Inquiry into Hospital-Acquired Infection — Consideration of Report of Health Committee

I move, That the House take note of the report of the Health Committee on the inquiry into hospital-acquired infection. It is really pleasing to see that at last hospital-acquired infection has been recognised, and that procedures have been put in place to attempt to minimise those incidents. New Zealand First was very pleased to see in the Government’s response to the report of the Health Committee tabled in the House today that the Government agrees in principle with the recommendations of the report, and is working towards the implementation of those recommendations. We were also pleased to see that the Government is working towards progressing—and I quote from the reply—“a national surveillance system for hospital-acquired infections”. The fact that there is not a nationwide standard and that data to date are not yet standardised across the sector means that it is not possible to evaluate and compare the rates of hospital-acquired infection between the district health boards. Unfortunately, that is still not possible, as different district health boards apply totally different standards. As outlined in the select committee report, there needs to be consistency in data collection and reporting across the health sector.

It was rather disturbing to read in the report that in New Zealand about 10 percent of the patients who are admitted to hospital will acquire an infection as a result of their stay there. Those infections pose a serious risk to both the patient and the staff, and the figures are increasing. The select committee was told, however, that the percentage of those infections is very similar in hospital patients in other developed countries. In the United States, hospital-acquired infection is the fourth-biggest cause of death, behind heart disease, strokes, and cancer. It is absolutely essential that in New Zealand our statistics do not mirror that trend, and that as much as possible is done to reduce the risks of the occurrence and transmission of hospital-acquired infections, as well as to prevent and control infectious disease outbreaks.

However, increasingly the evidence shows that the rate of hospital-acquired infections is rising, and that those infections are a real and persistent danger. The general public needs to be adequately informed about the hospital-acquired infections and the bloodstream infection rates in public hospitals. As pointed out in the select committee report, the Ministry of Health’s website is the ideal place for that information. Of course, it should be really easy for the reader to locate that information on that website. We need to reassure the public about the safety and quality of the public health system in New Zealand. People definitely do not want to have greater health problems in hospital than they had when they were initially admitted.

It is thought—and I have looked on other websites—that hospital-acquired infections have a huge variety of causes. It may be that today’s hospitals contain a greater proportion than previously of people who are sicker, who are older, and who are likely to be hospitalised for longer. It may be that basic hygiene procedures and practices are not being followed. There is, too, the emergence of antibiotic-resistant superbugs that pose an extremely serious risk for our hospital patients, and I understand that those superbugs are spreading within the system. That means that much stricter national standards of infection control are needed. It is also a dangerous situation, because methicillin-resistant Staphylococcus aureus bugs are resistant to at least three different classes of antibiotics. The bottom line is that if those bugs become resistant to further classes of antibiotics, infections will become totally untreatable. Just recently we had examples of operations being cancelled and of the temporary closure of wards, because a bug had infected patients and staff at many local hospitals right throughout the Wellington region. That totally disrupted hospital business for a large number of days, and it tells us that infection control in some hospital wards needs to be reviewed. The situation definitely should not be like that in a First World health system. District health boards should be required to record in their annual reports the outbreaks of superbugs in their hospitals and their communities.

In conclusion, New Zealand First supports the three recommendations that were made by the Health Committee and commented on in the Government report tabled today, and looks forward to the implementation of those recommendations.

MIKE WARD (Green): The Greens support the recommendations of the Health Committee inquiry into hospital-acquired infections. There are three recommendations, of which the standardisation of reporting procedures and the insistence on district health boards posting their rates of infection are the two major ones.

So what is the problem? Well, patients and staff entering our hospitals, rest homes, and places of healing are likely to acquire new diseases. In fact, they could wind up much sicker than when they entered, spend longer in hospital, and take much longer to recover, because of bacterial infections picked up in hospitals that are antibiotic resistant.

Any infection is potentially a problem. Infections acquired during periods of illness, when the body’s own immune system is depressed, are serious. When those infections, as a consequence of bacteria that have mutated, are resistant to most of the antibiotics in the pharmacist’s armoury, they are life-threatening.

How serious is the problem? Because of failures in the national surveillance system, including variations in the standard of data collection and variability in the accessibility of data, we cannot know for certain—hence the recommendations of the committee. But when 120 elderly and vulnerable residents in 10 Dunedin rest homes are infected by methicillin-resistant Staphylococcus aureus, the superbug, it is serious. E. coli, the most common cause of urinary tract infections, has mutated so that gentamicin, the main drug used by hospitals to fight such infections, no longer works. If that and the other resistant strains, including the methicillin-resistant Staphylococcus aureus, are no longer affected by the available drugs, we need to ask why and what we can do to protect ourselves.

The “Why?” and the “Are they resistant?” questions are not too complicated. We are over-prescribing. All too often antibiotics are the first line of defence, frequently against viral infections, to which they offer no protection, and all too often before our own defences—the lesser therapies such as rest—have been given a chance. We are feeding very similar products to livestock, including to many tens of millions of chickens prophylactically, not because they are sick, but because intensive farming methods such as battery chicken farming dramatically increase the likelihood of infection, so we medicate to stop them from getting ill. We also use the medications as growth promotants. Bacteria exposed to the same enemy over and over again will quickly develop resistance.

