staphylococcus aureus bacteraemia surveillance report

NPHS Communicable DiseaseSurveillance Centre

Staphylococcus aureus Bacteraemia Surveillance Report

Specialty Data

01/10/2001 - 31/12/2003

January 2005

Anonymised Version

Index

Page Introduction 3 Notes for Interpretation 4 Results Summary 5 Results 1. All Wales 6 Results 2. Trust Specific 12 Results 3. Statistical Process Control Charts 43 Discussion 79 Appendices 81

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Introduction Mandatory S. aureus bacteraemia surveillance was introduced in Wales in April 2001. Since October 2001 data has been collected on the medical specialty of the patient when the blood culture was taken. This report presents data on S. aureus by medical specialty for the period 01/10/2001-31/12/2003. The results for this report are divided into 3 sections:

i. All Wales Specialty data ii. Data for Individual Trusts iii. Statistical Process Control Charts

i. For the all Wales data, the numbers and rates of S. aureus bacteraemias

reported for each medical specialty where more than 30 bacteraemias were reported in the surveillance period have been provided. Data from specialties with 30 or fewer bacteraemias have been aggregated together and reported under the category ‘Others’. For all-Wales data, results have been compared using 3 different hospital activity measures as the denominator data: I) bed days, II) inpatient deaths and discharges/transfers and III) inpatient deaths and discharges/transfers plus outpatients and regular clinic attendances ie total specialty activity.

ii. For each Trust, the numbers and rates of S. aureus bacteraemias for all

specialties have been provided. For the Trust specific data, rates have been calculated for all specialties using bed days and inpatient deaths and discharges/transfers as the denominator data, other than A&E where outpatients have been included. In addition, rates by total specialty activity have been provided for oncology and haematology.

iii. Statistical process control (SPC) charts have been generated for all

specialties where more than 30 S. aureus bacteraemias have been reported. The charts provide a means of distinguishing between natural variation and ‘special cause’ variation. A rate that falls outside the control limits should lead to a search for the explanation for the situation, which has resulted in the outlier rate. The result maybe due to either a true high or low rate of S. aureus bacteraemia within the specialty or to reporting biases (e.g. incomplete reporting or over-reporting) or denominator inconsistencies. For the SPC charts, rates have been calculated using inpatient deaths and discharges/transfers for the majority of specialties, but for A & E outpatients have been included in the denominator, and for oncology and haematology total activity has been used ie inpatient deaths and discharges, outpatients and regular clinic attendances.

Total activity rates have not been calculated nor SPC charts generated for the specialty of nephrology, because of inconsistencies in the way that dialysis session data has been provided between Trusts. Nephrology rates will be updated at a later date.

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Notes for Interpretation 1. The report covers isolates with specimen dates in the period 01/10/2001 –

31/12/2003. 2. The denominator data was obtained from the Health Solutions Wales database,

Quest 1 (available to all NHS web users). 3. Bed days were calculated from the average daily occupied beds, provided from

Quest 1 and multiplied by the average number of days in the surveillance period. One patient in one bed for one night is one occupied bed day. The bed day rate relates the diagnosed cases to the total number of days during which patients have been in the specialty in the surveillance period.

4. The inpatient deaths and discharges rate relates the diagnosed cases to the total number of inpatients who have been treated in the specialty in the surveillance period.

5. The inpatient deaths and discharges etc rate uses inpatient deaths and discharges combined with numbers of outpatients attendances and regular clinic attendances as the specialty activity denominator. The inpatient deaths and discharges etc rate relates the diagnosed cases to the total number of patients who have been treated in the specialty in the surveillance period.

6. 95% Poisson exact confidence limits have been calculated around the bacteraemia rate for each specialty. These assist in determining whether particular specialties are outliers in terms of their rates or whether normal variation could account for the result in this period. Overlapping confidence interval bars indicate no significant difference between rates. For some graphs, because the confidence intervals were large, in order to improve the readability of the rest of the data, y-axis scales have been shortened so the top of the upper confidence limit is missing.

7. The data are also represented in the form of statistical process control charts for each specialty. The rates for the particular specialty for individual Trusts are plotted on the chart. The lines on the chart represent the mean, upper and lower limits of the Welsh rate for that specialty (defined by 3 standard deviations of the Welsh rate). This assumes that rates for that specialty in different Trusts will be largely similar. They allow the distinction between natural variation (rates that fall within the limits) and special cause variation, where something unusual is occurring in a Trust (rates that fall outside the limits). A rate that falls outside the control limits should lead to a search for the explanation for the situation, which has resulted in the outlier rate. This could be the result of either a true high or low rate of S. aureus bacteraemia or due to reporting biases eg incomplete reporting or over-reporting.

8. For the specialty report, Trusts have NOT been categorised into General Acute, Single Specialty and Specialist Trusts. All Trusts in Wales with numerator or denominator data for a particular specialty have been plotted on the SPC chart for that specialty.

9. Data represents S. aureus bacteraemias diagnosed in a particular specialty in a particular Trust; the S. aureus was not necessarily acquired in that specialty nor in that Trust.

10. Acute Trusts vary in their case mix and in their proportion of acute beds. Differences in numbers of patients with increased vulnerability to MRSA may contribute to differences in MRSA bacteraemia rates in different locations.

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Results Summary

• Compliance with reporting the medical specialty of the patient was high, with 99.3% (2525/2543) of S. aureus bactaeraemia reports containing this data item.

• Highest numbers of S. aureus, MRSA and MSSA bacteraemias were reported

from General Medicine, followed by Nephrology.

• 77% of MRSA bacteraemias were reported from the top 5 specialties for MRSA; 68% of MSSA bacteraemias were reported from the top 5 specialties for MSSA.

• The specialties with the highest proportion of methicillin resistance in the S.

aureus bacteraemias were general surgery (60%) and ITU (58%), compared with an overall percentage methicillin resistance of 43%.

• The specialties with the highest rates of bacteraemias differed according to the

denominator used to calculate the rates.

• Using total specialty activity as the denominator, the highest rate of MRSA bacteraemia was in the ITU, which was significantly higher than any other specialty, although nephrology was not included in these calculations.

• Using total specialty activity as the denominator, the highest rate of MSSA

bacteraemia was in the SCBU, although the rate in the SCBU was not significantly higher than for the next 2 highest specialties - ITU and cardiology. Once again nephrology was not included in these calculations.

• Within each Trust, there were some differences in bacteraemia rates in

different specialties.

• In the SPC charts generated for rates of MRSA bacteraemias, 5 specialties had Trusts with rates above the upper control limits: general medicine, general surgery, geriatric medicine, haematology and ITU.

• In the SPC charts generated for rates of MSSA bacteraemias, 4 specialties had

Trusts with rates above the upper control limits: general medicine, geriatric medicine, haematology and SCBU.

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RESULTS

1. All Wales

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2543 Staphylococcus aureus bacteraemias were reported in Wales for the period 01/10/2001 to 31/12/2003. 2525 of the bacteraemias were reported from a total of 34 different specialties and there were 18 bacteraemias of unknown specialty. MRSA bacteraemias were reported from 33 specialties and MSSA bacteraemias from 28 specialties. Although MRSA bacteraemias were reported from more specialties, 77% of MRSA bacteraemias were reported from the top 5 specialties, compared with 68% of MSSA bacteraemias reported from the top 5 specialties for MSSA. Table 1 gives the numbers of bacteraemias from all specialties where more than 30 S. aureus bacteraemias were reported in the time period. Those with less than 30 bacteraemia reports have been aggregated into an ‘Others’ category (the specialties included in the ‘Others’ category are listed in Appendix 1).

Table 1. The number of MRSA, MSSA and all S. aureus bacteraemias by medical specialty reported in Wales, Oct 01-Dec 03.

Specialty MRSA MSSA Total S. aureus

General Medicine 365 515 880

Nephrology 159 181 340

General Surgery 153 103 256

Intensive Therapy Unit 106 77 183

Geriatric Medicine 65 76 141

Accident/Emergency 29 107 136

Trauma/Orthopaedics 37 64 101

Paediatrics 7 67 74

Cardiology 16 47 63

Haematology 26 34 60

Urology 30 28 58

Oncology 18 31 49

Special Care Baby Unit 2 30 32

Others (inc UKN) 85 91 176

The overall percentage methicillin resistance in S. aureus bacteraemia isolates was 43%. Of the specialties where more than 30 S. aureus bacteraemias were reported in the time period, the specialties with the highest percentage methicillin resistance were general surgery and the intensive therapy unit, both with rates approaching 60% (see Table 2).

