Point Prevalence Survey of HospitalAcquired 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
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 Society
2006 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 Society
2006 PPS: Ireland
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•
•
•
•
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 Ireland
since 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 reconvened
October 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
45%
1,400
40%
35%
1,200
30%
1,000
25%
800
20%
600
15%
400
10%
200
5%
0
0%
MRSA
Year
MSSA
Proportion of isolates
Number of isolates
1,600
%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 published
shortly
Source: HPSC www.hpsc.ie
45%
400
40%
350
35%
300
30%
250
25%
200
20%
150
15%
100
10%
50
5%
0
0%
2004
2005
VREfm
2006
2007
2008
Year
VSEfm
2009
Proportion of resisstant isolates
Number of E. faecium isolates
450
2010 2011†
%VREfm
Total number of E. faecium (VREfm and VSEfm) bloodstream isolates, and VREfm
proportions from acute hospitals (public & private) by year, 2004 to 2011
VREfm, 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
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•
•
•
•
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 2011
Period 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
Overview of previous European PPS:
Sweden, 2003, 2004 2006
Scotland, 2007
E. COLI
S. AUREUS
P. AERUGINOSA
ENTEROCOCCUS SPP.
COAG-NEG. STAPH.
CANDIDA SPP.
KLEBSIELLA SPP.
PROTEUS SPP.
ENTEROBACTER SPP.
ACINETOBACTER SPP.
C. DIFFICILE
SERRATIA SPP.
MORGANELLA SPP.
Other
Greece, 2000
UK, 1996
Denmark, 2003, 2008
Finland, 2005
Portugal, 2003
Suisse, 2002
UK & IE, 2005
Italy, INF-NOS, 2002
Netherlands, 2007
Norway, 2002-2007
0
Spain, 1990-2007
5
10
15
% of isolates
France, 2001
Belgium, 2007
France, 2006
Mean HAI prevalence
7%
Italy, Lombardy, 2000
Slovenia, 2001
Latvia, 2003, (2004)
Lithuania, 2003,2005,2007
Germany, 1997
0%
2%
4%
6%
8%
10%
% patients with HCAI
21 documented PPS in European countries over past 15 years
26
20
25
Aims of this PPS
• To share the results of the PPS with those who need to know:
–
–
–
–
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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 infection
3. Urinary tract infection
4. Bloodstream infection
5. Gastrointestinal infection
6. Systemic infections
7. Skin & soft tissue infection
8. 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 collected
during PPS
Nursing &
Midwifery staff
PPS team
leader
PPS team
assisted 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 patient
100%
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 OF
PAPER FORMS TO
BE COMPLETED*
150 ACUTE BEDS
DIVIDED INTO 8
WARDS
300 ACUTE BEDS
DIVIDED INTO 12
WARDS
600 ACUTE BEDS
DIVIDED INTO 22
WARDS
Ward 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 & 2
can be directly transcribed from the completed Ward List.
For each eligible patient, the PPS team will need to decide:
Admitting consultant’s specialty
Underlying disease prognosis
Patient Form (Form C)
‘Patient on antimicrobials’ answered on Ward List
Also 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?
pps2012@hpsc.ie