1. Point Prevalence Survey of Hospital- Acquired Infections & Antimicrobial Use in Ireland PPS Data Collector Training April 2012 Background & Introduction to PPS Presentation 1

2. Schedule Registration Welcome Objectives Background & introduction to the ECDC PPS Completing the Ward List & deciding patient eligibility – Coffee break Hospital-acquired infection case definitions & case studies – Lunch

3. Schedule Antimicrobial use & case studies Review of the Patient Forms (Form C) Data entry Review of the Hospital Form (Form B) External validation, Summary, Evaluation – Close

4. Course Objectives Participants will understand and apply the methodology of the 2012 ECDC Point Prevalence Survey (PPS) of Hospital-Acquired Infections (HAI) & Antimicrobial Use Participants will be able to apply the definitions of antimicrobial use Participants will be able to apply the HAI case definitions

5. What is a PPS? A prevalence survey provides data at one particular point in time ‘snapshot’ Prevalence = numerator / denominator Numerator = number of patients on the ward who have an active HAI at the time of the survey Denominator = All eligible patients present on the ward at 8am on the day of the survey for that ward

6. What is a PPS? PPS team visits a ward at 11am on 10/5/12 There were 29 patients present on the ward at 8am The PPS team decides that 26 patients are eligible for inclusion in the PPS – Two have since been transferred to other wards and one has been discharged home After completing the PPS for the ward, 9 patients were identified as receiving systemic antimicrobials Prevalence of antimicrobial use on the ward = 9/26 x 100 = 34.6%

7. What is a PPS? After completing the PPS for the ward, 4 patients were identified as having active HAI HAI prevalence on the ward = 4/26 x 100 = 15.3%

8. Hospital Infection Society 2006 PPS UK & Ireland Ireland, Northern Ireland, England & Wales conducted a PPS of healthcare-associated infections (HCAI) in 2006 US Centers for Disease Control & Prevention (CDC) definitions of infection used Infections acquired in another hospital were excluded Only two questions regarding antibiotic use – Systemic antibiotic use ‘Y/N’ – IV antibiotic use ‘Y/N’

10. Hospital Infection Society 2006 PPS: Ireland 44 acute hospitals (88%) participated in 2006 PPS 7,541 patients surveyed 369 patients with HCAI HCAI prevalence 4.9% Systemic antibiotic use prevalence 34.2%

12. What’s been happening in Ireland since 2006?

13. C. difficile infection (CDI) May 2008: National guidance document issued and new cases of CDI became notifiable August 2009: Enhanced CDI surveillance scheme established – All cases of CDI new and recurrent reportable to enhanced surveillance. 37 acute hospitals participating in enhanced surveillance by Q3 2011 – National quarterly report issued – Quarterly report issued to each participating hospital

14. Source: HPSC www.hpsc.iewww.hpsc.ie

15. C. difficile subcommittee reconvened October 2011 to revise national guidelines

17. S. aureus invasive infection Captured via EARS-Net – 40 laboratories participated in 2011 S. aureus BSI via enhanced surveillance scheme – 16 laboratories participated in 2011 – 2011 results in preparation – 2010: 23% of SAB due to infected CVC & 6% due to infected PVC Source: HPSC www.hpsc.iewww.hpsc.ie

18. Total number of S. aureus (MRSA and MSSA) bloodstream isolates and proportion (%) MRSA from acute hospitals (public & private) by year, 2004 to 2011Q3 †Data for 2011 provisional to the end of Q3 only Source: HPSC www.hpsc.iewww.hpsc.ie

19. 2005 MRSA guidelines have just been updated and will be published shortly

20. Source: HPSC www.hpsc.iewww.hpsc.ie

21. Total number of E. faecium (VREfm and VSEfm) bloodstream isolates, and VREfm proportions from acute hospitals (public & private) by year, 2004 to 2011 VREfm, Vancomycin-resistant E. faecium; VSEfm, Vancomycin-susceptible E. faecium †Data for 2011 provisional to the end of Q3 only Source: HPSC www.hpsc.iewww.hpsc.ie

22. CRE Carbapenem resistant Enterobacteriaceae Multi-drug resistant Gram-negative organisms Extremely limited antimicrobial treatment options First reported case in Ireland in 2009 In 2011, CRE reported from 36 patients in 8 hospitals around Ireland – majority of cases reported from outbreaks Four hospitals reported CRE outbreaks in 2011 CRE infection is notifiable to public health National guidelines on the prevention & control of multi-drug resistant organisms (other than MRSA) will be published shortly

