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Healthcare-Associated Infection and Antimicrobial Resistance-Related Data from Acute Public Hospitals

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Healthcare-Associated Infection and Antimicrobial Resistance-Related Data from Acute Public Hospitals Healthcare-associated infection and antimicrobial resistance-related data from acute public hospitals Item Type Report Authors Health Service Executive (HSE), Health Protection Surveillance Centre (HPSC) Publisher Health Service Executive (HSE) Download date 02/10/2021 18:02:52 Link to Item http://hdl.handle.net/10147/51613 Find this and similar works at - http://www.lenus.ie/hse Healthcare-Associated Infection and Antimicrobial Resistance-Related Data from Acute Public Hospitals in Ireland, 2006-2007 Introduction As part of the HSE strategy for prevention and control of healthcare-associated infection (HCAI), launched in March 2007, the Health Protection Surveillance Centre (HPSC) has been asked to coordinate the publication of data relating to HCAI and antimicrobial resistance (AMR) for acute public hospitals in Ireland. This report provides the initial baseline publication of these data. Three datasets are included in this report, all relating to data reported by hospitals for 2006 and 2007: 1. Antibiotic consumption (Section 1, page 2) 2. Staphylococcus aureus bloodstream isolates (Section 2, page 6) 3. Alcohol-based hand rub consumption (Section 3, page 9) The first two datasets are based on data reported as part of existing European surveillance networks, namely the European Surveillance of Antimicrobial Consumption (ESAC) network and the European Antimicrobial Resistance Surveillance System (EARSS). The third is an indirect surveillance measure of hand hygiene activity. The primary value of these datasets, as with any surveillance data, is to the individual data providers, allowing individual hospitals to monitor trends over time, assess the impact of infection prevention and control interventions, and identify targets for future interventions and resource requirements. The datasets included in this report do not allow direct comparison of results between individual hospitals. This is due to a number of reasons: 1. Differences in hospital activity: The data do not take account of differences in patient populations, clinical services provided, inter-hospital patient transfers and other differences in activity between hospitals. 2. Differences in data collection: The data do not take account of potential differences in data collection methodology or resources between hospitals. 3. EARSS and ESAC methodology: The EARSS and ESAC surveillance systems are designed to collect national-level data on AMR and antibiotic consumption, respectively. Thus, when the data are broken down to individual 1 hospital level the comparisons that can be made at national level may no longer apply. 4. Denominator data used: Rates have been calculated using data on acute bed- days used, provided to the HSE Performance Monitoring Unit (PMU) by all acute publicly-funded hospitals on a monthly basis and validated by the reporting hospital before being released. This is based on the average number of available acute in-patient beds during the previous month, and not on the total bed capacity of a hospital. It does not include long-stay or day case (including dialysis) bed use, but does include acute psychiatric bed use (where the latter are included in the bed compliment of an acute hospital). The use of these denominator data may lead to an overestimate of rates for some hospitals, particularly if a hospital has a large number of non-acute beds, day- case beds and dialysis beds, which may contribute to overall hospital activity. While the PMU make every effort to ensure the data are validated, there are likely to be small discrepancies in the estimated number of acute bed-days used, compared to locally estimated data, due to fluctuations in the number of available acute beds. In addition, the denominator data are validated at the annual level only (rather than monthly or quarterly). Data on bed-days used for 2007 have not been fully validated, and rates based on these data should therefore be considered preliminary. There are a number of other caveats that need to be taken into account when interpreting the data in this report, and these are dealt with in more detail under each individual section. The rationale for publishing national results for the above datasets is to assess what surveillance is possible within current resources and identify future targets for standardised surveillance. (Section 4, Conclusions and recommendations, page 11) 1: Antimicrobial Consumption Background Over-use of antibiotics is a key factor in the emergence of antibiotic resistant bacteria. Ireland participates in ESAC, which aims to collate antibiotic consumption data across Europe using standardised methods. Hospital pharmacies