Point Prevalence Survey of Hospital-Acquired Infections & Antimicrobial Use in Ireland

Point Prevalence Survey of Hospital-Acquired Infections & Antimicrobial

Use in IrelandPPS Data Collector Training

April 2012

Background & Introduction to PPSPresentation 1

Schedule

• Registration• Welcome• Objectives• Background & introduction to the ECDC PPS• Completing the Ward List & deciding patient eligibility

– Coffee break

• Hospital-acquired infection case definitions & case studies– Lunch

Schedule

• Antimicrobial use & case studies• Review of the Patient Forms (Form C)• Data entry• Review of the Hospital Form (Form B)• External validation, Summary, Evaluation

– Close

Course Objectives

• Participants will understand and apply the methodology of the 2012 ECDC Point Prevalence Survey (PPS) of Hospital-Acquired Infections (HAI) & Antimicrobial Use

• Participants will be able to apply the definitions of antimicrobial use

• Participants will be able to apply the HAI case definitions

What is a PPS?

• A prevalence survey provides data at one particular point in time ‘snapshot’

• Prevalence = numerator / denominator• Numerator = number of patients on the ward who

have an active HAI at the time of the survey• Denominator = All eligible patients present on the

ward at 8am on the day of the survey for that ward

What is a PPS?

• PPS team visits a ward at 11am on 10/5/12• There were 29 patients present on the ward at 8am• The PPS team decides that 26 patients are eligible for

inclusion in the PPS – Two have since been transferred to other wards and one has been discharged home

• After completing the PPS for the ward, 9 patients were identified as receiving systemic antimicrobials

• Prevalence of antimicrobial use on the ward = 9/26 x 100 = 34.6%

What is a PPS?

• After completing the PPS for the ward, 4 patients were identified as having active HAI

• HAI prevalence on the ward = 4/26 x 100 = 15.3%

Hospital Infection Society2006 PPS UK & Ireland

• Ireland, Northern Ireland, England & Wales conducted a PPS of healthcare-associated infections (HCAI) in 2006

• US Centers for Disease Control & Prevention (CDC) definitions of infection used

• Infections acquired in another hospital were excluded

• Only two questions regarding antibiotic use– Systemic antibiotic use ‘Y/N’– IV antibiotic use ‘Y/N’

Hospital Infection Society2006 PPS: Ireland

• 44 acute hospitals (88%) participated in 2006 PPS• 7,541 patients surveyed• 369 patients with HCAI• HCAI prevalence 4.9%• Systemic antibiotic use prevalence 34.2%

What’s been happening in Irelandsince 2006?

C. difficile infection (CDI)

• May 2008: National guidance document issued and new cases of CDI became notifiable

• August 2009: Enhanced CDI surveillance scheme established – All cases of CDI new and recurrent reportable to enhanced surveillance. 37 acute hospitals participating in enhanced surveillance by Q3 2011– National quarterly report issued– Quarterly report issued to each participating

hospital

Source: HPSC www.hpsc.ie

C. difficile subcommittee reconvenedOctober 2011 to revise national guidelines

S. aureus invasive infection• Captured via EARS-Net

– 40 laboratories participated in 2011

• S. aureus BSI via enhanced surveillance scheme– 16 laboratories participated in 2011– 2011 results in preparation

– 2010: 23% of SAB due to infected CVC & 6% due to infected PVC

Source: HPSC www.hpsc.ie

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0

200

400

600

800

1,000

1,200

1,400

1,600

Prop

ortio

n of

isol

ates

Num

ber o

f iso

late

s

YearMRSA MSSA %MRSA

Total number of S. aureus (MRSA and MSSA) bloodstream isolates and proportion (%) MRSA from acute hospitals (public & private) by year, 2004 to 2011Q3†Data for 2011 provisional to the end of Q3 only

Source: HPSC www.hpsc.ie

2005 MRSA guidelines have just been updated and will be publishedshortly

Source: HPSC www.hpsc.ie

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0

50

100

150

200

250

300

350

400

450

2004 2005 2006 2007 2008 2009 2010 2011†

Prop

ortio

n of

res

issta

nt is

olat

es

Num

ber o

f E.

faec

ium

iso

late

s

YearVREfm VSEfm %VREfm

Total number of E. faecium (VREfm and VSEfm) bloodstream isolates, and VREfm proportions from acute hospitals (public & private) by year, 2004 to 2011VREfm, Vancomycin-resistant E. faecium; VSEfm, Vancomycin-susceptible E. faecium†Data for 2011 provisional to the end of Q3 only

Source: HPSC www.hpsc.ie

CRE• Carbapenem resistant Enterobacteriaceae• Multi-drug resistant Gram-negative organisms• Extremely limited antimicrobial treatment options• First reported case in Ireland in 2009• In 2011, CRE reported from 36 patients in 8 hospitals around

Ireland – majority of cases reported from outbreaks• Four hospitals reported CRE outbreaks in 2011• CRE infection is notifiable to public health• National guidelines on the prevention & control of multi-drug

resistant organisms (other than MRSA) will be published shortly

Period 1 = June 2011Period 2 = October 2011

Source: HPSC www.hpsc.ie

Aims of this PPS

• To conduct a PPS of HAI & antimicrobial use across all EU Member States during 2011-12 using a common protocol

