Frequently asked questions & answers

Here you can find an overview of our most frequently asked questions & answers to help you with the survey process. Click the buttons below to navigate to your desired topic.

General
Inpatient
Outpatient
Data security & privacy

General

Download the GPPS instructions infographic here.

The Global Point Prevalence Survey of Antimicrobial Consumption is a web-based tool that enables hospitals and healthcare facilities to measure and analyse their own antimicrobial prescribing practices.

There are three modules in which you can participate: the basic inpatient module, the healthcare-associated module (which is an extension of the inpatient module), and the outpatient module.

The main aim of the Global-PPS is to empower hospitals to measure and benchmark the quality of antimicrobial use, using the method of a point prevalence survey (PPS). Furthermore, we aim to aid hospitals in identifying targets to improve the quality of their antimicrobial prescribing, to prevent intervention-related Healthcare-Associated Infections, to help design hospital interventions to promote prudent antimicrobial use and to ultimately improve patient health.

Participating in the (Global-PPS) offers several key benefits. First, it provides healthcare institutions with valuable data on their antimicrobial use patterns, enabling them to benchmark their practices against other hospitals globally. This data-driven insight helps institutions identify trends, gaps, and opportunities for improvement in their antimicrobial stewardship programs, leading to more effective strategies for reducing resistance and optimizing patient outcomes. Additionally, the Global-PPS promotes collaboration and knowledge-sharing among healthcare institutions worldwide. By participating, hospitals can choose to contribute to a larger body of research that informs global policy on antimicrobial use, helping to combat the growing threat of antimicrobial resistance. All necessary materials to conduct the survey and access to the data entry platform are freely available, making it accessible to any institution that wishes to participate.

To start conducting the Global-PPS, we recommend that you prepare the following things:

  • Create a multidisciplinary team within your institution. Please choose one person who is the lead, or the focal person, for the survey. This person will become the local administrator, i.e. the person who oversees the project, and who registers the institution in the online data entry environment. It will become more feasible to do the PPS in a team that helps you collect and enter data.
  • If necessary, obtain ethical approval from the relevant ethical committee of your institution. For more information, go to our question 2 below about ethical approval.
  • Consult the relevant Global-PPS protocol:
    • the basic + optional healthcare-associated infections (HAI) inpatient protocol for (inpatient) hospitals (with optional interest in intervention-related healthcare-associated infections).
    • the outpatient protocol for (outpatient) healthcare facilities.
  • Print the data collection forms:
    • 1 Department form for each department that you survey
    • 1 Patient form for each patient that you survey
    • 1 Short patient form for 4 outpatients without antimicrobial treatments

Note: in the outpatient module, it is also possible to directly enter your department and patient data within the Global-PPS tool. For the inpatient module, this is only advised if you have all the information readily available at the point of data entry.

  • Inform and train your team! Inform your team and other staff present in the departments about the survey. Please train your team in advance on how to collect and record the data. You are very welcome to join one of our upcoming training webinars, or watch a recording of a previous webinar.
  • [Optional] Conduct a pilot study. To facilitate smooth data collection, it is possible to conduct a pilot study: a small, initial study to train your staff and make them more familiar with the method.

The need for ethical approval depends entirely on the regulations in your setting. If you participate in the inpatient module, you will need to obtain approval from the relevant ethical committee if your country/setting requires it for retrospective audits. Since the Global-PPS is considered a retrospective audit, some countries may not require ethical approval.

If you participate in the outpatient module, it depends on how you collect your data:

  • If you collect the data retrospectively, you will need to obtain approval from the relevant ethical committee if your country/setting requires it for retrospective audits. In some countries, you do not need ethical approval to conduct a retrospective audit.
  • If you collect the data prospectively, it’s more likely that you need ethical approval before conducting the study.

However, an exempt can be obtained from the ethical committee in case the PPS is considered a quality improvement study.

You can register for the Global-PPS in our online tool. First, you will need to register yourself and confirm your registration by email. After you log in, you can register your institution. The person who registers the institution automatically becomes the local administrator, the focal person for the Global-PPS. Then, you can add additional users, create your departments, and collect data. After data entry, you can download your report.

To learn more about the Global-PPS aims, methodology and different features, please join one of our upcoming training webinars, or watch a recording of a previous webinar.

Data can be entered in our online tool. Please find more detailed instructions in the user manuals in the application. You can only enter data after you have logged in to the application and registered your institution. Then you will need to select the survey period in which you collected data. Finally, you can proceed with data entry.

Our online tool contains detailed instruction videos as well as a user manual. Still have any questions? Please contact us at global-pps@uantwerpen.be.

Does the website not work well? Please check if you’re using Google Chrome. If not, it could be that the browser you are using does not fully support our online tool.

If you are using Chrome and have an internet connection, but still experience any issues, please contact us at global-pps@uantwerpen.be.

If you lost your password, you can click ‘Forgot password’ in the login page. After filling in your username and email address, a new password will be sent to you by email. You can change this password within the application under ‘My profile’ and ‘Change password’.

Yes, as an institutional administrator, you can add extra users. You can do this within our online tool, by going to ‘User management’ and then adding extra users. Please find more detailed instructions in the user manuals in the application.

Please note that these extra users can also download the institution feedback report.

You can also remove access for former users.

If you want to change the institution administrator because, for example, the former administrator no longer works in your institution, you can contact global-pps@uantwerpen.be with this request. Please put the former institution administrator in CC so that they are aware of this change.

If the institution has not been registered in the Global-PPS tool yet, you can register it and enter data for this institution. If it already exists, please contact us at global-pps@uantwerpen.be and we will get in touch with the institution administrator of the originally created institution. This administrator can add you as an extra user.

This means that this geographical region/county/district has not been registered yet and so, needs to be added. For this, you can contact the Global-PPS team at global-pps@uantwerpen.be and let them know which region/country/district needs to be added and for which institution.

After data entry, you can download your data in Excel and generate the feedback report after additional validation/finalization of your survey within our online tool. Please find more detailed instructions in the user manuals in the application.

If you are the administrator of multiple institutions, you can also obtain a merged feedback report containing aggregated data from all your institutions.

If you are interested in longitudinal data, you can use the interactive reporting function: a tool within the web application that allows you to create your own graphs, selecting different filters as you like. Please note this function is not available for the outpatient module yet.

You can generate the feedback report after validating/finalizing your survey within our online tool. Please find more detailed instructions in the user manuals in the application. The feedback report will be automatically sent to your email address after you click the button to generate the report.

The institution remains the owner of their database at all times and decides how the Global-PPS results are used. Please note that all validated data are used in the benchmarking results, aggregated with the results of all other institutions within that period. If less than three institutions participated in one period, the data will not appear in the benchmark.

The names of institutions are never disclosed in the benchmark and are not included in any manuscript or report without the institution’s explicit approval.

Yes, you can use the benchmarking data to compare your own data with the data of other institutions in your country, continent, Europe (for non-European institutions), and with institutions of a similar hospital type in your continent.

We ask you not to use these benchmarking data in any publications (including all published manuscripts, reports, abstracts, etc.). If you wish to use these benchmarking data, please contact us at global-pps@uantwerpen.be. We will then reach out to each institution to request their consent for using their data as benchmarking data in a manuscript.

All analyses are descriptive analyses at patient- or prescription-level. Data from your institution is compared to country-, continent- and institution-type-level data. More details on the results are presented in the feedback reports.

You can find an example of the inpatient feedback report under Documents . You can find an example of the outpatient feedback report under Outpatient project.

We think it is very important to address this issue before conducting the survey. In our feedback reports, we never present data by individual prescriber, as our goal is not to assess specific prescribers, but to improve overall prescribing practices. It might be good to take a look at our protocol and/or feedback report together with your prescribers/healthcare staff so that your staff can see what the study entails and how the results are reported. Where possible, involve the ward staff as much as possible and discuss the PPS results with them.

Furthermore, it is important to note that the results of your institution are never shared. Only the local admin and Global-PPS users of your institution can download the feedback report.

If during data collection or data entry, the auditor perceives questionable or potentially harmful prescribing practices (e.g. highly incorrect dose, drug-drug interactions with other medications, not considered medication allergies), please inform the prescriber immediately to safeguard patient care. Please record the original (potentially harmful) prescription in the survey, even if the treatment was changed, since this would be the practice if the auditor had not informed the prescriber.

