Question 1

Can healthcare-associated infections be completely avoided?

Accepted Answer

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% of cases can be prevented, depending on the type of infection.

Question 2

How common are healthcare-associated infections in hospital settings and what are the most common types?

Accepted Answer

The prevalence of healthcare-associated infections in Swiss hospitals has remained constant since 2017. The annual point prevalence study (PPS) conducted by Swissnoso shows an average rate of 5.9%. This rate is slightly below the European average of 7.1% (results of the PPS 2022–23 by the European Centre for Disease Prevention and Control).The most common infection types are surgical site infections following surgical procedures (32.9% of all healthcare-associated infections), followed by lower respiratory tract infections (16.9%), urinary tract infections (16%) and bloodstream infections (12.4%) (results of the 2024 PPS).

Question 3

How dangerous are healthcare-associated infections?

Accepted Answer

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

Question 4

What are healthcare-associated infections?

Accepted Answer

The NOSO Strategy defines healthcare-associated infections as infections that occur during a stay in a hospital or care home in connection with a diagnostic, therapeutic or nursing measure. Healthcare-associated infections can also result from the circumstances of the stay in the institution, for example by pathogens in the air or on surfaces.

Question 5

Who is responsible for implementing the NOSO Strategy?

Accepted Answer

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 can only be achieved if everyone plays their part.List of stakeholders

Question 6

What healthcare facilities is the NOSO strategy aimed at?

Accepted Answer

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.

Question 7

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

Accepted Answer

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. Governance2. Monitoring3. Prevention and control4. Education and research5. Evaluation.These fields of action, which have different strategic objectives, will be achieved through 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.

Question 8

Does the NOSO Strategy also pursue financial goals?

Accepted Answer

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

Question 9

What are the objectives of the NOSO Strategy?

Accepted Answer

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 to1. increase the safety of patients, residents and staff2. improve the protection of the population’s health3. contribute to the prevention and control of antibiotic resistance in Switzerland, and4. prevent the costs resulting from avoidable infections.

Question 10

Why is it called the “NOSO” Strategy?

Accepted Answer

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.

Question 11

What is the idea behind the NOSO Strategy?

Accepted Answer

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 prioritised in everyday work routines.

Question 12

Who was involved in developing the strategy?

Accepted Answer

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 care homes, the Swissnoso expert group, medical specialty societies, associations, insurers and other important stakeholders.

Question 13

Why has a national strategy been formulated for healthcare-associated infections?

Accepted Answer

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 healthcare-associated infections. The national NOSO Strategy outlines the required national programme. In 2016, reducing healthcare-associated infections 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.

Question 14

Are there any international regulations on healthcare-associated infections that also apply to Switzerland?

Accepted Answer

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.

Question 15

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

Accepted Answer

The aim of the federal government’s quality strategy is to ensure and promote the quality of medical services (quality development). Within this strategy, the reduction of healthcare-associated infections is addressed as part of patient safety measures.To the quality strategy

Question 16

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

Accepted Answer

Yes. Healthcare-associated infections involving resistant pathogens are the most difficult to treat. If the number of such infections is reduced, as well as the number of healthcare-associated infections in general, this will have an impact on the use of antibiotics as 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

Question 17

How can small hospitals with a very low number of infections measure a reduction in healthcare-associated infections?

Accepted Answer

When the number of infections is very low, measuring the reduction in the incidence of healthcare-associated infections 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 catheter-associated UTIs), 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.

Question 18

What practical means are available to hospitals to achieve their targets on reducing healthcare-associated infections?

Accepted Answer

To enable them to achieve the operational reduction targets defined for hospitals they have the minimum structural requirements for the prevention and control of healthcare-associated infections in Swiss acute care hospitals. These define the measures to be taken, particularly with regard to the monitoring and prevention of healthcare-associated infections, 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 healthcare-associated infections. 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 healthcare-associated infections.

Question 19

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

Accepted Answer

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

Question 20

Which institutions are the operational objectives aimed at?

