11/16/20161 Infection Prevention & Control: It’s everyone’s business! James Robertson CNS IP&C

11/16/20162 Is health care associated infection a big deal?  10% of inpatients will acquire an infection  Estimated cost in NZ’s public hospitals >$250,000,000 annually  1% of all deaths  Patients who are admitted with an infection are 11times more at risk of developing a HCAI

11/16/20163 The most common reasons for an ACC treatment injury claim

11/16/20164 A closer look at pathogens

What precautions do we undertake every day?  Standard Precautions  Transmission based Precautions

What are Standard Precautions?  They were designed to combat blood borne viruses  They apply to ALL patients  They are the minimum precautions undertaken and are used in conjunction with transmission based precautions  Includes environmental management

11/16/20167 Standard Precautions Hand hygienePersonal Protective Equipment Clinical waste Body fluid spills Clean environment Sharps safety Linen Accommodation Single use equipment Cough/Resp etiquette

11/16/20168 Their life in your hands!

11/16/20169 Hand Hygiene

11/16/ Nothing new to this...  Semmelweis  1843 Holmes  1854 Florence Nightingale  1867 Lister

11/16/ Florence Nightingale Crimean war 1854:  Death rate British soldiers >50%  Sanitary measures reduced it <3%  “...in all probability the poor sufferer would have had a better chance of recovery if treated at home.”

11/16/ Semmelweis’ Hand Hygiene Intervention Adapted from: Hosp Epidemiol Infect Control, 2 nd Edition, 1999.

11/16/ Hand Hygiene; A global mission A major international project endorsed by the World Health Organisation. Running with great success across the globe. Driven locally by HQSC as part of the Infection Prevention and Control programme:  Catheter Related Blood Stream Infections  Surgical Site and Procedure Infections  Hand Hygiene

11/16/ Why the need to change?  International compliance %  The old approach was clearly not working

11/16/ What’s new?  A structured approach to raising compliance in Hand Hygiene  Compliance reported every 4 months to Hand Hygiene New Zealand  Based on “Your 5 Moments for Hand Hygiene at the point of care”

11/16/ Your 5 moments for hand hygiene at the point of care* *Adapted from the WHO Alliance for Patient Safety 2006

11/16/ Hand Hygiene CCDHB  November 2009 Baseline 25% compliance  March % compliance

11/16/ What now.. and future goals The goal is to change Hand Hygiene culture in our organisation.  HQSC goal >80%  Ongoing audit activity and reports  Reduce Healthcare Associated Infection

Why do we use transmission- based precautions?  Mitigate the risk of transmission  Protect the vulnerable  Environmental control  Determine behaviour

What do we isolate?  Any known or suspected infectious disease  Any known colonisation of a significant organism  Any patient who is at a high risk of developing an infection

Transmission-based Precautions  Contact precautions  Droplet precautions  Airborne precautions  Protective precautions

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Specimens and the Lab Form  What is the question you wish to have answered by the laboratory?  Is the specimen of an appropriate quality?  Does the form identify the patient?  Clinical history including the specimen, the site, description, current antibiotic information, travel history etc...  You can never give too much information and all too often there is no where near enough!

What’s the organism?

11/16/ Clindamycin Erythromycin CotrimoxazoleCiprofloxacinChloramphenicolMupirocinRifampicinTetracycline Fusidic acid Gentamicin Is the organism resistant?

11/16/ MDRO(h)!!!!!!!

11/16/ Resistance

11/16/ Many Thanks Any Questions?