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Table 2. Proportion of S. aureus bacteraemias that are methicillin resistant in the top 13 medical specialties

Specialty % methicillin resistant

General Surgery 59.8

Intensive Therapy Unit 57.9

Urology 51.7

Nephrology 46.8

Geriatric Medicine 46.1

Haematology 43.3

General Medicine 41.5

Trauma/Orthopaedics 36.6

Clinical Oncology 34.9

Cardiology 25.4

Accident/Emergency 21.3

Paediatrics 9.5

Special Care Baby Unit 6.3

Comparisons of rates of S. aureus bacteraemias between specialties are difficult because of the different natures of the patient populations within different specialties. Some are characterised by high patient turnover with short lengths of stay, others have fewer patients but with longer lengths of stay. The balance between inpatient, outpatient and day case activity also varies considerably between specialties. In general it would be better to compare the rates within a specialty over time or compare the rates for different Trusts within a specialty (as done in the SPC charts). However, in order to give an indication of the different rates for different specialties, and to demonstrate how the choice of denominator influences the relative position of different specialties, bacteraemia rates in different specialties have been compared in Tables 3, 4 and 5, using different specialty activity data to calculate the rates. Specialties are listed in descending order based on their rate of total S. aureus bacteraemias. Bacteraemia Rates by Bed Days Table 3 and Figures 1, 2 and 3 in Appendix 2 present the data using bed days as the specialty activity measure used to calculate the rates. Bed days are calculated from the average daily occupied beds. One patient in one bed for one night is one occupied bed day. The bed day rate relates the diagnosed cases to the total number of days during which patients have been in the specialty in the surveillance period. Using the bed day denominator, highest rates were for A & E and Nephrology, but these high rates may reflect the different patient populations for these two specialties, where the majority of A & E patients are outpatients and the bed day data for nephrology excludes the dialysis patients.

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Table 3. Rates of total S. aureus, MRSA and MSSA bacteraemias per 1000 bed days by specialty

Specialty Bed Days

SA/1000 bed

days

MRSA/1000

bed days

MSSA/1000

bed days

Accident/Emergency 8745 15.55 3.32 12.24

Nephrology 54279 6.26 2.93 3.33

Intensive Therapy Unit 81637 2.24 1.30 0.94

Haematology 61906 0.97 0.42 0.55

Cardiology 104361 0.60 0.15 0.45

Oncology 100727 0.49 0.18 0.31

Urology 150671 0.38 0.20 0.19

General Medicine 2469666 0.36 0.15 0.21

Special Care Baby Unit 94341 0.34 0.02 0.32

Paediatrics 239122 0.31 0.03 0.28

General Surgery 868461 0.29 0.18 0.12

Trauma/Orthopaedics 707817 0.14 0.05 0.09

Geriatric Medicine 1116388 0.13 0.06 0.07

Bacteraemia Rates by Inpatient Deaths & Discharges Table 4 and Figures 4, 5 and 6 in Appendix 2 present the data using inpatient deaths and discharges (IPDD) as the specialty activity measure used to calculate the rates. Transfers have been added to the IPDD for ITU, since very few patients are discharged from ITU. The IPDD rate relates the diagnosed cases to the total number of inpatients treated in the specialty in the surveillance period. Once again highest rates are for nephrology and A & E, probably reflecting the high proportion of activity in these specialties that are not inpatients.

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Table 4. Rates of total S. aureus, MRSA and MSSA bacteraemias per 1000 inpatient deaths and discharges (and transfers for ITU) by specialty

Specialty IPDD

SA/1000

IPDD

MRSA/1000

IPDD

MSSA/1000

IPDD

Nephrology 5100 66.67 31.18 35.49



Haematology 7410 8.10 3.51 4.59


Cardiology 15374 4.10 1.04 3.06

Oncology 12221 4.01 1.47 2.54



Urology 31651 1.83 0.95 0.88

General Surgery 143329 1.79 1.07 0.72


Paediatrics 108353 0.68 0.06 0.62

Bacteraemia Rates by Total Specialty Activity Table 5 and Figures 7, 8 and 9 in Appendix 2 present the data using IPDD and outpatient and regular clinic attendances as the specialty activity measure used to calculate the rates. We have called this the IPDD etc rate. The IPDD etc rate relates the diagnosed cases to the total number of patients (inpatients, outpatients, and regular clinic attendances) treated in the specialty in the surveillance period. The results for nephrology have not been presented in this table, because of inconsistencies between Trusts in the way dialysis patients are reported. These will be updated at a later date. Using total specialty activity as the denominator, rates of total S. aureus, MRSA and MSSA are highest in ITU, with the total S. aureus and MRSA rate in ITU significantly higher than in any other specialty. Rates of MSSA are highest in ITU, but not significantly higher than in SCBU.

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Table 5. Rates of total S. aureus, MRSA and MSSA bacteraemias per 1000 inpatient deaths and discharges, outpatients and regular clinic attendances by specialty

Specialty

IPDD, trans, OP & reg

clinic attendances

SA/1000 IPDD etc

MRSA/1000 IPDD etc

MSSA/1000 IPDD etc





Cardiology 92276 0.68 0.17 0.51

Paediatrics 320534 0.23 0.02 0.21

General Surgery 614865 0.42 0.25 0.17

Urology 238765 0.24 0.13 0.12

Oncology 315021 0.16 0.06 0.10


Haematology 550819 0.11 0.05 0.06


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RESULTS

2. Trust Specific

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Trust A A total of 128 S. aureus bacteraemias were reported in the time period; 64 MRSA and 64 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 50%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty

Specialty S. aureus MRSA MSSA %Methicillin

resistant General Medicine 66 30 36 45.45General Surgery 20 14 6 70.00ITU 14 10 4 71.43Accident and Emergency 13 3 10 23.08Paediatrics 4 1 3 25.00Nephrology 3 0 3 0.00Rehabilitation 2 2 0 100.00Geriatric Medicine 2 2 0 100.00GP Other 1 0 1 0.00Gynaecology 1 0 1 0.00Trauma and Orthopaedic 1 1 0 100.00Old Age Psychiatry 1 1 0 100.00

Table 2. Rates of S. aureus bacteraemias per 1000 bed days by specialty

Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds ITU 3196 4.38 3.13 1.25General Surgery 45391 0.44 0.31 0.13GP Other 2547 0.39 0.00 0.39Paediatrics 14062 0.28 0.07 0.21General Medicine 262726 0.25 0.11 0.14Gynaecology 9537 0.10 0.00 0.10Old Age Psychiatry 42393 0.02 0.02 0.00Trauma and Orthopaedic 46377 0.02 0.02 0.00Accident and Emergency 0 Nephrology 0 Rehabilitation 0 Geriatric Medicine 0

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Table 3. Rates of S. aureus bacteraemias per 1000 inpatient deaths & discharges (IPDD) by specialty

Specialty No of IPDD

SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

ITU 583 24.01 17.15 6.86GP Other 119 8.40 0.00 8.40General Medicine 22957 2.87 1.31 1.57General Surgery 9235 2.17 1.52 0.65Paediatrics 8964 0.45 0.11 0.33Gynaecology 3862 0.26 0.00 0.26Trauma and Orthopaedic 4661 0.21 0.21 0.00Accident and Emergency 174118 0.07 0.02 0.06Nephrology 0 Rehabilitation 0 Geriatric Medicine 0 Old Age Psychiatry 0

SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where Trust A is outside the control limits are shown in the next section. Trust A fell above the control limits for rates of total S. aureus and MRSA bacteraemias in ITU. The rate of MSSA bacteraemias was below the lower control limit for the specialty of Trauma & Orthopaedics. These SPC charts have been provided.

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Trust B A total of 62 S. aureus bacteraemias were reported in the time period; 17 MRSA and 45 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 27%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Rates of S. aureus bacteraemias by total activity for oncology and haematology are provided in Table 4, since this is what has been used for the SPC charts for these 2 specialties. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant General Medicine 38 10 28 26.32General Surgery 10 6 4 60.00Trauma and Orthopaedics 7 1 6 14.29Accident and Emergency 4 0 4 0.00Palliative Medicine 2 0 2 0.00Oncology 1 0 1 0.00


Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds Accident and Emergency 1665 2.40 0.00 2.40Palliative Medicine 4808 0.42 0.00 0.42General Medicine 106634 0.36 0.09 0.26General Surgery 37388 0.27 0.16 0.11Trauma and Orthopaedics 26362 0.27 0.04 0.23Oncology 5489 0.18 0.00 0.18



SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

Palliative Medicine 474 4.22 0.00 4.22General Medicine 14289 2.66 0.70 1.96Trauma and Orthopaedics 4613 1.52 0.22 1.30General Surgery 6894 1.45 0.87 0.58Oncology 987 1.01 0.00 1.01Accident and Emergency 100497 0.04 0.00 0.04

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Table 4. Rates of S. aureus bacteraemias per 1000 inpatient deaths & discharges/ transfers, outpatients and regular clinic admissions (IPDD etc) by specialty

Specialty IPDD etcSA/1000 IPDD etc

MRSA/1000 IPDD etc

MSSA/1000 IPDD etc

Oncology 7996 0.13 0.00 0.13 SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where Trust B is outside the control limits are shown in the next section. Trust B did not fall outside the control limits for any of the top 13 specialties.

