Category Archives: Research

National HAI Point Prevalence Survey – August 2018 update

Data collection commencing!!

It has been an exciting month for the National Healthcare Associated Infection Point Prevalence Survey team. Our two Research Assistants, Sophia Robinson and Stephanie Curtis, have commenced their appointments and spent the past month undergoing surveillance training. After rigorously testing the data collection tool, they are now experts in utilising the tool to investigate HAIs and are excited to commence the data collection at our sites.

Site visits for data collection across Australia will commence next week, August 8th and continue until November 30th. We have locked in several dates with sites, starting with Geelong, Bendigo, Launceston, Burnie and Adelaide.

As previously announced, 19 hospitals will be participating in the study, these hospitals are listed below. We sincerely thank all the hospitals for their involvement, particularly the site Principal Investigators who have worked hard to progress ethics approvals and organise the logistics of our visits. We look forward to visiting you all soon!

  • Alfred Hospital, Vic
  • Bendigo Health, Vic
  • Calvary Hospital, ACT
  • Fiona Stanley Hospital, WA
  • Frankston Hospital, Vic
  • Gold Coast University Hospital, QLD
  • Hornsby Ku-ring-gai Hospital, NSW
  • Launceston General Hospital, Tas
  • North West Regional Hospital, Tas
  • Redcliffe Hospital, QLD
  • Royal Brisbane and Women’s Hospital, QLD
  • Royal North Shore Hospital, NSW
  • Sir Charles Gairdner Hospital, WA
  • The Prince of Wales Hospital, NSW
  • The Queen Elizabeth Hospital, SA
  • The Royal Adelaide Hospital, SA
  • The Royal Melbourne Hospital, Vic
  • The Tweed Hospital, Vic
  • University Hospital Geelong, Vic

 

​We will continue to provide updates on the project through this blog and Twitter via @PLR_aus and @1healthau , or for further information please contact either Dr Philip Russo or Professor Brett Mitchell 

 


Stephanie Curtis, Research Assistant, Australian National Healthcare Associated Infection Point Prevalence Survey

The Cerberus of science – dealing with ethics committees

We asked a colleage, Hannah Rosebrock, to write a blog for us, thank you Hannah.

In Greek mythology, Cerberus guards the gate of the underworld to prevent the dead from leaving. In social and clinical science, this role is fulfilled by ethics committees who stand as guardian between researchers and Cerberusparticipants and prevent the latter to be exploited by the former for the sake of science. The role of the Cerberus is a necessary one – although not very flattering, Cerberus is depicted as a three-headed beast. In the context of ethics committees, its three heads are called bureaucracy, officialdom and inefficiency.

According to the National Health and Medical Research Council (NHMRC) there are more than 200 HRECs operating in organisations and institutions throughout Australia (find a list of human Research Ethics Committees registered with NHMRC here). Although all HRECs base their decisions on the same principles deprived from the same National Statement on Ethical Conduct in Human Research, every HREC has its own application procedures, forms and processes. Further, gaining approval from one ethics committee is no vouch for approval from another ethics committee.

This lack of standardisation specifically affects multi-site projects which led to the founding of the National Mutual Acceptance Scheme (NMA) in 2013. Under the NMA scheme, multi-site research projects do not have to gain ethics approval from every site the project is conducted at but only once, from a NMA certified HREC. As of August 2017 the scope of the NMA scheme covers all human research conducted at a public health organisation in Queensland, New South Wales, the Australian Capital Territory, Victoria, South Australia, and – the latest addition to the scheme – Western Australia. Note: Northern Territory, Tasmania, and private health organisations are not included in the NMA scheme. Still, you might be tempted to think, that the NMA scheme has de-bureaucratised the ethics application process, and to some extent, this is true. There is certainly less duplication (if you don’t count private health organisations, Northern Territory and Tasmania). However, researchers are still fighting with a lack of standardisation, as every state has multiple NMA certified HRECs[1] and application procedures vary between and within states. This multitude in ethics committees, applications processes and forms, seems unnecessarily confusing, given that they are all assessed and certified by the same body (the NHMRC) for their compliance with the same criteria based on the same National Statement of Responsible Conduct in Human Research.

