Summary of CPE Transmission Risk Areas (TRA) in Victoria 

A hospital was recently added to the list of CPE TRA classified wards in Victoria, for more information see: https://www.vicniss.org.au/healthcare-workers/cpe-transmission-risk-areas-tra/.  Any patient who has had an overnight admission on a TRA during the ‘period of risk’ should be pre-emptively isolated and screened if admitted to any health service within 12 months of the patient’s discharge from the TRA.

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.

Access to this information is restricted to relevant health professionals, who must be registered for the VICNISS website. If you have any issues at all please contact the VICNISS Coordinating Centre. .

The current Victorian Guidelines for CPE requires all public and private health services undertake a CPE PPS on all patients in all transplant wards, haematology wards and intensive care units every six months.

Health services are requested to submit data from their second PPS survey this year to VICNISS via the User Portal by Saturday 31 December 2016.

Further guidance for health services undertaking a CPE PPS is available on the VICNISS website: https://www.vicniss.org.au/media/1236/pps-faq-data-collection-form.pdf or contact VICNISS Coordinating Centre if you have any other queries: vicniss@mh.org.au or 9342 9333.

The VICNISS occupational exposure (OE) module is to be reviewed in 2017. When finalised the module will be available to all Victorian hospitals, large (Type 1) and small (Type 2).

A number of references including: VIBES (VIC), current Type 2 OE form (VICNISS), NHSN (US), EPINet (US), CHRISP (QLD) have been considered to develop a draft OE data collection form. This form aims to assist hospitals to not only count OEs but also help to prevent future events (able to look at patterns, contributing factors etc).

To progress this and ensure the module is helpful to the ICP we are forming a focus group to review the OE form, e.g. any unnecessary questions, any questions that should be included, the terminology used and the accuracy/completeness of the different data fields (e.g. locations where exposure occurred, occupation).

If you wish to participate in the focus group please contact Judy Brett judy.brett@mh.org.au or 9342 9353. The plan would be to circulate the draft form to the focus group members and meet via teleconference early next year (date to be advised) or if you prefer, provide written feedback. This is your opportunity to have a say!!!

Gold Standard Auditor (GSA) Workshops in 2017

• February 23rd and 24th at the Alfred Hospital, Melbourne
• March 8th and 9th at Ballarat Base Hospital, Ballarat
• June 5th and 6th at Austin Hospital, Heidelberg
• September 28th and 29th at Box Hill Hospital, Box Hill

If you would like to register for any of the above workshops please go to: http://www.hha.org.au/ForHealthcareWorkers/workshops.aspx and select correct workshop from the drop down list at question 7 (Choose the workshop you would like to register for). 

Auditing Validation

Remember it is the responsibility of the Organisation Administrator at each hospital to ensure that all auditors submitting data are validated i.e. successfully passed the auditor training, collected 100 moments (or trained) in the last twelve months and completed the HHA auditor online learning package annually.

Data entry using HHC App Mobile

Auditing using a mobile device will save you time and ensure your data collection is more accurate. If you have any issues with your iPad minis (‘Toolkit/s’) i.e. passwords, removing restrictions, removing HHA Apple ID etc. please contact jennifer.bradford@mh.org.au. 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.

VICNISS will be meeting with the Victorian Department of Health and Human Services in December 2016 to discuss plans for the 2017 HCW Influenza Vaccination campaign. The 75% target for health care workers employed during the influenza period to be vaccinated remains unchanged in the Victorian health service performance monitoring framework 2016-2017. More information will be relayed to Health Services in the new year.

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. 

SIGNAL EVENT -SURGICAL Infection (SESI) - Previously known as the SURGICAL INFECTION REPORT (SIR)

This module has been reviewed and updated. This is an optional surveillance module for Type 2 Hospitals which provides a means to report serious surgical site infections.

‘Surveillance can provide information on the occurrence of unusually high rates of surgical site infections (clusters) and trends over time. However in smaller facilities where healthcare associated infections (HAIs) occur infrequently and large enough data sets to achieve meaningful statistical analysis are unable to be collected, signal event surveillance may be more useful3. SESI provides hospitals with a method to count complex surgical site infections (SSIs) and a crude measure of the burden of these SSI on the hospital.’ (VICNISS SESI Protocol)

From January 2017 (Quarter 3) there will be a webform available on the VICNISS website to enter and submit this data. At this point, there will also be the updated Protocol and Form Instructions to assist with data entry.

