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Healthcare-associated infection in Victoria
Surveillance report for 2014–15 and 2015–16
A joint venture between The University of Melbourne
and The Royal Melbourne Hospital
Acknowledgements
The VICNISS Coordinating Centre is fully funded by the Department of Health
and Human Services.
We thank the Department for their ongoing support of this program.
We thank the hospital executives and executive sponsors for their support.
We extend a special acknowledgment to all infection control nurses and staff who participate
in the surveillance program. Their ongoing support and commitment make this project
successful, and this report possible.
Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.
© State of Victoria, Department of Health and Human Services December 2017.
Where the term ‘Aboriginal’ is used it refers to both Aboriginal and Torres Strait Islander
people. Indigenous is retained when it is part of the title of a report, program or quotation.
Available at http:www.vicniss.org.au
Healthcare-associated infection in Victoria | 3
Overview
The VICNISS Coordinating Centre was
established in 2002 with the aim of reducing the
occurrence of healthcare associated infections
(HAIs). This includes any infection associated
with healthcare, primarily in hospital but also
during periods of outpatient treatment such as
haemodialysis or hospital in the home.
Patients undergoing medical treatment are at increased
risk of contracting an infection for a number of reasons,
including:
- Use of invasive medical equipment e.g. needles and
intravenous devices
- Surgery and other wounds which breach skin integrity
- Diseases and treatments (e.g. chemotherapy) which
suppress the immune system
Victoria has an advanced program for monitoring and
reporting healthcare-associated infections that has been
in place since 2002. The program collates data on both
outcomes (infections) and processes (actions associated with
the risk of infections), and reports to participating health
services, the Department of Health and Human Services, and
national agencies such as the Australian Institute of Health
and Welfare.
The major activity of the Coordinating centre is to collate,
analyse and report on data and information from hospitals
in Victoria. This information is used to identify hospitals
with higher than expected infection rates or lower than
expected quality measures, and this information is fed
back through both formal and informal processes to health
service executives and others who are able to address any
issues of concern and instigate improvements. The centre
also provides support to hospitals through provision of
expert advice and tools for monitoring as well as quality
improvement activities.
The HAI surveillance methodology used in Victoria is based
on that developed at the Centers for Disease Control and
Prevention (CDC) in the United States. This methodology is
considered international best practice and is used in many
parts of the world, including North and South America,
Canada, Japan, United Kingdom and many European
countries.
Infection surveillance should target activities with the
highest risk and those where improvements can be made.
In addition, there are national and (in some states) state
requirements. All public hospitals in Australia are required
to carry out continuous surveillance of Staphylococcus
aureus bloodstream infections (SAB) and Clostridium difficile
infections (CDI) and to participate in the national hand
hygiene initiative. In Victoria, all public hospitals are required
to supply details of staff vaccination rates for seasonal
influenza. Other activities, such as monitoring of infection
rates following surgery and in intensive care, depend on the
size and activity levels of the hospital.
Previous reports have contained data from five or more
years. This report contains only data for the time period
1 July 2014 to 30 June 2016. Future reports will be annual
and will contain annual updates only. Consequently,
improvements in infection rates and related indicators
which have been achieved over time may not be evident in
data presented. Time series data and previous reports are
available on the VICNISS website http://www.vicniss.org.au
and other results including time series analyses have been
published in peer reviewed literature.
4 | Healthcare-associated infection in Victoria
Executive summary
Victoria has continued to make progress in the
area of HAIs, with falling infection rates overall
and demonstrated improvements in processes
to prevent infections.
Collation of data through this program continues to
provide incentive for improvement and allows us to
observe improvements over time. Victoria remains a
leader in both HAI surveillance and response to new and
emerging problems. This is a testament to the dedication
and commitment of the many individuals and groups who
contribute to the surveillance program.
This ability to respond to new and emerging issues was
demonstrated once again in 2015/16 when VICNISS, the
Department and the Microbiological Diagnostic Unit (MDU)
combined to develop and implement the Victorian guideline
on carbapenamase-producing Enterobacteriaceae (CPE) in
response to the initial discovery of transmission of these
organisms in Victoria.
The rate of central line-associated bloodstream infections
(CLABSI) in intensive care units has continued to decrease.
The rate is currently just over 0.5 infections per 1000 line
days in “large” hospitals (major metropolitan) and just under
0.5 in all other hospitals.
The rate of Staphylococcus aureus bloodstream infections
in Victoria has fallen again and the rate for 2015/16 was
0.69 per 10,000 occupied bed days, down from 0.74 in
2014/15 and 0.84 the previous year. Staphylococcus aureus
bloodstream infections (SAB) are a significant healthcare-
associated infection, with a mortality of up to 20 per cent.
There has continued to be a slow but steady increase in interest
and participation from private hospitals. Private hospitals
mainly contribute to the central line associated bloodstream
infection surveillance and/or surgical site infection surveillance.
Rates of surgical site infections have not shown much change
over the past two years; however the long term trends are
still downward which is encouraging. Rates of antibiotic
prophylaxis continue to be an area of interest and the focus
has shifted to looking at aspects of compliance not so far
examined. These include second dosing of beta-lactam
antibiotics for prolonged procedures and correct dosing.
Clostridium difficile infections remain endemic but at much
lower levels than seen in Europe and North America. Rates
of severe disease are low. VICNISS continues to monitor this
infection and now collects data on this and other infections
from Public Sector Residential Aged Care Services (PSRACS).
This is an important step forward and integrates infection
control indicators from aged care with acute care, reflecting
the related nature of these services.
Healthcare-associated infection in Victoria | 5
Bloodstream infections related to use of central lines in intensive care units
Where?
All public hospitals with an
ICU report these infections.
Private hospitals report on a
voluntary basis
Who?
Of the infections
reported in 2014/15
and 2015/16: 27%
were females. The
median age of affected
patients was 46
How Many?
There were 37 infections in
2014/15 and 33 infections
in 2015/16. There were 33
contributing ICUs in 2014/15
and 35 in 2015/16
37 Infections 2014/15
33 Infections 2015/16
How does this compare to previous years?
The risk for patients of acquiring one of these infections in Victoria has reduced
significantly since surveillance began - by approximately 26% each year since 2003
6 | Healthcare-associated infection in Victoria
Infections in patients with intravenous lines
Introduction Patients who have intravenous (IV) lines inserted are at a
higher risk of infection due to having an invasive device
inserted into a vein. Some types of devices and some groups
of patients have a higher risk than others.
This section includes the results from surveillance of patients
who have intravenous lines inserted in a variety of different
care settings. In particular:
- patients in intensive care units (ICU)
- babies in neonatal ICU
- outpatient haemodialysis patients.
It describes the results of:
- rates of bloodstream infections (BSIs) in these patients
- types of organisms causing these infections
- monitoring the insertion of intravenous lines for
compliance with recommended practices.
Rationale for surveillance Infections can occur in patients who have a central or
peripheral line inserted as part of their care.
Central lines are catheters inserted in a large vein in the
neck, chest or groin and used to administer intravenous
fluids and medications, obtain blood samples or take
measurements.
Peripheral lines are catheters inserted into a peripheral vein,
usually in a limb, generally used to administer intravenous
fluids and medications.
Adult or paediatric patients in intensive care units (ICUs)
or babies in neonatal ICU are at high risk for central line-
associated blood stream infections (CLABSI) or peripheral
line-associated blood stream infections (PLABSI).