Inpatient

Participation

Any hospital admitting inpatients can participate in the inpatient module, both in the basic and healthcare-associated infections module. Other healthcare facilities with admitted patients can also participate, such as revalidation centres, long-term healthcare facilities, nursing homes.

If you have a mixed facility or mixed departments, consisting of inpatient beds and outpatient beds/consultation rooms, please survey these patients separately in the Global-PPS. Please survey all inpatient beds following the inpatient protocol and outpatient beds/consultation rooms following the outpatient protocol.

Pharmacies cannot participate in the Global-PPS, since our method is focused on prescribing and not dispensing patterns.

All antibiotics for systemic use (J01), antifungals (J02) and antimycotics (D01BA) for systemic use, antimalarials (P01B), antivirals for systemic use (J05), drugs for treatment of tuberculosis (J04A), antibiotics used as intestinal anti-infectives (A07AA), and nitroimidazole derivatives used as antiprotozoal agents (P01AB) are included in the Global-PPS. Antimicrobials for topical use are excluded (including creams, eye drops, ear drops, etc.).

For the Global-PPS antimicrobials are recorded according to the WHO ATC classification system. Please find a list of all included antimicrobial agents under Documents > ‘antimicrobial list’.

Oral antibiotics that are not absorbed by the gastro-intestinal tract into the blood, and hence are locally active, are included in the Global-PPS. These antibiotics fall under the WHO ATC class of A07AA, the intestinal anti-infectives.

However, please exclude antibiotics for topical or vaginal use, such as nystatin creams. Oral nystatin formulations, e.g. for oropharyngeal candidiasis, can be included.

Please find all specific intestinal anti-infectives and other antimicrobials included in the Global-PPS under Documents > ‘antimicrobial list’.

Inclusion criteria - Patients

All patients admitted on a ward (excluding day admissions such as endoscopy or renal units) at 8 a.m (or another time point of your choosing, but preferably when patients who stayed overnight have not been discharged yet). These patients are the denominator. The number of all admitted patients and beds should be filled in on the Ward form.

All patients admitted on the same ward receiving antimicrobial treatment are included as numerator. Please fill in a Patient form for each of these patients.

Exclude day hospitalizations and outpatients (these can be surveyed according to the outpatient module), and exclude patients admitted after 8 a.m. (or your respective time point) on the day of the survey. All patients who do not meet the inclusion criteria should be excluded from both the numerator and denominator data.

If the 1st dose of the antimicrobial is scheduled to be administered after the survey, do not include this antimicrobial in the survey. Record this patient in the denominator, but do not include this patient in the numerator: i.e., do not fill in a Patient Form for this patient.

Exception: if the patient was previously on e.g. parenteral antibiotic use, which was stopped the day before the survey, but a new oral antibiotic was started a few hours after the survey, you should consider this antibiotic as an ongoing antibiotic and hence include this antibiotic and this patient in the survey. Record the parenteral antibiotic in this case, as the oral antibiotic was started after the survey.

No, only count the patients (and beds) physically present in the ward you are auditing on the day of the PPS.  Look at the actual situation of the specific ward at the time of the PPS.

No, these patients should not be counted as inpatients in the survey if they are not admitted in the hospital. For example, if a nurse administers IV antibiotics at the patient’s home or if they are reviewed in the hospital without being re-admitted, they are not considered inpatients. While such patients may technically be classified as inpatients, their care resembles that of day patients, and they should be excluded from the Global-PPS.

Mothers who deliver in a polyclinic and are discharged within 24 hours of admission, along with their babies, are considered day care admissions and should be excluded from the survey. These are defined as ambulatory care patients (day cases).

Additionally, always follow the inclusion criteria as defined in protocol:

  • Include women who were admitted before 8 a.m. and still present at 8 a.m. Women admitted after 8 a.m. are excluded and should not be counted in either the denominator or numerator.
  • Babies present on the ward before 8 a.m. should be counted (unless they fall under day care admission, as noted above). Babies born after 8 a.m. are excluded from the survey.

Inclusion criteria - Departments & wards

Yes, we recommend that you survey the entire hospital if you participate for the first time in the Global-PPS (to obtain baseline data for all wards).

If it is not your first time participating in the Global-PPS with your hospital, you can also survey a selection of the departments, but we recommend that you include all wards for a certain main activity (medical, surgical, ICU): e.g., all adult ICU wards, all paediatric surgical departments, etc. We recommend this so that you collect sufficient data by activity, and subsequently, you will obtain valid rates by activity. For smaller hospitals (<250 beds), it remains advisable to survey the entire hospital.

Yes, also include the psychiatric wards/cases. Encode these wards as PSY-AMW (Psychiatry). This allows for the differentiation of these wards in the analyses, as prescribing patterns are likely different from those of other adult medical wards.

There are three survey periods every year: January-April, May-August, September-December.

In the inpatient modules, you can participate once per period, i.e. up to three times a year. Hospitals are free to choose if they wish to participate once, twice or three times a year.

The best time to conduct a survey is on a day that is representative of the usual practice on the ward. Often, this is a weekday, not during the weekend and not on a holiday.

No, you can survey departments on different days. However, you should survey the entire department on one day; you cannot split up the department and survey it on different days.

Each department should be surveyed on a single day at a specific point in time, such as 8 a.m. (or a different time of your choosing, but preferably before patients who stayed overnight have been discharged ).

No, unfortunately, it is not possible to participate more than once during a single survey period in the Global-PPS. You can take part up to three times a year—once in each survey period – but no more than that.

Yes, it is certainly possible to collect data retrospectively if all mandatory variables can be captured in the patient forms. Please also make sure you collect the data for one point in time, on one day. Please do not capture longitudinal data since this method is a point prevalence survey.

Data collection - General

Data should be recorded in the Ward forms and Patient forms. Please find all forms under Documents. Please print these forms in preparation of the survey, and collect all information on these forms. Afterwards, you can enter them in the online tool (see FAQ section on data Entry).

Yes, there are Ward and Patient forms for the inpatient module. If you participate in the additional healthcare-associated infections module, there’s also an HAI form. Please find all forms under Documents.

Data collection - Patients

Essential data to collect are:

  • the patients’ age and sex
  • antimicrobial agent
  • dose per administration
  • number of doses per day
  • route of administration
  • quality indicators for prescribing:
    • documentation of reason in notes
    • Guideline compliance
    • Documentation of stop/review date

Other mandatory variables include:

  • diagnosis or reason for prophylaxis based on a provided list of diagnoses/reasons, following the anatomical site.
  • indication for therapy (community versus hospital-acquired infection, medical versus surgical prophylaxis).
  • whether cultures were sent to the lab to document infection, and if the treatment choice is targeted based on identified micro-organisms and available microbiological or biomarker data.

For the optional HAI module, extra details on invasive devices are collected (e.g. peripheral vascular catheter, indwelling urinary catheter etc.).

Weight is an optional variable. You can leave it open, but preferably fill in the information for pediatric and neonatal patients (if this is known), since weight can be of great interest and relevance for this subgroup of patients.

You should consider a treatment based on a biomarker if the result of the biomarker is available at 8 a.m. on the day of the survey, and if the result solely or complementary to other clinical signs or microbiological tests contributed to the decision to treat with an antimicrobial and/or to the choice of a treatment.

Example:

  • If CRP results are used as an indicator for the presence of an infection, and hence supported the decision to start an antimicrobial treatment, you can score this treatment as based on a biomarker, even though the CRP result is not used for the choice of the antimicrobial drug.
  • If a biomarker result was obtained after 8 a.m. on the day of the survey, or a few days after the survey, and was used for review and follow-up of the antimicrobial treatment, score the treatment as not based on a biomarker, i.e. treatment based on a biomarker is ‘no’, because this result was not available at the time of the survey.

Category ‘other’ refers to lab biomarkers other than CRP, PCT or WBC.

Example:

  • If a prescription is based on the WBC and temperature of a patient, do not classify this as ‘other’, but please choose WBC as option.
  • Other non-biomarker diagnostic tests cannot be scored as ‘other biomarkers’. These include for example polymorphonuclear leukocytes (PMN, PML, or PMNL) in articular fluid. However, ‘erythrocyte sedimentation rate’ (ESR or sed rate), an indirect measure for the rate of inflammation, can for example be scored as ‘other biomarker’.

