No 21 - 2018
The HAIBA (Hospital-Acquired Infections Database), which has now been operational for three years, provides unique possibilities for ongoing monitoring of the development in hospital-acquired infections. In the course of 2017, the national monitoring of hospital-acquired infections via the HAIBA was extended through the addition of deep infections following planned total knee arthroplasty, EPI-NEWS 51/17. The HAIBA thus includes five types of infection: 1) bacteraemia (bacteria in the blood), 2), urinary tract infections, 3) intestinal infections with Clostridium difficile (C. difficile), 4) deep infections following planned (elective) total hip arthroplasty (THA) and 5) deep infections following planned total knee arthroplasty (TKA), EPI-NEWS 5.
For a detailed breakdown of the prevalence in the 2013-2017 period and development plans, please see the 2017 HAIBA annual report.
Dissemination and use of the HAIBA
Provided surveillance data are used actively to improve daily practice in healthcare, surveillance may contribute to reducing the occurrence of hospital-acquired infections. Therefore, HAIBA - in dialogue with the users - focuses on developing various ways to communicate monitoring data to optimally support the various user groups.
Current forms of communication
HAIBA provides aggregated data to the regions daily, which they can apply in regional and local analyses. If preferred, the regions can further process the data, e.g. by linking them to local data, and ensure dissemination to relevant local professionals.
HAIBA surveillance data are publicly available via eSundhed via Sundhedskvalitet (Healthcare Quality), an interactive website that provides access to various types of public healthcare data. In 2017, approx. 1,100 weekly visits (ranging from 44 to 2,079) were recorded to HAIBA data at eSundhed.
The Clinical Quality Development Programme of the Danish Regions (Danish abbreviation: RKKP) also collects the aggregated HAIBA data, allowing these data to form part of the efforts made to improve quality in the regions.
The Danish Ministry of Health has included data on bacteraemia and C. difficile from HAIBA as indicators in The National Healthcare Objectives under Objective 3 - improved survival and patient safety.
If HAIBA data were organised and provided to the regions as individual-level data with the associated person identification data, it would be possible to link these unequivocally to local data. This would increase considerably the opportunities to use the data in the local efforts. The technical solutions have been developed, but the legal basis still needs to be clarified.
Regional use initiatives
Some regions have chosen to present the data using statistical process control (SPC) and find that this makes sense in the dialogue between the infectious hygiene units and the clinicians.
In the Capital Region of Denmark, aggregated HAIBA data form part of the continuous regional and local surveillance efforts. Data on the five types of infection are reported monthly using SPC and are published along with data on antimicrobial consumption and resistant bacteria at the region’s website. This is done in an interactive data application and in a monthly report. The monthly report is forwarded to hospital managements.
In the North Denmark Region, HAIBA data are displayed in the region’s Management Information System. Data are presented in tables and graphics, including trend lines and medians based on the number of infections for bacteraemia, C. difficile and urinary tract infections. The median represents the occurrence recorded in the preceding calendar years. The presentation of the data allows the user to filter by period, week/month and internal organisation. The North Denmark Region is working to develop the system to allow for display of the development of infections in line with the SPC principles. Furthermore, the management monitors bacteraemia data as a strategic regional focus area.
In Region Zealand, the regional HAIBA data are processed in the Department of Clinical Microbiology using SPC and are presented in graphs showing development trends for the past 24 months. Graphs are made available on the region’s intranet and are, among others, used in connection with dialogue meetings in the hospitals’ hygiene committees and for training in infection prevention and control and antimicrobial consumption.
In the Region of South Denmark, selected hospitals have prepared their own SPC programs based on HAIBA data. The region is working to prepare diagrams for all hospitals in the region and to present these on a joint regional platform for use in blackboard meetings and in the hospital units’ general work to improve infectious hygiene.
