Select Committee on Science and Technology Minutes of Evidence

Memorandum by the Hospital Infection Society

  1.  Surveillance should be "bottom-up" rather than "top-down" as meaningful surveillance is carried out at the "coal face" and the highest degree of interest is generated there.

  2.  Regional/National/International data is a spin-off from the "bottom-up" approach. National data is interesting and can serve as a useful benchmark but we should not lose sight of the singular importance of local surveillance.

  3.  Core datasets should be agreed nationally.

  4.  Engagement with professional bodies and royal colleges is imperative and should be at an early stage to agree on the core dataset.

  5.  Once nationally agreed core dataset exists local teams must have freedom to influence dataset design however the core dataset must not be negotiable.

  6.  Collation and processing of data should be undertaken by any method that works.

  7.  Paper questionnaires have many advantages:

    (a)  Cheap.

    (b)  Always "switched on" as opposed to finding a computer in which to enter data.

    (c)  Easily modified to local need.

    (d)  Totally independent of hospital's IT system. In other words you can collect data however bad the IT system is at providing data. Also a lot of the data required, especially clinical data, will not be on a hospital's IT system.

  8.  Handheld computers for data collection sounds "sexy" but have major disadvantages:

    (a)  Expensive.

    (b)  Requires software for data collection.

    (c)  Requires training for staff.

    (d)  Slow to use.

    (e)  Restricted numbers will cause data collect to fall on a small number of individuals who will most likely not be able to cope.

    (f)  Soon out of date requiring replacement.

  9.  However handhelds/portable PCs may be extremely useful as a means of feedback. If you carry surveillance data on the handheld you may be able to answer questions from clinical teams "on the fly".

  10.  Data processing can be done locally if facilities exist and uploaded electronically to a regional centre. For those with no local facility for data processing questionnaires can be sent to the regional centre for scanning.

  11.  Regional centres must not be too big so as to prevent them from providing an individual service. Specifically, the best local involvement is obtained by allowing the local teams to design their own dataset (containing an unaltered core dataset). To allow this to happen the regional centre must be capable of providing a scannable questionnaire (or other suitable means) to meet local needs. There will be a limit as to how many local questionnaires that can be facilitated hence there will be a maximum size of a local centre. As an example I feel that only one centre will be required in Northern Ireland, Wales and Scotland but numerous centres will be needed for England.

  12.  Coordination of the regional datasets is required to facilitate easy aggregation into supra-regional/national datasets.

  13.  Rapid processing of data and return of the database to individual trusts is paramount.

  14.  The persons collecting the data will need all of the following:

    (a)  Basic computer skills and access to a computer.

    (b)  Data handling.

    (c)  Data analysis.

    (d)  Basic epidemiology.

    (e)  Basic statistics.

    (f)  Presentation skills.

    (g)  Report production.

  15.  Any surveillance process is useless if we do not attempt to stratify risk among patients.

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