eBulletin June 2004 Edition 9
In this Edition:
Reminders:
! Surveillance Data Forms:
As of June 1st, all Type 1 participating hospitals should be using Version 5 Manual and forms. Please discard
all previous editions of forms.
Surveillance of Procedures when Patients are Readmitted:
Just a reminder - when patients are readmitted with an infection following a VICNISS operative procedure, check if
the infection has occurred within 30 days of the procedure when there is no implant or, within 365 days where
there is an implant.
1st Quarter Reports
You may have noticed that in the Quarter 4 2003 reports for Type 1 hospitals, where appropriate we have commenced comparing
the hospital infection rates with the aggregate infection rate, and included a "p value" which indicates the
statistical significance of the difference between the two rates. Where a statistically significant difference was noted,
the Coordinating Centre will notify the Infection Control Consultant (ICC) directly before the report is posted on the website.
Following a recommendation from the VICNISS Advisory Committee, when a statistically significant difference is observed, as
well as making phone contact with the ICC, the Coordinating Centre will now send an email to the CEO and Executive Sponsor
for that site, (and cc to the Infection ICC) notifying them of the result, and to contact the ICC or the Coordinating
Centre for further details.
Results for the 1st Quarter, 2004 for both Type 1 and 2 hospitals will be available shortly.
VICNISS Data Evening -"Victorian Hospital Acquired Infection Rates - the first 12 months of VICNISS"
On Wednesday 14th of April the VICNISS Coordinating Centre presented
"Victorian Hospital Acquired Infection Rates - the first 12 months of VICNISS" at Le Meridien, and released the
first public annual report "VICNISS Hospital Acquired Infection Project, Year 2 Report - March 2004". The purpose
of the evening was to present the latest aggregate data from the VICNISS Coordinating Centre, and to acknowledge the hard
work and cooperation of all the infection control consultants and teams in the implementation of VICNISS.
More than sixty people who attended were greeted with wine and finger food prior to the brief presentations by Shane
Solomon, Executive Director, Metropolitan Health and Aged Care, and Dr John Youngman, Chair, Healthcare Associated Infection
Advisory Committee. This was followed by the presentation of the VICNISS data. At the conclusion of the evening, attendees
were able to retire to the lobby to finish off any leftover food and wine.
On behalf of the staff at the VICNISS Coordinating Centre, I would like to thank all who attended the evening. I would
also like to thank the staff of the Coordinating Centre for their work in organising the evening. If you have any specific
feedback on the evening, please contact us at VICNISS @ mh.org.au. Given the success of the evening it is likely another will
be held towards the end of this year. Copies of the VICNISS report have been sent out to all participating Type 1 hospitals.
If you would like a copy please contact Kylie Berry at VICNISS @ mh.org.au.
VICNISS Hospital Acquired Infection Project, Year 2 Report - March 2004
As mentioned above, the first public annual report "VICNISS Hospital Acquired Infection Project, Year 2 report - March
2004" was released on Wednesday 14th April to coincide with the presentation of the first 12 months of data. A copy
of the report has been sent to all Infection Control Consultants and CEO's in public hospitals, as well as other key stakeholders
including consumer groups. If you would like extra copies of the reports just contact us via VICNISS @ mh.org.au or you
can download a PDF version at
www.vicniss.org.au/AnnualReport.aspx.
Type 2 Surveillance Update
The Type 2 surveillance Pilot stage is now nearly completed. Discussion about the progress of the Pilot stage was presented
to the participating Infection Control consultants on 21st of May at 11.30am, George Hotel, Hamilton.
All other smaller hospitals (< 100 acute care beds) commenced the Type 2 surveillance program by 1st of June 2004. Surveillance
Plans (up to 31/12/04) should have been forwarded to the VICNISS Coordinating Centre prior to this commencement date.
The Type 2 VICNISS manual has been revised based on the Educational Workshop feedback. The latest version will be available via
the VICNISS website in about a month.
At the forthcoming Australian Infection Control Association (AICA) conference a poster will presented outlining some of
the data collected as part of the Type 2 Preplanning review. All Infection Control consultants who completed the corresponding
survey (as a group) are acknowledged.
Type 1 Education Workshop to be Repeated
A workshop on interpretation of reports and reviewing Type 1 Surveillance methodology is scheduled. ALL Type 1 hospitals
(Phases I, II and III) are welcome to attend.
As the planning of the day will be dependent on numbers attending, could you please RSVP to
Jane Motley by Wednesday
1st of July, 2004.
| DATE: | Wednesday, 21st July 2004 |
| TIME: | 1.00pm lunch (provided) for 1.30 start (finish 4.00pm, dependant on numbers |
| VENUE: | VICNISS, 10 Wreckyn St, North Melbourne (click here for a Map, PDF File
 88kb, opens in new window) |
Type 1 Satisfaction Survey 2004
As part of our quality process we will be asking all participating hospitals to respond to a Satisfaction Survey that will be distributed this month.
