VICNISS Surveillance Activities in our Hospitals

VICNISS surveillance activities are available to all acute and some non-acute health services in Victoria. Public hospitals are required to participate by the Department of Health & Human Services. Large acute hospitals have a different program of activities than smaller facilities, due to the different range of services undertaken such as surgical services and intensive care units.

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 DHHS 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:

1. Mandatory for all public health services :

(a). Staphylococcus aureus Bacteraemia (SAB)

Staphylococcus aureus is the most common cause of healthcare associated bacteraemias, causing significant illness and death; more than half of those infections are associated with healthcare procedures, and are thus potentially preventable. 

  • This surveillance module commenced in July 2010 and is part of a national data collection initiative
  • All public hospitals (including psychiatric but excluding residential aged care must perform continuous, hospital-wide SAB surveillance.

(b). Clostridium difficile Infection (CDI)

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

  •  This surveillance module commenced in September 2010. 
  •  All public hospitals (excluding residential aged care beds/facilities and children under 2 years of age) must continuously perform hospital-wide CDI surveillance.       

(c). Healthcare worker seasonal influenza vaccination

Vaccination for seasonal influenza is encouraged for healthcare workers by the DHHS and free vaccine is provided.

  •  This surveillance module commenced in 2005. 
  •  All public health services must collect this data each year and submit towards the end of the influenza season.       

2. Mandatory for public health services with an intensive care unit or neonatal intensive care unit :

(a). Central line-associated bloodstream infections in intensive care

For adult ICU surveillance, VICNISS hospitals are requested to report rates of Central Line Associated Bloodstream Infections (CLABSI) rates per 1000 days of device use.

(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 Infections (CLABSI) & Peripheral Line Associated Bloodstream Infections (PLABSI). 

3. Mandatory for all public 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. All hospitals with >100 beds contribute data on the SSI component. 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. 

  •  If coronary artery bypass graft surgery is performed, data must be collected continuously. 
  •  Hospitals are encouraged to undertake surveillance on two or more VICNISS Surgical procedures.

4. Optional Modules :

(a). Outpatient Haemodialysis events (OPHE)

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.

  •  Commenced in 2008

(b). Ventilator Associated Events (VAE)

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. 

  •  Commenced in 2014

(c). Central line insertion practices (CLIP)

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.

  •  Commenced in 2011

(d). Colorectal process adherence monitoring (COLO_PAM)

Colorectal surgery is relatively high risk for infection as it involves incision into the gastrointestinal tract.  Risks of infection following surgery can be reduced by following processes such as administering antibiotics prior to surgery, maintaining optimal blood glucose for diabetics, optimising oxygenation and keeping patients warm.  This module measures compliance with recommended practices for these processes. 

  • Commenced 2009

5. Modules for smaller hospitals :

(a). 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.

This report presents State-wide data assessing compliance with current recommendations for antibiotic prophylaxis in Victorian public hospitals with 50-99 beds. 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 some improvements in documentation, and most importantly, compliance with guidelines, promoting optimal use of antibiotics.

(b). 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. 

(c). 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. 

(d). 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. 

(e). Surgical infection report (SIR)

Smaller hospitals report serious surgical site infections without monitoring surgery – rates of infection are not calculated as they may not perform sufficient surgery for these to be meaningful. Infections are reported even if the surgery occurred at another hospital prior to the patient being transferred.  

(f)Healthcare worker measles/hepatitis B vaccination

To assess Victorian public hospitals policy compliance with the National Health, Medical and Research Council (NHMRC) and Department of Human Services (DHS) recommendations for susceptible health care workers specifically in regard to Measles-Mumps-Rubella (MMR) vaccination.