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April 2016

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:

SSI Webform Issue Update

Those submitting CLABSI data may have noticed that the new webform is available this quarter.  We hope that you are finding it user friendly and an improvement on the old version.  Be assured that work on the new SSI form is well underway and we hope to have that one available really soon.







CPE surveillance

Point Prevalence Survey

The Victorian Guideline on Carbapenemase-producing Enterobacteriaceae (CPE) published December 2015 requires a point prevalence survey (PPS) be performed every 6 months to screen all patients for CPE on all transplant wards, haematology wards and intensive care units. To assist hospitals to perform the PPS a fact sheet including FAQs is currently being developed. When available VICNISS will inform all ICPs and the document will also be available on the VICNISS website.

Hospitals will be required to submit CPE PPS data to VICNISS Coordinating Centre. Data fields will include: number of patients screened, screening method used, number of patients unable to be screened and the reason for not screening.

CPE Guideline Compliance Audit

The Victorian Guideline on CPE states health services should audit preparedness and response arrangements for CPE. All hospitals are required to complete the online audit by April 30th 2016.

An online data entry form (web form) to record hospital responses to the CPE compliance audit is available on the VICNISS website. A hardcopy of the audit tool can be found in Appendix B of the Victorian guideline on CPE. Audit questions are dependent on which tier the hospital is on (see Victorian Guideline on CPE [p.14] for more information regarding tiers  contact VICNISS)

To access the CPE audit web form the facility manager (usually infection control coordinator that is a registered VICNISS User) may need to update their access to VICNISS forms. Contact VICNISS if you require further assistance.

National Hand Hygiene Initiative Update

GSA Workshop

The next 2 day gold standard workshop will be held at the Royal Women's Hospital on Monday 16th and Tuesday 17th May, 2016. If you wish to attend this workshop, please register via the HHA website here:

GSA Upgrader 

The next GSA upgrader is being held at the Doherty Institute on Friday 29th April, 2016. If you are interested in upgrading from a general auditor to a GSA, please email This will be a 1 day workshop, so you are not required to do the 2 day workshop if you are already an auditor.

New Learning Management System (LMS)

The new LMS was launched on 23rd March, 2016. The aim was to make this more user friendly, update information and be able to access certificates anytime after completion. Users are required to log in first prior to completing the package and logins should not be shared. If you have any queries, email

Performance Indicators 2015 - 2016

The 2015-16 version of the “High Performing Health Services” document is now available on the DHHS website. There are very few changes from last year; apart from the fact that SSI rates have reverted to being assessed over two quarters of data as used to happen pre-2014-15.

2016 HCW Influenza Vaccination Module

The VICNISS 2016 HCW Influenza Vaccination Protocol and HCW Influenza Vaccination form and instructions for completion are now available on the website.  There is also a 2016 Healthcare Worker Vaccination Declaration Form template available under Protocol, Forms and Instructions.

Sanofi Pastuer is the supplier of the vaccine for the 2016 HCW Influenza Immunisation Program.  A fact sheet on the vaccine is available here; and the promotional material can be ordered here.

The 2016 HCW vaccine is a quadrivalent vaccine - FluQuadri and currently the estimated time of vaccine availability is mid April.  The composition of the 2016 Influenza virus vaccine is:

  • A (H1N1): an A/California/7/2009 (H1N1) - like virus
  • A (H3N2): am A/Hong Kong/4801/2014 (H3N2) - like virus
  • B: a B/Brisbane/60/2008 - like virus
  • B: a B/Phuket/3073/2013 - like virus

The DHHS Healthcare Worker Influenza Immunisation Program Information Sheet is now available. The information sheet contains the link to the DHHS website to order vaccines.

Type 1 Surveillance Update

Updated CLABSI Web Form

A new and improved web form for the CLABSI surveillance module is now available on the VICNISS website. Updates to the form include:

• Improved validation

• Improved tablet compatibility

• Incorporation of past user feedback

These changes should enable faster and more accurate data entry. Any feedback is most welcome, email:


VICNISS have now developed a 'competency' for several surveillance modules – SSI, CLABSI, CDI & SAB.  The competencies aim to ensure each participant has the knowledge required to adhere to VICNISS surveillance protocols, correctly identify infection events e.g. apply VICNISS case-definitions, and submit accurate and complete data, including that used for risk adjustment.

The competency must be completed by ICPs and other personnel that collect and report VICNISS surveillance data.

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 & CLABSI.

Contact the VICNISS Coordinating Centre if further information is required and for any other educational needs - email: or phone: 9342 9333. 

Type 2 Surveillance Update


The MRSA surveillance module has been reviewed.  It is estimated that the module with webform will be uploaded onto the VICNISS website ready for Quarter 1, 2016-2017. The changes to this module will be discussed during a webinar in June and detailed in an email to all ICC's.

Point Prevalence Survey - Hepatitis B & Measles

Type 2 Hospitals are required to complete a point prevalence survey each surveillance year.  In 2015, this was the STRUTI module.  For 2016-17 surveillance year the Hepatitis B and Measles staff immunisation modules will be the required point prevalence survey.

