Welsh Healthcare Associated
Infection Programme:
Reporting systems
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
• Introduction to WHAIP
• Summary of Surveillance programmes
• Data sources
• Reporting systems
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Welsh Healthcare Associated Infection
Programme (WHAIP)
Development, implementation and delivery of
mandatory HCAI surveillance programme &
Surgical Instrument Surveillance.
Identify preventable aspects and audit
compliance with agreed practices.
WHAIP provides local and national healthcare
associated infection surveillance systems
providing support in their use and data
analysis for the infection control teams in
Welsh hospitals.
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
HCAI Surveillance - Wales
MANDATORY
• Bacteraemia surveillance
– Staphylococcus aureus
(MRSA, MSSA)
– “Top Ten Bacteraemia”
• Critical Care HCAI surveillance
– Central Line associated
Bacteraemias
– Ventilator Associated
Pneumonias
• Surgical Site Infection
Surveillance
– Orthopaedic
– C-section
• Clostridium difficile surveillance
• Outbreak Surveillance
VOLUNTARY
• Surgical Site Infection
Surveillance
– Surveillance tool developed
for 1000 Lives campaign
• Catheter Associated Urinary Tract
Infection (CAUTI) surveillance
– Supporting urinary catheter
care bundle work within the
1000 Lives Plus programme
• Health Board Specific Surveillance
support
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Data sources
DataStore:
Bacteraemia surveillance – S. aureus, Top 10
Clostridium difficile
Web Based Data Entry:
Hospital outbreaks
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Data sources continued..
Form based data collection (scannable forms):
Critical care – CVC infections, VAP
Surgical site infection (SSI) – Orthopaedics,C-section
Single Use Instruments (SISP)
HSW data
Admissions
difficile)
HSW
data-sources(Clostridium
are updated
from the individual hospitals’
information departments. There is a 4 month delay in this data
Bed
days (Staphylococcus
being
published
by HSW whileaureus)
they process all the returns.
Users who require the data more timely for local reporting, can
Procedures (SSI, SISP)
obtain it directly from the hospital’s information department.
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Microbiology DataStore
Key facts:
• Provides a standard microbiology laboratory database
• Sits alongside the laboratory information management system
• Results are routinely collected (every hour)
• All results are stored – both positive and negative
• Local codes are utilised but also linked to standard codes
• Previous years reports are loaded from the LIMS
• Installed in all microbiology laboratories in Wales
• Administered from a central location
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Standardised Data Storage
Information management
system
Standard
output
(*DREP
SUBLAB
LABSPECN
Z,99.000001.TA
(*PDATA
NHSNUMB
PATID (*DREP
A678453Y
SUBLAB HENRY
SURNAME
LABSPECNRAYMON
Z,99.000001.TA
FORENAME
SEX (*PDATA M
NHSNUMB24 ASCOT STREET
PATADDL1
PATID (*DREP
PATADDL2
ELY A678453Y
SURNAME
HENRY
PATADDL3
CARDIFF
SUBLAB
FORENAME
RAYMON Z,99.000001.TA
PATADDL4
LABSPECN
SEX
PATADDL5
(*PDATAM
PATADDL1
24 ASCOT STREET
POSTCODE
CF14 3QX
NHSNUMB
PATADDL2
ELY
DATEOB
25.12.90
PATID
A678453Y
PATADDL3
CARDIFF HENRY
PDATA*)
SURNAME
(*SDETPATADDL4
FORENAME
RAYMON
AGE PATADDL5
8
SEX
M
POSTCODE
CF14 3QX24 ASCOT STREET
AGEMONTH
PATADDL1
DATEOB PATADDL2
25.12.90 ELY
AGEWEEK
PDATA*) PATADDL3
AGEDAY
CARDIFF
(*SDET PATADDL4
DOCTOR
Dr. A Jones
AGE
8
DATEREC
25.05.99
PATADDL5
AGEMONTH
ENTERBY
Ms J Brown
POSTCODE
CF14 3QX
AGEWEEK
XREFNUM
DATEOB
25.12.90
AGEDAY PDATA*)
SOURCLAB
DOCTOR (*SDET Dr. A Jones
TESTLAB
DATERECAGE
25.05.99 8
DATEREP
27.05.99
ENTERBYAGEMONTH
Ms J Brown
DATECOL
25.05.99
XREFNUMAGEWEEK
SPECSRCE
SOURCLAB
SPECTYPE
Urine
AGEDAY
TESTLABDOCTOR
SPECORIG
Mid-Stream
Dr. A Jones
DATEREPDATEREC
27.05.99 25.05.99
SPECSITE
25.05.99 Ms J Brown
(*CLINDDATECOLENTERBY
SPECSRCE
?UTI
XREFNUM
Urine
CLIND*)SPECTYPE
SOURCLAB
SPECORIG
OUTRNUM
TESTLABMid-Stream
(*ABT SPECSITE
DATEREP
27.05.99
(*CLIND DATECOL
Ampicillin
25.05.99
?UTI
SPECSRCE
ABT*) CLIND*) SPECTYPE
Urine
OUTRNUM
HAZARD
None
SPECORIG
Mid-Stream
(*ABT
REQLOCGP
198 Caerphilly Road
SPECSITE
(*CLIND Ampicillin
Test results
Standard database
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
?UTI
ABT*)
CLIND*)
HAZARD OUTRNUM
None
REQLOCGP
(*ABT 198 Caerphilly Road
Microbiology DataStore
Tools:
• Contract monitoring / laboratory workload
