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Hospital Performance: Healthcare-associated Staphylococcus aureus bloodstream infections in 2012–13, In Focus

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Key findings

In 2012–13, 1,547 cases of healthcare-associated S. aureus bloodstream infection were reported by the 115 major and large public hospitals covered in this report. This represents nearly 90% of the 1,724 cases of this infection reported by public hospitals nationally.

Bigger hospitals report more infections

Major hospitals reported a disproportionate share of healthcare-associated S. aureus bloodstream infections. These hospitals accounted for 81% of all reported cases and 62% of all patient bed days monitored.

  • At the 36 major hospitals with more vulnerable patients, there were 1,020 cases of S. aureus bloodstream infection. The average rate of infection was 1.35 per 10,000 patient bed days.
  • At the 40 major hospitals with fewer vulnerable patients, there were 382 cases of S. aureus bloodstream infection. The average rate of infection was 0.92 per 10,000 patient bed days.

Large hospitals accounted for about 8% of all reported cases and 11% of all patient bed days monitored.

  • At the 16 large hospitals with more vulnerable patients, there were 77 cases of S. aureus bloodstream infection. The average rate of infection was 1.05 per 10,000 patient bed days.
  • At the 23 large hospitals with fewer vulnerable patients, there were 68 cases of S. aureus bloodstream infection. The average rate of infection was 0.55 per 10,000 patient bed days.

Variation in infection rates and counts across similar hospitals

All major hospitals, reported at least one case of healthcare-associated S. aureus bloodstream infection.

  • At major hospitals with more vulnerable patients the rate of infection was more than three times higher at some hospitals than others (range: 0.53 to 1.93 per 10,000 patient bed days). Seven of these hospitals reported more than 40 cases.
  • At major hospitals with fewer vulnerable patients the rate of infection was 11 times higher at some hospitals than others (range: 0.20 to 2.29 per 10,000 patient bed days).

Among large hospitals, 36 of the 39 hospitals reported at least one case of healthcare-associated S. aureus bloodstream infection.

  • At large hospitals with more vulnerable patients the rate of infection ranged from 0 to 3.14 per 10,000 patient bed days.
  • At large hospitals with fewer vulnerable patients, the rate of infection ranged from 0 to 1.87 per 10,000 patient bed days.

Fair comparisons

To allow fairer comparisons, the Authority has allocated hospitals to one of four peer groups based on a combination of hospital size, type of services provided and the percentage of patients more at risk of acquiring a healthcare-associated infection. Hospitals with more vulnerable patients have a higher percentage of patients admitted for the treatment of conditions such as cancer, HIV/AIDS, burns or surgery than other hospitals.

There are uncertainties about the completeness and national consistency of the data across all hospitals. This means that results could be affected by some degree of under-reporting.

Higher rates cannot definitively indicate that patients at those hospitals are at greater risk of harm compared to patients at other hospitals. High values are however a cause for further investigation.

Table 1: Healthcare-associated S. aureus bloodstream infections in major and large public hospitals, by reported cases and rate per 10,000 patient bed days, 2012–13

Major hospitals

Major hospitals, more vulnerable patients*

Total number of hospitals in peer group 36
All cases reported nationally (%) 59%
All patient bed days monitored (%) 40%
State Hospital Cases Rate
NSW Nepean 35 1.82
Gosford 31 1.77
John Hunter 45 1.70
Prince of Wales 31 1.67
Westmead 46 1.61
Royal North Shore 37 1.61
Wollongong 27 1.48
St George 31 1.46
St Vincent's 19 1.34
Liverpool 34 1.22
Royal Prince Alfred 26 0.93
Vic Monash [Clayton] 41 1.76
Royal Melbourne 41 1.69
Western 20 1.46
The Alfred 34 1.39
Dandenong 22 1.28
The Northern 18 1.28
Geelong 22 1.26
Austin 27 1.21
Box Hill 18 1.18
Ballarat 10 1.15
St Vincent's 18 1.01
Qld Royal Brisbane & Women's 65 1.93
Mater Adult 10 1.81
Princess Alexandra 42 1.39
Townsville 22 1.11
Prince Charles 10 0.53
WA Sir Charles Gairdner 37 1.33
Royal Perth 38 1.14
Fremantle 18 0.82
SA Royal Adelaide 39 1.37
Flinders 22 0.95
Queen Elizabeth 11 0.79
Tas Royal Hobart 13 0.85
ACT Canberra 41 1.72
NT Royal Darwin 19 1.07
Peer result 1,020 1.35

Major hospitals, fewer vulnerable patients*

Total number of hospitals in peer group 40
All cases reported nationally (%) 22%
All patient bed days monitored (%) 22%
State Hospital Cases Rate
NSW Port Macquarie 17 2.29
Dubbo 11 1.95
Sutherland 18 1.56
Lismore 13 1.40
The Tweed 11 1.25
Coffs Harbour 11 1.11
Blacktown 13 1.08
Wyong 12 1.06
Shoalhaven 6 1.04
Concord 21 0.95
Bankstown 13 0.85
Wagga Wagga 7 0.79
Campbelltown 11 0.77
Manning 4 0.77
Tamworth 6 0.75
Orange 4 0.39
Vic Frankston 15 0.95
Maroondah 10 0.92
Bendigo 7 0.77
Goulburn Valley [Shepparton] 5 0.67
South West [Warrnambool] 3 0.56
Latrobe Regional [Traralgon] 4 0.42
Casey 3 0.42
Sunshine 6 0.38
Qld Gold Coast University 26 1.50
Rockhampton 12 1.47
Cairns 21 1.35
Nambour 16 1.03
Ipswich 10 0.91
Toowoomba 9 0.89
Logan 6 0.52
Mackay 3 0.44
Redcliffe 4 0.39
Caboolture 3 0.39
Bundaberg 2 0.28
WA South West [Bunbury] 5 1.04
SA Lyell McEwin 13 0.88
Tas Launceston 16 1.47
ACT Calvary Public 3 0.33
NT Alice Springs 2 0.20
Peer result 382 0.92

