Susan Harris ( ) Welsh Healthcare Associated Infection Programme Welsh Healthcare Associated Infection Programme: Reporting systems

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Introduction to WHAIP Summary of Surveillance programmes Data sources Reporting systems

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Welsh Healthcare Associated Infection Programme (WHAIP) Development, implementation and delivery of mandatory HCAI surveillance programme & Surgical Instrument Surveillance. Identify preventable aspects and audit compliance with agreed practices. WHAIP provides local and national healthcare associated infection surveillance systems providing support in their use and data analysis for the infection control teams in Welsh hospitals.

Susan Harris ( ) Welsh Healthcare Associated Infection Programme HCAI Surveillance - Wales MANDATORY Bacteraemia surveillance –Staphylococcus aureus (MRSA, MSSA) –“Top Ten Bacteraemia” Critical Care HCAI surveillance –Central Line associated Bacteraemias –Ventilator Associated Pneumonias Surgical Site Infection Surveillance –Orthopaedic –C-section Clostridium difficile surveillance Outbreak Surveillance VOLUNTARY Surgical Site Infection Surveillance –Surveillance tool developed for 1000 Lives campaign Catheter Associated Urinary Tract Infection (CAUTI) surveillance –Supporting urinary catheter care bundle work within the 1000 Lives Plus programme Health Board Specific Surveillance support

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Data sources DataStore: Bacteraemia surveillance – S. aureus, Top 10 Clostridium difficile Web Based Data Entry: Hospital outbreaks

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Data sources continued.. Form based data collection (scannable forms): Critical care – CVC infections, VAP Surgical site infection (SSI) – Orthopaedics,C-section Single Use Instruments (SISP) HSW data Admissions (Clostridium difficile) Bed days (Staphylococcus aureus) Procedures (SSI, SISP) HSW data-sources are updated from the individual hospitals’ information departments. There is a 4 month delay in this data being published by HSW while they process all the returns. Users who require the data more timely for local reporting, can obtain it directly from the hospital’s information department.

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Microbiology DataStore Key facts: Administered from a central location Provides a standard microbiology laboratory database Sits alongside the laboratory information management system Results are routinely collected (every hour) All results are stored – both positive and negative Local codes are utilised but also linked to standard codes Previous years reports are loaded from the LIMS Installed in all microbiology laboratories in Wales

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Standard output Standardised Data Storage Test results Standard database Information management system

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Research and surveillance: Respond to local and regional data queries Antibiotic resistance and community prescribing Regional antibiotic surveillance For further information contact Informatics Tools: Contract monitoring / laboratory workload Data browser / patient lookup Statistics module for antibiotic and organisms Microbiology DataStore

Susan Harris ( ) Welsh Healthcare Associated Infection Programme WHAIP Report types: Rates (Tabular and graphical formats) Time trends (run charts) Adverse events (Statistical Process Control Charts) both positive and negative Time/Numbers between events (graphical presentation) used for rare occurrences e. g. number of days or number of lines inserted between infections Moving averages (graphical presentation) Allows for seasonality Traffic Light System (graphical presentation) Performance alert

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Bacteraemia surveillance – S. aureus Data collected since April 2001 Quarterly numbers entered into a database on website until March From April 2010, data exported from data warehouse system called Datastore, used by all microbiology labs in Wales Total blood culture sets taken, total positive blood cultures, and for blood cultures positive for MRSA and MSSA, age, sex and specialty of the patient. Deduplicated – 14 days

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Bacteraemia surveillance – S. aureus Monthly Reports - MRSA & MSSA - Table of 13 months of data - Graph comparing cumulative numbers for current financial year with previous - Wales, Health Board & major acute hospital level data

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Monthly S. aureus bacteraemia reporting

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Bacteraemia surveillance – S. aureus Other reports 6 monthly updated rate reports MRSA & MSSA annual rates per 100,000 bed days Quarterly trend data from April 2001 SPC charts 12 month moving average chart Wales, Health Board and major acute hospital level data

Susan Harris ( ) Welsh Healthcare Associated Infection Programme MRSA Bacteraemia Rates Rate for 09/10 financial year - 7 per 100,000 bed days

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Bacteraemia surveillance – Top 10 Surveillance system in place since 2005 All positive blood cultures extracted from data warehouse system Rules applied for possible contaminant organisms (2 pos within 48h) Deduplicated – 14 days 10 organisms with highest counts reported Rates per 100,000 bed days Annual report produced

