Browsing by Author "Wells, Anne"
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Item A Major Reduction in Hospital-Onset Staphylococcus Aureus Bacteremia in Australia - 12 Years of Progress: An Observational Study(2014-10-01) Wells, Anne; Wilkinson, Irene; McCann, Rebecca; Collignon, Peter; Mitchell, Brett G.Background. Staphylococcus aureus bacteremia (SAB) is a serious cause of morbidity and mortality. This longitudinal study describes significant reductions in hospital-onset SAB (HO-SAB) in Australian hospitals over the past 12 years.
Methods. An observational cohort study design was used. Prospective surveillance of HO-SAB in 132 hospitals in Australia was undertaken. Aggregated data from all patients who acquired HO-SAB was collected (defined as 1 or more blood cultures positive for S. aureus taken from a patient who had been admitted to hospital for >48 hours). The primary outcome was the incidence of HO-SAB, including both methicillin-resistant (MRSA) and methicillin susceptible (MSSA) S. aureus strains.
Results. A total of 2733 HO-SAB cases were identified over the study period, giving an aggregate incidence of 0.90 per 10 000 patient-days (PDs) (95% confidence interval [CI], .86–.93). There was a 63% decrease in the annual incidence, from 1.72 per 10 000 PDs in 2002 (95% CI, 1.50–1.97) to 0.64 per 10 000 PDs (95% CI, .53–.76) in 2013. The mean reduction per year was 9.4% (95% CI, −8.1% to −10.7%). Significant reductions in both HO-MRSA (from 0.77 to 0.18 per 10 000 PDs) and HO-MSSA (from 1.71 to 0.64 per 10 000 PDs) bacteremia were observed.
Conclusions. There was a major and significant reduction in incidence of HO-SAB caused by both MRSA and MSSA in Australian hospitals since 2002. This reduction coincided with a range of infection prevention and control activities implemented during this time. It suggests that national and local efforts to reduce the burden of healthcare associated infections have been very successful.
Item A Strategy for the Prevention and Control of Healthcare Associated Infection in Tasmania 2013-2015(2013-12-01) McGregor, Alistair; Wilson, Fiona; Wells, Anne; Mitchell, Brett G.Healthcare associated infections continue to cause substantial patient morbidity and costs to health services. This document to reduce the incidence of these infections in Tasmania by developing a high quality, consistent infection prevention and control strategy across the state. In the past few years, Tasmania has been actively engaged in prevention through the work of the Australian Commission on Safety and Quality in Healthcare (ACSQHC). This strategy complements and supports the work of the ACSQHC, as well as National Safety and Quality Standards for Healthcare Services. The strategy outlines the overarching objectives for HAI prevention in the coming years. Specific aims for the TIPCU and the THOs are subsequently detailed.
Item ASID (HICSIG)/AICA Position Statement: Preventing Catheter-Associated Urinary Tract Infections in Patients(2011-06-01) Mason, Matthew; Wilson, Fiona; Stuart, Rhonda; Wells, Anne; Brown, Saffron; McGregor, Alistair; Ware, Chris; Mitchell, Brett G.Catheter-associated urinary tract infections (CAUTIs) occur frequently in healthcare settings. The insertion and maintenance of indwelling urinary catheters is a routine element of healthcare. In order to prevent CAUTI, it is important that healthcare professionals providing catheter care understand the indications for catheter use and the correct procedure for insertion and maintenance of catheters. This paper reviews and summarises three recent key publications on the prevention of CAUTIs and proposes the use of a care bundle and checklist for catheter indications, insertion and maintenance, and quality improvement.
Item Australian Graduating Nurses’ Knowledge, Intentions and Beliefs on Infection Prevention and Control: A Cross-Sectional Study(2014-12-12) Matheson, Lucinda; Cloete, Linda; Wilson, Fiona; Wells, Anne; Say, Richard; Mitchell, Brett G.Background: In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-associated infections (HAIs). The current study measures the knowledge, intentions and beliefs of third-year Australian nursing students on key infection prevention and control (IPC) concepts.
