1. Information for Action HCAI Surveillance Data: Laboratory data 15th July 2015 Mari Morgan
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2. Laboratory Surveillance Schemes
Staphylococcus aureus bacteraemia
Clostridium difficile
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3. Source of Data Specimen data entered into Trak
DataStore extracts results from Trak
Records that meet certain criteria are extracted from DataStore for use in surveillance
Data is processed, denominators applied, used for report production
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4. Criteria for Extraction from DataStore
S. aureus bacteraemia
Specimen type = blood culture
Organism identified = S. aureus
MRSA & MSSA distinguished on basis of antimicrobial sensitivity pattern
Specimen date (based on date received) is within date range of report
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5. Criteria for Extraction from DataStore
C. difficile
Test type = C. difficile GDH
GDH result = positive
Test type = C. difficile toxin test
Toxin test result = positive
Specimen date (based on date received) is within date range of report
Age is > 2 years or unknown
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6. Data Processing Deduplication
S. aureus bacteraemia – if < 14 days between consecutive positives, excluded as a duplicate episode
C. difficile – if < 28 days between consecutive positives, excluded as a duplicate episode
Surveillance definitions – clinically you may not treat this as a separate episode
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7. Data Processing
Samples from patients in private hospitals, privately run dialysis units and post-mortem samples excluded
Samples assigned as inpatient / non-inpatient based on the type of ward and the type of patient
Where inpatient/non-inpatient unknown, assumed to be inpatient until updated by HB
Where age is unknown for C. difficile, assumed to be > 2 years until updated by HB
In datastore field called wholoc – says whether ward is ip, op etc and the patcat – ip or op but patcat not used in very standardised way, often used to distinguish private from nhs
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8. Denominators
Monthly admissions data by HB and hospital provided by NHS Wales Informatics Service (NWIS) – where up to date data unavailable, data from the equivalent month in the previous year is used
Mid year population estimates from Office for National Statistics (ONS) – 2014 data published at end of June (a proportion of the population is used for calculating monthly rates)
If we didn’t use a proportion of the population, then we would be using the same denom throughout but the numerator would keep increasing. Rates would look really good at the beginning of the year - lull into false sense of security
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9. Reports Monthly Dashboard
C. difficile, MRSA bacteraemia and MSSA bacteraemia
Released on or before 7th of month
Monthly update tab – data for current and previous financial years – numbers, rates per 1000 admissions and rates per 100,000 population
Target reduction tab – progress against current Tier 1 target, Apr 14 – Sep 15
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12. Reports 6 monthly reports
C. difficile, MRSA bacteraemia and MSSA bacteraemia
Released in November for Apr – Sep data
Released in May for previous financial year – numerator data for FY does not change after that report published
Rates may change slightly one new mid year pop estimates become available
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15. Reports
Maps
A package of sample C. difficile maps was sent out in March and prescribing maps in April for data to end Sep 14 plus an evaluation form
Additional data on the location of residence of patient and the GP of the patient are used to produce these maps
All prescribing maps and the most popular C. difficile maps (Wales and HB) will be sent out by the end of July for the 2014/15 FY data
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16. Clostridium difficile surveillance
Maps by HB of diagnosis
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17. Clostridium difficile surveillance
Maps by HB of residence
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18. Clostridium difficile surveillance
Maps by GP of patient
Our most popular map
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19. Clostridium difficile surveillance
2014/15 FY report has been issued – 16% reduction in numbers, but variable across HBs
Wales rate = 43/100,000 population (51 in 2013/14)
Target = 31/100,000 population
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20. Future Reports Conversion of current monthly dashboard to Tableau
Development of early warning system in Tableau – weekly unprocessed data to identify unusually high numbers
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22. Thank you to all the healthcare organisations in Wales for their help with these surveillance schemes.
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