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 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 |