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Volume 4 No 22; 4 June 2010

Draft guidance on sampling for microbiological testing of the hospital environment

Guidance on the equipment and procedures that should be used when taking samples for the purposes of testing for microbiological contamination in hospital environments, and on the interpretation of results, has been circulated in draft form, as part of a stakeholder consultation exercise, by the HPA's Food, Water and Environmental Microbiology Network.

The guidelines would apply to both incident investigations (for example, of food poisoning outbreaks or nosocomial outbreaks of legionnaires disease) and to routine testing of hospital environments (such as the microbiological quality of renal dialysis fluids).

In the case of water sampling, the draft guidance covers sampling from taps, spas, swimming and hydrotherapy pools and rinse water from endoscopy washers. A significant proportion of the guidance relates to equipment/procedures appropriate for use when testing for legionella contamination of water systems.

The guidance considers, separately, equipment/procedures appropriate for sampling food and for taking samples from the air and from surfaces within the indoor hospital environment.

Also covered in a separate tabular section is guidance (including test parameters) on the interpretation of results of microbiology tests for a variety of purposes, including:
  • active air sampling to determine operating theatre air quality;
  • determination of the bioburden of medical instruments;
  • contamination of ready-to-eat foods including sandwiches; and
  • pharmacy samples.

The final version of this document is due to be published in Autumn 2010, following consideration of comments received during the ongoing consultation exercise.

Reference

1. Health Protection Agency. Draft guidelines for collection and interpretation of results from microbiological examination of food, water and environmental samples from the hospital environment, 1 June 2010. Downloadable from the HPA website at: Home > Consultations and Feedback > Open Consultations.

HCAI surveillance data to be published weekly

As part of the new coalition administration's commitment to opening up its data to the public, in the interest of increased transparency, a range of non-personal, non-sensitive data is being published on a recently launched government website, data.gov.uk. This includes information relating to schools, crime rates, the performance of local councils and, most recently, the results from the mandatory surveillance scheme for healthcare associated infections (HCAI) in England.

The HCAI data includes a new series of weekly reports on meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile infections (CDI) based on data reported to the Health Protection Agency (HPA), the first of which was published on 2 June 2010 on both data.gov.uk and the HPA websites [1].

Historically, the HPA has undertaken a public reporting function and published data on MRSA bacteraemia and CDI by NHS Acute Trust and PCT on a monthly, quarterly, and annual basis; these statistics, which are produced according to the Code of Practice for the production of Official Statistics, will continue to be published by the Agency.

The above-mentioned, new weekly data for MRSA bacteraemia and CDI are different from the monthly, quarterly and annual statistics in that analysis is by hospital (as opposed to Acute Trust and PCT-level reporting), the aim being to allow enquirers to obtain details of infection rates in hospitals in their locality. It is important to note that the new weekly reports are not classified as Official Statistics and that their interpretation should be undertaken with caution. The new data will only include hospital-apportioned cases. Mental health hospitals, care homes, hospices, general practitioners, and Independent Sector hospitals are excluded.

In summary, in addition to the existing mandatory reporting schedule for HCAI, weekly hospital level counts of MRSA bacteraemia and CDI are being published, as follows:
  • weekly hospital apportioned counts for NHS hospitals in England for MRSA bacteraemia for the preceding 12 weeks;
  • weekly hospital apportioned counts for NHS hospitals in England for Clostridium difficile infection (patients aged 2 years and over) for the preceding 12 weeks.

Further information, including definitions and caveats applying to the new weekly reports, is available in a guidance document [2].

References

1. HPA. Weekly Mandatory Surveillance Reports. HPA website: Home > Topics > Infectious Diseases > Infections A-Z > Staphylococcus aureus > Epidemiological Data > Mandatory Staphylococcus aureus bacteraemia surveillance scheme > Mandatory Surveillance Weekly Reports.

2. Weekly reporting of mandatory surveillance reports of meticillin-resistant Staphylococcus aureus bacteraemia and Clostridium difficile infection: Weekly Reporting Guidance Document [165 kB PDF].

Seasonal influenza: immunisation programme for 2010/11

Details of the seasonal influenza vaccination programme for 2010/11 have been circulated by the Chief Medical Officer for England [1]. The national policy for seasonal influenza vaccine is unchanged except for the extension of the scope of the programme to include all pregnant women - whether or not they are in a risk group - unless they have previously received an H1N1 swine flu vaccination.

The CMO letter states: "Pregnant women have not routinely been offered seasonal influenza vaccine in the past unless they were in a clinical risk group. However, there is good evidence that all pregnant women are at increased risk from complications if they contract the H1N1 swine influenza virus. In light of this, pregnant women in clinical risk groups will continue to be offered the seasonal influenza vaccine as usual. But in addition, those pregnant women who are not in a clinical risk group and who have not already received a dose of H1N1 swine influenza vaccine will also be offered the trivalent seasonal influenza vaccine once it becomes available. In the meantime, all pregnant women should continue to be offered the monovalent H1N1 swine influenza vaccine".

The CMO letter reviews the uptake of both seasonal and H1N1 swine influenza vaccines during the 2009/10 season, noting the steady increase in seasonal vaccine uptake in recent years (reaching 72.4% in those over 65 years of age in 2009/10) as well as the success of the swine flu vaccine campaign.

Uptake of seasonal influenza vaccine among healthcare workers also increased in the 2009/10 season (to 26.4%, from 16.5% in 2008/09) but the CMO letter notes that immunisation rates need to be further improved for this group so that "they may protect themselves, their family members and their patients". The CMO is to provide a report to assist NHS Trusts in their planning for future influenza vaccination programmes.

Reference

1. Department of Health. PL CMO (2010)1, PL CNO (2010)1, PL CPHO (2010)1: The influenza immunisation programme 2010/11.

WHO update on global pandemic situation

Pandemic influenza virus transmission continues in tropical parts of the world, primarily parts of the Caribbean and Southeast Asia, but in temperate zones of the southern hemisphere, countries are not reporting increases in influenza activity above epidemic thresholds, nor unusually early seasonal influenza activity, according to a global update presented to the WHO's International Health Regulations Emergency Committee on 1 June 2010 [1].

Across the African continent, activity is low or sporadic and data from West Africa indicates that the active transmission of pandemic influenza virus has largely subsided after peaking during February and March 2010. The WHO committee concluded that while the period of most intense pandemic activity appears likely to have passed it remains critical for countries to continue to maintain vigilance concerning the pandemic, including all necessary public health measures for disease control as well as influenza virus and disease surveillance.

A further meeting of the emergency committee to reassess the epidemiological situation will be convened in July, when information from the winter influenza season in the southern hemisphere will be available.

Reference

1. WHO. Director-General statement following the eighth meeting of the Emergency Committee, http://www.who.int/csr/disease/swineflu/8th_meeting_ihr/en/index.html.