Surveillance of healthcare-acquired infections in Queensland, Australia: Data and lessons from the first five years

Morton, Anthony P., Clements, Archie C. A., Doidge, Shane R., Stackelroth, Jenny, Curtis, Merrilyn and Whitby, Michael (2008) Surveillance of healthcare-acquired infections in Queensland, Australia: Data and lessons from the first five years. Infection Control and Hospital Epidemiology, 29 8: 695-701. doi:10.1086/589904


Author Morton, Anthony P.
Clements, Archie C. A.
Doidge, Shane R.
Stackelroth, Jenny
Curtis, Merrilyn
Whitby, Michael
Title Surveillance of healthcare-acquired infections in Queensland, Australia: Data and lessons from the first five years
Journal name Infection Control and Hospital Epidemiology   Check publisher's open access policy
ISSN 0899-823X
1559-6834
Publication date 2008-08-01
Year available 2008
Sub-type Article (original research)
DOI 10.1086/589904
Open Access Status Not yet assessed
Volume 29
Issue 8
Start page 695
End page 701
Total pages 7
Editor Suzanne F. Bradley
Gordon Ruby
Place of publication Thorofare, N.J. U.S.A
Publisher University of Chicago Press
Language eng
Subject C1
920404 Disease Distribution and Transmission (incl. Surveillance and Response)
111706 Epidemiology
Abstract OBJECTIVE. To present healthcare-acquired infection surveillance data for 2001-2005 in Queensland, Australia. DESIGN. Observational prospective cohort study. SETTING. Twenty-three public hospitals in Queensland. METHODS. We used computer-assisted surveillance to identify episodes of surgical site infection (SSI) in surgical patients. The risk-adjusted incidence of SSI was calculated by means of a risk-adjustment score modified from that of the US National Nosocomial Infections Surveillance System, and the incidence of inpatient bloodstream infection (BSI) was adjusted for risk on the basis of hospital level (level 1, tertiary referral center; level 2, large general hospital; level 3, small general hospital). Funnel and Bayesian shrinkage plots were used for between-hospital comparisons. PATIENTS. A total of 49,804 surgical patients and 4,663 patients who experienced healthcare-associated BSI. RESULTS. The overall cumulative incidence of in-hospital SSI ranged from 0.28% (95% confidence interval [CI], 0%-1.54%) for radical mastectomies to 6.15% (95% CI, 3.22%-10.50%) for femoropopliteal bypass procedures. The incidence of inpatient BSI was 0.80, 0.28, and 0.22 episodes per 1,000 occupied bed-days in level 1, 2, and 3 hospitals, respectively. Staphylococcus aureus was the most commonly isolated microorganism for SSI and BSI. Funnel and shrinkage plots showed at least 1 hospital with a signal indicating a possible higher-than-expected rate of S. aureus-associated BSI. CONCLUSIONS. Comparisons between hospitals should be viewed with caution because of imperfect risk adjustment. It is our view that the data should be used to improve healthcare-acquired infection control practices using evidence-based systems rather than to judge institutions.
Formatted abstract
Objective.
To present healthcare-acquired infection surveillance data for 2001–2005 in Queensland, Australia.

Design.
Observational prospective cohort study.

Setting.
Twenty-three public hospitals in Queensland.

Methods.
We used computer-assisted surveillance to identify episodes of surgical site infection (SSI) in surgical patients. The risk-adjusted incidence of SSI was calculated by means of a risk-adjustment score modified from that of the US National Nosocomial Infections Surveillance System, and the incidence of inpatient bloodstream infection (BSI) was adjusted for risk on the basis of hospital level (level 1, tertiary referral center; level 2, large general hospital; level 3, small general hospital). Funnel and Bayesian shrinkage plots were used for between-hospital comparisons.

Patients.
A total of 49,804 surgical patients and 4,663 patients who experienced healthcare-associated BSI.

Results.
The overall cumulative incidence of in-hospital SSI ranged from 0.28% (95% confidence interval [CI], 0%–1.54%) for radical mastectomies to 6.15% (95% CI, 3.22%–10.50%) for femoropopliteal bypass procedures. The incidence of inpatient BSI was 0.80, 0.28, and 0.22 episodes per 1,000 occupied bed–days in level 1, 2, and 3 hospitals, respectively. Staphylococcus aureus was the most commonly isolated microorganism for SSI and BSI. Funnel and shrinkage plots showed at least 1 hospital with a signal indicating a possible higher-than-expected rate of S. aureus–associated BSI.

Conclusions.
Comparisons between hospitals should be viewed with caution because of imperfect risk adjustment. It is our view that the data should be used to improve healthcare-acquired infection control practices using evidence-based systems rather than to judge institutions. 
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Faculty of Health and Behavioural Sciences -- Publications
2009 Higher Education Research Data Collection
 
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Created: Wed, 01 Apr 2009, 01:33:23 EST by Geraldine Fitzgerald on behalf of School of Public Health