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 – 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

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)

 

Con(fused)tact precautions

Whilst “festivus”1 is generally a happy time for most of us, unfortunately people still become unwell, and our hospital beds remain occupied. One of the beds in a large Australian acute care facility has accommodated a family friend who has undergone surgery and some moderate rehab after falling at home.

Given some predisposing conditions, the family friend was at risk of acquiring a HAI, and it is disappointing to report they required treatment for various types of HAIs. They were also found to have VRE, and were promptly placed into a single room, under Contact Precautions.

Puzzled Confused Lost Signpost Showing Puzzling Problem

Whilst this family has much to be sorry and concerned about, what concerns them greatly, and what they have found most upsetting, is the inconsistent information and advice they receive on a daily basis from healthcare workers on the specific precautions that they, as family visitors, must take. Gloves, no gloves, mask, no mask, cloth gown, plastic apron… they have had almost every combination of precautions recommended. They  have even been scolded by a HCW for wearing “inappropriate” attire, whilst all the time directly observing a broad array of PPE adopted by different HCWs as they enter the room. They feel confused, angry, and upset. They lack confidence in the HCW knowledge of what is required, and feel powerless in seeking clarification of what they should be doing.

I find this troubling on several fronts. First, inconsistency. If HCWs caring for patients with MROs are giving family visitors different messages on PPE, then chances are they don’t quite understand what is required to prevent spread (evident by HCW inconsistency in their own PPE). Second, why are family visitors made to feel as though they have endangered the lives of not only their relative, but also of every other patient in the hospital when they are simply doing as they are told. And third, I don’t suspect for one minute that this situation is unique to this ward, hospital, city, or country. This scenario will likely be repeated daily in all types of facilities (see also NOTE below).

As we know, HAI prevention requires multiple interventions all being applied correctly. Whilst the momentum of antimicrobial stewardship in the fight against AMR has rightly attracted much energy, and the importance of environment is emerging , a basic understanding of precautions, and consistency of PPE messaging for HCWS and visitors is surely a simple and measureable intervention we should not lose sight of.

Phil

  1. Seinfeld 1997 – Episode 10, Season 9.

NOTE – this may be due to a lack of robust evidence and debate about Contact Precautions (see here for an example), nevertheless, messages (policy) within a facility should surely be consistent.

 

Infection, prevention & control and Aboriginal and Torres Strait Islander People.

The Snake, the Staff and the Rainbow Serpent : A Call to ‘Fill the Gap’ in research relating to infection, prevention and control and Aboriginal and Torres Strait Islander People.

(Written by Victoria Gregory)1

 

Aboriginal and Torres Strait Islander people are the oldest surviving culture in the world, yet they will live approximately 10 years less than other Australians. Some contributing factors include indigenous people are at higher risk for emerging infectious diseases compared to other populations (Butler et al 2001). Examples of infectious diseases include respiratory tract infections, infections with antimicrobial-resistant organisms, and bacteremia and meningitis caused by Streptococcus pneumoniae, zoonotic diseases, viral hepatitis, Helicobacter pylori and respiratory syncytial virus infections, diseases caused by Group A and B streptococcus, tuberculosis, Haemophilus influenzae type b, and Neisseria meningitides (Butler et al 2001).

Here are some specific examples:

  • According to data from ‘healthinfonet’ between 2009 and 2013 tuberculosis notifications were 11 times higher for Indigenous people than for Australian born non-Indigenous people.
  • In 2014-15, Aboriginal and Torres Strait Islander people were three times more likely that non-indigenous people to be admitted to hospital for influenza and pneumonia.
  • In 2014, there were 170 cases of invasive meningococcal disease notified in Australia with 21 cases (12%) identified as Aboriginal; an increase from 2013 where 13 cases (8.7%) were identified as Aboriginal and one identified as Torres Strait Islander (0.7%).
  • In 2015, hepatitis C notifications were five times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people and the rate of HIV diagnosis was just over twice as high for Aboriginal and Torres Strait Islander people than non-Indigenous people. Notification rates for gonorrhoea were also 10 times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people. For syphilis, notification rates were six times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people. For chlamydia, notification rates were three times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people.
  • Skin infections are also common in Aboriginal and Torres strait Islander Communities (The Lowitja Institute).

These data paint a real and bleak picture, but there are many success stories, including:

  • An initiative by Australians for Native Title and Reconciliation group in 2007 which reported on successful Aboriginal and Torres Strait Islander health projects, such as:
    • ‘Tune into your health: Nunkawarrin Yunti Aboriginal Health Service’ where young people developed lyrics and songs about health issues affecting their community, a song called ‘It’s in your blood’ increased knowledge and awareness of Hepatitis C.
    • ‘Keeping safe with a snake: Marie Stropes International Australia’ an initiative raising awareness of sexual health.
    • ‘Mooditj: Sexual health and positive life skills’ an initiative by the Family Planning Association of Western Australia.
    • Healthworkforce Project and the Shalom Gamarada Ngiyani Yana Residential Scholarship program which has increased the numbers of Aboriginal and Torres Strait Islander students studying medicine and health at UNSW.
  • The implementation of the nationally funded Hib disease vaccination in 1993 which resulted in decrease of notifications of invasive Hib disease by more than 95%.
  • The painting above, ‘Healthcare in the Western Desert’ was created as part of an innovative project building mutual trust and respect involving Aboriginal artists from the Wankatjunka, Kakutja and Walpirri language groups and second year medical students from the University of Notre Dame during the students’ Remote Area Health Placement in the Kimberly. It highlights the 3 ‘snake and staff’ images representing the medical profession as well as symbols depicting women and children from the local communities and coloured squares representing the medical clinics and a number of circular jila (waterholes). The act of painting together transcended cultural differences and led to an evolution of knowledge and understanding for all participants.

Indigenous communities are at high risk for many infectious diseases, but there is limited research specifically relating to Indigenous health in relation to infection, prevention and control in Australia. Culturally appropriate research and ‘bottom-up’ prevention and control strategies, as well as long term commitment to their implementation is urgently required. It is our responsibility to mainstream Aboriginal and Torres Strait Islander equality in all the valuable work that we do in the infection, prevention and control sphere. This blog is a reminder of the alarming statistics around infections and a call to work on closing the gap in health outcomes in Australia.

This blog was written by Victoria Gregory.

References

  1. Australians for Native Title and Reconciliation. antar.org.au
  2. Closing the Gap Prime Minister’s Report 2017. Closing the gap.pmc.gov.au
  3. Australian Indigenous HealthInfonet.http://healthinfonet.ecu.edu.au/ Retrieved 29.11.17
  4.  Butler, J. C., Crengle, S., Cheek, J. E., Leach, A. J., Lennon, D., O’Brien, K. L., & Santosham, M. (2001). Emerging infectious diseases among indigenous peoples. Emerging infectious diseases, 7(3 Suppl), 554.
  5. The Lowitja Institute. http://www.crcah.org.au/search/site/infection
  6. The University of Notre Dame, Australia. http://www.nd.edu.au/news/media-releases/2017/077