Infection control in Australia. Glenys Harrington Infection Control Consultancy Melbourne Australia
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1 Infection control in Australia Glenys Harrington Infection Control Consultancy Melbourne Australia
2 Infection control in Australia Australian healthcare facilities Infection control practitioners/consultants State government commitment Multidisciplinary infection control teams Commonwealth government Australian Commission on Safety and Quality in Health Care Hand Hygiene Australia My Hosptials
3 Australian states and territories
4 Australia healthcare facilities Number of Hospitals (Australian Institute of Health and Welfare (AIHW) ( ) Public acute hospitals 735 Public psychiatric 18 Private hospitals 280 Private free standing day hospital facilities 293 Total 1,326
5 Australian Infection Control Practitioners/Consultants 1996 National Survey Australian Infection Control Association (AICA) Members responsible for coordinating Infection Control Results Study group 65% (644/993 AICA members) 97% women 42% between the ages of 41-50years Murphy et al. Who Coordinates Infection Control Programs in Australia. AJIC June 1999;27:
6 Australian Infection Control Practitioners/Consultants Work environment Acute, non acute and non hospital settings 38% publicly funded acute care facilities with < 251 beds 43% private non acute facilities with < 251 beds Staffing levels 85% worked part time 1FTE working alone was the most common staffing arrangement for facilities with > 251 beds (31% of hospitals) Murphy et al. Who Coordinates Infection Control Programs in Australia. AJIC June 1999;27:
7 Australian Infection Control Practitioners/Consultants Work environment Acute, non acute and non hospital settings 38% publicly funded acute care facilities with < 251 beds 43% private non acute facilities with < 251 beds Staffing levels 85% worked part time 1FTE working alone was the most common staffing arrangement for facilities with > 251 beds (31% of hospitals) Murphy et al. Who Coordinates Infection Control Programs in Australia. AJIC June 1999;27:
8 Australian Infection Control Practitioners/Consultants Training and education 89% had completed hospital-based nursing training 48% had completed an additional nursing certificate 23% had completed continuing education related to infection control/hospital epidemiology/sterilisation and disinfection Additional responsibilities 78% had additional responsibilities other than Infection control Clinical role Occupational health and safety Wound management Quality assurance Perceived requirements 62% clerical support More infection control staff Reorganisation of infection control duties More infection control information Murphy et al. Who Coordinates Infection Control Programs in Australia. AJIC June 1999;27:
9 State government commitment Victorian Infection Control Survey $13.6 million one off funding (mostly allocated to sterilisation equipment) $4 million for general equipment fund Late 1999 $33 million recurrent funding $2.2 million annually for additional ICPs (32) $1.6 million annually for implementation of strategic plans $250,000 allocated annually for rural regional infection control services $ 1.1 million annually over 3 years for the establishment of the Victorian Nosocomial Infection surveillance centre (VICNISS) Over $500,000 allocated for a state wide infection control survey $3 million allocated annually for implementation of cleaning standards Infection Control in Victorian Public Health Services
10 State government commitment Infection control strategic management plans 2000 Submission of a 3 year strategic management plan 5 priority outcome areas: Management commitment, leadership and accountability Monitoring of infection control and reducing infection rates Prevention of adverse events Protecting healthcare workers and visitors Surveillance Mid 2000 Expert panel review of strategic plans Department reports Commending innovative initiatives Identifying priority outcome areas Repeat infection control survey Infection Control in Victorian Public Health Services
11 State government commitment What did that mean to infection control teams? hospitals in the network Hospital A (acute) 583 beds and Hospital B (LTCF) 352 beds 4570 hospital employees 3 FTE (2 FTE acute, I FTE LTCF) ICP Ratios 1:311 beds (acute only 1:291 beds) hospitals in the network Hospital A (acute) beds 1:71 beds (including coordinator) 1:91 beds (excluding coordinator) Hospital B (LTCF) beds 1:331 beds Hospital C (Community) 90 beds 0.5:90 beds Total = 6 EFT Overall 1:124 beds
12 Multidisciplinary infection control teams Major metropolitan referral teaching hospitals Established multidisciplinary IC teams Manager/Coordinator working across a network More than 1 campus (3-4) Total beds up to 900 Facilities Acute care (state wide referral services) Community Sub-acute Rehabilitation Residential Care ICP resources Overall ICP Manager/Coordinator 3-6 ICPs (fulltime and part-time positions)
13 Multidisciplinary infection control teams Major metropolitan referral teaching hospitals Line management Infectious Diseases Director of Pathology Services (Dir Microbiology) Nursing Services Director of Quality and Customer Services Services Infection control Vaccination of healthcare workers/or support a staff health service Needlestick injury follow-up/or support a staff health service Exposure management/follow-up Report activities to an established Infection Control Committees
14 Multidisciplinary infection control teams Urban metropolitan teaching hospitals Established multidisciplinary IC teams Manager/Coordinator working across a network Total beds up to 850+ Acute care facility (400 beds) ICP resources Overall ICP Manager 3-4 ICPs (fulltime and part-time positions) Line management Nursing Services/Director of Quality and Customer Services Infectious Diseases/Medical Microbiology Support Services Infection control Vaccination of healthcare workers Needlestick injury follow-up Exposure management/follow-up May be asked to backfill other hospital roles Report activities to an established Infection Control Committee
15 Multidisciplinary infection control teams Rural public healthcare facilities 5 regions with up to 20 Healthcare facilities in each region ICPs at each facility (mostly part time) Hours vary from 1 day per fortnight to 3 days a week Most have a dual clinical role Line management to Nursing Services DHS initiative 2 ICPs per region/$50,000 operating budget per year Model determined by individual regions Most established a resource centre Education materials IC workshops Conduct audits Scholarships Consultant Infectious Diseases Service Includes onsite regular visits and telephone service Report activities to an established Committee (Infection Control/Risk Management)
