infection control - achs · infection control, ... 2.5 correct sap and dose for the knee prosthesis...

INFECTION CONTROL

VERSION 4.1

Retrospective data in full ACIR 2008 - 2015

Australasian Clinical Indicator Report 2008–2015 © ACHS. This work is copyright. Requests and inquiries concerning reproduction and rights should be addressed to [email protected]

Contents Infection Control, version 4.1 1

Infection surveillance......................................................................................................................... 1 1.1 Superficial SSI - hip prosthesis procedure (L) 1 1.2 Deep or organ / space SSI - hip prosthesis procedure (L) 3 1.3 Superficial SSI - knee prosthesis procedure (L) 4 1.4 Deep or organ / space SSI - knee prosthesis procedure (L) 5 1.5 Superficial SSI to chest incision site – CABG (L) 6 1.6 Deep or organ / space SSI to chest incision site – CABG (L) 8 1.7 Superficial SSI – LSCS (L) 9 1.8 Deep or organ / space SSI – LSCS (L) 11

Surgical antibiotic prophylaxis (SAP) ............................................................................................ 13 2.1 Timing of SAP for the hip prosthesis procedure (H) 13 2.2 Correct SAP and dose for the hip prosthesis procedure (H) 14 2.3 Discontinuation of SAP within 24 hours of the hip prosthesis procedure (H) 15 2.4 Timing of SAP for the knee prosthesis procedure (H) 17 2.5 Correct SAP and dose for the knee prosthesis procedure (H) 18 2.6 Discontinuation of SAP within 24 hours of the knee prosthesis procedure (H) 19 2.7 Timing of SAP for the CABG procedure (H) 21 2.8 Correct SAP and dose for the CABG procedure (H) 22 2.9 Discontinuation of SAP within 24 hours of the CABG procedure (H) 23 2.10 Timing of SAP for the LSCS procedure (H) 24 2.11 Correct SAP and dose for the LSCS procedure (H) 25 2.12 Discontinuation of SAP within 24 hours of the LSCS procedure (H) 26

Haemodialysis access-associated bloodstream infection surveillance ...................................... 27 3.1 Haemodialysis - AV-fistula access-associated BSI (L) 27 3.2 Haemodialysis - synthetic and native vessel graft access-associated BSI (L) 29 3.3 Haemodialysis - CI non-cuffed line access-associated BSI (L) 30 3.4 Haemodialysis - CI cuffed line access-associated BSI (L) 31

Vancomycin Resistant Enterococci (VRE) ..................................................................................... 33 4.1 VRE infection within the ICU (L) 33 4.2 VRE infection within non-ICU areas (L) 34

Staff Immunisation ........................................................................................................................... 35 5.1 Flu vaccination for permanent staff (H) 35 5.2 Hepatitis B vaccination for permanent staff (H) 36

Occupational exposures to blood and/or body fluids................................................................... 37 6.1 Reported parenteral exposures sustained by staff (L) 37 6.2 Reported non-parenteral exposures sustained by staff (L) 39

Characteristics of contributing HCOs ............................................................................................ 41

Summary of Results 45 Infection surveillance 45 Surgical antibiotic prophylaxis (SAP) 45 Haemodialysis access-associated bloodstream infection surveillance 47 Vancomycin Resistant Enterococci (VRE) 47 Staff Immunisation 47 Occupational exposures to blood and/or body fluids 48

Expert Commentary 49 Australasian College for Infection Prevention and Control (ACIPC) ........................................... 49

Introductory comments 49 Infection surveillance 49

Header 1

Australasian Clinical Indicator Report 2008–2015 Page 2 © ACHS. This work is copyright. Requests and inquiries concerning reproduction and rights should be addressed to [email protected]

Surgical antibiotic prophylaxis (SAP) 49 Haemodialysis access-associated bloodstream infection surveillance 49 Vancomycin Resistant Enterococci (VRE) 49 Staff Immunisation 49 Occupational exposures to blood and/or body fluids 49 General/closing comments 50 References 50


Infection Control, version 4.1 Infection surveillance

1.1 Superficial SSI - hip prosthesis procedure (L)

Rationale

A surgical site infection (SSI) is an infection that develops as a result of an operative procedure. These infections are associated with increased morbidity and mortality, prolonged hospital stays and increased healthcare costs. Surveillance of SSI rates, coupled with prompt feedback of data to surgeons and key stakeholders, has been shown to be an important strategy to reduce SSI rates. Numerator Number of superficial SSI following hip prosthesis procedures performed. Denominator Number of hip prosthesis procedures performed.

Desirable level: Low High Not specified Type of Indicator: Process Outcome Structure

Year No.

HCOs Total

numerator Total

denominator Rate# Rate# (20)

Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 157 186 19,227 0.97 0.65 1.39 62 9 2009 155 159 20,295 0.78 0.59 1.13 40 1 2010 149 152 20,863 0.73 0.57 1.04 33 2011 158 130 21,942 0.59 0.50 0.76 21 2 2012 162 121 21,944 0.55 0.48 0.70 16 2013 155 120 22,372 0.54 0.40 0.63 30 28 2014 146 103 21,964 0.47 0.34 0.59 28 4 2015 149 110 24,188 0.45 0.37 0.55 21 # per 100 procedures

In 2015, there were 282 records from 149 HCOs. The annual rate was 0.45 per 100 procedures.

Trends

The fitted rate improved from 0.90 to 0.42, a change of 0.48 per 100 procedures. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 0.47 per 100 procedures.

Trend plot of rates and centiles by year

0.0

0.2

0.4

0.6

0.8

1.0

1.2

Rate

per

100

pro

cedu

res

2008 2009 2010 2011 2012 2013 2014 2015

Year

A Low rate is desirable

80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate

Infection Control, version 4.1


Variation between strata

There were no significant stratum differences in 2014 and 2015.

Variation between HCOs

In 2015, the potential gains totalled 21 fewer superficial incisional SSIs, corresponding to a reduction by approximately one-tenth.

Outliers

There were no outlier HCOs in 2015.



1.2 Deep or organ / space SSI - hip prosthesis procedure (L)

Numerator Number of deep or organ / space SSI following hip prosthesis procedures performed. Denominator Number of hip prosthesis procedures performed.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 150 142 18,789 0.76 0.58 1.02 32 2009 152 130 20,174 0.64 0.49 0.84 31 1 2010 147 145 20,482 0.71 0.52 0.94 38 40 2 2011 156 143 21,604 0.66 0.47 0.83 41 3 2012 158 152 22,061 0.69 0.64 0.75 11 3 2013 153 131 22,686 0.58 0.45 0.72 30 3 2014 145 149 22,125 0.67 0.44 0.88 51 7 2015 149 143 24,615 0.58 0.48 0.71 25 # per 100 procedures


Trends






In 2015, the potential gains totalled 25 fewer deep incisional / organ space SSIs, corresponding to a reduction by approximately one-tenth.

Outliers


0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

Rate

per

100

pro

cedu

res

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate



1.3 Superficial SSI - knee prosthesis procedure (L)

Numerator Number of superficial SSI following knee prosthesis procedures performed. Denominator Number of knee prosthesis procedures performed.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 157 213 25,314 0.84 0.58 1.27 66 9 2009 160 148 27,695 0.53 0.35 0.82 51 7 2010 151 178 29,186 0.61 0.51 0.77 29 2011 159 174 29,844 0.58 0.38 0.83 61 8 2012 163 129 31,302 0.41 0.34 0.58 24 37 2013 156 152 31,434 0.48 0.42 0.61 20 37 2014 147 128 31,634 0.40 0.30 0.59 32 57 2015 149 119 34,718 0.34 0.21 0.52 46 2 # per 100 procedures


Trends






In 2015, the potential gains totalled 46 fewer superficial incisional SSIs, corresponding to a reduction by approximately one-third.

