SURVEILLANCE STEERING GROUP
Surveillance of Healthcare Associated
1.1 The Department of Health (DH) established
the Healthcare Associated Infection Surveillance Steering Group
(HAISSG) to provide it with strategic advice on the surveillance
of healthcare associated infection (HAI). This paper outlines
a proposed strategy on the surveillance of HAI for consideration
1.2 The overarching objective of HAI surveillance
is to minimise the morbidity and mortality arising from HAI through
the implementation of surveillance systems that provide information
for the prevention and control of infection.
2.1 Ministers of State have required that
systems are put in place to undertake surveillance and monitoring
of healthcare associated infection across the NHS so that the
overall level of infection can be ascertained and variations between
Trusts, hospitals and other healthcare activities can be compared.
3.1 The purpose of surveillance is to describe
patterns of infection and changes over time so that prompt and
appropriate actions may be instituted. It also provides a means
of comparing the performance of healthcare institutions and monitoring
the effectiveness of prevention and control measures in place.
3.2 It is proposed that developments in
surveillance and monitoring of infection undertaken by all NHS
Trusts are undertaken in three phases:
The implementation of hospital based and nationally
Alert organism surveillance; and
Monitoring of adverse patient events.
The development of hospital based and nationally
co-ordinated alert condition surveillance, followed by its implementation.
The extension of surveillance of HAI surveillance
to healthcare settings outside hospitals.
3.3 HAISSG has produced a general description
of these activities, including the principles to be applied in
their implementation. In addition, illustrative protocols have
been produced for priority organisms and conditions to be surveyed.
Focus on a minimum number of high
priority infections and conditions;
Outline a mechanism for the provision
of information at each level within the NHS as a basis for further
discussion with key stakeholders;
Identify suggested minimum datasets
for capture, collation and analysis; and
Take account of the current surveillance
activities undertaken and systems most widely used.
4.1 In order to be sustainable, routine
surveillance systems will need to collect only the minimum data
required for the prompt identification of problems and the overall
pattern of infection. As a result, it may be necessary to undertake
further investigation of problems identified through surveillance.
4.2 It is proposed that DH enters into an
agreement with a suitable service provider to establish and maintain
a capability to design, test and disseminate epidemiological tools
for the further detailed investigation of problems of healthcare
Improving clinical practice
4.3 Audit provides a mechanism by which
outcome of clinical interventions, including the reduction in
infections arising as a consequence of care, can be improved.
Such activities are likely to be focussed on specific priority
areas in individual specialties. Prevention of infection will
be only one element under consideration.
4.4 It is proposed that DH include the provision
of expert advice in support of clinical audit, as part of its
agreement with a suitable service provider.
4.5 Providers of clinical services will
need to have indicators of the appropriate standards to be achieved
in the prevention and control of infection. Such standards will
need to be based on current best practice and take account of
the differences in case-mix between hospitals.
4.6 It is proposed that, as part of its
agreement with a suitable service provider, DH ensure that appropriate
benchmarking activities are undertaken.
5.1 Decisions on securing an appropriate
service provider are a matter that rests with DH and is outwith
the terms of reference of HAISSG. However, HAISSG has been asked
to provide advice on a range of issues to ensure that future developments
take due account of what already exists, wherever possible maximising
the benefit of experience gained to date.
Experience to date
5.2 In April 2001, at the request of DH,
the Communicable Disease Surveillance Centre (CDSC), established
nationally co-ordinated surveillance of bacteraemia caused by
methicillin resistant S. aureus. At a point to be agreed,
the data collected should be brought in line with that set out
in the alert organism surveillance protocol for MRSA.
5.3 It is noted that, in the first instance,
DH is minded to enter into an agreement with PHLS for CDSC to
undertake routine surveillance and monitoring of HAI, in order
that the benefit and utility of existing systems for the capture
and transmission of data can be maximised.
5.4 The current form of agreement between
DH and PHLS for the development of a National Surveillance System
for Hospital Acquired Infection (NINSS) will come to an end in
March 2002. The achievements of NINSS were the subject of an external
review and set out in a report (The Cunningham report). It will
be essential to ensure that the experience, knowledge and expertise
gained through this project are harnessed to meet the emerging
Providing robust epidemiological
tools for the detailed investigation of problems of HAI;
Contributing to clinical audit; and
Responding to the needs of NHS performance
managers, through robust and reliable benchmarking.
5.5 The recommendation of the Cunningham
Report to establish a surveillance service to meet the needs of
the NHS is supported.
5.6 It is recommended that, in order to
"surveillance and monitoring
of infection" and "investigating problems and improving
standards" should be an integrated function;
as part of its agreement, DH secures
a performance management process that ensures that the work programme
extensive consultation is undertaken
with professional representatives of infection control teams and
public health professionals.
it is anticipated that Regional Directors
of Public Health will play a key role in the performance management
of this process;
plans should ensure a smooth transition
from existing to future arrangements;
in moving to any new arrangement,
provision is made for retaining knowledge and expertise gained
through NINSS; and data collected by existing surveillance and
monitoring systems, including NINSS, should be retained and appropriately
utilised for the purposes set out in this outline strategy.