in Ireland provided data on antibiotic usage in 2006 and 2007 to HPSC, where the data were analysed using ESAC methodology. Antibiotic usage is expressed in total defined daily doses per 100 bed-days used for both years. Further information can be found at the HPSC website under “Antimicrobial Consumption Surveillance” in the A-Z Index (www.hpsc.ie) 2 Definitions ESAC uses the Anatomical Therapeutic Chemical (ATC) index (www.whocc.no/atcddd) to classify all drugs used in human medicine into a hierarchical system with five levels. All systemic antimicrobial drugs at level one are divided into antibiotics, antifungals, antivirals, etc at the second level. The drugs are divided into their major classes and therapeutic subgroups at levels three and four, while the fifth level (ATC5) is the chemical substance. Each drug at ATC5 in conjunction with the route of administration (oral or intravenous) is given a defined daily dose (DDD), which is the assumed average maintenance dose per day for a drug used for its main indication in adults. The ATC-DDD system is the most widely used standardised system for measuring antibiotic consumption, and allows ESAC to make valid comparisons of national antibiotic consumption data from different participating countries. The following data are included in this report: • The principle measure of antibiotic consumption for each hospital is the inpatient antibiotic consumption rate, expressed as DDD per 100 bed days used. • The proportion of injectable antibiotics [parenteral or intra-venous (IV)] used over total antibiotic used is an indicator of the level of patient acuity and types of patients treated by a hospital. Hospitals with high levels of patient acuity and hospitals with a large paediatric patient population are likely to have a high proportion of injectable antibiotic use. • The proportion of hospital-specific antibiotics over total antibiotic consumption is a reflection of the level of patient acuity of a hospital, as well as an indicator of how much of a hospital’s antibiotic consumption is accounted for by outpatient or community care usage. This comprises drugs seldom used outside of the hospital setting (i.e. glycopeptides, aminoglycosides, carbapenems, monobactams, and third and fourth-generation cephalosporins). • The total DDD dispensed by a hospital pharmacy includes drugs dispensed for inpatient, outpatient and community use. • The proportion outpatient use is a measure of how much of the antibiotic dispensed by a hospital pharmacy is accounted for by non-inpatient use. Limitations • The data are based on the quantity of drugs issued from the pharmacy department in a hospital to the wards or outlying centres, and not on individual patient prescriptions. • The ATC-DDD system is based on the main indication for a given drug in adults. Thus, it tends to under-estimate antibiotic consumption in some patient groups, such as children and patients with chronic kidney disease. Conversely it tends to over-estimate antibiotic consumption in situations where a prolonged duration of antibiotic therapy is required, such as some HIV-related infections and treatment of chronic skin infections. 3 • The ATC-DDD system does not take account of local variations in antibiotic dosing or duration of therapy. • Only those hospitals with the “CliniScript” computer system have been able to participate fully. While a few hospitals with different systems have been able to supply data, there is a regional bias for using one or other computer system. 4 Table 1. Data on antimicrobial consumption by acute public hospital in Ireland, 2006 and 2007 2006 2007 Acute Inpatient Antibiotic Proportion of Proportion Antibiotics Acute Inpatient Antibiotic Proportion of Proportion Antibiotics Consumption Rate (DDD Proportion of IV hospital-specific Total DDD Issued for Outpatient Consumption Rate (DDD Proportion of IV hospital-specific Total DDD Issued for Outpatient Acute Public Hospitals per 100 bed-days used) antibiotics antibiotics used and Non-acute Use per 100 bed-days used) antibiotics antibiotics used and Non-acute Use Adelaide & Meath & National Children’s Hospital, Tallaght 89.7 49.0% 12.9% 170450.2 5.8% 86.2 52.5% 14.7% 167951.1 4.4% Bantry General Hospital * **** * **** Beaumont Hospital (Incl. St Joseph's Hospital, Raheny)a 78.9 52.3% 11.4% 194562.6 10.0% 79.6 47.0% 9.9% 199468.1 10.0% Cappagh National Orthopaedic Hospital, Dublin 50.7 52.2% 10.1% 12793.1 18.4% 54.2 52.7% 11.1% 13286.6 18.0% Cavan General Hospital * **** * **** Children's University Hospital, Temple Street 74.4 59.1% 22.6% 22357.4 1.1% 77.2 61.8% 24.3% 26045.0 1.3% Connolly Hospital, Blanchardstownb 88.8 43.4% 7.5% 51418.4 2.3% 80.8 39.9% 6.8% 69137.8 4.7% Coombe Women's Hospital 37.3 34.8% 4.5% 30930.7 28.9% 25.6 53.5% 9.3% 19130.6 21.1% Cork University Hospitalc 62.7 55.1% 13.6% 139236.1 7.1% 61.2 55.9% 15.4% 143852.1 8.6% Kerry General Hospital,
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