Rationale for measurement

Clostridium difficile (C. difficile) is a bacterium that can be found in the large bowel. A small proportion (less than 1 in 20) of the healthy adult population carry C. difficile and do not experience any symptoms. However sometimes when a person takes an antibiotic, some “good” bacteria die allowing C. difficile to multiply and this can lead to C. difficile infection (CDI), which affects the large bowel.

Symptoms of CDI include diarrhoea, stomach cramps, fever, nausea and loss of appetite. Most people get a mild illness and recover fully but in certain circumstances, patients can develop serious complications including colitis (inflammation of the bowel), which can be life threatening. Risk factors for developing infection include older age, antibiotic use, serious illness, immune-compromised state (weakened immunity), recent bowel surgery and long term hospitalisation or residence in other health care settings e.g. nursing  homes (www.hpsc.ie/A-Z)

Control of C. difficile comprises antibiotic stewardship (only using antibiotics when required and using the right antibiotic for the infection in question) and good infection prevention and control practice, which means patients, their family members and hospital staff regularly washing their hands and appropriate cleaning and disinfection of equipment. CDI rates in hospitals are recognised and used internationally as a good measure of the quality and safety of a health care service.

Measurement methodology and data sources

• Clostridium difficile – new cases of healthcare associated C. diff infection per 10,000 bed days (monthly)
• source for national data provided by BIU MDR

Target

• ≤2 per 10,000 bed days used (NSP 2024)

Performance
National – Hospital Group Comparator

• national performance of 2.5 not achieving target of ≤2 rate for August 2024
• RCSI HG performance of 1.6 achieving target of ≤2 rate for August 2024
• Mater, Navan and Cappagh Hospitals currently captured in Ireland East HG data

RCSI Hospital Group

• RCSI HG achieving target of ≤2 for August 2024 with a rate of 1.6/10,000 BDU (n=9)

Beaumont Hospital

• Beaumont Hospital not achieving target of ≤2 for August 2024 with a rate of 2.7/10,000 BDU (n=6)

Cavan & Monaghan Hospitals

• Cavan & Monaghan Hospitals achieving target of ≤2 for August 2024 with a rate of 0.0/10,000 BDU (n=0)

Connolly Hospital

• Connolly Hospital achieving target of ≤2 for August 2024 with a rate of 0.0/10,000 BDU (n=0)

Drogheda & Louth Hospitals

• Drogheda & Louth Hospitals not achieving target of ≤2 for August 2024 with a rate of 2.4/10,000 BDU (n=3)

Rotunda Hospital

• Rotunda Hospital achieving target of ≤2 for August 2024 with a rate of 0.0/10,000 BDU (n=0)

Introduction

Carbapenemase-Producing Enterobacteriaceae (CPE) infections are most commonly seen in people with exposure to healthcare settings such as hospitals and long-term care facilities. In healthcare settings, CPE infections occur among sick patients who are receiving treatment for other conditions. Patients carrying CPE either colonised or infected need to be identified and isolated to limit onward spread of this infection.

Rationale for measurement

All patients from the following cohorts will be swabbed on admission or transfer to establish whether they are colonised or infected with CPE. In line with national HCAI guidelines and HIQA standards, CPE testing is mandatory for all patients in the cohorts beneath:

• All patients admitted from Home to any healthcare facility (including the hospital into which they are being
  readmitted) in the previous 12 months
• All patients admitted directly from another healthcare facility (Acute or non-acute) – Hospital transfer in
  Ireland or from a healthcare facility abroad
• All patients admitted to the following specialist areas: Critical Care, Haematology, Transplant, Chemotherapy
  and Renal Dialysis Units
• All contacts of a patient identified as having CPE

Measurement methodology and data sources

• Local data extracts extrapolated for analysis and publication
  • Enumerator: Numbers of Patients from each of the above Cohorts who have been swabbed for CPE
  • Denominator: Numbers of patients admitted from each cohort
• RCSI CPE Report from Planning and Performance Section, Acute Hospital Division
  • Carbapenemase-Producing Enterobacteriaceae – cases of newly detected CPE per 10,000 BDU

Target

• 100% of patients from each of the cohorts identified will be screened for CPE.

