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All Wales Commentaries: Clostridium difficile Reports

The All Wales Clostridium difficile surveillance report with monthly trend data from October 2011 to September 2012 can be downloaded from:

All Wales C. difficile Surveillance Report Commentary October 2011 to September 2012

  • The surveillance scheme has been running since the 1st January 2005.
    These data cover number and rates of C. difficile cases identified in hospital inpatients in Wales between the 1st October 2011 and the 30th September 2012. From April 2011 data from non-inpatient locations has been collected and these numbers are also provided in the report.
    The total C. difficile rate per 1000 admissions in inpatients over 65 years in Wales for 01.10.11 to 30.09.12 was 6.43; this compares with a rate of 8.73 (revised since original publication because of an update in denominator data) for 01.10.10 to 30.09.11.
    The range of rates for different Health Boards in Wales was from 2.91 to 9.55 cases per 1000 admissions in the inpatients over 65 years age group.
    1143 cases of C. difficile were identified in inpatients over 65 years during the period 01.10.11 to 30.09.12, representing a 27% decrease in cases compared to 01.10.10 to 30.09.11. An additional 379 cases were identified in non-inpatients over 65 years.
    275 cases of C. difficile were identified in inpatients between two and 65 years of age; 19 per cent of the total inpatient cases seen. An additional 127 cases were identified in non-inpatients aged from two to 65 years for this time period. Non-inpatients figures include C. difficile from non-inpatient wards within hospitals and from community locations such as GPs and nursing homes.
    SPC charts use upper and lower control limits to indicate the range in rates that would be expected as a result of natural variation. These control limits can be reset when there has been a significant change in the data. New control limits were put in place for Wales as a whole from April 2010 but because of further reductions in rate during the 2011/12 financial year another recalculation has been introduced from June 2011. The markers that have been used to identify significant changes in rates are 8 consecutive points below the overall centre line or 12/14 consecutive points below the overall centre line. For individual Health Boards and hospitals splits have been made according to when either of the criteria has been met. For some hospitals no split has been made, but splits will be made in the future if either criterion has been met.
     
    During the time period of the report, laboratories in Wales moved from testing specimens for C. difficile using a single test (either a toxin A and B enzyme immunoassay or a neutralised cell toxicity assay) to a 2-stage test, incorporating a glutamate dehydrogenase (GDH) assay followed by a toxin enzyme immunoassay. For the 2-stage test, only those specimens that were both GDH and toxin positive were included as positive for C. difficile. The change in testing protocol may influence the numbers of C. difficile identified.
    The data are extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
    These data are NOT comparable with the C. difficile surveillance schemes of England, Scotland or Northern Ireland. The denominator used for calculating rates in the other UK countries is occupied bed days in the over 65 years, whereas admission data is used in Wales.

The All Wales Clostridium difficile surveillance report with monthly trend data from October 2010 to September 2011 can be downloaded from:

All Wales C. difficile Surveillance Report Commentary April 2011 to March 2012

  • The surveillance scheme has been running since the 1st January 2005.
  • These data cover number and rates of C. difficile cases identified in hospital inpatients in Wales between the 1st April 2011 and the 31st March 2012.
  • From April 2011 data from non-inpatient locations has been collected and these numbers are also provided in the report.
  • The total C. difficile rate per 1000 admissions in inpatients over 65 years in Wales for 01.04.11 to 31.03.12 was 7.18; this compares with a rate of 10.80 (revised since original publication because of an update in denominator data) for 01.04.10 to 31.03.11.
  • The range of rates for different Health Boards in Wales was from 2.77 to 9.76 cases per 1000 admissions in the inpatients over 65 years age group.
  • 1295 cases of C. difficile were identified in inpatients over 65 years during the period 01.04.11 to 31.03.12, representing a 32% decrease in cases compared to 01.04.10 to 31.03.11. An additional 426 cases were identified in non-inpatients over 65 years.
  • 291 cases of C. difficile were identified in inpatients between two and 65 years of age; 18 per cent of the total inpatient cases seen. An additional 131 cases were identified in non-inpatients from two to 65 years for this time period. Non-inpatients figures include C. difficile from non-inpatient wards within hospitals and from community locations such as GPs and nursing homes.
  • SPC charts use upper and lower control limits to indicate the range in rates that would be expected as a result of natural variation. These control limits can be reset when there has been a significant change in the data. New control limits were put in place for Wales as a whole from March 2010 but because of further reductions in rate during the 2011/12 financial year another recalculation has been introduced from June 2011. The markers that have been used to identify significant changes in rates are 8 consecutive points below the overall centre line or 12/14 consecutive points below the overall centre line. For Wales as a whole, the split has been made from April 2010 (after this point there were at least 8 consecutive points below the centre line). For individual Health Boards and hospitals splits have been made according to when either of the criteria has been met. For some hospitals no split has been made, but splits will be made in the future if either criterion has been met. 
  • The data are extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
  • These data are NOT comparable with the C. difficile surveillance schemes of England, Scotland or Northern Ireland. The denominator used for calculating rates in the other UK countries is occupied bed days in the over 65 years, whereas admission data is used in Wales.

