SSI prevention how do we know it is

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SSI prevention: how do we know it is happening? (Surveillance) December 2015

SSI prevention: how do we know it is happening? (Surveillance) December 2015

Outline • What is surveillance? • How do we know that it is happening?

Outline • What is surveillance? • How do we know that it is happening? • Post-discharge surveillance • Summary results (notes and questionnaire) • Discussion – recomended all Wales plan

What is surveillance? Monitor incidence of infection Surveillance is the ongoing systematic collection, analysis,

What is surveillance? Monitor incidence of infection Surveillance is the ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation Impact of of public interventions health practice, Early warning and integrated closely investigation of problems with the timely dissemination of these data to those who need to know. The final link of the surveillance chain is the application of these data to prevention and control (Centers for Disease Control and Prevention (CDC) 1988) Monitor trends / outbreaks Planning / interventions to control infection

Surveillance • Potential to improve infection rates by carrying out surveillance has been demonstrated

Surveillance • Potential to improve infection rates by carrying out surveillance has been demonstrated (Hayley et al. 1985) • Mandatory surveillance programme for csections in Wales since January 2006

How do we happening? know that surveillance is Final link of surveillance – prevention

How do we happening? know that surveillance is Final link of surveillance – prevention and control: ØTrend rates over time ØCompliance with surveillance Ø Are infection rates reducing with key interventions in place? C-sections – mainly through post discharge surveillance

Quality improvement methodology AIM MEASURE CHANGES

Quality improvement methodology AIM MEASURE CHANGES

Interventions and training (2006 – 2014) 2008 -2009 Re-design Target PD 2010 of form

Interventions and training (2006 – 2014) 2008 -2009 Re-design Target PD 2010 of form surveillance NICE 2010 2011 Wound diagnosis Antibiotic training timing (prior guidelines Clipping (not shaving); wound dressing; thermoregul ation 2009 -2010 Audit of data to incision) 2011 Skin prep (Chloraprep) Masterclass (1000 Lives +) Workshop PICO

Post-discharge surveillance • Post-discharge surveillance recommended for up to 30 days after c-section •

Post-discharge surveillance • Post-discharge surveillance recommended for up to 30 days after c-section • Whitby et al. (2002) “Unless these post-discharge infections are reliably identified, calculated rates of SSI will not represent an accurate assessment”

How do we know that happening accurately? surveillance is ØValidation of surveillance results? ?

How do we know that happening accurately? surveillance is ØValidation of surveillance results? ? ? Visits and audits – under reporting of infections in Wales post discharge?

Summary of what is happening post discharge within HBs • Audits of post discharge

Summary of what is happening post discharge within HBs • Audits of post discharge notes • Questionnaires filled out during HB visits

Audits of post discharge notes Ø Incorrect criteria utilised to define infection Ø Infections

Audits of post discharge notes Ø Incorrect criteria utilised to define infection Ø Infections based on swab result only Ø Organism grown – not always significant Ø GPs prescribing antibiotics without seeing the patient – SSI? Ø Notes mention antibiotics prescribed and nothing else?

Swab results Preliminary data (all Wales: 2014) Number of Swabs taken 50 45 Organism

Swab results Preliminary data (all Wales: 2014) Number of Swabs taken 50 45 Organism growth 40 Null growth 35 30 25 20 15 10 5 Month Approx only 14% of swabs had growth r be r em ec D N ov em be ct ob er O r be em pt Se Au gu st ly Ju e Ju n ay M ril Ap ch ar M ar y ru Fe b Ja nu ar y 0

Summary results - questionnaires • Depending on reply – following results at hospital or

Summary results - questionnaires • Depending on reply – following results at hospital or HB level Do you have a surveillance co-ordinator? Yes for 1 HB = surveillance team

Summary results - questionnaires Many use old version of the tool Difficulty collecting data

Summary results - questionnaires Many use old version of the tool Difficulty collecting data for out of area patients

All Wales process for collecting reliable SSI data post discharge

All Wales process for collecting reliable SSI data post discharge

Discussion 1. Typically how long do you follow-up the mother PD? < 10 days

Discussion 1. Typically how long do you follow-up the mother PD? < 10 days 10 – 13 days 14 – 20 days 21 - 28 days >28 days

Discussion 2. Does your answer to Q 1 vary depending on the presence /

Discussion 2. Does your answer to Q 1 vary depending on the presence / absence of a wound infection?

Discussion 3. What is the minimum / maximum time a mother should be followed-up

Discussion 3. What is the minimum / maximum time a mother should be followed-up to full fill surveillance needs (determine if patient had an infection or not)?

Discussion 4. If an infection is suspected what steps should the community midwife follow

Discussion 4. If an infection is suspected what steps should the community midwife follow to diagnose an infection for surveillance purposes? NB: Take into consideration this mornings session)

Discussion 5. Should the community midwife consult a GP to prescribe antibiotics? What are

Discussion 5. Should the community midwife consult a GP to prescribe antibiotics? What are your reasons!!!

Discussion 6. If we cannot discourage GP prescribing how should we consider such actions

Discussion 6. If we cannot discourage GP prescribing how should we consider such actions within surveillance?

Wales

Wales

Break time

Break time