Academic journal article Australian Health Review

Healthcare-Associated Infections in Australia: Time for National Surveillance

Academic journal article Australian Health Review

Healthcare-Associated Infections in Australia: Time for National Surveillance

Article excerpt

Introduction

A healthcare-associated infection (HAI) is an infection that occurs as a result of a health care intervention.1 Historically called a 'nosocomial' infection, meaning 'hospital acquired', the term 'healthcare' is now used in recognition that today much health care occurs outside a hospital. Examples of HAIs are bloodstream infections commonly caused by the presence of an intravenous device, or an infected surgical wound following a surgical procedure. Many HAIs result in significant morbidity and mortality.2 It is estimated that in Europe and North America, 12-32% of HAI bloodstream infections result in death.3 In Australia, it has been suggested that 175 000 HAIs occur annually,4 but the exact figure is unknown.

Surveillance is defined as 'the ongoing, systematic collection, analysis and interpretation of health data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those who need to know'.5 It is a fundamental component of modern health care, demonstrated by the recently released national safety and quality health service standards for Australian hospitals that include 19 criteria on the prevention and control of HAIs, and specifically mandate HAI surveillance.6

By its very existence, infection prevention implies that HAIs are preventable. Although it is challenging to quantify the preventable proportion of HAIs, there is agreement that a significant proportion and probably the majority of HAIs are preventable.7,8

The purpose of HAI surveillance is to provide quality data that can act as an effective monitoring and alert system.9 The aim is to reduce the incidence of preventable HAIs. A successful HAI surveillance program must be epidemiologically robust, valid, accurate, timely, useful, consistent and practical.5

Effective surveillance will deliver information to key stakeholders at all levels to inform decisions. The simple act of collecting HAI data will not reduce HAI;10 rather, data must stimulate action and drive improvement. HAI surveillance systems establish a baseline rate of infection which can then be used to detect clusters or outbreaks, identify problems, evaluate prevention and control measures, generate hypotheses concerning risk factors, guide treatment and prevention strategies, make comparisons with other facilities, inform planning and ultimately reduce the incidence of HAIs.11-14

Australia is one of the few developed countries without a national HAI surveillance program. Unlike the US, UK and many European countries, who have supported and maintained national HAI surveillance programs for decades, Australia lacks well structured processes to produce high quality national HAI data. In the UK and some states in the US, reporting of some HAIs has been mandated by law.15,16 Such international programs enable research on the epidemiology of HAIs, which also leads to enhanced and refined surveillance processes improving the quality of the HAI data now commonly reported in the public domain.17,18 In the US, hospitals are financially penalised on the occurrence of events, many of them HAIs, which are deemed preventable.19

Recent activity in Australia to develop national guides for the implementation of surveillance on Staphylococcus aureus bloodstream (SAB) infection, Clostridium difficile infection (CDI) and central line-associated bloodstream infection20 is positive but there is still much work to be done to improve our knowledge on the epidemiology of HAIs across Australia.

The purpose of this paper is to review well established international HAI surveillance programs and their impact on HAI rates, provide an overview of current Australian HAI surveillance programs and recommend a way forward to develop a national HAI surveillance program. This review focuses on the surveillance of infections in large acute public healthcare facilities, where the risk and consequences of infection are higher due to the nature of the care that takes place. …

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