FAQs

1. What is the idea behind the NOSO Strategy?

The overall objective of the National Strategy for the Monitoring, Prevention and Control of Healthcare-associated Infections (NOSO Strategy) is to reduce infections acquired at hospitals and care homes in Switzerland. With this strategy, the federal government, cantons and other key players are laying the foundations for a targeted and coordinated approach.  

Much had already been done to combat healthcare-associated infections (HAIs) before the NOSO Strategy. What was lacking however, was nationwide monitoring of the epidemiological situation, and generally applicable scientifically based standards for preventing and combating HAIs. In addition, healthcare facilities need targeted support so that the topic can be given a higher priority in everyday work routines.

2. Why is it called the “NOSO” Strategy?

NOSO is an abbreviation for “nosocomial”. The term is derived from the Greek νόσος (nósos) meaning “illness” and κομεῖν (komein) meaning “to care for”. Healthcare-associated infections that occur in a healthcare facility are therefore also known as nosocomial infections.

3. What are the objectives of the NOSO Strategy?

The NOSO Strategy aims to reduce the number of healthcare-associated infections in Switzerland and prevent the spread of potentially dangerous pathogens in hospitals and care homes in order to

1. increase the safety of patients, residents and staff
2. improve the protection of public health
3. contribute to preventing and combating antibiotic resistance in Switzerland, and
4. prevent the costs resulting from avoidable infections.

4. How are the objectives of the NOSO Strategy to be achieved in concrete terms?

The NOSO Strategy builds on existing structures and measures, clarifies responsibilities and helps to align the various efforts with the prevention and control objectives. It comprises five fields of action:

1. Governance
2. Monitoring
3. Prevention and control
4. Education and research
5. Evaluation.

These fields of action, which have different strategic objectives, are to be achieved with a package of 16 key measures. Since implementation of the strategy began in 2016, various measures have been taken on a staggered basis at the national level.

Details of the fields of action and the key measures can be found here.

5. What are healthcare-associated infections (HAIs)?

The NOSO Strategy defines healthcare-associated infections (HAIs) as infections that occur during a stay in a hospital or care home in connection with a diagnostic, therapeutic or nursing measure. HAIs may also be caused solely by the circumstances of the stay in the institution, for example by pathogens in the air or on surfaces.

6. How dangerous are such infections?

According to a survey conducted by Swissnoso in Swiss hospitals in 2017, almost 60,000 hospitalised people are affected by HAIs every year. There are around 5,900 deaths associated with this. Apart from the high mortality rate, these infections lead to longer or additional treatments and can cause long-term problems.

7. How common are HAIs and what are the most common types?

A study conducted by Swissnoso in 108 Swiss hospitals in 2022 showed that 5.9 per cent of patients suffered a hospital-acquired infection. This figure has remained constant in recent years and puts Switzerland in line with the European average.

As in previous years’ surveys, surgical site infections following surgical procedures (29 per cent of all healthcare-associated infections) are the most common, followed by urinary tract infections (16.3 per cent), lower respiratory tract infections (15.8 per cent) and bloodstream infections (8.9 per cent).

So far little is known about the frequency of HAIs in care homes. National surveys are expected in the coming years.

8. Can HAIs be completely avoided?

No. Patient-specific factors such as the immune system’s defences and concomitant illnesses also play a role in the occurrence of such infections, as do increasingly complicated medical interventions and therapies, for example in intensive care units.

However, with targeted monitoring, prevention and control, 35 to 55 per cent of cases can be prevented, depending on the type of infection.

9. Why has a national strategy been formulated for HAIs?

The Epidemics Act, which came into force on 1 January 2016, mandates the federal government – with the involvement of the cantons – to define objectives and strategies for the detection, surveillance, prevention and control of communicable diseases and to develop a national programme in connection with HAIs. The national NOSO Strategy outlines the required national programme. In 2016, reducing HAIs was also declared a priority measure in the Federal Council’s health policy priorities (as part of the Health2020 strategy) to improve the protection of the population's health.

10. What healthcare facilities is the NOSO strategy aimed at?

The NOSO Strategy currently targets inpatient care (hospitals and care homes) in Switzerland. An extension of the strategy to the outpatient sector for the years to come is under discussion.

11. Who was involved in developing the strategy?

The NOSO Strategy was developed in close collaboration with the Swiss Conference of Cantonal Ministers of Public Health (GDK), the H+ hospital association, the CURAVIVA association of Swiss nursing homes and institutions, the Swissnoso expert group, medical societies, associations, insurers and other important stakeholders.

12. Who is responsible for implementing the NOSO Strategy?

The federal government, specifically the Federal Office of Public Health (FOPH), and the cantons are responsible for implementing the NOSO Strategy within the scope of their powers and responsibilities. They work closely with numerous professional associations, authorities and organisations. Together with the healthcare-related professional associations, these stakeholders are key to coherent, broad-based implementation. The strategy’s goal of substantially and sustainably reducing healthcare-associated infections (HAIs) can only be achieved if everyone plays their part.

List of stakeholders

13. Does the NOSO Strategy also pursue financial goals?

According to a survey conducted by Swissnoso in Swiss hospitals in 2017, the costs resulting from HAIs amount to CHF 751 million, which equates to CHF 12,709 per HAI case. As a large proportion of HAIs can be avoided, investments in the prevention of HAIs also lead to cost reductions. It is currently impossible to say exactly how high the potential savings are in Switzerland.

