The Hospital Environment as a Source of Resistant Gram Negatives

Presented at the ASID Gram Negative \u27Superbugs\u27 Meeting, 2-3 Aug. 2013

Clostridium Difficile Infection: Incidence in an Australian Setting

Purpose: The aim of this study is to determine the incidence of Clostridium difficile infection (CDI) in an Australian hospital and highlight considerations for other Asian countries that are considering establishing or modifying existing CDI surveillance programs. Methods: An observational study design with dynamic population was used. Data from all persons hospitalized for more than 48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with healthcare associated, healthcare facility onset CDIs were identified. The calculation of the relative risk was performed to compare the occurrence of CDI in different groups. Results: Of the total 58,942 admissions examined, 158 admissions had CDI. The incidence of CDI per 1,000 admissions for the entire study period was 2.68 (95% confidence interval [2.28, 3.13]). There was a statistically significant increase in the incidence of CDI in 2010 compared to that of 2007 (p \u3c .001). The incidence of CDI increased from the 30–39-year age group. Conclusion: Comparisons between this study and others are challenging due to the lack of standardized definitions for CDI internationally. Noting the increases of CDI internationally and the associated mortality, there is increasing importance to monitor and report the incidence of this infection worldwide

A Critical Review to Plan the Future: An Infection Prevention and Control Conference with a Difference

This article discusses the program for the 4th International Australasian College for Infection Prevention and Control (ACIPC) Conference, which focuses on the future of infection prevention and control

Prolongation of Length of Stay and Clostridium Difficile Infection: A Review of the Methods Used to Examine Length of Stay Due to Healthcare Associated Infections

BACKGROUND: It is believed that Clostridium difficile infection (CDI) contributes to a prolongation of length of stay (LOS). Recent literature suggests that models previously used to determine LOS due to infection have overestimated LOS, compared to newer statistical models. The purpose of this review is to understand the impact that CDI has on LOS and in doing so, describe the methodological approaches used. AIM: First, to investigate and describe the reported prolongation of LOS in hospitalised patients with CDI. Second, to describe the methodologies used for determining excess LOS. METHODS: An integrative review method was used. Papers were reviewed and analysed individually and themes were combined using integrative methods. RESULTS: Findings from all studies suggested that CDI contributes to a longer LOS in hospital. In studies that compared persons with and without CDI, the difference in the LOS between the two groups ranged from 2.8days to 16.1days. Potential limitations with data analysis were identified, given that no study fully addressed the issue of a time-dependent bias when examining the LOS. Recent literature suggests that a multi-state model should be used to manage the issue of time-dependent bias. CONCLUSION: Studies examining LOS attributed to CDI varied considerably in design and data collected. Future studies examining LOS related to CDI and other healthcare associated infections should consider capturing the timing of infection in order to be able to employ a multi-state model for data analysis

Trends in Publication Scholarship in Healthcare Infection: A 12-year Analysis

Background: Healthcare Infection, the official publication of the Australasian College for Infection Prevention Control, is an international, peer-reviewed journal. This paper presents an analysis of the publication scholarship trends of articles published within Healthcare Infection, providing insight into future publication trends. Methods: A cross-sectional study design was used to explore published articles over a 12-year period, between 2002 and 2015. A content analysis was performed to examine the key thematic characteristics of all published articles. Citation data from articles published between 2011and 2015 were extracted from Scopus. Results: A total of 345 articles were published in Healthcare Infection during this time. The topics and content of the publications varied considerably. Approximately half the published articles were original research of which the majority were low level evidence. Other articles comprised discussion papers, review articles and editorials. Conclusion: In recent years, there has been an increase in international collaborations and diversification of topics published, including urinary tract infection, sharps injuries, health economics, and antibiotic resistance and stewardship

