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October 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:

Grand Final Fever 2016

Congratulations Bulldogs, well done! Commiserations Swans, remember there's always next year!  Great game!

Carbapenemase-producing Enterobacteriaceae (CPE)

Summary of CPE Transmission Risk Areas (TRA) in Victoria 

An up to date summary of TRA classified wards within Victorian hospitals is now available within the secure online portal at: This information is being made available in order that all hospitals are aware of what is required re screening and isolation. Any hospital with a TRA is provided with separate more specific information from the Victorian CPE Incident Management Team (VCIMT).

Access to this information is restricted to relevant health professionals, who must be registered for the VICNISS website. A reminder that access at each health service is managed and must be approved by the infection control coordinator/manager. If you have any issues at all please contact the VICNISS Coordinating Centre.

What is a TRA? Whenever CPE has been transmitted from one person to another in a hospital ward, that ward is classified as a Transmission Risk Area (TRA) for at least twelve months as per the Victorian guideline on CPE for health services. All transmission incidents are assessed by the Victorian CPE Incident Management Team (VCIMT). Heightened screening and infection control precautions apply during the initial TRA phase and are gradually downgraded. Once all screening requirements are met and results are clear for a period of time, TRA classifications are reviewed and stood-down by the VCIMT.

VCIMT recommended control measures have been applied and appropriate screening put in place within all TRA settings. Please note that there is no requirement to isolate or screen any patients transferred to a receiving facility outside of a TRA. The Department of Health and Human Services will continue to update health services with any TRA changes.

VRE Infection Surveillance - NOW also available for large hospitals

As many of you may be aware several hospitals in Victoria have reported an increased prevalence of Vancomycin-resistant Enterococcus (VRE) VanA.

Van A VRE is considered a pathogen of significance. Surveillance enables hospitals to accurately assess the rate of VRE infections and detect any change to the prevalence of VRE infections within their facility. In the past the VICNISS VRE surveillance module was only available to small hospitals (<100 beds) , however several large hospitals have indicated their interest in performing VRE surveillance thus this module is now also available for large hospitals (>100 beds). 

Small hospitals must continue to monitor all VRE infections. Large hospitals can choose to monitor VRE VanA only; VRE VanB only, or both. Contact VICNISS Coordinating Centre if you wish to commence VRE surveillance. Note: If a large hospital wishes to enter VRE data retrospectively e.g. commence January 2016, this can be accommodated.

Recently VRE forms have been slightly modified. Please ensure you are aware of the data required for the most recent data collection forms. For further details please see the VICNISS website VRE module.

Haemodialysis - New initiative to reduce bloodstream infections

The US CDC has teamed up with other kidney and dialysis organisations with an aim to reduce the number of potentially deadly bloodstream infections related to dialysis treatment.

The new initiative, known as the Making Dialysis Safer for Patients Coalition, aims to significantly decrease bloodstream infections among dialysis patients by promoting the use of CDC’s Core Interventions for Dialysis Bloodstream Infection Prevention. CDC is providing facilities with a package of resources that includes checklists, audit tools, how-to videos, continuing education training, and patient resources.

Please feel free to share this information with the haemodialysis unit at your facility and for more information re: resources, tools, and recommendations, visit

National Hand Hygiene Initiative Update

Gold Standard Auditor (GSA) Workshop in 2017

The next GSA Workshop in Victoria is scheduled for February 23rd & 24th 2017 at the Doherty Institute, Melbourne. If you would like to register for this workshop please go to: and select this workshop from the drop down list at question 7 (Choose the workshop you would like to register for). If these dates do not suit select VIC-Workshop Waitlist and you will be notified when another workshop is available.

Volunteers Required to Host Gold Standard Auditor (GSA) Workshops in 2017

Would your hospital like to host a GSA workshop in 2017? All that is required on your behalf is a room booking to accommodate twenty participants for two consecutive days and four GSAs from your organisation to assist with the practical session for an hour early on the second morning. Without your support the GSA workshops cannot run, so any assistance would be much appreciated.

