Category Archives: surveillance

National HAI PPS update – August 2018 (2). Data collection has commenced

It is exciting to see data collection for the CHAINS project has commenced. This week marks the third week of data collection. So far Sophie and Stephanie have visited University Hospital Geelong and Bendigo Health, busy collecting data via the electronic survey tool on their mobile devices. The survey tool allows for direct entry into the database to ensure no data loss on devices.

Thank you to the Site Investigators and Clinicians at both sites for their work and warm hospitality. It is greatly appreciated.

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The CHAINS team Stephanie (L) and Sophie (R) with Alison from University Hospital Geelong

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CHAINS team with Mandy and Jane from Bendigo Health

 

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

National HAI Point Prevalence Survey – April 2018 update

Progress on our National Healthcare Associated Infection Point Prevalence Survey is steady as we move our way through project milestones.

We are excited to have 19 hospitals participating in the study, representing all states and territories except for Northern Territory. Unfortunately we just could not fit NT into our travel schedule given our tight budget and brief timeframe.

Although this might seem like a small number of sites, our sampling method will provide us with confident estimates of the burden of healthcare associated infections in our population.

Project Manager Bridey Saultry is busy working with the Site Investigators at each site  carefully stepping through Site Specific Assessments and Research Contract Agreements. Completion of these forms is crucial so we can then confirm the dates between August and November for data collection at each site. Thank you to all the Site Investigators who have been shepherding these documents through their sites.

In an exciting development, we welcome the appointment of our two Research Assistants Sophie Robinson and Stephanie Curtis to our team. Sophie and Stephanie will be commencing with us in June, ready for data collection in July.

Two great papers describing National HAI Point Prevalence studies have recently been published. Impressive work continues in Scotland by Professor Jacqui Reilly’s team who describe the HAI rate as 4.6%, 2.7% and 3.2% in acute adults, paediatric and non-acute patient groups, respectively. The Scottish team propose a broader population based HAI prevention approach is required to reduce the incidence of community and hospital infections. Meanwhile researchers from the first multi-centre PPS in Japan estimated an overall rate of HAI as 7.7% in their population including paediatrics, neonates and non acute patients.

Australian HAI PPS data is not too far away…

If you have any queries about the PPS study, please use the query from at the bottom of our PPS page

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

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

 

Outside the box: Infection prevention beyond the hospital walls

The recent article published in the MJA by Agostino and colleagues from the Hunter New England area provided data that could be described as not so startling, but nevertheless alarming. Their study aimed to identify groups at risk of MRSA infection, as well as the proportion of patients with MRSA but no history of recent hospitalisation (previous 12 months).

In their large cohort, they found that “young people, Indigenous Australians, and residents of aged care facilities, are disproportionally affected by CA-MRSA infections”.

Two comments in their Discussion caught my eye. The authors call for:

  • the focus of control measures to move from the healthcare setting to the community
  • national surveillance of MRSAphotodune-598972-think-outside-the-box-xl

The results of this study are not so startling because the findings are consistent with previous studies, alarming because this is another piece of evidence highlighting the deficits of our local knowledge.

This brings me to my next point. I am excited to be part of a team conducting a large study exploring infection prevention in Australian residential and aged care facilities. Led by Prof Brett Mitchell, together with Prof Ramon Shaban and Dr Deborough MacBeth, we aim to mimic a recent program of work  that generated so much rich information about infection prevention in our hospital facilities. Here are links to a sample of some of papers from this work:

This cross sectional study aims to explore governance, education, practice, surveillance and competency and capability – five key domains relating to infection prevention and control. All aged care homes in Australia are in the process of being contacted.

The findings of this study will be significant, they will:

  • further support ACIPC to refine the role and scope of practice of ICPs and better target education strategies,
  • inform decision-makers faced with accessing and planning infection control resources in settings outside hospitals.
  • guide future research priorities in this area
  • understand priorities and gaps in infection control services

If you receive an invitation to participate, I strongly encourage you to do so.

We look forward to sharing our findings with you during 2018.

Phil

Not peeling grapes…

Standard 3.2.1 of the The National Safety and Quality Health Service Standards in Australia states “Surveillance systems for healthcare associated infections are in place”.

If I could wave the magic wand, the standard I woulrainbow-star-magic-wand-6834-pd like to see would say something like this, “Electronic surveillance systems for healthcare associated infections are in place in alignment with the national surveillance program” (it’s a big wand).

It’s a fact that very few healthcare facilities have dedicated HAI surveillance software, which means that for much of it, surveillance continues to be a manual, labour intensive activity. Not only is this burdensome, we also know it influences data quality. Why don’t we all use electronic surveillance software (ESS)? Capital expenditure aside, maybe its because ICPs (and others) aren’t convinced of their value i.e. what effect does it have on day to day practice, how does it influence the overall infection prevention program?

In a recent systematic review published in the Journal of Hospital Infection, we sought to establish the impact of ESS on infection prevention. We were able to identify 16 papers in a search from 2006 to 2016. The review can be accessed here

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There was much variation in the studies, so it was difficult make any strong conclusions. However, we did find that every paper described a marked reduction in time taken to collect data and ascertain cases. This is clearly a good thing for the ICP collecting data, but I don’t suspect that saved time is spent sitting around peeling grapes. Its possible that the ESS allowed them to broaden their surveillance activities, provide more accurate and better quality data, respond to outbreaks quicker, undertake local research projects,  enable more detailed reports for the clinicians (and less detailed dashboards for their Executives), not to mention standardise data for public reporting and informing the build of algorithms for greater efficiency.

Unfortunately we cant really be sure how an ESS influences (benefits) infection prevention because we don’t have the data. As we conclude in our paper, we need specific research exploring the effect of ESS on infection prevention as a primary outcome, and whether this has any impact on infection and /or patient outcomes.

It would be very interesting to know if any hospitals with ESS have explored this issue, or if those who are moving towards implementing an ESS have considered some metrics around the benefits.

– Phil