Management of Hospital-acquired Infection Volume One of Two

72 Pages·2003·0.58 MB·English

Management of
Hospital-acquired
Infection
Volume One of Two
Report of the
Controller and Auditor-General
Tumuaki o te Mana Arotake
The Audit Office
Private Box 3928, Wellington
Telephone: [phone]
e-mail: [email protected]
web site: www.oag.govt.nz
Report of the
Controller
and Auditor-General
Tumuaki o te Mana Arotake
Management of
Hospital-acquired Infection
Volume One of Two
June 2003
This is the first of two volumes of the report of a
performance audit we carried out under the authority of
section 16 of the Public Audit Act 2001.
ISBN 0-478-18105-1
FOREWORD
Foreword
Under the Public Audit Act 2001, my mandate to review issues of
effectiveness and efficiency was extended beyond core central and local
government entities. This is the first performance audit in the health
sector under the Act.
Audit Offices around the world take a close interest in what their
counterparts in other countries are doing. They try to learn from one
another and make good use of resources; for example, by sharing
approaches to avoid ‘reinventing the wheel’. Through this interest,
we noted the success of the report that the United Kingdom National
Audit Office published in February 2000 – The Management and Control
of Hospital Acquired Infection in Acute NHS Trusts in England. The team for
our audit is most grateful to the UK colleagues who worked on that
report, for providing material to help us with our audit – including access
to their survey, which we amended to reflect the New Zealand context.
In reporting the results of our survey (which form the basis of Volume Two),
we decided not to name individual District Health Boards (DHBs) as we
expected that, as a result of our report, hospitals would be implementing
improvements. We have provided all DHBs with comparative feedback of
survey results which we hope they will use to improve infection control
practices.
We appreciate the positive response of the health sector to our audit. The
idea of patients acquiring an infection as a result of treatment they
receive strikes at the core of the health system. We might have expected
to encounter some defensiveness among health sector staff. We did
not. Instead, we were consistently met with open-minded professionalism
from people wanting to continuously improve their clinical practices.
The Ministry of Health and DHB staff have acknowledged our audit as
providing a baseline from which to improve infection control
practices. I look forward to seeing this commitment applied to achieving
the improvements recommended in this report.
K B Brady
Controller and Auditor-General
12 June 2003
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CONTENTS
Contents
Page
Volume One
Summary and Recommendations
8
Summary 8
Recommendations 16
Part One: Background
21
What Is Infection Control? 23
Rationale for Our Audit 23
Risks of Hospital-acquired Infection 24
Extent of Hospital-acquired Infection 26
Costs of Dealing with Hospital-acquired Infection 28
How Can Infection Control Help? 29
The Infection Control Standard 30
How We Carried Out Our Audit 31
Part Two: The Framework for Infection Control
35
Introduction 37
New Zealand Public Health and Disability Act 2000 38
Health and Disability Services (Safety) Act 2001 42
Using Voluntary Accreditation to Prepare for Certification 44
Promoting Health and Disability Standards 45
Using Expert Advisory Groups 47
Undertaking National Surveillance 48
Part Three: District Health Board Governance
55
Introduction 57
Risk Reporting by DHBs to the Ministry 57
Assurance Within DHBs on Infection Control 60
Providing Assurance to Communities on Infection Control 64
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CONTENTS
Page
Contents
Figures
1 District Health Board Boundaries and Tertiary Hospitals 33
Volum2 e ROesnpeonsibilities for the Provision of Public Health Care Services 38
3 Accountability under the New Zealand PPuabgleic Health and
Disability Act 2000 39
Summary and Recommendations 9
4 Ministry Plans for Addressing Two High-priority
Summary 9
Objectives for Infectious Disease Control 41
Recommendations 15
5 Responsibilities for Implementing the Health and Disability
Part One:S Bearvcikcgerso (uSanfdety) Act 2001 21 43
What Is Infection Control? 22
VoluRmatieon Talwe foor Our Audit 22
Risks of Hospital-acquired Infection 22
Extent of Hospital-acquired Infection 25
Part Four: How Infection Control Is Organised
Costs of Dealing with Hospital-acquired Infection 26
How Can Iannfedct iMona Cnoantgroel dHelp? 28
75
The Infection Control Standard 28
Introduction 77
