Point Prevalence Survey of Hospital-Acquired Infections & Antimicrobial Use in European Acute Care Hospitals: May 2017
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Point Prevalence Survey of Hospital-Acquired Infections & Antimicrobial Use in European Acute Care Hospitals: May 2017 NATIONAL REPORT: IRELAND – DECEMBER 2018 Report Authors: Stephen Murchan, Helen Murphy & Karen Burns, HPSC Suggested Citation: Health Protection Surveillance Centre, Point Prevalence Survey of Hospital Acquired Infections & Antimicrobial Use in European Acute Care Hospitals, May 2017: National Report Ireland. P a g e | i Table of Contents Acknowledgements..................................................................................................................... iii Executive Summary ..................................................................................................................... iv Future Priorities .......................................................................................................................... vi Plain Language Summary ........................................................................................................... vii 1.0 Introduction ..................................................................................................................... 9 2.0 Methods ......................................................................................................................... 10 3.0 Participating Hospitals .................................................................................................... 13 4.0 Results .......................................................................................................................... 15 4.1 Characteristics of Participating Hospitals ........................................................................ 15 4.1.1 Hospital Characteristics ........................................................................................ 15 4.1.2 Multi-Modal Strategies…………………………………………………………………………………….18 4.1.3 Ward characteristics…………………………………………………………………..…………………….19 4.2 Characteristics of the Patient Population ....................................................................... 20 4.2.1 Patient Demographics .......................................................................................... 20 4.2.2 Patient Location by Ward & Admitting Consultant Specialty .............................. 21 4.2.3 Risk Factors for Hospital-Acquired Infection (HAI) in the study population ........ 22 4.3 HAI………..... ...................................................................................................................... 23 4.3.1 Overall Prevalence of HAI ..................................................................................... 23 4.3.2 HAI Patient Risk Factors ....................................................................................... 23 4.3.3 HAI Prevalence by Gender, Age, McCabe Score & Birth Weight ......................... 24 4.3.4 HAI Prevalence by Ward Specialty and Admitting Consultant Specialty .............. 25 4.3.5 HAI Prevalence by Surgery and Length-of-Admission Prior to HAI Onset ........... 26 4.3.6 HAI Onset and Origin ............................................................................................ 27 4.3.7 Distribution of HAI by Type .................................................................................. 28 4.4 Microbiology and Antimicrobial Resistance Markers ..................................................... 33 4.4.1 Microbiology and Antimicrobial Resistance Data ................................................ 33 4.5 Antimicrobial Use (AMU) ................................................................................................ 36 4.5.1 Overall Prevalence of AMU .................................................................................. 36 4.5.2 AMU Patient Risk Factors ..................................................................................... 36 4.5.3 AMU Prevalence by Gender, Age, McCabe Score & Birth Weight ....................... 37 4.5.4 AMU Prevalence by Ward Specialty and Admitting Consultant Specialty ........... 38 4.5.5 Route of Administration of Antimicrobials .......................................................... 39 4.5.6 Documentation of Indication & Compliance with Local Guidelines .................... 39 4.5.7 Antibacterials ....................................................................................................... 40 4.5.8 Antifungals............................................................................................................ 41 4.5.9 Indication for Antimicrobial Prescribing............................................................... 41 4.5.10 Treatment of Infection ......................................................................................... 