Scottish surveillance of healthcare associated infection

Collecting, monitoring, analysing and interpreting information on healthcare associated infections to inform clinical practice and improve patient care. Undertaking surveillance on healthcare associated infections on a number of organisms and procedures, allowing analysis over time periods to show trends and enable interpretation.

Clostridioides difficile infection

Clostridioides difficile infection (CDI) is an important cause of infectious diarrhoea, which usually follows the use of antibiotics. While CDI is mainly associated with the healthcare setting, there's also a significant impact in the community.

National mandatory CDI surveillance started in 2006 for over 65s and extended in April 2009 to include all patients from the age of 15 years old.

 

Escherichia coli bacteraemia (E. coli)

E. coli is currently the most common cause of bacteraemia in Scotland. It’s a bacterium that forms part of the normal gut flora and helps human digestion. Although most types of E. coli live harmlessly in the gut, some types can cause illness. When it gets into the blood stream E. coli can cause a bacteraemia. This can be the result of an infection in the urinary tract, or caused by surgery or inappropriate use of medical devices.

ARHAI coordinate the national mandatory surveillance programme which collects data from all E. coli blood stream infections to provide local and national intelligence.

 

Staphylococcus aureus bacteraemia

Staphylococcus aureus is a bacterium that's a common coloniser of human skin and mucosa. It can cause disease, particularly if there's an opportunity for the bacteria to enter the body. Illnesses that may develop include skin infections, wound infections, urinary tract infections, pneumonia, bacteraemia and bloodstream infections.

Since 2001, Scotland has had a mandatory MRSA bacteraemia surveillance programme which publishes quarterly reports of the numbers and rates of MRSA bacteraemias. In 2006 the programme was extended to include meticillin sensitive S. aureus (MSSA) bacteraemias. In 2014 it expanded again to include enhanced staphylococcus aureus bacteraemia (SAB) surveillance.

 

Surgical site infection

A surgical site infection (SSI) is an infection that occurs after surgery in the part of the body where the surgery was performed. SSI may be superficial, involving the skin only, or more serious, involving tissues under the skin, organs, or implanted material. SSI is one of the most common healthcare associated infections (HAI) and can have serious consequences for patients. SSIs can result in pain, suffering, and in some cases require additional surgical intervention.

The Scottish SSI surveillance programme was established in 2002 to estimate the risk of infection after specific procedures. Currently four surgical procedures are mandatory for inclusion within SSI surveillance: hip arthroplasty, caesarean section, planned large bowel surgery and planned major vascular surgery.

 

Surveillance of HAI in intensive care units

HAI are most widespread in intensive care units (ICU). Patients in intensive care are more likely to develop a HAI because they are very ill and usually require the use of medical devices such as endotracheal tubes to help with breathing, and vascular lines to support their treatment and delivery of medicines. Surveillance of HAI in ICU includes bloodstream infections, pneumonia, and infections associated with vascular lines and endotracheal tubes.

In 2009, a national surveillance programme was introduced which uses the case definitions and methods set out by the European Centre for Disease Prevention and Control (ECDC). To deliver and develop this surveillance we work collaboratively with the Scottish Intensive Care Society Audit Group (SICSAG).

 

Norovirus

Norovirus is a common cause of infectious gastroenteritis that results in diarrhoea and vomiting. As its most common during the winter months, norovirus is sometimes known as the winter vomiting bug, but infections can occur at any time of year.

NHS boards report all ward and bay closures due to norovirus to us, including number of patients and staff affected and length of outbreak. These figures are added to an ongoing dashboard with figures by board and date.