Proposals for E.coli surveillance Informatics- proposal for the Infection. VRE molecular epidemiology AMR alerts HPA repatriation Rotavirus

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1 HPS Update Proposals for E.coli surveillance Informatics- proposal for the Infection Intelligence Platform (IIP) VRE molecular epidemiology AMR alerts HPA repatriation Rotavirus

2 IIP Strategic intent.to move to a position of enhanced connectivity and linkage of national and local datasets to achieve a comprehensive, dynamic and responsive infection intelligence platform for NHS Scotland to support improved patient outcomes, reduce harm and minimise waste.

3 NHS BOARD SOURCES HPS SOURCES NSS SYSTEMS (HAI & AM) ISD SOURCES Staphaureus Bacteraemia Data(SAB) 1. REFERENCE LABORATORIES (EXTERNAL) [CHI] 1. ECOSS DATABASE (INTERNAL) HAI HEALTH PROTECTION SYSTEMS Clostridium difficile infection Data (CDI) Antimicrobial Resistance Data (AMR) COMMUNITY HEALTH INDEX REGISTRY CAREHOME AGE SEX Prescription Information Scotland (PIS) Hospital Medicine Utilisation Database (HMUD) SCOTTISH MORBIDITY RECORD DATABASE (SMR) NATIONAL AUDITS DATA RESPOSITORY - Clinical Quality Indicators -Scottish Patient Safety Programme NHS LABORATORIES SCI STORE 2. Surgical Site Infection (SSI) Antibiotics (SSI) Prescription Information System for Scotland (PRISMS) ICU Ward Watcher INFECTION ANTIBIOTICS INFECTION PREVENTION & CONTROL SYSTEMS (IPC) PATIENT ADMINISTRATION SYSTEMS (TRACKER) 3. Catheter Associated Urinary Tract Infection (CAUTI) 4. Prevalence Survey (PPS) 5. HELICS WIN (ICU/ECDC) HOSPITAL CAREHOME HEALTH PROTECTION SYSTEMS 14. TRAVEL Antimicrobial Management Integrated Database for Scotland (AMIDS) Scottish Audit of Surgical Mortality (SASM) Arthroplasty INFECTION T X SMR DATA JOINT & OTHER INFECTIONS Renal Registry LINES INFECTION MORTAILITY 6. MRSA SCREENING 13. Gastrointestinal & Zoonotic System (GIZ) PATIENT SAFETY SYSTEMS 7.NOROVIRUS WARD CLOSURES 12. Blood Borne Virus (BBV) Scottish Trauma Audit Group (STAG) INFECTION NO HAI IV ANTIBIOTICS date/time OTHER LOCAL SYSTEMS 8. HAND HYGINE AUDITS 11. RESPIRATORY Musculoskeletal Access Audit (MSk) No PRESCRIBING DATA SYSTEM 9. Surveillance of Healthcare Outbreak System (SHORS) 10. VACCINE UPTAKE LEGEND Data store Database The Scottish Stroke Care Audit (SSCA) Data No Output

4 Quick Wins Datasets ECOSS Electronic Communication of Surveillance in Scotland SMR Scottish Morbidity Record SSIRS Surgical Site Infection Reporting System SCI Store PIS Clinical Information (e.g. Lab results, Radiology reports) Repository Prescription Information Scotland NRS (GRO) National Records of Scotland (was GRO)

5 Proposed QW Projects 1. Identification of Risk Factors for selected Common Bacteraemias 2. Expansion of above to include other Common Bacteraemias and CDI. 3. Validation of IIP for SSI surveillance 4. Unintended consequences of AM prescribing change in surgical prophylaxis. 5. Sepsis Diagnosis, management and outcome 6. Impact of Primary Care AM prescribing on antimicrobial resistance patterns and HAI 7. Mortality associated with HAI

6 HPS AMR Alert System Provide laboratories with real-time (weekly) alerts on particular organisms with unusual resistance profiles The system is intended support the NHS boards in detecting emerging threats It can detect: Single isolates Clusters within hospitals or boards Clusters/increases across boards or nationally

7 AMR Alerts Jan-April Top 10 Alerts Enterococcus faecium - Vancomycin or Vancomycin+Teicoplanin Pseudomonas aeruginosa - Imipenem 26 Enterococcus faecalis - Vancomycin+Teicoplanin Acinetobacter baumannii - Meropenem Enterococcus faecalis - Vancomycin Acinetobacter baumannii - Imipenem Staphylococcus aureus MRSA - Teicoplanin Klebsiella pneumoniae - Meropenem Streptococcus species group B - Penicillin Staphylococcus aureus - Teicoplanin

8 Bug/Drug count Enterococcus faecium - Vancomycin or Vancomycin+Teicoplanin 538 Pseudomonas aeruginosa - Imipenem 307 Enterococcus faecalis - Vancomycin+Teicoplanin 26 Acinetobacter baumannii - Meropenem 25 Enterococcus faecalis - Vancomycin 25 Acinetobacter baumannii - Imipenem 20 Staphylococcus aureus MRSA - Teicoplanin 13 Klebsiella ll pneumoniae - Meropenem 12 Streptococcus species group B - Penicillin 11 Staphylococcus aureus - Teicoplanin 7

9 Current AMR Alert organisms Klebsiella pneumoniae: Escherichia coli: Acinetobacter spp: Pseudomonas aeruginosa: imipenem / meropenem imipenem / meropenem mipenem / meropenem imipenem / meropenem Group A streptococcus: penicillin Group B streptococcus: penicillin Group C streptococcus: penicillin Staphylococcus aureus: Enterococcus faecalis /faecium: vancomycin/teicoplanin vancomycin, teicoplanin tigecycline Revisions?

10 Repatriation of tests from HPA Serodiagnosis of Grp A no longer part of the SLA (circa 10k/yr) Serotyping Grp A will be performed from Stobhill (circa 10k/yr) Regional phenotypic testing (circa 10k/yr) WGS national debate ongoing

11 Group A Streptococcal referral criteria a) All Group A Streptococcal isolates from normally sterile body sites (such as blood, cerebrospinal fluid, joint aspirate, pericardial/peritoneal/pleural fluids, bone, endometrium, deep tissue or abscess at operation or post mortem), b) Group A Streptococcal isolates from a normally non-sterile site in combination with a severe clinical presentation, such as streptococcal toxic shock syndrome (STSS) or necrotising fasciitis. c) On identification of a suspected or confirmed GAS outbreak in acute health care or maternity setting.

12 Rotavirus immunisation and typing of strains prior to programme start Rotavirus immunisation programme which will be introduced into the routine childhood immunisation programme from 1 July 2013 for infants aged 2 and 3 months Approximately 20% of all Scottish cases (2012/13) will be typed to obtain baseline strain distribution prior to the immunisation programme