CONFIRMED MINUTES
Healthcare Associated Infections Governance Group (HAIGG)
Date
Tuesday 21 August 2012
Time
0900 –1400
Venue
Ministry of Health - No 1 The Terrace Wellington
Present
Jane O’Malley (Co-chair)
Don Mackie (Co-chair)
Arthur Morris
Sally Roberts
Virginia Hope
Denise Kivell (for Chris McKenna)
Hasan Bhally
Margaret Wilsher
Ruth Barratt
Emma Mold (Secretariat)
Grant Storey (Secretariat)
Chris McKenna
Apologies
1.
Welcome and Introductions
The Co-chairs opened the meeting welcoming members to the first
meeting of the HAIGG. Members accordingly introduced themselves.
2.
Purpose and Expectations
The Co-chairs spoke on the purpose of the HAIGG and the expectations
of the Ministry of Health, in particular, the Director-General of Health,
regarding the broad activities and advice to be delivered by the HAIGG.
Themes covered by resulting discussion included:

national leadership and setting the direction around healthcare
associated infections

addressing issues in a coordinated manner with the aim of
reducing harm from infections and cost to society

focus on antimicrobial resistance as a separate core issue,
including linkage with antimicrobial uses in veterinary/animal and
horticulture sectors

recognition of multiple groups in the sector and the need to
establish linkages between agencies

new and emerging threats.
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Members expressed the need for certainty that the HAIGG will have the
mandate to effect change and remedy issues in regard to healthcare
associated infections.
Members also expressed the need for the HAIGG to have a link with the
antimicrobial group convened by the Ministry for Primary Industries (MPI).
Discussion moved to the draft Terms of Reference (TOR).
The Director-General of Health briefly attended and expressed his
appreciation to the members for the work they will be undertaking on the
HAIGG.
3.
Draft Term of Reference
Discussion
Discussion identified a range of changes to the draft TOR. It was also
noted that the TOR identified the Group as ‘Healthcare Acquired
Infection Governance Group’ and that the term ‘Acquired’ needed to be
changed to ‘Associated’.
Agreed
That the following changes are made to the draft TOR and then
recirculated to the HAIGG for confirmation.
1.
The purpose of the HAIGG to read: To provide national leadership
and set direction for the Ministry of Health on the clinical, scientific,
and strategic aspects of surveillance, infection prevention and
control, antimicrobial resistance, and new and emerging threats to
the health of New Zealanders, with the aim of reducing harm and
cost to society from infections associated with healthcare exposure.
2.
The specific bullet points under the purpose of the HAIGG be
changed to read as follows:

assist the Ministry of Health in developing and implementing a
national plan that is adaptive and responsive for managing
healthcare associated infections (HAI)

establish linkages across the sector and with other agencies

provide national oversight of HAI

determine key priorities for HAI that require further action

recommend standards to prevent HAI

recommend indicators for HAI

regularly review
surveillance data

monitor overseas developments in the context of HAI and
provide advice on the implications for New Zealand

oversee the function of any sub-groups established by the
HAIGG

roles and responsibilities (members to consider this point)
New
Zealand
laboratory
and
clinical
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3.
4.
5.
Under ‘Accountability’ the first bullet point: provide timely and
comprehensive reports to the Ministry of Health, is changed to
read: provide timely and comprehensive reports to the DirectorGeneral of Health.
The membership of the HAIGG is expanded to include
representation
from:
(a) the Pharmaceutical Society of New Zealand; and (b) a
consumer.
That the MPI and PHARMAC be allocated slots on the meeting
agenda to attend and be linked with the activities of the HAIGG.
Action Points
i.
The MPI and PHARMAC are to be invited to attend the next
meeting to inform on activities relevant to the work of the HAIGG
(Grant).
ii.
A nomination from a representative from the Pharmaceutical
Society of New Zealand and a consumer representative will be
sought (Emma).
4.
Introductory Presentations by Members
Members were each invited to briefly speak about their interests,
expertise and spheres of influence in relation to HAI.
Noted
Key themes from the presentations included:

infection prevention and control workforce capacity (‘a tiny group’)
and the need for expansion of capabilities

antimicrobials, prescribing patterns, and local policies on antibiotic
stewardship

regional variations across a range of areas pertaining to HAI

impact of environmental factors and standards for cleaning and
monitoring to keep hospitals safe

prevention of new and emerging threats entering our hospitals

need for specialist educational papers to support workforce
development

use of ‘patient stories’ as part of key messaging

making best use of surveillance

links with Australia, common issues, ‘don’t reinvent the wheel’

clinical leadership and governance as a means for effecting change

involvement of private hospitals and residential care facilities.
5.
Key Issues and Hot Topics
Discussion
The following areas were identified as being key issues and questions.

