FAQs

1. What does the NOSO Strategy want?

The global objective of the National Strategy for the Monitoring, Prevention and Control of Healthcare-Associated Infections (NOSO Strategy) is the reduction of hospital and nursing home infections in Switzerland. Through the strategy, the Federal Government, the cantons and other important stakeholders lay the foundation for targeted and coordinated action.

Much has been done in the past to prevent HAIs. But what has been missing to date is a national system for monitoring the epidemiological situation and generally applicable, evidence-based standards for preventing and combating HAIs. In addition, healthcare facilities need targeted support to ensure that the topic receives a higher priority in their everyday work.

2. Why is the strategy called “NOSO”?

NOSO is short for “nosocomial”. The term is derived from the Greek νόσος (nósos), which means “disease”, and κομεῖν (komein), which means “to take care of”. Healthcare-associated infections that occur in healthcare facilities are called nosocomial infections – hence the name of the strategy.

3. What are the goals of the strategy?

The NOSO Strategy aims to reduce the number of HAIs and to prevent the spread of potentially dangerous pathogens in hospitals and nursing homes, in order to

1. increase the safety of patients, residents and staff,
2. improve protection of population health,
3. contribute to the prevention and control of antibiotic resistance in Switzerland, and
4. reduce follow-up costs.
   

4. What concrete measures are undertaken to reach these goals?

The NOSO Strategy builds on existing structures and measures, clarifies responsibilities and contributes to the various efforts being aligned with prevention and control objectives. It comprises five action areas, each of which has different strategic objectives and key measures:

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

In the coming years, various measures will be phased in at a national level.

Details on the different action areas and key measures can be found here.

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

The NOSO Strategy defines any infections as “healthcare-associated infections” (HAIs) that occur while staying in a hospital or nursing home in connection with a diagnostic, therapeutic or nursing measure, or that are simply due to the circumstances of the stay in the institution, possibly as a result of pathogens in the air or on surfaces.

6. How dangerous are these types of infections?

Every year, some 70,000 persons in Switzerland fall ill due to HAIs. The infections necessitate prolonged and/or additional treatment, can lead to long-term damage and are responsible for approximately 2,000 deaths per year. These are estimates by the Swissnoso expert panel (www.swissnoso.ch) based on previous studies.

They will be updated based on the results of the 2017 National Point Prevalence Survey, and published in the course of 2019.

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

A 2017 survey of Swiss hospitals showed that 5.9% of patients contract a hospital infection, which is about average for Europe.

According to the 2017 National Point Prevalence Survey, surgical site infections are the most common type of HAI (29% of all hospital infections), followed by lower respiratory tract infections (pneumonia, 18%), urinary tract infections (15%) and catheter-associated bloodstream infections (bacteraemias, 13%).

8. Can HAIs be avoided completely?

No. These types of infections also depend on patient-specific factors such as immune defences or comorbidities as well as increasingly complex medical interventions and treatments, e.g. in emergency wards.

Depending on the type of infection, however, between 35% and 55% of cases can be avoided through targeted monitoring, prevention and control measures.

9. Why was a national strategy developed for HAIs?

The Federal Council’s health policy priorities (“Health2020”) declared the reduction of HAIs one of the primary measures for improving the population’s health protection. The revised Epidemics Act that entered into force on 1 January 2016 charges the Federal Government – with the involvement of the cantons – with defining goals and strategies for the detection, monitoring, prevention and control of communicable diseases and with developing a national programme in the area of HAIs.

10. Who was involved in the development of the strategy?

The NOSO Strategy originated in close cooperation with the Swiss Conference of the Cantonal Ministers of Public Health (CMPH), H+ (the Hospitals of Switzerland), CURAVIVA (the association for Swiss nursing homes and institutions), the Swissnoso expert panel as well as medical professional societies, associations, insurers and other relevant stakeholders.

11. Who is responsible for implementing the NOSO Strategy?

As part of their respective responsibilities, the Confederation, specifically the Federal Office of Public Health (FOPH), and the cantons ensure that the national NOSO Strategy is implemented and work closely with numerous professional associations, authorities and organisations. Along with medical professional societies, these stakeholders are crucial for a coherent and broad-based implementation. The strategy objective, namely to ensure a substantial and sustainable reduction in HAIs, can only be achieved if all involved do their part.

See the list of the agencies involved in the NOSO Strategy

12. Does the NOSO Strategy have economic goals as well?

Follow-up costs caused by HAIs are estimated to amount to approx. CHF 230 million per year. Cost reduction is thus another objective of the strategy, even though the savings potential cannot be quantified at this time.

13. What has the Federal Government done so far to prevent HAIs?

The Swissnoso expert panel was founded in 1994 at the initiative of the FOPH. It publishes recommendations for the prevention and control of HAIs and antibiotic resistance. With the Swiss Hand Hygiene Campaign (2005/2006), Swissnoso coordinated the largest quality promotion campaign in the Swiss healthcare system to date.

Since 2009, the National Association for the Development of Quality in Hospitals and Clinics (ANQ) has been monitoring surgical site infections. The results are published yearly in the Swissnoso Bulletin.

14. Is there a connection between the NOSO Strategy and the Strategy on Antibiotic Resistance (StAR)?

Yes. The HAIs that are the hardest to treat and are responsible for the most deaths are those caused by resistant pathogens. Reducing the number of these types of infections has an impact on the use of antibiotics: fewer of them are needed to lower the risk of infection during surgical interventions or to control an infection in case of illness. This also lowers the risk of newly resistant pathogens spreading. This connection requires close cooperation between the two project teams.

15. The FOPH’s Quality Strategy also makes reference to hospital infections. What’s the connection?

The Confederation’s National Quality Strategy aims to ensure a high level of quality for medical services in hospitals. Improved quality for medical services increases patient safety and reduces the risk of HAIs. As part of the Quality Strategy, a pilot programme on the topic of urinary catheters is currently under way. The findings from that pilot programme will be incorporated in the NOSO Strategy.

16. Are there international guidelines pertaining to HAIs that Switzerland is subject to as well?

No. But as a Member State of the World Health Organization (WHO), Switzerland supports the “Global action plan on antimicrobial resistance” and the “Quality of care: patient safety” resolution (WHA55.18), with which the WHO Member States advocate for increased efforts in the area of patient safety. The NOSO Strategy aims to contribute to that effort.

Last modification 11.12.2019