Proposal for EU guidance on the establishment and implementation of infection prevention and control programmes in healthcare

There are variations in the implementation of infection prevention and control (IPC) programmes across European healthcare settings, indicating the need for standardised practices and enhanced efforts to improve the adoption of and monitoring compliance with IPC guidelines at national levels. This guidance underscores the need to establish and sustain IPC programmes at national and healthcare facility levels in the European Union and European Economic Area (EU/EEA) and is intended to be adapted by national authorities to their specific legal and organisational contexts, considering the heterogeneity of health systems. 

Healthcare-associated infections result in increased morbidity, prolonged hospital stays, higher healthcare costs and increased mortality. More than 3.5 million cases of HAIs are estimated to occur in the EU/EEA each year, leading to more than 90 000 deaths and corresponding to approximately 2.5 million disability adjusted life years (DALYs) [1]. In addition, HAIs account for more than 70% of the burden of antimicrobial resistance (AMR) in the EU/EEA [2]. Robust surveillance and laboratory capacity, healthcare worker and care provider awareness and training, and resources for maintaining the necessary governance, structures, and activities for IPC programmes are needed to reduce these burdens. 

ECDC encourages countries to establish, if not existing, maintain and strengthen national IPC programmes that adopt a risk-based approach to HAI prevention and control, grounded in surveillance data and stakeholder engagement. As levels of AMR, HAI burden, and pathogen epidemiology vary considerably across EU/EEA, countries should assess the strengths and weaknesses in their IPC programmes, prioritise areas for improvement and implement structured process improvement approaches to address gaps. 

This guidance for IPC programmes, focusing on the national level, hospitals, and long-term care facilities (LTCFs), is aligned with the EU legislative framework on AMR in human health and patient safety, as well as the WHO IPC Core Components. 

For effective national IPC programmes, the following actions are necessary: 

• Develop a national IPC action plan that clearly identifies responsible actors, defines priorities and actions, and allocates dedicated financial and human resources. 
• Implement monitoring and evaluation mechanisms for structure, process and outcome indicators for IPC, aligned with defined targets, to support continuous improvement of the IPC programme.
• Establish or strengthen HAI surveillance, a cornerstone of national IPC programmes. Progress toward digitalisation and automation should be embedded within legal frameworks, ensuring that healthcare facilities receive both financial and technological support to meet reporting requirements. National-level HAI data should be disseminated regularly and in a timely manner to relevant stakeholders, in line with the respective governance structure. 
• Adopt evidence-based technical IPC guidelines at the national level that outline actions for the prevention of HAIs and define national IPC standards to support the delivery of high-quality care. 
• Invest in financial and human resources to develop and sustain IPC training, both at the national level and within healthcare facilities, including partnership with higher education institutes to promote relevant research and continuous professional education. 

National health authorities have the ultimate responsibility for ensuring IPC policies are developed and implemented, setting up infrastructures necessary for IPC programmes and patient safety. Sustainable implementation of national IPC programmes is essential and should be reinforced by legal frameworks and the financial means for maintaining necessary structures and capacities. IPC policies are most effective when sufficient resources are allocated, and mechanisms for monitoring policy implementation are in place. Close coordination with sub-national administrative levels and healthcare facilities is particularly important to ensure compliance with policies in all levels of care provision. Although it is important to clearly define the roles of key stakeholders at national and sub-national levels, this guidance provides only a general overview of key actors and collaborative processes. The organisation of responsibilities among authorities in each country will depend on the respective health system’s governance, structure and legislative framework. 

Furthermore, this guidance recognises the unique context of long-term care facilities, which can vary significantly due to differences in population characteristics, infrastructure, and staffing. Tailored approaches are therefore essential when developing the IPC programmes for LTCFs as outlined in this document. This guidance includes steps for applying social and behavioural sciences approaches for strengthening the implementation of IPC guidelines. Understanding factors influencing behaviour can guide the development of behaviourally informed strategies and interventions to improve adoption of effective IPC practices. The engagement of healthcare workers, Proposal for EU guidance on establishment and implementation of IPC programmes in healthcare administration, patients and residents, who are service users, and implicated professional associations and scientific societies is essential in the co-creation of effective implementation. 

Alignment across healthcare facility administrative and IPC governance structures, technical guidelines, education and training programmes, and surveillance are key. Many components of IPC programmes, as suggested by WHO, have been largely implemented in EU/EEA countries. However, further work is needed to establish continuous monitoring and evaluation of implementation of these components, necessary for continuous IPC improvement. Example outcome, process and structure indicators and targets are provided in an annex to support countries in monitoring the performance of IPC programmes over time. Countries with well-established IPC programmes that already meet these IPC standards are encouraged to further strengthen their efforts. This includes enhancing the automation and quality of surveillance systems, expanding the use of the indicators and targets proposed in this document, and ensuring the allocation of sufficient skilled resources to sustain and improve IPC programmes over time.