Download Point Prevalence Survey of Healthcare associated

26th June 2012
Point Prevalence Survey of
Healthcare associated infection and
antimicrobial use
Information for Action
Dafydd Williams
ECDC PPS
NOT AGAIN
WHAT’S THIS?
Information for Action
Objective
• Overview of the ECDC PPS
– Discussing the methodology
– Summary of results
Information for Action
Why carry out an EU prevalence survey?
An external ECDC evaluation in 2008 recommended that:
“The European HAI surveillance needs to cover other types of
nosocomial infections besides surgical site infections and ICUacquired infections in order to estimate and monitor the complete HAI
disease burden”
“Since the implementation of an expanded continuous incidence
surveillance is very resource demanding, hospital-wide prevalence
surveys are efficient approaches to address it.”
Objectives of EU PPS 2011/2
1. To estimate the total burden (prevalence) of HAI & antimicrobial use
2. To describe patients, invasive procedures, infections and antimicrobials
prescribed
By type of patients, specialties or healthcare facilities
By EU country, adjusted or stratified
3. To disseminate results to those who need to know at local, regional,
national and EU level
Raise awareness
Train and reinforce surveillance structures and skills
Identify common EU problems and set up priorities
Evaluate the effect of strategies and guide policies (repeated PPS)
4. To provide a standardised tool to identify targets for quality improvement
ECDC – Methodology
• ECDC developed protocol
Information for Action
Health Boards
Number of
Hospitals
Number of
patients
surveyed
Number of
patient with
HAI
Abertawe Bro Morgannwg University Health Board
12
1963
47
2.4
(1.8-3.7)
Aneurin Bevan Health Board
15
1387
43
3.1
(2.3-4.6)
Betsi Cadwaladr University Health Board
19
1815
84
4.6
(3.8-5.7)
Cardiff and Vale University Health Board
8
1645
76
4.6
(3.7-5.7)
Cwm Taf Health Board
8
1026
16
1.6
(1.0-2.5)
Hywel Dda Health Board
13
1071
69
6.4
(5.1-8.1)
Powys Teaching Health Board
10
154
25
1
33
2
86
9094
362
Velindre NHS Trust
Wales total
Prevalence of
HAI
16.2 (11.2-22.9)
6.1
(1.7-19.6)
4.0 (3.6-4.4)
Overall HAI for Wales
Acute Sector
Non-Acute Sector
Number of
patients in Wales
HAI type
9094
=
=
=
Number of
HAI*
4.0%
4.3%
3.2%
% of HAI
Prevalence
(%) of HAI
by type
382
UTI
SSI
GI infection
Pneumonia
BSI
80
75
44
42
34
20.9
19.6
11.5
11.0
8.9
Skin and soft tissue infection
LRT infection
Eyes and ENT infection
Systemic infection
CRI-CVC
Reproductive tract infection
Neonatal infection
CRI-PVC
Bone and joint infection
CNS infection
CVS infection
32
25
22
8
5
4
3
3
2
2
1
8.4
6.5
5.8
2.1
1.3
1.0
0.8
0.8
0.5
0.5
0.3
0.9
0.8
0.5
Acute Sector
SSI
UTI
Pneumonia
(23.7%)
(16.7%)
(12.3%)
0.5
0.4
0.4
0.3
0.2
0.1
0.1
<0.1
<0.1
<0.1
<0.1
<0.1
<0.1
* Counts the number of HAI (i.e. Patients may have multiple HAI).
Key: UTI – urinary tract infection; SSI – surgical site infection; GI – gastrointestinal; BSI – bloodstream infection; LRT –
lower respiratory tract; ENT – ear - nose - throat; CRI-CVC – catheter related infection (central venous catheter); CRIPVC – catheter related infection (peripheral vascular cannula); CNS – central nervous system; CVS – cardiovascular
system.
Non-Acute
UTI
Eyes & ENT
SST
(36.1%)
(14.5%)
(12.1%)
Comparison with previous HAI
prevalence survey 2006
Year
Number of
patients
surveyed
Number of
patients with
HAI
2006
5734
364
6.4 (5.7 – 7.0)
2011 (stratified)
6217
271
4.4 (3.9 - 4.9)
HAI type
UTI
SSI
GI infection
Pneumonia
BSI
Skin and soft tissue infection
LRT infection
Eyes and ENT infection
Systemic infection
Reproductive tract infection
Bone and joint infection
CNS infection
CVS infection
Total
2006 prevalence of HAI*
(%)
15.5
18.0
15.5
9.8
8.0
12.5
14.3
3.0
1.5
0.8
1.0
0.3
0.0
5734
Prevalence (%)
of HAI (95%
CI)
2011 prevalence (%)
of HAI* (stratified)
17.5
24.3
12.5
12.9
11.1
7.5
5.4
3.6
2.9
1.1
0.7
0.4
0.4
6217
Prevalence of antimicrobial prescribing in Wales by
indication
Community
acquired infection
12.8 (12.1 - 13.5)
Hospital acquired
infection
8.8 (8.2 - 9.4)
Long
term/intermediate
care acquired
infection
0.3 (0.2- 0.4)
Surgical
prophylaxis
1.1 (0.9 - 1.4)
Medical prophylaxis
2.5 (2.2 - 2.9)
No antimicrobials
72.6 (71.6 - 73.5)
Other
0.1 (0.0 - 0.2)
Not recorded
0.9 (0.8 - 1.2)
Mixed Indications
1.0 (0.8 - 1.2)
Information for Action
• Overall 8.8% of patients surveyed
were being treated for a hospital
acquired infection only, as deemed
by the prescriber.
• Only 4.0% of patients were
considered to have a HAI as defined
by the HAI case definitions within
the survey.
Medical Device Utilisation
Number of
patients
surveyed
Number of patients
with one or more
devices in situ
9094
3369
Device
Number of
devices in situ*
37.0
UC
PVC
CVC
Intubation
Total number
of HAI in
Wales
% of device
utilisation
HAI type
1571
2368
375
210
17.3
26.0
4.1
2.3
Number of
HAI
HAI with
device in
situ prior
to onset
% of total
HAI
UTI (urinary catheter within 7 days
prior to onset)
80
40
10.4
Pneumonia (ventilated within 48
hours prior to onset)
42
10
2.6
BSI (CVC within 48 hours prior to
onset)
34
5
1.3
383