A methodology for a Point Prevalence Survey on antimicrobial prescriptions in a network of high skilled nursing homes in Europe, European Surveillance of Antimicrobial Consumption (ESAC), 2009

Background: Facing the treat of antimicrobial resistance in healthcare settings, optimising the use of antibiotics (AB) in nursing homes (NH) is an important priority for quality of care. However, data on AB-use in European (EU) NHs are scarce. The European Surveillance of Antimicrobial Consumption (ESAC) NH sub-project team (University of Antwerp & Scientific Institute of Public Health, Belgium), funded by the European Centre for Disease Prevention and Control, carried out a methodology. Objective: The project aimed to carry out a standardised methodology for repeated Point Prevalence Surveys (PPS) in a EU network of NHs in order to measure the prevalence of AB-use among residents and describe characteristics, risk factors and determinants at the resident- and NH-level.

Methods: National representatives (NR) from all EU countries were invited to participate in the network, recruiting participating ‘high skilled NH’s’ (IPSE-project definition): either at least 5 NHs/country (voluntary basis) with a minimum of 250 eligible residents/PPS, or a randomly selected representative sample of NHs. A national survey on NH characteristics, national/regional regulating mechanisms for AB use and infection control in NHs was set up, using a written standardised questionnaire completed by the NR from each participating country. Two consecutive PPS on AB-use were planned (April & November 2009) to measure the prevalence (one single day) of AB-use among residents present on the PPS-day for at least 24h. Antibacterials, antimycotics and tuberculostatics for systemic use and nasal decontamination of MRSA carriage were registered. A resident questionnaire collected individual determinants and characteristics of AB-treatment. An institutional questionnaire collected determinants for AB-use on NH-level and aggregated denominator data (risk factors & care load indicators) for the total NH-population. PPS data were collected by a local- or by an external surveyor. Paper questionnaires for optical reading were proposed. Data could also be entered using the specially developed web-based NH PPS software. Study tools were submitted to the Ethical committee. A written consent form was obtained from residents/proxy’s. Individual feedback reports were provided to participating NHs.  

Results: 21 EU countries responded to the national survey on NHs and their specific AB-policy characteristics. Furthermore, the NH network (19 countries) collected AB data in 301 NHs during the first European NH PPS.  

Conclusions: The PPS methodology appeared to be a useful, non labour-intensive tool and feasible at EU level. The national survey showed important structural and functional differences indicating that categorization of EU NHs will be an important challenge required for meaningful data comparisons.