Point Prevalence Survey of HospitalAcquired Infections & Antimicrobial
Use in Ireland
PPS Data Collector Training
April 2017
Background & Introduction to PPS
Presentation 1
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
What is a PPS?
• PPS team visits a ward at 11am on 10/5/17
• 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
– One has been discharged home
What is a PPS?
• After completing the PPS for the ward:
• 9 patients receiving systemic antimicrobials
• Prevalence of antimicrobial use = 9/26 x 100 = 34.6%
• 4 patients met case definitions for active HAI
• HAI prevalence on the ward = 4/26 x 100 = 15.3%
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%
ECDC 2012 PPS: Ireland
• 50 acute hospitals (42 public & 8 private)
• 9,030 patients
• 501 active HAI (5.2%):
•
•
•
•
•
SSI – 18%
Pneumonia – 17%
UTI – 15%
BSI – 13% & of those, 42% were vascular catheter related
CDI – 6%
• 4,532 antimicrobial prescriptions (34%):
•
•
•
•
•
63% IV
78% treatment of infection
11% surgical antimicrobial prophylaxis, of which 47% >24hrs
8% medical prophylaxis
Documented indication in 83%
http://www.hpsc.ie/AZ/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/Surveillance/HospitalPointPrevalenceSurveys/2012/PPS2012ReportsforIreland/
What are the changes in PPS 2017
protocol?
What’s been happening in Ireland
since 2012?
Revised PCHCAI Standards to be published in
2017
C. difficile infection (CDI)
• 2014: National guidelines revised
• Transition in laboratory testing protocols
• Enhanced CDI surveillance scheme continues, with
increase in participating hospitals 44 (2012) to 53
(2016)
• National quarterly report issued
• Quarterly report issued to each participating hospital
Source: HPSC www.hpsc.ie
S. aureus invasive infection
• Captured via EARS-Net
– ~99% population coverage
– Some microbiology laboratories have suspended participation,
due to resource issues
• S. aureus BSI via enhanced surveillance scheme
– 19 laboratories participated in 2016
– 23% of MRSA BSI & 20% of MSSA BSI deemed device-related
Source: HPSC www.hpsc.ie
1600
50%
1400
45%
40%
35%
1000
30%
800
25%
600
20%
%MRSA
Number of isolates
1200
15%
400
10%
200
5%
0
0%
Year
MRSA
MSSA
%MRSA
*2016 data are provisional to the end of Q3 only (note: data missing from 2 laboratories for Q3); ‡ 2015 missing data from 3 laboratories for 2 quarters each
Source: HPSC www.hpsc.ie
E. faecium
450
60%
400
50%
300
40%
250
30%
200
150
%VREfm
Number of isolates
350
20%
100
10%
50
0
0%
VREfm
Year
VSEfm
%VREfm
*2016 data are provisional to the end of Q3 only (note: data missing from 2 laboratories for Q3); ‡ 2015 missing data from 3 laboratories for 2 quarters each
VRE, vancomycin-resistant enterococcus; VREfm, vancomycin-resistant E. faecium; VSEfm, vancomycin-susceptible E. faecium
Source: HPSC www.hpsc.ie
E. coli
Multi-drug resistant K. pneumoniae
• 1,310 MDRKP cases
reported (Q1 2014 – Q3
2016) from 87% of acute
hospitals
• 20% increase in MDRKP
reported to Q3 2016 versus
same period 2015
• 2/3 reported in hospitalised
patients
• 59% required treatment of
MDRKP infection
CRE
• 15% of MDRKP also carbapenem resistant
• 195% increase in carbapenem resistant K.
