Infection Intelligence Platform (IIP)

Clinical studies

Professor Marion Bennie National Services Scotland

Vision

• A comprehensive, dynamic and responsive resource capability for Scotland that will harness existing health data to support clinicians in improving patient outcomes and reduce harm from community and healthcare acquired infection.

PATIENT(Community and

Healthcare acquired Infection )

Intrinsic (patient)

•Age / gender

•Colonised

•Morbidity

•Drug history

•Vaccine history

Extrinsic (environment)- Medicines (prior use)

- Lines/Catheters- Hand Hygiene

- Surgery -Length of stay

Prevention Intervention SIPS- Standard infection

control precautionsAntimicrobial stewardship

Patient outcome

Infection Management

Antibiotic policy

Infection control (TBP - Transmission based precautions)

Monitoring / Surveillance

Intended consequences

Unintended consequences

Vision

1. REFERENCE LABORATORIES

(EXTERNAL)

[CHI]1. ECOSS

DATABASE(INTERNAL)

Staphaureus BacteraemiaData(SAB)

Clostridium difficile

infectionData (CDI)

Antimicrobial Resistance Data (AMR)

3. Catheter Associated Urinary

Tract Infection (CAUTI)

4. Prevalence Survey(PPS)

5. HELICSWIN (ICU/ECDC)

6. MRSA SCREENING

7.NOROVIRUSWARD

CLOSURES

8. HANDHYGINE AUDITS

2. Surgical Site Infection (SSI)

9. Surveillance of Healthcare

Outbreak System (SHORS)

10. VACCINEUPTAKE

11. RESPIRATORY

13. Gastrointestinal & Zoonotic System

(GIZ)

12. Blood Borne Virus (BBV)

14. TRAVEL

NHS BOARD SOURCES HPS SOURCES ISD SOURCES

HOSPITAL

CAREHOME

HAI HEALTH PROTECTION

SYSTEMS

HEALTH PROTECTION

SYSTEMS

NHS LABORATORIES

INFECTION PREVENTION &

CONTROL SYSTEMS

(IPC)

PATIENT ADMINISTRATION

SYSTEMS

(TRACKER)

PATIENT SAFETY SYSTEMS

OTHER LOCAL SYSTEMS

NSS SYSTEMS (HAI & AM)

SCI STORE

CAREHOMEAGESEX

Prescription Information

Scotland (PIS)

PRESCRIBINGDATA SYSTEM

INFECTIONANTIBIOTICS

INFECTIONT X

SMR DATAJOINT & OTHER

INFECTIONS

LINESINFECTION

MORTAILITY

INFECTION – NO HAIIV ANTIBIOTICS

date/time

No

No

Data storeDatabase

Data OutputLEGEND

SCOTTISH MORBIDITY

RECORDDATABASE

(SMR)

NATIONAL AUDITS

DATA RESPOSITORY

- Clinical Quality Indicators-Scottish Patient Safety Programme

Antibiotics(SSI)

ICU Ward Watcher

Scottish Audit of Surgical

Mortality (SASM)

Arthroplasty

Renal Registry

Scottish Trauma Audit Group

(STAG)

MusculoskeletalAccess Audit

(MSk)

The Scottish Stroke Care

Audit (SSCA)

HospitalMedicineUtilisation Database (HMUD)

COMMUNITY HEALTH INDEX

REGISTRY

Antimicrobial Management

Integrated Database for

Scotland (AMIDS)

Prescription Information System for Scotland

(PRISMS)

Setup

Capability building

Full Capability

Future Position

Enhanced connectivity and linkage of existing national and local information to improve prevention and management of infection, reduce harm and minimise waste

Current Position

No strategic approach:

Uncoordinated integration of databases through small pockets of resources from national and local programmes on an hoc basis

Infrastructure to routinely connect current relevant national databases with infection information.

Generic capability to support patient care, enable measurement of intended and unintended consequences of interventions.

Incremental planned studies focussing on key infection related clinical goals.

