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 S.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 not achieving national target for March 2021
  • April and May data not available at time of report publication due to cyber attack

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 not achieving national target for March 2021
  • April and May data not available at time of report publication due to cyber attack

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) – Hospital transfer in Ireland or from a healthcare facility abroad
  • All patients admitted to the following specialist areas: Critical Care, Haematology, Transplant, Chemotherapy and Renal Dialysis Units
  • 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 screened for CPE.

Performance

  • May data not available at time of report publication due to cyber attack

  • May data not available at time of report publication due to cyber attack

  • May data not available at time of report publication due to cyber attack

  • May data not available at time of report publication due to cyber attack
  • NB national data unavailable for level of cohort screening

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% target proportion of healthcare workers who comply with hand hygiene protocols (HSE National target)

Performance

  • Performance data set updated monthly with local hospital data.

Beaumont Hospital

  • Beaumont Hospital currently achieving 96% compliance (May 2021)
  • national performance not available at time of publication

Connolly Hospital

  • Connolly Hospital achieving 97% compliance (May 2021)
  • national performance not available at time of publication

Cavan General Hospital

  • Cavan General Hospital achieving 91% compliance (May 2021)
  • national performance not available at time of publication

Monaghan Hospital

  • Monaghan Hospital achieving 91% compliance (May 2021)
  • national performance not available at time of publication

Rotunda Hospital

  • Rotunda Hospital achieving 97% compliance (May 2021)
  • national performance not available at time of publication

Drogheda Hospital

  • Drogheda Hospital achieving 92% compliance (May 2021)
  • national performance not available at time of publication

Louth County Hospital

  • Louth County Hospital achieving 92% compliance (May 2021)
  • national performance not available at time of publication

RCSI Hospital Group

  • overall RCSI HG is achieving 94% compliance (May 2021)
  • 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. Data source local hospital data. National performance data published annually:

Click here to view data source.

Target

  • HSE target increased for 2020-2021 to 75% proportion of healthcare workers who get vaccinated each year
  • RCSI HG target 95%

Performance

RCSI Hospital Group

  • Hospital compliance (as of May 2021): Beaumont (74%); Connolly (75%); Cavan (75%), Monaghan (88%); Drogheda (89%), LCH (72%); Rotunda (82%); RCSI Hospital Group (79%)
  • national data not available at time of publication
  • Flu vaccination programme runs from October to May and is now closed for 2020/2021 season

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

  • 95% compliance

Performance

  • national data not available

  • disciplines trained includes NCHDs, Consultants, Nurses, Midwives, Obs & Gynae NCHDs, Obs & Gynae Consultants

COVID-19 CASES ADMITTED ON SITES

Introduction

COVID-19 is a worldwide pandemic caused by a newly discovered coronavirus. Most people who are diagnosed with COVID-19 will experience mild to moderate symptoms and recover without specialist treatment. Approximately 15% of patients diagnosed with COVID-19 will require hospitalization and 2% of patients will require admission to an Intensive Care Unit (ICU).

Rationale for measurement

This metric provides information on numbers of patients admitted to hospital due to COVID -19 in RCSI HG.

Measurement methodology and data sources

Local data extracts extrapolated daily for analysis and publication from the 08.00 hours number of confirmed cases of Covid-19 admitted on site (TrolleyGAR)

Performance

  • due to cyber attack some dates not available at time of publication
  • all admissions to RCSI HG are tested pre-admission or on day of admission

COVID-19 TESTING PRIOR TO RESIDENTIAL CARE TRANSFER FROM HOSPITAL

Rationale for measurement

The role of COVID-19 testing in assisting with decision-making regarding transfers to congregated settings.  People for admission to a Long Term Residential Care Facility (LTRCF) should be tested for SARS-CoV-2. This is to help identify most of those who have infection, but it will not detect all of those with infection (Guidance on COVID-19 Admissions, transfers to and discharges from residential care facilities V1.2 23.12.20).

Measurement methodology and data sources

Testing should be performed within three days of planned admission/transfer to the LTRCF.

Target

100 % compliance of all residents who meet the criteria is tested and result available prior to admission/transfer

Performance – March 2021

COVID-19 STAFF VACCINATION

Rationale for measurement

COVID-19 is an illness that can affect your lungs and airways. It is caused by a virus called coronavirus. COVID-19 is very infectious and can be a serious disease that can lead to hospitalisation and even death. Anyone can get very sick from the COVID-19, including people who are otherwise healthy. By being vaccinated, hospital workers help protect themselves and their patients. From the end of December 2020, the HSE began to make COVID-19 vaccine available to hospital staff.

Measurement methodology and data sources

The proportion of hospital workers who have received a first dose of a COVID-19 vaccine. Data source local hospital data.

Target

  • RCSI HG target 100%* (unless medical grounds prevents HCWs uptake)

Performance – YTD 2021

  • frontline staff have been prioritised for vaccination