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C. Data queries
Case Entry

CE - FAQ0012 Q: What is the procedure for requesting an Unlock of the HCAI Data Capture System for signed-Off months in which cases need to be added, deleted or amended? A: Corrections to the number of records will require the CEO for the Trust to email the mandatory inbox ( mandatory.surveillance@ukhsa.gov.uk) to confirm that he/she is happy for data that has been signed off as correct to be unlocked. However, if you are only wanting to amend the records without adding or deleting them, then it would be sufficient to copy your CEO into the email so that he/she is aware that changes are going to be made to the data already held on the system. Once we receive this confirmation we will be able to unlock the data set for you at a time that is convenient for you or the person making the changes. Please be aware, unlocks are controlled and the data will automatically re-lock at midnight that night. Please note before unlocking the data set we will require the following information in order to unlock the data set: The collection you wish to unlock - e.g. MRSA, MSSA, P. aeruginosa, Klebseilla, E. coli or C. difficile? Are you adding, deleting, or amending records? How many records will be affected and what are their HCAI ID numbers? (Please note if you are adding cases you will need to provide ID numbers once you have entered them on to the HCAI data capture system.) The specimen months that will be affected Confirm whether the additional cases are a result of the routine mandatory versus voluntary data checks? If so, please provide the case ID’s for the cases (these may be found on the first column of the spreadsheet received). Provide a reason for deleting cases if this is required Provide a convenient date and time for the person making the changes (anytime during working hours; Mon-Fri, 8-5pm) Please note – we only require the case ID as a form of identification of the cases to be amended, PLEASE DO NOT SEND NHS numbers or any other patient identifiable information, as this is a breach of information governance.

CE - FAQ0013 Q: How do I enter Quarter Mandatory Laboratory Returns Data and what do I do if the time period is missing? A: Log-in as Data-Entry Select ‘Search’ Select ‘New Infection Episode’ at the bottom of the screen On the ‘New Infection Episode’ select QMLR on the drop-down menu Save the Data Collection Tab, after you have selected the correct quarter. At this point the you should have a “Message from the Webpage” popping up-informing you that the record has been saved (please take note of the QMLR ID), you will then be able to move onto the QMLR mandatory questions tab. At this point the you should have a “Message from the Webpage” popping up-informing you that the record has been saved (please take note of the QMLR ID), you will then be able to move onto the QMLR mandatory questions tab. For further reference, the above information can be found on our online Quarterly Mandatory Laboratory Return (QMLR) Report Please note that if the time period is/becomes missing in the drop-down list, this is due to the system automatically timing out therefore saving the case as incomplete and creating a unique ID number. In order to enter data for the period of October 2018 to December 2018 for example, ‘search’ for the QMLR ID. In order to identify the QMLR ID, use the 'Search' functionality. On the Search screen, select ‘Quarterly Mandatory Laboratory Return’ from the ‘Condition’ drop-down list. Select ‘01/10/2018’ for the ‘Date From’ calendar and then click on the ‘Find’ button. You can then access the October-December quarter by clicking on the ’View’ button next to the entry with the ‘Data Collection Date’ of 31-Dec-2018. You will now be able to identify the QMLR ID of the time period you wish to enter data for. Please provide this QMLR ID found in the ID column in the table) when requesting an unlock via the mandatory surveillance inbox. If the QMLR data has not yet been locked down, you can proceed with the data entry by clicking on the ‘Quarterly Mandatory Lab Return’ tab once you have viewed the quarter. If the data within the fields is greyed out an unlock is required. Please email us at mandatory.surveillance@phe.gov.uk with the QMLR ID and we will unlock the HCAI data capture system at a convenient date and time.

CE - FAQ0014 Q: Should contaminants be reported? A: With reference to the Chief Medical Officer Letter 9 June 2005, the protocol states that NHS trusts should report "all MRSA positive blood cultures detected in the laboratories, whether clinically significant or not, whether treated or not, whether acquired in the Trust or elsewhere." (Please note that the Department of Health and social care contact details on this letter are now out of date). The case definition as set out by DH has always included contaminants, so these needs to be counted in the trajectory figures to allow comparisons to be made. The free text comments field and the “source” fields of the risk factor page on the data capture system should be used to indicate that you believe such cases to be contaminants - this is helpful for identifying clinically significant blood cultures.