Methods: A cross-sectional study of final-year undergraduate nursing students from Schools of Nursing at six Australian universities was undertaken. Students were asked to participate in an anonymous survey. The survey explored knowledge of standard precautions and transmission based precautions. In addition intentions and beliefs towards IPC were explored.
Results: 349 students from six universities completed the study. 59.8% (95% CI 58.8–60.8%) of questions were answered correctly. Significantly more standard precaution questions were correctly answered than transmission-based precaution questions (p < 0.001). No association was found between self-reported compliance with IPC activities and gender or age. Certain infection control issues were correlated with the percentage of correctly answered transmission-based precaution questions. The participants were most likely to seek infection control information from an infection control professional.
Conclusion: Knowledge on transmission-based precautions was substandard. As transmission-based precautions are the foundation of IPC for serious organisms and infections, education institutions should reflect on the content and style of educational delivery on this topic.
Item Can Homemade Fit Testing Solutions be as Effective as Commercial Products?(2012-12-01) McKenzie, Duncan; McGregor, Alistair; Wells, Anne; Mitchell, Brett G.Background: Fit testing is used to determine whether a N95 mask will provide respiratory protection for the wearer by preventing inhalation of airborne transmitted microorganisms. National guidelines recommend that healthcare workers (HCW) who use N95 masks require fit testing. Quantitative fit testing requires the purchasing and use of fit testing solutions and associated equipment. In high volume, these solutions are expensive and may not be readily available, as was seen in the 2009 H1N1 influenza pandemic. The aim of this study was to determine how a homemade solution compared against a commercially available product and a placebo.
Methods: A fit test was performed on the same person, on three separate occasions, using three different solutions – commercial (45% sodium saccharin), homemade (to be disclosed) and placebo (water). The solution was double blinded and solutions were chosen and administered in a random order.
Results: A total of 48 people participated in this study. At the threshold testing stage, 8.3% did not taste any solution, 16.7% of people could taste the placebo, 89.6% could taste the commercial solution and 91.7% could taste the homemade solution. All persons who could taste the commercial solution could taste homemade solution.
Conclusion: The findings of our study suggest that fit testing solutions could be made locally with a similar effect to that of commercial products, that quantitative fit testing is unreliable and that serious consideration should be given to the role of quantitative fit testing in future guidelines and standards. We recommend that this study be conducted on a larger scale to support our findings.
Item Clostridium Difficile Infection in Tasmanian Public Hospitals 2006-2010(2011-09-01) Wells, Anne; Brown, Saffron; McGregor, Alistair; Ware, Chris; Mitchell, Brett G.Objective To describe the current epidemiology of Clostridium difficile infection (CDI) in Tasmania Design, setting and participants Tasmania undertakes continuous surveillance for CDI at all public hospitals. Data on cases of CDI between 2006 and 2010 were examined. All positive tests occurring within 8 weeks of a previous case, and cases occurring in children less than 2 years old were excluded, consistent with national definitions. Only cases identified at public hospitals were included in the analysis Main outcome measures The rate of CDI in Tasmanian hospitals over the study period and the ability to demonstrate the effect of variances in surveillance definitions. Results A total of 357 cases of CDI were reported over the study period – a rate of 3.08 per 10 000 patient care days (95%CI 2.90–3.27) or 0.94 per 1000 patient separations (95%CI 0.91–0.98) for hospital-identified cases of CDI. Yearly rates for the period 2006 to 2010 were 2.3, 3.2, 2.8 and 3.9 per 10 000 patient care days, respectively. The overall trend was an increase in cases over the study period. The CDI rate from 2009–10 was significantly higher than that from 2008–09. Of the total cases reported,64% were healthcare-associated, healthcare-facility onset (HCAHFO), equating to a rate of 2.1 per 10 000 patient care days over the 4-year period. Conclusion The Tasmanian rate of HCA HFO is increasing, and appears to be greater than that reported by other Australian states, but is less than many northern hemisphere regions, where hypervirulent strains of C. difficile are causing increasing morbidity and mortality. It is difficult to compare reported rates of CDI nationally and internationally owing to inconsistencies in study duration, denominator selection, testing effort and testing methodology. This study demonstrates the need for national standards for CDI testing and reporting.
