Infection prevention and control and antimicrobial stewardship in European long-term care, 2016-2017

Abstract

Abstract Background Europe's population is ageing. Long-term care facilities (LTCFs) for this vulnerable population are often relatively homelike with low staff-to-resident ratios. In 2016-2017, ECDC coordinated its third point prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European long-term care facilities (LTCFs). It included collection of data on structure and process indicators (SPIs) of infection prevention and control (IPC) and antimicrobial stewardship, to support countries' identification of national and local interventions in LTCFs. Methods In each country, national contacts recruited a convenience sample of LTCFs. National/LTCF PPS teams used a standard protocol that included case definition algorithms (adapted US CDC/SHEA definitions) applied to each resident with signs/symptoms of infection on the PPS day, and questions for LTCF staff on SPIs of IPC and antimicrobial stewardship activities. Denominators indicate the number of responses available for analysis. Results 3,052 LTCFs in 24 EU/EEA countries were recruited, with 102,301 residents included. The prevalence of HAIs (residents with ≥1 HAI) was 3.7%. Although 1,524/1,623 (94%) LTFS had a hand hygiene (HH) protocol, only 1,046/1,585 (66%) LTCFs had organised ≥1 HH training session for care professionals during the previous year. 1,185/1,561 (76%) LTCFs reported IPC training of nursing and paramedical staff. Only 340/1,639 (21%) of LTCFs reported training on appropriate prescribing and 493/1,623 (30%) LTCFs had provided feedback to GPs on antimicrobial consumption. On the PPS day, annual antimicrobial consumption data were available to only 530/1,623 (32%) LTCFs. Conclusions Even in LTCFs with the capacity to perform this PPS, IPC training was non-ubiquitous and antimicrobial stewardship activities, including training, were rarely reported. ECDC encourages EU/EEA countries to recruit LTCFs to participate in future PPSs, to allow them to benchmark HAI rates and practices. Key messages The prevalence of healthcare-associated infections in European long-term care facilities (LTCFs) highlights their requirement for infection prevention and control (IPC) and antimicrobial stewardship. This multi-national point prevalence survey (PPS) indicates that European countries can consider reinforcing IPC, antimicrobial stewardship practices and participation in PPSs in LTCFs.