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Minutes

Healthcare Associated Infections Governance Group (HAIGG)

Date: Monday 9 December 2013
Time: 09:30- 3:30pm
Location: Ministry of Health, 1 The Terrace, room 2-08
Chairs: Jane O’Malley, Don Mackie
Attendees: Arthur Morris, Deborah Williamson, Chris Mckenna, Margaret Wilsher, Sally Roberts, Hasan Bhally, Viv McEnnis (delegate of Ruth Barratt), Noeline Whitehead, Grant Storey Ryan McLane (MOH secretariat), Geoffrey Roche (MoH secretariat).
Item / Notes
1 / Review of the minutes of the teleconference of 6 November 2013
One small change was noted for the minutes of the meeting of 6 November 2013 (the word ‘antimicrobial’ to be rendered as a single word on page 2, 3rd bullet point). The minutes were otherwise set as correct.
2 / Review of the action points.
A revised Action Point list is attached to these Minutes.
It was noted that, for subsequent tracking of action points, each would be assigned a permanent number (‘action tracker’) that would be retained until completed. Action points from the last meeting were discussed as follows.
  • 13/1: Comment and Discussion on District Health Board (Infection Prevention and Control) IP & C Capabilities
In a recent meeting of CMOs it was noted that it would be useful for DHBs to know who the high performing DHBs are, so as to identify where to obtain advice. The DONs were provided the same aggregated data.
It was noted that clinical leaders need to be linked in such a way as to not give the impression that the HAIGG is doing the work of HealthCERT.
It was noted that there may be an issue with establishing a national framework for IP & C across all DHBs, given the lack of a legal framework empowering this.
It was noted that cross- DHB collaboration was essential given the non- localised nature of the threat of HAI.
It was noted that legal work ought to be done to make it as easy as possible to adopt surveillance strategies and work in collaboration.
Co-chairs will continue this discussion (on IP& C coordination across DHBs) with clinical leads around New Zealand, in particular on the IP & C Standards, what activity is taking place on their implementation, what is being done concerning assurance, and on regional, geographic and demographic variances and relationships.
Co-chairs willalso continue to liaise with clinical lead groups (COMs, DONs and DHAs) and Marion McLauchlan on IP & C work in DHBs.
  • 13/2: Letter to DHB laboratories
This letter has been circulated for internal review but has not yet been sent out to DHB laboratories.
  • 13/3: SHEA Guidelines for CDI
There was discussion as to the applicability of the Society for Healthcare Epidemiology of America (SHEA) guidelines to New Zealand DHBs. It was noted that Waitemata DHB has been using these guidelines for approximately a year.
The Ministry of Health Communicable Diseases Team is working with ESR to develop scope and definition for CDI surveillance, and will present to the HAIGG when ready.
Agreed:
the Ministry of Health will take the lead to discuss with ESR taking into account the SHEA Guidelines.
Actions:
HAIGG secretariat to add acute care to the agenda for the next HAIGG face to face meeting(13/12).
  • 13/4: Antimicrobial Resistance (update on antimicrobial resistance surveillance activities) – see details below under Agenda Item 5.
  • 13/5: Sampling Periods
An earlier action point that called for DHBs to be consulted on the possibility of a certain number of samples sent to ESR for surveillance. This action point is completed, as this work is already common practice.
  • 13/6 Strategic Plan – see details below under Agenda Item 3.
  • 13/7: Schema (Flow diagram illustrating Healthcare Associated Infection Management in New Zealand)
The schema diagram illustrating healthcare - associated infection management in New Zealand was discussed. It was asked whether it ought to be circulated and discussed with HQSC and ESR, so as to test the HAIGG’s understanding of the HAI management system in New Zealand.
Agreed:
  • that the schema diagram is a useful description of relevant entities and their relationships
  • that the schema diagram be circulated to key stakeholders for discussion after further review.
Actions:
Geoffrey Rocheto resend a revised version of the schema (with corrected formatting) to the HAIGG for further review, feedback due by 30 January 2014 (13/13).
  • 13/8: MDR TB Report
DHBs need to work across regions and nationally to rationalise allocation of resources to address MDR TB. It was suggested that a clinical network was insufficient to address the issue alone. Also discussed was the legal requirement of retaining patient privacy, which poses a problem for sharing information on individual cases.
To address this issue, it was suggested that Public Health Units become involved, and that the Ministry of Health distribute letters advising DHBs of the need to follow guidelines.
Delayed delivery of specimens was also a noted problem.
It was also recommended that HAIGG aligns with NZ Immigration, given that immigration assessment is considered“patchy” and it is uncertain whether guidelines are always followed. It was noted that the most likely vector for MDR –TB was an inbound airliner.
Actions:
Lisa Oakley will provide an update at the next HAIGGmeeting on MDR TB management(13/8).
Lisa Oakley is working on developing a clinical network that is able to address issues such as MDR TB (13/8).
  • 13/9 Consumer Representative for the HAIGG

