Results of the National healthcare associated infection point prevalence study (CHAINS)

On behalf of everybody involved in this exciting study, I am delighted to share the main outcomes that have now been published in Antimicrobial Resistance and Infection Control. We specifically targeted this journal given its significant international status, and importantly all articles are open access. This means that it is available to everybody all the time, and also allows for a pdf download.

Some key points on the study:

  • First national study of its type in Australia for over 30 years
  • Identified that 1 in 10 adult acute inpatients has an infection as a result of their healthcare
  • Most common infections were those following surgery, urinary tract infections and pneumoniaI
  • Identified many infections that hospitals would not normally be detected in routine surveillance processes
  • 1 in 10 patients were being managed for a multi-drug resistant organism
  • Australia is one of the few OECD countries that does not have a national surveillance program
  • Data was collected from19 large hospitals across the country over four months in 2018

A major strength of the study is the use of the same trained data collectors across all sites. This ensured consistency in the application of definitions and datas collection, and also negated any subjective influences if it were data from hospital-based collectors. This is a critical difference to other international PPS and adds reliability to our study.

Importantly, we did not include smaller or specialty hospitals, private hospitals and excluded all patients under 18. Future studies should be funded to all patients across all sites.

This is the first time in 34 years we have had an estimate of HAI prevalence across Australia. In the absence of a national HAI surveillance program, we suggest data from repeated national HAI PPS in all facilities could be used to inform and drive national prevention initiatives.

To read more about the findings, we have written an article in The Conversation, and access to the journal article is here. See highlights from the study in our brief animation below.

Again, a sincere thank you to the infection prevention teams from the participating sites, your support and cooperation was crucial to the success of this study.

We will discuss implications and other outcomes from the study in future blogs

Sincere thanks to the wonderful dedicated infection prevention teams from each of the participating sites for their cooperation and hospitality.

  • 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
  • The Prince of Wales Hospital, NSW
  • The Queen Elizabeth Hospital, SA
  • The Royal Adelaide Hospital, SA
  • Westmead Hospital, NSW

Acknowledgements

The authors acknowledge the work of the CHAINS Project Manager, Bridey Saultry, Research Assistants Ms Stephanie Curtis and Ms Sophie Robinson, Infection Prevention teams, site investigators and key stakeholders at the participating hospitals. The Centre for Quality and Patient Safety Research, Deakin University, for supporting and administering the project. We also acknowledge Kalisvar Marimuthu, Professor Jacqui Reilly and Professor Jennie Wilson for expert advice and guidance in the planning stages of this project

National HAI PPS Update – July 2019

On behalf of the research team I am delighted to inform you that data analysis from the CHAINS project has now been completed.

We have recently submitted a manuscript for publication and look forward to sharing the primary outcomes with you, hopefully in the near future.

In April this year, I was fortunate to present some preliminary data at the 29th European Congress of Clinical Microbiology & Infectious Diseases, in Amsterdam, The Netherlands. Interestingly, I received many comments from Europeans who couldn’t believe that regular HAI point prevalent surveys are not undertaken in Australia.

I was also recently invited by Safer Care Victoria to present some data to the Infection Control Clinical Network 2019 forum.  We are in the process of planning similar updates to all jurisdictions over the next few months. I will also be presenting some findings to the Healthcare Infection Advisory Committee of the Australian Commission for Safety and Quality in Health Care later this year.

Another important part of our dissemination strategy is to provide each participating hospital with a report that will allow them to compare their own data with other (de-identified) participating sites. This report is due later in the year.

We are looking forward to providing you with more detailed updates soon.

Phil

National HAI PPS Update – December 2018

Data collection for the national healthcare associated infection point prevalence survey (CHAINS) is complete.

We are now in the data analysis phase of the project. As agreed with each participating hospital, once the analysis has been completed, we will supply individual reports to each site on the outcomes of the study enabling de-identified hospital comparisons of the findings. We will also be disseminating findings through publications and conference presentations. Our aim is to commence reporting outcomes in the first half of 2019.

Over a 17 week period, our hardworking Research Assistants, Sophie Robinson and Stephanie Curtis collected PPS data from 19 hospitals, covering six States and one Territory. Sophie and Stephanie endured over twenty flights and 14 different rescheduling of travel plans! As is the case with study projects, both Stephanie and Sophie have now completed their roles. As lead investigator, it has been a pleasure to have had hard working and committed RAs, and on behalf of the CHAINS team, a huge thank you and we wish them all the best with their future work.

Once again our sincere gratitude to all the hard working and cooperative staff at each hospital. Without their persistence and cooperation we would not have been able to complete data collection on time.

