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Hi Lindy
In addition to my earlier comments I just wanted to add some info about alcohol that may have been overlooked and which may be worth consideration.Alcohols mechanism of action is by disrupting cell membrane. It has excellent effect against both gram -ve & gram +ve orgs and has excellent rapidity of action. It has no persistence or residual action. Optimum concentrations are 60%-90% and it does not penetrate organic material.
Cheers
CathWarm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Tim Spencer
Sent: Friday, 9 December 2016 7:36 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: skin prep for haemodyalisis – questionHi Lindy,
Sterile saline is just that – sterile saline!
It has no antiseptic properties at all and so I would not recommend cleaning the site with saline prior to cannulation. There is still potential to drag skin colonies into the fistula during the cannulation process.If anything, I would suggest the use of plain isopropyl alcohol (70%) as at least that will kill bacteria on the skins surface.
CHG & PI merely provide a longer acting antiseptic phase once on the skin.Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Vascular Access Consultant
Sent from my iPhone
On Dec 8, 2016, at 17:20, Lindy Ryan <Lindy.Ryan@NCAHS.HEALTH.NSW.GOV.AU> wrote:
HelloWe have a pt with sensitivity to povidine /iodine and CHG who has a fistula & is having regular haemodialysis .
Other than cleaning her skin with sterile normal saline prior to cannulating them for their dialysis is there any other skin antisepsis that could be used.
I have looked at referenced from CDC and APIC but there is nothing useful re any other skin antisepsis just wondering if anyone out there was using anything else in these pts with success or is sterile normal saline the only best option to stick with ?
Many thanks
Kind regards
Lindy
Lindy Ryan
Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Mid-North-Coast-LHD.jpg]
Wise and humane management of the patient is the best safeguard against infection
(Florence Nightingale Circa 1860)________________________________
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Hi Lindy
You obviously have a difficult clinical situation and critical decisions to make.
Given the very low true incidence of CHG sensitivity I would be keen to know that the patient has been properly assessed as being truly sensitive to CHG and also that efforts have been made to eliminate unnecessary exposure to CHG. Few people realise that CHG is commonly used in many domestic products and also in healthcare solutions where we may not expect it. As such, HCWs draw sometimes false conclusions about sensitivity/ allergy. There is a great paper just published by Kampf that poses the concept of antiseptic stewardship. Worth a read.
All of that said none of it helps your situation. If you choose to go the 70% alcohol route only I would then reinforce every other infection control measure that we know reduces infection ie. hand hygiene, impregnated dressings (perhaps AMD as CHG wont be appropriate), impeccable aseptic technique etc. These special cases in my experience can often become real challenges.
I wish you good luck managing this one. If you would like a copy of the stewardship paper let me know by PM.
I am v. fearful that CHG gets a bad wrap without a lot of deep thinking and in some ways it reminds me a lot of the early days of latex. Issues and cases like this require a cool, critical thinking head and a timely response you will be fine there.
Warm regards
CathCathryn Murphy RN, Bach Photog, MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Claire Rickard
Sent: Friday, 9 December 2016 9:14 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: skin prep for haemodyalisis – questionHi Lindy, I agree with Tim & Carolyn, you could use 70% alcohol (and of course let it dry :)). If this is going to be a regular patient, there is another good agent (and generally well tolerated e.g. Used in neonates) called octenidine which is used ++ in Europe but not currently registered in Aust, u could get your pharmacist to get Special Access Scheme approval from TGA and order from o/s.
Hope this helps, CClaire Rickard RN PhD FAHMS FACN
Director, Alliance for Vascular Access Teaching and Research (AVATAR), & Professor, National Centre of Research Excellence in Nursing Interventions, Menzies Health Institute QueenslandVisiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane & Women’s Hospitals
Honorary Professor, University of Manchester
Assistant: Jo.Wright@griffith.edu.au Tel: +61 7 3735 4886
[https://lh4.googleusercontent.com/i-R5K4-QTijRuqZ6l22XOUNBmPRWrBmS5Oys-Rh6s_Ylb-yfl1RUMDrJDGmfXdRXTJebq3cuuYNVOZkpgkNDzjZIYdTTqkZFmDGbmGfgbuE6Hx0kdMqk4AFuTtAphiCBDpPJ-0E] [https://docs.google.com/uc?export=download&id=0B6EekFFxxg8xazF6bEZQUjB0ZU0&revid=0B6EekFFxxg8xb2tYRDlzeURGdktqelNUSnd1NWFUUkpFUk5BPQ][https://docs.google.com/a/griffith.edu.au/uc?id=0B4oYPXWMHd46aGY4ZUtCSUk4UjA&export=download]
Interested in IV research? http://www.avatargroup.org.au
Follow the AVATAR Group
LinkedIn: http://bit.ly/2btniJ9
Facebook: https://www.facebook.com/avatargroup4111/
Twitter: https://twitter.com/AVATAR_grpInterested in joining AVAS? http://www.avas.org.au
On 9 December 2016 at 08:59, <Carolyn.Chenoweth@fmc-asia.com> wrote:
Hi Lindy,
See below for haemodialysis access cleansing that we recommend for patients in our dialysis clinics across Australia and Asia Pacific.1. Educate patients to wash their fistula with normal liquid hand soap (we do not use antimicrobial hand soap) at dedicated clinical hand basins (no liquids e.g. dialysate emptied into these sinks) on arrival.