Item Development and Trial of An Environmental Cleaning Assessment Program(2013-10-01) Wells, Anne; Wilson, Fiona; Mitchell, Brett G.Background: The Tasmanian Infection Prevention and Control Unit (TIPCU) reviewed methods of evaluating environmental cleanliness in healthcare in July 2012. At a subsequent State wide multidisciplinary forum, there was consensus for the TIPCU to develop a standardised method of assessing environmental cleanliness within Tasmanian healthcare using a combination of both visual and ultraviolet (UV) gel applicator assessments.
Methods: The TIPCU developed a protocol outlining methodology for performing both visual and UV gel cleanliness assessments. An on-line tool was used to develop secure web based data collection and reporting. We developed a training program which could be used for face to face or web based education and provided training of key personnel across the Tasmanian Health Organisations (THOs) in the use of the environmental cleaning assessment tools and accompanying data collection and reporting tools. The sites were provided with IPads for data entry, UV sensitive gel and UV lights for a 6 week trial and consultation period. We sought feedback from participants via an on-line survey.
Results: A trial period to test the programs functionality was held in the four Tasmanian larger acute public hospitals during April and May 2013. Over 80% of respondents were positive about the protocol, on-line tools and training. On qualitative feedback, the major themes that emerged were around the number of UV gel sites and the limitations in using the UV gel in some specialist areas. We have addressed each of these in the revised protocol.
Conclusion: The consultation phase of this project highlighted a number of modifications that were required in the protocol and on-line tools and was an important phase that allowed us to evaluate aspects of the program prior to finalisation of the protocol and tools.
Item Evaluating Environment Cleanliness Using Two Approaches: A Multi-centred Australian Study(2015-09-01) Wells, Anne; Wilson, Fiona; Mitchell, Brett G.Introduction: A standardised approach to evaluating environmental cleanliness is important to ensure consistency of assessor training, allow benchmarking of results between facilities, ensure consistency of the assessment of the environment and assist in meeting national accreditation standards. This paper describes the development process and the findings of the first 12 months of data following the introduction of a standardised program for evaluating environmental cleanliness within Tasmanian healthcare facilities using two different evaluation methods.
Methods: Evaluation of environmental cleanliness was undertaken as part of a structured program and involved the use of an ultraviolet solution and fluorescent light in addition to a visual assessment. Twelve Tasmanian hospitals participated in this study.
Results: A total of 290 fluorescent light assessments and 232 visual inspections were conducted. Using the fluorescent light assessment, the percentage of correctly cleaned items increased from a baseline of 82.3% to 85.4% over the 12-month study period. Using the visual assessment, 92.5% of items were deemed acceptable during the study period.
Conclusions: Our multi-centred study identified a high baseline level of cleanliness using a fluorescent light. We identified that objects were frequently deemed to be visually acceptable, yet may not have been cleaned. The project was supported by a range of online tools for data submission, training tools and a formal assessment of auditors.
Item Evaluating Environmental Cleanliness Using Two Approaches: A Multi-Centred Australian Study(2015-11-01) Wilson, Fiona; Wells, Anne; Mitchell, Brett G.A standardised approach to evaluating environmental cleanliness is important to ensure consistency of assessor training, allow benchmarking of results between facilities, ensure consistency of the assessment of the environment and assist in meeting national accreditation standards.
Item Graduate Nurses Knowledge of Infection Prevention and Control(2013-01-01) Matheson, Lucinda; Cloete, Linda; Wells, Anne; Say, Richard; Mitchell, BrettItem Reply to Worth et al(2014-12-15) Wells, Anne; Wilkinson, Irene; McCann, Rebecca; Collignon, Peter; Mitchell, Brett G.TO THE EDITOR—We thank Worth and colleagues for reflecting on some important points related to our recent study where we reported a 63% reduction in hospital-onset (HO) Staphylococcus aureus bacteremia (SAB) in Australia.
