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Aotearoa New Zealand national point prevalence survey of healthcare-associated infections | Tiro whānui ā-motu mō te...

16 Nov 2022

This report describes the approach to and findings of Aotearoa New Zealand’s first national point prevalence survey of healthcare-associated infections.

Below you can read the executive summary, or download a PDF of the full report or a PDF combining the executive summary, key finding infographics and patient perspectives.

Executive summary | He whakarāpopotonga matua

This report describes the approach to and findings of Aotearoa New Zealand’s first national point prevalence survey (PPS) of healthcare-associated infections (HAIs). The infection prevention and control team of the Health Quality & Safety Commission (the Commission) led the survey, with the aim of estimating the total burden (prevalence) of HAIs among adult patients in Aotearoa New Zealand public hospitals. This information will help us identify targets for quality improvement.

Planning for the PPS began in July 2020. A team of trained surveyors then conducted the survey between February and June 2021. A total of 5,469 adult patients were included, representing 313 wards across 31 hospitals from all 20 district health boards (DHBs). The survey followed international methodology and used standard HAI definitions.

Results showed 361 patients had at least one HAI, and together had a total of 423 HAIs. The national point prevalence of HAIs was 6.6 percent and the HAI rate was 7.7 infections per 100 patients. The national rate is similar to rates reported in other countries and regions such as Wales, Switzerland and the European Union.

The following were key findings from the PPS:

  • HAIs were more common in intensive care (23 percent) and surgical (8 percent) patients than in medical patients (4 percent) (p < 0.001).
  • Four HAI types contributed 74 percent (rounded) of all HAIs: surgical site infections (SSIs) (25 percent); urinary tract infections (UTIs) (19 percent); pneumonia (18 percent); and bloodstream infections (BSIs) (13 percent).
  • Of all patients in the survey, 66 percent had at least one invasive device in place. The most common types of devices were peripheral intravenous catheter (PIVC) (53 percent of all patients), central venous catheter (CVC) (10 percent) or urinary catheter (18 percent).
  • Univariate analyses do not show any association between higher HAI rates and ethnicity, gender of patients or referral of patients from regional DHBs.
  • Age, presence of a device and emergency admission were associated with higher HAI rates.
  • Clostridioides difficile (C. difficile) infection was uncommon (1.7 percent).

Specific pathogens were identified in 301 of the 423 HAIs. The most common isolates were Staphylococcus aureus (S. aureus) (21 percent), Escherichia coli (20 percent) and Enterococcus species (12 percent). Of the isolates, 42 (14 percent) had antimicrobial resistance; 13 percent of S. aureus were methicillin-resistant S. aureus (MRSA) and 28 percent of enteric Gram-negative bacilli had cephalosporin or carbapenem resistance. No Enterococcus isolate was vancomycin resistant. These findings will inform planning to reduce HAIs. Obvious focus areas include:

Reduce S. aureus infections associated with intravascular catheters

  • Prevention of peripheral intravenous catheter infections
  • Prevention of central venous catheter infections

Reduce SSI due to S. aureus

  • Expand the use of the ‘anti-staphylococcal’ bundle across all clean surgery

Reduce all infections associated with medical devices

  • Introduce care bundles for urinary catheter use
  • Introduce care bundles for ventilator-associated and hospital-acquired pneumonia

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