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Trust C A total of 30 S. aureus bacteraemias were reported from Velindre Trust in the time period. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Rates of S. aureus bacteraemias by total activity for oncology are provided in Table 4, which has been used for the SPC charts for this specialty. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant Oncology 30 11 19 36.67


Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds Oncology 42885 0.70 0.26 0.44

Table 3. Rates of S. aureus bacteraemias per 1000 inpatient deaths & discharges (plus transfers for ITU and outpatients for A&E) (IPDD) by specialty


SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

Oncology 5246 5.72 2.10 3.62 Table 4. Rates of S. aureus bacteraemias per 1000 inpatient deaths & discharges, outpatients and regular clinic admissions (IPDD etc) by specialty

Specialty No of

IPDD etcSA/1000 IPDD etc

MRSA/1000 IPDD etc

MSSA/1000 IPDD etc

Oncology 211457 0.14 0.05 0.09 SPC Charts Rates above or below the control limits for a specialty should be investigated. Rates for total S. aureus, MRSA and MSSA for oncology for Trust C all fell within the control limits, but the SPC charts for oncology have been included for interest.

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Trust D A total of 621 S. aureus bacteraemias were reported in the time period; 301 MRSA and 320 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 48%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Rates of S. aureus bacteraemias by total activity for oncology and haematology are provided in Table 4, since this is what has been used for the SPC charts for these 2 specialties. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant General Medicine 166 85 81 51.20Nephrology 165 71 94 43.03ITU 47 27 20 57.45General Surgery 47 34 13 72.34Haematology 30 16 14 53.33Accident and Emergency 23 3 20 13.04Paediatrics 21 1 20 4.76Cardiology 19 6 13 31.58Trauma and Orthopaedics 14 8 6 57.14Urology 13 8 5 61.54Geriatric Medicine 13 9 4 69.23Neurosurgery 10 3 7 30.00Cardiac Surgery 6 4 2 66.67Dermatology 5 2 3 40.00GP Other 5 3 2 60.00Thoracic Medicine 5 4 1 80.00SCBU 4 0 4 0.00Obstetrics 4 3 1 75.00Unknown 4 1 3 25.00Oncology 3 2 1 66.67ENT 3 3 0 100.00Gynaecology 3 2 1 66.67Rheumatology 2 0 2 0.00Neurology 2 1 1 50.00Rehabilitation 2 2 0 100.00Thoracic Surgery 1 1 0 100.00Oral Surgery 1 1 0 100.00Ophthalmology 1 0 1 0.00Mental Illness 1 1 0 100.00Gastroenterology 1 0 1 0.00

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Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds Nephrology 27234 6.06 2.61 3.45ITU 19486 2.41 1.39 1.03Haematology 19729 1.52 0.81 0.71Rheumatology 3202 0.62 0.00 0.62General Medicine 267242 0.62 0.32 0.30Dermatology 8298 0.60 0.24 0.36Urology 23434 0.55 0.34 0.21Cardiology 42500 0.45 0.14 0.31Paediatrics 53514 0.39 0.02 0.37General Surgery 132814 0.35 0.26 0.10GP Other 14517 0.34 0.21 0.14Neurosurgery 30100 0.33 0.10 0.23ENT 9371 0.32 0.32 0.00Cardiac Surgery 24781 0.24 0.16 0.08Ophthalmology 4693 0.21 0.00 0.21Oral Surgery 4780 0.21 0.21 0.00SCBU 20964 0.19 0.00 0.19Trauma and Orthopaedics 125085 0.11 0.06 0.05Gynaecology 26851 0.11 0.07 0.04Thoracic Surgery 9329 0.11 0.11 0.00Obstetrics 41474 0.10 0.07 0.02Thoracic Medicine 52443 0.10 0.08 0.02Geriatric Medicine 139800 0.09 0.06 0.03Neurology 21811 0.09 0.05 0.05Rehabilitation 113036 0.02 0.02 0.00Mental Illness 172476 0.01 0.01 0.00Oncology 3 1095.14 730.09 365.05Accident and Emergency 0 Gastroenterology 0

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SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

Nephrology 2257 73.11 31.46 41.65Haematology 2049 14.64 7.81 6.83Dermatology 536 9.33 3.73 5.60ITU 5477 8.58 4.93 3.65Rheumatology 274 7.30 0.00 7.30General Medicine 30581 5.43 2.78 2.65GP Other 974 5.13 3.08 2.05SCBU 1055 3.79 0.00 3.79Neurosurgery 2767 3.61 1.08 2.53Cardiology 5920 3.21 1.01 2.20Urology 4397 2.96 1.82 1.14Cardiac Surgery 2116 2.84 1.89 0.95General Surgery 17752 2.65 1.92 0.73Geriatric Medicine 7378 1.76 1.22 0.54Neurology 1543 1.30 0.65 0.65Paediatrics 18213 1.15 0.05 1.10Thoracic Surgery 874 1.14 1.14 0.00Trauma and Orthopaedics 13270 1.06 0.60 0.45ENT 3234 0.93 0.93 0.00Oral Surgery 1136 0.88 0.88 0.00Rehabilitation 2484 0.81 0.81 0.00Thoracic Medicine 6907 0.72 0.58 0.14Ophthalmology 2241 0.45 0.00 0.45Gynaecology 9497 0.32 0.21 0.11Mental Illness 3316 0.30 0.30 0.00Obstetrics 26821 0.15 0.11 0.04Accident and Emergency 274207 0.08 0.01 0.07Oncology 1 3000.00 2000.00 1000.00Gastroenterology 0

Table 4. Rates of S. aureus bacteraemias per 1000 inpatient deaths & discharges, outpatients and regular clinic admissions (IPDD etc) for oncology and haematology

Specialty No of


MRSA/1000 IPDD etc

MSSA/1000 IPDD etc

Oncology 1753 1.71 1.14 0.57Haematology 51627 0.58 0.31 0.27

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SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where Trust D is outside the control limits are shown in the next section. Rates of total S. aureus bacteraemias were above the upper control limit for the specialties of haematology and general medicine. Rates of MRSA bacteraemias were above the upper control limit for haematology, general surgery and general medicine. Rates of MSSA bacteraemias were above the upper control limit for haematology, and borderline for paediatrics and general medicine. Rates of total S. aureus and MSSA bacteraemias were below the lower control limit for the specialty of cardiology. These SPC charts have been provided.

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Trust E A total of 315 S. aureus bacteraemias were reported in the time period; 137 MRSA and 178 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 43%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Rates of S. aureus bacteraemias by total activity for oncology and haematology are provided in Table 4, since this is what has been used for the SPC charts for these 2 specialties. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant General Medicine 130 62 68 47.69General Surgery 35 19 16 54.29Accident and Emergency 33 7 26 21.21ITU 26 16 10 61.54Trauma and Orthopaedics 17 4 13 23.53Urology 13 7 6 53.85Haematology 12 4 8 33.33Geriatric Medicine 9 6 3 66.67SCBU 9 1 8 11.11Paediatrics 9 2 7 22.22Gastroenterology 5 2 3 40.00Cardiology 5 1 4 20.00Dermatology 3 3 0 100.00Rehabilitation 3 3 0 100.00Gynaecology 2 0 2 0.00Nephrology 2 0 2 0.00Rheumatology 1 0 1 0.00Obstetrics 1 0 1 0.00

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Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds Accident and Emergency 2664 12.39 2.63 9.76ITU 6207 4.19 2.58 1.61Haematology 11691 1.03 0.34 0.68Rheumatology 1867 0.54 0.00 0.54Urology 24597 0.53 0.28 0.24SCBU 18837 0.48 0.05 0.42Dermatology 9915 0.30 0.30 0.00General Surgery 133477 0.26 0.14 0.12General Medicine 514771 0.25 0.12 0.13Paediatrics 41180 0.22 0.05 0.17Trauma and Orthopaedics 124823 0.14 0.03 0.10Geriatric Medicine 100170 0.09 0.06 0.03Gynaecology 30419 0.07 0.00 0.07Obstetrics 48430 0.02 0.00 0.02Rehabilitation 200883 0.01 0.01 0.00Gastroenterology 0 Cardiology 0 Nephrology 0



SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

ITU 1749 14.87 9.15 5.72Haematology 1736 6.91 2.30 4.61Geriatric Medicine 1619 5.56 3.71 1.85SCBU 1740 5.17 0.57 4.60Rheumatology 281 3.56 0.00 3.56Dermatology 868 3.46 3.46 0.00Urology 5024 2.59 1.39 1.19General Medicine 64029 2.03 0.97 1.06General Surgery 25003 1.40 0.76 0.64Trauma and Orthopaedics 18391 0.92 0.22 0.71Paediatrics 15867 0.57 0.13 0.44Rehabilitation 5539 0.54 0.54 0.00Gynaecology 12377 0.16 0.00 0.16Accident and Emergency 390767 0.08 0.02 0.07Obstetrics 20807 0.05 0.00 0.05Gastroenterology 0 Cardiology 0 Nephrology 0

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Table 4. Rates of S. aureus bacteraemias per 1000 inpatient deaths & discharges, outpatients and regular clinic admissions (IPDD etc) in haematology and oncology

Specialty No of


MRSA/1000 IPDD etc

MSSA/1000 IPDD etc

Haematology 95639 0.13 0.04 0.08 SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where Trust E is outside the control limits are shown in the next section. Trust E did not fall above the control limits for any of the top 13 specialties. The rates of total S. aureus bacteraemias and MSSA bacteraemias were below the lower control limit for the specialty of General Medicine. These SPC charts have been provided.

