The Burden of Healthcare-Associated Infection in Australian Hospitals: A Systematic Review of the Literature

Introduction: Central to all efforts to control and prevent healthcare associated infections (HAIs) is the inherent need to measure the burden of infection and disease, classically referred to as surveillance. Australia does not have a national HAI surveillance system making it very difficult to systematically assess and report on the burden of hospital-acquired HAIs. This systematic review reports the incidence burden of HAIs in Australian hospitals as reported in the peer-reviewed literature from 2010 to 2016. Methods: Systematic review of the peer-reviewed literature reporting the incidence of HAIs in Australian hospitals between from 2010 to 2016 was identified using MEDLINE and CINAHL databases. The study protocol is registered with PROSPERO (registration number: CRD42016052997). Results: Of the 844 articles identified in the search, 24 articles were included in this review. Overall, these data suggest 83,096 HAIs per year in Australia, comprising 71,186 urinary tract infections, 4902 Clostridium difficile infections, 3946 surgical site infections, 1962 respiratory infections in acute stroke patients and 1100 hospital-onset Staphylococcus aureus bacteraemia. This is very large underestimate given the lack of or incomplete data on common infections such as pneumonia, gastroenterological and bloodstream infection, thus potentially missing up to 50% 60% of infections. If that is the case, the incidence of HAIs in Australia may be closer to 165,000 per year. Conclusion: There is a dearth of peer-reviewed literature reporting the incidence of HAIs in Australian hospitals, making it very difficult to an accurate burden of infection. On the eve of a global ‘post antibiotic era’, the need for national consensus on definitions, surveillance methodology and reporting is paramount

An assessment of high touch object cleaning thoroughness using a fluorescent marker in two Australian hospitals

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The burden of healthcare-associated infection in Australian hospitals: a systematic review of the literature

IntroductionCentral to all efforts to control and prevent healthcare associated infections (HAIs) is the inherent need to measure the burden of infection and disease, classically referred to as surveillance. Australia does not have a national HAI surveillance system making it very difficult to systematically assess and report on the burden of hospital-acquired HAIs. This systematic review reports the incidence burden of HAIs in Australian hospitals as reported in the peer-reviewed literature from 2010 to 2016.MethodsSystematic review of the peer-reviewed literature reporting the incidence of HAIs in Australian hospitals between from 2010 to 2016 was identified using MEDLINE and CINAHL databases. The study protocol is registered with PROSPERO (registration number: CRD42016052997).ResultsOf the 844 articles identified in the search, 24 articles were included in this review. Overall, these data suggest 83,096 HAIs per year in Australia, comprising 71,186 urinary tract infections, 4902 Clostridium difficile infections, 3946 surgical site infections, 1962 respiratory infections in acute stroke patients and 1100 hospital-onset Staphylococcus aureus bacteraemia. This is very large underestimate given the lack of or incomplete data on common infections such as pneumonia, gastroenterological and bloodstream infection, thus potentially missing up to 50%–60% of infections. If that is the case, the incidence of HAIs in Australia may be closer to 165,000 per year.ConclusionThere is a dearth of peer-reviewed literature reporting the incidence of HAIs in Australian hospitals, making it very difficult to an accurate burden of infection. On the eve of a global ‘post antibiotic era’, the need for national consensus on definitions, surveillance methodology and reporting is paramount

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. METHODS: A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support

An investigation of the assumptions that inform contemporary hospital infection control programs.

