Select Committee on Science and Technology Minutes of Evidence



Surveillance of Healthcare Associated Infection

Strategic Overview


  1.1  The Department of Health (DH) established the Healthcare Associated Infection Surveillance Steering Group (HAISSG) to provide it with strategic advice on the surveillance of healthcare associated infection (HAI). This paper outlines a proposed strategy on the surveillance of HAI for consideration by DH.

  1.2  The overarching objective of HAI surveillance is to minimise the morbidity and mortality arising from HAI through the implementation of surveillance systems that provide information for the prevention and control of infection.


  2.1  Ministers of State have required that systems are put in place to undertake surveillance and monitoring of healthcare associated infection across the NHS so that the overall level of infection can be ascertained and variations between Trusts, hospitals and other healthcare activities can be compared.


  3.1  The purpose of surveillance is to describe patterns of infection and changes over time so that prompt and appropriate actions may be instituted. It also provides a means of comparing the performance of healthcare institutions and monitoring the effectiveness of prevention and control measures in place.

  3.2  It is proposed that developments in surveillance and monitoring of infection undertaken by all NHS Trusts are undertaken in three phases:

Phase 1

  The implementation of hospital based and nationally co-ordinated:

    —  Alert organism surveillance; and

    —  Monitoring of adverse patient events.

Phase 2

  The development of hospital based and nationally co-ordinated alert condition surveillance, followed by its implementation.

Phase 3

  The extension of surveillance of HAI surveillance to healthcare settings outside hospitals.

  3.3  HAISSG has produced a general description of these activities, including the principles to be applied in their implementation. In addition, illustrative protocols have been produced for priority organisms and conditions to be surveyed. These protocols:

    —  Focus on a minimum number of high priority infections and conditions;

    —  Outline a mechanism for the provision of information at each level within the NHS as a basis for further discussion with key stakeholders;

    —  Identify suggested minimum datasets for capture, collation and analysis; and

    —  Take account of the current surveillance activities undertaken and systems most widely used.


Investigating problems

  4.1  In order to be sustainable, routine surveillance systems will need to collect only the minimum data required for the prompt identification of problems and the overall pattern of infection. As a result, it may be necessary to undertake further investigation of problems identified through surveillance.

  4.2  It is proposed that DH enters into an agreement with a suitable service provider to establish and maintain a capability to design, test and disseminate epidemiological tools for the further detailed investigation of problems of healthcare associated infection.

Improving clinical practice

  4.3  Audit provides a mechanism by which outcome of clinical interventions, including the reduction in infections arising as a consequence of care, can be improved. Such activities are likely to be focussed on specific priority areas in individual specialties. Prevention of infection will be only one element under consideration.

  4.4  It is proposed that DH include the provision of expert advice in support of clinical audit, as part of its agreement with a suitable service provider.


  4.5  Providers of clinical services will need to have indicators of the appropriate standards to be achieved in the prevention and control of infection. Such standards will need to be based on current best practice and take account of the differences in case-mix between hospitals.

  4.6  It is proposed that, as part of its agreement with a suitable service provider, DH ensure that appropriate benchmarking activities are undertaken.


Service providers

  5.1  Decisions on securing an appropriate service provider are a matter that rests with DH and is outwith the terms of reference of HAISSG. However, HAISSG has been asked to provide advice on a range of issues to ensure that future developments take due account of what already exists, wherever possible maximising the benefit of experience gained to date.

Experience to date

  5.2  In April 2001, at the request of DH, the Communicable Disease Surveillance Centre (CDSC), established nationally co-ordinated surveillance of bacteraemia caused by methicillin resistant S. aureus. At a point to be agreed, the data collected should be brought in line with that set out in the alert organism surveillance protocol for MRSA.

  5.3  It is noted that, in the first instance, DH is minded to enter into an agreement with PHLS for CDSC to undertake routine surveillance and monitoring of HAI, in order that the benefit and utility of existing systems for the capture and transmission of data can be maximised.

  5.4  The current form of agreement between DH and PHLS for the development of a National Surveillance System for Hospital Acquired Infection (NINSS) will come to an end in March 2002. The achievements of NINSS were the subject of an external review and set out in a report (The Cunningham report). It will be essential to ensure that the experience, knowledge and expertise gained through this project are harnessed to meet the emerging needs, namely:

    —  Providing robust epidemiological tools for the detailed investigation of problems of HAI;

    —  Contributing to clinical audit; and

    —  Responding to the needs of NHS performance managers, through robust and reliable benchmarking.


  5.5  The recommendation of the Cunningham Report to establish a surveillance service to meet the needs of the NHS is supported.

  5.6  It is recommended that, in order to achieve this:

    —  "surveillance and monitoring of infection" and "investigating problems and improving standards" should be an integrated function;

    —  as part of its agreement, DH secures a performance management process that ensures that the work programme is customer-led;

    —  extensive consultation is undertaken with professional representatives of infection control teams and public health professionals.

    —  it is anticipated that Regional Directors of Public Health will play a key role in the performance management of this process;

    —  plans should ensure a smooth transition from existing to future arrangements;

    —  in moving to any new arrangement, provision is made for retaining knowledge and expertise gained through NINSS; and data collected by existing surveillance and monitoring systems, including NINSS, should be retained and appropriately utilised for the purposes set out in this outline strategy.

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