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Trust F A total of 23 S. aureus bacteraemias were reported in the time period; 10 MRSA and 13 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 43%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Rates of S. aureus bacteraemias by total activity for oncology and haematology are provided in Table 4, since this is what has been used for the SPC charts for these 2 specialties. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant General Medicine 11 4 7 36.36General Surgery 6 5 1 83.33Accident and Emergency 3 1 2 33.33Oncology 2 0 2 0.00ITU 1 0 1 0.00


Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds ITU 1327 0.75 0.00 0.75General Surgery 21940 0.27 0.23 0.05General Medicine 71975 0.15 0.06 0.10Accident and Emergency 0 Oncology 0



SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

ITU 569 1.76 0.00 1.76General Surgery 3960 1.52 1.26 0.25General Medicine 7924 1.39 0.50 0.88Accident and Emergency 46788 0.06 0.02 0.04Oncology 0

Table 4. Rates of S. aureus bacteraemias per 1000 inpatient deaths & discharges/ transfers, outpatients and regular clinic admissions (IPDD etc) for oncology and haematology


MRSA/1000 IPDD etc

MSSA/1000 IPDD etc

Oncology 946 2.11 0.00 2.11

25

SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where Trust F is outside the control limits are shown in the next section. Trust F did not fall outside the control limits for any of the top 13 specialties. The rates of total S. aureus bacteraemias per 1000 IPDD were borderline below the lower control limit for the specialties of Trauma & Orthopaedics and General Medicine. These SPC charts have been provided.

26

Trust G A total of 169 S. aureus bacteraemias were reported in the time period; 76 MRSA and 93 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 45%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant General Medicine 59 17 42 28.81Nephrology 29 20 9 68.97Geriatric Medicine 20 12 8 60.00General Surgery 20 10 10 50.00ITU 16 9 7 56.25Trauma and Orthopaedic 8 4 4 50.00Cardiology 4 1 3 25.00GP Other 2 1 1 50.00Urology 2 1 1 50.00Paediatrics 2 0 2 0.00Accident and Emergency 2 0 2 0.00Palliative Medicine 1 0 1 0.00SCBU 1 0 1 0.00ENT 1 1 0 100.00Obstetrics 1 0 1 0.00Unknown 1 0 1 0.00


Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds Palliative Medicine 1 1095.14 0.00 1095.14Nephrology 1078 26.89 18.55 8.35Accident and Emergency 81 24.61 0.00 24.61ITU 3269 4.89 2.75 2.14General Medicine 94105 0.63 0.18 0.45General Surgery 65296 0.31 0.15 0.15Trauma and Orthopaedic 37049 0.22 0.11 0.11Cardiology 18854 0.21 0.05 0.16SCBU 5448 0.18 0.00 0.18ENT 6123 0.16 0.16 0.00Paediatrics 15500 0.13 0.00 0.13Urology 17445 0.11 0.06 0.06Geriatric Medicine 197769 0.10 0.06 0.04Obstetrics 21255 0.05 0.00 0.05GP Other 88300 0.02 0.01 0.01

27



SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

Nephrology 102 284.31 196.08 88.24Palliative Medicine 4 250.00 0.00 250.00ITU 652 24.54 13.80 10.74Accident and Emergency 26 76.92 0.00 76.92General Medicine 12236 4.82 1.39 3.43SCBU 408 2.45 0.00 2.45Geriatric Medicine 9210 2.17 1.30 0.87General Surgery 12502 1.60 0.80 0.80Trauma and Orthopaedic 5382 1.49 0.74 0.74Cardiology 2965 1.35 0.34 1.01GP Other 3198 0.63 0.31 0.31Urology 3342 0.60 0.30 0.30ENT 3199 0.31 0.31 0.00Paediatrics 7700 0.26 0.00 0.26Obstetrics 8222 0.12 0.00 0.12Accident and Emergency 179569 0.01 0.00 0.01

SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where Trust G is outside the control limits are shown in the next section. Trust G fell above the control limits for rates of total S. aureus bacteraemias in ITU and general medicine. The rate of MSSA bacteraemias in general medicine was also above the upper control limit. The rates of total S. aureus bacteraemias and MSSA bacteraemias were below the lower control limit for the specialty of Cardiology. These SPC charts have been provided.

28

Trust H A total of 228 S. aureus bacteraemias were reported in the time period; 126 MRSA and 102 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 55%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Rates of S. aureus bacteraemias by total activity for oncology and haematology are provided in Table 4, since this is what has been used for the SPC charts for these 2 specialties. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant General Medicine 77 38 39 49.35General Surgery 37 25 12 67.57Nephrology 30 24 6 80.00Trauma and Orthopaedics 16 8 8 50.00ITU 15 11 4 73.33Paediatrics 11 1 10 9.09Geriatric Medicine 10 5 5 50.00Cardiology 9 3 6 33.33Urology 6 3 3 50.00Haematology 5 2 3 40.00Accident and Emergency 4 1 3 25.00Oncology 3 2 1 66.67Gastroenterology 2 2 0 100.00Unknown 2 1 1 50.00Obstetrics 1 0 1 0.00


Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds Nephrology 6800 4.41 3.53 0.88ITU 4665 3.22 2.36 0.86Paediatrics 14720 0.75 0.07 0.68Haematology 7658 0.65 0.26 0.39General Medicine 134703 0.57 0.28 0.29General Surgery 65445 0.57 0.38 0.18Oncology 5618 0.53 0.36 0.18Cardiology 20718 0.43 0.14 0.29Urology 15014 0.40 0.20 0.20Trauma and Orthopaedics 48336 0.33 0.17 0.17Gastroenterology 9497 0.21 0.21 0.00Geriatric Medicine 121179 0.08 0.04 0.04Obstetrics 16234 0.06 0.00 0.06Accident and Emergency 0

29



SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

ITU 973 15.42 11.31 4.11Nephrology 721 41.61 33.29 8.32Haematology 934 5.35 2.14 3.21General Medicine 16155 4.77 2.35 2.41General Surgery 8517 4.34 2.94 1.41Oncology 695 4.32 2.88 1.44Cardiology 3093 2.91 0.97 1.94Trauma and Orthopaedics 6628 2.41 1.21 1.21Urology 3028 1.98 0.99 0.99Gastroenterology 1147 1.74 1.74 0.00Geriatric Medicine 6050 1.65 0.83 0.83Paediatrics 7300 1.51 0.14 1.37Obstetrics 6493 0.15 0.00 0.15Accident and Emergency 152585 0.03 0.01 0.02

Table 4. Rates of S. aureus bacteraemias per 1000 inpatient deaths & discharges/ transfers, outpatients and regular clinic admissions (IPDD etc) in oncology and haematology


MRSA/1000 IPDD etc

MSSA/1000 IPDD etc

Oncology 8754 0.34 0.23 0.11Haematology 47862 0.10 0.04 0.06

SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where Trust H is outside the control limits are shown in the next section. Trust H fell above the upper control limit for rates of total S. aureus and MRSA bacteraemias in General Surgery and General Medicine and the rate of total S. aureus bacteraemias for Trauma & Orthopaedics was on the borderline of the upper control limit. These SPC charts have been provided.

