Variation in health care-associated infection surveillance practices in Australia

doi:10.1016/j.ajic.2015.02.029

American Journal of Infection Control

Volume 43, Issue 7, 1 July 2015, Pages 773-775

https://doi.org/10.1016/j.ajic.2015.02.029 Get rights and content

Highlights

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Australia does not have a national healthcare associated infection (HAI) surveillance program
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HAI data collected from hospitals across Australia is released on a public website and used for comparisons
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Important differences between Australia eight State and Territory surveillance programs have been found which leads to uncertainty about the validity of existing HAI data
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Until the adoption of national uniform protocol, any attempt to compare State and Territory level data or aggregate for use at a national level will be flawed.

In the absence of a national health care-associated infection surveillance program in Australia, differences between existing state-based programs were explored using an online survey. Only 51% of respondents who undertake surveillance have been trained, fewer than half perform surgical site infection surveillance prospectively, and only 41% indicated they risk adjust surgical site infection data. Widespread variation of surveillance methods highlights future challenges when considering the development and implementation of a national program in Australia.

Section snippets

Methods

An online survey was administered to members of infection prevention staff from both public (ie, government funded) and private acute-care facilities with more than 50 beds who undertake HAI surveillance tasks. The survey sought information on infection prevention staff and team demographic characteristics, surveillance training, definitions, data sources, collection processes, analysis, and reporting. Four current and 2 former infection prevention staff members piloted the survey.

Recruitment

Results

A total of 104 completed responses were received over a 5-week period. Due to the logical design of the survey, respondents were not required to answer every question; therefore, the number of responses varied for different questions. Characteristics of the respondents and their surveillance practices are listed in Table 1.

When stratified by hospital size, several statistically significant differences were identified and are listed in Table 2. Other findings included respondents working in

Discussion

Widespread variation in HAI surveillance practices was found for states and territories, public and private institutions, and facilities of different sizes. Important disparities between states and territories such as definitions¹ and other items mean that until uniform national protocols are adopted, any attempt to compare state- and territory-level data or aggregate for use at a national level will be flawed.

Our study identified that just more than half of respondents who undertake HAI

Acknowledgment

The authors thank the members of the infection prevention staff who took the survey, the Australian Commission for Safety and Quality in Health Care, the state and territory health department representatives, and the Australasian College for Infection Prevention and Control.

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Electronic surveillance software (ESS) collects multiple patient data from hospital software to assist infection control professionals in the prevention and control of hospital-associated infections. This study aimed to understand the perceptions of end users (i.e., infection control professionals) and the facilitators and barriers related to a commercial ESS named ZINC and to assess its usability.
A mixed-method research approach was adopted among infection control professionals 10 months after the implementation of commercial ESS in the university hospital of Nancy, France. A qualitative analysis based on individual semistructured interviews was conducted to collect professionals’ perceptions of ESS and to understand barriers and facilitators. Qualitative data were systematically coded and thematically analyzed. A quantitative analysis was performed using the System Usability Scale (SUS).
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This study shows the value of ESS to support inpatient infections as perceived by infection control professionals. It reveals barriers and facilitators to the implementation and adoption of ESS. These barriers and facilitators should be considered to facilitate the installation of the software in other hospitals.
Improving surgical site infection prevention in Asia-Pacific through appropriate surveillance programs: Challenges and recommendation
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There is a lack of standardized definitions that are relevant and appropriate to healthcare facilities in APAC [20,34,35]. There are also varying SSI surveillance methodologies, protocols, and degrees of validation and accountability that have evolved [36]. This variability limits the understanding of the true epidemiology of SSI in APAC [36].
Surgical site infections (SSIs) represent a substantial clinical and economic burden on patients and the healthcare system. The prevention of SSIs entails surveillance activities which lead to effective mitigation strategies, which are lacking across Asia Pacific (APAC). This manuscript aims to document gaps and challenges across APAC that affect the undertaking of a successful SSI surveillance activities and to provide recommendations on overcoming such challenges.
A targeted literature review with relevance to APAC identified a series of salient points pertaining to SSI prevention guidelines, implementation, surveillance and outcomes, which was discussed in July 2019 at the APAC Surgical Site Infection Prevention Symposium. An expert panel, comprising eight multidisciplinary experts from APAC and the USA, subsequently amalgamated the key discussion points from the Symposium and their clinical experiences in developing this article.
The barriers to implementing a successful and effective APAC SSI surveillance program were identified as: (a) lack of standardized definitions, reporting methodology and accountability, (b) lack of fiscal resources, (c) reporting variability and under-reporting, and (d) lack of safety culture. Implementing an effective surveillance program in APAC will require countries to develop a well-designed and robust surveillance plan and ensure adequate training for staffs involved.
To improve SSI prevention in the region, it is imperative to encourage implementation of national programs with standardized methodologies and accountabilities. An ongoing APAC information exchange, including data and methodologies, will enable continuous learning within the APAC region.
Organisation and governance of infection prevention and control in Australian residential aged care facilities: A national survey
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Individuals in residential and aged care facilities (RACFs) are at risk of developing health care-associated infections (HAIs) due to factors such as age-related changes in physiology, immunity, comorbid illness and functional disability. The recent establishment of an Australian Royal Commission into the Quality of Residential and Aged Care Services highlights the challenges of providing care in this sector. This national study identified infection prevention and control (IPC) services, practice and priorities in Australian RACFs.
A cross-sectional study of 158 Australian RACFs comprising a 42-question survey incorporating five key domains relating to IPC namely governance, education, practice, surveillance, competency and capability was undertaken in 2018.
Of the 131 respondents, the majority 92.4% of respondents reported having a documented IPC program, 22.9% (n = 30) operated with a dedicated infection control committee The majority of RACFs reported lacking specialist and qualified experienced IPC professionals (n = 67). The majority of RACFs (90.1%, n = 118) reported the existence of a designated employee with IPC responsibilities. Of these 118 staff members with IPC responsibilities, 42.5% had a qualification in IPC. The reported average funded hours per month for IPC professional or an external provider of IPC activities was 14 (95% CI 9.6–18.9 h).
The overwhelming majority of RACFs deliver IPC services and report doing so in ways that meet the needs of their own specific contexts in the absence of the lack of formal guidelines when compared to the hospital sector. Quality residential and aged care free from HAIs requires formal structure and organization strategies.
Consumer knowledge and attitudes toward public reporting of health care–associated infection data
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There is little information regarding consumer knowledge of health care–associated infection (HAI). Furthermore, it is unclear how meaningful publicly reported HAI data is to consumers, how they may use it, and the most appropriate format for data presentation. The purpose of this study was to explore consumer knowledge and attitudes toward HAI and public reporting.
A qualitative study design, characterized by a series of semistructured interviews, was undertaken with purposively selected, adult elective surgical inpatients at a large metropolitan acute hospital. Interviews were digitally recorded and transcribed verbatim. Analysis of the data were conducted using thematic analysis.
Twenty interviews were conducted. The 5 major themes identified were: (1) awareness through experience, (2) focus on current illness, (3) patient contribution to infection prevention, (4) sources and mode of information, and (5) influence on choice of hospital.
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If public reporting of HAI data is to be aimed at consumers, further engagement with consumers is crucial to ensure the information provided is fit for purpose.
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Citation Excerpt :
Surveillance is a cyclical process encompassing recognition of an event, data collection, analysis, interpretation and dissemination [8]. Surveillance of HCAIs is a highly resource-intensive activity, with ‘traditional’ surveillance methods involving the infection prevention (IP) staff in exclusively manual data collection processes that are time-consuming, resource intensive, and generate data of variable quality [9–12]. In the USA it has been reported that up to 45% of IP staff time is dedicated to undertaking surveillance [13].
Surveillance of healthcare-associated infections is fundamental for infection prevention. The methods and practices for surveillance have evolved as technology becomes more advanced. The availability of electronic surveillance software (ESS) has increased, and yet adoption of ESS is slow. It is argued that ESS delivers savings through automation, particularly in terms of human resourcing and infection prevention (IP) staff time.
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: PLR is a recipient of the “Babe” Norman Scholarship to enable PhD studies. He also receives minor support from the Australia National Health and Medical Research Center (NHMRC)-funded Centre of Research Excellence in Reducing Healthcare Associated Infection (grant No. 1030103). ACC is supported by a NHMRC Career Development Fellowship. NG is funded by a NHMRC Practitioner Fellowship (grant No. 1059565). LH receives funding from the NHMRC Centre of Research Excellence in Reducing Healthcare Associated Infection (grant No. 1030103).

