Piloting a Novel State-Wide Smaller Hospital Nosocomial Infection Surveillance Program

ISSUE: There is no widely accepted method for nosocomial infection surveillance in smaller (<100 beds) acute care hospitals with low surgical throughput and no intensive care units. The aim of the Victorian Hospital Acquired Infection Surveillance System Coordinating Centre (VCC) was to develop, implement and evaluate a pilot nosocomial infection surveillance program for the Victorian state smaller hospitals. PROJECT: A pilot program was developed after consultation with key stakeholders and a literature analysis. The process indicator surveillance modules included ‘Surgical Antibiotic Prophylaxis’ and ‘Measles and Health Care Worker vaccination.’ The outcome indicator surveillance modules included ‘Multi-resistant Organism Infections,’ ‘Bloodstream Infections’ and ‘Outpatient Haemodialysis Events’ (Positive blood cultures or IV Vancomycin use). Surveillance data collection by Infection Control (IC) personnel was paper based and hospital and state level reports were generated. The program was piloted for 18 weeks in 14 hospitals. Evaluation data collection processes used to assess key components of the program included a combination of document analysis, surveys and interviews. RESULTS: All smaller hospitals in the pilot region agreed to participate. - At 10 hospitals outcome surveillance data collection was prospectively conducted. - Hospital documentation did not always support the collection of accurate or complete data. - It took an IC person on average 54 minutes per week to collect data. - Of the 70 monthly data summary collection forms required only 37% were faxed by the specified deadline. - Within all hospitals, a paper based system was considered sufficient. - The time taken to post reports on the VCC website was 8 weeks. - At 4 hospitals, medical staff was not represented at any meetings in which surveillance reports were routinely presented. - Specific action, for example distribution of guidelines, was only taken by 5 hospitals in response to one of the process indicator module reports. - Other high priority surveillance modules identified, for example employee vaccination compliance, were primarily related to Staff Health service responsibilities. LESSONS LEARNED: Overall, participation by the pilot hospitals in this smaller hospital nosocomial infection surveillance program was achievable. Some specific program elements, for example, data reporting timeframes needed to be modified. A revised program has now been ‘rolled out’ to the other 75 Victorian smaller acute care hospitals.