Please record the date when the antimicrobial was started, if this information is known. If this is not known, you may leave this field blank, as it is an optional variable.

Please do not write down the day of the survey if the actual start date is unknown.

Please choose between the following routes of administration: Oral (O), Parenteral (P), Intramuscular (IM), Inhalation (I) and Rectal (R).

The parenteral route includes the following routes of administration: intravenous (IV), subcutaneous (SC or SQ), intraosseous (IO), intraperitoneal (IP) and intrathecal (IT). While the intramuscular (IM) route of administration is also a form of parenteral administration, it should be coded as ‘Intramuscular’ (IM) rather than ‘Parenteral’ (P).

Example:

  • A patient receives antimicrobial treatment through intraperitoneal administration. The route of administration here is ‘Parenteral’ (P).

You need to report the dose in (1) Single Unit Dose and (2) Number of doses per day (N doses/day).

Single Unit Dose records the dosage given for 1 dose. Number of doses per day records how many doses are given each day.

For children, the dose is often expressed in mg/kg/day. Please convert this to mg per single dose by multiplying it by the weight of the child.

Example: 20 mg/kg/day for a 45 kg child, divided into 3 doses: Single Unit dose = 300 mg. N doses/day = 3.

(Total dose per day = 20 mg * 45 kg = 900 mg/day. The doses are administered 3 times a day: 900 mg / 3 = 300 mg. Hence, the Single Unit dose = 300 mg, and the N doses/day = 3.)

If an antibiotic with enzyme inhibitor was prescribed, such as piperacillin with tazobactam, or amoxicillin-clavulanate, please record only the dose of the antibiotic. Exclude the dose of the enzyme inhibitor. For example:

  • 3.375 g piperacillin/tazobactam, of which 3 g is piperacillin. Only these 3 g should be reported.
  • 1.2 g amoxicillin/clavulanic acid, of which 1 g is amoxicillin. Only the 1 g should be reported.

For fixed-dose combinations of active antimicrobials (such as co-trimoxazole), please record the dose of both antimicrobials!

For fixed-dose combinations of active antimicrobials, such as sulfamethoxazole and trimethoprim (co-trimoxazole), please record the dose of both antibiotics. For example:

960 mg co-trimoxazole, of which 800 mg is sulfamethoxazole and 160 mg trimethoprim. You should report the 960 mg.

Please record fixed-dose combinations as one antimicrobial in Global-PPS! For these combination therapies, add the dose of the first antimicrobial (800 mg) to the dose of the second antimicrobial (160 mg).

Exception: if a physician prescribes two antimicrobials for one diagnosis, but this is not a fixed-dose combination (e.g. amoxicillin and clarithromycin), you should record this as two separate antimicrobials for the same diagnosis, and record for each their own dose.

A few examples of fixed-dose combinations include

  • Sulfamethoxazole and trimethoprim
  • Artesunate and amodiaquine
  • Ampicillin and cloxacillin (“Ampiclox”)
  • Rifampicin, isoniazid, pyrazinamide, and ethambutol
  • Emtricitabine, tenofovir alafenamide and rilpivirine

If a patient receives an ongoing antimicrobial treatment a few times a week, e.g. 3 times a week (even if the patient does not receive the treatment on the day of the survey itself), you should write down the single unit dose as the actual dose that the patient receives, but change the N doses/day to 0.5 (every other day), 0.43 (twice a week), 0.33 (every 72 hours), 0.29 (twice a week), 0.14 (once a week), etc.

Examples:

  • 500 mg every other day: Single Unit Dose = 500 mg. N doses/day = 0.5 (= 1 dose / 2 days)
  • 750 mg every 72 hours: Single Unit Dose = 750 mg. N doses/day = 0.33 (= 1 dose / 3 days)
  • 2 g every week: Single Unit Dose = 1.2 g. N doses/day = 0.14 (= 1 dose / 7 days)
  • 1 g twice a week: Single Unit dose = 1 g. N doses/day = 0.29 (= 1 dose / 3.5 days)

For parenteral continuous administration, such as continuous 24 hours administration of vancomycin through a pump system, please provide the total dose divided by the number of hours of administration.

Example:

  • Drug name = vancomycin
  • Administered single dose= total dose over 24 hours / 24 (=total dose divided by 24)
  • Unit of dose = mg
  • Times a day = 24
  • Route = P

Please record the diagnosis as the reason to administer antimicrobials to the patient. For the diagnostic code, use the list of codes in the inpatient Patient Forms, which is split up into treatment and prophylaxis and outlined by anatomical site (see Appendix II in the data collection templates under Documents).

If the antimicrobial was prescribed for more than one reason, choose the most relevant reason. Request additional information from doctors, nurses, or pharmacists if needed. If there is no ‘most relevant option’, you could choose the first identified infection.

Examples:

Patient conditions

Diagnosis + code

Potential indication

Lower respiratory tract infections in patients with COPD or bronchiectasis

  • Bronchitis (Bron)
  • Pneumonia (Pneu) if there is a diagnosis of identified pneumonia
 

Cystic fibrosis exacerbations (‘tune-ups’), or pulmonary exacerbations, supported by positive X-ray

Pneumonia (Pneu)

 

Respiratory exacerbations in lung transplant patient

Pneumonia (Pneu)

 

Medical prophylaxis for COPD

Prophylaxis for Respiratory pathogens (Proph RESP)

 

Cholecystitis

  • Gastro-Intestinal infections (GI),
  • Intra-Abdominal Sepsis (IA) if accompanied with intra-abdominal sepsis
 

Cholangitis

Intra-Abdominal Sepsis (IA) if accompanied with biliary sepsis

 

Diverticulitis

Gastro-Intestinal infections (GI) if infected diverticula

 

Colitis

Gastro-Intestinal infections (GI)

 

Gastritis

Gastro-Intestinal infections (GI)

 

Hepatic encephalopathy

Prophylaxis for Gastro-Intestinal pathogens (proph GI)

Medical Prophylaxis

Asymptomatic bacteriuria with diabetes mellitus

Cystitis (CYS) if the diabetic patient has no kidney infection

CAI if based on culture <48h of admission, HAI2 if catheter-related & based on culture >48h  after admission, HAI4 if not related to catheter or HAI5/6

Peritonitis and PD peritonitis

Intra-Abdominal Sepsis (IA)

 

Prophylaxes concerning Cleft Lip and Palate

Prophylaxis for Skin & Soft Tissue, plastic or orthopedic surgery (Proph BJ)

Surgical Prophylaxis (1 dose, 1 day, >1 day)

Medical Prophylaxis of Mycobacterium Avium complex in HIV

  • Prophylaxis for Respiratory pathogens (Proph RESP)
  • Prophylaxis for Gastro-Intestinal pathogens (Proph GI) depending on the anatomical site targeted.
  • Medical Prophylaxis in General (MP-GEN) if no site is targeted.

Medical Prophylaxis.

Pregnancy and an antibiotic treatment for group B Streptococcus (GBS)

Obstetric/Gynaecological infections (OBGY)

 

Antiviral treatment for herpes zoster

  • Skin and Soft Tissue Infections (SST)
  • Eye infections (EYE) in case of herpes zoster ophthalmic
  • Ear Nose ant Throat infections (ENT) for herpes zoster oticus
  • Central Nervous System (CNS) infections for herpes zoster encephalitis.
 

Cytomegalovirus infection (CMV)

  • Central Nervous System (CNS) infections in case of encephalitis
  • Eye infections (EYE) for retinitis
  • Fever in Neutropenic patient (FN) for no defined site but neutropenic patient
  • Other if no information (only as last resort)
 

Prophylaxis for Transurethral resection of the prostate (TURP)

Prophylaxis for Urinary Tract Infections (proph UTI)

Surgical Prophylaxis (1 dose, 1 day, >1 day)

If the diagnosis is uncertain, the diagnostic code that should be assigned depends on a few things:

  • If the diagnosis or reason for treatment is not documented in the notes, you can ask for clarification from the ward staff or prescribers if possible. In this case, please remember to answer ‘No’ to the question ‘Reason documented in notes’.
  • If the diagnosis or reason for treatment is non-infectious, please score as ‘Other’ for diagnosis and indication.
  • If the diagnosis or reason for treatment is completely unknown, please score as ‘Unknown’ for diagnosis and indication.

