ITS 15 - Adoption of a Delphi technique to achieve consensus for a national infection surveillance program in Australian long term care facilities

Background: Worldwide, it is recommended long term care facility (LTCF) infection prevention and control (IPC) programs include surveillance activities. The Australian National Infection Surveillance Program for Aged Care (NISPAC) is seeking to develop, implement and evaluate a standardized program. In order to define the scope of the surveillance methods, an appropriate technique for stakeholder engagement was required.

Methods: A Delphi technique was employed to gain consensus amongst those with leadership roles in aged care, IPC and/or antimicrobial stewardship concerning preferred surveillance methods in LTCFs. Survey 1 across three categories (surveillance framework, process measures and infection definitions) focused on identifying the importance or appropriateness of incorporating a range of potential options into NISPAC; these options included for example infection modules (15 options), staff and resident vaccination compliance (7 options) and urinary tract infection definitions (4 options). Surveys 2 and 3 repeated this process (same participants), and also sought to rate the feasibility of incorporating the different options. Aggregate agreement levels were classified as consensual (>90%), high (75-89%), moderate (31-74%) or low ( < 30%).

Results: Consensual examples of options identified as important to incorporate into NISPAC included Clostridioides difficile*, cellulitis, soft tissue and wound^, gastroenteritis*, influenza-like illness*, norovirus*, pneumonia^ and urinary tract* infection modules, staff COVID-19 and influenza vaccination compliance and resident COVID-19, influenza and pneumococcal vaccination compliance. The consensually agreed urinary tract infection definition (with and without catheter) identified as appropriate to incorporate was Stone et al’s 2012 revised McGeer et al’s clinical criteria.

Conclusions: A Delphi technique was successfully used to achieve expert consensus concerning surveillance methods to be incorporated into NISPAC. Agreement levels for the feasibility of including consensually agreed important surveillance methods were mostly ‘consensual’ or ‘high’.

*Consensual or ^high-level agreement for ‘feasible to incorporate’ into NISPAC.