Nosocomial Infections (NI) present particular challenges compared to the surveillance of other infections. Their clinical, microbiological, epidemiological and even physio-pathological features are heterogeneous. Health systems in European countries are increasing the priority and resources for initiatives to foster NI surveillance and control activities because valid outcome data have the potential to improve the quality of patient care significantly.

In the extended European Union, there are approximately 3 million nosocomial infections and 50,000 attributable deaths per year.

The surveillance work of HELICS is underpinned by the following principles;

• NI cannot be identified on the basis of routine laboratory data alone but requires intensive data collection of a complex, clinical dataset to be meaningful.
• Feedback of data on NI has been shown to be effective in reducing the incidence of NI and is therefore to be encouraged.
• Good quality comparative data can be used to identify measures that prevent NI.

HELICS aims to deliver the following benefits;

• By carrying out surveillance according to agreed methodologies, meaningful comparisons of NI surveillance data will be achieved.
• Resources and expertise will help to encourage more countries to set up surveillance systems.
• Surveillance experience will be shared between countries.
• Interventions to reduce the risk of NI will be developed from the inter country comparisons of surveillance data.
• Enhanced, clinically-based data will help interpret data collected by other laboratory-based European networks.

Since the first Council of Europe recommendations in 1974, the need for harmonisation of NI control policies in Europe has been recognised. HELICS I created the scientific conditions necessary for an harmonised approach of surveillance in surgery and ICU. Following this first consensus phase, HELICS II proposed a global strategy for the implementation of a Network on Nosocomial Infections associating surveillance, control, training and research with an organisation of ‘network of existing networks’. HELICS III ('Implementation Phase I') focused on the harmonisation of existing European networks and the solution of the technical problems of producing epidemiological data and other relevant information for these infections.

The challenges facing the current phase of the HELICS programme (HELICS IV - 'Implementation Phase II') are to organise the routine production and dissemination of analyses and to extend the coverage of the programme progressively to countries or regions with little or no experience of surveillance. Three targets have a high level of consensus for the implementation of the European network:

• infections in the Intensive Care Unit (with three optional levels of comprehensiveness in data collection and analysis).
• infections in surgical patients.
• hospital-wide prevalence studies of nosocomial infections with clearly-defined case definitions and denominator data.