The burden of healthcare-associated infection in Australian hospitals: A systematic review of the literature

INTRODUCTION: Central to all efforts to control and prevent healthcare associated infections (HAIs) is the inherent need to measure the burden of infection and disease, classically referred to as surveillance. Australia does not have a national HAI surveillance system making it very difficult to systematically assess and report on the burden of hospital-acquired HAIs. This systematic review reports the incidence burden of HAIs in Australian hospitals as reported in the peer-reviewed literature from 2010 to 2016. METHODS: Systematic review of the peer-reviewed literature reporting the incidence of HAIs in Australian hospitals between from 2010 to 2016 was identified using MEDLINE and CINAHL databases. The study protocol is registered with PROSPERO (registration number: CRD42016052997). RESULTS: Of the 844 articles identified in the search, 24 articles were included in this review. Overall, these data suggest 83,096 HAIs per year in Australia, comprising 71,186 urinary tract infections, 4902 Clostridium difficile infections, 3946 surgical site infections, 1962 respiratory infections in acute stroke patients and 1100 hospital-onset Staphylococcus aureus bacteraemia. This is very large underestimate given the lack of or incomplete data on common infections such as pneumonia, gastroenterological and bloodstream infection, thus potentially missing up to 50%-60% of infections. If that is the case, the incidence of HAIs in Australia may be closer to 165,000 per year. CONCLUSION: There is a dearth of peer-reviewed literature reporting the incidence of HAIs in Australian hospitals, making it very difficult to an accurate burden of infection. On the eve of a global 'post antibiotic era', the need for national consensus on definitions, surveillance methodology and reporting is paramount.