In the Central Denmark Region, HAIBA has been used since January 2017 at Hospital Unit West during annual infectious hygiene revisions performed in all bed wards. Data are presented to establish a starting point for discussions and assessment of potential improvements. To ensure easy comparison, the reports present infection rates alongside those from the two previous years, and also allow for comparison with national, regional, hospital and department/bed ward-level using colour codes in line with the national quality objectives. At the departmental level, the value of own development is prioritised, and in this context comparisons are made with data on risk factors, including urinary catheters and peripheral and central venous catheters. HAIBA-data are available on the intranet via the departments’ data pages, which link directly to the department’s own data.
Status quo for 2017
In the beginning of 2017, the SSI was reorganised. All disease surveillance, laboratory-based as well as epidemiological surveillance, was merged into Infection Preparedness. To consolidate all monitoring systems and secure their operation, a new secretariat was established: The Dataintegration and Analysis Secretariat (DIAS). Professional operations of HAIBA are now handled by National Center for Hospital Hygiene (Danish abbreviation: CEI) in the Department for Infectious Epidemiology and Prevention, and technical operations are handled by DIAS.
In January 2017, Sophie Gubbels, MD MSc defended her PhD project entitled: The development of a national surveillance system for hospital-acquired infections in Denmark – The hospital Acquired Infections Database – HAIBA, on the development of HAIBA. In August 2017, Infection Prevention and Control Nurse Jette Holt, MA initiated a PhD project entitled: Surveillance and of hospital-acquired infections and dissemination of surveillance data. The objective of the project is to explore how HAIBA is being used in daily infections medicine practice, and where there is room for improvement. In this context, Jette Holt has established contact to the Infection Prevention and Control Units of all five Danish regions. The contact was made by phone or through visits. A questionnaire survey of the organisational structure of the hygiene organisations has been conducted in all five regions. Furthermore, following a semi-structured interview guide in four of the five regions, qualitative interviews were done on monitoring and prevention of hospital-acquired infections - including the use of HAIBA. The interviews are being completed in the last region in the course of the spring of 2018. Results are being processed and an article is upcoming.
In November 2017, the National Audit Office of Denmark published a report entitled: Prevention of hospital infections in which the regions are, among others, encouraged to establish objectives for the reduction of nosocomial infections. In this context, active use of the HAIBA and the ongoing collaborative projects are essential.
S. Gubbels, C.S. Jensen, B. Kristensen, J. Nielsen, Department of Infectious Disease Epidemiology and Prevention, M. Chaine, I. Johanson, K.S. Nielsen, M. Voldstedlund, Dataintegration and Analysis Secretariat, K. Mølbak, Infection Preparedness, C. Nobel, Customer Relations and Application Management, Danish Health Data Authority, A.M.B. Hellesøe, The Capital Region of Denmark’s Task Force for Reducing Hospital Acquired Infections, Copenhagen University Hospital (Rigshospitalet), J.O. Jarløv, Department of Clinical Microbiology, Herlev and Gentofte Hospitals, H.B. Borgeskov, Quality and Development, Region Zealand, P.D. Cramon, Quality and Development, Region Zealand, J. Engberg, Department of Clinical Microbiology, Slagelse Hospital, H.C. Schønheyder, Department of Clinical Microbiology, Clinical Diagnostics, Aalborg University Hospital, J. Kjær-Rasmussen, Improvement, Quality and Communication, North Denmark Region, S. Ellermann-Eriksen, Department of Clinical Microbiology, Aarhus University Hospital, L.N. Hansen, Corporate Quality, Regionshuset Viborg, Central Denmark Region, J.K. Møller, Department of Clinical Microbiology, Hospital Lillebælt, Vejle Hospital, A. Holm, Department of Clinical Microbiology, Odense University Hospital, L. Andersen, Department of Clinical Microbiology, Odense University Hospital, A. Jensen, Infection Prevention and Control Unit, Hospital Unit West, Søren Overgaard, Department of Orthopeadic Surgery O, Odense University Hospital, Department of Clinical Research, The University of Southern Denmark, Danish Hip Arthroplasty Register, Søren Solgaard, Danish Hip Arthroplasty Register, Frank Madsen, Danish Knee Arthroplasty Register, Anne Hjelm, The Clinical Quality Development Programme of the Danish Regions.