Preventing infections and antibiotic resistance has been a major public health priority by French public authorities since the 1990s–2000s and continues to be so today. France now has an advanced national infection prevention and control (IPC) programme that aligns with the World Health Organization (WHO) recommended core components for IPC. The programme is implemented by key stakeholders in the field and coordinated by French public authorities. The programme has demonstrated progress over time and has set ambitious objectives for the coming years.
How and where did they start?
Several national plans for preventing healthcare-associated infections (HAIs) have been implemented over the years, such as the 2009–2013 National Strategy for Preventing Healthcare-Associated Infections, the 2013–2017 National Patient Safety Programme and the 2015–2022 National Prevention Action Plan Against Healthcare-Associated Infections (Propias). Based on lessons learned, a new National Strategy for Preventing Infections and Antibiotic Resistance (2022-2025) has been developed, led by the Ministry of Health and Prevention, in collaboration with French national and regional health authorities as well as other ministries. This national strategy highlights the importance of:
- the equal promotion of measures for IPC and antimicrobial stewardship;
- the broad scope of IPC, within which both community-acquired and HAIs are included, as well as both bacterial and viral infections; and
- the implementation at all levels, particularly at the local level, with strong involvement of regional and territorial structures.
The synergistic approach is implemented at the regional level to harmonize the 3 healthcare sectors (hospitals, medico-social facilities and services, and the community) by the Regional Health Agencies (ARS), which are responsible for mobilizing all regional actors involved on the topic.
Two main actors provide support to the ARS:
- Centres supporting the prevention of healthcare-associated infections (CPias), responsible for the prevention of HAIs and the control of cross-transmission of infectious agents: They provide expertise and support, run networks of IPC professionals (IPC teams in hospitals and nursing homes) and perform investigation and follow-up of HAIs mandatory notifications.
- Centres for antibiotic stewardship (CRAtb): They carry out regional missions of expertise and support, including a strategic mission on antibiotic stewardship, and animation of networks of health professionals in charge of antibiotic stewardship activities (multidisciplinary teams and referents) in all 3 healthcare sectors.
The ARS coordinate these 2 structures and ensure their synergy. The 2 structures collaborate, particularly in providing training and communication strategies, and also by establishing close collaboration between the IPC and antibiotic stewardship activities and teams. Dedicated national funding exists for the CPias, the CRAtb, the antibiotic stewardship teams and the IPC teams in nursing homes.
In addition, some CPias take on missions of national interest piloted by the French public health agency (Santé publique France - SpF): surveillance (including infections associated with invasive devices, infections associated with interventional medicine, antimicrobial resistance, antibiotic consumption) or dissemination of data and tools for IPC and antibiotic stewardship, for instance. They are all part of the RéPias network (Healthcare-associated infections and antibiotic resistance prevention network).
France has set ambitious targets for 2025, including drastically ramping up improvements with hand hygiene measures and continuing the promotion of vaccination as cornerstone elements of the strategy. Improving and investing in enhanced hand hygiene and environmental hygiene practices in health care facilities and long-term care facilities offer cost-effective options with health and economic benefits tackling HAIs and antibiotic resistance in France. SpF is responsible for the national notification system for uncommon HAIs and emerging antimicrobial-resistant strains. It also conducts a national point-prevalence survey every 5 years on HAIs and antimicrobial treatments according to the European Centre for Disease Prevention and Control protocol.
This national strategy is focused on human health and therefore echoes to other strategies for the other sectors (especially the one developed for animal health, within which IPC is also a core component), all gathered under the umbrella of a One health AMR national action plan, following the recommendations set by WHO.
Success factors
IPC and addressing antibiotic resistance are spearheaded and supported by governmental bodies at the highest jurisdiction level, making an essential contribution to achieving consistent implementation of targets by enforcement agencies and by the responsible players in medical institutions and in the community.
The IPC strategy is implemented at the local level by expert centres and mobile teams that are close to the field and know the territories and their epidemiology, as well as their healthcare structures. It can best adapt the messages and intervention in conjunction with the regional health authorities. The ambition of the national strategy is to ensure a minimum ratio of infection preventionist, as stated in WHO core component one, and to go beyond as encouraged by these guidelines.
IPC is promoted with a broad vision and linked, when relevant, with antibiotic stewardship strategies. Indeed, the French experience has identified that IPC and antibiotic stewardship measures have mutually beneficial, interdependent and complementary effects. Preventing the most common infections through vaccination and simple everyday protective measures, for instance, is also key to reducing HAIs, and protecting the effectiveness of antibiotics. France has therefore developed several indicators within this strategy that are carefully monitored yearly.