Northern Ireland Point Prevalence Survey of Hospital Associated Infections and Antimicrobial Use 2017
The PHA coordinated Northern Ireland's participation in ECDC's National Prevalence Survey on Hospital-Acquired Infections & on Antimicrobial Use.
Hospitals in Northern Ireland participated in data collection during June 2017; 16 hospitals with 3,813 eligible patients surveyed. The median age of all patients was 68 years.
This report provides a snapshot of the levels of hospital-acquired infections (HAI) and levels of antimicrobial use (AMU) in acute hospitals in Northern Ireland during 2017.
Key results from the 2017 survey:
The prevalence of HAI was 6.1%. A total of 234 patients were diagnosed with an active HAI.
The most commonly identified HAIs were pneumonia (29% of all HAI), followed by surgical site infection (17%), gastrointestinal infection (10.4%), bloodstream infections (8.7%), urinary tract infection (6.2%) and systemic infection (6.2%).
Overall the prevalence of urinary catheter and central vascular catheter use has not changed since 2012. However, when similar survey populations were compared, the use of peripheral vascular catheters was significantly higher in 2017 than in either 2006 or 2012.
Gram-positive cocci accounted for 37.3% of all microorganisms, with the largest proportion being Staphylococcus aureus 18.6% and Enterococcus spp 9.8%. Gram-negative Enterobacteriaceae accounted for 35.3% - the largest proportion being Escherichia coli 20.6%.
As in the 2012 PPS, the proportion of MRSA identified in 2017 was very low (< 0.1%) maintaining the decrease from the PPS in 2006. Clostridium difficile accounted for 16.7% of all microorganisms reported. When similar survey populations were compared, Clostridium difficile prevalence remained around 0.3% of the patient population surveyed, similar to 2012 and lower than 1% identified in 2006.
The overall prevalence of antimicrobial use was 36.3%. The highest antimicrobial use (64.9%) was reported in adult intensive care units (ICUs) followed by mixed specialty (50.8%) and medical specialty (40.6%) wards. The prevalence of antimicrobial use in paediatrics was (31.3%).
The most common indication for antimicrobial prescribing was for community acquired infections - 22.6% of all patients; 60.6% of all prescribed antimicrobials.
Overall 8.1% patients were prescribed antimicrobials specifically for hospital associated infection. Prophylaxis accounted for 14.2% of all antimicrobials (5.3% surgical prophylaxis, 8.9% medical prophylaxis).
Overall, 11.7% of prescribed antimicrobials were not compliant with local guidelines, and significant proportions were prescribed off guideline including co-amoxiclav (28.4%), meropenem (10.7%), and piperacillin/tazobactam (15.5%).
The majority of antimicrobials were delivered parenterally (63%), and there was limited evidence of adoption of a formal 72 hour review of antimicrobial treatment.