Australian first ‘report card’ highlights the need for national surveillance of hospital infections

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Healthcare-associated infections (HAIs) are a major threat to patient safety and the quality of healthcare globally. Despite this, Australia does not have a nationally coordinated program for the surveillance and reporting of healthcare-associated infections. Now a new Australian publication has started the process of bringing together information about healthcare-associated infections nationally, in line with international best practice. A new report, Epidemiology of Healthcare-associated Infections in Australia, published in ClinicalKey aims to fill the gaps in data while confirming healthcare associated infections are common.

This new publication is Australia’s first peer-reviewed, evidence-based assessment of the epidemiology of HAIs, compiled by some of Australia's leading infection control professionals and researchers. It has been endorsed by the Australasian College for Infection Prevention and Control (ACIPC). 

Using publicly available data from hospital-acquired complications (HACs), and state-based surveillance systems, it presents the most current ‘report card’ of the incidence of HAIs and emerging of infection trends in Australian healthcare facilities. Its key finding was the lack of data and the diversity in approaches to infection surveillance.

Epidemiology of Healthcare-associated Infections in Australia aims to build national consensus on definitions, surveillance methodology and reporting of the incidence of HAIs. In doing so, it provides hospitals and those working in infection prevention and control an opportunity to benchmark and evaluate interventions to reduce infections and ensure transparency on reporting methods that will strengthen Australia’s efforts to prevent and control HAIs.

Professor Shaban, the Clinical Chair, Infection Control and Disease Prevention in the University of Sydney’s Marie Bashir Institute for Infectious Diseases and Biosecurity, and co-author of the report, said: “As the first publication of its kind, the aim is to provide transparency of infection rates in the absence of this information being co-ordinated and publicly available in Australia.” 

Co-author Professor Brett Mitchell, from the School of Nursing and Midwifery at the University of Newcastle said: “The big surprise was the lack of available data on infections for the public and the difficulty in obtaining data contained in the report. In particular, it was surprising that very little of the hospital-acquired complication (HAC) data for healthcare-associated infections is available, when in fact HACs reporting was implemented in part to help provide transparency of hospital performance.”

Queensland-based infection control expert and co-aothor, Dr Deborough Macbeth, said that no one knows or can accurately quantify the extent of the HAI issue in Queensland hospitals. “However based on the healthcare-associated complications data we know that hospital acquired infections do occur in Queensland hospitals. Infection prevention and control programs are designed to risk assess and implement strategies to mitigate infection risks and measure the success of these strategies.”

Professor Mitchell added that: “We don’t know the true rate of infection on any given day, because common infections are by and large only reported in HAC sets and these are almost exclusively not publicly available. We were unable to report the numbers of cases of different HAC infections. We do know from previous work that HAC infection data can be very unreliable. Peer-reviewed data and jurisdictional data also report limited data on common types of infections. 

“All this means we don’t have robust data on common infections in hospitals. Our report demonstrates Australia is in desperate need of a nationally co-ordinated approach to healthcare-associated infection surveillance. Australia is well behind many other countries in this regard.”

Professor Mitchell said COVID-19 has exposed gaps in our understanding of infection prevention strategies but has also demonstrated that data collection and transparency is possible to help inform a response. “We need to see continued investment and support for infection control activities at the national, state and local level. We also need targeted research providing evidence to prevent infections from occurring in the first instance.”

According to Dr Macbeth COVID-19 has “singularly highlighted” the importance of infection prevention and control. “The term ‘infection control’ is now part of the vocabulary of journalists. It regularly appears in media reports and members of the general public have a heightened awareness of infection prevention and control with matching expectations when consuming health services.

“The true value of infection prevention and control has suddenly been recognised and appreciated. This has been great for the profession but, more importantly, it has brought infection control into focus as the filter through which all healthcare must be delivered if it is to be safe care.”

Professor Shaban said the new publication was important for many reasons. “We need to understand where success is occurring and learn from this, as well as identify issues when they occur. National data is also needed to be able to evaluate the impact of interventions and initiatives.”

Dr Macbeth said that the book provides policy makers and health system executives the opportunity to plan the necessary changes required to address any gaps. “The resulting system changes could more closely monitor health outcomes and form the basis for the implementation of rational infection prevention strategies. 

“The book also serves to identify research gaps and opportunities for researchers and academics leading to a more complete picture of the extent of healthcare associated infection in Australia.”