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Tasmanian Acute Public Hospitals TASMANIAN INFECTION PREVENTION AND CONTROL UNIT Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report. Annual Report 2012 - 2013 August 2013 Department of Health and Human Services Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Report 2012-13 Tasmanian Infection Prevention and Control Unit (TIPCU) Department of Health and Human Services, Tasmania Published 2013 Copyright—Department of Health and Human Services Permission to copy is granted provided the source is acknowledged ISBN 978-0-9872195-4-1 Editors • Anne Wells, TIPCU • Fiona Wilson, TIPCU • Dr Alistair McGregor, TIPCU Suggested reference: Wells, A., Wilson, F., McGregor, A. (2013). Tasmanian Acute Public Hospitals Healthcare Associated Infection Surveillance Annual Report 2012 – 2013. Hobart: Department of Health and Human Services. Notes • This report does not contain the methodology used to collect the data. Protocols relating to the surveillance programs are published on the TIPCU website, www.dhhs.tas.gov.au/tipcu • An explanatory document is available on the TIPCU website. This document provides insight into understanding the surveillance report. • Data from previous reports should not be relied upon. Use the most to date report when quoting/using data. TASMANIAN INFECTION PREVENTION AND CONTROL UNIT Population Health Department of Health and Human Services GPO Box 125 Hobart 7001 Ph: 6222 7779 Fax: 6233 0553 www.dhhs.tas.gov.au/tipcu Page 1 of 32 Contents Contents 2 Executive summary 3 Progress 4 Staphylococcus aureus bacteraemia 5 Introduction 5 Tasmanian rates 5 Hospital rates 7 Community associated 8 Key points 9 Clostridium difficile infection 10 Introduction 10 Tasmanian rates 10 Hospital rates 12 Key points 14 Vancomycin resistant enterococcus (VRE) 15 Introduction 15 Tasmanian numbers 15 Hospital numbers 16 Key points 16 Hand hygiene compliance data 17 Tasmanian rates 17 Key points 18 Antibiotic utilisation surveillance 19 Introduction 19 Hospital rates 20 Acknowledgements 24 Appendix 25 Staphylococcus aureus bacteraemia 25 Clostridium difficile infection 28 Hand hygiene compliance data June 2013 30 Page 2 of 32 Executive summary This annual report provides a broad overview of the Tasmanian acute public hospitals healthcare associated infection surveillance that complements the quarterly surveillance data reports that the Tasmanian Infection Prevention and Control Unit (TIPCU) has been publishing since March 2009. The TIPCU website (www.dhhs.tas.gov.au/tipcu) contains details of the surveillance program, including the rationale for the indicators surveyed and the methodologies used in data collection, validation and analysis. These details are not contained in this report but are freely available online should further information be required.. Any form of comparison between hospitals should be done with extreme caution and direct comparisons are not recommended. Information about how Tasmanian rates compare with those of other Australian states (where available), are provided in the Key Points sections of this report. A question and answer document and an explanatory document are also available on the TIPCU website (www.dhhs.tas.gov.au/tipcu). The Appendices in this report contain more detailed information. Compared to the quarterly reports published by the TIPCU, this report contains some additional detail, such as infection rates by financial year. From this report, the following findings can be made: • the rate of healthcare associated Staphylococcus aureus bacteraemia remains low. • the number and rate of hospital identified and ‘healthcare associated-healthcare facility onset (HCA-HCF) Clostridium difficile infection (CDI) is slightly lower in 2012-13 compared to 2011- 12. • the numbers of persons with VRE continue to remain low • the rate of hand hygiene compliance has increased significantly since the commencement of the National Hand Hygiene Initiative, and is above the ‘My Hospitals’ threshold of 70%. Ms Anne Wells Dr Alistair McGregor Acting Assistant Director of Nursing, TIPCU Specialist Medical Advisor, TIPCU Page 3 of 32 Progress A great deal of progress in the area of infection prevention and control has occurred in Tasmania over the past few years. This can be demonstrated through: • development of the ‘Strategy for the prevention and control of healthcare associated infection in Tasmania 2013 – 2015’ • the sustained hand hygiene initiative within hospitals • implementation and continuation of surveillance programs based on nationally agreed methodology • development of a range of guidance and information material for healthcare workers and the public on important issues related to healthcare associated infections • performance indicators for key healthcare associated infections • development of state-wide infection prevention and control policies and protocols for those working in the DHHS. • enhanced interaction with the private healthcare sector and education providers • ongoing involvement with work undertaken by the Australian Commission of Safety & Quality in Healthcare • development of an environmental cleaning assessment program • provision of infection prevention and control education and training programs Page 4 of 32 Staphylococcus aureus bacteraemia Introduction Bloodstream infections (BSIs) are arguably the most important category of HAI as they cause significant patient morbidity and mortality. Staphylococcus aureus is the most common cause of serious healthcare associated BSI and has an estimated mortality of around 25-30%. Of approximately 7,000 episodes of Staphylococcus aureus bacteraemia (SAB) that occur in Australia each year, two thirds are healthcare associated with many of these being potentially preventable. Staphylococcus aureus bacteraemia was made a notifiable condition in 2008 pursuant to the Public Health Act 1997. Tasmania is the first and only Australian jurisdiction to introduce this measure. Surveillance of SAB is carried out in Tasmania using the nationally agreed surveillance definitions published by the Australian Commission on Safety and Quality in Health Care (ACSQHC). Healthcare associated SAB surveillance includes a number of patient groups including inpatients and short stay patients which includes renal dialysis patients. Tasmanian rates Figure 1 outlines the Tasmanian combined acute public hospital rates of healthcare associated Staphylococcus aureus bacteraemia (HCA SAB). The mean (average) rate of healthcare associated Staphylococcus aureus bacteraemia between July 2009 and June 2013 is 1.04 per 10 000 patient days (95% CI 0.87 – 1.21). Figure 1 Healthcare associated Staphylococcus aureus bacteraemia - rate by quarter. Page 5 of 32 Table 1 outlines the Tasmanian combined acute public hospital annual rate, including confidence intervals, of healthcare associated Staphylococcus aureus bacteraemia and Figure 2 shows the same information graphically without confidence intervals. Table 2 outlines the device related healthcare associated Staphylococcus aureus bacteraemia Table 1 Healthcare associated Staphylococcus aureus bacteraemia - rate by financial year. Financial Year Rate per 10 000 patient Lower 95% Confidence Upper 95% Confidence days Interval Interval 2009 – 10 1.11 0.76 1.46 2010 – 11 1.23 0.86 1.60 2011 - 12 0.85 0.53 1.17 2012 - 13 0.96 0.62 1.29 Figure 2 Healthcare associated Staphylococcus aureus bacteraemia - rate by financial year. Table 2 Device related healthcare associated Staphylococcus aureus bacteraemia – percentage by financial year Financial Year Total HCA SAB Total device related % of device related 2009 – 10 38 23 61% 2010 – 11 42 26 62% 2011 - 12 28 16 57% 2012 - 13 31 19 61% Page 6 of 32 Hospital rates Figure 3 and Figure 4 outlines the individual acute public hospitals rates of healthcare associated Staphylococcus aureus bacteraemia. This information is also contained in tables within the Appendix. Figure 3 Healthcare associated Staphylococcus aureus bacteraemia - rate by quarter. Figure 4 Healthcare associated Staphylococcus aureus bacteraemia - rate by financial year. Page 7 of 32 Community associated Table 3 outlines the Tasmanian number and incidence/100 000 population, including confidence intervals, of community associated Staphylococcus aureus bacteraemia (CA-SAB) by financial year and Figure 5 shows the same information graphically, without confidence intervals. Table 3 Community associated CA-SAB – number and incidence/100 000 population Financial Number Incidence per 100 000 Lower 95% Upper 95% Year population* Confidence Interval Confidence Interval 2008 – 09 50 9.9 7.2 12.7 2009 – 10 68 13.6 10.2 16.6 2010 – 11 52 10.2 7.4 12.9 2011 - 12 75 14.7 11.3 18.0 2012 - 13 77 15.0 11.7 18.4 *Population figures from ABS 3101.0 – Australian Demographic Statistics (Table 4). Figures for 2011-12 and 2012 – 13 uses the population as of December 2011. Figure 5 - Community associated CA-SAB – number and incidence/100 000 population Page 8 of 32 Key points • The Tasmanian rate of healthcare associated Staphylococcus aureus bacteraemia (HCA SAB) for 2012-13 is 0.96 per 10 000 patient days. This is comparable with other Australian states. o The rate of HCA SAB in Western Australia public hospitals (2011–12) was 0.59 per 10 000 bed days1. o The rate of HCA SAB in South Australia is reported as1.0 per 10 000 patient days in 20112. o The calculated rate for SAB in NSW for the period July – December 2011 is 0.1 per 10 000 patient days. From July 2011 NSW rates are based on the national definition3. o The rate of HCA
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