Academic calls for national surveillance of healthcare-associated infections
The only systematic review of Australian healthcare-associated infection rates published in peer-reviewed literature demonstrates the desperate need for a coordinated national surveillance program.
Professor Brett Mitchell’s research published in a paper today provides the most comprehensive estimate in decades of the number of infections occurring each year.
The number: 165,000.
But how significant is it? “We just don’t know,” says Mitchell, Director of the Lifestyle Research Centre at Avondale College of Higher Education. “The only way to answer the question is to regularly collect data from across the country or to conduct a survey that gives a snapshot in time.”
The latter, last conducted in 1984, is coming next year, with Mitchell supporting his co-author Dr Philip Russo from Deakin University to count how many patients in a sample of Australian hospitals have an infection on one day. “Patients in Australian hospitals are now sicker than they’ve ever been, so they’re more vulnerable to infection,” says Dr Russo, a Research Fellow in the Centre for Quality and Patient Safety-Alfred Health Partnership within Deakin’s School of Nursing and Midwifery.
Infections are still a significant burden on hospitals. As antibiotic resistance increases, these infections will become more difficult to treat and prevent. That’s not just a major challenge, that’s a significant threat.Professor Brett Mitchell, Director, Lifestyle Research Centre, Avondale College of Higher Education
Wanting to know the risk of infection in hospital before going to hospital “is a pretty basic question” says Mitchell, “but the availability of the data is limited.” The Australian Government’s MyHospitals website publishes limited data on only one infection—Staphylococcus aureus is rare and largely preventable but has an associated mortality of about 30 per cent. Other problems for patients, according to Mitchell: the narrowness—often limited to public hospitals—and inaccessibility of government reports and delays in reporting data. “The need for a coordinated national surveillance program is desperate.”
Australia is one of the only Organisation for Economic Cooperation and Development countries not to have such a program, says Mitchell. Why? Inertia. “The desire for a national surveillance program exists but leadership and ownership does not because the states have their own infection control units. Some publish rates openly and publicly, others do not. And there’s discrepancy in what they measure and how they measure.”
Funding is the key. “The money we’re currently spending on state surveillance units could be spent nationally on this program, giving a better bang for buck.”
A coordinated national surveillance program “is critical in setting national agendas and priorities,” says Mitchell. “Our results show infections are still a significant burden on hospitals. As antibiotic resistance increases, these infections will become more difficult to treat and prevent. That’s not just a major challenge, that’s a significant threat.”
Mitchell and his team’s estimate of 165,000 infections is significantly more robust than the previous estimate of 200,000, published in 2007 from data collected at two South East Queensland hospitals in 2004. It will, says Mitchell, help government make informed decisions about allocating resources and industry determine investment in products and research.
Current European studies showing infection rates of between three and eight per cent give some guide to what rates in Australia might be. “There’s no logical reason to think we’re going to be any better or any worse,” says Mitchell.
The opinion of Mitchell and his team mirrors that of the Australian Medical Association, which earlier this year called for the establishment of a National Centre for Disease Control to coordinate rapid and effective public health responses to manage communicable diseases and outbreaks. “Diseases and health threats do not respect borders” it said. The current approach to disease threats, and control of infectious diseases, “relies on disjointed State and Commonwealth formal structures, informal networks, collaborations, and the goodwill of public health and infectious disease physicians.”
“We can, no, we must do better,” says Mitchell.
The paper by Mitchell, Russo, Professor Ramon Shaban (Griffith University and Gold Coast Health), Dr Deborough MacBeth (Gold Coast Health) and Claudia-Jayne Wood (Avondale) appears today in the Australian journal, Infection, Disease and Health.