Snapshot survey of healthcare associated infections (HCAI) reveals overall drop in infections down to 6.4 per cent

23 May 2012 02:52 PM

The Health Protection Agency (HPA) is today publishing the results of the fourth HCAI Point Prevalence Survey (PPS) and also the first National Survey on Antibiotic use in England. This report provides a snapshot of the levels of healthcare-associated infections (HCAI) and levels of antibiotic use in hospital Trusts in England in Autumn 2011. This is also the first survey to include hospitals from the independent sector.

There have been three previous HCAI PPS surveys and the last survey was carried out in 2006. It is difficult to compare each survey as the data was collected in a different way. However, there was an overall drop in HCAI prevalence from 8.2 per cent in 2006 to 6.4 per cent in 2011.

The English PPS data collection was undertaken by hospital teams between September and November 2011; 103 organisations surveyed 52,443 eligible patients (50,778 from the NHS and 1,665 (3.2 per cent) from the independent sector. The average age of all patients was 69 years old. A total of 4,372 (out of the 52,443, eight per cent) children under 16 years of age were also surveyed. The average age in this group was one month.
Results from this year’s survey have shown that:

• A total of 3,360 patients were diagnosed with an active HCAI with 135 patients having more than one.
• Overall 6.4% of people in hospital had an HCAI.
• The most common types of HCAI were respiratory (including pneumonia and infections of the lower respiratory tract) (22.8 per cent), urinary tract infections (UTI) (17.2 per cent), and surgical site infections (15.7 per cent).
• The HCAI prevalence in independent hospitals was 2.2 per cent and 6.5 per cent in NHS organisations. Independent sector organisations and NHS Trusts however, are not comparable. The independent sector hospitals have a much smaller inpatient bed base with primarily elective admissions; shorter lengths of stay and much of their activity is conducted as day cases.
• The prevalence of HCAI was highest in those patients aged 1-23 months at 8.2 per cent followed by patients aged 65-79 years of age at 7.4 per cent. This reflects the vulnerability for HCAI at the extremes of age.
• When comparing ward specialties, HCAI prevalence was highest in patients in intensive care units (ICUs) at 23.4 per cent followed by surgical wards at eight per cent. These figures also reflect that the highest rates of infection occur in those patients who have devices or have had procedures performed.
• Since the last PPS in 2006 there has been a eighteen fold reduction overall in MRSA bloodstream infections - from 1.3 per cent to less than 0.1 per cent in patients; and a five fold reduction in C. difficile infections (from two per cent to 0.4 per cent).
• Most antibiotic use (53 per cent) in hospitals was in patients receiving treatment for infections which commenced in the community.
• Prevalence surveys are useful in providing data on the burden of all HCAI at any one point in time. They also give a better understanding of the relative frequency of different types of HCAIs that are present rather than focusing on one type.

This survey is part of a Europe-wide PPS initiative set up by the European Centre for Disease Prevention and Control (ECDC). It is the first time that all participating European Countries (EU) will use the same definitions and methodology in their surveillance which means that results should be more comparable across Europe.

Dr Susan Hopkins, healthcare epidemiologist at the HPA and the lead author of the report, said: “This report is an important collaboration between a great many different organisations and experts. It gives us a clear picture of the different types of infections that are occurring in hospitals and the bugs that cause them. Knowing exactly what is causing problems enables hospital Trusts to adopt the best strategies to deal with them.

“Further work is already underway to look at the data we have collected more closely and this will be published later. The Department of Health’s Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections will also be using this data to evaluate current strategies and determine future surveillance priorities.

“Measures that were put in place to tackle MRSA and C. difficile infections have ensured that over the last few years rates have consistently gone down. In the meantime other bacteria, notably Enterobacteriaceae (also known as coliforms), have increased. It is clear that we need to find ways to control and prevent transmission of these bacteria and this is an important priority.”

Professor Anthony Kessel, director of public health strategy and medical director at the HPA, said: “This is a very important piece of work and we are extremely grateful to the hospital Trusts that have contributed to it. The results of this survey are invaluable as they give us a clear picture of what policy advisors and health care professionals need to address as a priority.

“There have been great results achieved in reducing the levels of MRSA and C. difficile over the last five years in the NHS and these can be seen in the figures reported today. These have been accomplished through national policies and guidelines and changes to infection control. There are now new challenges to meet and I am sure that hospitals will be equally as vigilant in addressing these.”

 

Notes for editors:

1. The full report and appendices can be found here: http://www.hpa.org.uk/Publications/InfectiousDiseases/AntimicrobialAndHealthcareAssociatedInfections/
    
2. There will be further analyses of the English results to look at the cluster effect of HCAI and antimicrobial use (AMU) within organisations and to determine the effect of the case mix adjustment on prevalence.
   
   Other results from the survey showed that the most frequently reported bacteria were Enterobacteriaceae causing 32.4 per cent of all HCAI. These are bacteria which are found both in the environment and in the human intestine. Salmonella and E.coli are examples of these. Of those bacteria tested 12.4 per cent were resistant to third generation cephalosporins – this reflects multi-drug resistant bacteria, which require broad spectrum, last resort antibiotics for treatment.
   
   Overall use of antibiotics was 34.7 per cent and prevalence of use was highest in the independent sector (46.7 per cent compared to NHS organisations at 34.3 per cent). The majority of antibiotics were prescribed for infections that started in the community.
    
3. The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. In April 2013, subject to the usual approvals procedures for establishing new bodies, the Health Protection Agency will become part of a new organisation called Public Health England, an executive agency of the Department of Health. To find out more, visit our website: www.hpa.org.uk  or follow us on Twitter @HPAuk
    
4. For more information please contact the national HPA press office at Colindale on 0208 327 7901 or email colindale-pressoffice@hpa.org.uk. Out of hours the duty press officer can be contacted on 0208 200 4400.