Performance

• Beaumont Hospital data for August 2024 not available at time of report publication

• Connolly data for June, July and August 2024 not available at time of report publication

• NB national data unavailable for level of cohort screening

Rationale for measurement

Improving healthcare workers hand hygiene compliance has been described by the WHO as a key measure to reduce healthcare-associated infections. Poor hand hygiene practice can result in an increased risk of cross infections from one person to another by hand contact. It is best practice of all staff working in the healthcare facility washing their hands frequently including (1) before touching a patient, (2) before clean/aseptic procedures, (3) after body fluid exposure/risk, (4) after touching a patient, (5) after touching patient surroundings (WHO, 5 moments).

Measurement methodology and data sources:

• The proportion of healthcare workers who comply with hand hygiene protocols. Source of data – local hospital sites. Data reported monthly.

Target

• 90% target proportion of healthcare workers who comply with hand hygiene protocols (HSE National target)

Performance

• Performance data set updated monthly with local hospital data

Beaumont Hospital

• Beaumont Hospital achieving 94% compliance (August 2024). Target ≥90% achieved

Connolly Hospital

• Connolly Hospital achieving 97% compliance (August 2024). Target ≥90% achieved

Cavan General Hospital

• Cavan General Hospital achieving 92% compliance (August 2024). Target ≥90% achieved

Monaghan Hospital

• Monaghan Hospital achieving 97% compliance (August 2024). Target ≥90% achieved

Rotunda Hospital

• Rotunda Hospital achieving 92% compliance (August 2024). Target ≥90% achieved

Drogheda Hospital

• Drogheda Hospital achieving 95% compliance (August 2024). Target ≥90% achieved

Louth County Hospital

• Louth County Hospital achieving 96% compliance (August 2024). Target ≥90% achieved

RCSI Hospital Group

• overall RCSI HG is achieving 95% compliance (August 2024). Target ≥90% achieved

Rationale for measurement

Influenza (flu) can be a serious disease that can lead to hospitalisation and even death. Anyone can get very sick from the flu, including people who are otherwise healthy. By getting vaccinated, healthcare workers help protect themselves and their patients.

Measurement methodology and data sources

The proportion of healthcare workers who get vaccinated each year. Data source local hospital data. National performance data published annually:

Click here to view the data source.

Target

• HSE target increased in 2020-2021 to 75% proportion of healthcare workers who get vaccinated each year
• RCSI HG target 95%

Performance

RCSI Hospital Group

• Hospital compliance at February (2023/2024 season): Beaumont (50%); Connolly (48%); Cavan (36%), Monaghan (31%); Drogheda (70%), LCH (58%); Rotunda (63%); RCSI Hospital Group (53%)
• Flu vaccination programme runs from October to February and is now closed

Rationale for measurement

COVID-19 is an illness that can affect your lungs and airways. It is caused by a virus called coronavirus. COVID-19 is very infectious and can be a serious disease that can lead to hospitalization and even death. Anyone can get very sick from COVID-19, including people who are otherwise healthy. By being vaccinated, hospital workers help protect themselves and their patients. Vaccination for COVID-19 began in Ireland in late December 2020. From the end of December 2020, the HSE began to make COVID-19 vaccine available to hospital staff with Frontline Healthcare workers (FLHCWs) prioritised.

Frontline healthcare workers are defined as those whose work involves direct physical contact with people who use healthcare services (HSE 2021). Only FLHCWs who are available for frontline duties are included.

Measurement methodology and data sources

• the proportion of frontline healthcare workers currently deployed to frontline duties who have completed first and second doses and booster vaccine
• Data source – local hospital data.

Target

• RCSI HG target 100%

Performance

• national performance not available at time of report publication
• from March 2022 frontline healthcare workers’ vaccination status is no longer collated. National HR policy indicated frontline healthcare workers who are not vaccinated can return to the front line

Introduction

COVID-19 is a worldwide pandemic caused by a newly discovered coronavirus. Most people who are diagnosed with COVID-19 will experience mild to moderate symptoms and recover without specialist treatment. Approximately 15% of patients diagnosed with COVID-19 will require hospitalization and 2% of patients will require admission to an Intensive Care Unit (ICU).

Rationale for measurement

This metric provides information on numbers of patients admitted to hospital due to COVID-19 in RCSI HG.

Measurement methodology and data sources

Local data extracts extrapolated daily for analysis and publication from the 08.00 hours number of confirmed cases of Covid-19 admitted on site (TrolleyGAR)

Performance

• only symptomatic admissions to RCSI HG are tested pre-admission or on day of admission