Welsh Healthcare Associated Infection Programme: Reporting systems Susan

Welsh Healthcare Associated Infection Programme: Reporting systems Susan

Welsh Healthcare Associated Infection Programme: Reporting 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 VOLUNTARY 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 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 sources

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.. 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 aureus) being published by HSW while they process all the returns.

Users who require theSISP) data more timely for local reporting, can Procedures (SSI, obtain it directly from the hospitals information department. Susan Harris ([email protected]) 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 ([email protected]) Welsh Healthcare Associated Infection Programme Standardised Data Storage Information management system

Test results Standard database Standard output Susan Harris ([email protected]) Welsh Healthcare Associated Infection Programme 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 ([email protected]) 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 ([email protected]) 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 ([email protected]) 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 ([email protected])

Welsh Healthcare Associated Infection Programme Monthly S. aureus bacteraemia reporting Susan Harris ([email protected]) 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 ([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 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 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 ([email protected]) 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 ([email protected]) 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 ([email protected]) 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 ([email protected]) 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 ([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 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 C. difficile/1000 admissions

25.00 20.00 15.00 10.00 5.00 C. difficile Rate 12 per. Mov. Avg. (C. difficile Rate) 0.00

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 followup 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 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 ([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 C-Section Web Reporting System http://whaip-hai.nphs.wales.nhs.uk/SSI/login.aspx. 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 Trusts 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 Acknowledgments Thanks to the Infection Control teams and Clinical staff in the Welsh Health boards for participating in the surveillance schemes 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

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

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