VICNISS - Hospital Acquired Infection Project
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Overview
This report describes data from the Victorian Hospital-Acquired Infection Surveillance (VICNISS) project between February 2006 and February 2007, and developments in hospital infection surveillance activities in large hospitals (Type 1 surveillance) and in smaller, usually rural, Victorian public hospitals (Type 2 surveillance). The surveillance program for large hospitals is based on the United States NNIS program.
No clear trend in the aggregate surgical site infections (SSI) or intensive care unit device-associated infection rates over time has yet been identified in the VICNISS program. Coronary artery bypass graft surgery, major joint prosthetic surgery, Caesarean sections, cholecystectomies, and colon surgery remain the favoured surgical procedures for post-operative surveillance of surgical site infections. In each quarterly reporting period, hospitals with higher than expected infection rates are notified, and letters are sent to the infection prevention team and the chief executive officer. In future, we will also ask for a reply to these letters that outline the hospitals’ planned response to attempt to lower these rates.
There has been improvement in the appropriateness of choice of antibiotic for surgical antibiotic prophylaxis for some surgical procedures. This year, for the first time, hospitals received hospital-level reports on their own surgical antibiotic prophylaxis data for individual surgical procedure groups over time to identify those areas where improvement has or has not been achieved. Both clinical practice and data collection for surgical antibiotic prophylaxis needs further improvement, particularly in the areas of timing and duration of prophylaxis.
Influenza vaccination of healthcare workers is an important aspect of patient safety. The 2006 data in this report showed a slight improvement of healthcare worker vaccination uptake from the previous year. It is anticipated we will continue to see improvements in uptake of this vaccine in the future.
The development of surveillance software for the VICNISS hospitals has been another exciting initiative. After a thorough review of existing hospital-infection surveillance software locally and internationally, we are proceeding, in collaboration with the Victorian Partnership for Advanced Computing, with developing a software program that will integrate with hospital information systems. This software will reduce the amount of time required to collect surveillance data and allow hospitals to focus more on infection prevention. The software has been called SHIINe (Safer Hospitals Integrated Information Network) and is currently being piloted at two hospitals.
Data quality has been an important focus in this period. The validation study in large hospitals for coronary artery graft surveillance proved very informative. Together with the Australasian Society of Cardiothoracic Surgeons, we have undertaken a collaborative study seeking to improve risk adjustment methods. This prompted the VICNISS Coordinating Centre to suggest modifications in surveillance methods and reporting for this surgical group. Findings from this study have been presented at national and international conferences. Recommendations from these findings are now being examined and tested on a large US database to see if they are more generally applicable. We have appreciated the input of consumer representatives in considerations as to how VICNISS data can be usefully presented to the general public. This will be an increasingly important activity in preparation for the release of hospital-level data.
The smaller hospital program (Type 2 surveillance) is approaching maturity. We have learnt a lot about the hospital infection prevention needs in these (usually) rural hospitals. Some of these surveillance modules continue to identify problems that need to be addressed; for example, there is room for improvement in surgical antibiotic prophylaxis and staff immunisation. We continue to see very low rates of serious surgical infections, bloodstream infections after haemodialysis, and methicillin-resistant Staphylococcus aureus infections in these hospitals. These modules are constantly being reviewed to identify the most useful surveillance activities in the smaller hospitals.