Large hospitals

Large hospitals, more vulnerable patients*

Total number of hospitals in peer group 16
All cases reported nationally (%) 4%
All patient bed days monitored (%) 4%
State Hospital Cases Rate
NSW Calvary Mater [Newcastle] 19 3.14
Maitland 7 1.12
Canterbury 3 0.48
Ryde 1 0.23
Vic Peter MacCallum 13 2.71
Wimmera [Horsham] 4 1.59
Albury 5 1.15
Northeast Health [Wangaratta] 5 1.13
Mildura 4 0.78
Monash [Moorabbin] 3 0.77
West Gippsland [Warragul] 2 0.70
Victorian Eye & Ear 0 0.00
Qld Hervey Bay 7 1.48
Queen Elizabeth II 1 0.17
SA Modbury 2 0.29
Tas North West Regional [Burnie] 1 0.30
Peer result 77 1.05

Large hospitals, fewer vulnerable patients*

Total number of hospitals in peer group 23
All cases reported nationally (%) 4%
All patient bed days monitored (%) 7%
State Hospital Cases Rate
NSW Bathurst 5 1.36
Goulburn 4 1.26
Shellharbour 5 0.80
Manly 3 0.49
Mona Vale 2 0.34
Grafton 1 0.30
Fairfield 2 0.25
Hornsby 2 0.25
Auburn 0 0.00
Vic Wodonga 6 1.20
Central Gippsland [Sale] 3 0.97
Werribee Mercy Public 4 0.60
Sandringham 2 0.56
Angliss 2 0.31
Qld Mount Isa 2 1.21
Redland 4 0.70
WA Kalgoorlie 5 1.87
Armadale-Kelmscott 5 0.64
Albany 2 0.54
Rockingham 3 0.48
Swan District 3 0.39
Geraldton 0 0.00
SA Repatriation General 3 0.27
Peer result 68 0.55
*
More and fewer vulnerable patients refers to hospitals deemed to have, for their peer group, a high or low percentage of patient bed days under surveillance attributable to patients with one or more of the identified risk factors. Risk factors were not weighted to account for differences in the degree to which each factor contributes to risk of S. aureus infection. For more information on measures and peer groups, see the Technical Note
The percentage of vulnerable patients at this hospital was much higher than other hospitals in this peer group; this was due to the high percentage of cancer patients at Peter MacCallum, and surgery patients at Victorian Eye & Ear hospital.
Note:
The government-agreed target calls for a rate of no more than 2.0 healthcare-associated S. aureus bloodstream infections per 10,000 patient bed days for each state and territory.
Sources:
Australian Institute of Health and Welfare. National Staphylococcus aureus Bacteraemia Data Collection 2012–13, data extracted 17 December 2013. Australian Institute of Health and Welfare. Admitted Patient Care National Minimum Dataset 2011–12, data extracted 26 March 2012.

About the data

Cases of healthcare-associated S. aureus bloodstream infection are identified when a medical professional notices the symptoms and orders a blood test. If this blood test identifies a bloodstream infection by S. aureus, the infection control officer for the hospital is notified. These experts judge if the infection is healthcare-associated and if it is attributable to a hospital. Many steps are necessary for a case of healthcare-associated S. aureus bloodstream infection to be recorded. Failure of any of these steps can interrupt this sequence and lead to under-reporting of this infection.

Figure 1: Healthcare-associated S. aureus bloodstream infections in public hospitals, by major and large hospitals, 2012–13

Figure showing the Healthcare-associated S. aureus bloodstream infections in public hospitals, by major and large hospitals, 2012-13.

Peer Group Hospital Cases Rate per 10,000 bed days
Major hospitals, more vulnerable patients* Royal Brisbane & Women's Hospital Qld 65 1.99
Nepean Hospital NSW 35 1.96
Mater Adult Hospital Qld 10 1.83
Fremantle Hospital WA 18 0.81
The Queen Elizabeth Hospital SA 11 0.71
The Prince Charles Hospital Qld 10 0.52
Major hospitals, fewer vulnerable patients* Port Macquarie Hospital NSW 17 2.42
Dubbo Hospital NSW 11 2.07
Sutherland Hospital NSW 18 1.62
Gold Coast University Hospital Qld 26 1.44
Sunshine Hospital Vic 6 0.41
Calvary Public Hospital ACT 4 0.45
Bundaberg Base Hospital Qld 2 0.29
Alice Springs Hospital NT 2 0.20
Performance

Named hospitals were in the highest or lowest 10% of results for major hospitals. Major hospitals account for 81% of all reported cases.

Number of cases

Each dot represents a hospital. The size of the dot represents the number of S. aureus cases at that hospital.

The government-agreed target calls for a rate of no more than 2.0 healthcare-associated S. aureus bloodstream infections per 10,000 patient bed days for each state and territory.

*
More and fewer vulnerable patients refers to hospitals deemed to have, for their peer group, a high or low percentage of patient bed days under surveillance attributable to patients with one or more of the identified risk factors. Risk factors were not weighted to account for differences in the degree to which each factor contributes to risk of S. aureus infection. For more information on measures and peer groups, see the Technical Note
Sources:
Australian Institute of Health and Welfare. National Staphylococcus aureus Bacteraemia Data Collection 2012–13, data extracted 17 December 2013. Australian Institute of Health and Welfare. Admitted Patient Care National Minimum Dataset 2011–12, data extracted 26 March 2012.
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