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