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Infection prevention and control for specific diseases

Guidance and advice for healthcare workers and organisations to prevent and control specific diseases.

Carbapenemase-producing organisms (CPOs)

CPOs are bacteria that are resistant to a range of antibiotics. This includes carbapenems, which are primarily used as a last line treatment for serious gram-negative infections. CPOs include carbapenemase-producing Enterobacterales (CPE), Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii complex (A. baumannii complex). 

Bacteria can become resistant to carbapenems for different reasons, including carrying carbapenemase genes that produce enzymes which break down these antibiotics. Five major carbapenemase gene types that are found worldwide and have been detected in Australia include: 

  • Imipenemase (IMP)
  • Klebsiella pneumoniae carbapenemase (KPC)
  • New-Delhi metallo-β-lactamase (NDM)
  • Oxacillinase group (OXA)
  • Verona integron-encoded metallo-β-lactamase (VIM)

Infection prevention and control practices should focus on limiting the spread of all CPOs, regardless of their specific resistance mechanism.

Management of CPOs in healthcare settings

CPOs can spread quick and cause outbreaks in healthcare settings. Strategies to prevent and control the transmission of CPOs in healthcare settings are:

  • Planning, prevention and control
  • Screening and surveillance
  • Standard and transmission precautions
  • Environmental cleaning and reprocessing reusable equipment
  • Clearance
  • Education.

Recommendations for the control of CPE

The Recommendations for the Control of CPE (the CPE Guide) provides detailed advice on managing CPE. This is because CPE is one of the most significant and preventable CPOs in Australia, accounting for around one-half of the critical antimicrobial resistances (CARs) reported to the National Alert System for Critical Antimicrobial Resistances (CARAlert).

CPE infections have a high mortality because they often affect people with multiple morbidities and there islimited availability of treatment options. 

We have a range of resources to support the implementation of the recommendations of the CPE Guide:

The principles outlined in the CPE Guide specifically focus on the management of CPE. While similar principles may be relevant for other CPOs, tailored approaches to management may be necessary depending on how each organism spreads.

View further information on each of the management strategies:

Planning, prevention and preparation for the control of C. auris, including screening, surveillance and outbreak management, should be integrated into health service organisations’ infection prevention and control and antimicrobial stewardship (AMS) programs. These programs should align with local needs and the requirements of the National Safety and Quality Health Service (NSQHS) Standards, including implementing a hand hygiene program that is consistent with the current National Hand Hygiene Initiative, and state and territory requirements.

Health service organisations should follow state and territory policies for C. auris screening. In general, screening for C. auris on admission to hospital should be performed if the patient:

  • Is a direct transfer from an overseas hospital
  • Is a contact of a suspected or confirmed C. auris case, or
  • Has been admitted to an overseas health or aged care facility in the previous 12 months.

Patients who test positive for C. auris should have an alert placed in their healthcare record for easy identification. 

Each health service organisation, or state or territory, should select an appropriate active surveillance strategy for C. auris. In some states and territories, C. auris is also notifiable. Any isolate of C. auris should be monitored and reported in accordance with the relevant state and territory requirements

C. auris spreads through  direct contact with contaminated hands, equipment and surfaces. Standard and transmission-based precautions should be implemented when managing patients with suspected or confirmed C. auris infection or colonisation. 

This includes:

  • Use of appropriate personal protective equipment, such as aprons, gowns, and gloves
  • Patient placement (e.g. single room cohorting)
  • Minimising patient movement.

Further information on standard and transmission-based precautions is available here: Standard and transmission-based precautions posters.

C. auris can survive on equipment and surfaces for up to two weeks so thorough cleaning is essential. Health service organisations should have environmental cleaning and disinfection policies and procedures that specify :

  • What products to use and how to use them
  • How often hospital rooms and frequently touched surfaces should be cleaned
  • How to disinfect shared medical equipment, such as blood pressure cuffs (if unable to use dedicated patient equipment for those suspected or confirmed C. auris infection)
  • What to do when a patient is discharged

Health service organisations should monitor and audit cleaning according to relevant state or territory policies or procedures.

