A statewide smaller hospital nosocomial infection surveillance program: The first report, Victoria, Australia

Abstract

ISSUE: There was no ongoing standardized program for monitoring nosocomial infections or infection prevention strategies in the 90 smaller (<100 beds) public acute care hospitals in Victoria, Australia. This paper reports on initial data from a novel statewide surveillance program undertaken by these hospitals. PROJECT: In late 2003, a smaller hospital surveillance program developed by the VICNISS Coordinating Centre was piloted for 18 weeks in 14 hospitals. In May 2004, a revised program was “rolled out” to the other 76 statewide smaller hospitals. Trained infection control professionals using standard paper forms collected data on process and outcome indicator modules. These modules included surgical antibiotic (Ab) prophylaxis, measles and healthcare worker (HCW) vaccination, infections with multidrug-resistant organisms (MDROs), primary laboratory-confirmed bloodstream infections (LCBSIs), outpatient hemodialysis events (OPH, including positive bloodstream infections and IV vancomycin use), and deep incisional or organ space surgical site infections (SSIs). Reports were generated outlining hospital- and state-level results. RESULTS: Eighty-four (84) hospitals contributed data from May through September 2004. State level data is presented. In 15.5% of procedures, Abs were administered for a period exceeding 24 hours after the procedure. From 30 participating hospitals, 4.7% employees were found to be potentially susceptible to measles (Table 1 and 2). Table 1Surgical Ab Prophylaxis (19 participating hospitals) Objective Concordant with guidelines Adequate but NOT concordant with guidelines Inadequate Unknown Choice 538 procedures 50.7% 6.7% 40.1% 2.4% Timing 453 procedures 37.3% - 49.2% 13.5% Open table in a new tab Table 2Outcome indicators Objective Events (#) Rate 95% CI LCBSI per 10,000 Occupied Bed Days (OBDs) 12 0.78 0.40-1.36 MRSA infection <48 hrs of admission per 10,000 OBDs 18 1.41 0.84-2.23 MRSA infection >48 hrs after admission per 10,000 OBDs 11 0.86 0.43-1.54 OPHE per 100 patient months 1 0.42 0.0-2.4 Deep Incisional or Organ Space SSIs 18 - - Open table in a new tab LESSONS LEARNED: The rollout program was achievable in that almost all of the hospitals were able to submit data. As expected at this stage, the small number of outcomes yielded limited interpretable data. The well-received process indicator dataset which offered a larger sample size was a more productive application of resources. Antibiotic prophylaxis was suboptimal, and there was still a significant measles risk for some employees. ISSUE: There was no ongoing standardized program for monitoring nosocomial infections or infection prevention strategies in the 90 smaller (<100 beds) public acute care hospitals in Victoria, Australia. This paper reports on initial data from a novel statewide surveillance program undertaken by these hospitals. PROJECT: In late 2003, a smaller hospital surveillance program developed by the VICNISS Coordinating Centre was piloted for 18 weeks in 14 hospitals. In May 2004, a revised program was “rolled out” to the other 76 statewide smaller hospitals. Trained infection control professionals using standard paper forms collected data on process and outcome indicator modules. These modules included surgical antibiotic (Ab) prophylaxis, measles and healthcare worker (HCW) vaccination, infections with multidrug-resistant organisms (MDROs), primary laboratory-confirmed bloodstream infections (LCBSIs), outpatient hemodialysis events (OPH, including positive bloodstream infections and IV vancomycin use), and deep incisional or organ space surgical site infections (SSIs). Reports were generated outlining hospital- and state-level results. RESULTS: Eighty-four (84) hospitals contributed data from May through September 2004. State level data is presented. In 15.5% of procedures, Abs were administered for a period exceeding 24 hours after the procedure. From 30 participating hospitals, 4.7% employees were found to be potentially susceptible to measles (Table 1 and 2). LESSONS LEARNED: The rollout program was achievable in that almost all of the hospitals were able to submit data. As expected at this stage, the small number of outcomes yielded limited interpretable data. The well-received process indicator dataset which offered a larger sample size was a more productive application of resources. Antibiotic prophylaxis was suboptimal, and there was still a significant measles risk for some employees.