Haemodialysis patients are at a high risk of infection because the
process of haemodialysis requires frequent use of catheters or
insertion of needles to access the bloodstream. Haemodialysis
patients also have weakened immune systems, which increase
their risk of infection, and they require frequent hospitalisations
and surgery which exposes them to additional risk.1
A high proportion of intravenous line-associated infections
are thought to be preventable with good practices and
processes for line insertion and care.2
1 Centres for Disease Control and Prevention United States, Dialysis safety, www.cdc.gov/dialysis, accessed 11 December 2012
2 Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C 2006, ‘An intervention to decrease catheter-related bloodstream infections in the ICU’, N Engl J Med., vol. 355, no. 26, pp. 2725–32; and Stuart RL, Cameron DR, Scott C, Kotsanas D, Grayson ML, Korman TM, Gillespie EE, Johnson PD 2013, ‘Peripheral intravenous catheter-associated Staphylococcus aureus bacteraemia: more than 5 years of prospective data from two tertiary health services’, Med J Aust,.vol. 198, no. 10, pp. 551–53.
Healthcare-associated infection in Victoria | 7
0.67
0.49
0.53
0.49
Fig
ure
1
Infections associated with
central lines in ICU settings
Scope
Central line associated bloodstream infection (CLABSI)
surveillance data was collected for adult and paediatric patients
in ICUs who had central lines inserted and where the infections
were considered to be associated with the central line.
Participating organisations
In Victoria, ICUs are located only in the larger metropolitan,
regional, and teaching hospitals. There are 26 public
hospitals with adult and/or paediatric ICUs.
Participation in CLABSI surveillance is mandatory for
Victorian public hospitals with ICUs. For more information
see the Victorian Health Service Performance Monitoring
Framework www.health.vic.gov.au/hospital-performance/.
In 2014–15 and 2015–16, eight private hospitals also
participated in surveillance for ICU CLABSI.
Method
Surveillance of central line-associated infection was
conducted in accordance with VICNISS surveillance module:
central line-associated bloodstream infection (CLABSI) or
peripheral line-associated bloodstream infection (PLABSI) (ICU/
NNL) – protocol. This is based on the US Centres for Disease
Control (CDC) National Healthcare Safety Network (NHSN)
surveillance program. Hospitals with ICUs monitor and collect
data on a continuous basis for this measure.
Observations on the surveillance data
Figure 1: Central line associated bloodstream infection rates in adult intensive care units (CLABSI per 1000 central line days)
Figure 1 displays the annual ICU CLABSI rates with results presented in two groups: major teaching hospitals (A1 hospitals)
and ‘other’ hospitals (less specialised hospitals). The A1 hospital group comprises seven public and three private hospitals.
The ‘other’ hospital group comprises 19 public and five private hospitals.
2.00
1.80
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
0.00
2014 / 2015 2015 / 2016
Major teaching hospitals
All other hospitals
8 | Healthcare-associated infection in Victoria
Fig
ure
2
Infections in patients with
intravenous lines
Infections associated with central
and peripheral lines in neonatal ICU
Scope
Surveillance data were collected for babies in level 3
neonatal ICUs who had a central or peripheral line inserted
and where bloodstream infections were considered to be
associated with those lines.
Participation
In Victoria, four public hospitals have level 3 neonatal ICUs.
No private hospitals contribute data.
Method
Surveillance of central and peripheral line associated
infections were conducted in accordance with VICNISS
surveillance module (type 1) central line-associated bloodstream
infection (CLABSI) or peripheral line-associated bloodstream
infection (PLABSI) (ICU/NNL) – protocol. This is based on the
US CDC NHSN surveillance program. Hospitals with level 3
neonatal ICUs monitor and collect data on a continuous
basis for these measures.
Results are presented as rates per 1,000 central line or
peripheral line days.
Observations on surveillance
Figure 2: Central line associated bloodstream infection rates in neonatal intensive care units
(CLABSI per 1000 central line days, stratified by birthweight)
Figure 2 displays the CLABSI rates stratified by birth weight for neonatal ICUs in Victoria for the years 2014–15 and 205–16.
These rates have particularly wide confidence intervals reflecting the small pool of data available to calculate infection rates.
10
9
4.00 8
7
6
5
2.10
3.60
2014/15
2015/16
4
3
2.50
2
1
0
1.10
0.00 0.50
2.50
1.10
1.20
<750g 751-1000g 1001-1500g 1501-2500g >2500g
Fig
ure
3
Figure 3: Peripheral line associated bloodstream infection rates in neonatal intensive care units
(PLABSI per 1000 central line days, stratified by birthweight)
Figure 3 displays the PLABSI rates stratified by birth weight for neonatal ICUs in Victoria for the years 2014–15 and 2015–16.
These rates have particularly wide confidence intervals reflecting the small pool of data available to calculate infection rates.
10
9
8
7
2.1 6
2014/15
2015/16
1.3 0.9 5
4
3
2
1.1
0.6
1.6
0.6 0.6
1
0
<750g 751-1000g
1001-1500g
1501-2500g
0 0
>2500g
Healthcare-associated infection in Victoria | 9
10 | Healthcare-associated infection in Victoria
Infections associated with outpatient haemodialysis settings
Purpose
Outpatient haemodialysis patients were monitored for
any intravenous antibiotic start, positive blood culture or
presence of pus, redness or swelling at the vascular access
site.
Haemodialysis requires vascular access, which can either be
a graft or an enlarged blood vessel that can be punctured
to remove and replace blood. Patients who undergo dialysis
treatment have an increased risk of a HAI. In the event of a
suspected or actual infection, patients may receive antibiotics.
The infection may be superficial and restricted to the access
site, be blood borne, or rely on clinical diagnosis only. Blood-
borne infections and localised infections of the vascular
access site are common in haemodialysis patients.3
Because of frequent hospitalisations and receipt of
antimicrobial drugs, haemodialysis patients are also at high
risk of infection with antimicrobial-resistant bacteria. However
this does not seem to be a significant problem in Victoria at
present, where overall reported infection rates are low.
In addition to infections, patients starting antibiotics are also
monitored, with vancomycin given particular attention.
Participation
Surveillance of infections associated with outpatient
haemodialysis patients is voluntary. However, it has been
enthusiastically adopted by many hospitals, with relatively
consistent participation enabling conditional analysis of
trends over time.
In 2014–15, 45 dialysis facilities participated in outpatient
haemodialysis surveillance.
In 2015–16, 43 dialysis facilities participated in outpatient
haemodialysis surveillance.
Currently only public haemodialysis units participate in
surveillance.
Method
Active, patient-based prospective surveillance of infection
was conducted in accordance with VICNISS surveillance (type
1/2) module: haemodialysis event (HDE) – protocol. This is
based on the US CDC NHSN surveillance program.
Hospitals and other healthcare facilities that conduct same-
day admission haemodialysis monitor and collect data on
a continuous basis for this measure. Participating health
services submitted data quarterly to VICNISS Coordinating
Centre.
Observations on surveillance
There are four main types of vascular access, and ordered
according to increased risk of infection. These are:4
- arteriovenous fistulas constructed from the patient’s own
blood vessels
- arteriovenous grafts often constructed from synthetic
materials
- tunnelled central lines (permanent line) is a CVC that
travels a distance under the skin from the point of
insertion before terminating at or close to the heart or
one of the great vessels.