 

Cleaning the environment where there is a suspected or confirmed C. auris case should involve:

  • 2-step clean
    • physical clean using a detergent
    • disinfect with an Australian Register of Therapeutic Goods (ARTG)-listed hospital-grade disinfectant that kills fungi (yeasts) or a chlorine-based product such as sodium hypochlorite, where indicated for use;
  • 2-in-1 clean
    • Use a combined detergent and ARTG-listed hospital-grade disinfectant that is effective against fungi or a chlorine-based product, where indicated for use.

Or

Some common disinfectants, like quaternary ammonium compounds may not work against C. auris. It is important to review the manufacturer’s test reports to ensure efficacy against C. auris before use. 

Deciding when a patient is “cleared” of a C. auris infection depends on several factors, such as microbiological testing, clinical assessment and monitoring, appropriate treatment, evaluation of indwelling devices, discharge planning, and patient education. C. auris clearance should be determined in accordance with local and state or territory policies and in consultation with experts in clinical microbiology, infectious diseases or infection prevention and control.

Staff should be trained on how to prevent and manage the spread of C. auris infections. Education helps staff to understand and follow infection prevention and control requirements, support antimicrobial stewardship, and enhance reporting and clinical communication. Education should also highlight state or territory policies for reporting breaches in infection prevention and control practice and C. auris screening requirements.

Patients and visitors also should be told how to help prevent infection, such as:  

  • Practising good personal hygiene, including hand hygiene
  • Reporting symptoms and giving accurate medical histories, including recent overseas hospital admissions
  • Following any antimicrobial treatment instructions. 

The Commission has developed a suite of fact sheets for patients and visitors about infection prevention and control, and common and emerging healthcare-associated infections.

OtherNew South WalesVictoriaQueenslandSouth AustraliaWestern Australia

 

Candida auris infection considerations for the transfer or repatriation of an overseas patient to a NSW hospital

 

 

 

 

Candida auris (C. auris)

C. auris is a fungus (yeast) that is hard to treat because it is resistant to a range of antifungal medicines. It can cause serious infections in patients who are immunocompromised. Tt is important to correctly identify and manage this infectionquickly because it spreads easily and is difficult to treat,. .

C. auris in Australia

In Australia C. auris is monitored through the National Alert System for Critical Antimicrobial Resistances (CARAlert) and reporting is mandated in some states and territories. While reports of C. auris remain relatively low in Australia, CARAlert data show that the number of reports of C. auris isolates has been increasing over the past five years. 

For data on C. auris in Australia, see AURA 2023 and CARAlert annual reports and data updates. Infection prevention and control strategies

Successful prevention and control of C. auris is based on a combination of core strategies, including:

  • Planning, prevention and preparation
  • Screening and surveillance
  • Using standard and transmission-based infection-control precautions
  • Environmental cleaning and reprocessing reusable equipment
  • Staff and patient education
  • Processes to confirm when a patient is cleared.

View further information on each of these strategies:

Planning, prevention and preparation for the control of C. auris, including screening, surveillance and outbreak management, should be integrated into health service organisations’ infection prevention and control and antimicrobial stewardship (AMS) programs. These programs should align with local needs and the requirements of the National Safety and Quality Health Service (NSQHS) Standards, including implementing a hand hygiene program that is consistent with the current National Hand Hygiene Initiative, and state and territory requirements.

Health service organisations should follow state and territory policies for C. auris screening. In general, screening for C. auris on admission to hospital should be performed if the patient:

  • Is a direct transfer from an overseas hospital
  • Is a contact of a suspected or confirmed C. auris case, or
  • Has been admitted to an overseas health or aged care facility in the previous 12 months.

Patients who test positive for C. auris should have an alert placed in their healthcare record for easy identification. 

