Patient safety risk in EU, healthcare-associated infections and antibiotic use rise [Advocacy Lab Content]

An alarming new ECDC survey reveals that healthcare-associated infections (HAI) and antibiotic use are on the rise, increasing patient safety risks across Europe.

Each year, more than four million patients in the EU/EEA acquire at least one healthcare-associated infection while staying in an acute hospital.

The average share of hospital patients with at least one HAI in European acute hospitals has increased from 5.9  per cent in 2016-2017 to 7.1 per cent in 2022-2023, according to the latest point prevalence study, coordinated by the European Centre for Disease Prevention and Control (ECDC) in Stockholm.

The surveillance report shows that each year one or several healthcare-associated infections affect 4.3 million patients in hospitals in the EU/EEA. This poses a significant challenge for patient safety in hospitals across Europe, according to doctor Dr Andrea Ammon, Director of the ECDC.

“These recent numbers highlight the urgent need for further actions to mitigate this threat. By prioritising infection prevention and control policies and practices, as well as antimicrobial stewardship and improving surveillance, we can effectively combat the spread of these infections and protect the health of patients across the EU/EEA,” Ammon said.

Covid-19 infections impact HAI rise

In the point prevalence study, the number of patients with one or more healthcare-associated infections was measured simultaneously on a given day in an acute hospital across Europe.

The ECDC sample included almost 310,000 patients in 1,332 hospitals that were receiving care in 2022-2023 in 26 EU countries, 2 EEA countries (Norway and Iceland) and three Western Balkan countries (Kosovo, Montenegro and Serbia). However, aggregated results were only reported for the EU/EEA, corresponding to 293, 581 patients from 1,250 acute care hospitals.

Most of the these patients had acquired their HAI in the hospital where a prevalence study was conducted. However, some patients had already got one or more HAIs before, for example, in another hospital, in primary care or in long-term care facility.

The most common HAIs were identified as: respiratory tract infections – including pneumonia and Covid-19 – which accounted for almost a third of all reported HAIs.

Covid-19 infections in particular were contributing to the rise in HAIs, according to the ECDC and accounted for seven per cent of the total number of HAIs. Notably, 81 per cent of all Covid-19-cases were acquired at the hospital where the patient was cared for.

The respiratory tract infections were followed by urinary tract infections, surgical site infections, bloodstream infections and also by gastrointestinal infections.

Top five countries with HAIs

The five countries with the highest rates of HAIs were Cyprus, Greece, Portugal, Sweden and Italy, and the five countries with the lowest rates were Latvia, Romania, Montenegro, Bulgaria and Germany.

“National figures of HAIs should be treated with caution,” Dominique Monnet, Head of Section of Antimicrobial Resistance and Healthcare-Associated Infections at the ECDC, told journalists. Country figures could vary because of several factors, including the number of personnel that can execute infection tests on a given day.

“We see high levels in countries that are good at finding HAIs, and less in countries that haven’t enough personnel,”  Monnet said.

Sweden’s negative rates

As Euractiv reported in January, Sweden stands out among its Nordic neighbours and also in Europe, with one in ten patients in the survey having at least one HAI, compared to one in fifteen patients on average in EU/EEA.

“We are not satisfied with this result. One important explanation is that 20 per cent of the HAI patients in Sweden got their infections in a long-term care facility for the elderly, and another one is the high bed occupancy rate in Sweden, more than 90 per cent, compared to the European average of 73 per cent,” Ternhag, an infectious diseases doctor and analyst at the Swedish Public Health Agency, told Euractiv.

He stressed that Swedish hospitals continue to work with implementing effective infection and prevention control programs

Antimicrobial use increasing

The prevalence of patients receiving at least one antimicrobial is also increasing in the EU/EEA.

In 2016-2017 it amounted to 32.9 per cent of the hospitalised patients, compared to 35.5 percent in 2022-2023. The lowest prevalence was detected in psychiatric patients (2.8%) and the highest in intensive care patients (59.5%).

According to the ECDC, on any given day in the EU/EEA 390,000 hospitalised patients receive at least one antimicrobial drug. One in three microorganisms that were detected, were bacteria which are resistant to important antibiotics.

At least 20% of HAIs are deemed by the ECDC to be preventable by sustained and multifaceted so called Infection Prevention and Control (IPC) programmes in healtcare and hospital settings.

IPC measures are said to be more effective when they are part of multimodal implementation strategies, combining elements such as education, as well as monitoring and feedback to health workers.

However, simple measures such as hand hygiene and alcohol-based hand rub dispensers placed close to the patients, may also considerably lower the number of HAIs, according to the ECDC, which also urges countries to increase the number of singles rooms for patients with especially contagious infections.

[By Monica Kleja, edited by Vasiliki Angouridi, Brian Maguire]

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