point prevalence survey of hospital-acquired infections & antimicrobial use in ireland
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Point Prevalence Survey of Hospital-Acquired Infections & Antimicrobial Use in Ireland. PPS Data Collector Training April 2012 Background & Introduction to PPS Presentation 1. Schedule. Registration Welcome Objectives Background & introduction to the ECDC PPS - PowerPoint PPT PresentationTRANSCRIPT
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
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)