Surveillance of Blood Stream Infections in Patients Attending

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Surveillance of Blood Stream Infections in Patients Attending

Transcript Of Surveillance of Blood Stream Infections in Patients Attending

Surveillance of Blood Stream Infections in Patients Attending ICUs in England Protocol version 3.4
Infection in Critical Care Quality Improvement Programme

Surveillance of Blood Stream Infections in Patients Attending ICUs in England Protocol, version 3.4
About Public Health England
Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health.
Public Health England Wellington House 133-155 Waterloo Road London SE1 8UG Tel: 020 7654 8000 www.gov.uk/phe Twitter: @PHE_uk Facebook: www.facebook.com/PublicHealthEngland
Prepared by: Sarah Gerver, Rachel Murphy, Julia Abernethy, Charlotte Robin, Miroslava Mihalkova and Russell Hope on behalf of ICCQIP
Current ICCQIP Board Members: Peter Wilson (Consultant Microbiologist, University College London Hospital) [Chair], Julian Bion (Professor of Intensive Care Medicine, University of Birmingham) [Deputy Chair], Sarah Gerver (Senior Scientist, Public Health England), Jane Cassidy (Consultant Paediatric Intensivist, Birmingham Children’s Hospital), Russell Hope (Head of Mandatory Bacteraemia and CDI Surveillance, Public Health England), Susan Hopkins (Healthcare Epidemiologist, Public Health England), Miroslava Mihalkova (Scientist, Public Health England), Jennie Wilson (Reader in Healthcare Epidemiology, University of West London and Infection Prevention Society).
Alison Bedford-Russell (Neonatal Consultant, Birmingham Women’s NHS Foundation Trust), Joanna Conneely (Operations Manager, Public Health England), Paul Cosford (Director for Health Protection, Medical Director and Responsible Office for Public Health England, Public Health England), Matt Fogarty (Head of Patient Safety, NHS England), Wendy Harrison (Deputy Director, Faculty of Medicine, School of Public Health, Imperial College London), Alan Johnson (Consultant Clinical Scientist, Public Health England), George Leahy (HCAI Programme Board, Public Health England), Alistair Leanord (Consultant Microbiology, Queen Elizabeth University Hospital and Medical Advisor Healthcare Associated Infection Policy Unit, Chief Nursing Officer’s Directorate, The Scottish Government), Gary Masterson (Consultant in Critical Care Medicine and Anaesthesia, Royal Liverpool University Hospital and President Elect,
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Surveillance of Blood Stream Infections in Patients Attending ICUs in England Protocol, version 3.4
Intensive Care Society), Marilyn McDougall (Consultant in Children’s Intensive Care, Guy’s and St Thomas NHS Foundation Trust), Albert Mifsud (Consultant Microbiologist, Barts Health NHS Trust), Neena Modi (Professor of Neonatal Medicine, Imperial College London), Berit Muller-Pebody (Senior Scientist, Public Health England), Roger Parslow (Senior Lecturer in Epidemiology, Leeds Institute of Cardiovascular and Metabolic Medicine), Annette Richardson (Nurse Consultant Critical Care, Newcastle Upon Tyne NHS Foundation Trust), Andy Rhodes (Consultant in Anaesthesia and Intensive Care Medicine, St George’s University Hospital NHS Foundation Trust and Faculty of Intensive Care Medicine), Mike Sharland (Professor of Paediatric Infectious Diseases, St George’s University of London), Sally Wellsteed (Lead on Infection Control, Department of Health).
Former ICCQIP Board Members: Julia Abernethy (Senior Scientist, Public Health England), Anna Cichowska (Consultant in Public Health Strategy, Public Health England), Brian Cook (Associate Medical Director, Scottish Intensive Care Society), Anthony Kessel (Director of International Public Health, Public Health England), Rachel Murphy (Scientist, Public Health England), Kate Morrow (Patient Safety Lead, Infection Prevention and Management, NHS England), Charlotte Robin (Scientist, Public Health England), Alasdair Short (Board of Faculty of Intensive Care Medicine), Liz Stokle (HCAI Programme Board, Public Health England), Jennifer Taylor (HCAI Programme Board, Public Health England), Oliver Wills (HCAI Programme Board, Public Health England), David Tucker (Deputy Director, Infection Prevention Society), Duncan Wyncoll (Intensive Care Consultant, Guys and St Thomas’ NHS Foundation Trust),.
For queries relating to this document, please contact: [email protected]
© Crown copyright 2017 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v2.0. To view this licence, visit OGL or email [email protected] Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Any enquiries regarding this publication should be sent to [email protected]
Published August 2018
This document is available in other formats on request. Please call 020 8327 6868 or email [email protected]
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Surveillance of Blood Stream Infections in Patients Attending ICUs in England Protocol, version 3.4

Contents

About Public Health England

2

1. List of abbreviations and terms used

6

2. List of definitions

7

3. Introduction

9

3.1 Background

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3.2 Infection in Critical Care Quality Improvement Programme (ICCQIP)

