1887
  1. Home
  2. Eurosurveillance
  3. Volume 31, Issue 25, 25/Jun/2026
  4. Article
Surveillance Open Access
Like 0
Download

Abstract

BACKGROUND

Enhancing surveillance of bloodstream infections (BSIs) by extracting data from electronic health records (EHR) is often the first step in automating the surveillance of healthcare-associated infections (HAIs).

AIM

We assessed existing BSI surveillance systems and the progress in implementing EHR-BSI surveillance within the ECDC project Surveillance from Electronic Health Data (SUREHD).

METHODS

We summarised information on BSI surveillance systems through meetings with national representatives and review of national surveillance protocols and reports.

RESULTS

Of the 30 EU/EEA countries invited to join the SUREHD project, 17 actively participated from March 2023 to March 2025. All 17 countries conducted BSI surveillance within HAI or antimicrobial resistance programmes, and EHR-BSI surveillance was being implemented nationally (n = 9), regionally (n = 2) or at hospital level (n = 6). Reported challenges included data standardisation (n = 13), IT capacity (n = 10), data linkage (n = 7), system integration (n = 7) and data protection (n = 6). Few countries had access to structured EHR data on patient symptoms (n = 1), infection origin (n = 2) and catheter-related variables (n = 5). Most countries had not yet implemented data validation processes (n = 12) nor decided on standardised vocabularies for most variables. All countries aimed to automate EHR-BSI surveillance.

CONCLUSION

Automation of BSI surveillance is critically relevant for the development of surveillance systems and to support infection and control measures (IPC) for HAIs. Implementation of automated EHR-based BSI surveillance varied between countries; a generic protocol and a network of experts have established a way forward. Future efforts should focus on harmonisation, data quality, and leveraging EHR-BSI data to strengthen HAI surveillance and to improve IPC.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2026.31.25.2500618
2026-06-25
2026-07-18
/content/10.2807/1560-7917.ES.2026.31.25.2500618
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/31/25/eurosurv-31-25-4.html?itemId=/content/10.2807/1560-7917.ES.2026.31.25.2500618&mimeType=html&fmt=ahah