If patients have mobility issues and can’t access the clinical hand basins we offer alcohol based hand rubs to clean their hands and fistula.2. We recommend Chlorhexidine (0.5% to 2%) combined with alcohol, swabs for all skin cleansing prior to cannulation.
2% chlorhexidine can cause skin irritation while rarely have issues with 0.5% or 1%chlorhexidine and alcohol.
If chlorhexidine can’t be tolerated at all we either use povidine iodine or plain alcohol swabs.
The very rare patients who are highly sensitive to everything we just ensure very good hand washing and washing fistula with liquid hand soap.With best regards
Carolyn Chenoweth
Quality & Infection Prevention and Control Manager, Australia
Asia Pacific Quality & IPC SME. CICPFresenius Medical Care Australia Pty Ltd
Payneham Dialysis Clinic,
2 Portrush Road
PAYNEHAM 5070
Australia
T: +61 (0) 8 8165 4313
M: +61 (0) 407 810 800
http://www.fmc-ag.comFrom: “EXTERN ACIPC Infexion Connexion” <AICALIST@AICALIST.ORG.AU>
To: AICALIST@AICALIST.ORG.AU
Date: 09/12/2016 07:59 AM
Subject: skin prep for haemodyalisis – question
________________________________Hello
We have a pt with sensitivity to povidine /iodine and CHG who has a fistula & is having regular haemodialysis .
Other than cleaning her skin with sterile normal saline prior to cannulating them for their dialysis is there any other skin antisepsis that could be used.
I have looked at referenced from CDC and APIC but there is nothing useful re any other skin antisepsis just wondering if anyone out there was using anything else in these pts with success or is sterile normal saline the only best option to stick with ?
Many thanks
Kind regards
Lindy
Lindy Ryan
Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.auWise and humane management of the patient is the best safeguard against infection
(Florence Nightingale Circa 1860)________________________________
This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
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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—
Claire Rickard RN PhD FAHMS FACN
Director, Alliance for Vascular Access Teaching and Research (AVATAR), & Professor, National Centre of Research Excellence in Nursing Interventions, Menzies Health Institute QueenslandVisiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane & Women’s Hospitals
Honorary Professor, University of Manchester
Assistant: Jo.Wright@griffith.edu.au Tel: +61 7 3735 4886
[https://lh4.googleusercontent.com/i-R5K4-QTijRuqZ6l22XOUNBmPRWrBmS5Oys-Rh6s_Ylb-yfl1RUMDrJDGmfXdRXTJebq3cuuYNVOZkpgkNDzjZIYdTTqkZFmDGbmGfgbuE6Hx0kdMqk4AFuTtAphiCBDpPJ-0E] [https://docs.google.com/uc?export=download&id=0B6EekFFxxg8xazF6bEZQUjB0ZU0&revid=0B6EekFFxxg8xb2tYRDlzeURGdktqelNUSnd1NWFUUkpFUk5BPQ][https://docs.google.com/a/griffith.edu.au/uc?id=0B4oYPXWMHd46aGY4ZUtCSUk4UjA&export=download]
Interested in IV research? http://www.avatargroup.org.au
Follow the AVATAR Group
LinkedIn: http://bit.ly/2btniJ9
Facebook: https://www.facebook.com/avatargroup4111/
Twitter: https://twitter.com/AVATAR_grpInterested in joining AVAS? http://www.avas.org.au
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Hi Alison
Not sure if your library has academic links. If so you may be able to access Australian Standards and perhaps EN and ISO stadnards that way. For example through Griffith Uni I can access a limited few days access to ASs.
It is completely unrealistic to expect hospitals to access these additional Standards and IMHO a bureaucratic and commercial exercise out of control. It’s also a problem when Guidelines enshrine Aust Standards and the Standards change before the Guideline does (as is the case for several enshrinements in the existing National IC Guidelines.
Getting workable and easily updateable Guidelines would be a start…Guidelines that can respond to evidence, microbiologic trends and new, emerging technologies which are the most overlooked.
