eBulletin October 2003 Edition 6

Past VICNISS eBulletins

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In this Edition:

On the web: www.vicniss.org.au
Email: VICNISS @ mh.org.au

Reminders:

Communication: To ensure that we communicate appropriately to all sites, we ask that we be notified if there are any staff changes at your site, specifically in regards to Infection Control Staff, Executive sponsors and CEO's.

Surveillance plans: Participating hospitals may make changes to the type or duration of surveillance for each procedure group that have been submitted via the VICNISS surveillance plan but please let the coordinating centre know as soon as a change is made.

User group meeting: The last meeting for this year was held in September. The next planned meeting will be held in March 2004 at a date yet to be finalised.

Software Update

As mentioned in the last e-bulletin, in conjunction with the Office of Chief Clinical Advisor (OCCA) DHS, a working group was established to review the functional specifications for new VICNISS software and to explore any other existing software. This group is near finalising its work, and it is anticipated a decision regarding surveillance software will be made shortly. We will post any further updates on the website as they come to light.

Type 2 Surveillance Program

Thank you to all those who provided feedback on the proposed Type 2 Surveillance Program Discussion Paper. This feedback is currently being collated and will be included as a Agenda item for the next VICNISS Advisory Committee meeting. The 3-month Pilot Testing Stage in the Barwon South West region is due to commence soon. An Educational workshop for the participating hospitals in Warrnambool will be held prior to the commencement date.

Satisfaction Survey Results - Phase I

Thank you to all who participated in the VICNISS satisfaction survey in August this year. Infection Control Consultant (ICC) contacts of Phase I participating hospitals were asked to provide a copy of the survey to all ICC's at their site who participate in VICNISS surveillance activities. Surveys were anonymous, but respondents could identify themselves if they wished to. Of the 10 hospitals surveyed, nine responses were received. Responses to key services provided by VICNISS were surveyed and included satisfaction in the following areas:

the website
manual (V4.0)
VICNISS staff support & accessibility
communication eg.,e-Bulletin, website, email, phone, written, onsite visits, etc
reports - data and quality

Overall, the feedback was positive and key improvement areas have been identified such as VICNISS Type 1 Surveillance Manual that participants find cumbersome to use. Work has commenced on a new, improved version of the manual which will be released in February 2004. Input into the revised manual is actively encouraged by all users. The results from the survey form part of the evaluation of Phase I, and will assist us in future planning for VICNISS and the Coordinating Centre.

Future surveys will include sections on measuring the Infection Control resources required to undertake VICNISS Surveillance, and a section on the VICNISS eBulletin. If you have further suggestions regarding the satisfaction survey, pleases let us know. It is anticipated we will repeat the satisfaction survey early in 2004 for all Type 1 participating hospitals.

The results of the survey have been sent to the key ICC contacts at each Phase I hospital and will also be presented to the VICNISS Advisory Committee.

Communication Strategy

At the August VICNISS Advisory Committee, the VICNISS communication strategy was accepted for implementation. All hospitals should have now received a letter and an outline of that strategy. Importantly, the strategy recognises that the Infection Control Consultant will be the key contact for all communication from VICNISS. The communication strategy is also available at website.

VICNISS Technical Advisory Group Meeting - Changes to ICU Surveillance

In response to the request of participating hospitals, and after consultation with key stakeholders, some changes have been implemented to ICU Surveillance and include:

Central line associated bloodstream infection	Hospitals are no longer required to report Clinical Sepsis. Only Laboratory Confirmed BSI are now required. 48 hour follow up post ICU discharge for clinical sepsis no longer required
Ventilator Associated Pneumonia	48 hour follow up post ICU discharge for (VAP) no longer required.
Grouping of ICUs	To allow for appropriate grouping of ICU's in the Victorian aggregated database, VICNISS will now report rates using DHS groupings. Future VICNISS ICU data reports will have hospitals grouped as either 'A1' or 'Other'.

Hospitals affected by these changes will be contacted by their primary VICNISS Clinical Nurse Consultant. For more details, visit the VICNISS website.

ICU Surveillance

VICNISS would like to clarify our position on how long patients have to be in hospital before they develop an infection that should be included in the ICU, laboratory-confirmed bloodstream infection. For most bacterial hospital Acquired infections, the infection becomes evident 48 hours or more after admission however, this is an arbitrary time cut-off as the incubation period of infections can vary. For this reason, each infection must be assessed individually. In assessing each case, the ICC must clarify that the infection was not present or incubating at the time of admission to the ICU. In addition, for an infection to be line-associated, a central line must have been in-situ within the 48 hours before infection developed.

With these facts in mind, for patients in ICU with a central line in situ the BSI would be included if the BSI was detected from blood drawn in ICU if it was clear that their infection was Acquired while in the ICU, ie, not present or incubating at the time of arrival to ICU (if this cannot be established, then the patient must have been in the ICU for 48 hours or more).

Caesarean Surgical Site Infection Data

CSEC data was received from four hospitals in the last data collection. As previously mentioned, risk adjustment for caesarean sections requires a number of extra risk factors to be supplied for each patient. Completion rates for these fields were low, with less than 10% of the data complete. While VICNISS acknowledges that these data are often difficult to obtain, we are committed to providing infection rates which are adjusted using the best available methodology. Hospitals collecting data on CSEC patients will be approached in the near future to investigate ways in which the quality of these data can be improved. All suggestions will be gratefully received!!

Current Literature in Hospital Acquired Infection Surveillance

In the August 2003 edition of American Journal of Infection Control, Petra Gastmeier describes the first five years of the German Nosocomial Infection Surveillance System - also known as KISS. It is interesting to note that many of the challenges facing VICNISS were also experienced by KISS. These include implementing some minor modifications to NNIS methodology in response to local needs as the surveillance system evolved. In the same edition of AJIC, Zolldann et al compares two different methods for detecting infections in the ICU. The selective surveillance method they implemented demonstrated high sensitivity and a remarkable time reduction. The resources required to detect infections in ICU patients is a concern for all, this paper may provide some hints on how this could be made more efficient.

References:
Gastmeier P et al. Five years working with the German Nosocomial Infection Surveillance System (Krankenhaus Infektions Surveillance System). Am J Infect Control 2003;31:316-21

Zolldann D et al. Assessment of a selective surveillance method for detecting nosocomial infections in patients in the intensive care department. Am J Infect Control 2003;31:261-5

Department of Human Services, Victoria, The Place To Be