Clinical Excellence Commission HAI ICP Clinical Practice Forum - - PowerPoint PPT Presentation

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Clinical Excellence Commission HAI ICP Clinical Practice Forum - - PowerPoint PPT Presentation

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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

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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

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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.

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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.

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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
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Current work

  • Update of the Australian Guidelines for the Prevention and Control of

Infection in Healthcare

  • Access via MagicAPP + PDF on NHMRC website
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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

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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.

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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 Practice Proposed action

  • 1. Recommend Australian Guidelines for the Prevention

and Control of Infection in Healthcare include requirement for contact precautions for all patients with diarrhoea until pathology results are known It is proposed that states, territories and individual health service

  • rganisations continue to support the implementation of contact

precautions and appropriate bed placement in line with the updated Australian Guidelines for the Prevention and Control of Infection in Healthcare.

  • 2. Develop educational resources for clinicians and bed

managers on bed placement priorities for patients with diarrhoea or known/suspected CDI It is proposed that the Commission adapt existing state resources (listed under (5)) as national guidance.

  • 3. Develop national monitoring mechanism for

healthcare acquired CDI A snapshot report on 2016 administrative data will be provided at the April 2018 IJC meeting.

  • 4. Update ASID/ACIPC infection control position

statement A copy of the updated statement will be provided to the IJC for noting when it becomes available.

  • 5. Disseminate guidance to promote contact

precautions, including appropriate bed placement, for all patients with diarrhoea until pathology results are known It is proposed that states, territories and individual health service

  • rganisations continue to support the implementation of contact

precautions and appropriate bed placement, in line with the updated Australian Guidelines for the Prevention and Control of Infection in Healthcare.

  • 6. Review barriers to appropriate CDI testing

It is proposed that the Commission will write to relevant Commonwealth agencies and professional colleges to encourage these groups to undertake targeted and exploratory research on these specific topics.

  • 7. Perform desktop audit of all CDI clinical management

and treatment guidelines in Australia and identify inconsistencies

  • 8. Review utility of other indicators for providing more

meaningful outcome data to drive practice change

  • 9. Review utility of current hospital data for the

monitoring CDI in the community

  

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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

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Current work

  • ASID/ACIPC CDI infection control position statement

Free download https://www.sciencedirect.com/science/article/pii/S2468045118301433?via%3Dihub

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2019/2020 Priorities

  • Maintain currency of resources to supporting the Preventing and Controlling Healthcare

Associated Infection Standard

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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

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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

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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
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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 Response to Candida auris

  • CARAlert  prevalence C. auris,

colistin-R Enterobacterales, carbapenemase-producing Acinetobacter baumannii, carbapenemase-producing Pseudomonas aeruginosa

  • Test case for new networked national

surveillance and response protocol

  • Victorian (NSW), ASID guidance
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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/

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Who does what at the Commission?

HAI Advisory Committee State/Territory Contact Network NSW Kathy Dempsey Clinical Excellence Commission

X 8 states/territories

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HH benchmarks SAB CDI national indicators Healthcare associated complications Email: indicators@safetyandquality.gov.au National Safety and Quality Health Service Standards Accreditation Email: accreditation@safetyandquality.gov.au

Who does what at the Commission?

State/Territory Contact Network AURA CARAlert APAS AAW AMS Email: aura@safetyandquality.gov.au ams@safetyandquality.gov.au

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Who does what at the Commission?

HAI Advisory Committee State/Territory Contact Network NSW Kathy Dempsey Clinical Excellence Commission

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How do we make policy decisions?

Board Inter Jurisdictional Committee

Carrie Marr NSW Clinical Excellence Commission

Australian Health Ministers’ Advisory Council (+ Principal Committees) Elizabeth Koff Secretary, NSW Ministry of Health COAG Health Council Brad Hazzard NSW Minister for Health Council of Australian Governments Gladys Berejiklian Premier, NSW

HAI Advisory Committee State/Territory Contact Network

NSW Kathy Dempsey, Clinical Excellence Commission

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Safetyandquality.gov.au Twitter.com/ACSQHS Youtube.com/user/ACSQHC Jan Gralton

Senior Advisor, Infection Prevention and Control and Healthcare Associated Infections Jan.Gralton@safetyandquality.gov.au (02) 9126 3655