iii Contents Abbreviations 2Executive summary 3Developments over the last 12 months 5Results 11Type 1 data 12Type 2 data 28How do hospitals assess their performance 35How do hospitals use VICNISS ID: 960622
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VICNISS Hospital Acquired Infection Project: Year 4 report iii Contents Abbreviations 2Executive summary 3Developments over the last 12 months 5Results 11Type 1 data 12Type 2 data 28How do hospitals assess their performance? 35How do hospitals use VICNISS data? 36Limitations and challenges 37Whats next for VICNISS? 38Summary 39Spreading the word about VICNISS 40Glossary 44Appe
ndix A: Type 1 & 2 surveillance 48Appendix B: VICNISS Advisory Committee 52Appendix C: VICNISS Coordinating Centre staff 54Appendix D: Formulae 55 VICNISS Hospital Acquired Infection Project: Year 4 report 1 List of tables Table 1: Summary of average costs of infection following hip 8 and knee arthroplasty Table 2: Surgical antibiotic prophylaxis data from 28 1 May 2004 to 31 Dece
mber 2005 Table 3: Healthcare workers and measles vaccination data 29 from1 January 2005 to 31 December 2005 Table 4: Healthcare workers and hepatitis B vaccination data 29 from 1 January 2005 to 31 December 2005 Table 5: Peripheral venous catheter use from 30 1 January 2005 to 31 December 2005 Table 6: MRSA infection ()om 1 May 2004 to 31 December 2005 30Table 7: MRSA infH h;
&#xours;&#x fr2;�ection (48 hours) from 1 May 2004 to 31 December 2005 31Table 8: Laboratory-conH h;&#xours;&#x fr2;� rmed BSI (48 hours) from 31 1 May 2004 to 31 December 2005 Table 9: Outpatient haemodialysis events data from 32 1 May 2004 to 30 September 2005 Table 10: Parenteral occupational exposures data from 32 1 January 2005 to 31 December 2005 Table 11:
Non-parenteral occupational exposures data from 32 1 January 2005 to 31 December 2005 Table 12: Surgical infection report SSIs from 1 May 2004 to 31 December 2005 33Table 13: In uenza vaccines administered by minor staff category 2005 33 VICNISS Hospital Acquired Infection Project: Year 4 report 3 Executive summary Safety Network, and aim to ensure our data in most areas is colle
cted with methods that Performance Reports that are routinely provided to hospital boards and the Minister VICNISS Hospital Acquired Infection Project: Year 4 report Validation activitiesto Type 1 hospitals and an average of 2.1 visits each. All Type 2 regions have been meetings. In addition, there have been 44 visits to 23 individual Type 2 hospitals was developed by information te
chnology staff at the RGH, and has been used at that Developments over the last 12 months VICNISS Hospital Acquired Infection Project: Year 4 report 7Further use of the AEP during the review of the patients clinical notes captured morbidity (total loss of implant) and mortality rate (most likely cause of death due to implant The VICNISS study found that when the excess length of s
tay (LOS) and all additional hospital costs were added together, 126 infections cost the Victorian healthcare system Figure 1. Total cost per infection by procedure The average excess LOS per infection per patient was 27 days (range 2 142 days) with a total of 3407 excess bed days. Further analysis of the data demonstrated that deep patient bed days (LOS), which was significantly gr
eater ($4,587,127) than when just $1200,000$1800,000Superficial infectionsTotal costinfectionsOrgan space infections $1000,000$1600,000 Infection type$1400,000 KNEES VICNISS Hospital Acquired Infection Project: Year 4 report to VICNISS via 171 medical records that were reviewed by a researcher who was blinded Prophylactic antibiotic in surgeryJournal of Hospital Infection and the r
espectively. This is the first time data of this type have been available for cent of orthopaedic and 30 per cent of colon surgery procedures. For Type 2 hospitals, timing was not concordant with the guidelines for almost 41 per cent of procedures. in Type 1 hospitals and 27 per cent of procedures in Type 2 hospitals. Duration the recommended antibiotic was used 50 per cent of the ti