Our national guidelines are now 6 years old and very outdated. I appreciate that they are under review but I will bet that they will never quite be timely enough or they will remain silent on many critical issues.
A great example of contemporary guidelines are the EPIC series from the UK.
Sorry for the rant but it is all related and makes practice hard at the clinical level.
Cath
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.au—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Alison Shoobert
Sent: Monday, 17 October 2016 10:13 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Accessing EN & ISO StandardsAs a CNC in Infection Prevention I am currently undertaking a project reviewing CSDs across our local health district.
We have experienced difficulty accessing full versions of the EN and ISO standards listed as “Normative References” to read in conjunction with the AS. The information contained in these documents is needed to fully comprehend AS 4187:2014.
We are currently seeking funding to expand our subscription to our current standards provider, enabling us access which has a significant associated fee.
Is there another way…how have others accessed these documents?
I appreciate your input.
Alison Shoobert
CNC Infection PreventionMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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No doubt Claire Rickard will have an opinion but here is a start.
Rickard, C. M., Marsh, N. M., Webster, J., Gavin, N. C., McGrail, M. R., Larsen, E., Corley, A., Long, D., Gowardman, J. R., Murgo, M., Fraser, J. F., Chan, R. J., Wallis, M. C., Young, J., McMillan, D., Zhang, L., Choudhury, M. A., Graves, N. & Playford, E. G. 2015. Intravascular device administration sets: replacement after standard versus prolonged use in hospitalised patients-a study protocol for a randomised controlled trial (The RSVP Trial). BMJ Open, 5, e007257.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auDear colleagues
Thank you for previous responses.
Would any like to share if they have a policy/procedure for the hanging of IV lines?
At the Canberra Hospital we had a policy for length of time an iv line could be used before needing to be changed but it seems to have dropped off.
We have had the question from the wards regarding small infusions, eg antibiotics. Do the lines need to be changed with each new infusion?
Also once a bag is spiked how long can the bag be hung before being used with and without additives.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
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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.
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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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Motivation is powerful Sharyn. Preservation and self-preservation are sometimes even more powerful. Would make for a very interesting ethnographic PhD. Thank you for raising it.
Cheers
CathHi Cath et al,
This topic I find interesting on many levels due to the economics, public health impacts advancing technology.
Healthcare bundles utilised by healthcare workers can improve patient outcome and are evidenced by research. I have utilised many bundles with my background in adult ICU and IPAC nursing both in the UK private sector and Australian public health systemsA slight Segway off the topic of Non-payment for non-performance and BSI but a worth considering is the behaviour of HCWs.
Having relieved the Parenteral Nutrition CNC position over time and having discharged patients home with invasive lines for them to receive TPN that I have not come across a CLABSI within this patient population during surveillance.
That is not to say it doesn’t or hasn’t occurred. Patient/carer need to be assessed as competent with invasive line care: dressing changes, accessing and de-accessing, setting up infusions, flushing and locking lumens prior to discharge.
Ultimately a ‘Standard Precautions, Aseptic Technique and Hand Hygiene Bundle” of education and competency assessment is delivered the patient/carer to care for lines that are used for many years.I find it interesting a patient/carer from a non-health care background can use these principles successfully – however trained HCWs require bundles.
Regards,
Sharyn
Sharyn Hughes
Clinical Nurse Consultant |Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264490Click here Infection Prevention and Control to visit the IPAC webpage
Thanks Michael
Debate is healthy and considered review of emerging additional proven technologies is as you and I agree one aspect of HAI prevention. What I am hoping to do is provoke discussion, raise awareness and discourse. Infection control is a very hard role and a very frustrating one but clearly there is lots of room for innovation, consideration of new approaches including improved practice and technologies and monitoring and education. Financial penalty is a new driver and responses remind me of those responses and resistance we had in the early 1990s when pioneers like you and others of us around that long called for public reporting of HAIs. Look how far we have come and think about how much further we can go, in fact we have to go, in terms of prevention.
We are very fortunate in Australia to have some cutting edge researchers investigating all sorts of HAI interventions and outcomes and yes there will always be those who are premature and those that are laggards. I hope when I am cared for it is by a facility that is progressive as well as economically rationale in their infection prevention investment. Having good progressive public policy and practice also helps.
Cheers
CathHi Cath
You know I am also passionate about reducing the preventable healthcare infection burden, but I just wanted to debate some of the ‘technology consumables’ in a standard bundle approach.
Yes, we should all ensure that insertion and management of central lines is standardised, but the actual role of some technology solutions such as chlorhexidine impregnated dressings and devices, and impregnated access device caps for management, as just two examples of available technology, is still very much debatable, in my opinion, in management of all central lines.
