taking part in such surveys highlights their interest and commitment to identify opportunities for improvement, even with limited resources”.

Currently, ECDC is coordinating the HALT-3 survey, which results will be published in 2018. Pete Kinross pointed out: “we would like to stress the importance for national authorities in EU/EEA Member States to encourage as many long-term care facilities as possible to take part during the remaining HALT-3 surveillance waves, i.e. between April and June 2017, and September and November 2017”. He finalised: “these surveys are very relevant, as they serve as a tool to increase awareness and prevention of healthcare-associated infections in these long-term care facilities at the local, national and European level”.