ECDC PPS in European acute care hospitals, definition of HAI

The “Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals” protocol proposes the following definition of Healthcare-Associated Infection (HAI): an active healthcare-associated infection (HAI) (associated to acute care hospital stay) present on the day of the survey is defined as follows:

* an infection is active when signs and symptoms of the infection are present on the survey date
OR
* signs and symptoms were present in the past and the patient is (still) receiving treatment for that infection on the survey date. The presence of symptoms and signs should be verified until the start of the treatment in order to determine whether the treated infection matches one of the case definitions of healthcare  associated infection;

AND

* the onset of symptoms was on Day 3 or later (day of admission = Day 1) of the current admission

OR

* the patient presents with an infection but has been readmitted less than two days after a previous discharge from an acute care hospital

OR

* the patient has been admitted (or develops symptoms within two days) with an infection that meets the case definition of an active surgical site infection (SSI), and the patient either has symptoms that meet the case definition and/or is on antimicrobial treatment for that infection;

OR

* the patient has been admitted (or develops symptoms within two days) with C. difficile infection less than 28 days after a previous discharge from an acute care hospital;

OR

* an invasive device was placed on Day 1 or Day 2, resulting in an HAI before Day 3.

Results of tests/examinations that are not available on the survey date should neither be completed after the survey date nor taken into account when establishing whether the case definition criteria are fulfilled.

Device-associated HAI is an HAI in a patient with a (relevant) device that was used within the 48-hour period before onset of infection (even intermittently). The term ‘device-associated’ is only used for pneumonia, bloodstream infection and urinary tract infection. The ‘relevant devices’ are intubation, vascular (central/peripheral) catheter and urinary catheter, respectively. If the interval is longer than 48 ours, there must be compelling evidence that the infection was associated with device use. For catheter-associated UTI, the indwelling urinary catheter must have been in place within seven days before positive laboratory results or signs and symptoms meeting criteria for UTI were evident

The “Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals” protocol includes definitions for the following types of HAI:

surgical site infection (SSI); pneumonia (PN); urinary tract infection (UTI); bloodstream infection (laboratory-confirmed) (BSI); central or peripheral vascular catheter-related infection (CRI); cardiovascular system infection (CVS); central nervous system infection (CNS); eye, ear, nose or mouth infection (EENT); gastrointestinal system infections (GI); lower respiratory tract infection, other than pneumonia (LRI); reproductive tract infections (REPR); skin and soft tissue infections (SST); bone and joint infection (BJ); systemic infections (SYS); case definitions for neonates (NEO).

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Link to European IC/HH Core Competencies

• Area 3. Surveillance and investigation of healthcare associated infection (HAI)

References

• http://www.ecdc.europa.eu/en/publications/Publications/0512-TED-PPS-HAI-antimicrobial-use-protocol.pdf
• Horan et al. Definitions of key terms used in the NNIS system. See: Am J Infect Control 1997; 25:112-6