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Berlin Declaration

Towards a "European network to promote infection prevention for patient safety": 
a initiative to improve cooperation between scientific and professional societies. 
(Berlin Declaration)

Health Care Associated Infections (HCAI) have been recognized and approached as a clinical risk from many years. 
HCAI prevention and control has been developed through research and structured interventional programs in recent decades both in clinical, therapeutic and management fields. 
In the 80’s the SENIC study showed the significant role played by healthcare organisations in HCAI prevention and introduced this new essential level of action and responsibility to both professional practice and the Infection Control Practitioner role. 
At the same time the need to measure Healthcare Organizations (HCO) performances through quality indicators developed and now those that need or want recognition for their efforts in quality improvement, must demonstrate their skills on prevention and control of HCAI. HCAI rates are considered good markers of health care quality and almost all the different existing approaches for quality assessment include specific indicators about them. 
More recently the emphasis on clinical risk management, after the Institute of Medicine paper "To err is human", favoured a widespread range of initiatives aimed to control risk. An important aspect of HCAI prevention is now recognized at the macro-system level (i.e. the role of regional and national governments) for the many different ways they can influence and, sometimes, force single HCO to adhere to initiatives aimed to control, reduce, survey this risk. 

European countries have developed many different initiatives on HCAI prevention but they are not connected and with a lack of homogeneity due to different histories, health care systems, available resources, and epidemiological settings. These differences are not easy to align even if, in recent years, some scientific initiatives (i.e. Improving Patient Safety in Europe (IPSE), Hospital in Europe Link for Infection Control through Surveillance (HELICS), etc.) attempted to set common basic steps both on surveillance, control and training. 
Recently some EU institutional initiatives have entered the field: The European Centre for Disease Control and Prevention (ECDC) leads specific work on HCAI and antimicrobial resistance reduction and this, together with the recently published European Commission "Proposal for a Council Recommendation on Patient Safety, including the prevention and control of Health-Care Associated Infections". Both initiatives support European co-ordination at the political level and the management of HCAI risk as patient and staff movement across borders increases. 
In Europe many scientific and professional societies exist to support research and to promote knowledge, attitudes, good practices and training on prevention and control of this risk; the most of them are nationally based and have a long history of successful initiatives. They are actively engaged in this field and play an essential role in promotion HCAI prevention. Despite being involved on a national basis, in many cases scientific and professional societies may not have formal contact with each other, with the exception of participation in international scientific projects, congresses, etc. This is a critical point since throughout Europe there is a consistent capital of experiences, knowledge, scientific and professional culture, research skills and training opportunities that could be known, shared, and ultimately become part of a common platform. 
Scientific and professional societies also play a role in complementing actions as an outcome of national policy or practice promoted by HCO’s. The fact they can directly reach a vast number of professionals both with meetings and publications, and they can immediately feel the climate in the field, gives them a unique opportunity to support programs, to launch and monitor specific campaigns. 
In November 2008 a number of European scientific and professional societies involved in HCAI prevention met in Berlin to discuss European collaboration with regard to this issue. Representatives were convinced that the present epidemiological situation, the frequency of HCAI, and cross border movements of citizens, patients and healthcare staff needs international initiatives particularly at a European level. They conveyed that to cooperate and to share their experiences is something necessary in the European area considering Europe on geographical basis and not only European Union political borders. 
Representatives agreed there is no advantage to the formation of a new European scientific and professional society but instead proposed that a formal network could be the way to start a cooperation and collaboration. To create a network in fact means:

  • to respect and to assume the value of histories, traditions, activities and specificities of the existing scientific and professional societies;
  • to leave each country to evolve at its pace and to respect local characteristics;
  • to retain formal contact, and share initiatives, experiences, to promote joint projects, etc.;
  • to guarantee mutual support both for critical situations and for specific needs;
  • to be more effective in lobbying and advocating HAI prevention at the different levels (regional, national, international);
  • to be more visible for the media, for the public opinion and for the professional and scientific arena;
  • to make available to European Union, European Centre for Disease Prevention and Control, international institutions and other stake holders, a wide spread network able to support work programs, guaranteeing expertise, channels of communication and feedback.

On this basis, representatives agreed to write a declaration (Berlin declaration) made of a premise and 3 statements and to invite all European scientific and professional societies interested in HAI prevention to sign it and to join the initiative.

HCAI prevention ‘Berlin Declaration’

Premise. 
We scientific and professional societies working in infection prevention for patient safety, identify the following key challenges in Infection Prevention in Europe:

1. Patient safety

  • Different infection prevention approaches throughout Europe
  • Patient and staff movement through Europe
  • Compliance with Infection prevention activities and education

2. Public health implications of

individual clinical interventions

national/regional policies

3. Networking

  • Exchange experiences and knowledge
  • Defining priorities for action or research?


Statement 1. 
We as scientific and professional societies working in infection prevention for patient safety in Europe want to promote:

  • Activities to prevent and control infection risks including patients and staff movement throughout Europe;
  • Engagement of politicians, caregivers and individuals in addressing
    • public health implications,
    • challenges and opportunities related to infection prevention;
  • Exchange of experiences and harmonization of activities both for professionals and "customers";
  • Be an active partner in promoting patient safety in Europe.


Statement 2. 
We strongly believe that Infection prevention needs:

  • A Europe wide approach;
  • Greater involvement of and collaboration between:
    • Politicians/governments,
    • Infection prevention societies,
    • Public health, academic, education and research institutions,
    • Health care organizations,
    • Insurance companies,
    • Patients and customer organizations,
    • Industries.
  • Networking within infection prevention professional communities with collegiate approaches:
    • Competencies,
    • Education,
    • Advice and support.
    • Advice and support.
  • Particular emphasis on:
    • Behavioural change,
    • Evidence based intervention and practices,
    • Basic hygiene issues,
    • Proactive identification of emerging issues, measuring the impact of interventions to reduce HCAI’s 


Statement 3. 
We are convinced that a "European network to promote infection prevention for patient safety", recognising and making the most of all single member societies, will enhance fundamental support for infection prevention and patient safety throughout Europe. 
All European scientific and professional societies with interest in infection prevention and control in healthcare are invited to join and participate in the network.

Societies who have committed support to date:

  • Austria: Austrian Society for Hygiene, Microbiology and Preventive Medicine (ÖGHMP)
  • Croatia: Croatian Society for Medical Microbiology and Parasitology, Section for HCAI Prevention and Control
  • Czech Republic: Society for Hospital Hygiene and Epidemiology
  • Denmark
    • Danish Association for Infection Control Nurses (DSFH)
    • Danish Society of Clinical Microbiology
  • France: French Society of Hospital Hygiene (SFHH)
  • Germany: German Society of Hospital Hygiene (DGKH)
  • Italy: Italian Multidisciplinary Society for the Prevention of Infections in Healthcare Organizations (SIMPIOS)
  • Netherlands: Dutch Society of Infection Prevention and Control in the Health Care Setting
  • Norway:
    • Norwegian Forum for Hospital Infection Control
    • Norwegian Nurses Organisation: Professional Interest Group for Infection Control Nurses
  • Romania: Romanian Society of Microbiology
  • Sweden:
    • Swedish Association for Infection Control (SAIC)
    • Swedish Institute for Infectious Disease Control (SMI)
  • Turkey: Turkish Society of Hospital Infection and Control
  • UK:
    • Hospital Infection Society (HIS)
    • Royal College of Nursing
    • Infection Prevention Society (IPS)



Berlin November 28, 2008