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Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones – antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed.

Hand hygiene is the most effective way to stop the spread of microorganisms and to prevent healthcare-associated infections (HAI). The World Health Organization launched the First Global Patient Safety Challenge - Clean Care is Safer Care - in 2005 with the goal to prevent HAI globally. This year, on 5 May, the WHO's initiative SAVE LIVES: Clean Your Hands, which focuses on increasing awareness of and improving compliance with hand hygiene practices, celebrated its second global day. In this article, four Member States of the European Union describe strategies that were implemented as part of their national hand hygiene campaigns and were found to be noteworthy. The strategies were: governmental support, the use of indicators for hand hygiene benchmarking, developing national surveillance systems for auditing alcohol-based hand rub consumption, ensuring seamless coordination of processes between health regions in countries with regionalised healthcare systems, implementing the WHO's My Five Moments for Hand Hygiene, and auditing of hand hygiene compliance.

Hand hygiene is the most effective way to stop the spread of microorganisms and to prevent healthcare-associated infections (HAI). The World Health Organization launched the First Global Patient Safety Challenge - Clean Care is Safer Care - in 2005 with the goal to prevent HAI globally. This year, on 5 May, the WHO's initiative SAVE LIVES: Clean Your Hands, which focuses on increasing awareness of and improving compliance with hand hygiene practices, celebrated its second global day. In this article, four Member States of the European Union describe strategies that were implemented as part of their national hand hygiene campaigns and were found to be noteworthy. The strategies were: governmental support, the use of indicators for hand hygiene benchmarking, developing national surveillance systems for auditing alcohol-based hand rub consumption, ensuring seamless coordination of processes between health regions in countries with regionalised healthcare systems, implementing the WHO's My Five Moments for Hand Hygiene, and auditing of hand hygiene compliance.

Introduction Since 2000, a considerable increase in the number of Clostridium difficile infections (CDIs) leading to substantial morbidity, mortality and attributable costs has been observed, at least in North America and Europe [1]. Changes in the epidemiology of CDI have been mainly attributed to the emergence of a new hypervirulent strain called PCR ribotype 027, causing numerous outbreaks in North America and Europe [2,3] and, to a lesser extent, PCR ribotype 078 [1,4,5]. In addition, patients not previously considered to be at risk for the disease (e.g., without recent antibiotic therapy or hospitalisation) have also been described [1,6-8]. The European CDI study (ECDIS), initiated and funded by the European Centre for Disease Prevention and Control (ECDC), showed that the incidence of CDI varied from hospital to hospital [9]. In 2008, a weighted mean incidence of 4.1 cases (range: 0.0–36.3) per 10,000 patient-days per hospital reported by the ECDIS study was almost 70% higher than that reported in a previous European surveillance study in 2005 (2.45 cases per 10,000 patient-days per hospital, range: 0.13–7.1) [9,10]. ECDIS also revealed the contribution of strains other than PCR ribotype 027 and that some of these strains, notably PCR ribotypes 015, 018 and 056, could cause severe CDI. In response to the emerging problems associated with C. difficile, an ECDC working group published background information about the changing epidemiology of CDI, CDI case definitions and surveillance recommendations [2]. To support European Union (EU)/European Economic Area (EEA) Member States in increasing their capacity for CDI surveillance, ECDC also initiated and funded a new project – ECDIS-Net – to develop a European surveillance protocol and enhance laboratory capacity for diagnosis and typing of C. difficile in EU/EEA Member States. In 2011, a survey of existing CDI surveillance systems in European countries was performed as part of the ECDIS-Net project. The results of this survey, presented here, were later used to ...

Introduction After recognition of European outbreaks of Clostridium difficile infections (CDIs) associated with the emergence of PCR ribotype 027/NAP1 in 2005, CDI surveillance at country level was encouraged by the European Centre for Disease Prevention and Control (ECDC) [1]. In 2008, an ECDC-supported European CDI survey (ECDIS) identified large intercountry variations in incidence rates and distribution of prevalent PCR ribotypes, with the outbreak-related PCR ribotype 027 being detected in 5% (range: 0–26) of the characterised isolates [2]. The surveillance period was limited to one month and the representation of European hospitals was incomplete; however, this has been the only European (comprising European Union (EU)/European Economic Area (EEA) and EU candidate countries) CDI surveillance study. The authors highlighted the need for national and European surveillance to control CDI. Yet, European countries were found to have limited capacity for diagnostic testing, particularly in terms of standard use of optimal methods and absence of surveillance protocols and a fully validated, standardised and exchangeable typing system for surveillance and/or outbreak investigation. As of 2011, 14 European countries had implemented national CDI surveillance, with various methodologies [3]. National surveillance systems have since reported a decrease in CDI incidence rate and/or prevalence of PCR ribotype 027 in some European countries [4-8]. However, CDI generally remains poorly controlled in Europe [9], and PCR ribotype 027 continues to spread in eastern Europe [10-12] and globally [13]. In 2010, ECDC launched a new project, the European C. difficile Infection Surveillance Network (ECDIS-Net), to enhance surveillance of CDI and laboratory capacity to test for CDI in Europe. The goal of ECDIS- Net was to establish a standardised CDI surveillance protocol suitable for application all over Europe in order to: (i) estimate the incidence rate and total infection rate of CDI (including recurrent CDI cases) in European ...