Chapter 5
A National Programme for Infection Prevention and Control
Scoping the Priorities for Quality in the Health and Disability Sector
Introduction
This chapter discusses the process and programme to be implemented in the
NZ health and disability sector to improve infection prevention and control in
District Health Boards (DHBs) over the next three years.
The development and implementation of a national programme for infection
prevention and control will focus on three initiatives: implementation of hand
hygiene guidelines, reduction of catheter-related blood stream infections and
surveillance of surgical site infections.
Definitions used Surveillance
in this chapter
The continuous and systematic process of collection, analysis, interpretation
and dissemination of descriptive information for monitoring health problems.1
Immunity
The resistance of a host to a specific agent, characterised by measurable and
protective surface or humoral antibody and by cell-mediated immune
responses.2
Infection
The successful transmission of a microorganism to a host with subsequent
multiplication, colonisation and invasion.3
Healthcare acquired infections
Nosocomial infection
A localised or systemic condition resulting from an adverse reaction to the
presence of an infectious agent(s) not present at the time of admission to the
healthcare facility.4 Nosocomial infections are also referred to as hospital or
healthcare acquired or associated infections.
1
Buchler, J., Ed. (1998). Modern Epidemiology. Surveillance. Philadelphia, Lippincott-Raven.
Mayhall, C. Glen, Ed (1996) Hospital Epidemiology and Infection Control
Wenzel, R. et al, (1998) Infection Control in the Hospital. Ontario Decker Inc
2, 3
4
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Background
Introduction
Healthcare-acquired infections are documented to be a significant problem
worldwide. These include bloodstream infections, gastrointestinal infections
(e.g., the noro and rota viruses), urinary tract infections, surgical wound
infections, respiratory tract infections (e.g., pneumonia) as well as skin and
soft tissue infections. International studies show that on average, 5 to 10
percent of patients will acquire an infection whilst in hospital.
Healthcare-associated infection (also referred to as nosocomial infection)
presents many of the characteristics of a major patient safety problem. It has
multiple causes, relating both to the systems and processes of care provision,
as well as to behavioural practices.
Why is this
priority
important?
Reducing healthcare associated infections has been identified as a priority
because of both the disease burden and the economic burden that these
infections have created.
The disease burden
At any one time, over 1.4 million people worldwide are suffering from
infections acquired in hospital and up to 10% of patients admitted to modern
hospitals in the developed world acquire one or more infections. The only
published estimates in New Zealand are based on data collected at Auckland
District Health Board (ADHB) between 1996 and 1999.5 The pooled results
from Auckland, Green Lane and National Women’s Hospitals showed an
estimated prevalence rate of 9.5 per cent.
The economic burden
Healthcare associated infections in England are estimated to cost ₤1 billion a
year.6 In the United States, the estimate is between US$ 4.5- 5.7 billion per
year.7 The results from the NZ study predict an annual cost for hospitalacquired infection of up to $18.76 million to the ADHB and a national cost of
$136.61 million.8 Surgical site infections:
 account for about 14% of possible adverse events threatening patient
safety in hospitals in developed countries.
 occur in at least 5% of the patients undergoing surgical procedures every
year
 prolong hospital stay on average by 7.4 days, at an average cost of $1000
per day.
5
Graves N. Nicholls TM. Wong CGS. Morris AJ. The prevalence and estimates of the cumulative
incidence of hospital-acquired infections among patients admitted to Auckland District Health Board
hospitals in New Zealand. Infection Control and Hospital Epidemiology. 2003 Jan; 24(1): 56-61. (17 ref)
6
World Alliance for Patient Safety 2005 Global Patient Safety Challenge 2005-2006 World Health
Organisation
7
World Alliance for Patient Safety 2005 Global Patient Safety Challenge 2005-2006 World Health
Organisation
8
Graves N. Nicholls TM. Morris AJ. Modelling the costs of hospital-acquired infections in New Zealand.
Infection Control and Hospital Epidemiology. 2003 Mar; 24(3): 214-23. (49 ref).