30

Trust I A total of 135 S. aureus bacteraemias were reported in the time period; 58 MRSA and 77 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 43%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant General Medicine 63 27 36 42.86General Surgery 21 13 8 61.90Accident and Emergency 13 3 10 23.08ITU 10 6 4 60.00SCBU 9 1 8 11.11Geriatric Medicine 5 3 2 60.00Trauma and Orthopaedics 4 1 3 25.00Urology 3 2 1 66.67ENT 2 1 1 50.00Cardiology 2 1 1 50.00Gynaecology 1 0 1 0.00Paediatrics 1 0 1 0.00Obstetrics 1 0 1 0.00


Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds ITU 3290 3.04 1.82 1.22SCBU 3771 2.39 0.27 2.12ENT 4675 0.43 0.21 0.21General Surgery 58458 0.36 0.22 0.14Urology 9360 0.32 0.21 0.11General Medicine 298110 0.21 0.09 0.12Gynaecology 8501 0.12 0.00 0.12Trauma and Orthopaedics 35922 0.11 0.03 0.08Paediatrics 12966 0.08 0.00 0.08Obstetrics 19002 0.05 0.00 0.05Accident and Emergency 0 Geriatric Medicine 0 Cardiology 0

31



SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

SCBU 404 22.28 2.48 19.80ITU 846 11.82 7.09 11.82General Medicine 26031 2.42 1.04 1.38General Surgery 10656 1.97 1.22 0.75Urology 2431 1.23 0.82 0.41Trauma and Orthopaedics 5202 0.77 0.19 0.58ENT 2723 0.73 0.37 0.37Gynaecology 3487 0.29 0.00 0.29Paediatrics 7696 0.13 0.00 0.13Obstetrics 9900 0.10 0.00 0.10Accident and Emergency 160730 0.08 0.02 0.06Geriatric Medicine 0 Cardiology 0

SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where Trust I is outside the control limits are shown in the next section. Trust I fell above the upper control limit for rates of total S. aureus and MSSA bacteraemias in the SCBU. The bacteraemia data for Pontypridd & Rhondda have been plotted on the SPC chart for Geriatric Medicine and the rates for total S. aureus and MRSA bacteraemias fall above the upper control, however although 5 bacteraemias were reported from this specialty, no denominator for this specialty was available. These SPC charts have been provided.

32

Trust J A total of 148 S. aureus bacteraemias were reported in the time period; 55 MRSA and 93 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 37%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant General Medicine 81 30 51 37.04Accident and Emergency 14 5 9 35.71General Surgery 13 5 8 38.46ITU 9 4 5 44.44Trauma and Orthopaedics 9 4 5 44.44Paediatrics 6 0 6 0.00Cardiology 5 2 3 40.00Urology 4 3 1 75.00Dermatology 2 1 1 50.00Obstetrics 2 1 1 50.00ENT 1 0 1 0.00Geriatric Medicine 1 0 1 0.00Gynaecology 1 0 1 0.00


Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds Cardiology 648 7.71 3.08 4.63ITU 3726 2.42 1.07 1.34Dermatology 3242 0.62 0.31 0.31Urology 7168 0.56 0.42 0.14Paediatrics 12729 0.47 0.00 0.47General Medicine 239513 0.34 0.13 0.21General Surgery 41629 0.31 0.12 0.19ENT 3552 0.28 0.00 0.28Trauma and Orthopaedics 52925 0.17 0.08 0.09Obstetrics 15715 0.13 0.06 0.06Gynaecology 10017 0.10 0.00 0.10Geriatric Medicine 95568 0.01 0.00 0.01Accident and Emergency 0

33



SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

Cardiology 171 29.24 11.70 17.54ITU 807 11.15 4.96 6.20Dermatology 387 5.17 2.58 2.58General Medicine 32424 2.50 0.93 1.57Urology 2161 1.85 1.39 0.46Trauma and Orthopaedics 7075 1.27 0.57 0.71General Surgery 10341 1.26 0.48 0.77Paediatrics 5021 1.19 0.00 1.19ENT 2301 0.43 0.00 0.43Geriatric Medicine 2744 0.36 0.00 0.36Gynaecology 4117 0.24 0.00 0.24Obstetrics 8736 0.23 0.11 0.11Accident and Emergency 210996 0.07 0.02 0.04

The S. aureus bacteraemia rates for Trust J do not fall above the upper control limit for any of the specialties, using inpatient deaths and discharges as the denominator for most specialties, but adding in transfers for ITU, and outpatients for A&E, oncology and haematology. The rate of total S. aureus per 1000 IPDD in geriatric medicine in Trust J is below the lower control limit ie the rate is lower than would be expected for a Trust of that size. The SPC chart has been provided in the next section. This may be a genuine low rate or may be a reporting artefact, such as some of the constituent hospitals not having geriatric medicine as a specialty and reporting them as general medicine.

34

Trust K A total of 178 S. aureus bacteraemias were reported in the time period; 51 MRSA and 127 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 29%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Rates of S. aureus bacteraemias by total activity for oncology and haematology are provided in Table 4, since this is what has been used for the SPC charts for these 2 specialties. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant General Medicine 75 23 52 30.67Geriatric Medicine 24 9 15 37.50Accident and Emergency 14 2 12 14.29General Surgery 13 7 6 53.85Unknown 11 2 9 18.18GP Other 9 2 7 22.22ITU 7 1 6 14.29Paediatrics 6 1 5 16.67Trauma and Orthopaedics 6 0 6 0.00Urology 4 1 3 25.00Haematology 3 1 2 33.33Gynaecology 2 0 2 0.00ENT 1 1 0 100.00Oncology 1 0 1 0.00Cardiology 1 0 1 0.00Genito Urinary Medicine 1 1 0 100.00


Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds Accident and Emergency 1450 9.65 1.38 8.28ITU 6983 1.00 0.14 0.86Oncology 1309 0.76 0.00 0.76Paediatrics 9301 0.65 0.11 0.54Haematology 4832 0.62 0.21 0.41Geriatric Medicine 47084 0.51 0.19 0.32GP Other 19544 0.46 0.10 0.36General Medicine 211168 0.36 0.11 0.25Gynaecology 7590 0.26 0.00 0.26Urology 16092 0.25 0.06 0.19General Surgery 91674 0.14 0.08 0.07Trauma and Orthopaedics 48235 0.12 0.00 0.12ENT 10369 0.10 0.10 0.00Cardiology 0 Genito Urinary Medicine 0

35



SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

Geriatric Medicine 1458 16.46 6.17 10.29GP Other 902 9.98 2.22 7.76Haematology 360 8.33 2.78 5.56Oncology 230 4.35 0.00 4.35ITU 1701 4.12 0.59 3.53General Medicine 21755 3.45 1.06 2.39Paediatrics 3719 1.61 0.27 1.34Urology 2792 1.43 0.36 1.07General Surgery 11220 1.16 0.62 0.53Trauma and Orthopaedics 6228 0.96 0.00 0.96Gynaecology 2749 0.73 0.00 0.73ENT 3286 0.30 0.30 0.00Accident and Emergency 148269 0.09 0.01 0.08Cardiology 0 Genito Urinary Medicine 0

Table 4. Rates of S. aureus bacteraemias per 1000 inpatient deaths & discharges, outpatients and regular clinic admissions (IPDD etc) for oncology and haematology

Specialty No of


MRSA/1000 IPDD etc

MSSA/1000 IPDD etc

Haematology 90250 0.03 0.01 0.02Oncology 10917 0.09 0.00 0.09

SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where Trust K is outside the control limits are shown in the next section. Rates of total S. aureus, MRSA and MSSA bacteraemias were above the upper control limit for the specialty of geriatric medicine. Rates of total S. aureus and MRSA bacteraemias were below the lower control limit for ITU. These SPC charts have been provided.

36

Trust L A total of 398 S. aureus bacteraemias were reported in the time period; 152 MRSA and 246 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 38%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Rates of S. aureus bacteraemias by total activity for oncology and haematology are provided in Table 4, since this is what has been used for the SPC charts for these 2 specialties. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant Nephrology 89 38 51 42.70General Medicine 84 31 53 36.90ITU 35 20 15 57.14General Surgery 29 12 17 41.38Geriatric Medicine 25 8 17 32.00Cardiology 18 2 16 11.11Trauma and Orthopaedics 16 6 10 37.50Neurosurgery 14 12 2 85.71Urology 11 3 8 27.27Oncology 11 3 8 27.27Accident and Emergency 11 3 8 27.27Paediatrics 10 0 10 0.00SCBU 9 0 9 0.00Haematology 9 3 6 33.33Burns Surgery 8 6 2 75.00Plastic Surgery 7 3 4 42.86Cardiac Surgery 3 0 3 0.00Rheumatology 2 0 2 0.00Dermatology 2 0 2 0.00Rehabilitation 1 1 0 100.00Ophthalmology 1 1 0 100.00Gynaecology 1 0 1 0.00Obstetrics 1 0 1 0.00Gastroenterology 1 0 1 0.00

37


Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds Nephrology 19166 4.64 1.98 2.66ITU 22946 1.53 0.87 0.65Rheumatology 2521 0.79 0.00 0.79SCBU 15620 0.58 0.00 0.58Haematology 9536 0.94 0.31 0.63Rehabilitation 9825 0.10 0.10 0.00Burns Surgery 8976 0.89 0.67 0.22Cardiology 21641 0.83 0.09 0.74Dermatology 4947 0.40 0.00 0.40Neurosurgery 28170 0.50 0.43 0.07General Medicine 182949 0.46 0.17 0.29Oncology 35712 0.31 0.08 0.22Geriatric Medicine 204724 0.12 0.04 0.08Urology 20662 0.53 0.15 0.39General Surgery 118746 0.24 0.10 0.14Cardiac Surgery 19091 0.16 0.00 0.16Trauma and Orthopaedics 104504 0.15 0.06 0.10Plastic Surgery 35410 0.20 0.08 0.11Paediatrics 33796 0.30 0.00 0.30Ophthalmology 4949 0.20 0.20 0.00Gynaecology 16630 0.06 0.00 0.06Obstetrics 32169 0.03 0.00 0.03Accident and Emergency 0 Gastroenterology 0

