CONFIRMED MINUTES
Healthcare Associated Infections Governance Group (HAIGG)
Date
Tuesday 19 March 2013
Time
0900 –1400
Venue
Ministry of Health - No 1 The Terrace Wellington
Present
Don Mackie (Co-chair)
Jane O’Malley (Co-chair)
Sally Roberts
Deborah Williamson (standing in for Virginia Hope)
Bob Buckham
Ruth Barratt
Margaret Wilsher
Grant Storey (Secretariat)
In attendance
Greg Williams and Dr Dilky Rasiah (PHARMAC) 11am to
1pm
Dr Craig Thornley (Ministry for Primary Industries) 11am –
1pm
Apologies
1.
Arthur Morris, Hasan Bhally, Chris McKenna
Welcome and Apologies
The Co-chairs opened and welcomed members to the meeting. Apologies
were noted.
2.
Confirmation of the Minutes
The Minutes for the HAIGG meeting of 20 November 2012 were confirmed as a
true and accurate record of that meeting.
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3.
Matters Arising
a)
Consumer Representative for the HAIGG
Noted: attempts to identify a candidate for appointment to the HAIGG
have been unsuccessful.
Action Point:
i.
b)
The Co-chairs will identify
representative on the HAIGG.
a
candidate
for
the
consumer
Terms of Reference
The representative for the Infection Prevention and Control Nurse from
National Division of Infection Control Nurses informed HAIGG about the
name change for the representative group. The group is now known as
Infection Prevention and Control Nurses College, New Zealand Nurses
Organisation (NZNO).
Agreed: that the Membership section of the Terms of Reference be
amended to reflect the new name for the representative group, i.e.,
Infection Prevention and Control Nurses College, NZNO.
c)
Workforce Development and Post Graduate Education Papers
The subgroup has further information to gather in order to complete the
paper for the HAIGG on infection prevention and control workforce
development and post graduate education papers. Discussion themes
covered:
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need to review the present draft of the paper in the context of
‘matching demand against need’
ensuring that there is an appropriately trained and competent
workforce
assessment of infection prevention and control (IP&C) leadership
among IP&C nurses and consideration around needs of nurses
the need for engagement, participation and partnership with
residential care, disability sector, long term care facilities IP&C
settings in the context of the work HAIGG is doing on IP&C
workforce development
noting that the private surgical health sector is well represented for
IP&C
consideration to be given to including a representative from the
residential care / long term care facilities IP&C sector on the HAIGG
the limitations of the stocktake survey of current IP&C capabilities
impact the usefulness of the survey results for use in preparing the
paper.
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Action Points:
i.
Ruth Barratt, Jane O’Malley and Chris McKenna to discuss and
finalise the content of the draft paper in the context of ‘matching
demand against need’ and development of IP&C leadership and
needs of nurses.
ii.
The draft paper will need to be consulted with IP&C sector peers.
iii.
Don Mackie and Jane O’Malley will look into the question of whether
to include representation from the residential care / long term care
facilities IP&C sector on the HAIGG.
The Ministry’s Clinical
Leadership, Protection & Regulation Business Unit, and the Health
Quality & Safety Commission will be approached as part of
considering the question.
d)
Comment and Discussion on District Health Board IP&C Capabilities
Noting that limitations of the stocktake survey of current IP&C capabilities
impact the usefulness of the survey results for use in preparing the paper
on IP&C workforce development, members discussed IP&C more
generally. Points included:

requesting information about resources directly from district health
board IP&C managers would be a better approach than relying on
the information from the stocktake survey
seeking assurances from the district health boards over IP&C and
response capabilities in the context of communicable disease threats
and outbreak situations still vague needs a conversation between us
at the meeting soon
that the contingencies in primary care and community care settings
around IP&C and response capabilities in the context of
communicable disease threats and outbreak situations (how are
these resourced) are still to be fully determined [mapped], including
where public health services and medical officers of health roles fit.
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Agreed:
That the Ministry of Health should write to the chief executives of the
district health boards asking for:
i.
ii.
iii.
assurances around IP&C and plans that are in place for managing
incidents once we know what we are seeking assurances on
information on IP&C resources aren’t we asking the managers?
information on laboratory diagnostic support and resources or
approaches in the context of communicable disease threats and
outbreak situations (e.g. norovirus, Clostridium difficile). Specific
mention about the role of public health services needs to be
included, in particular, about how well these services are connected
to laboratories (both community and hospital) given that their work
incurs costs for laboratories ( refer to Clostridium difficile decisions).
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Action Point:
i.
e)
The Ministry of Health to write to district health boards seeking
assurances around IP&C and plans that are in place for managing
incidents and requesting information in relation to IP&C resources.
Guidelines for control of multidrug-resistant organisms in New Zealand
Noted: that the action point (page 6), the Ministry of Health will hold an
internal discussion about reviewing and updating of the guidelines, giving
consideration to scope of review and possible mechanisms to carry out
the review, and report back at the next meeting of the HAIGG, is pending.
f)
Creutzfeldt-Jakob Disease
An action point from the November 2012 meeting was: the Ministry of
Health to explore coordination of a small ‘expert group’ that is able to be
called upon at the time of a CJD incident to provide advice and
leadership.