Accepted Answer

The operational objectives have been drawn up as recommendations for Swiss acute care 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.

Question 21

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

Accepted Answer

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 healthcare-associated infections in acute care 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.

Question 22

How was the operational objectives document for acute hospitals developed?

Accepted Answer

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.

Question 23

What instruments are available to facilitate the implementation of the minimum structural requirements?

Accepted Answer

Swissnoso identifies and develops practical implementation aids on an ongoing basis in collaboration with the hospitals. Among other things, a checklist is available for self-assessment of implementation of the minimum requirements (German version). Participation in the regular point prevalence surveys on healthcare-associated infections and on the use of antimicrobial agents in Swiss acute care hospitals conducted by Swissnoso are also good ways for hospitals to track the rates of healthcare-associated infections, to decide on the necessary measures and to evaluate their impact.

Question 24

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

Accepted Answer

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.

Question 25

How much effort will the minimum structural requirements mean for hospitals?

Accepted Answer

The exact costs for acute hospitals that need to develop structures depend on several factors, including the size of the hospital. However, it should be noted that most acute care hospitals already have appropriate hygiene structures in place, and that preventing healthcare-associated infections can lead to substantial savings in both direct and indirect costs. The actual expenses therefore also depend the hospital’s current level of implementation. Rough cost estimates can be found in the document on minimum structural requirements.

Question 26

What is the difference between the operational reduction targets at national level and those at hospital level?

Accepted Answer

The reduction targets set out in the document of 5% by 2030 and 4% by 2035 are nationwide targets. In other words, through measures to reduce healthcare-associated infections, all hospitals should contribute to these national targets by the relevant year. To make this possible, every hospital will define its reduction targets according to its specific situation and prevalence rates, even if the national target is already achieved in a hospital. The important thing is to seek to reduce the prevalence rate versus the current situation.

Question 27

Are the minimum structural requirements also applicable for non-acute care settings, for example rehabilitation centres, psychiatric units and care homes?

Accepted Answer

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 structural requirements for care homes is one of the priorities of the NOSO Strategy for the coming years and part of the Action Plan on implementation of the NOSO Strategy in care home settings in Switzerland.

Question 28

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

Accepted Answer

The minimum structural requirements are recommendations which Swissnoso, the FOPH, H+ and the GDK advise implementing in their entirety. In May 2022, the GDK included the minimum requirements in its recommendations to the cantons. Most cantons have declared the implementation of the minimum structural requirements to be binding as part of service agreements with hospitals, or plan to integrate these standards in their service agreements.The minimum requirements could also become mandatory via quality agreements if they are selected as a measure in the agreement.

Question 29

How were the minimum structural requirements for acute care hospitals developed?

Accepted Answer

The minimum requirements were drawn up by a working group under the leadership of Swissnoso, with the involvement of the relevant medical specialty societies (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]).

Question 30

Who is responsible for implementation of the NOSO Action Plan for Care Homes?

Accepted Answer

The document is aimed at the competent cantonal authorities, the federal government, the associations of care homes, medical specialty societies, training institutions, and care homes themselves. Cantons that delegate tasks in the area of care facilities to the communes should ensure that the competent communal authorities are also involved. For every package of measures, the stakeholders have been defined with clearly-defined roles and corresponding responsibilities.

Question 31

Is the NOSO Action Plan for Care Homes binding?

Accepted Answer

The Action Plan is a recommendation in the form of a roadmap. It is fully endorsed by the FOPH, the Swiss Conference of Cantonal Ministers of Public Health (GDK) and the CURAVIVA association of Swiss care homes. However, implementation is not mandatory.

Question 32

What are the priority areas of the six packages of measures set out in the Action Plan on implementation of the NOSO Strategy in Swiss care homes?

