eBulletin July 2003 Edition 5

Past VICNISS eBulletins

Subscribe to eBulletin

In this Edition:

Phase III Commences

From July 2003 six additional hospitals will be contributing surveillance data for an expanded list of VICNISS procedures and ICU/HRN's.

Monthly Literature Review
Soon to be posted - a monthly review of the important infection control literature.

Reports
VICNISS Phase I Reports available via the VICNISS website to participating hospitals early next week.

August VICNISS User Group Meeting

Next Meeting:

DATE:	17.09.2003 - Please note date change
TIME:	1400 – 1500 ICU/HRN group 1500 – 1600 SSI group
VENUE:	St Vincent’s Hospital 11th floor conference room, Inpatient Services building Map and location details (PDF File 91kb, opens in new window)

To assist catering please confirm your attendance at the VUG with Jane Motley by 29th August.

Software Update

In conjunction with the Office of Chief Clinical Advisor (OCCA) DHS, a working group has been established to review the functional specifications for new VICNISS software. Representation from OCCA, DHS IT, Hospital IT, Infection Control Consultants and VICNISS are meeting regularly to expedite this process. In the meantime, the following will continue:

development of an in-house VICNISS aggregation database and paper forms for data collection;
provision of service to hospitals to input data (to avoid extra workload for hospitals);
increased site visits to ensure efficient electronic transfer of data where possible; and
first line helpdesk service for hospitals using version 3.3 eICAT software

Any further news regarding software will be posted on our website.

Type 2 Surveillance System

The strategic plan for the VICNISS Type 2 surveillance system to be implemented in smaller (<100 acute bed) Victorian public hospitals is to soon be distributed. There is to be a 3 month pilot phase involving one of the 5 rural health regions. This is planned to occur between late September 2003 until December 2003. The surveillance system will then be refined as necessary and 'rolled out' to the other smaller hospitals in March 2004. Evaluation will continue with a final impact report to be distributed before February 2005.

VICNISS Technical Advisory Group Meeting - Outcomes

The second meeting of the TAG was held on Wednesday 18th June prior to the VICNISS Advisory Committee. Topics discussed at the TAG included:

Hospital in the home program - VICNISS acknowledges that different hospitals employ different models of HITH programs. VICNISS only requests data on infections that are identified as an inpatient in an acute care setting. Whilst recognising the importance of surveillance in HITH and post discharge, and that hospitals may wish to collect this data in-house, infections identified in patients whilst in HITH will not be reported by VICNISS at this stage. New paper forms developed by VICNISS provide a field for hospitals to record this information, however,for those sites using eICAT 3.3 the ability to collect this data will be dependent on their use of the existing User Defined Fields.
What is an 'emergency' procedure - further work is being done to identify a suitable and applicable definition for ' this.
Antibiotic prophylaxis and hours of membrane rupture prior to hospital admission for C-Sections - further work is being done to clarify these fields. We will notify hospitals undertaking C-Section surveillance when more information is available, and post any new developments on our website.
Recording of tourniquet application times - Whilst VICNISS acknowledge this is desirable for some hospitals undertaking orthopaedic procedures to check prophylactic administration is given appropriately, it is not considered to be part of a routine data collection. However, this has been built into the functional specification for new software, and will be able to be used in-house by hospitals once software is available.
Multiple infections in one patient - Following the NNIS model, VICNISS count all infections in one patient following a surgical procedure e.g. if a CABGS patient develops a SSI at the sternum site and radial graft site, this is counted as two SSI's.
Admission of a patient with an existing SSI - in the event that a patient is admitted to a hospital with a SSI from a procedure that was performed elsewhere, VICNISS make the following comments:
- we encourage communication with the hospital where the procedure was performed to notify them of the SSI
- VICNISS could facilitate this communication process if requested
- the hospital that admits the patient with the SSI should not include this as an infection in the surveillance program.

The next TAG is to be held on Wednesday 20th August 2003.

APIC Conference, San Antonio 2003

I was privileged to have the opportunity to attend the 2003 APIC Conference in San Antonio in June. I arrived in SA late on Saturday night after 24 hours of travelling, prior to the Surveillance Workshop on Sunday run by Ona Baker Montgomery, Terri Lee and Gail Bennett. At the workshop I was able to catch up with Teresa Horan who has been a solid ally to VICNISS over the past year. About 200 people attended the workshop, and it became clear to me the that the knowledge of hospital epidemiology and the level of surveillance activities conducted in Victoria are certainly on a par, if not even more advanced than many of those in attendance. This feeling of reassurance was to repeatedly visit me throughout the remainder of the conference.

The conference itself went for four full days, with many concurrent sessions. The trade display was simply awesome, and received with great excitement by more than 2000 conference delegates. The trade display was open for the first two days of the conference. Delegates were provided with three hour lunch breaks to attend the display, and also review the poster exhibition. As lunch was not provided, the three hour break also allowed many delegates to visit downtown SA to sample the local fare.

Of the talks I attended, some of the highlights included Teresa Horan's presentation on "The Evolution of Surgical Site Infection Surveillance and Prevention". Prior to this talk, Teresa was awarded the Elaine Larson Lectureship. During her presentation, Teresa noted the various milestones of NNIS surveillance, and recognised the work of many of those around her at NNIS. She also mentioned the future direction of NNIS in the NHSN and looked to exciting new developments particularly in the area of procedure specific risk modelling for appropriate risk stratification.

Other presentations I attended included "Information Technology to detect and prevent infections" by Steven Solomon from CDC, the first Annual State of the Science Lecture by Barry Farr who summarised sentinel scientific publications and reports from the past twelve months, oral presentations on antimicrobial resistance, and a presentation on the National Surgical Infection Prevention Project by Peter Houck.

Possibly the most useful talk I attended was that of Teresa Horan's "New criteria to identify Nosocomial Pneumonia: What are they and how do they affect rates" where she discussed the NNIS experience of using the new pneumonia definitions. Teresa made several important points including:

Surveillance definitions will never satisfy clinicians for clinical diagnoses;
Surveillance definitions are population based;
Clinical definitions are individual based;
The first six months of NNIS data with the new definitions demonstrate rates have been lowered by about one third to one half, but it is too early to tell if this will be maintained - require larger numbers;
There were two late breaker sessions, the first being an update on the SARS outbreak ably chaired by Dr Cath Murphy who also briefly presented her own experience in managing SARS; and
A session on the Monkeypox outbreak in Wisconsin, which made headline news during the conference.

Overall the APIC conference was most impressive. To organise over 2000 delegates in such a smooth manner was no mean feat. Another impressive feature was the role that related Infection Control disciplines such as Epidemiologists, Medical Microbiologists and Infectious Diseases play in the APIC conference. Not only do these groups attend and present at conferences, they also play an active role in the administration and management of APIC and the individual APIC chapters.

Phil Russo
Deputy Director VICNISS CC

Department of Human Services, Victoria, The Place To Be