As 2018 closes it’s time to review what the year meant. What were its highlights, its low points and the achievements it delivered? As an experienced infection control and prevention professional (ICP) I like to look back on the year that was. This short blog highlights how it panned out for Australian ICPs. These insights are offered up in the seasonal spirit of sharing. May they provoke your own thinking about the year you had. Most of all may they challenge you to do more, better and smarter in 2019 and beyond.
Not so humble beginnings
2018 was off to a huge start in late January when the UAE Ministry of Health and Prevention announced some incredible goals. They were actively pushing the new limits of nanotechnology and telemedicine. Their aim is that by 2071 they will be treating astronauts in the world’s first space hospital. Their plans to use nano-robots injected into a patient’s bloodstream to identify and repair injured and sick cells is incredible. It will end invasive surgery as we currently know it. Think of the hundreds of infection control risks that could be eliminated by this advance. No more surgical site infections. Fewer instruments to reprocess and sterilise. Perhaps even the end of asepsis and breaches in sterile technique. The limitations are perhaps endless. If it ultimately brings safer healthcare for patients we are all for it. We also love it when futurists work with infection control experts to redesign the ways we work and the tools available to us. Much of the technology we now use daily to prevent and reduce healthcare acquired infections (HAIs) came from a wild idea held by someone determined to push the limits.
Hands off hand hygiene
Meanwhile in Australia we experienced yet another stand-off. Those promoting hand hygiene programs and the laboriously intensive manual observed audits now mandated across the country in one corner. In the other corner, those dreaming of sensible public policy reform. Surely we need to free up Australian ICPs to redirect their efforts to serious and urgent issues like outbreak investigation, staff vaccination, antimicrobial stewardship and better overall asepsis! Why would anyone hold a view different to that enshrined in public policy? Don’t they realise that hand hygiene is the single, most effective method of reducing HAIs? Well in May 2018 it seemed like our colleagues in the British parliament had uncovered, and were prepared to highlight the dirty secret of hand hygiene. As many of us had long suspected, “direct observation artificially inflates reported compliance”.
Does hand hygiene bring good return on investment?
We agree that hand hygiene is important. Much of the evidence indicates that there are causal relationships between HAI acquisition and inferior hand hygiene. It makes sense and the data seems to confirm it. Less understood is the ability of those responsible for funding more than a decade of the national Hand Hygiene Program (at a cost of millions of $AUD paid for by Australian voters) to consider alternatives. Is it time for those whose careers and research have been based almost entirely on hand hygiene to seriously ask themselves the tough questions? Does Hand Hygiene Australia give good return on investment?
Looking for bright spots (the non-infectious type).
After the upheaval of the first half of the year we tried hard to find the bright spots on the Australian infection prevention and control landscape. We kept a particular eye on the review of the National Health and Medical Research Council’s (NHMRC) “Australian Guidelines for the Prevention and Control of Infection in Healthcare”. In April 2018 the NHMRC offered a 4-week public consultation period. Members of the public and other stakeholders were offered the opportunity to review and comment on the then most recent draft of the Guidelines. Early indications as per the NHMRC’s website were that the public comments would be reviewed by the “expert” review committee for consideration and ultimately rejected or included in the final release of the updated Guidelines. The NHMRC indicated that such a revision could be expected by Nov-Dec 2018.
Ultra-violet surface disinfection
Given that the existing guidelines were last published in 2010 it would be reasonable to remain excitedly expectant. The huge developments and innovations in infection control research and technologies since 2010 desperately need to be incorporated in our national guidelines. In mid-November the much publicised national ACIPC conference was held in Brisbane. At that event small and unpalatable offerings from those “in-the-know” about the NHMRC’s draft guidelines suggested that recommendations regarding automated waterless systems for environmental disinfection had changed. Whilst still not recommended it was suggested that in the final draft they may have been removed from the “Do Not Use” list.
Sadly, in contrast it has been suggested that Chlorhexidine (CHG) use will be modified in the final draft. Despite several detailed public comments arguing for relaxation of the proposed inclusion of Chlorhexidine (CHG) on hospital’s risk registries, the allegedly not-conflicted “expert” advisory committee is yet to recognise the significant extent to which the benefits and infection reducing characteristics of CHG far outweigh the rarely reported risks associated with its use. Again, the lives and well-being of Australians unfortunately appear to be being put at risk as bureaucracy runs rampant. When they are eventually released we at Infection Control Plus will relish reading the Guidelines and intend providing some common sense reviews at that time.
Anything to celebrate?
What was there to celebrate in infection prevention in 2018? A few things come to mind. Firstly, we welcome the increasing adoption of pay-for-performance initiatives in Australia. As published late last year we recognise that whilst this model has limitations overall, it is one which inevitably raises the profile of ICPs within an organisation. It assist ICPs to be given the recognition and support required. Hopefully, it will bring better investment in organisational IP&C programs. We acknowledge there are issues with misclassification and coding error that have the potential to impair the reliability, sensitivity and validity of HAI data. We hope that over time these issues will drive greater, more fulfilling relationships between the IP&C program and important administrative departments such as finance and coding. Partnership is something most ICPs have done well since the beginnings of our speciality.
A very useful kit from the ACSQHC
In our opinion one of the most useful pieces of work developed in 2018 is the Australian Commission on Safety and Quality in Health Care’s Hospital-Acquired Complications Information Kit Fact Sheets to support safety and quality in Australian health services. Freely available for download from the Commission’s website, these fact sheets specially address each of the Hospital-Acquired Conditions (HACs). The section three fact sheets address Urinary tract infection page 41, Surgical site infection page 44, Pneumonia page 46, Bloodstream infection page 48, Central line and peripheral line associated bloodstream infection page 49, Multi-resistant organism page 51, Infection associated with prosthetics/implantable devices page 53 and Gastrointestinal infection. page 54. Give them a read to learn more about how common these HAIs are, what they cost and who they impact. That information can greatly assist all stakeholders in their efforts and offerings.
How was 2018 for Australian infection control? Well we had a ball. We managed to work with several long-term and new clients to produce tools, reports and recommendations to assist infection prevention in Australia and internationally. To keep us engaged and innovative we enjoy being provoked and provoked we were in 2018. Hopefully as you review your infection control year and the impacts you made you too will be inspired. We look forward to joining and supporting you in fighting the good fight again in 2019 and beyond. Happy New Year from the team at Infection Control Plus.