- non-tunnelled central lines (temporary line) is a CVC
that is fixed in place at the point of insertion and travels
directly from the skin entry site to a vein and terminates
close to the heart or one of the great vessels, typically
intended for short-term use
The most common access type continues to be
arteriovenous fistulas, followed by, arteriovenous grafts,
then permanent central lines. Very few temporary central
lines are used and data are not presented here.
3 VICNISS surveillance module: haemodialysis event (HDE) – protocol
4 CDC United States, ‘Dialysis event protocol’, www.cdc.gov/nhsn/PDFs/pscManual/8pscDialysisEventcurrent.pdf, accessed 13 December 2012
Healthcare-associated infection in Victoria | 11
Fig
ure
4
Event types under surveillance
Antibiotic starts: Patients may be administered antibiotics
if an infection is confirmed or suspected. If the infection is
caused by Staphylococcus the haemodialysis patient may be
administered the specific antibiotic, vancomycin.
Bloodstream infections (BSI):
- positive blood cultures – isolation of any microorganism
from a blood culture where contamination as a source
has been excluded
- access-related BSI – positive blood culture with the
suspected source identified as the vascular access site
or uncertain, and where contamination as a source has
been excluded
- local access infection – clinical symptoms of infection
present but access-related BSI is not present
Figure 4-6 below display rates of events for 2014–15 to 2015–16 for patients with arteriovenous fistulas, arteriovenous
grafts and permanent central lines respectively. Rates are reported per 100 patient months. As expected, the lowest rates
of infection and infection-related events are seen in patients with AV-fistulas, followed by those with AV grafts and then
permanent central lines.
Figure 4: Rates of events for patients with arteriovenous fistulas for 2014–15 to 2015–16 – events per 100 patient months
5
4.5
4
3.5
3
2.5
2
1.5
1
0.8 0.9
2014/15
2015/16
0.5
0
0.3 0.2
0.1 0.2
0 0.1
0.1 0.1
Antibiotic Starts
Vancomycin Starts
Positive Blood Cultures
Access Associated BSI
Local Access Infections
12 | Healthcare-associated infection in Victoria
Fig
ure
6
Fig
ure
5
Infections associated with outpatient
haemodialysis settings
Figure 5: Rates of events for patients with arteriovenous grafts for 2014–15 to 2015–16 – events per 100 patient months
5
4.5
4
3.5
3
2014/15
2015/16
2.5
2
1.5
1.6
2.00
1
0.5
0
0.8 1.0
0.3
0.6
0.2
0.1
0.3
0.6
Antibiotic Starts
Vancomycin Starts
Positive Blood Cultures
Access Associated BSI
Local Access Infections
Figure 6: Rates of events for patients with permanent central lines for 2014–15 to 2015–16 – events per 100 patient months
5
4.5
4
2014/15
2015/16
3.5
3
2.5
2
1.5
1
0.5
0
2.5
2.9
1.9 1.9
1.7
1.3
1.3
1.2
0.3
0.6
Antibiotic Starts
Vancomycin Starts
Positive Blood Cultures
Access Associated BSI
Local Access Infections
Healthcare-associated infection in Victoria | 13
Infections in patients undergoing surgery
Patients undergoing surgery are at risk of infection following their procedure, particularly if the
surgery involved the use of an implanted device such as an artificial hip or knee.
Infections after surgery
Who?
High risk surgeries are
monitored - for example
cardiac bypass surgery.
Between 1 July 2014
and 30 June 2016 80%
of bypass patients were
male. The median age of
patients having bypass
surgery was 68
How Many?
Between 1 July 2014
and 30 June 2016, 169
infections were reported
after bypass surgery
Where?
All 6 public hospitals
performing bypass surgery
participated in VICNISS
surveillance. One private
hospital also participated
How does this compare to previous years?
For cardiac surgery, as for other surgeries monitored, risk of an infection has fallen
since surveillance began. Overall, risk of post surgical infection has fallen 11% each
year since 2003
14 | Healthcare-associated infection in Victoria
Infections in patients
undergoing surgery
Introduction
This section consolidates the results from HAI
surveillance of patients who have had specific
types of surgery. The main surgical groups which
are monitored are:
- coronary artery bypass surgery
- orthopaedic surgery (hip and knee replacement)
- caesarean section
- abdominal hysterectomy
- colorectal surgery
- other cardiac surgery.
It describes the results of:
- rates of surgical site infection (SSI) with stratification
according to risk (type of surgery, patient factors)
- types of causative organisms associated with SSI
- monitoring of administration of surgical antibiotic prophylaxis.
Rationale for surveillance
Type of surgery
Some surgery carries a higher risk of infection. For example,
surgery where an implant is used (such as a knee replacement)
has a higher risk than some other types of surgery. ‘Dirty’ surgery,
such as that involving opening the gastrointestinal tract, has a
higher risk than ‘clean’ surgery. In general, HAIs are monitored and
reported for those types of surgery with the greatest infection risk.
Crude (unadjusted) infection rates
A crude infection rate is calculated with no adjustment for
patient risk; that is, assuming all patients have the same risk
of infection. Comparing these rates over time or between
hospitals or health services assumes that the mix of patients in
each year or at each hospital has been similar. This assumption
may be more valid for some procedures than others. For
example, this may be valid for patients undergoing caesarean
section, where maternal age is within a defined range and there
is no alternative surgical procedure. In contrast, the population
of patients undergoing cardiac bypass surgery may not be
comparable over time, where alternative treatments, such as
cardiac angioplasty, are increasingly used for management of
ischaemic heart disease. It is conceivable that the risk profile
of patients undergoing cardiac bypass could therefore change
over time. Different hospitals may have different patient mixes,
for example depending on their location or size.
Risk stratification
Some patients will always be at greater risk of infection than
others having the same type of surgery. A major determinant
of risk is the patient’s general state of health. For basic risk
stratification this is assessed via the Anaesthesiologist’s
Society of America (ASA) score. In addition, different types
of surgery carry different risk; and longer surgery generally
carries a higher risk.
One method of accounting for some of these differences
in risk is to allocate patients undergoing surgery to risk
categories depending on their risk of acquiring an infection.
The risk index currently used in Victoria is the same as that
used by NHSN; and has categories ranging from –1 to 3. The
risk index depends on the patients’ ASA score, the type of
surgery (clean/”dirty”) and the duration of the operation. It
may be altered if a laparoscope is used for the operation.
This helps to ensure that infection rates are calculated
on groups of patients with similar risk of contracting an
infection. When calculating risk-stratified rates individual
patients/procedures are excluded if a risk index cannot be
determined; and risk indices are excluded or combined
where there are very small numbers of procedures.
Superficial or deep/organ space infections
Infections are classified as superficial, deep or organ space.
Superficial infections are generally less serious and can
often be successfully treated with antibiotics alone. Deep
or organ space infections often require rehospitalisation
and sometimes reoperation. As well as being more serious
for patients, they are considered the most reliable for
investigating time trends or performing comparisons as they
rarely go undetected – patients are usually readmitted to
hospital. Superficial infections, on the other hand, may not
be detected by surveillance as patients may be treated by a
GP in the community.
Deep and organ space infections are often combined into a
single category for reporting purposes.
