Background
Healthcare associated infections (HAI) are an increasing problem worldwide and contribute significantly to morbidity and mortality in the hospital population1. The additional costs arising from treatment of HAI place a significant burden on healthcare resources. The Plowman Report published in 1999 estimates that HAI cost the National Health Service an additional £1 billion per year2.
The first Scottish National HAI Prevalence Survey3 was carried out by Health Protection Scotland (HPS) between October 2005 and October 2006. All acute hospitals and a 25% sample of non-acute hospitals were surveyed. Data were collected over one calendar year by independent data collectors employed by HPS. The survey reported that 9.5% and 7.3% of patients in acute and non-acute hospitals, respectively, had a HAI at the time of survey. The cost of inpatient HAI in Scotland was estimated to be £183 million.
The results from the Scottish survey provided the Scottish Government and HAI Task Force with an estimate of the burden of HAI in Scottish hospitals. The results informed planning of national initiatives by identification of priority areas for targeted incidence surveillance programmes and interventions to reduce HAI. As a by-product of the national survey, detailed hospital reports were prepared and disseminated to local Infection Control Teams (ICTs) for implementation of initiatives at a local level.
In addition to the work being undertaken in Scotland, the European Centre for Disease Prevention and Control (ECDC) has developed a protocol for measuring the prevalence of healthcare associated infection and antimicrobial use in acute, specialist and independent hospitals4. A Europe-wide prevalence survey is planned for September/October 2011 and it is likely that a European survey will be carried out annually.
HPS has been tasked by the Scottish Government to develop and implement a second national HAI prevalence survey and the decision has been taken to adopt the ECDC protocol to enable European benchmarking of HAI and antimicrobial prescribing prevalence using a consistent approach.
A letter will be issued by the Chief Nursing Officer for Scotland in April advising NHS Boards of the requirement for them to participate in the survey. The letter will request Caldicott Guardian approval and identification of a named person within each hospital who will be designated the Hospital Contact Point. This person will be responsible for coordination of the survey at a hospital level.
The Public Health Goal
The overarching goal of the system is to reduce morbidity and mortality as a result of healthcare associated infection in hospitalised patients in Scotland. The survey will contribute to achieving the six dimensions of healthcare quality and to the NHSScotland Quality Ambitions4 (http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/NHSQuality)
Aim and Objectives
The aim is to measure HAI and antimicrobial prescribing prevalence in Scottish NHS acute, non-acute and independent hospitals.
The objectives are to address the following questions:
- What is the overall prevalence of HAI and of specific types of HAI in acute and non-acute hospitals in Scotland?
- What is the overall prevalence of antimicrobial prescribing and types of antimicrobials prescribed in acute and non-acute hospitals in Scotland?
- What is the compliance with Scottish Antimicrobial Prescribing Group (SAPG) hospital-based empirical prescribing and surgical antibiotic prophylaxis prescribing indicators?
- What are the priority areas for future targeted incidence surveillance of HAI?
- What are the priority areas for future interventions to prevent and control HAI?
- What are the priority areas for future antimicrobial stewardship interventions?
- What is the feasibility of using HAI prevalence as a Quality Outcome Measure?
Approach
HPS will support local Infection Control Teams (ICTs) and Antimicrobial Management Teams (AMTs) who will be trained to collect HAI and antimicrobial prescribing data using the ECDC point prevalence survey protocol. As per the protocol, data will be collected during the months of September and October 2011 in all Scottish acute hospitals, both NHS and independent. Additionally data will be collected in the same 25% sample of NHS non-acute hospitals as the first national survey.
Data collection will be undertaken on paper forms and scanned and verified by HPS using handwriting recognition software.
Central data entry will reduce the burden on local teams. The HAI prevalence project team will provide support to the hospitals during September and October 2011 to ensure that the case definitions are being applied correctly. Interrater reliability testing of the application of case definitions will be carried out during the training sessions.
Data returned to HPS will be analysed with appropriate statistical support for inclusion in the final report which will be published at the closure of the project. Hospital level reports will be provided in a timely manner to enable identification and planning of local HAI reduction and antimicrobial stewardship initiatives. Data will be submitted to ECDC as Scotland’s contribution to the European point prevalence survey.
Training
Training will be delivered by HPS and includes a one day package that trains local teams to collect prevalence survey data. An optional five day package that covers the fundamentals of HAI epidemiology will be offered in 2012. Epidemiological capability will be developed in the NHS Boards and existing links between ICTs and AMTs developed through simultaneous data collection and issue of joint HAI and antimicrobial prescribing reports.
Publications
First National Prevalence Survey
Second National Prevalence Survey
Further Information
Leaflets
Poster
Scottish National Healthcare Associated Infection and Antimicrobial Prescribing Prevalence Survey: Information for ward staff.
Presentation
For further information and background:
Additional information about the survey will be made available in April following publication of the CNO letter.
References
- European Centre for Disease Prevention and Control. Annual Epidemiological Report on Communicable Diseases in Europe 2010. Stockholm, Sweden: European Centre for Disease Prevention and Control; 2010.
- Plowman R, Graves N, Griffin M, et al. The socio-economic burden of hospital acquired infection, Part 1. London: Public Health Laboratory Services; 1999.
- Reilly J, Stewart S, Allardice G, et al. NHS Scotland National HAI prevalence survey: Final Report. Glasgow: Health Protection Scotland; 2007.
- Scottish Government. The Healthcare Quality Strategy for NHSScotland. Edinburgh, Scotland: Scottish Government; 2010.
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