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National HAI PPS update – October 2018

The national healthcare associated infection point prevalence survey (CHAINS) is now in its third months of data collection, with 12 of the 19 participating hospitals having been visited by our Research Assistants, Sophie and Stephanie. Hospitals that have participated to date include:

  • University Hospital Geelong, Vic
  • Bendigo Health, Vic
  • Calvary Hospital, ACT
  • Launceston General Hospital, Tas
  • North West Regional Hospital, Tas
  • The Queen Elizabeth Hospital, SA
  • The Royal Adelaide Hospital, SA
  • The Royal Melbourne Hospital, Vic
  • The Tweed Hospital, Vic
  • Royal Brisbane and Women’s Hospital, QLD
  • Frankston Hospital, Vic

From now until the end of data collection in the last week of November, data will be collected from:

  • Gold Coast University Hospital, QLD
  • Fiona Stanley Hospital, WA
  • Westmead Hospital, NSW
  • The Prince of Wales Hospital, NSW
  • Royal North Shore Hospital, NSW
  • Hornsby Ku-ring-gai Hospital, NSW
  • Alfred Hospital, Vic

Unfortunately due to unforeseen circumstances regarding research activity in Western Australian hospitals, we have had to replace Sir Charles Gairdner Hospital with another site. At late notice, we are grateful to the team at Westmead Hospital NSW who have been able to process the required documentation at speed, and look forward to visiting them soon.

Once again, on behalf of the CHAINS team, sincere gratitude to all site investigators and infection prevention teams at the participating hospitals for their support and work on this exciting project. Some of you are pictured below!

 

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Deb and Stephanie, Redcliffe QLD

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Team Royal Brisbane and Womens, QLD

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Sophie, Marija, Angela and Stephanie, Royal Adelaide and Queen Elizabeth, SA

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Team Royal Melbourne, Vic

The best IPC article of 2018: a blogoff with Brett Mitchell

You can see Jon Otter’s blog and case for the the best infection control article here

 

What product do you use prior to urinary catheter insertion?

There is conflicting evidence and hence variation in practice, on which solution you should use for meatal cleaning prior to urinary catheter insertion. A systematic review demonstrates the variation in evidence.

Which do you use in your hospital or clinical practice?

You can vote using the poll below. The results will form part of the discussion in a talk at the IPS conference and ACIPC conference.

So, which is correct?

Well, we will soon be able to tell you whether chlorhexidine or saline is better (or no difference) at reducing CAUTI and asymptomatic bacteriuria. We have undertaken a RCT in three hospitals, involving hundreds of patients and catheter insertions. The aim is to determine the effectiveness and cost effectiveness of chlorhexidine vs saline. The outcomes are asymptomatic bacteriuria and CAUTI.

Data collection was completed earlier this year and analysis is also nearing completion.

Some preliminary results will be presented at the IPS conference in Glasgow in October and more detailed results at the ACIPC conference in Brisbane and HIS conference in Liverpool (England).

I would like to thank the participating hospitals – Canberra hospital, Sydney Adventist Hospital and Lismore hospital.

More to come on this, so stay tuned. The results, regardless of what they are, will help shape guidelines and clinical practice internationally.

Brett

Researcher team: Prof Brett Mitchell, Dr Oyebola Fasugba, Dr Anne Gardner, Dr Jane Koerner, Prof Peter Collignon, Prof Allen Cheng, Prof Nick Graves, Mrs Vicky Gregory (Project Manager)

Funding: This project is supported a grant from the HCF Foundation, a nationally competitive grant.

References

Fasugba, O., Koerner, J., Mitchell, B. G., & Gardner, A. (2017). Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections. Journal of Hospital Infection, 95(3), 233-242.

Mitchell, B. G., Fasugba, O., Gardner, A., Koerner, J., Collignon, P., Cheng, A. C., … & Gregory, V. (2017). Reducing catheter-associated urinary tract infections in hospitals: study protocol for a multi-site randomised controlled study. BMJ open, 7(11), e018871.
Chicago.

 

Reducing urinary catheter use

One of the ways  to reduce the risk of catheter associated urinary tract infection (CAUTI) is to reduce catheter duration. Evidence has shown the value of stop orders and reminders (to remove the catheter ASAP) at reducing the incidence of CAUTI.

We have finished a RCT  in an Australian hospital, exploring the effect of an electronic reminder, attached to a catheter bag, on reducing catheter duration. We also surveyed nurses and undertook a focus group.

I’m looking forward to presenting results at the IPS conference in Glasgow and ACIPC later in the year in Australia. 

 

Researchers: Mitchell, BG., Fasugba, O., Russo, P., Cheng, A., Northcote, M. (Hannah Rosebrock, Research Officer).

Funding: This study was supported by an Commonwealth government commercialisation grant.

References

Meddings, J., Rogers, M. A., Krein, S. L., Fakih, M. G., Olmsted, R. N., & Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual saf, 23(4), 277-289.

