HCAI and Antimicrobial Point Prevalence Survey – England

The HPA are coordinating England's participation in ECDC's Fourth National Prevalence Survey on Healthcare Associated Infections & First National Prevalence Survey on Antimicrobial Use and Quality Indicators in England.

 

Over four million people in the EU are estimated to acquire a healthcare-associated infection (HCAI) every year, some of whom will die as a direct result of the infection. It has been estimated that 20–30% of all such infections could be prevented by better infection prevention and control procedures.[1]

Surveillance of HCAIs is an essential component of infection prevention and permits public health bodies to take action by planning and implementing more effective, evidence based policies and strategies [2].   However, robust comparable data (other than mandatory reporting) are not currently available for the NHS in England making it difficult to quantify overall if there have been any changes in NHS trusts' infection rates for HCAIs other than those reported on a mandatory basis [3]. In 2008, ECDC carried out a review of 17 national or regional point prevalence surveys of HCAI and antimicrobial use in European countries [1]. From this analysis, it was evident that major methodological differences between the protocols made data comparison or pooling at the EU level impossible and emphasized the need for an agreed EU protocol.

Prevalence surveys are useful in providing data on the proportion of HCAI at any one point (or period) in time and give a better understanding of burden of all HCAI rather than relying on  mandatory data which only accounts for a small proportion of HCAI.   There have been three previous HCAI prevalence surveys in England/ UK (Figure1.)

*not Scotland

The European Surveillance of Antimicrobial Consumption Point Prevalence Survey conducted in 2009 showed the prevalence of antimicrobial prescribing was 27.8% however only a small number of English hospitals participated in this survey.

The ECDC 2011-12 point prevalence survey is unique in that all participating EU countries will use the standardised methods so that results will be comparable. The advantages of the ECDC-led Europe-wide PPS of HCAI and antimicrobial prescribing are;

• Contribute to ECDC programme on AMR and HCAI reduction
• Benchmark against other EU countries
• Build European networks to share best practice
• Assist hospitals in evidencing compliance with outcomes 8 and 9 of the Care Quality Commission (CQC) framework and Criterion 5 and Criterion 9 of Health & Social Care Act 2008. 

In England this point prevalence survey will inform the following questions of acute hospitals/ Trusts:

1. What is the overall prevalence of HCAI and of specific types of HCAI?
2. What is the overall prevalence of antimicrobial prescribing and types of antimicrobials prescribed?
3. What is the overall prevalence of invasive devices and types of devices?
4. What are the priority areas for future targeted incidence surveillance of HCAI?
5. What are the priority areas for future interventions to prevent and control HCAI?
6. What are the priority areas for future antimicrobial stewardship interventions?

Hospitals in England participated in data collection between September and November 2011. The English report will be available in April 2012. For further information please contact the HPA PPS team via email on: PPSEngland@hpa.org.uk

England PPS Steering Group

Chair: Prof. Anthony Kessel, Director Public Health Strategy, HPA
DH representative: Ms. Sally Wellsteed
HIS representative: Dr. Adam Fraise/ Dr. Barry Cookson
IPS representative: Ms. Tracey Cooper
BIA representative: Dr. Louise Teare
ARHAI Chair/ Paediatric representative: Prof. Mike Sharland
BSAC/ARHAI representative/ Pharmacist representative: Prof. Jonathan Cooke
HPA - HCAI & AMR PB
RM – Dr. Bharat Patel
RE  – Dr. Mark Reacher
HPA Colindale – Prof. Barry Cookson, Dr. Liz Sheridan
Coordinators: Dr. Susan Hopkins, Ms. Karen Shaw

References

1. European Centre for Disease Prevention and Control: Annual Epidemiological Report on Communicable Diseases in Europe 2008. Stockholm, European Centre for Disease Prevention and Control, 2008
2. ECDC, Importance of Surveillance; Surveillance is essential to understanding the epidemiology of infectious diseases.  Website site 13 May 2011 www.ecdc.europa.eu
3. National Audit Office, Improving patient care by reducing the risk of hospital acquired infection: A progress report, Report by the comptroller and auditor general HC 876 sessiuon 2003-4, London Stationary Office, 2004.
4. Humphreys H, Newcombe RG, Enstone J, Smyth ET, McIlvenny G, Fitzpatrick F, et al; Hospital Infection Society Steering Group. Four country healthcare associated infection prevalence survey 2006: risk factor analysis. J Hosp Infect. 2008 Jul; 69(3):249-57. Epub 2008 Jun 11.
 

Further information & documentation

HCAI and Antimicrobial PPS England Information Slideset (PDF, 170 KB)
HCAI and Antimicrobial PPS FULL slideset 1 day course (PowerPoint Presentation, 5.1 MB)
HCAI and Antimicrobial PPS England Data entry forms (PDF, 1.1 MB)
Colour copies:
HCAI and Antimicrobial PPS England Protocol (col) (PDF, 610 KB)
HCAI and Antimicrobial PPS England Long codebook (col) (PDF, 886 KB)
HCAI and Antimicrobial PPS England Short codebook (col) (PDF, 663 KB)

Black & white copies:
HCAI and Antimicrobial PPS Protocol ( B & W).pdf (PDF, 545 KB)
HCAI & Antimicrobial PPS Long codebook B&W (PDF, 841 KB)
HCAI and Antimicrobial PPS Short codebook ( B & W).pdf (PDF, 627 KB)

Post training information
HCAI and Antimicrobial Point Prevalence Survey Application.zip (ZIP Archive, 1.9 MB)
HCAI and Antimicrobial PPS Course presentation (1 day) (PowerPoint Presentation, 5.3 MB)
HCAI and Antimicrobial PPS Facilitation Answers (Word Document, 91 KB)
HCAI and Antimicrobial PPS England Summary data form (Excel Spreadsheet, 98 KB)
HCAI and Antimicrobial PPS England Summary Data form.pdf (PDF, 45 KB)

Case studies for completion post training day
HCAI & Antimicrobial PPS Training - Case Study 1 (Word Document, 25 KB)
HCAI & Antimicrobial PPS post-training Case Study 2 (Word Document, 24 KB)