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National Healthcare Agreement: PI 22-Healthcare associated infections, 2013 QS

Identifying and definitional attributes

Metadata item type:Help on this termQuality Statement
METeOR identifier:Help on this term507447
Registration status:Help on this termHealth, Superseded 14/01/2015

Relational attributes

Indicators linked to this Quality statement:Help on this term

National Healthcare Agreement: PI 22-Healthcare associated infections, 2013 Health, Superseded 25/11/2013

Data quality

Quality statement summary:Help on this term
  • The indicator uses a definition of a patient episode of Staphylococcus aureus bacteraemia (SAB) agreed by all states and territories and used by all states and territories.
  • There may be imprecise exclusion of private hospital and non-hospital patient episodes due to the inherent difficulties in determining the origins of SAB episodes.
  • For some states and territories there is less than 100 per cent coverage of public hospitals. For those jurisdictions with incomplete coverage of public hospitals (in the numerator), only patient days for those hospitals that contribute data are included (in the denominator). Differences in the types of hospitals not included may impact on the accuracy and comparability of rates.
  • The accuracy and comparability of the rates of SAB among jurisdictions and over time is also limited because the count of patient days (denominator) reflects the amount of admitted patient activity, but does not reflect the amount of non-admitted patient activity.
  • The data for 2011-12 are comparable with those from 2010-11 except for Queensland.
  • The patient day data may be preliminary for some hospitals/jurisdictions.
Institutional environment:Help on this term

The Australian Institute of Health and Welfare (AIHW) calculated the indicator from data provided by states and territories.

The AIHW is an independent statutory authority within the Health and Ageing portfolio, which is accountable to the Parliament of Australia through the Minister. For further information see the AIHW website.

The data supplied by the states and territories were collected from hospitals through the healthcare associated infection surveillance programs run by the states and territories. The arrangements for the collection of data by hospitals and the reporting to State and Territory health authorities vary among the jurisdictions. 

Timeliness:Help on this term

The reference period for this data is 2011‑12.

Accessibility:Help on this term

The following states and territories publish data relating to healthcare-associated SAB in various report formats on their websites:

New South Wales: Your Health Service public website reports SAB by individual hospital.

<http://www.health.nsw.gov.au/hospitals/search.asp

New South Wales: Healthcare associated infections reporting for 8 infection indicators by state.

<http://www.health.nsw.gov.au/quality/hai/index.asp>

Tasmania: Acute public hospitals healthcare associated infection surveillance report.

<http://www.dhhs.tas.gov.au/peh/tasmanian_infection_prevention_and_
control_unit/publications_and_guidelines
>

Western Australia: Healthcare Associated Infection Unit - Annual Report and aggregate reports.

<http://www.public.health.wa.gov.au/3/455/3/reports__healthcare_associated_
infection_unit.pm
>  

South Australia: Healthcare Associated Bloodstream Infection Report.

<http://www.health.sa.gov.au/INFECTIONCONTROL/Default.aspx?
PageContentID=18&tabid=147
>
Interpretability:Help on this term

Jurisdictional manuals should be referred to for full details of the definitions used in healthcare-associated infection surveillance.

Definitions for this indicator are published in the performance indicator specifications.

Relevance:Help on this term

This indicator is for patient episodes of SAB acquired, diagnosed and treated in public acute care hospitals. The definition of a public acute care hospital is ‘all public hospitals including those hospitals defined as public psychiatric hospitals in the Public Hospital Establishments NMDS’. All types of public hospitals are included, both those focusing on acute care, and those focusing on non-acute or sub-acute care, including psychiatric, rehabilitation and palliative care. The provision of ‘acute’ services varies among jurisdictions, so it is not possible to exclude ‘non-acute’ hospitals from the indicator in a way that would be uniform among the states and territories. Therefore all public hospitals have been included in the scope of the indicator so that the same approach is taken for each State and Territory.

The SAB patient episodes reported were associated with both admitted patient care and with non-admitted patient care (including emergency departments and outpatient clinics). No denominator is available to describe the total admitted and non-admitted patient activity of public hospitals. However, the number of patient days for admitted patient activity is used as the denominator to take into account the large differences between the sizes of the public hospital sectors among the jurisdictions. The accuracy and comparability of the SAB rates among jurisdictions and over time is limited because the count of patient days reflects the amount of admitted patient activity, but does not reflect the amount of non-admitted patient activity. The amount of hospital activity that patient days reflect varies among jurisdictions and over time because of variation in admission practices.

In 2012, the scope of the indicator was revised to include unqualified newborns. Data backcast for 2010-11 are provided in addition to the current reference period. It is not possible to backcast the data for earlier years.

Only patient episodes associated with public acute care hospitals in each jurisdiction are counted. If a case is associated with care provided in another jurisdiction then it may be reported (where known) by the jurisdiction where the care associated with the SAB occurred.

Almost all patient episodes of SAB will be diagnosed when the patient is an admitted patient. However, the intention is that patient episodes are reported whether they were determined to be associated with admitted patient care or non-admitted patient care in public acute care hospitals.

The data presented have not been adjusted for any differences in case-mix between the states and territories.

Analysis by state/territory is based on the location of the hospital.

Accuracy:Help on this term

For some states and territories there is less than 100 percent coverage of public hospitals. For those jurisdictions with incomplete coverage of public hospitals (in the numerator), only patient days for those hospitals (or parts of hospitals) that contribute data are included (in the denominator). Differences in the types of hospitals not included may impact on the accuracy and comparability of rates.

For 2010-11 and previous years, data for Queensland include only patients aged 14 years and over.

Sometimes it is difficult to determine if a case of SAB is associated with care provided by a particular hospital. Counts therefore may not be precise where cases are incorrectly included or excluded. However, it is likely that the number of cases incorrectly included or excluded would be small.

It is possible that there will be less risk of SAB in hospitals not included in the SAB surveillance arrangements, especially if such hospitals undertake fewer invasive procedures than those hospitals which are included.

There may be imprecise exclusion of private hospital and non-hospital patient episodes due to the inherent difficulties in determining the origins of SAB episodes.

For 2011-12 and backcast 2010-11 data, all states and territories used the definition of SAB patient episodes associated with acute care public hospitals as defined above. 

The patient day data may be preliminary for some hospitals/jurisdictions.

Coherence:Help on this term

National data for this indicator were first presented in the 2010 COAG Reform Council report. Since that report further work has been undertaken on data development for this indicator, including the definition of an episode of SAB and a suitable denominator, as well as the coverage of public hospitals. The most recent work has been to revise the scope of the indicator to include unqualified newborns. Data have been backcast for the 2010-11 reference period. It is not possible to backcast the data for earlier years. Data for 2011-12 and 2010-11 are therefore not comparable with data for previous years. The 2011-12 and 2010-11 data presented in this report are comparable, except for Queensland, where the 2010-11 data does not include patients aged 13 years and under. 

As 2008-09 data were provided prior to the development of agreed national definitions, by only five jurisdictions, and was limited to principal referral and large hospitals, these data are not comparable with 2009-10 data, except for Tasmania.

Some jurisdictions have previously published related data (see Accessibility above).

Relational attributes

Related metadata references:Help on this term

Has been superseded by National Healthcare Agreement: PI 22-Healthcare associated infections, 2014 QS Health, Superseded 14/01/2015

Supersedes National Healthcare Agreement: PI 39-Healthcare-associated Staphylococcus aureus (including MRSA) bacteraemia in acute care hospitals, 2012 QS Health, Superseded 14/01/2015

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