Title: Infection Intelligence Platform (IIP) Clinical studies Professor Marion Bennie National Services Scotland
1 Infection Intelligence Platform (IIP)Clinical
studies Professor Marion Bennie National
Services Scotland
2Vision
- A comprehensive, dynamic and responsive resource
capability for Scotland that will harness
existing health data to support clinicians in
improving patient outcomes and reduce harm from
community and healthcare acquired infection.
3Vision
- Intrinsic (patient)
- Age / gender
- Colonised
- Morbidity
- Drug history
- Vaccine history
- Extrinsic (environment)
- - Medicines (prior use)
- Lines/Catheters
- Hand Hygiene
- Surgery
- Length of stay
- Prevention Intervention
- SIPS- Standard infection control precautions
- Antimicrobial stewardship
Infection Management Antibiotic policy Infection
control (TBP - Transmission based precautions)
Patient outcome
Monitoring / Surveillance Intended
consequences Unintended consequences
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5NHS Scotland Infection Intelligence Platform Road
Map
6Benefits (Improve care - reduce harm - reduce
variation)
- Patients
- Support individual prevention/treatment plans
- NHS Boards
- Drive quality improvement in local service
delivery model (intended/ unintended
consequences) - National Surveillance
- Identify emergence of antimicrobial resistance
- Research
- Support evidence based clinical practice
7Deliverables (2013-2016)
- To gain the necessary information governance
approvals - To build the required IMT Infrastructure to
support the IIP by technically linking six
sources initially - To complete a series of exemplar clinical studies
to test the IIP capability and effectiveness
8Key Datasets
- ECOSS Electronic Communication of Surveillance
in Scotland (antimicrobial resistance data) - HMUD Hospital Medicines Utilisation Database
- PIS Prescribing Information System (primary
care prescribing) - SCI Store Clinical Information (e.g. Lab
results, Radiology reports) Repository - SMR Scottish Morbidity Record (SMR)SMR01
- Inpatients, Day Cases, Discharge Diagnosis
- SMR02 Maternity Inpatients, Day Cases,
Discharge Diagnosis - SMR99 Mortality
- SSIRS Surgical Site Infection Reporting System
9Study Themes
Themes Study Number
1. Identification of Risk Factors for selected Common Bacteraemias Study 1 2
2. Validation of IIP for Surgical Site Infection (SSI) surveillance Study 3
3. Impact of Primary Care antimicrobial prescribing on antimicrobial resistance patterns and HAI Studies 4-7
4. Mortality associated with HAI Studies 8 9
5. Sepsis Diagnosis, management and outcome Studies 10-13
6. Intended and Unintended consequences of antimicrobial prescribing change in surgery Studies 14-16
10Theme 1 - Risk Factor Analysis in bacteraemias
(ECOSS / SMR studies 12)
- To describe the demographics and co-morbidities
of patients with common bacteraemias and CDI - SAB and E.Coli (test -SIRN funded)
- Extend to include MRSA,MSSA, CDI
- Establish routine linkage for ongoing
surveillance as risks of infection changeover
time
11Theme 4 - Mortality Associated with HAI(ECOSS /
SMR/SSIRS studies 89)
- To determine the case fatality (30 and 90 days)
associated with common HAI - SSI, SAB, CDI (test )
- To identify variation in case fatality associated
with risk factors - To produce standard reporting mechanisms for MRSA
and CDI death from 2015 (current system to stop
in 2014)
12Theme 2 - Surgical Site Infection (SSI)
surveillance(ECOSS / SMR/SSIRS study 3)
- Current manual collection of data locally to
input into national datamart - Mandatory minimum of 2 operation categories
(caesarian and hip arthroplasty mandatory, where
practised) - To test capability of IIP to reproduce data
(SSIRS) through routine record linkage (ECOSS and
SMR ) to replace the need for manual data
collection within the Health Boards.
13Theme 3 - Primary care antimicrobial prescribing
- impact on resistance patterns and HAI(ECOSS
/ SMR//PIS studies 4-7)
- To develop generic surveillance system to
estimate associations - Antimicrobial exposure and risk of CDI (test
SIRN funded ) then extend to other HAI - Examination of 4 antimicrobials in UTIs and
impact on resistance and clinical outcome (test
SIRN funded ) then extend to other infections
14Theme 5 - Sepsis diagnosis, management and
outcome (SMR/SCI Store studies 10-11)
- Use of blood culture as a proxy marker for sepsis
- To quantify changes in 30 day mortality (from
date of blood culture) following adoption of
restricted antibiotic policy (test Tayside and
Lanarkshire ) then extend to all NHS Boards - Establish robust sepsis outcome measure to
monitor progress to national target
15Theme 5 - Sepsis diagnosis, management and
outcome (SMR/SCI Store/HMUD/HEPMA studies
12-13)
- Monitoring impact of key high risk antibiotics in
hospitals e.g. carbapenameses on emergent
bacteremias - Policy change intervention
- Individual patient level outcome
-
16Theme 6 - Surgery consequences of changing
antimicrobial prescribing policies (SMR/SCI
Store/HMUD studies 14-16)
- To examine renal toxicity (acute kidney injury)
following introduction of restricted antibiotic
policies - Test in NHS Lanarkshire
- Extend to all NHS Boards and for other identified
laboratory measures - To evaluate reduction in 4C use and impact on CDI
and mortality