EDUCATION

VICNISS provides education to all new Infection Control Coordinators in Victorian public hospitals. We are happy to visit Metropolitan and Regional hospitals to provide ‘one on one’ education sessions, covering surveillance methodology as well as specific instructions on the ‘required’ surveillance data that new ICCs may be required to collect and submit quarterly.

If you are new to the role, or have a new ICC on your Team, please give us a call at VICNISS so that we can arrange a date for a site visit.  

Also, if any sole IC Practitioner is going on extended leave, particularly when the leave coincides with the due date for quarterly surveillance data submission, can you please contact VICNISS to discuss data entry options,

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.

Is airborne transmission of Acinetobacter baumannii possible?

Healthcare-associated infections due to Acinetobacter species have traditionally been regarded a result of hand-borne transmission from a known patient or environmental source, or arising in patients with prior colonisation. Yakupogullari Y et al. noted increases in the incidence of Acinetobacter infections despite substantial reductions in other healthcare-associated infections in a large European healthcare facility, so sought to understand the potential dynamics of airborne spread as a way to understand local epidemiology (Am J Infect Control 2016; 44:1595-1599).

Prospective surveillance was performed in 2013, with air sampling performed in the ICU from 4 defined areas, as well as additional sampling (1m, 2m or 3m from bedside) for patients diagnosed with Acinetobacter infection. All A. baumannii isolates were molecularly typed (PCR) to investigate the clonal relationship between clinical samples and environmental air sampling. Study sites were all HEPA filtered.

A total of 186 air samples were collected (118 from defined regions of ICU; 68 from patients’ bedsides). A. baumannii was isolated from 26 (13.9%) of these, and 13 genetic clones were identified. A. baumannii existed at 0.39 CFU/m3 in the bedside air of infected patients, and was present at 0.27 CFU/m3 in other ICU areas. A clonal relationship was identified between air genotypes and clinical isolates, and the air closest to infected patients (1m) contained greater concentrations of the organism than air sampled at a greater distance from the patient (2m or 3m).

Findings demonstrate that ICU patients infected with A. baumannii can discharge the bacterium into the air. One limitation of the study is the small number of patients included in the cohort, and the lack of clinical information provided concerning cases. For example, it would be relevant to understand if patients were receiving targeted antimicrobial therapy for A. baumannii at time of sampling, and if patients were on closed-circuit ventilation systems. Notwithstanding these limitations, a healthcare facility with increasing incidence of infections despite appropriate implementation of staff hand hygiene measures and contact precautions may consider additional measures for control (e.g. negatively-pressured single-room).

Hospital-acquired Staphylococcus aureus bloodstream infections: significance of non-CVC-associated events 

Bloodstream infection due to Staphylococcus aureus is associated with significantly morbidity, mortality and healthcare cost. While the presence of indwelling medical devices (e.g. central venous catheters, CVCs) is a recognised risk for infection, hospital-acquired infections may also arise in other settings. Kovacs C.S. et al. (Am J Infect Control 2016; 44:1252-1255) sought to determine the incidence, clinical characteristics and outcomes of primary hospital-acquired bloodstream infection (HABSI) due to S. aureus.

Retrospective analysis of all S. aureus HABSI at a US healthcare facility was performed for the period 2010-2013. National Healthcare Safety Network definitions for primary and secondary HABSI were applied. Primary HABSI that did not meet the definition for central-line associated bloodstream infection (CLABSI) was considered non-CLABSI. Potential risks for infection were gleaned by review of medical charts.

In total, 346 HABSIs due to S. aureus were identified (incidence 0.24/1000 patient days). A total of 122 primary infections were identified: 78 (64%) were CLABSIs, and 44 (36%) were non-CLABSIs. MRSA isolates comprised 48.7% and 43.2% of these groups, respectively. Twenty-six (43.1%) non-CLABSI events occurred in the presence of a peripheral intravenous catheter or midline catheter. Approximately half of infections had onset outside of an ICU ward. Mean time from hospital admission to onset of infection was shorter for non-CLABSI compared with CLABSI events (6 vs. 16.3 days, p=0.001). Complicated bacteraemia was more common in the non-CLABSI group (15.9% vs. 0%). 30-day all-cause mortality was comparable in for both groups (21.8% vs. 20.4%, p=0.86).

These findings highlight the burden of illness associated with non-CLABSI S. aureus bloodstream infections (significant mortality and complications), and the need for prevention programs to focus upon peripheral intravenous catheters and midline catheters. Such programs are required broadly in non-ICU settings. In light of the early onset of non-CLABSI infections, prevention programs must specifically include review of practices at time of hospital admission (e.g. management of peripheral intravenous catheters in transferred patients).