NHS Boards' rate of CDI (clostridium difficile infections) in patients aged 15 and over is 0.32 cases or less per 1,000 total occupied bed days. Standard currently under review.
Current national performance
In the year ending December 2018, the rate of identifications of CDI cases across NHSScotland was 0.27 per 1,000 occupied bed days among patients aged 15 and over. This is the most recent data relating to the standard.
Update (July 2019)
In October 2017, Health Protection Scotland introduced a new format for reporting the quarterly epidemiological data. This included changing the standardised denominator data for Staphylococcus aureus bacteraemia (SAB, comprising MRSA and MSSA), Clostridioides (formerly Clostridium) difficile infections (CDI) and Escherichia coli bacteraemia (ECB), to bring them in line with other countries across Europe. The standardised denominator changed from 1,000 total occupied bed days to 100,000 total occupied bed days to reflect the healthcare cases and 100,000 population for community cases.
From July 2019, the data is no longer available in its historic format, using the old denominators, as previously reported on Scotland Performs: NHSScotland.
Accordingly, this LDP Standard is currently under review. While this work is ongoing, please refer to the Official Statistics Publication: Quarterly epidemiological data on CDI, ECB, SAB and Surgical Site Infection in Scotland.
HPS monitor outcomes from the mandatory surveillance of CDI on a quarterly basis, including total CDI cases and CDI incidence rates for every NHSScotland Board; distinguishing between healthcare and community associated infections.
As part of the monitoring process, HPS identify and advise any NHSScotland Health Boards that have produced exceptions. The Board is required to produce an action plan to address the reported surveillance rate exceedance. Please see the full Standard Operating Procedure for Production of Quarterly Exception Reports.
In addition to this, the purpose of the comprehensive practical guidance set out in Health Protection Scotland’s (HPS) National Infection Prevention and Control Manual (NIPCM) is to ensure that the assessment, reporting and escalation of infection incidents, outbreaks or data exceedance is robust on a daily basis. Chapter 3 of the NIPCM is designed to support early recognition of potential infection incidents, which includes CDI.
About this LDP standard
Healthcare Associated Infections (HAIs) are a significant public health threat. The inpatient cost of HAI originating in NHS acute care hospitals was reported to be £137 million in 2013. Tackling and reducing HAIs is a key priority for the Scottish Government and NHSScotland in terms of the safety and well-being of patients, staff and the public.
This LDP standard provides professional and clinical guidance in reducing Healthcare Associated Infection (HAI) in hospitals and other settings ensuring safe and effective care, evolving services in line with the 2020 vision, and systems as well as maximising healthcare outcomes for patients.
Performance against this standard
Since 2007, Scotland has achieved significant reductions in CDI.
Over the last five years specifically, we have continued to see a reduction in CDI in Scotland. The 2018 Healthcare Associated Infection Annual Report, published by Health Protection Scotland on 3 May 2019, found that there has been a decreasing year on year trend in the incidence rate of CDI of 7.5%, in patients 15 years and older, between 2014 and 2018.