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Dear colleagues
Thank you for your great response to my question regarding the change in definition of SSI’s.
Another question for you.
At Canberra Hospital we have been collecting whole of hospital blood stream infection data since 1998.
Would any IC’s be willing to share what other hospitals in Australia also do whole of hospital blood stream surveillance.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
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Heather
I would be very interested in sharing and hearing of what you find, as this was recently given to me to find out what other facilities do in relation to blood stream surveillance.
For all facilities – all positive blood cultures are flagged on the hospital pathology system. We use the commission documents in relation to definitions for SAB & CLABSI. Plus, I reference the CDC if it is something more difficult.
We have been collecting data for a number of years. However I only have confidence in the quality of the data for the last 2 years. This is because we have instituted an internal data validation process.
We report all HAI related bloodstream infections. Our SABs are reported to an executive level and are a KPI. From July 1st 2015, the hospital is financially penalised for every Criterion 1 HAI as per the state purchasing agreement, we are only now just starting to see this, and I don’t know if this will change our processes.
We are very fortunate that we have access to electronic information. Here are the questions that we use to prompt the need to review a result further.
1. What are they admitted with? Read the viewer/ieMR notes, check for recent admission/discharge, do they have indwelling devices? prompt or a history that suggests that they are at risk, e.g. renal patient, Hx AML with recent chemo etc. prompt
2. Have they accessed Healthcare (Both inpatient / outpatient) recently?
* Within 48 hours of discharge is a prompt. In all honesty if they have been discharged in the last 7 days prior to the positive result it raises a flag to identify if I need to look further, could they have accessed any post-acute care?
* Within 31 days of a surgical event, could this be related to a surgical site infection, this is a prompt to look further.
3. Look at the admission date & time. It is important to look at the time arrived into ED, this should be recorded in the viewer/ieMR, our look to other local processes if recorded elsewhere.
* If it is >48 hours after admission, this is a prompt to look further
* If it is within 48 hours of admission BUT the admission reasons is not related to the positive blood culture this would be a prompt to look further. E.g. if a patient was admitted with NSTEMI, but had a Staphylococcus aureus bacteraemia – could it be related to a PIVC inserted by QAS?
4. What is the organism? It may take a couple of days for the organism to be identified, some are slow growers. This is why I have run through the series of questions as above, this way if the patient is still in the ward you can go and review them yourself might get a photo if it is healthcare acquired and criterion 1.
* criterion 1 (commonly causes an infection) or
* criterion 2 (Common contaminants either skin or environmental)
5. Call the laboratory, or go in a look at the blood culture folder, find your patient on the list and see what the medical staff have listed as the focus.
* If it is a contaminant you can ignore the positive blood culture, no further action required.
* If it is a bacteraemia, and it has been flagged for any of the reasons identified above, you will need to review the chart for more information.ALL first time results that are >48hours after admission, or it could be related to either outpatient treatment or another facility are taken to a meeting between the Micro/ID registrars and Infection Control. These are presented and discussed. A final determination is made. If we identify modifiable actions present (aseptic technique etc), these are fed back to the attributable ward/location.
Personally as I review a large number of results – I keep them on an excel spread sheet. I find this easier to manage as with both our local pathology system (AUSLAB) and HAI reporting system, some results will “flag” multiple times, and it saves me going through the whole process. I review on average 90-100 positive results each month. And it takes up a significant proportion of my time!
Happy to answer more questions if you have any.
Thanks
Mandy Davidson
RN DipPHTM MPHTM JCU
CNC Infection Prevention & Control
Townsville Hospital & Health Service
Pathology Building
IMB 38
P: 4433 3567
Mandy.Davidson@health.qld.gov.au
[cid:image001.jpg@01D20DD1.AF549E50]Dear colleagues
Thank you for your great response to my question regarding the change in definition of SSI’s.
Another question for you.
At Canberra Hospital we have been collecting whole of hospital blood stream infection data since 1998.
Would any IC’s be willing to share what other hospitals in Australia also do whole of hospital blood stream surveillance.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
This email, and any attachments, may be confidential and also privileged. If you are not the intended recipient, please notify the sender and delete all copies of this transmission along with any attachments immediately. You should not copy or use it for any purpose, nor disclose its contents to any other person.
