Protocol for infection surveillance - Hampshire Hospitals NHS ...

Surveillance of Infection Protocol
BASINGSTOKE AND NORTH HAMPSHIRE NHS FOUNDATION TRUST
Surveillance of Infection Protocol
IC/289/09
Owner Name Bruce Wake
Job Title
Infection Surveillance Coordinator
Final approval Name
Infection Control Committee
committee
Date of meeting 10 December 2009
Authoriser Name Dr Nicki Hutchinson
Job title
Director Infection Prevention and Control
Signature
Date of authorisation 21 December 2009
Review date (maximum 3 years December 2012
from date of
authorisation)
Audience (tick all that apply) Trust staff
NHS
General public
Standards Standards for Better
Health
NHSLA
Executive summary
This protocol explains the rationale behind surveillance of infections, lists the national
and local requirements for surveillance. It explains how the surveillance is done and
who it is reported to.
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Surveillance of Infection Protocol
CONTENTS
Page
1.0 Introduction 3
2.0 Surgical Site Infection Surveillance 3
2.1 Background 3
2.2 Aims 3
2.3 SSIS targets 3
3.0 SSIS Coordinator Responsibilities 4
3.1 Data collection 4
3.2 Submission of data 4
3.3 Reconciliation of submitted data 4
3.4 Data sharing 5
4.0 Staphylococcus aureus Surveillance and Reporting 5
4.1 Background 5
4.2 Coordinator Responsibilities 5
4.3 Data collection 5
4.4 Submission of data 6
4.5 Reconciliation of submitted data 6
4.6 Recording data locally 6
5.0 Clostridium difficile Reporting 6
5.1 Coordinator Responsibilities 6
5.2 Data collection 6
5.3 Submission of data 6
5.4 Reconciliation of submitted data 7
5.5 Recording data locally 7
6.0 All Significant Bacteraemia 7
6.1 Coordinator responsibilities 7
6.2 Recording data locally 7
7.0 Norovirus outbreaks 8
8.0 Enhanced Influenza A H1N1 Surveillance 8
9.0 Enhanced Invasive Group A Streptococcus Surveillance 8
9.1 Data sharing 8
10.0 Alert Organisms 8
10.1 Coordinator responsibilities 9
10.2 Data sharing 9
11.0 Miscellaneous 9
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Surveillance of Infection Protocol
1.0 Introduction
Infections acquired in hospital are recognised to be associated with significant
morbidity. They result in extended length of hospital stay, pain, discomfort and
sometimes prolonged or permanent disability.
In “Getting ahead of the Curve”- a strategy for infectious diseases (Department of
Health, DOH 2003), the prevention of HCAI was highlighted as a priority for action by
the Chief Medical Officer. An important component of the strategy for action included
surveillance. This data is fedback nationally to the HPA and locally to the SHA and
PCT as required within contract schedules. Within BNHFT surveillance data is
shared with the Board of Directors, the executive committee and the divisional
boards. At present surveillance is undertaken for the following infections:
Surgical site infections
Staphylococcus aureus bacteraemias including MRSA
C difficile
Significant hospital acquired bacteraemias especially IV line related infections
Invasive group A streptococcal infections
Norovirus outbreaks
Swine flu (H1N1)
2.0 Surgical Site Infection Surveillance
2.1 Background
Surgical site infections (SSI) account for approximately 10% of all Health care
acquired infections (HCAI) and is estimated to double the cost of patient care
resulting in an additional average 6.5 days of hospital stay. (Health Protection
Agency) HPA.
The (DOH) steering group on HCAI recommended that Surgical Site Infection
Surveillance (SSIS) in Orthopaedic surgery, become mandatory from April 2004 in all
English Trusts, along with voluntary areas of SSIS, which include general,
gynaecology, vascular, and cardiac surgery.
2.2 Aims
One of the key aims of this surveillance service is to enable participating hospitals to
compare their rates of SSI in a specific group of surgical procedures against a
benchmark (the pooled mean rate of other participating hospitals). For this
comparison to be valid the data collection methods used by participating hospitals
must be similar. This requires active surveillance where designated, trained
personnel use a variety of methods to identify cases of infection (HPA). Research
has shown that well organised surveillance and infection control programmes that
include feedback of infection rates to surgeons were associated with significant
reduction in SSI.
2.3 SSIS targets
• Surgical procedures commonly performed or associated with high risk of
infection.
• Surgery that requires at least three days post-operative hospital stay and
where maximum benefit from surveillance is likely to be obtained. It excludes
endoscopy, diagnostic procedures and wounds not closed in theatre (HPA).
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Surveillance of Infection Protocol
Note:
• If an implant has not been inserted, SSIS should be stopped on the 30 th day
after the operation (as infection after this time would not meet the definition of
SSI).
• If an implant has been inserted SSIS should continue for 1 year after the
operation (as an infection may meet SSI definition). Any patients readmitted with
joint infection will be monitored by the coordinator.
3.0 The SSI Coordinator Responsibilities
• Collecting data from (medical & nursing notes / clinical personnel / positive
microbiology cultures).