Please contact if you would like to discuss further.

Auditing using HHCApp Mobile

We have had several reports recently of mobile devices ‘freezing’ when trying to enter data. Apparently this is an issue when accessing HHCApp Mobile via Safari and can be resolved by accessing the site via Chrome.

iPad minis (‘Toolkit/s’)

If you have any issues with your iPad minis (‘Toolkit/s’) i.e. passwords, removing restrictions, removing HHA Apple ID etc. please contact If you are having other issues i.e. syncing, error messages etc. please refer to the iPad troubleshooting guides for apple devices and android devices (new).  

Please ensure you synchronise all sessions on your mobile device AND log out of mobile devices after every session. If you don’t do this any data collected after a password change or system update will have to be entered into HHCApp manually. To log out of a mobile device you need to press the logout button. Simply closing the browser/navigating to a new page is not sufficient.

Committee of Presidents of Medical Colleges - Position Statement

The Committee of Presidents of Medical Colleges recently released a strong position statement on the Importance of Effective Hand Hygiene. Please follow the link below:

2016 HCW Influenza Vaccination Module

The 2016 HCW Influenza Vaccination surveillance is now completed. All data has been submitted and reports is now available on the VICNISS website. As you are no doubt aware the DHHS, ‘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.

Type 1 Surveillance Update

Submitting Electronic SSI Data to VICNISS

For those hospitals submitting SSI data in an electronic format to VICNISS there is a new Upload portal on the VICNISS website. All data submitted through the portal will be required to meet the updated specifications for column names and data types. If you would like to know more about submitting data through the portal please contact us. 

Type 2 Surveillance Update


There have been a few additional minor amendments to the MRSA protocol, as well as the web form. If you download a hard copy of the form, please ensure you have the latest version. The reports for both MRSA and VRE modules are currently being reviewed. These should be available for Quarter 1 reports.


Please refer to ‘VRE Infection Surveillance’ on page 1 of bulletin.

HCW Hepatitis B and Measles Immunity modules

The web forms for both modules are now available on the VICNISS website. From Quarter 2, all data is to be submitted via the webform.

The Measles and Hepatitis B immunity Reports, however are still under development. As a result reports for Hepatitis B and Measles' data submitted in Quarter 3 and Quarter 4 are not currently available. It is anticipated the reports will be able to be generated by November 2016.

VICNISS Quality Assurance Project for Smaller Hospitals

The final site visits to conduct the QA project have been completed. Many thanks to all ICCs that assisted in this process.

The QA Project aims to determine the accuracy and completeness of required surveillance modules of the small acute care Victorian hospitals (0 – 99 beds). This onsite survey and audit process is a tool to assess accuracy of submitted data. This will provide information on the consistency between reporters and identify any areas that require providing additional education and training.

Data will be analysed and a report on the results will be available later this year. 


Thanks to all those that participated in the 2016 Aged Care NAPS. The data collection period has now closed and full results will be available mid 2017. If you haven’t already generated your Aged Care NAPS report for your facility, you can do this by logging in to the NAPS website and clicking on Reports.

Environmental Cleaning Survey

VICNISS has been requested to circulate this message re: Environmental Cleaning Survey. The working group would appreciate input from Australian infection prevention and control staff involved in cleaning and disinfection practices in health care facilities.

  • On behalf of the International Society of Chemotherapy for Infection and Cancer (ISC), the Infection Prevention & Control working group, we would be grateful if you could complete this anonymous survey.
  • Our aim is to provide a perspective on cleaning and disinfecting practices in hospitals internationally. Your input would be very valuable. The questionnaire should require 15 minutes to complete.

        If you wish to participate, you can find the questionnaire here:

       In anticipation,

       Nikki Kenters, Tom Gottlieb, Andreas Voss and the IPC working group

As you can see this survey is not associated with VICNISS however we are happy to assist any health service/association with distribution of similar emails if requested.