Antibiotic prophylaxis
Administering a dose of antibiotic prior to surgical procedures
has been shown to be effective in reducing infections
following many types of surgery. However, to be effective, the
type of antibiotic chosen must be appropriate, and it must be
administered at an optimal time to allow it to be present in
the patient’s tissues when the surgical incision is made.
Healthcare-associated infection in Victoria | 15
Method Active, patient-based prospective surveillance of SSI was
conducted in accordance with VICNISS surveillance module:
surgical site infection (SSI) – protocol. This is based on the US
CDC NHSN surveillance program.
Surgical categories are classified as per the VICNISS procedure
groups, using ICD10-AM and CMBS codes. Antibiotic prophylaxis
compliance is assessed using the current version of the
Therapeutic guidelines antibiotic and the guidelines from the
National Surgical Infection Prevention Project in the United States.
The surgical procedures monitored by individual hospitals vary
depending on:
- types of surgery performed
- requirements outlined in the department’s High-
performing health services document
- local infection rates.
Data is submitted quarterly by participating health services
to VICNISS Coordinating Centre.
Data are presented for 2014-15 and 2015-16. SSI results are
presented as a rate per 100 procedures, stratified by risk index,
and also by all infections or deep/organ space infections.
Crude SSI Rates Table 1 below displays crude SSI rates for 2014–15 and
2015–16. These rates have not been subjected to any form
of risk adjustment for different patient mix between the two
years reported.
Table 1: Crude surgical site infection rates for 2014-15
and 2015-16
The following table contains Victorian state rates for all
contributing hospitals for surgical procedues where more
than 100 procedures were performed in each year and more
than one hospital contributed data.
Procedure group
Year
Total procedures
Total valid infections
Infection rate (infections
per 100 procedures)
Abdominal hysterectomy
2014-15 661 7 1.1
2015-16 679 9 1.3
CABG – chest and donor
2014-15 2320 80 3.4
2015-16 2324 89 3.8
CABG – chest only
2014-15 116 2 1.7
2015-16 131 2 1.5
Caesarean section
2014-15 10345 93 0.9
2015-16 9943 92 0.9
Cardiac surgery
2014-15 574 3 0.5
2015-16 574 4 0.7
Cholecystectomy
2014-15 371 4 1.1
2015-16 309 0 0.0
Colon surgery
2014-15 947 84 8.9
2015-16 1038 77 7.4
Herniorraphy
2014-15 275 2 0.5
2015-16 434 2 0.5
Hip prosthesis
2014-15 5310 72 1.4
2015-16 6127 54 0.9
Knee prosthesis
2014-15 4357 36 0.8
2015-16 5166 37 0.7
Infections in patients
undergoing surgery
16 | Healthcare-associated infection in Victoria
Rates of SSI by risk index The figures below display SSI rates by surgery type and risk
index for 2014-15 and 2015-16. Higher rates of infection are
usually seen in the higher risk indices (2–3). However the
risk index is more predictive for some types of surgery than
others. Note that some procedures are mandatory for all
hospitals performing the procedures; others are voluntary,
therefore time trends must be interpreted with caution.
Observations on surveillance
The following figures depict the annual risk adjusted
infection rates for surgical procedures for Victoria for 2014-
15 and 2015-16. Results are presented for surgeries and
risk indices where sufficient procedures were performed
and more than one hospital contributed data. Figures are
presented for total infections and also for complex infections
(deep and organ space). The figure (‘n’) represents the
number of procedures in the dataset for that year.
SSI – abdominal hysterectomy
Participation
Participation by Victorian public health services in SSI
surveillance for this procedure is voluntary.
In 2014-15, and 2015-16 there were four and three hospitals
monitoring and reporting SSIs.
Healthcare-associated infection in Victoria | 17
Fig
ure
8
Fig
ure
7
Figure 7: Surgical site infections following hysterectomy (total infections, rate per 100 procedures)
10
9
8
7
6
5
4
3
2
1
0.47 0.46 0.59
0
2.10
3.60
0.79
2014/15 (n=212)
2015/16 (n=219)
2014/15 (n=338)
2015/16 (n=334)
2014/15 (n=111)
2015/16 (n=126)
LOW RISK PATIENTS HIGHER RISK PATIENTS HIGHEST RISK PATIENTS
Figure 8: Surgical site infections following hysterectomy (deep/OS infections, rate per 100 procedures)
10
9
8
7
6
5
4
3
2
1
0 0.00
0.46 0.30
1.50
0.00 0.00
2014/15 (n=212)
2015/16 (n=219)
2014/15 (n=338)
2015/16 (n=334)
2014/15 (n=111)
2015/16 (n=126)
LOW RISK PATIENTS HIGHER RISK PATIENTS HIGHEST RISK PATIENTS
Infections in patients
undergoing surgery
18 | Healthcare-associated infection in Victoria
Fig
ure
10
Fig
ure
9
SSI - Cardiac Bypass Graft Participation by Victorian public health services in SSI surveillance for this procedure is mandatory.
In 2014-15, and 2015-16 there were 6 public and 3 private hospitals monitoring and reporting SSIs
Figure 9: Surgical site infections following cardiac bypass grafts (total infections, rate per 100 procedures)
10
8
6
4 3.22 2.97
2
3.73
5.39
0
2014/15 (n=212)
2015/16 (n=219)
2014/15 (n=563)
2015/16 (n=760)
LOW RISK PATIENTS HIGHER RISK PATIENTS
Figure 10: Surgical site infections following cardiac bypass grafts (deep/OS infections, rate per 100 procedures)
10
8
6
4
2 0.81
1.31
1.42 1.71
0 2014/15 (n=1863)
2015/16 (n=1682)
2014/15 (n=563)
2015/16 (n=760)
LOW RISK PATIENTS HIGHER RISK PATIENTS
Healthcare-associated infection in Victoria | 19
Fig
ure
12
Fig
ure
11
SSI - Caesarean Section Participation in SSI surveillance for caesarean section is mandatory for Mercy Health and The Royal Women’s Hospital. For more
information see the Victorian Health Service Performance Monitoring Framework www.health.vic.gov.au/hospital-performance/.
Participation is voluntary for other Victorian public health services. In 2014-15 and 2015-16 there were 17 hospitals
monitoring C-sections, including one private hospital.
Figure 11: Surgical site infections following Caesarean sections (total infections, rate per 100 procedures)
10
8
6
4
2
0.83 0.79 0.86 0.97
2.30 2.28
0
2014/15 2015/16 2014/15 2015/16 2014/15 2015/16
(n=5529) (n=5302) (n=4424) (n=4247) (n=392) (n=394)
LOW RISK PATIENTS HIGHER RISK PATIENTS HIGHER RISK PATIENTS
Figure 12: Surgical site infections following Caesarean sections (deep/OS infections, rate per 100 procedures)
10
8
6
4
2
0.31 0.25 0.38 0.31
0
1.02 1.02
2014/15 (n=5529)
2015/16 (n=5302)
2014/15 (n=4424)
2015/16 (n=4247)
2014/15 (n=392)
2015/16 (n=394)
LOW RISK PATIENTS HIGHER RISK PATIENTS HIGHER RISK PATIENTS
Infections in patients
undergoing surgery
20 | Healthcare-associated infection in Victoria
Fig
ure
14
Fig
ure
13
SSI - cardiac surgery Participation in SSI surveillance for cardiac surgery is voluntary. In 2014-15 and 2015-16 there were 4 hospitals
monitoring cardiac surgery.