pneumoniae to end Q3 2016 versus 2015
• CRE outbreaks in acute hospitals & LTCF
• From January 2017, MDRKP surveillance
replaced by CRE surveillance
+ 90 CPE confirmed
Jan – Feb 2017
Data courtesy of Prof M Cormican, CPEARLS
Hospital antimicrobial consumption
Source: HPSC www.hpsc.ie
Hospital antimicrobial consumption
2017 PPS will provide you with data
on compliance or non-compliance with
local restricted use policy
Source: HPSC www.hpsc.ie
Source: HPSC www.hpsc.ie
Aims of this PPS
• To repeat a PPS of HAI & antimicrobial use across all
EU Member States during 2016-17 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
European PPS: 2011-12
Estimated on any day in Ireland, 494
patients with HAI & 3,289 on antimicrobials
Estimated in any year, 20,491 patients in
in Ireland with HAI
28
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
Support business cases for improved IPC, antimicrobial stewardship,
surveillance & microbiology laboratory diagnostic resources
Summary
• Last PPS performed in Ireland five years ago
• Many interim developments to raise awareness of
HAI & need for prudent antimicrobial use
• 2017 PPS provides us with the opportunity to see
where we are now, to direct our future interventions
for ongoing improvement in patient care and staffing
levels related to IPC, antimicrobial stewardship,
surveillance and microbiology laboratory activities
Overview of data to be collected
during PPS
A1 – PPS team
A2 – Night nursing &
midwifery staff
B – PPS team
leader
C – PPS team
assisted by
staff caring
for patients
Ward List (Form A1)
Ward List (Form A2)
Hospital Form (Form B)
Hospital Form (Form B)
Patient Form (Form C)
There is space on Form C to record up to five systemic antimicrobial prescriptions
AND
up to three different hospital-acquired infections
Patient Form (Form C)
Use extension sheet Form C Pages 3 & 4 for HAIs 2 & 3 and antimicrobial prescriptions 3, 4, 5
Patient Form (Form C)
• Two pages for vast majority of patients – extension
sheets for patients with ≥2 HAI or ≥3 antimicrobials
• Five sections:
– Section 1 – Patient details
– Section 2 – Risk factors
– Section 3 – Condition of interest – HAI Y/N & Antimicrobial
use Y/N
– Section 4 – HAI data
– Section 5 – Antimicrobial use data
Sections 1, 2, 3 completed for EVERY eligible patient
100%
Patient Form (Form C)
• Two pages for vast majority of patients – extension
sheets for patients with ≥2 HAI or ≥3 antimicrobials
• Five sections:
– Section 1 – Patient details
– Section 2 – Risk factors
– Section 3 – Condition of interest – HAI Y/N & Antimicrobial
use Y/N
– Section 4 – HAI data
– Section 5 – Antimicrobial use data
Sections 1, 2, 3, 4 completed for EVERY eligible patient
with an active HAI ~ 5 - 10%
Patient Form (Form C)
• Two pages for vast majority of patients – extension
sheets for patients with ≥2 HAI or ≥3 antimicrobials
• Five sections:
– Section 1 – Patient details
– Section 2 – Risk factors
– Section 3 – Condition of interest – HAI Y/N & Antimicrobial
use Y/N
– Section 4 – HAI data
– Section 5 – Antimicrobial use data
Sections 1, 2, 3 & 5 completed for EVERY eligible patient
receiving systemic antimicrobials ~ 33%
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 Lists
(Forms A1 & A2)
8
12
22
Hospital Form
(Form B)
1
1
1
Patient Forms
(Form C)
150
300
600
Form C
Section 1, 2, 3
150
300
600
Form C (AMU)
Section 1, 2, 3 & 5
50
100
200
Form C (HAI)
Section 1,2, 3, & 4
8
15
30
*Completed paper versions of all Form A1s, one Form B & all Form Cs are used to
enter your hospital’s PPS data onto secure ‘web-based’ data entry system
Patient Form (Form C)
Patient Form (Form C)
The answers to 10/12 (83%) questions in Section 1 & 2
can be directly transcribed from the completed Ward List A2
For each eligible patient, the PPS team will need to decide:
Admitting consultant’s specialty – prepare and laminate list ahead of PPS &
give a copy to each PPS team member
Surgical procedure for patients who have had surgery on this admission
Underlying disease prognosis – review of notes and talk to ward staff
Patient Form (Form C)
‘Patient on antimicrobials’ on Ward List – BUT double check medication charts – MP, SP could be missed
Also check Ward List to identify patients who have undergone surgery in the last 24 hours to pick up
surgical antimicrobial prophylaxis administered since 8am yesterday
Patient Form (Form C)
Patient Form (Form C)
Getting ready to do your PPS
1. PPS team identified and trained
2. PPS team leader has hospital code (same as 2012 code) and
webform log-in username and password
3. VPN connection tested for webforms data entry
4. Local PPS dates agreed
5. PPS ward schedule prepared & distributed to wards
6. Ward List A1 (one per ward) started in consultation with
CNM
7. DONM to request ward CNMs ensure their Ward List A2
completed by 8am on day of PPS
Getting ready to do your PPS
8. Brief night nursing manager on Ward List A2, in case of
queries
9. Data gathered for Hospital Form B
10. Ward codes, ward specialty, consultant specialty assigned,
local antimicrobial restricted list with laminated copy for
each data collector
11. Ward list A2 & Instruction Sheet given to nursing staff on day
prior to PPS
12. Sufficient copies of patient forms, protocols available
13. Administrative support identified and trained in form entry
14. Verify PPS data entry on VPN connected PC available
Any Questions?
[email protected]