How We Carried Out Our Audit 29
Roles and Responsibilities for Infection Control 77
Part TPwlaon: nTihneg FInrafemcteiowno Crko nfotrro Il nAfcetcivtiiotines Control 32 79
IFnitnraondcuiactl iMonanagement of Infection Control 33 81
New Zealand Public Health and Disability Act 2000 35
Staffing Infection Control 84
Health and Disability Services (Safety) Act 2001 38
Assurance about the Quality of Infection Control Systems and Practices 95
Using Voluntary Accreditation to Prepare for Certification 41
Promoting Health and Disability Standards 42
Part Five: Relationships Between Infection Control
Using Expert Advisory Groups 44
Undertaking Naatniodn atlh Seur vReiellsant coef the Hospital Se4r5vice 99
Part Three: District Health Board Governance 51
Introduction 101
Introduction 52 Risk
Role and Organisation of the Infection Control Committee 102
Reporting by DHBs to the Ministry 52 Assurance
WithinU DseH oBf sIn ofnec Itniofnec Ctioonnt rCool nRterporlesentatives 54 P r o v i d i1n09g
AssurIannfceec ttioo nC Comonmtruoln aitnieds t ohne MInafencatgioemn eCnotn otfr oRli5sk8 110
Working with Occupational Health Services 113
FigureWsorking with Laboratory Services 116
Links with Medical Officers of Health 118
1 Map of District Health Board Boundaries 20
Creating the Right Hospital Environment for Infection Control 121
2 Responsibilities for the Provision of Public Health
care services 34
3 Accountability under the New Zealand Public Health and
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CONTENTS
Disability Act 2000 36 Page
4 Ministry Plans for Addressing Two High-priority
Part SixO: bSjeecttivtiens gfo rI nInffeecctitoiuosn D iCseoasne tCroonlt rPololicies, 37
5 Responsibilities for Implementing the Health and Disability
Educating People to Follow the Policies,
Services (Safety) Act 2001 40
and Making Sure They Do
127
VoluImntreod uTcwtioon 129
What Infection Control Policies and Procedures Are in Place
Paarntd F Wouhra: tH Doow T Ihnefye Cctoiovner ?Control Is Organised and Managed 72129
Introduction 73
Policies on the Use of Antibiotics 136
Roles and Responsibilities for Infection Control 73
Keeping Infection Control Policies and Procedures Up to Date 138
Financial Management of Infection Control 75
Training and Education for Hospital Staff in Infection Control 139
Planning Infection Control Activities 77
AuSdtaitfifningg t hIen fAecptpiolinca Ctioonnt orof lInfection Control Policies and Pro79cedures 142
MoQnuitaolritiyn gA osfs uCroamncpeli aonf cIen fwecitthio Ann Ctiobniotrtiocl Policies 89 147
Involvement of Infection Control Staff in Clinical Audits 148
Part Five: Relationships Between Infection Control
Part Saenvd ethne: R Sesct roef ethne iHnogs paitnald S eSrvuicreveillance to Identif9y2
IntroductiHonospital-acquired Infection 93 Role and
151
Organisation of Infection Control Committees 94 U s e
Introduction 153
of Infection Control Representatives 100
PoIlnicfieecst ifoonr SCcorenetnroinl ga nPdat itehnet sM aannda Sgteamff etno tI dofe nRtiisfyk Infection 101 153
WWhaot rIks iSnugr vweiitlhla Onccec?upational Health Services 104 158
WWhaot rSkuinrvge williatnhc Le aIsb oUrnadtoerryta Skeernv fiocre sHospital-acquired Infect1i0o7n? 159
Links with Medical Officers of Health 108
Infection Control Teams’ Access to Surveillance Data 162
Creating the Right Hospital Environment for
Reporting Surveillance Results 164
Infection Control 111
Surveillance of Patients After Discharge from Hospital 167
Assessing the Need for Isolation Facilities 169
Part Six: Setting Infection Control Policies,
Educating People to Follow Them, and Making Sure They Do 117
Part Eight: Managing Outbreaks of Hospital-
Introduction 118
acquired Infection
What Infection Control Policies Are in Place and What 173
Do They Cover? 118
Introduction 175
Policies on the Use of Antibiotics 125
Survey Responses on Plans for Managing Outbreaks 176
Keeping Infection Control Policies and Procedures Up-to-date 126
Effective Communication During Outbreaks 177
Training and Education for Hospital Staff in Infection Control 127
SurveAyu Rdeistipnogn sthese oAnp Oplviecrasteioenin og ft hInef Mecatinoang eCmonentrto ol fP Ooulitcbireesaks 178
Repoartnindg P orfo Oceudtubrreesaks 130 178
Monitoring of Compliance with Antibiotic Policies 135
Survey Responses on the Distribution of Reports on Outbreaks 180
Involvement of Infection Control Staff in Clinical Audits 136
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CONTENTS
Part Seven: Screening and Surveillance to Identify Page
Hospital-acquired Infection 139
FigureInstroduction 140
Policies for Screening Patients and Staff to Identify Infection 140
