Infection Clinical Network Strategy day · 2018-09-03 · This is a rapidly evolving space with...

Infection Clinical Network – Strategy day 21 August 2018

Twitter: #ICN2018

Dr. Brett Sutton

Position title: Deputy Chief Health Officer (Communicable Diseases)

Organisation: Department of Health and Human Services

A few words from the Chair… I believe the Infection Clinical Network represents a genuine opportunity to advance important work in infectious disease management and infection prevention and control.

The membership and its broader engagement with stakeholders means we can use the very best of our passion, experience, wisdom (and influence!) to address several key challenges, and perhaps even some wicked problems.

This is a rapidly evolving space with emergent and re-emergent threats. But we also have new technologies, new evidence and ‘big data’ to inform action.

I sincerely hope today is a productive and engaging one with new ideas and energy. I very much look forward to the ongoing work with all of you.

Infection Clinical Network – Strategy day 21 August 2018

Today’s program

Meet the team Current state of Emergency Care in Victoria Our goals Defining our priorities – Sli.Do polling Next steps TBC – panel session Twitter: #ICN2018 Sli.Do meeting ID: #1934

Purpose

To define the 3-5 priority areas for ICN work over

the next 3 years, pending endorsement by Safer

Care Victoria

Housekeeping

Exits

Table arrangements

Breaks (Morning Tea 11:00-11.20, Lunch 12.50 – 13.30)

Dietary requirement table

Phones, pagers

‘Sli.Do [link] (instructions on table)

MCEC WiFi Access [link] (instructions on table)

Welcome

Robyn Hudson Director Clinicians as Partners

Safer Care Victoria

Infection Clinical Network

Strategy Day

Our mission To ensure outstanding health care for all Victorians. Always. Our purpose To enable all health services to deliver safe, high quality care and experiences for patients, staff and clinicians.

Safer Care Victoria

Targeting Zero

The Healthcare Associated Infection Committee be absorbed by a newly formed Infection Clinical Network The Cleaning Standards process indicator be discontinued and replaced by a comparable patient reported cleanliness one Work toward Zero Central-Line Associated Bloodstream Infections

Other Activities

Better Care Victoria Sepsis Collaborative Emergency Care Clinical Network Sepsis bundle of care Sepsis Scaling Collaboration Regional Infection Control Programs

Where do we fit?

Our structure

Maternity and Newborn Stroke Critical Care Palliative

Paediatrics Cardiac Emergency Older People

Renal Infection

Clinical Networks

Clinical networks

Identify best practice in their relevant specialty

area and share and support implementation of best practice approaches

Identify mechanisms to decrease unwarranted

clinical practice variation when appropriate

Identify treatments or procedures for which

there is an evidence of a material volume-outcome

relationship

Develop clear and measureable statewide

safety and quality improvement goals

Provide advice on clinical quality measures for

statewide improvement and benchmarking work

Provide advice to Safer Care Victoria and the

DHHS on clinical quality and safety implications of

policy, planning and commissioning decisions.

Clinical networks

Identify best practice in their relevant specialty

area and share and support implementation of best practice approaches

Identify mechanisms to decrease unwarranted

clinical practice variation when appropriate

Identify treatments or procedures for which

there is an evidence of a material volume-outcome

relationship

Develop clear and measureable statewide

safety and quality improvement goals

Provide advice on clinical quality measures for

statewide improvement and benchmarking work

Provide advice to Safer Care Victoria and the

DHHS on clinical quality and safety implications of

policy, planning and commissioning decisions.