me, and administered at the VICNISS Hospital Acquired Infection Project: Year 4 report 11Type 1 dataa) Intensive care unit annual data:i) central line-associated bloodstream infections and causative organisms.b) Surgical site infection rates annual data:i) coronary artery bypass graftsii) cholecystectomyiii) colon surgeryiv) Caesarean sectionv) hip arthroplastyvi) knee arthropl
asty.c) Neonatal intensive care unit cumulative data:i) central line-associated bloodstream infectionsii) peripheral line-associated bloodstream infections.Type 2 dataa) compliance with surgical antibiotic prophylaxisb) compliance with measles vaccination guidelinesc) compliance with hepatitis B vaccination guidelinesd) peripheral venous catheter compliancee) multi-resistant organi
sm infection ratef) laboratory-confirmed bloodstream infectionsg) outpatient haemodialysis event rateh) occupational exposuresi) surgical infection report. VICNISS Hospital Acquired Infection Project: Year 4 report 13 Figure 3. Annual intensive care unit central line-associated bloodstream infection rates for other hospitals Figure 3 demonstrates the annual central line-associated b
loodstream infection rate in the other hospitals since the beginning of the VICNISS program. A slight variation VICNISS Hospital Acquired Infection Project: Year 4 report 15 Figure 5. Frequency of causative organisms in intensive care unit central line-associated bloodstream infections other hospitals Staphylococcus aureus appears to have increased. Only two years of data are VI
CNISS Hospital Acquired Infection Project: Year 4 report 17 Figure 7. Annual cholecystectomy surgical site infection rates by risk category Figure 7 demonstrates the cholecystectomy SSI rates for 2003, 2004 and 2005. In risk VICNISS Hospital Acquired Infection Project: Year 4 report 19 Figure 9. Annual Caesarean section surgical site infection rates by risk category Figure 9 demon
strates the Caesarean section surgery SSI rates for 2003, 2004 and 2005. The rates for risk category 0 remain quite stable. Following a high rate in 2003, VICNISS Hospital Acquired Infection Project: Year 4 report 21 Figure 11. Annual knee arthroplasty surgical site infection rates by risk category for risk category 1. The more volatile rates in risk category 2 may be influenced b
y the VICNISS Hospital Acquired Infection Project: Year 4 report 23 Figure 13. Annual frequency of causative organisms following knee arthroplasty Figure 13 demonstrates the frequency of causative organisms in SSIs following knee arthroplasty. Clearly, the most common organism is remained constant over the three years. Over the past two years, the frequency VICNISS Hospital Acqui
red Infection Project: Year 4 report 25Neonatal intensive care unit data Figure 15. Neonatal intensive care unit central line-associated bloodstream infection rate April 2004 to December 2005 Figure 15 demonstrates the central line-associated BSI in neonatal ICUs. Rates are stratified by birthweight, as babies with lower birthweight are generally considered VICNISS Hospital Acqu
ired Infection Project: Year 4 report 27 Figure 17. Neonatal intensive care unit central line-associated bloodstream infection pathogens Figure 17 shows the annual frequency of causative organisms in neonatal central line-associated bloodstream infections for all birthweights combined. This is the first year VICNISS Hospital Acquired Infection Project: Year 4 report 29Healthcare w
orkers and measles vaccination assess Victorian public hospitals policy compliance with the National Health, Medical and Research Council (NHMRC) and Department of Human Services (DHS) recommendations for susceptible healthcare workers, specifically in regard to measles-mumps-rubella (MMR) vaccination determine the current status of healthcare workers susceptible to measles. Table
3. Healthcare workers and measles vaccination data from 1 January 2005 to 31 December 2005 Objective (13 participating hospitals) FrequencyDocumented measles policy92.3%Measles policy consistent with guidelines 92.3%Total staff� (born 1966) with documented evidence immunity to measles or laboratory-con53.4%Healthcare workers and hepatitis B vaccination assess Victorian pub