Specific scenarios to consider:

  • If you have a policy in your setting that certain patients (e.g. premature newborns with or without certain risk factors) get treated with antibiotics directly after admission (or delivery), not based on any clinical signs and symptoms, please code this as Medical or Surgical Prophylaxis (NEO-MP for premature newborn patients).
  • If the treatment is based on clinical signs and symptoms, whether they are due to infection or otherwise, please do not encode this as prophylaxis, but rather as the most appropriate clinical diagnosis. If fear of sepsis is the reason for treatment, you could indicate sepsis as diagnostic code.
  • If a treatment was started e.g. for a suspected infection, but this was ruled out earlier and changed to a non-infectious diagnosis (e.g. thrombosis of the iliac veins), and the treatment was not stopped, please choose the diagnosis and indication ‘Other’.
  • If an antibiotic is started based solely on a biomarker result, e.g. elevated CRP levels, the diagnosis and indication should be ‘Other’.

If a patient has sepsis with a known origin, such as urosepsis, please choose the appropriate anatomic site for the diagnostic code. Do not choose the code sepsis since this code is only meant for cases of sepsis where the anatomic site is unknown.

For example: For patients with urosepsis, this would be Pye/Cys (preferably Pye, since this will more likely cause sepsis). For patients with meningitis, please choose CNS.

If an incorrect diagnosis was made, e.g. due to incorrect interpretation of the microbiology data, and this was discovered during the audit, please continue the PPS as if the correct diagnosis was made: consider the given diagnosis on 8 a.m. of the survey for the guideline compliance, reason in notes, etc.

If the incorrect diagnosis and consequently the prescription might be harmful in any way for the patient, please inform the prescriber immediately to safeguard patient care. Please record the original (incorrect) diagnosis in the survey, even if this diagnosis and treatment were later changed, since this would have been the practice if the auditor had not informed the prescriber.

By definition, if symptoms started before 48 hours after admission, then you should classify it as community-acquired. If symptoms occurred 48 hours after admission, encode it as hospital-associated. 

Exception: if a patient was re-admitted with a surgical site infection, this is by definition code HAI1.

Specific scenarios to consider::

  • If an infant is admitted directly after birth from the delivery room and is now under treatment for sepsis, this is classified as community-acquired, since symptoms started <48 hours after admission. In addition, all early onset sepsis (i.e. at age <48 hours) is classified as community acquired (CAI) according to the protocol.
  • If a patient is admitted for sepsis, but the patient was on dialysis, chemotherapy or was a recipient of OPAT in the past month, you should still classify this as CAI, since sepsis was acquired <48 hours after admission. Outpatient-related infections are not defined in the Global-PPS, therefore, to keep it simple, please record this as CAI.
  • If a patient was admitted after 4 days with a surgical site infection, this is classified as HAI1.
  • If a burn patient undergoes debridement early during their hospital stay and subsequently obtains an infection, it is considered CAI if this is <48 hours after admission. It is considered HAI if >=48 hours after admission.

No, you can only score one reason to treat. You cannot score multiple diagnoses and indications. If your prescription was based on multiple diagnoses and indications, please choose the most relevant one. Request additional information from doctors, nurses, or pharmacists if needed. If there is no ‘most relevant option’, you could choose the first identified infection.

Please choose for the Diagnostic code the prophylaxis option for the most appropriate anatomic site. When the prophylaxis is for general use, not targeting a specific organ or site, please choose Medical Prophylaxis in General (MP-GEN).

After choosing the appropriate diagnostic code, select the appropriate indication code to record whether it concerns a Medical or Surgical Prophylaxis. For Surgical Prophylaxis, additionally choose between a single dose Surgical Prophylaxis (SP1), one day Surgical Prophylaxis (SP2), or >1 day Surgical Prophylaxis (SP3).

Examples:

  • Please choose Prophylaxis for Respiratory pathogens (Proph RESP) if e.g. azithromycin is prescribed as prophylaxis for exacerbations of COPD. Since this is not prescribed as surgical prophylaxis, please choose Medical Prophylaxis as Indication.
  • Please choose Prophylaxis for Gastro-Intestinal pathogens (Proph GI) if e.g. rifaximin is prescribed as prophylaxis for hepatic encephalopathy. Since this is not prescribed as surgical prophylaxis, please choose Medical Prophylaxis as Indication.

Reason in Notes captures information on whether the reason for prescribing an antimicrobial is documented in the notes (medical, nursing, or other files) at the start of treatment. It must be clearly written down so anyone (e.g. a replacing clinician or other staff member) can easily understand the rationale when consulting the medical or nursing files. 

Specific scenarios to consider:

  • Even if all staff are aware that e.g. amoxicillin-clavulanate (Augmentin) is prescribed for pneumonia in a certain patient, but this is not recorded in the patient’s files, you should score ‘no’ for Reason in Notes.
  • If the reason is very briefly but clearly described somewhere in the patient’s files, please score ‘yes’ for Reason in Notes.
  • If the prescriber did not record it, but e.g. the nurse or pharmacist recorded the reason for prescription, then the reason is still visible in the patient’s files, which is the aim of this variable. In this case, score ‘yes’ for Reason in Notes.
  • If a surgery report includes a section listing all administered medications, you can mark ‘yes’ for Reason in Notes if an antimicrobial is present, even if it is not explicitly labelled as surgical prophylaxis. It is reasonable to assume that the antibiotic was given for this purpose, given its context within perioperative care.

To record guideline compliance for an antimicrobial prescription, you need to check:

  • Whether local guidelines exist. Please refer to the guidelines that are used on the wards, whether these are institutional, national, or international guidelines (e.g. WHO guidelines).
  • Whether the drug is compliant with these guidelines:
    • Y – Yes
    • N – No
    • NA – Not Assessable because of absence of local guidelines for the specific indication
    • NI – No Information because diagnosis/indication is unknown

Please tick ‘No Information’ if the diagnosis is completely unknown or if the diagnosis is ‘Other’, in this case you cannot be certain whether the prescription is according to local guidelines.

Following the advice of an infectious disease specialist is considered as guideline-compliant.

Guideline compliance must be recorded for each antimicrobial: if one patient receives multiple antimicrobials, please assess for each prescription whether it was according to the local guidelines.

If multiple antimicrobials are prescribed for one diagnosis, but the guidelines recommend monotherapy, please score one of these antimicrobials as guideline-compliant (if the guidelines do recommend monotherapy with this antimicrobial) and score the other antimicrobials as non-compliant.

In the feedback report, we analyze guideline compliance at patient- & diagnosis-level:

  • If all antimicrobials are compliant for one diagnosis = treatment is guideline-compliant
  • If one antimicrobial is non-compliant but other antimicrobials are compliant for one diagnosis = treatment is not guideline-compliant

In the inpatient protocol, compliance to guidelines refers to the choice of drug, not the dosing, and also not the route of administration or duration of therapy. To keep it simple, in this case the treatment is according to the guidelines because the choice or type of antibiotic was according to the guidelines.

This question assesses whether an end date for stopping antibiotic treatment or prophylaxis, or a review date for re-evaluating it, is documented in the patient file or another written document. It must be recorded in writing, not just communicated verbally.

Specific scenarios to consider:

  • If the antimicrobial is prescribed ‘until cultures are ready’ or ‘awaiting infectious disease physician to review’, then the prescription will be reviewed later. In these cases, you can select ‘Yes’ for ‘Is a stop/review date recorded?’.
  • In case of an automatic stop order (ASO) of e.g. 3 days on all antibiotics/antimicrobials: according to the protocol, the stop or review date should be documented in the notes. If the day of therapy is displayed in the patient chart or medical record (e.g. ‘day 1 of 3’), answer ‘Yes’. However, if the day of therapy or duration of treatment is not explicitly stated in the record, answer ‘No’, even if the prescribing physician is aware of the ASO of 3 days.

The treatment should be considered as empiric:

  • When no microbiological examinations (culture and sensitivity testing) were done to guide treatment,
  • When microbiological examinations were done, but the results were not yet available at the time of the PPS,
  • When the results of the microbiological examinations were negative or not assessable (e.g. ‘no growth’).