Improvement goals

Paediatric Clinical Network Renal Clinical Network Stroke Clinical Network Mental Health Clinical Network

Older Persons Clinical Network Critical Care Clinical Network Emergency Clinical Network Palliative Care Clinical Network

Approximately 1500 consumers, clinicians, academics and

advocacy groups have identified the priority areas for

improvement

Improvement goals

600 people will be screened for mood disturbance who have a stroke

1520 will receive care aligned to a stroke unit of care

3335 people will receive inotropes/vassopressors appropriately

1194 people will have improved care due to the application of the

clinical care guidelines in hip fracture

Improvement goals

261 children will not have a tonsillectomy

250 children will not be prescribed AST

177 women will not have a 3rd or 4th degree tear of their perineum

494 Victorians who start dialysis each year will have consent

Heading 1

Thank you

Central line-associated bloodstream infections in Victoria

A/Professor Leon Worth

VICNISS Coordinating Centre

Doherty Institute, Melbourne

CLABSI

• Bloodstream infection associated with an indwelling central venous catheter

• short-term devices e.g. non-tunnelled CVC

• medium and long-term devices e.g. Hickman, port, PICC

• Significant outcomes • prolonged hospitalisation (7-21 days)

• costs (US $12,000)

• mortality (OR 2.75; in-hospital mortality, ICU patients)

• Generally regarded as preventable

Ziegler MJ, et al. Infection 2014 Stevens V, et al. Clin Microbiol Infect 2014

Pronovost P, et al. N Engl J Med 2006

CLABSI: a look over time

2000 2018 2009 2003 2006 2012 2015

2002: Victorian ICU CLABSI surveillance commenced (VICNISS)

2008: Modified CLABSI case definition #1 (NHSN) ‘common commensals’

2013: Modified CLABSI case definition #2 (NHSN) ’mucosal barrier injury’

2012: National guidelines for CVC insertion & maintenance (ANZICS/ACSQHC)

2006: Validation of Victorian surveillance program (VICNISS)

2015/16: Target zero, Performance Monitoring Framework (DHHS)

Burden & pathogens

Paediatric ICU: 2.21/1000 CVC days Neonatal ICU: 2.20/1000 CVC days Haematology/oncology: 1.9/1000 CVC days

CVC insertion practices

2013-2018 • 21 clinical departments • total CVC insertions = 5453 • ‘Full bundle’ compliance

87.5-100%* *hand hygiene + maximum barriers + appropriate skin antisepsis + skin antisepsis dry before insertion

Preventability

• International, local experience

• Evolution of care bundles over time, extrapolation from ICU studies

Standard Additional

Insertion Insertion

Hand hygiene Antimicrobial-impregnated CVCs

Avoidance of femoral site Maintenance

Skin asepsis CHG-impregnated dressings

Removal of unnecessary devices CHG body washes

Maximal barrier precautions Antimicrobial locks

Maintenance

‘Scrub the hub’

Victorian prevention programs

Klintworth G, Stafford J, O'Connor M, Leong T, Hamley L, Watson K, Kennon J, Bass P, Cheng AC, Worth LJ

Am J Infect Control 2014

Setting: 700-bed tertiary hospital (2011-2012)

Implementation: multimodal, 20-month roll-out, hospital-wide, existing ICU bundle

Additional measures: CHG body washes, minocycline-rifampicin coated CVCs

Findings: Reduction in ICU CLABSI (2.3 to 0.9/1000 CVC days), reduced non-ICU CLABSI (2.5 to 1.3/10000 OBDs), median time to CLABSI onset 13 days

Lessons: CVC insertion checklist not practical, need for improved CVC maintenance.

Entesari-Tatafi D, Orford N, Bailey MJ, Chonghaile MN, Lamb-Jenkins J, Athan E

Med J Aust 2015

Setting: 19-bed adult ICU, tertiary hospital (2009)

Implementation: multimodal

Additional measures: Biopatch, CHG body washes, daily line review

Findings: reduction in ICU CLABSI (2.2 to 0.5/1000 CVC days), median dwell time 5 days

Lessons: challenge of standardised line insertion practices outside ICU

Summary

• CLABSI in adult ICUs • 10-year diminishing rates, currently ~0.7/1000 CVC days

• Non-ICU and paediatric/neonatal populations

• CVC insertion practices • compliance with best practice

• CVC maintenance and bundles of care • diversity, site-specific, resourcing implications

Clinicians as Partners

Monica Holdsworth Manager, Acute Care Cluster

Safer Care Victoria

Emergency Care, Infection, Critical Care Clinical Networks

Sepsis – are state wide initiatives

enough?

