Official Statistics

Annual commentary on MRSA, MSSA and Gram-negative bacteraemia and Clostridiodies difficile infections from independent sector healthcare organisations in England: April 2021 to March 2022

Updated 17 November 2023

UK Health Security Agency and this report

Beginning in April 2021, the UK Health Security Agency (UKHSA) was created and is responsible for protecting every member of every community from the effect of infectious diseases, chemical, biological, radiological, and nuclear incidents and other health threats. We provide intellectual, scientific, and operational leadership at national and local level, as well as on the global stage, to make the nation’s health secure.

The agency replaces Public Health England (PHE) and is an executive agency of the Department of Health and Social Care (DHSC). The transition to UKHSA included the integration of both staff and systems. Accordingly, the systems and processes responsible for the publication of the previous annual epidemiological commentaries were incorporated into UKHSA. The same methods of data capture, analysis and dissemination have been employed in the production of this report.

Executive summary

Between 1 April 2021 and 31 March 2022, 118 cases of E. coli bacteraemia, 93 cases of Klebsiella spp. bacteraemia, 35 cases of P. aeruginosa bacteraemia, 7 cases of MRSA bacteraemia, 32 cases of MSSA bacteraemia, and 53 cases of Clostridioides difficile infections (CDI) were reported by Independent Sector (IS) healthcare providers.

Thirteen of 24 IS healthcare organisations provided bed occupancy data. Among these providers, when examining the rates of reported healthcare associated infection (HCAI), the highest overall incidence case rate was observed for E. coli bacteraemia (5.4 per 100,000 bed-days plus discharges, n = 118), while the lowest overall case rate was for MRSA bacteraemia (0.3 per 100,000 bed-days plus discharges , n= 7). Incidence rates for the other HCAI reported infections were; Klebsiella spp. bacteraemia (4.4 per 100,000 bed-days plus discharges, n= 93), CDI (2.5 per 100,000 bed-days plus discharges, n= 53), P. aeruginosa bacteraemia (1.6 per 100,000 bed-days plus discharges, n= 35) and MSSA bacteraemia (1.5 per 100,000 bed-days plus discharges, n= 32).

These figures include all cases reported by the IS and do not take into account whether or not the infection was thought to be associated with the Independent Sector organisation themselves. Below is a summary of key differences between the NHS and IS organisations which should be considered if looking at data from both sectors (Table 1).

Table 1. Summary of key differences between the NHS and IS

Independent sector organisations	NHS acute trusts
Data are not classified based on onset of the bacteraemia of infection.	Data are categorised into ‘Hospital-onset’ and ‘Community-onset’ cases. ‘Hospital-onset’ cases are those thought to have been associated with a given NHS Trust during an associated hospital admission,while ‘Community-onset’ cases are not associated with a current hospital admission. However, ‘Community-onset’ cases are not all community-associated as patients may have had prior healthcare interactions.
Primarily elective patient-mix	Broad patient-mix including emergency-based treatments
Constantly changing facility list	Mainly static list of providers
Large number of specialist facilities	Mainly general acute facilities
Organisations may comprise geographically diverse hospitals	Mainly local clusters of hospitals
Rates calculated using bed-days plus discharges due to the high proportion of day cases compared to the NHS	Mostly rates are calculated using bed-days (occupied beds at midnight – inpatient bed-days figures are available online) or population,

Introduction

This report is the latest in a series of publications of HCAI surveillance data on MRSA, MSSA and Gram-negative (E. coli, Klebsiella spp. and P. aeruginosa) bacteraemia and Clostridioides difficile (CDI) reported by IS healthcare organisations to UKHSA. IS healthcare organisations providing regulated activities (see The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) undertake surveillance on HCAIs and report identified cases to UKHSA as specified in the Code of Practice.

Patient-level data is provided to UKHSA via the secure Data Capture System (DCS). The data for this publication was extracted on 24 August 2022.

Presentation of data

Counts and rates (per 100,000; bed-days and discharges) of MRSA, MSSA, E. coli, Klebsiella spp. and P. aeruginosa bacteraemia and CDI are presented by IS organisation for the 12-month period 1 April 2021 and 31 March 2022. (An IS organisation can comprise a group of hospitals owned by one company or a single hospital. It is possible to identify a group versus a hospital using the ‘number of hospitals in organisation’ field.)

