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February 2017

e-Bulletin Newsletter



Contact us

VICNISS Healthcare Associated Infection Surveillance Coordinating Centre
792 Elizabeth Street
Melbourne 3000
Victoria Australia
Phone: +61 3 9342 9333
Fax: +61 3 9342 9355
Email: VICNISS @


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Reminders - Data:


Are you twitter-aware? Twitter is a great way to keep up to date with the latest in healthcare new, journals and everything else that is going on around the globe. If you don’t have an account getting one is easy. VICNISS, NCAS, ACIPC, CDC, WHO, HHA , and countless other organisations and individuals all have accounts putting out information. Don’t forget if you have a twitter account please follow us @VICNISS_CC and also @NCAS_Aus

Occupational Exposure (OE) Module Revision - Type 1 & 2

The VICNISS occupational exposure (OE) module is currently being reviewed. When finalised the module will be available to all Victorian hospitals, large (Type 1) and small (Type 2) as an optional surveillance module.

This OE module aims to assist hospitals to not only count OEs but also help to prevent further events (able to look at patterns, contributing factors etc).

Recently a draft OE data collection form was emailed to all ICPs on the VICNISS database for comment.  There are significant changes to the current OE form used by Type 2 Hospitals.

If you have not received the draft OE form for review please contact VICNISS for a copy. Your feedback and comments are appreciated and will be considered before the form is uploaded for use.  It is anticipated that the start date for the new OE form will be July 2017.  This is your opportunity to have a say!!!

Closing Date for comment is Friday 24 February, 2017

Staphylococcus aureus Bacteraemia (SAB) Module Update

The Australian Commission on Safety and Quality in Healthcare (ACSQHC) recently updated the Staphylococcus aureus Bacteraemia (SAB) definitions. VICNISS will be amending the data forms accordingly with the main change being the definition of neutropenia in SAB definition 2.

The amended protocol, form and form instructions will be available on the VICNISS website from the end of next week. Anyone performing SAB surveillance should be familiar with the latest version of this module.

Staphylococcus aureus Bacteraemia (SAB) Investigation Guide

SABs are severe life-threatening infections with an associated mortality of approximately 30%. They are in the main associated with healthcare. They can represent a failure to prevent, and or to effectively treat a primary infection.

VICNISS has developed a SAB investigation tool to assist ICPs. This SAB investigation guide is now available on the VICNISS website and should be used:

  1. when the primary infection which caused a SAB cannot be identified from local surveillance,
  2. to facilitate planning of organisational-wide quality improvement program, and
  3. if there is a change in epidemiology (e.g. clustering of cases in a single ward, new emergence of MRSA SAB).

This tool will enable thorough investigation of patients with a healthcare associated SAB (VICNISS SAB definition 1 or 2) to find the primary cause and, where possible, through system change, reduce the risk of further SABs occurring.

This guide is for hospital use, i.e. not routinely submitted to VICNISS, however in the event of a hospital having an unusually high number of SAB infections, the Department of Health and Human Services may request a copy of the investigation guides and details of subsequent action taken by the hospital.

Bloodstream Infection Surveillance - do you want the option to report non-central line associated BSI???

Currently VICNISS offers surveillance modules for central line-associated bloodstream infection (CLABSI) in the ICU (mandatory partipation) and outside the ICU (optional participation).

Would you (or your intensivists) find it valuable to report on and receive rates of  primary bloodstream infections that are not central line related. We believe hospitals that are performing CLABSI surveillance in ICU already investigate all BSIs to assess whether they meet primary bloodstream infection criteria (i.e. not related to another site) and then if the central line criteria are met. If this would be of value to you we could expand the current module to inpcorporate reporting of these infections, and provide a separate report - please let us know by Friday 3rd march, 2017.

VRE SURVEILLANCE – available for all Victorian hospitals

A reminder that the VRE surveillance module is now available to all Victorian hospital (large and small). Large hospitals can choose to monitor VRE VanA only; VRE VanB only, or both. Small hospitals must continue to monitor all VRE infections.