Current state wide initiatives • Better Care Victoria Sepsis Collaborative

• Emergency Care Clinical Network Sepsis: bundle of care

Professor Kaz Thursky,

Clinical Advisor

Better Care Victoria

Knox Private

John Fawkner

Cabrini

Epworth

SJOG Geelong

Epworth Geelong

Participating health services Implementing a sepsis bundle of care in ED and UCC project

SJOG Ballarat

ECCN ED/UCC project site

BCV whole of hospital

project site

Western Alfred

Eastern

Peninsula

Werribee Mercy

Collaborate with nearby health services

Safer Care Victoria Emergency Care Clinical Network • Since 2016 • Hybrid collaborative model

32 health services • Prof Anne Maree Kelly,

Emergency Physician, Clinical Advisor

• Emergency Departments

and Urgent Care Centres

Better Care Victoria • 2018 (first wave) • Collaborative model 11

health services • Professor Kaz Thursy,

Infectious Diseases Physician, Clinical Advisor

• Whole of hospital

Safer Care Victoria

Maternity & Newborn Clinical Network Maternity eHandbook (sepsis) Newborn eHandbook (sepsis)

Paediatric Clinical Network Collaborative model 11 health services Royal Children’s Hospital Whole of hospital

Gaps

• Paediatrics – a definition to accurately and consistently identify

children with sepsis

• Maternity – state wide bundle of care

• Urgent Care Centres – pharmacy and testing

• Emergency Departments – missed diagnosis

Opportunities

• Coordination

• Adjust for all settings

• Consistent state wide resources

• Minimise system related issues i.e. patient transfers

Monica Holdsworth Manager, Acute Care Cluster

Safer Care Victoria

Monica.holdsworth@safercare.vic.gov.au

Ph: 9096 5621

2018 Influenza Season – an

opportunity for colalboration

Dr Annaliese van Diemen

Communicable Disease Prevention & Control

2017 Influenza season

Lets be frank - it was awful

Hospitals

• Emergency department demand

• ICU admissions

• Isolation beds

• Patient flow

• Antiviral access

• Sick staff

Aged Care

• Outbreaks, sick and dying residents

• Unwell staff

• Unhappy families

• Commonwealth response

General Practice

• Huge demand

• Pressure for antibiotics

• Backlash re: vaccine

Public Health

• Hundreds of outbreaks

• Surveillance data backlogs

• Political pressure

• Unable to help with some requests – e.g.

sourcing antivirals

2018 Collaboration activities

Better data

• Coordinating health service, ambulance, community and

sentinal surveillance data for state wide picture for the first time

• Predicting demand across the system rather than in silos

Practical guidance

• Aged care, anti-viral usage and hospital outbreak guidelines

Connecting the dots

• Residential in-reach services

• RICPRAC

Opportunity #1 Practice makes perfect

2017 wasn’t actually that bad…..

• Poor vaccine match, not a pandemic or novel strain

• H3 predominant – generally higher morbidity and mortality

• Dual peak resulting in a longer season

We have an opportunity to practice, every year, for ‘the big one’

• We can’t create systems on the fly

• There are no disadvantages to optimising our systems

• In the world of advocacy, creating alliances (i.e. collaboration) is

how things stay on the radar

Opportunity #2 – Community & Hospital

How many primary care practitioners are in the room?

• Biggest opportunity for collaboration which is missing today and

in our overall influenza system management

• Most difficult one to do

• Rely on general practice for vaccination coverage, to keep

people out of hospital, to know when to send them in

• Will be even more reliant on them in the event of a pandemic

• Ideas? Thoughts for the session later in the day?