6 What Did the 2000-01 Infection Control Programme Contain? 80
What Is Surveillance? 145
7 RWatihoa ot fS Ourcvcueiplliaedn cBee Idss U pnerd eInrtfeackteionn f oCro Hntorospl Pitraalc-atictqiounierer dat
1I Jnufleyc t2i0o0n1s? 146 86
8 InWfehctaito Pnr Copoonrttriooln T oefa Tmims’e A (%cc)e Dsso t oIn Sfeucrtvioenil lCaonncetr oDla Ptraactitioners149
ReSppoenrtdin ogn S Duirfvfeeriellnatn Icnef eRcetisounl tCsontrol Activities? 151 88
9 SuWrvheoi lAlarne cMe eomf Pbaetrise onft sth Aef Itnefre Dctiisocnh Carognet rforol Cmo Hmomsipttietael? 153 104
Assessing the Need for Isolation Facilities 155
10 Who Receives the Minutes of Infection Control Committee
Meetings? 106
11 Illustration of Infection Control Risks Extracted from the Risk
Part Eight: Managing Outbreaks of Hospital-Acquired Infection 159
Register of One DHB 112
Introduction 160
12 Does an Infection Control Procedure Exist? 131
Survey Responses on Plans for Managing Outbreaks 160
13EfEfexctetinvte o Cf Ionmfemctuionni cCaotinotnro Dl Purroincegd Ouuretsb, rbeya kHsospital Servic1e62 132
14SuRrevpeoyr tRinegsp Aonntsibesio otinc OUvsaegresi agnhdt oPfa Otteurtnbsr eoaf kBsacteria Resis1t6a2nce 147
15ReWphoyrt Iins gIt oImf Opourttbarneta tkos Control Methicillin-resistant163 S u r v e y
ReSstappohnysloecso occnu tsh aeu rDeuisst (rMibRutSiAon)? of Reports on Outbreaks 165 154
16FPigroutorcoels for Screening Patients on Admission for Multi-drug-
resistant Organisms 156
6 Which Details Were Included in the 2000-01
17 Example of Analysis of Infection Data that Can Produce
Infection ControlProgramme? 78 7
Valuable Results for Clinicians 165
Ratio of Infection Control Practitioners to Occupied
18 Infection Control Teams’ Views on the Arrangements for Isolating:
• Patients with Transmissible Diseases
• Patients with Low Immunity 170
Explanatory Notes:
1 Frequent footnote references are made in this report to our survey by
questionnaire of DHBs. The blank questionnaire form is available on our
web site www.oag.govt.nz under “Publications”. All results are taken from
a survey population of 21 DHB hospital services unless otherwise stated.
The footnotes identify the relevant part of the survey questionnaire by form,
question, and part – e.g. F2: Q10, a, b, c refers to Form 2, Question 10, and
sub-parts a, b, and c of that question.
2 In this report we have used quotations extracted from DHB survey responses
to highlight some issues and/or opinions. The quotations are shown in
stylised text boxes.
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SUMMARY
Summary
Infection control is an essential element of good clinical practice
and is vital for patient safety. The purpose of our performance audit
was to describe and assess systems for managing hospital-acquired
infection in public hospitals.
Overall Conclusions
Hospital-acquired infections are recognised nationally and internationally
as a serious problem. In common with other parts of the world,
they are an important concern in New Zealand’s public hospitals.
Here, and in other developed countries, it is estimated that about
10% of patients admitted to hospital will acquire an infection as a result
of their hospital stay. The costs of dealing with hospital-acquired
infections in this country’s public hospitals are estimated to be
more than $137 million a year.
A fair proportion of hospital-acquired infections can be avoided through
effective infection control practices. Everyone working in a hospital
should take responsibility for infection control. Making sure they do take
responsibility – and that every reasonable action is taken to manage the
risk of infection – is challenging.
The legislative framework and the Infection Control Standard1
(the Standard) provide a solid basis for hospital services2 to establish
effective arrangements for infection control. Hospital services are making
progress towards meeting the Standard. Some dimensions of infection
control are working particularly well – such as collaboration between
infection control and laboratory staff. Others require more attention –
for example, auditing of infection control practice, which provides a vital
source of assurance about compliance by hospital staff.
1 Standards New Zealand: NZS 8142:2000 Infection Control. Organisations obliged to comply with the
Health and Disability Services (Safety) Act 2001 will be required to demonstrate compliance with this
Standard (for existing licensed providers by 1 October 2004).
2 The term hospital services refers to that part of the DHB delivering services in a hospital setting within
the DHB.
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