Elsevier

Infection, Disease & Health

Volume 24, Issue 4, November 2019, Pages 187-193
Infection, Disease & Health

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

https://doi.org/10.1016/j.idh.2019.06.004Get rights and content

Highlights

  • A cross-sectional study of 158 Australian residential and aged care facilities (RACFs).

  • Majority of RACFs have an infection control program and an employee with infection prevention and control responsibilities.

  • Support for RACF staff who are responsible for infection prevention and control could be enhanced.

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

Introduction

Every year, there are approximately 160,000 cases of healthcare-related infection (HAI) in Australian hospitals, and 1.9 million hospital bed days are used to treat them [1], [2]. The Australian Commission on Safety and Quality in Health Care (ACSQHC) acknowledges that in the hospital context, the success of its multi-million dollar HAI program depends almost entirely on the ability of infection control professionals (ICPs) to implement recommended strategies [3]. There are different national guidelines for infection prevention and control in hospitals [4] and residential aged care facilities (RACFs) [5]. Residential aged care is delivered to older people in Australia by service providers who are approved under the Aged Care Act 1997. A range of care options and accommodation are available for older people who are unable to continue living independently in their own homes [6]. The term ‘nursing home’ is not used in Australia.

There are studies that have examined infection control in the RACFs outside of Australia [7], [8], [9], [10], however there are few published Australian studies. The peer-reviewed research literature that does exist on infection control in RACFs in Australia is limited to infection data, antimicrobial use and stewardship [11], [12], [13], [14], [15]. None peer-reviewed literature include a report undertaken by the Australian Aged Care Quality Agency [16]. Limited or no information has been published on access to advice and support, how infection-control services are organised and descriptions of infection-control programs, practices, policies and education in RACFs. This is not surprising, as until recently there was limited information regarding organisational support, ICP skills and education and the staffing and resources used to deliver infection-control programs in Australian hospitals [17]. These are all important elements of improving healthcare quality [18], and it is critical that these issues be understood if implementation of infection-control strategies is to succeed.

We sought to address specific gaps in our understanding of infection control services in the Australian aged care sector and to build on internationally published work and recent explorations of infection-control units in Australian hospitals [19], [20], [21], [22], [23], [24], [25], [26], [27], [28]. In this paper, we present our findings on the governance structures and processes within Australian RACFs and details regarding their infection control programs, including who is responsible for delivering them.

Section snippets

Study design

In 2018, we conducted an online cross-sectional survey of RACFs across all Australian states and territories.

Participants

All RACFs in Australia were eligible for inclusion in the study. Contact details were derived from a database operated by the Australian Government that is meant to be inclusive of all RACFs in Australia. An invitation to participate and promotional material were sent via post to all RACFs listed in the database. For multicentre RACFs, only the primary location of the RACF was invited to

Participants

A total of 1230 RACFs received a postal invitation to participate in the study. Of those, 40% (n = 493) were followed up with a reminder phone call. A total of 134 (10.9%) of the RACFs completed the survey, which in total equated to 11,899 funded beds. Responses were received from every state and territory in Australia, as follows: New South Wales (n = 45), Queensland (n = 23), Victoria (n = 31), Tasmania (n = 8), Western Australia (n = 10), South Australia (n = 11), Northern Territory (n = 2)

Discussion

This paper describes how IPC activities in Australian RACFs are reported to be governed and resourced and is based on the results of a survey that included a broad range of facilities from all Australian states and territories. We also aimed to highlight the challenges faced by RACFs, their priorities and the opportunities that these may present in the future. Therefore, the survey results may help define the future direction of IPC in the RACFs in Australia.

It is important to note that RACFs

Ethics

Ethics approval for this study was granted by Avondale College of Higher Education Human Research Ethics Committee (Approval 2017.23).

Authorship statement

BM, RS, DB and PR designed the project. BM is the Chief Investigator for the project. BM drafted the paper. All authors provided critical input into the paper. All authors approved the manuscript.

Conflicts of interest

Two of the authors have editorial affiliations with the journal, while two other authors are editorial board members. All authors were blinded to this submission in the journal's electronic editorial management system and none of the authors played any editorial role in handling this paper whatsoever.

Funding

This study was supported by a competitive research grant awarded by Medtronics. Avondale College of Higher Education provided in-kind support for this study. Neither Medtronic nor Avondale College of Higher Education played any role whatsoever in the design, analysis, interpretation or publications resulting from this project.

Provenance and peer review

Not commissioned; externally peer reviewed.

References (38)

Cited by (9)

  • Policy Analysis for Prevention and Control of Influenza in Aged Care

    2022, Journal of the American Medical Directors Association
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    Although our study identified 3 Australian policy documents, the coverage was inadequate. In a recent survey 51% of 158 Australian ACFs reported a lack of qualified and experienced infection control specialists and reported producing facility specific policies, and cited the absence of structured national guidance compared with the hospital sector.79 Governance and legislation varied across the 9 countries.

  • Education and training in infection prevention and control: Exploring support for national standards

    2021, Infection, Disease and Health
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    A more comprehensive approach to IPC training and performance monitoring is needed. However, a “one-size-fits-all” approach will be unsuitable for some organisations [14] or exceed IPC resource capacity [15], especially in Australasia, where IPC is often a relatively low priority for clinical and organisational leaders [15–17]. Targeted IPC professional development/leadership programmes are more likely to achieve the goals of a national IPC training programme.

  • Scope of practice and educational needs of infection prevention and control professionals in Australian residential aged care facilities

    2020, Infection, Disease and Health
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    While there is growing international research and evidence on infection prevention and control, little is known within the Australian context. Recent research has examined the organisation and governance of infection prevention and control in Australian residential aged care facilities [16], while other papers have focused on antimicrobial use and stewardship [7,11,13,17–20]. There is, however, a paucity of evidence published about HAI outbreaks, governance and education programs held for healthcare workers within Australian RACFs.

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