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

Quick insight into ECCMID 2018

After a great few days at ECCMID conference in Madrid, I thought I would give some highlights. There were many good sessions and presentations, but I have picked a few that stood out for me. To set the scene, for those who haven’t been to ECCMID, it is huge. Around 15,000 delegates and 15+ sessions going at any one time. The poster area is the size of a airport hanger. Planning is key.

Petra Gastmeier contributed to many pieces of work at the conference, but on the first day, presented on “Before an outbreak – is complete sanitation of robotic surgical instruments possible?”. She discussed two key outcomes when answering this question. First, is the instrument clean or not; second, does the instrument affects surgical site infection rates. Her talk concluded by with the concept that at present, based on literature, robotics instruments do not appear to increase SSI rates. However, a strong CSSD is required.  Maybe the reasons is that the process includes disinfection and sterilisation. The presentation can be viewed here.

 

John Rossen discussed whole genome sequencing in outbreaks. Challenges and advantanges of WHS were discussed. One issue is the cost and turnaround time. He discussed his work, which involved used WGS to develop a local PCR test – to distinguish outbreak strains from others. This overcomes the cost and timeliness issues. The presentation can be viewed here

 

Jon Otter, always great to listen to, was heavily involved in the conference. If you haven’t seen his blog, make sure you check it out (but don’t forget us). Jon always makes his work available on the blog as well.  I have picked one of Jon’s talks,” Before an outbreak – what to do after first MDR Gram-negatives enter your hospital?”. A great interactive session with live voting. There was variation from the audience, with respect to what products (chlorine or HP) are used for control CPE. A key take home from me, was that cleaning and sinks, are a key issue. There was quite a strong focus on the role of sink in MRGN control at the conference. The presentation can be viewed here.

 

Ben Cooper talking about modelling. Some key things from his talk were – ‘models help us think’. I really like that motto. Time series analysis are good, but poorly analysed. The way of the future is to use models to design high quality RCTs. His presentation can be viewed here.

 

In something close to my heart, given some studies I am involved with, was a talk by Marc Bonton (@MarcBonten) on pragmatic trial designs. Some key takes homes: consider the natural history of the disease. It is easily to find an intervention that works, if the infection rates was trending down anyway. Cluster RCTs are good, but consider selection bias and carry over effects. His presentation can be viewed here.

 

There was a session that had short presentations on current / early research findings. Many topics were covered, from hand dryers to risk factors for predicting ESBL carriers. Sessions topics and presentations are here.  One stand out me, for novelty, was a study that explored norvirus dispersal. It is worth a look.  Norovirus was spilt in a laboratory, then cleaned. Results are very interesting. The presentation by Caroline Lopes Ciofi-Silva is worth seeing as you get a real sense of what they did. I feel for those who cleaned up the norovirus – I wonder if they got sick??

 

There was also an interesting study exploring contact precautions Vs standard precautions, involving 30,000+ patient in 20 non ICUs – to determine any difference in EBSL acquisition. Findings are suggesting no difference, but the key for me, is whether the rooms were single rooms. If so, they would probably would not expect to find any difference. If the ICUs were single rooms, then I think we are none the wiser – especially as most hospitals are not 100% single rooms. If there were shared rooms, this may be the catalyst to rethink contact precautions.

 

There was also a great “Year in review” for infection control. I could never do this justice and it is worth seeing the presentations. Hilary Humphreys presented first and went through a mountain of papers. Looking forward to hearing Hilary again at ACIPC 2018 in Brisbane.

 

There is plenty I have missed. You can use the ECCMID live website to find and view other presentations. I also tweeted about other presentations. Speaking of Twitter, there were some great interactions on Twitter at the conference, including those who were not present. It is a great way to find out they key discussion points at conferences.

 

 

 

 

National HAI Point Prevalence Survey – February 2018 update

There have been some recent exciting developments in our planning for Australia’s first national point prevalence survey in over 30 years continues. You may have noticed we are seeking two Research Assistants who will be engaged to collect data from all participating facilities. There are two full time roles for four months available, comprising of one month of surveillance training and use of data collection tools, and three months travelling across Australia to all sites to collect data. If you would like to find out more about these exciting positions, or know somebody who is interested, more information can be found here (applications close 11 March 2018)

Another major development has been the granting of ethics approval through Alfred Heath via the National Mutual Acceptance (NMA) system. The NMA is a system of single scientific and ethical review of multicentre human research projects in public health organisations in, Australian Capital Territory, New South Wales, Queensland, South Australia, Victoria and Western Australia. We have also been granted a separate approval from the Tasmanian Health and Medical Human Research Ethics Committee. Work is now focussed on processing Site Specific Assessments and Research Collaborative Agreements with each site. Thanks to Project Manager Bridey Saultry and all the site Principal Investigators who are working hard on these documents.

We are also in the process of fine tuning the data collection tools. Data will be collected via mobile devices using an online survey tool. As previously noted, our study protocol is based on the European Centers for Disease Control and Prevention protocol. This means that the major outcomes generated from this study will be comparable to those generated from ECDC PPS study’s.

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

I look forward to our next update.

 

 

Phil

Disclosure: ACIPC Board Director (President Elect)