Infection Intelligence Platform (IIP) Clinical studies Professor Marion Bennie National Services Scotland

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Infection Intelligence Platform (IIP)Clinical
studies Professor Marion Bennie National
Services Scotland
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Vision

• 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.

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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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NHS Scotland Infection Intelligence Platform Road
Map
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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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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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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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Study 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
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Theme 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

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Theme 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)

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Theme 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.

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Theme 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

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Theme 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

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Theme 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

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Theme 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