Nursing & Health

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.

This 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.

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.

Researchers and infection control experts at Australian Catholic University’s School of Nursing, Midwifery and Paramedicine; Avondale College for Higher Education; Canberra Hospital; and Victorian Healthcare Associated Infection Surveillance Coordinating Centre are working in partnership to develop a national surveillance system for HAUTIs using point prevalence survey.

Staphylococcus aureus bacteraemia (SAB) is a major cause of morbidity and mortality. During 2009, a national surveillance definition for SAB was developed through the Australian Commission on Safety and Quality in Healthcare (ACSQHC). The aim of this paper is to review the literature surrounding SAB surveillance and in doing so, evaluate the recently developed Australian national definition for SAB. The issues examined in this paper that relate to SAB surveillance include detection, the management of duplicates, classification and acquisition of SAB. Upon reviewing the literature, it was clear that the national Australian SAB surveillance definitions developed by the ACSQHC Healthcare Associated Infection Surveillance Committee are consistent with the majority of literature. Where inconsistencies exist, for example the lack of acquisition information in SAB surveillance programs in the United Kingdom, it is clear that the Australian surveillance definitions are more robust and provide more useful information. The national surveillance definitions for SAB developed by the ACSQHC surveillance committee sets an improved standard for other countries.

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.

Purpose: The aim of this study is to determine the incidence of Clostridium difficile infection (CDI) in an Australian hospital and highlight considerations for other Asian countries that are considering establishing or modifying existing CDI surveillance programs.

Methods: An observational study design with dynamic population was used. Data from all persons hospitalized for more than 48 hours over 4 years in a tertiary hospital in Australia were analyzed. Persons with healthcare associated, healthcare facility onset CDIs were identified. The calculation of the relative risk was performed to compare the occurrence of CDI in different groups.

Results: Of the total 58,942 admissions examined, 158 admissions had CDI. The incidence of CDI per 1,000 admissions for the entire study period was 2.68 (95% confidence interval [2.28, 3.13]). There was a statistically significant increase in the incidence of CDI in 2010 compared to that of 2007 (p < .001). The incidence of CDI increased from the 30–39-year age group.

Conclusion: Comparisons between this study and others are challenging due to the lack of standardized definitions for CDI internationally. Noting the increases of CDI internationally and the associated mortality, there is increasing importance to monitor and report the incidence of this infection worldwide.

This 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.

Objectives: To report the quarterly incidence of hospital-identified Clostridium difficile infection (HI-CDI) in Australia, and to estimate the burden ascribed to hospital-associated (HA) and community-associated (CA) infections.

Design, setting and patients: Prospective surveillance of all cases of CDI diagnosed in hospital patients from 1 January 2011 to 31 December 2012 in 450 public hospitals in all Australian states and the Australian Capital Territory. All patients admitted to inpatient wards or units in acute public hospitals, including psychiatry, rehabilitation and aged care, were included, as well as those attending emergency departments and outpatient clinics.

Main outcome measures: Incidence of HI-CDI (primary outcome); proportion and incidence of HA-CDI and CA-CDI (secondary outcomes).

Results: The annual incidence of HI-CDI increased from 3.25/10 000 patient days (PD) in 2011 to 4.03/10 000 PD in 2012. Poisson regression modelling demonstrated a 29% increase (95% CI, 25% to 34%) per quarter between April and December 2011, with a peak of 4.49/10 000 PD in the October–December quarter. The incidence plateaued in January–March 2012 and then declined by 8% (95% CI, 11% to 5%) per quarter to 3.76/10 000 PD in July–September 2012, after which the rate rose again by 11% (95% CI, 4% to 19%) per quarter to 4.09/10 000 PD in October–December 2012. Trends were similar for HA-CDI and CA-CDI. A subgroup analysis determined that 26% of cases were CA-CDI.

Conclusions: A significant increase in both HA-CDI and CA-CDI identified through hospital surveillance occurred in Australia during 2011–2012. Studies are required to further characterise the epidemiology of CDI in Australia.

Healthcare settings are dangerous places. For those receiving care, the risk of unintended harm from healthcare failures continues to be significant. Given this, there is a need to monitor standards in healthcare, not only to identify potential issues, but also to plan and evaluate interventions aimed at improving healthcare standards. Public reporting of performance standards is one aspect to monitoring standards, but not the only one. Public reporting also brings with it challenges. This perspective explores the recent move to publicly report one healthcare-associated infection (HAI) on the MyHospitals website and comments on the broader issue of using existing HAI data for the purposes of public reporting.