• To estimate the total burden of HAI & antimicrobial use within:– EU– Each Member State– Each participating healthcare facility– By specialty type– By patient type

26

Overview of previous European PPS:

0% 2% 4% 6% 8% 10%

Germany, 1997Lithuania, 2003,2005,2007

Latvia, 2003, (2004)

Slovenia, 2001Italy, Lombardy, 2000

France, 2006Belgium, 2007

France, 2001

Spain, 1990-2007Norway, 2002-2007Netherlands, 2007

Italy, INF-NOS, 2002UK & IE, 2005

Suisse, 2002Portugal, 2003Finland, 2005

Denmark, 2003, 2008UK, 1996

Greece, 2000Scotland, 2007

Sweden, 2003, 2004 2006

% patients with HCAI

Mean HAI prevalence 7%

0 5 10 15 20 25% of isolates

OtherMORGANELLA SPP.

SERRATIA SPP.C. DIFFICILE

ACINETOBACTER SPP.ENTEROBACTER SPP.

PROTEUS SPP.KLEBSIELLA SPP.

CANDIDA SPP.COAG-NEG. STAPH.

ENTEROCOCCUS SPP.P. AERUGINOSA

S. AUREUSE. COLI

21 documented PPS in European countries over past 15 years

Aims of this PPS

• To share the results of the PPS with those who need to know:– Local– Regional– National– International– EU

• To use the data generated within YOUR hospital to help YOU and your colleagues to: – Identify priority areas for future targeted HAI surveillance– Identify interventions to prevent HAI– Identify areas for targeting antimicrobial stewardship

Preliminary PPS data:submitted to ECDC at 28/2/12

• Most common HAI types reported from participating hospitals to date:

1. Pneumonia 2. Surgical site infection3. Urinary tract infection4. Bloodstream infection5. Gastrointestinal infection6. Systemic infections7. Skin & soft tissue infection8. All other infection types

Preliminary data only - for information

Preliminary PPS data:submitted to ECDC at 28/2/12

• Over half of all HAI episodes associated with positive microbiology results

• HAI causative microorganisms:– Enterobacteriaceae– Gram-positive cocci– Other Gram-negative bacilli– Fungi

Preliminary data only - for information

Summary

• Last PPS performed in Ireland six years ago– 44 acute hospitals, 7,521 patients surveyed– 34.2% on antibiotics– 4.9% HCAI

• Many interim developments to raise awareness of HAI & need for prudent antimicrobial use

• 2012 PPS provides us with the opportunity to see where we are now and to direct our future interventions for ongoing improvement

Any Questions?

Overview of data to be collectedduring PPS

Nursing &Midwifery staff

PPS teamleader

PPS teamassisted by staff caring for patients

Ward List (Form A)

Hospital Form (Form B)

Patient Form (Form C)

Patient Form (Form C)

• Three pages• Five sections

– Section 1 – Patient details– Section 2 – Risk factors– Section 3 – Condition of interest – Antimicrobial use Y/N

and HAI Y/N– Section 4 – Antimicrobial use data– Section 5 – HAI data

Sections 1, 2, 3 completed for EVERY eligible patient100%

Patient Form (Form C)

• Three pages• Five sections

– Section 1 – Patient details– Section 2 – Risk factors– Section 3 – Condition of interest – Antimicrobial use Y/N

and HAI Y/N– Section 4 – Antimicrobial use data– Section 5 – HAI data

Sections 1, 2, 3 & 4 completed for EVERY eligible patient receiving systemic antimicrobials ~ 33%

Patient Form (Form C)

• Three pages• Five sections

– Section 1 – Patient details– Section 2 – Risk factors– Section 3 – Condition of interest – Antimicrobial use and

HAI– Section 4 – Antimicrobial use data– Section 5 – HAI data

Sections 1, 2, 3, 4 & 5 completed for EVERY eligible patient receiving systemic antimicrobials with an active HAI ~ 5%

Your hospital....TOTAL NUMBER OFPAPER FORMS TO BE COMPLETED*

150 ACUTE BEDS DIVIDED INTO 8

WARDS

300 ACUTE BEDS DIVIDED INTO 12

WARDS

600 ACUTE BEDS DIVIDED INTO 22

WARDSWard Forms (Form A)

8 12 22

Hospital Form (Form B)

1 1 1

Patient Forms (Form C)

150 300 600

Form C Section 1, 2, 3

92 185 370

Form C Section 1, 2, 3 & 4

50 100 200

Form C Section 1,2, 3, 4 & 5

8 15 30

*The completed paper versions of one Form B & all Form Cs are used to enter your hospital’s PPS data onto secure ‘web-based’ data entry system

Patient Form (Form C)

Patient Form (Form C)

There is space on Form C to record up to five systemic antimicrobial prescriptions AND

up to three different hospital-acquired infections

Patient Form (Form C)

Patient Form (Form C)

The answers to 10/12 (83%) questions in Section 1 & 2can be directly transcribed from the completed Ward List.For each eligible patient, the PPS team will need to decide: Admitting consultant’s specialtyUnderlying disease prognosis

Patient Form (Form C)

‘Patient on antimicrobials’ answered on Ward ListAlso check Ward List to identify patients who have undergone surgery in the last 24 hours to pick up surgical prophylaxis

Patient Form (Form C)

Patient Form (Form C)

Any Questions?

[email protected]