• Analysing data
• Forwarding data to the HPA via a web link
• Acting as a point of contact to receive data from the HPA( quarterly reports)
• Sharing data results
Note: SSIS can be undertaken at local level if deemed necessary
3.1 Data collection
• Review operating theatre lists to identify patients for specific chosen category.
• Visit patient from first post- operative day until discharge (three occasions
advised by Health Protection Agency) HPA.
• Use assigned data collection form provided by the HPA.
• Make the patient aware of the relevance of SSIS / confidentiality of
information / dissemination of results.
• All patients to receive a booklet on “Monitoring surgical wounds for infection”(
HPA) Coordinator contact details are on the back of booklet.
• Verbal consent is taken from the patient, to receive a follow up telephone call
between four and six weeks post discharge, regarding wound status.
Alternatively a post discharge questionnaire can be given to the patient to be
completed at 30 day post discharge and returned to the Infection Surveillance
Coordinator. This post discharge surveillance is a mandatory requirement by
the SSIS database.
• Liase with microbiology, regarding wound swab results to confirm SSI.
• Collect relevant data via Sapphire computer system :- (ASA score, duration of
operation, grade of surgeon).
• Identify, and monitor patients readmitted with SSI and inform HPA.
• Liase with planning department to confirm admission / discharge list to ensure
that no patients have been overlooked in specific category.
• Check discharge operation code via PMS system.
3.2 Submission of data
• Data is submitted via a password protected electronic weblink to the HPA.
• Each record entered is given a serial number and this is used between the
Trust and the HPA for any further correspondence regarding the patient.
• Coordinator keeps own database for reference.
3.3 Reconciliation of submitted data
Approximately 4 weeks after the end of the surveillance period each participating
hospital will be asked to confirm the number of forms they have submitted for that
period and for how many of these SSI has been reported. This allows the
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Surveillance of Infection Protocol
surveillance of patients still in hospital at the end of the surveillance period to be
completed and ensures that all the data has been received by the coordinating
centre and is included in the individual hospital report.
3.4 Data sharing
Coordinator receives HPA report via e.mail and forwards to:
• Surgeons
• Nursing staff (wards / theatres / specialist)
• Managerial staff
• Physiotherapy & Occupational Therapy (orthopedic patients)
• Infection Control Committee
• Trust Board
• Liases with Public Relations department to ensure public awareness of SSIS
results through:
o
o
The Trust website
A Visual display all clinical areas
4.0 Staphylococcus aureus Surveillance and Reporting
4.1 Background
Since October 2005, all MRSA Hospital and Community acquired bacteraemia for the
Trust are reported via a web link to the HPA - Mandatory Enhanced Surveillance
Scheme (MESS). This new enhanced reporting system allows the capture of a more
comprehensive data set on MRSA than the quarterly mandatory surveillance
scheme. The core mandatory MRSA surveillance schemes continue to operate
independently of this enhanced scheme.
MESS gives trusts a more accurate picture of their situation and contributes to
building a better evidence base regarding risk factors for infections. The enhanced
reporting system:
• Enables reports to be entered in “real time” as they occur.
• Allows Trusts to specify the department or speciality where the patient was
being treated when the infection was identified
• Allows calculation of speciality specific MRSA rates.
• Allows for seperation of MRSA bacteraemia infections identified within 2 days
of admission from those identified after 2 days.
The DOH aims to have a national reduction of MRSA bacteraemia of 50% by 2008.
From April 2006 the HPA introduced voluntary reporting of MSSA bacteraemia.
Basingstoke and North Hampshire Hospital Foundation Trust has utilised this
surveillance since its inauguration.
4.2 Coordinator responsibilities include
4.3 Data collection
• Liases daily with the Consultant Microbiologist and the ICNet system, to
identify all MRSA & MSSA positive blood culture episodes (and their source)
detected in BNHFT laboratory, whether clinically significant or not, whether
treated or not, whether acquired in the Trust or elsewhere.
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Surveillance of Infection Protocol
Note:
• Positive blood cultures from the same patient within 14 days of the initial
culture are considered to be part of the original episode and should not be
reported
• Positive blood cultures more than 14 days apart should be reported as these
are considered to be a new episode.
4.4 Submission of data
Data is entered via a password protected web link to the HPA which includes:
• Core Dataset
• Risk Factor page (this is for Trust information only, to help with root cause
analysis (RCA). It is not information for publication by the HPA or Department
of Health.
4.5 Reconciliation of submitted data
• Trusts using the website have access to all the data they have entered.
• This can be compared to a regional and national aggregate also available to
Trusts from the website
4.6 Recording data locally
A database has been developed to record information regarding MRSA and MSSA
bacteraemia. This database is used to create information in spreadsheet format for
display on the Trust Reporting Warehouse computer drive. The database is also
used to record results of RCA and as a learning resource.
5.0 Clostridium difficile reporting
Clostridium difficile has been included in the MESS reporting scheme by the HPA
in April 2007. Coordinator enters cases via the website on a daily or weekly basis.
5.1 Coordinator responsibilities include
5.2 Data collection
Note:
• Liaises daily with the Consultant Microbiologist and the ICNet system, to
identify all C.difficile toxin positive episodes (and their source) detected in
BNHFT laboratory, whether clinically significant or not, whether treated or not,
whether acquired in the Trust or elsewhere.
