Healthcare Associated Infection (HAI)

“Infection Prevention is Everybody’s Business”

About the Program

A focus of the work of the Australian Commission on Safety and Quality in Health Care (ACSQHC) is on areas of the health system where current and complex problems or community concerns could benefit from urgent national consideration and action to achieve a measurable reduction in healthcare associated infection. The Healthcare Associated Infection (HAI) program, nominated as one of the priority areas for 2007/10, aims to build on facility and jurisdictional initiatives to develop a national approach to reducing health care associated infection by identifying and addressing systemic problems and gaps, and ensuring comprehensive actions are undertaken in a nationally coordinated way by leaders, decision makers in both public and private health sectors.

View HAI flow chart (PDF 15 KB)

There are five key initiatives in the overall strategy:

1. National HAI Surveillance System
2. National Infection Control Guidelines
3. National Hand Hygiene Project
4. Building Clinician Capacity
5. Antibiotic Utilisation

1. National HAI Surveillance System

Aim: To reduce harm to patients from hospital associated infections through the use of surveillance.

As the first of several initiatives to reduce hospital associated infections, it seeks to explore options for surveillance systems to monitor health care associated infection and provide timely feedback to jurisdictions, managers and clinicians. The result is an evidence-based and authoritative analysis that can promote stronger linkages between other health data systems and with policy makers, and to ensure that the messages derived from surveillance data can be turned into public health action for better health outcomes.

A report ‘Reducing harm to patients from healthcare associated infection: the role of surveillance’ was compiled by 51 experts from across Australia and provides an overview of current healthcare associated infection issues and surveillance initiatives in Australia, and a review of international and Australian surveillance literature. It provides a comprehensive picture of the surveillance of HAI in Australia, demonstrates the costs that these infections impose upon individual Australians and the health system.

Each chapter includes recommendations and a summary of key points based on the material presented. We greatly appreciate your comments and your assistance in helping us ensure that this strategy is of value to those receiving health services and those working in the field.

A copy of Reducing harm to patients from healthcare associated infection: the role of surveillance and a copy of the key working document is available to download along with a list of editors and contributors (PDF 24 KB).

The Commission is inviting comment on the report 'Reducing harm to patients from healthcare associated infection: the role of surveillance'.

Should you wish to comment on individual chapters a template is provided:
Consultation re implementation of surveillance recommendations (Template for single chapters)

Submissions marked "Surveillance of healthcare associated infections" should be forward to:
GPO Box 5480 SYDNEY NSW 2001

Or emailed to:
mail@safetyandquality.gov.au

The ACSQHC will accept written submissions up to 30 September 2008.

Note: To ensure maximum transparency all submissions will be published on the Commission's website, including the names of individuals and /or organisations making the submission. The Commission will consider requests to withhold the contents of any submissions made in whole or part.

2. National Infection Control Guidelines

Aim: To ensure permanent currency and greater useability of the National Infection Control Guidelines.

The Commission has engaged the NHMRC to undertake the revision process to provide Guidelines relevant to infection prevention and control across the broad spectrum of health care settings:

• Examination of international guidelines on infection control;
• Sourcing feedback on the usefulness and relevance of the current Guidelines produced by the CDNA through stakeholder forums and invitation for submissions;
• The development of an implementation strategy to enhance uptake and adoption including stakeholder consultation throughout the guideline development process;
• The development of contingency and implementation infection control plans for the management of emerging pathogens that require a rapid response;
• Development of educational materials and companion documents for user groups;
• Development of indicators and an evaluation and monitoring plan for the guidelines;
• A process by which the guidelines can be monitored and reviewed to maintain currency.

The Stakeholder Forums were held in March 2008 to discuss the key issues for consideration in the revision of the National Infection Control Guidelines. This project is scheduled to complete by July 2009

The National Infection Control Guidelines Project

3. National Hand Hygiene Project
(Adapted from World Health Organization (WHO) Guidelines on Hand Hygiene in Healthcare)

Aim: To leverage existing initiatives beginning with National Hand Hygiene Project to embed local initiatives to enable wider national implementation and provide for sustained monitoring of compliance.

Hand Hygiene has been identified as a high priority for preventing health care associated infection worldwide. The Commission has awarded a contract to Austin Health Victoria under the leadership of Professor M Lindsay Grayson, Director of the Infectious Disease Department to undertake the Commission's National Hand Hygiene Project. The purpose of the National Hand Hygiene Project is to develop a national approach to hand hygiene.

The National Hand Hygiene Project will deliver:

1. Australian hand hygiene guidelines adapted from the WHO — World Alliance for Patient Safety "Clean Care is Safer Care" Program
2. A National Hand Hygiene Initiative Education Strategy based on the Australian hand hygiene guidelines
3. Establishment of clearly defined Outcome Measures for accurate auditing applicable across all health care settings
4. Development of guidelines and audit tool/s based on the Outcome Measures
5. Education program to support the hand hygiene audit tools
6. Development of a mechanism for the electronic collection of outcomes data and information transfer to Hand Hygiene Australia

Hand Hygiene flyer (PDF 120 KB)
WHO poster - Your 5 moments for Hand Hygiene (PDF 196 KB)

4. Building Clinician Capacity

Aim: To increase the ability of infection control professionals by providing them with skills and resources to engage and educate clinicians, managers and healthcare consumers to adopt a collective HAI prevention mindset.

