1. Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre & Beaumont Hospital, Dublin, Ireland HPSC, SARI and National HCAI surveillance

2. 1.What is HPSC? 2.What is SARI? 3.National HCAI surveillance 4.What about line infections?

3. H.P.S.C. Health Protection Surveillance Centre

4. 4 HPSC- History and Governance Established (NDSC) Nov 1998 –Surveillance of Communicable Diseases –Epidemiological investigation, Advice, Training and Research –International Liaison EU/WHO Incorporated into HSE in January 2005 –Division of Population Health; –Name change - Health Protection Surveillance Centre –Same remit

5. 5 HPSC Activity Surveillance Provision of Expert Advice Research Training Collecting data Collating it Analysing it and Communicating information to those who need to know Operational Support to the Health System Policy advice Public information Identifying and developing best practice – initiation and collaboration For professionals in communicable disease control – especially joint training Teaching

6. 6 Where HPSC fits into the Great Scheme of Things HPSC

7. www.hpsc.ie

10. C. difficile

16. MRSA

18. …….and more!

19. 2001

21. http://www.hse.ie/eng/Publications/Health_Protection/Health_Care_Associated_Infection/Governance_Fr amework_March_2007.pdf

22. National guidelines

23. National committee Subcommittees Surgical site infection surveillance Catheter-associated UTI IV catheter-associated infection Antibiotic stewardship (x2) MRSA in ICU Regional committees

24. 1.EARSS 2.ESAC 3.MRSA in ICU Prevalance Survey 4.Alcohol hand gel consumption 5.North South MRSA Study 1999 6.HIS HCAI Prevalance Study 2006

26. www.hpsc.ie

35. MRSA in ICU Prevalance Study

37. 32 hospital ICU’s in 2008 Average MRSA prevalence rates 2.9% to 21.2% MRSA acquisition rates vary nationally from 0% to 3.3%. Data suggests that ICU’s with lower isolation room resources have a higher MRSA acquisition rate compared to ICU’s with more resources despite having a similar percentage of patients ventilated.

38. MRSA Isolates 192 cases in North (5.3/100,000) 508 cases in South (6.5/100,000) Males > Females Highest rates, 65 years or more 25-44 yrs.4.4/100,000 (South)  75yrs. 111/100,000 (South)

39. SouthNorth Hospital92%69% GP 4%20% Nursing Home 2%10% Psychiatry 2% 1%

40. Clinical Status No. (%) Colonised (carriage) 271(62) Local infection124(28) Invasive infection44(10) Risk factors for invasive disease – iv line – surgery/ invasive procedure

41. NorthSouth MRSA/S aureus bacteraemia25%36% Hospitals with antibiotic policy95%41% Infection control nurse on site100%85% Isolation rooms available100%87%

42. HIS HCAI Prevalance Survey

50. North South MRSA Study 5% (North) and 10% (South) cases had invasive infection Patients with invasive infection were more likely to have a history of PVC or CVC than those with colonisation only.

51. HIS HCAI Prevalance Survey 449 patients had a primary BSI, 184(41%) of which were CVC related CVC presence significantly associated with primary BSI More patients in RoI had IVCs in situ when compared N. Irl As in other countries, presence of a CVC in Irish patients was associated with a HCAI.

52. S.aureus bacteraemia: 283 cases South-East Ireland 2002-6 SourceNumber% of Total Central Venous Catheter9132% Peripheral Venous Catheter4215% Burns et al.CMI 2007 13;(s1)s520 47% due to venous access

53. Enhanced EARSS 2175 587 98 One in four S.aureus bacteraemias in Ireland is due to infection associated with a central venous catheter One in twenty S.aureus bacteraemias in Ireland is due to infection associated with a peripheral venous cannula

54. Enhanced EARSS 2175 587 98 One in four S.aureus bacteraemias in Ireland is due to infection associated with a central venous catheter One in twenty S.aureus bacteraemias in Ireland is due to infection associated with a peripheral venous cannula

55. Enhanced EARSS

56. Irish guidelines: Prevention of CR-BSI

57. Summary IV lines = potentially modifiable risk factor for bacteraemia Surveillance data essential to monitor effectiveness of any intervention ‘You cant manage what you cant measure’