We can throw money and resources into technological solutions, but are we really getting the ‘best bang for our buck’ with our healthcare spending by doing this? There needs to be better evidence to base these choices on, and groups like Claire Rickard’s vascular access research group with large multicentre trials will hopefully start providing some answers to these questions in the future. But to promote using these technological solutions for all central line management (eg ‘bundle approach’), is premature in my opinion. Unless I have misinterpreted what you are proposing.
In the private sector, we are already facing issues with the private health funds in regard to what they are saying is ‘preventable’. Most of their current systems are based on coding, and we all know how well clinical codes reflect the infection risk and preventability. I welcome debate about how we can reduce the risk of preventable infections, and feel the professional bodies such as ACIPC and ASID should have a role to play in developing criteria to be used by funding bodies. Maybe our professional association should be lobbying on behalf of the members for this to be discussed.
All my opinion only, of course.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this emailHere is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
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Thanks Michael
Debate is healthy and considered review of emerging additional proven technologies is as you and I agree one aspect of HAI prevention. What I am hoping to do is provoke discussion, raise awareness and discourse. Infection control is a very hard role and a very frustrating one but clearly there is lots of room for innovation, consideration of new approaches including improved practice and technologies and monitoring and education. Financial penalty is a new driver and responses remind me of those responses and resistance we had in the early 1990s when pioneers like you and others of us around that long called for public reporting of HAIs. Look how far we have come and think about how much further we can go, in fact we have to go, in terms of prevention.
We are very fortunate in Australia to have some cutting edge researchers investigating all sorts of HAI interventions and outcomes and yes there will always be those who are premature and those that are laggards. I hope when I am cared for it is by a facility that is progressive as well as economically rationale in their infection prevention investment. Having good progressive public policy and practice also helps.
Cheers
CathHi Cath
You know I am also passionate about reducing the preventable healthcare infection burden, but I just wanted to debate some of the ‘technology consumables’ in a standard bundle approach.
Yes, we should all ensure that insertion and management of central lines is standardised, but the actual role of some technology solutions such as chlorhexidine impregnated dressings and devices, and impregnated access device caps for management, as just two examples of available technology, is still very much debatable, in my opinion, in management of all central lines.
We can throw money and resources into technological solutions, but are we really getting the ‘best bang for our buck’ with our healthcare spending by doing this? There needs to be better evidence to base these choices on, and groups like Claire Rickard’s vascular access research group with large multicentre trials will hopefully start providing some answers to these questions in the future. But to promote using these technological solutions for all central line management (eg ‘bundle approach’), is premature in my opinion. Unless I have misinterpreted what you are proposing.
In the private sector, we are already facing issues with the private health funds in regard to what they are saying is ‘preventable’. Most of their current systems are based on coding, and we all know how well clinical codes reflect the infection risk and preventability. I welcome debate about how we can reduce the risk of preventable infections, and feel the professional bodies such as ACIPC and ASID should have a role to play in developing criteria to be used by funding bodies. Maybe our professional association should be lobbying on behalf of the members for this to be discussed.
All my opinion only, of course.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this emailHere is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
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https://www.paicap.org/index.html
This is an interesting US website that addresses Preventing Avoidable Infectious Complications by Adjusting Payment. Grace Lee from Harvard is one of the world leading authorities on this issue.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHere is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
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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Here is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
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Thanks Marilyn and others I have this data – ANZICS is as you know ICU data and useful. Would be great to also know rates in non-ICU settings eg oncology, BMT etc.
Cath
The ANZICS data is available on their website
http://www.anzics.com.au/Downloads/CLABSI%20Report%202014-15.pdf
Marilyn
Professor Marilyn Cruickshank RN PhD FACN
Director National Healthcare Associated Infection Program
Professor School of Nursing and Midwifery, Griffith University
Australian Commission on Safety and Quality in Health Care
GPO Box 5480 Sydney NSW 2001 | Level 5, 255 Elizabeth Street, Sydney NSW 2000
( (02) 9126 3586 | ? 0423 842 897 | http://www.safetyandquality.gov.au
[cid:image001.gif@01D2020D.3BCBFB60]Follow us on Twitter @ACSQHC
[Commission-and-NSQHS-logos]Cath, you can access the Victorian data through the Department of health website here:
http://performance.health.vic.gov.au/Home/Report.aspx?ReportKey425
AnnDr Ann Bull | Operations Director
VICNISS Coordinating Centre
Doherty Institute | 2nd Level
792 Elizabeth St Melbourne VIC 3000
T: + 61 3 93429351 | F: +61 3 93429351 | http://www.vicniss.org.au
[cid:image004.png@01D193ED.A14B64A0]Dear All
I am working on an urgent project and wondering if anyone knows of any current, valid and reliable Australian CLABSI rate data available anywhere in public domain? I am especially interested in incidence, attributable morbidity, cost etc.
