susan harris ( [email protected] ) welsh healthcare associated infection programme welsh...

Susan Harris ([email protected])Welsh Healthcare Associated Infection Programme

Welsh Healthcare Associated Welsh Healthcare Associated Infection Programme: Infection Programme: Reporting systemsReporting systems


• Introduction to WHAIP

• Summary of Surveillance programmes

• Data sources

• Reporting systems


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.


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


Data sourcesData sources

DataStore:DataStore:

Bacteraemia surveillance – S. aureus, Top 10

Clostridium difficile

Web Based Data Entry:

Hospital outbreaks


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.


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


Standard output

Standardised Data Storage

Test results

Standard database

Information management system


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


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


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


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


Monthly S. aureus bacteraemia reporting


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


MRSA Bacteraemia Rates•Rate for 09/10 financial year - 7 per 100,000 bed days


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


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


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)



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


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



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


Clostridium difficile rates• Rate for 09/10 financial year = 15.0 /1000 admissions• Seasonal pattern



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

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5.00

10.00

15.00

20.00

25.00

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C. difficile Rate

12 per. Mov. Avg. (C. difficile Rate)


Critical Care Surveillance

• VAPs• CVC Infections


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


Bi-monthly report - example


Annual report - example


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


Bi-monthly report - example


Surgical Site Infection Surveillance

• Orthopaedics• Caesarean Section


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


Surgical Site Infection Surveillance - Orthopaedics

• Quarterly reports issued to Health Boards• Annual report published on website


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

Table 4. Incidence of inpatient SSI by procedure type in Wales in 2008


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)


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


http://whaip-hai.nphs.wales.nhs.uk/SSI/login.aspx.


http://whaip-hai.nphs.wales.nhs.uk/SSI/login.aspx



•Reports are available for Health Boards to download from web reporting tool



• Example report available from web reporting system



• Annual report published on website


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


Outbreak Reporting system


Outbreak Reporting system

User manual available on request


Outbreak Reporting system - example

http://howis.wales.nhs.uk/haisp/login.cfm

http://howis.wales.nhs.uk/haisp/login.cfm


Thanks to the Infection Control teams and Clinical staff in the Welsh Health boards for participating in the surveillance schemes

Acknowledgments


Further information about the HCAI surveillance programmes in Wales is available from the WHAIP intranet site: www.wales.nhs.uk/whaip

susan harris ( [email protected] ) welsh healthcare associated infection programme welsh...

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