Opportunity #3 – Collaborative design

Collaboration ‘The action of working with someone to

produce something’

• Thus far ‘production’ has focussed on good outcomes and

systems

• We must have the right people at the table from the beginning

• More practically – advocate for clinical collaboration and

engagement in every level of service design – including the

buildings

• Isolation rooms, cohorting areas, building products which are

safe and durable

Thank you

To receive this publication in an accessible format phone <phone number>, using the National Relay Service 13 36 77 if

required, or email infectious.diseases@dhhs.vic.gov.au

Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.

© State of Victoria, Department of Health and Human Services August 2018.

Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual

services, facilities or recipients of services. This publication may contain images of deceased Aboriginal and Torres Strait Islander peoples.

Where the term ‘Aboriginal’ is used it refers to both Aboriginal and Torres Strait Islander people. Indigenous is retained when it is part of the title of

a report, program or quotation.

Partnering with consumers in the

Infection Clinical Network

Infection Clinical Network Strategy Day

Belinda MacLeod-Smith, Consumer lead, Partnering in healthcare

project

Email: Belinda.macleod-smith@safercare.vic.gov.au

Twitter: @belmac_ic

Session outline

1. Consumers as Partners Branch

2. The ‘what and why’ of consumer participation

1. Consumer partnering in the ‘new’ Standard Three

(Healthcare associated infection prevention and

control)

2. The principles of partnering/engagement

3. Brief participation case studies

Consumer lead – Partnering in

healthcare framework • Lived experience as a carer for my husband through idiopathic

cardiomyopathy from 2015, three years on a LVAD (artificial

heart) then heart transplant in 2015 (also thyroidectomy, severe

sepsis, ECMO)

• 20+ years strategic communication, marketing and engagement

professional

• Moved to Melbourne 2012 – originally from Adelaide, where

complex cardiac care not possible

• Currently with Safer Care Victoria as consumer lead for

Partnering in healthcare project, and at Health Issue Centre as

Manager, Consumer engagement

• Former inaugural on-staff consumer advisor for Western Health

• Volunteer with Heart and Lung Transplant Trust (peer support)

• Committee member for Australian College of Emergency Medicine

FACEM, Victorian Agency for Health Information (VAHI) Advisory

Group, and VAHI PROMS/PREMS steering committee

• Steering committee member /research partner for #icuRESOLVE

Getting to know you Your health service works with health consumer representatives either

formally (structured, ongoing activities) or informally (one-off, sporadic

activities)

• on governance or steering committees

• on a Community Advisory Committee

• in co-design projects – as part of the steering group, potential research

partners or subjects

• as part of the investigating team in research and development projects

• to participate in training/professional development/orientation of staff

and volunteers

• in one-off participation in a focus group or round of focus groups on the

same subject

• to contribute to shortlisting and selection panels staff recruitment

• to co-present at forums and conferences

• in the process of awarding scholarships and grants

• as volunteers for quality activities (such as inpatient experience

interviews)

Summary 2017- 2018 Consumers as Partners’ Branch

Key Priorities

• Establish state approach

to Patient and Family

escalation of care

• Establish SCV Academy and

PEER network

• Sentinel events/ SENSE

events/ Incident reviews

and safety system

assessments

• Drive/ Support Patient

Safety Improvement

Projects e.g. Mesh

• Continue to support

Consumer engagement,

training and support

Patient Safety Culture

•Open communication

training (open

disclosure)

•Consumer focused

communication skills

training

•Patient Opinion pilot

Communication Breakdown

•Co-design capability building

•Expand use of PROMS & PREMS in improvement

•Consumers in re-design/ innovation & improvement

•Co- production pilot

Unwarranted variation in Practice

• Partnering in Healthcare Framework – development and implementation

• Inform the further development of VHES (keen to test alternative solutions for VHES)

• SCV Patient and Family Council

• Complaints Management & data linkage

• Patient stories

• Health Service CAC evaluation and investigation of a state wide CAC

Unwarranted variation in

Patient Experience

What is

participation/partnering?

Why is consumer participation

important?

