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Vision

Infection Intelligence Platform (IIP) Clinical studies Professor Marion Bennie National Services Scotland. Vision.

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Vision

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  1. Infection Intelligence Platform (IIP)Clinical studies Professor Marion Bennie National Services Scotland

  2. Vision A comprehensive, dynamic and responsive resource capability for Scotland that will harness existing health data to support clinicians in improving patient outcomes and reduce harm from community and healthcare acquired infection.

  3. PATIENT (Community and Healthcare acquired Infection ) Vision • Intrinsic (patient) • Age / gender • Colonised • Morbidity • Drug history • Vaccine history • Extrinsic (environment) • - Medicines (prior use) • Lines/Catheters • Hand Hygiene • Surgery • Length of stay • Prevention Intervention • SIPS- Standard infection control precautions • Antimicrobial stewardship Infection Management Antibiotic policy Infection control (TBP - Transmission based precautions) Patient outcome Monitoring / Surveillance Intended consequences Unintended consequences

  4. NHS Scotland Infection Intelligence Platform Road Map Further enhancement of connectivity to include current and future local databases Full Capability Incremental planned studies focussing on key infection related clinical goals. Capability building Future Position Infrastructure to routinely connect current relevant national databases with infection information. Generic capability to support patient care, enable measurement of intended and unintended consequences of interventions. Setup Enhanced connectivity and linkage of existing national and local information to improve prevention and management of infection, reduce harm and minimise waste Current Position No strategic approach: Uncoordinated integration of databases through small pockets of resources from national and local programmes on an hoc basis

  5. Benefits (Improve care - reduce harm - reduce variation) Patients Support individual prevention/treatment plans NHS Boards Drive quality improvement in local service delivery model (intended/ unintended consequences) National Surveillance Identify emergence of antimicrobial resistance Research Support evidence based clinical practice

  6. Deliverables (2013-2016) To gain the necessary information governance approvals To build the required IM&T Infrastructure to support the IIP by technically linking six sources initially To complete a series of exemplar clinical studies to test the IIP capability and effectiveness

  7. Key Datasets • ECOSS Electronic Communication of Surveillance in Scotland (antimicrobial resistance data) • HMUD Hospital Medicines Utilisation Database • PIS Prescribing Information System (primary care prescribing) • SCI Store Clinical Information (e.g. Lab results, Radiology reports) Repository • SMR Scottish Morbidity Record (SMR)SMR01 • Inpatients, Day Cases, Discharge & Diagnosis • SMR02 – Maternity Inpatients, Day Cases, Discharge & Diagnosis • SMR99 – Mortality • SSIRS Surgical Site Infection Reporting System

  8. Study Themes

  9. Theme 1 - Risk Factor Analysis in bacteraemias(ECOSS / SMR – studies 1&2) • To describe the demographics and co-morbidities of patients with common bacteraemias and CDI • SAB and E.Coli (test -SIRN funded) • Extend to include MRSA,MSSA, CDI • Establish routine linkage for ongoing surveillance as risks of infection changeover time

  10. Theme 4 - Mortality Associated with HAI(ECOSS / SMR/SSIRS – studies 8&9) • To determine the case fatality (30 and 90 days) associated with common HAI • SSI, SAB, CDI (test ) • To identify variation in case fatality associated with risk factors • To produce standard reporting mechanisms for MRSA and CDI death from 2015 (current system to stop in 2014)

  11. Theme 2 - Surgical Site Infection (SSI) surveillance(ECOSS / SMR/SSIRS – study 3) • Current manual collection of data locally to input into national datamart • Mandatory minimum of 2 operation categories (caesarian and hip arthroplasty mandatory, where practised) • To test capability of IIP to reproduce data (SSIRS) through routine record linkage (ECOSS and SMR ) to replace the need for manual data collection within the Health Boards.

  12. Theme 3 - Primary care antimicrobial prescribing - impact on resistance patterns and HAI(ECOSS / SMR//PIS – studies 4-7) • To develop generic surveillance system to estimate associations • Antimicrobial exposure and risk of CDI (test – SIRN funded ) then extend to other HAI • Examination of 4 antimicrobials in UTIs and impact on resistance and clinical outcome (test – SIRN funded ) then extend to other infections

  13. Theme 5 - Sepsis: diagnosis, management and outcome (SMR/SCI Store – studies 10-11) • Use of blood culture as a proxy marker for sepsis • To quantify changes in 30 day mortality (from date of blood culture) following adoption of restricted antibiotic policy (test – Tayside and Lanarkshire ) then extend to all NHS Boards • Establish robust sepsis outcome measure to monitor progress to national target

  14. Theme 5 - Sepsis : diagnosis, management and outcome (SMR/SCI Store/HMUD/HEPMA – studies 12-13) • Monitoring impact of key high risk antibiotics in hospitals e.g. carbapenameses on emergent bacteremias • Policy change intervention • Individual patient level outcome

  15. Theme 6 - Surgery – consequences of changing antimicrobial prescribing policies (SMR/SCI Store/HMUD – studies 14-16) • To examine renal toxicity (acute kidney injury) following introduction of restricted antibiotic policies • Test in NHS Lanarkshire • Extend to all NHS Boards and for other identified laboratory measures • To evaluate reduction in 4C use and impact on CDI and mortality

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