Category Archives: Brett Mitchell

The burden of HAIs in Australia

Today, we published an article in Infection, Disease and Health estimating the number of HAIs occuring in Australia each year. [1]

To do this, we undertook a systematic review of the peer reviewed literature between 2010 and 2016. We identified 24 articles that reported the incidence of HAIs in Australian hospitals.

Overall, data from these multi centred studies suggested 83,000 HAIs per year in Australia. UTIs are were the most common, followed by C.difficile, SSIs, respiratory infections and Staphylococcus aureus bacteraemia. HAI burden.png

Of course, these numbers are a very  large underestimate given the lack of or incomplete data on common infections. It is also limited to data published in the peer reviewed literature.

Incidence data on infections such as pneumonia, gastroenterological and bloodstream infections (other than SAB) were not identified, thus potentially
missing up to 50% of infections. That being the case, the

PPS blog incidence of HAIs in Australia may be closer to 165,000 per year.

Don’t believe me? Have a look at the results of point prevelance studies in Europe (right). Respiratory tract infections, bloodstream infections and others account for a large proportion of HAIs.  Of course, Australia has not had a PPS undertaken in 30 years, so we don’t really know. However, for readers of this blog, you will know that will soon change.

A figure of 200,000 HAIs per year in Australia is commonly cited, however, this figure was derived from one study undertaken several years ago (a sign of what was available at the time). Our study, may, in part, demonstrate the increasing number of publications on HAIs in Australia. We are certainly not suggesting a reduction in HAIs and any such claim based on the findings of our study should be immediately dismissed.

There are some other equally important findings from our study:

  • There needs to be a determination and action by state and national government bodies to achieve consensus on national HAI definitions
  • We need national approaches to HAI surveillance and transparent regular reporting. Australia is so far behind other countries in this regard [2] [3]
  • In the absence of action by government, we call on those undertaking HAI surveillance (especially incidence) to report your data in the peer reviewed literature

We also found there is little information about healthcare associated respiratory infections, such as pneumonia. Maybe it is in the too hard basket (nice blog by Martin Keirnan which says it all). Well, I think we should do something about healthcare associated pneumonia – at the very least, understand the incidence and risk factors a little better. I am working on it…..

______________________

Footnote: Some of the research I have been involved with has been supported by donations from the public. For that, I am very grateful. Should you or your company wish to make a tax deductible donation, you can do so here.

References

  1. Mitchell, BG., Shaban, R., MacBeth, D., Wood, CJ., Russo, PL (2017). The burden of healthcare-associated infection in Australian hospitals: A systematic review of the literature. Infection Disease and Health. https://doi.org/10.1016/j.idh.2017.07.001
  2. Russo, P. L., Cheng, A. C., Richards, M., Graves, N., & Hall, L. (2015). Healthcare-associated infections in Australia: time for national surveillance. Australian Health Review, 39(1), 37-43.
  3. Russo PL, Cheng AC, Mitchell BM, & L, H. (2017). Healthcare associated infections in Australia – Tackling the “known unknowns”! Australian Health Review, (published online 7 March 2017), http://dx.doi.org/10.1071/AH16223

 

Australian HAI Point Prevalence Study is Coming

Followers of this blog will know how passionate Phil Russo and Brett Mitchell are about the need for national surveillance and a point prevalence study (PPS). Map Aus2We are very pleased to let you know that a HAI PPS is coming, by way of a research project.

For more information, please see www.ipcca.com.au/pps

 

 

Next national HAI initiative – CAUTI of course #ACICP conference

To conclude the ACIPC conference in Melbourne this year, three different views were proposed for what the national national HAI initiative should be. Dr Phil Russo presented a case for national surveillance, while Prof Linsday Grayson presented a case for peripheral vascular devices. I had the job of presenting a case for CAUTI.

The debate allowed 15 mintes each for us to present, followed by a panel discussion, discusion and questions from the floor, in addition to questions from Twitter (for those not present but following online).

Following some great questions, humour and some lively discussion, in the end, Phil won the debate, with 50%, followed by peripheral vascular devices (30%) and CAUTI (20%). It was clear however, that all three projects had debatesupport and it was strongly suggested that all three be implemented with the next 5 years.

I did make a good come back, scoring up from a prepoll of 6%!

If you would like to see the CAUTI presentation I delivered, here it is: ACIPC presentation: Next national HAI Initiative, CAUTI or in pdf format here

Brett

Disclosure: BM was the Scientific Chair or ACICP 2016, PR was on the scientific committee.

 

Daddy, you swallowed a bug

“Daddy, maybe you swallowed the bugs”

I was tucking my four year old son into bed. He asked how I was feeling and I said that I was feeling a little sick. He said ‘maybe you ate chicken that wasn’t cooked’. I explained that I had not eaten any chicken. He then said ‘maybe you touched some bugs and swallowed them’. Now, that was a plausible explanation.

This simple conversation made me think of two things:

  1. Am I talking about infection control too much with my son (or maybe we should all talk more about infection prevention with our kids)
  2. Although simple, he is onto something, that as a civilised intelligent species, we seem still not to appreciate. What I hear you ask…..

Antimicrobial resistance.

On the news today, I heard about Antarctic Sewage Contamination. Some of the most pristine oceans in the world are contaminated with raw sewage (ironically from research bases that are working in the interests of the environment).  The most stand out point is was that researchers found some mammals (e.g. seals) showing signs of antibiotics resistance.

How? Humans consume antibiotics – directly (e.g. treatment) or indirectly by consuming meat or similar products that provided antibiotics.

With the winter cold and flu season kicking off in the Southern Hemisphere, it is time we all took some personal and community responsibility by prudent antibiotic use – or even better, antibiotic avoidance. We can all talk to friends and our children about the importance of preserving this miracle drug and infection prevention.

So, my son, for a four year, has cracked something we still continue to have trouble accepting and or changing – the vicious cycle of the overuse and or misuse of antibiotics.

Just for the record, I didn’t have an antibiotics resistance diarrheal disease, nor did I end up with D+V. I must have only consumed a small dose of the bugs….

 

ECCMID: surveillance my favourite

Welcome to Infectiondigest. On this blog you will hear thoughts, reflections and maybe the occasional rambling on issues that relate to infection prevention and control.We hope to stimulate some debate and discussion on a range of topics, in the backdrop of our geographical region.

I recently went to ECCMID in Amsterdam. With over 11,000 attendees it is certainly a conference that attracts delegates. There were a few reasons why I wanted to go: to catch up with colleagues, build networks and update knowledge both in certain areas of ID and also infection prevention and control. It ticked the box on all counts, but the IP&C content was the most disappointing. There was not much content on this topic, relative to others in my view. It is very interesting hearing about latest treatments and drugs but in the end, we are and will continue to be become more reliant on ‘basic’ infection control practices. What we really need is investment in high quality infection control studies.

For me, on IP&C, one of the highlights was a talk on the last day, before I had to quickly leave to catch my plane. Automated monitoring of nosocomial infections . This talk made me think about how far behind we are in Australia when it comes to surveillance. There we were in Amsterdam, contemplating the pros and cons of automated vs semi automated surveillance, whereas in Australia, we barely have a national HAI surveillance program.  Perhaps we will leapfrog everyone else in this space, but I doubt it.

 

Brett Mitchell @infectiondigest