Download Morbidity Definition Template, Summer 2014

Morbidity Definition Template, Summer 2014.
-----------------------------------------------------------------------------------------------------------1. Morbidity name:
Hospital acquired Infection (HCAI)
-----------------------------------------------------------------------------------------------------------2. Natural timescale for identifying morbidity (e.g. within 7 days of operation, before
discharge from hospital, within 1 month of operation etc):
For most HCAIs, they would be identified and diagnosed within the hospital admission by a
positive laboratory result with clinical symptoms of an infection.
For surgical site infections (including Infective Endocarditis, IE) the recommend time scale
by NICE is 28 days. There are a few exceptions and late onset SSIs can occur after 28 days
post operatively
-----------------------------------------------------------------------------------------------------------3a. Do suitable standard, accepted, definitions exist that can be used?
Yes.
Definitions ( epic3: National Evidence-Based Guidelines for Preventing HealthcareAssociated Infections in NHS Hospitals in England, Journal of Hospital Infection
Volume 86, Supplement 1 , Pages S1-S70, January 2014)
Bacteraemia
The presence of microorganisms in the bloodstream
Bacteriuria
The presence of microorganisms in the urine. If there are no symptoms of infection, this is
called ‘asymptomatic bacteriuria’
Bloodborne virus
A viral infection transmitted by exposure to blood and sometimes other bodily fluids.
Bloodborne viruses include hepatitis B and C as well as human immunodeficiency virus
Bloodstream infection
(BSI)
The presence of microbes in the blood with symptoms of infection
Catheter-associated
urinary tract infection
(CAUTI)
The presence of symptoms or signs attributable to microorganisms that have invaded the
urinary tract, where the patient has, or has recently had, a urinary catheter
Catheter colonisation
Microorganisms present on a surface of a catheter that could potentially lead to infection
Catheter-related
bloodstream infection
(CR-BSI)
An infection of the bloodstream where microorganisms are found in the blood of a patient
with a central venous access device, the patient has clinical signs of infection (e.g. fever,
chills and hypotension) and there is no other apparent source for the infection. For
surveillance purposes, this often refers to bloodstream infections that occur in patients with a
central venous access device and where other possible sources of infection have been
excluded. A more rigorous definition is where the same microorganism is cultured from the
tip of the catheter as grown from the blood; simultaneous quantitative blood cultures with at
least a 5:1 ratio of microorganisms cultured from the central venous access device vs
peripheral; differential time to positivity of at least 2 h for blood cultures cultured peripherally
vs from central venous access device
Catheter-related
infection
Any infection related to a central venous access device, including local (e.g. insertion site)
and systemic (e.g. bloodstream) infectio
Colonisation
Microorganisms that establish themselves in a particular environment, such as a body
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surface, without producing disease
Gram-negative/positive bacteria
The type of bacteria as identified by Gram's staining method. Gram-positive bacteria appear
dark blue or purple under a microscope. Such bacteria have a thick layer of peptidoglycan on
their cell walls. Gram-negative bacteria appear red under a microscope and have an outer
layer of lipoprotein and a thin layer of peptidoglycan
Healthcare-associated
infection (HCAI)
Infection acquired as a result of the delivery of health care either in an acute (hospital) or
non-acute setting
Infection
Microorganisms that have entered the body and are multiplying in the tissues, typically
causing specific symptoms
Meticillin-resistant
Staphylococcus
aureus (MRSA)
Strains of S. aureus that are resistant to many of the antibiotics commonly used to treat
infections. Epidemic strains also have a capacity to spread easily from person to person
Severe acute
respiratory syndrome
(SARS)
A severe form of pneumonia caused by a coronavirus
Urinary tract infection
(UTI)
The invasion of the tissues of the bladder by microorganisms causing symptoms or signs of
infection such as dysuria, loin pain, suprapubic tenderness, fever, pyuria and confusion
MRSA: Public Health England- PHE (formerly the Health Protection Agency) has been
managing, on behalf of the Department of Health, the mandatory surveillance of
Staphylococcus aureus bacteraemia in England since April 2001.
The following aggregated data ("quarterly lab returns") are also collected as part of this
surveillance scheme:


