![Page 1: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/1.jpg)
Fidelma Fitzpatrick
Consultant Microbiologist,Health Protection Surveillance Centre &
Beaumont Hospital, Dublin, Ireland
HPSC, SARI and National HCAI surveillance
![Page 2: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/2.jpg)
1. What is HPSC?
2. What is SARI?
3. National HCAI surveillance
4. What about line infections?
![Page 3: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/3.jpg)
H.P.S.C.
Health Protection Surveillance Centre
![Page 4: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/4.jpg)
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
![Page 5: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/5.jpg)
5
HPSC ActivitySurveillance
Provision of
Expert Advice
Research
Training
• Collecting data• Collating it• Analysing it and• Communicating information to those who need to know
• 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
![Page 6: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/6.jpg)
6
CEO
Office of the CEO
Communication, Service
Governance
Director of HR
Assistant Directors x 3
Industrial Relations, Employee Wellbeing
& Welfare, Legal/Advisory
Services, Partnership,
Workforce Planning, Recruitment, Employment Monitoring,
Performance Management,
Learning & Development, Management Development,
PPARS
Director of Population Health
Assistant Directors x 4
Strategic Planning & Evaluation, Health Intelligence, Health Inequality & Social Inclusion, Health
Promotion & Improvement,
Communicable Diseases
Surveillance & Control & Other
Health Protection Issues
Director of PCCC
Assistant Directors x 4
Planning, Monitoring & Evaluation,Contracting
Development of Service Frameworks,Provision of Expert
Advice, System Support
Director of Shared Services
Assistant Directors x 2
GMS PB,
HR – Payroll, Superannuation,
Recruitment. Personnel,
Finance – Purchase to Pay, Financial
Reporting, Accounting
Receivables, Financial Systems &
Reporting, ICT – Infrastructure
Services,Application Services,
Data & Integration Service,
ICT Customer Support, Customer Relations, Service
Development
Director of NHO
Assistant Directors x 4
Planning,Contracts &
Utilisation Review,Quality Risk &
Customer Care,National Ambulance
Service
Director of Finance
Assistant Directors x 4
Financial Planning, Costing &
Evaluation, Statutory Reporting & Control,
Management Reporting,
Procurement & VFM, FISP
Director of CMOD
Assistant Directors x 2
Change Management,
Central Resource, Leadership,
Development, Streamlining
Agencies – Change Process, Service Improvement & Organisational Development,
Director of ICT
Assistant Directors x 4
Design &
Procurement, Implementation &
Rollout, Project Governance & interconnectivity,
Projects Management,
Strategy Formulation, Library
& Research, Innovation Centre
Director of Corporate Afffairs
Where HPSC fits into the Great Scheme of Things
HPSC
![Page 7: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/7.jpg)
www.hpsc.ie
![Page 8: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/8.jpg)
www.hpsc.ie
![Page 9: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/9.jpg)
![Page 10: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/10.jpg)
C. difficile
![Page 11: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/11.jpg)
![Page 12: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/12.jpg)
![Page 13: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/13.jpg)
![Page 14: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/14.jpg)
![Page 15: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/15.jpg)
![Page 16: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/16.jpg)
MRSA
![Page 17: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/17.jpg)
![Page 18: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/18.jpg)
…….and more!
![Page 19: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/19.jpg)
2001
![Page 20: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/20.jpg)
![Page 21: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/21.jpg)
http://www.hse.ie/eng/Publications/Health_Protection/Health_Care_Associated_Infection/Governance_Framework_March_2007.pdf
![Page 22: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/22.jpg)
National guidelines
![Page 23: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/23.jpg)
•National committee•Subcommittees
• Surgical site infection surveillance• Catheter-associated UTI• IV catheter-associated infection•Antibiotic stewardship (x2)•MRSA in ICU
•Regional committees
![Page 24: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/24.jpg)
1. EARSS
2. ESAC
3. MRSA in ICU Prevalance Survey
4. Alcohol hand gel consumption
5. North South MRSA Study 1999
6. HIS HCAI Prevalance Study 2006
![Page 25: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/25.jpg)
![Page 26: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/26.jpg)
www.hpsc.ie
![Page 27: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/27.jpg)
![Page 28: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/28.jpg)
![Page 29: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/29.jpg)
![Page 30: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/30.jpg)
![Page 31: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/31.jpg)
![Page 32: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/32.jpg)
![Page 33: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/33.jpg)
![Page 34: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/34.jpg)
![Page 35: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/35.jpg)
MRSA in ICU Prevalance Study
![Page 36: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/36.jpg)
![Page 37: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/37.jpg)
• 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.
