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Hospital Acquired Infection ... |
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Infection is rife - the currect situation
Hospital Infection rife - the current situation....
As Shadow Health Minister, Jillian Skinner has for years been calling on the State Labor Government to take serious action to address the alarming rate of hospital acquired infections.
More golden staph deaths than road deaths ....
The latest confirmation of the seriousness of golden staph (Staphylococcus aureus bacteraemia) infection is the study reported in the Medical Journal of Australia's October 2009 edition which found that 21% of people contracting these infections died within 30 days.
When a 21% death rate is applied to 2008 data for infections associated with just 30 NSW Hospitals obtained by Nine News (reported 6pm news Friday October 9th 2009), 434 deaths resulted.
Hospital Acquired Infections 2008 Calendar Year* |
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Hospital |
No of infections |
21% of infections** |
| Westmead | 243 | 51 |
| John Hunter | 150 | 32 |
| Liverpool | 144 | 30 |
| Blacktown | 136 | 29 |
| Royal North Shore | 125 | 26 |
| Nepean | 121 | 25 |
| Royal Prince Alfred | 115 | 24 |
| Prince of Wales | 113 | 24 |
| Wollongong | 111 | 23 |
| Concoird | 79 | 17 |
| St George | 71 | 15 |
| Bankstown/Lidcombe | 68 | 14 |
| Sutherl;and | 58 | 12 |
| Campbelltown | 36 | 8 |
| Horn sby | 36 | 8 |
| Orange | 35 | 7 |
| Port Macquarie | 34 | 7 |
| St Vincent's | 34 | 7 |
| Newcastle Mater | 33 | 7 |
| Ryde | 33 | 7 |
| Tweed | 33 | 7 |
| Shoalhaven | 32 | 7 |
| Children's Hospital Westmead | 31 | 7 |
| Coffs Harbour | 30 | 6 |
| Gosford | 28 | 6 |
| Lismore | 28 | 6 |
| Sydney Children's Hospital | 28 | 6 |
| Tamworth | 26 | 5 |
| Maitlan | 22 | 5 |
| Dubbo | 19 | 4 |
| Manly | 17 | 4 |
TOTAL: top 30 hospitals |
2,069 | 434 |
TOTAL: alll reported infections (see table below) |
2,410 | 506 |
For comparison .. |
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NSW Deaths of all road users 2008*** |
397 | |
| * top 30 hospitals - data obtained under FOI by Nine News | ||
| ** Mortality rate of infections identified in eMJA article 'Staphylococcus aureus bacteraemia: a major cause of mortality in Australia and New Zealand' October 4 2009 | ||
| *** including drivers, passengers, pedestrians, motorcyclists, cyclists. Dept Infrastructure, Transport, Regional Development and Local Government 'Road Deaths Australia 2008 Statistical Summary' | ||
As shown above, when the 21% death rate is applied to collated data relating to particular types and locations of hospital infections published on the NSW Health website, 506 deaths resulted.
| Healthcare Associated Infection in NSW 2008 Calendar Year | No. of infections |
| Centrally Inserted Lines* | 125 |
| Peripherally Inserted Lines | 4 |
| Staphylococcus aureus bloodstream infections | 1,340 |
| Surgical Site Infections in patients undergoing total hip replacement | 65 |
| Surgical Site Infections in patients undergoing total knee replacement | 68 |
| Surgical Site Infections in patients undergoing cardiac artery bypass graft surgery | 65 |
| Methicillin-resistant Staphlococcus aureus (MRSA) infections + colonisations in ICU. ** | 693 |
| Multi-resistant acinetobacter baumannii (MRAB) infections + colonisation in ICU | 50 |
Total: |
2,410 |
| * Data from Royal Prince Alfred Hospital and Concord Hospital have been excluded from this graph due to incomplete denominator data. | |
| ** Problems were encountered by Area Health Services in the interpretation and reporting of these data during the 2008 period. NSW Health is currently revising these issues. | |
This compares, as the chart shows, with 397 road accident related deaths in NSW in 2008.
Publishing data a key to saving lives ....
Professor John Turnbridge, the author of the study is reported as saying the infection rate would probably halve if hospitals were forced to acknowledge the growing problem because it would lead to better hand-washing methods and improved care of intravenous catheters.
And an editorial in the eMJA states: 'Mandatory reporting and public sharing of information would likely lead to improved health care practices and save lives'
While NSW Health infection control policy published on its website includes measures intended to address hospital infection, the government has refused to publish any data about where infections are occuring and at what rate.
