Validation of surveillance activities: Staphylococcus aureus and vancomycin-resistant Enterococcus infections in small Australian hospitals

Ms Alex Hoskins1, Dr Noleen Bennett1, Associate Professor Leon Worth1, Ms Sandra Johnson1, Dr Nabeel Imam1, Dr Ann Bull1, Professor Michael Richards1

1Victorian Healthcare Associated Infection Surveillance Coordinating Centre, Melbourne, Australia


The Victorian Healthcare Associated Infection Surveillance Coordinating Centre (VICNISS) is responsible for analysis and reporting of state-wide data collected for surveillance of healthcare-associated infections (HAIs) in all public hospitals. The objective of this study was to evaluate the quality of data captured through the small hospitals’ (<100 acute beds) program.


Of 88 participating public healthcare facilities, a convenience sample of 20 hospitals was used to retrospectively assess detection of Staphylococcus aureus bloodstream (SAB), methicillin-resistant S. aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) infections occurring during 2015. Laboratory extracts were obtained and standardised surveillance definitions applied. Surveillance data submitted during 2015 were compared with gold standard assessment by two external reviewers.


78 confirmed SAB events, 59 MRSA and 5 VRE infections occurred at studied facilities. Sensitivity of routine surveillance activities for detection of SAB events was 74.4% (95% confidence interval [CI] 63.7-82.7%), and specificity was 100.0% (95% CI 34.2-100.0%). MRSA infections were less accurately detected and reported, with sensitivity of 47.5% (95% CI 35.3-60.0%) and specificity of 90.9% (95% CI 84.1-95%). All confirmed VRE infections (n=5) were correctly reported.


Current surveillance activities in small Victorian hospitals identify SAB events with moderate-high sensitivity. MRSA infections are reported less accurately, and although of low incidence, VRE infections are satisfactorily captured by surveillance activities. In addition to direct support of small hospital surveillance programs by the Coordinating Centre, novel methods of monitoring (e.g. use of automated methods) require evaluation as a means of improving data quality.


Alex Hoskins has been working in Infection Prevention and Control since 2003, working in both the public and private health sector.  Her post graduate qualifications include a Master of Nursing (Perioperative); Infection Control Graduate Certificate, Post Graduate Diploma in Education and she is an Accredited Nurse Immuniser.

Alex has been a member of the VICNISS Team since January 2015 where she helps coordinate the small Victorian Public Hospital surveillance program.  Alex has a keen interest health care worker immunisation and infection prevention and control education.

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