Surveillance: Report: Clostridium difficile (C. difficile) and Staphylococcus aureus ( and ) Bi-annual Report Time period: 1 st April to 30 th September 2016 Health Board: Wales Content: Issued by: Pg 2 C. difficile Pg 5 Pg 8 Welsh Healthcare Associated Infection Programme (WHAIP) Issue date: 29 th December 2016
Clostridium difficile Surveillance 1. Clostridium difficile (C. difficile) C. difficile surveillance notes for interpretation This report presents data on numbers of C. difficile in Wales April to September 2016, with trend data April 2010. Data is mainly collected via Datastore, a data warehouse system used by all microbiology laboratories in Wales. This data is supplemented manually with C. difficile specimens patients in Powys Teaching Health Board where the laboratory used for processing the specimen is in England. Data is extracted for the surveillance scheme using the following criteria: o The patient is at least 2 years old o The sample was not taken a patient in a private, a privately run dialysis unit or post-mortem o The sample had a positive C. difficile toxin test, if a single test (either a toxin A and B enzyme immunoassay or a neutralised cell toxicity assay) protocol was in use in the laboratory at the time the investigation was carried out, or a positive glutamate dehydrogenase (GDH) assay combined with a positive C. difficile toxin enzyme immunoassay, if a two-stage testing protocol was in use in the laboratory at the time the investigation was carried out. o Multiple positive samples the same patient within a 28 day period are excluded as duplicates Hospital admission data has been supplied by NHS Wales Informatics Service (NWIS) the Patient Episode Database for Wales (PEDW). Population data has been extracted https://statswales.wales.gov.uk/catalogue/populationand-migration/population/estimates. All ages are included in the admission and numbers used to calculate rates. Mid 2015 estimates have been used to calculate the April September 2016 rates. These rates will be updated when the mid 2016 estimates become available. 2
Clostridium difficile Surveillance Wales Wales C. difficile, Apr Sep 16 543 cases of C. difficile have been reported for Apr-Sep 16. This is a 22% decrease in numbers compared to Apr-Sep 15. The rate of C. difficile per 1,000 has decreased by 23% 3.13 to 2.41. (Table 1.1.) Compared to Apr-Sep 15, 7 of the 8 health boards/trust in Wales have achieved a reduction in numbers of C. difficile. (Table 1.1.) Compared to Apr-Sep 10, there has been a 65% decrease in the C. difficile and a 66% decrease in the rate of C. difficile per 1,000 in Wales. (Table 1.2.) Compared to Apr-Sep 10, 7 of the 8 health boards/trust in Wales have achieved a reduction in numbers of C. difficile. (Table 1.1.) Powys Teaching Health Board had some changes in data collection methods over this time period. 66% (358) of cases were diagnosed in the 18 acute s, 7% (40) in non-acute s and 25% (137) in non- locations. 8 locations were not specified. 59% (320) of cases were diagnosed in inpatient locations. The inpatient rate for Wales is 1.42 per 1,000 for this period. 57% (307) of C. difficile were in female patients and 80% (434) were in patients aged 66+ for this 6 month period. The rate of C. difficile per 100,000 has decreased by 22% compared to Apr-Sep 15, 44.67 to 34.95. (Table 1.2.) Compared to Apr-Sep 10, the rate of C. difficile per 100,000 has decreased by 66%. (Table 1.2.) Table 1.1. Wales numbers of C. difficile, percentage change in numbers ( Apr Sep 15 and Apr Sep 10) and rates per 1,000 and 100,000 by health board, Apr Sep 16 C. difficile C. difficile Apr Sep 15 C. difficile Apr Sep 10 C. difficile/ 1,000 C. difficile /100,000 ABM 107-30% (152) -52% (224) 2.45 40.61 Aneurin Bevan 80-22% (103) -78% (370) 1.74 27.43 Betsi Cadwaladr 161-20% (202) -60% (401) 3.42 46.24 Cardiff and Vale 92 +12% (82) -74% (352) 2.80 37.85 Cwm Taf 27-29% (38) -72% (96) 1.01 18.15 Hywel Dda 64-37% (101) -38% (103) 2.34 33.31 Powys Teaching 11-8% (12) +57% (7) 12.79 16.54 Velindre 1-75% (4) -90% (10) 1.02 N/A Wales 543-22% (694) -65% (1563) 2.41 34.95 Wales average 68 3.45 31.45 Wales median 72 2.40 33.31 3
