Point prevalence surveys of healthcare associated infections and antimicrobial prescribing

Background

Point prevalence surveys

Healthcare associated infections (HCAI) are a major public health concern and a significant cause of global morbidity and mortality. The European Centre for Disease Prevention and Control (ECDC) estimates that 3.2 million patients develop a HCAI every year in Europe. Point prevalence surveys (PPS) are useful for measuring HCAI outcome and antimicrobial prescribing, they also provide a snapshot of the proportion of the population with a HCAI or receiving antimicrobials at the time of the survey.

National PPS are undertaken approximately every five years in Scotland to review the current epidemiology of HCAI and antimicrobial prescribing. To date there have been three hospital PPS, these have been in 2005 to 2006, 2011 and 2016. Two long term care facility PPS took place in 2010 and 2017.

PPS in hospitals

In 2016, the Scottish Government tasked our organisation with co-ordinating a third Scottish national PPS of HCAI and antimicrobial prescribing in hospitals and advised the NHS boards of the requirement to participate.

The survey found that approximately one in 22 acute adult inpatients had a HCAI at the time of survey, this was 4.6% with a 95% confidence interval of 4.1 to 5.1. The most commonly reported infections were urinary tract infections at 24.5%. Additionally, approximately one in three acute adult inpatients were receiving antimicrobials, this was 35.7% with a 95% confidence interval of 34.2 to 37.2.

The intelligence is being used to inform the development of key priority areas and recommendations for the prevention, control and surveillance of HCAI, as well as for quality improvement interventions for antimicrobial stewardship. This assists the Scottish Government in the further development of:

  • national policy to reduce HCAI
  • improving antimicrobial prescribing
  • containing antimicrobial resistance (AMR) in Scottish hospitals

PPS in long term care facilities

In October 2017, we co-ordinated a second voluntary PPS of HCAI and antimicrobial prescribing in long term care facilities (LTCF) in Scotland. Scotland has an increasingly older and frailer population with ever more complex health and social care needs and LTCF are an important source of HCAI which contribute to the morbidity and mortality in this population.

The prevalence of HCAI was found to be 5.9% with 95% confidence interval of 5.0 to 7.0. The most common HCAI types were:

  • 38.1% respiratory tract infections
  • 31.0% urinary tract infections
  • 23.0% skin and soft tissue infections

The prevalence of antimicrobial prescribing was 6.5%, this was with a 95% confidence interval of 5.6 to 7.7. Four-fifths of antimicrobials were being prescribed for the treatment of infection.

The results from this survey provided a robust and current evidence base that is specific to the Scottish LTCF settings and are being used to inform the development of local and national strategies to reduce HCAI and contain AMR. The results also provided an opportunity to describe infection, prevention and control (IPC) and antimicrobial stewardship structures and processes in LTCF.