The treatment should be considered as targeted:

  • When the treatment is based upon a positive microbiological result. This can be any culture and/or sensitivity result from a relevant clinical specimen. If a microbiological result is available at 8 a.m. on the day of the survey and the treatment is in line with this result, we assume there is enough evidence to say that the treatment is targeted.
  • If a specific microorganism has been identified and it is either susceptible, no specific resistance type was found, or sensitivity testing was not performed, you can still score the treatment as ‘targeted’ and complete the microorganism fields but leave the resistance type fields blank.

For prophylactic prescriptions (surgical or medical), score empiric treatment or leave this field open.

Specific scenarios to consider:

  • If the microbiological result is outdated and not currently relevant, then the treatment counts as empiric. If the microbiological result is old but still relevant, such as an ever-recurring infection, then the treatment counts as targeted.
  • In case the microbiological result is known, yet the antimicrobial treatment is not adapted to this result (e.g. not de-escalated) and hence is not the most appropriate choice, please still choose targeted treatment. You can still record the microbiological result data in the form. However, be sure to take this potentially inappropriate choice into consideration for the ‘Guideline compliance’ variable.
  • In case the microbiological result is obtained, but the treatment is not yet adapted to this result because the prescriber has not had the time yet at 8 a.m. to revise the prescription, please record the original antimicrobial prescription on 8 a.m. on the day of the survey and score this as empirical if the microbiological results were not available when this prescription was originally prescribed.

Choose up to three of the (most relevant) microorganisms found based on the microbiology results. Please find a list of all available microorganisms and resistance types to choose from in the Inpatient Data Collection Forms (Appendix IV) under Documents.

All relevant microorganisms should be reported, even if they are sensitive to all tested drugs. For sensitive microorganisms, do not fill in any resistance type. Please only fill in the resistance type fields if you have a confirmed resistance type (e.g. by antibiogram).

If you have any microorganism that is not included in this list, please choose ‘other Enterobacterales’, ‘other bacteria’ or ‘other fungi’. If you have any resistance type that is not included in the list, please choose ‘other MDRO’. 

Example:

  • Resistance types for Amp C-producers, such as Serratia marcecens, or Morganella morganii, fall under ‘other MDROs’.

All invasive devices that can be scored are the following, and can also be found in the HAI Inpatient Data Collection Forms under Documents:

  • Indwelling Urinary Catheter (UC)
  • Peripheral Vascular/intravenous Catheter (PVC)
  • Central Vascular Catheter (CVC)
  • Non-invasive positive and negative mechanical ventilation (CPAP, BiPAP, CNEP, etc.)
  • Invasive respiratory endotracheal intubation (IRI)
  • Inserted tubes and drains (T/D)

Example:

Invasive devices which can be scored are:

  • Percutaneous endoscopic gastrostomy (PEG) should be encoded as Tube/drain.

Invasive devices which should not be scored are:

  • Although a Nasogastric tube (NGT) and Nasojejunal tube (NJT) are essentially considered as an invasive device, these are not scored as Tubes and drains. They are not passing the skin as such where we want to make the relation with SST infections; and they do not belong to any other category either e.g. (not IRI)
  • Arteriovenous fistula is considered as a minimally invasive treatment option for hemodialysis, but is not scored as an invasive device for the Global-PPS.
  • The invasive device Port-a-Cath as an implantable venous port is not scored as a central line.

Data collection - Departments & wards

Total number of eligible patients = Total number of patients (whether on antibiotics or not, thus all patients) admitted and occupying a bed on the ward at 8 a.m. on the day of the survey.

Total number of beds = Total number of available beds on the ward, whether occupied or not.

The number of eligible patients, i.e. the first denominator, allows us to calculate antimicrobial use rates (N patients on antibiotics at 8 a.m. on the day of the survey / total number of patients present on the ward at 8 a.m. on the day of the survey).

The number of beds, i.e. the second denominator, allows us to calculate bed occupancy (N patients admitted on the ward at 8 a.m. on the day of the survey / total N beds available on the ward at 8 a.m. on the day of the survey).

The term ‘eligible’ refers to these admitted patients corresponding to the inclusion and exclusion criteria defined by the protocol . E.g. exclude outpatients, day hospitalizations, day surgery, and exclude patients admitted after 8 a.m. (all these patients are excluded from the denominator and of course also from the numerator).

Please use one Ward form and enter the department as one ward. On the Ward form, tick ‘mixed activity’. Collect the number of beds and number of admitted patients separately for each activity. E.g., if you have medical and surgical patients in one ward, count the number of medical beds, the number of admitted medical patients, the number of surgical beds and the number of admitted surgical patients, and fill this in on the Ward form.

For each patient, write down the appropriate activity on the Patient form.

Note: if you e.g. have medical patients in a surgery ward but they do not undergo surgery, please encode them as medical patients and define the ward as a mixed ward.

If you have a ward with mixed activities, but with no fixed number of beds attributed to both activities, please divide the empty available beds over the two activities using the ratio of admitted patients in both activities. E.g. if you have 30 beds, of which 20 occupied, where 16 patients are surgical and 4 are medical, then the number of beds attributed to surgery should be: 16/20 * 30 = 24. The number of medical beds are 4/20 * 30 = 6.

If you have many beds/admitted patients for each specialty, you can treat this department as if it were two different departments, i.e. create two Ward forms for this department and enter them separately into the application.

If you have very few beds for one of the specialties, or for all of the specialties, you can use one Ward form and enter the department as one ward. You can write down the specialty with the most beds and/or admitting the most patients.

Examples:

  • if you have a mixed PICU and NICU department with few (NICU) bed or admitted patients, please encode this as PICU department.
  • If you have a mix of pneumology and cardiology patients, please split them up if you have sufficient beds, since pneumology patients may have a different risk of being on antibiotics than cardiology patients.

Please complete the Ward form with the total number of beds and admitted patients, but do not fill in any Patient form. Please also enter this in the application in the same way: complete the Ward form, do not create any Patient forms. In your results, the antimicrobial use prevalence will be zero for this department.

Please fill in the correct, current names on the paper Ward form, and change the names under ‘Departments’ in the web-based application before you enter your survey data.

Please encode this ward as ‘CAR-AICU (Cardiac AICU)

Define the department as a NICU department (code NICU). For later analyses, you can define in the Ward name the highest level of specialty (NICU level 1, level 2 or level 3) or the level presenting the most patients if a NICU covers several levels.

  • NICU–level 1: Special care only Neonatal Units
  • NICU–level 2: Medium Neonatal Units. High dependency care + short term Intensive Care. Low birth weight newborns care.
  • NICU–level 3: Large Neonatal Units. Tertiary referral care. Very low birth weight care.

A Gynaecology-Obstetric ward may admit several types of patients among which 1) healthy pregnant women who have not yet delivered, 2) healthy women who have delivered, with their baby, 3) pregnant women in observation with pathology, 4) non-pregnant women admitted with a gynaecological pathology.

Encode this ward into two wards:

  1. Ward 1 counts all women whether they are pregnant or not, having a pathology or not. Encode this ward as AMW (Adult Medical Ward), with main activity Medicine. If a considerable number of surgery patients are admitted as well, count the attributable beds and patients with suspected or confirmed surgery and define the ward with MIXED activity (thus medicine and surgery). Attribute the number of beds and patients among the two different activities. Note: include also patients in the delivery room if they were present on the ward on the day of the survey at 8 a.m.
  2. Ward 2 counts all babies born before 8 a.m. on the day of the survey. Count the number of baby beds and the number of babies admitted (born) before 8 a.m. (=denominator). Encode this supplementary ward as a NMW (Neonatal Medical ward). Name this ward preferably ‘nursery’ ward.

Data can be entered within our online tool. Please find more detailed instructions in the user manuals in the application. To begin, ensure you’re logged in and have registered your institution. After that, select the appropriate survey period for which you collected data. Then, follow these steps for data entry: (1) create your departments under ‘Departments’, (2) create a new ward under ‘Surveys’ > ‘New ward’, (3) add new patients under ‘Surveys’ > ‘New patient’.

You can validate data by going to ‘Surveys’ > ‘Subscribed’ and clicking the validation button. A new page with validation errors will pop up, which you will first need to resolve before final validation. Please find more detailed instructions in the user manuals in the online tool.

