Listening to our stakeholders - Feedback from stakeholders on MRSA bacteraemia and C.difficile infection surveillance

This meeting was for those who report MRSA bacteraemias and C. difficile infections to the Health Protection Agency or who use the Health Protection Agency's data. The meeting was an opportunity to give feedback and help in improving the surveillance system and epidemiological outputs.

Derek Butler and Maria Cann were invited to participate on behalf of MRSA Action UK. We have always advocated a system that could report a broader range of infectious pathogens than MRSA and Clostridium difficile and are only too aware of the impact other infectious pathogens have on patients and continue to campaign for wider reporting, including at a hospital level. The surveillance system is one of the best, if not the best in the world. So this was a welcome opportunity to give a perspective from the patient viewpoint, and make the Department of Health and Health Protection Agency aware of the questions we are frequently asked by people in hospital or awaiting surgery.

In addition to advocating publishing data at a hospital level, we also advocated publishing infections by speciality, this has a two-fold benefit, one for patients who will want to know risks and be able to choose and book facilities and surgeons who have lower infection risk. The other benefit is to the professionals, being able to share experience and good practice by having access to more meaningful data. In addition to the information on pathogens it was clear that a linkage to antimicrobial prescribing was needed from the discussions. It was not currently possible to link data with the growing resistant pathogens and the prescribing of antimicrobials. Other parts of the surveillance system were also not being used effectively, the tool for measuring route cause analysis was underused by many NHS Trusts. Ways of encouraging reporting and learning from this tool need to be adopted. The Department of Health Improvement Teams had played a significant role in changing the culture from an acceptance that infections were inevitable to a culture of zero tolerance to preventable infections; the programme would be finishing at the end of this financial year. We expressed concern and said this work needed to continue and be extended beyond the hospital setting and into the wider community, a point that was accepted and would be considered by the Department of Health in the ongoing work to drive improvement. 

A summary of the day is outlined below.

Dr Christine McCartney, Healthcare Associated Infection and Antimicrobial Resistance Programme Lead, Health Protection Agency, introduced the meeting and the objectives of the day, presentations on how the work of the Health Protection Agency and Department of Health had used the surveillance programme to tackle the problems with MRSA and Clostridium difficile.  Presentations will be made available here and include:

The DH perspective on HCAI mandatory surveillance (Sally Batley, DH)

How the data is used, HPA: surveillance and epidemiology (Dr Miranda Murray, HPA)

Trust level analysis (Prof Gary French, Guy's and St Thomas' NHS Foundation Trust and King's College London)

Keynote address - Prof Brian Duerden, Department of Health

Feedback from the HCAI DCS User Survey - national and regional overview

Dr Miranda Murray and Dr Deirdre Lewis, HPA

Presentations on the breakout sessions will also be published here soon, these interactive breakout sessions sought to discuss and investigate further areas already highlighted in the user survey as of interest to the NHS.  Delegates had opportunities to ask questions, comment, offer suggestions as to future changes and developments and engage in discussion with other participants, and included:

System developments: HCAI Data Capture System (the web enabled system for MRSA Bacteraemia and C. Difficile

This session provided an overview of the HCAI Data Capture System as well as its uses. Participants were given the opportunity to give feedback on their experiences of using the system as well as to provide suggestions for improvement, focusing on

- Usability of the system

- Data entry processes

- Report generating

Stakeholders were asked:

- Does the system currently meet user needs?

- How could data entry processes be improved and streamlined in order to avoid replication of entry on multiple systems?

- How could the report generator be adapted or simplified in order to better serve the needs of users? Are there any reports users would be keen to see? Are there any reports users do not feel are relevant?

- What additions do you feel are essential to future development of the HCAI Data Capture system?

Routine epidemiology and surveillance reports

The HPA is currently in the process of developing its epidemiology and reporting function and were keen to establish what information users would be keen to receive on a routine basis. Participants in this session were given the opportunity to offer suggestions as to the types of analysis that would be of use as well as to the frequency with which these reports should be made available, and focused on:

- Potentially useful epidemiological outputs

- Format of epidemiological outputs

- Availability and frequency of epidemiological outputs

- What epidemiological outputs/levels of comparison do users feel would be of particular benefit to their organisation? (e.g. age/sex breakdowns, comparison by/within region, comparison by Trust type etc.)

- Would users like to see these outputs produced to an agreed schedule (e.g. monthly/quarterly) or on more of an ad-hoc basis?

- Should the ability to produce bespoke epidemiological analyses be made available via the HCAI Data Capture System report generator?

Mandatory reporting - monthly reporting, quarterly commentaries, annual report
This session will focus on the regular mandatory surveillance publications (data tables and accompanying information) that are made available to both the NHS and the wider public. Participants were given the opportunity to provide feedback on the layout, format and content of this information, focusing on:

- Format of the routinely published data tables - is the information set out in a clear and understandable manner?

- Content of the routinely published data tables - is the right level of information included and is it easy to interpret?

- Content of all accompanying information (commentaries, data caveats etc.) - is the information set out clearly/concisely and does it include the correct level of detail?

- How could the mandatory reporting function be strengthened in order to better suit the needs of users?

- How could the layout/format of the data tables be changed/simplified in order to ensure that the included information is of more use to both the NHS and the wider public?

- How could the content of the data tables be changed/adapted in order to assist in interpretation of the data by the NHS and other users?

- What could be done to make the accompanying information (commentaries, caveats etc.) easier for both the NHS and wider public to understand?

- What additional information would users be keen to see included in these regular publications?

Risk factor/clinical data
It is currently possible for NHS acute Trusts to report risk factor data via the HCAI Data Capture System (web enabled data collection system). This information is reported on a voluntary basis and completion levels vary markedly between organisations.

This session focused on risk factor data collection and gave participants the opportunity to discuss the functionality of the risk factor pages and to offer suggestions for improvement. Participants were invited to indicate what steps could be taken in order to encourage better completion among NHS organisations., focusing on:

- Structure/format of the risk factor pages on the HCAI Data Capture System
- Content of the risk factor pages

- Does the risk factor currently meet user needs? (data entry processes, functionality etc.)

- How could risk factor data entry processes be improved and streamlined in order to avoid replication of entry on multiple systems?

- What steps can be taken in order to encourage better completion of the risk factor data?

- What kind of routine feedback/analysis would NHS organisations be keen to receive on the risk factor data?

Regional and local surveillance
The HPA currently provides regional and local surveillance through its network of Regional Offices and Health Protection Units. They were keen to establish whether this is meeting the needs of the NHS. Participants in this session were given the opportunity to provide feedback on the outputs they receive or would like to receive, focusing on:

- Intraregional comparisons and benchmarking

- Provision of surveillance in house, by PCTs or SHAs

- ad hoc and in-depth analysis
- What added value can the Regional Offices and HPUs offer over and above what is already provided?

- What outputs would you like to see?

- What would be most helpful to you?