Peripheral Venous Catheter (PVC) Module & Report

Type 1 hospitals can now participate in the PVC Use Monitoring surveillance module. This module includes process measures from insertion to removal and outcomes including infections. Reports for participating hospitals will be available via the user portal.

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

STRUTI is a multi-State / Territory surveillance collaboration. This point-prevalence survey of healthcare associated urinary tract infections will commence June 2015. This is a required component for Victorian Type 2 Acute Care Hospitals, however, is available as an optional component for Aged Care Facilities. Data for the point prevalence survey is to be collected between 1st June and 31st July, 2015 and submitted electronically via the STRUTI website by 31st July 2015.

Infection Control representatives will need to register on the STRUTI website and complete a compulsory training package with assessment prior to the data entry process. Further instructions including training packages – for both Acute Care Hospitals and Aged Care Facilities, together with hard copies of the data collection forms - will be forwarded to all Victorian Type 2 Hospitals by the end of May, 2015.

Just a reminder…

Type 2 large (50 – 99 acute care beds) hospitals are required to annually complete the Surgical Antibiotic Prophylaxis module. This module aims to improve the choice, timing and duration of prophylactic antibiotics used to prevent infections at the surgical site.

It is anticipated that the revised Hepatitis B and Measles Healthcare Worker immunity modules will be ready for electronic data entry by July 2015.

Impact of a disinfectant cap (70% alcohol) for reducing bloodstream infections associated with central venous catheters

For prevention of central line-associated bloodstream infections (CLABSIs), mechanical decontamination of the hub is recommended. To streamline this process, and reduce the time requirements for healthcare workers managing catheters, in vitro data suggest that bacterial contamination can be reduced by use of a disinfectant cap over IV needleless connectors. Merrill K.C. et al. (Am J Infect Control; 2014 42:1274-1277) analysed the effect of universal IV needleless connector disinfectant cap implementation on the rate and type of CLABSI in a large US healthcare facility.

The study was performed at a 430-bed US hospital comprising a trauma centre. The intervention consisted of hospital-wide implementation of a luer-lock disinfection cap with 70% alcohol, for all patients with peripheral and central venous catheters, beginning in January 2012. The disinfectant cap was placed on all IV needleless connectors when the connectors were not in use. Compliance was monitored. CLABSI rates were calculated for the 12 months prior to the intervention and compared to the 12 months following the intervention. A generalised linear model using Poisson distribution was fit to determine if the difference in CLABSI rates was significant.

Prior to the intervention, the mean CLABSI rate was 1.5/1000 CVC days. After implementation, the mean rate was 0.88/1000 CVC days. The incidence rate ratio was 0.577 (p = 0.004), indicating a >40% decrease in the rate of infections following the intervention. When product costs were included in an economic estimate, the intervention demonstrated a cost-benefit of $282,840 for a 12-month period.

While findings suggest significant impact of using a disinfectant cap for needleless connectors, study limitations must also be acknowledged. In particular, this study failed to report the potential impact of co-interventions upon CLABSI rates. The authors refer to a ‘standard central line bundle’ being used at the study site. However, it is not clear which elements were included in this bundle, nor the local compliance with bundle elements. As such, it is difficult for other healthcare facilities to understand the context for the study, and whether the use of caps in addition to their existing practices would be likely to improve clinical outcomes. Future studies should consider analysis of multifactorial CLABSI prevention programs to determine the relative contribution of this novel intervention.

Anaesthetic practices potentially associated with bacterial contamination of intravenous fluids and drugs.

In patients undergoing surgery, pre-, intra and post-operative factors contribute to the risk of acquiring healthcare-associated infections. Intra-operative anaesthetic practices have traditionally been difficult to evaluate, given variation in clinical practices by individual anaesthetic staff, and the challenge of clinical auditing within a sterile environment. Mahida N. et al. (J Hosp Infect 2015; 90:70-74) evaluated anaesthetic practice indirectly using a standard questionnaire and clinical sampling of syringes, IV lines, ventilator switches and oxygen flowmeter knobs.

The study was performed at a single UK healthcare facility. A convenience sample of 101 surgical cases was selected for evaluation. Culture of switches, knobs, syringes and IV lines was performed in a standardised manner. A 9-item questionnaire was distributed to anaesthetic staff at the start of each surgical procedure. Responses were anonymous.

Of the 101 studied procedures, 64% were elective and 33% were elective. Orthopaedic and gastrointestinal procedures were most commonly represented (26% and 25% of total, respectively). In 13 surgical cases, like organisms were cultured from 2 or more sites, with the majority of isolates (14/15) being coagulase-negative staphylococci. In 2 cases, the same organism was cultured from ventilator, syringe and IV extension line, suggesting cross-contamination. The overall rate of contamination was 15% for syringe tips. Overall, 98 questionnaires were returned. A significant association was found between emergency cases and contaminated syringes (odds ratio 4.5, 95% CI 1.37-14.8, p = 0.01). Other risk factors, including hand hygiene practices, use of needles for drawing up drugs, use of multiple boluses from syringes, insertion of cannula outside of theatre, and non-capping of three-way taps between uses, were not significantly associated with bacterial contamination.

Findings suggest that cross-contamination is a potential risk, although the observed rate of contamination was low (2/101 cases, 2%). This is concordant with anaesthetic practice contributing to risk of healthcare-associated infections. However, confirmatory clinical outcome evaluation is lacking (i.e. occurrence of infections in post-operative period). It is plausible that procedures performed under emergency conditions may be at higher risk (e.g. time constraints limiting optimal clinical practice). Study limitations include the fact that control specimens were not collected to quantify environmental or baseline product contamination, and anaesthetic staff were requested to self-report clinical practice, with the potential for reporting/selection bias.