16 Multidisciplinary infection control teams Large private healthcare facilities More than 1 campus (4-5) Acute care facility ( beds) Perform a large number of elective clean surgical procedures such as CABGs and orthopaedic procedures ICU units ICP resources Usually 1 fulltime ICP May have additional ICP part time (i.e. 2 days per week) Line management Nursing Services/Operations Manager Services Infection control Vaccination of healthcare workers Needlestick injury follow-up Exposure management/follow-up May be asked to backfill other hospital roles Report activities to an established Infection Control Committee
17 Australia Victoria VICNISS Healthcare Associated Infection Surveillance System VICNISS Coordinating Centre
18 Australia Western Australia Healthcare Associate Infection Unit
19 Australia Western Australia Healthcare Associate Infection Unit
20 Australia Western Australia State-wide surveillance systems Mandatory indicators
21 Commonwealth government Australian Commission on Safety and Quality in Health Care The Commission is to lead and coordinate improvements in safety and quality in health care across Australia
22 Commonwealth government Australian Commission on Safety and Quality in Health Care Advisory Committees: HAI Advisory Committee Antimicrobial Stewardship Advisory Committee Hand Hygiene Advisory Committee HAI Technical Working Group Key Publications Reducing Harm to Patients from Health Care Associated Infection: The Role of Surveillance Antimicrobial Stewardship in Australian Hospitals
23 Commonwealth government Australian Commission on Safety and Quality in Health Care Advisory Committee HAI Advisory Committee Advise on national strategies for healthcare associated infection and assist in implementing the strategies Recommend national research priorities for action Recommend and monitor national standards and indicators Recommend strategies for translating evidence into practice Work collaboratively with other national safety and quality bodies Overseeing the function of any subcommittees established by the Healthcare Associated Infection Advisory Committee/Commission
24 Commonwealth government Australian Commission on Safety and Quality in Health Care Online Interactive Education Modules for Infection Prevention and Control: Basic epidemiology and statistics Basic microbiology and multi-resistant organisms (MRO) Cleaning, disinfection and sterilisation Infectious agent screening and immunisation of healthcare workers Infectious agent screening and immunisation of healthcare workers Management of occupational exposures Outbreak management Principles of infection prevention and control Renovation, repairs and redevelopment risk management Surveillance and quality improvement
25 Commonwealth government Australian Commission on Safety and Quality in Health Care Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010)
26 Commonwealth government Australian Commission on Safety and Quality in Health Care Surveillance implementation guides: Staphylococcus aureus bacteraemia (SAB) National Mandatory Clostridium difficile infection (CDI) National Mandatory
27 Commonwealth government Australian Commission on Safety and Quality in Health Care Surveillance implementation guides: Central Line Associated Bloodstream Infections (CLABSI) June 2010 Aims: Standardisation of definitions Voluntary Web site support (coming) checklists Australian and New Zealand Intensive Care Society (ANZICS) Undertake the CLABSI Prevention Project in Australian Intensive Care Units Support hospitals in reducing CLABSI in ICU to less than 1 per 1,000 line days Facilitated the acceptance of a consistent national CLABSI definition, and surveillance reporting that supports benchmarking across the country
28 Commonwealth government - Australian Commission on Safety and Quality in Health Care Hand Hygiene Australia
29 Commenced 2009 Commonwealth government - Australian Commission on Safety and Quality in Health Care Hand Hygiene Australia Standardised national approach Standardise education material Regular audit system Gold standard auditors Up to 200 training sessions Based on the World Health Organisation 5 Moment of Hand Hygiene Multimodal approach Grayson ML et al. Outcomes from the first 2 years of the Australian National Hand hygiene Initiative. MJA 195 (10) 21 November 2011
30 Commonwealth government - Australian Commission on Safety and Quality in Health Care Hand Hygiene Australia Disease outcomes Staphylococcus aureus bloodstream infections/patient days and occupied bed days Hospital onset if >48hrs after admission before intervention during interventions Results Late 2010 HH compliance 68.3% (95% CI, 68.1%-68.5%) Early 2009 HH compliance 63.6% (95% CI, 63.2%-64%) influenced by prexisting HH program in Victoria Mean baseline 43.6% % improved to 67.8% without Victorian data Widespread sustained in improvement in HH Public and private hospitals Grayson ML et al. Outcomes from the first 2 years of the Australian National Hand hygiene Initiative. MJA 195 (10) 21 November 2011
31 Commonwealth government - Australian Commission on Safety and Quality in Health Care Hand Hygiene Australia Rates of MRSA bacteraemia July before intervention during intervention Results Rates declined during (P = 0.008) Limitations?related to HH program or other factors Grayson ML et al. Outcomes from the first 2 years of the Australian National Hand hygiene Initiative. MJA 195 (10) 21 November 2011
32 Commonwealth government Australian Commission on Safety and Quality in Health Care Hand Hygiene Australia Rates of hospital onset staphylococcus bacteraemia, MRSA bacteraemia, Methicillin sensitive staph aureus bacteraemia during intervention Results Stable No overall reduction Grayson ML et al. Outcomes from the first 2 years of the Australian National Hand hygiene Initiative. MJA 195 (10) 21 November 2011
33 Commonwealth government My hospitals My Hospitals Information on hospitals throughout Australia How they compare against national, state and territory data including: Hospital profile Services offered Number of admissions Waiting times for emergency departments and elective surgery Safety and quality (Staphylococcus aureus bacteraemia) Part of the performance and accountability framework of Australia's National Health Reform Agreement
34 Commonwealth government My hospitals
35 Thankyou Glenys Harrington Infection Control Consultancy Melbourne Australia
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