Item Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report 19 - Quarter 3 2013(2013-01-01) Mitchell, Brett G.; McGregor, Alistair; Wilson, Fiona; Wells, AnneThis surveillance report describes data relating to a number of key Healthcare Associated Infection (HAI) ‘indicators’. It is the intention of the Tasmanian Infection Prevention and Control Unit (TIPCU) to publish this report quarterly.
Item Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report 20 - Quarter 4 2013(2014-01-01) Mitchell, Brett G.; McGregor, Alistair; Wilson, Fiona; Wells, AnneItem Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report 21 - Quarter 1 2014(2014-02-01) Mitchell, Brett; McGregor, Alistair; Wilson, Fiona; Wells, AnneThis surveillance report describes data relating to a number of key Healthcare Associated Infection (HAI) indicators. The Tasmanian Infection Prevention and Control Unit (TIPCU) publish this report quarterly. The TIPCU website (www.dhhs.tas.gov.au/tipcu) contains details of the surveillance program, including the rationale for the indicators surveyed and the methodologies used in data collection, validation and analysis. In addition, an explanatory document has been developed to accompany this surveillance report. Any form of comparison between hospitals should be done with extreme caution and direct comparisons are not recommended. Information about how Tasmanian rates compare with those of other Australian states are provided in the Key Points sections of this report. The Appendices in this report contain more detailed information. The key findings of this report are: • The rate of healthcare associated Staphylococcus aureus bacteraemia remains low. • In Quarter 1, 2014, there was an increase in hospital identified Clostridium difficile infection (CDI) and healthcare associated – healthcare facility onset Clostridium difficile infection (HCA – HCF CDI). • The occurrence of vancomycin resistant enterococcus remains low. • The Tasmanian hand hygiene compliance rate increased in the latest data collection period and exceeds the national threshold level.
Item Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report 22 - Annual Report 2013-14(2014-12-01) Mitchell, Brett G.; McGregor, Alistair; Wilson, Fiona; Wells, AnneThis annual report provides an overview of the Tasmanian acute public hospitals healthcare associated infection surveillance. This complements the quarterly surveillance data reports that the Tasmanian Infection Prevention and Control Unit (TIPCU) has been publishing since March 2009. The TIPCU website (www.dhhs.tas.gov.au/tipcu) contains details of the surveillance program, including the rationale for the indicators surveyed and the methodologies used in data collection, validation and analysis. These details are not contained in this report but are freely available online should further information be required.
Item Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report 23 - Quarter 3 2014(2014-08-01) Mitchell, Brett G.; McGregor, Alistair; Wilson, Fiona; Wells, AnneThis annual report provides an overview of the Tasmanian acute public hospitals healthcare associated infection surveillance. This complements the quarterly surveillance data reports that the Tasmanian Infection Prevention and Control Unit (TIPCU) has been publishing since March 2009. The TIPCU website (www.dhhs.tas.gov.au/tipcu) contains details of the surveillance program and the methodologies used in data collection, validation and analysis. These details are not contained in this report but are freely available online should further information be required.
Any form of comparison between hospitals should be done with extreme caution and direct comparisons are not recommended. Information about how Tasmanian rates compare with those of other Australian states (where available), are provided in the Key Points sections of this report. The Appendices in this report contain more detailed information.
Compared to the quarterly reports published by the TIPCU, this report contains some additional detail, such as infection rates by financial year and antimicrobial use. From this report, the following findings can be made:
• The rate of healthcare associated Staphylococcus aureus bacteraemia remains low.
• The rate and number of both hospital identified Clostridium difficile infection (CDI) and healthcare associated – healthcare facility onset Clostridium difficile infection (HCA – HCF CDI) are similar to those in the previous quarter.
• The occurrence of vancomycin resistant enterococcus remains low.Item Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report 24 - Quarter 4 2014(2015-11-01) McGregor, Alistair; Wilson, Fiona; Wells, Anne; Mitchell, Brett G.This quarterly surveillance report provides an overview of the Tasmanian acute public hospitals healthcare associated infection surveillance. The TIPCU website (www.dhhs.tas.gov.au/tipcu) contains details of the surveillance program and the methodologies used in data collection, validation and analysis. These details are not contained in this report but are freely available online should further information be required.
