Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Welsh Healthcare Associated Welsh Healthcare Associated Infection Programme: Infection Programme: Reporting systemsReporting systems
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
• Introduction to WHAIP
• Summary of Surveillance programmes
• Data sources
• Reporting systems
Susan Harris ([email protected])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 ([email protected])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 ([email protected])Welsh Healthcare Associated Infection Programme
Data sourcesData sources
DataStore:DataStore:
Bacteraemia surveillance – S. aureus, Top 10
Clostridium difficile
Web Based Data Entry:
Hospital outbreaks
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Data sources continued..Data sources continued..
Form based data collection (scannable forms):Form based data collection (scannable forms):
Critical care – CVC infections, VAP
Surgical site infection (SSI) – Orthopaedics,C-section
Single Use Instruments (SISP)
HSW dataHSW data
Admissions (Clostridium difficile)
Bed days (Staphylococcus aureus)
Procedures (SSI, SISP)
HSW data-sources are updated from the individual hospitals’ information departments. There is a 4 month delay in this data being published by HSW while they process all the returns. Users who require the data more timely for local reporting, can obtain it directly from the hospital’s information department.
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Microbiology DataStore
Key facts:
• Administered from a central location
• 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
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Standard output
Standardised Data Storage
Test results
Standard database
Information management system
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Research and surveillance:
• Respond to local and regional data queries• Antibiotic resistance and community prescribing• Regional antibiotic surveillance
For further information contact Informatics
Tools:
• Contract monitoring / laboratory workload• Data browser / patient lookup• Statistics module for antibiotic and organisms
Microbiology DataStore
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
WHAIP Report types: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 ([email protected])Welsh Healthcare Associated Infection Programme
Bacteraemia surveillance – Bacteraemia surveillance – S. S. aureusaureus
• 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 ([email protected])Welsh Healthcare Associated Infection Programme
Bacteraemia surveillance – Bacteraemia surveillance – S. aureusS. 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 ([email protected])Welsh Healthcare Associated Infection Programme
Monthly S. aureus bacteraemia reporting
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Bacteraemia surveillance – Bacteraemia surveillance – S. aureusS. 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 ([email protected])Welsh Healthcare Associated Infection Programme
MRSA Bacteraemia Rates•Rate for 09/10 financial year - 7 per 100,000 bed days
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Bacteraemia surveillance – Top 10Bacteraemia 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 ([email protected])Welsh Healthcare Associated Infection Programme
Bacteraemia surveillance – Top 10Bacteraemia surveillance – Top 10
Top 10 data for 2009
Rank OrganismRate 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 ([email protected])Welsh Healthcare Associated Infection Programme
Clostridium difficileClostridium 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 ([email protected])Welsh Healthcare Associated Infection Programme
Clostridium difficileClostridium 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 ([email protected])Welsh Healthcare Associated Infection Programme
Clostridium difficileClostridium difficileData to end June ‘10 show numbers of C. difficile from inpatients aged >65 are not currently on target to achieve 20% reduction
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Clostridium difficileClostridium 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 ([email protected])Welsh Healthcare Associated Infection Programme
Clostridium difficile rates• Rate for 09/10 financial year = 15.0 /1000 admissions• Seasonal pattern
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Clostridium difficileClostridium difficile
12 month moving average
Monthly rate and 12 month moving average rate of C. difficile per 1000 admissions in inpatients aged >65 in Wales, 01/01/05 - 31/03/10
0.00
5.00
10.00
15.00
20.00
25.00
C. d
iffi
cile
/100
0 ad
mis
sio
ns
C. difficile Rate
12 per. Mov. Avg. (C. difficile Rate)
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Critical Care Surveillance
• VAPs• CVC Infections
Susan Harris ([email protected])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 ([email protected])Welsh Healthcare Associated Infection Programme
Bi-monthly report - example
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Annual report - example
Susan Harris ([email protected])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 ([email protected])Welsh Healthcare Associated Infection Programme
Bi-monthly report - example
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Annual report - example
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Surgical Site Infection Surveillance
• Orthopaedics• Caesarean Section
Susan Harris ([email protected])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 follow-
up appointment
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Surgical Site Infection Surveillance - Orthopaedics
• Quarterly reports issued to Health Boards• Annual report published on website
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
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
Annual report - example
Quarterly report - example
Table 4. Incidence of inpatient SSI by procedure type in Wales in 2008
Susan Harris ([email protected])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 ([email protected])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 ([email protected])Welsh Healthcare Associated Infection Programme
http://whaip-hai.nphs.wales.nhs.uk/SSI/login.aspx.
C-Section – Web Reporting System
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
C-Section – Web Reporting System
•Reports are available for Health Boards to download from web reporting tool
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Surgical Site Infection Surveillance – C-Section
• Example report available from web reporting system
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Surgical Site Infection Surveillance – C-Section
• Annual report published on website
Susan Harris ([email protected])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 ([email protected])Welsh Healthcare Associated Infection Programme
Outbreak Reporting system
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Outbreak Reporting system
User manual available on request
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Outbreak Reporting system - example
http://howis.wales.nhs.uk/haisp/login.cfm
Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme
Thanks to the Infection Control teams and Clinical staff in the Welsh Health boards for participating in the surveillance schemes
Acknowledgments
Susan Harris ([email protected])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