HAI Trends: A comparison across Australia, Taiwan and Malaysia
September 12, 2012
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Overview
Incidence by infection type
Surveilience trends
Role of different stakeholders
Best practices
Conclusion
Agenda
Last word
Overview
Malaysia Taiwan Australia
HAI incidence 13.9% 4% 6-8%
Common infection type SSI > RTI > UTI UTI > BSI > RTI UTI > RTI > SSI
Mortality due to HAI 3-5% 3-5% 3.3%
Incidence by hospital type Public (80%) Private (75%) NA
Loss: Additional bed days 3.25 mn 551 k 1.97 mn
Loss: Cost SSI- 340 $ mnBSI- 1800-2400 $/patient
BSI- 3700-29000 $/patient BSI- 686 mn $SSI- 268 mn $
In all countries incidence of infection is directly proportional to hospital size
Up to 70% HAI can be reduced: Infection control procedures optimized
Incidence by Infection Type
HAI: Percentage split by infection type
34.0%
16.0%6.0%
12.0%
32.0% UTI
RTI
BSI
SSI
Others
Others: skin, soft tissues, ophthalmology, reproductive, gastritis and others
Note: All figures are rounded; the base year is 2009.Source: ACSQHC and Frost & Sullivan
Australia20.0%
21.0%
14.0%
23.0%
12.0%10.0% UTI
RTI
BSI
SSI
Clinical Sepsis
Note: All figures are rounded; the base year is 2010.Source: WHO, MOH and Frost & Sullivan Interviews
Malaysia
Note: All figures are rounded; the base year is 2010.Source: TNIS and Frost & Sullivan AnalysisTaiwan
Surveillance trends
• National Committee on Infection Control: Meets twice a year to review data from 16 state hospitals.
• Focus on UTI, SSI, RTI, clinical sepsis, and BSI as well as use of antibiotics.
• Implemented programs: Clean Wound Infection Rate and study on Efficacy of Nosocomial Infection Control project.
Type of Surveillance Methods
Targeted organisms : Methicillin-resistant Staphylococcus aureus (MRSA)/Extended-spectrum ß-Lactamases (ESBL)
Results collected daily and submitted monthly to Quality in Medical Care section, MOH
Point Prevalence Study One day prevalence surveillance, hospital wide; conducted twice a year on the same day throughout the nation
Participated by all state hospitals, specialist hospitals, Universities hospitals and district hospitals providing microbiology cultures
Hospital-acquired Infections: Surveillance Trends (Malaysia), 2010
Source: MOH Malaysia
Malaysia
• Devising Malaysian Nosocomial Infection Surveillance System (NSS).
• Dec 2010, Patient Safety Council devised safety goals for healthcare facilities.
• Introduced mandatory reporting of Infection Control to strengthen the health tourism..
Taiwan
TNIS: use epidemiological database• Identify trends • Compare inter- and intra- hospital
data for quality measures• Assist hospitals to develop
surveillance • Provide timely feedback on
measures to improve quality of care.
Web-based Reporting:For hospitals without NSS- enter data on TNIS website directly
Electronic Data Interchange (EDI):For hospitals with NSS, HIS and TNIS are bridged.
Taiwan is more, vis-à-vis other countries, IT enabled in HAI control
Source: Frost & Sullivan analysis.
Australia
Surveillance programs are different for different statesNew South Wales - NSW Health introduced a mandatory comprehensive data collection system that monitors eight types of HAI data across all public hospitals in the state.
Victoria - Victorian Hospital-Acquired Infection Surveillance (VICNISS): Established 2002, Collects and analyses data on HAI in acute care public hospitals in Victoria
NSSWestern Australia - The Healthcare Associated Infection Surveillance Western Australia (HISWA): Established 2005; mandatory reporting of specific HAI for all public hospitals.
Queensland – (CHRISP)The Centre for Healthcare-related Infection Surveillance & Prevention: Establish and refine a standardized, validated surveillance system public hospitals
Source : Frost & Sullivan
Role of Different Stakeholders
Role of Information Technology (IT)
Some Hospitals are using high-tech tools to track who is washing their hands.
Source : Frost & Sullivan Analysis; Primary interviews
Hand Hygiene sensing device detects alcohol in gel used to wash hands and sends an IR signal to persons badge to record the washing event. If person enters near 7 foot zone of a patient monitor then the badge will vibrate as a reminder.
Role of IT:
• Surveillance: Data Mining integrating medical record with laboratory, ADT & treatment information.
• Reporting
• Risk assessment
• Compliance
Role of IT- Business Analytics Value Proposition
Business Analytics play a vital role in surveillance, reporting, risk assessment and compliance
Data WarehousingIntegrated storage, computation and networking
Knowledge ManagementOrganizational policies designed with the goal of turning information into insights
BaseliningEstablishing KPIs and metrics for data gathering
Data ManagementData collection, organization and distribution
CollaborationSharing valuable insights across the organization
ReportingData visualization and accessibility through appropriate channels
AnalyticsQuerying, statistical analysis, predictive modeling, forecasting
Source: Frost & Sullivan analysis.
