HAI Trends: A comparison across Australia, Taiwan and Malaysia
HAI Trends: A comparison across Australia, Taiwan and Malaysia September 12, 2012
Agenda Overview Incidence by infection typeText Blocks Surveilience trends - Actions Role of different stakeholders Best practices Conclusion Last word
Overview Malaysia Taiwan AustraliaHAI incidence 13.9% 4% 6-8%Common infection type SSI > RTI > UTI UTI > BSI > RTI UTI > RTI > SSIMortality due to HAI 3-5% 3-5% 3.3%Incidence by hospital type Public (80%) Private (75%) NALoss: Additional bed days 3.25 mn 551 k 1.97 mnLoss: Cost SSI- 340 $ mn BSI- 3700-29000 $/patient BSI- 686 mn $ BSI- 1800-2400 $/patient SSI- 268 mn $ Up to 70% HAI can be reduced: Infection control procedures optimized In all countries incidence of infection is directly proportional to hospital size
HAI: Percentage split by infection type Australia Malaysia 10.0% 20.0% UTI UTI 12.0% 32.0% 34.0% RTI RTI 21.0% 12.0% 16.0% BSI BSI SSI 23.0% 6.0% SSI Others Clinical Sepsis 14.0%Others: skin, soft tissues, ophthalmology, reproductive, gastritis and others Note: All figures are rounded; the base year is 2010. Note: All figures are rounded; the base year is 2009. Source: WHO, MOH and Frost & Sullivan Interviews Source: ACSQHC and Frost & Sullivan Taiwan Note: All figures are rounded; the base year is 2010. Source: TNIS and Frost & Sullivan Analysis
Malaysia• National Committee on Infection Control: • Devising Malaysian Nosocomial Meets twice a year to review data from 16 Infection Surveillance System (NSS). state hospitals. • Dec 2010, Patient Safety Council devised• Focus on UTI, SSI, RTI, clinical sepsis, safety goals for healthcare facilities. and BSI as well as use of antibiotics. • Introduced mandatory reporting of Infection• Implemented programs: Clean Wound Control to strengthen the health tourism.. Infection Rate and study on Efficacy of Nosocomial Infection Control project. Hospital-acquired Infections: Surveillance Trends (Malaysia), 2010 Type of Surveillance Methods Targeted organisms : Methicillin-resistant Results collected daily and submitted monthly to Staphylococcus aureus (MRSA)/Extended-spectrum Quality in Medical Care section, MOH ß-Lactamases (ESBL) 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 Source: MOH Malaysia
TaiwanTaiwan is more, vis-à-vis other countries, IT enabled in HAI control TNIS: use epidemiological database Web-based Reporting: •Identify trends For hospitals without NSS- enter •Compare inter- and intra- hospital data on TNIS website directly data for quality measures •Assist hospitals to develop surveillance •Provide timely feedback on measures to improve quality of care. Electronic Data Interchange (EDI): For hospitals with NSS, HIS and TNIS are bridged. Source: Frost & Sullivan analysis.
Australia Surveillance programs are different for different states New 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 Western Australia - The HealthcareInfection Surveillance (VICNISS): Associated Infection SurveillanceEstablished 2002, Collects and analyses NSS Western Australia (HISWA):data on HAI in acute care public Established 2005; mandatory reportinghospitals in Victoria 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 hospitalsSource : Frost & Sullivan
Role of Information Technology (IT)Some Hospitals are using high-tech tools to track who is washing their hands. Role of IT: • Surveillance: Data Mining integrating medical record with laboratory, ADT & treatment information. • Reporting • Risk assessment • Compliance 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. Source : Frost & Sullivan Analysis; Primary interviews
Role of IT- Business Analytics Value PropositionBusiness Analytics play a vital role in surveillance, reporting, risk assessment and compliance Knowledge Management Data Warehousing Organizational policies designed with Integrated storage, computation and networking the goal of turning information into insights Collaboration Sharing valuable insights across the Baselining organization Establishing KPIs and metrics for data gathering Reporting Data visualization and accessibility Data Management through appropriate channels Data collection, organization and distribution Analytics Querying, statistical analysis, predictive modeling, forecasting Source: Frost & Sullivan analysis.
Role of IT- Informed Decisions Processes Facilitated by Benefits for the Business Analytics Organization Real-time monitoring Improved alignment of organizational sub-units with the overall strategy Measuring and comparing Cost efficiency, increased efficiencies within and across profitability and improved hospital departments resource utilization Evaluating department performance Improved diagnosis, reduced down to personnel level and length of stay and reduction in identifying avenues for errors leading to increased improvement patient satisfaction Improved knowledge Forecasting department activities accessibility Assisting clinical decisions Improved decision making Forecasting patient flows Source: Frost & Sullivan analysis.
Role of Government Prepare guidelines Establish Conduct regulations & trainings & conduct supervise IC inspections committees Hospital Dedicated Infection accreditation personnel for Control larger hospitals Corrective measures & Establish actions regional support plans Establish reporting systems to control quality- Surveillance Source: Frost & Sullivan analysis.
Role of IndustryIndustry participants collaborate with ICP’s actively and play an active role in infection control • Adequate training and/or instructions are provided by the suppliers. Training • 24/7 assistance. • Sponsor ICPs for conferences or events. Supporting • However, this trend is in large private hospitals?? • Visit ICP’s regularly to appraise them on emerging trends Updating in infection control. Source : Frost & Sullivan Analysis; Primary interviews
Malaysia Best Practices: Challenges: • Multi-modal approach & patient safety • Overcrowding in public hospitals council to formulate policies & guidelines. • Lack of infrastructure, • One of the few countries to sign the “Clean Care Is Safer Care” pledge in • Under staffed physicians and association with the WHO in 2006. nurses • Medical tourism: Private hospitals obtained International accreditation and Way forward: certifications for patient safety visible & key issue, & implemented safety To promote medical tourism programs. collaboration of participants (disinfection and sterilization • MOH working with Association of Private industry) with MOH is vital in Hospitals Malaysia (APHM) and implementing effective infection Malaysian Productivity Council to develop control measures. a national set of Patient Safety indicators. Source: Frost & Sullivan analysis.
Taiwan Medical Tourism:Incidence of HAI in hospitals aresignificantly less vis-à-vis other developed For hospital accreditation DOH andWestern countries- Taiwan CDC Taiwan CDC promotes “Program ofA) Devised Patient-safety policy Nosocomial Infection Control Inspection and Quality Improvement”B) Planned intervention programs to and integrates procedures and reduce instances of nosocomial standards for inspection of nosocomial infections antimicrobial resistance. infection control. 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 Source: Frost & Sullivan Analysis
Australia Challenges: Best practices: • Higher incidences of HAI are due to • With the establishment of Australian different practices and guidelines Commission on Safety and Quality in followed in each state Health Care and the initiatives on hand hygiene, most hospitals had significant • Standard surveillance in place for reduction in methicillin-resistant HAI, there is no national Staphylococcus aureus (MRSA) rates. coordinating agency or Consequently it reduced burden caused commission. due to infection rates. 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. Source: Frost & Sullivan analysis.