Frequently Asked Questions
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General FAQs |
Type 1 Specific FAQs |
Type 2 Specific FAQs
General FAQs List
Type 1 Specific FAQs List
Type 2 Specific FAQs List
General FAQs
- Is the data be available under the Freedom of Information Act (FOI)?
The Health Records Act (Victoria) covers health information in Victorian public and private
sectors from 1 July 2002.
VICNISS will be collecting de-identified data that will only be available to each participating hospital as aggregated data. As
no identifying patient details are kept by VICNISS the Coordinating Centre will be unable to disclose any patient details if
requested to do so under FOI.
The obligation of VICNISS to release data under FOI may depend on the individual request and may need clarification in law.
Considerations may include the public interest if there is an advantage in data remaining confidential.
VICNISS has sought further clarification regarding the impact of FOI on the VICNISS Coordinating Centre surveillance data.
However, each hospital should make independent enquires to establish the likely impact the legislation may have for their
facility in regard to the data they collect.
For more information about this Act, contact the Health Services Commissioner.
- Is there any official time requirement for a hospital to keep VICNISS data
collection forms once they are submitted?
There is no official time that a hospital must store the VICNISS data collection forms after submission to VICNISS Coordinating
Centre. It is entirely up to the individual facility but one suggestion might be to keep the forms for 12 to 18 months as infections
can occur and should be recorded if they occur within 365 days in the case of an implant being used.
Type 1 FAQs
- General: The Type 1 VICNISS surveillance manual was revised on 1st July 2008. What are the significant changes?
There were a number of significant changes in Type 1 Surveillance Manual which include:
- Surveillance activities divided into two distinct modules:
1) Procedure associated module (section 5) - SSI surveillance
2) Device associated modules (section 6) - includes CLABSI, PLABSI, VAP, haemodialysis
- Section 4 - VICNISS Participation Requirements
* VICNISS performance indicators and notice of inability form included in manual
- Section 5 - Procedure Associated Module
* New updated forms to be used from 1st July 2008
- Section 6 - Device Associated Module
* Location of attribution and Transfer rule defined (section 6.2.4)
* CLABSI definitions changed - criterion 2b has been deleted "common skin contaminant is cultured from at least one blood culture
from a patient with an intravascular line, and the physician institutes appropriate antimicrobial therapy" (see section 6.2.7)
* More explanatory notes re CLABSI definitions are provided ( see section 6.2.7)
* Temperature guide for patients ≤ 1 year of age has been revised ( see section 6.2.7, note 5)
- Section 6.4 - Haemodialysis Surveillance
* New module commencing July 1st 2008.
- Section 7 – Forms
* ALL VICNISS forms have been revised and should be used as of 1st July 2008.
- SSI: If a patient is discharged to rehabilitation but remains
within the health service should they be monitored for surgical site infection?
Currently VICNISS surveillance methodology has not been expanded to include
post discharge surveillance. When the patient has been discharged from the acute care facility they no longer require
follow up. If the patient is re-admitted to the acute care facility with a surgical site infection and within 30 days
(non-implantable's) or within 365 days (implantable's) then the infection details are recorded against the first patient admission.
- SSI: Following surgery a patient is discharged and develops signs of a superficial
infection. He is subsequently readmitted to hospital for reasons other than infection, e.g. haemodialysis. Is this SSI considered
post-discharge or readmit?
In this scenario, the patient’s admission was planned for reasons other than infection thus it would be considered post-discharge
and would not be reported by VICNISS. If the reason for the patient’s hospitalisation was extended and included treatment of the
infection it would be considered a re-admission and would be reported by VICNISS.
- SSI: One of the criteria used to calculate Risk Index is operation time. What are some examples of 75th percentile of the duration for surgery?
A risk index point is allocated if an operation lasts more than t hours where t is the 75th percentile of the duration of surgery for
that particular operative procedure (rounded to the nearest hour). That is, 75% of the operations for that procedure were shorter than
t hours and 25% were longer than t hours. 75th percentiles for common procedures are:
Surgical Procedure Group
CABG – Chest and donor
Hip Prosthesis
Knee Prosthesis
|
Surgery duration 75th Percentile
300 minutes
120 minutes
120 minutes |
- SSI: If an operation is performed using a laparoscope but requires extension of the
incision e.g. for removal of tumor, is this still considered “laparoscopic”?
The laparoscopic data field should be ticked yes in this scenario if no other instrumentation was used. If, however, the incision
was significantly extended and other instrumentation was required then the surgery is no longer considered laparoscopic only and “no”
should be indicated in the laparoscopic data field. If it is unclear from the operation report if other instrumentation was required
you may need to clarify with the attending surgeon.
- SSI: What does “Membrane Rupture (before procedure)” mean?
Indicate “yes” if membranes were ruptured before the caesarean section – this includes spontaneous and artificial rupture
of membranes. Indicate “no” if membranes were not ruptured or recorded as being ruptured at the time of the caesarean section.
- SSI: Is VICNISS collecting data on partial hip replacements?
Initially VICNISS intended to use the NHSN procedure category of HPRO which includes both total and partial hip replacements.
However, feedback from participating hospitals has indicated that it would be preferable to separate total hip replacements from
partial. This issue was also discussed by the VICNISS Technical Advisory Group. Consequently the data collection process
has been altered to allow for the distinction between total and partial hip replacements.
- SSI: What constitutes an implantable device?
The VICNISS definition for an implantable is:
"a nonhuman-derived foreign body that is permanently placed in the patient during a VICNISS operative procedure and is not
routinely manipulated for diagnostic or therapeutic purposes."