Further enhancement of connectivity to include current and future local databases

NHS Scotland Infection Intelligence Platform Road Map

Benefits (Improve care - reduce harm - reduce variation)

• Patients – Support individual prevention/treatment plans

• NHS Boards – Drive quality improvement in local service

delivery model (intended/ unintended consequences)

• National Surveillance – Identify emergence of antimicrobial resistance

• Research – Support evidence based clinical practice

Deliverables (2013-2016)

• To gain the necessary information governance approvals

• To build the required IM&T Infrastructure to support the IIP by technically linking six sources initially

• To complete a series of exemplar clinical studies to test the IIP capability and effectiveness

Key Datasets

• ECOSS Electronic Communication of Surveillance in Scotland (antimicrobial resistance data)

• HMUD Hospital Medicines Utilisation Database

• PIS Prescribing Information System (primary care prescribing) • SCI Store Clinical Information (e.g. Lab results, Radiology reports)

Repository

• SMR Scottish Morbidity Record (SMR)SMR01 – Inpatients, Day Cases, Discharge & Diagnosis– SMR02 – Maternity Inpatients, Day Cases, Discharge &

Diagnosis– SMR99 – Mortality

• SSIRS Surgical Site Infection Reporting System

Themes Study Number

1. Identification of Risk Factors for selected Common Bacteraemias

Study 1 & 2

2. Validation of IIP for Surgical Site Infection (SSI) surveillance

Study 3

3. Impact of Primary Care antimicrobial prescribing on antimicrobial resistance patterns and HAI

Studies 4-7

4. Mortality associated with HAI Studies 8 & 9

5. Sepsis Diagnosis, management and outcome Studies 10-13

6. Intended and Unintended consequences of antimicrobial prescribing change in surgery

Studies 14-16

Study Themes

Theme 1 - Risk Factor Analysis in bacteraemias (ECOSS / SMR – studies 1&2)

• To describe the demographics and co-morbidities of patients with common bacteraemias and CDI

– SAB and E.Coli (test -SIRN funded)– Extend to include MRSA,MSSA, CDI– Establish routine linkage for ongoing

surveillance as risks of infection changeover time

Theme 4 - Mortality Associated with HAI(ECOSS / SMR/SSIRS – studies 8&9)

• To determine the case fatality (30 and 90 days) associated with common HAI – SSI, SAB, CDI (test )

• To identify variation in case fatality associated with risk factors

• To produce standard reporting mechanisms for MRSA and CDI death from 2015 (current system to stop in 2014)

Theme 2 - Surgical Site Infection (SSI) surveillance(ECOSS / SMR/SSIRS – study 3) • Current manual collection of data locally to input

into national datamart

• Mandatory minimum of 2 operation categories (caesarian and hip arthroplasty mandatory, where practised)

• To test capability of IIP to reproduce data (SSIRS) through routine record linkage (ECOSS and SMR ) to replace the need for manual data collection within the Health Boards.

Theme 3 - Primary care antimicrobial prescribing - impact on resistance patterns and HAI(ECOSS / SMR//PIS – studies 4-7)

• To develop generic surveillance system to estimate associations– Antimicrobial exposure and risk of CDI

(test – SIRN funded ) then extend to other HAI

– Examination of 4 antimicrobials in UTIs and impact on resistance and clinical outcome (test – SIRN funded ) then extend to other infections

Theme 5 - Sepsis: diagnosis, management and outcome (SMR/SCI Store – studies 10-11)

• Use of blood culture as a proxy marker for sepsis

• To quantify changes in 30 day mortality (from date of blood culture) following adoption of restricted antibiotic policy (test – Tayside and Lanarkshire ) then extend to all NHS Boards

• Establish robust sepsis outcome measure to monitor progress to national target

Theme 5 - Sepsis : diagnosis, management and outcome (SMR/SCI Store/HMUD/HEPMA – studies 12-13)

• Monitoring impact of key high risk antibiotics in hospitals e.g. carbapenameses on emergent bacteremias

– Policy change intervention – Individual patient level outcome

Theme 6 - Surgery – consequences of changing antimicrobial prescribing policies (SMR/SCI Store/HMUD – studies 14-16)

• To examine renal toxicity (acute kidney injury) following introduction of restricted antibiotic policies – Test in NHS Lanarkshire – Extend to all NHS Boards and for other identified

laboratory measures

• To evaluate reduction in 4C use and impact on CDI and mortality