Each health service organisation, or state or territory, should select an appropriate active surveillance strategy for C. auris. In some states and territories, C. auris is also notifiable. Any isolate of C. auris should be monitored and reported in accordance with the relevant state and territory requirements

C. auris spreads through direct contact with contaminated hands, equipment and surfaces. Standard and transmission-based precautions should be implemented when managing patients with suspected or confirmed C. auris infection or colonisation. 

This includes:

  • Use of appropriate personal protective equipment, such as aprons, gowns, and gloves
  • Patient placement (e.g. single room cohorting)
  • Minimising patient movement.

Further information on standard and transmission-based precautions is available here: Standard and transmission-based precautions posters

C. auris can survive on equipment and surfaces for up to two weeks so thorough cleaning is essential. Health service organisations should have environmental cleaning and disinfection policies and procedures that specify:

  • What products to use and how to use them
  • How often hospital rooms and frequently touched surfaces should be cleaned
  • How to disinfect shared medical equipment, such as blood pressure cuffs (if unable to use dedicated patient equipment for those suspected or confirmed C. auris infection)
  • What to do when a patient is discharged

Health service organisations should monitor and audit cleaning according to relevant state or territory policies or procedures.

Disinfection

Cleaning the environment where there is a suspected or confirmed C. auris case should involve:

  • 2-step clean
    • physical clean using a detergent
    • disinfect with an Australian Register of Therapeutic Goods (ARTG)-listed hospital-grade disinfectant that kills fungi (yeasts) or a chlorine-based product such as sodium hypochlorite, where indicated for use;
  • 2-in-1 clean
    • Use a combined detergent and ARTG-listed hospital-grade disinfectant that is effective against fungi or a chlorine-based product, where indicated for use.

Or

Some common disinfectants, like quaternary ammonium compounds may not work against C. auris. It is important to review the manufacturer’s test reports to ensure efficacy against C. auris before use. 

Staff should be trained on how to prevent and manage the spread of C. auris infections. Education helps staff to understand and follow infection prevention and control requirements, support antimicrobial stewardship, and enhance reporting and clinical communication. Education should also highlight state or territory policies for reporting breaches in infection prevention and control practice and C. auris screening requirements.

Patients and visitors also should be told how to help prevent infection, such as:  

  • Practising good personal hygiene, including hand hygiene
  • Reporting symptoms and giving accurate medical histories, including recent overseas hospital admissions
  • Following any antimicrobial treatment instructions. 

The Commission has developed a suite of fact sheets for patients and visitors about infection prevention and control, and common and emerging healthcare-associated infections.

Deciding when a patient is “cleared” of a C. auris infection depends on several factors, such as microbiological testing, clinical assessment and monitoring, appropriate treatment, evaluation of indwelling devices, discharge planning, and patient education. C. auris clearance should be determined in accordance with local and state or territory policies and in consultation with experts in clinical microbiology, infectious diseases or infection prevention and control.

OtherNew South WalesVictoriaQueenslandSouth AustraliaWestern Australia

 

Candida auris infection considerations for the transfer or repatriation of an overseas patient to a NSW hospital

 

 

 

 

Clostridioides difficile infection (CDI) in Australia 

 Clostridioides difficile infection (CDI) is a serious gastrointestinal disease, often caused by inappropriate antimicrobial use such as antibiotics.

What is Clostridioides difficile?

Clostridioides difficile (also known as Clostridium difficile) is an anaerobic, spore-forming, gram-positive bacterium typically associated with gastrointestinal disease. It is common in the natural environment and in healthcare environments and can be spread between individuals through direct or indirect contact. 

Clostridioides difficile infection (CDI) is often linked to prolonged and unnecessary use of antimicrobial therapy.

Preventing and controlling CDI

Health service organisation can use several strategies to reduce the spread of CDI. Many of these also apply to community and primary healthcare settings. settings.

Information for primary health providers

More than 80% of hospital patients with CDI have symptoms before they get to hospital. Early testing and treatment in primary and community care are key interventions that will help improve patient outcomes, reduce the severity of disease, and prevent further spread of CDI in the community.