Outliers

In 2015, there was one outlier record from one outlier HCO whose combined excess was two more superficial incisional SSIs. The outlier HCO rate was 3.3 per 100 procedures.

0.0

0.2

0.4

0.6

0.8

1.0

Rate

per

100

pro

cedu

res

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate



1.4 Deep or organ / space SSI - knee prosthesis procedure (L)

Numerator Number of deep or organ / space SSI following knee prosthesis procedures performed. Denominator Number of knee prosthesis procedures performed.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 151 108 25,020 0.43 0.36 0.51 18 2009 155 97 27,289 0.36 0.31 0.43 12 2010 149 124 28,591 0.43 0.34 0.53 25 19 1 2011 155 122 29,262 0.42 0.30 0.59 35 4 2012 159 112 31,001 0.36 0.25 0.50 34 1 2013 152 121 31,443 0.38 0.28 0.51 34 28 2014 146 123 31,814 0.39 0.30 0.49 28 2 2015 148 94 34,834 0.27 0.27 0.32 # per 100 procedures


Trends






There were no potential gains in 2015.

Outliers


0.0

0.1

0.2

0.3

0.4

0.5

Rate

per

100

pro

cedu

res

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate



1.5 Superficial SSI to chest incision site – CABG (L)

Numerator Number of superficial SSI (in the chest incision site) following coronary artery bypass graft (CABG) procedures performed.

Denominator Number of coronary artery bypass graft (CABG) procedures performed.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 35 84 8,057 1.04 0.55 1.50 39 9 2009 36 95 8,223 1.16 0.71 1.68 37 3 2010 37 90 7,781 1.16 0.97 1.45 15 2011 36 75 7,065 1.06 0.54 1.35 37 7 2012 34 57 6,739 0.85 0.80 0.93 3 2013 34 47 6,018 0.78 0.59 0.95 12 2014 35 72 6,199 1.16 0.81 1.60 22 3 2015 38 67 6,328 1.06 0.66 1.60 25 5 # per 100 procedures


Trends

There was no significant trend in the fitted rate.





In 2015, the potential gains totalled 25 fewer superficial incisional SSIs, corresponding to a reduction by approximately one-third.

Outliers

In 2015, there were two outlier records from two outlier HCOs whose combined excess was five more superficial incisional SSIs. The outlier HCO rate was 5.6 per 100 procedures.

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

Rate

per

100

pro

cedu

res

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate



Funnel plot of excess events

-6

-4

-2

0

2

4

6Ex

cess

0 10 20 30 40 50 60 70

Largest Denominator size Smallest



1.6 Deep or organ / space SSI to chest incision site – CABG (L)

Numerator Number of deep or organ / space SSI (in the chest incision site) following coronary artery bypass graft (CABG) procedures performed.



Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 32 59 7,678 0.77 0.54 1.07 18 2009 36 70 8,160 0.86 0.58 1.26 23 3 2010 37 87 7,624 1.14 0.72 1.55 32 2 2011 36 61 7,065 0.86 0.83 0.89 3 2012 34 58 6,727 0.86 0.82 0.89 3 2013 34 54 6,138 0.88 0.81 1.08 4 2014 36 54 6,454 0.84 0.67 1.01 11 1 2015 39 54 6,610 0.82 0.76 1.00 4 # per 100 procedures


Trends






There was relatively little variation between HCOs and so the potential gains were small in 2015.

Outliers


0.0

0.2

0.4

0.6

0.8

1.0

1.2

Rate

per

100

pro

cedu

res

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate



1.7 Superficial SSI – LSCS (L)

Numerator Number of superficial SSI following lower segment caesarean section procedures (LSCS) performed.

Denominator Number of lower segment caesarean section procedures performed.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 98 317 36,147 0.88 0.34 1.53 194 111 57 2009 98 309 37,707 0.82 0.33 1.41 183 88 62 2010 99 301 37,914 0.79 0.29 1.40 192 56 2011 98 253 37,396 0.68 0.37 1.07 114 56 19 2012 100 194 38,581 0.50 0.33 0.66 68 64 8 2013 90 231 37,498 0.62 0.33 1.00 107 31 16 2014 73 120 17,314 0.69 0.21 0.98 84 35 2015 83 217 36,744 0.59 0.27 0.99 119 61 31 # per 100 procedures


Trends



0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

Rate

per

100

pro

cedu

res

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate



Variation between strata Rates by Public / Private

Year Stratum No.

HCOs Total

numerator Total

denominator Stratum

rate# Standard

error Stratum

gains 2015 Private 47 88 24,789 0.43 0.060 Public 36 129 11,955 0.93 0.086 61 # per 100 procedures

Boxplot of Rates by Public / Private


In 2015, the potential gains totalled 119 fewer superficial incisional SSIs, corresponding to a reduction by approximately one-half.

Outliers

In 2015, there were seven outlier records from six outlier HCOs whose combined excess was 31 more superficial incisional SSIs. The outlier HCO rate was 3.7 per 100 procedures.


0

1

2

3

4

5

6

7

8

9

Rate

per

100

pro

cedu

res

Private Public

-10

-8

-6

-4

-2

0

2

4

6

8

10

Exce

ss

0 25 50 75 100 125 150




1.8 Deep or organ / space SSI – LSCS (L)

Numerator Number of deep or organ / space SSI following lower segment caesarean section (LSCS) procedures performed.

Denominator Number of lower segment caesarean section (LSCS) procedures performed.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 95 67 35,148 0.19 0.070 0.22 42 19 2009 96 50 37,840 0.13 0.065 0.15 25 8 2010 97 66 39,056 0.17 0.081 0.25 34 7 2011 99 86 39,344 0.22 0.082 0.25 54 32 22 2012 100 62 39,750 0.16 0.097 0.15 24 8 4 2013 90 60 38,896 0.15 0.080 0.21 29 12 7 2014 74 29 17,752 0.16 0.055 0.22 19 6 2015 82 46 36,595 0.13 0.083 0.13 16 9 3 # per 100 procedures


Trends



0.00

0.05

0.10

0.15

0.20

0.25

Rate

per

100

pro

cedu

res

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate




Year Stratum No.

HCOs Total

numerator Total

denominator Stratum

rate# Standard

error Stratum

gains 2015 Private 47 19 24,746 0.10 0.010 Public 35 27 11,849 0.18 0.014 9 # per 100 procedures



In 2015, the potential gains totalled 16 fewer deep incisional / organ space SSIs, corresponding to a reduction by approximately one-third.

Outliers

In 2015, there were two outlier records from two outlier HCOs whose combined excess was three more deep incisional / organ space SSIs. The outlier HCO rate was 1.3 per 100 procedures.


0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Rate

per

100

pro

cedu

res

Private Public

-4

-2

0

2

4

Exce

ss

0 25 50 75 100 125 150




Surgical antibiotic prophylaxis (SAP)

2.1 Timing of SAP for the hip prosthesis procedure (H)

Rationale

These clinical indicators were derived as they complement the surveillance of surgical site infections (SSIs) and are a fundamental component of any antimicrobial stewardship program aimed at guiding the appropriate use of SAP. There is also strong evidence in the literature that suggests that SAP is effective in reducing the risk of SSIs. Numerator Number of patients who received surgical antibiotic prophylaxis (SAP) within 1 hour prior to

induction for the hip prosthesis procedure. Denominator Number of hip prosthesis procedures performed.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 8 384 403 95.3 95.2 98.0 11 7 2015 26 2,519 2,743 91.8 90.6 99.4 207 112 # per 100 procedures





In 2015, the potential gains totalled 207 more patients who receive surgical antibiotic prophylaxis within one hour prior to induction.

Outliers

In 2015, there were four outlier records from four outlier HCOs whose combined excess was 112 fewer patients who receive surgical antibiotic prophylaxis within one hour prior to induction. The outlier HCO rate was 59.9 per 100 procedures.