Finally, a big thank you, farewell and good luck to Bridey Saultry our Project Manager. All those involved in CHAINS will know Bridey has worked tirelessly over the past 12 months. Bridey has also finished in her role with the CHAINS project, and is now preparing the exciting arrival of a new family member.

On behalf of the CHAINS team, enjoy the festive break, and we look forward to providing more updates in 2019!

Phil

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Sophie (L) and Stephanie (R) with Sharyn Hughes completing data collection at the last CHAINS site, Royal North Shore NSW.

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

Best article for 2018 – #blogoff

Jon Otter and I have been having a ‘blog off’, with the aim of presenting the best infection control paper for 2018 (to date). Below, I put my case forward. You can read Jon’s post here. After you read both blogs and listen to points made via Twitter, we encourage you to vote (for the article I present!). Follow more on Twitter (@1healthau) and #mitchellvsotter via this link. Results will be presented during my social media talk on Monday 1st October (& via Twitter). You can vote using this link: https://www.surveymonkey.com/r/SL23H6K

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My (Brett Mitchell’s) choice of article

Choosing the best article is always fraught with danger. There are so many great infection control articles in 2018, but for this blog, I have chosen something that impacts everyone working in infection control – contact precautions (CP).  The article – Impact of Discontinuing Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: An Interrupted Time Series Analysis by Bearman et al.

There are three main reasons, why I believe this article is noteworthy:

  1. Advancement of knowledge in a difficult area
  2. Sets foundation for additional studies
  3. The implications for changing practice around contact precautions are profound

What is the article about?

In this single centre quasi experimental study, seven horizontal infection control interventions were evaluated. One of these, was the discontinuation of CP for patients with MRSA and VRE. During the study period, using interrupted time-series analysis, infection rates for MRSA and VRE decreased, in addition to device associated HAIs – following discontinuation of CP. Importantly, compliance with CP was monitored prior to cessation, 94% compliance with CPs hospital wide, from nearly 2700 observations. The authors conclude with the suggestions that the discontinuation of CP for patients infected or colonized with MRSA or VRE, when combined with horizontal infection prevention measures was not associated with an increased incidence of MRSA and VRE device-associated infections. MRSA HAI decreased by 1.3 per 100,000 bed days and VRE HAI decreased by 7.5/100,000 bed days. Not statistically significant, but clinically relevant in the context of no increase or difference.

Advancement of knowledge

Evidence supporting the use of CPs is largely based on observational studies, theory and expert opinion. Undertaking RCTs in infection control is challenging and not always possible, not the least on the topic of evaluating the impact of stopping CPs.  We have seen other work which has tested the value of universal glove and gown use, but limited work on ceasing CPs. This study takes a big step forward, using a robust design. It adds to a small but growing body of evidence investigating the universal application of CP for patients with any MRO.

Sets foundation

Another important aspect of this study, is that it sets the foundation for more work. It appears that no harm was caused as a result of ceasing CPs. This evidence is critical when attempting to seek funds for future studies, convincing a hospital to attempt something similar and obtaining ethical approvals. It was ‘gutsy’ to undertake a study that ceased CP, but the pragmatic and clever approach of bundling this with other horizontal infection control initiative made this palatable, as well as being able to unpick the relative effect of ceasing CP, using interrupted time series. In so doing, the authors have taken this controversial topic forward and established platform for multi-site sites (plus or minus randomisation).

For the record, I am not suggesting we should change practice around CPs yet, nor I am suggesting CP do not work in the prevention transmission of certain organisms. Rather, I am saying we should be open to the idea and support work that helps answer this question one way or another.

Implications

Imagine the implications if CPs were not required for patients with certain organisms. As quoted in a recent paper by Prof Nick GravesBecause you exist in a world of scarce resources, the choices you make have economic consequences”. The implications regarding CPs are significant and include the (reduction) in cost of personal protection equipment to the increased availability of single rooms as a starting point. In addition, think about the time invested in

identifying patients with MROs, placing them in CPs, monitoring compliance and the associated education with staff. The freeing up of resources, where there are finite resources, is critically important and present new opportunities.

The authors are to be congratulated for tackling a vexed issue and opening the door to the next stage. We need more research in infection prevention and control, that tackles the ‘known unknowns’, so we can advance the science of the profession, have practice underpinned by strong evidence and provide optimal patient care. Where else to start, than with evidence around CPs?  Regardless of whether you are clinician, an infection control professional, policy maker or researcher, this article should be of interest to you. Let’s hope more studies can build on this in the near future.

If you are in agreement, don’t forget to vote for this article here

 

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.