As many of you may be aware several hospitals in Victoria have reported an increased prevalence of Vancomycin-resistant Enterococcus (VRE) VanA. Participating in surveillance enables hospitals to accurately assess the rate of VRE infections and detect any change to the prevalence of VRE infections within their facility as well as providing valuable information about the epidemiology of this organism across the state if multiple facilities participate.  We would encourage participation, if possible for hospitals with >100 acute beds.

Contact VICNISS Coordinating Centre ( or 9342 9333) if you wish to commence VRE surveillance or have any queries.

National Hand Hygiene Initiative Update

Gold Standard Auditor (GSA) Workshops in 2017

  • March 8th & 9th at Ballarat Base Hospital, Ballarat (limited places still available)
  • June 5th & 6th at Austin Hospital, Heidelberg
  • October 3rd and 4th at Maroondah Hospital, Ringwood East

If you would like to register for any of the above workshops please go to and select the correct workshop from the drop down list at question 7 (Choose the workshop you would like to register for).

National Hand Hygiene Compliance Application (HHCApp) Enhancements

HHA have recently made some improvements to HHCApp. These include a print button to facilitate printing of the compliance dial gauges and a new poster providing a one page summary report of individual department results which can be downloaded as a pdf file for easy distribution and display. For further information on these enhancements please go to:

Late mobile data?

A new process has been added to HHCApp to prevent mobile data that is synced after the audit is complete, from changing the dataset. Any Hand Hygiene Compliance data on a mobile device that has not been synced before the audit changes to 'Complete' will now go automatically into a 'local audit' when the device is next synced. This local audit is generated by the database and will be named with the auditors 'username' and the date/ time of the sync. Example: 'IgnazS_temp_audit_20160713_1156'

2017 HCW Influenza Vaccination Module

The 75% target for health care workers employed during the influenza period to be vaccinated, remains unchanged in the 2017 HCW Influenza Vaccination Campaign.

2017 HCW vaccine is a quadrivalent vaccine. There are two vaccine brands supplied this year:

  • FluQuadri (Sanofi Pasteur)
  • Afluria Quad (Seqirus) – this vaccine is only indicated for use in people aged 18 years and over 

The composition of the quadrivalent influenza virus vaccine in 2017 is:

  • A/Michigan/45/2015 (H1N1)pdm09-like virus (A/Singapore/GP 1908/2015 (IVR-80)
  • A/Hong Kong/4801/2014 (H3N2)-like virus
  • B/Brisbane/60/2008-like virusB/Phuket/3073/2013 like virus.

VICNISS has reviewed the 2017 HCW influenza vaccination protocol, however, there are no significant changes, The protocol, hardcopy data form and instructions, as well as a template for a HCW influenza vaccination declaration form are now available on the VICNISS website.

The DHHS information sheet for the 2017 HealthCare Worker Vaccination Campaign, which includes links to order the vaccines, will be emailed to all ICPs in early March 2017.

The start date for the 2017HCW Vaccination Campaign  is 3rd April, 2017.

VICNISS will be hosting a webinar to provide information on the 2017 Healthcare worker influenza vaccination campaign. The webinar will be scheduled mid March. Whilst there are no changes to the surveillance definitions from 2016, the webinar will provide useful information for ICPs new to the role. An email will be sent to all ICPs in the next couple of weeks with information about joining the webinar.