The purpose of the study was to investigate the assumptions that underpin contemporary hospital infection control programs from the perspective of the influence of clinical culture on the integration and ownership of the infection control program. The results of numerous studies have linked low levels of adherence with infection control principles amongst health care providers as the most significant factor contributing to nosocomial infection. Despite early successes in reducing nosocomial infection rates, results derived from current research demonstrate that nosocomial infection has remained a challenge to healthcare providers and patients alike and outbreaks are regularly reported in the infection control literature. Serious economic and social impact has resulted from the increasing levels of antibiotic resistance that have been reported amongst pathogens associated with nosocomial infection. This interpretive study takes an ethnographic approach, using multiple data sources to provide insight into the culture and context of infection control practice drawing upon clinicians' work and the clinician's perspective. There were three approaches to data collection. A postal survey of surgeons was conducted, a group of nurses participated in a quality activity, and a clinical ethnography was conducted in an intensive care unit and an operating theatre complex. Data were analysed in accordance with the qualitative and quantitative approaches to data management. Findings indicate that the clinical culture exerts significant influence over the degree to which the infection control program activities change practice and that rather than imposing the infection control program on the clinical practice setting from outside, sustained practice change is more likely to be achieved if the motivation and impetus for change is culturally based. Moreover surveillance, if it is to influence clinicians and their practice, must provide confidence in its accuracy. It must be meaningful to them and linked to patient care outcomes. Contemporary hospital infection control programs, based on assumptions about a combination of surveillance and control activities have resulted in decreased nosocomial infection rates. However, sustained infection control practice change has not been achieved despite the application of a range of surveillance and control strategies. This research project has utilized an ethnographic approach to provide an emic perspective of infection control practice within a range of practice contexts. The findings from this study are significant within the context of spiraling health costs and increasing antibiotic resistance associated with nosocomial infection

Surgeons' Perspectives on Surgical Wound Infection Rate Data in Queensland, Australia.

Background: The results of the Study on the Efficacy of Nosocomial Infection Control (SENIC) project demonstrated that hospitals with active infection control programs had lower rates of nosocomial infection than those without such programs. A key component of these programs was the inclusion of a systematic method for monitoring nosocomial infection and reporting these infections to clinicians. Objectives: To identify the perspectives of surgeons in Queensland, Australia, regarding infection rate data in terms of its accuracy and usefulness as well as their perceptions regarding acceptable infection rates for surgical procedures classified as "clean" or "contaminated." Methods: A postal survey was conducted, with a convenience sample of 510 surgeons. Results: More than 40% (n = 88) of respondents believed that the acceptable infection rate associated with clean surgical procedures should be less than 1%, a rate much lower than the threshold of 1.4% to 4.1% set by the Australian Council on Healthcare Standards (ACHS). Almost 30% (n = 55) of respondents reported that they would accept infection rates of 10% or higher for contaminated surgical procedures, which is higher than the ACHS threshold of 1.4% to 7.9%. Respondents identified failure to include postdischarge infections in the data and difficulties standardizing criteria for diagnosis of infection as the major impediments to the accuracy and usefulness of data provided. Conclusion: The results of this study have significant implications in relation to the preparation of surgical site infection reports, especially in relation to the inclusion of postdischarge surveillance data and information regarding pathogens, antibiotic sensitivities, and comorbidities of patients developing surgical site infection. Surgeons also identified the need to include information regarding the use of standardized definitions in the diagnosis of wound infection and parameters that allow comparison of infection rates to improve their perceptions regarding data accuracy and usefulness

Auditing hand hygiene rates for quality and improvement

Since the work of Ignaz Philipp Semmelweis, hand hygiene has been recognised as an effective means of preventing healthcare-associated infection. More recently, the World Health Organisation developed guidelines and strategies for improving hand hygiene compliance which have subsequently been adopted and implemented in healthcare facilities around the world. In Australia the imperative to ensure appropriate hand hygiene as a component of safe healthcare provision has been supported and promoted at state and national levels by various bodies. However, in spite of improvements in compliance rates and reported decreases in multi-resistant organisms, criticism has arisen around the commitment of scarce healthcare resources to hand hygiene auditing. This study demonstrates that hand hygiene audits can contribute to quality healthcare delivery and improvement.Griffith Health, School of Nursing and MidwiferyNo Full Tex

Credentialing the infection control practitioner

The following proposal is submitted by the AICA's credentialling and certification subcommittee for your consideration. It outlines a process and procedure for interim credentialling of infection control practitioners. In submitting this proposal, the subcommittee acknowledges that, while competency-based education is the preferred process for credentialling, there are clinicians who, in the absence of educational opportunities, have developed a specialist level of competency in infection control practice through self education and experience. Committee members also recognise the need for self-regulation of accrediting processes, to maintain standards in practice and support members in their clinical roles. We ask you to review the following proposal and invite your comments and critique, to be received by the last week in January 1998