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

6

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%

HIS HCAI Prevalance Survey

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’