38



SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

Nephrology 2020 44.06 18.81 25.25Rheumatology 163 12.27 0.00 12.27SCBU 880 10.23 0.00 10.23Haematology 1019 8.83 2.94 5.89Rehabilitation 125 8.00 8.00 0.00Burns Surgery 1097 7.29 5.47 1.82ITU 6220 5.63 3.22 2.41Cardiology 3224 5.58 0.62 4.96Dermatology 377 5.31 0.00 5.31Neurosurgery 2934 4.77 4.09 0.68General Medicine 23735 3.54 1.31 2.23Oncology 3820 2.88 0.79 2.09Geriatric Medicine 9748 2.56 0.82 1.74Urology 4619 2.38 0.65 1.73General Surgery 17182 1.69 0.70 0.99Cardiac Surgery 1926 1.56 0.00 1.56Trauma and Orthopaedics 10415 1.54 0.58 0.96Plastic Surgery 9725 0.72 0.31 0.41Paediatrics 18333 0.55 0.00 0.55Ophthalmology 1892 0.53 0.53 0.00Gynaecology 7881 0.13 0.00 0.13Obstetrics 15336 0.07 0.00 0.07Accident and Emergency 229429 0.05 0.01 0.03Gastroenterology 0

Table 4. Rates of S. aureus bacteraemias per 1000 inpatient deaths & discharges, outpatients and regular clinic admissions (IPDD etc) by specialty

Specialty No of


MRSA/1000 IPDD etc

MSSA/1000 IPDD etc


SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where Trust L is outside the control limits are shown in the next section. Trust L fell above the upper control limit for rates of total S. aureus and MSSA bacteraemias in the SCBU. These SPC charts have been provided.

39

Trust M A total of 101 S. aureus bacteraemias were reported in the time period; 33 MRSA and 68 MSSA bacteraemias. The overall percentage methicillin resistance for the Trust was 33%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Rates of S. aureus bacteraemias by total activity for oncology and haematology are provided in Table 4, since this is what has been used for the SPC charts for these 2 specialties. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant General Medicine 29 8 21 27.59Geriatric Medicine 26 7 19 26.92Nephrology 22 6 16 27.27General Surgery 5 3 2 60.00 Paediatrics 4 1 3 25.00ITU 3 2 1 66.67Trauma and Orthopaedic 3 0 3 0.00Oncology 3 2 1 66.67Urology 2 2 0 100.00Accident and Emergency 2 1 1 50.00ENT 1 1 0 100.00Haematology 1 0 1 0.00


Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds Accident and Emergency 2885 0.69 0.35 0.35ITU 4885 0.61 0.41 0.20General Medicine 85469 0.34 0.09 0.25Haematology 3232 0.31 0.00 0.31Oncology 9707 0.31 0.21 0.10 Paediatrics 17824 0.22 0.06 0.17Geriatric Medicine 125181 0.21 0.06 0.15Urology 16610 0.12 0.12 0.00ENT 10108 0.10 0.10 0.00General Surgery 56057 0.09 0.05 0.04Trauma and Orthopaedic 40735 0.07 0.00 0.07Nephrology 0

40



SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

ITU 1012 2.96 1.98 0.99Oncology 1200 2.50 1.67 0.83Haematology 436 2.29 0.00 2.29Geriatric Medicine 12046 2.16 0.58 1.58General Medicine 16962 1.71 0.47 1.24Urology 3764 0.53 0.53 0.00General Surgery 9907 0.50 0.30 0.20 Paediatrics 8430 0.47 0.12 0.36Trauma and Orthopaedic 6782 0.44 0.00 0.44Accident and Emergency 125571 0.02 0.01 0.01ENT 3922 0.25 0.25 0.00Nephrology 0

Table 4. Rates of S. aureus bacteraemias per 1000 inpatient deaths & discharges/ transfers, outpatients and regular clinic admissions (IPDD etc) in oncology and haematology


MRSA/1000 IPDD etc

MSSA/1000 IPDD etc


SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where Trust M is outside the control limits are shown in the next section. Trust M did not fall above the control limits for any of the top 13 specialties. The rate of total S. aureus bacteraemias was below the lower control limit for the specialties of General Surgery and General Medicine and borderline below for Accident and Emergency. The rate of MRSA bacteraemias was below the lower control limit for the specialty of General Medicine and borderline below for Geriatric Medicine. The rate of MSSA bacteraemias was below the lower control limit for the specialty of Urology. These SPC charts have been provided.

41

Trust N A total of 7 S. aureus bacteraemias were reported in the time period; 4 MRSA and 3 MSSA bacteraemias. The overall percentage methicillin resistance for Powys Local Health Board was 57%. Numbers of bacteraemias and percentage methicillin resistance by specialty are given in Table 1. Rates of S. aureus bacteraemias by bed days are given in Table 2 and by inpatient deaths and discharges in Table 3. Table 1. Number of S. aureus bacteraemias and % methicillin resistance by specialty


resistant Geriatric Medicine 6 4 2 66.67General Medicine 1 0 1 0.00


Specialty No of Bed

days SA/1000

beds MRSA/1000

bed days MSSA/1000

beds General Medicine 301 3.32 0.00 3.32Geriatric Medicine 84911 0.07 0.05 0.02



SA/1000 IPDD

MRSA/1000 IPDD

MSSA/1000 IPDD

General Medicine 7 142.86 0.00 142.86Geriatric Medicine 3454 1.74 1.16 0.58

SPC Charts Rates above or below the control limits for a specialty should be investigated. SPC charts for specialties where N is outside the control limits are shown in the next section. Rates for N did not fall above the upper control limit for any of the top 13 specialties. Rates of total S. aureus and MSSA bacteraemias in A & E were below the lower control limit. These SPC charts have been provided.

42

RESULTS

3. Statistical Process Control Charts

43

Total S. aureus bacteraemias in the medical specialty of Accident & Emergencyby IPDD and outpatients by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

J

N

I

B H

A

G

E

FM

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

200 250 300 350 400 450 500 550 600 650sqrt IPDD etc

sqrt

S. a

ureu

s bac

tera

emia

s

44

MRSA bacteraemias in the medical specialty of Accident & Emergency by IPDD and Outpatients by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

J

N

I

B

H

A

G

E

F M

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

200 250 300 350 400 450 500 550 600 650sqrt IPDD etc

sqrt

MR

SA b

acte

raem

ias

45

MSSA bacteraemias in the medical specialty of Accident & Emergency by IPDD and outpatients by NHS Trust 01/10/2001 - 31/12/2003

M

F

E

G

A

HB

I

N

J

D

K

L

0.0

1.0

2.0

3.0

4.0

5.0

6.0

200 250 300 350 400 450 500 550 600 650sqrt IPDD etc

sqrt

MSS

A b

acte

raem

ias

46

Total S. aureus bacteraemias in the medical specialty of Cardiology by IPDD by NHS Trust 01/10/2001 - 31/12/2003

EG

H

I

N

J

D

K

L

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

0 10 20 30 40 50 60 70 80sqrt IPDD

sqrt

S. a

ureu

s bac

tera

emia

s

47

MRSA bacteraemias in the medical specialty of Cardiology by IPDD by NHS Trust 01/10/2001 - 31/12/2003

EG

H

I

N

J

D

L

0.0

1.0

2.0

3.0

4.0

0 10 20 30 40 50 60 70 80sqrt IPDD

sqrt

MR

SA b

acte

raem

ias

48

MSSA bacteraemias in the medical specialty of Cardiology by IPDD by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

J

N

I

H

GE

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

0 10 20 30 40 50 60 70 80

sqrt IPDD

sqrt

MSS

A b

acte

raem

ias

49

Total S. aureus bacteraemias in the medical specialty of General Medicine by IPDD by NHS Trust 01/10/2001 - 31/12/2003

M

F

E

GA

H

B

I

N

J

D

KL

0

2

4

6

8

10

12

14

16

0 30 60 90 120 150 180 210 240 270sqrt IPDD

sqrt

S. a

ureu

s bac

tera

emia

s

50

MRSA bacteraemias in the medical specialty of General Medicine by IPDD by NHS Trust 01/10/2001 - 31/12/2003

M

F

E

G

A

H

B

I

N

J

D

K

L

0

2

4

6

8

10

12

0 30 60 90 120 150 180 210 240 270

sqrt IPDD

sqrt

MR

SA b

acte

raem

ias

51

MSSA bacteraemias in the medical specialty of General Medicine by IPDD by NHS Trust 01/10/2001 - 31/12/2003