Figure 13: Surgical site infections following other cardiac surgery (total infections, rate per 100 procedures)
10
9
8
7
6
5
4
3
0.79 2
1
0
2014/15 (n=382)
0.32
2015/16 (n=317)
0.00
2014/15 (n=182)
1.20
2015/16 (n=250)
LOW RISK PATIENTS HIGHER RISK PATIENTS
Figure 14: Surgical site infections following other cardiac surgery (deep/OS infections, rate per 100 procedures)
10
9
8
7
6
5
4
3
2 0.52 0.00 0.00
1
0.80
0
2014/15 (n=382)
2015/16 (n=317)
2014/15 (n=182)
2015/16 (n=250)
LOW RISK PATIENTS HIGHER RISK PATIENTS
Healthcare-associated infection in Victoria | 21
Fig
ure
16
Fig
ure
15
SSI - hip replacements Participation in SSI surveillance for hip replacements is mandatory for hospitals performing more than 50 procedures
annually. In 2014-15 and 2015-16 there were 30 and 31 hospitals monitoring hip replacements respectively, including 24
public hospitals.
Figure 15: Surgical site infections following hip replacements (total infections, rate per 100 procedures)
10
8
6
3.45
4
2.05
2
0.70 0.53
1.22
0.82
0 2014/15 2015/16 2014/15 2015/16 2014/15 2015/16
(n=1717) (n=2061) (n=2868) (n=3284) (n=735) (n=782)
LOW RISK PATIENTS HIGHER RISK PATIENTS HIGHER RISK PATIENTS
Figure 16: Surgical site infections following hip replacements (deep/OS infections, rate per 100 procedures)
10
8
6
4 2.48 1.79
2
0.52 0.29
0.84
0.52
0 2014/15 (n=1717)
2015/16 (n=2061)
2014/15 (n=2868)
2015/16 (n=3284)
2014/15 (n=735)
2015/16 (n=782)
LOW RISK PATIENTS HIGHER RISK PATIENTS HIGHER RISK PATIENTS
Infections in patients
undergoing surgery
22 | Healthcare-associated infection in Victoria
2
0.48
0.30 0.48 0.45 0.40
0 2014/15
(n=1247) 2015/16 (n=1642)
2014/15 (n=2102)
2015/16 (n=2425)
2014/15 (n=1008)
Fig
ure
18
Fig
ure
17
SSI - knee replacements Participation in SSI surveillance for knee replacements is mandatory for hospitals performing more than 50 procedures
annually. In 2014-15 and 2015-16 there were 28 and 31 hospitals monitoring knee replacements respectively, including 24
public hospitals.
Figure 17: Surgical site infections following knee replacements (total infections, rate per 100 procedures)
10
8
6
4
2
0.72 0.73 1.00
0.62 0.60 0.91
0 2014/15 2015/16 2014/15 2015/16 2014/15 2015/16
(n=1247) (n=1642) (n=2102) (n=2425) (n=1008) (n=1099)
LOW RISK PATIENTS HIGHER RISK PATIENTS HIGHER RISK PATIENTS
Figure 18: Surgical site infections following knee replacements (deep/OS infections, rate per 100 procedures)
10
8
6
4
0.55
LOW RISK PATIENTS
HIGHER RISK PATIENTS
2015/16 (n=1099)
HIGHER RISK PATIENTS
Healthcare-associated infection in Victoria | 23
Fig
ure
20
Fig
ure
19
SSI - colorectal surgery Participation in SSI surveillance for colorectal surgery is voluntary. In 2014-15 and 2015-16 there were 7 hospitals
monitoring colorectal surgery respectively, all of them public hospitals.
Figure 19: Surgical site infections following colorectal surgery (total infections, rate per 100 procedures)
20
18
16
14
12
10
8
2.79 3.24 6
4
2
9.11
7.51
14.98
13.24
0
2014/15 (n=215)
2015/16 (n=278)
2014/15 (n=348)
2015/16 (n=413)
2014/15 (n=287)
2015/16 (n=272)
LOW RISK PATIENTS HIGHER RISK PATIENTS HIGHEST RISK PATIENTS
Figure 20: Surgical site infections following colorectal surgery (deep/OS infections, rate per 100 procedures)
20
18
16
14
12
6.97 10
8
6
4 0.93 1.44
2
3.65
2.91
4.04
0
2014/15 (n=215)
2015/16 (n=278)
2014/15 (n=348)
2015/16 (n=413)
2014/15 (n=287)
2015/16 (n=272)
LOW RISK PATIENTS HIGHER RISK PATIENTS HIGHEST RISK PATIENTS
24 | Healthcare-associated infection in Victoria
Causative organisms responsible for healthcare associated infections
Which organisms cause these infections?
Staphylococcus aureus
was the most common
bacteria isolated for all
major surgical groups
monitored; and also
haemodialysis related
infections*
Enterococcus faecalis
was the most common bacteria
isolated from infections in neonatal
intensive care
Coagulase negative Staphylococcus
was the most common bacteria
isolated from bloodstream infections
in intensive care.
*Infections occurring between 1 July 2014 and 30 June 2016
Healthcare-associated infection in Victoria | 25
No. of patients with infections and organisms reported 118
No. of Infections with Organisms 123
No. of Distinct Pathogens 21
No. of patients with infections and organisms reported 21
No. of Infections with Organisms 21
No. of Distinct Pathogens 6
Fig
ure
22
Fig
ure
21
Causative organisms in intensive care settings
Figure 21: Pathogens isolated in adult intensive care(CLABSI) 2014-2016
Staphylococcus areas
Enterococcus faecium
Enterococcus faecailis
0 20 40 60 80 100
MRSA
MSSA
SA - Unkown
VRE
VSE
E - Uknown
Coagulase Negative Staphylococcus (19.4%)
Staphylococcus aureus (18.5%)
Enterococcus faecalis (13.7%)
Enterococcus faecium (6.5%)
Klebsiella pneumoniae (5.6%)
Escherichia coli (5.6%)
Candida spp. (4.8%)
Enterobacter spp. (4.0%)
Candida albicans (4.0%)
Acinetobacter spp. (3.2%)
Serratia spp. (2.4%)
Other Organism (1.6%)
Pseudomonas aeruginosa (1.6%)
Stenotrophomonas maltophilia (1.6%)
Bacillus spp. (1.6%)
Figure 22: Pathogens isolated in neonatal intensive care (CLABSI/PLABSI) 2014-2016
Staphylococcus areas
Enterococcus faecium
0 20 40 60 80 100
MRSA
MSSA
SA - Unkown
VRE
VSE
E - Uknown
Enterococcus faecalis (42.9%)
Coagulase Negative Staphylococcus (19.0%)
Staphylococcus aureus (14.3%)
Escherichia coli (14.3%)
Candida spp. (4.8%)
Enterobacter spp. (4.8%)
Causative organisms in outpatient
haemodialysis
26 | Healthcare-associated infection in Victoria
No. of patients with infections and organisms reported 112
No. of Infections with Organisms 117
No. of Distinct Pathogens 22
No. of patients with infections and organisms reported 70
No. of Infections with Organisms 71
No. of Distinct Pathogens 19
Figu
re 2
4
Fig
ure
23
Figure 23: Pathogens isolated from infections following cardiac bypass surgery 2014-2016
Staphylococcus areas
Enterococcus faecium
Enterococcus faecailis
0 20 40 60 80 100
MRSA
MSSA
SA - Unkown
VRE
VSE
E - Uknown
Staphylococcus aureus (34.8%)
Coagulase Negative Staphylococcus (18.1%)
Pseudomonas aeruginosa (8.0%)
Serratia spp. (5.8%)
Other Organism (4.3%)
Enterobacter spp. (4.3%)
Klebsiella pneumoniae (2.9%)
Escherichia coli (2.9%)
Proteus spp. (2.2%)
Enterococcus faecalis (2.2%)
