1. HCAI Tier 1 Targets Mari Morgan, WHAIP
6th November 2014
HCAI Tier 1 Targets Mari Morgan, WHAIP
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2. HCAI Tier 1 Targets
For 01/04/2014 to 30/09/2015, the major HBs in Wales should have rates of no more than the following:
C. difficile – 31 per 100,000 resident population
MRSA bacteraemia – 2.6 per 100,000 resident population
Major HBs – Powys and Velindre excluded
HCAI Tier 1 Targets

3. HCAI Tier 1 Targets - Background
Wales rates 2012/13: C. difficile: 63 per 100,000 population (33 – 92) MRSA bacteraemia: 5.2 per 100,000 population (4 - 7) Aim to reduce Wales rate by 50% and reduce variability between HBs.
HCAI Tier 1 Targets

4. HCAI Tier 1 Targets - Background
Rates of total C. difficile per 100,000 population in UK countries by financial year
Age standardisation
HCAI Tier 1 Targets

5. HCAI Tier 1 Targets - Background
Rates of MRSA bacteraemia per 100,000 population in UK countries by financial year
HCAI Tier 1 Targets

6. HCAI Tier 1 Targets – How are they calculated?
Numerator = Total C. difficile (age 2y+)/MRSA bacteraemia diagnosed in HB (IP, OP, GP) with spec dates from 01/04/14 – 30/09/15
Denominator = HB resident population * 1.5
HCAI Tier 1 Targets

7. HCAI Tier 1 Targets – How are they calculated?
Each HB provided with max no of C. difficile/ MRSA bacteraemia in the 18m period that would still allow them to achieve the target rates, using 2012 mid year population estimates.
Health Board
C. difficile (2013/14)
Abertawe Bro Morgannwg University
245 (219)
Aneurin Bevan University
273 (383)
Betsi Cadwaladr University
326 (447)
Cardiff & Vale University
225 (260)
Cwm Taf University
139 (82)
Hywel Dda University
181 (148)
MRSA bacteraemia (2013/14)
21 (29)
23 (22)
27 (47)
19 (31)
12 (13)
15 (20)
HCAI Tier 1 Targets

8. HCAI Tier 1 Targets – How are they monitored?
Weekly downloads from Datastore of C. difficile and blood culture test results
Cleaning, deduplication
Monthly dashboard produced HBs and WG, published on HB websites, Wales on PHW website
Remove QA samples, aspirates in blood culture bottles etc
Cdiff are deduplicated based on 28 days, MRSA bacteraemia – 14 days
Dashboard also includes MSSA results – not part of target
HCAI Tier 1 Targets

9. HCAI Tier 1 Targets – How are they monitored? Monthly Update Tab
All data for the current financial year is provisional. Final numbers for the year are available around June/July for the previous financial year.
Rates per 1000 admissions or per 100,000 population.
Select box at the top – you can choose entire HB or one of the major acute hosps within HB or Wales and select organisms – Cdiff, MRSA or MSSA bacteraemia.
Wales HCAI Surveillance Review

10. HCAI Tier 1 Targets – How are they monitored?

11. HCAI Tier 1 Targets – How are they monitored? Target Monitoring Tab

12. HCAI Tier 1 Targets – How are we doing so far?
1/3 into target time period
No HBs currently on trajectory to achieve C. difficile or MRSA bacteraemia target (using average monthly numbers)
Wales rates for Apr-Sep 14:
C. difficile = 44 (HBs: )
MRSA bacteraemia = 5.1 (HBs: )
These were the rates provided in the last monthly dashboard. Next one will be issued tomorrow – data for Apr – Sep will be updated.
HCAI Tier 1 Targets

13. HCAI Tier 1 Targets – How are we doing so far?
Because we are not on trajectory now, doesn’t mean that the target won’t be achieved).
The rate is like an average speed check; if we go faster than 50 at the beginning, we need to go slower than 50 later on to make it 50 overall. Everyone’s numbers are too high at the beginning of the surveillance period which means they will need to be much lower later on in the target period and will still achieve target
HCAI Tier 1 Targets

14. HCAI Tier 1 Targets – How are we doing so far?
C. difficile: 24% fewer cases compared to Apr – Sep 13
MRSA bacteraemia: 1% fewer cases compared to Apr – Sep 13
C. difficile
MRSA bacteraemia
For some HBs it is too late for the MRSA bacteraemia target. Maybe that they can demonstrate that for the last 6 months of the target period they achieved the required rate.
HCAI Tier 1 Targets

15. HCAI Tier 1 Targets – What would success look like?