Tag Archives: surveillance

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

A journey of a thousand miles begins with a single step – Laozi

(This blog was inspired by the session at ECCMID 2016 also mentioned by Brett)

There are some things we Antipodeans are good at and are arguably international leaders, and some things we’re not (sporting references will be overlooked for now).

Take for example Australia’s innovative and novel National Hand Hygiene Initiative (NHHI). Obviously declaring conflict here, but a national program rolled out across Australia that recently had over 900 healthcare facilities submit compliance data is an example of what enthusiasm, strong leadership, central coordination and jurisdictional cooperation combined with adequate resources can achieve.

Clearly the start up of the NHHI was resource intensive, and this has been well documented,  and it is difficult to measure the precise effect the NHHI has had on HAIs, particularly when HAI surveillance in Australia is so disparate. Undeniably it has bought the importance of hand hygiene to the forefront of clinicians, executive and politicians. And when these groups listen to infection prevention, it’s a good thing.

Australia also leads the way in antimicrobial stewardship. At the recent ECCMID conference in Amsterdam, AMS was a common theme in many sessions, and several Australians presented new knowledge identified through novel audit tools. Feedback from across the globe has reflected much interest at the appropriateness data being generated.

And then there are things that make us watch in awe, like surveillance. My poster on national surveillance in Australia at ECCMID received a moderate amount of visitors (and not one mistook me for being Austrian). The top two comments were “Nice layout, good colors” and “Really, you don’t have a national surveillance program?”

As Brett has mentioned in his post, the final session at ECCMID was about surveillance and public reporting, and we had Eli Perencevich present perspectives from the US and Europe. England now has a public reporting tool where consumers can drill down to Trust by infection and time period for an assortment of HAIs, presumably this will expand to all mandatory surveillance activities in the future. A presentation by Maaike van Mourik from the Netherlands about semi and fully automated surveillance systems and their utility for the numerous stakeholders was inspiring. Maaike demonstrated how a semi automated surveillance system resulted in an impressive surveillance workload reduction for ICPs and 100% case sensitivity

Will we live to see the day in Australia where electronically sourced, risk adjusted HAI data is collected by an automated surveillance program which is then analysed and interpreted by infection prevention experts, and then submitted to a central agency where data is collated, benchmarks established, and published on an interactive webpage providing complete transparency for consumers?

Unfortunately many other countries are closer to that day than Australia, but we must move in this direction… A journey of a thousand miles…

Why have a national HAI surveillance program, (I hear you ask), when the surveillance you do is perfectly adequate for your needs? Answers to that question will be provided in later blogs!

PLR

ECCMID: surveillance my favourite

Welcome to Infectiondigest. On this blog you will hear thoughts, reflections and maybe the occasional rambling on issues that relate to infection prevention and control.We hope to stimulate some debate and discussion on a range of topics, in the backdrop of our geographical region.

I recently went to ECCMID in Amsterdam. With over 11,000 attendees it is certainly a conference that attracts delegates. There were a few reasons why I wanted to go: to catch up with colleagues, build networks and update knowledge both in certain areas of ID and also infection prevention and control. It ticked the box on all counts, but the IP&C content was the most disappointing. There was not much content on this topic, relative to others in my view. It is very interesting hearing about latest treatments and drugs but in the end, we are and will continue to be become more reliant on ‘basic’ infection control practices. What we really need is investment in high quality infection control studies.

For me, on IP&C, one of the highlights was a talk on the last day, before I had to quickly leave to catch my plane. Automated monitoring of nosocomial infections . This talk made me think about how far behind we are in Australia when it comes to surveillance. There we were in Amsterdam, contemplating the pros and cons of automated vs semi automated surveillance, whereas in Australia, we barely have a national HAI surveillance program.  Perhaps we will leapfrog everyone else in this space, but I doubt it.

 

Brett Mitchell @infectiondigest