Noted: the Ministry advised that it is not justifiable to establish a small
‘expert group’ considering the rarity of CJD incidents. The Ministry’s
preferred approach for obtaining advice in relation to a CJD incident is to
identify practitioners with the skill sets required and hold a teleconference.
4.
Draft Discussion Paper on Management of Clostridium difficile
Discussion
Discussion covered the range of key issues yet to be addressed in terms of
achieving consistent approaches to the diagnosis and management of
Clostridium difficile infections in hospital settings. Specific issues raised were:
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a standardised laboratory diagnostic testing approach needs to be agreed
with the sector and this is also key to the surveillance of Clostridium
difficile infection
a change in current testing approaches will have a cost impact, in
particular for the community/private laboratory setting
a letter needs to be sent to clinical directors of diagnostic medical
laboratories, clinical microbiologists, and chief medical officers regarding
appropriate laboratory algorithms for testing for Clostridium difficile
district health boards need to be informed accordingly on the cost impacts
around the diagnosis of Clostridium difficile
district health board contracts for community/private laboratory services in
their regions need to be such that they enable community laboratories to
undertake appropriate testing
currently there is no incentive to test since the disease burden of
Clostridium difficile infection is unknown
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laboratory information systems (their ability and capacity to retrieve
information) are critical elements for supporting surveillance
surveillance requirements for Clostridium difficile are not solely laboratory
results but also need to include appropriate denominator information to
allow a standardised rate to be calculated, and clinical and other patient
related information as part of the overall data package for this bacterium
education at primary care level in relation to Clostridium difficile infection
noted the successful workshop on Clostridium difficile held in February
2013.
Agreed:
Progressing forwards the following sequence of actions was agreed.
i.
ii.
iii.
iv.
Testing: define the recommended diagnostic strategy for diagnosing
Clostridium difficile infection and prepare evidence around justifying the
need for testing.
Cost: identify the cost of the recommended testing approach.
System readiness: identify potential barriers exist in relation to
implementing a standardised testing approach throughout New Zealand.
Surveillance: agreed that surveillance should be hospital-based to start
with. Once hospital-based surveillance is successfully implemented
consideration about extending surveillance to the community setting
could be undertaken. In the interim there might be some research or
information gathering undertaken in relation to cases of community onset
Clostridium diffcile infection.
Information from the above actions will inform the content of the letter to clinical
directors of diagnostic medical laboratories, clinical microbiologists, and chief
medical officers regarding testing for Clostridium difficile.
Action Points
i.
ii.
5.
The Ministry of Health to undertake internal work to attempt to identify
costs around best practice approach to Clostridium difficile testing and
evidence to support the justification for placing an emphasis on
Clostridium difficile surveillance.
Deborah Williamson to liaise with community laboratories to identify the
amount (if any) of testing undertaken.
Infection, Prevention & Control Measures to Control Clostridium difficile
The feedback and comments about the draft one-pager on IP&C measures to
control Clostridium difficle were discussed. The overall text and advice
contained in the document was agreed.
The draft one-pager guidance will be circulated to the IP&C professional sector
and directors of nursing in district health boards for consultation.
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Once finalised the guidance statement will be sent to directors of nursing in
district health boards, IP&C teams, and also the private sector for their
information to guide local policies in relation to IP&C measures to control
Clostridium difficle.
Action Point
i.
Ruth Barratt to send the draft to the IP&C professional sector the directors
of nursing in district health boards for consultation.
Ruth Barratt to present the ‘finalised guidance’ to HAIGG for sign-off.
ii.
6.
Antimicrobial Resistance
New Zealand is not immune from the global issues that surround antimicrobial
resistance. This item was put forward for discussion on our current situation
and activities in combating antimicrobial resistance, and to inform where
possible areas of activity around antimicrobial resistance are either lacking or
could be improved.
Discussion
Officials from PHARMAC and the Ministry for Primary Industries took part in the
discussion. Themes discussed included:

approach to surveillance of antimicrobial resistance in New Zealand and
major changes made in Australia to its approach to surveillance of
antimicrobial resistance
antibiotic stewardship and rational use of antimicrobials in patient care
and animal husbandry. One-health concept mentioned.
guidelines in relation to control of antimicrobial resistant organisms
attitudes and behaviour change in relation to prescribing is required in
certain quarters but achieving this has barriers, for example, currently
there are no restrictions around veterinarian prescribing
global travel and migration to New Zealand are major contributors to
distribution of bacteria and their resistance genes.
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Action Point
i.
Deborah William to prepare a summary of the current antimicrobial
resistance surveillance activities undertaken by ESR. The summary will
include information on present knowledge gaps and areas lacking or
needing improvement.
