Surveillance for invasive fungal infections in hospitalised patients: development of a risk-matrix to enable meaningful reporting during construction works

Lisa Hall⁷, Dr Shio Yen Tio¹, Miss Emily Harding³, Professor Monica A Slavin^1,2,5, Professor KA Thursky^1,2,5, Mr Stephen Ratcliffe⁶, Mr Ajit Singh⁶, Associate Professor LJ Worth^2,4,5

¹Victorian Infectious Diseases Service (VIDS), The Royal Melbourne Hospital, Parkville, Australia,
²Infectious Diseases Department, Peter MacCallum Cancer Centre, Parkville, Australia,
³Pharmacy Department, The Royal Melbourne Hospital, Parkville, Australia,
⁴Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Doherty Institute, Parkville, Australia,
⁵National Centre for Infections in Cancer (NCIC), Parkville, Australia,
⁶Melbourne Health, The Royal Melbourne Hospital, Parkville, Australia,
⁷School of Public Health, Faculty of Medicine, University of Queensland, Brisbane , Australia

Introduction:

Construction works are associated with increased risk of invasive fungal infections (IFI), particularly in immunocompromised populations, contributing to high mortality and healthcare costs. We sought to develop a standardised IFI monitoring system in the setting of excavation works in close proximity to a healthcare precinct encompassing oncology, haematology and bone marrow transplant services.

Methods:

A multidisciplinary task force was established to oversee development of the surveillance strategy. European Organisation for Research and Treatment of Cancer criteria were applied to define IFI using clinical, laboratory and radiological elements. A consensus process was employed to develop a novel 7-point risk-stratification tool quantifying likelihood of community versus healthcare-acquisition. Scoring was based upon number of healthcare attendances during the preceding 30-days, admission to a HEPA-filtered ward, known history of mould colonisation and occupation.

Results:

In the 2-year baseline period, 60 IFI episodes were detected (18 proven, 24 probable, 18 possible), corresponding to a rate of 1.6/10,000 occupied bed days (OBDs). Following commencement of works, 18 IFI episodes (3 proven, 8 probable, 7 possible) were identified during a 5-month period, corresponding to an IFI rate of 1.8/10,000 OBDs. Statistical process control charting flagged an apparent increase in cases 2-months after works commenced. However, detailed case-review and risk-matrix scores did not reflect high-likelihood of healthcare-acquisition. As a result, expanded antifungal prophylaxis regimens were not implemented.

Conclusions:

In the setting of high-risk environmental exposure, IFI surveillance requires both time-trend analysis and exposure risk-assessment to provide meaningful data to inform the need for enhanced prevention measures.

Biography:

Dr Shio Yen Tio recently obtained her FRACP in Infectious Diseases, and has developed an interest in the area of infections in immunocompromised host. She is currently working on a few projects with the ID team at RMH and Peter Mac, and is considering a PhD down the track.