Examples are given as: mechanical heart, prosthetic heart valves (including cardiac sternal wires), joint prostheses, nonhuman vascular grafts, permanent
screws, wires and mesh.
Implants do not include: homologous grafts, such as heart, kidney and liver; or devices that are placed or used during an operation solely for haemostasis or other temporary measure (e.g. clips or drains)
NB: Surveillance is required up to 365 days after the procedure date.
- SSI: What should be recorded if the ASA score is not available?
The ASA score provides data to calculate infection frequencies and rates by ASA classification and is an element of the VICNISS SSI
risk index. It is therefore, important that an estimated score is not given if there is no ASA score recorded.
If the anaesthetist does not document the ASA score, enter as not available (N/A) in the database. Incomplete data cannot be
included in the VICNISS analysis of infection rates. It is important to encourage the routine collection of ASA scores in all
patients undergoing VICNISS surgical surveillance.
If the person performing data collection is following up the ASA score leave the field blank until it is available.
- SSI: Are the Antibiotic and Antibiotic End Time fields in the SSI module NHSN
required fields or only VICNISS required fields?
- SSI: The Antibiotic End Time data will be very difficult to collect as it is seldom recorded accurately
if at all on the anaesthetic chart.
The Antibiotic and Antibiotic End Time were proposed as VICNISS required fields
and have not been adopted from NHSN. In July
2000 the report of the Victorian Expert Working Group on Surveillance of Nosocomial Infections published a
minimum data set recommended for use by VICNISS. The recommendations included that surgical site surveillance data be collected
in the following areas relating to antibiotic usage:
- Antibiotic given pre/peri operatively
- Antibiotic name
- Antibiotic route
- Antibiotic time
The Expert Advisory Group advised that:
"The timing of antibiotic prophylaxis should be explored as a possible indicator for all Victorian hospitals. It is a process
indicator but one clearly associated with outcomes." p45.
This reflected the importance of appropriate prophylactic antibiotic use in reducing surgical site infection rates. The
VICNISS Coordinating Centre recognises that the Antibiotic End Time data will be very difficult to collect and therefore
has changed the antibiotic fields on the form to capture data more accurately.
- SSI: Some hospitals have collapsed the 4 wound class
categories into 3. How
should we enter our data in the surgical site module now?
In the VICNISS required field: WOUND CLASS there is 4 categories with the following points allocated in risk stratification.
CLEAN WOUNDS
CLEAN-CONTAMINATED WOUNDS
CONTAMINATED WOUNDS
DIRTY OR INFECTED WOUNDS
|
0
0
1
1 |
The patient's SSI risk index is calculated by allocating one point to the patient for a wound classification of
Contaminated or Dirty/Infected wound classification, an ASA score >3 and, for an operation lasting more than t hours
where t is the approximate 75th percentile of the duration of surgery for that particular operative procedure.
Where the clean wound and clean-contaminated wound class categories have been collapsed it will not affect risk
stratification as both categories receive 0 points.
- SSI: What are the definitions for surgical site infections?
The definitions (required for the Surgical Site Infection module) for Superficial, Deep and
Organ space surgical site infections are included in the Type 1 Surveillance Manual and the
Type 2 Surveillance Manual.
- ICU: Must a patient have a central line insitu
continuously for 48 hours to be included in the ICU data collection?
A patient is required to have had a vascular access device that terminated at or close to the heart or in one of the great vessels
within the 48-hour period before the development of the bloodstream infection. If the time interval
(between line removal and the positive blood culture) was longer than 48 hours, there
must be compelling evidence that the infection was related to the vascular access device.
i.e. The patient is only required to have a central line in at any time in the 48 hours preceding the presentation of the bloodstream infection.
Type 2 FAQs
- How is the data to be reported?
Data is to be reported according to the calendar months. Examples:
- For the MRO, BSI and Outpatient Haemodialysis Event surveillance modules December data is to be forwarded to VICNISS during January.
- For the SSI surveillance module December data is to be forwarded during February.
- The Process Indicators are to be reported the month after completion.
- Are Occupied Bed Days to be collected as part of the Multi Resistant Organism,
Bloodstream Infection and Occupational Exposures surveillance modules?
No, this data is now collected directly from the Department of Human Services.
- Multi Resistant Organism (MRO) Surveillance Module: Are MRO
colonisations recorded?
This module measures health care acquired infections (NOT colonisation) only attributed to
MRSA and VRE for the surveillance period.
- Multi Resistant Organism (MRO) Surveillance Module: Are readmitted positive
MROs counted each time?
If a patient is readmitted with an already counted unresolved MRO infection this infection is counted.
- Bloodstream Infection (BSI) Surveillance Module: Are all primary
laboratory confirmed BSIs collected and reported?
No, only those that are detected 48 hours post admission.
- Health Care Workers and Measles Vaccination Surveillance Module: Are
ICCs required to view any documented evidence of immunity to measles?
No.
- Outpatient Haemodialysis Event (OPHE) Surveillance Module: Are visiting
chronic haemodialysis patients to be included?
No. The module includes chronic haemodialysis patients only who are permanently listed on the units program.
- Surgical Infection Report (SIR) Surveillance Module: Are superficial
surgical site infections collected and reported as part of the Surgical Infection report surveillance module?
No, only deep incisional and organ space surgical site infections are collected and reported as part of this module.
- Peripheral Venous Catheter (PVC) Surveillance Module: Who are the 'target
population' for this module?
- Multi data acute care patients only are included;
- Patients whose PVC was inserted in another health care facility are excluded;
- Patients whose PVC was inserted in the Emergency Department are included; and
- Patients transferred to another health care facility with a PVC still insitu are excluded.