Recommendations

Management of Hospital-acquired Infection.

The Framework for Infection Control

The Ministry should review the administration of its expert advisory groups relating to infection control, to enable the groups to be fully effective.
In consultation with DHBs, the Ministry should review the way it collects and feeds back data on bloodstream infections, to make such data more reliable and consistently available.
The Ministry should work with ESR⁹ and DHBs to establish a timetable and project plan for setting up national surveillance of hospital-acquired infection along the lines indicated in paragraph 2.42 on page 49.

District Health Board Governance

The Ministry should continue its actions to improve DHBs’ monthly risk reporting, with particular emphasis on consistent reporting so that all risks, and measures to mitigate them, are reliably identified.
DHB Boards should receive regular information on rates of hospital-acquired infection and the operation of infection control systems. They should also receive periodic reports on their hospitals’ progress towards meeting the Infection Control Standard.
DHB Boards should consider using their Hospital Advisory Committee to help them oversee infection control.
DHBs should specify infection control services (including periodic reporting) in service agreements with their hospitals.
DHBs should specify in their annual and strategic plans how they intend to give effect to the Ministry’s priorities relating to the prevention and control of hospital-acquired infection.
DHBs should set out in their plans a timetable for achieving certification, and report to their communities on progress made by their hospital services and other health care service providers towards meeting the statutory deadline.
DHBs should obtain views from their communities on the assurance they want on hospital-acquired infection. DHBs’ reporting should take account of these views and any local circumstances that affect the practicality of reporting, such as patient numbers. Periodic reporting (either in the DHB’s annual report or another appropriate vehicle) might, for example, provide information on:

rates and types of hospital-acquired infection and comparisons with previous periods, with brief explanations of trends;
summaries of the management of any prolonged infection outbreaks that occurred during the period; and
planned actions to address any identified concerns.

How Infection Control Is Organised and Managed

Hospital services should ensure that all relevant hospital managers are assigned infection control responsibilities – including clinical leaders and managers with responsibility for risk management and quality assurance.
Hospital services should make long-term plans for infection control in the context of meeting the Infection Control Standard by October 2004.
Hospital services should consider establishing separate infection control budgets, having regard to the benefits and drawbacks in terms of priorities for resource use, transparency, independence, and capability.
Hospital General Managers (or their equivalent) should monitor resources applied to infection control.
Hospital services should review the way in which infection control staff spend their time, to ensure that key activities – such as surveillance, monitoring hospital hygiene, and audit – receive the appropriate attention.
In consultation with the Ministry, DHBs and hospital services should design a model to help determine the appropriate level of resources applied to infection control. The model should take account of all relevant factors – such as bed numbers, bed occupancy, complexity of medical and surgical procedures and associated technology, and patient mix.
Hospital managers should consider assigning additional clerical support to infection control practitioners, thereby leaving the practitioners free to carry out the wide range of tasks that require their infection control expertise.
Hospital services should periodically review whether their infection control resources are adequate, and look for ways of increasing resources where such additional expenditure is shown to be cost-effective.
Hospital managers and staff should make use of the infection control audit tool (published by Standards New Zealand as a companion document to the Infection Control Standard).

Relationships Between Infection Control and the Rest of the Hospital Service

Hospital services should ensure that:

their infection control committee includes representation from occupational health and the hospital pharmacy; and
members attend committee meetings on a regular basis, to help ensure that discussions draw on the full range of views and experience.

Infection control committees should consider producing an annual report of their activities and plans, to help maintain the profile of the infection control service and to keep staff and managers informed of infection control issues.
Hospital services should consider the merits of putting in place a network of infection control representatives (or review the effectiveness of the existing network), having regard to both potential benefits and the obstacles to making best use of the network.
Hospital services should use a risk-based approach for their infection control planning, and integrate infection control into their quality assurance and risk management programmes.
Hospital services should ensure that the activities of occupational health and infection control are well co-ordinated, and that the two groups collaborate in the interests of patient and staff safety.
DHBs should specify in their service agreements with hospitals the role of the Medical Officer of Health as a public health link between the hospital and the community on the management of hospital-acquired infection.
Hospital services that do not yet have arrangements for their laboratories to report notifiable diseases directly to the Medical Officer of Health should consider the need to put such arrangements in place.
The infection control team should be consulted when changes to the hospital environment (including contracting of services) are proposed.

Setting Infection Control Policies, Educating People to Follow the Policies, and Making Sure They Do

Hospital services should review the scope of their infection control policies, procedures, and practices, to ensure that they cover all relevant activities.
The Ministry should consider establishing a working party to review information on overseas practices and developments on the re-use of items intended for a single use, with a view to providing timely guidance to DHBs.
DHBs should explore using the Health Intranet maintained by the Ministry to facilitate communication and collaboration, and to share educational material and information on policies, procedures, best practice, and local initiatives.
Hospital services should:

ensure that all hospital staff – including doctors and support services staff – receive training in infection control when they join the hospital; and
provide refresher training to all relevant staff to maintain awareness and encourage compliance with standards.

Hospital services should treat auditing compliance with infection control policies and procedures as a core quality assurance activity, and ensure that their infection control teams are adequately resourced to spend the necessary time on this work.
Hospital services should consider the need to review how well the infection control team and the hospital pharmacy are working together to ensure compliance with antibiotic policies.
Infection control teams should be involved in the design and conduct of clinical audits (as members of the audit team or indirectly through consultation or discussion) to ensure that such audits have regard to infection control risks associated with clinical facilities and processes, and to identify opportunities for improvement in infection control practices arising from audit findings.

Screening and Surveillance to Identify Hospital-acquired Infection

In consultation with DHBs, the Ministry should draw up guidance on how and to what extent surveillance data should be collected.
Infection control teams should review how reporting of surveillance data to quality/risk managers and clinical staff can be improved.
Hospital services should put in place systems to help them identify patients re-admitted with a hospital-acquired infection.
Hospital services should review the adequacy of their arrangements for isolating patients.

Managing Outbreaks of Hospital-acquired Infection

Hospital services should ensure that reports on the management of outbreaks are distributed widely to all hospital managers responsible for taking action to prevent and control hospital-acquired infection and minimise future risk.

9: ESR is the Institute of Environmental Science and Research Limited, a Crown Research Institute specialising in environmental and public health, and forensic science.

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