Transcript Document

HPSC, SARI and
National HCAI
surveillance
Fidelma Fitzpatrick
Consultant Microbiologist,
Health Protection Surveillance Centre &
Beaumont Hospital, Dublin, Ireland
1. What is HPSC?
2. What is SARI?
3. National HCAI surveillance
4. What about line infections?
H.P.S.C.
Health Protection Surveillance Centre
HPSC- History and
Governance
• Established (NDSC) Nov 1998
– Surveillance of Communicable Diseases
– Epidemiological investigation, Advice, Training and
Research
– International Liaison EU/WHO
• Incorporated into HSE in January 2005
– Division of Population Health;
– Name change - Health Protection Surveillance Centre
– Same remit
4
HPSC Activity
Surveillance
Provision of
Expert Advice
• Collecting data
• Collating it
• Analysing it and
• Communicating information to those
who need to know
• Operational Support to the Health
System
• Policy advice
• Public information
Research
• Identifying and developing best
practice – initiation and collaboration
Training
• For professionals in communicable
disease control – especially joint
training
• Teaching
5
Where HPSC fits into the Great Scheme of Things
CEO
Office of
the CEO
Director of HR
Director of
Population Health
Director of PCCC
Director of Shared
Services
Assistant Directors
x3
Assistant Directors
x4
Assistant Directors
x4
Assistant Directors
x2
Industrial Relations,
Employee Wellbeing
& Welfare,
Legal/Advisory
Services,
Partnership,
Workforce Planning,
Recruitment,
Employment
Monitoring,
Performance
Management,
Learning &
Development,
Management
Development,
PPARS
Strategic Planning &
Evaluation, Health
Intelligence, Health
Inequality & Social
Inclusion, Health
Promotion &
Improvement,
Communicable
Diseases
Surveillance &
Control & Other
Health Protection
Issues
Planning,
Monitoring &
Evaluation,
Contracting
Development of
Service Frameworks,
Provision of Expert
Advice, System
Support
HPSC
GMS PB,
HR – Payroll,
Superannuation,
Recruitment.
Personnel,
Finance – Purchase
to Pay, Financial
Reporting,
Accounting
Receivables,
Financial Systems &
Reporting, ICT –
Infrastructure
Services,
Application Services,
Data & Integration
Service,
ICT Customer
Support, Customer
Relations, Service
Development
Communication,
Service
Governance
Director of NHO
Director of Finance
Director of CMOD
Director of ICT
Assistant Directors
x4
Assistant Directors
x4
Assistant Directors
x2
Assistant Directors
x4
Planning,
Contracts &
Utilisation Review,
Quality Risk &
Customer Care,
National Ambulance
Service
Financial Planning,
Costing &
Evaluation, Statutory
Reporting & Control,
Management
Reporting,
Procurement & VFM,
FISP
Change
Management,
Central Resource,
Leadership,
Development,
Streamlining
Agencies – Change
Process, Service
Improvement &
Organisational
Development,
Director of
Corporate Afffairs
Design &
Procurement,
Implementation &
Rollout,
Project Governance
& interconnectivity,
Projects
Management,
Strategy
Formulation, Library
& Research,
Innovation Centre
6
www.hpsc.ie
www.hpsc.ie
C. difficile
MRSA
…….and more!
2001
http://www.hse.ie/eng/Publications/Health_Protection/Health_Care_Associated_Infection/Governance_Fr
amework_March_2007.pdf
National guidelines
•National committee
•Subcommittees
• Surgical site infection surveillance
• Catheter-associated UTI
• IV catheter-associated infection
•Antibiotic stewardship (x2)
•MRSA in ICU
•Regional committees
1.
2.
3.
4.
5.
6.
EARSS
ESAC
MRSA in ICU Prevalance Survey
Alcohol hand gel consumption
North South MRSA Study 1999
HIS HCAI Prevalance Study 2006
www.hpsc.ie
MRSA in ICU Prevalance Study
• 32 hospital ICU’s in 2008
• Average MRSA prevalence rates 2.9% to
21.2%
• MRSA acquisition rates vary nationally
from 0% to 3.3%.
• Data suggests that ICU’s with lower
isolation room resources have a higher
MRSA acquisition rate compared to ICU’s
with more resources despite having a
similar percentage of patients ventilated.
MRSA Isolates
192 cases in North (5.3/100,000)
508 cases in South (6.5/100,000)
Males > Females
Highest rates, 65 years or more
25-44 yrs. 4.4/100,000 (South)
75yrs.
111/100,000 (South)
South North
Hospital
GP
Nursing Home
Psychiatry
92%
4%
2%
2%
69%
20%
10%
1%
Clinical Status
Colonised (carriage)
Local infection
Invasive infection
No. (%)
271(62)
124(28)
44(10)
Risk factors for invasive disease
–iv line
– surgery/ invasive procedure
MRSA/S aureus bacteraemia
North
25%
South
36%
Hospitals with antibiotic policy
95%
41%
Infection control nurse on site
100%
85%
Isolation rooms available
100%
87%
HIS HCAI Prevalance Survey
Prevalence Rate of HCAI and MRSA
9
8.19
8
Rate (%)
7
6
6.35
5.43
4.89
5
4
3
2
1.28
0.87
1
0.85
0
HCAI Prevalence Rate
England
MRSA Prevalence Rate
Wales
N. Ireland
Rep of Ireland
0.49
Prevalence Rate of HCAI and MRSA by Infection Type (1)
6
England Wales N. Ireland Rep of Ireland
5
Rate (%)
4
3
2
1
0
BSI
UTI
Pneumonia
SSI
BSI
UTI
Pneumonia
SSI
Prevalence of HCAI by Infection type (2)
2.5
England Wales N. Ireland Rep of Ireland
Rate (%)
2
1.5
1
0.5
0
Bone & joint
Cardiovascular System Central Nervous System
Eyes,ENT or Mouth
GI system
LRT (excl pneumonia)
Reproductive tract
Skin & soft tissue
Systemic
Clostridium difficile Prevalence Rate
2
1.98
1.5
%
1.1
1.13
1
0.48
0.5
0.19
0
England
Wales
N. Ireland
Rep of Ireland
BH
North South MRSA Study
• 5% (North) and 10% (South) cases had
invasive infection
• Patients with invasive infection were
more likely to have a history of PVC
or CVC than those with colonisation
only.
HIS HCAI Prevalance Survey
• 449 patients had a primary BSI,
184(41%) of which were CVC related
• CVC presence significantly associated
with primary BSI
• More patients in RoI had IVCs in situ
when compared N. Irl
• As in other countries, presence of a
CVC in Irish patients was associated
with a HCAI.
S.aureus bacteraemia:
283 cases
South-East Ireland 2002-6
Source
Central Venous Catheter
Number % of Total
91
32%
47% due to
Peripheral Venous Catheter 42
15%
venous access
Burns et al .CMI 2007 13;(s1)s520
Enhanced EARSS
2175
587
98
One in four S.aureus bacteraemias in Ireland is due to infection
associated with a central venous catheter
One in twenty S.aureus bacteraemias in Ireland is due to infection
associated with a peripheral venous cannula
Enhanced EARSS
2175
587
98
One in four S.aureus bacteraemias in Ireland is due to infection
associated with a central venous catheter
One in twenty S.aureus bacteraemias in Ireland is due to infection
associated with a peripheral venous cannula
Enhanced EARSS
Irish guidelines:
Prevention of CR-BSI
Summary
• IV lines = potentially modifiable risk
factor for bacteraemia
• Surveillance data essential to
monitor effectiveness of any
intervention
• ‘You cant manage what you cant
measure’