Type 1 Performance Indicators
Data collation for Quarter 1 2004 has now commenced at the Coordinating Centre. The collation, analysis, and report writing
takes between 4 to 6 of weeks depending on how much data cleaning and manual input is required. We anticipate that reports will
be posted on the website in mid June.
All hospitals undertaking Type 1 surveillance activities were requested to submit data to the Coordinating Centre by
Friday 7th May. Some hospitals continue to have difficulty submitting data on time. This is particularly relevant as
Performance Indicator 2.2 relates to the timeliness of submitting data. Commencing now, Quality Reports posted with the Data
reports will include information regarding the Performance Indicators for each hospital. The Performance Indicators are
able to be downloaded from our website from the following link: (old link no longer available).
If data are submitted late, we are unable to provide the latest infection rates for comparison. We strongly encourage
all hospitals to submit data on time. If you are experiencing any difficulties with submitting your data, please contact
the Coordinating Centre to discuss how the issue can be managed.
New Appointments at VICNISS
Welcome to Matt Mason, from Bairnsdale Health who has joined the VICNISS Advisory Committee as the Infection Control regional
representative and to Ellen Kinkell who has joined the VICNISS Coordinating Centre as a Research Nurse for the orthopaedic costing study.
Neurosurgery Surveillance - External Ventricular Drains
If your hospital is currently undertaking (or is considering) surveillance of Craniotomies (CRAN) or Ventricular Shunts
(VSHN) we would like to hear from you. VICNISS is exploring the option of surveillance of procedures where an EVD is inserted.
Surveillance of EVD's may be more useful as an alternative to these 2 procedure groups as EVD's have a higher infection
rate and warrant specific surveillance rather than being combined with craniotomies.
CDC/MMWR Guidelines for Preventing Healthcare Associated Pneumonia, 2003 Released
The full Guidelines for Preventing Health-Care Associated Pneumonia 2003 Full text document has now been posted at:
www.cdc.gov/ncidod/hip/guide/CDCpneumo_guidelines.pdf. Of particular note is the section on recommended
surveillance for Ventilator Associated Pneumonias - the document recommends that facilities,
"Conduct surveillance for bacterial pneumonia in ICU patients who are at high risk for health-care-associated bacterial
pneumonia (e.g., patients with mechanically assisted ventilation or selected postoperative patients) to determine trends and
help identify outbreaks and other potential infection-control problems. The use of the new NNIS system's surveillance definition
of pneumonia is recommended. Include data on the causative microorganisms and their antimicrobial susceptibility patterns.
Express data as rates (e.g., number of infected patients or infections per 100 ICU days or per 1,000 ventilator days)
to facilitate intra-hospital comparisons and trend determination. Link monitored rates and prevention efforts and feed data
back to appropriate health-care personnel".
Infection Dates are Compulsory
As part of our quality process we routinely check the data for missing fields. During this process VICNISS has detected
a number of infection records that are missing the date of infection. Where infection date is missing from a record the
record is excluded from VICNISS data analysis and may significantly change the reported rates.
Surgical Antibiotic Prophylaxis - Reporting of Timing of Antibiotics
On the new forms you will note that in order to facilitate reporting of time of administration of antibiotics, the form
allows a range of options in addition to reporting the exact time. Please note that reporting of the exact time is preferred,
and provides the best possible data for your hospital and for VICNISS. The options are intended ONLY for those patients
for whom it is not possible to record an exact time. The choice of "on induction" in particular assumes that the
antibiotics are administered immediately as soon as possible after induction and prior to incision.
VICNISS are hoping to begin reporting on surgical antibiotic prophylaxis in the near future. This has been undertaken in
Type 2 surveillance and reporting is based on appropriate choice of antibiotic, timing of administration and duration
of antibiotics following the procedure.
Websites of Interest (from SHEA)
The Pennsylvania Health Care Cost Containment Council (PHC4) is an independent state agency responsible
for addressing the problem of escalating health costs, ensuring the quality of health care, and increasing access for all
citizens regardless of ability to pay. This website presents surgeon level data. www.phc4.org/
Consumers Union site on hospital infections.
www.stophospitalinfections.org
The Leapfrog Group was created to help save lives and reduce preventable medical mistakes by mobilising
employer purchasing power to initiate breakthrough improvements in the safety of health care and by giving consumers information
to make more informed hospital choices. www.leapfroggroup.org/
