ECDC ARHAI networks: achievements in 2013-2014 and challenges for 2015-2016

Dominique L. Monnet, Head of Programme Antimicrobial Resistance & Healthcare-associated Infections (ARHAI)

Stockholm, 11-13 February 2015

Epidemic Intelligence

and Response

Public Health Training

External Communication

Microbiology Coordination

Scientific Assessment

Epidemiological methods

Surveillance

ARHAI

Antimicrobial Resistance and Healthcare-Associated Infections (1) Office of the Chief Scientist . Disease Programme Section

– Dominique L. Monnet, Head of Disease Programme – Barbara Albiger, Programme manager – Elmira Khazeeva, Secretary

Surveillance and Response Support Unit . Surveillance Section

– Ole E. Heuer, Senior Expert AMR surveillance, Group Leader – Liselotte Diaz Högberg, Expert AMR surveillance – Klaus Weist, Senior Expert Antimicrobial consumption surveillance – Carl Suetens, Senior Expert HAI surveillance – Jolanta Griškevičienė, Expert HAI surveillance – Pete Kinross, Expert HAI surveillance – To be recruited, Senior Expert AMR & HAI

. Scientific Assessment Section – Anna-Pelagia Magiorakos, Senior Expert AMR & HAI – Alessandro Cassini, Expert AMR & HAI

. Epidemic Intelligence and Response Section – Diamantis Plachouras, Expert AMR & HAI

Surveillance and Response Support Unit (continued) . Epidemiological Methods Section

– Daniel Palm, Senior Expert – Karin Johansson, Expert

Public Health Capacity and Communication Unit

. Public Health Training Section – Carmen Varela, Senior Expert and Group Leader, Training Network Strenghtening – Vladimir Prikazsky, Expert

. External Communication Section – Sarah Earnshaw, Group Leader, Press, Media and Information – Giovanni Mancarella, Communciation Officer – Andrea Mendez, Communication Specialist – Karen Aimard, Communication Officer – Andrea Würz, Communciation Officer – Boyana Todorova, Communication Officer

Office of the Director, International Relations Section – Nabil Safrany, International Relations Officer

Antimicrobial Resistance and Healthcare-Associated Infections (2)

Austria Federal Ministry of Health Greece Hellenic Centre for Dis.

Control and Prev. Norway Norwegian Institute of Public Health

Belgium Scientific Institute of Public Health Hungary National Center for

Epidemiology Poland Nat. Inst. of Public Health – Nat. Inst. of Hygiene

Bulgaria National Centre of Infectious and Parasitic Diseases

Iceland Centre of Health Security and Comm. Disease Prevention

Portugal Directorate General of Health

Croatia Croatian Nat. Inst. of Public Health Ireland Health Protection

Surveillance Centre Romania National Institute of Public Health

Cyprus Directorate of Medical and Public Health Services

Italy Ministry of Health Slovakia Public Health Authority of the Slovak Republic

Czech Republic

National Institute of Public Health Latvia Centre for Disease Prev.

and Control Slovenia National Institute of Public Health

Denmark Danish Health and Medicines Authority Lichtenstein Principality of

Liechtenstein Spain Ministry of Health, Social Services and Equality

Estonia Health Board Lithuania Ministry of Health Sweden Public Health Agency of Sweden

Finland National Institute for Health and Welfare Luxembourg Health Directorate United

Kingdom Public Health England (Colindale)

France Institute for Public Health Surveillance Malta Superintendence of

Public Health

Germany Robert Koch Institute Netherlands

National Institute for Public Health and the Environment

List of nominated Coordinating Competent Bodies (CCBs)

Source: ECDC, 2015.

Source: ECDC Management Board (MB23-16), 9-10 November 2011.

Disease Network Coordination Committees (DNCCs), 2015-2018

• Results after elections, by alphabetical order • Enter in function for Joint DNCC Meeting, 14-15 April 2015

• EARS-Net José Campos, Tim Eckmanns, Vincent Jarlier, Alan Johnson, Jos Monen, Annalisa Pantosti, Gunnar Skov Simonsen, Alkiviadis Vatopoulos, Dorota Żabicka, Helena Žemličková

• ESAC-Net Marcel Bruch, Philippe Cavalié, Herman Gossens, Jenny Hellman, Susan Hopkins, Stephanie Natsch, Anna Olczak-Pieńkowska, Ajay Oza, Arjana Tambić, Peter Zarb

• HAI-Net* Aleksander Deptuła, Petra Gastmeier, Mayke Koek, Jana Kolman, Outi Lyytikäinen, Maria Luisa Moro, Mercedes Palomar, Jacqui Reilly, Anne Savey, Reinhild Strauss, Rolanda Valintėlienė

*Due to an equal number of votes, the HAI-Net CC is exceptionally composed of 11 (instead of 10) members.

