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 is achieving national performance target for monthly reporting period (2020)
  • national data not available at time of report publication

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 achieving national performance target for monthly reporting period (2020)
  • national data not available at time of report publication

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

  • 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 90% compliance (September 2020)
  • national performance not available at time of publication

Cavan / Monaghan Hospital

  • Cavan / Monaghan Hospital achieving 93% compliance (September 2020)
  • national performance not available at time of publication

Connolly Hospital

  • Connolly Hospital achieving 97% compliance (September 2020)
  • national performance not available at time of publication

Rotunda Hospital

  • Rotunda Hospital achieving 94% compliance (September 2020)
  • national performance not available at time of publication

Our Lady of Lourdes Hospital / Louth County Hospital

  • OLOL / LCH Hospitals achieving 93% compliance (September 2020)
  • national performance not available at time of publication

RCSI Hospital Group

  • overall RCSI HG is achieving 93% compliance (September 2020)
  • 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 100% (excluding staff deemed medically unfit to take vaccine)

Performance

RCSI Hospital Group

  • RCSI HG achieved national target for flu season 2019-2020.
  • Hospital compliance (as of September 2020): Beaumont (Beaumont vaccination commencing in October); Connolly (35%); Rotunda (Rotunda vaccination commencing in October); Cavan (17%), Monaghan (44%); OLOL (27%), LCH (25%); RCSI Hospital Group (28%)

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
** National data not available

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 the numbers of patients admitted to hospital due to COVID -19 in the RCSI Hospital Group

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

  • all admissions to RCSI HG are tested pre-admission or on day of admission

Introduction

Chronic obstructive pulmonary disease (COPD) is a disease of the lungs characterised by airflow obstruction. This airflow obstruction is usually progressive and only partially reversible. The disease is associated with increasing dyspnoea (breathlessness) and in more severe cases can be associated with exacerbations of the disease, which may require intervention either in primary care, attendance at the hospital or even admission to hospital. Patients with severe COPD may suffer frequent exacerbations of their disease requiring medical attendance, potential hospitalisation and severe disruption of their quality-of-life. (End to End COPD Model of Care, December 2019, National Clinical Programme for Respiratory).

Rationale for measurement

Ireland has the highest rate of hospitalisation for COPD of all Organisation for Economic Co-operation and Development (OECD) countries. In 2013 (the latest year for which OECD data are currently available), the age standardised hospitalisation rate in Ireland based on OECD age standardisation equated to an age-sex standardised rate of 395/100,000, is almost double the OECD average of 201 hospitalisations per 100,000 population. Early supported discharge from hospital can benefit patients as they receive treatment in their own home. In addition the risk of patients contracting a hospital acquired infection is reduced. The RCSI HG measures re-admission of patients within 30 Days, this is the same timeframe as that measured in the medical readmission rate. International data demonstrates a variation in 30 day readmission rates for COPD patients. A systematic review of 34 studies has found the range of avoidable readmissions can vary between 5 and 79% with a median of 27%[1]. A more recent review by Shah et al suggest that patients hospitalized for COPD are likely to have a 30-day re-admission rate of 22.6%[2]

Measurement methodology and data sources

KPI 1: Median LOS for patients admitted with COPD

KPI 2: % re-admission to same acute hospitals of patients with COPD within 30 days.
Local HIPE Data extrapolated quarterly for analysis and publication

Targets

KPI 1: Median LOS for patients admitted with COPD – 5 Days

KPI 2: % re-admission to same acute hospitals of patients with COPD within 30 days -22.6%

Performance

KPI 1: Median LOS for patients admitted with COPD

  • Cavan, Connolly and Our Lady of Lourdes Hospital achieving national target for KPI 1
  • Beaumont Hospital is not achieving national target for KPI 1

[1] Van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ. Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ. 2011;183(7):E391–E402.

[2] Shah T, Press V, Huisingh-Scheetz M, White SR. COPD readmissions: addressing COPD in the era of value-based health care. Chest. 2016;150 (4):916–926.

KPI 2: % re-admission to same acute hospitals of patients with COPD within 30 days

  • Note Data outlined is re-admission within 30 Days to same acute hospital, the same timeframe as measured in the medical readmission rate. National KPI for COPD measures readmission within 90 Days.
  • Recent international data suggests a re-admission rate for COPD patients of 22.6% within 30 days

Breakdown of Patient Age Profiles

  • Beaumont Hospital and Our Lady of Lourdes Hospital had the greatest number of patients readmitted with COPD aged 70-79 years old
  • Cavan and Connolly hospitals had the greatest number of patients readmitted with COPD aged 60-69 years