VICNISS Surveillance Activities in our Hospitals   

VICNISS surveillance activities are available to all acute and some non-acute health services in Victoria. All public and private hospitals are required to participate by the Department of Health (DH). Health facilities are categorised by peer groupings, modified from the Australian Institute of Health and Welfare (AIHW) groupings. The type and nature of the hospital services provided, determine the program of surveillance activities.  

Some surveillance “modules” are mandatory and others are optional. For example, surveillance of Staphylococcus aureus bacteraemia is a national indicator and thus is mandatory for all facilities in Australia. Other activities are mandated by the Victorian DH for particular health services. Health services should have some flexibility in choosing surveillance activities, for example if they have, or suspect they may have a particular problem which needs to be addressed.  

Surveillance in Victoria is also a mixture of process and outcome indicators. Outcomes are generally infections, whereas processes are events associated with prevention of infections such as vaccination or administration of antibiotics prior to surgery. In the latter case compliance with the “correct” or recommended process is monitored.  

Wherever possible surveillance modules including protocols and definitions are based on the United States Centers for Disease Control and Prevention (CDC) National Health and Safety Network (NHSN) system. These protocols are widely used globally and largely validated.  

Below is a brief description of the activities undertaken: 


Mandatory for all health services

(a) Staphylococcus aureus Bacteraemia (SAB) (this surveillance module commenced in July 2010 and is part of a national data collection initiative) 

Staphylococcus aureus is one of the most common causes of healthcare-associated bloodstream infection, causing significant illness and death; more than half of those infections are associated with healthcare procedures, and are therefore potentially preventable. 

      • All public and private hospitals (including psychiatric but excluding residential aged care) must perform continuous, hospital-wide SAB surveillance. 

(b) Clostridioides difficile Infection (CDI) (this surveillance module commenced in September 2010) 

Clostridioides difficile infections cause diarrhoea and sometimes serious infections, often in patients who have been on antibiotics. 

      • All public hospitals (excluding residential aged care beds/facilities and children under 2 years of age) must continuously perform hospital-wide CDI surveillance, and private hospitals commenced voluntary participation in 2019.        

(c) Healthcare worker seasonal influenza vaccination (this surveillance module commenced in 2005) 

From 2022 influenza vaccinations will be required for healthcare workers in hospitals and ambulance services. For more information click on the link below: 

      • All public and private health services must collect this data each year and submit towards the end of the influenza season.     
(d) COVID-19 Patient Monitoring (this surveillance module commenced in 2020) 
Active surveillance of all patients with confirmed COVID-19 admitted to hospital in Victoria is continuously conducted. 

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Mandatory for all public AND private health services with an intensive care unit or neonatal intensive care unit

(aCentral line-associated bloodstream infections in intensive care

For adult ICU surveillance, VICNISS hospitals are requested to report central line-associated bloodstream infection (CLABSI) rates per 1000 device days. 

(b) Central line and peripheral line associated bloodstream infections in neonatal intensive care 

For NICU surveillance, VICNISS hospitals are requested to report rates of central line-associated bloodstream infection (CLABSI) & peripheral line-associated bloodstream infection (PLABSI) rates. 

Mandatory for all public AND private health services performing significant amounts of surgery

(a) Surgical site surveillance (SSI) 

This involves monitoring patients who have had surgery for infections that develop subsequently at the surgical site. Infection rates are calculated separately for different types of surgery and for different groups of patients within the surgery type as some patients are at higher risk of contracting an infection than others. This allows comparison of rates between health services.  
Data must be collected continuously if the following procedures are performed and conditions regarding numbers of procedures/birth episodes are met (as outlined in the DH Performance Monitoring Framework): 
      • Coronary artery bypass graft surgery 
      • Hip and knee replacement surgery 
      • Caesarean section surgery 
Data must be collected for two continuous quarters if colorectal surgery is performed. 
Hospitals are encouraged to undertake surveillance on two or more VICNISS Surgical procedures. 

(b) Surgical infection report (SIR) 

Smaller hospitals performing low surgical volumes report serious surgical site infections without monitoring all surgical procedures. Infections are reported even if the surgery occurred at another hospital prior to the patient being transferred.  

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Optional Modules

(a) Outpatient Haemodialysis events (HDE) (commenced in 2008) 

Bacteraemias and localised infections of the vascular access site are common in haemodialysis patients. Because of frequent hospitalisations and receipt of antimicrobial drugs, haemodialysis patients are also at high risk for infection with drug-resistant bacteria. 
International studies have reported a decrease in local vascular access infections and access-associated bacteraemias following the introduction of a surveillance program based on NHSN standardised methods and definitions. 
Outpatient haemodialysis centres attached or affiliated with a hospital (hub or satellite) are encouraged to undertake surveillance on hospitalisations, in unit (outpatient) IV antibiotic starts, and positive blood cultures. 

(b) Ventilator Associated Events (VAE) (module commenced in 2014) 

This surveillance occurs in intensive care units and includes patients on ventilators. These patients are at an increased risk of pneumonia and related conditions which is what this surveillance is designed to detect. 

(c) Central line insertion practices (CLIP) (module commenced in 2011) 

Central lines are a special type of intravascular catheter which are normally inserted into the arm or chest and end up in a large vein near the heart. Patients with central lines in place are at risk of contracting bloodstream infections and there are recommended practices for their insertion and maintenance to help prevent these infections. This module measures compliance with the recommended practices for insertion of central lines which include hand hygiene, use of equipment such as gloves and gowns and the site of insertion of the line. 

(d) Surgical process adherence monitoring (Surgi-PAM) (module commenced in July 2023) 

Risks of infection following surgery can be reduced by correctly following processes such as administering antibiotics prior to surgery, appropriate skin preparation, maintaining optimal blood glucose for diabetics, optimising oxygenation, and keeping patients warm. This module measures compliance with recommended practices for these processes.  

(e) Surgical antibiotic prophylaxis (SAP) 

Surgical antibiotic prophylaxis (administration of antibiotic around the time of surgery) has been shown to be effective in reducing the incidence of surgical wound infections for many types of surgery. The measurement of compliance of surgical antibiotic prophylaxis against recommended guidelines is a common process measurement in many surveillance programs worldwide. 
Regular reporting on antibiotic prophylaxis as part of the VICNISS surveillance program and the ability for hospitals to be able to compare their performance with State-wide data has resulted in improvements in documentation, and most importantly, compliance with guidelines, promoting optimal use of antibiotics. 

(f) Occupational exposures (OE) 

Hospitals monitor exposure of staff to blood and body fluid exposures through events such as needlestick injuries. These can be minimised through education and use of protective equipment and safety devices.  

(g) Peripheral venous catheter use (PVC) 

The majority of people admitted to hospital have a peripheral venous catheter inserted for vascular access. This module aims to optimise the safety associated with the use of Peripheral Venous Catheters (PVCs). Although the incidence of local or bloodstream infections (BSIs) associated with PVCs is usually low, serious infectious complications may result in considerable annual morbidity. This module monitors processes associated with the correct insertion, care, and removal of PVCs.  

(h) Multi-resistant organisms 

Infections with organisms resistant to antibiotics in small hospitals are relatively infrequent, so these are monitored closely. Small hospitals report infections with organisms such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci, which may occur relatively frequently in large hospitals however are rare in smaller facilities.  

(i) Healthcare worker measles/hepatitis B vaccination 

To assess Victorian public hospitals policy compliance with the National Health, Medical and Research Council (NHMRC) and Victorian DH recommendations for susceptible health care workers specifically regarding Measles-Mumps-Rubella (MMR) and hepatitis B virus vaccination. 


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