Wednesday, May 23, 2012

HPA: Healthcare-Associated Infection (HCAI) Survey


# 6340


The UK’s HPA has released a comprehensive survey of antimicrobial use, and HCAI (Healthcare-Associated Infections), across 114 hospitals (99 NHS acute trusts and 5 independent sector organizations), providing us with a snapshot of conditions between September and November 2011.


Although the full global burden of HCAIs or HAIs (Hospital Acquired Infections) is unknown and underappreciated, even in countries with modern healthcare facilities they constitute a major threat to life and health.


The following is an oft quoted assessment from the CDC on HAI’s (Hospital Acquired Infections) in the United States back in 2010.

A new report from CDC updates previous estimates of healthcare-associated infections. In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections:

  • 32 percent of all healthcare-associated infection are urinary tract infections
  • 22 percent are surgical site infections
  • 15 percent are pneumonia (lung infections)
  • 14 percent are bloodstream infections


The subject of HAIs is often addressed by Maryn McKenna on her excellent Superbug Blog, and was a major focus of her book SUPERBUG: The Fatal Menace Of MRSA. Both are highly recommended.


The HPA is working to reduce the incidence of HAIs in the UK, and according to their latest report, progress has been made. The greatest reductions have been made in MRSA bloodstream infections and C. difficile infections.


Of special note, Enterobacteriaceae (includes E. coli, Klebsiella spp.,Enterobacter spp. and others) were the most frequently reported organisms associated with HCAI, infecting roughly .9% of the patient population, and making up nearly 1/3rd of all infections.


Links to the 140 page preliminary report, 144 page appendices, and a 16  page FAQ at the link below.


English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use, 2011: preliminary data

English PPS on HCAI and AMU 2011



Publication date: May 2012


The Health Protection Agency (HPA) coordinated the fourth National Point Prevalence Survey (PPS) on healthcare-associated infection (HCAI) and first National PPS on antimicrobial use (AMU) in England. This survey is not directly comparable to previous surveys.


The aims of the PPS were to determine the burden of HCAI and AMU in acute hospitals and to use the results to identify priority areas for the future.

Key points

  • The prevalence of healthcare-associated infections (HCAI) was 6.4% in 2011 compared to 8.2% in 2006.
  • The most frequent HCAIs detected were respiratory tract, urinary tract and surgical site infections.
  • The prevalence of antimicrobial use (AMU) was 34.7%. This is the first time AMU was measured nationally. This provides a baseline for future monitoring.
  • The prevalence of HCAIs, AMU and device use was highest in intensive care units, which relates in part to the complexity and vulnerability of patients in this setting.

Download full publication

English National Point Prevalence Survey on Healthcare-Associated Infections and Antimicrobial Use, 2011 - Appendices (PDF, 3.3 MB)


PPS Frequently Asked Questions (PDF, 654 KB)


English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use, 2011 (PDF, 1.9 MB)


While there is much to be gleaned from these reports, a few highlights from the FAQ include:



3.1 What is the overall prevalence of HCAI in English hospitals?

The overall prevalence of HCAI in acute hospitals was 6.4%.The prevalence in NHS acute trusts was 6.5% Independent sector organisation had a lower prevalence of HCAI of 2.2%.

It is not appropriate to compare the prevalence between these hospital types because they represent distinct case mixes, patient populations and specialties. Further the numbers included were very small in paediatric and independent hospitals and these results should be interpreted with caution.

3.2 Does a prevalence of 6.4% mean that if I go in to hospital I have a one in sixteen chance of getting a HCAI?

No. This means that at any time one in sixteen inpatients in hospital will have a HCAI. A prevalence survey counts the number of patients with HCAI at any point in time.

People with HCAI tend to stay in hospital longer and those patients who stay in hospital for longer periods of treatment tend to be more seriously ill and therefore more at risk of contracting HCAI. The large majority of patients are successfully treated in hospital and go home without acquiring a HCAI.

3.3 Can you tell me what my chance is of contracting HCAI during my hospital stay?

No. This is not shown by the current prevalence survey. In order to calculate how likely a person is to get a HCAI an incidence study would be required. This would look at all patients who were treated within the hospital on a regular basis over a defined time period.





The other focus of this survey was to determine the level of AMU (Antimicrobial Usage) in acute care hospitals in England.  The report found:


The overall prevalence of AMU was 34.7%. The prevalence of AMU was greatest in the independent sector hospitals (46.7%) compared with NHS organisations at 34.3%. The prevalence of AMU in adults was 35.3% and in paediatrics 28.7%. AMU prevalence was greatest in ICU at 60.8%.

The total number of antimicrobials prescribed in the survey was 25,942 for 18,219 (34.7%) patients, which equates to 1.4 AM per patient prescribed antimicrobials. AMU were most frequently prescribed for community acquired infections (53.0%). Thirteen percent of patients were on an antimicrobial (AM) for surgical prophylaxis; 30.3% of surgical prophylaxis was administered for greater than one day.


The majority of AMU was for respiratory tract infections (30.9%). The second most common reason for AMU was skin, soft tissue, bone and joint infections (19.0%).


The use of a standardized survey technique should go a long ways towards developing better year-to-year comparisons of HCAIs and AMU in UK facilities, and will facilitate comparisons with other EU countries that have adopted similar surveys.

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