All health boards in Wales collect comparative data on a variety of healthcare associated infection topics. From July 2013, the Welsh Government asked all health boards to publish monthly reports for their hospitals. This new information is available here. The historical information for Hywel Dda is available from the Public Health Wales Healthcare Associated Infection Program teams page here. You can also look at information for any other health board in Wales here.
Surveillance is an important tool for the infection control team. It allows us to look at trends with different organisms. However, one of the concerns I have always shared is that these publications schemes concentrate on specific organisms or specific conditions and ignore the wider picture. Fortunately, Wales is less fixated on specific organisms and does continue to maintain a much more holistic approach to all healthcare associated infections.
In my article on Should I worry about Healthcare Associated Infections I have tried to put HCAI’s in context.
The Wales Audit Office report on HCAI reviewd the all Wales position in 2007. The report was examined by the National Assembly’s Audit Committee in February 2008 and I extract below my statement from the transcript when answering a question about MRSA:
|Dr Simmons: Eleanor said that it cannot go on like this, but I would suggest that it is not going on as she suggested. What we have demonstrated in Wales is clear declines over the years; we have a number of locally-based trust targets whereby individual trusts will demonstrate reductions in their target. As a result of the surveillance, although we did not target MSRA, we have seen that it has fallen by a statistically significant amount; we are two standard deviations below the mean, which is significant. So, we are making progress in all of these areas.|
|You pointed to pages 18 and 19, but we must be very careful. With regard to the top 10 bacteraemias in figure 3, we deliberately developed that surveillance scheme to carefully place MRSA in context for you, from an Assembly point of view. Nowhere else in the UK is doing that and that is possibly part of the reason why you get this constant focus. Of the bacteraemia listed, you would normally associate the top four infections as coming in from the community. So, in other words, a patient has an infection and they get admitted to hospital because it is serious. E. coli is a common infection—it is gut flora and commonly causes urinary tract infection, and severe urinary tract infection will bring people into hospital. We are conscious of that, because the other side is that all of those top four infections, but especially the first two infections, can be acquired after 48 hours in hospital. So if we catheterise a patient inappropriately, that catheter can acquire organisms over time, including E. coli, and the patient can get a bacteraemia.|
|The fifth infection in the list, Klebsiella, is interesting. That, generally, would be considered to be a healthcare-associated or hospital-acquired infection. It is above MRSA in the list and it has no focus. Our strategy is to focus on all aspects of healthcare-associated infection, and, while the Office for National Statistics does not tell us how many patients have died of Klebsiella—because it has not bothered to look at it and has focused on the infections that have received attention—I would suggest that more people are likely to die of a Klebsiella infection or of an E. coli infection than would ever die of MRSA. These are much more potent organisms because of their very nature—with regard to septicaemia or endotoxaemia, we are aware that endotoxin is part of the cell wall of some of these gram-negative organisms, such as E. coli or Klebsiella. MRSA is totally different. Staphylococcus aureus being what is called a gram-positive organism, it does not have endotoxin and cannot cause an endotoxaemia. It does kill people, but less frequently than the gram-negative organisms. Our surveillance is demonstrating where we need to focus. An individual trust will have access to data such as that in figure 2 outlining the issues for that trust and what it should be tackling. We set this challenge: use the surveillance to ask the question, locally, ‘What should I do here to tackle healthcare-associated infection?’.|
You can find all the documents on the National Assembly website and read all the evidence.