Preventing health care-associated infections.

Infection Control--the WoW Factor: Tenacity, Energy, Humour, was the theme of NZNO's National Division of Infection Control Nurses' conference in Nelson in August. The 167 delegates at the three-day event heard from an impressive line-up of national and international speakers.

Health care is more dangerous than scheduled airlines, European railroads, mountain climbing and nuclear power, Australian infectious diseases physician and clinical microbiologist John Ferguson told the delegates in a presentation on preventing health care-associated infection: risks, health care systems and behaviour. This assertion was based on American research looking at the total number of lives lost and the number of encounters per fatality of a range of activities. It revealed that in the United States, 5000 lives are lost per year as a result of health care-associated infections. Australian research into 14,000 hospital admissions to 28 hospitals in New South Wales and South Australia showed that 16.6 percent resulted in an adverse event.

Ferguson, who works for Hunter New England Health, said health care staff were increasingly at risk, with one in five sub-acute respiratory syndrome (SARS) cases being health staff; 4.6 percent of health care staff in the United States are methicillin-resistant staphylococcus aureus (MRSA) carriers and one in 20 had experienced MRSA.

Explaining James Reason's different models of error, he said the person model regarded errors as a product of distraction or carelessness, while the legal/moral model was predicated on the fact that responsible professionals shouldn't make errors. Those who did were bad or negligent. Both these models blamed the individual. But the system model was based on the fact that to err is human and that errors were unavoidable. Remedial efforts should be aimed at removing "error traps" and strengthening defences, ie systems.

He referred to the Swiss cheese model which involved "an alignment of defects in successive layers of defences/barriers."

Ferguson referred to latent conditions within systems as "resident pathogens" in the system. These arose from "top level decisions by designers, builders, procedure writers and top-level management" that produced conditions that created long-term weaknesses in system defences.

Only a very small proportion of adverse events were the result of human culpability. A system approach to error management aimed to limit dangerous errors and create systems that were able to tolerate error and contain its damaging effects. Latent conditions that affected health care-associated infection risk included personnel management, clinical care, environmental systems, quality systems and support services.

He concluded his presentation with reference to the "five transforming concepts" essential for patient safety, developed by Harvard School of Public Health professor Lucian Leape. These are reforming health professional education; enhanced consumer and patient involvement inpatient care; the expectation of full transparency in patient care; care integration in and across health care organisations; and restoration of pride, meaning and joy in professional work.

Ferguson had given another presentation at the conference on approaches to elearning for infection prevention and control.

The conference ended on an upbeat note, with a humorous look at infection control, "I don't know whether to laugh or cry", given by nurse consultant in prevention and control of infection, Southport and Ormskirk National Health Service Trust, Martin Kiernan. He had also given a presentation on the first day of the conference--"Together we stand--infection control professionals are the true patient champions." Kiernan is the president of the United Kingdom's Infection Prevention Society, which incorporates the Infection Control Nurses' Association.

Other keynote speakers included education manager with the New Zealand Organisation for Quality, Lynley Coburn, and medical microbiologist at Brisbane Hospital, Joan Faoagali.

A feature of the second day of conference was a light hearted debate--Infection control is an art not a science. Based on the decibel levels of the audience's cheering, the negative team of Kiernan, Faoagail and infection diseases physician at Nelson Marlborough District Health Board, Richard Everts, took the honours, but only just.

The conference dinner had a World of Wearable Art theme, with many delegates fashioning health-related items into outfits. The next conference will be in Dunedin but no dates have been set.

Report by co-editor Teresa O'Connor