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Why is this
priority
important?
(continued)
The importance of this issue in New Zealand has been further highlighted in
the Controller and Auditor-General’s Report in 2003. The Controller and
Auditor-General reported on the management of hospital-acquired infection
in public hospitals in New Zealand and described and assessed systems for
managing these infections in public hospitals.
This report, Management of Hospital-Acquired Infection, comprehensively
examined current infection control procedures in New Zealand public
hospitals. There were several reasons given for the publication of this audit
report:
1. Hospital-acquired infections pose a serious risk to patients and hospital
staff.
2. A significant cost is associated with hospital-acquire infection.
3. Hospital-acquired infections are avoidable.
4. Certification requirements under the Health and Disability Services
(Safety) Act 2001 require providers of health care services to meet the
Infection Control Standard.
The report found that some dimensions of infection control, such as
collaboration between infection control and laboratory staff, are working well.
However, other areas, for example the auditing of infection control practices
in hospitals, require attention. The report outlined 39 recommendations to
improve infection control practices in New Zealand hospitals.
In May 2004, the Health Committee requested a briefing from the Office of
the Attorney General (OAG) and conducted an inquiry into the issue of
hospital-acquired infections. The Health Committee supported the OAG
review and subsequently presented the Report on Inquiry into HospitalAcquired Infection to the House. This report recommended to the
Government that the Ministry of Health work to implement three key
recommendations to improve infection control practice across New Zealand.
These were to:
1. establish a national surveillance system for infections acquired in the
health and disability system
2. set and enforce nationwide standards that apply to the collection of data
on hospital-acquired infection rates and hospital-acquired bloodstream
infection rates
3. ensure comparative data on all bloodstream infections and hospitalacquired infections are posted on the Ministry of Health website and are
updated regularly.
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Why is this
priority
important?
(continued)
On 29 July 2004, the Cabinet Committee approved the Government
response to the Health Committee Report ‘Inquiry into Hospital-Acquired
Infection’ (May, 2004). The Government tabled a response to the Health
Committee on this report, in Parliament, on 4 August 2004. This response
included a directive to the Ministry to submit a report by November 2004
outlining cost-effective options in furtherance of Recommendation 1. Both
the Report of the Controller and Auditor-General and the response by the
Health Committee called for the establishment of a New Zealand-wide
infection surveillance programme. The report of the Office of the Controller
and Auditor General however, primarily focuses on the hospital setting. The
Health Committee and the Legislation Cabinet Committee recognise the need
to extend the inquiry to include all levels of the health and disability system;
primary, secondary and tertiary levels of care.
One further point needs to be made. Failure to comply with hand hygiene is
considered the leading cause of healthcare-associated infections, contributes
to the spread of multi-resistant organisms and is recognised as a significant
contributor to outbreaks of infection. “The potential benefit of successful
hand hygiene promotion outweighs its costs, and widespread promotion
should be should be supported”.9 The excess use of hospital resources
associated with only four or five serious healthcare-associated infections may
equal the entire annual budget for hand hygiene products used in patient care
areas.
An economic analysis of the United Kingdom’s “cleanyourhands” hand
hygiene promotional campaign concluded that the programme would be costbeneficial even if healthcare-associated infection rates were decreased by as
little as 0.1%.10
9
World Alliance for Patient Safety 2005 WHO Guidelines on Hand Hygiene in Health Care: A Summary
World Alliance for Patient Safety 2005 WHO Guidelines on Hand Hygiene in Health Care: A Summary
10
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Review of international action
Introduction
Over the past twenty years there has been a great deal of focus placed on the
control of infections in international health systems. It would appear that the
types of strategies used to address this issue vary for country to country.
Some of these strategies are summarised below.
World Alliance
for Patient
Safety
In October 2004, WHO launched the World Alliance for Patient Safety in
response to a World Health Assembly Resolution (2002) urging WHO and
Member States to pay the closest possible attention to the problem of patient
safety. The Alliance raises awareness and political commitment to improve
the safety of care and facilitates the development of patient safety policy and
practice in all WHO Member States.