Indicators

Epidemic intelligence

Coordination

Ongoing surveillance

Ad-hoc studies / projects

Point prevalence survey

Risk assessment : syst. reviews and guidance

Communication

Training

ECDC Antimicrobial Resistance and Healthcare-Associated Infections Programme, 2007-2015

EARS-Net ESAC-Net HAI-Net

EuSCAPE, LA-MRSA

Contribution to WHO Hand Hygiene Day European Antibiotic Awareness Day

Interactive database & Reports

Point prevalence survey of HAI and antimicrobial use in acute care hospitals (2nd PPS in 2016-2017)

Infection control indicators (2015)

Antibiotic stewardship indicators (2015)

HAI LTCFs, CDI surv.

Hosp. IPC prog.

Infection control training (TRICE-IS)

Coord. Committee Coord. Committee

Joint Meetings of ARHAI Networks

Short course on prevention and control of MDROs

Periop. prophylaxis

EPIS AMR-HAI EPIS AMR-HAI

Interactive database & Annual report

Interactive database & Annual report

CPE, ESBL

Inter-agency report - JIACRA (2014)

Directory of online resources for infection prevention and control (2015)

Coord. Committee

Hosp. use (2015) Burden of HAI & AMR(2015)

Source: ECDC, 2015.

Source: ECDC, 2015 (http://ecdc.europa.eu/en/activities/diseaseprogrammes/ARHAI/Pages/index.aspx).

2013-2014 • EARS-Net: annual reports, updates of interactive database,

EQA exercise • ESAC-Net: reports and updates of interactive database

• HAI-Net: • Point prevalence survey of HAI and antimicrobial use, 2011-2012:

report and interactive database, trainings, validation in 4 countries • Surgical site infections: 2010-2011 report • HAI and antimicrobial use in long-term care facilities (HALT) reports,

2010 & 2013 • Feasibility study for EU surveillance of Clostridium difficile infection

• Support to standardisation of antimicrobial susceptibility testing methods and clinical breakpoints for surveillance of antimicrobial resistance

Surveillance activities (1)

2015-2016

• EARS-Net: annual reports, updates of interactive database, EQA

• ESAC-Net: report 2013-2014, updates of interactive database, start of hospital antimicrobial consumption surveillance • HAI-Net: - HAI in intensive care units: 2008-2012 report (2015, in press) - Surgical site infections: 2012 & 2013 reports - HAI and antimicrobial use in long-term care facilities (3rd PPS) - Start of Clostridium difficile infection surveillance (2016) - Prep. (2015), then start 2nd PPS in acute care hospitals (2016) - Introduction of structure & process indicators: PPS, ICU • Support to standardisation of antimicrobial susceptibility testing methods and clinical breakpoints for surveillance of antimicrobial resistance

Surveillance activities (2)

Source: ECDC, 2015 (http://www.ecdc.europa.eu/en/data-tools/atlas/Pages/atlas.aspx).

• Surveillance Atlas of Infectious Diseases: integration of EARS-Net, ESAC-Net and HAI-Net data

• Link data across the three networks, at hospital level

• Burden (deaths and costs) of HAIs and AMR updated estimates for the EU and by country

• Introduce structure and process indicators

• Improve country participation in HAI surveillance: all EU/EEA Member States, validated data (PPS)

Surveillance activities (3)

2013-2014

• Interim results from the European survey on carbapenemase-producing Enterobacteriaceae (EuSCAPE) project 2013

2015-2016 • EuSCAPE: final report (2015) • Self-assessment and evaluation (post-EuSCAPE, 2015) • Livestock-associated MRSA survey (2015) • Survey on molecular typing of carbapenem-resistant

Enterobacteriaceae in Europe (preparatory work with consultations of experts in 2015)

Ad-hoc studies/surveys

2013-2014 • Epidemic Intelligence Information System (EPIS)

for AMR and HAI events • Country visit to discuss AMR and HAI issues (Portugal)

2015-2016 • Open the EPIS platform to all members of EARS-Net,

ESAC-Net and HAI-Net, i.e. All nominated National Focal Points and Operational Contact Points

• Country visits to discuss AMR and HAI issues - Invitations from Spain and Cyprus - Budget for 2-3 visits / year

• Unexpected requests

Epidemic intelligence and response support activities

2013-2014 • Perioperative antibiotic prophylaxis (systematic review and guidance)

• Triazole-resistant Aspergillus spp. (risk assessment)

• Infection control measures to prevent the transmission of ESBL-producing Enterobacteriaceae and of carbapenemase-producing Enterobacteriaceae (2 systematic reviews)

• Healthcare-associated MRSA (systematic review) Köck R, et al. Euro Surveill 2014 Jul 24;19(29). pii: 20860.

2015-2016 • Organisation of hospital infection control programmes

Zingg W, et al. Lancet Infect Dis 2015; 15(2): 212-24.

