Curriculum standards

Knowledge guides

LG18: Healthcare-associated infections

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

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Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

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Conditions

Infections:
- device-related:
  - catheter-associated urinary tract infection (CAUTI)
  - intravascular line infections, including:
    - central line-associated bloodstream infections (CLABSI)
  - ventilator-associated pneumonia
- surgical site
- with multidrug-resistant organisms
Occupational exposures, such as:
- needlestick injuries
Other healthcare-associated infections, such as:
- hospital-acquired pneumonia
Outbreaks, such as:
- diarrhoeal illness, such as:
  - norovirus
- highly transmissible viruses, such as:
  - measles
- respiratory illness, such as:
  - influenza
  - respiratory syncytial virus (RSV)
  - SARS-CoV-2

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Aetiology of common pathogens, such as:
- blood-borne viruses, such as:
  - hepatitis:
    - B
    - C
  - human immunodeficiency virus (HIV)
- extended-spectrum beta-lactamase (ESBL):
  - methicillin-resistant Staphylococcus aureus (MRSA)
  - vancomycin-resistant enterococci (VRE)
- multidrug-resistant organisms:
  - Candida auris
  - carbapenem-resistant Enterobacterales (CREs)
  - Clostridioides difficile
  - gram-negative infections:
    - drug-resistant Enterobacterales, such as:
      - AmpC
      - carbapenemase-producing (CPE)
    - multi-resistant Acinetobacter baumannii complex
    - multi-resistant Pseudomonas aeruginosa
- those of public health concern, such as:
  - Legionella pneumophila
  - Listeria monocytogenes
  - Neisseria meningitidis
Aetiology of resistance patterns, generally and locally
Clinical manifestations, frequency, and pathophysiology of common healthcare-acquired infections
Colonisation
Infection prevention consideration, such as:
- antimicrobial stewardship principles
- occupational exposure
- preventive measures for healthcare staff, and required immunisation
- standard and transmission-based precautions
- sterilisation and disinfection procedures
- waste management
Modes of entry
Molecular epidemiology techniques
Outbreak investigation
Reservoirs and modes of transmission
Risk factors and pathogenesis for healthcare associated infections, such as:
- bloodstream
- diarrhoeal
- respiratory
- surgical site infection
- urinary tract
Surveillance principles

Framework of outbreak preparedness, readiness, and response at a national level
Local clinical governance and safety quality systems
Local infection prevention guidelines
National Safety and Quality Health Service Standards by the Australian Commission on Safety and Quality in Health Care, and the Ngā Paerewa Health and Disability Services Standard
Screening of patients for novel or emerging pathogens

Antimicrobial stewardship, resistance, and prophylaxis, including surgical prophylaxis, and their impact on host biome
Changes in host biome, susceptibility, and immunity when hospitalised
Healthcare-associated infection control requirements in organisational structures, and the use of indicators for such
Impact of nosocomial infections on patient health and outcomes
Pharmacologic and non-pharmacologic strategies to prevent surgical site infections
Role of surveillance and feedback reporting, the different surveillance systems, and their validation

Infection control policy development and implementation

Action plan development
Cost-benefit analysis
Evidence base for policy decisions
Guidelines, such as:
- contagion-specific guidelines, such as those for:
  - COVID
  - influenza:
    - avian, including H5N1
- high-consequence infectious diseases
- local, national, and international clinical standards and protocols
- Mpox
- suspected bioterrorism
Outbreak preparedness and investigation

Management of multi-resistant organisms

Attributable mortality and morbidity
Host risk factors
Local prevalence and incidence rates
Prevention of development and transmission, including:
- contract tracing
- detection of colonisation
- principles of antimicrobial stewardship
- transmission-based precautions
Relationship between colonisation, infection, and resistance mechanisms
Typical sites of colonisation, including when and how to screen for multi-resistant organisms based on local guidelines

Principles and practice of infection prevention

Antisepsis
Aseptic technique
Environmental control measures, such as:
- cleaning
- decontamination
- disinfection
- isolation
- sharps disposal
- sterilisation
Hand hygiene
Isolation and cohorting strategies
Measures to control and prevent infection during hospital renovations and/or construction
Minimisation of device use
Personal protective equipment (PPE) categories for different scenarios, and appropriate donning and doffing
Staff education, health, immunisation, occupational exposures, and training
Surveillance and outbreak investigation
Transmission-based precautions, such as:
- airborne
- contact
- droplet
- standard
Ventilation and air-conditioning systems
Waste management
Water systems