National Safety and Quality Health

Service Standards (NSQHS)

Background: 1. Standards describe expected safe, high quality care

and systems needed to deliver it

2. Developed by the Australian commission on Safety and

Quality in Health Care in 2011

3. Developed with state and territory health

departments, health service organisations, consumers

and the private sector

4. First assessments were in 2013

5. Standards are a condition of funding for Victorian

public health services

6. Version 2 of NSQHS Standards released in November

2017

7. Assessment using the new standards will start

January 2019

What’s different?

How is patient-centred care

embedded in

the new standards?

Standard 3: Healthcare associated infection prevention and control

Action 3.3 Clinicians use organisational processes from the

Partnering with Consumers Standard when preventing and

managing healthcare-associated infections, and implementing

the antimicrobial stewardship program to:

a.Actively involve patients in their own care

b.Meet the patient’s information needs

c.Share decision-making

Are there foundation principles for

engagement?

• The great news is that the concept

of consumer (stakeholder)

participation has been around for

decades.

• Some of you may have heard of the

International Association of Public

Participation (IAP2) and their

conceptual ‘Spectrum of Public

Participation’

• The IAP2 concept is a great place

to start, but not the only approach

to participation

• It’s been adapted by organisations

world wide, including the majority

of local government entities in

Australia

Formal or informal? What’s your

cheese? • Different kinds of

participation suit

different kinds of

activities.

• The important thing

to remember is the

purpose, and the

promise you make to

consumers.

• Like a good cheese

platter, one size

does not fit all, and

sometimes a mix of

‘hard and soft’ gives

the best result.

How much influence does the consumer have on

decision-making?

Inform

•“We will keep you informed”

• Tactics can be about giving or gathering – flyers, brochures, newsletters, websites, public meetings or surveys, focus groups, suggestion boxes

Consult

• “We will listen to and acknowledge your concerns”

• Workshops, consumer reps on committees/advisory groups

• Online discussion groups

• Meetings/forums

• Circulation for comment

• Conferences/seminars

• Evaluation surveys

Involve or Partner

• “Your concerns/hopes will be directly reflected in decisions made”

• Strategic alliances are built using a combination of methods

• Workshops, consumer representatives on committees/advisory groups

• Roundtables

• Patient forums

• Surveys

• Focus groups

Collaborate or delegate

•“We will look to you for advice and innovation and incorporate this into decisions as much as possible”

• Shift some or all of the decision making to consumers – i.e. budget allocation, program management

Empower or Control

• “We will implement what you decide”

• Community appointed management committees i.e. Aboriginal community controlled health organisation

s.

Power - Lower Power - Medium Power - Higher

Inform: We will keep you

informed

Consult: We will listen to and

acknowledge your concerns

Involve: We will work with you to ensure your concerns

and aspirations are reflected in decisions made

Collaborate: We will look to you for advice and

innovation and incorporate this into decisions as

much as possible

Empower: We will implement what you

decide

Resources and contact details

"Know there isn’t a cookie cutter formula for engaging #pts. Always

ask your #pt partners what works best for them.“

https://sites.google.com/view/howtoengagepts/home

#howtoengagepatients:Global crowd-sourced site featuring research,

templates, tools and Tweetchat summaries.

https://www.iap2.org.au/Resources/IAP2-Published-Resources

The Australian branch of the International Association for Public

Participation (IAP2). Hit the ‘‘Resources“ tab.

https://www.mosaiclab.com.au/microskills/

Free tips for quality engagement and participation (great set of engagement

hints and tips)

Belinda Macleod-Smith (Twitter: @belmac_ic), Consumer Lead

T 03 9096 5484, E belinda.macleod-smith@safercare.vic.gov.au

Exploring the Evidence Date: 21 August 2018

Chair: Associate Professor Caroline Marshall

Position title: Head of Infection Prevention and Control,

Infectious Disease Physician (VIDS)

Organisation: Melbourne Health

Welcome

The Five Hot Topics

• Multi-resistant organisms

• Antimicrobial stewardship

• Healthcare environment

• Infections associated with devices

• Healthcare worker

Professor Ben Howden

Position title: Director of Microbiological Diagnostic Unit(MDU)

Public Health Laboratory

Organisation: Doherty Institute

Why Multi-Resistant Organisms?

