Category Archives: Phil Russo

Some take aways from #ACIPC17 Conference, Canberra

Congratulations to the organisers of ACIPC Conference 2017 Parliament_House_Canberra_Dusk_Panoramain Canberra. Well done to the Conference Committee and the Scientific Committee. A great program and venue adding to the always enjoyable catch up with colleagues local, national and international.

There were many highlights. Due to other commitments, I missed a few of the major plenaries. Nevertheless, I came away with some clear take home messages from those I did get to, here are just a few of them…

  1. An emerging theme from the presentations was that of public reporting and financial penalties (PR&FP) associated with healthcare associated infections (HAIs). The likelihood that Australia needs to accept that these are inevitable for a range of HAIs is clear. In case you missed it, Benjamin Magid presented an excellent talk touching on the Australian Commission for Safety and Quality in Health Care use of what are called Hospital Acquired Complications, that use administrative coding data to detect healthcare associated infections, and which I have blogged about previously.
    One of the many advantages of living and working in Australia and hosting keynotes from the US is that they often provide a window to the future. At various stages, Prof Pat Stone, A/Prof Dev Anderson and Dr Susan Huang all related stories about their experience of PR&FP. From their experience it would seem, at some point in time, the implementation of PR&FPs does eventually turn into a positive for infection prevention (and hence our patients). From what we hear, PR&FPs seem to result in a recognition of infection prevention that subsequently provide opportunities to increase resources. Thats not to say there was no pain during the “journey”, and we should be prepared for that. Although Dev Anderson did argue against the notion of PR&FPs in the final debate, he was quick to tweet afterwards that in fact he does support it! Finally on this point, we should continue to explore better use of existing data if validated, strive to minimise the burden of data collection, and consider whether current HAI definitions are suitable for the PR&FP environment.
  2. The quality of the free papers gets better every year. The addition of the quick poster presentations and the new format of the 3 minute research presentations was a celebration of the excellent research being undertaken in our field. Updates on current studies (e.g. the large and complex REACH project) further added to our awareness of exciting work being undertaken by our colleagues. The next few years will see many of these projects yield new knowledge and fill sessions of conferences to come!
  3. The consumer voice is powerful. The presentation delivered by Mathew Ames left many in the auditorium not only in tears, but also resolute about the work we undertake.
  4. Finally for now, I believe the pop up sessions during lunch were a big winner. Informal yet intimate, a great way to get close to those people who are always hard to find at conferences. A great initiative hopefully here to stay..

But thats just some of my impressions from the sessions I saw. You might have seen something completely different. If so, comment below and let us know…

Looking forward to Brisbane in 2018.

TIP: Next year, if you have trouble remembering the correct Twitter hashtag, think  character count efficiency...save the character count by dropping the “20” from “2018”

#ACIPC18

 

Phil
Disclosure – ACIPC Board member (President Elect) and member of the ACIPC Conference Scientific Committee 2017

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.

 

What does the evidence say?

The Australian Commission for Safety and Quality in Health Care has recently developed 16 “Hospital acquired complications” (HACs) that have been published on their website.

Whilst the website provides information on the development of these HACs, it does not specifically detail their purpose. One of the 16 HACs is “Healthcare Associated Infection”, which is comprised of eight different HAI “diagnoses”, including “multiresistant organisms” and “gastrointestinal infections”.

There is clear evidence, both locally and internationally, that coding data does not accurately identify HAIs, and any attempt to do so would misrepresent the truth.

Successful infection prevention efforts rely on valid data. If the data are not accurate, then not only do we run the risk of misdirecting interventions and misinterpreting the outcome of interventions, we are also wasting precious resources.

It is a wonder why, in this field where so often we don’t have good evidence for certain practices, that when good evidence does exist, it still does not seem to influence policy and practice.

Phil

Declaration: Philip Russo is a member of the ACSQHC HAI Advisory Committee. 

Time to change?

Interesting times with our own status of no government (though we have been here  before), Brexit, upsets at UEFA Euro 2016, why not throw another curly one out there…

In the first edition of the Colleges new journal Infection Disease and Health an article by Mitchell and Ferguson report the results of a study they undertook using administrative coding data to identify healthcare associated urinary tract infection across eight hospitals. Not surprisingly, they have added to the increasing body of literature that continues to demonstrate that using coding data to identify HAIs is extremely unreliable.

We all know HAI surveillance is resource intensive. But imagine if administrative data could be used for HAI surveillance. How much of the current surveillance burden on ICPs would be lifted?

There are many issues with using administrative data, such as the skill of the coder, completeness of documentation, identifying infections incubating on admission etc, as well a mismatch between codes and current HAI definitions.

At the ECCMID 2016 conference earlier in the year, Maaike van Mourik proposed that maybe it is time to review the HAI definitions so that administrative data codes, and electronic databases can be interrogated to identify HAIs? Sure, this may not pick up all HAIs, but neither do current systems…

Keeping in mind that HAI data could be (is) used to impose financial penalties and performance manage hospitals, would you be supportive of a change in HAI definitions that would increase the likelihood of administrative data codes being used to identify HAIs and:

  • be almost as accurate as current HAI surveillance definitions?
  • allow more time to implement preventative interventions?
  • could therefore be applied uniformly across all healthcare facilities?

 

Phil