Infections and Antibiotic Use in Long-Term Care Facility Residents: HALT-4 Point Prevalence Survey in EU/EEA Countries 2023–2024

This is the fourth time the ECDC has conducted a prevalence study on healthcare-associated infections and antibiotic use in European LTCFs (HALT-4). The survey collected data from over 66,000 residents and 1,097 LTCFs in 18 EU/EEA countries during 2023 and 2024.

Approximately 3% of residents in participating countries had at least one HAI, the most common being urinary tract infections (UTIs), respiratory tract infections (RTIs), and skin infections. In Iceland, the proportion of residents with a recorded infection was 3.5%.

More than 4% of residents in EU/EEA countries were receiving one or more antibiotics at the time of the survey, with nearly one-third of antibiotics being administered prophylactically. UTIs were the most common indication for both treatment and prophylactic use.

In Iceland, about 7% of LTCF residents were receiving one or more antibiotics. Over half of all antibiotics in Icelandic LTCFs were given prophylactically, which is high compared to other EU/EEA countries. Nearly half of these were used to prevent UTIs.

Only 19% of LTCF staff in Iceland had been vaccinated against seasonal influenza , and 8% against COVID-19—figures that are low compared to other EU/EEA countries (30% vaccinated against influenza, 82% against COVID-19).

The survey also assessed infection prevention and control (IPC) measures and whether antibiotics were used appropriately. Although most facilities in EU/EEA countries had hand hygiene protocols, more than 20% lacked staff specifically trained in IPC. Fewer than half had an IPC committees, and nearly 40% had no antimicrobial stewardship program.

Four out of five LTCFs in participating countries used hand sanitizer as the main method for hand hygiene, while one-fifth primarily relied on handwashing with soap and water. However, nearly one-third of facilities lacked regular monitoring of hand hygiene and did not routinely provide feedback to staff.

Following this survey, the ECDC urges national health authorities and LTCF managers to:

• Strengthen IPC in LTCFs through staff training, improved monitoring, and clear guidelines.

• Implement hand sanitizer as the main hand hygiene method and launch awareness campaigns about its importance in preventing infections.

• Develop and implement strong antimicrobial stewardship programs to promote prudent antibiotic use, especially for prophylactic use.

These actions are essential to improve the health of LTCF residents and to combat the spread of antimicrobial resistance in Europe.

The Chief Epidemiologist