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National Healthcare Agreement: PI 22-Healthcare associated infections, 2014

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termProgress measure
Short name:Help on this termPI 22-Healthcare-associated infections, 2014
METeOR identifier:Help on this term517636
Registration status:Help on this termHealth, Superseded 14/01/2015
Description:Help on this termStaphylococcus aureus bacteraemia (SAB) associated with acute care public hospitals (excluding cases associated with private hospitals and non-hospital care).
Indicator set:Help on this termNational Healthcare Agreement (2014) Health, Superseded 14/01/2015
Outcome area:Help on this termHospital and Related Care Health, Standard 07/07/2010
National Health Performance Authority (retired), Retired 01/07/2016
Quality statement:Help on this termNational Healthcare Agreement: PI 22-Healthcare associated infections, 2014 QS Health, Superseded 14/01/2015

Collection and usage attributes

Computation description:Help on this term

Acute care public hospitals are defined as all public hospitals including those hospitals defined as public psychiatric hospitals in the Public hospital establishments National minimum data set (NMDS). All types of public hospitals are included, both those focusing on acute care, and those focusing on non-acute or subacute care, including psychiatric, rehabilitation and palliative care.

Unqualified newborns are included in the indicator. Hospital boarders and posthumous organ procurement are excluded from the indicator.  

A patient-episode of SAB is defined as a positive blood culture for Staphylococcus aureus. For surveillance purposes, only the first isolate per patient is counted, unless at least 14 days has passed without a positive blood culture, after which an additional episode is recorded.

A Staphylococcus aureus bacteraemia will be considered to be healthcare-associated if: the first positive blood culture is collected more than 48 hours after hospital admission or less than 48 hours after discharge, OR, if the first positive blood culture is collected 48 hours or less after admission and one or more of the following key clinical criteria was met for the patient-episode of SAB:

  1. SAB is a complication of the presence of an indwelling medical device (e.g. intravascular line, haemodialysis vascular access, cerebrospinal fluid (CSF) shunt, urinary catheter)
  2. SAB occurs within 30 days of a surgical procedure where the SAB is related to the surgical site
  3. An invasive instrumentation or incision related to the SAB was performed within 48 hours
  4. SAB is associated with neutropenia (less than 1 x 109) contributed to by cytotoxic therapy

Exclusions:

Cases where a known previous positive test has been obtained within the last 14 days are excluded. For example: If a patient has SAB in which 4 sets of blood cultures are positive over the initial 3 days of the patient's admission only one episode of SAB is recorded. If the same patient had a further set of positive blood cultures on day 6 of the same admission, these would not be counted again, but would be considered part of the initial patient-episode.

Note: If the same patient had a further positive blood culture 20 days after admission (i.e. greater than 14 days after their last positive on day 5), then this would be considered a second patient-episode of SAB.

Denominator: includes unqualified newborns, excludes posthumous organ procurement and hospital boarders.

See Establishment—number of patient days, total N[N(7)] for the definition of patient days. Also included in the denominator are patient days for unqualified newborns, which are not covered in the linked definition. Patient days for unqualified newborns must be reported in addition to patient days as defined in the link. 

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

Presented as:

  • a number, and
  • per 10,000 patient days.

Coverage: Denominator ÷ Number of patient days for all public hospitals in the state or territory.

Any variation from the specifications by jurisdictions will be footnoted and described in the data quality statement.

Computation:Help on this term

Numerator

10,000 x (Numerator ÷ Denominator).

Numerator:Help on this term

Number of SAB patient episodes (as defined above) associated with acute care public hospitals.

Numerator data elements:Help on this term
Data Element / Data SetData Element
Establishment—organisation identifier (Australian)
Data Source
State/territory infection surveillance data
Guide for use
Data source type: Administrative by-product data
Data Element / Data SetData Element
Person—person identifier
Data Source
State/territory infection surveillance data
Guide for use
Data source type: Administrative by-product data
Data Element / Data SetData Element
Hospital service—care type
Data Source
State/territory infection surveillance data
Guide for use
Data source type: Administrative by-product data
Data Element / Data SetData Element
Episode of admitted patient care—condition onset flag
Data Source
State/territory infection surveillance data
Guide for use
Data source type: Administrative by-product data
Data Element / Data SetData Element
Episode of care—additional diagnosis
Data Source
State/territory infection surveillance data
Guide for use
Data source type: Administrative by-product data
Denominator:Help on this term

Number of patient days for public acute care hospitals under surveillance (i.e. only for hospitals included in the surveillance arrangements).

Include unqualified newborns, exclude posthumous organ procurement and hospital boarders.

Denominator data elements:Help on this term
Data Element / Data SetData Element
Establishment—organisation identifier (Australian)
Data Source
State/territory admitted patient data
Guide for use
Data source type: Administrative by-product data
Data Element / Data SetData Element
Episode of admitted patient care—admission date
Data Source
State/territory admitted patient data
Guide for use
Data source type: Administrative by-product data
Data Element / Data SetData Element
Episode of admitted patient care—separation date
Data Source
State/territory admitted patient data
Guide for use
Data source type: Administrative by-product data
Disaggregation:Help on this term

2012–13—State and territory, by:

  • Methicillin-resistant Staphylococcus aureus (MRSA)/Methicillin-sensitive Staphylococcus aureus (MSSA)

Some disaggregation may result in numbers too small for publication.