A workshop was held on 26 September 2007 at Bellerive Oval in Hobart for Infection Control Professionals (PDF 40 KB) from around the country to identify the issues that they saw as important ones facing them as Infection Control Professionals (ICP). The participants worked in small groups to discuss a range of ICP issues (PDF 22 KB) and Hand Hygiene strategies (PDF 15 KB) that affected infection control practitioners.

Infection Prevention is Everybody's Business Workshop presentation (PDF 448 KB)

Specific Outcomes and Objectives of this clinical capacity initiative are:

• To engage clinicians at a local level;
• Development of a communication process to engage senior managers about the role of the ICP in prevention and reduction of HAI's;
• To foster consensus regarding realistic organisational HAI prevention goals and resource allocation based on the use of data for reporting, planning and action including a risk management approach to infection control issues;
• Development of a method for estimating the economic impact of HAls as the basis for an annual organisational assessment and development of an annual prevention plan;
• A formalised Mentoring program that targets rural/ isolated and novice Infection Control Practitioners and which supports experienced Infection Control Practitioners to undertake the role of mentor;
• The development, endorsement and release of national standardised best practice approaches to eliminating Healthcare Associated Infections.

This work is currently being undertaking. You can read the ‘Literature Review’ (PDF 307 KB) and the ‘Scope of Practice Review’ will be available by the end of November 2008.

A number of matters have been refined and work has been completed as a result of the 'Literature Review' and 'Scope of Practice Review'. Part of this has been the development of the 'Draft Elements of Infection Prevention and Control Programs'. This is presently out for comment by AICA membership. A discussion paper to accompany the elements of Infection Control Programs will be available early 2009 for wider consultation.

• DRAFT Elements of Infection Prevention and Control Programs for comment by AICA Members (PDF 103 KB)
• Elements of an Infection Control Program (PDF 232 KB)

5. Antibiotic Utilisation

Aim: To facilitate the establishment of effective antimicrobial stewardship programs at the national, state, institutional and community sector.

The management of antimicrobial resistance requires four elements:

• Comprehensive antimicrobial resistance and usage surveillance programs
• Strategies to improve the use of antimicrobial agents (antimicrobial stewardship programs)
• Effective infection control programs to minimise secondary spread of resistance
• Development of new drugs and vaccines

Comprehensive antimicrobial resistance and usage surveillance programs are necessary to inform antimicrobial stewardship strategies and measure their effect. A comprehensive infection control program is necessary to maintain the benefits of antimicrobial stewardship strategies.

Antimicrobial stewardship has been defined as ‘an ongoing effort by a health-care institution to optimize antimicrobial use among hospital patients in order to improve patient outcomes, ensure cost-effective therapy and reduce adverse sequelae of antimicrobial use (including antimicrobial resistance)’. Stewardship programs aim to change antimicrobial prescribing to reduce unnecessary use and promote the use of agents less likely to select resistant bacteria, in line with guidelines and demonstrated incidence of antimicrobial resistance (as shown by antibiograms, an antibiogram being the result of laboratory testing on an isolated pathogen to find out what antimicrobials the pathogen is resistant to). Successful programs have been shown to reduce institutional resistance rates as well as morbidity, mortality and cost.

A Forum was held on 11 September 2008 to:

1. Establish level of activity in antimicrobial surveillance and containment strategies in acute care sector (public and private) in Australia.
2. Agree on core components of a successful antimicrobial stewardship program – local / state / national
3. Identify barriers to develop local antibiotic stewardship programs
4. Develop recommendations for a national strategy for improving the use of antimicrobials in the acute care sector.

Committees

Antimicrobial Stewardship Advisory Committee
Hand Hygiene Advisory Committee
Implementation Advisory Committee
Infections Control Guidelines Steering Committee
National HAI Surveillance Expert Working Group

HAI Events

Upcoming Events

8-10 October 2008 - AICA Conference, MCG Victoria.

29-31 October 2008 - National Forum on Safety and Quality in Health Care, Adelaide Convention Centre Adelaide.

Recent events

3-6 March 2008 - NHMRC Infection Control Guidelines Stakeholder Forums.

13 August 2008 - TICPA Conference, Hobart

7-10 September 2008 - International Symposium on Staphylococci and Staphylococcal Infections, Cairns Convention Centre Cairns

11 September 2008 - Forum on Antibiotic Stewardship, Sydney

Links to other HAI websites

Australian Infection Control Association (AICA)
Healthcare Infection Control Special Interest Group (HICSIG)
Australian Group on Antimicrobial Resistance (AGAR)
Australian Society for Antimicrobials
Australian Society for Infectious Diseases
Communicable Diseases Network of Australia
Expert Advisory Group on Antimicrobial Resistance (EAGAR)

Contacts

Marilyn Cruickshank, Program Manager
(02) 9263 3786

Susanne Mouwen, Project Officer
(02) 9263 3641

Email: mail@safetyandquality.gov.au

Updated: 13 November, 2008

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