HCAI survey reveals overall drop in infections

The UK’s Health Protection Agency (HPA) has published the results of the fourth HCAI Point Prevalence Survey (PPS) and also the first National Survey on Antibiotic use in England. The report provides a snapshot of the levels of healthcare-associated infections (HCAI) and levels of antibiotic use in hospital Trusts in England in Autumn 2011. This is also the first survey to include hospitals from the independent sector.

Compared with the previous HCAI PPS survey carried out in 2006, there was an overall drop in HCAI prevalence from 8.2% in 2006 to 6.4% in 2011. The English PPS data was collected by hospital teams between September and November 2011; 103 organisations surveyed 52,443 eligible patients with an average age of 69 years. A total of 4,372 children under 16 years of age were also surveyed. The average age in this group was one month.

Results from this year’s survey showed that:

• A total of 3,360 patients were diagnosed with an active HCAI with 135 patients having more than one.
• Overall 6.4% of people in hospital had an HCAI.
• The most common types of HCAI were respiratory (including pneumonia and infections of the lower respiratory tract) (22.8%), urinary tract infections (UTI) (17.2%), and surgical site infections (15.7%).
• The prevalence of HCAI was highest in those patients aged 1-23 months at 8.2% followed by patients aged 65-79 years of age at 7.4%. This reflects the vulnerability for HCAI at the extremes of age.
• When comparing ward specialties, HCAI prevalence was highest in patients in intensive care units (ICUs) at 23.4% followed by surgical wards at 8%. These figures also reflect that the highest rates of infection occur in those patients who have devices or have had procedures performed.
• Since the last PPS in 2006 there has been an 18-fold reduction overall in MRSA bloodstream infections from 1.3% to less than 0.1% in patients; and a five-fold reduction in C. difficile infections from 2% to 0.4%.
• Most antibiotic use (53%) in hospitals was in patients receiving treatment for infections that commenced in the community.

Prevalence surveys are useful in providing data on the burden of all HCAI at any one point in time. They also give a better understanding of the relative frequency of different types of HCAIs that are present rather than focusing on one type.

This survey is part of a Europe-wide PPS initiative set up by the European Centre for Disease Prevention and Control (ECDC). It is the first time that all participating European countries will use the same definitions and methodology in their surveillance, which means that results should be more comparable across Europe.

‘This report is an important collaboration between a great many different organisations and experts. It gives us a clear picture of the different types of infections that are occurring in hospitals and the bugs that cause them. Knowing exactly what is causing problems enables hospital Trusts to adopt the best strategies to deal with them,’ said Dr Susan Hopkins, healthcare epidemiologist at the HPA and the lead author of the report.

‘Measures that were put in place to tackle MRSA and C. difficile infections have ensured that over the last few years rates have consistently gone down. In the meantime other bacteria, notably Enterobacteriaceae (also known as coliforms), have increased. It is clear that we need to find ways to control and prevent transmission of these bacteria and this is an important priority.’