Clostridium difficile Surveillance Wales Table 1.2. Wales numbers and rates of C. difficile per 1,000 and 100,000, Apr 10 Sep 16 C. difficile C. difficile/ 1,000 Population* C. difficile/ 100,000 Apr Sep 16 543 225458 2.41 1553788 34.95 Sep 16 105 37284 2.82 254719 41.22 Aug 16 96 36822 2.61 263210 36.47 Jul 16 85 37997 2.24 263210 32.29 Jun 16 106 38486 2.75 254719 41.61 May 16 78 38500 2.03 263210 29.63 Apr 16 73 36369 2.01 254719 28.66 2015/16 FY 1243 449440 2.77 3099086 40.11 Apr Sep 15 694 221573 3.13 1553788 44.67 2014/15 FY 1318 446699 2.95 3092036 42.63 Apr Sep 14 686 223490 3.07 1550254 44.25 2013/14 FY 1577 442821 3.56 3082412 51.16 Apr Sep 13 901 219353 4.11 1545428 58.30 2012/13 FY 1934 439792 4.40 3074067 62.91 Apr Sep 12 998 220574 4.52 1541245 64.75 2011/12 FY 2142 455772 4.70 3063758 69.91 Apr Sep 11 1214 224821 5.40 1536076 79.03 2010/11 FY 2795 448561 6.23 3049971 91.64 Apr Sep 10 1563 223855 6.98 1529164 102.21 *Monthly = (Total / days in year) x days in month Figure 1.1. Wales monthly and 12 month moving average rates of C. difficile per 1,000, Apr 10 Sep 16* 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 C. difficile/1,000 12 month moving average rate of C. difficile/1,000 *12 month moving average rates are shown Mar 11 as this is when the first full FY of data is complete 4
Staphylococcus aureus Surveillance 2. (meticillin-resistant Staphylococcus aureus) surveillance notes for interpretation This report presents data on numbers of blood cultures () in Wales April to September 2016, with trend data April 2010 (other than for Powys Health Board where data collection started in April 2011). Data is mainly collected via Datastore, a data warehouse system used by all microbiology laboratories in Wales. This data is supplemented manually with specimens patients in Powys Health Board where the laboratory used for processing the specimen is in England. Data is extracted for the surveillance scheme using the following criteria: o Staphylococcus aureus (S. aureus) was identified a blood culture sample o The sample was not taken a patient in a private, a privately run dialysis unit or post-mortem o Multiple positive samples the same patient within a 14 day period are excluded as duplicates S. aureus positive blood cultures are assigned as (meticillin-resistant S. aureus) or (meticillin-sensitive S. aureus) on the basis of sensitivity to the antibiotic flucloxacillin Hospital admission data has been supplied by NHS Wales Informatics Service (NWIS) the Patient Episode Database for Wales (PEDW). Population data has been extracted https://statswales.wales.gov.uk/catalogue/populationand-migration/population/estimates Mid 2015 estimates have been used to calculate the April September 2016 rates. These rates will be updated when the mid 2016 estimates become available. 5