Both Hepatitis B and Measles Healthcare Worker Immunity modules have recently been revised. The new protocol, hard copy forms and instructions are now available on the VICNISS website. An online data entry form (web form) is under development and will be available for Quarter 1, 2016-2017. If you have any questions please contact us. 


There will be a webinar held for Type 2 Hospital ICC's in June 2016.   This webinar will discuss the changes in the MRSA, Hepatitis B and Measles modules.  An email will be sent with the date and registration process.

Peripheral Venous Catheter Use (PVC) Surveillance Module

There have been some minor changes to the webform, protocol and instructions for completing the data form. There are now additional fields that allow an ‘estimated date of insertion’ or ‘estimated date of removal’ if the actual date is unknown.

The Report will include a percentage calculation of PVCs that were removed before or replaced at 72-96 hours, using the estimated date if the actual date is not documented. There will be an additional report that provides information on the undocumented processes of insertion date and removal date.


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 completely national survey.  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.

Due to interest, we will be holding some additional Aged Care NAPS online training sessions. The following session dates are still available: -

  • Tuesday 7th July 1400-1500 AEST 
  • Thursday 9th July 1100-1200 AEST  
  • Monday 13th July 1400-1500 AEST  
  • Wednesday 15th July 1000-1100 AEST 
  • Thursday 16th July 1000-1100 AEST

If you would like to attend any of these, please email


Infection Control Literature Review - April 2016

Mycobacterium chimaera infections following open-heart surgery associated with contaminated heater-cooler units

Mycobacterium chimaera is a nontuberculous mycobacteria species responsible for human infections, primarily pulmonary infections in patients with existing chronic respiratory disease (e.g. cystic fibrosis). Identification of this organism requires molecular diagnosis using 16S ribosomal RNA gene sequencing. Sax H et al. (Clin Infect Dis 2015; 61:67-75) identified 6 patients with M. chimaera infection who underwent open-chest heart surgery at a Swiss healthcare facility between 2008 and 2012. Environmental sampling was performed to investigate potential sources of infection.

A case was defined as a patient with proven invasive M. chimaera infection following open-chest heart surgery. The definition of infection included cultures or confirmation by molecular diagnostics in heart valves with histopathological signs of infection. Cases were identified retrospectively, after the infection control team at the studied institution were notified initially of 2 cases of infection. Water and air samples were collected from operating rooms, ICUs, and wards.

For the 6 cases of infection, latency between surgery and infection ranged between 1.5 and 3.6 years. Five cases had echocardiographic findings of endocarditis. Diversity of prosthetic valves and aortic valves was noted, suggesting that production-related contamination was unlikely. M. chimaera was cultured from 5 heater-cooler units and an air sample associated with one of the affected units. Different PCR patterns were observed for isolates sampled from different units, indicating a diversity of infecting strains.

During open-chest heart surgery, heater-cooler units are used for the purposes of warming patients and cooling of cargioplegia solution. These units are placed inside operating rooms and utilise non-sterilised tap water. While outbreaks of non-tuberculous mycobacteria infections in cardiac surgery have previously been reported, these have mostly been without source identification. This outbreak investigation confirmed an airborne transmission pathway associated with contaminated heater-cooler units. Given the long latency period for the reported cluster of infections, it is conceivable that similar problems may have not been identified in other institutions. Effective measures for prevention, including surveillance and sterilisation processes for units, are required.

Achieving high influenza vaccine uptake among healthcare workers without use of mandatory programs

Despite international guidelines recommending healthcare worker (HCW) influenza vaccination, uptake among HCWs frequently remains low. While some institutions have implemented mandatory programs, this practice remains controversial and Australian healthcare facilities do not routinely adopt mandatory strategies. Drees M et al. (Infect Control Hosp Epidemiol 2015; 36:717-724) reported experience of a dedicated (but non-mandatory) program used to successfully increase uptake of HCW influenza vaccination across a 2-hospital 1100 bed academic healthcare system in the U.S.

In the 3 years prior to the 2011-2012 influenza season, HCW vaccine uptake was 57-72%. A multidisciplinary team was convened to improve vaccination uptake to at least 90%. A multimodal campaign was implemented in the 2011-2012 influenza season and continued through 2014-2015 seasons. After implementation, influenza vaccination uptake increased to 92%, followed by 93% for 3 consecutive seasons.

Key components of the intervention included: strengthening tracking and enforcement of policies, increasing availability and promotion of vaccination, disciplinary process for noncompliance, and financial incentive. A mandatory declination policy was introduced, mask-wearing was employed for non-vaccinated staff, ‘I’m vaccinated’ badges were worn by vaccinated staff and weekly compliance reports were issued to managers. A minimum 75% vaccination uptake was set, with payment of a financial bonus to all full-time employees compliant with the program.

Findings indicate the sustainability of the program without resorting to a mandate, and are consistent with previous reports of successful programs based on psychology theory and behavioural change interventions. Notably, the campaign did build upon an existing bonus program, and it is likely that this component would not be feasible for other healthcare systems planning to implement similar interventions.