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4. Aims and Objectives

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5. Data Collection

11

5.1 Overview

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5.2 Inclusion criteria for reporting to the surveillance system

11

5.3 Case definitions

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5.4 Method of reporting data on the ICU data capture system

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5.5 BSI monthly filing/sign-off

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5.6 Core BSI dataset to be collected

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5.7 BSI Event Form

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5.8 Patient/Specimen

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5.9 Clinical symptoms

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5.10 Repeat positive blood culture

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5.11 Treatment

39

5.12 CVC Data

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5.13 Source of infection

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6. Denominator data

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6.1 Denominator data flows

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6.2 ‘ICU Daily Census’ tool (formerly ‘Month by Days’)

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6.3 ‘Monthly Denominator Summary’

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7. Dashboard

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7.1 Introduction

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7.2 Summary Dashboard

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7.3 Benchmarking Dashboard

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8. Viewing, updating and deleting BSI event data

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8.1 Viewing a case(s)

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8.2 Updating a case

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Surveillance of Blood Stream Infections in Patients Attending ICUs in England Protocol, version 3.4

8.3 Deleting a case

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8.4 Running a line list report

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9. Viewing and updating denominator data

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9.1 Viewing and updating ‘Monthly Denominator Summary’

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9.2 Viewing and updating monthly denominator summary using Daily Census 63

9.3 Running a denominator line listing report

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10. Sign-off

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10.1 Signing-off tool

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10.2 Sign-off episode screen

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11. Plans for data analysis

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11.1 Summary of data outputs

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11.2 Data quality

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11.3 Reported data

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11.4 Data outputs

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12. Confidentiality and data sharing

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13. Access to the ICU DCS

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13.1 User Administration

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13.2 Data linkage and data sharing

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14. Reference list

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15. Appendix 1: Case Definitions

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15.1 Bloodstream infection (BSI)

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16. Appendix 2: Organism code list

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17. Appendix 3: Mandatory fields required for period submission/sign-off

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18. Appendix 4: Denominator forms to aid with data collection

