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A Review of Healthcare-Acquired Infection Surveillance Systems

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A Review of Healthcare-Acquired Infection Surveillance Systems A Review of Healthcare-Acquired Infection Surveillance Systems Mahashweta Patel A thesis submitted in fulfilment for the degree of Master of Public Health at the University of Otago, Dunedin, New Zealand October 2013 Abstract Introduction: Healthcare-acquired infections (HAIs) are a common adverse health event affecting hospitalised patients in both developing and developed countries. They are associated with substantial health and economic burden on patients and healthcare systems. Therefore, it is critical that programmes are in place to reduce the burden of infection in already vulnerable hospitalised patients. Surveillance systems for HAIs are vital for effective prevention and control of HAIs and are a cost effective approach to reducing disease. The importance of surveillance systems for HAI control has been accepted globally and many countries have established national surveillance systems with the aim to prevent HAIs. This project commenced after consultation with contacts from the Southern District Health Board (SDHB) requesting an investigation to identify the approach to HAI surveillance in SDHB hospitals. Prior to study, the HAI surveillance system in Dunedin Hospital involved reporting to a variety of bodies. Additionally, minimal information was known about the overarching collation of internal reporting. Aims The study presented in this thesis aimed to review hospital surveillance systems for HAIs in New Zealand and internationally. There are three key objectives to this study: 1. To identify and review the fundamentals of HAI surveillance and to establish international best practice. 2. To conduct an in depth case study of HAI surveillance in SDHB hospitals. 3. To identify the HAI surveillance performed in other New Zealand DHB hospitals. Methods: International best practice for HAI surveillance was established by a literature review. Key stakeholder interviews were performed with clinical and managerial staff from SDHB hospitals to gain an understanding of the surveillance performed in SDHB hospitals. A self- administered questionnaire was developed to review the HAI surveillance performed in other New Zealand hospitals. i Results: The literature review found that many developed counties including Australia, England, Scotland, The Netherlands, Germany, and France have adapted the Center for Disease Control and Prevention’s National Nosocomial Infection Surveillance, which has now developed into the National Healthcare Safety Network for the surveillance of HAIs. The national approach allows for benchmarking and uses standardised HAI definitions, data collection and reporting methods. The study presented in this thesis found that the infection prevention and control team in Dunedin Hospital and the infection control team in Southland Hospital implement surveillance on blood stream infections, multidrug resistant organisms and Clostridium difficile infections. The maternity wards in both hospitals perform their own in-patient and post discharge surveillance for caesarean wound infections. Within Dunedin hospital the neonatal and intensive care units implement in-house surveillance on line-associated infections and central line-associated bacteraemia respectively. The national HAI surveillance questionnaire found that the majority of the main HAIs are under surveillance in surveyed DHB hospitals with the exception of catheter associated urinary tract infections and ventilator associated pneumonia. The methods used for surveillance and the reporting of surveillance information vary for each DHB hospital and each type of infection. Most hospitals surveyed perceived themselves as “good” or “very good” for the timeliness of collecting and reporting, validity of data collection, accuracy and completeness of numerator and denominator data, application of HAI surveillance data and analyses of HAI surveillance data. Discussion and Conclusions: The approaches to HAI surveillance in New Zealand DHB hospitals vary according to infections monitored, protocols used, analysis performed and dissemination of data. The New Zealand Health Quality & Safety Commission has provided an essential start to a collaborative approach to SSI surveillance. A willingness of hospital staff to engage in HAI surveillance programmes is fundamental for success. The collection of national HAI surveillance data is important as it would allow for the identification of national trends and benchmarking. This would be achieved as a by-product of locally established cohesive surveillance systems. ii Acknowledgements There are several people that I would like to thank for their continual support during this extensive process. Firstly I would like to thank my supervisors- Dr Patricia Priest and Dr Simon Horsburgh both of whom have been there for me and have provided incredible support, guidance and have shared their knowledge and expertise. I am inspired by you both and it has been great working with you. I would like to thank Kim Caffell, Chris Lovell-Smith and Marion Poore for their on-going consultations and insight into the workings of SDHB hospitals and for helping to initiate this project. I would like to thank all the participants involved in the study for sharing their knowledge and time. To the department of Preventive and Social Medicine for providing financial support and making me feel welcomed and part of the team. I would like to acknowledge the other research students within the department who have shared this process with me, thank you for advice and support. I feel a strong connection with you all and look forward to seeing the incredible contributions you all make. Finally, I would like to thank my family and friends- Mum, Dad, Jagruti and Vidit for their love and support, and Caine, Mike and my other friends for their encouragement. iii Table of Contents Abstract ........................................................................................................................ i Acknowledgements ..................................................................................................... iii Table of Contents ......................................................................................................... iv List of Tables ................................................................................................................ ix List of Figures ............................................................................................................... xi List of Abbreviations .................................................................................................... xii 1 Introduction .......................................................................................................... 1 1.1 Aim and Objectives ......................................................................................................... 2 1.2 Thesis Summary .............................................................................................................. 2 2 Background ........................................................................................................... 3 2.1 The Public Health Issue .................................................................................................. 3 2.2 Healthcare Acquired and Nosocomial Infections ........................................................... 4 2.2.1 Types of Healthcare Acquired Infections............................................................ 5 2.3 Risk factors and predisposing factors for HAIs ............................................................... 7 2.4 Prevention of HAIs .......................................................................................................... 8 2.5 Surveillance of HAIs ........................................................................................................ 8 2.6 The New Zealand Context .............................................................................................. 9 2.6.1 National Setting .................................................................................................. 9 2.6.2 Southern District Health Board......................................................................... 12 2.6.3 HAI surveillance in New Zealand ...................................................................... 13 2.7 Reports and Documents Presenting New Zealand HAI Information............................ 16 2.7.1 Health Roundtable Reports .............................................................................. 16 2.7.2 Global Trigger Tool Report ............................................................................... 17 2.7.3 Australasian Indicator Report ........................................................................... 18 2.8 Background summary ................................................................................................... 19 3 Literature Review ................................................................................................ 20 3.1 Introduction .................................................................................................................. 20 3.2 Objectives ..................................................................................................................... 20 3.3 Methods ....................................................................................................................... 20 3.3.1 Data sources ..................................................................................................... 20 iv 3.3.2 Search terms ....................................................................................................
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