Introduction to the Infection Intelligence Platform (IIP) Professor Marion Bennie National Services Scotland University of Strathclyde

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Introduction to the Infection Intelligence
Platform (IIP)Professor Marion Bennie National
Services Scotland University of Strathclyde
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National reduction in 4C antibacterials in
primary care

• Target antibacterials
• Cephalosporins
• Ciprofloxacin
• Clindamycin
• Co-amoxiclav

Data from Scottish Antimicrobial Prescribing
Group Primary Care Prescribing Indicators
reports, 2010 and 2012-13
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From Strategy To Bedside Care
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Better Access To And Use Of Surveillance
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IIP - Vision

• Improving patient outcomes and reducing harm from
  infection through an innovative, integrated
  database, to support clinicians within the NHS in
  Scotland

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IIP - Vision

• 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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Step 1 - AMIDS (Antimicrobial Integrated Database
Scotland)
ECOSS (resistance)
PIS (prescribing)
HMUD (prescribing)
ACaDMe (acute cancer, deaths and mental health)
AMIDS

• Combined Data
• Use AMR
• Use CDI
• Standard reports
• Snapshot all NHS boards
• Trend board vs Scotland

PCs (users in NHS)
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Fluoroquinolone use and resistance(Ecoli
bacteraemia)NHS Board and Scotland 2008-11
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Step 2 - Unintended Consequences
Local Hospital Medicines Database
Orthopaedic Surgery
Serum Creatinine
SCI STORE
Local Prescribing
SMR01
Post-operative Acute Kidney Injury, all patients,
unadjusted analysis pre vs. last post-operative
creatinine measurement (NHS Tayside, Peter Davey)
Antibiotic Policy Change
New Antibiotic Policy fully implemented
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Step 3 Policy Support

• Strategic Case
• NHS Scotland eHealth Strategy Board in March 2013
  (agreed)
• Business Case
• Clinical engagement (review group)
• SGHCD HAI National Advisory Group in July 2013
  (approved)

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IIP - Road Map
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IIP - Benefits (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

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Case Vignette - Patient with catheter urinary
tract infection (UTI)

• A 75 year old man in a residential home with long
  term catheter
• multiple co-morbidities (diabetes mellitus and
  congestive heart failure)
• Discharged from hospital 6 weeks ago following a
  catheter related UTI.
• Since return home he has had a non-severe episode
  of C.difficile (CDI) diarrhoea which resolved
  with treatment.
• Seen by the out of hours service with a probable
  recurrence of a catheter related UTI and
  prescribed trimethorpim.
• 24 hours later he has become more unwell with
  sepsis and is admitted to hospital and treated
  with empiric amoxil and gentamicin.

• Risk factors
• Is this patient at increased risk of CDI in both
  settings?
• Is the patient at increased risk of CDI
  recurrence within 3 months of the original
  episode?
• Treatment
• What is the likely local and national antibiotic
  sensitivity and clinical effectiveness of
  different antibiotics in both clinical settings?
• Outcomes
• Is current treatment of UTI in the community
  associated with increased hospital admissions
  with sepsis? What is the 30-day mortality of
  patients admitted with sepsis?
• Is the use of gentamicin in the acute empiric
  setting associated with increased acute kidney
  injury (AKI)?

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Deliverables (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

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IIP - Project Governance
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Key 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

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IIP Clinical studies
Clinical Study Work Stream
Risk factors SAB E Coli bacteraemia Risk Factors
Routine analysis risk factors for common bacteraemia Risk Factors
Primary Care prescribing and HAI CDI Interventions
Primary Care prescribing and other HAI Interventions
UTI Primary Care prescribing and AMR Interventions
Other Primary Care prescribing and AMR Interventions
High risk antibiotic prescribing and outcomes from emerging resistant pathogens Interventions
Validation of IIP for SSI surveillance Outcomes
Mortality associated with SSI, SAB, CDI, HAI Outcomes
MRSA and CDI deaths routine reporting Outcomes
30 day mortality after blood culture SAPG restrictive policy evaluation Outcomes
Standardised 30 day blood culture mortality SPSP sepsis collaborative evaluation Outcomes
Consequences of secondary care antibiotic policy changes AMR and clinical outcome Outcomes
Surgical prophylaxis changes AKI in NHS Lanarkshire and across Scotland (n2) Outcomes
Addition of local datasets (e.g. ICNet, HEPMA, HMUD) to IIP Technical
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Acknowledgements

• IIP Core Project Team
• IIP User Group
• IIP Joint Project Board