Point Prevalence Survey

CPE Point Prevalence Surveys (PPS)

The Victorian Guideline on CPE requires all hospitals conduct a CPE PPS every 6 months in all ICU’s, organ transplant wards & haematology wards. If your hospital does not have these ward types a PPS is not required. A web form, as well as instructions for completion of the form and a list of frequently asked questions, are all available on the VICNISS website

The Victorian Department of Health & Human Services requires hospitals (with high risk wards listed above) to submit the PPS data via the VICNISS User Portal by Sunday 31 July 2016.

CPE Surveillance Forms

If a CPE case is identified the ICP (or delegate) must complete a CPE Surveillance Form. You may remember from a previous email (sent 6 May 2016) that the CPE Surveillance Form Part A had been updated (replaced old surveillance form Part A and Part B in the Victorian Guidelines on CPE). The DHHS has now released an updated CPE surveillance Form Part B (replaces old surveillance form Part C). Part B must be completed if there is evidence of CPE transmission/outbreak. See attached copies of the current forms, which are also available on the VICNISS website.

CPE Guidelines Compliance Audit

The Victorian Guideline on CPE states health services should audit compliance with the Victorian Guidelines on CPE. All hospitals were required to complete the online audit by April 30th 2016. If you have not already completed the audit please do so as ASAP.  

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 or if you require further clarification contact VICNISS)

Summary

All CPE forms and other resources e.g. surveillance forms (hardcopy), PPS protocol & FAQs. instruction for PPS form, education tools and information sheets for patients/clinicians can be found on the VICNISS website, see modules > carbapenemase-producing enterobacteriaceae. (https://www.vicniss.org.au/healthcare-workers/modules/carbapenemase-producing-enterobacteriaceae-cpe/ )  

GSA Workshop

The next private hospital 2 day gold standard workshop will be held at Penisula Health, Frankston Hospital on Thursday 11th and Friday 12th August, 2016. If you wish to attend this workshop, please register via the HHA website here: http://www.hha.org.au/ForHealthcareWorkers/workshops/workshop-online-booking.aspx

HHA Learning Management System

The LMS has been access by thousands of healthcare workers around Australia. The main issues noted have been around registration. All users are required to register first if this is their first time accessing the LMS. It is not the HHCApp login. The other issue with selection of the correct learning package. If you are completing your annual hand hygiene validation, you need to browse catalogue, select HH auditor modules, then select annual validation. The nursing midwifery package does not meet the needs of an annual validation. If you have any queries, email hhalearning@austin.org.au

Auditing Tip

iPads are great for collecting moments and make auditing much faster. If you have any issues such as syncing or error messages, refer to the iPad troubleshooting guides for apple devices and android devices (new).  

The 2016-17 version of the “High Performing Health Services” document is not as yet available on the DHHS website, however from communications with DHHS we are not anticipating any changes to surveillance requirements.

The 2016 HCW Influenza Vaccination campaign is well underway, with some hospitals already winding down their active promotion.

The Department of Health and Human Services, ‘High-performing health services, Victorian health service performance monitoring framework 2016-2017’, includes a state-wide target of 75 per cent of health service staff employed during the influenza period to be vaccinated.

The data collection period for 2016 is 18th April 2016 to 19th August 2016. Data are to be submitted to VICNISS by 2 September 2016. The webform will be available on the VICNISS website by early August 2016.

2016-17 Surveillance Plans

Please complete your 2016-2017 annual surveillance plan for each hospital and return it to VICNISS by June 30 2016. The surveillance plan (both pdf and word versions) can be accessed on the VICNISS website under manuals, VICNISS participation requirements and the pdf version can be accessed here. Please ensure you meet the VICNISS participation requirements as per the performance indicators. While 2016/17 versions cannot be finalised until after the DHHS performance requirements are out, no changes are anticipated.

Updated SSI Web Form

The new SSI web form was released this week. Things you should notice:

• 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@mh.org.au

Two new user guides are also available to assist facility managers with the new SSI webform. SSI webform user guide and web-portal user registration. Web-portal user Registration Guide.

Antibiotic Prophylaxis – updates consistent with v 15 Guidelines (CSEC and HYST)

There have been some jobs lurking in our “to do” list which have been neglected due to other priorities such as CPE and updating web forms. One of these has been updates to our antibiotic prophylaxis assessment rules to make them consistent with version 15 of the guidelines. Apologies for the delay – changes will apply retrospectively to procedures on or after performed after 1 July 2015. In summary, there are some differences in recommended antibiotics for CSEC and (e.g. clindamycin is now recommended) and the recommendations now differ for VHYST and HYST.

