The Nosocomial Infection National Surveillance Scheme (NINSS) was established by the DH and the Public Health Laboratory Service in 1996 with the aim of gathering information that would not only identify HCAIs but also lead to their reduction through identifying areas for improvement in care (e.g. conducting surgical site infection surveillance and identifying and reducing patient risk factors), and helping to guide national best practice to prevent avoidable infections (see Chapter 18). Up until 2004, participation was voluntary, but this was the year in which HCAIs were pushed right to the top of the political agenda and HCAI reduction was in the throes of rapidly becoming a national priority for action. It was in 2004 that it became mandatory for Trusts under- taking orthopaedic surgery (where the consequences of SSI can be severe) to annually submit three months of data regarding orthopaedic SSIs in relation to at least one of the four categories of orthopaedic surgery depicted in Box 3.6.
SSI surveillance is also undertaken in relation to other surgical procedures, which are sub- categorised (see Box 3.7) and which have been selected for surveillance because historically higher rates of infection have been detected for them (HPA, 2011).
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Surveillance involves completion of a data spreadsheet (simple tick boxes and short responses), which is commenced on admission and then completed throughout the patient’s hospital stay until discharge. It can be completed by nursing and/or medical staff (who often complete it poorly) but is often overseen by Audit and Surveillance Nurses or dedicated Surveillance Clerks. The data are entered onto the SSI website, where they are checked for completeness and errors, and any queries are referred back to the hospital reporting the data. Individual hospital reports are gener- ated, which can be used to influence improvements both locally and on a national level. Box 3.8 depicts some of the information that is collated.
Box 3.6 SSIs – orthopaedic surgery
Total hip replacement Total knee replacement Hip hemiarthroplasty
Open reduction of long bone fracture.
Box 3.7 Other surgical procedures
Abdominal hysterectomy
Bile duct, liver or pancreatic surgery Breast surgery
Cardiac surgery Cranial surgery
Non-laparoscopic cholecystectomy Gastric surgery
Large bowel surgery Small bowel surgery Spinal surgery Vascular.
Source: Data from HPA, 2011.
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Box 3.8 Some of the data collected for SSI surveillance
•
Patient’s full name, date of birth, NHS number, hospital number, height and weight•
Date of admission•
Operation date•
Indication for surgery•
Category of procedure•
Type of surgery (emergency or elective)•
Whether surgery was due to trauma•
ASA (American Society of Anesthesiologists) score (see Chapter 18)•
Wound class•
Grade of surgeon•
Whether a prosthesis was inserted and antibiotic cement was used•
Duration of surgery (time of incision and time of closure)•
Antimicrobial prophylaxis•
Record of patient and wound review (e.g. temperature, whether the wound is clean and dry, or any breakthrough on dressing)•
The date on which surveillance was discontinued and why•
Whether an SSI questionnaire was provided post discharge or whether the patient was contacted by telephone•
Whether the patient was given any information on SSIs•
If the patient developed an SSI – date of onset, how it was detected, the criteria for suspecting or diagnosing an SSI, the type of SSI, the specific site of infection and the causative organism.Source: Data from HPA, 2011.
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Further resources are available for this book, including interactive multiple choice questions. Visit the companion website at:
www.wiley.com/go/fundamentalsofinfectionprevention
Chapter summary: key points
•
All healthcare staff are involved in audit and surveillance activities.•
Auditing compliance with infection control practice is an integral part of any HCAI prevention programme.•
Audit results are only as good as the information obtained.•
Audit results should be fed back to staff promptly, and compliance with implementing recommended actions should be monitored.•
Surveillance enables the early identification of illnesses, infections and infectious diseases that can lead to outbreaks and assists in the identification of risk factors for the develop- ment of HCAIs.•
Done properly, audit and surveillance can be tools for change, leading to improvements in patient care both locally and nationally.References
Department of Health (DH) (2006). Essential Steps to Safe, Clean Care: Self-Assessment Tools and Resources. DH, London.
Gould I.M. (2005). The clinical significance of meticillin-resistant Staphylococcus aureus. Journal Hospital Infection. 61 (4): 277–282.
Health Protection Authority (HPA) (2010). List of causative agents. http://www.hpa.org.uk/Topics/
InfectiousDiseases/InfectionsAZ/NotificationsOfInfectiousDiseases/ListOfCausativeAgents/
(accessed 2 March 2013)
Health Protection Agency (HPA) (2011). Protocol for the surveillance of surgical site infections.
Surgical Site Infection Surveillance Service (SSISS), HPA, London.
Health Protection Agency (HPA) (2013a). Botulism. http://www.hpa.org.uk/Topics/Infectious Diseases/InfectionsAZ/Botulism (accessed 2 March 2013)
Health Protection Agency (HPA) (2013b). Cholera. http://www.hpa.org.uk/Topics/Infectious Diseases/InfectionsAZ/Cholera (accessed 2 March 2013)
45
Health Protection Agency (HPA) (2013c). Diphtheria. http://www.hpa.org.uk/Topics/Infectious Diseases/InfectionsAZ/Diphtheria/ (accessed 2 March 2013)
Health Protection Agency (HPA) (2013d). General information about Brucellosis. http://
www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Brucellosis/GeneralInformation/
bruc001GeneralInformation (accessed 2 March 2013)
Health Protection Agency (HPA) (2013e). Leprosy. http://www.hpa.org.uk/Topics/Infectious Diseases/InfectionsAZ/Leprosy (accessed 2 March 2013)
Health Protection Agency (HPA) (2013f). Malaria. http://www.hpa.org.uk/Topics/Infectious Diseases/InfectionsAZ/Malaria (accessed 2 March 2013)
Health Protection Agency (HPA) (2013g). Mandatory surveillance of Escherichia coli bacteraemia.
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/EscherichiaColi/Mandatory Surveillance (accessed 2 March 2013)
Health Protection Agency (HPA) (2013h). Polio. http://www.hpa.org.uk/Topics/InfectiousDiseases/
InfectionsAZ/Polio (accessed 2 March 2013)
Health Protection Agency (HPA) (2013i). Rabies. http://hpa.org.uk/Topics/InfectiousDiseases/
InfectionsAZ/Rabies (accessed 2 March 2013)
Health Protection Agency (HPA) (2013j). Tetanus. http://www.hpa.org.uk/Topics/Infectious Diseases/InfectionsAZ/Tetanus (accessed 2 March 2013)
Health Protection Agency (HPA) (2013k). Yellow fever. http://www.hpa.org.uk/Topics/Infectious Diseases/InfectionsAZ/YellowFever/ (accessed 2 March 2013)
McCormick A. (1993). The notification of infectious diseases in England and Wales. Communicable Disease Report. 3 (2): R19–R24.
NHS Commissioning Board (2013). Guidance on the Reporting and Monitoring of Arrangements and Post Infection Review Process for MRSA bloodstream infections from April 2013. http://
www.england.nhs.uk/ourwork/patientsafety/zero-tolerance/
World Health Organization (WHO) (2013a). Haemorrhagic fevers, viral. http://who.int/topics/
haemorrhagic_fevers_viral/en/ (accessed 2 March 2013)
World Health Organization (WHO) (2013b). Rabies. http://www.who.int/topics/rabies/en (accessed 2 March 2013)