Each year, the Alliance delivers a number of programmes covering systemic
and technical aspects to improve patient safety around the world. “Clean Care
is Safer Care” is the title of the current Global Patient Safety Challenge; the
focus is on preventing infection associated with health care.
Hand hygiene remains the primary measure for reducing health careassociated infection and the spread of antimicrobial resistance. A wide range
of hand hygiene programmes is underway around the world. For brief
programme descriptions see Appendix Two. To assist countries to reduce the
burden of health care-associated infection WHO have produced “Guidelines
on Hand Hygiene in Health Care” and recommend the implementation of
these guidelines in all health systems and services.11
The hand hygiene promotion campaign at the University of Geneva Hospitals,
Switzerland, is the first reported experience of a sustained improvement in
compliance with hand hygiene, coinciding with a reduction of nosocomial
infections and multi-resistant Staphylococcus aureus cross-transmission. The
successful strategy included repeated monitoring of compliance and
performance feedback, communication and education tools, constant
reminders in the work environment, active participation and feedback at both
individual and organisational levels, senior management support and
involvement of sector leaders. The promotion of alcohol-based hand rub at
the point of care largely contributed to enhanced compliance. Including both
direct costs associated with the intervention and indirect costs associated with
healthcare workers time, the promotion campaign was cost-effective. The
total cost corresponded to less than 1% of the costs associated with
healthcare-associated infections.
11
World Alliance for Patient Safety 2005 WHO Guidelines on Hand Hygiene in Health Care: A Summary
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World Alliance
for Patient
Safety, cont.
A number of hand hygiene programmes have been conducted in international
health systems. The Clinical Excellence Commission (NSW) has offered to
provide to the New Zealand health and disability sector, all the resources that
they have developed for the hand hygiene strategy in the NSW health system.
Creating High
Reliability in
Healthcare
organisations
Since the landmark reports from the Institute of Medicine (IOM) in 199912
and 200113 that documented that deficiencies in quality and safety of care,
healthcare has turned to “high reliability organisations” e.g. aviation, who
have achieved a high degree of safety or reliability despite operating in
hazardous conditions. Reliability is often presented as a defect rate in units of
ten and generally represents the number of defects per opportunity for that
defect. In healthcare, an opportunity for a defect usually translates to a
population of patients at risk of the medical error or adverse event. To begin
to understand exactly what reliability means in healthcare and how we know
if it is reliable, a study was undertaken at Johns Hopkins University by the
Quality and Safety Research Group to develop a model of reliability focusing
on rate-based measures of safety in a specific clinical area. The model to
improve reliability includes:
 Identifying interventions associated with an improved outcome in a
specific patient
 Selecting interventions that have the biggest impact on outcomes and
convert these into behaviours
 Developing measures to evaluate reliability and
 Measuring baseline performance
 Ensuring patients receive evidence-based interventions.
The rate-based measures of safety that were selected were the standardised
measures for intravenous catheter-related blood stream infection developed
by the National Nosocomial Infection Surveillance System (NNIS).
The project focused first on improving the safety culture in the ICU because
of the belief that this change was necessary before teams could redesign care
and improve reliability. At the start of the study 100 ICUs agreed to
participate the results from 98 ICUs are presented in Table 1 overleaf.
12
To Error is Human: Building a Safer Health Ststem (1999) Institute of Medicine of the National Academies
Crossing the Quality Chasm: A New System for the 21st Century (2001) Institute of Medicine of the National
Academies
13
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Table 1: Catheter-Related Blood Stream Infection Rates per ICU-Month
of Observation by Time Period*
ICU-Months of
Observation (%)
Proportion with
Zero CRBSI
p-value**
Pre-intervention
baseline
203 (23%)
59%
Reference
Peri-intervention
218 (25%)
66%
0.17
0 – 3 months postintervention
193 (22%)
74%
0.002
4 – 6 months postintervention
145 (16%)
74%
0.003
7 – 9 months postintervention
54 (6%)
80%
0.005
Unknown
69 (8%)
75%
0.016
Time Period*
CRBSI = Catheter-Related Blood Stream Infection; ICU = intensive care unit
* Time period is measured in relation to implementation of the CRBSI
intervention
** p-value for comparison with the proportion of ICU-months with zero
CRBSI at pre-intervention baseline using two-sample test of proportion.