Please note that you can only validate your data if you have entered at least 10 patients.

You can obtain the results in different ways: an Excel export, feedback slides, and customizable results in the interactive module.

The Excel file contains your raw data. In this file, each row is one antimicrobial prescription. Some variables will be automatically added, such as ATC-codes, AWaRe classification and DDDs. You can download this within the Global-PPS application.

You obtain the feedback report in a PDF-file, where all data are pre-analysed. You can download this feedback report after finalizing your units and survey. There are three reports you can download: (1) the one-point feedback report, with results for your hospital for one survey period, (2) the merged feedback report, with results for multiple hospitals you coordinate for one survey period, and (3) the longitudinal feedback report, with results for your hospital for multiple survey periods up until 2022. Please note the longitudinal feedback report is not supported after 2022, please use the interactive module for your longitudinal results.

The interactive module offers a customizable tool within the Global-PPS online tool, where you can easily create your own results. You can create longitudinal graphs for your hospital in this tool, adding additional filters as you like.

You can download all results from within our online tool:

  • Excel report: go to ‘Surveys’ > ‘Export’ and it will be automatically downloaded. If you wish to export your results for a different survey, first go to ‘Surveys’ > ‘Subscribe’ and select the appropriate survey under ‘Action’. Then download the export for this survey.
  • One-point feedback report: Go to ‘Surveys’ > ‘Subscribed’ and validate your data for the survey you wish to download your feedback report for. After validation, you can download the report by going to ‘Surveys’ > ‘Subscribed’ and then clicking the button under ‘Action’. Your feedback report will be sent to you by email.
  • Merged feedback report: Go to ‘Surveys’ > ‘Merged Feedback’ and select the hospitals and survey period for which you would like to download a feedback report. Your feedback report will be sent to you by email.
  • Longitudinal feedback report: Go to ‘Surveys’ > ‘Longitudinal Feedback’. Please note you can only download a feedback report for the years 2015-2022. Your feedback report will be sent to you by email.
  • Interactive feedback report: Go to ‘Surveys’ > ‘Interactive feedback’ and select the results you would like to see, including the additional filters you would like to apply.

Outpatient

Participation

All outpatient healthcare facilities can participate in the outpatient module, including outpatient departments, primary healthcare centres, dental clinics, day surgery wards, community healthcare centres, etc.

If you have a mixed facility or mixed departments, consisting of inpatient beds as well as outpatient beds/consultation rooms, please survey these activities separately in the Global-PPS. I.e., please survey all inpatient beds according to the inpatient module, and all outpatient beds/consultation rooms according to the outpatient module.

Pharmacies cannot participate in the Global-PPS, since our method is focused on prescribing and not dispensing patterns.

Patients

All patients seen in consultation for any reason (by appointment or without appointment) during a defined time slot of the survey. Exclude patients who are admitted as inpatients, who require overnight admission or stay.

Important exception: if you survey emergency or observation departments, please include all patients in the survey, even if they were admitted overnight, as long as they were still present in the department during the defined time frame of the survey. This exception is made since it is not always clear for emergency and observation departments if the patient will stay, be transferred to another department or sent home

No, you cannot make a selection of patients. It is important that you include all patients, with all diagnoses and symptoms.

We will make sure you can filter based on diagnoses/symptoms in the outpatient extension of the interactive module, once we release this extension.

The number of patients that you should survey is flexible, although we recommend surveying for at least 4 hours, and perhaps a full day or for a few days if you have very few patients that are seen for consultation throughout the day.

This also depends on the aim of your survey: if you want to design targets for antimicrobial stewardship, it is advisable to check if you have collected a sufficient number of patients who receive an antimicrobial prescription (e.g., 30 patients). In this way, it will be easier to see if there is a certain pattern of prescribing. If you have an insufficient number of patients on antimicrobial prescriptions, it might be difficult to distinguish whether this prescription was in line with the normal prescribing behaviour in your setting, or if it was an exception.

If you want to do a very first screening of your healthcare setting to see where the most antimicrobials are prescribed, you may need a smaller number of patients with antimicrobial prescriptions than when you want to effectively design targets for stewardship.

Departments

All outpatient departments, emergency/observation departments, general practitioner practices, dental clinics, day surgery departments, general outpatient clinics, community healthcare centres, etc., can participate.

If you have, for example, departments with both inpatients and outpatients, you can split them up and survey the outpatients in the outpatient module. There is one exception: for emergency and observation wards. These wards have to be surveyed entirely in the outpatient module, and you will have to score the admission status for each patient.

Yes, certainly. All outpatient departments, emergency/observation departments, general practitioner practices, dental clinics, day surgery departments, general outpatient clinics, community healthcare centres, etc., can participate.

No, we do recommend to survey all departments in your institution the first time you participate, to set a baseline for your entire institution. However, it is possible to survey only a few departments in your hospital. Keep in mind that you should survey all departments of the same specialty type, because we report the numbers by specialty type in the feedback report.

Each year, there are three survey periods: January-April, May-August, September-December.

In the outpatient module, you can participate multiple times per period, if you wish to do so. Data within one survey will be aggregated in the feedback report. However, if you wish to analyse your data at more frequent intervals than these three periods, you can download your data in Excel.

The best time to conduct a survey is on a day that is representative for your usual practice. Often, this is a weekday, not during the weekend and not on a holiday.

Please choose a time period that is most representative of your setting. If regular consultation hours are between 8 a.m. and 5 p.m., it would be best to survey in that period.

If patients need to remain after their consultation, for example, to await biomarker test results or advice from an infectious disease specialist, ensure that you follow up with them until their treatment for the survey day is confirmed. Make sure to schedule the survey during a time frame that allows you to reliably follow up with each patient until their final treatment is determined.

For example, if you often have to wait a few hours before the result of a biomarker is obtained when the treatment depends on that result, survey from e.g. 8 a.m. until 12 p.m., and follow-up all patients that were seen during this time, so that you know the results by the end of the day.

Alternatively, if you capture all information in patient files, you can retrospectively survey your institution.

Yes, you can definitely collect data retrospectively, as long as you can retrieve all required information from the patient files, and as long as you survey for a consecutive period of at least 4 hours. It is important that you include all patients seen in your survey window, including patients without an antimicrobial treatment.

Please additionally make sure that all biomarker/POCT/RDT results were available at the time of the prescription. If not, please record ‘Treatment based on [biomarker][POCT/RDT]’ as ‘No’.

No, you can survey different departments on different days. But you should survey one entire department on one day.

This depends on how busy your department is. For very busy departments, it might be sufficient to survey for 4 hours. For less busy departments, it might be necessary to survey for one or multiple days, until you reach a sufficient number of patients for the analysis.

The number of patients you should survey is flexible, although we recommend that you survey e.g. at least 30 patients receiving antimicrobial treatments, in order to obtain valid results.

Yes. Unlike the inpatient module, it is possible in the outpatient module to survey multiple times within one survey period. If you want to do so, you can include the unit multiple times within one survey.

Data within one survey will be aggregated in the feedback report. However, if you wish to analyse your data at more frequent intervals than these three periods, you can download your data in Excel.

Data collection - General

Essential data to collect are the patients’ age category, sex and presenting symptoms. Data on admission status should be additionally collected for emergency and observation departments.

More detailed information should be collected for each patient receiving antimicrobial treatment. This includes information on their specific age and underlying morbidities, as well as treatment-related information, such as:

  • the specific antimicrobial agent,
  • dose per administration,
  • number of doses per day,
  • route of administration,
  • anatomical site of infection,
  • indication of therapy (community- versus hospital-acquired infection or prophylaxis)
  • whether the treatment was based on a Point-of-Care test, Rapid Diagnostic Test or biomarker, whether (blood) cultures were taken before the start of the treatment
  • whether local guidelines are available for the prescribed treatment.

Denominator data are the number of patients that visited the department in the surveyed time slot on the day of the PPS.

There are two methods for data collection: on paper forms before data entry in the web-based application, or directly in the web-based application.

  1. Data should be recorded on the Unit forms and Patient forms. Please find all forms under Documents. Please print these forms in preparation of the survey, and collect all information on these forms. Afterwards, you can enter them in the web application.
  2. Alternatively, it is possible to record all data directly into the web-based application.

