VICNISS Healthcare Associated Infection Surveillance Coordinating Centre
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Type 2 VICNISS Surveillance Manual, Forms and Supporting Information

Available to be downloaded below:

If you would like assistance in the use of any of the available tools and software please contact Noleen Bennett at the VICNISS Coordinating Centre.

Surveillance Supporting Documents Updated
Online Data Entry Forms (Web Forms) User Guide (PDF 1.5mb)
The Online Data Entry Forms User Guide provides the Infection Control staff with information on online data entry available on the VICNISS website. Modules available for online data entry for Type 2 participants include Staphylococcus aureus Bacteraemia, Clostridium difficile Infection, Haemodialysis Event, Methicillin Resistant Staphylococcus aureus, Occupational Exposure, Influenza Vaccination, and the Monthly Summary Form.
Oct11
VICNISS Type 2 Procedure Groups, ICD10-AM Codes, & CMBS Codes (PDF 142kb)
This information is also available to view on the VICNISS Type 2 Procedure Groups, ICD10-AM Codes, & CMBS Codes page on the VICNISS website.
Aug11
CDC/NHSN Surveillance Definition of Healthcare-Associated Infection (HAI) and Criteria for Specific Types of Infections in the Acute Care Setting (PDF 111kb Oct11

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Surveillance Manual, Modules and Forms Updated
(Please note that forms may be updated from time to time. As this occurs, relevant hospital Infection Control Consultants will be advised and updated forms will be available below). 
1.Type 2 Surveillance Manual - Version 10 (PDF 1mb) (To be Updated Shortly)
The VICNISS Surveillance Manual provides the Infection Control staff with helpful information on VICNISS definitions, case-finding, methodology, data sources, and data collection forms.
Dec07
 Annual Surveillance Plan (PDF 45kb) (Word 61kb) Jun11
 Notice of Inability to Undertake VICNISS Surveillance Activities Form (PDF 94kb)
As advised in the VICNISS eBulletin April 2008, if a hospital is unable to undertake the surveillance activities as listed in the Performance Indicator document for any period of time, formal notification to the VCC is required by completing the above form. This notification needs to be signed by the Infection Control Coordinator and the Infection Control Executive Sponsor. This information will then be forwarded to the Department.
Oct11
 Monthly Summary Form (PDF 48kb) (Submit via Online Web Form Only) (To be Updated Shortly) Sep10
  Monthly Event Sheet Fax Cover Page to VICNISS (PDF 115kb) (To be Updated Shortly) Jun10
Hand Hygiene Initiative Updated
2. Hand Hygiene Initiative (PDF 27kb) Oct11
Process Indicators Updated
3. Surgical Antibiotic Prophylaxis Data Collection Form (PDF 189kb) (To be Updated Shortly) Jun10
4. Health Care Worker Measles Vaccination Surveys (Sections A, B & C) (PDF 178kb) (To be Updated Shortly) Dec07
5. Health Care Worker Hepatitis B Vaccination Surveys (Sections A, B & C) (PDF 181kb) (To be Updated Shortly) Dec07
6. Peripheral Venous Catheter Use Survey (Section A) & Data Collection Form (Section B) (PDF 197kb) (To be Updated Shortly) Jun10
Outcome Indicators Updated
7. Methicillin Resistant Staphylococcus aureus Form and Supporting Information (PDF 58kb) (Submit via Online Web Form Only) (To be Updated Shortly) Oct10
8. Staphylococcus aureus Bacteraemia (PDF 158kb) Oct11
    Protocol (PDF 107kb) Oct11
    Instructions for Completion of Form (PDF 34kb) Oct11
    Form (PDF 41kb) (Submit via Online Web Form Only) Oct11
    Application of SAB Case Definitions, Example Scenarios (PDF 67kb) Oct11
    Bloodstream Infection Fact Sheet and Guide for Investigation Sheets (PDF 94kb) Oct11
9. Vancomycin Resistant Enterococcus Form and Supporting Information (PDF 49kb) (Submit via Online Web Form Only) (To be Updated Shortly) Oct10
10. Clostridium difficile Infection (PDF 110kb) Oct11
    Protocol (PDF 62kb) Oct11
    Instructions for Completion of Form (PDF 25kb) Oct11
    Form (PDF 42kb) (Submit via Online Web Form Only) Oct11
11. Occupational Exposure Data Collection Form ( PDF 171kb) (Submit via Online Web Form Only) (To be Updated Shortly)
  ** Occupational Exposure - OPTIONAL Data Collection Forms (not included in the Manual) (PDF 48kb)
Jun10
Dec07
12. Surgical Infection Report Data Collection Form (PDF 199kb) (To be Updated Shortly)
  ** Surgical Site Infection Fact Sheet and Guide for Investigation Sheets (not included in the Manual) (PDF 44kb) to be used in conjunction with SIR module.
Dec07
Dec07
13. Haemodialysis Event (HDE) (PDF 192kb) Oct11
    Protocol (PDF 65kb) Oct11
    Instructions for Completion of Forms (PDF 66kb) Oct11
    Form - Denominator (PDF 26kb) (Submit via Online Web Form Only) Oct11
    Form - Numerator (PDF 65kb) (Submit via Online Web Form Only) Oct11
Surgical Site Infection Updated
14. Surgical Site Infection (SSI) (PDF 310kb) Oct11
    Protocol (PDF 137kb) Oct11
    Instructions for Completion of Forms (PDF 94kb) Oct11
    Form - Surgical Site Procedure (Denominator) (PDF 54kb) (Submit via Hardcopy or Online Web Form Oct11
    Form - Caesarean Section Procedure (Denominator) (PDF 56kb) (Submit via Hardcopy or Online Web Form Oct11
    Form - Surgical Site Infection (Numerator) (PDF 55kb) (Submit via Hardcopy or Online Web Form Oct11
Influenza Vaccination Updated
15. Healthcare Worker Influenza Vaccination Compliance
The influenza vaccination program for all Victorian public hospitals for 2011 has commenced. VICNISS has provided the following forms to assist with this program.
 
    Form - Data Collection (2011) (PDF File 31kb) (Submit via Online Web Form Only) Feb11
    Form - Consent (2011) (PDF File 16kb) Feb11
    Form - Declination (2011) (PDF File 16kb) Feb11
    Form - Declination B (2011) (PDF File 18kb) Feb11

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Department of Health, Victoria