Disaggregation data elements:Help on this term
Data Element / Data SetData Element
Establishment—Australian state/territory identifier
Data Source
State/territory infection surveillance data
Guide for use
Data source type: Administrative by-product data
Data Element / Data SetData Element
Methicillin-resistant Staphylococcus aureus  MRSA)/Methicillin-sensitive Staphylococcus aureus (MSSA) indicator
Data Source
State/territory infection surveillance data
Guide for use
Data source type: Administrative by-product data
Comments:Help on this term

Most recent data available for 2014 Council of Australian Governments (COAG) Reform Council (CRC) report: 2012–13.

The number of SAB patient episodes associated with acute public hospitals under surveillance includes SAB patient episodes associated with all public hospitals, and the number of patient days for public acute care hospitals under surveillance includes the number of patient days for all public hospitals under surveillance.

For some states and territories there is less than 100 per cent coverage of hospitals. This may impact on the reported rate. For those jurisdictions with incomplete coverage of acute care public hospitals (in the numerator), only patient days for those hospitals that contribute data are included (in the denominator). Specifically, if a hospital was not included in the SAB surveillance arrangements for part of the year, then the patient days for that part of the year are excluded. If part of the hospital was not included in the SAB surveillance arrangements (e.g. children's wards, psychiatric wards), then patient days for that part of the hospital are excluded. Patient days for 'non-acute' hospitals (such as rehabilitation and psychiatric hospitals) are included if the hospital was included in the SAB surveillance arrangements, but not otherwise. However, all these patient days are included in the coverage rate denominator measure of total number of patient days for all public hospitals in a state or territory.

Some states operate a 'signal surveillance' arrangement for smaller hospitals whereby the hospital notifies the appropriate authority if a SAB case is identified, but the hospital is not considered to have formal SAB surveillance as per larger hospitals. Where this arrangement is in place, these hospitals should be included as part of the indicator. That is, SAB patient episodes and patient days should be included as 'under surveillance'.

Only episodes associated with acute public hospital care in each jurisdiction should be counted. If a case is associated with care provided in another jurisdiction (cross border flows) then it is reported (where known) by the jurisdiction where the care associated with the SAB occurred.

There may be patient episodes of SAB identified by a hospital which did not originate in the identifying hospital (as determined by the definition of a patient episode of SAB), but in another public hospital. If the originating hospital is under SAB surveillance, then the patient episode of SAB should be attributed to the originating hospital and should be included as part of the indicator. If the originating hospital is not under SAB surveillance, then the patient episode is unable to be included in the indicator.

Patient episodes associated with care provided by private hospitals and non-hospital health care are excluded.

Patient days for unqualified newborns are included. Patient days for hospital boarders and posthumous organ procurement are excluded.

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

Where there is significant variation, for example non-coverage of cases diagnosed less than 48 hours after admission, in the data collection arrangements it will affect the calculation of values across states and territories.

Variation in admission practices across jurisdictions will influence the denominator for this indicator impacting on comparability of rates.

Jurisdictional manuals should be referred to for full details of definitions used in infection control surveillance.

Note that patient episodes of SAB are just one type of healthcare associated infection. Hence, this performance indicator is not a complete measure of healthcare associated infections for the outcome area of Hospital and Related Care.

Representational attributes

Representation class:Help on this termRate
Data type:Help on this termReal
Unit of measure:Help on this termEpisode
Format:Help on this termNN[N]

Indicator conceptual framework

Framework and dimensions:Help on this termSafety

Data source attributes

Data sources:Help on this term
Data SourceState/territory infection surveillance data
Frequency
Annual
Data custodian

State/territory health authorities



Data SourceState/territory admitted patient data
Frequency
Annual
Data custodian
State/territory health authorities

Accountability attributes

Reporting requirements:Help on this termNational Healthcare Agreement
Organisation responsible for providing data:Help on this termAustralian Institute of Health and Welfare
Benchmark:Help on this term

National Healthcare Agreement: PB g-Better health: the rate of Staphylococcus aureus (including MRSA) bacteraemia is no more than 2.0 per 10,000 occupied bed days for acute care public hospitals by 2011-12 in each state and territory, 2014

Further data development / collection required:Help on this term

Specification: Substantial work required, the measure requires significant work to be undertaken.

Relational attributes

Related metadata references:Help on this term

See also National Healthcare Agreement: PB g-Better health: the rate of Staphylococcus aureus (including MRSA) bacteraemia is no more than 2.0 per 10,000 occupied bed days for acute care public hospitals by 2011–12 in each state and territory, 2014 Health, Superseded 14/01/2015

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

Has been superseded by National Healthcare Agreement: PI 22-Healthcare associated infections, 2015 Health, Superseded 08/07/2016

See also National Healthcare Agreement: PI 23-Unplanned hospital readmission rates, 2014 Health, Superseded 14/01/2015

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