References

  1. Centers for Disease Control and Prevention (CDC). Bloodstream infection (BSI) events. Atlanta: CDC. [Accessed: 24 Jun 2026]. Available from: https://www.cdc.gov/nhsn/psc/bsi/index.html
  2. Kontula KSK, Skogberg K, Ollgren J, Järvinen A, Lyytikäinen O. Population-based study of bloodstream infection incidence and mortality rates, Finland, 2004-2018. Emerg Infect Dis. 2021;27(10):2560-9.  https://doi.org/10.3201/eid2710.204826  PMID: 34546161 
  3. García-Rodríguez JF, Mariño-Callejo A. The factors associated with the trend in incidence of Bacteraemia and associated mortality over 30 years. BMC Infect Dis. 2023;23(1):69.  https://doi.org/10.1186/s12879-023-08018-0  PMID: 36737678 
  4. Mehl A, Åsvold BO, Lydersen S, Paulsen J, Solligård E, Damås JK, et al. Burden of bloodstream infection in an area of Mid-Norway 2002-2013: a prospective population-based observational study. BMC Infect Dis. 2017;17(1):205.  https://doi.org/10.1186/s12879-017-2291-2  PMID: 28284196 
  5. Ljungquist O, Blomstergren A, Merkel A, Sunnerhagen T, Holm K, Torisson G. Incidence, aetiology and temporal trend of bloodstream infections in southern Sweden from 2006 to 2019: a population-based study. Euro Surveill. 2023;28(10):2200519.  https://doi.org/10.2807/1560-7917.ES.2023.28.10.2200519  PMID: 36892472 
  6. Kern WV, Rieg S. Burden of bacterial bloodstream infection-a brief update on epidemiology and significance of multidrug-resistant pathogens. Clin Microbiol Infect. 2020;26(2):151-7.  https://doi.org/10.1016/j.cmi.2019.10.031  PMID: 31712069 
  7. European Centre for Disease Prevention and Control (ECDC). Assessment of electronic health records for infectious disease surveillance. Stockholm: ECDC; 19 Nov 2021. Available from: https://www.ecdc.europa.eu/en/publications-data/assessment-electronic-health-records-infectious-disease-surveillance
  8. van Mourik MSM, van Rooden SM, Abbas M, Aspevall O, Astagneau P, Bonten MJM, et al. PRAISE: providing a roadmap for automated infection surveillance in Europe. Clin Microbiol Infect. 2021;27(Suppl 1):S3-19.  https://doi.org/10.1016/j.cmi.2021.02.028  PMID: 34217466 
  9. Schønning K, Dessau RB, Jensen TG, Thorsen NM, Wiuff C, Nielsen L, et al. Electronic reporting of diagnostic laboratory test results from all healthcare sectors is a cornerstone of national preparedness and control of COVID-19 in Denmark. APMIS. 2021;129(7):438-51.  https://doi.org/10.1111/apm.13140  PMID: 33949007 
  10. Gubbels S, Nielsen J, Voldstedlund M, Kristensen B, Schønheyder HC, Ellermann-Eriksen S, et al. National automated surveillance of hospital-acquired bacteremia in Denmark using a computer algorithm. Infect Control Hosp Epidemiol. 2017;38(5):559-66.  https://doi.org/10.1017/ice.2017.1  PMID: 28274300 
  11. European Commission (EC). Design and implementation of multinational surveillance systems using routinely collected electronic health records in EU/EEA. Brussels: EC; 13 Dec 2021. Available from: https://ec.europa.eu/info/funding-tenders/opportunities/portal/screen/opportunities/tender-details/9819
  12. European Centre for Disease Prevention and Control (ECDC). High-level antimicrobial resistance meeting in Brussels. Stockholm: ECDC; 8 May 2024. Available from: https://www.ecdc.europa.eu/en/news-events/high-level-antimicrobial-resistance-meeting-brussels
  13. European Centre for Disease Prevention and Control (ECDC). Competent Bodies. Stockholm: ECDC. [Accessed: 24 Jun 2026]. Available from: https://www.ecdc.europa.eu/en/about-ecdc/who-we-are/governance/competent-bodies
  14. European Parliament and European Council. Regulation (EU) 2025/327 of the European Parliament and of the Council of 11 February 2025 on the European Health Data Space and amending Directive 2011/24/EU and Regulation (EU) 2024/2847. Office of the European Union. Luxembourg: Publications Office of the European Union. 05.03.2025:L 96. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=OJ:L_202500327
  15. European Centre for Disease Prevention and Control (ECDC). TESSy metadata report. Stockholm: ECDC; 25 May 2025. Available from: https://www.ecdc.europa.eu/en/publications-data/tessy-metadata-report
  16. European Commission (EC). Commission Implementing Decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions. Office of the European Union. Luxembourg: Publications Office of the European Union. 06.07.2018:L 170. Available from: https://eur-lex.europa.eu/eli/dec_impl/2018/945/oj/eng
  17. European Centre for Disease Prevention and Control (ECDC). European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 19 Nov 2025. Available from: https://www.ecdc.europa.eu/en/about-us/networks/disease-networks-and-laboratory-networks/ears-net-data
  18. European Centre for Disease Prevention and Control (ECDC). Healthcare-associated Infections Surveillance Network (HAI-Net). Stockholm: ECDC; 5 Oct 2023. Available from: https://www.ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-and-laboratory-networks/hai-net