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Bacteraemia surveillance – Top 10 Top 10 data for 2009 RankOrganism Rate per 100,000 bed days 1Escherichia coli (E.coli)51 2Staphylococcus aureus (MSSA)18 3Enterococcus species13 4Klebsiella species10 = 5Coagulase-negative Staphylococcus9 =5Streptococcus pneumoniae9 7Staphylococcus aureus (MRSA) 8 8Pseudomonas aeruginosa5 =9Proteus species4 =9Serratia species4

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Clostridium difficile Surveillance in >65s since 2005 Expanded to >1s in 2008 All toxin positive C. difficile extracted from data warehouse system Deduplicated – 28 days C. difficile Annual Operating Framework (AOF) Target introduced for financial year 10/11 – 20% reduction on baseline numbers for each health board (inpatients aged >65)

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Clostridium difficile Monthly Reports Table of 13 months of data Graph comparing cumulative monthly numbers for current financial year with baseline months Wales, Health Board & major acute hospital level data Traffic light system

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Clostridium difficile Data to end June ‘10 show numbers of C. difficile from inpatients aged >65 are not currently on target to achieve 20% reduction

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Clostridium difficile Other Reports 6 monthly updated rates report Rates per 1000 admissions for inpatients aged >65 Numbers of inpatients aged 2-65 Monthly trend data from Jan 2005 SPC charts 12 month moving average chart Wales, Health Board and major acute hospital level data

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Clostridium difficile rates Rate for 09/10 financial year = 15.0 /1000 admissions Seasonal pattern

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Clostridium difficile 12 month moving average

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Critical Care Surveillance VAPs CVC Infections

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Critical Care Surveillance - VAP Mandatory surveillance since Sep 2008 Data collected via scannable forms HELICS VAP definition used Bimonthly reports issued to ICUs Annual report published on website

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Bi-monthly report - example

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Annual report - example

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Critical Care Surveillance – CVC Infections Mandatory surveillance since Sep 2007 Introduced in conjunction with care bundle Data collected via scannable forms HELICS CVC definition used plus additional CVC associated definition Bimonthly reports issued to ICUs Annual report published on website

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Bi-monthly report - example

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Annual report - example

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Surgical Site Infection Surveillance Orthopaedics Caesarean Section

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Surgical Site Infection Surveillance - Orthopaedics Mandatory since 2003 Elective primary hip & knee arthroplasty Continuous surveillance Paper questionnaires Optical mark reader CDC definitions for SSI Post –discharge data collected at 6 week follow- up appointment

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Surgical Site Infection Surveillance - Orthopaedics Quarterly reports issued to Health Boards Annual report published on website

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Procedure TypeNo. of Procedures*No. of SSI% SSI95% CI All mandatory procedures – 1.5 Elective primary hip arthroplasty – 1.7 Elective primary knee arthroplasty – 1.7 Annual report - example Quarterly report - example Table 4. Incidence of inpatient SSI by procedure type in Wales in 2008

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Surgical Site Infection Surveillance – C- Section Mandatory since 2006 Continuous surveillance Paper questionnaires Optical mark reader CDC definitions for SSI Post-discharge data collected by community midwives up to 28 days post procedure Data accessible to participants via a web based reporting system (manuals available on request)

Susan Harris ( ) Welsh Healthcare Associated Infection Programme C-Section – Web Reporting System Secure web-based database. All contributing hospitals are able to view their data A valid user id and password is required. Data can be viewed using a series of pre-defined reports or exporting the dataset to a third party product

Susan Harris ( ) Welsh Healthcare Associated Infection Programme C-Section – Web Reporting System

Susan Harris ( ) Welsh Healthcare Associated Infection Programme C-Section – Web Reporting System Reports are available for Health Boards to download from web reporting tool

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Surgical Site Infection Surveillance – C- Section Example report available from web reporting system

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Surgical Site Infection Surveillance – C- Section Annual report published on website

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Outbreak Reporting All Trusts to report on HAI outbreaks / incidents Set up Outbreak Surveillance Co-ordinator from within Trust’s Infection Control Team Data accessible to participants via a web based reporting system (manuals available on request) Reporting via web using the hospital outbreak definition provided

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Outbreak Reporting system

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Outbreak Reporting system User manual available on request

Susan Harris ( ) Welsh Healthcare Associated Infection Programme

Susan Harris ( ) Welsh Healthcare Associated Infection Programme

Susan Harris ( ) Welsh Healthcare Associated Infection Programme

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Outbreak Reporting system - example

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Thanks to the Infection Control teams and Clinical staff in the Welsh Health boards for participating in the surveillance schemes Acknowledgments

Susan Harris ( ) Welsh Healthcare Associated Infection Programme Further information about the HCAI surveillance programmes in Wales is available from the WHAIP intranet site: