Download Meticillin Resistant Staphylococcus Aureus (MRSA) bacteraemia

Healthcare Associated Infection
Healthcare-associated infection (HCAI) refers to infections that occur as a result of
contact with the healthcare system in its widest sense - from care provided in your own
home, to general practice, nursing home care and care in acute hospitals. The term has
recently been coined in recognition that increasingly complex procedures are undertaken
outside hospitals. Previously, when most complex healthcare was hospital based, the
term hospital-acquired infection was used.
To support the reduction of HCAI in Wales the Welsh Government has implemented
mandatory surveillance schemes across all Health Boards. The schemes provide
information about rates of certain important infections highlighting for them potential
areas for investigation and action.
Aneurin Bevan Health Board believes that this information should be made easily
available to anyone who wishes to have sight of it.
Meticillin Resistant Staphylococcus Aureus (MRSA) bacteraemia infections
Bacteraemia means the presence of bacteria in blood. MRSA bacteraemia surveillance is
the monitoring of the rates of these bacteria in patient blood samples.
Special blood samples are taken from patients in hospitals who show symptoms of
infection with Staph. aureus, and these are then tested in the laboratory for the presence
of the bacteria.
Since April 2001, all acute Health Boards in Wales have been required by the Welsh
Government to implement surveillance of Staphylococcus aureus (including MRSA)
bacteraemias.
Rates of MRSA bacteraemia infection are very low across Aneurin Bevan Health Board –
the number of patients is in single figures each month.
MRSA Trend
Aneurin Bevan Health Board & Wales
16
Aneurin Bevan Health Board Hospitals
14
14
All Wales Comparison
Oct - Dec 2012
Jul - Sep 2012
Apr - Jun 2012
Jan - Mar 2012
Oct - Dec 2011
Jul - Sep 2011
Apr - Jun 2011
0
Jan - Mar 2011
0
Oct - Dec 2010
2
Jul - Sep 2010
2
Apr - Jun 2010
4
Jan - Mar 2010
4
Oct - Dec 2009
6
Jul - Sep 2009
6
Apr - Jun 2009
8
Jan - Mar 2009
8
Oct - Dec 2008
10
Jul - Sep 2008
10
Apr - Jun 2008
12
Jan - Mar 2008
12
Oct - Dec 2007
MRSA Bacteraemias per 100,000 Bed Days
16
Clostridium difficile (C. difficile) surveillance
C. difficile is a spore-forming bacterium which is present as one of the 'normal' bacteria
in the gut (bowel) of up to 3% of healthy adults, where it rarely causes problems.
C. difficile can cause illness when various antibiotics disturb the balance of 'normal'
bacteria in the gut.
When C. difficile overgrows in the gut it produces toxins, which causes a range of disease
— from no symptoms in some cases, to diarrhoea of varying severity, which may resolve
once antibiotic treatment is stopped, through to severe inflammation of the bowel which
can sometimes be life-threatening.
People over the age of 65 years are more susceptible to contracting infection; over 80%
of cases are reported in this age group. The risk for disease increases in patients with the
following:
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antibiotic exposure
gastrointestinal (gut) surgery/manipulation
long length of stay in healthcare settings
a serious underlying illness
conditions that cause suppression of the immune system
advanced age
The bacterium survives well in the environment, particularly because it can produce
spores, which allows it to survive in very unfavourable environments. Patients pick up the
organism from the environment and in combination with the imbalance in gut flora
caused by the use of antibiotics disease can develop.
Unfortunately patients with diarrhoea, especially if severe or accompanied by
incontinence, may unintentionally spread the infection to other patients, which may lead
to outbreaks of C. difficile in hospitals. In addition, the ability of this bacterium to form
spores enables it to survive for long periods in the environment (e.g. on floors and
around toilets) and to be carried in the air e.g. during bed making.
Therefore, good infection control procedures in healthcare settings are essential to
minimise the spread of the bacterium. The effectiveness of these measures can be
indicated through the surveillance of C. difficile infections.
Since January 2005, all Health Boards in Wales have been required by the Welsh
Government to undertake surveillance of the number of cases of Clostridium difficile (C.
difficile) infection.
Clostridium difficile — In-patients over 65
Aneurin Bevan Health Board and Wales
35
35
30
All Wales Comparison
Jan-13
Oct-12
Jul-12
Apr-12
Jan-12
Oct-11
Jul-11
Apr-11
Jan-11
0
Oct-10
0
Jul-10
5
Apr-10
5
Jan-10
10
Oct-09
10
Jul-09
15
Apr-09
15
Jan-09
20
Oct-08
20
Jul-08
25
Apr-08
25
Jan-08
Clostridium difficile per 1,000 Admissions >65 Years
Aneurin Bevan Health Board Hospitals
30
Surgical site infection (SSI) surveillance
What are surgical site infections (SSIs)?
A surgical site is the incision or cut in the skin made by a surgeon to carry out a surgical
procedure. The position and size of the surgical site depends on the intended procedure
and the type of surgery. For example, laparoscopic surgery (which uses fine instruments
and a video-camera) requires very small incisions whereas more complex surgery may
require a very large incision.
A SSI can occur when bacteria from the skin, other parts of the body or the environment
enter the incision made by the surgeon and multiply in the tissues. This results in
physical symptoms as the body tries to fight the infection. There may be pus,
inflammation, swelling, pain and fever.
Why do surgical site infections occur?
SSI is relatively rare. High standards of asepsis (procedures that reduce the risk of
bacterial contamination e.g. sterile equipment) in operating theatres are key to
minimising the risk of infection. However, they cannot always be prevented.
The likelihood of an SSI depends on a number of factors related to both the patient and
the surgical procedure. In particular, the risk of developing a SSI varies according to the
type of surgery, the general health of the patient at time of operation and the length of
the operation.
Two SSI schemes exist — Orthopaedic (hip and knee) and Caesarean section procedures.
Orthopaedic SSI
Hip Procedures
January 2011 – December 2011
January 2012 – December 2012
Gwent
1.4% (1 in 70)
1.1% (1 in 90)
All-Wales
1.8% (1 in 55)
1.5% (1 in 66)
Knee Procedures
January 2011 – December 2011
January 2012 – December 2012
Gwent
1.4% (1 in 70)
2.0% (1 in 50)
All-Wales
1.3% (1 in 77)
1.6% (1 in 62)
Gwent
3.9% (1 in 25)
3.7% (1 in 27)
All-Wales
8.0% (1 in 13)
7.0% (1 in 14)
Caesarean section
January 2011 – December 2011
January 2012 – December 2012
Further detailed information around the surveillance schemes can be accessed
on Public Health Wales website – click:
Welsh Healthcare Associated Infection Programme
or from the Aneurin Bevan Infection Prevention Team on 01873 732048.