The modified inpatient bed-days IS denominator (bed-days plus discharges) is provided for the most recent financial year available (April 2021 to March 2022) as an indication of the size of each facility.

The hospital type (large hospital = 50 or more beds, small hospital = fewer than 50 beds), NHS treatment centre, diagnostic centre seeing mainly day case patients and women’s health) is listed for the hospitals within a group. This indicates the type of services provided (where a group comprises more than one hospital type, all types are listed). This is correct as of 23 August 2022 based on information supplied to UKHSA.

Additional information can be found in the accompanying OpenDocument Spreadsheet. Some IS organisations included in the data tables may have not been reporting for the entire period. These hospitals are included in Appendix 2. Cases amongst renal patients have been excluded.

Interpreting the data

The data is available in the accompanying OpenDocument Spreadsheet and shows counts and rates of all reported cases of:

• MRSA bacteraemia by Independent Sector Healthcare Organisation – April 2021 to March 2022 (Table T1)
• MSSA bacteraemia by Independent Sector Healthcare Organisation – April 2021 to March 2022 (Table T2)
• E. coli bacteraemia by Independent Sector Healthcare Organisation – April 2021 to March 2022 (Table T3)
• Klebsiella spp. bacteraemia by Independent Sector Healthcare Organisation –April 2021 to March 2022 (Table T4)
• P. aeruginosa bacteraemia by Independent Sector Healthcare Organisation – April 2021 to March 2022 (Table T5)
• CDI by Independent Sector Healthcare Organisation – April 2021 to March 2022 (Table T6)

The data does not provide:

• a basis for comparisons between different IS organisations due to differences in size and range (case mix) of patients seen
• a basis for reliable comparison of these infections between the NHS and IS organisations

A full discussion of these issues is presented elsewhere. (The reasons behind this are discussed in Commentary on Reporting of C. difficile infections and MRSA bacteraemia from the Independent Sector, published 2009.)

Specific data caveats

Below is a list of specific caveats to be considered in relation to the published data.

Data quality

Not all IS organisations have signed off their data or submitted data for the reporting period. Data for such organisations may not yet be finalised and therefore may not be accurate. IS organisations that have not signed off their data for the time period are highlighted in the accompanying OpenDocument Spreadsheet.

Duplicate entries

Data entered onto the DCS by the NHS and IS are collected in 2 parallel systems. This means that data on a single case may be entered by either an NHS trust or an IS organisation or both. Data have only been de-duplicated against the NHS dataset for cases reported via the DCS. If a case is reported by an IS provider and an NHS acute trust, the IS case is excluded as a duplicate entry if:

• the NHS case was reported with a patient location of ‘NHS acute trust’, and the IS case was reported with a patient location that is not ‘IS provider’
• the NHS case was reported with a patient location of ‘NHS acute trust’, and the IS case was reported with a patient location of ‘IS provider’ but the NHS case has a specimen date within 14 days (28 days for CDI) prior to the IS case

Multiple cases reported by one IS provider or by multiple IS providers only are not de-duplicated. Additionally, NHS number, which is one of the variables used to de-duplicate records, is not always known for patients treated in the IS, so potential duplicate records entered onto the DCS may not be identified.

Organisational changes

Some IS organisations included in the data tables may have not been open for the entire reporting period, or at all. This may reduce the count of these infections in such IS organisations, compared to those that were open for the whole period. However, this will also be reflected in their bed occupancy data, so any rate calculated still has validity over the shorter period. Organisations which were not open throughout the entire reporting period are listed in Appendix 2.

Results

A total of 24 organisations are included in this report, 10 of which are groups of more than one hospital and the remaining 14 are single hospitals. Occupancy data (inpatient bed-days plus discharges – see Appendix 2 for further details) was available for 14 organisations. Individual rates for these organisations are included in the accompanying OpenDocument Spreadsheet

E. coli bacteraemia (Table T1)

A total of 118 cases were reported from April 2021 to March 2022 by the following organisations: HCA International (84 cases); The London Clinic (10 cases); Circle Health (6 cases); BUPA Cromwell Hospital (5 cases); Aspen Healthcare (f4 cases); Nuffield Health and Royal Hospital for Neuro-disability (3 cases each); Spire Healthcare (2 cases each); and The Kent Institute of Medicine and Surgery (KIMS) (one case).

Among IS providers that submitted their modified inpatient bed-days, the incidence rate of E. coli bacteraemia for April 2021 to March 2022 was 5.5 cases (n=118) per 100,000 bed-days plus discharges.

