The Chair Opened and Welcomed Members to the Meeting. Apologies Were Noted

1. Welcome and Apologies

The Chair opened and welcomed members to the meeting. Apologies were noted.

1. Confirmation of the Minutes

The following corrections were made to the draft Minutes for the HAIGG meeting of 21 August 2012:

• page 3, Action Point (i), – full stop inserted after ‘(Grant)’
• page 4, first bullet point, - replaced ‘hypervirulent’ with ‘Clostridium difficile’
• page 4, section 6, - ‘That members would give further consider to………’ corrected to read as ‘That members would give further consideration to………’
• page 5, section 7, seventh bullet point, - replaced ‘hypervirulent’ with ‘Clostridium difficile’.

Agreed:

• That with the above corrections made, the minutes of the HAIGG meeting held on 21 August 2012 were a true and accurate record of that meeting.

1. Matters Arising

a) Draft Terms of Reference

Discussion on the draft Terms of Reference resulted in the following changes being made.

• Correction to the ‘Purpose’ statement to remove a typing error; the statement 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’.
• Deletion of the bullet point ‘recommend indicators for HAI’.

With the above correction made the Terms of Reference for the Healthcare Associated Infections Governance Group were accepted.

In relation to the HAIGG membership Ministry officials informed members that efforts to recruit a consumer representative and a representative from the Pharmaceutical Society of New Zealand were still on going. The person identified as a possible representative for consumers has not responded to the Ministry of Health on the matter. The possibility of advertising for a consumer representative was raised.

Action Points:

1. Dr Sally Roberts to make contact with the original proposed person for the position.
2. Dr Arthur Morris to provide names of some possible candidates for the position.

b) Description of HAIGG document for the sector

It was noted that the document had been finalised and sent to the Chief Executive Officers for District Health Boards for their information.

c) HAIGG subgroup working on preparing information on workforce development and formal postgraduate specialist education papers

Ruth Barratt informed members that the subgroup was still in the process of gathering information in order to prepare a paper for the HAIGG. Discussion highlighted the following workforce development issues:

• there is no formal Infection Prevention and Control (IP&C) post graduate qualification available in New Zealand that is recognised by Health Workforce New Zealand (HWFNZ)
• there are no specialised IP&C papers available in New Zealand at a level suitable for the senior nurse career pathway
• the Level 8 IP&C papers offered by the Griffith University in Australia are not recognised by the Nursing Council of New Zealand (NCNZ). If these papers were recognised by the NCNZ then a discussion could be had with HWFNZ about funding
• discretion of funding for workforce education rests with District Health Boards. Auckland DHB provides funding for IP&C nurses to undertake the Griffith course
• a funded pathway is required for senior nurses to undertake IP&C courses and qualifications within each DHB
• those working in IP&C have a variable qualifications, ranging from specific IP&C qualifications to ‘registered nurse’ who learns on the job
• the IP&C course offered by the Waiariki Institute of Technology does not meet the IP&C needs of senior nurses and Directors of Nursing
• no career pathway for IP&C nurses; members agreed that there should be such a pathway in New Zealand
• it is acknowledged that there are other non-nursing professionals who have an FTE for IP&C including medical staff, public health professionals, laboratory scientists and epidemiologists.

Action Point

The subgroup of HAIGG is continuing preparation of a paper for the HAIGG on workforce development and formal post graduate specialist education papers. The paper will include information about the need for a career pathway for IP&C nurses and other health professionals and also provide some options for overcoming the issues around workforce development.

1. Stocktake of current infection prevention and control capability

Members received a report back on the stocktake survey of the current infection control capability of the healthcare system to identify and manage emerging risks in relation to HAIs. This is a key deliverable for HAIGG.

Despite a number of limitations with the survey it was generally agreed that the survey did provide information of interest, including some strengths and opportunities of the current capabilities.

Action Points

1. Revisit the survey data to check whether a question on hospital bed size was included (Emma).
2. Prepare a summary of the survey findings and circulate to members for review and comment (Grant).
3. The Ministry of Health to send the finalised summary of the findings to the survey participants for their information (Grant).

1. Workforce development

This item was discussed as part of section (c) under Matters Arising.

1. Clostridium difficile

Discussion

The paper prepared by a subgroup of the HAIGG on what needs to be done in relation to managing Clostridium difficile was discussed at length. Points arising from discussion included:

• agreement on described categories of patients in which Clostridium difficile infection (CDI) should be suspected
• to date severe CDI disease is not often seen in New Zealand
• diagnostic strategy for Clostridium difficile presents challenges
• shift away from enzyme linked immunoassay (EIA) testing towards molecular-based testing and this adds expense due to higher cost of molecular-based testing; information shared on cost difference between testing approaches based on information from a member’s District health Board
• molecular-based tests appear to pick up hypervirulent strains whereas EIA tests do not
• importance of knowing whether patient has hypervirulent strain or not in the context of hospital management of the patient
• patterns of test requesting varies between District Health Boards
• repeat test requesting by clinicians was identified as an issue
• sensible use of resources approach required at District Health Board level
• more education of requestors particularly at the ‘nurse level’ is required to reduce inappropriate laboratory test requesting
• packages of learning tied in with norovirus is required
• surveillance of CDI at a population based level and a hospital based level is required
• the need to make Clostridium difficile notifiable
• agreement that the surveillance definition developed by SHEA/IDSA should be used, noting that initially we should opt to capture both 4 and 12 weeks after discharge as the time period in relation to onset of diarrhoea and at a future date consider revising the time period. The initial longer time period will allow the opportunity to see where in terms of timeframes the majority of cases present
• hand hygiene and clarification around the use of soap and water and alcohol-based hand rubs (ABHR). It was agreed that the use of ABHR should still be encouraged within the patient area but the use of soap and water after patient care is still advised
• Clostridium difficile in the context of a marker of quality in District Health Boards
• raised as an issue was the letter from the Ministry of Health’s Chief Medical Officer to District Health Boards on 25 October 2012, in relation to a hypervirulent strain of Clostridium difficile and confusion by some members of HAIGG over whether the letter was from the HAIGG or the Ministry

Agreed

That the Ministry of Health will ensure the HAIGG is better kept advised about Ministry of Health communications to the sector on healthcare associated infections related matters.

Action Points

1. The subgroup will continue to strengthen the paper on what needs to be done in relation to managing Clostridium difficile.
2. This will include providing more information on a diagnostic strategy for Clostridium difficile (Sally Roberts and Arthur Morris to draft guidelines for laboratory diagnosis).
3. The subgroup will, prior to finalising the paper, discuss the paper with key people attending an IP&C workshop convened by the Health Quality & Safety Commission and scheduled for 11 February 2013.
4. Dr Virginia Hope to seek advice on approaches to surveillance of Clostridium difficile from ESR staff.
5. The Ministry of Health to explore making Clostridium difficile notifiable.
6. The Ministry of Health to discuss with public health the potential for their involvement is aspects of the management of Clostridium difficile in the event the bacterium becomes notifiable.
7. Ruth Barratt to prepare a one page information summary on IP&C and Clostridium difficile.

1. Guidelines for control of multidrug-resistant organisms in New Zealand

The Ministry of Health asked the HAIGG for advice and recommendations on the following guidelines, Guidelines for the Control of Multidrug-Resistant Organisms in New Zealand (2007) and the Guidelines for the Control of Methicillin-resistant Staphylococcus aureus in New Zealand (2002).

• Is there still a need for national guidelines that act as a resource for local guideline development within health and disability care facilities?
• Do the present guidelines still reflect current accepted good practice around the management of multidrug-resistant organisms or do they need to be updated?
• If reviewing and updating the guidance is recommended, then:

 should the two present antimicrobial-resistant organism control guidelines be integrated during a review and update process; OR

 should more recent international guidelines be modified for use in New Zealand?

 who might be potential providers to consider for undertaking the tasks?

Advice

HAIGG considers that:

• from a community provider perspective this is still a need for this type of guidance
• District Health Boards have their own policies and guidelines in relation to control of multi drug-resistant organisms but use the guidelines as a basis for policy
• the guidelines are due for review, that they be condensed into a single document, and that a range of present content information be deleted with links provided to alternative sources of information.

The main issue facing a review and update of the guidelines is identifying a provider to perform the process.

Recommendation

The HAIGG recommends that the guidelines undergo review and update and that the updated version be presented as a single electronic document.

Action Point

1. The Ministry of Health will hold an internal discussion about reviewing and updating of the guidelines, giving consideration to scope of review and possible mechanisms to carry out the review, and report back at the next meeting of the HAIGG.

1. Creutzfeldt-Jakob Disease (CJD)

This item was presented for discussion around possible opportunities for the HAIGG to be helpful to the sector in relation to CJD incidents. Discussion noted that:

• maintaining knowledge and awareness of approaches to infection control as they relate to CJD incidents is challenging given the rarity of this disease
• Auckland District Health Board has undertaken to do an annual review of its CJD Infection Control policy to maintain an up to date set of recommendations
• need to be able to call on ‘wise heads’ to discuss approach to CJD incidents when they arise.

Action Point

The Ministry of Health to explore coordination of a small ‘expert group’ that is able to be called upon at the time of a CJD incident to provide advice and leadership.

1. PHARMAC

Discussion took place between PHARMAC officials and members informing on PHARMAC’s activities relevant to the work of the HAIGG. On-going interaction is planned for future meetings.

1. Ministry for Primary Industries (MPI)

A presentation and discussion took place between the MPI official and members informing on MPI’s activities in relation to antimicrobials and potential relevance to the work of the HAIGG. On-going interaction is planned for future meetings.

1. Planned Next Meeting Date

The next meeting is scheduled for either 9 March 2013 or 27 March 2013. The members were asked to advise on a preferred date.

1. Meeting Closure

The meeting closed around 1.45 pm.

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