What are the gaps? • Reducing variation in microbiology reporting

• Ensuring effective/rapid susceptibility testing for new/uncommon

antimicrobials

• Effective surveillance for all relevant AMR pathogens

• Effective transmission prevention (PPE, isolation rooms)

• Hand hygiene

• Improving communication between facilities

• Staphylococcus aureus bloodstream infections (MRSA)

• Urinary tract infections/urosepsis ( ESBLs)

How can the Infection Clinical Network add value?

Consider AMR across the spectrum: • Integrated surveillance (what is happening, where, what is new) • Diagnostics (optimised, access to molecular diagnostics, extended

antibiograms, environmental microbiology) • Primary lab reporting (RCPA pathology stewardship etc) • Best practice empiric and directed therapy (community, hospitals) • Prevention (travel, transfers, screening, isolation, cleaning, HH)* • Outbreak detection and management (state-wide)* • Education (eg. UTI diagnostics and therapy in the community)

• Targeted issues (MRSA/MSSA bacteraemia; ESBL UTIs) *Communication between facilities

Associate Professor Kirsty Buising

Position title: Deputy Director of National Centre for

Antimicrobial Stewardship, Director of the

Guidance Group; Infectious Diseases Physician

Organisation: Doherty Institute

Why Antimicrobial Stewardship?

Critical for Patient Safety and Quality Critical for AMR control Failure to act will cost more money Guidelines need active implementation to effect change: resources/tools Generalizable - These conditions are common Equity - Sites without on site resources/ expertise Need - Data suggest some sites are doing poorly Cost effective - Duplication of effort Feasible - great examples of effective activities already exist

What are the gaps? Logistics

Drug shortages

- coordinate stock and advice

Last line /rare drug supply

- centralize access

Micro Testing

- When to test

- How to collect specimens

- How to interpret results

Common Resources

- UTI

- Pneumonia

- Surgical prophylaxis

- Cellulitis

- Influenza

- Clostridium difficile

- Fungal infections

Checklists, Posters, Pathways

Drug guidelines, Policies

Patient information

Staff information

How can the Infection Clinical Network add value? We are the only jurisdiction without a statewide AMS service Qld AMS, NSW CEC, SA RuralAMS, WA AMS, TICPU Coordination is cost effective – eg; ceftazidime-avibactam stock expiry Common resources/ tools – Reduce confusion, standardise advice Collaboration saves time and effort Build local staff capacity by building supportive networks - sustainable Clarify lines of responsibility, accountability – safer We cannot continue to measure poor performance without action

Donna Cameron

Position title: Infection Control Consultant

Organisation: Department of Health and Human Services

(Communicable Diseases)

Why the Healthcare Environment? • Cleaning compliance of hospitals is no longer reported to DHHS

• Victorian Hospital Experience Survey (VHES) data

• Complaints received

• Non-standardised cleaning methods and products

• Quite differing cleaning and disinfection protocols & methods between facilities

• Assessment of cleaning

• Increasing no’s contract cleaners => issues with training and accountability

• Green cleaning and sustainability

• Construction and renovation

• Commissioning standards and air sampling protocols

• Health care facility design

• Management of the built environment, e.g., water systems

• Increasing expectations to manage other risks, e.g. legionella

What are the gaps?

• Environmental cleaning

• Management of the built environment

How can the Infection Clinical Network add value? • Reduce variation in practice in cleaning and disinfection

• Assess evidence, influence development of multi-centre project with aim of developing a guideline to standardise ‘environmental hygiene’ practices

• Develop indicators for monitoring outcomes

• Health care facility Commissioning guideline

• Assess evidence and advise on development of a guideline

Associate Professor Craig Aboltins

Position title: Infection Disease Physician

Organisation: Northern Health

Topic: Infection associated with medical devices

Why infections associated with devices? 1. Staphylococcus aureus bacteraemia • Health care associated (HA-SAB)

• 1919 cases over 5 years in Victoria

• Number and rate decreased earlier this decade. Stable since.