I suspect that ANZICs has the best dataset but it is not freely available outside of the ANZICs network.
In the absence of this type of detailed data I am assuming extrapolation is the best approach. Grateful for any insights.
How I long for greater transparency of data for all HAIs.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
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Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
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______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the “svha.org.au” domain (or any other domain of St Vincent’s Health Australia Limited or any of its related bodies corporate) (an “SVHA Email Address”) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.Click here to report this email as spam.
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http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
Dear Heather
I have checked the CDC’s official NHSN surveillance page for you and the definitions are attached above.
It appears that the definition for a superficial infection is 28 days and a “deep incisional” infection is 30-90 days.
It is important always to remember that with NHSN definitions (and probably many of the definitions used in other countries for formal surveillance that they are surveillance/ classification definitions not for diagnostic purposes) ie. they are used for case-counting and as such can be subject to error but not used for making treatment decisions like antimicrobial interventions. This anomaly is most evident if we look deeply at CLABSI and CR-BSI definitions and try to tease out the differences.
I haven’t followed the CDC SSI definition too closely but my best guesses without doing research for you would be that the change came from a simplification of the surveillance method to meet changes in government requirements and also to take into account the ways, places and systems that and in which surgery is now performed compared to the early 1970s when NNIS, NHSN’s predecessor began. Also CDC and CMS (their Federal govt agency which is a bit like a hybrid of our ACSQHC and Medicare and Dept. of Human Services ) have made many refinements to HAI monitoring and reporting with set targets and public access to meaningful data (unlike Australia :() so all of these factors will periodically lead to definitional change.
Changing the definitions, (I actually haven’t checked the historic definition so am assuming you have correctly observed a change) of course plays havoc with measuring long-term change and improvement which again can be a subtle way for stakeholders on many levels to look like there is improvement when maybe there isn’t. (sorry for cynicism) This was recently the case for CAUTI in HNSN definitions.
Have you looked for any recent published US articles on SSI that argue for a change in definition and give an explanation?
If you would like me to I would happily pass on your query to many of my mates in the US who either run NHSN or are NHSN users as I am sure that they would have better responses. Let me know.
It’s great that you question this issue and I would love to know what other epidemiologists have to say about this question so I hope they respond as well.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auDear Colleagues
The CDC changed the definition of a hospital acquired surgical site infection of a joint replacement from 1 year to 90 days.
Have all hospitals adopted this new protocol?
I would also be interested to know what brought about this change, and is this generally considered a positive change.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.
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Great news about your work and good luck with the abstract. It should make for interesting material at ACIPC if you are successful.
Cheers
CathFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Emily Bailey
Sent: Friday, 17 June 2016 9:57 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Media Release: Australia’s most comprehensive report on antibiotic resistance releasedDear Cath (and AICA list)
Thank you for your comments below on the ACSQHC report on AMR. In regards to the cost/burden of antimicrobial resistance in Australia, I agree re the need for a better understanding of the burden of AMR in our local context to support resource allocation decisions in Infection Prevention and Control programs.
It may interest you to know that our Centre of Research Excellence group (CRE in Reducing Healthcare Associated Infections), which is funded by the NHMRC and operates out of QUT in Brisbane, currently has an active research project modelling the health economic impact of antimicrobial resistance in Australia. This work is being led by Dr Kate Halton and Dr Teresa Wozniak.
We hope to be able to provide meaningful results from this work to the College, the ACSQHC, the federal DOH and the wider IPC community in 2017. An abstract will be submitted to present the project methodology and interim findings at the ACIPC conference in November this year.
Kind regards
EmilyEmily Bailey | Centre Manager
Centre of Research Excellence in Reducing Healthcare Associated Infections
Institute of Health and Biomedical Innovation | School of Public Health & Social Work
Queensland University of Technology | 60 Musk Ave, Kelvin Grove, QLD 4059 | Australia
E: e5.bailey@qut.edu.au | http://www.cre-rhai.org.au
CRICOS No. 00213JThe CRE-RHAI is funded by the National Health and Medical Research Council (NHMRC) of Australia (Grant 1030103). The work conducted by the CRE-RHAI is solely the responsility of the Administering and Participating Institutions and individual researchers, and do not reflect the views of the NHMRC.
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Dr Cathryn Murphy
Sent: Friday, 17 June 2016 5:45 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Media Release: Australia’s most comprehensive report on antibiotic resistance releasedDear Ramon
Thank you for sharing this work and thanks also to whoever was the Colleges representative on this Committee. Their output in terms of the Report are impressive and at the same time very concerning.