The National Antibiotic Prescribing Survey for Aged Care will commence late June. This is a combined antibiotic use and infection survey, similar to those previously run in Victoria. All aged care facilities are strongly encouraged to participate.

For furtehr information please email support@naps.org.au

Antimicrobial coated peripherally-inserted central venous catheters: a beneficial intervention?

Antimicrobial coated central venous catheters (CVCs) have demonstrated efficacy for prevention of central line-associated bloodstream infections (CLABSIs). Both antibiotic (minocycline/rifampicin) and antimicrobial (chlorhexidine/silver sulfadiazine) impregnated devices have been shown to decrease bacterial colonisation and CLABSI. Clinically, these may be used in the setting of increased infection rates despite utility of recommended prevention bundles. Peripherally-inserted CVCs (PICCs) are increasingly being used in place of non-tunnelled CVCs, but the potential benefit of antimicrobial coating of these devices has not been well-studied. In 2011, the FDA approved a chlorhexidine-impregnated PICC. Storey S et al. (Am J Infect Control 2016; 44:636-641) sought to determine the impact of this device upon risk for CLABSI and thromboembolism.

The study was conducted at a US centre over an 18-month period. Patients admitted to cardiovascular thoracic, medical intensive care and oncology units and who required a PICC device were eligible for inclusion, and were randomised to receive either a chlorhexidine-impregnated or non-impregnated PICC. Devices were either single or double lumen.

One hundred and eighty-seven patients were analysed (n=80 and 87 in chlorhexidine PICC and non-impregnated PICC groups, respectively). Studied devices were in situ for a median of 8 days in both groups. Three patients developed CLABSI – 2 in the chlorhexidine-impregnated PICC group, and one in the control group (p=0.067). Three patients developed venous thromboembolism – 1 in the chlorhexidine-impregnated group, and 2 in the control group (p>0.99). Moderate bleeding was more frequent in the chlorhexidine-impregnated device group, compared to the control group (32.5 vs. 1.1%, p<0.001).

Findings suggest that in high-risk patient populations, chlorhexidine-impregnated PICC devices are not associated with a reduction in CLABSI or venous thromboembolism. Further, the risk of post-insertion bleeding may be increased. The study is limited by small sample size, and may not have been sufficiently powered to detect a difference in outcomes. Larger multicentre trials, including patients with longer PICC dwell times, are required.

Risk of infection following colonisation with carbapenem-resistant Enterobacteriaceae

In recent years, carbapenem-resistant Enterobacteriaceae (CRE) have emerged internationally as significant pathogens accounting for healthcare-associated infections. Colonisation is considered to be a risk factor for subsequent infection. However, the attributable risk related to colonisation has not been quantified. Tischendorf J et al. (Am J Infect Control 2016; 44:539-543) undertook a systematic review to evaluate the relationship between colonisation with CRE and subsequent infection.

Literature published between 1991 and 2015 were searched for clinical trials or observational studies reporting both CRE colonisation and infection. Point-prevalence studies were excluded. For evaluable studies, patient populations and nature of screening methods were determined. The proportion of CRE-colonised patients who developed infection was summarised, as was the infection site and all-cause mortality.

Initial search identified 178 potentially relevant abstracts. Of these, 10 studies fulfilled inclusion criteria (total of 1,806 colonised patients). All were studies of adult inpatients, with 4 exclusively in an intensive care setting. Four studies were conducted in an outbreak setting. Seven studies reported carbapenem-resistant Klebsiella pneumoniae, 2 reported carbapenem-resistant Acinetobacter baumannii, and one study reported multiple CRE. Colonisation was defined as detection of CRE in the gastrointestinal tract, by rectal swab in the majority of instances. Among all colonised patients, 299 infections (rate of 16.5%) were reported, although rates of infection in individual studies varied widely (0-89%). Half of all described infections were pneumonia, followed in decreasing order by urinary tract infections, bloodstream infections, and skin/soft tissue infections. Overall mortality rate was 10%.

Findings demonstrate that a considerable proportion of patients colonised with CRE go on to develop infection with CRE (16.5%). Limitations include the variation in screening practices and potential for reporting bias. Notably, time to onset of infection following colonisation was not evaluable, and studies varied considerably in duration of follow-up of patients.