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TECHNICAL DOCUMENTPoint prevalence survey ofhealthcare-associated infectionsand antimicrobial use inEuropean acute care hospitalsProtocol version 5.3www.ecdc.europa.eu
ECDC TECHNICAL DOCUMENTPoint prevalence survey of healthcareassociated infections and antimicrobialuse in European acute care hospitalsProtocol version 5.3, ECDC PPS 2016–2017
Suggested citation: European Centre for Disease Prevention and Control. Point prevalence survey of healthcareassociated infections and antimicrobial use in European acute care hospitals – protocol version 5.3. Stockholm:ECDC; 2016.Stockholm, October 2016ISBN 978-92-9193-993-0doi 10.2900/374985TQ-04-16-903-EN-N European Centre for Disease Prevention and Control, 2016Reproduction is authorised, provided the source is acknowledged.ii
TECHNICAL DOCUMENTPPS of HAIs and antimicrobial use in European acute care hospitals – protocol version 5.3ContentsAbbreviations . viBackground and changes to the protocol. 1Objectives . 3Inclusion/exclusion criteria . 4Hospitals . 4Wards . 4Patients . 4Sample design . 5Sampling of patients within the hospital . 5Representative sampling of hospitals (for PPS coordinating centres only) . 5Steps . 5Design effect and sample size . 5Other sampling methods: reporting of results and data collection periods . 7Data collection . 8When? . 8Who will collect the data? . 8Training of surveyors . 8Data processing . 8Overview of collected data . 9Light (unit-based) protocol . 9Standard (patient-based) protocol . 9Hospital data . 10Definition of hospital data . 12Hospital variables to be added by PPS coordinating centre before submission to ECDC’s TESSy . 17Ward data . 18Definition of ward data . 18Patient data (standard protocol option) . 20Definition of patient data . 20Antimicrobial use data and HAI data . 23Antimicrobial use data . 23Definitions of antimicrobial use data . 23Healthcare-associated infection data . 24Key terms and notes . 24Definitions of healthcare-associated infection data . 25Recommended case-finding algorithm for healthcare-associated infections. 27Numerator data in the light protocol . 28National/regional data . 29Objectives . 29Notes. 29Definition of national/regional data . 29Data structure and variable names . 31Standard protocol option record types . 31Light protocol option record types . 31Note on microorganism and resistance data . 31Acknowledgements . 33iii
PPS of HAIs and antimicrobial use in European acute care hospitals – protocol version 5.3TECHNICAL DOCUMENTAnnex 1. Additional materials . 39Codebook. 39Forms . 39TESSy variable definitions and validation rules . 39Note on case definitions of healthcare-associated infections. 39Annex 2. Codebook . 40Specialty code list . 40Diagnosis (site) code list for antimicrobial use . 42Indications for antimicrobial use . 42Antimicrobial ATC codes (2016) . 43Healthcare-associated infections: code lists . 49HAI code list, table . 49Definition of active HAI . 50HAI case definition codes, overview . 51BSI origin (BSI source) code list . 52Case definitions of healthcare-associated infections . 53SSI: SURGICAL SITE INFECTION . 53PN: PNEUMONIA . 54UTI: URINARY TRACT INFECTION. 55BSI: BLOODSTREAM INFECTION . 56CRI: CATHETER-RELATED INFECTION . 57BJ: BONE AND JOINT INFECTION . 58CNS: CENTRAL NERVOUS SYSTEM INFECTION . 59CVS: CARDIOVASCULAR SYSTEM INFECTION . 60EENT: EYE, EAR, NOSE, THROAT, OR MOUTH INFECTION . 62LRI: LOWER RESPIRATORY TRACT INFECTION, OTHER THAN PNEUMONIA. 64GI: GASTROINTESTINAL SYSTEM INFECTION . 65REPR: REPRODUCTIVE TRACT INFECTION . 67SST: SKIN AND SOFT TISSUE INFECTION . 68SYS: SYSTEMIC INFECTION . 70NEO: SPECIFIC NEONATAL CASE DEFINITIONS . 71Algorithm for diagnosis of catheter-related infections . 72Microorganism code list . 73Microorganism code list (PPS selection), by category . 73Antimicrobial resistance markers and codes . 77Surgery categories . 78NHSN surgery codes . 78Examples of non-NHSN surgery . 80References . 81iv
TECHNICAL DOCUMENTPPS of HAIs and antimicrobial use in European acute care hospitals – protocol version 5.3FiguresFigure 1. Examples of included and excluded patients in the point prevalence survey . 4Figure 2. Increasing design effect (DEFF) as a function of cluster size (average acute care hospital size) in the2011–2012 PPS database . 6Figure 3. Hospital data 1/3 (form H1) . 10Figure 4. Hospital data 2/3 (form H2) . 11Figure 5. Hospital data 3/3 (form H3, optional): Ward indicator data collected at hospital level . 11Figure 6. Ward data (form W) . 18Figure 7. Patient-based risk factors (form A): one form per patient, antimicrobial use and HAI data collected onsame form. 20Figure 8. Recommended case finding algorithm for healthcare-associated infections . 27Figure 9. Antimicrobial use and HAI data form in the LIGHT option (form B2). 28Figure 10. National/regional data (form N) . 29TablesTable 1. Number of hospitals and patients needed to estimate an HAI prevalence of 6% (5–7%) with design effectdepending on average acute care hospital size by country . 6Table 2. Criteria to categorise the national PPS sample representativeness . 7Table 3. Conversion chart: PPS I protocol PPS antimicrobial marker data to the 4th level TESSy format . 32Table 4. Participants to ECDC PPS meetings on the first and second PPS protocol, by country and institution, 2009–2015 . 33v