I have only had a chance to glean this Report at this stage but am struck by two issues. Firstly, the extent of antimicrobial misuse in residential long-term care settings with approximately 50% of the almost 10% of residents being treated having no confirmed or suspected infection. Having just lost my remaining parent in aged care and watching such antimicrobial misuse first hand I am especially passionate about learning how the Colleges response to the Report will address this issue.
Secondly, Section 1.3 of the Report addresses the cost of antimicrobial resistance and is completely devoid of any local Australian costings or estimates. Instead it refers to a very few reports all of which are from the United Kingdom. Readers are given estimated extrapolations which suggest the cost of AMR per episode of care ranges from ($10 to $41, 200).
Given the increasing need for IC&P staff to cost justify almost every aspect of their program and in particular capital costs for new technologies and equipment proven to reduce HAIs including cases of AMR is it not time we Australian IC&Ps started lobbying for timely access to reliable HAI costing data even at just a local level. It saddens me that after 50 years of formal infection control programs in this country we are still unable to truly demonstrate the return on our investment. Few other industries would survive such circumstances and I wonder if we will.
Would love to hear the opinions of others on these issues and as always I am willing to assist the College or individual members in strategizing ways to address them.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Professor Ramon Shaban, ACIPC President
Sent: Thursday, 16 June 2016 11:24 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Fwd: Media Release: Australia’s most comprehensive report on antibiotic resistance releasedColleagues
Please note release of the First Australian report on antimicrobial resistance in human health by the Australian Commission on Safety and Quality in Health Care.More information is available at the following link.
http://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/
Kind regards,
Ramon[ACIPC_Logo_Colour_RGB_Hi_Res.jpg]
Professor Ramon Z Shaban
PRESIDENTAustralasian College for Infection Prevention and Control
GPO Box 3254, Brisbane Qld 4001
Tel: +61 7 3735 6463 Mobile: 0478 312 668Email: president@acipc.org.au
———- Forwarded message ———-
From: ACSQHC Communications <communications@safetyandquality.gov.au>
Date: 16 June 2016 at 10:09
Subject: Media Release: Australia’s most comprehensive report on antibiotic resistance released
To:Having trouble reading this? View it in your browser. Not interested? Unsubscribe instantly.
[Australian Commission on Safety and Quality in Health Care]
Thursday 16 June
Media Release: Australias most comprehensive report on antibiotic resistance released
THURSDAY 16 JUNE 2016
The Australian Commission on Safety and Quality in Health Care (the Commission) has released a landmark report outlining the most comprehensive picture of antimicrobial resistance, antimicrobial use and appropriateness of prescribing in Australia to date.
Antimicrobial Use and Resistance in Australia (AURA) 2016: First Australian report on antimicrobial use and resistance in human health highlights antimicrobial use and resistance as a critical and immediate challenge to health systems in Australia and around the world.
AURA 2016 contains valuable data on antimicrobial use in the community, hospitals and residential aged care facilities; key emerging issues for antimicrobial resistance; and a comparison of Australias situation with other countries.
Commission Senior Medical Advisor Professor John Turnidge said that AURA 2016 sets a baseline that will allow trends to be monitored over time and highlights areas where future work will inform action to prevent the spread of antimicrobial resistance.
Antimicrobial resistance is one of the most significant challenges for the delivery of safe, high-quality health services, and has a direct impact on patient care and patient outcomes.
Antibiotic resistance has developed because of the overuse and misuse of antibiotics, and now, bacterial infections that were once easily cured with antibiotics are becoming harder to treat. In 2014, nearly half the people in Australia were prescribed antimicrobials so the threat of antimicrobial resistance has the potential to affect every individual.
Read the media release in full.
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Thanks Trent
Im sorry if my comment about ROI mislead you. I am advocating that ICPs need better local cost data so that they can use it in business cases for supporting outlay for new technologies, devices and interventions that are effective but cost-prohibitive.
I appreciate that the public understand little and question little about HAIs generally so yes I too agree we have lots of work to do to bring them to the table and to help them help themselves.
Thank you for your own work on AMR.
Cheers
CathFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Trent Yarwood
Sent: Friday, 17 June 2016 8:42 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Media Release: Australia’s most comprehensive report on antibiotic resistance releasedHi Cath (et al)
It’s an interesting and challenging question. You’re right – there is some data about from overseas, examples including:http://www.rand.org/randeurope/research/projects/antimicrobial-resistance-costs.html
http://cid.oxfordjournals.org/content/49/8/1175.long
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)00270-4
http://www.bmj.com/content/346/bmj.f1493
but a definite paucity of Australian data; hopefully now that AURA is up and running we’ll be able to use the longitudinal data to estimate some of these things (ie: resistance increased by this much and model based on overseas data on length of stay etc).