Enterococcus faecium (2.2%)
Candida albicans (2.2%)
Morganella morganii (1.4%)
All Others (5.8%)
Figure 24: Pathogens isolated from infections following colorectal surgery 2014-2016
Staphylococcus areas
Enterococcus faecium
Enterococcus faecailis
0 20 40 60 80 100
MRSA
MSSA
SA - Unkown
VRE
VSE
E - Uknown
Staphylococcus aureus (23.1%)
Pseudomonas aeruginosa (19.8%)
Escherichia coli (14.3%)
Enterococcus faecium (7.7%)
Enterobacter spp. (5.5%)
Candida albicans (4.4%)
Morganella morganii (3.3%)
Enterococcus spp. (3.3%)
Coagulase Negative Staphylococcus (2.2%)
Pseudomonas spp. (Other) (2.2%)
Streptococcus spp. (Group C & G) (2.2%)
Bacteroides fragilis (2.2%)
Proteus spp. (2.2%)
Klebsiella pneumoniae (2.2%)
Streptococcus spp. (Group F) (1.1%)
Healthcare-associated infection in Victoria | 27
No. of patients with infections and organisms reported 70
No. of Infections with Organisms 70
No. of Distinct Pathogens 13
No. of patients with infections and organisms reported 6
No. of Infections with Organisms 6
No. of Distinct Pathogens 7
Fig
ure
25
Fig
ure
26
Figure 25: Pathogens isolated from infections following Caesarean section 2014-2016
Staphylococcus areas
Enterococcus faecium
Enterococcus faecailis
0 20 40 60 80 100
MRSA
MSSA
SA - Unkown
VRE
VSE
E - Uknown
Staphylococcus aureus (56.2%)
Escherichia coli (13.7%)
Coagulase Negative Staphylococcus (8.2%)
Other Organism (5.5%)
Serratia spp (2.7%)
Enterococcus faecalis (2.7%)
Enterococcus spp. (2.7%)
Pseudomonas aeruginosa (1.4%)
Klebsiella pneumoniae (1.4%)
Haemophilus influenza (1.4%)
Corynebacterium spp. (1.4%)
Bacteroides spp. (1.4%)
Streptococcus viridians (1.4%)
Figure 26: Pathogens isolated from infections following hysterectomy 2014-2016
Staphylococcus areas
Enterococcus faecailis
0 20 40 60 80 100
MRSA
MSSA
SA - Unkown
VRE
VSE
E - Uknown
Staphylococcus aureus (25%)
Other Organism (12.5%)
Escherichia coli (12.5%)
Enterococcus faecalis (12.5%)
Proteus spp. (12.5%)
Pseudomonas aeruginosa (12%)
Streptococcus spp. (Group A) (12.5%)
Causative organisms in outpatient
haemodialysis
No. of patients with infections and organisms reported 78
No. of Infections with Organisms 103
No. of Distinct Pathogens 18
Fi
gure
27
Figure 27: Pathogens isolated from infections following haemodialysis infections 2014-2016
Staphylococcus areas
Enterococcus faecium
Enterococcus faecailis
0 20 40 60 80 100
MRSA
MSSA
SA - Unkown
VRE
VSE
E - Uknown
Staphylococcus aureus (39.1%)
Coagulase Negative Staphylococcus (20.9%)
Escherichia coli (5.2%)
Pseudomonas aeruginosa (5.2%)
Enterococcus faecalis (5.2%)
Enterobacter spp. (3.5%)
Stenotrophomonas maltophilia (3.5%)
Klebsiella pneumoniae (3.5%)
Enterococcus faecium (3.5%)
Proteus spp. (2.6%)
Staphylococcus spp. (2.6%)
Other Organism (1.7%)
All Others (1.7%)
28 | Healthcare-associated infection in Victoria
-
Surveillance of specific organisms or types of organisms
Clostridium difficile infections
Purpose
CDI surveillance includes all patients presenting to a public
hospital with a C. difficile toxin-positive specimen identified by
a laboratory and confirmed by a suitably qualified healthcare
worker. The infection is designated as healthcare-associated
when the infection was considered to be associated with
their episode of care.
Participation
At the department’s request, all Victorian public hospitals
including (mental health facilities) must perform CDI surveillance.
Method
CDI surveillance was conducted in accordance with the
VICNISS surveillance Clostridium difficile infection (CDI) –
protocol. The definition is in accordance with the Australian
Commission on Safety and Quality in Healthcare’s National
definition and calculation of hospital identified Clostridium
difficile infection. Hospitals collect data on a continuous
basis for this measure. Participating health services submit
quarterly data to VICNISS Coordinating Centre for collation
and analysis. Results are presented each quarter as rates per
10,000 occupied bed days. Comparable data are available
from October 2010.
Observations on surveillance
Surveillance of CDI infections has now been carried out
continuously in Victoria since late 2010. After an initial rise
in reported infections most likely explained by increased
awareness and testing, the number of cases has been
relatively stable. All cases identified by healthcare facilities
are reported, whether considered to be community or
healthcare associated. In the case of CDI, it can be difficult to
distinguish between community and healthcare associated
infections.
Strains associated with particular ribotypes and which
have caused outbreaks, and the majority of morbidity and
mortality overseas are not being detected in appreciable
numbers in Victoria. However, ribosome testing is performed
on a relatively small proportion of isolated strains. Data
is collected on markers of severity of illness and the
proportions of severe disease in Victoria remain low. Severe
disease is defined as cases admitted to intensive care,
requiring surgery due to complications of CDI or where death
occurs within 30 days of infection and is attributed to CDI. In
2014–15 and 2015–16 the percentage of cases with severe
disease was 2.1 per cent and 1.7 per cent respectively.
30 | Healthcare-associated infection in Victoria
Healthcare-associated infection in Victoria | 31
Community
Fig
ure
29
Fig
ure
28
Figure 28: Numbers of Clostridium difficile infections by category including all hospital identified infections for
2014/15 and 2015/16
2000
1800
1600
1400
1200
1000
800
600
400
200
2014/15
2015/16
0 Healthcare associated
Indeterminate
Unknown
All hospital identified
Figure 29: Rate of hospital identified Clostridium difficile infections classified as healthcare associated for 2014/15
and 2015/16 (infections per 10,000 occupied bed days)
5.0
4.0
3.0
2.0
1.0
0
2.2 2.3
2014/15 2015/16
2014/15
2015/16
Fig
ure
30
Surveillance of specific organisms
or types of organisms
Staphylococcus aureus bacteraemia
Purpose
SAB surveillance includes all patients admitted to a public
hospital with a bacteraemia caused by either Methicillin-
susceptible S.aureus (MSSA) or Methicillin-resistant S.aureus
(MRSA) and where the infection was considered to be
associated with their episode of care.