42 4.5.11 Surgical Antimicrobial Prophylaxis ....................................................................... 47 4.5.12 Medical Prophylaxis ............................................................................................. 48 4.6 HAI & AMU Prevalence by Hospital Ownership & Type.................................................. 49 HSE-Health Protection Surveillance Centre (HPSC) Tel: +353 1 8765 300 www.hpsc.ie 25-27 Middle Gardiner Street, Dublin 1, Ireland. Fax: +353 1 856 1299 2017 ECDC PPS of HAI & AMU: IRELAND NATIONAL REPORT P a g e | ii 5.0 Prevalence of HAI & AMU: Ireland & Neighbouring Countries ………………………………………....55 6.0 PPS Ireland 2017 versus 2012: Key Findings……………………………………………………………………..58 7.0 Discussion .................................................................. …………………………………………………….59 8.0 References ...................................................................................................................... 63 9.0 Appendices ..................................................................................................................... 63 Appendix A: PPS Steering Group Membership .................................................................. 65 Appendix B: List of Acronyms ............................................................................................. 65 Appendix C: PPS Data Collection Forms ............................................................................. 68 HSE-Health Protection Surveillance Centre (HPSC) Tel: +353 1 8765 300 www.hpsc.ie 25-27 Middle Gardiner Street, Dublin 1, Ireland. Fax: +353 1 856 1299 2017 ECDC PPS of HAI & AMU: IRELAND NATIONAL REPORT P a g e | iii Acknowledgements The members of the PPS Steering Group sincerely acknowledge the commitment of the staff in the 60 participating hospitals: . PPS team leaders & data collectors . Administrative staff, ward nursing and midwifery staff, clinicians, antimicrobial and clinical ward pharmacists . Chief executive officers and managers . Ms Mary Wynne, HSE Nursing and Midwifery Services Director . Mr Liam Woods, HSE National Director of Acute Hospitals . Dr Kevin Kelleher, Assistant National Director – Strategic Planning & Transformation, Public Health & Child Health & Director, HPSC . Dr Philip Crowley, HSE Quality & Patient Safety Director . Mr Simon Nugent, Chief Executive, Private Hospitals Association . Colleagues in the Public Health Agency, Northern Ireland . Dr Carl Suetens and Mr Tommi Karki, European Centre for Disease Prevention and Control, Sweden HSE-Health Protection Surveillance Centre (HPSC) Tel: +353 1 8765 300 www.hpsc.ie 25-27 Middle Gardiner Street, Dublin 1, Ireland. Fax: +353 1 856 1299 2017 ECDC PPS of HAI & AMU: IRELAND NATIONAL REPORT P a g e | iv Executive Summary This report presents the findings of the second point prevalence survey (PPS) of hospital-acquired infections (HAI) and antimicrobial use (AMU) conducted in Ireland and the European Union (EU)/European Economic Area (EEA) using a common protocol.1, The first PPS was performed in 50 Irish hospitals in May 2012 and repeated in 60 hospitals in May 2017.2,3 The number of patients included, along with the national HAI and AMU prevalence increased between the two surveys. For 49 hospitals that have participated in both PPS to date, increases in median patient age, the proportion of patients aged ≥65 years and the prevalence of vascular catheter use were observed. The European Centre for Disease Prevention and Control (ECDC) has estimated that on any given day, there are 670 inpatients in Irish hospitals with a HAI, translating to almost 30,000 patients in Ireland affected by HAI annually.4 Hospital & Eligible Patient Characteristics . In May 2017, 60 acute Irish hospitals (46 public and 14 private) participated in the voluntary European ECDC PPS of HAI and AMU. The breakdown of participating hospitals by type included: primary (n=9), secondary (n=17), tertiary (n=7), specialist public (n=13), specialist private (n=1) and private (n=13) . The average number of acute beds in the 46 public hospitals ranged from 72 to 588, depending on the hospital type. The average proportion of single patient rooms was lowest in public primary (15%), secondary (20%), specialist (23%) and tertiary (29%) hospitals and was highest in private hospitals (52%) . All hospitals reported having an infection prevention and control nurse (IPCN), 17 reported having no infection prevention and control doctor (IPCD) and 17 reported having no antimicrobial pharmacist (AMP) . The resource of whole time equivalent (WTE) IPCN per 100 beds was similar for both public (0.8) and private hospitals (0.9). Private hospitals reported 0.24 IPCD per 100 beds, higher than that of public hospitals (0.17). Public hospitals reported 0.26 AMP per 100 beds, higher than that of private hospitals (0.14) . Of 10,333