Item Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report 25 - Quarter 1 2015(2015-03-01) Mitchell, Brett G.; McGregor, Alistair; Wilson, Fiona; Wells, AnneThis quarterly surveillance report provides an overview of the Tasmanian acute public hospitals healthcare associated infection surveillance. The TIPCU website (www.dhhs.tas.gov.au/tipcu) contains details of the surveillance program and the methodologies used in data collection, validation and analysis. These details are not contained in this report but are freely available online should further information be required. Any form of comparison between hospitals should be done with extreme caution because data are not adjusted for patient characteristics that varies between hospitals. Further, the relatively small Tasmanian population and small number of events can result in volatility of rates from time to time. The raw data in the Appendices illustrates this. Information about how overall Tasmanian rates compare with those of other Australian states where available, are provided in the Key Points sections of this report. This report demonstrates the following findings: • The rate of healthcare associated Staphylococcus aureus bacteraemia remains low. • The rate and number of both hospital identified Clostridium difficile infection (CDI) and healthcare associated – healthcare facility onset Clostridium difficile infection (HCA – HCF) have decreased in Q1 2015 compared with Q4 2014. • The number of vancomycin resistant enterococcus identified has continued to increase.
Item Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report 26 - Annual Report 2014-2015(Department of Health and Human Services, 2015-01-01) Mitchell, Brett G.; McGregor, Alistair; Wilson, Fiona; Wells, AnneThis report provides an overview of the Tasmanian acute public hospitals healthcare associated infection surveillance. This report contains the following findings:
-The rate of healthcare associated staphylococcus aureus bacteremia (SAB) remains low
-There has been a small decrease in the number of community associated SAB during 2014-15
-The number and rate of both 'hospital identified Clostridium difficile infection (CDI) and healthcare associated-healthcare facility onset (HCA-HCF) are lower in 2014-15 compared to 2013-14.
-The number of new isolates of VRE have increased over the first two months of 2015.
-There remains room for improvement in the judicious use of antibiotics, in line with best practice, in some Tasmanian acute care settings.
-All hospitals have a hand hygiene compliance rate above the National Benchmark of 70 per cent.
Item TIPCU Engagement Program in Rural Hospitals and Non-Acute Settings(2013-01-01) Mitchell, Brett G.; Wilson, Fiona; Wells, AnneIntroduction: In 2012 the Tasmanian Infection Prevention and Control Unit (TIPCU) implemented an Infection Control Assessment (ICA) program in rural hospitals and non-acute settings (RHANAS). The three main aims of the ICA program are:
- Build clinician capacity in RHANAS
- Have the ability to assess and manage infection control risks
- Foster local ownership of infection prevention and control by individual service providers and clinicians.
The project implementation and evaluation is ongoing.
Methods: The ICA consists of a range of location and process specific audits, designed specifically for RHANS. Each rural hospital in Tasmania participated in the ICA program during 2012. The program was undertaken collaboratively by a TIPCU CNC, regional infection prevention and control clinical nurse educator and either the DON of the hospital or a designated representative. The majority of the assessments were done on site at each rural hospital in conjunction with a short education program which was tailored on requests from each facility.
Results: Consistent themes emerged from the results of each rural hospital ICA. These included the following set of challenges relating to infection prevention and control:
- No management plan including no regular or structured auditing program
- No consistent orientation messages
- Limited direction for site portfolio holders
- Limited or no healthcare associated infection surveillance programs
- No ongoing education for staff
- Outdated policies and procedures
Conclusion: The TIPCU in conjunction with the regional Tasmanian Health Organisations (THO) are working collaboratively to address the challenges identified by the ICA program. The TIPCU have produced a template for an infection prevention and control management plan, a portfolio position description and tools for undertaking surveillance in RHANS. The additional challenges identified by the ICA are being addressed at the local THO level.