Complexity Thinking in Healthcare Associated infections (HCAI)

Dr Mike Simmons
Mrs Sharon Daniel

Hywel Dda University Health Board

Hywel Dda University Health Board (HDUHB) acknowledged that infection in our elderly population arriving from primary to secondary care is a major concern with exponential numbers of Escherichia coli (E. coli) bacteraemia by the end of 2013.

They agreed to take a complexity approach to solving and set a target of reducing E. coli bacteraemia as a common patient-focused endpoint.

Initiatives to be tested by two competing rules:

Quality Interventions Introduced

Line chart showing organism rate per 100,000 of different diseases from 2002 to 2016.

Outputs Observed

Fall in urine submissions (approx 12,000 per year) across HDUHB but primary loss is in negative samples: quality improvement through education of service users in when it is appropriate to send urine samples – positive samples continue at similar number per month.

E. coli bacteraemia rate plateau by end of 2015 and was maintained to end April 2016 but more recently has seen a further increase.

However, review of positive blood cultures across Wales shows a possible plateau now developing in the Hywel Dda population while other health board areas may be approaching the levels formerly only seen in Hywel Dda.

This Project Supports Prudent Healthcare

Anticipated Benefits

Increased understanding of the infection management needs of patients in primary care.

Part of Cohort Bevan Exemplars 2015-16