Dimension: Infection Control and Management

Rationale for measurement

Bloodstream infection with S. aureus (which includes MRSA bloodstream infection) occurring more than 48 hours after admission is likely to be hospital-acquired (i.e. the patient is unlikely to have come in with this infection – rather they may have got this infection in the hospital).

What is Staphylococcus aureus?

A bacteria that is commonly carried on the skin or in the nose, where it mostly causes no harm (= carriage or colonisation). Infection occurs when it manages to get through the skin or into other parts of the body where it can multiply and cause a person to become ill.

  • It can cause a wide range of infections in hospitals – most commonly skin/wound infections.
  • Bloodstream infection is one of the more serious infections and can cause significant morbidity and mortality (in addition to increased length of stay and more medications/procedures). As aureus is a skin bacteria – when it gets into the bloodstream in hospital patients it is usually because of a break in skin. Therefore patients with IV lines (drips) and wounds and patients that have had recent procedures (surgery) are at risk if infection prevention and control precautions have not been applied consistently.

Measurement methodology and data sources

  • S Aureus notification rate per 10,000 bed days used (monthly)
  • source for national data provided by BIU MDR

Target:

  •  <1 new cases per 10,000 Bed Days Used (BDU)

Performance National – Hospital Group Comparator 

  • RCSI HG is not achieving national performance target for reporting period of April 2019

Rationale for measurement

Clostridium difficile (C. difficile) is a bacterium that can be found in the large bowel. A small proportion (less than 1 in 20) of the healthy adult population carry C. difficile and do not experience any symptoms. However sometimes when a person takes an antibiotic, some “good” bacteria die allowing C. difficile to multiply and this can lead to C. difficile infection (CDI), which affects the large bowel.

Symptoms of CDI include diarrhoea, stomach cramps, fever, nausea and loss of appetite. Most people get a mild illness and recover fully but in certain circumstances, patients can develop serious complications including colitis (inflammation of the bowel), which can be life threatening. Risk factors for developing infection include older age, antibiotic use, serious illness, immune-compromised state (weakened immunity), recent bowel surgery and long term hospitalisation or residence in other health care settings e.g. nursing homes (www.hpsc.ie/A-Z)

Control of C. difficile comprises antibiotic stewardship (only using antibiotics when required and using the right antibiotic for the infection in question) and good infection prevention and control practice, which means patients, their family members and hospital staff regularly washing their hands and appropriate cleaning and disinfection of equipment. CDI rates in hospitals are recognised and used internationally as a good measure of the quality and safety of a health care service.

Measurement methodology and data sources

  • Clostridium difficile – new cases of healthcare associated C. diff infection per 10,000 bed days (monthly)
  • source for national data provided by BIU MDR

Target

  • <2 per 10,000 bed days used

Performance National – Hospital Group Comparator

  • RCSI HG is not achieving national performance target for reporting period of April 2019

Introduction

Carbapenemase-Producing Enterobacteriaceae (CPE) infections are most commonly seen in people with exposure to healthcare settings such as hospitals and long-term care facilities. In healthcare settings, CPE infections occur among sick patients who are receiving treatment for other conditions. Patients carrying CPE either colonised or infected need to be identified and isolated to limit onward spread of this infection.

Rationale for measurement

All patients from the following cohorts will be swabbed on admission or transfer to establish whether they are colonised or infected with CPE. In line with national HCAI guidelines and HIQA standards, CPE testing is mandatory for all patients in the cohorts beneath:

  • All patients admitted from Home to any healthcare facility (including the hospital into which they are being readmitted) in the previous 12months
  • All patients admitted directly from another healthcare facility (Acute or non-acute) in Ireland or from a healthcare facility abroad
  • All patients admitted to the following specialist areas, Intensive Care Units, High Dependency Units, Coronary Care Units, Neonatal Intensive Care Units, haematology, transplant, chemotherapy and renal dialysis
  • All contacts of a patient identified as having CPE

 Measurement methodology and data sources

  • Local data extracts extrapolated for analysis and publication
    • Enumerator: Numbers of Patients from each of the above Cohorts who have been swabbed for CPE
    • Denominator: Numbers of patients admitted from each cohort
  • RCSI CPE Report from Planning and Performance Section, Acute Hospital Division
    • Carbapenemase-Producing Enterobacteriaceae – cases of newly detected CPE per 10,000 BDU

Target

  • 100% of patients from each of the cohorts identified will be swabbed for CPE.