M

F

E

GAH

B

I

N

J

D

K L

0

2

4

6

8

10

12

0 30 60 90 120 150 180 210 240 270sqrt IPDD

sqrt

MSS

A b

acte

raem

ias

52

Total S. aureus bacteraemias in the medical specialty of General Surgery by IPDD by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

J

N

I

B

H

A G

E

FM

0

1

2

3

4

5

6

7

8

9

0 20 40 60 80 100 120 140 160 180sqrt IPDD

sqrt

S. a

ureu

s bac

tera

emia

s

53

MRSA bacteraemias in the medical specialty of General Surgery by IPDD by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

J

N

I

B

H

A

G

E

F

M

0

1

2

3

4

5

6

7

0 20 40 60 80 100 120 140 160 180sqrt IPDD

sqrt

MR

SA b

acte

raem

ias

54

MSSA bacteraemias in the medical specialty of General Surgery by IPDD by NHS Trust 01/10/2001 - 31/12/2003

M

F

E

G

A

H

B

I

N

J

D

K

L

0

1

2

3

4

5

6

0 20 40 60 80 100 120 140 160 180sqrt IPDD

sqrt

MSS

A b

acte

raem

ias

55

Total S. aureus bacteraemias in the medical specialty of Geriatric Medicine by IPDD by NHS Trust 01/10/2001 - 31/12/2003

M

E

G

A

H

IN

J

D

K L

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

0 20 40 60 80 100 120sqrt IPDD

sqrt

S. a

ureu

s bac

tera

emia

s

56

MRSA bacteraemias in the medical specialty of Geriatric Medicine by IPDD by NHS Trust 01/10/2001 - 31/12/2003

ME

G

A

H

I

N

J

DKL

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

0 20 40 60 80 100 120

sqrt IPDD

sqrt

MR

SA b

acte

raem

ias

57

MSSA bacteraemias in the medical specialty of Geriatric Medicine by IPDD by NHS Trust 01/10/2001 - 31/12/2003

LK

D

J

NI

H

G

E

M

0.0

1.0

2.0

3.0

4.0

5.0

0 20 40 60 80 100 120

sqrt IPDD

sqrt

MSS

A b

acte

raem

ias

58

Total S. aureus bacteraemias in the medical specialty of Haematology by IPDD etc by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

JN I B

H

AG

E

F

M

0.0

1.0

2.0

3.0

4.0

5.0

6.0

0 50 100 150 200 250 300 350 400

sqrt IPDD etc

sqrt

S. a

ureu

s bac

tera

emia

s

59

MRSA bacteraemias in the medical specialty of Haematology by IPDD, outpatients and regular day attenders by NHS Trust 01/10/2001 - 31/12/2003

M F

E

G A

H

B IN J

D

K

L

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

0 50 100 150 200 250 300 350 400

sqrt IPDD etc

sqrt

MR

SA b

acte

raem

ias

60

MSSA bacteraemias in the medical specialty of Haematology by IPDD etc by NHS Trust 01/10/2001 - 31/12/2003

M

F

E

G A

H

B IN J

D

K

L

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 50 100 150 200 250 300 350 400

sqrt IPDD etc

sqrt

MSS

A b

acte

raem

ias

61

Total S. aureus bacteraemias in the medical specialty of ITU by IPDD and Transfers by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

JI

B

HAG

E

F

M

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

0 10 20 30 40 50 60 70 80

sqrt IPDD etc

sqrt

S. a

ureu

s bac

tera

emia

s

62

MRSA bacteraemias in the medical specialty of ITU by IPDD and Transfers by NHS Trust 01/10/2001 - 31/12/2003

M

F

E

GA H

B

I

J

D

K

L

0.0

1.0

2.0

3.0

4.0

5.0

6.0

0 10 20 30 40 50 60 70 80 90

sqrt IPDD etc

sqrt

MR

SA b

acte

raem

ias

63

MSSA bacteraemias in the medical specialty of ITU by IPDD and Transfers by NHS Trust 01/10/2001 - 31/12/2003

MF

E

G

A H

B

IJ

D

K

L

0.0

1.0

2.0

3.0

4.0

5.0

0 10 20 30 40 50 60 70 80

sqrt IPDD etc

sqrt

MSS

A b

acte

raem

ias

64

Total S. aureus bacteraemias in the medical specialty of Oncology by IPDD, outpatients and regular day admissions by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

J

C

NI

B

H

G E

F

M

0.0

1.0

2.0

3.0

4.0

5.0

6.0

0 50 100 150 200 250 300 350 400 450 500

sqrt IPDD etc

sqrt

S. a

ureu

s bac

tera

emia

s

65

MRSA bacteraemias in the medical specialty of Oncology by IPDD, outpatients and regular day admissions by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

J

C

N I B

H

G E

F

M0.0

1.0

2.0

3.0

4.0

0 50 100 150 200 250 300 350 400 450 500

sqrt IPDD etc

sqrt

MR

SA b

acte

raem

ias

66

MSSA bacteraemias in the medical specialty of Oncology by IPDD, outpatients and regular day admissions by NHS Trust 01/10/2001 - 31/12/2003

M

F

EG

HB

IN

C

J

D K

L

0.0

1.0

2.0

3.0

4.0

5.0

0 50 100 150 200 250 300 350 400 450 500

sqrt IPDD etc

sqrt

MSS

A b

acte

raem

ias

67

Total S. aureus bacteraemias in the medical specialty of Paediatrics by IPDD by NHS Trust 01/10/2001 - 31/12/2003

M

F

E

G

A

H

B

I

J

D

K

L

0.0

1.0

2.0

3.0

4.0

5.0

50 60 70 80 90 100 110 120 130 140 150sqrt IPDD

sqrt

S. a

ureu

s bac

tera

emia

s

68

MRSA bacteraemias in the medical specialty of Paediatrics by IPDD by NHS Trust 01/10/2001 - 31/12/2003

M

F

E

G

AH

B IJ

DK

L0.0

0.5

1.0

1.5

2.0

2.5

50 60 70 80 90 100 110 120 130 140

sqrt IPDD

sqrt

MR

SA b

acte

raem

ias

69

MSSA bacteraemias in the medical specialty of Paediatrics by IPDD by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

J

I

B

H

A

G

E

F

M

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

50 75 100 125 150sqrt IPDD

sqrt

MSS

A b

acte

raem

ias

70

Total S. aureus bacteraemias in the medical specialty of SCBU by IPDD by NHS Trust 01/10/2001 - 31/12/2003

MF

E

G

A HB

I

J

D

K

L

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

5 10 15 20 25 30 35 40 45

sqrt IPDD

sqrt

S. a

ureu

s bac

tera

emia

s

71

MSSA bacteraemias in the medical specialty of SCBU by IPDD by NHS Trust 01/10/2001 - 31/12/2003

MF

E

G

A HB

I

J

D

K

L

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

0 5 10 15 20 25 30 35 40 45

sqrt IPDD

sqrt

MSS

A b

acte

raem

ias

72

Total S. aureus bacteraemias in the medical specialty of Trauma & Orthopaedics by IPDD by NHS Trust 01/10/2001 - 31/12/2003

M

F

E

G

A

H

B

I

N

J

D

K

L

0.0

1.0

2.0

3.0

4.0

5.0

6.0

0 20 40 60 80 100 120 140 160sqrt IPDD

sqrt

S. a

ureu

s bac

tera

emia

s

73

MRSA bacteraemias in the medical specialty of Trauma & Orthopaedics by IPDD by NHS Trust 01/10/2001 - 31/12/2003

MF

EG

A

H

B I

N

J

D

K

L

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 20 40 60 80 100 120 140 160sqrt IPDD

sqrt

MR

SA b

acte

raem

ias

74

MSSA bacteraemias in the medical specialty of Trauma & Orthopaedics by IPDD by NHS Trust 01/10/2001 - 31/12/2003

L

K DJ

N

I

B

H

A

G

E

F

M

0.0

1.0

2.0

3.0

4.0

5.0

6.0

0 20 40 60 80 100 120 140 160sqrt IPDD

sqrt

MSS

A b

acte

raem

ias

75

Total S. aureus bacteraemias in the medical specialty of Urology by IPDD by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

J

N

I

H

G

E

M

0

1

2

3

4

5

0 10 20 30 40 50 60 70 80sqrt IPDD

sqrt

S. a

ureu

s bac

tera

emia

s

76

MRSA bacteraemias in the medical specialty of Urology by IPDD by NHS Trust 01/10/2001 - 31/12/2003

L

K

D

J

N

I

H

G

E

M

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 10 20 30 40 50 60 70 80sqrt IPDD

sqrt

MR

SA b

acte

raem

ias

77

MSSA bacteraemias in the medical specialty of Urology by IPDD by NHS Trust 01/10/2001 - 31/12/2003

