Education

A VICNISS Type 1 Education session designed for surveillance newcomers or ICPs that would like a refresher on VICNISS surveillance principles and any changes to the program is being held:

Date: Wednesday 21st october 2015

Time: 0900-1630 hrs

Venue: VICNISS Coordinating Centre, Seminar Room 1, Mezzanine Level. Doherty Institute, 792 Elizabeth Street. Melbourne

RSVP Friday 16th October to vicniss@mh.org.au

Morning Tea and lunch will be provided.  Venue is readily accessible by public transport. Car parking and other travel costs are at your own expense.  If you have any further queries please contact the VICNISS Coordinating Centre via email or phone 9342 9333

Data Submission

For those hospitals not using webforms or SHIINe to submit VICNISS data please ensure the most recent data collection form is used and all data fields are included. VICNISS data collection forms and istructions for completion of the forms can be found in the VICNISS Manual.

STRUTI – Surveillance to reduce urinary tract infections

Many thanks to all hospitals and health services that participated in the STRUTI Point Prevalence Survey.  Data entry for this point-prevalence survey of healthcare associated urinary tract infections closed on 7th August, 2015.  Hospitals will be able to access reports shortly.

Surgical Infection Report

The Surgical Infection Report module has been reviewed. This module is available to largeType 2 hospitals (50 – 99 acute care beds). It aims to provide a method for individual hospitals to count significant surgical infections (SSIs); ie deep and organ space surgical site infections. There are some changes to the module, which are explained in the protocol. The up-dated protocol, hard copy form, and supporting documents are available on the VICNISS website. For the 1st quarter data entry period, you will need to download the data entry forms and fax them to VICNISS, however, it is anticipated that the webform will be available for the 2nd quarter data entry period.

Peripheral Venous Catheter (PVC) Module

Since 2014, the PVC module has been available in an electronic format for data entry. Whilst some health services have elected to fax their hard copy data entry forms to VICNISS, it is now requested that all data be entered electronically via the VICNISS website.

Should anyone experience difficulties with this process, please call VICNISS on 03 9342 9333.

The revised Hepatitis B and Measles Healthcare Worker immunity modules will be ready for electronic data entry by the end of 2015.

Infection burden in patients managed in home healthcare settings

Over the last 4 decades, a shift in healthcare models has led to expansion of ambulatory-care programs, with a reduction in length of stay for acute-care hospital admissions. Small and ad hoc reports of infections in home healthcare settings have been published. However, robust estimates of infection are lacking, and surveillance systems have therefore not been structured for this setting. Shang J et al. (Am J Infect Control 2015; 43:454-459) sought to describe rates of hospitalisation and emergency care caused by infections among US patients receiving home health care.

The study was a secondary data analysis of a 20% sample of the 2010 national Outcome and Assessment Information Set (OASIS) data. OASIS was developed in 1999 by the Health Care Financing Administration in collaboration with the Center for Health Sciences and Policy Research, to monitor the quality of home health care (HHC) with a standardised assessment tool. OASIS assessment is required for all Medicare-certified HHC agencies eligible for reimbursement by Medicare or Medicaid in the US. To identify infections, the reasons why a HHC patient received emergency care when transferred to an inpatient facility, and the reasons why HHC patients were hospitalised were extracted. These items include 18 possible medical conditions, 4 of which are related to infections: respiratory infection, urinary tract infection, intravenous catheter-related infection, and wound infection.

The studied sample included 199,462 patients from 8,255 HHC agencies. Approximately half had had an inpatient stay during the 14 days prior to HHC admission. In total, 18.2% patients had unplanned hospitalisations, of which 17% were caused by infections: respiratory infections in 7.7%, wound infections in 4.7%, urinary tract infections in 4.4% and IV catheter-related infections in 0.3%. When compared to patients without infection, patients with infection were more likely to be younger, male, white, have had an acute hospital stay 14 days prior to HHC admission, cancer or renal disease, and to be receiving IV therapy or parenteral nutrition.

Respiratory, wound and urinary tract infections are a significant adverse outcome in HHC populations in the US. This study utilised the outcome of unplanned hospitalisation or emergency care as a measure of significant events in patients managed in the home. Furthermore, coded data were used to estimate relative disease burden of specific infections. These two approaches hold merit for future monitoring strategies, and for broader application to non-US settings.

KPC-producing Klebsiella pneumoniae: findings from a large hospital outbreak in Germany

Carbapenem-resistant Klebsiella pneumoniae isolates (KPC) are emerging as a public health concern in healthcare environments. Ducomble T et al. (J Hosp Infect 2015; 89:179-185) reported a 25-month period of a hospital outbreak in Germany (2010-2012), in order to determine mortality and length of hospital stay among cases. During the outbreak, a PCR-based method was implemented, and the effect of this change on the detection of new cases was analysed.

A case was defined as any hospitalised patient in whom KPC-2-producing K. pneumoniae was isolated from a clinical or screening sample. Clinical infection was defined when an isolate was detected in a clinical sample and a medical diagnosis was established by the treating physician. Colonisation was defined as the isolation of a KPC-2-producing pathogen but without clinical manifestation of infection. Retrospective data collection was performed in 2012. PFGE was performed for stored isolates, and only isolates with identical pattern to the outbreak strain were analysed.

The index case was a patient transferred from a Greek hospital in 2010, from whom an isolate with KPC-2-producing K. pneumoniae was recovered 10 days later. 71 further cases were detected over the ensuing 2 year period, recovered by culture-based methods in 61 (85%), and PCR in 11 (15%) instances. Half of cases were detected while hospitalised in the surgical intensive care unit, and the remaining cases were hospitalised in 16 different wards. Of 64 cases with available information, 24 (38%) had been exposed to carbapenem antibiotics within the 30 days before KPC-2 K. pneumoniae detection. In total, 35/72 (47%) cases had clinical infection. Of the 50 cases that were initially found to be colonised, 13 (26%) subsequently developed infection. Length of stay after detection of KPC-2-producing K. pneumoniae was 57 days among infected cases, compared with 25 days among colonised cases. The crude mortality rate was 47%: 60% among infected cases and 35% among colonised patients. The median time to contact isolation was reduced from 5.0 days to 1.5 days following the implementation of a PCR-based technique for detection.

Not surprisingly, KPC-2-producing K. pneumoniae was mainly isolated from patients with severe underlying illnesses, and clinical infection was associated with increased mortality and length of stay. Not unexpectedly, the introduction of direct PCR enabled time to contact isolation to be decreased significantly. Notably, approximately ¼ of cases with colonisation subsequently developed an infection. Colonised patients should therefore be identified for targeted risk-reduction measures, including exposure to antibiotics, and judicious use of medical devices and invasive procedures.