Mandatory Surveillance of Healthcare Associated Infections HCAI

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Mandatory Surveillance ofHealthcare Associated
Infections (HCAI)
Srilaxmi Degala Information Officer Health
Protection Agency East Midlands
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Mandatory Reporting of HCAI

• Undertaken by Health Protection Agency for Dept
  Health
• Meticillin Resistant Staphylococcus aureus
  (MRSA)
• Glycopeptide Resistant Enterococci (GRE)
• Clostridium difficile
• Surgical Site Infections (SSI) orthopaedic

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MRSA/GRE Data collection

• MRSA/GRE
• Quarterly collection taken place since April 2001
• By acute trust and now reported on the HPA web
  site by named trust
• MRSA only
• Enhanced web based surveillance since Oct 2005
• Called HCAI Data Capture Site

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Mandatory reporting of MRSA and GRE bacteraemias
Quarterly Data Collection

• Key data sets
• Number of blood culture sets examined
  (including duplicates)
• Number of positive cultures
  (all organisms, inc. contaminants and duplicates)
• Number of S. aureus blood cultures
  (de-duplicated)
• Number of MRSA blood cultures (de-duplicated)
• (Note for GRE the speciality is provided)

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Mandatory reporting of MRSA and GRE bacteraemias
Denominators

• Expressed as
• Proportion of Trust activity (from KH03 data
  returns) - All wards, average occupied bed days
  (not inc day cases)
• Results produced by Trust
• As MRSA blood cultures per 10,000 bed days
• All MRSA bacteraemias to be includedi.e. Trust
  plus any from the community or transfers

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Rate of MRSA per 10,000 bed days by East
Midlands NHS Trusts April 2001 to September
20066 monthly analysis
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Process control chart Graphical example
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MRSA Enhanced Surveillance HCAI Data Capture
System
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MRSA Enhanced Surveillance - Mandatory Fields

• ID
• Owner
• Date Entered
• Last Update
• Date Shared
• Region Code
• SHA Code
• Trust Code
• NHS No
• Hospital No
• Lab No
• Forename
• Initial
• Sound Ex
• DOB
• Date Admitted
• Date Specimen
• Date Specimen Type
• Week No

• Place Admitted From
• Hosp Admitted From
• Admitted From Other
• Specialty Code
• Specialty
• Treatment Specialty Code
• Treatment Specialty
• Aug Care Code
• Aug Care
• Hospital Code
• Hospital
• Sex
• Lab Code
• Other Lab
• Patient Category
• Patient Category Other
• Specimen Location
• Specimen Location Other
• Non UK Country

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MRSA Enhanced Surveillance Data Input Screen
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MRSA Enhanced Surveillance Data Input Screen
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MRSA Enhanced Surveillance Typical Summary
Report
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MRSA Enhanced Surveillance Example of Line
Listing
Theres more that way
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MRSA Enhanced web based system- Summary

• Allows more information to be recorded about
  the cases
• Gives more timely information
• Provides enhanced information of trust v
  community v transferred cases, speciality etc
• Nationwide

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Reporting MRSA/GRE

• Nationally published on HPA website
• GRE published annually as the number of cases
• MRSA published quarterly as numbers of cases,
• 6 monthly rates and annual rates.
• Locally
• HPA Feedback to Trusts quarterly
• Process control chart - to help monitoring

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Mandatory Surveillance of C difficile - Data
collection to March 2007

• Collected quarterly via CoSurv ( an electronic
  data collection system from
  microbiology laboratories) and checked
  with lab
• Data - collected on patients ?65
  years
• - faecal specimens
• - de-duplicated at 28 days
• Collated at HPA Regional Office and sent to HPA
  Centre for Infection for analysis
• Denominator is per 1000 bed days of patients
  aged ?65 years

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C difficile Data reporting

• Nationally
• Published on HPA website, by number of cases and
  annual rates per 1000 bed days for patients 65
  years and over
• Locally
• Updated figures included in quarterly report
• Raised similar questions on inclusion of
  community cases - as for MRSA
• Concerns over rises in case numbers
• Concerns over O27 strain
  
• New web based surveillance to come on line April
  2007
• Repeat of typing survey point prevalence study
  

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Cases of Clostridium difficile in patients aged
65 years and over in East Midlands by quarter
January 2004 to December 2006
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Mandatory reporting of SSI Data collection
started April 1st 2004

• Minimum of 3 consecutive months surveillance
  (to commence at the start of a calendar
  quarter) in at least one of
• - Total hip replacements
• - Knee replacements
• - Hip hemiarthroplasties
• - Open reductions of long
  bone fractures
• Note - Hospitals can choose to collect
  continuously. If their number of
  operations is too small to provide meaningful
  results (lt50/ quarter), then they need to
  collect for longer period to estimate their rate
  of SSI.
• Option to submit data via a web link.

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SSI Reporting

• Sent to Trust at the end of each quarter they
  participate in.
• To include data from
• - current period
• - combined data from previous periods
• Section on incidence of SSI in other hospitals
  in England thus compare to other participants
• But only summary sent to HPA locally

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• Thank you
• My Contact Details
• Srilaxmi Degala
• Information Officer
• East Midlands Health Protection Unit
• The City Hospital
• Hucknall Road
• Nottingham
• NG5 1PB
• Tel  [phone]
• Fax [phone]
• Email Srilaxmi.Degala_at_hpa.org.uk