Staphylococcus aureus Surveillance Wales Wales, Apr Sep 16 40 cases of in Wales have been reported for Apr Sep 16. This is a 22% decrease in numbers compared to Apr Sep 15. The rate of per 1,000 has decreased by 23%, 0.23 to 0.18. (Table 2.1.) Compared to Apr Sep 15, 4 of the 8 health boards/trust in Wales have achieved a reduction in numbers of. 3 health boards/trust had the same for both time periods. (Table 2.1.) Compared to Apr Sep 10, there has been a 66% decrease in the and a 67% decrease in the rate of per 1,000 in Wales. (Table 2.2.) Compared to the Apr Sep 10, all health boards/trust in Wales have achieved a reduction in numbers of. (Table 2.3.) 93% (37) cases were diagnosed in the 18 acute s and 3% (1) in non-acute s. 2 locations were not specified. 65% (26) of cases were diagnosed in inpatient locations. The inpatient rate for Wales is 0.12 per 1,000 for this period. 23% (9) of were in female patients and 65% (26) were in patients aged 66+ for this 6 month period. The rate of per 100,000 has decreased by 22% compared to Apr Sep 15, 3.28 to 2.57. (Table 2.2.) Compared to Apr Sep 10, the rate of per 100,000 has decreased by 67%. (Table 2.2.) Table 2.1. Wales numbers of, percentage change in numbers ( Apr Sep 15 and Apr Sep 10) and rates per 1,000 and 100,000 by health board, Apr Sep 16 Apr Sep 15 Apr Sep 10 /1,000 /100,000 ABM 8 =0% (8) -72% (29) 0.18 3.04 Aneurin Bevan 2-80% (10) -82% (11) 0.04 0.69 Betsi Cadwaladr 14-13% (16) -50% (28) 0.30 4.02 Cardiff and Vale 6-33% (9) -73% (22) 0.18 2.47 Cwm Taf 1-50% (2) -91% (11) 0.04 0.67 Hywel Dda 9 50% (6) -44% (16) 0.33 4.68 Powys Teaching 0 =0% (0) N/A 0.00 0.00 Velindre 0 =0% (0) -100% (2) 0.00 N/A Wales 40-22% (51) -66% (119) 0.18 2.57 Wales average 5 0.13 2.22 Wales median 4 0.11 2.47 6
Table 2.2. Wales numbers and rates of per 1,000 and 100,000, Apr 10 Sep 16 / 1,000 Population* / 100,000 Apr Sep 16 40 225458 0.18 1553788 2.57 Sep 16 7 37284 0.19 254719 2.75 Aug 16 7 36822 0.19 263210 2.66 Jul 16 10 37997 0.26 263210 3.80 Jun 16 8 38486 0.21 254719 3.14 May 16 0 38500 0.00 263210 0.00 Apr 16 8 36369 0.22 254719 3.14 2015/16 FY 101 449440 0.22 3099086 3.26 Apr Sep 15 51 221573 0.23 1553788 3.28 2014/15 FY 166 446699 0.37 3092036 5.37 Apr Sep 14 82 223490 0.37 1550254 5.29 2013/14 FY 165 442821 0.37 3082412 5.35 Apr Sep 13 80 219353 0.36 1545428 5.18 2012/13 FY 161 439792 0.37 3074067 5.24 Apr Sep 12 89 220574 0.40 1541245 5.77 2011/12 FY 199 455772 0.44 3063758 6.50 Apr Sep 11 93 224821 0.41 1536076 6.05 2010/11 FY 218 448561 0.49 3049971 7.15 Apr Sep 10 119 223855 0.53 1529164 7.78 *Monthly = (Total / days in year) x days in month Figure 2.1. Wales monthly and 12 month moving average rates of per 1,000, Apr 10 Sep 16* 1.0 0.8 0.6 0.4 0.2 0.0 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 /1,000 12 month moving average rate of /1,000 *12 month moving average rates are shown Mar 11 as this is when the first full FY of data is complete 7
Staphylococcus aureus Surveillance 3. (meticillin-sensitive Staphylococcus aureus) surveillance notes for interpretation This report presents data on numbers of blood cultures () in Wales April to September 2016, with trend data April 2010 (other than for Powys Health Board where data collection started in April 2011). Data is mainly collected via Datastore, a data warehouse system used by all microbiology laboratories in Wales. This data is supplemented manually with specimens patients in Powys Health Board where the laboratory used for processing the specimen is in England. Data is extracted for the surveillance scheme using the following criteria: o Staphylococcus aureus (S. aureus) was identified a blood culture sample o The sample was not taken a patient in a private, a privately run dialysis unit or post-mortem o Multiple positive samples the same patient within a 14 day period are excluded as duplicates S. aureus positive blood cultures