Santé publique France’s initiatives regarding healthcare-associated infections are guided by the 2022–2025 National Strategy.

Santé publique France’s activities include:

• epidemiological surveillance of healthcare-associated infections through:

  • coordinating national surveillance and prevention missions for healthcare-associated infections delegated to the Support Centers for the Prevention of Healthcare-Associated Infections (CPias);

  • conducting national prevalence surveys;

  • contributing to European surveillance;

• managing reports of healthcare-associated infections;

• prevention of healthcare-associated infections.

Epidemiological surveillance of healthcare-associated infections

Since February 3, 2017, Santé publique France has been leading national surveillance and expert missions regarding the control and prevention of healthcare-associated infections (HAIs) and antimicrobial resistance (decree of February 3, 2017) in collaboration with the Support Centers for HAI Prevention (CPias), regional structures resulting from the reform of the CClin-Arlin network, the regional units of Santé publique France, and the National Reference Centers (CNR).

In 2018, five national missions were defined by an expert committee, the “National Missions on Healthcare-Associated Infections” (CMNIAS), and were delegated for the 2018–2023 period to six CPias following a call for proposals. Their scope of action, previously focused on infection prevention and antibiotic resistance, has expanded to include promoting the appropriate use of antibiotics in collaboration with the CRAtb (Decree No. 2022-1445 of November 18, 2022, regarding regional centers for antibiotic therapy).

Their missions were defined by an expert committee, “National Missions for the Prevention of Healthcare-Associated Infections and Antibiotic Resistance” (CominaPIA), which succeeded the CMNIAS. A second term for the national missions, within this expanded scope, began on October 1, 2023, for a duration of five years. For this period, they are delegated to six coordinating and associated CPias as well as four associated CRAtbs.

What are the national missions?

• First: “Surveillance and prevention of healthcare-associated infections and antibiotic resistance (including the appropriate use of antibiotics) in outpatient care and the medical-social sector,” led by the CPias Pays-de-Loire in partnership with the CPias Auvergne-Rhône-Alpes, the CRAtb Pays-de-Loire, and the CRAtb Normandie.

• Second: “Surveillance and prevention of antibiotic resistance (including the appropriate use of antibiotics) in healthcare facilities,” led by the CPias Grand Est in partnership with the CPias Nouvelle-Aquitaine, the CRAtb Provence-Alpes-Côte d’Azur, and the CRAtb Grand-Est.

• Spiadi: “Surveillance and prevention of infections associated with invasive devices,” led by the CPias Centre-Val de Loire.

• Spicmi: “Surveillance and prevention of infection risks associated with surgical and interventional medical procedures,” led by CPias Île-de-France in partnership with CPias Pays-de-Loire.

• Matis: “Support for actions to prevent healthcare-associated infections and antibiotic resistance (including the appropriate use of antibiotics): assessment, training, communication, documentation,” led by the CPias Nouvelle-Aquitaine in partnership with the CPias Îles de Guadeloupe.

CominaPIA’s scientific deliberations took into account the missions of the CPias, the CRAtb, and Santé publique France. They were based on an assessment of the current situation and the results of a prior consultation with stakeholders. The committee also incorporated the objectives of the interministerial “Antimicrobial Resistance” roadmap and European programs coordinated by the ECDC. This committee is responsible for the annual evaluation of the implementation of these missions.

The website of the Network for the Prevention of Infections and Antibiotic Resistance and the Proper Use of Antibiotics (RéPIA), which brings together the national missions, is available at the following address: https://www.preventioninfection.fr/.

Network for the Surveillance and Prevention of Healthcare-Associated Infections

Santé publique France coordinates the epidemiological surveillance of healthcare-associated infections and the monitoring of antibiotic resistance through various mechanisms defined in five national missions (learn more). Among these, three missions are dedicated to the surveillance of healthcare-associated infections: Primo, Spicmi, and Spiadi.

These missions are carried out at the regional level by the 17 CPias and CRAtb.

National prevalence survey

• National prevalence survey of healthcare-associated infections and antibiotic treatments in healthcare facilities

National prevalence surveys (ENP) have been regularly conducted since 1996 in all French healthcare facilities, both public and private. Their primary objective is to measure, on a given day, the prevalence of healthcare-associated infections and the use of anti-infective treatments among hospitalized patients. The survey also describes the main characteristics of healthcare facilities in terms of operations and patient demographics.

Prevalence surveys also aim to raise awareness among all healthcare staff in healthcare facilities regarding the risk of nosocomial infections and the importance of monitoring antimicrobial use in hospitals.

The 2022 national prevalence survey was conducted in 1,155 healthcare facilities and covered 151,676 patients.

• National Survey on the Prevalence of Healthcare-Associated Infections and Antibiotic Use in Long-Term Care Facilities: Prev’Ehpad

A national prevalence survey of healthcare-associated infections is conducted in long-term care facilities every five years. The most recent survey was conducted in 2016: PREV’HEPAD 2016.

The next national prevalence survey in nursing homes is scheduled for May–June 2024.

The objective of this survey is to measure the prevalence of healthcare-associated infections and anti-infective treatments prescribed to residents in nursing homes in France, and to describe the main characteristics of nursing homes in terms of their operations and resident profiles.

Prevalence surveys also aim to engage all professionals and prescribers in nursing homes and identify priorities for action and monitoring regarding prevention policies and the appropriate use of antibiotics.

Contribution to the European surveillance system

France contributes to the European surveillance network for healthcare-associated infections (HAI-Net), coordinated by the European Centre for Disease Prevention and Control (ECDC). The surveillance network’s priorities include coordinating European prevalence studies on healthcare-associated infections (HAIs) and antibiotic use in short-stay and long-stay facilities, monitoring surgical site infections, and monitoring HAIs in intensive care units.

In particular, the 2017 (PPS-2) and 2022 (PPS-3) ENP surveys are part of this European program. Consequently, a portion of the data from short-stay facilities is transmitted to the ECDC.

Similarly, the 2016 Prev’Ehpad survey contributed to the European HALT-3 survey.

Reporting of healthcare-associated infections in healthcare facilities

• Data analysis and support for investigating reports and alerts

The reporting system for healthcare-associated infections, established in 2001, has relied on the e-Sin digital tool since 2012. This application enables the monitoring of the management of infectious episodes reported by healthcare facilities, in coordination with the Cpias. Some of these reports may trigger a public health alert of national or international scope.

This innovative system requires active communication with healthcare professionals to raise their awareness of the importance of reporting. The reporting letter, integrated into the application, is an example of a communication tool for users of this system.

In addition, Santé publique France produces annual and thematic national reports based on the e-Sin database.

Prevention measures to reduce healthcare-associated infections

Santé publique France also supports prevention initiatives aimed at reducing the incidence of healthcare-associated infections.

• MATIS

MATIS is a mission designed to support the four other national missions and to assist with HAI prevention efforts for healthcare professionals, through the deployment of assessment, training, communication, and documentation tools.

It is implemented regionally by all CPias.

The assessment, training, communication, and documentation initiatives have been entrusted to the CPias of Nouvelle-Aquitaine and the CPias of the Guadeloupe Islands, which carry out the MATIS mission: Cross-Sectoral Support Mission for the Prevention of Healthcare-Associated Infections. This communication mission works in collaboration with other national missions; it creates and shares prevention tools for healthcare professionals, CPias, EOHs, healthcare service users, and patients. The first toolkit, “Hand Hygiene,” is available online.

Three toolkits are already available on the Repias website:

• Hand Hygiene

• Fecal Risk

• Respiratory Hygiene