Healthcare Infection Indicators
Healthcare associated infections (HAI) are infections that patients acquire during
treatment for other conditions, or that healthcare workers acquire delivering healthcare.
HAIs can be very serious and may increase length of hospital stay. A proportion
of HAI are preventable. Preventing and controlling these infections in hospitals
are priorities for Queensland Health and is the key to keeping patients and staff
safe.
People who get an infection in their blood can become very sick. These infections
can occur:
- Prior to the patient being admitted to hospital (community-acquired bloodstream
infection),
- During their hospital stay (inpatient healthcare associated bloodstream infection),
- When a patient receives treatment through an outpatient or home healthcare service
such as haemodialysis (non-inpatient healthcare associated bloodstream infection).
Bloodstream infection is not always directly related to a hospital procedure, but
it may happen if a patient already has an infection somewhere else in their body
(e.g. urinary tract infection or chest infection). In hospitals infection can result
from having an indwelling medical device e.g. intravenous drip or urinary catheter.
Most of the germs that cause these infections can be treated with routine antibiotics.
This is an area where special efforts are made to try to prevent infection such
as good hand hygiene and handling the drip or catheter correctly. For more information
please view
factsheet.
Staphylococcus aureus ('Staph') is a very common germ that about one
in three people have in their nose or on their skin. This germ does not cause problems
for most people who have it, but sometimes it can cause serious infections such
as skin or wound infections, pneumonia or infections of the blood. Hospitals monitor
healthcare associated Staphylococcus aureus BSI very closely, as these can
lead to death in some patients.
Surgical site infections (SSI) occur when harmful germs enter the body through any
cut the surgeon makes in the skin to perform the operation. Infections happen because
germs are normally almost everywhere - on people's skin, in the air and on things
that people touch. Most infections are caused by germs in and on the body. It is
important to know that most patients who have surgery do not get an infection. The
number of patients that might get an infection in their wound varies by the type
of surgery. Some procedures have a higher risk of infection due to the difficulty
of the surgery and the patient's vulnerability to infection (e.g. due to having
disease such as diabetes). Infections can occur while a patient is in hospital or
after they have left the hospital. Symptoms can appear at any time from hours to
weeks after surgery. Infections from surgery involving an implant such as an artificial
knee or hip, can become apparent a year or more after the operation. However, most
infections (over 80%) occur near the surface of the skin and are easily treated
with routine antibiotics and wound care.
The following procedures are monitored:
Total hip replacement: Hip replacement surgery is for
people with severe hip damage or pain related to chronic osteoarthritis, rheumatoid
arthritis, and other degenerative (wearing down) processes or fractures involving
the hip joint. The procedure involves surgically replacing the damaged or diseased
cartilage and bone with artificial materials called implants or prostheses.
Revision total hip replacement:A revision total hip
replacement is repeat surgery to replace a joint replacement. Reasons for performing
a revision joint replacement include worn-out implants, infection of a replaced
joint and instability or malpositioning of an implanted joint.
Total knee replacement: Knee replacement surgery (knee
arthroplasty) is for people with severe knee damage and pain related to osteoarthritis,
rheumatoid arthritis, and traumatic arthritis. A total knee replacement involves
removing the damaged cartilage and bone of the knee joint and replacing these with
artificial materials called implants or prostheses.
Revision total knee replacement:A revision total knee
replacement is repeat surgery to replace a joint replacement. Reasons for performing
a revision joint replacement include worn-out implants, infection of a replaced
joint, and instability or malpositioning of an implanted joint.
Coronary artery bypass grafts (CABG) (chest incision and graft
(donor) site):CABG (pronounced 'cabbage') is a surgery used to bypass
blocked heart arteries by creating new passages for blood flow to the heart muscle.
Arteries or veins from other parts of the body are used as grafts to create alternative
blood-flow pathways. Infection can occur at the chest incision (sternal wound),
graft (donor) site, or both.
An occupational exposure is an incident that exposes a healthcare worker to another
person's blood or body fluid during their work, which may place them at risk of
blood borne virus infection. This can include:
- A percutaneous injury, where the healthcare worker's skin has
been cut or penetrated by a needle or other sharp object that may be contaminated
with blood or other body fluid. (For example, a needlestick injury or cut with a
sharp object such as a scalpel blade).
- A non-percutaneous (mucosal) exposure, where there is contact
of mucous membranes or non-intact skin (e.g. exposed skin that is chapped or abraded)
with blood or body fluids. (For example, a blood splash to the eyes).
For more information please view
factsheet.
There are certain 'significant organisms' that have potential to spread in hospitals
and require special management to stop them being passed on to other patients. One
of these is Clostridium difficile. Clostridium difficile (also known
as 'C. difficile' or 'C diff') is a bacterium (germ) that produces
toxins which can cause diarrhoea. C. difficile infection (CDI) can lead to
more serious intestinal (bowel, gut) diseases including colitis (inflammation of
the gut), sepsis, and in rare cases death. C. difficile lives in the human intestine
of about 2% to 5% of the population particularly young children (less than 2 years
of age), without causing an infection ('carrier'). C. difficile is also able
to form spores which can survive in the hospital environment for long periods of
time. Infection control practitioners monitor every laboratory sample that tests
positive for the C. difficile toxin. However it is important to note that
not all of these indicate healthcare associated infections. For more information
please view the CDI
factsheet.
Hand hygiene is a general term referring to any action of hand cleansing including
hand washing, antiseptic hand wash, antiseptic hand rub or surgical hand antisepsis.
Queensland Health uses the '5 Moments for hand hygiene' auditing methodology. For
more information please view the hand hygiene
factsheets.
Interpreting the reports
Status
Statistical control limits are used to compare the individual hospital's HAI rate
with the state-average to determine whether the infection rate is what would be
expected. Statistical control limits are not calculated when numbers (e.g. of procedures)
are too small to be informative, or where statistical models are not available.
The following colour-codes are used to indicate whether a hospital's infection rate
is within the expected range, higher or lower than expected.
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Infection rate higher than would be expected
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Infection rate lower than would be expected.
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Infection rate within the expected range.
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Hospitals that are 'red' have put in place strategies to address the infection rates.
For more information please visit
here.
For more information on how to interpret the reports please view the report interpretation
factsheet
here.
