26/06/2010

Offa and HCAI: A view from & Acton Burnell Wrexham

Pengwern

Welshpool Ludlow Rod Warren Laboratory L u The Welsh Marches dl (formerly PHLS) o w , C hi rk & th Ludlow & Chirk belonging originally to the e Mortimer Earls of March MRSA bacteraemias E ar ls of M ar c h

Primary and 1st recurrences MRSA Welsh resident MRSA bacteraemias in S&TH bacteraemia & 14 day mortality

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Non-nasal new MRSA New nasal MRSA

New and old nasal MRSA detected New and old nasal MRSA detected

Community hospitals now on monthly screen RJAH 50/50 Welsh/Shropshire

New cases non-nasal Mup S MRSA Mup S MRSA by SDU

No change in ! Some reductions in emergencies S o m e

r e d u c t i o n s

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a d m i s s i 26/06/2010

New cases nasal Mup S MRSA Nasal Mup S MRSA by SDU

Nasal MRSA positives on Medical wards previous “MRSA patients”

Surgical wards New cases non-nasal Mup R MRSA

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New nasal carriers MupR MRSA New nasal Mup R MRSA by SDU

Emergent multi res MupR MRSA Big lessons!

• Policy in place does not equal policy followed. • It is no-ones job to take microbiology samples • If you miss something it will turn up next time • If the source is not there you won’t catch it

MRSA yields Numbers re MRSA

4 26/06/2010

Macrolide and cipro reduction on MRSA in S&TH Hypothesis from wounds • Carriage (ongoing source) may be at low level and antagonised by normal flora • Selective antibiotic use reduction may reduce spread or encourage something new. • The only selective antibiotics are those that are present in concentrations between the MIC of the normal flora and the resistant strain in the site of carriage. So:- – Lipophilic and sweat antibiotic levels for skin – Gut levels for faecal flora – MIC of resistance in serum not relevant to special site conc’n

MRSA and associated antibiotics.Monthly C difficile aged 2 & upwards. patients receiving vs MRSA Nos. New cases

C difficile C.difficile by SDU

5 26/06/2010

C difficile & pos assoc antibiotics C diff & neg assoc antibiotics

C difficile ribotype by hospitalisation/NH in last 30/7 ESBL E.coli bacteraemia

Ribotyping from Dr K Hardie & Prof P Hawkey, CDRN

Cip R Tri R ESBL-producing E coli new infections Other MR Ecoli

6 26/06/2010

Marches input & receipts (Shrewsbury and Cip R Tri R ESBL pos E coli Hereford) -from Powys • Attend NPHS outbreak meetings – 1 in 15 years. • No medical representation and policy input into IC committee and no policies copy since 1995. Q Trust now has IC committee. No CMM. IC policies in revision • Alert organisms to NPHS nurse. Never any dialogue on consequences/clusters except from EHDs. EHDs > now serviced from Birmingham Q Dialogue with DPH and chief Nurse Powys> ?Future Welsh ICD without microbiology service commitment to Powys. No local management contact at all. NI other liaison except through NPHS CCDC. Vicarious liability for transmissions. • Much exemplary good contact with Powys GPS • Shropshire antibiotic policy distributed & adopted.

S.aureus bacteraemias English Hospitals with 1 or more C diff & 1 or more MRSA bacteraemia in 12 weeks to 31/5/2010

Political & religious walls & wells Castell Powis

Seat of only extant Dukedom? Shame about William 111!!

Thank you and good luck! Offas dyke near Chirk Bethlehem St Oswalds well, Maserfeld, : 5 August 642 Penda of & of Powys versus Oswald of

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