Clinical Excellence Commission HAI ICP Clinical Practice Forum Program Update Jan Gralton Senior Advisor, Infection Prevention and Control and Healthcare Associated Infections 9 May 2019
Current work Update of the Australian Guidelines for the Prevention and Control of • Infection in Healthcare 2 systematic reviews Antimicrobial surfaces - Systematic review of antimicrobial surfaces to reduce infection rates in hospitalised populations Novel disinfection - Systematic review of novel disinfection methods to reduce infection rates in high risk hospitalised populations Not yet enough high quality evidence on the efficacy of hydrogen peroxide vapour, ultra-violet light or antimicrobial surfaces to support their routine use for infection prevention and control in Australian healthcare facilities. The use of hydrogen peroxide vapour and ultra-violet light may be considered in high-risk settings and during outbreaks when other disinfection options have been exhausted. If emerging disinfectants are already being used in healthcare facilities, it is advised that this should always be used in addition to standard cleaning practices.
Current work Update of the Australian Guidelines for the Prevention and Control of • Infection in Healthcare 3 literature reviews The impact of chlorhexidine resistance The incidence of anaphylaxis related to chlorhexidine The current epidemiology and evidence on transmission and prevention of norovirus. Use chlorhexidine appropriately and only when clinically indicated, to assist in preventing chlorhexidine resistance and adverse reactions Any adverse reactions to chlorhexidine should be maintained in an organisational risk register and reported to the Therapeutic Goods Administration. The Guidelines advise healthcare workers to adhere to exclusion periods and remain away from work until 48 hours after symptom resolution. Rather than closing an entire ward or unit to manage an outbreak of norovirus in a healthcare facility, it may be more efficient to control an outbreak by grouping similarly symptomatic patients in bays. If taken, this approach needs to be implemented promptly and early (within three days of the first case becoming ill) in combination with adequate infection control strategies.
Current work Update of the Australian Guidelines for the Prevention and Control of • Infection in Healthcare Other updated information: - Hand hygiene - Wearing of personal protective equipment - Involving patients and their carers - Antimicrobial resistance - Replacement of PIVC - Clinical handover - HCW immunisation (in line with the Australian Immunisation Handbook) - TGA-listed hard surface disinfectants
Current work Update of the Australian Guidelines for the Prevention and Control of • Infection in Healthcare Access via MagicAPP + PDF on NHMRC website
Current work National surveillance for SAB and CLABSI • SAB hospital-level benchmark - IJC-endorsed proposal: 1.0 per 10,000 patient days - Stratify by peer group, and line-related v non-line related SABs - Review strategies to reduce SAB and other HAI-bacteraemias CLABSI definition - No big changes have been made to the case definition - Neutropenia definition revised to be consistent with SAB definition - CLABSI following observed, deliberate patient access of a central line should not be excluded from CLABSI reporting
Current work Actions to improve CDI prevention and control in the future • 2 x Technical Reports published in 2018 2 proposed actions • It is recommended that administrative data be used at a national level on an ongoing basis to monitor the prevalence of CDI for informing on the relative increases and decreases in CDI prevalence. • It is recommended that health services continue to use traditional HAI surveillance and exposure classification processes to monitor and respond to local CDI trends.
Current work Actions to improve CDI prevention and control in the future • 2 x Technical Reports published in 2018 Priority actions identified by the Community of Proposed action Practice It is proposed that states, territories and individual health service 1. Recommend Australian Guidelines for the Prevention organisations continue to support the implementation of contact and Control of Infection in Healthcare include precautions and appropriate bed placement in line with the updated requirement for contact precautions for all patients with Australian Guidelines for the Prevention and Control of Infection in diarrhoea until pathology results are known Healthcare. 2. Develop educational resources for clinicians and bed It is proposed that the Commission adapt existing state resources (listed managers on bed placement priorities for patients with under (5)) as national guidance. diarrhoea or known/suspected CDI 3. Develop national monitoring mechanism for A snapshot report on 2016 administrative data will be provided at the April healthcare acquired CDI 2018 IJC meeting. 4. Update ASID/ACIPC infection control position A copy of the updated statement will be provided to the IJC for noting when statement it becomes available. It is proposed that states, territories and individual health service 5. Disseminate guidance to promote contact organisations continue to support the implementation of contact precautions, including appropriate bed placement, for precautions and appropriate bed placement, in line with the updated all patients with diarrhoea until pathology results are Australian Guidelines for the Prevention and Control of Infection in known Healthcare. 6. Review barriers to appropriate CDI testing 7. Perform desktop audit of all CDI clinical management and treatment guidelines in Australia and identify inconsistencies It is proposed that the Commission will write to relevant Commonwealth agencies and professional colleges to encourage these groups to 8. Review utility of other indicators for providing more undertake targeted and exploratory research on these specific topics. meaningful outcome data to drive practice change 9. Review utility of current hospital data for the monitoring CDI in the community
Current work Annual CDI monitoring • 2017/2018 Snapshot report to be published this year https://www.safetyandquality.gov.au/wp-content/uploads/2015/05/Clostridium-difficile-infection-2016-Data-Snapshot.pdf
Current work ASID/ACIPC CDI infection control position statement • Free download https://www.sciencedirect.com/science/article/pii/S2468045118301433?via%3Dihub
2019/2020 Priorities • Maintain currency of resources to supporting the Preventing and Controlling Healthcare Associated Infection Standard
2019/2020 Priorities • Maintain currency of resources to supporting the Preventing and Controlling Healthcare Associated Infection Standard • Maintain currency of resources to support implementation of the Australian Guidelines for the Prevention and Control of Infection in Health Care
2019/2020 Priorities • Maintain currency of resources to supporting the Preventing and Controlling Healthcare Associated Infection Standard • Maintain currency of resources to support implementation of the Australian Guidelines for the Prevention and Control of Infection in Health Care
2019/2020 Priorities • Maintain currency of resources to supporting the Preventing and Controlling Healthcare Associated Infection Standard • Maintain currency of resources to support implementation of the Australian Guidelines for the Prevention and Control of Infection in Health Care • Review the national hand hygiene benchmark Current benchmark: 80% Public reporting Consultation with states and territories re: national approach to hand hygiene
2019/2020 Priorities • Maintain currency of resources to supporting the Preventing and Controlling Healthcare Associated Infection Standard • Maintain currency of resources to support implementation of the Australian Guidelines for the Prevention and Control of Infection in Health Care • Review the national hand hygiene benchmark • Continue to develop appropriate responses Response to Candida auris for the management of selected infections informed by data from AURA and other CARAlert prevalence C. auris, monitoring colistin-R Enterobacterales, carbapenemase-producing • Monitor the need for, and provide national Acinetobacter baumannii, infection control and prevention resources carbapenemase-producing Pseudomonas aeruginosa where required for emerging infectious diseases Test case for new networked national surveillance and response protocol Victorian (NSW), ASID guidance
2019/2020 Priorities • Maintain currency of resources to supporting the Preventing and Controlling Healthcare Associated Infection Standard • Maintain currency of resources to support implementation of the Australian Guidelines for the Prevention and Control of Infection in Health Care • Review the national hand hygiene benchmark • Continue to develop appropriate responses for the management of selected infections informed by data from AURA and other monitoring • Monitor the need for, and provide national infection control and prevention resources where required for emerging infectious diseases AURA 2019 https:/ / www.safetyandquality.gov.au/ AURA/ aura-2019/
Who does what at the Commission? State/Territory HAI Advisory Contact Network Committee X 8 states/territories NSW Kathy Dempsey Clinical Excellence Commission
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