Healthcare associated infections
February 2006
Strategies for improvement: role of the healthcare professional
Active surveillance and investigation
High quality information on HCAIs and antimicrobial resistance is essential to tracking progress, investigating underlying causes and instituting prevention and control measures. The availability of complete and accurate information to clinical staff and patients has been recognised as the cornerstone of infection control. [Go to note 1] The DH identified active surveillance and investigation as one of the key action areas in controlling HCAIs. In England, the HPA Centre for Infection (CFI) is responsible for the surveillance and monitoring of HCAIs through a national surveillance scheme co-ordinated by the Healthcare Associated Infection and Antimicrobial Resistance (HCAIs & AMR) Department of the Communicable Disease Surveillance Centre (CDSC). As part of the national HCAIs surveillance initiative, mandatory surveillance in England was introduced for MRSA in 2001, followed by GRE in 2003, C.difficile in 2004 and orthopaedic SSIs in 2004. In addition a voluntary initiative known as the Surgical Site Infection Surveillance Service (SSISS) (formerly the Nosocomial Infection National Surveillance Scheme) was established in 1996 to encourage the surveillance of SSIs.
In Wales, the WHAISG is responsible for surveillance of HCAIs and mandatory surveillance of MRSA was introduced in 2001, followed by SSI for knee and hip operatives in 2003 and C.difficile in hospital inpatients aged over 65 in 2005. Health Protection Scotland (HPS) is responsible for surveillance of HCAIs in Scotland where mandatory surveillance of MRSA was introduced in 2001, followed by SSI in 2002. The Healthcare-associated Infection Surveillance Centre (HISC) is responsible for surveillance of HCAIs in Northern Ireland where mandatory surveillance of MRSA was introduced in 2002 followed by C.difficile in 2005. All hospitals in Northern Ireland performing adult orthopaedic procedures have participated in a SSI surveillance initiative organised by the HISC. There is however, no national mandatory surveillance scheme for all HCAIs and the full extent of the problem remains difficult to gauge. Although mainly an organisational and managerial concern, healthcare professionals have an important role to ensure that accurate records are maintained and that all new infections are accurately reported if surveillance is to be effective.
Further information
- Action areas and guidelines on active surveillance and investigation can be found in Winning ways: working together to reduce healthcare associated infection in England (Department of Health, 2003).
- Details of the activities and roles of the Healthcare-Associated Infection and Antimicrobial Resistance (HCAIs & AMR) Department can be found on the HPA website here at www.hpa.org.uk/infections/about/dir/dir_hcai.htm