Independent of the HREC approval, researchers have to seek approval from the relevant Research Governance office (RGO) for each site the project is conducted at. There is no such thing as a mutual acceptance scheme for research governance approval, every site has its own assessing criteria for determining the site’s suitability for conducting a given research project. This adds to the generally labour-some and tedious process of gaining ethics approval.  In terms, this uses resources, and most commonly tax payer funded resources. In one Australian study, the cost of obtaining ethics and relevant approvals was $348,000 or 38% of study budget.

Applications for HREC approval are often no less than 63 pages; applications for Research Governance approval encompass about 23 pages – exclusive the extensive supporting documentation required, which can be up to another 150+ pages. Applications to both, HREC and RGO’s vary, with some still requiring submission in hardcopy by snail-mail, (additionally to email, USB and online forms) and will only be assessed, once received in hardcopy. This method is unnecessarily prone to error. To simplify, you must take steps away, rather than adding additional steps. The entire process is so focussed on detail that researchers, as well as assessing HREC and RGO officials can’t see the wood for the trees anymore. So much information is requested that even low-risk research projects that involve none to minimal involvement with participants, and thus hardly justify the use of the term ‘participants’, seem to turn into a second Stanford prison experiment throughout the process.

 

[1] Queensland has 7 NMA certified HRECs, New South Wales has 11, Victoria has 7, South Australia has 5 and Western Australia has 3 (Australian Capital Territory has 1). Find a full list here.

Australian HAI point prevalence survey – update

As you might know, I am leading a team of investigators to conduct the first national HAI point prevalence survey in Australia in over 30 years.

We are grateful to have received so many expressions of interest from hospitals across Australia. Of course if we had endless resources we would survey all hospitals, however as you would appreciate, we have limited funding, and therefore are focussing on 20 public hospitals classified as either Principal Referral or Group A hospitals (AIHW peer group).

Data collection in our study will be undertaken by two trained research assistants, who will collect data from each participating site. This will avoid the burden of data collection  from hospital resources, and importantly add consistency to application of definitions and data collection processes (a current gap in Australian HAI surveillance).

On top of HAI data, we are also looking to estimate device usage and explore some issues around single rooms and MRO’s, and so have developed some secondary objectives specific for these.

Primary objectives

  1. To estimate the total prevalence of HAIs among inpatients aged ≥18 in public acute care hospitals in Australia
  2. To describe the HAIs by site, type of patient, specialty, type of facility and geographical location

Secondary objectives

  1. To determine the prevalence of patients:
    • managed under transmission based precautions isolation in a single room
    • with an indwelling urinary catheter device
    • with vascular access device(s)
    • with a multi drug resistance organism (infection or colonisation)

Ethics submission is close, and we are working hard on ensuring this is processed efficiently so we can turn our attention to Site Specific Assessments and Research Collaborative Agreements.

Finally a welcome to Bridey Saultry who will be commencing soon as Project Manager for our study. Bridey will be working with us half time to ensure we keep on track with this exciting study.

If you have any questions about the study, you can contact us by completing the form below.

More updates to follow.

Phil

 

The Pub Test

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For many Australians there is a long held tradition of going to the pub at the end of the day/week to discuss life’s big questions (a practice not native to Australia I’m sure). Sadly, the pubs I frequented in my youth are now apartments (because we need more of those!) and like the live music they used to support, they are gradually disappearing from our urban landscape.

Anyhow, arising from the communal attempt to discuss worldly issues, comes the term “the pub test”.  Briefly, the pub test seeks to evaluate the views of “ordinary Australians” on certain issues. In my home state of Victoria, the recent application of the pub test has resulted in the downfall of several senior politicians who were accused of rorting their privileges by making extravagant travel claims. Though arguably they may not have breached any rules (stretching them perhaps). The media applied the pub test and the punters down at the pub believed the politician’s behaviour was unacceptable. In an impressive display of the power of the popular vote, these politicians have been stood down.

Now I’m not convinced of the rigour of the pub test, not the least I suspect the results may be influenced by the pubs location and the time of night you visited, but nevertheless it got me thinking, what if we applied the pub test to the state of infection prevention in Australia?

I wonder if these statements, reflecting some of our local infection prevention issues, would pass the pub test?

  • Some people get an infection as a result of their healthcare, but we’re not really sure how many Australians this happens to.
  • If you are infected with a ‘superbug’ in some hospitals, sometimes the staff that look after you will be wearing gowns, gloves and masks, and sometimes they wont.
  • If you are placed in a room that was previously occupied by a patient with a ‘superbug’ you are probably at a higher risk of being infected with that ‘superbug’ than if you are placed in another room.
  • Not all hospitals use the same criteria to identify an infection.
  • If you ask a hospital CEO which of the surgeons in their hospital has the highest infection rate, they probably wont tell you.

