RESUMO
To determine the burden of skin and soft tissue infections (SSTI), the nature of antimicrobial prescribing and factors contributing to inappropriate prescribing for SSTIs in Australian aged care facilities, SSTI and antimicrobial prescribing data were collected via a standardised national survey. The proportion of residents prescribed ⩾1 antimicrobial for presumed SSTI and the proportion whose infections met McGeer et al. surveillance definitions were determined. Antimicrobial choice was compared to national prescribing guidelines and prescription duration analysed using a negative binomial mixed-effects regression model. Of 12 319 surveyed residents, 452 (3.7%) were prescribed an antimicrobial for a SSTI and 29% of these residents had confirmed infection. Topical clotrimazole was most frequently prescribed, often for unspecified indications. Where an indication was documented, antimicrobial choice was generally aligned with recommendations. Duration of prescribing (in days) was associated with use of an agent for prophylaxis (rate ratio (RR) 1.63, 95% confidence interval (CI) 1.08-2.52), PRN orders (RR 2.10, 95% CI 1.42-3.11) and prescription of a topical agent (RR 1.47, 95% CI 1.08-2.02), while documentation of a review or stop date was associated with reduced duration of prescribing (RR 0.33, 95% CI 0.25-0.43). Antimicrobial prescribing for SSTI is frequent in aged care facilities in Australia. Methods to enhance appropriate prescribing, including clinician documentation, are required.
Assuntos
Antibacterianos/administração & dosagem , Prescrição Inadequada/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Dermatopatias Infecciosas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Feminino , Humanos , Masculino , Dermatopatias Infecciosas/microbiologia , Infecções dos Tecidos Moles/microbiologiaRESUMO
Central line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs) result in poor clinical outcomes and increased costs. Although frequently regarded as preventable, infection risk may be influenced by non-modifiable factors. The objectives of this study were to evaluate organisational factors associated with CLABSI in Victorian ICUs to determine the nature and relative contribution of modifiable and non-modifiable risk factors. Data captured by the Australian and New Zealand Intensive Care Society regarding ICU-admitted patients and resources were linked to CLABSI surveillance data collated by the Victorian Healthcare Associated Infection Surveillance System between 1 January 2010 and 31 December 2013. Accepted CLABSI surveillance methods were applied and hospital/patient characteristics were classified as 'modifiable' and 'non-modifiable', enabling longitudinal Poisson regression modelling of CLABSI risk. In total, 26 ICUs were studied. Annual CLABSI rates were 1·72, 1·37, 1·00 and 0·93/1000 CVC days for 2010-2013. Of non-modifiable factors, the number of non-invasively ventilated patients standardised to total ICU bed days was found to be independently associated with infection (RR 1·07; 95% CI 1·01-1·13; P = 0·030). Modelling of modifiable risk factors demonstrated the existence of a policy for mandatory ultrasound guidance for central venous catheter (CVC) localisation (RR 0·51; 95% CI 0·37-0·70; P < 0·001) and increased number of sessional specialist full-time equivalents (RR 0·52; 95% CI 0·29-0·93; P = 0·027) to be independently associated with protection against infection. Modifiable factors associated with reduced CLABSI risk include ultrasound guidance for CVC localisation and increased availability of sessional medical specialists.
Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva , Idoso , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Infecção Hospitalar/microbiologia , Humanos , Incidência , Pessoa de Meia-Idade , Risco , Vitória/epidemiologiaRESUMO
Detection of a hypervirulent strain of Clostridium difficile in Victoria led to commencement of targeted surveillance for C. difficile infection in 2010. Cases were reported through the Victorian Healthcare Associated Infection Surveillance System. Between 1 October 2010 and 31 March 2011, 477 cases of C. difficile infection were identified; 11 (2.3%) secondary to a hypervirulent strain. Three hundred and seventy (1.7 per 10,000 occupied bed days) were healthcare associated. Data reflect successful implementation of continuous surveillance for C. difficile infection. With hypervirulent C. difficile infection now reported in other Australian states, development of a national data repository for C. difficile infection is necessary.
Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Diarreia/microbiologia , Enterocolite Pseudomembranosa/epidemiologia , Vigilância da População , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Clostridioides difficile/isolamento & purificação , Clostridioides difficile/patogenicidade , Enterocolite Pseudomembranosa/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Vitória/epidemiologia , Virulência , Adulto JovemRESUMO
Accreditation standards for Australian aged care homes include the requirement for programs to ensure infections are controlled. Effective infection prevention programs are supported by surveillance data providing the impetus for quality improvement and facilitating evaluation of interventions at the facility level. In 2016, infection control professionals employed in Victorian public-sector residential aged care services were surveyed to examine the nature and resourcing of local infection prevention programs and monitoring activities. Overall, 164 services participated (90% response rate). A high proportion (84%) reported executive support for infection surveillance, with mean allocation of 12h per fortnight per facility for infection prevention activities. Current surveillance activities included monitoring of infections and antimicrobial use (90%), influenza vaccination compliance for staff (96%) and residents (76%) and monitoring of infection due to significant organisms (84%). A successful statewide program including eight quality indicators has subsequently been implemented in Victoria. We suggest that a national focus could strengthen this framework, ensuring a uniform strategy with enhanced benchmarking capacity. Stakeholder engagement and refinement of appropriate indicators for monitoring quality improvement in public, not-for-profit and private sectors within aged care is required.