Yes, the Unit forms and Patient forms. Please find all forms under Documents. Data entry into the web-based application follows the same logic as these data collection forms.

Data collection - Patients

You can include up to 6 symptoms per patient, but it is perfectly fine to record only the most relevant symptoms. The list with symptoms is available in our protocol and data collection forms, available under Documents.

Admission status is a question only asked for emergency and observation wards. Please only collect this information if your patient was seen in an emergency or observation ward. Otherwise, you do not need to collect this information.

If your patient was seen in emergency or observation care, you should collect this information for all patients, including those without antimicrobial prescriptions.

Please choose between the following options:

  • Already admitted if the patient was admitted in the same institution
  • Suspected admission if you strongly suspect the patient will be admitted, but this did not happen yet during the survey period
  • Referral to another institution if the patient was referred to another institution
  • Home if the patient was sent home
  • Unknown if it is completely unknown what happened to the patient, e.g. this was not recorded during data collection

You should consider a treatment based on a biomarker if the result of the biomarker is available at the time of the prescription on the day of the survey, and if the result solely or complementary to other clinical signs or microbiological tests contributed to the decision to treat with an antimicrobial and/or to the choice of a treatment.

Example:

  • If CRP results are used as an indicator for the presence of an infection, and hence supported the decision to start an antimicrobial treatment, you can score this treatment as based on a biomarker, even though the CRP result is not used for the choice of the antimicrobial drug.
  • If a biomarker result was obtained the day after the survey, or a few days after the survey, and was used for review and follow-up of the antimicrobial treatment, score the treatment as not based on a biomarker, i.e. treatment based on a biomarker is ‘no’, because this result was not available during the survey.

At this moment, it is unfortunately not possible to record this information. Please record all new prescriptions, these will likely provide useful information for your facility.

In the future, we are planning to develop an ‘Outpatient institution profile’, where you can add more detailed information for your healthcare setting, such as lack of information on ongoing/previous antimicrobial prescriptions.

If an antibiotic with enzyme inhibitor was prescribed, such as piperacillin with tazobactam, or amoxicillin-clavulanate, please record only the dose of the antibiotic. Exclude the dose of the enzyme inhibitor. For example:

  • 3.375 g piperacillin/tazobactam, of which 3 g is piperacillin. Only these 3 g should be reported.
  • 1.2 g amoxicillin/clavulanic acid, of which 1 g is amoxicillin. Only the 1 g should be reported.

For fixed-dose combinations of active antimicrobials (such as co-trimoxazole), please record the dose of both antimicrobials!

For fixed-dose combinations of active antimicrobials, such as sulfamethoxazole and trimethoprim (co-trimoxazole), please record the dose of both antibiotics. For example:

  • 960 mg co-trimoxazole, of which 800 mg is sulfamethoxazole and 160 mg trimethoprim. You should report the 960 mg.

Please record fixed-dose combinations as one antimicrobial in Global-PPS! For these combination therapies, add the dose of the first antimicrobial (800 mg) to the dose of the second antimicrobial (160 mg).

Exception: if a physician prescribes two antimicrobials for one diagnosis, but this is not a fixed-dose combination (e.g. amoxicillin and clarithromycin), you should record this as two separate antimicrobials for the same diagnosis, and record for each their own dose.

A few examples of fixed-dose combinations include

  • Sulfamethoxazole and trimethoprim
  • Artesunate and amodiaquine
  • Ampicillin and cloxacillin (“Ampiclox”)
  • Rifampicin, isoniazid, pyrazinamide, and ethambutol
  • Emtricitabine, tenofovir alafenamide and rilpivirine

If a patient receives an ongoing antimicrobial treatment a few times a week, e.g. 3 times a week (even if the patient does not receive the treatment on the day of the survey itself), you should write down the single unit dose as the actual dose that the patient receives, but change the N doses/day to 0.5 (every other day), 0.43 (twice a week), 0.33 (every 72 hours), 0.29 (twice a week), 0.14 (once a week), etc.

Examples:

  • 500 mg every other day: Single Unit Dose = 500 mg. N doses/day = 0.5 (= 1 dose / 2 days)
  • 750 mg every 72 hours: Single Unit Dose = 750 mg. N doses/day = 0.33 (= 1 dose / 3 days)
  • 2 g every week: Single Unit Dose = 1.2 g. N doses/day = 0.14 (= 1 dose / 7 days)
  • 1 g twice a week: Single Unit dose = 1 g. N doses/day = 0.29 (= 1 dose / 3.5 days)

Please record the diagnosis as the reason to treat the patient. For the diagnostic code, use the list of diagnostic codes in the Outpatient Patient Forms (Appendix I), which is categorized by anatomical site and which you can find under Documents.

Choose the most applicable option if the antimicrobial was prescribed for more than one reason. Request additional information from doctors, nurses, or pharmacists if needed. If there is no ‘most applicable option’, you could choose the first identified infection, or you would simply have to make a choice.

If a patient has sepsis with a known origin, such as urosepsis, please choose the appropriate anatomic site for the diagnostic code . Do not choose the code sepsis, since this code is only meant for cases of sepsis where the anatomic site is unknown.

For example: For patients with urosepsis, this would be Pye/Cys (preferably Pye, since this will more likely cause sepsis). For patients with meningitis, please choose CNS.

If an incorrect diagnosis was made, e.g. due to incorrect interpretation of diagnostic tests, and this was discovered during the audit, please continue in the PPS as if the correct diagnosis was made: consider the given diagnosis at the time of prescription during the survey for the guideline compliance, reason in notes, etc.

If the incorrect diagnosis and consequently the prescription might be harmful in any way for the patient, please inform the prescriber immediately to safeguard patient care. Please record the original (incorrect) diagnosis in the survey, even if this diagnosis and treatment were later changed, since this would have been the practice if the auditor had not informed the prescriber.

By definition, if the patient has been discharged from the hospital < 48 hours and has a known hospital infection or a new infection < 48 hours after discharge from hospital, this classifies as a hospital-associated infection. Additionally, if the patient develops an infection >48 hours after admission and is still admitted, it counts as hospital-associated infection.

If the patient develops symptoms >48 hours after discharge, or within the first 48 hours of admission, then it classifies as a community-acquired infection.

Exception: if a patient was re-admitted with a surgical site infection, this is by definition code HAI.

Examples:

  • If a patient comes in for consultation with an infection, and has not been admitted/discharged for >48 hours before their consultation, then this infection counts as a community-acquired infection.
  • If a patient comes in for consultation with an infection but was discharged the day before, it counts as a hospital-associated infection.
  • All early-onset sepsis (i.e. at age <48 hours) is classified as community acquired (CAI) according to the protocol.
  • If a patient comes in for consultation with a suspected infection and was on dialysis, chemotherapy or was a recipient of OPAT in the past month, you should still classify this as CAI, since the patient was not admitted for any of these therapies. Outpatient related infections are not defined in the Global-PPS, therefore, to keep it simple, please record this as CAI.
  • If a patient comes back 4 days after (inpatient or outpatient) surgery with a surgical site infection, this is classified as HAI1.

No, you can only score one reason to treat. You cannot score multiple diagnoses and indications. If your prescription was based on multiple diagnoses and indications, please choose the most relevant one.

Please choose for the Diagnostic code the prophylaxis option for the most appropriate anatomic site. When the prophylaxis is for general use, not targeting a specific organ or site, please choose Medical Prophylaxis in General (MP-GEN).

After choosing the appropriate diagnostic code, select ‘Indications’ to record whether it concerns a Medical or Surgical Prophylaxis. For Surgical Prophylaxis, additionally choose between a single dose Surgical Prophylaxis (SP1), one day Surgical Prophylaxis (SP2), or >1 day Surgical Prophylaxis (SP3).

Examples:

  • Please choose Prophylaxis for Respiratory pathogens (Proph RESP) if e.g. azithromycin is prescribed as prophylaxis for exacerbations of COPD. Since this is not prescribed as surgical prophylaxis, please choose Medical Prophylaxis as Indication.
  • Please choose Prophylaxis for Gastro-Intestinal pathogens (Proph GI) if e.g. amoxicillin clavulanate is prescribed as prophylaxis for elective abdominal surgery. Please choose Surgical Prophylaxis as Indication.