lic hospitals policy compliance with NHMRC recommendations identify the uptake of hepatitis B vaccine offered to at-risk healthcare workers. Table 4. Healthcare workers and hepatitis B vaccination data from 1 January 2005 to 31 December 2005 Objective (35 participating hospitals) FrequencyDocumented hepatitis B policy97.1%Hepatitis B policy consistent with guidelines 68.6%Total sta
ff vaccinated with con rmatory blood tests 61.7%Peripheral venous catheter use from the Centers for Disease Control and Prevention (2002). VICNISS Hospital Acquired Infection Project: Year 4 report 31 Table 7. MRSA inf�ection (48 hours) from 1 May 2004 to 31 December 2005 CategoryNo. of No. of eventsAcute OBDsRate95% IntervalAggregate8434518,5720.60.4-0.8Small5310128,5180.80
.4-1.4Medium2313217,0010.60.3-1.0Large87173,0530.40.2-0.8Laboratory confirmed bloodstream inf�ections (48 hours)those that occur 48 hours or more after admission to hospital. This was based on the assumption that those identified within 48 hours were not considered to be acquired Table 8. Laboratory�-confirmed BSI ( 48 hours) from 1 May 2004 to 31 December 2005 Categor
yNo. of No. of eventsAcute OBDsRate95% IntervalAggregate8644592,1660.70.5-1.0Small534128,5180.30.1-0.8Medium2311217,0010.50.3-0.9Large1029246,6471.20.8-1.7Outpatient haemodialysis centre VICNISS Hospital Acquired Infection Project: Year 4 report 33Surgical infection report Table 12. Surgical infection report SSIs from 1 May 2004 to 31 December 2005 CategoryNo. of eventsStatewide Lar
geInfluenza vaccination reportThe surveys objective was to measure the uptake rate of influenza vaccine at each site, A total of 76 (65 per cent) hospitals responded to the survey. Of these, 43 were able to provide data on the specific staff category of recipients. Results from these 43 sites are demonstrated in Table 13 below. VICNISS Hospital Acquired Infection Project: Year 4 rep
ort 35other demands on limited infection control resources. When a hospital was unable Department of Human Services and outlining the reasons for the lack of participation.Like all surveillance programs VICNISS requires ongoing evaluation and refinement, and How do hospitals assess their performance? VICNISS Hospital Acquired Infection Project: Year 4 report 37software system.data
collection resources to identify and collect all risk factors for infection after Limitations and challenges VICNISS Hospital Acquired Infection Project: Year 4 report 39 Summary VICNISS Hospital Acquired Infection Project: Year 4 report 413. Bennett N, Berry K, Boardman C, Bull A, Burrell S, Friedman N, Motley J, Richards M August 2005, Auckland.4. Bennett N, Berry K, Boardman C
, Bull A, Burrell S, Friedman N, Motley J, Richards M & Russo P, A statewide smaller hospital nosocomial infection surveillance program: the first report, Victoria, Australia, Society for Healthcare Epidemiology of America 15th Annual Scientific Meeting, 9 12 April 2005, Los Angeles.5. Bennett N, Berry K, Boardman C, Bull A, Burrell S, Friedman N, Richards M & Russo P, Educating s
maller rural hospital infection control nurses, Victoria, Australia, APIC Annual Educational Conference and International Meeting, June 2006, Tampa.6. Bennett N, Berry K, Boardman C, Bull A, Burrell S, Friedman N, Richards M & Russo P, Piloting a novel statewide smaller hospital nosocomial infection surveillance program, APIC Annual Educational Conference and International Meeting
, June 2006, Tampa.7. Bennett N, Berry K, Boardman C, Bull A, Burrell S, Friedman N, Motley J, Richards M & Russo P, Piloting a statewide smaller hospital nosocomial infection surveillance program, NSW Infection Control Conference, 15 September 2004, Sydney.8. Bennett N, Berry K, Boardman C, Bull A, Burrell S, Friedman N, Motley J, Richards M & Russo P, Piloting a statewide smalle