-40

-30

-20

-10

0

10

20

30

40

Exce

ss

0 5 10 15 20 25 30 35 40




2.2 Correct SAP and dose for the hip prosthesis procedure (H)

Numerator Number of patients who received the correct surgical antibiotic prophylaxis (SAP) and dose for the hip prosthesis procedure.

Denominator Number of hip prosthesis procedures performed.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 8 333 403 82.6 80.4 98.3 63 31 2015 25 2,180 2,680 81.3 73.2 97.1 423 183 # per 100 procedures





In 2015, the potential gains totalled 423 more patients who receive the correct surgical antibiotic prophylaxis and dose.

Outliers

In 2015, there were seven outlier records from six outlier HCOs whose combined excess was 183 fewer patients who receive the correct surgical antibiotic prophylaxis and dose. The outlier HCO rate was 40.6 per 100 procedures.


-60

-40

-20

0

20

40

60

Exce

ss

0 5 10 15 20 25 30 35 40




2.3 Discontinuation of SAP within 24 hours of the hip prosthesis procedure (H)

Numerator Number of patients whose surgical antibiotic prophylaxis (SAP) was discontinued within 24 hours following the completion of the hip prosthesis procedure.

Denominator Number of hip prosthesis procedures performed.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 7 242 356 68.0 79.7 96.7 102 51 2015 23 1,885 2,435 77.4 62.2 95.6 444 150 231 # per 100 procedures


Variation between strata Rates by State

Year Stratum No.

HCOs Total

numerator Total

denominator Stratum

rate# Standard

error Stratum

gains 2015 NSW 9 496 778 64.3 5.82 150 Other 14 1,389 1,657 83.6 3.99 # per 100 procedures

Boxplot of Rates by State


In 2015, the potential gains totalled 444 more patients whose surgical antibiotic prophylaxis is discontinued within 24 hours.

Outliers

In 2015, there were eight outlier records from six outlier HCOs whose combined excess was 231 fewer patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. The outlier HCO rate was 48.1 per 100 procedures.

20

30

40

50

60

70

80

90

100

Rate

per

100

pro

cedu

res

“Other” NSW




-60

-40

-20

0

20

40

60Ex

cess

0 5 10 15 20 25 30 35




2.4 Timing of SAP for the knee prosthesis procedure (H)

Numerator Number of patients who received surgical antibiotic prophylaxis (SAP) within 1 hour prior to induction for the knee prosthesis procedure.

Denominator Number of knee prosthesis procedures performed.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 8 513 524 97.9 97.6 99.5 8 4 2015 22 3,213 3,377 95.1 93.2 99.5 147 59 # per 100 procedures






Outliers

In 2015, there were two outlier records from two outlier HCOs whose combined excess was 59 fewer patients who receive surgical antibiotic prophylaxis within one hour prior to induction. The outlier HCO rate was 67.0 per 100 procedures.


-60

-40

-20

0

20

40

60

Exce

ss

0 5 10 15 20 25 30 35




2.5 Correct SAP and dose for the knee prosthesis procedure (H)

Numerator Number of patients who received the correct surgical antibiotic prophylaxis (SAP) and dose for the knee prosthesis procedure.



Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 8 442 524 84.4 62.6 99.4 79 44 2015 21 2,623 3,000 87.4 80.8 96.7 278 84 # per 100 procedures






Outliers

In 2015, there were four outlier records from three outlier HCOs whose combined excess was 84 fewer patients who receive the correct surgical antibiotic prophylaxis and dose. The outlier HCO rate was 58.1 per 100 procedures.


-40

-30

-20

-10

0

10

20

30

40

Exce

ss

0 5 10 15 20 25 30 35




2.6 Discontinuation of SAP within 24 hours of the knee prosthesis procedure (H)

Numerator Number of patients whose surgical antibiotic prophylaxis (SAP) was discontinued within 24 hours following the completion of the knee prosthesis procedure.



Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 7 299 430 69.5 54.6 98.3 124 50 2015 20 2,345 2,822 83.1 66.4 97.7 411 213 213 # per 100 procedures


Variation between strata Rates by Metro / Non-metro

Year Stratum No.

HCOs Total

numerator Total

denominator Stratum

rate# Standard

error Stratum

gains 2015 Metropolitan 13 1,176 1,536 76.8 4.21 213 Non-Metro 7 1,169 1,286 90.7 4.60 # per 100 procedures

Boxplot of rates by Metro / Non-metro



Outliers

In 2015, there were eight outlier records from six outlier HCOs whose combined excess was 213 fewer patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. The outlier HCO rate was 58.3 per 100 procedures.

20

30

40

50

60

70

80

90

100

Rate

per

100

pro

cedu

res

Metropolitan Non-Metro




-80

-60

-40

-20

0

20

40

60

80Ex

cess

0 5 10 15 20 25 30




2.7 Timing of SAP for the CABG procedure (H)

Numerator Number of patients who received surgical antibiotic prophylaxis (SAP) within 1 hour prior to induction for the coronary artery bypass graft (CABG) procedure.



Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 1 32 32 100 100 100 2015 6 581 653 89.0 88.9 96.8 51 26 # per 100 procedures

In 2015, there were 10 records from six HCOs. The annual rate was 89.0 per 100 procedures.





Outliers

In 2015, there was one outlier record from one outlier HCO whose combined excess was 26 fewer patients who receive surgical antibiotic prophylaxis within one hour prior to induction. The outlier HCO rate was 34.0 per 100 procedures.



2.8 Correct SAP and dose for the CABG procedure (H)

Numerator Number of patients who received the correct surgical antibiotic prophylaxis (SAP) and dose for the coronary artery bypass graft (CABG) procedure.



Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 1 26 32 81.3 81.3 81.3 2015 4 356 393 90.6 87.2 98.1 29 # per 100 procedures

In 2015, there were six records from four HCOs. The annual rate was 90.6 per 100 procedures.





Outliers




2.9 Discontinuation of SAP within 24 hours of the CABG procedure (H)

Numerator Number of patients whose surgical antibiotic prophylaxis (SAP) was discontinued within 24 hours following the completion of the coronary artery bypass graft (CABG) procedure.



Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 1 7 32 21.9 21.9 21.9 2015 5 290 422 68.7 52.0 93.1 103 25 # per 100 procedures

In 2015, there were eight records from five HCOs. The annual rate was 68.7 per 100 procedures.





Outliers

In 2015, there was one outlier record from one outlier HCO whose combined excess was 25 fewer patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. The outlier HCO rate was 43.8 per 100 procedures.



2.10 Timing of SAP for the LSCS procedure (H)

Numerator Number of patients who received surgical antibiotic prophylaxis (SAP) within 1 hour prior to induction for the lower segment caesarean (LSCS) procedure.



Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 3 545 600 90.8 70.3 99.9 54 34 2015 12 3,268 3,806 85.9 77.8 96.8 418 115 # per 100 procedures






Outliers

In 2015, there were two outlier records from two outlier HCOs whose combined excess was 115 fewer patients who receive surgical antibiotic prophylaxis within one hour prior to induction. The outlier HCO rate was 66.2 per 100 procedures.


-100

-80

-60

-40

-20

0

20

40

60

80

100

Exce

ss

0 2 4 6 8 10 12 14 16 18




2.11 Correct SAP and dose for the LSCS procedure (H)

Numerator Number of patients who received the correct surgical antibiotic prophylaxis (SAP) and dose for the lower segment caesarean section (LSCS) procedure.



Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 3 500 600 83.3 47.8 99.2 95 59 2015 10 2,618 3,380 77.5 67.1 91.3 467 120 # per 100 procedures






Outliers

In 2015, there were four outlier records from four outlier HCOs whose combined excess was 120 fewer patients who receive the correct surgical antibiotic prophylaxis and dose. The outlier HCO rate was 63.5 per 100 procedures.


