‘Health is an investment, and quality of care is a basic duty’
István Ujhelyi MEP
The virtual roundtable entitled ‘Preventing infections in the surgical care pathway to tackle antimicrobial resistance’ took place on Tuesday 17 November 2020 from 14:00 to 17:30 Brussels time. The purpose of the meeting was to discuss pathways to reduce the burden on surgical site infections (SSIs), curbing antimicrobial resistance and, crucially, enhancing patient safety in Europe. The debate was followed by the launch of HFE Insight Report on ‘Identifying the gaps between evidence and practice in the prevention of surgical site infections’ ” showing a striking gaps between evidence-based measures suggested by official guidelines and medical practices in European hospitals which represent a serious concern for the safety of European patients.
Despite efforts put in place by European hospitals, Healthcare-Associated Infections (HAIs) continue to be the most frequent adverse event during care delivery. Every day, about 80,000 Europeans in hospitals throughout the continent have at least one HAI: 1 in 18 patients. Overall, the ECDC estimates that approximately 8.9 million infections occur each year in EU healthcare settings, and many of such HAIs, as highlighted by the 2017 Resolution of the World Health Assembly, lead to sepsis. This, in turn, result in approximately 37,000 deaths throughout the Union. Hence, HAIs continue to be a significant threat to patient safety throughout Europe. A crucial example of a HAI are Surgical Site Infections (SSIs). SSIs themselves are a threat to millions of lives and lead to over 16,000 deaths. As any HAI, SSIs are often caused by antimicrobial resistance (AMR), which increases costs and the complexity of treatment. But SSIs are preventable, and if the necessary actions are taken, the threat of drug-resistant infections will be minimised, resulting in millions of lives saved. Hence it is paramount that better systems to prevent them are put in place to increase patient safety and care throughout the continent.
In this context, this virtual roundtable was an opportunity to bring together high-level speakers from the WHO, the ECDC, country-level experts and EU health stakeholders with the view to discuss current gaps on the current level of implementation of the WHO Guidelines on SSIs and provide useful political recommendations to prevent and manage the incidence of such infections across the surgical care pathway to curb SSIs and AMR, and, ultimately, enhance patient safety in Europe.
The roundtable was opened by HFE President Dr Roberto Bertollini who called for a holistic, and multilevel strategy to tackle SSIs: from system change to further education, surveillance, and awareness of this issue by EU policymakers, practitioners, healthcare workers, and patients.
The debate was hosted by MEP Istvan Ujhelyi (Hungary, S&D) who called on the need to reduce HAIs and showed his commitment for a harmonised and cohesive European health system and to push health policy issues in the EU. He also highlighted the need for access to quality health and care throughout the Union regardless of where citizens live as it is a matter of human rights and decency. He also showed his interest in the European Parliament report on EU4HEALTH calling the European Commission to develop new guidelines on patient safety and on boosting investment to modernise EU health systems to increase the fight against HAIs and AMR.
To provide a clearer picture of the state of play regarding AMR, Dr Dominique Monnet, Head of the Antimicrobial Resistance and Healthcare-associated Infections Programme at the European Centre for Disease Prevention and Control (ECDC), provided an overview of the extent of this issue in Europe. He stated that the ECDC’s figures on antibiotic consumption confirmed the large variation between countries and praised the efforts of the healthcare community to tackle this vital issue. But Dr Monnet reminded attendants that AMR is still one of the biggest challenges for Europeans as, for instance, Vancomycin consumption, a last-line antibody, has almost doubled since 2015 according to ECDC data. He further highlighted that 25% of healthcare professionals do not have access to guidelines of infection management and that there is a need for their further education and an improvement of infection control practices. Finally, Dr Monnet emphasised that the Covid-19 pandemic has reminded healthcare professionals that compliance with guidelines is critical for the safety of patients and that such compliance now needs to be extended and mandated to finally decrease AMR.