The All Wales Clostridium difficile surveillance report with monthly trend data from October 2010 to September 2011 can be downloaded from:

All Wales C. difficile Surveillance Report Commentary October 2010 to September 2011

  • These data cover C. difficile cases identified in hospital in-patients in Wales between the 1st October 2010 and the 30th September 2011.
  • The surveillance scheme has been running since the 1st January 2005.
  • The total C. difficile rate per 1000 admissions in in-patients over 65 years in Wales for 01.10.10 to 30.09.11 was 8.86; this compares with a rate of 14.23 for 01.10.09 to 30.09.10.
  • The range of rates for different Health Boards in Wales was from 3 to 13 cases per 1000 admissions in the >65 year age group.
  • 1574 cases of C. difficile were identified in the >65 years during the period 01.10.10 to 30.09.11, representing a 37% decrease in cases compared to 01.10.09 to 30.09.10.
  • SPC charts use upper and lower control limits to indicate the range in rates that would be expected as a result of natural variation. These control limits can be reset when there has been a significant change in the data. Because of the reduction in the rates of C. difficile in Wales the control limits have been reset to reflect these lower rates. The markers that have been used to identify significant changes in rates are 8 consecutive points below the overall centre line or 12/14 consecutive points below the overall centre line. For Wales as a whole, the split has been made from April 2010 (after this point there were at least 8 consecutive points below the centre line). For individual Health Boards and hospitals splits have been made according to when either of the criteria has been met. For some hospitals no split has been made, but splits will be made in the future if either criterion has been met.
  • Data on cases in the age group from two years to 65 years have also been published for the period 01.10.10 to 30.09.11. These show that 326 cases of C. difficile were identified in in-patients between two and 65 years of age; 17 per cent of the total cases seen.
  • The data are extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
  • These data are NOT comparable with the C. difficile surveillance schemes of England, Scotland or Northern Ireland. The denominator used for calculating rates in the other UK countries is occupied bed days in the over 65 years, whereas admission data is used in Wales.

The All Wales Clostridium difficile surveillance report with monthly trend data from October 2009 to September 2010 can be downloaded from:

All Wales C. difficile Surveillance Report Commentary October 2009 to September 2010

  • These data cover C. difficile cases identified in hospital in-patients in Wales between the 1st October 2009 and the 30th September 2009.
  • The surveillance scheme has been running since the 1st January 2005.
  • The total C. difficile rate per 1000 admissions in in-patients over 65 years in Wales for 01.10.09 to 30.09.10 was 14.5; this compares with a rate of 14.9 for the equivalent period in the previous year.
  • The range of rates for different Health Boards in Wales was from 8 to 26 cases per 1000 admissions in the >65 year age group.
  • 2541 cases of C. difficile were identified in the >65 years during the period 01.10.09 to 30.09.10, representing a 3% decrease in cases from the equivalent period in the previous year.
  • There was a peak in cases seen during January and February 2010, when a number of hospitals in Wales experienced a marked increase in C. difficile. This increase was followed by a reduction back to more average numbers.
  • The data for September 2010 shows a significantly lower rate of C. difficile in inpatients aged over 65 in Wales and provisional data up to December 2010 suggests the low rates continue.
  • Data on cases in the age group from two years to 65 years have also been published for the period 01.10.09 to 30.09.10. These show that 483 cases of C. difficile were identified in in-patients between two and 65 years of age; 16 per cent of the total cases seen.
  • The data are extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
  • These data are NOT comparable with the C. difficile surveillance schemes of England, Scotland or Northern Ireland. The denominator used for calculating rates in the other UK countries is occupied bed days in the over 65 years, whereas admission data is used in Wales.