———————————————————————–
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.
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The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Hi Mandy
As you know I have a very keen interest in how the financial penalties are being introduced across Australia.
You suggested that “… From July 1st 2015, the hospital is financially penalised for every Criterion 1 HAI as per the state purchasing agreement, we are only now just starting to see this, and I don’t know if this will change our processes.””
Are you able to describe exactly what the penalty is, how it is deemed ie. does the hospital general budget get reduced retrospectively or does a specific unit budget get reduced.
How do your administrators let you know when your hospital has been penalised or do you let them know how many cases and therefore what the budget reduction may be?
When you say you are keen to see the implications will be do you think it will lead to further investment in infection prevention, greater emphasis on clinical practice overall or individual-specific ramifications.
This whole pay-for-performance thing rolled out across the US during my APIC Presidency and the APIC member response was much more lively than anything I sense among us. As you will all know the papers published around this show varying impact but from an on-the-ground view that APIC members had it was an incredible driver for better investment in infection prevention and various technologies. I pray that we Aussies don’t miss this opportunity or misjudge it.
Looking forward to your feedback and other views. Also why is it that QLD seems to be the only state penalising?
Cheers
CAthHeather
I would be very interested in sharing and hearing of what you find, as this was recently given to me to find out what other facilities do in relation to blood stream surveillance.
For all facilities – all positive blood cultures are flagged on the hospital pathology system. We use the commission documents in relation to definitions for SAB & CLABSI. Plus, I reference the CDC if it is something more difficult.
We have been collecting data for a number of years. However I only have confidence in the quality of the data for the last 2 years. This is because we have instituted an internal data validation process.
We report all HAI related bloodstream infections. Our SABs are reported to an executive level and are a KPI. From July 1st 2015, the hospital is financially penalised for every Criterion 1 HAI as per the state purchasing agreement, we are only now just starting to see this, and I don’t know if this will change our processes.
We are very fortunate that we have access to electronic information. Here are the questions that we use to prompt the need to review a result further.
1. What are they admitted with? Read the viewer/ieMR notes, check for recent admission/discharge, do they have indwelling devices? prompt or a history that suggests that they are at risk, e.g. renal patient, Hx AML with recent chemo etc. prompt
2. Have they accessed Healthcare (Both inpatient / outpatient) recently?
* Within 48 hours of discharge is a prompt. In all honesty if they have been discharged in the last 7 days prior to the positive result it raises a flag to identify if I need to look further, could they have accessed any post-acute care?
* Within 31 days of a surgical event, could this be related to a surgical site infection, this is a prompt to look further.
3. Look at the admission date & time. It is important to look at the time arrived into ED, this should be recorded in the viewer/ieMR, our look to other local processes if recorded elsewhere.
* If it is >48 hours after admission, this is a prompt to look further
* If it is within 48 hours of admission BUT the admission reasons is not related to the positive blood culture this would be a prompt to look further. E.g. if a patient was admitted with NSTEMI, but had a Staphylococcus aureus bacteraemia – could it be related to a PIVC inserted by QAS?
4. What is the organism? It may take a couple of days for the organism to be identified, some are slow growers. This is why I have run through the series of questions as above, this way if the patient is still in the ward you can go and review them yourself might get a photo if it is healthcare acquired and criterion 1.
* criterion 1 (commonly causes an infection) or
* criterion 2 (Common contaminants either skin or environmental)
5. Call the laboratory, or go in a look at the blood culture folder, find your patient on the list and see what the medical staff have listed as the focus.
* If it is a contaminant you can ignore the positive blood culture, no further action required.
* If it is a bacteraemia, and it has been flagged for any of the reasons identified above, you will need to review the chart for more information.ALL first time results that are >48hours after admission, or it could be related to either outpatient treatment or another facility are taken to a meeting between the Micro/ID registrars and Infection Control. These are presented and discussed. A final determination is made. If we identify modifiable actions present (aseptic technique etc), these are fed back to the attributable ward/location.
Personally as I review a large number of results – I keep them on an excel spread sheet. I find this easier to manage as with both our local pathology system (AUSLAB) and HAI reporting system, some results will “flag” multiple times, and it saves me going through the whole process. I review on average 90-100 positive results each month. And it takes up a significant proportion of my time!
