What if a national HAI Surveillance program is not worth it for Australia? Literature is glowing with many benefits of a national program, but sometimes I get the feeling that true validation of many programs is glossed over. Yes, validation studies are complex and expensive, which is why there are so few. So then, are we really comfortable forging ahead with national surveillance if we’re not totally sure that data is completely true?
How accurate do we need national HAI data to be? The answer to this is, I guess, it depends on its use. Is it used to compare and penalise poor performing hospitals? Then surely it needs to be close to 100% accurate. Is it used for internal purposes, and tracked over time internally as a quality activity? Then probably, we can forgo some accuracy, so long as the method is consistent – which in itself presents a whole new angle. Do those collecting the data always use the same sources? Are those who apply the HAI criteria in total agreement all the time? If there is only a tiny degree of variation in these factors between two surveillance people in one hospital, imagine the degree of difference between 100 surveillance people from 50 hospitals, and how this might effect national data.
It is exciting that the sense of implementation science is now coming to the fore. We cant just develop bundles that reduce infection rates by significant amounts (as demonstrated in robust studies) and say “there you go, do this”. It is clear we need to also address the implementation process to ensure the said bundle is accepted and implemented correctly to facilitate maximum effect.
So this is for surveillance too. My PhD has taken me down the road of identifying the gaps in HAI surveillance in Australia, some of which is published (here and here, more soon hopefully!). With ethics now complete, I will shortly be exploring what attributes of a surveillance program key stakeholders value most. The results from my discrete choice experiment will be fascinating (to me anyhow), and will have a large impact on my final recommendations…
So what if the key stakeholders don’t value a national program but are quite happy doing what they do now? Well I can tell you that some of what is being one now is useless and a waste of precious infection prevention resources. Why it is being done I don’t know for sure, but I suspect at the very least, there is a box somewhere that gets ticked…nevertheless, I believe much across the land can be improved to provide more meaningful data and better guide both local and national interventions.
Will my research produce evidence based recommendations for a national HAI surveillance program? Well yes, on several points. Part of what they provide will be vital data on what key stakeholders value in a national program, and what they don’t value. This small but crucial bit of information will calibrate our spinning compass, and also plant the first tiny baby steps to successful implementation – should a national program ever be developed.