• Data browser / patient lookup
• Statistics module for antibiotic and organisms
Research and surveillance:
• Respond to local and regional data queries
• Antibiotic resistance and community prescribing
• Regional antibiotic surveillance
For further information contact Informatics
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
WHAIP Report types:
Rates (Tabular and graphical formats)
Time trends (run charts)
Adverse events (Statistical Process Control
Charts) both positive and negative
Time/Numbers between events (graphical
presentation) used for rare occurrences e.g. number of
days or number of lines inserted between infections
Moving averages (graphical presentation)
Allows
for seasonality
Traffic Light System (graphical presentation)
Performance alert
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Bacteraemia surveillance – S. aureus
• Data collected since April 2001
• Quarterly numbers entered into a database on
website until March 2010.
• From April 2010, data exported from data
warehouse system called Datastore, used by all
microbiology labs in Wales
• Total blood culture sets taken, total positive blood
cultures, and for blood cultures positive for MRSA
and MSSA, age, sex and specialty of the patient.
• Deduplicated – 14 days
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Bacteraemia surveillance – S. aureus
Monthly Reports
- MRSA & MSSA
- Table of 13 months of data
- Graph comparing cumulative numbers
for current financial year with
previous
- Wales, Health Board & major acute
hospital level data
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Monthly S. aureus bacteraemia reporting
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Bacteraemia surveillance – S. aureus
Other reports
6 monthly updated rate reports
• MRSA & MSSA annual rates per 100,000 bed
days
• Quarterly trend data from April 2001
• SPC charts
• 12 month moving average chart
• Wales, Health Board and major acute hospital
level data
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
MRSA Bacteraemia Rates
•Rate for 09/10 financial year - 7 per 100,000 bed days
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Bacteraemia surveillance – Top 10
• Surveillance system in place since 2005
• All positive blood cultures extracted from data
warehouse system
• Rules applied for possible contaminant
organisms (2 pos within 48h)
• Deduplicated – 14 days
• 10 organisms with highest counts reported
• Rates per 100,000 bed days
• Annual report produced
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Bacteraemia surveillance – Top 10
Top 10 data for 2009
Rank
Organism
Rate per
100,000 bed days
1
Escherichia coli (E.coli)
51
2
Staphylococcus aureus (MSSA)
18
3
Enterococcus species
13
4
Klebsiella species
10
=5
Coagulase-negative Staphylococcus
9
=5
Streptococcus pneumoniae
9
7
Staphylococcus aureus (MRSA)
8
8
Pseudomonas aeruginosa
5
=9
Proteus species
4
=9
Serratia species
4
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Clostridium difficile
• Surveillance in >65s since 2005
• Expanded to >1s in 2008
• All toxin positive C. difficile extracted from
data warehouse system
• Deduplicated – 28 days
• C. difficile Annual Operating Framework (AOF)
Target introduced for financial year 10/11 –
20% reduction on baseline numbers for each
health board (inpatients aged >65)
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Clostridium difficile
Monthly Reports
•
•
•
•
Table of 13 months of data
Graph comparing cumulative monthly
numbers for current financial year with
baseline months
Wales, Health Board & major acute hospital
level data
Traffic light system
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Clostridium difficile
Data to end June ‘10 show numbers of C. difficile from inpatients
aged >65 are not currently on target to achieve 20% reduction
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Clostridium difficile
Other Reports
6 monthly updated rates report
• Rates per 1000 admissions for inpatients aged
>65
• Numbers of inpatients aged 2-65
• Monthly trend data from Jan 2005
• SPC charts
• 12 month moving average chart
• Wales, Health Board and major acute hospital
level data
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Clostridium difficile rates
• Rate for 09/10 financial year = 15.0 /1000
admissions
• Seasonal pattern
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Clostridium difficile
12 month moving average
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Critical Care Surveillance