Equally frustrating, however, is the fact that talking about economic costs completely turns the public off. There was great research published by Wellcome Trust (blog post is here: https://blog.wellcome.ac.uk/2015/07/29/antimicrobial-resistance-still-widely-misunderstood/ ; unfortunately, they’ve redone their website, so the link to the full report is broken) that pretty clearly shows that if we say “AMR will cost eleventy trillion dollars” that the public don’t understand, don’t really care and just think that HCWs are lobbying for more funding. The report went on to suggest that we need to personalise the stories to patient / family / relative. Following on your email:
“Grandpa Jack went to hospital to have a knee replacement so he could still go an play bowls on the group visit from the nursing home. Because he’d been on antibiotics for more than six months, he got a resistant infection and spent 4 months in hospital and never played bowls again”.
(Obviously this is a bit too much of a scare campaign, but you get the idea)
We’re finally getting some government action; now we need to engage the public.
Cheers,
Trent Yarwood
Infectious Diseases Physician – Antimicrobial Stewardship
Cairns Hospital
(no conflicts)—
Trent Yarwood
trentyarwood@gmail.com
PGP Key: 246AF263On 17 June 2016 at 05:44, Dr Cathryn Murphy <cath@infectioncontrolplus.com.au> wrote:
Dear RamonThank you for sharing this work and thanks also to whoever was the Colleges representative on this Committee. Their output in terms of the Report are impressive and at the same time very concerning.
I have only had a chance to glean this Report at this stage but am struck by two issues. Firstly, the extent of antimicrobial misuse in residential long-term care settings with approximately 50% of the almost 10% of residents being treated having no confirmed or suspected infection. Having just lost my remaining parent in aged care and watching such antimicrobial misuse first hand I am especially passionate about learning how the Colleges response to the Report will address this issue.
Secondly, Section 1.3 of the Report addresses the cost of antimicrobial resistance and is completely devoid of any local Australian costings or estimates. Instead it refers to a very few reports all of which are from the United Kingdom. Readers are given estimated extrapolations which suggest the cost of AMR per episode of care ranges from ($10 to $41, 200).
Given the increasing need for IC&P staff to cost justify almost every aspect of their program and in particular capital costs for new technologies and equipment proven to reduce HAIs including cases of AMR is it not time we Australian IC&Ps started lobbying for timely access to reliable HAI costing data even at just a local level. It saddens me that after 50 years of formal infection control programs in this country we are still unable to truly demonstrate the return on our investment. Few other industries would survive such circumstances and I wonder if we will.
Would love to hear the opinions of others on these issues and as always I am willing to assist the College or individual members in strategizing ways to address them.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Professor Ramon Shaban, ACIPC President
Sent: Thursday, 16 June 2016 11:24 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Fwd: Media Release: Australia’s most comprehensive report on antibiotic resistance releasedColleagues
Please note release of the First Australian report on antimicrobial resistance in human health by the Australian Commission on Safety and Quality in Health Care.More information is available at the following link.
http://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/
Kind regards,
RamonProfessor Ramon Z Shaban
PRESIDENTAustralasian College for Infection Prevention and Control
GPO Box 3254, Brisbane Qld 4001
Tel: +61 7 3735 6463 Mobile: 0478 312 668Email: president@acipc.org.au
———- Forwarded message ———-
From: ACSQHC Communications <communications@safetyandquality.gov.au>
Date: 16 June 2016 at 10:09
Subject: Media Release: Australia’s most comprehensive report on antibiotic resistance released
To:Having trouble reading this? View it in your browser. Not interested? Unsubscribe instantly.
[Australian Commission on Safety and Quality in Health Care]
Thursday 16 June
Media Release: Australias most comprehensive report on antibiotic resistance released
THURSDAY 16 JUNE 2016
The Australian Commission on Safety and Quality in Health Care (the Commission) has released a landmark report outlining the most comprehensive picture of antimicrobial resistance, antimicrobial use and appropriateness of prescribing in Australia to date.
Antimicrobial Use and Resistance in Australia (AURA) 2016: First Australian report on antimicrobial use and resistance in human health highlights antimicrobial use and resistance as a critical and immediate challenge to health systems in Australia and around the world.
AURA 2016 contains valuable data on antimicrobial use in the community, hospitals and residential aged care facilities; key emerging issues for antimicrobial resistance; and a comparison of Australias situation with other countries.
Commission Senior Medical Advisor Professor John Turnidge said that AURA 2016 sets a baseline that will allow trends to be monitored over time and highlights areas where future work will inform action to prevent the spread of antimicrobial resistance.