Discussion with PHARMAC officials included:
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the range of data available through PHARMAC’s information system (for
example, claims data, antibiotic usage, location of usage etc)
interest in talking with ESR about possibility of matching claims data
against antimicrobial resistance surveillance data
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PHARMAC’s move to restrict prescribing of anti-infectives in the new
Hospital Medicines List
PHARMAC is about to write to clinicians confirming the anti-infectives
section of the list. Officials indicated that it would be good to include a
supportive statement from HAIGG on the policy change and the HAIGG
agreed this would happen
important that PHARMAC approaches are joined up with antibiotic
protocols that operate in district health boards
The Ministry of Health and PHARMAC will together work out messaging about
PHARMAC’s policy change to restrict prescribing of anti-infectives. Use of
patient stories noted as a helpful tool to use for messaging purposes.
IP&C nurses were identified as an important group to message through as well.
7.
PHARMAC Update
Part of the PHARMAC update was covered as part of Item 6 (Antimicrobial
Resistance), in particular, the policy change to restrict prescribing of antiinfectives in the new Hospital Medicines List (Section H).
PHARMAC’s Anti-Infective Subcommittee has discussed the possibility of
National Antimicrobial guidelines. The Ministry of Health attended the meeting
as an invited ‘observer’.
Discussion followed and points raised were:
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mechanisms for writing and updating guidelines and how guidelines are
implemented across the sector were identified as issues
clinical organisation policies and restrictions were suggested as more
useful for enforcement purposes
achieving agreement among the sector on guidelines can be very difficult
culture change on antimicrobial use needs to be achieved. Overseas
trained senior specialists were identified as a particular group where noncompliance with local policies is an issue
best practice principals support clinical governance
the Australian antibiotics guidelines developed by the Therapeutic
Guidelines Group (www.tg.org.au) is currently developing version 15 of its
antibiotic guideline and it was discussed whether these could be adopted
for use in New Zealand
Agreed
The Ministry of Health will provide a letter of support for PHARMAC’s policy on
restricting prescribing of anti-infectives in the new Hospital Medicines List.
Action Point
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i.
8.
Don Mackie and Jane O’Malley to arrange for the New Zealand Formulary
and the Health Quality and Safety Commission to be linked into
PHARMAC’s policy implementation plans and where possible provide
support for the change in policy.
Ministry for Primary Industries (MPI) Update
The update to HAIGG covered:
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activities of the Agriculture Compounds and Veterinary Medicines Group
in relation to review of sales of antibiotics used in animals
veterinarians have no restrictions on prescribing
mention that the process for registrations and approvals of non-human
antimicrobials is prescriptive and takes into account World Health
Organization recommendations
the 2011 report on the 2009-2010 baseline survey of antimicrobial
resistance in bacteria from selected New Zealand food. It is coming up to
five years since this survey was carried out. Whether a second survey
should be carried out, and if so, whether that survey should assess the
same pathogens are questions that MPI will need to decide.
The use of antibiotics in aqua-farming, oral administration of antibiotics (as
growth enhancers) in poultry, and veterinary prescribing were part of a more
general discussion.
Agreed
That the knowledge gaps in relation to the Ministry of Primary Industries’ roles
and functions with regard to antimicrobial agricultural compounds and
antimicrobial resistance should be identified and listed. The list could then be
given to the Ministry for Primary Industries (MPI) well prior to the next meeting
of HAIGG with the invite to MPI to bring its relevant experts to the meeting for
further discussion.
9.
Creutzfeldt-Jakob Disease (CJD) Support
Unlike Australia, New Zealand does not have any support system that offers
information and assistance for family members and friends of patients suffering
with suspected CJD and other prion disease and for those at increased risk of
developing CJD.
The Ministry of Health tabled options on how best to provide support,
information and assistance for family members and friends of patients suffering
with suspected CJD and other prion disease and for those at increased risk of
developing CJD.
Members did not support any of the options around providing support. It was
felt that the need for such support is very rare and information can be accessed
via the Australian CJD Support website.
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The Neurological Foundation of New Zealand was identified as worth
approaching to inquire about support and information services for CJD.
Action Point:
i.
The Ministry of Health will contact the Neurological Foundation of New
Zealand to see whether it has any support and information services for
CJD.
10. General Business
National Plan for Managing Healthcare Associated infections
A member noted that the HAIGG has spent considerable time in relation to
developing advice around Clostridium difficile.
The Co-chairs expressed concern that the HAIGG has among its role and
purpose (refer to the Group’s Terms of Reference): (a) assist the Ministry of
Health in developing and implementing a national plan that is adaptive and
responsive for managing healthcare associated infections; (b) establish
linkages across the sector and with other agencies; and (c) link with Emergency
and Disaster planning where linkages are helpful without getting diverted from
core objectives of the Terms of Reference.
Members agreed that HAIGG needed to commence thinking about a national
plan and also identify clearly ‘what agency is responsible for what’. It was
suggested that the internal paper to the Director-General of Health (Healthcare
Acquired Infections –February 2012) provides a basis for documenting a map
of the various agencies and their responsibilities in relation to healthcare
associated infections.
Action Point
For the next meeting the Ministry of Health will identify some information on
overseas structural models for managing and responding to healthcare
associated infections and present it at the next meeting for discussion.
11. Planned Next Meeting Date
The date for the next meeting is to be advised.
12. Meeting Closure
The meeting closed at 2pm.
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