Jane O’Malley is currently discussing this matter with HQSC.
  • 13/10: CDI Algorithm
An algorithm and implementation guide will be created based on the revised standard, and the standard, algorithm and guide will be posted on the Ministry website. This work is underway and will be completed in 2014.
  • 13/11 HQSC role of the HAIGG; report back on the meeting of 6 December 2013 (MoH, ESR, HQSC)
It was noted that the purpose of the meeting on 6 December 2013 was to ensure that HQSC and HAIGG are working collaboratively, and to discuss respective work plans and goals. The table below summarises respective work areas.
A subsequent meeting is scheduled for 19 December to discuss IT implementation issues; HQSC would like fuller disclosure of HAIGG work plans. Deborah Williams has proposed to HQSC a meeting at ESR premises. It was also suggested that HQSC and HAIGG align their inputs with IPC Health and Disability Standards.
HQSC / HAIGG / ESR
CLB
SSI
Hand Hygiene
IC- Net
Quality Improvement
Capacity Building / Integration / Systematic surveillance
EpiSurv
Actions:
HAIGG secretariat to schedule a follow- up meeting at co- chair level with HQSC prior to the 14 February 2014 face to face meeting (13/11 repeats)
3 / Strategic Planning: Review and Agreement
Attached to these Minutes is a revised strategic plan document for comment by the HAIGG by 20 January 2014.
Agreed:
  • ‘Key stakeholders’ are to be added the Strategic Plan, including ACC and MPI, NGOs (including the private hospital sector) and aged and primary care sectors
  • Have key players agree to the first phase of the Strategic Plan, so as to establish a platform for further work.
Actions:
HAIGG members to provide comment on the revised Strategic Plan document to the HAIGG secretariat by 20 January 2014(13/14).
HAIGG secretariat to have the revised Strategic Plan ready for agreement by the HAIGG at the face to face meeting on 14 February 2014 (13/15).
Ryan McLaneto cross- reference the Strategic Plan with the Terms of Reference(13/16).
HAIGG secretariatto begin the process of revising the Terms of Reference to address the assurance role; that is, to clarify that the HAIGG needs to know that the health system is ready to address whatever HAI issues arise(13/17).
HAIGG secretariatto provide an additional bullet point to the Strategic Plan regarding further work on respiratory infections and antibiotics (13/18).
4 / IP & C Standards, audit process, drafting and review. (Krysta Ardern, Policy, Ministry of Health)
Krysta Ardern, Policy Analyst (Policy, Strategic Priorities), outlined the process for the next stage in the revision of the Health and Disability Standards of which IP&C is one category,and how to engage with this part of the review process. It was noted that the Ministry of Health is responsible for reviewing the Standards at least once every four years. Objectives of this stage of the review are to explore options to improve structure, underlying purpose, alignment with best practice, and relevancy of the standards. A modular approach, with sub- sections for specific work environments, is being considered.
The Ministry has already spoken with HQSC and ACC but wishes also to engage with sector and consumer groups. A Health Report is currently in preparation; this goes to ministers for approval before finalisation of the approach to be taken to the revision of the detailed standards themselves.
It was recommended that the HAIGG provides commentary early in the new year.
Discussion
It was noted that it is difficult to blend auditable standards with aspirational goals in standards; minimal standards “ensure quality assurance, not quality improvement.”
5 / Institute of Environmental Science and Research (ESR) Antimicrobial Resistance (AMR) Surveillance and Activities- Update (Deborah Williamson) (work done by ESR but under contract to the Ministry of Health)
Deborah Williamson outlined enhanced AMR surveillance that ESR is undertaking on behalf of the Ministry across five work areas scheduled for 2014 and 2015, as discussed and planned with the Communicable Diseases Team, Ministry of Health. Enhanced surveillance activities are:
  • Staphylococcus aureus surveillance, to obtain contemporary data on the resistance of S.aureus isolates in New Zealand (S. aureus was last surveyed in 1999)
  • Neisseria gonorrhoeae surveillance, to provide a national update on antimicrobial resistance among gonococci
  • analysis of clinical ESBL- producing Enterobacteriaceae, to provide information on the susceptibility of an extended range of antibiotics.
Reporting of surveillance data will focus on timely and local feedback of results, to make results more relevant to individual DHBs.
A microbiological laboratory network will also be established.
6 / MPI presentation regarding MPI actions addressing AMR (Warren Hughes, MPI).
Warren Hughes outlined the work of MPI on antimicrobial resistance under the Agricultural Compounds and Veterinary Medicines Act 1997. This Act requires most veterinary medicines to be registered and requires MPI to assess their risks to agricultural security, trade, animal welfare and public health. The last one gives a mandate to MPI to manage antibiotic resistance in relation to agricultural compounds (as defined in the Act). [1]
It was noted that there is some overlap of this responsibility with that of the Environmental Protection Authority (EPA), which focuses on wider public health aspects along with environmental matters.
MPI has an antimicrobial resistance steering group, which meets once a year and discusses antimicrobial resistance matters at a policy level. In addition, MPI has established an antimicrobial resistance technical advisory group which deals with technical matters. MPI are currently working on the 2009-2011 version of a report on antibiotics sales for both veterinary medicines and the one horticultural product.
Particular areas of interest going forward for MPI are antimicrobial resistance are the role of pets, convenience use of antibiotics and the use of Streptomycin in response to Psa (Pseudomonas syringaepvactinidiae, bacterial kiwifruit vine disease) outbreaks in kiwifruit.
Discussion
It was asked where the responsibility lay regarding cases of MRSA linked with livestock (the example cited given was MRSA cases linked with pigs in Europe). In response it was noted that livestock MRSA disease is not one of the animal diseases requiring notification, but is reported informally. Formal notification for it would require consideration of rationale, costs and benefits in consultation with other departments.
7 / Next meeting
Agreed
The next face to face meeting of the HAIGG will be 14 February 2014, starting at 9 am and finishing at 3pm.
8 / Meeting closed

[1]Agricultural Compounds and Veterinary Medicines Act 1997, part 1 section 2 (1).