The burden of healthcare associated infections in Australia: a modified national point prevalence survey

Background: In the absence of national healthcare associated infection (HAI) surveillance in Australia, the burden of HAI is unknown. The one and only point prevalence survey (PPS) conducted in 1984 identified a HAI prevalence of 6.3%. We conducted a national PPS survey to determine the prevalence of HAI in Australia. Materials/methods: Two trained research assistants collected data using a modified PPS European Centre for Disease Prevention and Control protocol. Large public acute hospitals were invited to participate. Non-acute wards and inpatients <18 years of age were excluded. Patients were systematically sampled on each eligible ward by randomly selecting either odd or even numbered beds (50% sample). If patients were neither receiving antimicrobial (AM) therapy (excluding surgical prophylaxis) or had a temperature >38C then it was assumed they did not have HAI, and no further data was collected. Results: Preliminary data: 19 public acute care hospital from five States and one Territory were surveyed over 4 months. Of 2327 patients included, the mean age was 63, and 53% were male. 232 patients had a HAI (10.0%;95%CI:8.8-11.3) and a total of 310 HAIs were identified. Of patients with a HAI, 76% had 1 HAI, 18% had 2, and 8% had 3. Hospital prevalence ranged from 5.7%–17.0%. The three most prevalent HAIs were SSI (38%), pneumonia (19%), and UTI (18%). 56% of patients had a peripheral vascular device, 21% a urinary catheter, 45% were receiving AM (excluding those on surgical prophylaxis), and 10% of patients were being actively managed for the presence of a multi-resistant organism. The prevalence of patients in intensive care units with a HAI was 25.4% (95%CI:18.4-33.3). The most common pathogens were S.aureus (21.2%), E.coli (13.7%), P.aeruginosa (6.9%) and C.albicans (6.9%). Conclusions: This is the first time a national HAI PPS has been conducted in Australia in 34 years. HAIs not routinely surveyed in Australia have been identified revealing new insights into the burden of HAI. The use of specifically trained data collectors resulted in high interrater reliability ensuring consistency of case finding. The modified PPS method is ideal for large scale surveillance when resources are limited. Larger HAI PPS across a broader range of facilities is warranted.