• Precautions for patients being transferred between healthcare institutions across borders (guidance)

• ECDC directory of online resources (& toolbox)

Systematic reviews and guidance documents

Source: ECDC, 2015. http://www.ecdc.europa.eu/en/healthtopics/Healthcare-associated_infections/guidance-infection-prevention-control/Pages/guidance-prevention-control-infections-caused-by-multidrug-resistant-bacteria-and-healthcare-associated-infections.aspx

Source: ECDC, 2015. http://www.ecdc.europa.eu/en/healthtopics/Healthcare-associated_infections/guidance-infection-prevention-control/Pages/guidance-prevention-control-infections-caused-by-multidrug-resistant-bacteria-and-healthcare-associated-infections.aspx

2013-2014 • Core competencies for infection control and hospital hygiene professionals in the European Union • Training infection control and hospital hygiene professionals in Europe (2 articles) Brusaferro S, et al. Euro Surveill. 2014 Dec 11;19(49). pii: 20985. Brusaferro S, et al. J Hosp Infect 2015. In press.

2015-2016 • Short course on control of multidrug-resistant organisms (MDROs) in healthcare settings (20-22 Jan. 2015) • Evaluation of existing national courses against the core competencies (2015) • Field Epidemiology Manual Wiki for infection control and hospital hygiene (2016)

Public health training activities

Source: ECDC, 2015 (http://ecdc.europa.eu/en/EAAD/Pages/Home.aspx).

2014 • European Antibiotic Awareness Day: a five-year perspective of Europe-

wide actions to promote prudent use of antibiotics. Euro Surveill 2014 Oct 16;19(41). pii: 20928.

• 17 November: Event at ECDC, with the Public Health Agency of Sweden • 18 November: >40 European countries, together with WHO/Europe • 18 November: Global reach through collaboration with the U.S., Canada

and Australia and WHO Regional Offices • #EAAD: >4000 tweets, 14 million impressions;

#AntibioticDay: >6000 tweets, 41 million impr. 2015-2016 • European Antibiotic Awareness Day, 18 Nov. • Technical Advisory Committee + Meetings with experts • New materials & toolkit (tbd) • European event and social media activities • Contribution to global awareness activities on 18 November

European Antibiotic Awareness Day

https://storify.com/EAAD_EU/patient-stories

Support to the Commission

2013-2014 • Regular teleconferences • Contribution to 2nd report on the implementation

of Council Recommendation 2009/C 151/01 • Contribution to progress report on the

implementation of the Commission’s 5-year action plan (in press)

2015-2016 • Regular teleconferences • Support on the implementation of the

Commission’s 5-year action plan • Evaluation of the implementation of Council

Recommendation 2002/77/EC • Other actions in action plan

2013-2014 • European Food Safety Authority (EFSA) & ECDC.

European Union Summary Report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2012 http://www.ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-in-zoonotic-and-indicator-bacteria-summary-report-2012.pdf

• European Medicines Agency (EMA) Antimicrobial Advice Ad Hoc Expert Group (AMEG). Use of antibiotics in animals: impact on public health and animal health. http://www.ema.europa.eu (Regulatory > Veterinary medicines > Antimicrobial resistance > Use of antibiotics in animals)

• EMA. Sales of veterinary antimicrobial agents in 26 EU/EEA countries in 2012. Fourth ESVAC Report. http://www.ema.europa.eu (Regulatory > Veterinary medicines > Antimicrobial resistance > European Surveillance of Veterinary Antimicrobial Consumption)

• ECDC/EFSA/EMA. Joint Interagency Antimicrobial Consumption

and Resistance Analysis (JIACRA) Report (30 January 2015) http://www.ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-JIACRA-report.pdf

Collaboration with other EU agencies

2013-2014 • Contribution to Global report on surveillance of AMR • Contribution to WHO/Europe´s strategic action plan on AMR • See below

2015-2016 • Regular teleconferences • Contribution to Global Action Plan on AMR • Contribution to WHO “SAVE LIVES: Clean Your Hands”

campaign, 5 May • Collaboration on surveillance of AMR

(meetings of WHO/Europe’s CAESAR, AGISAR, WHO/HQ expert consultation) and antimicrobial consumption

• Collaboration on European Antibiotic Awareness Day • Possible joint country visits

Collaboration with WHO

Source: CDC, 2015 (http://www.cdc.gov/drugresistance/tatfar/).

2015-2016 • Process for transatlantic communication

of critical events – new AMR trends • Indicators for hospital antimicrobial

stewardship programmes • Standards for measuring antimicrobial

use in hospitals

3rd Joint Meeting of the ARHAI Networks, Stockholm, 11-13 February 2015

• Network sessions EARS-Net, ESAC-Net, HAI-Net

• Dinner at hotel (today 11/2)

• Plenary session organised by the Public Health Agency of Sweden (Thursday 12/2 pm)

• Dinner organised jointly with the Swedish Ministry of Health and Social Affairs (12/2)

• Final plenary session (Friday 13/2, 11:30-13:30)

• Lunch & departure

• Slides (SlideShare) & evaluation

Thank you!

Source: EARS-Net, 2014. Infographic: A. Haeger, ECDC.