(I can think of many other examples to put to the pub test, and I invite you to share yours).

What would be the reaction of the ‘ordinary Australian’ to these statements? Would the power of the popular vote on these issues catch the eye of those in authority?

 

Declarations: I occasionally go to a pub – Phil

 

 

Making antimicrobial resistance and the control of communicable disease, like infection control, is really everyone’s business.

As I reflect on another year, there have been many headline issues in infection control and communicable diseases. One headline was arguably the brightest, loudest and most prominent—antimicrobial resistance. In many respects 2016 was the year for antimicrobial resistance (AMR). The march of resistance and the grave concerns therein, particularly with the spread of carbapenem-resistant Enterobacteriaceae or CRE, have focused the attention of many. Global recognition and focus came via the United Nations as well as multi-national whole of government emphasis of AMR as a priority in the United Kingdom, the United States and other countries around the world. The year also saw a much-needed corrective global focus and attention on access and excess rather than overuse and misuse. All made for interesting times for clinicians, patients and consumers, and society in general. It also makes for interesting times for what comes next. In considering the priorities for research and innovation, the following seem to me to be some of the important focal areas for the future:

One priority focal point should be the formal designation of the control of communicable diseases, the spread of infection and antimicrobial resistance as societal, political, health and research priorities within a One Health approach. As we have seen, the United Nations declared AMR as a global health priority, only forth health priority to be so declared. The WHO and its many divisions applied renewed focus of AMR around the world. The United States and United Kingdom has posited AMR squarely as a whole-of-government and whole of society issue. Others have followed suit in various forms. Doing so matters. Such declarations matter. They transact change. Such designations focus the efforts and attention turn of governments, NGO, researchers, funding bodies, industry, clinicians, educators and society more broadly. Some doubt the significant and weight of such declarations as declared health and/or research priorities. To those I say try de-designate an existing health or research priority that has unfinished business and see what happens. For example removing cancer from Australia’s list of national health and research priorities would never be entertained, and any attempt would attract unanimous condemnation. The new and impressive Australian Medical Research Future Fund and Australian Medical Research and Innovation Priorities 2016-2018 have AMR and the control of communicable diseases as core priorities. Such designation is commended, but more is needed. AMR should be a national designated national health priority, as it is one issue that underpins so many health areas. It also underpins the fabric of society.

Another focus should be the acceleration and expansion of infection-excluding diagnostics and technology. While technology and resources for rapid and definitive diagnosis is the ultimate goal, excluding infection attributable injury and disease that has a reliance on antibiotics would go a long way to reducing our use of antibiotics. 

Closely related to this is the need for intense and considered focus on new and renewed countermeasures. This should include, but is not limited to, One Health vaccine development for conditions that have reliance on antimicrobials, drug discovery, rapid definitive diagnostics at both bench and bedside, utility of non-classic pharmacological interventions such as bacteriophages, and the standardisation of laboratory testing.

Moreover, we should focus on extending the evidence and practice base that is we know works (or not as the case may be) in human health and non-health related context into animal, agricultural and environment sectors for a truly One Health approach. Is it not time equivalent of the Five Moments for Hand Hygiene for veterinarians?

Finally, and not before time, it’s time cast of the armoury of own specialist professions and embrace the many in non-clinical professions, and call upon them to join be part of the solution to AMR. It is high time we harnessed existing and new knowledge into human factors and behaviour modification to bring about whole of societal change within a One Health approach. This should focus on existing evidence base for non-infection control and non-health to effect changes in human factors for reliance on antibiotics for all populations across the lifespan and across One Health. So much is known about behaviour change in the non-health areas, as marketing and behavioural sciences. It is difficult to see how these cannot be applicable (or relevant in some form) to AMR. What we can learn from our non-clinical peers about changing people behaviours from the commercial work is enormous. Moreover, such focus must be across the spectrum of disease and illness including prevention, treatment, rehabilitation and coalescence.

AMR is not, and can no longer be considered, a problem for just for clinicians both human and veterinary, and industry to solve. It is a whole of society challenge, and many of the solutions are non-clinical. It, like infection control, is everyone’s business.