More information

Key actions for Australian health service organisations using heater-cooler devices in cardiac surgery 

Heater-cooler devices used in cardiac surgery can sometimes become contaminated with non-tuberculous Mycobacterium species. If this happens, the device can release contaminated aerosols into the air, which may infect patients. These infections can take several years to appear, making them difficult to detect early. 

Health service organisations should follow this guidance in conjunction with safety notices, alerts and other advice provided by their state and territory health authorities and the Australian Guidelines for the Prevention and Control of Infection in Healthcare.

For more information visit the Therapeutic Goods Administration website.

National Infection Control Guidance Non-tuberculous Mycobacterium infections associated with heater-cooler devices

The National Infection Control Guidance: Non-tuberculous Mycobacterium infections associated with heater-cooler devices has been updated to reflect recent Food and Drug Administration (FDA) advice about devices and non-Mycobacterium species implicated in the transmission of these infections.

Vancomycin-resistant enterococci (VRE)

Preventing and controlling VRE is an important patient safety issue for Australian healthcare.

VRE in Australia

The occurrence of VRE in Australia is monitored by the Antimicrobial Use and Resistance in Australia (AURA) Surveillance System through the Australian Group on Antimicrobial Resistance (AGAR) and Australian Passive AMR Surveillance (APAS). The first APAS report found that vancomycin non-susceptible Enterococcus faecium strains are now very common across Australia.

AGAR Sepsis Outcome Program reports show that overall rates of vancomycin resistance in Enterococcus faecium are declining nationally. However, Australia has one of the highest rates of resistance to vancomycin in E. faecium compared with almost all European countries.

Australian Guidelines for the Prevention and Control of Infection in Health Care: Core strategies

The Australian Guidelines for the Prevention and Control of Infection in Healthcare 2019 (AICGs) outline strategies for identification and management of VRE in healthcare settings. The guidelines recommend that, where a patient is known to be either colonised or infected with a multidrug-resistant organism (MRO) including VRE, contact precautions should be used in addition to standard precautions.

The AICGs recommend two approaches for the prevention and control of MROs:

  • Core strategies, for any situation where MRO infection or colonisation is suspected or identified
  • Organism-based or resistance mechanism-based approaches if the core strategies alone are not reducing infection rates 

Core strategies

Controlling VRE relies on consistently applying core infection-control practices. These include:

  • strict hand hygiene
  • appropriate use of personal protective equipment (PPE)
  • specific contact-based precautions, such as increased environmental cleaning. 

More information is available here: VRE Break the chain of transmission (infographic)

VRE screening 

The AICGs acknowledge there is no national agreement on the best way to screen for MROs including VRE. For development of screening protocols for VRE, the AICGs suggest consideration of the following factors:

  • Local prevalence of VRE
  • The reason for admission of the patient
  • The risk status of the unit to which they are admitted
  • The likelihood that the patient is carrying VRE.

Other resources

State and territory health department also provide guidance on preventing and controlling VRE:

Staphylococcus aureus bloodstream infection (SABSI) prevention resources

Healthcare-associated Staphylococcus aureus bloodstream infection (SABSI) is commonly associated with significant morbidity and mortality. Resources to support prevention of these infections in health service organisations play an important role; information on strategies to support these activities, and access to a range of resources, are included on this page. 

Research over many years shows that strong, consistent infection prevention and control practices can significantly reduce the the incidence of preventable SABSI.

Key actions to prevent SABSI in health care include:

  • Hand hygiene to minimise transmission of microorganisms on healthcare worker’s hands
  • Optimal insertion, management and removal of intravascular devices
  • Preoperative methicillin-resistant Staphylococcus aureus (MRSA) screening
  • Perioperative antimicrobial prophylaxis and targeted, appropriate antimicrobial therapy
  • Optimisation of surgical site management
  • Feedback on infection surveillance and reporting to clinicians.

The Commission has collated national and state and territory SABSI prevention resources to support organisations to reduce the risk of SABSI.

More information on Staphylococcus aureus bloodstream infection (SABSI) surveillance

Last updated: 20 March 2026