_____________________________________________________________________________________________
Creating High
Reliability in
Healthcare
organisations,
cont.
Dr Lucian Leape in his key note address at the Australasian Conference for
Safety and Quality in Health Care in August 2006 reported the continuing
improvements in 68 Michigan ICUs. Between March 04 – June 05 these ICUs
had reported no catheter-related blood stream infections for more than six
months. These results represent savings of:
 1578 lives
 81,000 hospital days
 $165 M
In intensive care, health care-associated infection affects about 30% of
patients and the attributable mortality may reach 44%.
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National
Surveillance
Systems
Surveillance of infections is one of the most important functions of a hospital
infection control programme. Conventional nosocomial infection surveillance
has relied on ward rounds, reviews of medical charts and paper based reports
of microbiologic results. Many countries have introduced national
surveillance systems that consist of:
 local action to collect and report infection data,
 local action to reduce infections
 national reporting of infection data
 nationally co-ordinated action to further reduce infections.
The most established and respected surveillance system for healthcareacquired infection is the National Nosocomial Infection Surveillance System
(NNIS) in the United States. NNIS incorporates all of the requirements of an
efficient surveillance system and has also shown a return on the original
investment. Reports from NNIS indicate that over the past decade, infection
prevention programs and surveillance systems have decreased the incidence
of nosocomial bloodstream infections by between 31 and 44 per cent.14
Infection identification in the United Kingdom is laboratory-based for
bloodstream infections and ward-based for surgical site infections and urinary
tract infections. The main difference between this system and others is that it
utilises a 24-hour post-hospitalisation determination for infection rather than
the standard 48 hours.
The New South Wales (NSW) Department of Health (DoH) has introduced
the Infection Control Program Quality Monitoring system. In 1998, a
surveillance project funded by the NSW DoH was piloted throughout 10
public hospitals. The surveillance system used NNIS definitions for the
surveillance of hospital-acquired infections. NSW Health and the Australian
Council on Healthcare Standards (ACHS) jointly developed a mandatory
system and a methodology for collecting and reporting data. The pilot
programme has since been mandated for over 200 hospitals throughout NSW.
Reports are used to evaluate and improve infection control programs,
practices and policies. The data are collected every six months and the
aggregated data are reported on the NSW Health website.15
A review of national surveillance is summarised in Appendix Three.
14
15
Association for Professionals in Infection Control and Epidemiology,( 2002)
www.health.nsw.gov.au
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Progress in the New Zealand Health and Disability Sector
Policy
directives or
strategies to
date
Infection prevention and control programmes have been in existence in various
forms within most New Zealand public hospitals for more than 20 years. A national
surveillance system has already been established for monitoring bloodstream
infections. However it is only within recent times that an appropriate framework
has been established that allows for the effective functioning of such programmes.
The legislative environment that has been established since 2000 emphasises
patient safety, effectiveness and quality improvement, which are integral to
infection prevention and control.
In 2000, a New Zealand standard (NZS 8142: 2000 Infection Control) was
released to provide guidance on how to reduce the spread of infection within New
Zealand healthcare facilities. This standard aims to facilitate consistently safe and
high quality service delivery by identifying principles designed to reduce the rate of
infection in the health and disability sector.
The Health and Disability Services (Safety) Act 2001 requires Designated Audit
Agencies (DAAs) to audit healthcare facilities in order to measure compliance
against the NZS 8142:2000 infection control standard. All New Zealand healthcare
providers that are covered by this Act have been audited within the last two years.
The findings from these audits demonstrate the considerable variability of infection
prevention and control systems in DHB hospitals and importantly the extensive
variability of surveillance of healthcare acquired surgical site infection and the lack
of surveillance of procedure related healthcare acquired infections.