-60

-40

-20

0

20

40

60

Exce

ss

0 2 4 6 8 10 12 14 16




2.12 Discontinuation of SAP within 24 hours of the LSCS procedure (H)

Numerator Number of patients whose surgical antibiotic prophylaxis (SAP) was discontinued within 24 hours following the completion of the lower segment caesarean section (LSCS) procedure.



Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 3 594 600 99.0 99.0 99.0 2015 12 3,078 3,624 84.9 81.1 99.8 540 239 # per 100 procedures






Outliers

In 2015, there were two outlier records from one outlier HCO whose combined excess was 239 fewer patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. The outlier HCO rate was 53.2 per 100 procedures.


-200

-150

-100

-50

0

50

100

150

200

Exce

ss

0 2 4 6 8 10 12 14 16 18




Haemodialysis access-associated bloodstream infection surveillance

3.1 Haemodialysis - AV-fistula access-associated BSI (L)

Rationale

Haemodialysis access-associated bloodstream infections (BSIs) cause considerable morbidity. A proportion of infections are potentially preventable through adherence to appropriate standards of care and the avoidance where possible of devices that have more frequent occurrence of infection. Numerator Number of AV-fistula access-associated bloodstream infections. Denominator Number of patient-months for patients dialysed through AV-fistula.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 25 29 14,531 0.20 0.17 0.27 5 9 2009 25 25 9,588 0.26 0.18 0.31 8 7 2010 26 20 12,264 0.16 0.10 0.16 7 9 4 2011 23 21 12,014 0.17 0.090 0.13 10 11 8 2012 21 5 25,509 0.020 0.020 0.020 2013 20 4 11,510 0.035 0.034 0.037 2014 22 5 19,337 0.026 0.026 0.026 2015 23 12 17,724 0.068 0.068 0.068 # per 100 patient-months

In 2015, there were 40 records from 23 HCOs. The annual rate was 0.068 per 100 patient-months.

Trends

The fitted rate improved from 0.24 to 0.031, a change of 0.21 per 100 patient-months. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 0.21 per 100 patient-months.




0.00

0.05

0.10

0.15

0.20

0.25

0.30

Rate

per

100

pat

ient

-mon

ths

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate





Outliers




3.2 Haemodialysis - synthetic and native vessel graft access-associated BSI (L)

Numerator Number of synthetic and native vessel graft access-associated bloodstream infections. Denominator Number of patient-months for patients dialysed through synthetic and native vessel grafts.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 15 2 964 0.21 0.21 0.21 2015 20 8 1,399 0.57 0.56 0.56 # per 100 patient-months






Outliers




3.3 Haemodialysis - CI non-cuffed line access-associated BSI (L)

Numerator Number of centrally inserted non-cuffed line access-associated bloodstream infections. Denominator Number of patient-months for patients dialysed through centrally inserted non-cuffed line.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 9 19 333 5.71 4.02 6.13 6 2009 11 5 1,413 0.35 0.35 0.35 2010 14 5 259 1.93 1.93 1.94 2011 12 10 178 5.62 2.34 4.98 6 6 2012 13 2 354 0.57 0.57 0.57 2013 12 1 168 0.60 0.60 0.60 2014 9 0 62 0 0 0 2015 12 7 270 2.59 2.11 3.12 1 # per 100 patient-months


Trends







Outliers


0

1

2

3

4

5

6

7

8

9

Rate

per

100

pat

ient

-mon

ths

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate



3.4 Haemodialysis - CI cuffed line access-associated BSI (L)

Numerator Number of centrally inserted cuffed line access-associated bloodstream infections. Denominator Number of patient-months for patients dialysed through centrally inserted cuffed line.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 23 107 4,435 2.41 1.17 3.57 55 8 2009 25 67 3,902 1.72 1.53 2.33 7 2010 24 97 4,259 2.28 0.98 3.70 55 43 26 2011 24 48 4,052 1.18 1.17 1.30 3 2012 22 42 5,615 0.75 0.26 2.15 28 26 10 2013 20 34 3,585 0.95 0.60 1.81 13 2014 17 27 2,035 1.33 1.33 1.33 2015 22 58 3,104 1.87 0.60 2.82 39 37 3 # per 100 patient-months


Trends

The fitted rate improved from 2.1 to 1.0, a change of 1.0 per 100 patient-months. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 1.1 per 100 patient-months.


0.0

0.5

1.0

1.5

2.0

2.5

3.0

Rate

per

100

pat

ient

-mon

ths

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate



Variation between strata Rates by State

Year Stratum No.

HCOs Total

numerator Total

denominator Stratum

rate# Standard

error Stratum

gains 2015 NSW 13 55 2,309 2.28 0.29 37 Other 9 3 795 0.67 0.49 # per 100 patient-months

Boxplot of Rates by State


In 2015, the potential gains totalled 39 fewer bloodstream infections, corresponding to a reduction by approximately two-thirds.

Outliers

In 2015, there was one outlier record from one outlier HCO whose combined excess was three more bloodstream infections. The outlier HCO rate was 9.8 per 100 patient-months.

0

1

2

3

4

5

6

7

8

9

Rate

per

100

pat

ient

-mon

ths

“Other” NSW



Vancomycin Resistant Enterococci (VRE)

4.1 VRE infection within the ICU (L)

Rationale

According to the Australian Group on Antimicrobial Resistance (AGAR), the prevalence of VRE infection is rising in Australia. These healthcare-associated infections (HAIs) are commonly seen in high risk areas such as intensive care units, haematology and oncology units and dialysis centres. Numerator Number of ICU associated new vancomycin resistant enterococci (VRE) healthcare-

associated infections. Denominator Number of ICU bed days.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 35 10 69,028 1.45 1.45 1.45 2015 45 49 138,896 3.53 0.52 3.63 42 25 # per 10,000 bed days

In 2015, there were 79 records from 45 HCOs. The annual rate was 3.53 per 10,000 bed days.




In 2015, the potential gains totalled 42 fewer new VRE healthcare-associated infections, corresponding to a reduction by approximately four-fifths.

Outliers

In 2015, there were four outlier records from four outlier HCOs whose combined excess was 25 more new VRE healthcare-associated infections. The outlier HCO rate was 65.1 per 10,000 bed days.


-15

-12

-9

-6

-3

0

3

6

9

12

15

Exce

ss

0 10 20 30 40 50 60 70 80




4.2 VRE infection within non-ICU areas (L)

Numerator Number of non-ICU associated new vancomycin resistant enterococci (VRE) healthcare-associated infections.

Denominator Number of non-ICU bed days.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2014 56 32 1,904,512 0.17 0.088 0.16 15 6 2015 84 128 4,068,442 0.31 0.074 0.29 98 49 # per 10,000 bed days

In 2015, there were 144 records from 84 HCOs. The annual rate was 0.31 per 10,000 bed days.




In 2015, the potential gains totalled 98 fewer new VRE healthcare-associated infections, corresponding to a reduction by approximately three-quarters.

Outliers

In 2015, there were seven outlier records from seven outlier HCOs whose combined excess was 49 more new VRE healthcare-associated infections. The outlier HCO rate was 1.9 per 10,000 bed days.


-15

-12

-9

-6

-3

0

3

6

9

12

15

Exce

ss

0 25 50 75 100 125 150




Staff Immunisation

5.1 Flu vaccination for permanent staff (H)

Rationale

Immunising staff against vaccine-preventable diseases such as influenza and hepatitis B will result in lower morbidity and mortality rates among patients and reduced absenteeism from healthcare workers. Healthcare organisations (HCOs) are encouraged to formulate a comprehensive immunisation policy for all healthcare workers. Numerator Number of permanent healthcare employees that received a flu vaccination. Denominator Number of permanent healthcare employees.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2015 53 13,385 24,285 55.1 30.1 78.6 5,712 2,414 # per 100 permanent healthcare employees

In 2015, there were 74 records from 53 HCOs. The annual rate was 55.1 per 100 permanent healthcare employees.


