Timeliness of a potential automated system for national surveillance of healthcare-associated infections in England

Background: Surveillance of healthcare-associated infections (HCAIs) is important for public health, however data collection and reporting can be burdensome for healthcare staff. In England, local hospital groups are required to submit their monthly HCAI cases to the UK Health Security Agency (UKHSA) by the 15th day after the month end. Aim: Understand the potential timeliness of a centrally-implemented, automated HCAI surveillance system in England, using data feeds already in place at UKHSA. Methods: We set up prospective daily monitoring of existing microbiological and hospital patient data feeds at UKHSA, for seven arbitrary activity dates between 14 Nov 2022 and 1 Sep 2023. For each activity date, we counted the numbers of records relevant to that date that were available on each subsequent day, by laboratory and health provider. Findings: Although new records are received and loaded daily at UKHSA, it took 1-3 weeks for 90% of bloodstream infection records pertaining to specimens collected on a particular date to become available, up to a month for 90% of relevant admission/emergency department dates (relevant for determining onset category), and up to two months for 90% of inpatient diagnosis codes (relevant for determining risk factors). Patterns of receipt from different organisations varied. Conclusion: Implementing HCAI surveillance centrally at UKHSA using existing data feeds would mean slower ascertainment than the current system, but this should be balanced against potential gains in consistency of data across organisations and reduced workloads. Waiting times could be reduced by targeting the slowest organisations for support and/or investment.