There are several factors that increase the risk of patients acquiring a bloodstream
infection. These factors include the number of intravenous or intra-arterial lines
(“drips”/intravenous catheters) patients have (the greater the number of lines, the
higher the risk). Another factor is the status of a patient’s immune system
The Ministry of Health collects data on blood stream infections for Hospital
Benchmark Information purposes from secondary and tertiary DHBs. Both tertiary
and secondary DHBs provide services to the people in their districts, but tertiary
DHBs are generally larger and provide specialist services to secondary DHBs.
Six DHBs are identified as having tertiary status for the Hospital Benchmark
Information (Auckland, Counties Manukau, Waikato, Capital & Coast, Canterbury
and Otago) being expected to report higher Hospital Acquired Bloodstream
Infection rates. For Hospital Benchmark Information purposes, it may be
appropriate to also classify MidCentral as a tertiary DHB because, as a cancer
centre, it provides tertiary services.
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Policy
directives or
strategies to
date, cont.
The criteria for hospital acquired bloodstream infections used to calculate the rate
for the Hospital Benchmark Information report are:

a blood test more than 48 hours after admission to hospital shows an infection

there is no evidence the infection was present on admission (unless the patient
had been in the same hospital recently)

when blood tests show bacteria normally found on skin, two tests are required
to confirm there is an infection (unless a clinician deems there is a
bloodstream infection, in which case one test is enough).
infections/inpatients
%
Hospital Acquired Bloodstream Infection rates–all DHBs:
These results demonstrate the potential for improvement from implementing a
programme similar to the Michigan hospitals programme.
In 2002, guidance on microbiological surveillance of endoscopes and
recommendations for cleaning and disinfection were developed and published.16
This was in response to concerns about the potential transfer of bacterial or viral
infection by endoscope and cases of transmission of infection between patients via
a flexible hollow endoscope and the subsequent recall of patients. The
implementation of this surveillance programme by DHBs has reduced the numbers
of patients who require recall. This has resulted from the number of treatments with
endoscopes that culture positive, falling from thousands in 2002 to single figures in
2005.
On 29-30 September 2006 the World Health Organization (WHO) held a meeting
in Geneva for Commonwealth Fund countries to discuss the WHO’s Action on
Patient Safety (High 5s) initiative. The Deputy Director-General, Clinical Services
Directorate attended to represent Australia and New Zealand.
16
Microbiological Surveillance of Flexible Hollow Endoscopes SNZ HB 8149:200.
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Policy
directives or
strategies to
date, cont.
The WHO identified a number of patient safety issues, including those related to
medication, infection and communication between different health providers as
well as between health providers and patients. The five issues agreed on for further
work were:
 Handwashing, using recently published WHO guidelines
 Hand-off communication
 High concentration medications
 Medication reconciliation
 Wrong site / wrong procedure / wrong person surgery, including
patient identification.
New Zealand is interested in four of the WHO priorities:
 Handwashing, using recently published WHO guidelines
 Hand-off communication
 High concentration medications
 Medication reconciliation.
WHO is looking for each country involved in the “High 5s” to select up to 10
hospitals to work on up to five issues selected from a list prepared by WHO. The
list is yet to be confirmed but it is anticipated that all four of the issues most
relevant to New Zealand (as listed above) will be included in the list.
The Ministry and DHBs will work together to determine which hospitals (if not all)
and initiatives are most appropriate when WHO has confirmed the list of issues and
how initiatives are to be monitored. The WHO is planning a press event in London
in early December 2006 to announce the Action on Patient Safety (High 5s)
initiative.
