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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

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.

http://www.vicniss.org.au/

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.


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


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.

http://www.cdc.gov/dialysis


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

http://www.health.vic.gov.au/hospital-performance/


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



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.


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

http://www.cdc.gov/nhsn/PDFs/pscManual/8pscDialysisEventcurrent.pdf


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


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




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





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


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


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.


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


undergoing surgery


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.


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.


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)



undergoing surgery


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)



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)




undergoing surgery


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)


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)



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)


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)



undergoing surgery


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)


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


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)


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)



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


No. of patients with infections and organisms reported 118

No. of Infections with Organisms 123

No. of Distinct Pathogens 21




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



0 20 40 60 80 100

MRSA

MSSA

SA - Unkown

VRE

VSE

E - Uknown





Candida spp. (4.8%)


Causative organisms in outpatient

haemodialysis








Figu

re 2

4

Fig

ure

23

Figure 23: Pathogens isolated from infections following cardiac bypass surgery 2014-2016




0 20 40 60 80 100

MRSA

MSSA

SA - Unkown

VRE

VSE

E - Uknown




Serratia spp. (5.8%)





Proteus spp. (2.2%)




Morganella morganii (1.4%)

All Others (5.8%)

Figure 24: Pathogens isolated from infections following colorectal surgery 2014-2016




0 20 40 60 80 100

MRSA

MSSA

SA - Unkown

VRE

VSE

E - Uknown







Morganella morganii (3.3%)

Enterococcus spp. (3.3%)


Pseudomonas spp. (Other) (2.2%)

Streptococcus spp. (Group C & G) (2.2%)

Bacteroides fragilis (2.2%)

Proteus spp. (2.2%)


Streptococcus spp. (Group F) (1.1%)








Fig

ure

25

Fig

ure

26

Figure 25: Pathogens isolated from infections following Caesarean section 2014-2016




0 20 40 60 80 100

MRSA

MSSA

SA - Unkown

VRE

VSE

E - Uknown





Serratia spp (2.7%)


Enterococcus spp. (2.7%)



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



0 20 40 60 80 100

MRSA

MSSA

SA - Unkown

VRE

VSE

E - Uknown

Staphylococcus aureus (25%)




Proteus spp. (12.5%)

Pseudomonas aeruginosa (12%)

Streptococcus spp. (Group A) (12.5%)

Causative organisms in outpatient

haemodialysis




Fi

gure

27

Figure 27: Pathogens isolated from infections following haemodialysis infections 2014-2016




0 20 40 60 80 100

MRSA

MSSA

SA - Unkown

VRE

VSE

E - Uknown







Stenotrophomonas maltophilia (3.5%)



Proteus spp. (2.6%)

Staphylococcus spp. (2.6%)


All Others (1.7%)


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.


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.



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.


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


http://www.aihw.gov.au/


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.


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.

https://www2.health.vic.gov.au/public-health/infectious-diseases/infection-control-guidelines/carbapenemase-producing-enterobacteriaceae-management




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


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%


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.


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.

http://www.health.vic.gov.au/immunisation


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”


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.


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


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



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


The Peter Doherty Institute for Infection and Immunity

792 Elizabeth St, Melbourne Victoria

www.doherty.edu.au

http://www.doherty.edu.au/

http://www.doherty.edu.au/

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