• Community 2. Peripheral intravenous cannula (PIVC) infection

• 24%-35% HA-SAB caused by PIVC (up to 50% of PIVC not being used)

• Non-ICU CLABSI

3. Aseptic technique (ANTT) 4. Hand Hygiene

Ann Bull. VICNISS and contributors. Communication: 14.8.18

Sue Trenery. NH. Communication 14.8.18

Stuart et al. PIVC assoc SAB. MJA 2013

Rhodes et al. Reducing SAB assoc with PIVC. J Hosp Inf 2016

Worth et al. SAB in Australian hospitals: findings from VICNISS. MJA 2014

Infections associated with devices: what are the gaps? • Staphylococcus aureus bacteraemia

• Good reporting. Putting together detailed data. Interventions. Management.

• Peripheral intravenous cannula infections • Poor practice. State-wide data. Interventions

• CLABSI outside of ICU • State-wide data. Similar interventions as for ICU CLABSI?

• Aseptic technique (ANTT)

• Hand hygiene • Community health care

• Network of specialists • Gather data

• Assess evidence and prioritise

• Connections to implement interventions

• Examples of possible interventions • PIVC bundles (shown to improve PIVC care and reduce SAB)

• Role of CLABSI and CLIP monitoring for non-ICU central venous access

• Management of SAB

• Role of newer interventions: rifampicin impregnated cardiac device pockets

• ANTT and hand hygiene ?

How can the Infection Clinical Network add value?

Rhodes et al. Reducing SAB assoc with PIVC. J Hosp Inf 2016

Ray-Burruel. I-DECIDED tool. BMJ Open 2018

www.ausmed.com

www.ceramtec.com

Dr. Finn Romanes

Position title: Public Health Physician

Organisation: Department of Health and Human Services

(Communicable Diseases)

Why the healthcare worker?

• Our people are at risk of an exposure to vaccine-preventable diseases, and other infections

• Services need to protect healthcare workers, and healthcare workers need to protect patients

• Vaccination is an efficient, effective and safe intervention • Infection prevention and control is a frontline protection against

common and emerging pathogens in a world of increasing resistance

• Pandemics, whilst low probability, carry high risks and consequences and healthcare workers are central to the response

What are the gaps? • We lack high coverage against recommended vaccine-preventable

diseases in healthcare workers across the Victorian health sector • There is established evidence of HCW-patient transmissions, and vaccination is efficient and effective, but

we lack high coverage and good use of systems like the Australian Immunisation Register

• Voluntary programs are associated with poorer compliance, and counselling and education have failed to

achieve high coverage across the recommended seven VPDs (plus hepatitis A and BCG)

• There is room to improve skills and practical experience around

personal protective equipment and infection prevention • Infection prevention and control basics are critical for staff and patient safety and avoidable morbidity

• Pandemic preparedness needs ongoing attention • Modelling shows that a pandemic of severity similar to 1918 in today’s arrangements could lead to over

592,000 cases, 7000 deaths, up to 50% absenteeism and be drawn out of 7-10 months in Victoria

• Healthcare workers will be critical on the frontline – needing confidence around plans, stockpiles, roles

and actions

How can the Infection Clinical Network add value? Healthcare worker vaccination policy • Advise on, input to and influence emerging Victorian Government policy on HCW vaccination, including

incentives and mandates, in a time of policy movement

Infection prevention and control and personal protective equipment • Identify, select, design and oversee new tools, guidelines or training modules to strengthen knowledge

and practical skills in use of PPE

Pandemic preparedness • Influence and oversee health system awareness of obligations around equipment, knowledge and skills,

and plans for pandemic preparedness