Total blood culture sets examined (a sample arising from a single venepuncture,
irrespective of the number of bottles tested)
Total number of positive blood cultures (all positive results for bacterial growth,
including repeat specimens and contaminants)
Positive blood cultures from the same patient within 14 days of the initial culture are
considered to be part of the original episode and should not be reported. Duplicate reports,
more than 14 days apart should be reported as these are considered to be a separate
episode.
Evidence Base criteria for diagnosing infections:
 SSI- NICE guidance, 2014
 Central venous catheter blood stream infections- matching Michigan 2014
 C diff- Everyone Counts: Planning for Patients 2013/14: Technical Definitions,
commissioning board, s h e a - i d s a g u i d e l i n e, 2010
 Norovirus- Guidelines for the management of norovirus outbreaks in acute and
community health and social care settings, 2012, HPA
 MRSA- Everyone Counts: Planning for Patients 2013/14: Technical Definitions,
commissioning board, PHE Microbiology Services Colindale Bacteriology Reference
Department User Manual APRIL 2014
-Guidance on the diagnosis and management of PVL-associated Staphylococcus
aureus infections (PVL-SA) in England, 2008, Health Protection Agency
 MSSA2
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




Urinary tract infections- diagnosis of UTI- Quick reference guide for Primary care,
HPA, 2011
Catheter related urinary tract infectionsVentilator acquired infectionsRespiratory infectionsMulti drug resistant organism- Guidelines for the Prevention and Control of Multi-drug
resistant organisms (MDRO) excluding MRSA in the healthcare setting, 2012
(Published on behalf of the Royal College of Physician’s clinical advisory group on Healthcare Associated
Infections inassociation with HSE Quality and Patient Safety)
-----------------------------------------------------------------------------------------------------------3b. If no (or partially no) to part 3a – can you outline a general strategy for how this
morbidity would be identified/diagnosed/monitored? (detailed definitions are not needed
until final 10 morbidities have been chosen, but it is helpful to have some thoughts on this).
-----------------------------------------------------------------------------------------------------------3c. Do the definitions encompass morbidities directly attributable to surgery or to
presence post-surgery (regardless of cause) (During panel meeting, we discussed
potentially having definitions for both “attributable” morbidity & “present” morbidity, or
choosing one or the other).


Attributable: SSIs, blood stream, urinary catheter, vascular access device, ventilator
acquired,
Present: UTI, respiratory infections, gastro-intestinal diseases
-----------------------------------------------------------------------------------------------------------4. How feasible is it to monitor this morbidity for EVERY cardiac paediatric patient
(morbidities to be identified within 4-6 weeks following surgery for THIS project)? (e.g.
what are the resource/staffing implications? Is there any subjectivity involved? Are
timescales suitable?)
Some HCAI are already collected:
 “Mandatory reporting of methicillin resistant Staphylococcus aureus (MRSA)
bacteraemia and Clostridium difficile infection (CDI) has been in place for National
Health Service (NHS) acute Trusts for several years. Independent Sector (IS)
hospitals began reporting MRSA bacteraemia and CDI, from January 2008. In
January 2011 this scheme was extended to include surveillance of MSSA
bacteraemia and E. coli bacteraemia in June 2011. IS healthcare organisations
providing regulated activities undertake surveillance on HCAIs and report to Public
Health England (PHE) as specified in the Code of Practice. Please refer to the UK
Legislation website and The Health and Social Care Act 2008 for more information.”
Taken from
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http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HCAI/Epidemiological
DataHCAI/hcaiISreportingintro/
Would be able to collect all data required at 4-6 weeks postoperatively.
Resource required to go through all patient records to identify is clinical and laboratory
evidence of infection
Mandated reportable HCAI (already collated and submitted): MSRA bacteraemia, MSSA
bacteraemia, E-Coli bacteraemia, C-Diff, SSIs (inc IE)
Infections that should be internally reported: All positive cultures from clinical samples
Infections that would be identifiable from review of patient records: Respiratory, Urinary
catheter, vascular access device, ventilator acquired,
-----------------------------------------------------------------------------------------------------------5. Any comments on whether this morbidity is a possible consequence of an another
morbidity that we are also considering? (e.g. Developmental delay – neurological injury –
these considerations may help the selection panel in its final selection)
Other morbidities that might affect HCAI
Length of stay- more exposure to infections
Problems feeding- NG/NJ/Gastrostomy increase the risk of infection
ECMO/Mecahnical support- increased risk of infection
Unplanned reintervention/re-operation- increased risk of infection
Length of ICU stay- more exposure, if requiring multiple lines/investigations/invasive
monitoring/procedures then high risk
-----------------------------------------------------------------------------------------------------------6. Any other comments for the selection panel?
SSIs- In the NICE guidance there are grades of SSI’s. These categorise the infection.
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