24. Period 1 = June 2011 Period 2 = October 2011 Source: HPSC www.hpsc.iewww.hpsc.ie

25. Aims of this PPS To conduct a PPS of HAI & antimicrobial use across all EU Member States during 2011-12 using a common protocol To estimate the total burden of HAI & antimicrobial use within: – EU – Each Member State – Each participating healthcare facility – By specialty type – By patient type

26. 26 Overview of previous European PPS: Mean HAI prevalence 7% 21 documented PPS in European countries over past 15 years

27. Aims of this PPS To share the results of the PPS with those who need to know: – Local – Regional – National – International – EU To use the data generated within YOUR hospital to help YOU and your colleagues to: – Identify priority areas for future targeted HAI surveillance – Identify interventions to prevent HAI – Identify areas for targeting antimicrobial stewardship

28. Preliminary PPS data: submitted to ECDC at 28/2/12 Most common HAI types reported from participating hospitals to date: 1.Pneumonia 2.Surgical site infection 3.Urinary tract infection 4.Bloodstream infection 5.Gastrointestinal infection 6.Systemic infections 7.Skin & soft tissue infection 8.All other infection types Preliminary data only - for information

29. Preliminary PPS data: submitted to ECDC at 28/2/12 Over half of all HAI episodes associated with positive microbiology results HAI causative microorganisms: – Enterobacteriaceae – Gram-positive cocci – Other Gram-negative bacilli – Fungi Preliminary data only - for information

30. Summary Last PPS performed in Ireland six years ago – 44 acute hospitals, 7,521 patients surveyed – 34.2% on antibiotics – 4.9% HCAI Many interim developments to raise awareness of HAI & need for prudent antimicrobial use 2012 PPS provides us with the opportunity to see where we are now and to direct our future interventions for ongoing improvement

31. Any Questions?

32. Overview of data to be collected during PPS Nursing & Midwifery staff PPS team leader PPS team assisted by staff caring for patients

33. Ward List (Form A)

34. Hospital Form (Form B)

35. Patient Form (Form C)

36. Three pages Five sections – Section 1 – Patient details – Section 2 – Risk factors – Section 3 – Condition of interest – Antimicrobial use Y/N and HAI Y/N – Section 4 – Antimicrobial use data – Section 5 – HAI data Sections 1, 2, 3 completed for EVERY eligible patient 100%

37. Patient Form (Form C) Three pages Five sections – Section 1 – Patient details – Section 2 – Risk factors – Section 3 – Condition of interest – Antimicrobial use Y/N and HAI Y/N – Section 4 – Antimicrobial use data – Section 5 – HAI data Sections 1, 2, 3 & 4 completed for EVERY eligible patient receiving systemic antimicrobials ~ 33%

38. Patient Form (Form C) Three pages Five sections – Section 1 – Patient details – Section 2 – Risk factors – Section 3 – Condition of interest – Antimicrobial use and HAI – Section 4 – Antimicrobial use data – Section 5 – HAI data Sections 1, 2, 3, 4 & 5 completed for EVERY eligible patient receiving systemic antimicrobials with an active HAI ~ 5%

39. Your hospital.... TOTAL NUMBER OF PAPER FORMS TO BE COMPLETED* 150 ACUTE BEDS DIVIDED INTO 8 WARDS 300 ACUTE BEDS DIVIDED INTO 12 WARDS 600 ACUTE BEDS DIVIDED INTO 22 WARDS Ward Forms (Form A) 81222 Hospital Form (Form B) 111 Patient Forms (Form C) 150300600 Form C Section 1, 2, 3 92185370 Form C Section 1, 2, 3 & 4 50100200 Form C Section 1,2, 3, 4 & 5 81530 *The completed paper versions of one Form B & all Form Cs are used to enter your hospital’s PPS data onto secure ‘web-based’ data entry system

40. Patient Form (Form C)

41. There is space on Form C to record up to five systemic antimicrobial prescriptions AND up to three different hospital-acquired infections

42. Patient Form (Form C)

43. The answers to 10/12 (83%) questions in Section 1 & 2 can be directly transcribed from the completed Ward List. For each eligible patient, the PPS team will need to decide:  Admitting consultant’s specialty  Underlying disease prognosis

44. Patient Form (Form C)  ‘Patient on antimicrobials’ answered on Ward List  Also check Ward List to identify patients who have undergone surgery in the last 24 hours to pick up surgical prophylaxis

45. Patient Form (Form C)

47. Any Questions? pps2012@hpsc.ie