 


The All Wales Clostridium difficile surveillance report with monthly trend data from January to December 2009 can be downloaded from:

 

 

C. difficile  - All Wales data 01.01.09 to 31.12.09 – Key Points

  • These data cover C. difficile cases identified in hospital in-patients in Wales between the 1st January 2009 and the 31st December 2009.
  • These data have been presented by Health Board although some of the surveillance period is from before the establishment of the Health Boards.
  • The surveillance scheme has been running since the 1st January 2005.
  • The total C. difficile rate per 1000 admissions in in-patients over 65 years in Wales for 01.01.09 to 31.12.09 was 15.1; this compares with a rate of 17.1 for 2008.
  • The range of rates for different Health Boards in Wales was from 7 to 22 cases per 1000 admissions in the >65 year age group.
  • 2654 cases of C. difficile were identified in the >65 years during the period 01.01.09 to 31.12.09, representing a 12% decrease in cases from the 2008 total (3002 cases).
  • There was a peak in cases seen during January 2009, when a number of hospitals in Wales experienced a marked increase in C. difficile. This increase was followed by a reduction back to more average numbers for the rest of the year and the variation continues to show seasonality.
  • There are a number of possible explanations for this increase in cases at the beginning of 2009, including:
    • Increased incidence of Viral Gastroenteritis infections and outbreaks in the Winter of 08/09
    • The introduction of a strain of C. difficile known as ribotype 027 into some of the hospitals in Wales
    • Increased testing for C. difficile in hospitals
    • Other important factors include the use of antimicrobial agents, bed occupancy rates, cleaning schedules and hand hygiene compliance.
    • Health Boards are advised to consider all these factors as they respond to the increases seen in their individual hospitals.
  • Data on cases in the age group from two years to 65 years have also been published for the period 01.01.09 to 31.12.09. These show that 532 cases of C. difficile were identified in in-patients between two and 65 years of age; 17 per cent of the total cases seen.
  • The data are extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
  • These data are NOT comparable with the C. difficile surveillance schemes of England, Scotland or Northern Ireland. The denominator used for calculating rates in the other UK countries is occupied bed days in the over 65 years, whereas admission data is used in Wales.

 


The All Wales Clostridium difficile surveillance report with monthly trend data from 01/07/2008 to 30/06/2009 can be downloaded from:

 

 

C. difficile  - All Wales data 01.07.08 to 30.06.09 – Key Points

  • These data cover C. difficile cases identified in hospital in-patients in Wales between the 1st July 2008 and the 30th June 2009.
  • These data are from a time period before the establishment of the Health Boards therefore reports are based on old NHS Trusts.
  • The surveillance scheme has been running since the 1st January 2005.
  • The total C. difficile rate per 1000 admissions in in-patients over 65 years in Wales for 01.07.08 to 30.06.09 was 15.46; this compares with a rate of 17.86 for the equivalent period last year.
  • The range of rates for different Trusts in Wales was from 8 to 25 cases per 1000 admissions in the >65 year age group.
  • 2744 cases of C. difficile were identified in the >65 years during the period 01.07.08 to 30.06.09, representing a 11% decrease in the cases for 01.07.07 to 30.06.08 (3095 cases).
  • There was a peak in cases seen during January 2009, when a number of Trusts in Wales experienced a marked increase in C. difficile. This increase was followed by a reduction back to more average numbers for the rest of the year and the variation continues to show seasonality.
  • There are a number of possible explanations for this increase in cases at the beginning of 2009, including:
    • Increased incidence of Viral Gastroenteritis infections and outbreaks in the Winter of 08/09
    • The introduction of a strain of C. difficile known as ribotype 027 into some of the hospitals in Wales
    • Increased testing for C. difficile in hospitals
    • Other important factors include the use of antimicrobial agents, bed occupancy rates, cleaning schedules and hand hygiene compliance.
    • Trusts are advised to consider all these factors as they respond to the increases seen in their individual hospitals.
  • Data on cases in the age group from two years to 65 years have also been published for the period 01.07.08 to 30.06.09. These show that 602 cases of C. difficile were identified in in-patients between two and 65 years of age; 18 per cent of the total cases seen.
  • The data are extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
  • These data are NOT comparable with the C. difficile surveillance schemes of England, Scotland or Northern Ireland. The denominator used for calculating rates in the other UK countries is occupied bed days in the over 65 years, whereas admission data is used in Wales.


