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The UK Health Security Agency (UKHSA) has published its Point Prevalence Survey (PPS) on healthcare-associated infections (HCAIs), antibiotic use (AMU) and antibiotic stewardship (AMS) for England in 2023.
The survey looks at data from 121 NHS trusts and independent sector organisations across England. It provides a one-day snapshot of prevalence levels in our healthcare system, offering insights on current practices and where targeted intervention across various healthcare settings are needed most.
The report for 2023 found that overall HCAIs were present in 7.6% of patients, a 1% increase on the last reported figures in 2016. This rise could be associated with increased pressure on the healthcare system following the COVID-19 pandemic and more unwell patients due to an ageing population or more patients with comorbidities. Work is being done to understand the increase further.
The results suggest England’s HCAI prevalence level is consistent with trends seen in other European countries, including Spain, Sweden and Ireland.
Prevalence varied across different settings. In acute NHS trusts, 8% of patients tested positive for an HCAI. However, expected higher levels at 16.6% were recorded in acute specialty trusts, such as orthopaedic and children’s trusts where patients can be more susceptible to HCAIs. Among specialty trusts, HCAI prevalence was highest in Intensive Care Units (ICUs) at 15.9%.
Of the total number of 3,493 HCAIs reported by the participating organisations, pneumonia/lower respiratory tract infections (PNLRI) were the most common sites of infection (29.6%), followed by urinary tract infections (UTIs) (17.5%), and sepsis/disseminated infections (10.6%).
This year’s report included mental health and community sites for the first time, with prevalence levels at 5.1% and 5% respectively. These additional data sets are essential to develop our understanding of the HCAI risks and antibiotic use levels across different healthcare settings in England for comparative purposes.
The overall prevalence of antibiotic use in all hospital patients surveyed was 34.1% in 2023. This means that out of the 44,372 patients included in the national analysis, 15,134 were treated with an antibiotic on the day of the survey. In NHS acute care hospitals, the overall antibiotic use prevalence was similar in 2023 (37.3%), compared to 2016 (36.7%).
Further analysis of the antibiotics prescribed showed that ‘Access’ and ‘Reserve’ antibiotics accounted for 31.3% and 6% of total antibiotic use respectively in participating hospitals. The UK’s 2024 AWaRe (Access, Watch, Reserve) categorisation system is a tool used to help healthcare professionals prescribe the most appropriate antibiotics for patients while protecting their future effectiveness. Most patients should receive ‘Access’ antibiotics in the first instance. They offer the most effective treatment while minimising the potential for resistance. However, in some cases, for example seriously ill patients in hospitals, treatment with ‘Watch’ or ‘Reserve’ antibiotics may be required. Watch’ antibiotics are first or second choice antibiotics for a limited number of infections, while ‘Reserve’ are “last resort” or new antibiotics.
By 2029, the UK is aiming to achieve 70% of total use of antibiotics from ‘Access’ across the human healthcare system to preserve efficacy. According to the latest assessment in 2023, this was 64.1% for England across the healthcare sector.
Dr Colin Brown, Deputy Director at UKHSA, said
It’s good to see that overall levels of healthcare-associated infections remained relatively similar in 2023, compared to 2016. This is likely thanks to the efforts of staff across the healthcare system who work tirelessly to implement effective infection prevention and control measures, and ensure antibiotics are being prescribed and taken appropriately.
However, levels have still increased in some parts of the health service, which must be addressed – together with continuing to drive down overall levels. Work is being conducted to better understand the drivers so that we can protect patients, especially those who are more susceptible to these types of infection such as the elderly and people with comorbidities.