Following the opening remarks of this roundtable, an evaluation of the current SSIs situation throughout Europe was presented. Firstly, Prof. Dr med. Wolf O. Bechstein, the President of the DGAV, compared the SSI situation in Germany to those of other European countries and showed factors that could lead to higher rates of SSIs such as global warming, the effects of which is normally underestimated. Secondly, Dr Massimo Sartelli, a Member of the ACOI, showed the Italian and Greek perspectives on SSIs and stated that there is still no sense of urgency by most policymakers. Dr Sartelli called on focusing on preventing SSIs rather than curing them and the need for a ‘cultural change’ in which infection prevention and control is of high importance and invited ‘heroes’ to drive sectorial behavioural change. Thirdly, Dr Josep M. Badia, the President of the Spanish Observatory of Infection in Surgery, presented the Spanish experience and stated that though guidelines are extensive, a major issue occurring among Spanish healthcare workers is their non-compliance with them. Dr Badia exposed a vast amount of procedures occurring in Spanish hospitals that do not comply with EU guidelines as well as a high level of disagreement between surgeons and some guidelines. Finally, Prof. Peter Sagar, a Member of Royal College of Surgeons of England, exposed the UK’s perspective and the best practices that need to be done in each surgical operational phase to reduce the risk of SSIs while emphasising that senior surgeons should lead by example and provide staff with guidance. After their presentations, the speakers agreed that there are a variety of actions that need to occur to tackle SSIs throughout the EU.
Following this concept, five multi-level recommendations were presented by members of the research team to reduce the burden of SSIs. Dr Kemal Rasa, the President of the Surgical Infection Society, asserted that there is a need for a ‘post-guideline’ era and the sector needs to act with proper measures and adopt new surveillance methods to be able to deal with SSIs adequately: from mobile phone applications to the use of AI. This would allow for the earlier detection of SSIs and reduce the risk to patients. Prof. Benedetta Allegranzi, the Technical Lead of the Infection Prevention and Control Hub and Task Force of the WHO, agreed with such that there is a need to act to reduce SSIs but this needs to be done with a multilevel approach involving all stakeholders as shown in the WHO implementation framework: educating people, providing them with feedback and data, continuing to remind them with a ‘checklist’ of good practices, and finally change the culture in the practices.
Such a multilevel approach requires a high degree of data. And on this theme, Dr Paul Garassus, the President of the European Union of Private Hospitals, furthered the notion of a preventive approach in healthcare but with a strong focus on providing quality information to professionals. He called for the creation of an international dashboard where professionals would have their performance benchmarked to the one of other practitioners, allowing for the imposition of a quality culture in European hospitals, leading to the protection of human capital.
Following on the theme of education and the lack of implementation of guidelines, Paola Kruger, the Patient representative of the European Patient’ s Academy, argued that patients become key partners through further education and not just be end-users in healthcare. Prof. Dr Pascal Astagneau of Sorbonne University also contended that there is a need for a harmonised training and education system from the beginning of the careers of healthcare professionals at university. He showed how the education of each medical professionals should occur, with specific preparations to reduce the SSI rate. Such training should use modern technologies such as VR sets and simulation-based learning to boost the skills needed to prevent SSIs.
Finally, Dr Tommi Kärki, the expert on antimicrobial resistance and healthcare-associated infections of the ECDC, maintained that there is a need for active surveillance of SSIs and monitoring of the implementation of prevention measure and called for hospital guidelines to be in line with the international guidelines, especially at the local level, due to the large variation of guidelines compliance.
Overall, participants agreed on the multilevel approach that needs to be taken to tackle HAIs and SSIs. It is necessary to build consensus around evidence-based guidelines such as the one from WHO and define clear protocols to prevent SSIs. But there is a need for the creation of a cultural change amongst healthcare workers through the use of data, educating patients with multilingual handouts to increase their freedom of choice, and the need for further investment in the deployment of new technologies to monitor patients after leaving hospitals. All such measures are needed to achieve an improvement in the quality of healthcare that Europeans enjoy, and decrease the impact of HAIs and SSIs throughout the continent.
We invite you to read the full published report. The press release and an extract of the full report are also available in multiple languages: press release (available in English, French, German, Italian, and Spanish) and the extract of the report (available in English, French, German, Italian, and Spanish).