There were no significant stratum differences in 2015.


In 2015, the potential gains totalled 5,712 more permanent healthcare employees who receive a flu vaccination.

Outliers

In 2015, there were 16 outlier records from 15 outlier HCOs whose combined excess was 2,414 fewer permanent healthcare employees who receive a flu vaccination. The outlier HCO rate was 19.9 per 100 permanent healthcare employees.


-800

-600

-400

-200

0

200

400

600

800

Exce

ss

0 10 20 30 40 50 60 70




5.2 Hepatitis B vaccination for permanent staff (H)

Numerator Number of permanent Category A healthcare employees that have an up to date pathology result indicating serological immunity or evidence of vaccination for Hepatitis B.

Denominator Number of permanent Category A healthcare employees.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2015 28 9,713 13,272 73.2 51.6 94.2 2,790 1,280 # per 100 permanent Category A healthcare employees

In 2015, there were 41 records from 28 HCOs. The annual rate was 73.2 per 100 permanent Category A healthcare employees.


There were no significant stratum differences in 2015.


In 2015, the potential gains totalled 2,790 more permanent Category A healthcare employees vaccinated for Hepatitis B.

Outliers

In 2015, there were 13 outlier records from 10 outlier HCOs whose combined excess was 1,280 fewer permanent Category A healthcare employees vaccinated for Hepatitis B. The outlier HCO rate was 48.8 per 100 permanent category a healthcare employees.


-400

-300

-200

-100

0

100

200

300

400

Exce

ss

0 5 10 15 20 25 30 35 40




Occupational exposures to blood and/or body fluids

6.1 Reported parenteral exposures sustained by staff (L)

Rationale

An occupational exposure as defined below may put the injured person at risk of acquiring a blood borne viral infection. International reports suggest that determining the magnitude of the occupational exposure is the first step in developing local programs and strategies designed to reduce this risk. Organisations are encouraged to collect additional data relating to the injury, such as the type of injury, the activity surrounding the injury and any factors relating to devices, equipment or human behaviour which may have contributed to the exposure. Numerator Number of reported parenteral exposures sustained by staff. Denominator Number of occupied bed days.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 232 3,362 8,464,475 0.040 0.027 0.049 1,082 453 302 2009 248 3,282 9,141,719 0.036 0.022 0.042 1,248 329 238 2010 232 3,661 9,322,236 0.039 0.026 0.047 1,270 382 279 2011 246 3,449 9,308,636 0.037 0.024 0.045 1,173 599 317 2012 261 3,625 10,340,148 0.035 0.021 0.043 1,449 639 290 2013 366 4,535 13,218,078 0.034 0.020 0.037 1,913 1,400 343 2014 371 4,410 13,088,876 0.034 0.019 0.040 1,882 371 2015 347 6,433 11,831,652 0.054 0.009 0.050 5,415 2,625 # per 100 bed days

In 2015, there were 634 records from 347 HCOs. The annual rate was 0.054 per 100 bed days.

Trends

The fitted rate deteriorated from 0.035 to 0.042, a change of 0.007 per 100 bed days.




0.00

0.01

0.02

0.03

0.04

0.05

Rate

per

100

bed

day

s

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate




In 2015, the potential gains totalled 5,415 fewer reported parenteral exposures, corresponding to a reduction by approximately four-fifths.

Outliers

In 2015, there were seven outlier records from five outlier HCOs whose combined excess was 2,625 more reported parenteral exposures. The outlier HCO rate was 7.3 per 100 bed days.


-3000

-2000

-1000

0

1000

2000

3000

Exce

ss

0 50 100 150 250 350 450 550 650




6.2 Reported non-parenteral exposures sustained by staff (L)

Numerator Number of reported non-parenteral exposures sustained by staff. Denominator Number of occupied bed days.


Year No.

HCOs Total

numerator Total


Rate# (80)

Centile Gains

Stratum Gains

Outlier Gains

2008 222 1,268 8,355,167 0.015 0.009 0.016 479 83 2009 238 1,228 9,076,198 0.014 0.008 0.014 488 131 2010 223 1,263 9,225,397 0.014 0.008 0.015 538 127 2011 239 1,478 9,146,346 0.016 0.008 0.015 749 293 2012 256 1,395 10,247,216 0.014 0.006 0.014 745 517 232 2013 362 1,767 13,130,031 0.013 0.008 0.013 755 215 2014 365 1,592 12,693,584 0.013 0.007 0.012 729 194 2015 338 1,361 11,491,394 0.012 0.006 0.014 703 390 107 # per 100 bed days

In 2015, there were 616 records from 338 HCOs. The annual rate was 0.012 per 100 bed days.

Trends

The fitted rate improved from 0.015 to 0.012, a change of 0.003 per 100 bed days. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 0.002 per 100 bed days.


0.000

0.002

0.004

0.006

0.008

0.010

0.012

0.014

0.016

0.018

Rate

per

100

bed

day

s

2008 2009 2010 2011 2012 2013 2014 2015

Year


80th centile rate

20th centile rate

Fitted rate

Aggregate rate x

Period average rate




Year Stratum No.

HCOs Total

numerator Total

denominator Stratum

rate# Standard

error Stratum

gains 2015 Private 126 326 4,148,700 0.008 0.0005 Public 212 1,035 7,342,694 0.014 0.0004 390 # per 100 bed days



In 2015, the potential gains totalled 703 fewer reported non-parenteral exposures, corresponding to a reduction by approximately one-half.

Outliers

In 2015, there were 12 outlier records from 11 outlier HCOs whose combined excess was 107 more reported non-parenteral exposures. The outlier HCO rate was 0.041 per 100 bed days.


0.0

0.0

0.0

0.1

0.1

0.1

0.1

0.1

Rate

per

100

bed

day

s

Private Public

-25

-20

-15

-10

-5

0

5

10

15

20

25

Exce

ss

0 50 100 150 200 250 300 350 400 450 500 550 600




Characteristics of contributing HCOs Public/ Private and Metropolitan/ Non-metro total denominators and number of HCOs by clinical indicator

All indicators Combined Public % Private % Metropolitan % Non-metro % Total

Infection Control Indicators Combined HCOs 234 58% 167 42% 219 55% 182 45% 401

Indicators by Topic

Infection surveillance

Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 1.1 Superficial SSI - hip prosthesis procedure (L) HCOs 47 32% 102 68% 111 74% 38 26% 149

Denominator 5,131 21% 19,057 79% 20,603 85% 3,585 15% 24,188 1.2 Deep or organ / space SSI - hip prosthesis procedure (L)

HCOs 45 30% 104 70% 111 74% 38 26% 149 Denominator 5,022 20% 19,593 80% 20,916 85% 3,699 15% 24,615

1.3 Superficial SSI - knee prosthesis procedure (L) HCOs 48 32% 101 68% 110 74% 39 26% 149 Denominator 5,986 17% 28,732 83% 28,473 82% 6,245 18% 34,718

1.4 Deep or organ / space SSI - knee prosthesis procedure (L)

HCOs 46 31% 102 69% 110 74% 38 26% 148 Denominator 5,814 17% 29,020 83% 28,475 82% 6,359 18% 34,834

1.5 Superficial SSI to chest incision site - CABG (L) HCOs 7 18% 31 82% 36 95% 2 5% 38 Denominator 1,899 30% 4,429 70% 6,172 98% 156 2% 6,328

1.6 Deep or organ / space SSI to chest incision site - CABG (L)

HCOs 7 18% 32 82% 37 95% 2 5% 39 Denominator 1,899 29% 4,711 71% 6,454 98% 156 2% 6,610

1.7 Superficial SSI - LSCS (L) HCOs 36 43% 47 57% 57 69% 26 31% 83 Denominator 11,955 33% 24,789 67% 32,167 88% 4,577 12% 36,744

