hai trends: a comparison across australia, taiwan and malaysia

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


Role of IT- Informed Decisions


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


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


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.


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.


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]

hai trends: a comparison across australia, taiwan and malaysia

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