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 الملفات > ‘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 الملفات > ‘antimicrobial list’.

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 1^st 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.

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 should be recorded in the Ward forms and Patient forms. Please find all forms under الملفات. 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 (see FAQ section on ).

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 الملفات.

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 الملفات).

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:

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’.

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 ‘Other’ (and the indication ‘).
• 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.

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 الملفات.

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 الملفات:

• 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.

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. For us, it does not matter what the typical activity of the ward is. It only matters what type of activity the patients receive.

Example:

• If a patient develops a surgical site infection after surgery and is admitted in the hospital, you should classify this patient under activity Medical if the patient was already admitted as medical patient at 8 a.m. on the day of the survey. Define this ward then as a mixed ward. If the patient underwent surgery at 8 a.m. on the day of the survey and was not yet admitted, please classify this patient under activity Surgical.

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.

Encoding the CCU depends on the level of service offered:

• If it is a slightly more caring ‘general cardiac medical ward’ with (some) monitored beds it is medical. Encode as an AMW (Adult Medical Ward) with activity Medicine.
• If the ward has a doctor at all times and the nurse-to-patient ratio is 1:3 or better (1:2 or 1:1) then it is an adult-ICU. Encode as AICU (Adult Intensive Care Unit) with activity Intensive Care.

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 web application. 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 web application.

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 web application, 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 web application:

• 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.