Reason in Notes captures information on whether the reason for prescribing an antimicrobial  is documented in the notes (medical, nursing, or other files) at the start of the treatment. It must be clearly written down so anyone (e.g. replacing clinician or other staff member) can easily understand the rationale when consulting the medical or nursing files. 

Example:

  • Even if all staff are aware that e.g. amoxicillin-clavulanate (Augmentin) is prescribed for pneumonia in a certain patient, but this is not recorded in the patient’s files, you should score ‘no’ for Reason in Notes.
  • If the reason is very briefly but clearly described somewhere in the patient’s files, please score ‘yes’ for Reason in Notes.
  • If the prescriber did not record it, but e.g. the nurse or pharmacist recorded the reason for prescription, then the reason is still visible in the patient’s files, which is the aim of this variable. In this case, score ‘yes’ for Reason in Notes.
  • If a surgery report includes a section listing all administered medications, you can mark ‘yes’ for Reason in Notes if an antimicrobial is present, even if it is not explicitly labelled as surgical prophylaxis. It is reasonable to assume that the antibiotic was given for this purpose, given its context within perioperative care.

The local guidelines considered in the Global-PPS are any institution guidelines, national guidelines, WHO guidelines, or e.g. the WHILE App or any book that is used in the institutions.

Please choose between the following options: Yes, No, Unknown, No information. No information is chosen when the diagnosis is completely unknown. Unknown is chosen when it is truly not known whether guidelines exist for the diagnosis, but please first check with the prescriber, or any physician, nurse or pharmacist within the institution to see whether there are any guidelines available.

If guidelines exist, you will need to assess whether the drug, dose, duration and route of administration was according to these local guidelines.

You can consider a prescription as guideline complaint when the prescription is for example adapted to the antibiogram, according to the weight or renal function of your patient, and/or following the advice of an infectious disease specialist who is the expert in the institution.

Choose between: Yes, No, Not assessable, Unknown. Not assessable can be chosen when guidelines exist, but do not describe the guideline for e.g. route of administration, even though they do describe the guideline for drug and dosing.

Please consult the prescriber or other prescribers in your institution for the guideline compliance assessment. It might be the case that the written guideline is not followed, but that the prescription was adapted based on the antibiogram/consult of ID specialist/etc.

Guideline compliance must be recorded per antimicrobial prescription: if one patient receives multiple antimicrobials, please assess for each prescription whether it is according to the local guidelines.

If multiple antimicrobials are prescribed for one diagnosis, but the guidelines recommend monotherapy, then please score one of these antimicrobials as guideline-compliant (if the guidelines do recommend monotherapy with this antimicrobial), and score the other antimicrobials as non-compliant.

In the feedback report, we analyze guideline compliance at patient- & diagnosis-level:

  • If all antimicrobials are compliant for one diagnosis = treatment is guideline-compliant
  • If one antimicrobial is non-compliant but other antimicrobials are compliant for one diagnosis = treatment is not guideline-compliant

Data can be entered within our online tool. Please find more detailed instructions in the user manuals in the application. To begin, ensure you’re logged in and have registered your institution. After that, select the appropriate survey period for which you collected data. Then, follow these steps for data entry:: (1) create your departments under ‘Departments’, (2) create a new unit under ‘Surveys’ > ‘Outpatient module’, (3) add new patients under ‘Surveys’ > ‘Outpatient module’ in the appropriate unit.

This depends on the availability of your data. If you have already collected all data on paper forms, it takes approximately 1-2 minutes to enter the data for a patient with an antimicrobial prescription, and (less than) a minute to enter the data for patients without an antimicrobial prescription.

If you want to enter the data directly in the web-based tool without collecting it first on paper, the time it takes to enter your data depends on whether you have to ask the patient all required information, if you have to look the information up from the patient file, and how organized and accurate your patient files are.

It can take ±3-8 minutes to enter the data of each patient with an antimicrobial prescription, again depending on how long it takes to ask the patient or to look up their file in the system of your institution. It usually takes 1-2 minutes to enter patients without antimicrobial prescriptions, since only a few questions are asked.

Yes, you can edit patient information at any time before the survey is closed.

If you collect patient information on paper forms, ensure that you write the survey number automatically assigned to each patient in the web-based application once their information is entered. This allows you to trace which patient corresponds to the data in the online tool. Since the online tool does not allow entering an institution identifier, it’s essential to record the assigned survey number on the paper form. If you have finalized your unit or finalized the survey and you still want to make edits or correct data, you can re-open the survey and re-open the unit before making any edits.

If the survey is closed, you can contact us at global-pps@uantwerpen.be with the question to re-open the survey.

You can obtain the results in different ways: an Excel export, and feedback slides.

The Excel file contains your raw data. In this file, each row is one antimicrobial prescription. Some variables will be automatically added, such as ATC-codes, AWaRe classification and DDDs. You can download this within the Global-PPS application.

You obtain the feedback report in a PDF-file, where all data are pre-analysed. You can download this feedback report after finalizing your units and survey.

You can download all results from within our online tool:

  • Excel report: go to ‘Surveys’ > ‘Export’ and it will be automatically downloaded. If you wish to export your results for a different survey, first go to ‘Surveys’ > ‘Subscribe’ and select the appropriate survey under ‘Action’. Then download the export for this survey.
  • One-point feedback report: Go to ‘Surveys’ > ‘Outpatient module’ and finalize your units and your survey if you have not yet done this. Then, a new button will appear: ‘Generate feedback’. After clicking this, your feedback report will be sent to you by email.

Data security and privacy

Your hospital collects and enters the data (patients, treatments, etc.) and remains responsible for it at that stage. Ownership of the data stays with your hospital throughout. Once it’s uploaded, the University of Antwerp/Global-PPS stores and manages it as a separate, independent party. The two roles are kept clearly apart, and the link between a patient’s identity and their record is never part of what gets uploaded, it stays with your hospital.

After you log in and enter data, it travels over a secure, encrypted connection to the Global-PPS platform. There, a series of checks verifies that the information is complete and consistent. The data is then stored in the University of Antwerp’s own secure data centre — never on a personal laptop or a personal local computer — under the university’s security policies.

If we notice something unusual, the Global-PPS data webmasters will contact you directly to clarify. Any correction is always made in consultation with you, the person who entered the data. Nothing is silently changed.

Yes. You can ask for confirmation of what data is held about you, request corrections if something is inaccurate, and request erasure under certain conditions. You can also export your own data in a structured, machine-readable format (Excel).

No, not unless your hospital and Global-PPS explicitly agree to it. Any such sharing is formalised in a separate Data Sharing Agreement, it never happens automatically or by default.

No. Global-PPS relies on pseudonymization: names and other direct identifiers are never stored, and each patient is assigned a randomly generated ID instead. Only your own hospital keeps the key that links that ID back to a real patient file — Global-PPS itself never has that link.

Access to your hospital’s data is strictly restricted to authorized users from your hospital. Beyond that, only Global-PPS researchers can work with the pooled data, and even they only access it under controlled conditions.

The same core GDPR rights apply throughout: the right to know what’s stored, the right to have inaccurate data corrected, the right to request erasure, and the right to export the data in a portable format.

The connection between your device and the Global-PPS platform is encrypted, so data can’t be intercepted in transit. Post-quantum encryption — a stronger standard designed to resist even future quantum-computer attacks — is currently being rolled out.

All stored data is encrypted, so even in the unlikely event someone gained unauthorised access to the database, they wouldn’t be able to read it. The University of Antwerp’s data centre itself is also physically secured, with access control, locks, and camera surveillance.

Think of it like the layers of an onion, protecting the core (the application and database) from the outside in: a physical layer (the data centre building), a network layer (firewalls, VPNs, intrusion detection), an application layer (password rules, secure coding, role-based logins), a data layer (encryption), and a human layer (staff awareness of security risks).

Yes — access requires authenticated credentials and follows password policies, , so users only see what they’re entitled to see. Multi-factor authentication is planned as an additional layer going forward.

No, we do not use AI to process any data yet, though the use of artificial intelligence to help improve efficiency, for example by flagging inconsistent data entry, is likely to be implemented in the near future. It is important to note, however, that we are NOT considering the use of Autonomous AI (the so-called AI Agents). Decisions involving sensitive information are always kept firmly under human and security oversight.