Minutes for the Healthcare Acquired Infections Governance Group

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Minutes for the Healthcare Acquired Infections Governance Group (HAIGG)
Monday 12 May 2014, Sudima Hotel, Christchurch
09.00 – 16.00
Present
Arthur Morris
Deborah Williamson
Chris McKenna
Margaret Wisher
Bob Buckham
Sally Roberts
Hasan Bhally
Ruth Barratt
Sheldon Ngatai
Invited
Michelle Taylor 09.00 – 10.00
Ministry of Health
Jane O’Malley (Co-chair) (present till 13.30)
Don Mackie (Co-chair)
Jane Pryer
Lisa Oakley
Geoffrey Roche (minutes)
Apologies
Noeline Whitehead
Chris McKenna
1.
Welcome and introductions
The Co-chairs welcomed Sheldon Ngatai to HAIGG as the consumer representative.
2.
Confirmation of the meeting minutes of the HAIGG 14 February 2014
Amendments
The following sections of the draft Minutes were amended to read:


Page 1 change sentence to read a “matter of public record” not “scrutiny”
Page 3 item 7 remove reference to the work “embarrassing”
1
With the above amendments the minutes of the HAIGG 14 February 2014 were
confirmed as a true and accurate record of that meeting.
3.
IT and ICNet presentation
A substantial discussion took place to discuss the need for a software package for
the Infection Prevention and Control (IP&C) sector. This included:


a paper outlining the use and utility of an IPC software suit for the purpose of
surveillance and monitoring of healthcare associated infections
a demonstration of ICNet software programme from Michelle Taylor from
Canterbury DHB.
Discussion
Themes discussed included:




benefits of an automated system
differences between local and national surveillance systems
procurement process for purchasing IPC software
priority and the question of where IPC software fits with the Ministry’s plan for
development of IT programmes.
Action
A suggestion that the Co-chairs to communicate to the Director General of Health
the need for an IT system for the purpose of managing risk of HAIs, at both local and
national levels. (This action supersedes earlier action of the writing of a letter to the
IT board).
5.
Action Plan update
13.1 Governance: Comment and Discussion on DHB IP& C capabilities
The HAIGG would like to convey to District Health Boards an overview of how the
governance group can support them
Agreed:
It was agreed that the Co- chairs (Jane O’Malley and Don Mackie) should attend the
Chief Executives of DHBs meeting, in September rather than sending a letter.
Action:
The Co-chairs (Jane O’Malley and Don Mackie) to decide what the key IPC strategic
messages will be.
2
Item 13.2: Surveillance: Letter to all DHB Labs.
Completed action.
Item 13.3: Surveillance: Consultation with HQSC, agreement to adopt SHEA
definitions for hospital-based surveillance for CDI.
Deborah Williams provided an update on progress on the establishment of the New
Zealand Microbiology Network (NZMN). Deborah also informed HAIGG that the
NZMN:


will establish definitions for hospital based surveillance for CDI
will then inform HAIGG on how best to establish hospital- based surveillance for
CDI.
Discussion:
Themes of the discussion included:




SHEA definitions for CDI
whether CDI surveillance data would be used to compare the performance of
DHBs.
relationship between the NZMN and the HAIGG
that the NZMN is a means of operationalising some of the HAIGGs activities,
and a means of proposing the best way forward.
Agreed:
It was agreed that:
i.
ii.
the SHEA definitions had been agreed previously for use in hospital definition
for CDI
surveillance data is not intended to act as a hospital performance indicator.
Item 13.24 Workforce Capacity: Drafting of workforce development and post
graduate education papers
Discussion:
Members discussed the draft paper on workforce development and the clarity of the
content of the draft paper.
Action:
Workforce paper to be re-written and the reviewed again by HAIGG.
3
Item 13.25 Infection Prevention & Control Procedures: Development of best
practice guidelines and standards for environmental cleaning of hospitals
The Victorian Cleaning Standards have been put forward as way of standardising
environmental cleaning practices in healthcare facilities as it offers a cleaning audit
tool.
Discussion:
Could problems (cleaning) become more apparent as standards are implemented?
Majority of hospitals are already using the Victorian Cleaning Standards (VCS).
Action:
Follow up to be sought following the Directors of Nursing meeting in March 2014, as
use of the VCS was itemised (unfortunately representative for this item not present
at today’s meeting)
6.
Antimicrobial Stewardship
Discussion:
Several papers on Antimicrobial Stewardship had been circulated to the HAIGG.
Given that New Zealand’s ability to be influential at a global level is limited, the
discussion focused on local issues.
Issues identified were:

the need for better enforcement of prescribing practices, in particular in smaller
hospitals
inadequate clinical guidance
inadequate consumer medical literacy
inadequate communications amongst staff
a lack of evidence based guidelines
the lack of teams who can provide robust advice
antibiotics shortages
inadequate surveillance







A scoping research paper draft was compiled by the Health Quality and Safety
Commission, which provided advice in three parts:
i.
ii.
iii.
National coordination
Guidelines
Quality improvement measures.
4
Actions:
The following actions were identified
i.
ii.
iii.
iv.
7/9.
determine what is already being done in New Zealand to manage “bugs” and
whether the ‘machinery’ required already exists.
statement to be drafted on expectations of DHBs. This statement will be used
in discussions with CMOs.
review of the Australian Therapeutic Guidelines (for possible adaptation by
NZ)
invite representatives from PHARMAC and MPI to next HAIGG face to face
meeting.
Strategic Plan
The HAIGG strategic Plan was circulated for comment; refer to the draft Strategic
Plan for specific edits discussed.
It was noted that the Accident Compensation Corporation (ACC) is looking into
hospital acquired infection and associated injuries (secondary injuries after trauma,
pressure injuries, wound infections and encephalopathy) and is interested in the
HAIGG strategic plan. It was suggested that an ACC representative be invited to the
next HAIGG meeting.
11.
Items of interest / round the table
Journal Articles
Several journal articles were tabled as items of interest.
Research Project
Hasan Bhally presented a recent research project on HAIs conducted at Waitakere
Hospital (a 135 bed secondary level care public facility with adult General Medicine
and Rehabilitation wards) by Hasan, K. Read, S. Sapsford and T. Sapsford.
The study aimed to determine the characteristics of patients with HAIs, and the
proportion and spectrum of infections as an admitting diagnosis in patients.
The researchers looked at all patients who had a diagnosis of infection on admission
and if they had a hospital acquired infection. The diagnosis of infection was purely
clinician based. The impact and severity of infections was not looked at.
It was found that the most common types of infection were lower respiratory tract
infection (LRTI) (41%). No difference in rate was seen associated with the type of
device used, unlike other studies on the same issue.
5
Findings:



Infection was found to be a common clinical admitting diagnosis in hospitalised
patients, with a diagnosis of LRTI often not supported by microbiological tests.
HAI is prevalent (10.7%), and urinary tract infection is the most common type in
the setting studied.
Patients with HAI are older, have longer stays, and are more likely to be
present in a rehabilitation ward at the time of diagnosis.
The findings emphasise the need to determine the setting of the infection and the
importance of determining how many of these infections are actually preventable.
Most hospital acquired pneumonias and most non- catheter related UTIs could not
have been prevented.
General Discussion:
It was noted that a SHEA paper on obligatory vaccination for healthcare staff has
shown that this is clearly beneficial. It was also noted that new Worksafe policy
required that there is now an obligation on workers to ensure the safety of others in
their organisation. It was noted that there is an analogue with workplace smoking
policies. A recent British Medical Journal article on the pros and cons of obligatory
vaccination had recently been published.
Action:
It was decided that obligatory vaccination be placed on the HAIGG action point list
12.
Meeting Closure
The meeting closed at 15.15
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