Performance– Beaumont Specialist areas Info does not include CCU/Oncology

CPE Contact Screening:

  • 35 confirmed cases of newly detected CPE in RCSI Hospital Group YTD 2019
  • national performance for April unavailable at time of publication

Rationale for measurement

Improving healthcare workers hand hygiene compliance has been described by the WHO as a key measure to reduce healthcare-associated infections. Poor hand hygiene practice can result in an increased risk of cross infections from one person to another by hand contact. It is best practice of all staff working in the healthcare facility washing their hands frequently including (1) before touching a patient, (2) before clean/aseptic procedures, (3) after body fluid exposure/risk, (4) after touching a patient, (5) after touching patient surroundings (WHO, 5 moments).

Measurement methodology and data sources:

  • The proportion of healthcare workers who comply with hand hygiene protocols. Source of data – report on Hand Hygiene Compliance in HSE Acute Hospitals. This is measured twice yearly. To view the report, click here.

Target

  • 90% HSE target proportion of healthcare workers who comply with hand hygiene protocols.

Performance

  • Performance data set updated monthly with local hospital data.

Beaumont Hospital

  • Beaumont Hospital is not achieving target (April 2019 78%)
  • national performance not available at time of publication

Cavan General Hospital

  • Cavan / Monaghan Hospital is achieving target (April 2019 93%)
  • national performance not available at time of publication

Connolly Hospital

  • Connolly Hospital is achieving target (April 2019 95%)
  • national performance not available at time of publication

Rotunda Hospital

  • Rotunda Hospital is achieving target (April 2019 94%)
  • national performance not available at time of publication

Our Lady of Lourdes Hospital, Drogheda

  • OLOL / LCH Hospitals are not achieving target (April 2019 89%)
  • national performance not available at time of publication

RCSI Hospital Group

  • overall RCSI HG is achieving target (April 2019 90%)
  • national performance not available at time of publication

Rationale for measurement

Influenza (flu) can be a serious disease that can lead to hospitalisation and even death. Anyone can get very sick from the flu, including people who are otherwise healthy. By getting vaccinated, healthcare workers help protect themselves and their patients.

Measurement methodology and data sources

The proportion of healthcare workers who get vaccinated each year. Click here to view data source.

Target

  • HSE target increased for 2018-2019 to 60% proportion of healthcare workers who get vaccinated each year.

Performance

RCSI Hospital Group

Note: Seasonal flu vaccine data for 2012-2013 unavailable for Rotunda; for 2014-2015 unavailable for Cavan Hospital; for Our Lady of Lourdes Hospital Drogheda is unavailable from 2012-2015

  • RCSI HG has achieved national target this flu season 2018-2019. Flu season commenced October 2018.
  • National performance unavailable at time of publication
  • Hospital compliance (as of April 2019): Beaumont (62%); Connolly (64%); Rotunda (81%); Cavan/Monaghan (53%); OLOL/LCH (83%); RCSI Hospital Group (69%)

Background

Sepsis is a common and time-dependent medical emergency. It can affect a person of any age and from any social background. While it may occur more frequently in people with certain underlying medical conditions, it can also occur in healthy individuals. In 2016, the number of deaths amongst in-patients with a diagnosis of sepsis within Irish hospitals was 2,735. Sepsis is responsible for 37,000 deaths annually in the UK.

Internationally, approaches to optimal sepsis management, which are based on early recognition of sepsis with timely intervention within the first hour, have reported reductions in mortality from severe sepsis/septic shock in the order of 20-30%.

Rationale for measurement

In 2014 the HSE introduced the National No 6 Sepsis Clinical Guideline. This guideline endorses the concept of ‘Sepsis Six’ – a set of six tasks (including administration of oxygen, blood cultures, administration of antibiotics and intravenous fluids, lactate measurement and monitoring of urine output) to be completed within one hour by practitioners at the front line. In conjunction with this, the HSE have an on-line e–learning Sepsis module available as a teaching module for non-Obstetrics & Gynaecology clinical staff.

Sepsis Training modules specifically aimed at maternal sepsis recognition and treatment are available by completion of an accredited Maternity Sepsis Training module such as PROMPT – Practical Obstetric Multi-Professional Training Maternity Sepsis Training.

Methodology

Monthly report from individual hospitals on the number and category of clinical staff who have completed:

  • Sepsis e-learning module (non-Obstetrics & Gynaecology staff)
  • PROMPT (or equivalent accredited Obstetrics & Gynaecology Sepsis Module, e.g. Rotunda Hospital Obstetric Emergency Training, RHOET) 

Target

100% compliance

Performance* Staff trained = NCHDs, Consultants, Nurses, Midwives, Obs & Gynae NCHDs, Obs & Gynae Consultants