Approximately 4.3 million people acquire a healthcare‑associated infection (HAI) each year in acute care hospitals in EU countries, Iceland and Norway (ECDC, 2024[1]). HAIs lead to increases in patient morbidity, long-term health complications, extended hospital stays and mortality (WHO, 2022[2]). They also contribute to the unnecessary use of healthcare resources and represent a preventable financial burden on healthcare systems, with related costs representing up to 6% of public hospital budgets (Slawomirski, Auraaen and Klazinga, 2017[3]).
On average, 7.1% of patients in the EU acquired an HAI during their hospital stay in 2022–23 (Figure 6.20). The observed rates were lowest in Latvia, Romania and Bulgaria (less than 4% of patients), and highest in Cyprus and Greece (more than 12% of patients), although there are wide confidence intervals around the rate in Cyprus. Prevalence is impacted by differences in diagnostic testing and reporting, as on average, countries with higher testing frequency detected more HAIs. The 2022‑23 data showed no general improvement of the situation since 2016‑17 as the prevalence of HAIs was similar, leaving aside new inclusions in the survey such as COVID‑19 and infections imported from long-term care facilities.
The differences between countries narrow when accounting for the selection of hospitals (confidence intervals) and patient characteristics that affect probability of infection (predicted prevalence). The predicted prevalence, though still impacted by testing frequency, ranges from 5% to 6% in Bulgaria, Romania, Latvia, the Slovak Republic and Lithuania, up to 10% in Italy and over 8% in Cyprus, Malta, Portugal and Greece.
As shown in Figure 6.21, the most frequently reported types of HAI across the EU were respiratory tract infections (29.3% of the total) including pneumonia (19.0%), COVID‑19 (7.0%) and other lower respiratory tract infections (3.3%), urinary tract infections (19.2%), surgical site infections (16.1%), bloodstream infections (11.9%) and gastro‑intestinal infections (9.5%). The prevalence of COVID‑19 infections varied across countries, linked to the prevalence in the community during the time of the survey.
Between 35‑70% of HAIs could be avoided through better infection prevention and control (IPC) measures (WHO, 2022[2]). Although most effective when implemented as a comprehensive package of IPC activities, hand hygiene is the most effective single measure to reduce infections with actions such as ensuring access to hand hygiene facilities, training of health personnel, regular audits and feedback, and enhancing environmental hygiene through more effective cleaning practices (OECD, 2023[4]).
On average, 55.6% of hospital beds in the EU had alcohol-based handrub dispensers at the point of care, allowing for easy access to sanitary equipment (Figure 6.22). This ranged from under 10% in Romania and Bulgaria to more than 90% in Spain, Hungary, Luxembourg and Portugal. In general, high availability of dispensers was associated with a lower prevalence of antimicrobial-resistant HAIs at the country level, though the actual use of dispensers also matters. For example, although Hungary reported 100% availability of dispensers at the point of care, it ranked lowest in the consumption of alcohol-based handrub, indicating sub-optimal utilisation of the dispensers.
Adequate staffing and awareness of infection prevention are essential, and dedicated IPC teams can support IPC education and training activities (OECD, 2023[4]). The average number of IPC nurses (measured in full-time equivalent) per 250 beds was 1.2 in 2022‑23, ranging from 0 in Lithuania, Latvia and the Slovak Republic to 2.8 in Cyprus and 3.1 in Ireland (Figure 6.22). At the hospital level, high IPC nurse staffing level is associated with higher observed prevalence of HAIs due to better diagnosis and reporting, but with lower prevalence of antimicrobial-resistant HAIs. In 2022‑23, most countries reached the WHO target staffing level of 1 IPC nurse per 250 beds. However, only Cyprus and Ireland achieved the updated ECDC target of 2.5 nurses per 250 beds. Compared to the 2016‑17 survey, the average levels of IPC staffing levels and availability of handrub dispensers have improved, which can in part be attributed to the spotlight on IPC placed by the COVID‑19 pandemic (ECDC, 2024[1]).
