Surveillance of Healthcare-Associated Infections

Healthcare-associated infections (HAIs) are the most common complication for hospitalised patients in Australia, with approximately 165,000 cases annually (NHMRC 2019).

These infections, which can occur in any healthcare setting, cause unnecessary pain and suffering for the patient, prolong hospital stays and add to the cost of care (ACSQHC 2019).

However, through HAI surveillance, approximately one-third of these cases can be prevented (VICNISS 2020).

What is a Healthcare-Associated Infection (HAI)?

The term healthcare-associated infection (HAI) refers to any infection acquired as a result of healthcare, either directly or indirectly (ACSQHC 2019).

HAIs may be caused by a variety of pathogens, some of which are multi-resistant organisms (MROs) that are especially difficult to identify and treat (NSW DoH 2017).

Generally, the most common HAIs are those related to surgical or invasive procedures. These include:

• Catheter-associated urinary tract infections (CAUTI);
• Central line-associated bloodstream infections (CLABSI);
• Surgical site infections (SSI); and
• Ventilator-associated pneumonia (VAP).

(Premier 2014)

What is HAI Surveillance?

HAI Surveillance is the practice of monitoring and reporting HAI incidents. Surveillance allows health service organisations to evaluate current practice, observe outcomes, deliver feedback to staff and implement HAI prevention strategies as required. The aim is to improve clinical practice and consequently, patient outcomes (VICNISS 2020; ACSQHC 2019).

Using infection rate data, organisations can assess the effectiveness of any strategies they have implemented. Once data has been collected, it can be delivered to the appropriate personnel and used to inform the development of future policies, procedures and protocols (VICNISS 2020; ACSQHC 2019).

Surveillance can help organisations determine:

• Whether there is an infection issue;
• The extent of the issue; and
• The factors that are contributing to the issue.

(VICNISS 2020)

The importance of HAI surveillance can be summarised by these three key points:

1. Clients have the right to expect the same quality of care from any organisation, regardless of its size or location. Therefore, if there are certain organisations with a greater prevalence of HAIs, this issue must be identified and addressed.
2. Health service organisations have an obligation to make informed and appropriate decisions. Using data, organisations can determine where they need to direct their resources.
3. Surveillance can help organisations identify successful infection-prevention interventions.

(Russo et. al 2018)

HAI Surveillance in the National Safety and Quality Health Service Standards

HAI surveillance is outlined in Action 3.4 of the National Safety and Quality Health Service Standards, under Standard 3: Preventing and Controlling Healthcare-Associated Infection.

The aim of this action is for organisations to seek out data that will help them prevent HAIs and practice antimicrobial stewardship. Providers are required to develop surveillance strategies that:

• Collect sufficient data on HAIs and antimicrobial use within the organisation.
• Monitor, assess and utilise surveillance data to reduce the risk of HAIs and inform appropriate antimicrobial prescribing; and
• Report surveillance data to all relevant parties (relevant workforce, organisation’s governing body and other relevant groups).

(ACSQHC 2019)

What does Surveillance Monitor?

Health service organisations may use surveillance to monitor:

• Staphylococcus aureus bacteraemia;
• Clostridium difficile infections;
• Central line-associated bloodstream infections;
• Catheter-associated urinary tract infections;
• Surgical site infections;
• Ventilator-associated complications;
• Infections in intensive care units;
• Infections related to invasive devices (outside of ICU);
• Significant multi-resistant organisms;
• Intravascular devices;
• Hand hygiene;
• Workforce immunisation;
• Occupational exposures to blood and body fluids;
• Residential aged care;
• Consistency of antimicrobial prescribing;
• Whether antimicrobials are being prescribed in line with the Australian Therapeutic Guidelines;
• Whether the outbreak management process is being adhered to; and
• Post-discharge infection data from other organisations, clinicians or general practitioners.

(ACSQHC 2019; VICNISS 2020)

Establishing an Effective Surveillance Plan

In order for surveillance to work effectively, organisations should:

• Follow all relevant statutory requirements, safety standards and guidelines;
• Use laboratory-based surveillance and clinical ward rounds to identify infections;
• Monitor antibiotic-resistant bacteria and other pathogens of significance;
• Use surveillance across the entire organisation; and
• Provide feedback from surveillance data analysis to health services.

(VIC DoH 2015)

Conclusion

Healthcare-associated infections are common and often have adverse consequences for clients.

However, surveillance allows health service organisations to gather data that can then be used to establish and monitor interventions to reduce the prevalence of HAIs.

Additional Resources

• ACSQHC, Action 3.4 Surveillance
• VICNISS
• Appropriate Antibiotic use in Aged Care

References

• Australian Commission on Safety and Quality in Health Care 2019, Healthcare-Associated Infection Program, ACSQHC, viewed 20 July 2020, https://www.safetyandquality.gov.au/our-work/healthcare-associated-infection
• National Health and Medical Research Council 2019, Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019), NHMRC, viewed 20 July 2020, https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-prevention-and-control-infection-healthcare-2019
• New South Wales Department of Health 2017, Healthcare Associated Infection, NSW DoH 2017, viewed 20 July 2020, https://www.health.nsw.gov.au/professionals/hai/Pages/default.aspx
• Premier 2014, Healthcare Associated Infections (HAIs), Premier, viewed 20 July 2020, https://www.premiersafetyinstitute.org/safety-topics-az/healthcare-associated-infections-hais/hai/
• Russo, P L, Cheng, A, Mitchell, B G & Hall, L 2018, ‘Healthcare-Associated Infections in Australia: Tackling the 'Known Unknowns', Australian Health Review, vol. 42 no. 2, viewed 21 July 2020, https://research.avondale.edu.au/cgi/viewcontent.cgi?article=1145&context=nh_papers
• VICNISS 2020, What is Surveillance?, VICNISS, viewed 20 July 2020, https://www.vicniss.org.au/about/what-is-surveillance/
• Victoria Department of Health 2015, Healthcare-associated Infection Prevention, VIC DoH, viewed 21 July 2020, https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/infection-prevention/healthcare-associated-infection