Four Country Healthcare Associated Infection Prevalence Survey 2006: overview of the results

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Summary

A survey of adult patients was conducted in February 2006 to May 2006 in acute hospitals across England, Wales, Northern Ireland and the Republic of Ireland to estimate the prevalence of healthcare-associated infections (HCAIs). A total of 75 694 patients were surveyed; 5743 of these had HCAIs, giving a prevalence of 7.59% (95% confidence interval: 7.40–7.78). HCAI prevalence in England was 8.19%, in Wales 6.35%, in Northern Ireland 5.43% and in the Republic of Ireland 4.89%. The most common HCAI system infections were gastrointestinal (20.6% of all HCAI), urinary tract (19.9%), surgical site (14.5%), pneumonia (14.1%), skin and soft tissue (10.4%) and primary bloodstream (7.0%). Prevalence of MRSA was 1.15% with MRSA being the causative organism in 15.8% of all system infections. Prevalence of Clostridium difficile was 1.21%. This was the largest HCAI prevalence survey ever performed in the four countries. The methodology and organisation used is a template for future HCAI surveillance initiatives, nationally, locally or at unit level. Information obtained from this survey will contribute to the prioritisation of resources and help to inform Departments of Health, hospitals and other relevant bodies in the continuing effort to reduce HCAI.

Introduction

The surveillance of healthcare-associated infection (HCAI), i.e. the collection of standardised data, its dissemination and the subsequent action accruing from the results, is an important aspect of infection prevention. Prevalence surveys of HCAI provide data regarding patients, at one particular point in time, and are generally easy to conduct, relatively inexpensive and are not especially time-consuming.1 Incidence surveys are more difficult to perform, especially when carried out at a national level.

When conducting surveillance at a national level, a balance has to be struck between the collection of complex and detailed information and the need to decrease the load on infection control and prevention teams, while enhancing accuracy.2 National surveillance of HCAI has been introduced in North America and in many European countries, including the UK. Aggregated data on orthopaedic procedures from Scotland, Wales, and Northern Ireland (NI) (Pan Celtic collaboration) has shown a decrease in surgical site infection (SSI) rates over four years.3 In Germany, the German National Nosocomial Infection Surveillance Systems (KISS) has documented a decrease in SSI rates between the first and third years of its implementation.4 In Norway between 1996 and 1998, there was a reduction in the urinary tract infection (UTI) rate (per 100 patients) from 2.4 to 1.7, lower respiratory tract infection (LRTI) rate from 1.5 to 0.8 and a fall in postoperative wound infection rate from 5.7 to 4.3.5 Even in the absence of designated and specific intervention measures, the collection of data and the feedback of surveillance data to a wide range of healthcare professionals can have a beneficial effect in terms of HCAI prevention.

National prevalence surveys of HCAI are increasingly common; recent reports include those from Greece and Spain.6, 7 The overall prevalence in the Greek survey was 9.3% whereas in the most recent Norwegian survey carried out in 2002 and 2003 the prevalence varied from 5.1 to 5.4%.8 In the UK, the first national prevalence survey was carried out in 1980 and included 18 186 patients.9 The overall HCAI prevalence was 9.2%, with UTI being the most common infection. The second national prevalence survey took place over a 15-month period in 1993 and 1994 and in addition included hospitals in the Republic of Ireland (RoI). In all, 157 hospitals participated and data were collected on 37 111 patients.10 The HCAI prevalence in that survey was 9.0% but the prevalence was higher in larger/referral hospitals (11.2%) compared with smaller hospitals (8.4%). The second national prevalence survey prompted many hospitals to perform continuous surveillance in a more focused way and the intervening period has seen the establishment of mandatory reporting of meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infections, Clostridium difficile, orthopaedic SSIs etc., as part of the National Health Service's initiatives in enhancing the quality and safety of patient care.

The aims of this third national prevalence survey were to determine the prevalence of all HCAI in acute hospitals including UTI, SSI, bloodstream infection, soft tissue infections, and LRTIs, with specific information to be collected on MRSA infections and C. difficile. In addition, the survey was designed to help develop a consistent methodology for prevalence surveys into the future, and to maintain compatibility with studies carried out in other countries. This report outlines the overall results from that survey.

Section snippets

Organisation

In November 2004, the Department of Health (England) requested the Hospital Infection Society (HIS) to take the lead in organising a third national prevalence survey in England. Subsequently, the Departments of Health of Wales, NI, and the RoI were invited to participate. Health Protection Scotland had already planned a similar prevalence survey for Scotland.

A prevalence survey steering group was established by HIS comprising HIS members, Infection Control Nurses Association (ICNA) members,

Results

The prevalence survey was conducted in 270 hospitals; 190 hospitals in England (130 Trusts); 45 hospitals in RoI; 20 hospitals in Wales (13 Trusts); 15 hospitals in NI (12 Trusts) and included 75 694 patients of which 19 984 that had undergone a surgical procedure. In England, a comparison of sampling data to actual beds surveyed was available for 90.0% (117/130) of Trusts. Of these Trusts, almost 80% (92/117) surveyed more than the number of patients requested by sampling and, of these, 19.6%

Discussion

This is the largest prevalence survey of HCAI ever conducted in England, Wales, NI and the RoI. The importance of HCAI to the Departments of Health of the four countries was demonstrated by the commissioning and funding of the survey. Concern regarding HCAI amongst healthcare providers and infection prevention and control teams is emphasised by the high rate of participation in the survey. The survey was mandatory in Wales. Voluntary participation in the other countries resulted in 77% of

Acknowledgements

This survey would not have been completed successfully and within schedule without the co-operation and support of the co-ordinators, microbiologists, IPCTs and other staff within the participating hospitals. We would like to acknowledge the assistance given by the HIS and ICNA members who helped with the training of the participants. We would also acknowledge the assistance and support of the members of WHAIP, HISC and HPSC who contributed to the success of the prevalence survey. In addition,

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