Role of IT- Informed Decisions
Source: Frost & Sullivan analysis.
Processes Facilitated by Business Analytics
Benefits for the Organization
Real-time monitoring
Measuring and comparing efficiencies within and across
hospital departments
Evaluating department performance down to personnel level and
identifying avenues for improvement
Forecasting department activities
Assisting clinical decisionsForecasting patient flows
Improved alignment of organizational sub-units with the overall strategy
Cost efficiency, increased profitability and improved resource utilization
Improved diagnosis, reduced length of stay and reduction in errors leading to increased patient satisfaction
Improved knowledge accessibility
Improved decision making
Prepare guidelines
Establish regulations &
conduct inspections
Conduct trainings &
supervise IC committees
Hospital accreditation
Dedicated personnel for
larger hospitals
Establish regional support
plans
Corrective measures &
actions
Establish reporting systems to control
quality- Surveillance
Infection Control
Role of Government
Source: Frost & Sullivan analysis.
Role of Industry
TrainingTraining
SupportingSupporting
UpdatingUpdating
Industry participants collaborate with ICP’s actively and play an active role in infection control
Source : Frost & Sullivan Analysis; Primary interviews
• Adequate training and/or instructions are provided by the suppliers.
• 24/7 assistance.
• Sponsor ICPs for conferences or events.
• However, this trend is in large private hospitals??
• Visit ICP’s regularly to appraise them on emerging trends in infection control.
Best Practices
1
Practice standard precautions
Infection rate reduced after National Hand Hygiene Initiative
Best Practices to Prevent HAI
2
Protocols Adhered:Hand HygieneSafe use & disposal of sharp & biomedical wasteRoutine environmental cleaning & fumigationReprocessing reusable instruments & equipmentRespiratory hygieneWaste management
still most effective method, otherwise we wouldn’t have this conference
Infection Control Personnel - People who implement policies, guideline and advice hospital staffs in executing safety and quality measures to combat infection
3
Meetings:
CEO, Medical Head, Practitioners • Requirements, • Measures to curb, • Statistics • Future plans
4
Apprise:
Public Health Authorities on Infection Control measures
5
Risk Management:• Frame policy• Train & educate stake holders
Source: Frost & Sullivan analysis.
Conclusion
Malaysia
Way forward:
To promote medical tourism collaboration of participants (disinfection and sterilization industry) with MOH is vital in implementing effective infection control measures.
Challenges:
• Overcrowding in public hospitals
• Lack of infrastructure, • Under staffed physicians and
nurses
Best Practices:
• Multi-modal approach & patient safety council to formulate policies & guidelines.
• One of the few countries to sign the “Clean Care Is Safer Care” pledge in association with the WHO in 2006.
• Medical tourism: Private hospitals obtained International accreditation and certifications for patient safety visible & key issue, & implemented safety programs.
• MOH working with Association of Private Hospitals Malaysia (APHM) and Malaysian Productivity Council to develop a national set of Patient Safety indicators.
Source: Frost & Sullivan analysis.
Taiwan
Medical Tourism:
For hospital accreditation DOH and Taiwan CDC promotes “Program of Nosocomial Infection Control Inspection and Quality Improvement” and integrates procedures and standards for inspection of nosocomial infection control.
Source: Frost & Sullivan Analysis
Best Practices:
• Introduction of accreditation and rating system for hospitals
• Apportioning the income toward infection control
• Introduction of patient safety and quality control measures.
• Use of IT
Incidence of HAI in hospitals are significantly less vis-à-vis other developed Western countries- Taiwan CDC A) Devised Patient-safety policy
B) Planned intervention programs to reduce instances of nosocomial infections antimicrobial resistance.
Australia
Way forward: Legislations on mandatory reporting of infections is likely to bring out the accurate
trend in Australia.
Drastic reduction HAI rates is expected between 2013 and 2015: Measures by ACSQHC and streamlining it nationally with proper definition, surveillance, reporting, and feedback measures.
Challenges: • Higher incidences of HAI are due to
different practices and guidelines followed in each state
• Standard surveillance in place for HAI, there is no national coordinating agency or commission.
Best practices:
• With the establishment of Australian Commission on Safety and Quality in Health Care and the initiatives on hand hygiene, most hospitals had significant reduction in methicillin-resistant Staphylococcus aureus (MRSA) rates. Consequently it reduced burden caused due to infection rates.
Source: Frost & Sullivan analysis.
Last Word
Last Word
Investment in Healthcare IT is the
way forward for favovable outcomes in HAI
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For Additional Information
Donna JeremiahCorporate CommunicationsAsia Pacific+61 (0) 8247 8927 [email protected]
Carrie LowCorporate CommunicationsAsia Pacific+603 6204 [email protected]
Jessie LohCorporate CommunicationsAsia Pacific+65 6890 [email protected]