Healthcare-associated infections: Where do we stand in 2017? New data, new approaches

Every five years, the National Survey on the Prevalence of Healthcare-Associated Infections and Antimicrobial Use in Healthcare Facilities (ENP) provides a snapshot of healthcare-associated infections in France. How common are they? Under what circumstances do they occur? By answering these questions, Santé publique France provides healthcare professionals and patients with indicators to better understand and prevent these infections. These data complement those produced annually by the surveillance networks coordinated by Santé publique France with the Support Centers for the Prevention of Healthcare-Associated Infections (CPias). Their structure and missions have recently been redefined to place greater emphasis on prevention.

alternative text

Healthcare-associated infections remain a priority in 2017

For the first time, the prevalence is no longer declining

The 2017 ENP1 shows a stable prevalence of infected patients between 2012 and 2017: 5%, or 1 in 20 hospitalized patients. The main bacteria involved are: Enterobacteriaceae, including Escherichia coli (nearly 1/4 of infections), and Staphylococcus aureus (13%). Nosocomial infections also remain more prevalent in intensive care units (1 in 4 patients infected), which treat more vulnerable patients exposed to multiple invasive procedures.

The proportion of postoperative infections is on the rise

From 2012 to 2017, the proportion of postoperative infections (surgical site infections, or SSIs) rose from 13.5% to 16%, making them the second most common type of infection behind urinary tract infections (28%) and ahead of pneumonia (15.5%). Among SSI, deep and organ infections are increasing the most.

This upward trend is consistent with the 2016 Raisin data on the incidence of surgical site infections for certain orthopedic procedures (knee replacements) and lower extremity varicose vein surgeries. Furthermore, the occurrence of these infections, particularly in gastrointestinal surgery and obstetric-gynecological surgery, may be influenced by certain individual risk factors, such as smoking, diabetes, and hypertension. Finally, the administration of antibiotics prior to surgery (surgical antibiotic prophylaxis) could be improved, as it still too often does not comply with recommendations.

Methicillin-resistant Staphylococcus aureus (MRSA) is less common in hospitals

From 2012 to 2017, the proportion of methicillin-resistant Staphylococcus aureus (MRSA) decreased from 38% to 27%, and the prevalence of patients infected with MRSA fell by 7.5%; it now accounts for nearly 2 out of every 1,000 patients. This decrease is consistent with the latest Raisin data, which also show a decline in the incidence of MRSA infections.

A New Organizational Structure for Prevention

As part of its monitoring, surveillance, alert, and prevention missions, the coordination of national missions for the Centers for the Prevention of Healthcare-Associated Infections (CPias) has been entrusted to Santé publique France. The new organizational structure currently being implemented expands the scope of national surveillance missions for healthcare-associated infections (HAIs) and RATB to cover the entire patient care pathway: outpatient care, medical-social facilities, and healthcare facilities.

Five national missions have been defined. Their objective is to generate data to support prevention, training, and communication efforts:

  • surveillance and prevention of antibiotic resistance (AAR) and healthcare-associated infections (HAIs) in outpatient care and the medical-social sector;

  • the surveillance and prevention of AAR in healthcare facilities;

  • surveillance and prevention of infection risks associated with surgical and interventional medical procedures;

  • surveillance and prevention of infections associated with invasive devices;

  • support for prevention initiatives: assessment, training, communication, and documentation.

This last mission supports the other four. Its purpose is to strengthen assessment, training, and prevention tools by drawing on infection rates and new indicators (best practices, etc.).

Results of the Call for Proposals: 3 missions already filled

The National Healthcare-Associated Infections Missions Committee evaluated 10 applications. Based on its analysis, the teams designated by Santé publique France to carry out 3 of the 5 surveillance and prevention missions for 5 years are:

  • The CPias Grand Est in partnership with the CPias Nouvelle Aquitaine for the mission on Surveillance and Prevention of RATB in Healthcare Facilities.

  • The CPias Centre Val de Loire for the Surveillance and Prevention of Infections Associated with Invasive Devices mission.

  • CPias Nouvelle-Aquitaine, in partnership with CPias Iles de Guadeloupe, for the mission to support prevention efforts: assessment, training, communication, and documentation.

The first initiative of this new mission is the launch of the I.control game to test your knowledge and become a master of standard precautions: http://icontrol.cpias-nouvelle-aquitaine.fr

Learn more:

1 The 2017 ENP was conducted in May and June 2017 among 403 healthcare facilities and collected data from 80,988 patients.