Accepted Answer

The first package of measures focuses on reinforcing cantonal and institutional infection prevention and control (IPC) structures and on the promotion of networks.Other packages of measures concern the development of minimum structural requirements and national recommendations on infection prevention topics that are relevant to care homes. A national IPC expert group has been set up to define these requirements and recommendations for care home settings.The Action Plan also seeks to promote IPC training for care home staff. To this end, IPC topics relevant to care home settings should be incorporated more in further training and events, and needs-based IPC training that is tailored to users’ needs should be introduced in care facilities.Finally, the realisation of a point prevalence study to record the prevalence of healthcare-associated infections and antibiotic consumption in Swiss care homes is also part of the Action Plan.

Question 33

Which institutions is the NOSO Action Plan for Care Homes aimed at?

Accepted Answer

The NOSO Action Plan for Care Homes was drawn up as a recommendation for Swiss care home settings. In the interests of integrated healthcare provision, however, interfaces with acute care hospitals, rehabilitation clinics, organisations providing home care and outpatient care, and other social care facilities should be involved in a targeted manner.

Question 34

What is the objective of the NOSO Action Plan for Care Homes?

Accepted Answer

The NOSO Action Plan for Care Homes aims to educate all stakeholders about the importance of infection prevention and control (IPC) by 2029 and to close existing gaps through the systematic implementation of measures. Effective IPC structures within care homes and authorities will guarantee stability and resilience throughout Switzerland, including in times of crisis.

Question 35

How was the NOSO Action Plan for Care Homes document developed?

Accepted Answer

The FOPH drew up the NOSO Action Plan for Care Homes on the basis of feedback from the stakeholder workshop held in September 2023 and the working group involving key players from the care home sector. A comprehensive consultation was conducted in the process. The Action Plan is therefore the result of close collaboration between the FOPH and the Swiss Conference of Cantonal Ministers of Public Health (GDK), cantonal partners, the CURAVIVA association of Swiss care homes, and the relevant medical specialty societies and training institutions. The Action Plan was approved by CURAVIVA and the GDK Conference in June 2025.

Question 36

How does the NOSO Action Plan for Care Homes relate to the NOSO Strategy?

Accepted Answer

The Action Plan is based on the 16 key measures from the NOSO Strategy, from which four priority measures were selected at a stakeholder workshop in September 2023 for implementation in care home settings. For these four key measures, a total of six packages of measures were defined in the Action Plan.

Question 37

Were the experiences from the COVID-19 pandemic incorporated in the development of the Action Plan for Care Homes?

Accepted Answer

Yes, the valuable experience and insights gained from the COVID-19 pandemic were incorporated in the Action Plan.Care homes were hard hit by the COVID-19 pandemic. Initially, care facilities were lacking the specialist knowledge to handle a pandemic, particularly with regard to isolation measures. The working conditions for healthcare professionals were also very stressful. The pandemic particularly highlighted the conflicting priorities of introducing protective measures  to prevent infection while maintaining residents’ quality of life. Various publications set out recommendations to improve the quality of infection prevention in long-term care, some of which were included in the packages of measures set out in the Action Plan.

Question 38

Why is an action plan needed on implementation of the NOSO Strategy in Switzerland’s care homes? Why is it important?

Accepted Answer

The objective of the NOSO Strategy is to reduce healthcare-associated infections in hospitals and care homes, and to prevent the spread of potentially dangerous pathogens. In an initial phase, the NOSO Strategy supported various baseline studies to record the requirements in care homes. The COVID-19 pandemic also highlighted the fact that targeted infection prevention and control is important in these settings. The action plan responds specifically to this requirement.

Question 39

How common are healthcare-associated infections in care home settings, and what are the most common types?

Accepted Answer

A systematic survey (SPOT point prevalence study) was conducted for the first time in September 2024 to gauge the situation in care homes. 94 care homes with a total of 7,244 residents took part. The prevalence of healthcare-associated infections was at 2.3%, with UTIs the most common (44%), followed by respiratory infections (15%) and skin/soft tissue infections (15%).The study also highlights that 2.6% of care home residents received a systemic antibiotic treatment.

NOSO Strategy: FAQs

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