• VAPs
• CVC Infections
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Critical Care Surveillance - VAP
•
•
•
•
•
Mandatory surveillance since Sep 2008
Data collected via scannable forms
HELICS VAP definition used
Bimonthly reports issued to ICUs
Annual report published on website
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Bi-monthly report - example
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Annual report - example
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Critical Care Surveillance – CVC Infections
• Mandatory surveillance since Sep 2007
Introduced in conjunction with care bundle
• Data collected via scannable forms
• HELICS CVC definition used plus additional
CVC associated definition
• Bimonthly reports issued to ICUs
• Annual report published on website
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Bi-monthly report - example
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Annual report - example
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Surgical Site Infection Surveillance
• Orthopaedics
• Caesarean Section
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Surgical Site Infection Surveillance Orthopaedics
•
•
•
•
•
•
•
Mandatory since 2003
Elective primary hip & knee arthroplasty
Continuous surveillance
Paper questionnaires
Optical mark reader
CDC definitions for SSI
Post –discharge data collected at 6 week followup appointment
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Surgical Site Infection Surveillance Orthopaedics
• Quarterly reports issued to Health Boards
• Annual report published on website
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Annual report - example
Table 4. Incidence of inpatient SSI by procedure type in Wales in 2008
Procedure Type
No. of Procedures*
No. of SSI
% SSI
95% CI
All mandatory procedures
6085
75
1.2
1.0 – 1.5
Elective primary hip arthroplasty
2496
29
1.2
0.8 – 1.7
Elective primary knee arthroplasty
3589
46
1.3
1.0 – 1.7
Quarterly report - example
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Surgical Site Infection Surveillance –
C-Section
•
•
•
•
•
•
Mandatory since 2006
Continuous surveillance
Paper questionnaires
Optical mark reader
CDC definitions for SSI
Post-discharge data collected by community
midwives up to 28 days post procedure
• Data accessible to participants via a web
based reporting system (manuals available on
request)
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
C-Section – Web Reporting System
•
Secure web-based database.
•
All contributing hospitals are able to view their data
•
A valid user id and password is required.
•
Data can be viewed using a series of pre-defined
reports or
•
exporting the dataset to a third party product
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
C-Section – Web Reporting System
http://whaip-hai.nphs.wales.nhs.uk/SSI/login.aspx.
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
C-Section – Web Reporting System
• Reports are available for Health Boards to download
from web reporting tool
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Surgical Site Infection Surveillance –
C-Section
• Example report available from web reporting
system
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Surgical Site Infection Surveillance –
C-Section
• Annual report published on website
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Outbreak Reporting
• All Trusts to report on HAI outbreaks / incidents
• Set up Outbreak Surveillance Co-ordinator from
within Trust’s Infection Control Team
• Data accessible to participants via a web based
reporting system (manuals available on request)
• Reporting via web using the hospital outbreak
definition provided
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Outbreak Reporting system
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Outbreak Reporting system
User manual available on request
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Outbreak Reporting system - example
http://howis.wales.nhs.uk/haisp/login.cfm
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Acknowledgments
Thanks to the Infection Control teams and
Clinical staff in the Welsh Health boards for
participating in the surveillance schemes
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
Further information about the HCAI surveillance
programmes in Wales is available from the WHAIP
intranet site: www.wales.nhs.uk/whaip
Susan Harris (susan.harris2@wales.nhs.uk)
Welsh Healthcare Associated Infection Programme