M

E

G

H

I

N

J

D

K

L

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

0 10 20 30 40 50 60 70 80sqrt IPDD

sqrt

MSS

A b

acte

raem

ias

78

DISCUSSION

79

Analysis of the data for this report has highlighted several issues with regard to the collection of specialty, as part of an enhanced S. aureus bacteraemia data set. Firstly, compliance with reporting the specialty of a patient when a blood culture was taken was very high, with 99% of specialties identified. Secondly, interpretation of a patient’s specialty may vary both within a site and between sites. For certain Trusts we had bacteraemia data reported for a specialty, but no denominator data for that specialty available for that period of time, indicating a discrepancy between the criteria for identifying a specialty between those that report the S. aureus bacteraemia data and those that report the hospital activity data. Between Trusts there is also likely to be different methods of classification of specialty, particularly amongst medical patients, with some Trusts using the broad classification of General Medicine, whereas others subdivide into geriatric medicine, gastroenterology etc. For future reports, although it may be useful to provide trend analysis within a Trust for these smaller specialties, on an all Wales basis and for comparisons between Trusts, specialties will be merged into broader categories for analysis. Thirdly, comparisons of rates of S. aureus bacteraemias between specialties are problematic because of the different natures of the patient populations. Proportions of inpatients, outpatients and regular clinic attendances vary considerably between specialties. For most specialties, it is only hospital inpatients where a blood culture is likely to be taken and therefore feature in the S. aureus bacteraemia data. However, for specialties such as nephrology, oncology, haematology and accident & emergency, it is quite likely that blood cultures would be taken from outpatients and regular clinic attenders. Since S. aureus bacteraemias from the outpatient groups will feature in the numerator of the rate calculations, the outpatient groups should also feature in the denominator. In addition, from specialties such as nephrology, where patients have a long term line present, it is likely that multiple bacteraemias from the same patient, are reported as separate bacteraemias because of the 14 day rule. This inflates the numerator for such specialties and it is not appropriate to compare with other specialties where this is unlikely to happen. For this report we have provided rates using 3 types of denominator, so that the influence of denominator choice can be shown on ranking of specialties. For future reports, only what we consider to be the most appropriate denominator for each specialty will be used and specialties will not be directly comparable. Fourthly, statistical process control charts comparing rates between Trusts within the top thirteen specialties do show some Trusts outside the control limits. These Trusts should investigate the reasons for this. It may have arisen as a result of reporting errors, differences in classifications of specialties, differences in case mix within specialties between Trusts etc or may reflect genuine differences in rates between Trusts in a particular specialty. This could be used as a starting point for action in those specialties with rates above the upper control limit and for sharing practices with those with rates below the lower control limit. The next specialty report will encompass three years of collection of specialty data and will allow some trend analysis to see the direction of the bacteraemia rates.

80

APPENDICES

81

Appendix 1

Specialties included in the ‘Others’ category

Specialty

Burns Surgery

Cardiac Surgery

Dermatology

ENT

Gastroenterology

Genito Urinary Medicine

GP Other than maternity

Gynaecology

Mental Illness

Neurology

Neurosurgery

Obstetrics

Ophthalmology

Old Age Psychiatry

Oral Surgery

Palliative Medicine

Plastic Surgery

Rehabilitation

Rheumatology

Thoracic Medicine

Thoracic Surgery

Unknown specialty

82

Appendix 2 Figure 1.

Rate of total S. aureus bacteraemias per 1000 bed days (95% CI) by medical specialty in Welsh hospitals Oct 01-Dec 03

0.0

5.0

10.0

15.0

20.0

Acciden

t/Emerg

ency

Nephro

logy

Inten

sive T

herapy U

nit

Haemato

logy

Cardiol

ogy

Oncolog

y

Urolog

y

Genera

l Med

icine

Special

Care B

aby U

nit

Paediat

rics

Genera

l Surg

ery

Trauma/O

rthop

aedics

Geriatr

ic M

edici

ne

SA/1

000

bed

days

Figure 2.

Rate of MRSA bacteraemias per 1000 bed days (95% CI) by medical specialty in Welsh hospitals Oct 01-Dec 03

0.0

1.0

2.0

3.0

4.0

5.0

Acciden

t/Emerg

ency

Nephro

logy

Inten

sive T

herapy U

nit

Haemato

logy

Cardiol

ogy

Oncolog

y

Urolog

y

Genera

l Med

icine

Special

Care B

aby U

nit

Paediat

rics

Genera

l Surg

ery

Trauma/O

rthop

aedics

Geriatr

ic M

edici

ne

MR

SA/1

000

bed

days

83

Figure 3.

Rate of MSSA bacteraemias per 1000 bed days (95% CI) by medical specialty in Welsh hospitals Oct 01-Dec 03

0.0

4.0

8.0

12.0

16.0

Acciden

t/Emerg

ency

Nephro

logy

Inten

sive T

herapy U

nit

Haemato

logy

Cardiol

ogy

Oncolog

y

Urolog

y

Genera

l Med

icine

Special

Care B

aby U

nit

Paediat

rics

Genera

l Surg

ery

Trauma/O

rthop

aedics

Geriatr

ic M

edici

ne

MSS

A/1

000

bed

days

Figure 4.

Rate of total S. aureus bacteraemias per 1000 IPDD & transfers (95% CI) by medical specialty in Welsh hospitals Oct 01-Dec 03

01020304050607080

Nephro

logy

Acciden

t/Emerg

ency

Inten

sive T

herapy U

nit

Haemato

logy

Special

Care B

aby U

nit

Cardiol

ogy

Oncolog

y

Genera

l Med

icine

Geriatr

ic M

edici

ne

Urolog

y

Genera

l Surg

ery

Trauma/O

rthop

aedics

Paediat

rics

SA/1

000

IPD

D

84

Figure 5.

Rate of MRSA bacteraemias per 1000 IPDD & transfers (95% CI) by medical specialty in Welsh hospitals Oct 01-Dec 03

0

10

20

30

40

Nephro

logy

Acciden

t/Emerg

ency

Inten

sive T

herapy U

nit

Haemato

logy

Special

Care B

aby U

nit

Cardiol

ogy

Oncolog

y

Genera

l Med

icine

Geriatr

ic M

edici

ne

Urolog

y

Genera

l Surg

ery

Trauma/O

rthop

aedics

Paediat

rics

MR

SA/1

000

IPD

D

Figure 6.

Rate of MSSA bacteraemias per 1000 IPDD & transfers (95% CI) by medical specialty in Welsh hospitals Oct 01-Dec 03

0

10

20

30

40

50

Nephro

logy

Acciden

t/Emerg

ency

Inten

sive T

herapy U

nit

Haemato

logy

Special

Care B

aby U

nit

Cardiol

ogy

Oncolog

y

Genera

l Med

icine

Geriatr

ic M

edici

ne

Urolog

y

Genera

l Surg

ery

Trauma/O

rthop

aedics

Paediat

rics

MSS

A/1

000

IPD

D

85

Figure 7.

Rate of total S. aureus bacteraemias per 1000 IPDD etc (95% CI) by medical specialty in Welsh hospitals Oct 01-Dec 03

0

2

4

6

8

10

12

Inten

sive T

herapy U

nit

Special

Care B

aby U

nit

Geriatr

ic M

edici

ne

Genera

l Med

icine

Cardiol

ogy

Paediat

rics

Genera

l Surg

ery

Urolog

y

Oncolog

y

Trauma/O

rthop

aedics

Haemato

logy

Acciden

t/Emerg

ency

SA/1

000

IPD

D e

tc

Figure 8.

Rate of MRSA bacteraemias per 1000 IPDD etc (95% CI) by medical specialty in Welsh hospitals Oct 01-Dec 03

0

2

4

6

8

Inten

sive T

herapy U

nit

Special

Care B

aby U

nit

Geriatr

ic M

edici

ne

Genera

l Med

icine

Cardiol

ogy

Paediat

rics

Genera

l Surg

ery

Urolog

y

Oncolog

y

Trauma/O

rthop

aedics

Haemato

logy

Acciden

t/Emerg

ency

MR

SA/1

000

IPD

D e

tc

86

Figure 9.

Rate of MSSA bacteraemias per 1000 IPDD etc (95% CI) by medical specialty in Welsh hospitals Oct 01-Dec 03

0

2

4

6

Inten

sive T

herapy U

nit

Special

Care B

aby U

nit

Geriatr

ic M

edici

ne

Genera

l Med

icine

Cardiol

ogy

Paediat

rics

Genera

l Surg

ery

Urolog

y

Oncolog

y

Trauma/O

rthop

aedics

Haemato

logy

Acciden

t/Emerg

ency

MSS

A/1

000

IPD

D e

tc

87

staphylococcus aureus bacteraemia surveillance report

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