Select Committee on Science and Technology Minutes of Evidence


APPENDIX 2

PHASE 1

1.  INTRODUCTION

  1.1  This appendix describes the key elements for routine surveillance together with the public health and epidemiological principles to be applied. Illustrative protocols for priority surveillance and monitoring activities are also included.

2.  PUBLIC HEALTH AND EPIDEMIOLOGICAL PRINCIPLES

Definition

  2.1  Surveillance is a continuous process of systematic collection, effective collation and analysis of pertinent data with prompt dissemination of the results to those who need to know, particularly those with responsibility for prevention and control.

Principles

  2.2  Surveillance of healthcare associated infections covered by this Agreement will:

    —  address the public health priorities set by DH;

    —  utilise a common approach across the NHS, including appropriate linkages between surveillance required for hospital infection control purposes and that needed to protect the public health;

    —  facilitate the collection and analysis of data locally for local needs whilst also contributing to regional and national surveillance;

    —  wherever possible, only collect data that has utility at the local level;

    —  identify and monitor the impact of the problem, including infections associated with healthcare that become manifest in the community;

    —  be based on defined populations so that meaningful comparisons can be made; and

    —  be supported by appropriate IT systems.

Purpose of surveillance

  The purpose of surveillance is to provide information for action. The systems covered by this specification are required to describe the pattern HAI in the NHS and contribute to:

2.3.1  National level:

    —  the development of policy;

    —  planning and monitoring services;

    —  assessing effectiveness of interventions; and

    —  informing Ministers, Parliament and the public.

2.3.2  Regional and Health Authority level:

    —  the development of local and regional plans;

    —  monitoring healthcare delivery; and

    —  performance management of infection control services.

2.3.3  Local level:

    —  detect problems at an early stage, to assist in timely action; and

    —  monitor the effectiveness of prevention and control measures in place.

  2.3  The first phase of this specification includes:

    —  nationally co-ordinated surveillance of HAI; and

    —  monitoring of incidents and events of HAI.

Confidentiality

  2.4  Data relating to individual hospitals shall be handled in the strictest confidence. Identifiable data should be known only to the individual hospitals.

  2.5  Service providers shall comply with the Data Protection Act (Date) and other statutory requirements, relating to data and information management.

3.  MONITORING OF ADVERSE PATIENT INCIDENTS DUE TO INFECTION

  3.1  An adverse incident involving an NHS patient is an event that actually (or potentially) results in unintended harm to the patient. Some such incidents are related to infection which, on occasion, have resulted in severe illness or even death. The majority of infections are an inevitable consequence of clinical interventions, a minority are preventable. It is important that where such infections are preventable all appropriate actions are taken to achieve this and when infections do occur their potential to spread is contained.

  3.2  Following committees of inquiry into two major outbreaks of communicable disease, salmonella food poisoning at Stanley Royd Hospital in Wakefield and Legionnaires' disease at Stafford and a subsequent inquiry into the public health function, guidance was issued to the NHS on the arrangements for communicable disease control [EL(91)123 and HSG(93)56]. These communications required the development and adoption of plans for the management of major incidents of infection, including such incidents occurring in NHS premises.

  3.3  When a serious problem actually or potentially exists (eg outbreaks of Salmonellosis), the Infection Control Doctor will, in conjunction with the Consultant in Communicable Disease Control, convene an outbreak control committee. This is a matter of professional judgement, but guidance in these matters is contained in Outbreak Control Plans that all Trusts are required to have in place. Within these plans there is also a requirement that the incident be reported beyond the Trust, to the Health Authority and to the Regional Director of Public Health.

  3.4  Monitoring of adverse patient incidents will be a part of routine audit of clinical practice. As a result, it will neither be necessary nor appropriate for every adverse event to be reported beyond the context in which the event occurs. However, the National Patient Safety Agency requires an initial analysis of such incidents to determine the risk to patients. In the event that a serious problem actually or potentially exists then central reporting arrangements need to be invoked.

  3.5  Following untoward events associated with other areas of healthcare, the Government, medical professions and the NHS gave a commitment to minimise the incidence of unintended harm to patients arising as a consequence of clinical treatment. Doing less harm: Improving the safety and quality of care through reporting, analysing and learning from adverse incidents involving NHS patients—Key requirements for health care providers (DoH 2001), provides a framework for corporate learning from experience.

  3.6  Trusts will have surveillance and other arrangements in place for monitoring problems of infection arising in patients under their care. Therefore, it is not intended that the system described in the attached protocol will monitor all events. Rather it seeks to identify only those events that have a significant impact on the ability of the Trust to care for patients or on the health of the wider community.

  3.7  The protocol for reporting of such incidents, together with the specification of the data to be collected, seeks to embed existing arrangements set out in major outbreak plans into the framework being developed by the Department of Health and NHS Patient Safety Agency.

  3.8  Chief Executives in NHS Trusts and PCTs in conjunction with their Control of Infection Teams and the local Consultant in Communicable Disease Control will need to ensure that their Outbreak Control Plans reflect the guidance issued in Doing Less Harm and the protocol outlined in this document.

4.  ALERT ORGANISM SURVEILLANCE

  4.1  Alert organism surveillance comprises:

    —  the routine and systematic collection and collation of data on specified micro-organisms isolated from patients with infection occurring in a health care facility;

    —  timely analysis of data to allow the prompt identification of changes in patterns of infection;

    —  the prompt distribution of the nature and extent of change to those who need to know, specifically those responsible for the care of individual patients and the prevention and control of infection; and

    —  periodic systematic review of the systems in place.

  4.2  Alert organism surveillance will be part of routine surveillance activities of infection control teams working in the NHS. Certain organisms will be of particular interest in particular situations. Not all will be of relevance on a wider basis.

  4.3  This specification sets out a protocol for surveillance of specified organisms that have wider, as well as local, relevance. It is anticipated that all the organisms included in this specification will form an essential and useful part of the surveillance programmes at the local level. The use of a specified dataset by all infection control teams will provide a basis on which meaningful comparisons can be made.

  4.4  An essential feature of this approach to surveillance is that:

    —  local surveillance, including the analysis and distribution of information, will be undertaken locally; and

    —  national and regional surveillance, including the analysis and distribution of data to DH and RDsPH, will be the responsibility of CDSC.

  4.5  The organisms included in this specification for local, regional and national surveillance are:

    —  S aureus, including MRSA;

    —  C difficile; and

    —  Glycopeptide resistant enterococci (GRE).

  4.6  A requirement of this agreement is that any system provided to Trusts to enable them to report to the regional and national centres, should also allow them to survey additional organisms, should they wish to do so.

5.  PROTOCOLS

  5.1  In order to achieve the overall objectives, a set of definitions and recommended methods are set out for each infection or event identified as a priority. These are set out in the form of protocols.

  5.2  Each protocol is set out systematically, in a format promulgated by WHO.

    —  Rationale for surveillance: Describes the public health significance of the infection/event.

    —  Trigger for surveillance: Indicates the point at which the implementation of surveillance should be considered or existing arrangements reviewed.

    —  Recommended type of surveillance: Describes the type of surveillance to be undertaken (using standard definitions).

    —  Recommended case definition: Sets out the criteria for an infection/event to be included in the particular surveillance activity covered by the protocol.

    —  Recommended minimum dataset: Describes the minimum data items required. Others may be added by agreement.

    —  Others: Include analysis, presentation and uses of data are self-explanatory.


 
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