PPS of HAIs and antimicrobial use in European acute care hospitals – protocol version 5.3TECHNICAL DOCUMENTAbbreviationsA&EAccidents and emergencyAMAntimicrobial/antimicrobial agentAMRAntimicrobial resistanceATCAnatomical Therapeutic Chemical classification system (WHO)AUAntimicrobial useBSIBloodstream infectionCDCCentres for Disease Control and Prevention (Atlanta, USA)CDIClostridium difficile infectionsCFUColony-forming unitsCVCCentral vascular catheterDSNDedicated surveillance networkEARS-NetEuropean Antimicrobial Resistance Surveillance Network (at ECDC)ECDCEuropean Centre for Disease Prevention and ControlEEAEuropean Economic AreaEFTAEuropean Free Trade AssociationESACEuropean Surveillance of Antimicrobial Consumption projectESBLExtended-spectrum beta-lactamasesESCMIDEuropean Society of Clinical Microbiology and Infectious DiseasesESGARSESCMID Study Group on Antimicrobial Resistance SurveillanceESICMEuropean Society of Intensive Care MedicineFTEFull-time equivalentHAIHealthcare-associated infectionsHAI-NetHealthcare-Associated Infection surveillance Network (at ECDC)HALTHealthcare-associated infections in long-term care facilities (ECDC-sponsored follow-up projectto IPSE WP7)HCWHealthcare workerHELICSHospitals in Europe Link for Infection Control through Surveillance projectICUIntensive care unitIPSEImproving Patient Safety in Europe projectLTCFLong-term care facilityLRTLower respiratory tractMSMember StatesNHSNNational Healthcare Safety Network (at CDC)PPSPoint prevalence survey(also used as an abbreviation of the current survey)PVCPeripheral vascular catheterSPIStructure and process indicatorSSISurgical site infectionTESSyThe European Surveillance System (ECDC’s web-based data reporting system for thesurveillance of communicable diseases)TRICETraining in Infection Control in Europe (ECDC-sponsored follow-up project to IPSE WP1)WHOWorld Health Organizationvi
TECHNICAL DOCUMENTPPS of HAIs and antimicrobial use in European acute care hospitals – protocol version 5.3Background and changes to the protocolIn July 2008, the coordination of the EU-funded network IPSE (Improving Patient Safety in Europe) [1] and itscomponent for the surveillance of healthcare-associated infections, HELICS (Hospitals in Europe Link for InfectionControl through Surveillance), were transferred to ECDC to form ECDC’s healthcare-associated infectionssurveillance network, HAI-Net. Later, ECDC adopted a plan to conduct EU-wide point prevalence survey (PPS) ofhealthcare-associated infections (HAIs), based on the recommendations of the external evaluation of the IPSEnetwork and on the conclusions of an expert group that met in January 2009. It was also agreed to include thehospital PPS component of the EU-funded ESAC project (European surveillance of antimicrobial consumption) inthe ECDC PPS protocol.ECDC subsequently developed a protocol for PPSs of HAIs and antimicrobial use in acute care hospitals throughseven expert meetings held between 2009 and 2011. More than 100 experts and representatives from all EUMember States, two EEA countries, four EU enlargement countries, international partners (the European Society ofIntensive Care Medicine, WHO Regional Office for Europe, the United States Centers for Disease Control andPrevention), the ESAC project and ECDC contributed to the development of the PPS protocol. The first ECDC PPSbased on this protocol was conducted in 2011–2012 (version 4.2 and 4.3 of the protocol, see [2]).The protocol provides a standardised methodology to Member States and hospitals in response to article II.8.c ofCouncil Recommendation 2009/C 151/01 of 9 June 2009 on patient safety, including the prevention and control ofhealthcare-associated infections [3]. It also integrates the main variables of the ESAC hospital PPS protocol,thereby also providing support to Council Recommendation 2002/77/EC of 15 November 2001 on the prudent useof antimicrobial agents in human medicine.Version 5.3 is the final protocol for the second EU-wide point prevalence survey 2016–2017. It contains majorchanges compared to protocol version 4.3 (PPS 2011–2012). Compared to version 5.1 and version 5.2 (distributedto EU/EEA Member States in January and May 2016, respectively), the current version on
ii Suggested citation: European Centre for Disease Prevention and Control. Point prevalence survey of healthcare- associated infections and antimicrobial use in European acute care hospitals – protocol version 5.3.
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