CE - FAQ0015 Q: What is the case definition of MRSA bacteraemia used for reporting cases onto the DCS? A: The protocol outlines the case definitions for MRSA bacteraemia. In summary the case definition for MRSA bacteraemia is as follows: All cases of MRSA bacteraemia caused by S. aureus resistant to methicillin, oxycillin and flucloxacillin. This includes all MRSA positive blood cultures identified within each Trust, whether clinically significant or not, whether treated or not, whether acquired in Trust providing the testing or not. All cases should be reported regardless of location of the patient at the time the specimen was taken i.e. regardless of whether the patient was in a hospital or another setting; this includes blood cultures taken within 48 hours of admission to hospital. Positive blood cultures taken within 14 days of the first sample should not reported as they are considered to be the same episode, unless a negative blood culture has been obtained in the interim period. Positive blood cultures taken more than 14 days after the first sample of each episode should be reported, as these are considered to be part of a new episode. MecA-negative isolates are not regarded as MRSA in this instance, and need not be reported, irrespective of their level of meticillin resistance

CE - FAQ0016 Q: What is the case definition of CDI used for reporting cases onto the DCS? A: The protocol outlines the case definitions for CDI and MRSA bacteraemia. In summary the case definition for CDI is as follows: Professor Brian Duerden, An Inspector Calls, British Infection Society/Association of Medical Microbiologists newsletter, March 2010 '...reporting of cases in the mandatory surveillance system should be based upon the diagnosis made according to the algorithm used; if the patient has been diagnosed as a case of CDI according to the diagnostic system used, then it should be reported as a positive case.' In addition, the following case definitions apply: All cases of infection caused by C. difficile in patients 2 years of age and older. Cases in patients aged under 2 years need not be reported; however, Trusts may use the system to record these cases if they so wish. These will be excluded from data for publication. All cases should be reported regardless of location of the patient at the time the specimen was taken i.e. regardless of whether the patient was in a hospital or another setting. Positive specimens taken within 28 days of the first specimen should not be reported as they are considered to be the same episode, unless a negative result has been obtained between the two positive results. Positive specimens taken more than 28 days after the first sample of each episode should be reported as these are considered to be part of a new episode. The surveillance system assumes the following: Only stools from symptomatic patients are tested, i.e. only liquid/loose stools that take the shape of the container (Bristol Stool Chart types 5–7) should be examined. In suspected cases of ‘silent’ CDI, such as ileus, toxic megacolon or pseudomembranous colitis without diarrhoea, other diagnostic procedures, such as colonoscopy, white cell count (WCC), serum creatinine and abdominal CT (computerised tomography) scanning, may be required. Non-diarrhoeal stools should not be tested[r2] . That all individuals aged 65 years or more with diarrhoeal symptoms will be tested for C. difficile and those aged under 65 years will be tested based on clinical indication such as the “typical” C. difficile smell, recent exposure to antibiotics or proton pump inhibitors, contact with healthcare settings, or treatment of the GI tract.

CE - FAQ0017 Q: Is there a deadline for entering cases by? A: The enhanced patient level data collected on MRSA bacteraemia and CDI for any given month is signed off by the Trust CEO by the 15th of the following month; data should therefore be entered by this sign off date. For example, data for May 2019 is signed off by June 15th 2019 and May 2019 data should be entered by June 15th 2019. Cases can be retrospectively entered for signed off months by contacting mandatory.surveillance@phe.gov.uk. Aggregate data collection (Quarterly Mandatory Laboratory Returns [QMLRs]) is entered on a quarterly basis and data for each quarter (i.e. January-March, April-June etc) is automatically signed off six weeks after the end of the quarter.

CE - FAQ0018 Q: Do I have to enter a case of MRSA bacteraemia or CDI tested within our Trust for a facility (e.g. another NHS or Independent Sector hospital, a GP, a Community hospital) that is not part of the Trust? A: Yes. All positive specimens tested within your Trust must be entered. Remember when entering the case information it is possible to specify the patient’s location at the time that the specimen was collected. This allows the Trust reporting the specimen to record if the specimen was collected from a healthcare facility outside the Trust.

CE - FAQ0019 Q: Do I need to enter a positive MRSA bacteraemia or CDI specimen from a deceased patient? A: Not for bacteraemias, however positive specimens taken from a live patient who subsequently dies should be included. For CDI the answer is yes; unlike other collections positive specimens from deceased patients should be reported. Unlike bacteraemias, CDI testing is less likely to be affected by contamination during sample collection.

CE - FAQ0021 Q: How do I delete a record that I have just added? A: To remove/delete a case that has already been inputted onto the system, you need to: Type in the Case ID number (or the patient NHS number or DOB if this is not available) on the 'Search' page and select the appropriate organism i.e. MRSA, C.difficile, E.coli etc. Click on the blue 'Find' button. Select the case/s you wish to delete by ticking the checkbox next to the blue 'View' button on the left hand side of the case. This should activate the 'blue “delete” button, on the bottom right hand sidfe of the HCAI DCS. Click on the “delete” button to delete a record/s on the HCAI DCS.

CE - FAQ0022 *Q: We have had postive cases of Psuedomonas mendocina/Fluorescens* do I need to report it?** A: Only Pseudomonas aeruginosa are mandatory to report.

CE - FAQ0023 Q: I am a sub ICB/ICB user how can I amend data on the DCS? A: sub ICB/ICB users are only authorised to add/amend data on the risk factor tabs for Gram-negative data collections; using the CCG data entry role. Please ensure you have logged on using this role. In the event, you do not have the role available in your dropdown list, please contact the HCAI DCS support team who will add it on to your account.