Infection control must remember lessons of history.

Today is an exciting and challenging time for infection control practitioners throughout New Zealand and the world. Although we struggle to convince employers that we are worth more and do not have enough hours, resources or full-time equivalents to do our job as we would like it done, new challenges are always around the corner to keep our job interesting and worthwhile.

National and global issues

The practice specialty of infection control will continue to be faced with a variety of national and global issues. These include:

* The infectious disease consequences arising from natural disasters and war: This year began with the aftermath of the Boxing Day tsunami tragedy in South East Asia. The scale of the natural disaster was unprecedented. This, in turn, required an unprecedented scale of international co-operation and relief effort. The infection consequences of the disaster may include disease and sickness caused by contaminated water, insect-borne disease, inadequate nutrition and food supplies, inadequate medical treatment of injuries and inadequate shelter, to name a few. The global response has been heartening, though challenges will remain for those countries affected for a Long time yet. NZNO's National Division of Infection Control Nurses has joined the International Federation of Infection Control Nurses (IFIC), in supporting our colleagues in tsunami-affected areas. The division has donated $5000 to assist the infection control nurses from those regions to attend the IFIC conference this year and participate in ongoing education and networking.

* The challenge of antimicrobial resistance: Microbes continue to demonstrate their hardiness and cunning by exhibiting resistance to antibiotics used in treatment against them. New Zealand's Institute of Science and Research Laboratory has collected and analysed antimicrobial data from hospital and community laboratories in New Zealand since 1988. The results of their surveillance can be found on www.surv.esr.cri.nz. The full analysis of the antimicrobial resistance data from 2004 is not yet published. However, preliminary discussions indicate that extended spectrum beta lactamase (ESBL) producing organisms, eg ESBL E.coli, continued to increase in New Zealand during 2004, causing infections in patients in both acute care and long-term care facilities. Prudent antimicrobial use (both in humans and animals), together with excellent infection control practices, remain the two fundamental activities to combat the development of antimicrobial resistance.

* Emerging and re-emerging infectious diseases.

In the Last two years, Severe Acute Respiratory Syndrome (SARS) has shown us that new emerging infectious diseases can cause a huge strain on health systems globally and regionally. Canada and Hong Kong are examples of countries badly affected by SARS, but all countries would have been foolish to ignore developments and fail to actively plan prevention strategies. The ease and speed of global travel means these diseases can appear quickly on new frontiers. SARS has also shown that, where there is a commitment to working together globally in research, answers can be found in a timely manner.

Threat of bird 'flu pandemic 

Now the global threat of an avian or bird 'flu pandemic looms, with recent warnings from top health officials in the world. (See news and events p7.)

* Infection control standards: At a national level, the work towards re-certification against the Health and Disability Sector Standards continues, with infection control practices a key focus. The key New Zealand Standard: Infection Control NZS8142:2000 is currently being reviewed by Standards New Zealand.

* Construction related illness and infections: New building projects in both hospitals and long-term care facilities and renovation projects will continue to keep infection control nurses busy this year. We need to advise on protective measures to be put in place during the actual work, to minimise the risk of dust-related infections, especially aspergillosis. This is a respiratory disease associated with building dust and is an infection risk for immunocompromised patients and carries a high morbidity and mortality rate.

Infection control nurses also advise on infection control facility requirements for new or renovated buildings, eg the number of handbasins required and the floor coverings. This input into facility and planning design can be time consuming.

The responsibility for excellence in infection control practice is not the sore domain of those in specialist infection control positions, but rather the responsibility of all health care professionals.

Infection control is about doing the unglamorous and basics right: adhering to good hand hygiene practices; standard precautions; identifying those patients who are thought or known to pose a risk of disease transmission, and appropriately isolating them; ensuring that equipment purchased for use on patients can be adequately cleaned, and disinfected or sterilised prior to use on other patients, or else safety discarded.

All health professionals should never forget those infection control lessons of the past. As a keynote speaker at a past infection control division conference, American infection control specialist Sue Crowe stated: "History forgotten is history repeated."

Karen Davis, RCpN, BHSc, CIC, is the infection control nurse specialist at Mercy Hospital in Dunedin. She is a former chair and now vice-chair of the NZNO National Division of Infection Control Nurses.