Trevor English - Invited Speaker - HiNZ 2015 Conference, Christchurch.

1. The Power of Information
Achieving a National Infection Management System
October 2013
Trevor English

2. Health Sector Challenges
• Challenges in implementing consistent standards for IPC practice and surveillance
have been identified by the the public health sector
• These negatively impact patient safety and outcomes, increase the burdens of cost
and ability for the sector to tackle increased demand on IPC, including concerns with
infections and antimicrobial resistance
• Without methods for defining and measuring current practice and infectious diseases it
is hard to determine how the New Zealand health sector is performing, what
interventions are needed or possible and how they perform
• Local IPC practice is challenged by manual processes, lack of accessibility and
transparency to real time data to support good clinical decisions and patient
management
• Surveillance is challenging due to a lack of national standards and definitions, as
well as the same issues with data accessibility and communication

3. A Blitz of Media Coverage

4. Nothing New on the Horizon

5. The “return of our old enemies in an
untreatable form”
“The majority of new infectious diseases that have emerged in the
last 40 years are caused by drug-resistant bacteria.”
Ellen Silbergeld, Professor of Environmental Health Sciences and Epidemiology,
Johns Hopkins University’s, Bloomberg School of Public Health

6. What is really at stake?
“Everything about how we live and expect to live. Once upon a time in the
United States — that is, before World War II — infections that we now think
of as easily treatable routinely struck down children, as well as adults in the
prime of life.” Editor Remapping Debate
• More complications
• More hospitalizations and less successful treatment
• More deaths
In the USA each year 1.7 million acquire HAI and there are 99,000 deaths,
according to the Center for Disease Control and Prevention
INFECTION control costs about $76 million a year in Australian public
hospitals but 177,000 patients acquire an infection each year, a Lake
Macquarie academic study has found.

7. Healthcare-associated infections
• Occur in up to 10% of patients receiving healthcare
• NZ Hospital Healthcare Associated Infections estimated cost $137m
pa
• ACC DHB Treatment Injury Claims 2011/12 infection related events
exceeded 900. A subset of SSIs between 2005-2013 cost ACC
$11.4m
• SSI are the second most common type of healthcare-associated
infection (≈20% of all HAI) and are associated with an increased
LOS and cost
• Patients who develop SSI have a 2-to-11 fold higher risk of death
than patients without an SSI
• Surveillance programmes (monitoring and feedback) result in
reduction in SSI

8. The Problem and Solution
The Dream
The Path
The Team The Team
“in New Zealand we don’t have the money
so we have to think”

9. Interventions proven to reduce SSI
• Warm the patient (on the way to theatre)
• Complete the surgical checklist
• Surgical antimicrobial prophylaxis – ‘right drug, right dose,
right time’
• Alcohol-based skin preparation and sterile drapes
• Continue warming the patient
• Double gloves

10. Interventions proven to reduce SSI
• High flow oxygen (≈ 80%)
• Monitoring of blood glucose
• Wound protectors for colorectal surgery
• Antimicrobial sutures for colorectal surgery
• Good surgical technique
• Avoid blood transfusions

11. National SSII Programme
Staged delivery of the programme
– Orthopaedics – total hip and knee joint arthroplasty
(2013)
– Cardiac Surgery (2015)
– Caesarean sections ?
Started with orthopaedics – hip and knee joint
arthroplasties
– 8 ‘development site’ DHB → All 20 DHB by Oct 2013
– Manual collection of data entered via the web into a
central data warehouse hosted at Canterbury DHB
– Central reporting
» Process measures and outcome markers

12. National SSII Programme
CDC NHSN (NNIS) definitions for surgical site infections
• Superficial, deep incisional or organ/joint space
Standardized data collection
– Patient demographics, surgeon details, surgical process and 30
and 90 day follow-up
– Shift from 1 year to 90 day follow-up
Web-based entry into a national database
Multi-discipline collaboration

13. Quality and Safety Markers
QSM = process markers and outcome measures
Process markers
– Best practice processes or interventions known to lead to
reduced harm and improved outcome for patients
• Surgical antimicrobial prophylaxis
• Skin antisepsis
Outcome measures
– Capture the expected reduction in harm, improvement in
health and associated cost savings from interventions put
in place

14. Improvement in action

15. Improvement in action

16. Improvement in action

17. Improvement in action

18. ICNet
• “Off the shelf” software solution
• IPC reporting platform with
modules
– SSI module
– Antimicrobial stewardship
• Currently in use at
– CDHB and West Coast DHB
– TDHB
– HBDHB
• Committed to use
– ADHB
– Waitemata DHB
• National Monitor supporting the
SSII programme

19. ICNet overview
Operations
Infections
Patient
Movements
Antibiotics
ICNet NG
Infection
Surveillance
SSI Monitor
Surgical Site
Infection
ABX-Alert
Antimicrobial
Stewardship

20. IPC staff productivity case study
Same patterns in UK and CDHB
0
1
2
3
4
Data Entry Lab Results Data
Analysis
Patient Data
Search
Management
Reporting
Patient
Surveillance
Pre ICNet Post ICNet
4
2
4
33
2
0.5 0.5
IP&C work pattern changes at Chesterfield Trust have been replicated at CDHB.
Using ICNet to clear administration tasks allows IP&C staff to spend more time and
focus on patient care and infection prevention.
50%+ Reduction
3
1 1 1

21. A clinician’s perspective
Dr Sally Roberts, National Clinical Lead, HQSC
1. ”Infection prevention and control requires accurate readily available data
collected in a timely manner to fully inform decision making. The current means
of capturing data – laborious manual-based methods – does not support this. A
software solution is urgently required.
2. Analysis and reporting needs to be simplified. The current burden of
manual data capture often distracts from data interpretation and does not allow
time for quality improvement activities. The SSII national monitor has shown that
centralised reporting of the data will allow for the delivery of comparable data
across all DHBs.
3. Data collection needs to be consistent nationally. Manual methods allow
for variation in the application of standard definitions, avoidance of capturing all
essential data as it exists in multiple databases and is often person-dependent.
4. We will not be able deliver the HQSC IPC programmes, in particular the SSII
programme, without such a programme as the manual collection of data is not
deemed a high priority for resource-limited IPC services.”

22. To achieve the dream
• National leadership / priority / Plan
• Engaged infection control practitioners
• Coordinated approach to infection control
• Common data systems
• Vendor support
• National reporting and use of the data
• National procurement process

23. We are on the path!
• National leadership / priority / Plan
– Recognition of need
– MoH, HQSC and ESR
– National business case work
• Engaged infection control practitioners
– Workforce demonstrated engagement with SSII
– Generally motivated group
• Coordinated approach to infection control
– Actively collaborate nationally – could enhance

24. We are on the path!
• Common data systems
– ICNet in 6 DHBs, National Monitor in place
– Laboratory providers
• 8 DHB Labs – 6 on or committed to ICNet
• 4 Private lab providers
• Vendor Support
• National reporting and use of the data
– SSII national monitor is in place
– ESR need access to good timely data
• National procurement process

25. The Problem and Solution
The Dream
The Path
The Team The Team
“in New Zealand we don’t have the money
so we have to think”