1. Point Prevalence Survey of Hospital-Acquired Infections & Antimicrobial Use in Ireland
PPS Data Collector Training
April 2017
Background & Introduction to PPS
Presentation 1

2. What is a PPS?
A prevalence survey provides data at one particular point in time ‘snapshot’
Prevalence = numerator / denominator
Numerator = number of patients on the ward who have an active HAI at the time of the survey
Denominator = All eligible patients present on the ward at 8am on the day of the survey for that ward

3. What is a PPS? PPS team visits a ward at 11am on 10/5/17
29 patients present on the ward at 8am
The PPS team decides that 26 patients are eligible for inclusion in the PPS:
Two have since been transferred to other wards
One has been discharged home

4. What is a PPS? After completing the PPS for the ward:
9 patients receiving systemic antimicrobials
Prevalence of antimicrobial use = 9/26 x 100 = 34.6%
4 patients met case definitions for active HAI
HAI prevalence on the ward = 4/26 x 100 = 15.3%

5. Hospital Infection Society 2006 PPS: Ireland
44 acute hospitals (88%) participated in 2006 PPS
7,541 patients surveyed
369 patients with HCAI
HCAI prevalence = 4.9%
Systemic antibiotic use prevalence = 34.2%

6. ECDC 2012 PPS: Ireland 4,532 antimicrobial prescriptions (34%):
50 acute hospitals (42 public & 8 private)
9,030 patients
501 active HAI (5.2%):
SSI – 18%
Pneumonia – 17%
UTI – 15%
BSI – 13% & of those, 42% were vascular catheter related
CDI – 6%
4,532 antimicrobial prescriptions (34%):
63% IV
78% treatment of infection
11% surgical antimicrobial prophylaxis, of which 47% >24hrs
8% medical prophylaxis
Documented indication in 83%

8. What are the changes in PPS 2017 protocol?

9. What’s been happening in Ireland since 2012?

10. Revised PCHCAI Standards to be published in 2017

11. C. difficile infection (CDI)
2014: National guidelines revised
Transition in laboratory testing protocols
Enhanced CDI surveillance scheme continues, with increase in participating hospitals 44 (2012) to 53 (2016)
National quarterly report issued
Quarterly report issued to each participating hospital

12. Source: HPSC www.hpsc.ie

15. S. aureus invasive infection
Captured via EARS-Net
~99% population coverage
Some microbiology laboratories have suspended participation, due to resource issues
S. aureus BSI via enhanced surveillance scheme
19 laboratories participated in 2016
23% of MRSA BSI & 20% of MSSA BSI deemed device-related
Source: HPSC

16. Source: HPSC www.hpsc.ie
*2016 data are provisional to the end of Q3 only (note: data missing from 2 laboratories for Q3); ‡ 2015 missing data from 3 laboratories for 2 quarters each
Source: HPSC

19. E. faecium Source: HPSC www.hpsc.ie
*2016 data are provisional to the end of Q3 only (note: data missing from 2 laboratories for Q3); ‡ 2015 missing data from 3 laboratories for 2 quarters each
VRE, vancomycin-resistant enterococcus; VREfm, vancomycin-resistant E. faecium; VSEfm, vancomycin-susceptible E. faecium
Source: HPSC

20. E. coli

21. Multi-drug resistant K. pneumoniae
1,310 MDRKP cases reported (Q – Q3 2016) from 87% of acute hospitals
20% increase in MDRKP reported to Q versus same period 2015
2/3 reported in hospitalised patients
59% required treatment of MDRKP infection

22. CRE 15% of MDRKP also carbapenem resistant
195% increase in carbapenem resistant K. pneumoniae to end Q versus 2015
CRE outbreaks in acute hospitals & LTCF
From January 2017, MDRKP surveillance replaced by CRE surveillance

23. + 90 CPE confirmed Jan – Feb 2017
Data courtesy of Prof M Cormican, CPEARLS

24. Hospital antimicrobial consumption
Source: HPSC

25. Hospital antimicrobial consumption
2017 PPS will provide you with data
on compliance or non-compliance with
local restricted use policy
Source: HPSC

26. Source: HPSC www.hpsc.ie

27. Aims of this PPS
To repeat a PPS of HAI & antimicrobial use across all EU Member States during using a common protocol
To estimate the total burden of HAI & antimicrobial use within: EU
Each Member State
Each participating healthcare facility
By specialty type
By patient type

28. European PPS: 2011-12 Estimated on any day in Ireland, 494
patients with HAI & 3,289 on antimicrobials
Estimated in any year, 20,491 patients in
in Ireland with HAI 28

31. Aims of this PPS
To share the results of the PPS with those who need to know:
Local
Regional
National
International EU
To use the data generated within YOUR hospital to help YOU and your colleagues to:
Identify priority areas for future targeted HAI surveillance
Identify interventions to prevent HAI
Identify areas for targeting antimicrobial stewardship
Support business cases for improved IPC, antimicrobial stewardship, surveillance & microbiology laboratory diagnostic resources