Implementation of a national surveillance programme in New Zealand has been
seriously considered and examined by the Ministry since 1996. In the early 1990s,
HAISS (the ‘hospital-acquired infection surveillance system’) was proposed and in
the late 1990s a national surveillance programme with the acronym ‘RISK’
(reducing infection through surveillance and knowledge) was proposed as a joint
venture between Alexander and Alexander, the Institute of Environmental Science
and Research and Medlab South. Initial development of both systems involved
computer software designed by the Institute of Environmental Science and
Research. HAISS allowed for surveillance of non-traumatic surgical wounds
throughout hospitals and for intensive care unit-based surveillance of pneumonias,
bloodstream infections and urinary tract infections. However, both of these
previous proposals were deemed cost-prohibitive at the time.
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Policy
directives or
strategies to
date, cont.
A recent survey of DHBs which was undertaken to identify activity that
relates to the six priorities for quality has revealed that a number of DHBs are
working on various aspects of infection prevention and control.
Strategies that were identified through the survey include:





Northland DHB: has developed infection control link nurses in each
ward/department and a programme of monitoring of intravenous sites.
Auckland DHB: measure blood stream infection rates six monthly in ICC
Wairarapa DHB: has provided education sessions on the use of personal
protective equipment to hospital services and some community providers
Counties Manukau DHB: has implemented a Multi Resistance
Taskforce; undertaken targeted surgical site surveillance; hand washing
programmes and ongoing compliance to Infection Control Standards.
Otago DHB : implementation of hand gels throughout the organization in
association with a 'Keep your dirty hands off me" campaign.
These survey results do not fully represent the extent of activity in DHBs in
infection prevention and control but do confirm that the need for a nationally
programme to progress reduction in healthcare acquired infections through
improved hand hygiene, reduction in blood stream and surgical related
infections
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The recommended programme scope
Introduction
This section of the report provides the details of the intended approach to
improving infection prevention and control and in the health and disability
sector.
The proposed programme will provide an ongoing implementation plan for
the New Zealand Standard for infection control and a mechanism for
implementing and assuring compliance with the recommendations made by
OAG in their Report on Inquiry into Hospital-Acquired Infection to the
House.
As stated earlier in this report these recommendations were to:
 establish a national surveillance system for infections acquired in the
health and disability system;
 set and enforce nationwide standards that apply to the collection of data
on hospital-acquired infection rates and hospital-acquired bloodstream
infection rates;
 ensure comparative data on all bloodstream infections and hospitalacquired infections are posted on the Ministry of Health website and are
updated regularly.
The proposed strategy will demonstrate and implement the New Zealand
Health and Disability Sector’s commitment to the Global Patient Safety
Challenge that has been established by the World Alliance for Patient Safety.
This programme will be catalysed by New Zealand joining the international
Global Safety Challenge and committing to implementing actions to improve
the safety of healthcare by reducing healthcare acquired infections.
Programme
objectives
The Primary Objectives of the Infection Prevention and Control Programme
will be
1. to reduce healthcare acquired infections in District Health Board
services.
2. to provide a system of national surveillance of healthcare acquired
infections so that continuous improvement can occur.
The Secondary Objectives will be to:
 decrease procedure and surgical site infection rates
 decrease catheter-related blood stream infections
 increase patient empowerment to undertake their role in preventing
infection
 implement surveillance and IT to support data collection
 improve the safety culture.
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Scope summary
The programme has three main components:
1. Surveillance of procedure-related and surgical site infections.
2. Implementation of a Clean Care is Safer Care (hand hygiene)
Programme (including the use of alcohol hand rub)
3. Intravenous catheter sepsis intervention
Component 1 must take first priority. The surveillance system will enable the
measurement of success of the other two components. The second component
should however be commenced shortly after the commencement of the
implementation of the surveillance system and component 3 could be delayed
for 12 months if necessary.
All components should be developed and implemented over 24 to 36 months.
Together they will form the basis of an ongoing national infection prevention
and control system for New Zealand that can be extended beyond DHBs to all
health and disability providers.
COMPONENT 1
COMPONENT 2
36 months
SURVEILLANCE
SYSTEM
HAND HYGIENE
“Talking wall” strategy
Alcohol hand rub
Consumer empowerment
strategy
NSW / ACHS surveillance
system
Policy development
Education
COMPONENT 3
IV SEPSIS
Ongoing
Modified Breakthrough
programme for ICUs
Exclusions
Ongoing national
infection prevention and
control system
Private hospitals and clinics, community services will be excluded.
