1. Information for Action Point Prevalence Survey of Healthcare associated infection and antimicrobial use 26 th June 2012 Dafydd Williams

2. Information for Action ECDC PPS NOT AGAIN WHAT’S THIS?

3. Objective Overview of the ECDC PPS –Discussing the methodology –Summary of results Information for Action

4. Why carry out an EU prevalence survey? An external ECDC evaluation in 2008 recommended that: “The European HAI surveillance needs to cover other types of nosocomial infections besides surgical site infections and ICU- acquired infections in order to estimate and monitor the complete HAI disease burden” “Since the implementation of an expanded continuous incidence surveillance is very resource demanding, hospital-wide prevalence surveys are efficient approaches to address it.”

5. Objectives of EU PPS 2011/2 1.To estimate the total burden (prevalence) of HAI & antimicrobial use 2.To describe patients, invasive procedures, infections and antimicrobials prescribed By type of patients, specialties or healthcare facilities By EU country, adjusted or stratified 3.To disseminate results to those who need to know at local, regional, national and EU level Raise awareness Train and reinforce surveillance structures and skills Identify common EU problems and set up priorities Evaluate the effect of strategies and guide policies (repeated PPS) 4.To provide a standardised tool to identify targets for quality improvement

6. ECDC – Methodology ECDC developed protocol Information for Action

7. Health Boards Number of Hospitals Number of patients surveyed Number of patient with HAI Prevalence of HAI Abertawe Bro Morgannwg University Health Board121963 472.4 (1.8-3.7) Aneurin Bevan Health Board151387 433.1 (2.3-4.6) Betsi Cadwaladr University Health Board191815 844.6 (3.8-5.7) Cardiff and Vale University Health Board81645 764.6 (3.7-5.7) Cwm Taf Health Board81026 161.6 (1.0-2.5) Hywel Dda Health Board131071 696.4 (5.1-8.1) Powys Teaching Health Board10154 2516.2 (11.2-22.9) Velindre NHS Trust133 26.1 (1.7-19.6) Wales total 869094 3624.0 (3.6-4.4)

8. Number of patients in Wales HAI typeNumber of HAI* % of HAIPrevalence (%) of HAI by type 9094382 UTI8020.9 0.9 SSI7519.6 0.8 GI infection4411.5 0.5 Pneumonia4211.0 0.5 BSI348.9 0.4 Skin and soft tissue infection328.40.4 LRT infection256.50.3 Eyes and ENT infection225.80.2 Systemic infection82.10.1 CRI-CVC51.30.1 Reproductive tract infection41.0<0.1 Neonatal infection30.8<0.1 CRI-PVC30.8<0.1 Bone and joint infection20.5<0.1 CNS infection20.5<0.1 CVS infection10.3<0.1 * Counts the number of HAI (i.e. Patients may have multiple HAI). Key: UTI – urinary tract infection; SSI – surgical site infection; GI – gastrointestinal; BSI – bloodstream infection; LRT – lower respiratory tract; ENT – ear - nose - throat; CRI-CVC – catheter related infection (central venous catheter); CRI- PVC – catheter related infection (peripheral vascular cannula); CNS – central nervous system; CVS – cardiovascular system. Overall HAI for Wales = 4.0% Acute Sector=4.3% Non-Acute Sector=3.2% Acute Sector SSI(23.7%) UTI (16.7%) Pneumonia(12.3%) Non-Acute UTI(36.1%) Eyes & ENT(14.5%) SST(12.1%)

9. Comparison with previous HAI prevalence survey 2006 YearNumber of patients surveyed Number of patients with HAI Prevalence (%) of HAI (95% CI) 2006 57343646.4 (5.7 – 7.0) 2011 (stratified) 62172714.4 (3.9 - 4.9) HAI type2006 prevalence of HAI* (%) 2011 prevalence (%) of HAI* (stratified) UTI15.517.5 SSI18.024.3 GI infection15.512.5 Pneumonia9.812.9 BSI8.011.1 Skin and soft tissue infection12.57.5 LRT infection14.35.4 Eyes and ENT infection3.03.6 Systemic infection1.52.9 Reproductive tract infection0.81.1 Bone and joint infection1.00.7 CNS infection0.30.4 CVS infection0.00.4 Total57346217

10. Information for Action Prevalence of antimicrobial prescribing in Wales by indication

11. Overall 8.8% of patients surveyed were being treated for a hospital acquired infection only, as deemed by the prescriber. Only 4.0% of patients were considered to have a HAI as defined by the HAI case definitions within the survey.

12. Medical Device Utilisation Number of patients surveyed Number of patients with one or more devices in situ DeviceNumber of devices in situ* % of device utilisation 9094336937.0 UC157117.3 PVC236826.0 CVC3754.1 Intubation2102.3 Total number of HAI in Wales HAI typeNumber of HAI HAI with device in situ prior to onset % of total HAI 383 UTI (urinary catheter within 7 days prior to onset) 804010.4 Pneumonia (ventilated within 48 hours prior to onset) 42102.6 BSI (CVC within 48 hours prior to onset) 3451.3