Staphylococcus aureus bacteraemia as a quality indicator for hospital infection control.
OBJECTIVE
To evaluate the practicality and effectiveness of a new program that made health care-associated Staphylococcus aureus bacteraemia (SAB) a quality indicator at Austin Health.


METHODS
Roll-out of the program over 9 months and review over 27 months from January 2006. Every episode of SAB at Austin Health was promptly reviewed, and classified as community- or health care-associated and as inpatient- or non-inpatient-related. Feedback was provided to treating clinicians for every SAB episode considered potentially preventable, and education-based interventions were introduced where appropriate.


METHODS
Episodes of SAB associated with health care at Austin Health per 1000 separations (hospital discharges) per month.


RESULTS
We identified 131 episodes of health care-associated SAB, of which 90 (68.7%) were caused by methicillin-susceptible S. aureus, 96 (73.3%) occurred in inpatients, and 65 (49.6%) were associated with a vascular access device. The health care-associated SAB rate was 1.1 per 1000 separations in the first 9 months, and fell by 55% to 0.51 per 1000 separations in the subsequent 18 months. We estimated that there were 80 fewer SAB episodes (95% CI, 20-140) than expected had the initial rate remained unchanged, a national saving of $1.75 million to Austin Health over 27 months. About 16 hours per month of clinical nurse consultant time was required to maintain the program, representing a 0.1 equivalent full-time position, or a cost of $7000-$9000 per year.


CONCLUSIONS
Introducing a structured program to investigate all health care-associated SABs, rather than only infections with methicillin-resistant S. aureus, revealed a large under-recognised burden of potentially preventable infections. The program was simple and low-cost, and the rate of health care-associated SAB has fallen significantly since its introduction.
Dendle
Claire
C
Medical Education Unit, Austin Health, Melbourne, VIC, Australia.
Martin
Rhea D
RD
Cameron
Donna R
DR
Grabsch
Elizabeth A
EA
Mayall
Barrie C
BC
Grayson
M Lindsay
ML
Johnson
Paul D R
PD
D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000592:standards*; D055624:Methicillin-Resistant Staphylococcus aureus; D019984:Quality Indicators, Health Care; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013211:Staphylococcus aureus; D014739:Victoria / Q000453:epidemiology