Exploring opportunities for support in healthcare-associated infections (HAI) – Romania, 4–7 July 2016

Mission report Technical guidance
Time period covered: 4 - 7 July 2016

European Centre for Disease Prevention and Control. Exploring opportunities for support in healthcare-associated infections – Romania, 4–7 July 2016. Stockholm: ECDC; 2017.

​On 27 May 2016, the Romanian Minister of Health sent a letter to the Director of ECDC requesting support with the containment of healthcare-associated infections (HAI) in Romania. From 4 to 7 July 2016, a team of multidisciplinary experts in public health, infection control and epidemiology, from ECDC and Norway, made an exploratory visit to Romania. The team visited the Ministry of Health, hospitals in and around Bucharest, and national institutes where they met key national stakeholders. The purpose of the visit was not to perform an inspection, but rather to gain an understanding of the situation, engage in discussions, and propose actions for consideration by the responsible authorities in Romania. This mission report contains details of the visit and the follow-up proposals.

Executive summary

A team of experts from ECDC and Norway visited Romania between 4 and 7 July 2016 to discuss aspects related to the detection, surveillance, prevention and control of healthcare-associated infections (HAIs), together with staff at the Ministry of Health, the National Institute of Public Health and with key Romanian stakeholders.  
The visit aimed to answer a request for support by the Minister of Health to tackle the challenges that the country is currently facing in this area. Its purpose was to gather further understanding of the situation and to engage in discussions with different actors involved.  

During this visit, the team of experts were able to see examples of good practice but also areas for improvements. There is also a strong political will to further improve the situation. Based on the discussions and observations, the team identified areas for further actions that could be considered in the short and medium terms by the responsible authorities in Romania. These areas are related to:

  • 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. 
  • 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. 
  • Organising appropriate training for various categories of staff working in the hospitals.  
  • 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. 
  • Improving microbiology standards and protocols to monitor HAIs and ensuring a national reference microbiology function for 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.
  • Cementing the role of functional multidisciplinary infection control committees at hospitals and national level where all relevant stakeholders are empowered to drive change. 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.


These conclusions and recommendations were welcomed by the Minister of Health, who stressed his commitment to work further to address the challenges posed by HAIs in the country. ECDC restated its availability to continue to support specific activities and to perform a complementary peer-review focused on the prudent use of antimicrobial agents.