Assuntos
Instituição de Longa Permanência para Idosos , Controle de Infecções/métodos , Benchmarking , Pesquisas sobre Atenção à Saúde , Humanos , Controle de Infecções/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , VitóriaRESUMO
Carbapenemase-producing Enterobacteriaceae (CPE) infections are increasingly reported in Australian hospitals, but prevalence is unknown. In 2016, Victorian hospitals conducted CPE point-prevalence surveys in high-risk wards (intensive care, haematology, transplant). Forty-three hospitals performed 134 surveys, with 1839/2342 (79%) high-risk patients screened. Twenty-four surveys were also performed in other wards. Inability to obtain patient consent was the leading reason for non-participation. In high-risk wards, no CPE cases were detected; three cases were identified in other wards. Since there is low prevalence in high-risk wards, continuous screening is not recommended. Targeted screening may be enhanced by review of patient consent processes.
Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Hospitais , Infecções por Enterobacteriaceae/diagnóstico , Humanos , Programas de Rastreamento , Prevalência , Vitória/epidemiologiaRESUMO
BACKGROUND: Healthcare-associated infections in neonatal and paediatric populations are associated with poorer outcomes and healthcare costs, and surveillance is a necessary component of prevention programmes. AIM: To evaluate burden of illness, aetiology, and time-trends for central and peripheral line-associated bloodstream infection (CLABSI and PLABSI) in Australian neonatal and paediatric intensive care units (ICUs) between July 1st, 2008 and December 31st, 2016. METHODS: Using National Healthcare Safety Network methods, surveillance in neonatal and paediatric units was performed by hospitals participating in the Victorian Healthcare Associated Infection Surveillance System. Mixed effects Poisson regression was used to model infections over time. FINDINGS: Overall, 82 paediatric CLABSI events were reported during 37,125 CVC-days (2.21 per 1000 CVC-days), 203 neonatal CLABSI events were reported during 92,169 CVC-days (2.20 per 1000 CVC-days), and 95 neonatal PLABSI events were reported during 142,240 peripheral line-days (0.67 per 1000 peripheral line-days). Over time, a significant decrease in quarterly risk for neonatal CLABSI events was observed (risk ratio (RR): 0.98; 95% confidence interval: 0.97-0.99; P = 0.023) and this reduction was significant for the 751-1000 g birth weight cohort (RR: 0.97; P = 0.015). Most frequently, coagulase-negative Staphylococcus spp. (24.2%) and Staphylococcus aureus (16.1%) were responsible for CLABSI events. A significant reduction in Gram-negative neonatal infections was observed (annual RR: 0.85; P < 0.001). CONCLUSION: CLABSI rates in neonatal and paediatric ICUs in our region are low, and neonatal infections have significantly diminished over time. Evaluation of infection prevention programmes is required to determine whether specific strategies can be implemented to further reduce infection risk.
Assuntos
Infecções Relacionadas a Cateter/complicações , Unidades de Terapia Intensiva Pediátrica , Sepse/epidemiologia , Dispositivos de Acesso Vascular/efeitos adversos , Monitoramento Epidemiológico , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Lactente , Recém-Nascido , Controle de Infecções/métodos , Masculino , Vitória/epidemiologiaRESUMO
A validation study was conducted in smaller (<100 acute beds) Victorian hospitals to evaluate case detection for Staphylococcus aureus bloodstream (SAB), meticillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococci (VRE) infections. Overall, 142 infections were identified in 20 hospitals. For routine surveillance of SAB events, sensitivity was 74.4% and specificity was 100.0%. For MRSA infections, sensitivity was 47.5% and specificity was 90.9%. All confirmed VRE infections were reported correctly. Of unreported SAB and MRSA infections, 80% (N = 16) and 83.9% (N = 26) were community-associated infections, respectively. Future programme refinements include targeted education to ensure appropriate application of case definitions, particularly those including community onset.
Assuntos
Infecção Hospitalar/epidemiologia , Monitoramento Epidemiológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Hospitais , Staphylococcus aureus/isolamento & purificação , Enterococos Resistentes à Vancomicina/isolamento & purificação , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Sensibilidade e Especificidade , Vitória/epidemiologiaRESUMO
The advent of public reporting of hospital-acquired infection rates has sparked ongoing discussion about the most appropriate surveillance data to present. When we used different numerators to calculate rates of surgical site infection following coronary artery bypass graft surgery, we found that some hospitals' rates and their rankings were notably affected.