• Positive C.difficile toxin assays from the same patient within 28 days of the
initial positive assay are considered to be part of the original episode and
should not be reported.
• Positive C.difficile toxin assays more than 28 days apart should be reported
as these are considered to be a new episode or recurrence or relapse.
5.3 Submission of data
Data is entered via a password protected web link to the HPA which includes:
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Surveillance of Infection Protocol
• Core Dataset
• Risk Factor page (this is for Trust information only, to help with root cause
analysis (RCA). It is not information for publication by the HPA or Department
of Health.
5.4 Reconciliation of submitted data
• Trusts using the website have access to all the data they have entered.
• This can be compared to a regional and national aggregate also available to
Trusts from the website
5.5 Recording data locally
A database has been developed to record information regarding C.difficile infection.
This database is used to create information in spreadsheet format for display on the
Trust Reporting Warehouse computer drive. The database is also used to record
results of RCA and as a learning resource.
6.0 All Significant Bacteraemia
Coordinator collects, analyses, and shares data on all significant bacteraemia in
order:
• To support change as necessary
• Review clinical practice
• Teach and train staff
• Update policies
6.1 Coordinator responsibilities include:
• Liaison with Consultant Microbiologist and ICNet system to identify all
significant bacteraemia.
Compiles monthly figures to reveal:
• Total number of bacteraemia
• Total number of significant hospital and community acquired bacteraemia
• Type and source of hospital and community acquired bacteraemia
• Risk factors related to hospital acquired bacteraemia to identify
contamination rate via:
o Central IV catheter
o Peripheral IV catheter
o Surgical site infection
o Ventilator associated infection
o Urinary catheter
• Identify hospital acquired bacteraemia each clinical area
6.2 Recording data locally
A database has been developed to record information regarding significant
bacteraemia. This database is used to create information in spreadsheet format for
display on the Trust Reporting Warehouse computer drive. The database is also
used to record results of RCA and as a learning resource.
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Surveillance of Infection Protocol
7.0 Norovirus outbreaks
Hospital outbreaks of Norovirus are reported to the Health Protection Agency via a
web link. Norovirus outbreaks are also reported through the Trust Incident Reporting
system and recorded as Serious Untoward Incidents. It is therefore important to
record the number of patients and staff affected and their location at time of infection
to facilitate investigation.
The Infection Surveillance Coordinator will:
• Record the number of patients and staff affected and location
• Liaise with hospital managers to determine whether wards are closed.
• Report to the HPA via web link www.hpa-bioinformatics.org.uk/NoroOBK
8.0 Enhanced Influenza A H1N1 Surveillance
Enhanced surveillance of H1N1 Influenza A (swine Flu) was instigated by the HPA in
August 2009. This programme requires that each Trust report all hospitalised
patients who have contracted H1N1 Flu A.
The Surveillance Coordinator will:
• Liaise with the Laboratory to determine all positive H1N1 patients
• Determine those patients hospitalised
• Report to HPA all Hospitalised patients via web link nww.flusurv.nhs.uk
• Coordinate the gathering of case histories with clinical staff
9.0 Enhanced Invasive Group A Streptococcus Surveillance
Invasive Group A Streptococcus surveillance identifies those infections from usually
sterile sites and where the infection causes a major disease state.
• Reports are generated on an electronic spreadsheet and can be emailed to
the HPU, Hampshire and Isle of Wight Office.
• Surveillance is only required when instigated by the Health Protection
Agency. The HPA will decide upon a start date and finish date.
9.1 Data sharing
• The Infection Control Committee Meeting
• The Trust Governance Board
• The three Divisional Boards
• The Executive Committee.
• Visual display of MRSA & MSSA bacteraemia results throughout the Trust, for
patient and public awareness.
• Trust Reporting Warehouse computer drive
10.0 Alert Organisms
Alert organisms are those that may have a significant impact on the management of
the hospital and identify potential problems with infection prevention and control. The
organisms included are:
• MRSA as colonisation and as infection, whether community or hospital
acquired.
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• C. difficile as recorded on the Trust Surveillance database.
• All Staph aureus infections
• Group A Streptococcus infections
• Group B Streptococcus infections and colonisation
• Group C Streptococcus infection
• Extended Spectrum Beta-Lactamase producers (ESBL)
• Enteric pathogens
10.1 Coordinator responsibilities include:
Surveillance of Infection Protocol
Ensuring data link to Microbiology data system for updated information on a monthly
basis. Interpretation of data from microbiology to spreadsheet and other formats
10.2 Data sharing
• The Infection Control Committee Meeting
• The Trust Governance Board
• The three Divisional Boards
• The Clinical Governance Board.
• Trust Reporting Warehouse computer drive
11.0 Miscellaneous
The Infection Surveillance Coordinator will assist where necessary with information
relating to infection prevalence, for the purposes of satisfying requests relating to
Freedom of Information and Patient Advice and Liaison.
The coordinator will assist the Infection Control Team with the development of gantt
charts, databases and spreadsheets to aid documenting outbreaks
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