Wendy Beckingham

Increasing incidence of Clostridium difficile infection, Australia, 2011-2012

Objectives: To report the quarterly incidence of hospital‐identified Clostridium difficile infection (HI‐CDI) in Australia, and to estimate the burden ascribed to hospital‐associated (HA) and community‐associated (CA) infections.

A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals

Objectives Urinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs. Setting Data were collected from three public and three private Australian hospitals over the first 6 months of 2013. Participants A total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded. Outcome measures The primary outcome measures were the HAUTI and CAUTI point prevalence. Results Overall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter (26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition. Conclusions These study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly.

ATP bioluminescence to validate the decontamination process of gastrointestinal endoscopes

Abstract Introduction Gastrointestinal endoscopes play an effective diagnostic role in modern medicine. The endoscopes become heavily contaminated with microorganisms during procedures and need careful reprocessing. Methods A prospective study was carried out at a gastroenterology hepatology unit to evaluate ATP bioluminescence, measured as relative light units (RLUs), to validate the decontamination processing of endoscopes. Flushes from endoscopes involved in 120 endoscopic procedures at four different stages: pre-patient (before the procedure), post-patient (after the procedure), post-cleaning (after manual cleaning) and post-disinfection were examined by ATP testing and microbiological culture. The hypothetical pass or fail limit of 100 RLUs was set according to previous studies in the literature. When the disinfection process failed, the above process was repeated. Results Average RLU readings were: pre-patient: 48; post-patient: 124 052; post-cleaning: 1423; and postdisinfection: 144. The corresponding culture results were: pre-patient: all negative; post-patient: all positive except for four; post-cleaning: positive except for 26; and post-disinfection: all negative. Although 21 (17%) of post-disinfection specimens showed failed ATPlevels of more than 100 RLUs, when the cleaning and disinfection process was repeated before they were used, all scopes then showed a pass level of less than 100 RLUs. Conclusions ATP bioluminescence has the potential to play an important role in the validation process. This process would allow a quick turnaround time following a simple check procedure to be classified as safe in a busy endoscopic unit.

Healthcare associated urinary tract infections: a protocol for a national point prevalence study

Abstract Background Urinary tract infections account for ~30% of healthcare-associated infections reported by hospitals. Virtually all healthcare-associated urinary tract infections (HAUTIs) are caused by instrumentation of the urinary tract, creating an opportunity to prevent a large proportion of HAUTIs, including catheter-associated urinary tract infections (CAUTIs). In Australia, there is no specific national strategy and surveillance system in place to address HAUTIs or CAUTIs. To determine the need for prospective surveillance of HAUTIs, we propose undertaking a national point prevalence study. This paper describes the methods that could be used to undertake such a study. Methods A cross-sectional point prevalence design is proposed. The population is all patients hospitalised overnight in Australian hospitals, with the sample to exclude outpatients and those in emergency departments. The proposed operational definition is that used by the Health Protection Agency. A standardised training package for data collectors is recommended with standardised data collection and analysis processes described. Individual patient consent should be waived. Discussion Explanation of aspects of the proposed methods are provided, primarily based on findings from a pilot study that informed the development of the proposed protocol. This included development and delivery of training for data collectors and use of the Health Protection Agency HAUTI surveillance definition, rather than the Centers for Disease Control definition. Conclusion Conducting a national point prevalence study on HAUTIs including CAUTIs will provide evidence that can be subsequently used to debate the cost effectiveness and value of prospective surveillance. By conducting a pilot study and critically evaluating that process, we have been able to propose a method that could be used for a single hospital or national study.

Vancomycin-resistant enterococci surveillance of intensive care patients: incidence and outcome of colonisation

Abstract Background Vancomycin-resistant enterococci (VRE) colonisation serves as a reservoir and increases the risk of developing an infection with VRE. Treatment difficulties and infection control measures associated with vancomycin-resistant enterococci present significant costs to health care facilities. To determine the incidence of VRE colonisation in ICU, data collected included hospital and ICU admission, discharge dates, positive and negative VRE swabs for each hospital or ICU admission. Methods This study was performed to identify the number of VRE colonisations occurring in the Intensive Care Unit (ICU) and the outcome of these colonised patients. The clinical records of 99 VRE patients identified as having been to ICU during 2009 and 2010 were reviewed. Results These patients had a total of 111 ICUadmissions. Of these, 30 were classified as definite or probable ICUacquired VRE colonisations. This equated to 30.1 acquisitions per 10 000 occupied bed days. Thirty-eight patients acquired their VRE from clinical areas other than ICU. In 24 other patients the place of VRE could not be ascertained. In another 19 patients VRE was present when they were admitted from the community but 15 of these (79%) had been hospitalised within the last year. Of the 30 ICU-colonised patients, none developed infections. However, three patients initially colonised in another clinical area developed an infection with VRE while in ICU. Conclusion Our study supports the findings of others that most people at risk of VRE colonisation or infection are severely unwell. The high level of colonisation occurring in other clinical areas added to the healthcare expenses in ICU. The increased costs associated with VRE and our findings indicate a greater need to better control VRE transmission not only in the ICU, but in all health care settings.

Review of neonatal unit continuous positive airways pressure (CPAP) (with humidification)

Infections, in particular healthcare associated infections (HCAI), in the neonatal intensive care unit (NICU) are recognised as major causes of morbidity and deaths. The most common way bacteria are spread from patient-to-patient in hospitals is via the hands of staff (e.g. MRSA). Outbreaks and, on occasions, HCAIs are caused by bacteria associated with water (e.g. pseudomonas). A study by Freige estimated that infection with Pseudomonas aeruginosa results in approximately 1,400 deaths each year in the United States of America. Outbreaks of P. aeruginosa are linked to many sources but some of the more common have been contaminated respiratory equipment, antiseptics and tap water.