1.8 Deep or organ / space SSI - LSCS (L) HCOs 35 43% 47 57% 57 70% 25 30% 82 Denominator 11,849 32% 24,746 68% 32,124 88% 4,471 12% 36,595



Surgical antibiotic prophylaxis (SAP)

Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 2.1 Timing of SAP for the hip prosthesis procedure (H) HCOs 6 23% 20 77% 19 73% 7 27% 26

Denominator 639 23% 2,104 77% 2,335 85% 408 15% 2,743 2.2 Correct SAP and dose for the hip prosthesis procedure (H)

HCOs 6 24% 19 76% 16 64% 9 36% 25 Denominator 639 24% 2,041 76% 1,904 71% 776 29% 2,680

2.3 Discontinuation of SAP within 24 hours of the hip prosthesis procedure (H)

HCOs 5 22% 18 78% 16 70% 7 30% 23 Denominator 549 23% 1,886 77% 1,772 73% 663 27% 2,435

2.4 Timing of SAP for the knee prosthesis procedure (H) HCOs 6 27% 16 73% 16 73% 6 27% 22 Denominator 476 14% 2,901 86% 2,506 74% 871 26% 3,377

2.5 Correct SAP and dose for the knee prosthesis procedure (H)

HCOs 6 29% 15 71% 12 57% 9 43% 21 Denominator 476 16% 2,524 84% 1,409 47% 1,591 53% 3,000

2.6 Discontinuation of SAP within 24 hours of the knee prosthesis procedure (H)

HCOs 5 25% 15 75% 13 65% 7 35% 20 Denominator 401 14% 2,421 86% 1,536 54% 1,286 46% 2,822

2.7 Timing of SAP for the CABG procedure (H) HCOs 1 17% 5 83% 6 100% - 0% 6 Denominator 215 33% 438 67% 653 100% - 0% 653

2.8 Correct SAP and dose for the CABG procedure (H) HCOs 1 25% 3 75% 4 100% - 0% 4 Denominator 215 55% 178 45% 393 100% - 0% 393

2.9 Discontinuation of SAP within 24 hours of the CABG procedure (H)

HCOs 1 20% 4 80% 5 100% - 0% 5 Denominator 215 51% 207 49% 422 100% - 0% 422

2.10 Timing of SAP for the LSCS procedure (H) HCOs 5 42% 7 58% 9 75% 3 25% 12 Denominator 1,373 36% 2,433 64% 3,188 84% 618 16% 3,806

2.11 Correct SAP and dose for the LSCS procedure (H) HCOs 4 40% 6 60% 7 70% 3 30% 10 Denominator 1,318 39% 2,062 61% 2,762 82% 618 18% 3,380

2.12 Discontinuation of SAP within 24 hours of the LSCS procedure (H)




Haemodialysis access-associated bloodstream infection surveillance

Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 3.1 Haemodialysis - AV-fistula access-associated BSI (L) HCOs 17 74% 6 26% 11 48% 12 52% 23

Denominator 7,883 44% 9,841 56% 13,487 76% 4,237 24% 17,724 3.2 Haemodialysis - synthetic and native vessel graft access-associated BSI (L)

HCOs 15 75% 5 25% 10 50% 10 50% 20 Denominator 769 55% 630 45% 972 69% 427 31% 1,399

3.3 Haemodialysis - CI non-cuffed line access-associated BSI (L)

HCOs 11 92% 1 8% 7 58% 5 42% 12 Denominator 267 99% 3 1% 241 89% 29 11% 270

3.4 Haemodialysis - CI cuffed line access-associated BSI (L)


Vancomycin Resistant Enterococci (VRE)

Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 4.1 VRE infection within the ICU (L) HCOs 22 49% 23 51% 37 82% 8 18% 45

Denominator 81,444 59% 57,452 41% 122,427 88% 16,469 12% 138,896 4.2 VRE infection within non-ICU areas (L) HCOs 44 52% 40 48% 60 71% 24 29% 84

Denominator 2,356,698 58% 1,711,744 42% 3,468,189 85% 600,253 15% 4,068,442

Staff Immunisation

Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 5.1 Flu vaccination for permanent staff (H) HCOs 17 32% 36 68% 37 70% 16 30% 53

Denominator 13,140 54% 11,145 46% 19,596 81% 4,689 19% 24,285 5.2 Hepatitis B vaccination for permanent staff (H) HCOs 4 14% 24 86% 23 82% 5 18% 28

Denominator 4,233 32% 9,039 68% 11,633 88% 1,639 12% 13,272



Occupational exposures to blood and/or body fluids

Clinical Indicator Public % Private % Metropolitan % Non-metro % Total 6.1 Reported parenteral exposures sustained by staff (L) HCOs 216 62% 131 38% 173 50% 174 50% 347

Denominator 7,523,806 64% 4,307,846 36% 9,063,247 77% 2,768,405 23% 11,831,652 6.2 Reported non-parenteral exposures sustained by staff (L)

HCOs 212 63% 126 37% 170 50% 168 50% 338 Denominator 7,342,694 64% 4,148,700 36% 8,863,589 77% 2,627,805 23% 11,491,394



Summary of Results

Infection surveillance 1.1 Superficial SSI - hip prosthesis procedure (L) In 2015, there were 24,188 procedures reported from 149 HCOs. The annual rate was 0.45 per 100 procedures. The fitted rate improved from 0.90 to 0.42, a change of 0.48 per 100 procedures. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 0.47 per 100 procedures. In 2015, the potential gains totalled 21 fewer superficial incisional SSIs, corresponding to a reduction by approximately one-tenth.

1.2 Deep or organ / space SSI - hip prosthesis procedure (L) In 2015, there were 24,615 procedures reported from 149 HCOs. The annual rate was 0.58 per 100 procedures. The fitted rate improved from 0.72 to 0.60, a change of 0.12 per 100 procedures. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 0.12 per 100 procedures. In 2015, the potential gains totalled 25 fewer deep incisional / organ space SSIs, corresponding to a reduction by approximately one-tenth.

1.3 Superficial SSI - knee prosthesis procedure (L) In 2015, there were 34,718 procedures reported from 149 HCOs. The annual rate was 0.34 per 100 procedures. The fitted rate improved from 0.74 to 0.35, a change of 0.39 per 100 procedures. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 0.38 per 100 procedures. In 2015, the potential gains totalled 46 fewer superficial incisional SSIs, corresponding to a reduction by approximately one-third. There was one outlier record from one outlier HCO whose combined excess was two more superficial incisional SSIs. The outlier HCO rate was 3.3 per 100 procedures.

1.4 Deep or organ / space SSI - knee prosthesis procedure (L) In 2015, there were 34,834 procedures reported from 148 HCOs. The annual rate was 0.27 per 100 procedures. The fitted rate improved from 0.43 to 0.33, a change of 0.10 per 100 procedures. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 0.093 per 100 procedures. There were no potential gains in 2015.

1.5 Superficial SSI to chest incision site - CABG (L) In 2015, there were 6,328 procedures reported from 38 HCOs. The annual rate was 1.06 per 100 procedures. There was no significant trend in the fitted rate. In 2015, the potential gains totalled 25 fewer superficial incisional SSIs, corresponding to a reduction by approximately one-third. There were two outlier records from two outlier HCOs whose combined excess was five more superficial incisional SSIs. The outlier HCO rate was 5.6 per 100 procedures.

1.6 Deep or organ / space SSI to chest incision site - CABG (L) In 2015, there were 6,610 procedures reported from 39 HCOs. The annual rate was 0.82 per 100 procedures. There was no significant trend in the fitted rate. There was relatively little variation between HCOs and so the potential gains were small in 2015.

