3/08/2012

1

Infection control in Australian

medical practice: Current practice

and future developments

John Ferguson

Infectious Diseases & Microbiology

Director, Infection Prevention & Control, Hunter

New England Health Service,

Newcastle, NSW

July 2012, ASID Zoonosis ConferenceMMWR July 30, 1999

MMWR July 30, 1999

Infection prevention & control

• …. Infection control and hospital epidemiology are akin to

public health practice, practiced within the confines of a

particular health-care delivery system….

• …. addresses factors related to the spread of infections within

healthcare settings (whether patient-to-patient, from patients to

staff and from staff to patients, or among-staff), including:

– prevention (via hand, hygiene/ cleaning/ disinfection/

sterilization/ vaccination/ surveillance),

– monitoring/investigation of demonstrated or suspected

spread of infection within a particular health-care setting

(surveillance and outbreak investigation), and

– management (interruption of outbreaks)

Intervention

Students and doctors required to clean their hands with a chlorinated lime solution when

entering the labour room in particular when moving from the autopsy to the labour room

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Medical Infection Prevention and

Control: practice essentials

• Generic measures

– Standard precautions

– Asepsis

– Immunisation

– Sterilisation and disinfection

– Antimicrobial stewardship

– Surveillance and audit

– Risk identification and management

– Healthcare facility design

• Targeted measures

STANDARD PRECAUTIONS

The assumption is made that all human blood or

other body fluids are potentially infectious.

The aim of these practices is to protect patients,

visitors and health care workers from exposure

to infection via the contact route by using

STANDARD practices for ALL parts of the

healthcare system and ALL contacts between staff

and patients.

Standard Precautions: what is included?

• Hand hygiene before and after patient care

• Use of personal protective equipment as required to prevent blood or body substance exposure (gloves, mask, eye protection, gowns)

• Cleaning and disinfection of patient care environments

• Safe handling of sharps (contaminated needles/ instruments)

• Safe handling and disposal of contaminated waste

• Safe handling of spills and environmental contamination

• Safe handling and transport of laboratory specimens and contaminated reused equipment

• Safe transport, cleaning and storage of laundry

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Australia: national hand hygiene

program

• Adoption of the WHO 5 Moments for Hand Hygiene standard

• Point of care access to alcohol-based hand rubs

• Uniform approach to hand hygiene training and audit

• Audits three times per year across most public and private facilities

• Publically reported audit data

• Outcome indicator - Healthcare-associated Staphylococcus aureus bloodstream infections

.

Point-of-care availability

Reports and planned evaluation Hunter New England, NSW data:

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Medical Infection Prevention and

Control: practice essentials

• Generic measures

• Targeted measures

– Screening of at-risk patient groups for

colonisation/infection with key pathogens

– Additional (transmission-based)

precautions: airborne, droplet, contact

– Outbreak management

National initiatives

HC facility design: critical issues

• facilities for the isolation of infectious patients;

• air handling and ventilation;

• linen handling;

• separation of ‘clean’ and ‘dirty’ work flows;

• storage;

• waste management

• surface finishes.

• Surveillance

• National IPC Guidelines (with NHMRC)

• Hand hygiene- national HH program

• IC practitioner capacity building

• Antimicrobial stewardship • Estimated 200,000 healthcare-associated

infections per annum in Australia

• Recommended priorities for national

surveillance in Australia

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Public reporting of hospital performance

Healthcare-associated Staphylococcus aureus

bloodstream infection by AIHW Peer Group

(2010_11 data)

Peer group A1 and A2 hospitals (83 facilities, 1,616 events,

mean = 1.36/10,000)

0

0.5

1

1.5

2

2.5

3

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82

per

10,0

00 b

ed

-days

Peer group A1, A2 Hospitals

0.00

0.50

1.00

1.50

2.00

2.50

3.00

0 50000 100000 150000 200000 250000 300000 350000

Total bed-days

SA

B / 1

0,0

00 b

ed

-days

Endorsed - 17 Oct 1999

ELEMENTS:

1. Workplace based infection control plan

2. Standard Infection Control Procedures

3. High Risk Procedures and need for additional precautions

4. Demonstrated commitment to infection control practices

5. Monitoring of infection control programs

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Future developments

Standard 3 – appropriate

antimicrobial useExperience in Perth: effect of reducing 3rd generation

cephalosporin use on C. difficile incidence

.Reference: : Dr Claudia Thomas, PhD thesis 2003

Wide unexplained variation in tertiary

hospital cephalosporin use (NAUSP 2009_10) Standard 3 – asepsis requirement

• Undergraduate and postgraduate training

• Procedure definition – wide current variation in the way in which common invasive procedures are performed

• Audits of compliance – how, what procedures, how often?

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Sources of intravascular catheter infection

Skin

Vein

Intraluminalfrom tubes and hubs

Haematogenousfrom distant sites

Extraluminalfrom skin

Infusate from contamination

during preparation of additives

Environmental hygiene: need for a

higher standard• Environmental reservoir is implicated in transmission

of many nosocomial pathogens

• Patients expect not to be contaminated either by staff

or an unclean healthcare environment

• Environmental hygiene standard:

– cleaning AND disinfection of patient care environments

– environmental audits that go beyond a visibly clean standard

http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf

Risk identification & management

• Hospital epidemiology still a fledgling discipline in Australia

• Challenge to better identify at-risk patients and outbreaks in real-time

• Implement targeted, cost-effective interventions using public health principles

• Need for sophisticated software that assists analysis of microbiological and patient demographic and administrative data

Emerging infectious disease

threats to healthcare settings

• Foreign acquired multi/pan drug resistant

bacteria including tuberculosis

• Zoonotic pathogens – eg. SARS

coronovirus

• Novel pathogens

Infection prevention and control

in the pacific/ SE Asia region

• High incidence of healthcare infection

• High burden of (drug-resistant) tuberculosis

in many locations with nosocomial spread

• Most countries with under-developed or

absent infection control effort

• Virtually no antimicrobial stewardship work

• Increases risk to Australian patients…

Thank you!