![Page 38: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/38.jpg)
MRSA IsolatesMRSA Isolates
192 cases in North (5.3/100,000)
508 cases in South (6.5/100,000)
Males > FemalesMales > Females
Highest rates, 65 years or more
25-44 yrs. 4.4/100,000 (South)
75yrs. 111/100,000 (South)
![Page 39: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/39.jpg)
SouthSouthNorthNorth
Hospital 92% 69%
GP 4% 20%
Nursing Home 2% 10%
Psychiatry 2% 1%
![Page 40: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/40.jpg)
Clinical Status Clinical Status No. (%)No. (%)
Colonised (carriage) 271(62)
Local infection 124(28)
Invasive infection 44(10)
Risk factors for invasive diseaseRisk factors for invasive disease
–iv line– surgery/ invasive procedure
![Page 41: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/41.jpg)
NorthNorth SouthSouth
MRSA/S aureus bacteraemia 25% 36%
Hospitals with antibiotic policy 95% 41%
Infection control nurse on site 100% 85%
Isolation rooms available 100% 87%
![Page 43: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/43.jpg)
Prevalence Rate of HCAI and MRSA
8.19
1.28
6.35
0.87
5.43
0.85
4.89
0.49
0
1
2
3
4
5
6
7
8
9
HCAI Prevalence Rate MRSA Prevalence Rate
Rate
(%)
England Wales N. Ireland Rep of Ireland
![Page 44: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/44.jpg)
Prevalence Rate of HCAI and MRSA by Infection Type (1)
0
1
2
3
4
5
6
BSI UTI Pneumonia SSI BSI UTI Pneumonia SSI
Rate
(%)
England Wales N. Ireland Rep of Ireland
![Page 45: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/45.jpg)
Prevalence of HCAI by Infection type (2)
0
0.5
1
1.5
2
2.5
Bone & joint Cardiovascular System Central Nervous System Eyes,ENT or Mouth GI system LRT (excl pneumonia) Reproductive tract Skin & soft tissue Systemic
Rate
(%)
England Wales N. Ireland Rep of Ireland
![Page 46: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/46.jpg)
![Page 47: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/47.jpg)
![Page 48: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/48.jpg)
![Page 49: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/49.jpg)
Clostridium difficile Prevalence Rate
1.98
1.1 1.13
0.48
0.19
0
0.5
1
1.5
2
England Wales N. Ireland Rep of Ireland BH
%
![Page 50: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/50.jpg)
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.
![Page 51: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/51.jpg)
HIS HCAI Prevalance Survey
• 449 patients had a primary BSI, 184(41%) of which were CVC related
• CVC presence significantly associated with primary BSI
• More patients in RoI had IVCs in situ when compared N. Irl
• As in other countries, presence of a CVC in Irish patients was associated with a HCAI.
![Page 52: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/52.jpg)
S.aureus bacteraemia:283 cases
South-East Ireland 2002-6
Source Number % of Total
Central Venous Catheter 91 32%
Peripheral Venous Catheter 42 15%
Burns et al .CMI 2007 13;(s1)s520
47% due tovenous access
![Page 53: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/53.jpg)
Enhanced EARSS
2175
587
98
One in four S.aureus bacteraemias in Ireland is due to infectionassociated with a central venous catheter
One in twenty S.aureus bacteraemias in Ireland is due to infectionassociated with a peripheral venous cannula
![Page 54: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/54.jpg)
Enhanced EARSS
2175
587
98
One in four S.aureus bacteraemias in Ireland is due to infectionassociated with a central venous catheter
One in twenty S.aureus bacteraemias in Ireland is due to infectionassociated with a peripheral venous cannula
![Page 55: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/55.jpg)
Enhanced EARSS
![Page 56: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/56.jpg)
Irish guidelines: Prevention of CR-BSI
![Page 57: Fidelma Fitzpatrick Consultant Microbiologist, Health Protection Surveillance Centre &](https://reader036.vdocuments.mx/reader036/viewer/2022062309/56813fdd550346895daac5bb/html5/thumbnails/57.jpg)
Summary
• IV lines = potentially modifiable risk factor for bacteraemia
• Surveillance data essential to monitor effectiveness of any intervention
• ‘You cant manage what you cant measure’