Nursing & Health

Background: In the past decade the policy and practice context for infection control in Australia and New Zealand has changed, with infection control professionals (ICPs) now involved in the implementation of a large number of national strategies. Little is known about the current ICP workforce and what they do in their day-to-day positions. The aim of this study was to describe the ICP workforce in Australia and New Zealand with a focus on roles, responsibilities, and scope of practice.

Methods: A cross-sectional design using snowball recruitment was employed. ICPs completed an anonymous web-based survey with questions on demographics; qualifications held; level of experience; workplace characteristics; and roles and responsibilities. Chi-squared tests were used to determine if any factors were associated with how often activities were undertaken.

Results: A total of 300 ICPs from all Australian states and territories and New Zealand participated. Most ICPs were female (94%); 53% were aged over 50, and 93% were employed in registered nursing roles. Scope of practice was diverse: all ICPs indicated they undertook a large number and variety of activities as part of their roles. Some activities were undertaken on a less frequent basis by sole practitioners and ICPs in small teams.

Conclusion: This survey provides useful information on the current education, experience levels and scope of practice of ICPs in Australia and New Zealand. Work is now required to establish the best mechanisms to support and potentially streamline scope of practice, so that infection-control practice is optimised.

The purpose of this review is to describe some of the main methodologies currently used in assessing environmental cleanliness as well as document current local, national and international practices.

Background: In Australia, little is known about the risk of acquiring methicillin-resistant Staphylococcus aureus(MRSA) from prior room occupants. The aims of the study are to understand the risk ofMRSAacquisition from prior room occupants and to further extend the existing knowledge-base on the role of discharge cleaning in hospitals.

Methods: A non-concurrent cohort study was undertaken in five wards at a 250-bed general hospital in Tasmania, Australia. All admitted patients were screened for MRSA. Weekly screenings for all patients who remained in hospital were undertaken. New MRSA acquisitions were identified. The exposed group were patients whose immediate prior room occupant had MRSA, while the unexposed prior room occupant did not have MRSA.

Results: 6228 patients were at risk of acquiringMRSA,with 237 newMRSAacquisitions equating to an acquisition rate of 3.8% for each at-risk patient admission. The unadjusted odds ratio for acquiring MRSA when the prior room occupant had MRSA was 2.9 (95% CI 2.2–3.9). Using logistic regression, exposure to a prior occupant harbouring MRSA remained a significant predictor of subsequent acquisition, after controlling for variables, OR 2.7 (95% CI 2.0–3.6).

Conclusion: Admission to a room previously occupied by a person with MRSA increased the odds of acquisition for the subsequent patient, independent of other risk factors. It demonstrates the necessity of having effective discharge cleaning practices in place. We believe increased attention to discharge room cleaning in hospitals is required and the reconsideration of additional recommendations for discharge cleaning.

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.

Introduction: 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:

1. Build clinician capacity in RHANAS
2. Have the ability to assess and manage infection control risks
3. 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.

Background

Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016–2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs.

Methods

A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices.

Results

Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices.

Conclusions

A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.

Hospital-acquired complications data on urinary tract infections is unreliable, and could result in hospitals being incorrectly financially penalised.

Background

The role of environment in infection prevention and control is being increasingly acknowledged. However, gaps remain between what is promoted as best practice in the literature and what is occurring in healthcare settings. In part, this is due to a lack of generally accepted scientific standards, further confounding the ability to demonstrate an undisputed role for the healthcare environment in healthcare-acquired infections (HAIs). Evaluating environmental cleanliness in a standardised format is required, in order to enable a framework for performance management and provide a method by which interventions can be evaluated. Standardised assessment would provide reliable data to support quality-improvement activities and to ensure that healthcare staff have relevant and useful information to inform and adapt practice.

Methods

This integrative literature reviewdescribes approaches to assessing environmental cleanliness. A search of the published literature was undertaken, in combination with a targeted review of the grey literature.

Results

Four methods for assessing environmental cleanliness were identified: visual inspection, fluorescent gel marker, adenosine triphosphate (ATP) and microbial cultures. Advantages and disadvantages for each are explored.

Conclusion

Methods that evaluate cleaning performance are useful in assessing adherence to cleaning protocols, whereas methods that sample bio-burden provide a more relevant indication of infection risk. Fast, reproducible, costeffective and reliable methods are needed for routine environmental cleaning evaluation in order to predict timely clinical risk.

Hospitals help sick people and there is evidence of infection control issues in hospitals which the discussion in this podcast examines.

Background: To evaluate the current incidence, mortality and length of stay associated with healthcare associated urinary tract infections (HAUTIs). Material/methods: A non-concurrent cohort study design is used, conducted between 1 January 2010 and 30 June 2014. All patients admitted to one of the eight participating Australian hospitals and who were hospitalised more than two days were included. The primary outcomes measures were the incidence, mortality and excess length of stay associated with healthcare associated urinary tract infections. Results: From 162,503 patient admissions, 1.73% (95% CI 1.67–1.80) of admitted patients acquired a HAUTI. Using a multi-state model, the expected extra length of stay due to HAUTI was 4 days, 95% CI 3.1–5.0 days. Using a Cox regression model, infection significantly reduced the rate of discharge (HR 0.78, 95%CI, 0.73-0.83. Women were less likely to die (HR 0.71, 95%CI 0.66-0.75), whereas older patients were more likely to die (HR 1.40, 95%CI 1.38-1.43). Death was rarer in a tertiary referral hospital compared to other hospitals, after adjusting for age and sex (HR 0.74, 95%CI, 0.69-0.78). Conclusions: This study is the first study to explore the burden of HAUTIs in hospitals using appropriate statistical methods in a developed country. Our study indicates that the incidence of HAUTI in addition to its associated extra length of stay in hospital, present a burden to the hospital system. With increasing incidence of UTI due to antimicrobial resistant organisms, surveillance and interventions to reduce the incidence of HAUTI are required.