INTRODUCTION Healthcare‐associated infections (HAI) are a major public health problem affecting more than 90,000 patients on any given day in European acute care hospitals, which results in an estimated 4.5 million cases each year (1). HAI are associated with increased morbidity and mortality (2). Data on attributable mortality are limited, hampering accurate estimates of the burden of HAI. The attributable mortality of HAI is difficult to assess because of various competing causes of death in severely ill patients, especially in intensive care units (ICU). In addition, death is a consequence of events that occur over a period of time, which is usually not well addressed in statistical models. Attributable mortality of HAI is usually estimated by calculating the difference in the relative risk of death between patients with and without HAI from comparative studies or by modelling approaches (3‐8). However, statistical approaches are not easily applied in individual hospitals as they require detailed data on a cohort of patients and statistical expertise. Potential sources of bias, such as heterogeneity in multicentre studies and time‐ dependency of the observed outcome, need to be taken into account (5, 9), and the results can be difficult to assess, as they depend primarily on the availability of data on risk factors. Another approach to estimate the attributable mortality of HAI is to perform mortality review studies that entail a descriptive evaluation, for each patient who died with an HAI, of the likelihood that the HAI contributed to the death of the patient according to clinical judgement. The European Centre for Disease Prevention and Control (ECDC) coordinates the European Healthcare‐Associated Infections surveillance Network (HAI‐Net). In 2013, the European Commission requested that the ECDC should collect additional data on mortality from HAI. To address the request, ECDC introduced mortality review into the HAI‐Net surveillance protocols with a measure that categorises the contribution of an HAI to death in three categories: no contribution, possibly contributed and definitely contributed, based on the work of Kaoutar et al (10). As the validity of mortality reviews has never been established (e.g. through autopsy studies) and standardisation of the criteria and review process across hospitals and countries would be necessary, ECDC initiated a study to evaluate the validity, feasibility and reproducibility of the review measure. METHODS Preparation An expert panel was established to support the project group in developing the study 6 107 Mortality review reproducibility study
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