are assigned as (meticillin-resistant S. aureus) or (meticillin-sensitive S. aureus) on the basis of sensitivity to the antibiotic flucloxacillin Hospital admission data has been supplied by NHS Wales Informatics Service (NWIS) the Patient Episode Database for Wales (PEDW). Population data has been extracted https://statswales.wales.gov.uk/catalogue/populationand-migration/population/estimates Mid 2015 estimates have been used to calculate the April September 2016 rates. These rates will be updated when the mid 2016 estimates become available. 8
Staphylococcus aureus Surveillance Wales Wales, Apr Sep 16 349 cases of have been reported for Apr Sep 16. This is a 15% decrease in numbers compared to Apr Sep 15. The rate of per 1,000 has decreased by 16%, 1.85 to 1.55. (Table 3.1.) Compared to the equivalent period last year, 5 of the 8 health boards/trust in Wales have achieved a reduction in numbers of. (Table 3.1.) Compared to Apr Sep 10, there has been a 7% increase in the and a 7% increase in the rate of per 1,000 in Wales. (Table 3.2.) Compared to the Apr Sep 10, 3 of the 8 health boards/trust in Wales have achieved a reduction in numbers of. (Table 3.3.) Powys Teaching Health Board had some changes in data collection methods over this time period. 97% (338) of cases were diagnosed in the 18 acute s, 1% (4) in non-acute s and <1% (1) in non- locations. 6 locations were not specified. 53% (185) of cases were diagnosed in inpatient locations. The inpatient rate for Wales is 0.82 per 1,000 for this period. 36% (127) of were in female patients and 51% (179) were in patients aged 66+ for this 6 month period. The rate of per 100,000 has decreased by 15% compared to Apr Sep 15, 26.32 to 22.46. (Table 3.2.) Compared to Apr Sep 10, the rate of per 100,000 has increased by 6%. (Table 3.2.) Table 3.1. Wales numbers of, percentage change in numbers ( Apr Sep 15 and Apr Sep 10) and rates per 1,000 and 100,000 by health board, Apr Sep 16 Apr Sep 15 Apr Sep 10 /1,000 /100,000 ABM 67-22% (86) +20% (56) 1.53 25.43 Aneurin Bevan 59 +28% (46) -5% (62) 1.29 20.23 Betsi Cadwaladr 69-1% (70) +3% (67) 1.47 19.82 Cardiff and Vale 52-32% (76) -15% (61) 1.58 21.52 Cwm Taf 28-56% (63) =0% (28) 1.04 18.82 Hywel Dda 72 +11% (65) +50% (48) 2.64 37.47 Powys Teaching 0 =0% (0) N/A 0.00 0.00 Velindre 2-33% (3) -33% (3) 2.05 N/A Wales 349-15% (409) +7% (325) 1.55 22.46 Wales average 44 1.45 20.47 Wales median 56 1.50 20.23 9
Table 3.2. Wales numbers and rates of per 1,000 and 100,000, Apr 10 Sep 16 / 1,000 Population* / 100,000 Apr Sep 16 349 225458 1.55 1553788 22.46 Sep 16 60 37284 1.61 254719 23.56 Aug 16 53 36822 1.44 263210 20.14 Jul 16 61 37997 1.61 263210 23.18 Jun 16 59 38486 1.53 254719 23.16 May 16 61 38500 1.58 263210 23.18 Apr 16 55 36369 1.51 254719 21.59 2015/16 FY 765 449440 1.70 3099086 24.68 Apr Sep 15 409 221573 1.85 1553788 26.32 2014/15 FY 759 446699 1.70 3092036 24.55 Apr Sep 14 388 223490 1.74 1550254 25.03 2013/14 FY 751 442821 1.70 3082412 24.36 Apr Sep 13 378 219353 1.72 1545428 24.46 2012/13 FY 728 439792 1.66 3074067 23.68 Apr Sep 12 345 220574 1.56 1541245 22.38 2011/12 FY 651 455772 1.43 3063758 21.25 Apr Sep 11 317 224821 1.41 1536076 20.64 2010/11 FY 659 448561 1.47 3049971 21.61 Apr Sep 10 325 223855 1.45 1529164 21.25 *Monthly = (Total / days in year) x days in month Figure 3.1. Wales monthly and 12 month moving average rates of per 1,000, Apr 10 Sep 16* 2.5 2.0 1.5 1.0 0.5 0.0 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 /1,000 12 month moving average rate of /1,000 *12 month moving average rates are shown Mar 11 as this is when the first full FY of data is complete 10