Standardising surveillance of nosocomial infections: The HISS Program

Abstract

Standardised surveillance of nosocomial infections in Australia had not been addressed until June 1998 when the New South Wales Health Department funded the development and implementation of the first standardised surveillance system for hospital infection: the Hospital Infection Standardised Surveillance program (HISS). The introduction of a standardised surveillance system needs to balance the requirements of a Health Department and the needs of hospitals. The Health Department requires data to develop aggregated rates for the setting of thresholds for all nosocomial infections while hospitals require rates to reflect the quality of clinical care and provide data for evidence-based infection control practices. The Hospital Infection Epidemiology and Surveillance (HIES) Unit has attempted to balance these requirements using a 'sentinel surveillance' approach with standardised definitions and methodology. The HISS program utilizes eICAT software modified for its standardised requirements of data collection. To date, 10 hospitals surveyed sentinel multiple resistant organisms (MRO), eight also elected sentinel surgical procedures (SSP) and intravascular device-related bacteraemia (IVDRB) modules, and two the seasonal respiratory syncytial (RSV) and rota-virus modules in paediatric patients. The surgical site infection rates in three commonly monitored SSP were 1.8% (95% confidence interval (CI) 0.7-3.9%) for coronary artery bypass (CABG), 3.3% (95% CI 1.4-6.8%) lower segment Caesarean section (LSCS) and 7.7% (95% CI 3.4-14.6%) colorectal surgery. The rate of IVDRB was 4.7 per 1000 central venous catheter days (95% CI 2.2-8.6) and 1.1 per 1000 peripheral line-days (95% CI 0.1-3.9). Methicillin resistant Staphylococcus aureus (MRSA) accounted for 99% of all new infections diagnosed with an endemic MRO.