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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: 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.