Infection Control Literature Review - October 2016

Outcomes of a universal screening program for CPE in the UK

Carbapenemase-producing Enterobacteriaceae (CPE) infections are emerging as a significant threat to healthcare worldwide. Some regions in Asia and Europe report CPE as endemic, with outbreaks of infection more widely reported in the US and UK. Otter JA et al. (J Antimicrob Chemother 2016 DOI: 10.1093/jac/dkw309) sought to determine the prevalence of CPR colonisation in a hospital cohort at time of admission.

Between February and May 2015, adult patients admitted to a UK tertiary healthcare facility were approached within 72 hours of admission. Consent was obtained, a rectal swab was collected, and standardised questionnaire was completed.

Overall, 4567 patients were approached to participate in the study. Of these, 4006 (87.7%) provided a rectal swab and completed risk factor questions. 435 (9.5%) answered risk factor questions but did not provide a rectal swab, and 126 (2.8%) did not answer risk factor questions or submit a swab. Six CPE were cultured from 5 of the 4006 screened patients (0.1%). Three patients were colonised with Escherichia coli, one patient was colonised with Citrobacter frundeii, and one patient was colonised with E. coli and Klebsiella pneumonia. Of these isolates, 4 were OXA-48 and 2 were NDM carbapenemases. 41.9% of patients had an overnight stay in a UK hospital in the 12 months prior, and 54.1% had taken antibiotics in the last 6 months. Hospitalisation abroad was significantly associated with CPE colonisation (OR 64.3, p<0.001).

Findings demonstrate an extremely low prevalence of CPE carriage in an unselected cohort of hospitalised patients in the UK. Targeting patients with recent overseas hospitalisation is the most appropriate measure for guiding screening practices in this setting.


Evaluating an alternative method of surveillance for central line-associated bloodstream infection in patients with cancer

In recognition of the potential for bloodstream infections in cancer patients to arise from the gastrointestinal tract, and the impact of this upon central line-associated bloodstream infection surveillance, National Healthcare Safety Network surveillance criteria include the definition of mucosal barrier injury (MBI) laboratory-confirmed bloodstream infection. In contrast, the clinical definition of catheter-related bloodstream infection (CRBSI) proposed by the Infectious Diseases Society of America stipulates simultaneous quantitative blood cultures drawn from central and peripheral sites or calculation of differential time to positivity of these culture results, to confirm CRBSI. Chaftari A-M C, et al. (Am J Infect Control 2016; 44:931-934) sought to compare these definitions in cancer patients managed at a US cancer centre.

This retrospective evaluation was performed in patients managed at the M.D. Anderson Cancer Center between January 2013 and March 2014. CLABSI and MBI were classified according to NHSN criteria, and CRBSI according to the IDSA definition. To enable application of all definitions, only cases having 2 positive simultaneous blood cultures drawn from the CVC and peripheral site or any blood culture and a quantitative catheter tip growing the same organism were selected.

Of 426 CLABSI events during the study period, 149 were eligible for evaluation. Seventy of these 149 (47%) had definite CRBSI, and 63 (42%) fulfilled criteria for MBI bloodstream infection. CRBSI was more commonly defined in patients with no MBI, when compared with those having MBI (69% vs. 18%).

Findings are consistent with earlier published works, suggesting that the NHSN criteria may over-estimate the CVC as the source of BSI – only 47% of those meeting CLABSI criteria had confirmed CRBSI. Notably, 17% of those with MBI laboratory-confirmed bloodstream infection met criteria for CRBSI, suggesting that the exclusion of cancer patients with MBI as a source for infection could potentially miss CRBSI events. The major limitation of this study is that CRBSI criteria could not be applied in the majority of cancer patients (65%) - this definition requires 2 positive blood cultures, and is also reliant upon confirmatory laboratory testing which may not be provided routinely. Therefore, the utility of the CRBSI definition as a pragmatic method for device-related bloodstream infection surveillance is limited.