  19. Observational Health Data Sciences and Informatics (OHDSI). Standardized Data: The OMOP Common Data Model. New York: OHDSI. [Accessed: 24 Jun 2026]. Available from: https://www.ohdsi.org/data-standardization/
  20. European Centre for Disease Prevention and Control (ECDC). European surveillance of healthcare-associated infections in intensive care units – HAI-Net ICU protocol, version 1.02. Stockholm: ECDC; 18 Mar 2015. Available from: https://www.ecdc.europa.eu/en/publications-data/european-surveillance-healthcare-associated-infections-intensive-care-units-hai
  21. World Health Organization (WHO). Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. Geneva: WHO; 1 Nov 2016. Available from: https://www.who.int/publications/i/item/9789241549929
  22. World Health Organization (WHO). Guidelines for the prevention of bloodstream infections and other infections associated with the use of intravascular catheters: part I: peripheral catheters. Geneva: WHO; 12 May 2024. Available from: https://www.who.int/publications/i/item/9789240093829
  23. Price L, MacDonald J, Melone L, Howe T, Flowers P, Currie K, et al. Effectiveness of national and subnational infection prevention and control interventions in high-income and upper-middle-income countries: a systematic review. Lancet Infect Dis. 2018;18(5):e159-71.  https://doi.org/10.1016/S1473-3099(17)30479-6  PMID: 29100898 
  24. Iwami M, Ahmad R, Castro-Sánchez E, Birgand G, Johnson AP, Holmes A. Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis. BMJ Open. 2017;7(1):e012520.  https://doi.org/10.1136/bmjopen-2016-012520  PMID: 28115331 
  25. Shehab N, Alschuler L, McILvenna S, Gonzaga Z, Laing A, deRoode D, et al. The National Healthcare Safety Network’s digital quality measures: CDC’s automated measures for surveillance of patient safety. J Am Med Inform Assoc. 2024;31(5):1199-205.  https://doi.org/10.1093/jamia/ocae064  PMID: 38563821 
  26. van Rooden SM, van der Werff SD, van Mourik MSM, Lomholt F, Møller KL, Valk S, et al. Federated systems for automated infection surveillance: a perspective. Antimicrob Resist Infect Control. 2024;13(1):113.  https://doi.org/10.1186/s13756-024-01464-8  PMID: 39334278 
  27. Edelstein M, Lee LM, Herten-Crabb A, Heymann DL, Harper DR. Strengthening global public health surveillance through data and benefit sharing. Emerg Infect Dis. 2018;24(7):1324-30.  https://doi.org/10.3201/eid2407.151830 
  28. European Commission (EC). EU4Health. Brussels: EC. [Accessed: 24 Jun 2026]. Available from: https://commission.europa.eu/funding-tenders/find-funding/eu-funding-programmes/eu4health_en
  29. Semler SC, Wissing F, Heyder R. German Medical Informatics Initiative. Methods Inf Med. 2018;57(S 01):e50-6.  https://doi.org/10.3414/ME18-03-0003  PMID: 30016818 
  30. European Commission (EC). eHealth Network. Brussels: EC. [Accessed: 24 Jun 2026]. Available from: https://health.ec.europa.eu/ehealth-digital-health-and-care/digital-health-and-care/eu-cooperation/ehealth-network_en
  31. European Commission (EC). Recommendation on a European Electronic Health Record exchange format. Brussels: EC; 6 Feb 2019. Available from: https://digital-strategy.ec.europa.eu/en/library/recommendation-european-electronic-health-record-exchange-format
  32. Aghdassi SJ, van der Werff SD, Catho G, Brekelmans M, Peña Diaz LA, Buetti N, et al. Hospital-onset bacteraemia and fungaemia as a novel automated surveillance indicator: results from four European university hospitals, 2018 to 2022. Euro Surveill. 2025;30(24):2400613.  https://doi.org/10.2807/1560-7917.ES.2025.30.24.2400613  PMID: 40539312 
  33. Verberk JDM, Aghdassi SJS, Abbas M, Nauclér P, Gubbels S, Maldonado N, et al. Automated surveillance systems for healthcare-associated infections: results from a European survey and experiences from real-life utilization. J Hosp Infect. 2022;122:35-43.  https://doi.org/10.1016/j.jhin.2021.12.021  PMID: 35031393 
First steps in establishing surveillance of bloodstream infections from electronic health record derived data, EU/EEA countries, March 2023 to March 2025