Klebsiella spp. bacteraemia (Table T2)

A total of 93 cases were reported from April 2021 to March 2022 by the following organisations: HCA International (65 cases); BUPA Cromwell Hospital (10 cases); The London Clinic (8 cases); Circle Health (4 cases); Nuffield Health (3 cases) and Aspen Healthcare, Royal Hospital for Neuro-disability and Spire Healthcare (one case each).

Among IS providers that submitted their modified inpatient bed-days, the incidence rate of Klebsiella spp. bacteraemia for April 2021 to March 2022 was 4.3 cases (n=93) per 100,000 bed-days plus discharges.

Pseudomonas aeruginosa bacteraemia (Table T3)

A total of 35 cases were reported from April 2021 to March 2022 by the following organisations: HCA International (26 cases); BUPA Cromwell Hospital (3 cases); Spire Healthcare and The London Clinic (2 cases each); and Circle Health and Nuffield Health (one case each).

Among IS providers that submitted their modified inpatient bed-days, the incidence rate of P. aeruginosa bacteraemia for April 2021 to March 2022 was 1.6 cases (n=35) per 100,000 bed-days plus discharges.

MRSA bacteraemia (Table T4)

A total of 7 cases were reported from April 2021 to March 2022 by the following organisations: HCA International (5 cases) and BUPA Cromwell Hospital and Circle Health (one case each).

Among IS providers that submitted their modified inpatient bed-days data, the incidence rate of MRSA bacteraemia for April 2021 to March 2022 was 0.3 cases (n=7) per 100,000 bed-days plus discharges.

MSSA bacteraemia (Table T5)

A total of 32 cases were reported from April 2021 to March 2022 by the following organisations: HCA International (18 cases); Nuffield Health and Spire Healthcare (3 cases each); BUPA Cromwell Hospital, Circle Health and The London Clinic (2 cases each) and Ramsay Health Care UK and Royal Hospital for Neuro-disability (one case each).

Among IS providers that submitted their modified inpatient bed-days, the incidence rate of MSSA bacteraemia for April 2021 to March 2022 was 1.5 cases (n=32) per 100,000 bed-days plus discharges.

CDI (Table T6)

A total of 53 cases were reported from April 2021 to March 2022 by the following organisations: HCA International (31 cases); BUPA Cromwell Hospital (7 cases); Nuffield Health and Spire Healthcare (4 cases each); Royal Hospital for Neuro-disability (3 cases); and Circle Health and The London Clinic (2 cases each).

Among IS providers that submitted their modified inpatient bed-days, the incidence rate of C. difficile infection for April 2021 to March 2022 was 2.5 cases (n=53) per 100,000 bed-days plus discharges.

Appendix 1. How to calculate bed-day plus discharge denominator

The denominator we use, which is more appropriate for shorter stay hospitals is:

Bed-days in year + discharges in year

Instead of counting only the number of nights the patient was resident at midnight for, as per the denominator used for NHS rate calculations, this counts the number of different days a patient was in the hospital. A day case will count as one bed-days plus discharges (calculated as 0 midnights but one discharge) while a one night stay in the year will count as 2 bed-days plus discharges (calculated as one midnight residence and one discharge).

Bed-days

Bed-days in year is the sum of the number of occupants in a bed each midnight during the associated year:for example, the sum of the number of bed occupants at midnight day end 1 April 2021 added to the number of bed occupants at midnight for each subsequent day up to and including 31 March 2022.

Discharges

Discharges are counted as the number of patients with a discharge date between 1 April and 31 March: for example, the sum of the number of patients discharged on 1 April 2021 added to the number discharged for each subsequent day up to and including 31 March 2022

This includes any day cases that were admitted and discharged the same date.

Figures provided are aggregated for each organisation (where an organisation owns more than hospital or facility) or for the individual hospital if an organisation comprises one hospital or facility.

Appendix 2. Organisational changes among IS providers during the reporting period April 2021 to March 2022

(This data was correct as at 23 August 2022 and as supplied to UKHSA.)

Table 2. Hospitals that closed, opened, changed ownership or ceased during the reporting; April 2021 to March 2022

IS provider name	Site name	Status	Month
British Pregnancy Advisory Service	BPAS Wistons Clinic	Closed	May 2021
British Pregnancy Advisory Service	BPAS (Crawley)	Closed	June 2021