The All Wales Clostridium difficile surveillance report with monthly trend data from 01/01/2008 to 31/12/2008 can be downloaded from:

C. difficile – All Wales data 01.01.08 – 31.12.08 – Key points

  • These data cover C. difficile cases identified in hospital in-patients in Wales between the 1st January 2008 and the 31st December 2008.
  • The surveillance scheme has been running since the 1st January 2005. This report represents the fourth complete year of surveillance.
  • The total C. difficile rate per 1000 admissions in in-patients over 65 years in Wales for 2008 was 17.05; this compares with a rate of 16.92 for 2007.
  • The range of rates for different Trusts in Wales was from 10 to 28 cases per 1000 admissions in the >65 year age group.
  • 3002 cases of C. difficile were identified in the >65 years during 2008, representing a 2% increase on the cases for 2007 (2944 cases).
  • The main cause of the increase in cases was the peak of cases seen during January – April 2008, when a number of Trusts in Wales experienced a marked increase in C. difficile. This increase was followed by a reduction back to more average numbers for the rest of the year and the variation continues to show seasonality.
  • There are a number of possible explanations for this increase in cases at the beginning of 2008, including:
    • Increased incidence of Viral Gastroenteritis infections and outbreaks in the Winter of 07/08
    • The introduction of a new strain of C. difficile known as ribotype 027 into Wales
    • Increased testing for C. difficile in hospitals
    • Other important factors include the use of antimicrobial agents, bed occupancy rates, cleaning schedules and hand hygiene compliance.
    • Trusts are advised to consider all these factors as they respond to the increases seen in their individual hospitals.
  • Data on cases in the age group from two years to 65 years have also been published for 2008. These show that 663 cases of C. difficile were identified in in-patients between two and 65 years of age; 18 per cent of the total cases seen.
  • The data are extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
  • These data are NOT comparable with the C. difficile surveillance schemes of England, Scotland or Northern Ireland. The denominator used for calculating rates in the other UK countries is occupied bed days in the over 65 years, whereas admission data is used in Wales.

 


The All Wales Clostridium difficile surveillance report with monthly trend data from 01/07/2007 to 30/06/2008 can be downloaded from:

C. difficile – All Wales data 01.07.07 – 30.06.08 – Key points

  • These data cover C. difficile cases identified in hospital in-patients in Wales between the 1st July 2007 and the 30th June 2008.
  • The surveillance scheme has been running since the 1st January 2005.
  • The total C. difficile rate per 1000 admissions in in-patients over 65 years in Wales for this period was 18; this compares with a rate of 16 for the period 01/07/06 – 30/06/07.
  • The range of rates for different Trust in Wales was from 8 to 28 cases per 1000 admissions in the >65 year age group.
  • 3072 cases of C. difficile were identified in the >65 years during 01/07/07 – 30/06/08, representing nearly a 10% increase on the cases for 01/07/06 – 30/06/07.
  • The main cause of the increase in cases was the peak of cases seen during January – April 2008, when a number of Trusts in Wales experienced a marked increase in C. difficile.
  • There are a number of possible explanations for this increase, including:
    • Increased incidence of Viral Gastroenteritis infections and outbreaks in the Winter of 07/08
    • The introduction of a new strain of C.difficile known as ribotype 027 into Wales
    • Increased testing for C.difficile in hospitals
    • Other important factors include the use of antimicrobial agents, bed occupancy rates, cleaning schedules and hand hygiene compliance.
    • Trusts are advised to consider all these factors as they respond to the increases seen in their individual hospitals.
  • For the first time, data on cases in the age group from two years to 65 years have been published. Data are presented for the first six months of 2008. These show that 439 cases of C. difficile were identified in in-patients between two and 65 years of age; 20 per cent of the total cases seen. Although these cases have not previously formed part of the national surveillance scheme, C. difficile cases from younger age groups have previously been monitored locally by Trusts and the patients treated for C. difficile accordingly.
  • The data are extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
  • These data are NOT comparable with the C. difficile surveillance schemes of England, Scotland or Northern Ireland. The denominator used for calculating rates in the other UK countries is occupied bed days in the over 65 years, whereas admission data is used in Wales.

 

 

The All Wales Clostridium difficile surveillance report with monthly trend data from 01/01/2007 to 31/12/2007 can be downloaded from:

C. difficile – All Wales data 01.01.07 – 31.12.07 – Key points

  • These data cover C. difficile cases in the over 65 year age group identified in Wales between the 1st of January 2007 and the 31st December 2007.
  • The surveillance scheme has now been running for three years since the 1st January 2005.
  • The total C. difficile rate per 1000 admissions in in-patients over 65 years in Wales for this period was 16.84, this compares with a rate of 14.84 in 2006 and 14.80 in 2005.
  • The range of rates for different Trust in Wales was from 8.6 to 27.7 cases per 1000 admissions in the >65 year age group.
  • 2926 cases of C. difficile were identified in the >65 years during 2007 compared with 2586 for 2006, this is a 13% increase since 2006.
  • The main cause of the increase in cases experienced during 2007 was the peak of cases seen during the first quarter of the year when a number of Trusts in Wales experienced a marked increase in C. difficile. This increase was followed by a reduction back to more average numbers for the rest of the year and the variation continues to show seasonality.
  • Increases in C. difficile infection rates can be associated with a variety of factors including the pattern of antimicrobial usage, bed occupancy rates, cleaning schedules and hand hygiene compliance. Laboratory testing protocols can also influence the numbers of cases detected and there is some evidence to suggest that there has been an increase in testing in Wales during 2007. Trusts are advised to consider all these factors as they respond to the increases seen in their individual hospitals.
  • The data are extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
  • These data are NOT comparable with the C. difficile surveillance schemes of England, Scotland or Northern Ireland. The denominator used for calculating rates in the other UK countries is occupied bed days in the over 65 years. Age specific bed day data is not available in Wales, so we use admissions data to measure the hospital throughput instead.
 