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Surveillance of Blood Stream Infections in Patients Attending ICUs in England Protocol, version 3.4
1. List of abbreviations and terms used
BC – blood culture BSI – bloodstream infection CVC – central venous catheter CA-BSI – catheter associated bloodstream infection CR-BSI – catheter related bloodstream infection CVC-BSI – central venous catheter bloodstream infection CDC – Centers for Disease Control and Prevention ECDC – European Centre for Disease Prevention and Control HCAI – healthcare associated infection HES – Hospital Episode Statistics HRA – Health Research Authority HSCIC – Health and Social Care Information Centre ICCQIP – Infection in Critical Care Quality Improvement Programme ICNARC – Intensive Care National Audit and Research Centre ICU – Intensive care unit ICU DCS – Intensive care unit data capture system NDAU – Neonatal Data Analysis Unit NDS – Neonatal Data Set NIGB - National Information Governance Board for Health and Social Care PHE – Public Health England PICANET – Paediatric Intensive Care Audit Network PII – Patient Identifiable Information SGSS – Second Generation Surveillance System
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Surveillance of Blood Stream Infections in Patients Attending ICUs in England Protocol, version 3.4
2. List of definitions
Blood Stream Infection Event Form - the data collection form used to report a case on the data capture system. Includes patient details, details of positive blood culture, signs and symptoms at the time of the first blood culture, treatment details, CVC details and source of infection
Central venous catheter (CVC) - a vascular catheter that ends close to or in the great vessels (femoral, subclavian, jugular, aorta etc.); this includes peripherally inserted central catheters. CVCs can be short or long term. Common names (not exclusive) are PICC, CVC, portocath, tesio, hickman, etc.
Central venous catheter bloodstream infection (CVC-BSI) - a bloodstream infection thought to be related to/associated with a central venous catheter
Hospital Episode Statistics (HES) - a data warehouse containing details of all admissions, outpatient appointments and A&E attendances at NHS hospitals in England. To determine prior healthcare interactions in other facilities for patient transfers and subsequent outcomes; to determine co-morbidities and procedures associated with the ICU admission.
Health and Social Care Information Centre (HSCIC) - the national provider of information, data, and IT systems for health and social care
Infection in Critical Care Quality Improvement Programme (ICCQIP) - a clinician-led collaboration of professional organisations in intensive care, healthcare epidemiology, microbiology and infection prevention and control hosted by Public Health England. The overarching aim of ICCQIP is to improve the quality of patient care in ICUs. Specifically the aims of the ICU BSI surveillance are to obtain a national picture of BSI incidence in ICUs in England to inform quality improvement programmes.
Intensive care unit data capture system (ICU DCS) - the online web system where cases and denominator information are entered locally by ICUs
Line list - patient-level data downloaded from the ICU DCS using the report generator
Neonatal Data Analysis Unit (NDAU) - an independent academic unit, part of Imperial College London; the NDAU developed and manages the National Neonatal Research Database as a national resource; the NDAU is the official Developer of the Neonatal Data Set
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Surveillance of Blood Stream Infections in Patients Attending ICUs in England Protocol, version 3.4
Neonatal Data Set (NDS) - a defined list of data items extracted from electronic patient records on all admissions to Neonatal Units in England, Scotland and Wales, and held in the National Neonatal Research Database; the NDS is an NHS Digital approved NHS Information Standard NHS Spine - central NHS repository of patient demographic information to obtain mortality outcome and to map patients to healthcare geographies based on GP and residential details Second Generation Surveillance System (SGSS) - PHE receives antimicrobial susceptibility data from bacteria tested in NHS laboratories (majority of labs submitting by 2016). This system will be used to validate the hospital level reports and additionally to obtain susceptibility data on bacteria
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Surveillance of Blood Stream Infections in Patients Attending ICUs in England Protocol, version 3.4
3. Introduction
3.1 Background
Patients in intensive care represent a particularly vulnerable patient population at risk of developing healthcare association infections (HCAIs) due to a variety of factors such as disease severity, comorbidities, the need to undergo invasive procedures vital for care, and greater antibiotic exposure. The prevalence of healthcare associated infections is higher in intensive care units (ICUs) compared to other ward specialties as highlighted in the 2011 point prevalence survey in England where HCAI prevalence in ICUs was found to be 23.4% compared to 6.4% overall (1). The same study found antimicrobial use to be almost twice as high in ICUs compared to overall prevalence of antimicrobial use (60.8% versus 34.7% respectively) (1).
The impact of HCAIs on morbidity, mortality, length of stay and cost is well documented (2); as such many interventions have been developed to reduce HCAI incidence (3), although historically in England most interventions have been focussed on reductions in the incidence of specific organisms (predominantly Meticillin Resistant Staphylococcus aureus bacteraemia (MRSA) and Clostridium difficile infection) rather than more generally on the ICU setting or device related infections. However, recently in England a large initiative aimed to reduce central line catheter related blood stream infection (BSI) in adult and paediatric ICUs was run by the National Patient Safety Agency (NPSA) (4). The 2-year programme which started in April 2009 was called “Matching Michigan” in reference to an earlier American study which demonstrated a large reduction in catheter related BSI using a range of technical and behavioural interventions (5).The Matching Michigan study observed a 60% reduction in CVC-BSI rates in adult ICUs after the intervention, with a smaller (48%) non-significant reduction in paediatric rates. However, the effects of the intervention were difficult to disentangle from a wider secular trend of declines in BSIs associated with a range of interventions over time. Matching Michigan and a parallel ethnographic study identified the need for a more systematic collection and reporting of infection data (4;6) and following this conclusion the Infection in Critical Care Quality Improvement Programme (ICCQIP) was developed to act on the recommendations (7).
3.2 Infection in Critical Care Quality Improvement Programme (ICCQIP)
ICCQIP, a group of professionals from across the NHS, charities, and Public Health England, was established in 2012 to develop a national surveillance and quality improvement programme for HCAIs in the intensive care setting. An initial survey of ICUs in England was conducted to garner opinion on priorities and potential data collections (7). The results showed considerable support for surveillance of infections in ICUs with CVC associated bloodstream infections highlighted as the main priority.
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Surveillance of Blood Stream Infections in Patients Attending ICUs in England Protocol, version 3.4
4. Aims and Objectives
The overarching aim of ICCQIP is to improve the quality of patient care in ICUs. Specifically the aims of the ICU BSI surveillance are to obtain a national picture of BSI incidence in ICUs in England to inform quality improvement programmes. This will be achieved by collecting the following data from participating English ICUs:
 Each BSI identified in the ICU, including patient identifiers, information about the patient’s signs and symptoms, information on repeat blood cultures for skin commensals, treatment, CVC history, and site of infection
 Denominator information allowing rates of BSI and CVC-related BSI to be calculated
Additionally, data linkage to several existing datasets will enable more detailed analysis and case-mix adjustment. It is planned that the following datasets will be linked to the data provided to the ICU DCS to obtain additional clinical information on ICU BSI cases reported to us:
 Intensive Care National Audit and Research Centre (ICNARC)  Paediatric Intensive Care Audit Network (PICANET)  Neonatal Data Set (NDS)  Neonatal Infection Surveillance Network (NeonIN)  Healthcare datasets:
o Second Generation Surveillance System (SGSS) - PHE receives antimicrobial susceptibility data from bacteria tested in NHS laboratories (majority of labs submitting by 2016). This system will be used to validate the hospital level reports and additionally to obtain susceptibility data on bacteria
o Hospital Episode Statistics (HES) - to determine prior healthcare interactions in other facilities for patient transfers and subsequent outcomes; to determine co-morbidities and procedures associated with the ICU admission
o NHS Spine – central NHS repository of patient demographic information, to obtain mortality outcome and to map patients to healthcare geographies based on GP and residential details
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IcusPatientsBlood Stream InfectionsDataEngland Protocol