r hospital nosocomial infection surveillance program, Third Australasian Conference on Safety and Quality in Health Care, July 2005, Adelaide.9. Bennett N, Berry K, Boardman C, Bull A, Burrell S, Friedman N, Richards M & Russo P, Surgical antibiotic prophylaxis in smaller hospitals, APIC Annual Educational Conference and International Meeting, June 2006, Tampa.10. Bennett N, Berry
K, Boardman C, Bull A, Burrell S, Friedman N, Richards M & Russo P, Surgical antibiotic prophylaxis in smaller hospitals, Society for Healthcare Epidemiology of America 16th Annual Scientific Meeting, March 2006, Los Angeles.11. Bennett N, Berry K, Boardman C, Bull A, Burrell S, Friedman N, Motley J, Richards M & Russo P, Surveillance for smaller hospitals: what are the alternati
ves?, Victorian Infection Control Professionals Biennial Conference, November 2005, Melbourne.12. Bennett N, Berry K, Boardman C, Bull A, Burrell S, Friedman N, Motley J, Richards M & Russo P, The potential for surgical site infection rate surveillance in smaller acute public hospitals, Victoria, Australia, Society for Healthcare Epidemiology of America 15th Annual Scientific Meet
ing, 9 12 April 2005, Los Angeles.13. Bennett NJ, Berry KS, Boardman CJ, Bull AL, Burrell SJ, Friedman ND, Motley JE, Richards MJ & Russo, PL, The potential for surgical site infection rate surveillance in smaller Victorian public acute care hospitals, Australian Infection Control Association Third Biennial Conference, June 2004, Hobart.14. Boardman C, The VICNISS costing study of
infections associated with selected orthopaedic procedures, Victorian Infection Control Professionals Association Conference, November 2005. VICNISS Hospital Acquired Infection Project: Year 4 report 4325. Russo PL, Bull AL, Bennett NJ, Boardman C, Burrell SJ, Motley JE, Friedman ND & Richards MJ, Data from larger hospitals participating in the VICNISS Hospital-Acquired Infection
Surveillance System Victoria, Australia, Communicable Diseases Control Conference, May 2005, Sydney.26. Russo PL, Bull A, Bennett NJ, Boardman C, Burrell SJ, Motley JE, Friedman ND & Richards M, Nosocomial infection surveillance and epidemiology, The 29th Australian and New Zealand Annual Scientific Meeting on Intensive Care, October 2004, Melbourne.27. Russo PL, Bull A, Bennett
NJ, Boardman C, Burrell SJ, Motley JE, Friedman ND & Richards M, The establishment of a statewide surveillance program for hospital-acquired infections in large acute public hospitals, Victoria, Australia, Association for Practitioners in Infection Control and Epidemiology 32nd Educational Conference and International Meeting, 19 23 June 2005, Baltimore, Maryland.28. Russo PL, Bul
l A, Bennett NJ, Boardman C, Burrell SJ, Motley JE, Friedman ND & Richards M, The establishment of a statewide surveillance program for hospital-acquired infections in large acute public hospitals, Victoria, Australia, Society for Healthcare Epidemiology of America 15th Annual Scientific Meeting, 9 12 April 2005, Los Angeles.29. Russo PL, Bull AL, Bennett NJ, Boardman C, Burrell SJ
, Motley JE, Friedman ND & Richards MJ, The establishment of a statewide surveillance program for hospital-acquired infections in large Victorian public hospitals, Communicable Diseases Control Conference, May 2005, Sydney.30. Boardman C. The VICNISS Costing Study of infections associated with selected orthopaedic procedures. Australian Resource Centre for Healthcare Innovations Se
minar, Brisbane. July 2005.31. Boardman C. The VICNISS Costing Study of infections associated with selected orthopaedic procedures. Victorian Infection Control Professionals Association Conference, Melbourne November 2005. 32. Bennett NJ. Surveillance for smaller hospitals what are the alternatives? Victorian Infection Control Professionals Association Conference, Melbourne Novembe
r 2005.33. Bennett NJ, Berry KS, Boardman CJ, Bull AL, Burrell SJ, Friedman ND, Richards MJ* & Russo PL. Surgical Antibiotic Prophylaxis in Smaller Hospitals, Victoria, Australia. Society of Healthcare Epidemiology Conference, Chicago, March 2006.34. Bennett N, Berry K, Boardman C, Bull A, Burrell S, Friedman N, Richards M & Russo P. Surgical Antibiotic Prophylaxis in Smaller Hospita
