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Australian hospitals, the optimum resource allocation forinfection prevention and control programs is uncertainand there has been very little information in the literaturespecific to Australian settings to guide such decisions.Historically, infection control programs have often beenviewed as expensive overheads with little appreciationof the potential of such programs to produce financialbenefits whilst simultaneously improving the outcomeof patient care. It is evident that more local researchneeds to be done in this area to guide the decisionmakers.References1. Wilson R, Runciman WB, Gibberd RW, HarrisonBT, Newby L, Hamilton JD. The quality in Australianhealth care study. The Medical Journal of Australia.1995;163:458-471.11. Scheckler W, Brimhall D, Buck A, et al. Requirementsfor infrastructure and essential activities of infectioncontrol and epidemiology in hospitals: a consensuspanel report. American Journal of Infection Control.1998;26:47-60.12. Saint S, Veenstra DL, Lipsky BA. The clinical andeconomic consequences of nosocomial centralvenous catheter-related infection: are antimicrobialcatheters useful? Infection Control and HospitalEpidemiology. 2000;21:375-380.13. Centers for Disease Control and Prevention.Guidelines for the Prevention of IntravascularCatheter-related infections. Morbidity and MortalityWeekly Report (MMWR). 2002;51:1-29.14. Haley RW. The scientific basis for using surveillanceand risk factor data to reduce nosocomial infectionrates. Journal of Hospital Infection. 1995;30:3-14.2. Smith SD, Doebbeling BN. Costs of nosocomialinfections. Current Opinion in Infectious Diseases.1996;9:286-290.3. Centres for Disease Control and Prevention. Publichealth focus: surveillance, prevention and controlof nosocomial infections. Morbidity and MortalityWeekly Report. 1992;41:783-787.4. Kohn L, Corrigan J, Donaldson M. To err is human:buiding a safer health system. Washington, DC:Institute of Medicine; 1999.5. Plowman R, Graves N, Griffin M, et al. The Socioeconomicburden of hospital acquired infection.London: DoH/PHLS; 1999.6. Australian Infection Control Association ExpertWorking Group. National Surveillance of HealthcareAssociated Infections in Australia. A Report to theCommonwealth Department of Health and AgedCare; 2001.7. Davey P, Hernanz C, Lynch W, Malek M, Byrne D.Human and non-financial costs of hospital-acquiredinfection. Journal of Hospital Infection. 1991;18:79-84.8. Wenzel RP. The economics of nosocomial infections.Journal of Hospital Infection. 1995;31:79-87.9. Weinstein RA. Controlling antimicrobial resistancein hospitals: infection control and use of antibiotics.Emerging Infectious Diseases. 2001;7:188-192.10. Haley RW, Culver DH, White JW, Morgan WM, EmoriTG. The efficacy of infection surveillance and controlprograms in preventing nosocomial infections inUS hospitals. American Journal of Epidemiology.1985;121:182-205.36
Communicable Disease Control BranchInfection Control ServiceChris CopeAnita MarwoodThe Infection Control Service monitors healthcareassociated infection and antibiotic utilisation, identifyingtrends and feeding back information to contributinghospitals. The information is used by contributors intheir continuous quality improvement activities. 1 Thesystem is voluntary and includes both public and privatehospitals. Currently the Service conducts statewidesurveillance for bloodstream infections, multi-resistantorganisms and antibiotic utilisation. The followinghighlight some of the important trends noted since thesurveillance began, and presents accumulated data upuntil the end of 2005.All rates are expressed per occupied bed days (OBDs).Staphylococcus aureus is the most common organismcausing BSI in hospital patients, and is associated witha high morbidity and mortality. The number of episodescaused by S.aureus has fallen steadily over the past fiveyears in South Australian hospitals (Figure 2).The proportion of S.aureus isolates that are methicillinresistant(MRSA), has also sustained a downward trendsince the peak in 2000 of almost 48% to approximately30% in the past two years. In addition to interventionsaimed at improving intravenous line care, other effortsto control the spread of MRSA have contributed to thispositive result.Figure 2: Trend in nosocomial inpatient S. aureusbloodstream infection for seven major metropolitanhospitals.BLOODSTREAM INFECTIONSBloodstream infection (BSI) data are contributedcurrently by 14 South Australian metropolitan hospitals(8 public and 6 private). Healthcare associated BSIdata have been provided by seven major metropolitanhospitals since July 1996 (5 public and 2 private).Enhanced surveillance using revised national BSIdefinitions commenced in January 2002. 2Although intravascular devices remain the primaryfocus of bloodstream infection, the total number ofintravenous line-related episodes has fallen significantlysince 2002 (Figure 1). This is attributed to severalinterventions in the major metropolitan hospitalstargeted at improving intravenous line managementincluding (but not limited to) the widespread introductionof alcohol-based hand gels and the introduction of adedicated “Line Nurse” in one major hospital.Figure 1: Trend in nosocomial bloodstream infectionsin SA metropolitan hospitals.MULTI-RESISTANT ORGANISMS (MRO)MRSA surveillance has been in progress sinceSeptember 2001 and data have been voluntarilysupplied by 16 hospitals (8 public and 8 private). MROsurveillance was expanded in 2002 to incorporate otherresistant epidemiologically significant organisms and upto the end of 2005 was contributed to by 15 hospitals (7public and 8 private).Methicillin-resistant Staphylococcus aureus (MRSA)There were 786 episodes of new healthcare associatedMRSA acquisitions reported during 2005. This includesboth infections and carriage without clinical symptoms.While identification of new MRSA isolations has onlydecreased marginally (Figure 3), the infection rate hasdecreased significantly from 2.9 per 10,000 OBDs in2002 to 1.6 per 10,000 OBDs in 2005 (p
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