Community acquired infections will not be included in any of these three
components.
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Component 1:
National
Surveillance
Programme
This programme proposes utilising the already-established NSW infection
surveillance programme in New Zealand. This could be achieved in one of
two ways. Either:
1. the implementation of the New South Wales definitions and methodology,
or
2. deploying the complete system.
Whilst the major benefit of the surveillance system is that local rates and
improvement can be measured and monitored, the latter option would also
allow institutions to compare infection rates with those from similar-sized
institutions throughout New Zealand and NSW and to learn from the best
performers in both health systems.
The NSW Healthcare-Associated Infection Surveillance System is a
mandatory reporting system that was introduced in January, 2003. It now
involves 271 hospitals in New South Wales. NSW Health and the ACHS
jointly developed the Infection Control Program Quality Monitoring
methodologies for infection control practitioners to collect and report clinical
indicator data relating to healthcare-associated infections in NSW public
health organisations. The indicators were selected following consideration of
morbidity, cost, preventability and transmission risks. They also reflect the
current priority areas for the NSW state infection control programme and
policy development.
Each component of the Infection Control and Prevention Programme will use
these infection clinical indicators to measure and understand the system
baseline, to monitor infection rates and to track progress and demonstrate
improvement.
Implementation of the NSW system will involve;
 Negotiating the purchase of the system
 Developing national policy to support the system. Policy priorities could
include matters such as:
o Identifying which indicators need to be collected
o national reporting requirements
o how definitions of the indicators should be interpreted
o how data are to be used localy to achieve improvement
o how data will be used nationally to further enhance improvement
 Amending the NSW system to accommodate NZ requirements
 Piloting the system in approximately 4 organisations
 Developing and implementing an education programme for appropriate
staff, including infection control staff, in all DHBs, to ensure the most
effective use of the system
 Implementing the system across all DHBs.
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The Ministry will be responsible for
Action required 1. Procurement and distribution of surveillance software
at levels of
2. Development and distribution of national policy
organisation
3. Development of a nationally coordinated implementation plan
4. Oversight of implementation including with EpiQual
5. Development and delivery of the education and training programme
Component 1:
The DHBs will be responsible for
1. Software implementation
2. Reviewing infection control policy and procedures to incorporate national
surveillance requirements
3. Implementation of surveillance
4. Developing DHB level implementation plan that reflects supports that
national imitative
5. Local project management resource
6. Collecting data required to measure improvement and project progress
7. Leading, guiding and supporting the programme.
Pilot site
enrolment
It is proposed that a number of DHB hospitals initially be engaged to
participate in the collection and submission of data on the four NSW
mandatory indicators
 central line associated bloodstream infections
 multi-resistant organisms
 at least one procedure specific surgical site infection
 occupational exposures that present a risk of transmission of bloodborne disease).
The purpose of the pilot will be to assess and ensure the applicability of the
indicators, to identify and address and indicator definitional or data collection
problems.
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Component 2:
Hand hygiene
Participating in the proposed WHO’s Action on Patient Safety (High 5s)
initiative will enhance the infection prevention and control programme by:
 Acknowledging nationally and internationally the importance of
healthcare-associated infection
 Sharing experiences and available surveillance data
 Supporting the implementation of the hand hygiene guidelines
 Making reliable information available at the district and national levels.
This component of the programme will consist of three key strategies
1. A “talking wall” strategy. This is essentially an awareness campaign that
consists of the use of posters that contain messages that encourage
healthcare providers to attend to hand hygiene. The posters have been
developed by behavioural psychologists who have determined the most
effective messages to put in the posters. The Clinical Excellence
Commission in NSW has recently launched their “talking wall” strategy
and has offered to provide the MoH will any assistance including posters
to use in NZ.