1.7 Superficial SSI - LSCS (L) In 2015, there were 36,744 procedures reported from 83 HCOs. The annual rate was 0.59 per 100 procedures. The fitted rate improved from 0.85 to 0.54, a change of 0.31 per 100 procedures. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 0.28 per 100 procedures. In 2015, the potential gains totalled 119 fewer superficial incisional SSIs, corresponding to a reduction by approximately one-half. There were seven outlier records from six outlier HCOs whose combined excess was 31 more superficial incisional SSIs. The outlier HCO rate was 3.7 per 100 procedures.

1.8 Deep or organ / space SSI - LSCS (L) In 2015, there were 36,595 procedures reported from 82 HCOs. The annual rate was 0.13 per 100 procedures. There was no significant trend in the fitted rate. In 2015, the potential gains totalled 16 fewer deep incisional / organ space SSIs, corresponding to a reduction by approximately one-third. There were two outlier records from two outlier HCOs whose combined excess was three more deep incisional / organ space SSIs. The outlier HCO rate was 1.3 per 100 procedures.

Surgical antibiotic prophylaxis (SAP) 2.1 Timing of SAP for the hip prosthesis procedure (H) In 2015, there were 2,743 procedures reported from 26 HCOs. The annual rate was 91.8 per 100 procedures. There was no significant trend in the fitted rate. In 2015, the potential gains totalled 207 more patients who receive surgical antibiotic prophylaxis within one hour prior to induction. There were four outlier records from four



outlier HCOs whose combined excess was 112 fewer patients who receive surgical antibiotic prophylaxis within one hour prior to induction. The outlier HCO rate was 59.9 per 100 procedures.

2.2 Correct SAP and dose for the hip prosthesis procedure (H) In 2015, there were 2,680 procedures reported from 25 HCOs. In 2015, the potential gains totalled 423 more patients who receive the correct surgical antibiotic prophylaxis and dose. There were seven outlier records from six outlier HCOs whose combined excess was 183 fewer patients who receive the correct surgical antibiotic prophylaxis and dose. The outlier HCO rate was 40.6 per 100 procedures.

2.3 Discontinuation of SAP within 24 hours of the hip prosthesis procedure (H) In 2015, there were 2,435 procedures reported from 23 HCOs. The annual rate was 77.4 per 100 procedures. In 2015, the potential gains totalled 444 more patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. There were eight outlier records from six outlier HCOs whose combined excess was 231 fewer patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. The outlier HCO rate was 48.1 per 100 procedures.

2.4 Timing of SAP for the knee prosthesis procedure (H) In 2015, there were 3,377 procedures reported from 22 HCOs. The annual rate was 95.1 per 100 procedures. There was relatively little variation between HCOs and so the potential gains were small in 2015. There were two outlier records from two outlier HCOs whose combined excess was 59 fewer patients who receive surgical antibiotic prophylaxis within one hour prior to induction. The outlier HCO rate was 67.0 per 100 procedures.

2.5 Correct SAP and dose for the knee prosthesis procedure (H) In 2015, there were 3,000 procedures reported from 21 HCOs. The annual rate was 87.4 per 100 procedures. In 2015, the potential gains totalled 278 more patients who receive the correct surgical antibiotic prophylaxis and dose. There were four outlier records from three outlier HCOs whose combined excess was 84 fewer patients who receive the correct surgical antibiotic prophylaxis and dose. The outlier HCO rate was 58.1 per 100 procedures.

2.6 Discontinuation of SAP within 24 hours of the knee prosthesis procedure (H) In 2015, there were 2,822 procedures reported from 20 HCOs. The annual rate was 83.1 per 100 procedures. In 2015, the potential gains totalled 411 more patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. There were eight outlier records from six outlier HCOs whose combined excess was 213 fewer patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. The outlier HCO rate was 58.3 per 100 procedures.

2.7 Timing of SAP for the CABG procedure (H) In 2015, there were 653 procedures reported from six HCOs. The annual rate was 89.0 per 100 procedures. In 2015, the potential gains totalled 51 more patients who receive surgical antibiotic prophylaxis within one hour prior to induction. There was one outlier record from one outlier HCO whose combined excess was 26 fewer patients who receive surgical antibiotic prophylaxis within one hour prior to induction. The outlier HCO rate was 34.0 per 100 procedures.

2.8 Correct SAP and dose for the CABG procedure (H) In 2015, there were 393 procedures reported from four HCOs. The annual rate was 90.6 per 100 procedures. In 2015, the potential gains totalled 29 more patients who receive the correct surgical antibiotic prophylaxis and dose.

2.9 Discontinuation of SAP within 24 hours of the CABG procedure (H) In 2015, there were 422 procedures reported from five HCOs. The annual rate was 68.7 per 100 procedures. In 2015, the potential gains totalled 103 more patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. There was one outlier record from one outlier HCO whose combined excess was 25 fewer patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. The outlier HCO rate was 43.8 per 100 procedures.

2.10 Timing of SAP for the LSCS procedure (H) In 2015, there were 3,806 procedures reported from 12 HCOs. The annual rate was 85.9 per 100 procedures. In 2015, the potential gains totalled 418 more patients who receive surgical antibiotic prophylaxis within one hour prior to induction. There were two outlier records from two outlier HCOs whose combined excess was 115 fewer patients who receive surgical antibiotic prophylaxis within one hour prior to induction. The outlier HCO rate was 66.2 per 100 procedures.

2.11 Correct SAP and dose for the LSCS procedure (H) In 2015, there were 3,380 procedures reported from 10 HCOs. The annual rate was 77.5 per 100 procedures. In 2015, the potential gains totalled 467 more patients who receive the correct surgical antibiotic prophylaxis and



dose. There were four outlier records from four outlier HCOs whose combined excess was 120 fewer patients who receive the correct surgical antibiotic prophylaxis and dose. The outlier HCO rate was 63.5 per 100 procedures.

2.12 Discontinuation of SAP within 24 hours of the LSCS procedure (H) In 2015, there were 3,624 procedures reported from 12 HCOs. The annual rate was 84.9 per 100 procedures. In 2015, the potential gains totalled 540 more patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. There were two outlier records from one outlier HCO whose combined excess was 239 fewer patients whose surgical antibiotic prophylaxis is discontinued within 24 hours. The outlier HCO rate was 53.2 per 100 procedures.

Haemodialysis access-associated bloodstream infection surveillance 3.1 Haemodialysis - AV-fistula access-associated BSI (L) In 2015, there were 17,724 patient-months reported from 23 HCOs. The annual rate was 0.068 per 100 patient-months. The fitted rate improved from 0.24 to 0.031, a change of 0.21 per 100 patient-months. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 0.21 per 100 patient-months. There were no potential gains in 2015.

3.2 Haemodialysis - synthetic and native vessel graft access-associated BSI (L) In 2015, there were 1,399 patient-months reported from 20 HCOs. The annual rate was 0.57 per 100 patient-months. There were no potential gains in 2015.

3.3 Haemodialysis - CI non-cuffed line access-associated BSI (L) In 2015, there were 270 patient-months reported from 12 HCOs. The annual rate was 2.59 per 100 patient-months. There was no significant trend in the fitted rate. There was relatively little variation between HCOs and so the potential gains were small in 2015.

3.4 Haemodialysis - CI cuffed line access-associated BSI (L) In 2015, there were 3,104 patient-months reported from 22 HCOs. The annual rate was 1.87 per 100 patient-months. The fitted rate improved from 2.1 to 1.0, a change of 1.0 per 100 patient-months. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 1.1 per 100 patient-months. In 2015, the potential gains totalled 39 fewer bloodstream infections, corresponding to a reduction by approximately two-thirds. There was one outlier record from one outlier HCO whose combined excess was three more bloodstream infections. The outlier HCO rate was 9.8 per 100 patient-months.

