Category Archives: surveillance

The burden of HAIs in Australia

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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…..

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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

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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

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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 do we know about antimicrobial use in Australian residential aged care facilities?

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The National Centre for Antimicrobial Stewardship (NCAS) is a multidisciplinary collaborative funded by the NHMRC with a strong track record of innovation and Capturesuccessful translation into clinical practice. We asked Dr Noleen Bennett from NCAS to write about a national antimicobial prescribing survey in aged care. It has brought up some interesting findings.

Thanks for Noleen for this blog – Phil, Brett and Ramon.

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The short answer is we know antimicrobial use in Australian residential aged care facilities (RACFs) needs to be improved. The unacceptable risk otherwise is the emergence of multi drug resistant infections and other adverse consequences in this vulnerable population.

In 2015, 186 RACFs participated in the pilot Aged Care National Antimicrobial Prescribing Survey. Key areas for improvement were identified and included:

  • inadequate documentation
    • 31.6% of prescriptions did not have an indication justifying their use
    • 65.0% of prescriptions did not have a review or stop date documented.
  • the use of antimicrobials for unspecified skin infections
    • 17.5% of antimicrobials were being used for unspecified skin infections.
  • prolonged duration of prescriptions.
    • 31.4% of prescriptions had been prescribed for longer than six months.

All Australian RACFs and multi-purpose services are now strongly encouraged each year to participate in acNAPS. Participation assists in ensuring compliance with national guidelines and targeting local and national actions to support appropriate antimicrobial use.

For further information, the friendly NAPS team can be contacted via email support@nasp.org.au or phone (03) 9342 9415. The data collection period for the 2016 acNAPS has been extended. Data can now be collected and entered prior to Friday 9th September.

Declaration: Dr Noleen Bennett is employed at the National Centre for Antimicrobial Stewardship and is the Project Officer for the Aged Care National Antimicrobial Prescribing Survey

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Brett: For those interested in other Australian data in residential and aged care (infection and antimicrobials related) here are some links to articles. (This is not an exhaustive list)

 

 

What does the evidence say?

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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.