Development and Trial of An Environmental Cleaning Assessment Program

Background: The Tasmanian Infection Prevention and Control Unit (TIPCU) reviewed methods of evaluating environmental cleanliness in healthcare in July 2012. At a subsequent State wide multidisciplinary forum, there was consensus for the TIPCU to develop a standardised method of assessing environmental cleanliness within Tasmanian healthcare using a combination of both visual and ultraviolet (UV) gel applicator assessments. Methods: The TIPCU developed a protocol outlining methodology for performing both visual and UV gel cleanliness assessments. An on-line tool was used to develop secure web based data collection and reporting. We developed a training program which could be used for face to face or web based education and provided training of key personnel across the Tasmanian Health Organisations (THOs) in the use of the environmental cleaning assessment tools and accompanying data collection and reporting tools. The sites were provided with IPads for data entry, UV sensitive gel and UV lights for a 6 week trial and consultation period. We sought feedback from participants via an on-line survey. Results: A trial period to test the programs functionality was held in the four Tasmanian larger acute public hospitals during April and May 2013. Over 80% of respondents were positive about the protocol, on-line tools and training. On qualitative feedback, the major themes that emerged were around the number of UV gel sites and the limitations in using the UV gel in some specialist areas. We have addressed each of these in the revised protocol. Conclusion: The consultation phase of this project highlighted a number of modifications that were required in the protocol and on-line tools and was an important phase that allowed us to evaluate aspects of the program prior to finalisation of the protocol and tools

Evaluating Environment Cleanliness Using Two Approaches: A Multi-centred Australian Study

Introduction: A standardised approach to evaluating environmental cleanliness is important to ensure consistency of assessor training, allow benchmarking of results between facilities, ensure consistency of the assessment of the environment and assist in meeting national accreditation standards. This paper describes the development process and the findings of the first 12 months of data following the introduction of a standardised program for evaluating environmental cleanliness within Tasmanian healthcare facilities using two different evaluation methods. Methods: Evaluation of environmental cleanliness was undertaken as part of a structured program and involved the use of an ultraviolet solution and fluorescent light in addition to a visual assessment. Twelve Tasmanian hospitals participated in this study. Results: A total of 290 fluorescent light assessments and 232 visual inspections were conducted. Using the fluorescent light assessment, the percentage of correctly cleaned items increased from a baseline of 82.3% to 85.4% over the 12-month study period. Using the visual assessment, 92.5% of items were deemed acceptable during the study period. Conclusions: Our multi-centred study identified a high baseline level of cleanliness using a fluorescent light. We identified that objects were frequently deemed to be visually acceptable, yet may not have been cleaned. The project was supported by a range of online tools for data submission, training tools and a formal assessment of auditors

Evaluating Environmental Cleanliness Using Two Approaches: A Multi-Centred Australian Study

A standardised approach to evaluating environmental cleanliness is important to ensure consistency of assessor training, allow benchmarking of results between facilities, ensure consistency of the assessment of the environment and assist in meeting national accreditation standards

TIPCU Engagement Program in Rural Hospitals and Non-Acute Settings

Introduction: In 2012 the Tasmanian Infection Prevention and Control Unit (TIPCU) implemented an Infection Control Assessment (ICA) program in rural hospitals and non-acute settings (RHANAS). The three main aims of the ICA program are: Build clinician capacity in RHANAS Have the ability to assess and manage infection control risks Foster local ownership of infection prevention and control by individual service providers and clinicians. The project implementation and evaluation is ongoing. Methods: The ICA consists of a range of location and process specific audits, designed specifically for RHANS. Each rural hospital in Tasmania participated in the ICA program during 2012. The program was undertaken collaboratively by a TIPCU CNC, regional infection prevention and control clinical nurse educator and either the DON of the hospital or a designated representative. The majority of the assessments were done on site at each rural hospital in conjunction with a short education program which was tailored on requests from each facility. Results: Consistent themes emerged from the results of each rural hospital ICA. These included the following set of challenges relating to infection prevention and control: No management plan including no regular or structured auditing program No consistent orientation messages Limited direction for site portfolio holders Limited or no healthcare associated infection surveillance programs No ongoing education for staff Outdated policies and procedures Conclusion: The TIPCU in conjunction with the regional Tasmanian Health Organisations (THO) are working collaboratively to address the challenges identified by the ICA program. The TIPCU have produced a template for an infection prevention and control management plan, a portfolio position description and tools for undertaking surveillance in RHANS. The additional challenges identified by the ICA are being addressed at the local THO level