ls APIC Annual Educational Conference and International Meeting Tampa June 2006. 35. Bennett N, Berry K, Boardman C, Bull A, Burrell S, Friedman N, Richards M & Russo P. Piloting a Novel State-Wide Smaller Hospital Nosocomial Infection Surveillance Program APIC Annual Educational Conference and International Meeting Tampa June 2006. 36. Bennett N, Berry K, Boardman C, Bull A, Burrell
S, Friedman N, Richards M & Russo P. Educating Smaller Rural Hospital Infection Control (IC) Nurses, Victoria, Australia APIC Annual Educational Conference and International Meeting Tampa June 2006. VICNISS Hospital Acquired Infection Project: Year 4 report 45 AreaDeIntravascular device relatedBloodstream infection linked with the presence of an intravascular deviceLaparoscopyTyp
e of surgery in which a small incision (cut) is made in the abdominal wall through which an instrument (a laparoscope) is placed to permit structures within the abdomen and pelvis to be seen. A diversity of tubes can be pushed through the same incision in the skin. Probes or other instruments can be introduced through the same opening. In this way, a number of surgical procedures can
be performed without the need for a large surgical incision. Often called keyhole surgery, the risk of infection in surgical procedures using a laparoscope is much less than for operations where a large incision is performedMethicillin-resistant Staphylococcus aureus (MRSA)A methicillin (antibiotic) resistant strain of Staphylococcus aureusNeonatalA baby within the rst four weeks
of birthNNISNational Nosocomial Infection Surveillance. The NNIS system at the Centers for Disease Control & Prevention (Atlanta, Georgia) has served as an aggregating institution for US hospitals for over 30 yearsNosocomialThe term comes from two Greek words: nosus meaning disease + komeion meaning to take care of. Hence, to any disease contracted by a patient while under me
dical care. However, nosocomial has been whittled down over the years and now just refers to hospitals it is now synonymous with hospital-acquired Number of days a patient is admitted to a hospital bedOther hospitalsAll hospitals not de ned as Group A1. See Group A1Outcome indicatorAn indicator that measures an outcome (for example, infection rate)PathogenAn agent of disease; that
is, a disease producer. The term pathogenis used most commonly to refer to infectious organisms. These include micro-organisms such as bacteria, viruses and fungi Peripheral lineAn intravenous (IV) catheter inserted into a vein, usually in the armPeripheral line associated bloodstream infectionA bloodstream infection thought to have been caused by the presence of a peripheral linePn
eumoniaIn ammation of one or both lungs. Pneumonia is frequently, but not always, due to infection. The infection may be bacterial, viral, fungal or parasitic Point prevalenceThe number of events or persons with a given disease or other attribute during ed point in timePrevalenceThe number of events (for example, instances of a given disease or other condition) in a given populatio
n at a designated timeProcedure speci cRelated to a speci c procedure. Procedure-speci c infection rates for total hip replacements, for example, are only those infection rates that relate to total hip replacements VICNISS Hospital Acquired Infection Project: Year 4 report 47 AreaDeVICNISS Advisory CommitteeA committee that provides stakeholder advice to the VICNISS Coordinating
Centre on the implementation, development and deliverables of the VICNISS programVICNISS Coordinating CentreA centre that collects and analyses data from individual hospitals and reports to participants and the Department of Human Services on aggregate, risk-adjusted, procedure-speci c infection ratesVICNISS Technical Advisory GroupA group that provides the VICNISS Advisory Committ
ee with recommendations about speci c surveillance issuesVICNISS user groups User groups that provide a forum for program participants to support and/or liaise with the VICNISS Coordinating Centre and other participants VICNISS Hospital Acquired Infection Project: Year 4 report 49 Adjusting for risk elective cholecystectomy (removal of the gallbladder) through keyhole surgery is at