The last report published by the Clinical Excellence Commission revealed that there were 53,817 clinical ‘incidents’ in the NSW health system and includes data about a range of incidents. However it provides no details of one of the key hospital performance indicators – hospital acquired infections.
- Falls – page 10 - 12,321 incidents (19 classified as severe or SAC1),
- Medication and IV Fluid Incidents – page 13 - 10,953 (four classified as SAC1),
- Clinical Management – page 15 - 7,218 incidents (182 classified as SAC1),
- General Clinical Management – page 18 - 91 SAC1 incidents,
- Maternal and Perinatal – page 20 - 36 SAC1 incidents,
- Wrong patient/site/procedure – page 22 - 45 SAC1 incidents,
- Suicides – page 24 - seven,
- Infection control – page 26 -no data
- Complaints – page 28 - 7,207
The report notes the establishment of the Healthcare Associated Infection (HAI) prevention program which 'aims to reduce dramatically the possibility of any patient developing an infection while in hospital'
Whilst the government has made it mandatory for health staff to report infections the information, as far as individual clinicians are concerned, falls into the big black hole that consumes most data collected by NSW Health.
Where reports are issued they are so generalised that there is nothing to indicate to the individual staff member that their unit is problematic and changes need to be made. Or indeed to unit or hospital managers that they need to redirect resources to a site where infection is rife.
A recent history of monitoring infection .....
From January 1 2003, a statewide system of reporting of hospital acquired infections was introduced. Under the mandatory policy, each 6-months every public hospital has an obligation to provide de-identified infection data according to specific clinical indicators. The indicators were developed by a team of experts and have been reviewed and modified since their implementation. Outlined in the publication 'Infection control program quality monitoring indicators', it identifies the range of infections and circumstances to be monitored.
In February 2004, the Health Minister defended the NSW hospital infection rate on ABC radio, after figures showing 2,000 patients a year die after contracting infections during their stay.
On March 27th 2006, the NSW Health Minister launched a campaign to reduce health care associated infections, saying in a media release at the time: "Health care associated infections (HAIs), particularly those involving Multiresistant Organisms (MROs) pose a very real and serious threat to people who are admitted to hospital, however many of these infections are preventable."
In October 2005 the government unveiled a plan which included reduction of the number of hospital infections as part of the performance appraisals of senior health executives with much greater enforcement of hand-washing bynurses, doctors and allied health workers. .
Clinical Excellence Commission, Chief Executive Cliff Hughes, said at the launch of a hand-washing campaign that :"
Eliminating infections ... saved money and freed up hundreds of beds a year. Every single episode [of infection] that we remove from our hospitals is a potential life saved."
In June 2008 the AMA called for public reporting of infection rates: “Where these figures have been published overseas, health systems have been able to address the causes and bring down the rates,” said AMA (NSW) President Dr Brian Morton. The AMA linked high infection rates with high bed occupancy rates - where staff are kept busy dealing with increased patient numbers.
NSW Liberal-Nationals Coalition policy ....
The Liberal-Nationals have promised to establish an Independent Bureau of Information to report on hospital performance which will include publication of data about infection rates at ward level in hospitals
'Making it Work' - the Coalition's plan for reform of governance of the health system released in March 2009 - outlines our commitment to publish details of hospital acquired infection. It states:
The Coalition has adopted Garling’s recommendation that a Bureau of Health Information, be established independent from NSW Health, stand-alone or part of the Clinical Excellence Commission (CEC), “ … to access, interpret and report on all data relating to safety and quality of patient care and facilitate its interpretation and re-issue to the unit level on a regular basis.”.
The Coalition acknowledges that accurate information is needed to develop models of best practice and supports greater use of technology in collecting accurate data about health care – whether it involves electronic medical records, tracking patient diagnostics, treatments, length of hospital stay, discharge planning or electronic prescribing.
The Coalition believes that full public disclosure of accurate critical health system information – both of a financial and health outcomes nature - will allow the community and front-line health workers to be able to see what is happening in terms of budgets and patient care. Such increased transparency and accountability is important for driving quality of care.
Transparency in reporting medical errors, including hospital acquired infection, is imperative in driving improvement. This needs to be done at ward level to indicate where greater emphasis needs to be placed on infection control resources and activities. It has been suggested that hospital infections, which cause immense distress to patients also cost millions of dollars in re-admissions and long-term treatment.
Further details about other initiatives to reduce healthcare associated infections will be released in coming months.