VICNISS Hospital Acquired 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 Manual, Data Collection Forms and Information

Please Note:

  1. 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. (All forms open in a new window).
  2. The Surgical Site Infection Module 5.10 based on the Type 1 program is still being updated. As from July 2008, the Type 1 SSI module forms were updated. Please use the Type 1 forms below until the Type 2 Manual is updated.
  3. As from July 2008, Type 1 hospitals also began the Outpatient Haemodialysis Module 5.9, and new forms were developed. Please use the Type 1 forms below until the Type 2 Manual is updated.
Surveillance Manual and Forms Updated
Type 2 Surveillance Manual - Version 10 (PDF File 1mb, opens in a new window)
The VICNISS Surveillance Manual provides the Infection Control staff with helpful information on VICNISS definitions, case-finding, methodology, data sources, and data collection forms (see Section 7 for forms, also available to download separately below).
Dec 07
 VICNISS Type 2 Procedure Groups and ICD10-AM Codes (PDF File 73kb) (Formerly section 7.1 in Version 9 - removed from v10) Oct 08
7.1 Annual Surveillance Plan (PDF File 36kb) (Word File 294kb) Apr 08
Notice of Inability to Undertake VICNISS Surveillance Activities (PDF File 23 kb, opens in new window)
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.
Oct 09
7.2 Monthly Event Sheet Fax Cover Page to VICNISS (PDF File 115kb) Dec 07
  ** Examples of how to complete the Monthly Event Sheet Fax Cover Page correctly (PDF File 48kb) Dec 07
5.1 Process Indicator: Surgical Antibiotic Prophylaxis Data Collection Form (PDF File 189kb) Dec 07
5.2 Process Indicator: Health Care Worker Measles Vaccination Surveys (Sections A, B & C) (PDF File 178kb) Dec 07
5.3 Process Indicator: Health Care Worker Hepatitis B Vaccination Surveys (Sections A, B & C) (PDF File 181kb) Dec 07
5.4 Process Indicator: Peripheral Venous Catheter Use Survey (Section A) & Data Collection Form (Section B) (PDF File 197kb) Dec 07
5.5 Multi Resistant Organism (MRO) Data Collection Form (PDF File 193kb) Dec 07
5.6 Staphylococcus aureus Bloodstream Infection Data Collection Form (PDF File 254kb) Dec 07
  ** Bloodstream Infection Fact Sheet and Guide for Investigation Sheets (not included in the Manual) (PDF File 48kb) to be used in conjunction with module 5.6. Dec 07
5.7 Occupational Exposure Data Collection Form ( PDF File 171kb) Dec 07
  ** Occupational Exposure - OPTIONAL Data Collection Forms (not included in the Manual) (PDF File 48kb) Dec 07
5.8 Surgical Infection Report Data Collection Form (PDF File 199kb) Dec 07
  ** Surgical Site Infection Fact Sheet and Guide for Investigation Sheets (not included in the Manual) (PDF File 44kb) to be used in conjunction with module 5.8. Dec 07
5.9 Type 1 Form 4.1 Haemodialysis Incident (Numerator) (PDF File 93kb) 15Jan09
5.9 Type 1 Form 4.2 Haemodialysis (Denominator) (PDF File 100kb) Jul 08
5.10 Type 1 Form 1.1 Surgical Site Procedure (Denominator) (PDF File 146kb) Jul 08
5.10 Type 1 Form 1.2 Surgical Site Infection (Numerator) (PDF File 109kb) Jul 08
5.10 Type 1 Form 1.3 Caesarean Section Procedure (Denominator) (PDF File 118kb) Jul 08
5.10 Type 1 Form 1.4 Caesarean Section Infection (Numerator) (PDF File 108kb) Jul 08

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Influenza and Pneumococcal Public Hospital Vaccination Program 2010 Updated
The Influenza vaccination program for all Victorian public hospitals for 2010 has commenced. VICNISS has provided the following forms to assist with this program.
Public Hospital Staff Influenza Vaccination: Data Collection Form (2010) (PDF File 76kb) Feb 10
Public Hospital Staff Influenza Vaccination: Consent Form (2010) (PDF File 17kb) Feb 10
Public Hospital Staff Influenza Vaccination: Declination Form (2010) (PDF File 17kb) Feb 10
Public Hospital Staff Influenza Vaccination: Declination Form B (2010) (PDF File 17kb) Feb 10

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