In the spring of 1990, I took my first trip to Veyrier-du-Lac, France to participate in the first Cours Europeen D'Hospitologie, a course on hospital-acquired infections for French physicians, organized by Dr. Jacques Fabry with the support of Fondation Mérieux. I was only a few months in my position as Chief of the Surveillance Activity of CDC’s Hospital Infection Program, although I had served as Hospital Epidemiologist at the University of Michigan Hospitals for the previous four years. I had also been an EIS Officer in CDC’s Hospital Infection Program in the early 1980s as part of my training, so I was familiar with the topics that I was asked to discuss at the course. For me, it was an opportunity to collaborate with colleagues in Europe and teach. Recent correspondence with the course organizer, Dr. Fabry, has helped me reflect on and recognize the profound impact of the efforts.
The topics of my talks at the course were the importance of surveillance of hospital acquired infections, the CDC surveillance protocols and related prevention measures at each site of infection such as primary bloodstream infection and urinary tract infection. CDC has long recognized the importance of surveillance in public health1. In 1970, CDC began a structured surveillance system for monitoring hospital-acquired infections in U.S. hospitals known as the National Nosocomial Infection Surveillance (NNIS) system2. The NNIS system was the first of its kind and required the use of uniform definitions, standard case-finding procedures, and risk stratification to generate data that were fed back to participating institutions that were used as benchmarks, and provided national data on hospital infections. The system grew from 19 hospitals to over 300 hospitals in the early 2000s. In 1986, NNIS moved away from a hospital-wide surveillance requirement for participation to focused surveillance, adding adult and pediatric intensive care units, high-risk nursery, and surgical patient components3,4,5.In 2005, the NNIS system was replaced by the National Health Safety Network (NHSN) and continues to be a reporting system that monitors components of Healthcare-Acquired Infections (HAIs) including those in hospital settings6.
Technical issues aside, demonstrating that the CDC undertook the venture of setting up a national program to monitor and control healthcare-associated infections in the United States was the element that had lasting influence. At the time, the political institutions in France (and other European countries) were still reluctant to place resources in a national program. I remember the presence of a representative of the French Ministry of Health at that first course. The attendance of this representative contributed to my intense anxiety when I got up to speak. However, most of that anxiety derived from giving my introduction in my meager French to French people! I can still recall the look of surprise on Dr. Fabry’s face as I spoke in french. I also vividly remember my surprise (and relief) with the applause that I received from the audience after my introduction! I realized that my small effort had the desired effect—to help forge a cooperation and lasting friendship between our countries and between Dr. Fabry and myself.
As two French physicians wrote, “Until the early 1990s, the development of infection control (IC) and hospital hygiene policy had been unacceptably delayed in France.”7 The French Ministry of Health representative convulsively took notes during that first course, which had an effect. In 1992, the French Ministry of Health created a national committee and five regional (interregional) centers for hospital-acquired Infection Control (IC) in order to define, coordinate and implement a national IC policy.7
I was to teach and help organize the next five courses at Veyrier-du-Lac, each year with both French physicians and physicians from an expanding array of European countries including Italy, Spain, Belgium, Switzerland, and Germany. During the 1990s several European countries began to set up national or regional networks for the surveillance of hospital acquired infections. Most of these networks were based on the CDC’s NNIS model. Hospitals in Europe Link for Infection Control through Surveillance (HELICS) was an international partnership of national and regional networks organized by the network coordinators, which ran for 15 months from October 1994 to December 19958. I attended the first HELICS meeting in Brussels as the only American. According to Dr. Fabry, “The US example was very motivating... [the participating European countries] have all been led to follow the CDC's lead. The presence of CDC [at the course shows how] CDC can rise to the challenge in healthcare, and how cooperation between nations is so essential for the future of health.”9
At the time, I was unaware of the effect that my presence—really the CDC presence--would have. Often, one needs a greater perspective to fully understand the impact. I feel an immense pride to have been part of those courses and to know how important they were in France and other countries.
CDC has traditionally been involved in the control of healthcare-associated infections through various international initiatives, which is vital to public health. Unfortunately, that involvement is threatened. The Trump administration has made significant changes at CDC including abolishing the Healthcare Infection Control Practices Advisory Committee (HICPAC), a federal advisory committee that provided guidance and recommendations to the CDC and the U.S. Department of Health and Human Services (HHS) on infection control practices in healthcare settings. Members of CDC are now restricted from travel and making public presentations at meetings. New CDC websites are prohibited, although updates of current sites may still occur. Substantial reductions in personnel at CDC have already occurred with the potential for more in the future. As The Infectious Diseases Society of America recently stated, “The elimination of large swaths of highly trained and dedicated employees at Health and Human Services and throughout the agencies it oversees, including the National Institutes of Health, the Centers for Disease Control and Prevention, the Food and Drug Administration and other offices responsible for protecting America’s health, is counter to the goal of keeping America healthy.”10 As this example demonstrates, decreasing CDC presence will affect not only America’s health but the health of rest of the world.
Notes :
1- Gaynes R. History of Infection Control in the United States. Hygiènes. 2018;26(4):23-28.
2- Emori TG, Culver DH, Horan TC, et al. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control. 1991;19(1):19-35.
3- Jarvis WR, Edwards JR, Culver DH, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med. 1991;91(3B):185S-191S.
4- Gaynes RP, Edwards JR, Jarvis WR, et al. Nosocomial infections among neonates in high-risk nurseries in the United States. National Nosocomial Infections Surveillance System. Pediatrics. 1996;98(3):357-361.
5- Horan TC, Culver DH, Gaynes RP, et al. Nosocomial infections in surgical patients in the United States, January 1986-June 1992. National Nosocomial Infections Surveillance (NNIS) System. Infect Control Hosp Epidemiol. 1993;14(2):73-80.
6- National Healthcare Safety Network (NHSN). Patient Safety Component. NHSN: janvier 2025. 458 p. Available from : Manualhttps://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf (Accessed 2025 Apr 22).
7- Astagneau P, Brücker G. Organization of hospital-acquired infection control in France. J Hosp Infect. 2001;47(2):84-87.
8- Mertens R, Van Den Berg JM, Fabry J, Jepsen OB. HELICS: a European project to standardise the surveillance of hospital acquired infection, 1994-1995. Euro Surveill. 1996;1(4):28-30.
9- J. Fabry. Personal communication
10- Infectious Diseases Society of America. Statement on April 1 HHS Job Cuts [Internet]. Available from : https://www.idsociety.org/news--publications-new/articles/2025/statement-on-april-1-hhs-job-cuts/ (Accessed 2025 Apr 22).