Noleen Bennett

Antimicrobial stewardship in residential aged care facilities: need and readiness assessment

BackgroundInformation about the feasibility, barriers and facilitators of antimicrobial stewardship (AMS) in residential aged care facilities (RACFs) has been scant. Exploring the prevailing perceptions and attitudes of key healthcare providers towards antibiotic prescribing behaviour, antibiotic resistance and AMS in the RACF setting is imperative to guide AMS interventions.MethodsSemi-structured interviews and focus groups were conducted with key RACF healthcare providers until saturation of themes occurred. Participants were recruited using purposive and snowball sampling. The framework approach was applied for data analysis.ResultsA total of 40 nurses, 15 general practitioners (GPs) and 6 pharmacists from 12 RACFs were recruited. Five major themes emerged; perceptions of current antibiotic prescribing behaviour, perceptions of antibiotic resistance, attitude towards and understanding of AMS, perceived barriers to and facilitators of AMS implementation, and feasible AMS interventions. A higher proportion of GPs and pharmacists compared with nurses felt there was over-prescribing of antibiotics in the RACF setting. Antibiotic resistance was generally perceived as an issue for infection control rather than impacting clinical decisions. All key stakeholders were supportive of AMS implementation in RACFs; however, they recognized barriers related to workload and logistical issues. A range of practical AMS interventions were identified, with nursing-based education, aged-care specific antibiotic guidelines and regular antibiotic surveillance deemed most useful and feasible.ConclusionsAreas of antibiotic over-prescribing have been identified from different healthcare providers’ perspectives. However, concern about the clinical impact of antibiotic resistance was generally lacking. Importantly, information gathered about feasibility, barriers and facilitators of various AMS interventions will provide important insights to guide development of AMS programs in the RACF setting.

SURGICAL ANTIBIOTIC PROPHYLAXIS IN SMALLER HOSPITALS

Background:  In 2004, The Victorian Hospital Acquired Infection Surveillance System Coordinating Centre established a smaller hospital (<100 beds) surveillance programme that included an optional ‘surgical antibiotic prophylaxis’ (SAP) module. Appropriate SAP is believed to be one of the most effective strategies to reduce surgical site infections after certain surgical procedures.

Influenza vaccination uptake among Victorian healthcare workers: evaluating the success of a statewide program

Objective: Annual influenza vaccination is recommended for all Australian healthcare workers (HCWs). In 2014, a target vaccination uptake of 75% was set for Victorian healthcare facilities. This study aimed to determine the 2014 uptake, describe trends over time and propose an enhanced reporting framework.

Infections and Antimicrobial Use in Australian Residential Aged Care Facilities: A Comparison between Local and International Prevalence and Practices

INTRODUCTION In July 2011, 29 residential aged care facilities (RACF) located in the Grampians rural region, Victoria, participated in the Grampians healthcare-associated infection (HAI) and antimicrobial use point prevalence study. METHODS On a single day, trained infection control consultants collected data using two surveys. The RACF survey enabled collection of information (e.g. occupancy levels) about each RACF and its residents. The resident survey was completed for eligible high-level care residents who presented with signs and symptoms of a HAI and/or were prescribed an antimicrobial. A literature review was undertaken so comparisons could be made against similar studies. RESULTS The Grampians prevalence of residents presenting with ≥1 HAI (3.8%) was higher than the pooled prevalence (2.3%) for four international studies (P=0.01). The Grampians prevalence of residents prescribed ≥1 antimicrobial (8.3%) was higher than the pooled prevalence (5.8%) for eight international studies (P=0.009). CONCLUSION The prevalence of the Grampians residents presenting with ≥1 HAI and residents prescribed ≥1 antimicrobial were both observed to be significantly higher than pooled data from similar international studies.

Survey of infection control and antimicrobial stewardship practices in Australian residential aged‐care facilities

This study assessed infection prevention and antimicrobial stewardship (AMS) practices in Australian residential aged‐care facilities (RACF). Two hundred and sixty‐five surveys (15.6%) were completed with all states represented and the majority (177 (67.3%)) privately run. Only 30.6% RACF had infection control trained staff on site. Few facilities had AMS policies, only 14% had antimicrobial prescribing restrictions. Most facilities offered vaccination to residents (influenza vaccination rates >75% in 73% of facilities), but pneumococcal vaccination was poor.

Infections after coronary artery bypass graft surgery in Victorian hospitals ‐ VICNISS Hospital Acquired Infection Surveillance

Objective: To establish a surveillance program reporting surgical site infection rates after coronary artery bypass graft surgery (CABGS) in Victorian public hospitals.

Influenza vaccination of Australian healthcare workers: strategies to achieve high uptake

Annual influenza vaccination of healthcare workers (HCWs) is recommended by the Australian National Health and Medical Research Council.1 However, uptake among Australian HCWs is variable and frequently below 50%.2 In 2014, the Victorian Department of Health and Human Services increased the target vaccination coverage for all HCWs employed in public acute care healthcare facilities from 60% to 75% and introduced this target as a key performance indicator.3 We sought to evaluate the scope of strategies implemented and determine those that were associated with higher vaccination uptake.

Influenza vaccination of Victorian healthcare workers: will a higher target increase vaccine uptake?

Annual influenza vaccination of healthcare workers (HCW) is an important component of infection prevention in healthcare facilities and confers multiple benefits, including reduced incidence of influenza among HCWs,1 lower rates of staff absenteeism1 and reduced patient mortality.2 Although estimated vaccination rates of healthcare personnel in the United States have now exceeded 70%,3 the majority of published reports in Australia have indicated poorer uptake, with rates generally less than 50%.4,5 However, data captured more recently by the Victorian Healthcare-Associated Infection Surveillance System (VICNISS) Coordinating Centre suggest that aggregate vaccination rates in Victoria have increased from 38% to 64.7% during the period 2005 to 2013 (see Figure 1). In 2013, 94 Victorian public hospitals and health services reported rates spanning 35.2% to 95%.

Quality of Data Reported to a Smaller-Hospital Pilot Surveillance Program

This data quality study assessed the accuracy of data collected as part of a pilot smaller-hospital surveillance program for methicillin-resistant Staphylococcus aureus (MRSA) infection and bloodstream infection (BSI). For reported MRSA infection, estimated values were as follows: sensitivity, 40%; specificity, 99.9%; and positive predictive value, 33.3%. For reported BSI, estimated values were as follows: sensitivity, 42.9%; specificity, 99.8%; and positive predictive value, 37.5%.

Infections in Australian Aged-Care Facilities: Evaluating the Impact of Revised McGeer Criteria for Surveillance of Urinary Tract Infections

Our survey of 112 Australian aged-care facilities demonstrated the prevalence of healthcare-associated infections to be 2.9%. Urinary tract infections (UTIs) defined by McGeer criteria comprised 35% of all clinically defined UTIs. To estimate the infection burden in these facilities where microbiologic testing is not routine, modified surveillance criteria for UTIs are necessary.