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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