Workforce development – who is the work force and what is the
current capability?
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6.
Surveillance systems - are we making the best use and how do we
pull data together from across the various systems of surveillance?
The need to link clinical outcome data with laboratory surveillance
data and the potential usefulness of a shared electronic record in
order to obtain better overall understanding of HAIs and their
impacts.
Impact of clinical governance in district health boards on HAIs and
the economic evidence for investment on HAI.
Strategy for quality improvement and link with capacity and
capability to roll out a strategy.
Multi-drug resistant organisms in the community and in hospitals.
Use of antibiotics – what is happening in intensive care units, and
haematology/oncology units? Concern over lack of consistency
across a range of treatment areas and antibiotic prescribing.
Clostridium difficile – should Clostridium difficile strains be
notifiable? The need for a consistent testing algorithm; concern
over implications of an emerging local hypervirulent strain
(NZ11/21) and its control; raising awareness over testing for the
organism in cases with gastroenteritis requiring hospitalisation.
Impacts on patients with HAIs and their families – isolation and
depression; the use of patient stories as part of key messaging.
Education of workforce and workforce development – lack of level
8 or above post graduate papers on infection prevention and
control. E-learning can be an effective tool, it was noted that there
is a high usage by nurses but a low usage by clinicians presently.
The role of the HAIGG in setting of policy around HAI and
importance of processes for consultation, feedback and for
achieving buy-in at the ‘high level’.
Environmental hygiene and impacts of constrained budgets. Public
healthcare sector and private healthcare sector – what are the
accountability requirements for residential care facilities? Private
provider contracts may not have the necessary accountabilities as
compared with those applied to district health boards.
The review of the Health and Disability Services Standards is
commencing before the end of 2012. This presents an opportunity
for reviewing the infection prevention and control standards as part
of the overall review.
Are there areas where ‘quick wins’ could be achieved or innovative
practices implemented?
Defining Deliverables for Next 12 Months
Agreed
That the members would give further consideration to defining the key
deliverables after receipt of the Meeting Minutes. It was further agreed
that the initial priorities are:
1.
A one pager be prepared that outlines the rationale of:
a.
why HAIGG exists?
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2.
3.
4.
b.
what HAIGG are doing?
c.
what you can expect from HAIGG by when?
The HAIGG will complete a comprehensive stocktake in relation to
the current infection control capability of the healthcare system to
identify and manage emerging risks in relation to HAIs. This
stocktake builds on the paper prepared in February 2012 for the
Director General in relation to HAI. The HAIGG members will add
to the February 2012 paper individually and develop a survey to
provide additional information.
The one pager together with the HAIGG’s TOR will be sent to the
healthcare sector (including private hospitals and rest homes) as
soon as possible followed by the survey in October.
Workforce development and post graduate work and training in
relation to HAIs.
Action Points
i.
The February 2012 internal briefing paper to the Director-General
of Health which describes current activities across the healthcare
sector in relation to healthcare acquired infections be sent to
HAIGG members for updating of content.
ii.
A template for the brief letter to outline the purpose of the HAIGG
be sent to members for their input. (Emma)
iii.
Convene a subgroup of HAIGG (Jane O’Malley, Ruth Barratt, and
Denise Kivell) to prepare information in relation to workforce
development and formal post graduate specialist education papers.
7.
Clostridium difficile
Noted
From the discussion the following points were noted.

The hypervirulent strains of C.difficile predated hand hygiene
messages.

Concern over dual messages (alcohol rubs versus soap and water)
in relation to this organism noting compliance with messages is
presently problematic in some clinical areas.

Work on one message based around the WHO 5 moments for
hand hygiene.

Clean environment is essential and that constrained cleaning
budgets have in some cases lead to infection control issues.

Most of the time patients with diarrheoa are isolated and this
reduces risk around person to person spread.

Varied approaches to laboratory testing and hence not able to
compare positivity rates between district health boards. There is a
need for a consistent approach for testing.
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
Surveillance should be yearly, Clostridium difficile cases made
notifiable, and a testing algorithm defined and agreed nationally.

Need to meet with the MPI to discuss whether the NZ11/21 strain is
in livestock.
Agreed
That a subgroup is convened to describe what needs to be done in
relation to managing Clostridium difficile and the advice to give to the
Director-General of Health. The drafted material will then be reviewed
by the HAIGG.
Advice to be prepared for the Director-General of Health on processes
and Clostridium difficile
Action Point
i.
Convene a subgroup of the HAIGG (Sally Roberts, Arthur Morris,
Hasan Bhally, Virginia Hope) to prepare information on what needs
to be done in relation to managing Clostridium difficile and the
advice to give to the Director-General of Health by November 2012.
8.
Other Business
Creutzfeldt Jakob Disease (CJD)
Agreed
That CJD be an agenda item for the next meeting to discuss the
opportunity for the HAIGG to be helpful to the sector in relation to CJD
incidents.
9.
Next Meeting
The next meeting is scheduled for 20 November 2012.
10. Meeting Closure
The meeting closed at 2pm.
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