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Alexis+Sent%C3%ADs&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sentís Alexis</a>, <a href="/search?value1=Tine+Dalby&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dalby Tine</a>, <a href="/search?value1=Tommi+%CE%9A%C3%A4rki&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Κärki Tommi</a>, <a href="/search?value1=Francisco+Orchard&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Orchard Francisco</a>, <a href="/search?value1=Angelo+D%26apos%3BAmbrosio&option1=author&noRedirect=true" class="nonDisambigAuthorLink">D&apos;Ambrosio Angelo</a>, <a href="/search?value1=Miriam+Van+den+Nest&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Van den Nest Miriam</a>, <a href="/search?value1=Bernhard+Benka&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Benka Bernhard</a>, <a href="/search?value1=Nathalie+Shodu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Shodu Nathalie</a>, <a href="/search?value1=Karl+Mertens&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mertens Karl</a>, <a href="/search?value1=Emanuel+Bra%C4%91a%C5%A1evi%C4%87&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brađašević Emanuel</a>, <a href="/search?value1=Antea+Jezid%C5%BEi%C4%87&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jezidžić Antea</a>, <a href="/search?value1=Markella+Marcou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Marcou Markella</a>, <a href="/search?value1=Linos+Hadjihannas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hadjihannas Linos</a>, <a href="/search?value1=Jan+Kubele&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kubele Jan</a>, <a href="/search?value1=Sophie+Gubbels&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gubbels Sophie</a>, <a href="/search?value1=Louise+Stougaard&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Stougaard Louise</a>, <a href="/search?value1=Liidia+Dotsenko&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dotsenko Liidia</a>, <a href="/search?value1=Piret+Mitt&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mitt Piret</a>, <a href="/search?value1=Imke+Wieters&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wieters Imke</a>, <a href="/search?value1=Alexandra+Hoffmann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hoffmann Alexandra</a>, <a href="/search?value1=Antonis+Maragkos&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Maragkos Antonis</a>, <a href="/search?value1=Fortunato+D%26apos%3BAncona&option1=author&noRedirect=true" class="nonDisambigAuthorLink">D&apos;Ancona Fortunato</a>, <a href="/search?value1=Agnese+Comelli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Comelli Agnese</a>, <a href="/search?value1=Auguste+Salnaite&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Salnaite Auguste</a>, <a href="/search?value1=Andre+Brincat&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brincat Andre</a>, <a href="/search?value1=Michael+A+Borg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Borg Michael A</a>, <a href="/search?value1=Manon+Brekelmans&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brekelmans Manon</a>, <a href="/search?value1=Stephanie+van+Rooden&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Rooden Stephanie</a>, <a href="/search?value1=Anders+Skyrud+Danielsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Skyrud Danielsen Anders</a>, <a href="/search?value1=Torunn+Alberg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Alberg Torunn</a>, <a href="/search?value1=Irena+Klavs&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Klavs Irena</a>, <a href="/search?value1=Da%C5%A1a+Kavka&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kavka Daša</a>, <a href="/search?value1=Luc%C3%ADa+Garc%C3%ADa-San+Miguel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">García-San Miguel Lucía</a>, <a href="/search?value1=Pilar+Gallego-Berciano&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gallego-Berciano Pilar</a>, <a href="/search?value1=Hanna+Billstr%C3%B6m&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Billström Hanna</a>, <a href="/search?value1=Olov+Aspevall&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Aspevall Olov</a>, <a href="/search?value1=Diamantis+Plachouras&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Plachouras Diamantis</a>, <a href="/search?value1=Hanne-Dorthe+Emborg&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Emborg Hanne-Dorthe</a>, <a href="/search?value1=Carlos+Carvalho&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Carvalho Carlos</a>, <a href="/search?value1=Anthony+Nardone&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nardone Anthony</a>, <a href="/search?value1=on+behalf+of+the+EHR-BSI+working+group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">on behalf of the EHR-BSI working group</a></span>. First steps in establishing surveillance of bloodstream infections from electronic health record derived data, EU/EEA countries, March 2023 to March 2025. <a href="/content/ecdc">Euro Surveill.</a> 2026;31(25):pii=2500618. <a href="https://doi.org/10.2807/1560-7917.ES.2026.31.25.2500618" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2026.31.25.2500618</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 08 Aug 2025;&nbsp;&nbsp; <span class="generated">Accepted</span>: 24 Mar 2026 </span> </p>
/content/10.2807/1560-7917.ES.2026.31.25.2500618
/content/10.2807/1560-7917.ES.2026.31.25.2500618
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error