Antimicrobial resistance is one of the most significant challenges for the delivery of safe, high-quality health services, and has a direct impact on patient care and patient outcomes.
Antibiotic resistance has developed because of the overuse and misuse of antibiotics, and now, bacterial infections that were once easily cured with antibiotics are becoming harder to treat. In 2014, nearly half the people in Australia were prescribed antimicrobials so the threat of antimicrobial resistance has the potential to affect every individual.
Read the media release in full.
Back to top
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Follow us
[rss]
Contact Us t: 02 9126 3611 or 02 9126 3617
e: communications@safetyandquality.gov.au
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Dear Ramon
Thank you for sharing this work and thanks also to whoever was the Colleges representative on this Committee. Their output in terms of the Report are impressive and at the same time very concerning.
I have only had a chance to glean this Report at this stage but am struck by two issues. Firstly, the extent of antimicrobial misuse in residential long-term care settings with approximately 50% of the almost 10% of residents being treated having no confirmed or suspected infection. Having just lost my remaining parent in aged care and watching such antimicrobial misuse first hand I am especially passionate about learning how the Colleges response to the Report will address this issue.
Secondly, Section 1.3 of the Report addresses the cost of antimicrobial resistance and is completely devoid of any local Australian costings or estimates. Instead it refers to a very few reports all of which are from the United Kingdom. Readers are given estimated extrapolations which suggest the cost of AMR per episode of care ranges from ($10 to $41, 200).
Given the increasing need for IC&P staff to cost justify almost every aspect of their program and in particular capital costs for new technologies and equipment proven to reduce HAIs including cases of AMR is it not time we Australian IC&Ps started lobbying for timely access to reliable HAI costing data even at just a local level. It saddens me that after 50 years of formal infection control programs in this country we are still unable to truly demonstrate the return on our investment. Few other industries would survive such circumstances and I wonder if we will.
Would love to hear the opinions of others on these issues and as always I am willing to assist the College or individual members in strategizing ways to address them.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Professor Ramon Shaban, ACIPC President
Sent: Thursday, 16 June 2016 11:24 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Fwd: Media Release: Australia’s most comprehensive report on antibiotic resistance releasedColleagues
Please note release of the First Australian report on antimicrobial resistance in human health by the Australian Commission on Safety and Quality in Health Care.More information is available at the following link.
http://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/
Kind regards,
Ramon[ACIPC_Logo_Colour_RGB_Hi_Res.jpg]
Professor Ramon Z Shaban
PRESIDENTAustralasian College for Infection Prevention and Control
GPO Box 3254, Brisbane Qld 4001
Tel: +61 7 3735 6463 Mobile: 0478 312 668Email: president@acipc.org.au
———- Forwarded message ———-
From: ACSQHC Communications <communications@safetyandquality.gov.au>
Date: 16 June 2016 at 10:09
Subject: Media Release: Australia’s most comprehensive report on antibiotic resistance released
To:Having trouble reading this? View it in your browser. Not interested? Unsubscribe instantly.
[Australian Commission on Safety and Quality in Health Care]
Thursday 16 June
Media Release: Australias most comprehensive report on antibiotic resistance released
THURSDAY 16 JUNE 2016
The Australian Commission on Safety and Quality in Health Care (the Commission) has released a landmark report outlining the most comprehensive picture of antimicrobial resistance, antimicrobial use and appropriateness of prescribing in Australia to date.
Antimicrobial Use and Resistance in Australia (AURA) 2016: First Australian report on antimicrobial use and resistance in human health highlights antimicrobial use and resistance as a critical and immediate challenge to health systems in Australia and around the world.
AURA 2016 contains valuable data on antimicrobial use in the community, hospitals and residential aged care facilities; key emerging issues for antimicrobial resistance; and a comparison of Australias situation with other countries.
Commission Senior Medical Advisor Professor John Turnidge said that AURA 2016 sets a baseline that will allow trends to be monitored over time and highlights areas where future work will inform action to prevent the spread of antimicrobial resistance.
Antimicrobial resistance is one of the most significant challenges for the delivery of safe, high-quality health services, and has a direct impact on patient care and patient outcomes.
Antibiotic resistance has developed because of the overuse and misuse of antibiotics, and now, bacterial infections that were once easily cured with antibiotics are becoming harder to treat. In 2014, nearly half the people in Australia were prescribed antimicrobials so the threat of antimicrobial resistance has the potential to affect every individual.
Read the media release in full.
Back to top
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Follow us
[rss]
Contact Us t: 02 9126 3611 or 02 9126 3617
e: communications@safetyandquality.gov.au
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