2. The second component is the supply and use of alcohol rub product in
patient locations. Alcohol rub has been scientifically proven to be better
than soap for reducing the number of organisms on a person’s hands. It is
being recommended for use in many international health systems. A plan
for the efficient and cost effective procurement of such products will be
part of the implementation process.
3. Component 3 comprises the engagement of consumers in the hand
hygiene strategy. The purpose of this is to empower consumers; patients
and their families and carers to question health care providers about
whether they have washed their hands and to ask them to do so if they
haven’t.
The success of this programme should be measured through
 overt observation methods
 calculation of the volume of product that is being used, as the volume of
use relates directly to the reduction in infections
 the surveillance system and the rate of infections reported
 surveys of staff and patients about awareness of the need for hand
hygiene.
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Scoping the Priorities for Quality in the Health and Disability Sector
Component 2:
Action required
at levels of
organisation
The Ministry will be responsible for:
1. Processes required to join the WHO Global Challenge
2. Development of a nationally coordinated implementation plan
3. Oversight of implementation with EpiQual
4. Development of patient resources and patient awareness campaign
5. Developing a procurement plan for purchase and distribution of alcoholbased hand rub gel.
The DHBs will be responsible for:
1. Participation in the campaign
2. Distribution of patient resources
3. Collection data required to measure improvement and project progress
4. Procurement and distribution of alcohol-based hand rub gel to ensure
supplies are readily available in all health care settings
5. Development of a DHB level implementation plan that reflects supports
that national imitative
6. Provision of a local project management resource
7. Leadership, guidance and support for the programme.
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Scoping the Priorities for Quality in the Health and Disability Sector
Component 3:
IV catheter
strategy
The programme that is proposed for the reduction in intravenous catheter
sepsis is a Breakthrough series with Intensive care units across the country.
It is proposed that this be run over a nine month period and not commenced
until approximately January 2009. This will allow time for the previous two
components of the nation infection programme to be bedded down.
Component 3:
Action required
at levels of
organisation
The Ministry will be responsible for
1. Development and co-ordination of the collaborative processes
2. Oversight of implementation with EpiQual
The DHBs will be responsible for
1. Developing DHB level policy that reflects national policy and supports
the improvement process
2. Reviewing infection control policy and procedures to incorporate
collaborative requirements
3. Implementing evidenced-based practice
4. Participating in the collaborative and providing local project management
resource
5. Collecting data that are required to measure improvement and project
progress
6. Leadership, guidance and support for the programme
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Scoping the Priorities for Quality in the Health and Disability Sector
References
Bibliography
Association for Professionals in Infection Control and Epidemiology (2002).
Presentation to the Institute of Medicine.
Association for Professionals in Infection Control and Epidemiology (2004).
National Conference, Phoenix, Arizona.
Ayliffe, G. and English M. (2003). Hospital Infection: from miasmas to
MRSA. Cambridge, University Press.
Centers for Disease Control and Prevention (CDC) (2001). "Updated
guidelines for evaluating public health surveillance systems:
recommendations from the guidelines working group." MMWR 50: 13-24.
Edmonds, M., Ed. (2004). National and International Surveillance systems for
Nosocomial Infections. Prevention and Control of Nosocomial Infections, 4th
edition. Philadelphia, Lippincott Williams & Wilkins.
McLaws, M., Murphy, C., Whitby, M. (2000). "Standardising surveillance of
nosocomial infections: The HISS program." Quality Clinical Practice 20: 611.
National Audit Office (2004). Improving patient care by reducing the risk of
hospital acquired infection: A progress report: Report by the Comptroller and
Auditor General HC 876 Session 2003-2004:14 July 2004. UK: National
Audit Office.
Wenzel, R. (1997). Prevention and Control of Nosocomial Infections, 3rd
Edition. Baltimore, Williams and Wilkins.
Wenzel, R. (2004), Prevention and Control of Nosocomial Infections, 4th
Edition. Philadelphia, Lippincott Williams & Wilkins.
World Alliance for Patient Safety (2005), Global Patient Safety Challenge
2005-2006, World Health Organisation, Switzerland
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