Participation
Participation in SAB surveillance is mandatory for Victorian public
hospitals (including mental health facilities). For more information
see the Victorian Health Service Performance Monitoring
Framework: www.health.vic.gov.au/hospital-performance/.
All eligible Victorian public health services participate. Several
private hospitals also carry out surveillance and submit data
on SAB.
Method
SAB surveillance was conducted in accordance with the
VICNISS surveillance module Staphylococcus aureus bacteraemia
(SAB) – protocol. The definition is in accordance with the
Australian Commission on Safety and Quality in Healthcare’s
National definition and calculation of hospital-identified
Staphylococcus aureus infection.
Hospitals collect data on a continuous basis for this measure.
Participating health services submit data quarterly to VICNISS
Coordinating Centre. Comparable data is available from the
third quarter (January to March) of 2009–10. Rates of SAB are
reported quarterly per 10,000 occupied bed days.
Observations on surveillance
Figure 30 displays rates of SAB calculated using occupied bed
days as the denominator, including the hospital bed days
accrued by patients most at risk for SAB.
SAB rates in Victoria have decreased since the introduction
of a coordinated surveillance program in 2010.9 A number of
interventions have taken place in Victoria during this time
that may have contributed to this decrease including the
introduction of the VICNISS SAB surveillance program and
the National Hand Hygiene Initiative.
The decrease in SAB rates in Victoria has been mirrored by
national SAB rates, which have also declined since national
data collation was introduced. More information on SAB
rates in other states and territories as well as rates by
hospital peer group is available on the Australian Institute of
Health and Welfare website http://www.aihw.gov.au/
Figure 30: Healthcare associated Staphylococcus aureus bacteraemia rates for 2014/15 and 2015/16 (infections per
10,000 occupied bed days)
1.0
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
Total SAB rate MRSA rate
2014/15
2015/16
Healthcare-associated infection in Victoria | 33
Carbapenamase producing
Enterobacteriacea (CPE)
Purpose
Carbapenemase-producing Enterobacteriaceae are a group
of bacteria that have developed resistance to a number
of front line antibiotics including carbapenems which are
considered ‘last resort’ antibiotics for the treatment of
serious infections. Carbapenemase genes encode enzymes
that degrade carbapenem antibiotics. Enterobacteriaceae
comprise the largest family of gram-negative bacteria
causing human infection and includes common pathogens
such as Escherichia coli, Klebsiella and Enterobacter species.
These organisms are normal flora of the gastrointestinal
tract but have the potential to cause infection and
disseminate antimicrobial resistance.
Participation
Reporting of cases of CPE is mandatory in Victoria. A case of
CPE is defined in the Victorian guidelines on carbapenamase
producing Enterobacteriaceae for Victorian health services:
https://www2.health.vic.gov.au/public-health/infectious-
diseases/infection-control-guidelines/carbapenemase-
producing-enterobacteriaceae-management
Method
The department is the lead agency for the statewide
response to CPE. The department has engaged several
partner agencies, namely the Microbiological Diagnostic Unit
Public Health Laboratory and the VICNISS Coordinating Centre
to assist with the surveillance and response to CPE in Victoria.
Observations on surveillance
Data collection on all cases of CPE commenced in January
2016. In addition, VICNISS developed online audit facilities
through which hospitals were expected to audit compliance
with the first version of the CPE guidelines, plus a facility
to collate data resulting from mandatory point prevalence
surveys. Hospitals were also able to report the results of
the audits and point prevalence surveys through the secure
VICNISS portal.
Point prevalence surveys were mandated in areas
considered to be high risk such as transplant and
haematology wards and intensive care units. The prevalence
of CPE was found to be almost zero from the surveys and
the point prevalence surveys are no longer mandated in the
second version of the guidelines.
Reports on CPE are expected to be released in 2018.
34 | Healthcare-associated infection in Victoria
Healthcare worker immunisation against seasonal influenza
Vaccination of healthcare workers against seasonal influenza
The proportion of
healthcare workers
vaccinated in Victoria
has doubled from 41%
when data collection
began in 2005 to 80%
in 2016
100
90
2015 was the first year in
which the proportion of
medical staff vaccinated
exceeded the proportion of
nursing staff vaccinated
80
70
60
50
40
30
20
10
0
2010 2011 2012 2013 2014 2015 2016
How does this compare to previous years?
A large change occurred in 2014 after a state target was introduced: the proportion
increased from 59% to 72%. In 2015 and 2016 the proportion appears to have
stabilised at around 80%
Healthcare-associated infection in Victoria | 35
HCW influenza vaccination and exposure to blood and body fluids
Introduction This section contains the results from surveillance relating
to healthcare workers in Victorian public health services. In
particular:
- rates of vaccination of healthcare workers against
seasonal influenza
- occupational exposures to blood and body fluids in
smaller health services.
Purpose and rationale for
surveillance Healthcare workers are considered to be a group of special
interest for influenza vaccination, since vulnerable patients
who are exposed to a healthcare staff member with
influenza can become infected. Additionally, reduction in
healthcare staff numbers due to illness may adversely affect
the care of vulnerable patients. The National Health and
Medical Research Committee (NHMRC) recommends that all
healthcare workers involved in direct patient care should be
vaccinated.
The department provides seasonal influenza vaccination free
of charge to Victorian health services for their healthcare
workers.
Occupational exposures to blood and body fluids constitute
a risk to healthcare workers and most are considered
preventable with safe work practices and the use of safety
engineered medical devices. It has been estimated that
there are up to 18,000 sharps injuries in Australia each year
and they are one of the most common causes of physical,
pathological and psychological hazards for many healthcare
workers. VICNISS collates data on these exposures in small
health services; and is planning to collate data from all health
services from 2017.
Healthcare worker seasonal
influenza vaccination
Purpose
To identify the proportion of healthcare workers vaccinated
against seasonal influenza.
Participation
All Victorian public health services can request from the
department’s Immunisation Section the seasonal influenza
vaccination to immunise their staff. For more information:
www.health.vic.gov.au/immunisation.
All Victorian public health services contribute data for this
measure.
Method
Surveillance was conducted in accordance with the VICNISS
surveillance module: staff influenza vaccination protocol.
Hospitals collect data for a finite period for this measure.
Data is submitted annually by participating health services to
VICNISS Coordinating Centre.
Results are presented as the proportion of staff known to be
immunised by clinical category. Comparable data is available
since 2005.
Observations on the surveillance data
Figure 31 displays the percentage of staff in Victorian public
health services known to be vaccinated against seasonable
influenza in 2015 and 2016. There was a slight increase in
the total proportion of staff known to be vaccinated in 2016.
Figure 32 has more detailed data by health care worker
category.
36 | Healthcare-associated infection in Victoria
Fig
ure
32
Fig
ure
31
HCW influenza vaccination and
exposure to blood and body fluids
Figure 31: Percentage of eligible healthcare workers vaccinated in 2015 vs 2016
100
90
80
70
60
50
40
30
20
10
0
2014/15 2015/16
Figure 32: Percentage of healthcare workers vaccinated in 2015 and 2016 by major staff category
100
90
80
70
60
50
40
30
20
10
2014/15
2015/16
0 Allied Staff
Lab Staff
Medical
Staff
Nursing
Staff
Other Cat A&B Staff
Category C
Staff
*Category not collated. In 2016, these staff were included in “Other Cat A&B Staff”
Healthcare-associated infection in Victoria | 37
Fig
ure
33
Occupational exposures in
smaller health services
Purpose
Transmissions of bloodborne pathogens through
occupational exposures such as needle-stick injuries
represent a significant risk to healthcare workers.
