Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &

1. HPSC, SARI and National HCAI surveillance Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre & Beaumont Hospital, Dublin, Ireland

2. What is HPSC? What is SARI? National HCAI surveillance What about line infections?

3. H.P.S.C. Health Protection Surveillance Centre

4. HPSC- History and Governance • Established (NDSC) Nov 1998 • Surveillance of Communicable Diseases • Epidemiological investigation, Advice, Training and Research • International Liaison EU/WHO • Incorporated into HSE in January 2005 • Division of Population Health; • Name change - Health Protection Surveillance Centre • Same remit

5. HPSC Activity • Collecting data • Collating it • Analysing it and • Communicating information to those who need to know Surveillance Provision of Expert Advice Research Training • Operational Support to the Health System • Policy advice  • Public information • Identifying and developing best practice – initiation and collaboration • For professionals in communicable disease control – especially joint training • Teaching

6. HPSC Where HPSC fits into the Great Scheme of Things

7. www.hpsc.ie

8. www.hpsc.ie

10. C. difficile

16. MRSA

18. …….and more!

19. 2001

21. http://www.hse.ie/eng/Publications/Health_Protection/Health_Care_Associated_Infection/Governance_Framework_March_2007.pdfhttp://www.hse.ie/eng/Publications/Health_Protection/Health_Care_Associated_Infection/Governance_Framework_March_2007.pdf

22. National guidelines

23. National committee • Subcommittees • Surgical site infection surveillance • Catheter-associated UTI • IV catheter-associated infection • Antibiotic stewardship (x2) • MRSA in ICU • Regional committees

24. EARSS • ESAC • MRSA in ICU Prevalance Survey • Alcohol hand gel consumption • North South MRSA Study 1999 • HIS HCAI Prevalance Study 2006

26. www.hpsc.ie

35. MRSA in ICU Prevalance Study

37. 32 hospital ICU’s in 2008 • Average MRSA prevalence rates 2.9% to 21.2% • MRSA acquisition rates vary nationally from 0% to 3.3%. • Data suggests that ICU’s with lower isolation room resources have a higher MRSA acquisition rate compared to ICU’s with more resources despite having a similar percentage of patients ventilated.

38. North/South Study of MRSA in Ireland,1999 MRSA Isolates 192 cases in North (5.3/100,000) 508 cases in South (6.5/100,000) Males > Females Highest rates, 65 years or more 25-44 yrs. 4.4/100,000 (South) 75yrs. 111/100,000 (South)

39. South North Hospital 92% 69% GP 4% 20% Nursing Home 2% 10% Psychiatry 2% 1%

40. Clinical Status No. (%) Colonised (carriage) 271(62) Local infection 124(28) Invasive infection 44(10) Risk factors for invasive disease • iv line • surgery/ invasive procedure

41. North South MRSA/S aureus bacteraemia 25% 36% Hospitals with antibiotic policy 95% 41% Infection control nurse on site 100% 85% Isolation rooms available 100% 87%

42. HIS HCAI Prevalance Survey

46. Individual hospital results

50. North South MRSA Study • 5% (North) and 10% (South) cases had invasive infection • Patients with invasive infection were more likely to have a history of PVC or CVC than those with colonisation only.