Assuntos
Ponte de Artéria Coronária/efeitos adversos , Infecção Hospitalar/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Humanos , Incidência , Vigilância de Evento Sentinela , Estatística como Assunto/métodos , Vitória/epidemiologiaRESUMO
BACKGROUND: Patients with chronic renal failure who require haemodialysis are at high risk for infections. AIM: To determine the burden of bloodstream and local access-related infections and the prescribing patterns for intravenous antibiotics in Australian haemodialysis outpatients. METHODS: A surveillance network was established following stakeholder consultation, with voluntary participation by haemodialysis centres and data collation by the Victorian Healthcare Associated Infection Surveillance System Coordinating Centre. Definitions for infection and intravenous antimicrobial starts were based upon methods employed by the Centers for Disease Control and Prevention. Longitudinal mixed-effects Poisson regression was used to model time-trends for the period 2008-2015. FINDINGS: Forty-eight of 78 Victorian dialysis centres participated in the network, with 3449 events reported over 78,826 patient-months. Rates of bloodstream infection, local infection and intravenous antimicrobial starts were much higher for patients with tunnelled central lines (2.60, 1.41, and 3.37 per 100 patient-months, respectively), compared to those with arteriovenous fistulae (0.27, 0.23, and 0.73 per 100 patient-months, respectively) and arteriovenous grafts (0.76, 1.08, 1.50 per 100 patient-months, respectively). Staphylococcus aureus was the most frequent pathogen, with meticillin-resistant isolates (MRSA) responsible for 14.0%. Access-related infections diminished significantly across all vascular-access modalities over time. Vancomycin contributed nearly half of all antimicrobial starts consistently throughout the study period. CONCLUSION: Risk for bloodstream and local access-related infections is highest in Australian haemodialysis patients with tunnelled central lines. S. aureus is the most frequent cause of infection, with a low incidence of MRSA. Future programmes should evaluate infection prevention practices and appropriateness of antibiotic prescribing in this population.
Assuntos
Anti-Infecciosos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Uso de Medicamentos , Monitoramento Epidemiológico , Diálise Renal/efeitos adversos , Insuficiência Renal/complicações , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Prevalência , Insuficiência Renal/terapia , Vitória/epidemiologiaRESUMO
A statewide assessment of the compliance of surgical antibiotic prophylaxis (SAP) with guidelines was undertaken for large public hospitals in Victoria, Australia. This was carried out using data collected as part of a surveillance system for hospital-acquired infections. The study population comprised patients in Victorian public hospitals with >100 beds (N=27) undergoing cardiac surgical procedures, hip or knee arthroplasty, cholecystectomy, appendectomy, colon surgery or hysterectomy over a 21-month period. Australian guidelines recommend SAP for all 10 643 surgical procedures included in this study. Combining all procedures, 87% received SAP, the choice of antibiotic was concordant with guidelines for 53.3% of procedures, and the choice of antibiotic was considered to be 'adequate but not concordant' for 23.9% of procedures. SAP was considered to be inadequate for 18.9% of procedures. A large number of antibiotic regimens were utilized for cardiac and orthopaedic surgery. Documentation of timing of administration was not submitted for more than half of all procedures. Timing was concordant with guidelines for 76.4% of procedures when documented. Prophylactic antibiotic choice was generally more concordant with guidelines for cardiac and orthopaedic procedures than for other types of surgery. However, even for these procedures, where infections carry high morbidity, SAP was sometimes inadequate. Regular reporting on SAP compliance from data collected during surveillance for hospital-acquired infections is achievable. This should lead to improvements in both compliance and documentation.
Assuntos
Antibioticoprofilaxia/estatística & dados numéricos , Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais Públicos/normas , Cuidados Pré-Operatórios/normas , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/administração & dosagem , Humanos , Vigilância de Evento Sentinela , Fatores de Tempo , VitóriaRESUMO
BACKGROUND: With epidemic strains of Clostridium difficile posing a substantial healthcare burden internationally, there is a need for longitudinal evaluation of Clostridium difficile infection (CDI) events in Australia. AIM: To evaluate time trends and severity of illness for CDI events in Australian healthcare facilities. METHODS: All CDI events in patients admitted to Victorian public hospitals between 1(st) October 2010 and 31(st) December 2014 were reported to the Victorian Healthcare Associated Infection Surveillance System. CDI was defined as the isolation of a toxin-producing C. difficile organism in a diarrhoeal specimen, and classified as community-associated (CA-CDI) or healthcare-associated (HA-CDI). Severe disease was defined as admission to an intensive care unit, requirement for surgery and/or death due to infection. Time trends were examined using a mixed-effects Poisson regression model, and the Walter and Edward test of seasonality was applied to evaluate potential cyclical patterns. FINDINGS: In total, 6736 CDI events were reported across 89 healthcare facilities. Of these, 4826 (71.6%) were HA-CDI, corresponding to a rate of 2.49/10,000 occupied bed days (OBDs). The incidence of HA-CDI was highest in the fifth quarter of surveillance (3.6/10,000 OBDs), followed by a reduction. Severe disease was reported in 1.66% of events, with the proportion being significantly higher for CA-CDI compared with HA-CDI (2.21 vs 1.45%, P = 0.03). The highest and lowest incidence of HA-CDI occurred in March and October, respectively. CONCLUSIONS: A low incidence of HA-CDI was reported in Victoria compared with US/European surveillance reports. Seasonality was evident, together with diminishing HA-CDI rates in 2012-2014. Severe infections were more common in CA-CDI, supporting future enhanced surveillance in community settings.