: Conflicts of interest: PLR is a member of the Australian Commission for Safety and Quality in Health Care, Healthcare Associated Infection Advisory Committee, and previously was operations director at the VICNISS Healthcare Associated Infection Surveillance Coordinating Centre. MR is director of the VICNISS Healthcare Associated Infection Surveillance Coordinating Centre, which established and runs the state health care infection surveillance program in Victoria. He is chair of the Australian Commission for Safety and Quality in Health Care, Healthcare Associated Infection Advisory Committee. NG provides advice to the Centre for Healthcare Related Infection Surveillance and Prevention (CHRISP), Queensland Health, and is a member of the Australian Commission for Safety and Quality in Health Care, Healthcare Associated Infection Advisory Committee. LH was previously manager of epidemiology and research at CHRISP, and is a member of the Australian Commission for Safety and Quality in Health Care, Healthcare Associated Infection Technical Working Group.

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American Journal of Infection Control

Highlights

Section snippets

Methods

Results

Discussion

Acknowledgment

References (13)

Surveillance of hospital-acquired infections in Australia – One Nation, Many states

J Hosp Infect

Validation of healthcare associated Staphylococcus aureus bloodstream infection surveillance in Western Australia

Healthcare Infection

Economic rationale for infection control in Australian hospitals

Healthcare Infection

Methodologies used in surveillance of surgical wound infections and bacteremia in Australian hospitals

Am J Infect Control

Healthcare-associated infections in Australia: time for national surveillance

Aust Health Rev

Reducing harm to patients from health care associated infection: the role of surveillance

Cited by (16)

Perceptions of infection control professionals toward electronic surveillance software supporting inpatient infections: A mixed methods study

Improving surgical site infection prevention in Asia-Pacific through appropriate surveillance programs: Challenges and recommendation

Organisation and governance of infection prevention and control in Australian residential aged care facilities: A national survey

Consumer knowledge and attitudes toward public reporting of health care–associated infection data

Impact of electronic healthcare-associated infection surveillance software on infection prevention resources: a systematic review of the literature

Point prevalence surveys of healthcare-associated urinary tract infections: Development, pilot testing and evaluation of face-to-face and online educational packages

Brief reportVariation in health care-associated infection surveillance practices in Australia

Highlights

Section snippets

Methods

Results

Discussion

Acknowledgment

J Hosp Infect

Healthcare Infection

Healthcare Infection

Am J Infect Control

Healthcare-associated infections in Australia: time for national surveillance

Aust Health Rev

Reducing harm to patients from health care associated infection: the role of surveillance

Brief report
Variation in health care-associated infection surveillance practices in Australia