The All Wales Clostridium difficile surveillance report with monthly trend data from 01/07/2006 to 30/06/2007 can be downloaded from:

C. difficile – All Wales data 1.07.06 – 30.06.07 – Key points:

  • These data cover C. difficile cases in the over 65 year age group identified in Wales between 01.07.2006 and 30.06.2007
  • The surveillance scheme has now been running for two and half years since 01.01.2005
  • The total C. difficile rate per 1000 admissions in in-patients over 65 years in Wales for this period was 16.16, this compares with a rate of 13.74 in the year 01.07.2005 – 30.06.2006.
  • The range of rates for different trusts seen in Wales was from 6.37 – 37.28 cases per 1000 admissions >65 years.
  • 2811 cases of C. difficile were identified in the >65 years between 01.07.2006 and 30.06.07 compared with 2470 between 01.07 2005 and 30.06.06.
  • An increase above the upper control limit on the SPC chart was seen in Wales in March 2007, this appears to reflect an increase in the numbers of cases of C. difficile experienced in a number of Trusts in Wales over the first quarter of 2007. When compared with data from previous years, the pattern is similar in that the highest rates of infection are seen in the first quarter of the year, demonstrating seasonal variation.
  • Subsequent months have shown a decline in cases back towards rates previously seen in Wales over the first two years of the surveillance scheme.
  • The data is extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
  • These data are NOT compatible with the English C. difficile surveillance data as the cases in England are looked at per 1000 patient bed days in all ages rather than per 1000 admissions in the > 65 years.
 

The All Wales Clostridium difficile surveillance report with monthly trend data from 01/01/2006 to 31/12/2006 can be downloaded from:

C. difficile – All Wales data – Key points:

  • These data cover C. difficile cases in the over 65 age group identified in Wales between 01.01.2006 and 31.12.06
  • This is the second year of data collected by this surveillance scheme.
  • The total C. difficile rate per 1000 admissions in in-patients over 65 years in Wales for this period was 14.84, this compares with a rate of 14.79 in 2005.
  • The range of rates was from 6.48 – 32.78 cases per 1000 admissions >65 years.
  • C. difficile rates in Wales have remained steady over the 2 year period of the mandatory surveillance scheme so far.
  • The data is extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
  • Winter seasonality is seen in these data with a high peak seen in the January – March period, and a suggestion of an increase towards the end of the year.
  • These data are NOT comparable with the English data as the cases in England are looked at per 1000 patient bed day > 65 years rather than per 1000 admissions.

 


The All Wales Clostridium difficile surveillance report with monthly trend data from 01/07/2005 to 30/06/2006 can be downloaded from:

The All-Wales Clostridium difficile surveillance report with monthly trend data from 01/01/2005 to 31/12/2005 can be downloaded from:
Key points from this report are highlighted below:
 

C. difficile – All Wales data – Key points:

  • These data cover C. difficile cases in the over 65 age group identified in Wales between 01.01.2005 and 31.12.05
  • This is the first year of data collected by this surveillance scheme.
  • The total C. difficile rate per 1000 admissions in in-patients over 65 years in Wales for this period was 14.79
  • The range of rates was from 6 – 34 cases per 1000 admissions >65 years.
  • The data is extracted automatically from laboratory systems of hospitals in Wales and therefore all hospitals have contributed data to this surveillance scheme.
  • Winter seasonality is seen in these data with a high peak seen in the January – March period, and a suggestion of an increase towards the end of the year.
  • These data are NOT comparable with the English data as the cases in England are looked at per 1000 patient bed day > 65 years rather than per 1000 admissions.
  • These data will become more useful as trend data is produced over time.
  • At the moment it gives hospitals in Wales an indication of their current rates vs the other hospitals in Wales and also picks up fluctuations from the average rate which may require investigation.



Last updated: 04/02/2013