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An investigation of a clinical governance or clinical practice issue Essay Example

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Investigation of a CG or CPI Issue

Surveillance of Healthcare Associated Infections (HAIs) in Australian Hospitals

Statement of the Issue

HAIs cause significant morbidity and mortality (Russo et al, 2014, p. 1). Therefore, it is important to ensure that HAIs are eliminated or minimised as much as possible. HAI surveillance programs have been shown to be effective in reducing HAI rates (Zingg et al, 2015, p. 214). Therefore, the rationale of this CPI issue is that gaps in HAI surveillance activities in Australian hospitals can be identified and hence improvements in surveillance programs identified to ensure maximum prevention of healthcare associated infections and ensure patient safety.


Healthcare associated infections (HAI) refer to infections that are acquired during the hospital stay and stem from healthcare intervention (Russo et al, 2014, p. 1). For example, bloodstream infections that are mostly caused by presence of intravenous devices or infection of a surgical wound after surgery are HAIs (Russo et al, 2014, p. 1). HAIs cause significant medical consequences and present a significant challenge for patient safety because they result in significant morbidity and mortality. In Australia, it is estimated that approximately 175, 000 HAIs occur yearly (Russo et al, 2014, p. 1).

Surveillance programs for HAIs in Australia have started where public reporting of HAI rates is conducted (Russo et al, 2015, p. 2). Surveillance refers to ‘the ongoing, methodical collection, analysis and interpretation of health data fundamental to the planning, implementation, and assessment of public health practice. Surveillance is an essential aspect of healthcare and national safety and quality health service standards for Australian hospitals has criteria for HAI surveillance in order to prevent and control HAIs (Russo et al, 2015, p. 2).


Zingg et al explains that (2015, p. 215) HAIs affect a high number of patient globally annually and this leads to significant deaths and many additional days of hospital stay for the patients. In Australia, the prevalence of HAIs is very high. The impact of HAIs is significant: deaths, longer hospital stay, readmission, and more time –off work, as well as further usage of hospital and community resources. According to Gardner et al (2014, p. 3)Australia lacks a specific national strategy and surveillance system for undertaking surveillance activities for HAIs. This is in spite of high rate of HAIs in Australian hospitals. Additionally, Australia has not carried out a national point prevalence study on HAIs for a long time since the last national prevalence study for HAIS was carried out in 1984 where prevalence of HAIs was found to be at 6.3% and urinary tract infections contributing to 22% of HAIs (Gardner et al, 2014, p. 3). Even though currently there is no national or state level surveillance for HAIs in Australia, there are various surveillance programs that are used to survey HAIs in Australian hospitals. Therefore, exploring this issue is significant in finding out the efficacy of the surveillance programs in reducing HAIs in Australian hospitals.

Literature Critique

Healthcare associated infections cause significant medical consequences and significantly impacts patient safety (Gardner et al, 2014, p. 1). Recent evidence shows that the prevalence of HAIs is 10% per 100 patients (Gardner et al, 2014, p. 1). This indicates the serious of the issue and hence it is necessary to come up with strategies that can reduce the prevalence of HAIs. This is supported by Russo et al (2014, p. 1) who explains that HAIs cause significant morbidity and mortality and hence preventing and control of HAIs is important. Gardner et al (2014, p. 3) further adds that HAIs are the most common complication of hospitalisation in patient. Nonetheless, HAIs can be prevented and therefore it is very possible to significantly lower the rate of HAIs using effective infection prevention and control programs (Gardner et al, 2014, p. 3). Surveillance programs have been shown to be effective in preventing and reducing the rate of HAIs. According to Gardner (2012, p.3) prevalence surveys and active surveillance for HAIs have the ability to prevent and accurately detect HAIs in hospitals. As a result, the HAIs can be prevented and treated early enough due to early detection.

Evidence indicates that surveillance of HAIs in hospitals is effective in reducing their rates. For example, the last Australian national prevalence for HAIs indicated that UTIs contributed to 22% of hospital acquired infections. However, the most recent report within Australian hospitals indicated that the rate of UTIs in hospitals has reduced up to 1.66%. This indicates the efficacy of surveillance in reducing and preventing HAIs (Gardner, et al, 2014, p. 3). A study conducted by Russo et al (2014, p. 4) supports this and found out that well established HAI surveillance programs reduces the rates of HAIs internationally. However, there are various gaps in Australian surveillance programs. For example, there is inadequate training on individuals involved in HAI surveillance within Australia, difference in various surveillance methods, efforts duplication as well as restricted capacity to collect and analyse the collect data at national level (Russo et al, 2015, p. 3). This shows that Australia needs to implement more rigorous surveillance programs that will be able to collect high quality data on HAIs and hence effective surveillance of HAIs and successful prevention and decrease of HAI rates (Zingg et al, 2015, p. 215).


The studies show that effective surveillance national programs are successful in reducing the rates of HAIs (Russo et al, 2015, p. 2). However, the efficacy of the surveillance programs is highly dependent on the ability to collect robust and reliable data. Australia does not have adequately structured procedures to produce high quality national HAI data (Zingg et al, 2015, p. 215). This is because Australian surveillance national programs lack robust standardised surveillance procedures and hence the data collected from different states cannot be used in assessing HAI rates nationally. It is therefore evident that if Australia implement robust surveillance processes, the rates of HAIs are likely to reduce significantly (Russo, 2014, p. 5). Implementation of surveillance programs with robust standardised processes in Australia is likely to facilitate research on epidemiology of health acquired infections which will lead to improved and refined surveillance procedures and hence improve the quality of HAI data and eventually lead to reduced rate of HAIs in Australian hospitals.


Gardner A, Mitchell B, Beckingham W & Fasugbal O, 2014, A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals, BMJ, 4:e005099

Russo P, Cheng A, Richards M, Graves N & Hall L, 2014, Healthcare-associated infections in Australia: time for national surveillance, Australian Health Review, vol. 39, no. 1.


Russo P, Barnett A, Cheng A, Richards M, Graves N & Hall L, 2015, Differences in identifying healthcare associated infections using clinical vignettes and the influence of respondent characteristics: a cross-sectional survey of Australian infection prevention staff, Antimicrobial Resistance and Infection Control, vol. 54, no.29.


Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, Allegranzi B, Magiorakos

AP, Pittet D, 2015, For the systematic review and evidence-based guidance on organization of hospital infection control programmes (SIGHT) study group. Hospital organisation, management, and structure for prevention of health-care associated infection: a systematic review and expert consensus, Lancet Infect Dis. Vol. 15, no. 2, pp. 212-224. <http://ecdc.europa.eu/en/healthtopics/healthcare-associated_infections/guidance-infection-prevention-control/documents/hospital-organisation-management-structure-for-prevention-health-care-associated-infection-systematic-review.pdf>