Occupational exposures to blood or body fluids in healthcare
settings have the potential to transmit hepatitis B, hepatitis C
or human immunodeficiency virus (HIV).
Participating organisations
Participation by Victorian public health services in this
surveillance is voluntary.
Data collection
Surveillance was conducted in accordance with the VICNISS
type 2: occupational exposure surveillance data collection
form on an as-required basis. This is based in part on the
CDC Workbook for designing, implementing and evaluating a
sharps injury prevention program and NSW Health Infection
control program quality monitoring indicators user manual.
Health services submit data if an occupational exposure
is reported. Comparable data is available from 2006–07
to date. Results are presented annually as the number of
exposures per 10,000 acute occupied bed days.
Observations on the surveillance data
There are three key types of occupational exposures
involving acute patient sources:
- parenteral exposure – the piercing of skin with a
contaminated sharp (any contaminated object that can
penetrate the skin including, but not limited to, needles,
scalpels, broken glass, broken capillary tubes and
exposed ends of dental wires)
- non-parenteral exposure – when blood or other
potentially infectious materials makes contact with the
eye, mouth, other mucous membrane or non-intact skin
contact
- human bite.
The results are displayed in Figure 33 below. The Victorian
Blood Exposure Surveillance Group (ViBES), a voluntary
group comprising 18 large health services, collates similar
data. ViBES has reported rates of 4.3 percutaneous
exposures (equivalent to parenteral and non-parenteral
combined) per 10,000 occupied bed days. The rates for the
type 2 hospitals (fewer than 100 beds) are thus comparable
to those reported from type 1 hospitals (100 beds or more).
Figure 33: Occupational exposures (smaller hospitals) – exposures per 10,000 occupied bed days
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Parental Non-Parental
2014/15
2015/16
38 | Healthcare-associated infection in Victoria
Glossary
Term
Definition
Antibiotic prophylaxis Use of antibiotics prior to surgery to prevent infections at the surgical site
ASA score American Society of Anaesthesiology score – designed to assess the patient’s physical status. Ranges from 1 for a healthy patient to 5 for a patient who is not expected to survive 24 hours without an operation.
Bloodstream infection (BSI) Presence of live pathogens in the blood, causing an infection
CDC Centers for Disease Control and Prevention (United States)
CDI Clostridium difficile infection
Central line / central venous catheter (CVC)
A catheter (tube) that is passed through a vein to end up in the thoracic (chest) portion of the vena cava (the large vein returning blood to the heart) or in the right atrium of the heart
Central line-associated bloodstream infection (CLABSI)
A bloodstream infection thought to have been caused by the presence of a central line
Cholecystectomy A surgical procedure to remove the gallbladder
Coronary artery bypass graft surgery
A surgical procedure that creates new pathways around blocked or narrowed arteries to allow blood to reach the heart muscle again
Central line days The number of days for which an intravenous catheter has been present in a patient
the department the Department of Health and Human Services
Healthcare-associated infection (HAI)
Any infection that occurs during or after hospitalisation that was not present or incubating at the time of the patient’s admission
Infection Invasion of pathogenic micro-organisms in a bodily part or tissue that may produce tissue injury and progress to disease
Intensive care unit (ICU) A hospital unit that usually treats very sick patients. Patients in intensive care units are at a higher risk of developing infections.
Methicillin-resistant Staphylococcus aureus (MRSA)
A methicillin (antibiotic) resistant strain of Staphylococcus aureus
Neonatal Relating to a baby within the first four weeks of birth
NHSN The National Healthcare Safety Network is a surveillance system that integrates patient and healthcare personnel safety surveillance systems managed by the Division of Healthcare Quality Promotion (DHQP) at CDC
Non-parenteral exposure Blood or other potentially infectious materials makes contact with the eye, mouth, other mucous membrane or non-intact skin contact
Occupied bed days (OBD) Number of days a patient is admitted to a hospital bed
Pathogen An agent of disease. The term pathogen is used most commonly to refer to infectious organisms such as bacteria, viruses and fungi
Parenteral exposure Piercing of skin with a contaminated sharp instrument
Peripheral-line associated bloodstream infection (PLASBI)
A bloodstream infection thought to have been caused by the presence of a peripheral line
Risk index A means of stratifying patients according to their risk of infection, which allows appropriate comparison of infection rates
SAB Staphylococcus aureus bacteraemia
Surgical site infection (SSI) An infection at the site of an operation (usually an incision) that is caused by the operation
Surveillance The ongoing systematic collection, analysis and interpretation of data
Term
Definition
Type 1 hospitals Victorian hospitals with 100 beds or greater
Type 2 hospitals Victorian hospitals with less than 100 beds
VICNISS Advisory Committee A committee providing stakeholder advice to the VICNISS Coordinating Centre on the implementation, development and deliverables of the VICNISS program
VICNISS Victorian healthcare-associated infection surveillance system
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Appendix A: VICNISS Advisory Committee
Purpose The VICNISS Advisory Committee provides stakeholder input and advice to the Coordinating Centre on the implementation,
development and activities of VICNISS.
Members between 2014 and 2016
Member
Representing
Mr Matthew Richards Infection control consultant –Public
Dr Peter Bradford Executive Director, Clinical Governance/Medical Services, Melbourne Health
Ms Sarah Gray Consumer
Mr Steven Peushel Consumer
Ms Glenda Gorrie Infection Prevention,
Quality, Safety and Patient Experience, Department of Health and Human Services
Dr Vij Sanjiv College of Intensive care Medicine of Australia & New Zealand, Australian and New Zealand Intensive Care Society
Ms Anne Lickliter Infection control consultant - Public
Ms Carol Rosevear Infection control consultant - Private
Prof Michael Richards VICNISS Coordinating Centre
Ms Pauline Woodburn Infection Control Consultant - Rural
Dr Rhonda Stuart Australian Society for Infectious Diseases
Mr David Love Royal Australasian College of Surgeons
Mr Lincoln Fowler Infection Control Consultant - Rural
Ms Leanne Houston Infection Control Consultant - Public
Mr Shane Thomas Consumer
Dr Sanjiv Vij College of Intensive Care Medicine, Australia and New Zealand
Dr Ann Bull VICNISS Coordinating Centre
Mr Jonathan Prescott A/g Manager Safety Programs, Quality and Safety, Department of Health and Human Services
Appendix B: VICNISS Coordinating Centre staff
Staff 2014–2016 Professor Michael Richards MD, MB, BS, FRACP, Director
Dr Ann Bull PhD, M.App.Epid., A/g Operations Director
Simon Burrell, Database Manager
Sharada Hulluru, NET/SQL Programmer
Noleen Bennett RN, MPH, CNC Infection Control
Jennifer Bradford RN, CNC Infection Control
Judy Brett BN, RM, CNC Infection Control
Liz Orr RN, CNC Infection Control
Dr Leon Worth, MB, BS, FRACP, Grad Dip Epi, PhD, Infectious Diseases Physician
Ling Wang, NET/SQL Programmer
Chris Clark, Administrative Officer
Tim Spelman, Statistician
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The Peter Doherty Institute for Infection and Immunity
792 Elizabeth St, Melbourne Victoria
www.doherty.edu.au
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