Type 1 Surveillance Data Entry Tip

Bilateral Procedures e.g. HPRO, KPRO

When recording duration of a bilateral procedure it is important to determine if both knees/hips were operated on concurrently or sequentially. The time recorded on the data collection form should only be for one procedure which will then be allocated to both. The VICNISS manual states: "to document duration of a bilateral procedure, indicate the incision start time to finish time for the entire procedure if performed concurrently. If performed sequentially and there are two procedure durations submit the longest duration; if only one procedure duration recorded divide by two and submit half total duration"

New VICNISS Report: Summary of Completed Data Submitted to VICNISS

This new VICNISS report is located on the VICNISS website>Reports >Data Submission & Quality>Summary of Completed Data Submitted to VICNISS. The user chooses the hospital and quarter to produce a table that summarises all denominator and event data submitted to VICNISS for the selected period. It does not include draft forms. It is a good idea to check this summary after completing all data entry to ensure all data has been completed and submitted to VICNISS,

Type 2 Surveillance Update

The Smaller Public Hospitals Healthcare Associated Infection Surveillance Quality Assurance Project report is nearly complete. The ICPs that participated in this project will receive this report via email. It is planned that other ICPs will be able to access this report via the VICNISS website.


VICNISS has been asked to submit a proposal to the Victorian Aging and Aged Care Branch that recommends ‘infection prevention indicators’ that could be reported by the public sector residential aged care facilities. To obtain further information about this proposal please contact Noleen Bennett via (03) 9342 9333.

Important to know is that the shingles vaccine is now available in Australia. It is provided free for people aged 70 years under the National Immunisation Program. There is also a five year catch up program for people aged 71-79 years until 31 October 2021. Routine vaccination of persons aged 70-79 years is expected to obtain the greatest benefits against shingles and its complications. Further information can be obtained via The Australian Immunisation Handbook 10th edition.

Infection Control Literature Review - February 2016

WHO guidelines for prevention of surgical site infections: pre-operative measures

Surgical site infections (SSIs) are responsible for a large proportion of healthcare-associated infections, being the second most common cause of these infections in Europe and the USA. Prevention programs for SSIs are complex and multi-factorial, and require key strategies to be implemented in pre-, intra- and post-operative periods. As such, the WHO convened an expert/consensus group to evaluate evidence-based prevention strategies focussed on pre-operative measures (Lancet Infect Dis 2016; 16: e276–87). Each recommendation is graded according to strength (strong or conditional) and quality.

Pre-operative measures for SSI prevention are summarised as thirteen recommendations, including:

(i) Immunosuppressive medication should not be discontinued before surgery,

(ii) Consider the administration of oral or enteral multiple nutrient-enhanced nutritional formulas in underweight patients who undergo major surgical operations,

(iii) Patients should bathe or shower before surgery; either a plain soap or an antimicrobial soap may be used for this purpose,

(iv) Patients undergoing cardiothoracic or orthopaedic surgery with known nasal carriage of S. aureus should receive perioperative intranasal applications of mupirocin 2% ointment with or without a combination of chlorhexidine (CHG) body wash,

(v) Perioperative intranasal applications of mupirocin 2% ointment with or without a combination of CHG bodywash are suggested to be used also in patients undergoing other types of surgery,

(vi) Preoperative oral antibiotics combined with mechanical bowel preparation are suggested for use in adult patients undergoing elective colorectal surgery,

(vii) Mechanical bowel preparation alone (without administration of oral antibiotics) should not be used in adult patients undergoing elective colorectal surgery,

(viii) In patients undergoing any surgical procedure, hair should either not be removed or, if absolutely necessary, it should be removed only with a clipper. Shaving is strongly discouraged at all times, whether preoperatively or in the operating room,

(ix) Administration of surgical antibiotic prophylaxis (SAP) should be before the surgical incision when indicated,

(x) SAP should be administered within 120 min before incision, while considering the half-life of the antibiotic,

(xi) Surgical hand preparation should be performed either by scrubbing with a suitable antimicrobial soap and water or using a suitable alcohol-based hand rub before donning sterile gloves,

(xii) Alcohol-based antiseptic solutions based on CHG for surgical site skin preparation should be used in patients undergoing surgical procedures, and

(xiii) Antimicrobial sealants should not be used after surgical site skin preparation for the purpose of reducing SSI.

These recommendations are a valuable resource for hospital infection programs in developed countries. However, given the quality of evidence, conditional recommendations must be evaluated locally by stakeholders, and in the context of the patient and surgical factors most frequently encountered within an individual healthcare facility.