Fidelma Fitzpatrick
Consultant Microbiologist,Health Protection Surveillance Centre &
Beaumont Hospital, Dublin, Ireland
HPSC, SARI and National HCAI surveillance
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
4
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
5
HPSC ActivitySurveillance
Provision of
Expert Advice
Research
Training
• 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
• Identifying and developing best practice – initiation and collaboration
• For professionals in communicable disease control – especially joint training• Teaching
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CEO
Office of the CEO
Communication, Service
Governance
Director of HR
Assistant Directors x 3
Industrial Relations, Employee Wellbeing
& Welfare, Legal/Advisory
Services, Partnership,
Workforce Planning, Recruitment, Employment Monitoring,
Performance Management,
Learning & Development, Management Development,
PPARS
Director of Population Health
Assistant Directors x 4
Strategic Planning & Evaluation, Health Intelligence, Health Inequality & Social Inclusion, Health
Promotion & Improvement,
Communicable Diseases
Surveillance & Control & Other
Health Protection Issues
Director of PCCC
Assistant Directors x 4
Planning, Monitoring & Evaluation,Contracting
Development of Service Frameworks,Provision of Expert
Advice, System Support
Director of Shared Services
Assistant Directors x 2
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
Director of NHO
Assistant Directors x 4
Planning,Contracts &
Utilisation Review,Quality Risk &
Customer Care,National Ambulance
Service
Director of Finance
Assistant Directors x 4
Financial Planning, Costing &
Evaluation, Statutory Reporting & Control,
Management Reporting,
Procurement & VFM, FISP
Director of CMOD
Assistant Directors x 2
Change Management,
Central Resource, Leadership,
Development, Streamlining
Agencies – Change Process, Service Improvement & Organisational Development,
Director of ICT
Assistant Directors x 4
Design &
Procurement, Implementation &
Rollout, Project Governance & interconnectivity,
Projects Management,
Strategy Formulation, Library
& Research, Innovation Centre
Director of Corporate Afffairs
Where HPSC fits into the Great Scheme of Things
HPSC
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_Framework_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. EARSS
2. ESAC
3. MRSA in ICU Prevalance Survey
4. Alcohol hand gel consumption
5. North South MRSA Study 1999
6. 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 IsolatesMRSA Isolates
192 cases in North (5.3/100,000)
508 cases in South (6.5/100,000)
Males > FemalesMales > Females
Highest rates, 65 years or more
25-44 yrs. 4.4/100,000 (South)
75yrs. 111/100,000 (South)
SouthSouthNorthNorth
Hospital 92% 69%
GP 4% 20%
Nursing Home 2% 10%
Psychiatry 2% 1%
Clinical Status Clinical Status No. (%)No. (%)
Colonised (carriage) 271(62)
Local infection 124(28)
Invasive infection 44(10)
Risk factors for invasive diseaseRisk factors for invasive disease
–iv line– surgery/ invasive procedure
NorthNorth SouthSouth
MRSA/S aureus bacteraemia 25% 36%
Hospitals with antibiotic policy 95% 41%
Infection control nurse on site 100% 85%
Isolation rooms available 100% 87%
Prevalence Rate of HCAI and MRSA
8.19
1.28
6.35
0.87
5.43
0.85
4.89
0.49
0
1
2
3
4
5
6
7
8
9
HCAI Prevalence Rate MRSA Prevalence Rate
Rate
(%)
England Wales N. Ireland Rep of Ireland
Prevalence Rate of HCAI and MRSA by Infection Type (1)
0
1
2
3
4
5
6
BSI UTI Pneumonia SSI BSI UTI Pneumonia SSI
Rate
(%)
England Wales N. Ireland Rep of Ireland
Prevalence of HCAI by Infection type (2)
0
0.5
1
1.5
2
2.5
Bone & joint Cardiovascular System Central Nervous System Eyes,ENT or Mouth GI system LRT (excl pneumonia) Reproductive tract Skin & soft tissue Systemic
Rate
(%)
England Wales N. Ireland Rep of Ireland
Clostridium difficile Prevalence Rate
1.98
1.1 1.13
0.48
0.19
0
0.5
1
1.5
2
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 Number % of Total
Central Venous Catheter 91 32%
Peripheral Venous Catheter 42 15%
Burns et al .CMI 2007 13;(s1)s520
47% due tovenous access
Enhanced EARSS
2175
587
98
One in four S.aureus bacteraemias in Ireland is due to infectionassociated with a central venous catheter
One in twenty S.aureus bacteraemias in Ireland is due to infectionassociated with a peripheral venous cannula
Enhanced EARSS
2175
587
98
One in four S.aureus bacteraemias in Ireland is due to infectionassociated with a central venous catheter
One in twenty S.aureus bacteraemias in Ireland is due to infectionassociated 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’