Happy to answer more questions if you have any.
Thanks
Mandy Davidson
RN DipPHTM MPHTM JCU
CNC Infection Prevention & Control
Townsville Hospital & Health Service
Pathology Building
IMB 38
P: 4433 3567
Mandy.Davidson@health.qld.gov.au
[Logo 2015]Dear colleagues
Thank you for your great response to my question regarding the change in definition of SSI’s.
Another question for you.
At Canberra Hospital we have been collecting whole of hospital blood stream infection data since 1998.
Would any IC’s be willing to share what other hospitals in Australia also do whole of hospital blood stream surveillance.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
This email, and any attachments, may be confidential and also privileged. If you are not the intended recipient, please notify the sender and delete all copies of this transmission along with any attachments immediately. You should not copy or use it for any purpose, nor disclose its contents to any other person.
———————————————————————–
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
********************************************************************************
This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.
Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.
If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.
If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.
Although Queensland Health takes all reasonable steps to ensure this email does not contain malicious software, Queensland Health does not accept responsibility for the consequences if any person’s computer inadvertently suffers any disruption to services, loss of information, harm or is infected with a virus, other malicious computer programme or code that may occur as a consequence of receiving this email.
Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.
**********************************************************************************
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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Hi Heather
We also collect HA-BSI data which commenced in 2012.
I am very happy to share with you and others performing this surveillance if you want to email me direct.Regards
Rosie Lee CICP-E I Coordinator Infection Prevention & Management I Royal Perth Hospital I
Royal Perth Bentley Group I EMHS ILevel 6, South Block, Wellington Street PERTH WA 6000
T: (08) 9224 2805 F:(08) 92241989
E: rosie.lee@health.wa.gov.au
http://www.rph.health.wa.gov.au | http://www.bhs.health.wa.gov.au
[cid:image001.jpg@01D1EC0E.B0B3DD90]
The contents of this e-mail transmission are intended solely for the named recipient (s), may be confidential, and may be privileged or otherwise protected from disclosure in the public interest. The use, reproduction, disclosure or distribution of the contents of this e-mail transmission by any person other than the named recipient (s) is prohibited. If you are not a named recipient please notify the sender immediately.Dear colleagues
Thank you for your great response to my question regarding the change in definition of SSI’s.
Another question for you.
At Canberra Hospital we have been collecting whole of hospital blood stream infection data since 1998.
Would any IC’s be willing to share what other hospitals in Australia also do whole of hospital blood stream surveillance.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
This email, and any attachments, may be confidential and also privileged. If you are not the intended recipient, please notify the sender and delete all copies of this transmission along with any attachments immediately. You should not copy or use it for any purpose, nor disclose its contents to any other person.
———————————————————————–
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Dear Heather,
All public hospitals and most private hospitals in South Australia do whole of hospital BSI surveillance, and the larger ones have been doing so since 1997.
For our current surveillance definitions and BSI annual report see: http://www.sahealth.sa.gov.au/HAIstatisticsRegards,
Irene Wilkinson BSc(Hons) MPH
Manager, Infection Control Service
Communicable Disease Control Branch
System Peformance and Service Delivery
SA Health
Government of South Australiahttp://www.sahealth.sa.gov.au/infectionprevention
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This e-mail may contain confidential information, which also may be legally privileged. Only the intended recipient(s) may access, use, distribute or copy this e-mail. If this e-mail is received in error, please inform the sender by return e-mail and delete the original. If there are doubts about the validity of this message, please contact the sender by telephone. It is the recipient’s responsibility to check the e-mail and any attached files for viruses.Dear colleagues
Thank you for your great response to my question regarding the change in definition of SSI’s.
Another question for you.
At Canberra Hospital we have been collecting whole of hospital blood stream infection data since 1998.
Would any IC’s be willing to share what other hospitals in Australia also do whole of hospital blood stream surveillance.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
This email, and any attachments, may be confidential and also privileged. If you are not the intended recipient, please notify the sender and delete all copies of this transmission along with any attachments immediately. You should not copy or use it for any purpose, nor disclose its contents to any other person.
———————————————————————–
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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