Validation of healthcare-associated infection surveillance in smaller Australian hospitals

Area of Science:

• Infectious Diseases
• Hospital Epidemiology
• Public Health Surveillance

Background:

• Effective surveillance of bloodstream infections is crucial for patient safety and infection control.
• Smaller hospitals (<100 acute beds) may have unique challenges in implementing surveillance programs.
• Accurate detection of Staphylococcus aureus bloodstream (SAB), meticillin-resistant S. aureus (MRSA), and vancomycin-resistant enterococci (VRE) is vital.

Purpose of the Study:

• To evaluate the case detection performance of surveillance systems for SAB, MRSA, and VRE in smaller Victorian hospitals.
• To identify potential gaps and areas for improvement in the current surveillance program.
• To inform future refinements for enhanced accuracy in detecting healthcare-associated and community-associated infections.

Main Methods:

• A validation study was conducted across 20 Victorian hospitals with fewer than 100 acute beds.
• Case detection rates (sensitivity and specificity) were assessed for SAB, MRSA, and VRE infections.
• Analysis included identifying the proportion of unreported infections that were community-associated.

Main Results:

• Overall, 142 infections were identified during the study period.
• Routine surveillance demonstrated high specificity (100.0%) for SAB but moderate sensitivity (74.4%).
• MRSA detection showed lower sensitivity (47.5%) and 90.9% specificity, with most unreported cases being community-associated (83.9%).
• All confirmed VRE infections were correctly reported.

Conclusions:

• Current surveillance effectively detects VRE and has high specificity for SAB in smaller hospitals.
• Sensitivity for MRSA detection is suboptimal, with a significant proportion of missed cases originating from the community.
• Program refinements, including targeted education on case definitions for community-onset infections, are recommended.