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August 2015

e-Bulletin Newsletter



Contact us

VICNISS Healthcare Associated Infection Surveillance Coordinating Centre
Doherty Institute. Level 2,    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:

VICNISS Website Upgrade

The VICNISS website has been an upgraded. 

To ensure you have full access to each of your heatlh service facilities, please register separately for each facility you are responsible for.

Please be patient, if you have any issues with any of the website please contact us and we will be happy to assist.








NEW!!! VICNISS Surveillance Competency Units

VICNISS have developed a 'competency' for several surveillance modules with more to come. The competency should be completed by ICPs and other personnel that collect and report VICNISS surveillance data. The competencies aim to ensure each participant has the knowledge required to: adhere to VICNISS surveillance protocols; correctly identify infection events i.e., apply VICNISS case-definitions; and submit accurate and complete data, including those used for risk adjustment.

Each VICNISS competency comprises a training course (includes learning activities) followed by a quiz using multiple choice questions. A score of 85% or better will demonstrate adequate knowledge and understanding to perform the nominated VICNISS module.

If the participant does not successfully complete the module competency after three attempts further education by VICNISS staff will be arranged.

CLICK HERE for more information on the competency for CDI, SAB & SSI.

VICNISS Online Data Entry Forms (Web forms)

We are continuing work on the upgrade of the online data entry forms. Your patience is appreciated while this is in progress as we understand some of the current forms are sometimes slow to respond.

National Hand Hygiene Initiative

Hand Hygiene Compliance Target for Victoria

The Victorian compliance benchmark is 80% as outlined in the High Performing Health Services - Victorian health service performance monitoring framework 2015-2016.

Reporting NHHI moments by hospital campus

From July 1st 2015, each hospital is required to submit hand hygiene data at a campus level. The number of moments each campus is required to collect is based on acute inpatient bed numbers submitted to the Agency Information Management System as of 31 March 2015. For further information on the required number of moments required to submit or any further questions, please contact

Where a campus fails to submit the required number of moments in an audit period they will receive zero points toward their Performance Assessment Score for that period. If you are concerned your hospital may not be able to submit the required number of moments by midnight on the due date, please contact Assistance may be available if notified within the audit period but cannot be offered after the due date.

Gold Standard Auditor Workshop in September

The next 2 day gold standard workshop will be run at Peninsula Health on the 3rd and 4th September 2015. It is currently full. If anyone is interested on going onto the waitlist to attend this workshop, please email

Upgrade from a general auditor to a Gold Standard auditor workshop

There has been a little bit of interest in upgrading auditors from general auditors to gold standard auditors. Given this, a workshop has been orgainised to be held on 6th October 2015 at VICNISS 792 Elizabeth St Melbourne, 3000. It will be run from 9:30am until 1:30pm. For any further information or to register, please contact

iPad Tips

Please make sure you log out of the iPad after every session. Errors in reporting can occur if users sync their data after the closure of an audit period. It can also cause problems if a password is changed whilst the user is logged into a mobile device. To avoid any errors, ensure you log out after each use.

iPads can make auditing much faster as it negates the need to enter data into the HHCApp after the auditing has finished saving valuable time. HHA is continuing to roll out the iPad mini’s for auditing. If your organisation would like more information please email

Surveillance Plans & Performance Indicators 2015 - 2016

We have received surveillance plans from most health services for 2015-16. If you have not submitted your plan yet please do so ASAP.

While the 2015-16 version of the “High Performing Health Services” document has not yet been released, we have had ongoing discussions with DHHS to ensure that the requirements in the VICNISS Performance Indicator document reflect the contents of this document.

HCW Influenza Vaccination

The 2015 Healthcare Worker Influenza Vaccination data collection period finishes on Friday 21 August, with data submission, via the webform, is due by Friday 4 September. If you have any questions or problems with your data submission please contact the VICNISS Coordinating Centre via email ( or phone 9342 9333.

Type 1 Surveillance Update


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

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.

Type 2 Surveillance Update

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.




The pilot of the National Antibiotic Prescribing Survey for Aged Care runs until August 31st. This is a combined antibiotic use and infection survey, similar to the ones which have been run in Victoria for the past several years. The big difference is this will be the first national survey, hence the creation of the Australian Infection Surveillance (AIS) entity to hold the data. All aged care facilities are encouraged to participate at the following link: The first reports are expected to be available to participating facilities within two weeks.

Infection Control Literature Review - May 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.