A State-wide Smaller Hospital Healthcare Acquired Infection Surveillance Program: A Five Year Report, Victoria, Australia

Background: Late 2003, the VICNISS Coordinating Centre developed a healthcare acquired infection (HAI) surveillance program for the smaller (<100 public acute care beds) hospitals in the Australian state of Victoria. The VICNISS larger hospital HAI surveillance program was not applicable because mostly these smaller hospitals do not perform major surgery or have intensive care units. The program was piloted for 18 weeks in 14 hospitals. In May 2004, a revised program was ‘rolled out’ to the other 76 smaller hospitals.

Objective: To report the five year results from a novel HAI surveillance program in smaller hospitals.

Methods: Trained Infection Control Professionals collected data from multiple sources using standard paper forms. Process indicator surveillance modules included ‘Surgical antibiotic prophylaxis,’ ‘Health care workers (HCW) and measles/hepatitis B immunisation’ and ‘Peripheral venous catheter (PVC) use’. Outcome indicator surveillance modules included ‘Methicillin-resistant staphylococcus aureus (MRSA) infections’, ‘Bloodstream infections’ (BSI), ‘Occupational exposures’ (OE), and ‘Deep incisional or organ space surgical site infections’ (SSIs).

Results: Aggregate data collected between 1/5/04 and 30/6/09 are presented:

 (A) Process Indicators

 1. Surgical antibiotic prophylaxis (31 participating hospitals)
In 23.8%, 35.5% and 13.5% of the surgical procedures, the choice, timing and duration of antibiotic respectively was inadequate.

 2. HCWs and measles/ hepatitis B immunisation
-43.2% of employees in 27 hospitals were potentially susceptible to measles.
-28.1% of employees in 46 hospitals were potentially susceptible to hepatitis B.

 3. PVC use (25 participating hospitals)
Compliance with recommended practices outlined in the Centers for Disease Control and Prevention Guidelines for the prevention of intravascular catheter related infections were recorded for 89.8% opportunities.

 (B) Outcome Indicators (90 participating hospitals)

 

Module	Rate per 10,000 occupied bed days	95% CI
MRSA infection 48hrs post admission	0.7	0.6-0.8
Staphylococcus aureus BSI	0.2	0.2-0.3
Parenteral OEs	3.6	3.3-3.9
Non-parenteral OEs	1	0.9-1.2

 

297 deep incisional or organ space SSIs were reported. 32.7% of these were ‘inherited’ from a transferring hospital.

Conclusions: Almost all smaller hospitals in Victoria have participated in the VICNISS HAI surveillance program. After five years, there is now strong evidence that MRSA infections, BSIs, OEs and deep incisional or organ space SSIs across these smaller hospitals are infrequent. Antibiotic prophylaxis is suboptimal and there is a significant measles risk for some employees.