A 9-year infection-control surveillance program in Sydney-based residential aged-care facilities

Abstract

There are very limited Australian data on the incidence of infections in the residential aged-care setting. The objective of this study was to undertake a program of surveillance to establish a baseline rate of infection within the high-care residential facilities of the Columbia Aged Care Services Group in Sydney, Australia. Further, this baseline rate would be used as a benchmark to prompt subsequent process monitoring for infection control with the aim of decreasing infection rates. Data were collected using a surveillance form compliant with the internationally recognised McGeer (1991) definitions for infection surveillance in long-term care facilities. The data were initially collected across five facilities from March 2001 to December 2005 and the data were reviewed during this period. The audit continued from January 2006 to December 2009 to monitor the success of ongoing surveillance and best-practice interventions. The rate of infection calculated over the first 5-year period established the baseline at 3.1 infections per 1000 occupied-bed days (95% CI, 3.0–3.3). For respiratory infections and for all facilities, a monthly seasonal trend was detected using time series analysis, with the majority of infections occurring during the months of May to September and peaking in July. After intervention, the July peak diminished during the second period, although it still exceeded the baseline rate. Infection rates were relatively constant over time for most facilities throughout the surveillance period. Control chart analysis identified several spikes in infection rates that were recorded as a result of outbreaks. This comprehensive long-term surveillance programhas provided a valuable baseline rate of infection for comparison. It has also facilitated a proactive approach to infection prevention and control, such that problem areas and ‘high-risk’ periods can now be identified and managed. The application of this approach should be considered in other high-care residential settings – perhaps nationally, given the absence of uniform systematic surveillance systems in any Australian state or territory. However, there is a need to reviewand validate the 20-year-old American definitions of McGeer et al . for the contemporary Australian context.