lower new risk factors and explanations of why certain factors increase risk. In most cases, VICNISS Coordinating Centre is undertaking work to test how well the NNIS Risk Index into two groups: Group A1 and Other. Even though the hospitals in Group A1 have VICNISS Hospital Acquired Infection Project: Year 4 report 51Type 2 surveillance modules ModuleAimSurgical antibiotic pro
phylaxisTo improve the selection, timing and duration of prophylactic antibiotics used to prevent infections at the surgical site Healthcare workers and measles To assess Victorian public hospitals policy compliance with NHMRC and DHS recommendations for susceptible healthcare workers, speci cally in regard to measles-mumps-To determine current status of healthcare workers suscepti
ble to measlesHealthcare workers and hepatitis B To assess Victorian public hospitals policy compliance with NHMRC recommendations. To identify uptake of hepatitis B vaccine offered to at-risk healthcare workersPeripheral venous catheter (PVC) useTo optimise the safety associated with the use of PVCs.Short-term PVCs are inserted in peripheral veins for vascular access. Although the
incidence of local or bloodstream infections associated with PVCs is usually low, serious infectious complications may result in considerable Multi-resistant organism (MRO)To provide a method for individual hospitals to measure infections caused by MRSA or vancomycin resistant enterococci (VRE)Primary laboratory conbloodstream infection (LC-BSI)To provide a method for individual hos
pitals to measure LC-BSIsOutpatient haemodialysis centreTo provide a method for individual outpatient haemodialysis centres to monitor bloodstream and vascular access infections and IV vancomycin useOccupational exposureTo provide a method for individual hospitals to measure reported occupational exposuresSurgical site infectionTo provide a method for hospitals to monitor targeted su
rgical proceduresSurgical infection reportTo ensure certain signi cant but infrequent deep and organ space infections are counted. The following infections are to be recorded: deep SSI organ space SSI VICNISS Hospital Acquired Infection Project: Year 4 report 53 MemberRepresentingProfessor Graham BrownVictorian Infectious Diseases Service Ms Donna CameronVictorian Infection Contr
ol Professionals Association Mr Clinton DunkleySenior Program Advisor Infection Control, Quality and Safety Branch, Department of Human ServicesMr David FordDirector of Clinical Support, Melbourne HealthProfessor Lindsay GraysonAustralasian Society for Infectious Diseases Ms Sheila HargraveConsumersMs Glenys HarringtonVictorian Infection Control Professionals Association Dr Chris Mac
IsaacVictorian Regional Committee, Joint Faculty of Intensive Care Medicine Mr Matthew MasonVictorian Infection Control Professionals Association Ms Alison McMillanManager, Quality and Safety Branch, Department of Human ServicesMr Felix Pintado (Chair)Australian College of Health Service ExecutivesDr Mike RichardsDirector, VICNISS Coordinating CentreMr Phil RussoDeputy Director, VICN
ISS Coordinating CentreProfessor Denis SpelmanVACIC Surveillance Subcommittee and Australasian Society for Infectious Diseases Mr Bruce WaxmanRoyal Australasian College of Surgeons VICNISS Hospital Acquired Infection Project: Year 4 report 55Surgical site infection (SSI)Central line-associated bloodstream infection (CLABSI)Ventilator-associated pneumonia (VAP) *as per VICNISS defin
ition Confidence intervalsestimates of the true rate. The true rate could only be calculated from accurate data Example of a confidence interval of 10 per cent would also be calculated from a sample of 10 procedures with one between 0.3 per cent and 44.5 per cent), which suggests the calculated rate of 10 per Appendix D: Formulae Number of SSIs*Number of proceduresSSI rate =
x 100 Number of BSI* in patients with central lineNumber of central line daysCLABSI rate = x 1000 Number of pnuemonia* in patients with ventilatorNumber of ventilator daysVAP rate = x 10