Vancomycin Resistant Enterococci (VRE) 4.1 VRE infection within the ICU (L) In 2015, there were 138,896 bed-days reported from 45 HCOs. The annual rate was 3.53 per 10,000 bed-days. In 2015, the potential gains totalled 42 fewer new VRE healthcare-associated infections, corresponding to a reduction by approximately four-fifths. There were four outlier records from four outlier HCOs whose combined excess was 25 more new VRE healthcare-associated infections. The outlier HCO rate was 65.1 per 10,000 bed-days.

4.2 VRE infection within non-ICU areas (L) In 2015, there were 4,068,442 bed-days reported from 84 HCOs. The annual rate was 0.31 per 10,000 bed-days. In 2015, the potential gains totalled 98 fewer new VRE healthcare-associated infections, corresponding to a reduction by approximately three-quarters. There were seven outlier records from seven outlier HCOs whose combined excess was 49 more new VRE healthcare-associated infections. The outlier HCO rate was 1.9 per 10,000 bed-days.

Staff Immunisation 5.1 Flu vaccination for permanent staff (H) In 2015, there were 24,285 permanent healthcare employees reported from 53 HCOs. The annual rate was 55.1 per 100 permanent healthcare employees. In 2015, the potential gains totalled 5,712 more permanent healthcare employees who receive a flu vaccination. There were 16 outlier records from 15 outlier HCOs whose combined excess was 2,414 fewer permanent healthcare employees who receive a flu vaccination. The outlier HCO rate was 19.9 per 100 permanent healthcare employees.

5.2 Hepatitis B vaccination for permanent staff (H) In 2015, there were 13,272 permanent Category A healthcare employees reported from 28 HCOs. The annual rate was 73.2 per 100 permanent Category A healthcare employees. In 2015, the potential gains totalled 2,790 more permanent Category A healthcare employees vaccinated for Hepatitis B. There were 13 outlier records



from 10 outlier HCOs whose combined excess was 1,280 fewer permanent Category A healthcare employees vaccinated for Hepatitis B. The outlier HCO rate was 48.8 per 100 permanent Category A healthcare employees.

Occupational exposures to blood and/or body fluids 6.1 Reported parenteral exposures sustained by staff (L) In 2015, there were 11,831,652 bed-days reported from 347 HCOs. The annual rate was 0.054 per 100 bed-days. The fitted rate deteriorated from 0.035 to 0.042, a change of 0.007 per 100 bed-days. In 2015, the potential gains totalled 5,415 fewer reported parenteral exposures, corresponding to a reduction by approximately four-fifths. There were seven outlier records from five outlier HCOs whose combined excess was 2,625 more reported parenteral exposures. The outlier HCO rate was 7.3 per 100 bed-days.

6.2 Reported non-parenteral exposures sustained by staff (L) In 2015, there were 11,491,394 bed-days reported from 338 HCOs. The annual rate was 0.012 per 100 bed-days. The fitted rate improved from 0.015 to 0.012, a change of 0.003 per 100 bed-days. This trend was also significant after allowing for the changing composition of HCOs contributing over the period. The rate change was 0.002 per 100 bed-days. In 2015, the potential gains totalled 703 fewer reported non-parenteral exposures, corresponding to a reduction by approximately one-half. There were 12 outlier records from 11 outlier HCOs whose combined excess was 107 more reported non-parenteral exposures. The outlier HCO rate was 0.041 per 100 bed-days.



Expert Commentary Australasian College for Infection Prevention and Control (ACIPC)

Introductory comments The prevention of healthcare-associated infection (HAIs) is everybody’s business, and surveillance of HAIs is crucial to good infection prevention. HAI surveillance data is used to identify problem areas, target interventions and then ultimately measure their effect. Without reliable data, resources are potentially wasted on practices that do not provide optimal patient and healthcare worker safety. As the peak body for infection prevention and control in Australasia, the Australasian College for Infection Prevention and Control (http://www.acipc.org.au) welcomes the opportunity to provide commentary on the ACHS Clinical Indicator data for 2015.

Infection surveillance Of the eight CIs in this section, there were improvements reported in six CIs, with no obvious difference reported in deep or organ / space knee and chest infections. Of the remaining six CIs, four report superficial surgical site infection (SSI). Caution is advised when interpreting data reporting superficial SSIs as there is no valid method to identify SSI that will frequently manifest post-discharge. Deep and organ space SSI data are generally more reliable as they often result in readmission of the patient, however they may not always present at the hospital where the procedure was performed.1

Surgical antibiotic prophylaxis (SAP) Inappropriate antimicrobial use is a driver of antimicrobial resistance, and is a major area of work under the National Antimicrobial Resistance (AMR) Strategy.2 Surgical antibiotic prophylaxis is the most common reason for antibiotics to be prescribed in a hospital setting3 and recent national surveys have demonstrated areas for improvement. The data in these CI further support the need to improve prescribing practices. National work is being undertaken specific to surgical antibiotic prophylaxis by the National Centre for Antimicrobial Stewardship and the National Antimicrobial Prescribing Survey.4

Haemodialysis access-associated bloodstream infection surveillance Although for the majority of the CIs no obvious gain was demonstrated, haemodialysis patients remain a high at risk group due to their underlying illness and the frequency of medical procedures performed. Ongoing effort is required to minimise the risk of HAIs in this group.

Vancomycin Resistant Enterococci (VRE) Vancomycin Resistant Enterococci (VRE) is one of several multi-resistant organisms (MROs) of concern. The Australian Commission on Safety and Quality in Health Care (ACSQHC) is currently undertaking major work to address this issue through the Antimicrobial Use and Resistance in Australia (AURA) Project.5 The AURA project is working towards a uniform reporting process to identify trends across all MROs at a national level and will provide meaningful data to inform infection prevention policy.

Staff Immunisation Healthcare worker immunisation is a major infection prevention strategy and affects both patients and staff. All health care workers (HCWs) should be vaccinated in alignment with recommendations in The Australian Immunisation Handbook.6 These data indicated that further effort to immunise HCWs are needed.

Occupational exposures to blood and/or body fluids These data from over 300 HCOs indicate that occupational exposure to blood and body fluids remain a major concern for all HCWs despite recent advances in the safety of medical devices. Detailed data analysis is required to inform ongoing efforts to reduce the number of exposures.



General/closing comments Data from these CIs display a reduction in the reported infection outcomes and an improvement in many of the reported process CIs. Detailed analysis of the data may reveal areas where targeted interventions could be implemented. It is not possible to form any strong conclusions from these data as there are many limitations when attempting to generate national data particularly as Australia does not have a national HAI surveillance program. The College supports the ongoing work of the ACSQHC’s National Surveillance Initiative to explore options for a national surveillance system to monitor HAIs.

References

1. Tanner J, Padley W, Kiernan M et al. A benchmark too far: findings from a national survey of surgical site infection surveillance. The Journal of Hospital Infection 2013; 83(2): 87-91.

2. Department of Health. Antimicrobial resistance (AMR). Accessed from http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-amr.htm

3. Australian Commission on Safety and Quality in Health Care (ACSQHC). Antimicrobial prescribing practice in Australian hospitals: results of the 2014 National Antimicrobial Prescribing Survey. 2015.

4. National Centre for Antimicrobial Stewardship (NCAS). National Antimicrobial Prescribing Survey. Accessed from https://www.naps.org.au

5. Australian Commission on Safety and Quality in Health Care. Antimicrobial Use and Resistance in Australia Project. Accessed from http://www.safetyandquality.gov.au/national-priorities/amr-and-au-surveillance-project/

6. Department of Health. The Australian Immunisation Handbook, 10th edition. Canberra ACT; Australian Government Department of Health. Accessed from http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home

http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-amr.htm

https://www.naps.org.au/

http://www.safetyandquality.gov.au/national-priorities/amr-and-au-surveillance-project/

infection control - achs · infection control, ... 2.5 correct sap and dose for the knee prosthesis...

Documents