14. Is there a connection between the NOSO Strategy and the national programme to combat antibiotic resistance (StAR)?

Yes. HAIs with resistant pathogens are the most difficult to treat. If the number of such infections can be reduced, as can the number of IASs in general, this will have an impact on the use of antibiotics: fewer will be needed to fight infection in the event of illness. This also reduces the risk of resistant pathogens developing and spreading. This correlation means that close cooperation is needed between the two strategies.

To the StAR Human strategy

15. The federal government's quality strategy also refers to healthcare-associated infections. What is the connection?

The aim of the federal government’s quality strategy is to assure and promote the quality of medical services (quality development). In this strategy, the reduction of healthcare-associated infections is addressed in the context of patient safety.

To the quality strategy

16. Are there any international regulations on HAIs that also apply to Switzerland?

No. However, Switzerland is a member of the World Health Organization (WHO) and supports its global strategy on infection prevention and control, its overarching global strategy on patient safety and the Global Action Plan on Antimicrobial Resistance. In it, the WHO member states speak out in favour of stepping up efforts in connection with patient safety. The NOSO strategy is intended to contribute to this.

17. How were the minimum structural requirements for acute hospitals developed?

The minimum requirements were drawn up by a working group under the leadership of Swissnoso, with the involvement of the relevant professional associations (SSHH, SSI, SIPI and fibs). They are based on scientific evidence and have been adapted for Switzerland on the basis of international recommendations (European Centre for Disease Prevention and Control (ECDC) and World Health Organization (WHO)).

18. How much expense will the minimum structural requirements entail for hospitals?

The precise costs for acute hospitals that have to develop structures depend on several factors, including the size of the hospital. However, it should be noted that most acute hospitals already have appropriate hygiene structures in place and that significant direct and indirect costs can be saved by preventing HAIs. The actual costs therefore also depend on the current status of implementation in the relevant hospital. Rough cost estimates can be found in the document on minimum structural requirements.

19. Are the minimum structural requirements binding? Who is responsible for implementation?

The minimum structural requirements are recommendations which Swissnoso, the FOPH, H+ and the GDK advise implementing in their entirety. However, most cantons in Switzerland have declared the implementation of the minimum structural requirements to be binding as part of service agreements with the hospitals.

20. What is planned for other non-acute facilities, for example rehabilitation centres, psychiatric units and care homes?

These minimum requirements were developed specifically for acute inpatient settings. They are therefore not applicable, or not fully applicable to other areas of care and other types of facilities. The development of minimum requirements for care homes is one of the priorities of the NOSO Strategy for the coming years.

21. How do the structural minimum requirements relate to the federal government’s quality strategy?

The quality strategy addresses the topic of reducing healthcare-associated infections in the context of patient safety. As the minimum structural requirements help to combat such infections, their implementation is an important tool for care providers to prevent adverse events and harm to patients.

22. What tools are available to facilitate the implementation of the minimum structural requirements?

Swissnoso identifies and develops practical implementation aids in collaboration with the hospitals. Among other things, a checklist is available for self-assessment of the implementation of the minimum requirements (german version). Participation in the regular point prevalence surveys of HAIs and the use of antimicrobial agents in Swiss acute hospitals conducted by Swissnoso are also good means for hospitals to track the development of HAI rates and evaluate the impact of the measures.

23. How was the operational objectives document for acute hospitals developed?

The FOPH developed the operational objectives in collaboration with the partners of the NOSO Strategy on the basis of international recommendations. The document is the result of a consensus between all the specialist organisations involved and has been validated by the H+ hospital association, the Conference of Cantonal Directors of Public Health (GDK) and the National Centre for Infection Prevention, Swissnoso.

24. Which institutions are the operational objectives aimed at?

The operational objectives have been drawn up as recommendations for Swiss acute hospitals. Psychiatric clinics, rehabilitation clinics and retirement and care homes are not included, as these institutions operate under different conditions. In addition, tools for infection prevention and control are not yet equally available to them.

25. How do the operational objectives facilitate the implementation of the NOSO Strategy?

The overall objective of the NOSO Strategy is to reduce healthcare-associated infections. The operational objectives will help to achieve this overarching goal. They correspond to a roadmap for a sustainable reduction in HAIs in acute hospitals in Switzerland by 2035. To this end, the aids to the implementation of the operational objectives provide a framework for implementing the minimum structural requirements and evaluating the impact of the IPC-related measures implemented in the hospitals.

26. What is the relationship between the operational objectives and the minimum structural requirements?

The operational objectives refer to the minimum structural requirements for the prevention and control of HAIs in Swiss acute hospitals. Once the hospitals have defined their operational reduction targets, they have this catalogue of measures for preventing and combating HAIs available to them to introduce measures and achieve their targets.

27. What practical means are available to hospitals to achieve their HAI reduction targets?

To enable them to achieve the operational reduction targets defined for hospitals they have the minimum structural requirements for the prevention and control of HAIs in Swiss acute hospitals. These define the measures to be taken, particularly with regard to HAI monitoring and prevention, and staff training. As part of the NOSO Strategy, Swissnoso is continuously developing further tools to facilitate implementation of the minimum requirements and reduce the number of HAIs. Examples of this include a checklist for self-assessment of the implementation of the minimum requirements and modules for monitoring and prevention of the most common HAIs.

28. How can small hospitals with a very low number of infections measure a reduction in HCAIs?

When the number of infections is very low, measuring the reduction in the incidence of HCAIs is not appropriate. In such cases, it is more appropriate to choose another type of reduction target, such as a reduction in absolute numbers (e.g. halving the number of urinary catheter-related infections), or to choose process indicators, e.g. related to hand hygiene. The important thing is to reflect on the issues and choose indicators that make sense in the specific situation of the hospital.

Last modification 13.06.2024