32. Summary Last PPS performed in Ireland five years ago
Many interim developments to raise awareness of HAI & need for prudent antimicrobial use
2017 PPS provides us with the opportunity to see where we are now, to direct our future interventions for ongoing improvement in patient care and staffing levels related to IPC, antimicrobial stewardship, surveillance and microbiology laboratory activities

33. Overview of data to be collected during PPS
A1 – PPS team
A2 – Night nursing &
midwifery staff
B – PPS team
leader
C – PPS team
assisted by
staff caring
for patients

34. Ward List (Form A1)

35. Ward List (Form A2)

36. Hospital Form (Form B)

37. Hospital Form (Form B)

38. up to three different hospital-acquired infections
Patient Form (Form C)
There is space on Form C to record up to five systemic antimicrobial prescriptions AND
up to three different hospital-acquired infections

39. Patient Form (Form C)
Use extension sheet Form C Pages 3 & 4 for HAIs 2 & 3 and antimicrobial prescriptions 3, 4, 5

40. Sections 1, 2, 3 completed for EVERY eligible patient
Patient Form (Form C)
Two pages for vast majority of patients – extension sheets for patients with ≥2 HAI or ≥3 antimicrobials
Five sections:
Section 1 – Patient details
Section 2 – Risk factors
Section 3 – Condition of interest – HAI Y/N & Antimicrobial use Y/N
Section 4 – HAI data
Section 5 – Antimicrobial use data
Sections 1, 2, 3 completed for EVERY eligible patient
100%

41. Sections 1, 2, 3, 4 completed for EVERY eligible patient
Patient Form (Form C)
Two pages for vast majority of patients – extension sheets for patients with ≥2 HAI or ≥3 antimicrobials
Five sections:
Section 1 – Patient details
Section 2 – Risk factors
Section 3 – Condition of interest – HAI Y/N & Antimicrobial use Y/N
Section 4 – HAI data
Section 5 – Antimicrobial use data
Sections 1, 2, 3, 4 completed for EVERY eligible patient
with an active HAI ~ %

42. Patient Form (Form C)
Two pages for vast majority of patients – extension sheets for patients with ≥2 HAI or ≥3 antimicrobials
Five sections:
Section 1 – Patient details
Section 2 – Risk factors
Section 3 – Condition of interest – HAI Y/N & Antimicrobial use Y/N
Section 4 – HAI data
Section 5 – Antimicrobial use data
Sections 1, 2, 3 & 5 completed for EVERY eligible patient
receiving systemic antimicrobials ~ 33%

43. Your hospital.... TOTAL NUMBER OF PAPER FORMS TO BE COMPLETED*
150 ACUTE BEDS DIVIDED INTO 8 WARDS
300 ACUTE BEDS DIVIDED INTO 12 WARDS
600 ACUTE BEDS DIVIDED INTO 22 WARDS
Ward Lists (Forms A1 & A2) 8 12 22
Hospital Form (Form B) 1
Patient Forms (Form C)
150
300
600
Form C
Section 1, 2, 3
Form C (AMU)
Section 1, 2, 3 & 5 50
100
200
Form C (HAI)
Section 1,2, 3, & 4 15 30
Figures calculated based on estimated prevalence of AMU 33% and HAI 5%
*Completed paper versions of all Form A1s, one Form B & all Form Cs are used to
enter your hospital’s PPS data onto secure ‘web-based’ data entry system

44. Patient Form (Form C)

45. Patient Form (Form C)
The answers to 10/12 (83%) questions in Section 1 & 2
can be directly transcribed from the completed Ward List A2
For each eligible patient, the PPS team will need to decide:
Admitting consultant’s specialty – prepare and laminate list ahead of PPS &
give a copy to each PPS team member
Surgical procedure for patients who have had surgery on this admission
Underlying disease prognosis – review of notes and talk to ward staff

46. Patient Form (Form C)
‘Patient on antimicrobials’ on Ward List – BUT double check medication charts – MP, SP could be missed
Also check Ward List to identify patients who have undergone surgery in the last 24 hours to pick up
surgical antimicrobial prophylaxis administered since 8am yesterday

47. Patient Form (Form C)

48. Patient Form (Form C)

49. Getting ready to do your PPS
PPS team identified and trained
PPS team leader has hospital code (same as 2012 code) and webform log-in username and password
VPN connection tested for webforms data entry
Local PPS dates agreed
PPS ward schedule prepared & distributed to wards
Ward List A1 (one per ward) started in consultation with CNM
DONM to request ward CNMs ensure their Ward List A2 completed by 8am on day of PPS

50. Getting ready to do your PPS
Brief night nursing manager on Ward List A2, in case of queries
Data gathered for Hospital Form B
Ward codes, ward specialty, consultant specialty assigned, local antimicrobial restricted list with laminated copy for each data collector
Ward list A2 & Instruction Sheet given to nursing staff on day prior to PPS
Sufficient copies of patient forms, protocols available
Administrative support identified and trained in form entry
Verify PPS data entry on VPN connected PC available

51. Any Questions?