Better Information For Hospitals In The Fight Against C Difficile, UK

Main Category: MRSA / Drug Resistance
Also Included In: Infectious Diseases / Bacteria / Viruses;  Public Health
Article Date: 17 Apr 2007 - 12:00 PDT

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A new web based system to enhance monitoring of Clostridium difficile (C difficile) is being introduced this month, enabling trusts and PCTs to monitor progress on local C. difficile targets and to identify and focus on 'infection hotspots' in the future.

Accurate surveillance is essential in any strategy to reduce infections and the new system, modelled on the MRSA data collection system, will provide an improved national picture on the incidence of C. difficile associated diarrhoea by collecting data on nearly all cases rather than just those over 65.

Chief Nursing Officer Christine Beasley said "The MRSA surveillance system is widely regarded as one of the best in the world and our experience has allowed us to learn much more about sources of infection and specialties where MRSA bacteraemia occur most often. This knowledge has helped hospitals to target these areas and drive MRSA infection rates down and we want to replicate this for C difficile."

In a letter to the NHS, Christine Beasley and the Chief Medical Officer Sir Liam Donaldson explained the benefits of the changes for local Trusts, highlighting barriers to accurate national monitoring of C difficile.

Under the current system, C difficile cases are reported from Trust laboratories and a case is assigned to the reporting laboratory's Trust, regardless of where the patient came from. This means that if a Trust laboratory carries out work for other Trusts, community hospitals and primary care, their published infection rate will include these other patients, making their rate higher than it really is. Consequently, patients, their families and medical advisers may be misled over the scale of C difficile in the Trust.

The new system will show where cases occur rather than just assigning all cases to the reporting laboratory's Trust, giving the public and NHS access to more accurate data. This is the first stage of the surveillance system and a group of NHS professionals are working on a risk factor page that Trusts will be able to use to identify 'hot spots' i.e. the places where they should be targeting interventions to reduce infection rates.

All PCTs are now required to agree local targets with their Trusts for reducing Clostridium difficile infections. This new surveillance system will allow them to monitor progress against these targets on a monthly basis. As this system is based on the one currently used to monitor MRSA, there will be minimal training needs for NHS staff avoiding any unnecessary burdens on the NHS.

The letter also highlighted the importance of local surveillance, stressing that Trusts and SHAs must continue to have systems that provide early warning of outbreaks and allow early implementation of control measures when necessary, as well as monitoring progress toward local reduction targets.

All central data collections must go through the Review of Central Returns (ROCR) process and are subject to Review of Central Returns (ROCR) approval. An application for this new C difficile system has been submitted and we expect a response by the summer.

1. The letter from the Chief Medical Officer and the Chief Nursing Officer 'Changes to the mandatory healthcare associated infection surveillance system for Clostridium difficile associated diarrhoea from April 2007' is available at: http://www.dh.gov.uk/HCAI

2. The HPA have developed the changes to the mandatory healthcare associated infection surveillance system for Clostridium difficile associated diarrhoea which will apply from April 2007

3. Local targets for C. difficile were introduced in the NHS operating framework for 2007/08. This can be found at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_063267

4. The latest data on MRSA and C difficile is due for publication on 26th April from the HPA

5. Under the current mandatory surveillance system the total number of cases of C difficile in patients aged over 65 years is reported electronically every quarter. The introduction of the local targets for C. difficile in the NHS operating framework for 2007/08 has highlighted the fact that the national surveillance data cannot support local monitoring of this infection. Primary Care Trusts have agreed local targets to reduce markedly C. difficile infections for the year commencing April 2007.

6. The fields required will be those to identify the case, date of birth (all cases over 2 years old to be reported); sex; specimen date; reporting laboratory and location of the patient at the time the specimen was taken. The inclusion of the date of birth will allow comparisons with previous years' data for the over 65s The under 2s are excluded as C. difficile rarely causes clinical disease in this age group.

A second voluntary page for risk factor information such as antibiotic treatment is being developed and will be available in early summer.

http://www.dh.gov.uk

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