To the second question of why we are seeing such high rates of infections, I suspect, as simplistic as it may appear, that the answer is underfunding. Not only has funding for rest homes not kept pace with inflation, there are instances where funding levels have actually fallen. At a meeting at the Whare Aroha Home and Hospital in Rotorua, I heard yet again about the funding difficulties that face people charged with caring for our elderly. The most serious were the funding constraints on the care of dementia sufferers. The amount allocated for the care of those most vulnerable people has fallen from $104 per patient per day in 1987 to $97 per day today. Those people require a much higher level of supervision. Although the level of disability may vary, all are likely to be at substantially greater risk of infection than their peers in the wider community.

If the professionals charged with their care are unable to afford the optimum level of staffing, then, for many, infection is only a matter of time. Their removal to a hospital is similarly inevitable, and the risk of infection, not just to the patients, but to anyone entering our hospitals—particularly the staff—is heightened. Those people who are likely to be affected must be tested before they enter hospital so that we can take greater care to avoid infection. We are talking about a life-threatening disease—septicaemia. We are talking about an infection that may be the consequence of injury or operation. More important, we are talking about the infection of people when they are at their most vulnerable, when their own defences are likely to be depressed, and when they are already traumatised by the processes and illnesses for which they are in care.

Avoiding infection is hardly a new science. Lister, Pasteur, and Fleming are not new names. But avoiding infection requires extreme cleanliness and extreme care, and it would help if we took steps to avoid any escalation of the incidence of resistant bacteria, by avoiding the excessive prescribing of antibiotics as growth promotants. As I said before, we are talking here about a threat to the most vulnerable in our community. The Greens support the recommendations of the select committee, and we look forward to other measures to avoid continued escalation of the resistant bacteria in the future.

I rise to take a short call on the report of the Health Committee’s inquiry into hospital-acquired infection. I find it very interesting that we are debating this on a members’ day. This phenomenon of debating an inquiry report has not occurred in the 4 years I have been in the House. I think that is very healthy in itself, because those who were on the select committee found this an interesting inquiry.

It came about from an Audit Office report. The Audit Office work-stream identified some concerns with the reporting of hospital-acquired infection. It is not rest home - acquired infection; it is hospital-acquired infection. Many rest homes have some hospital beds, but we have to be very careful to differentiate when we look at district health board reports to the Ministry of Health.

In essence, the committee found that this condition has been around ever since we have had hospitals. It is not a new phenomenon for people to acquire infection in hospitals. We do not want to panic the community of New Zealand, but the select committee did agree that there needed to be national standards of infection reporting that need to be consistently applied and reported against.

We were a little concerned that some of the district health boards, despite our request, did not give evidence to our inquiry. That was of concern to us. But we are really pleased to see, in the recommendations in the Government report, that the ministry is taking this seriously, which means that the work of select committees is very valuable in terms of being an external audit of the goings-on in Government. We will look forward to the report back from the Ministry of Health in November of this year. I am sure the report will come to the select committee, and will identify the most appropriate and cost-effective way of setting up a national data surveillance system. That is what we are asking for.

We are very pleased with the monitoring initiatives of each district health board now. The select committee reports on each board, its balanced scorecard, and how it is performing, and we want to see infection surveillance as part of that reporting. Another very good aspect of our recommendations is the move to post that information on the ministry’s website. But I think we must be very cautious. I say to the Green member that if he had been part of the committee, he would realise that we do not want to raise community anxiety. We simply need to keep a report card on each district health board. It will be great when district health boards start reporting on rest homes, as then we will have comprehensive data.

But the issue goes back to the fundamentals of cross infection. The Green member was correct about the over-prescribing of antibiotics, but the issue simply goes back to one of the fundamentals—basic hand-washing in hospitals. There is no great state-of-the-art combatant against hospital infections. Members must remember that when people go into hospital, they are often carrying this infection with them. It is on our skin and in our gut. It is only when we are sick that the infection becomes so manifest.

As chair of the select committee, I am pleased that we did a very short inquiry. We did not hear a lot of submissions. The ministry came before us. We have heightened awareness on an issue that causes concern to New Zealanders and to those of us involved in health monitoring, and the ministry is taking our response seriously. I will hold the Health Committee accountable for follow-up actions in our review of the Ministry of Health.

HEATHER ROY (ACT): I want to take just a short call to reiterate a lot of what the previous speaker has said. Infection control in hospitals is an important issue and it can be a difficult one, but a lot of hospital-acquired infection is very easy to combat with quite basic hygiene implementation. Hand-washing is extremely important, but busy nurses and doctors travelling around wards, and other health professionals too, often just forget to wash their hands between seeing patients.

I remember that when I was a physiotherapy student in Dunedin there was a very high infection rate. I think it was in the orthopaedic department. An investigation was launched and the reason became apparent quite quickly. An orthopaedic surgeon was very keen on having medical students in theatre so they could learn, but the result of more people being in the theatre—people who perhaps had not gone through all the scrubbing up and routines that the surgeons and theatre staff had gone through—was that infection was introduced. The patients were the unwitting victims in that scenario. The hospital acted very quickly and put into the theatre an observatory with a perspex screen, behind which the medical students stood. The infection rate quickly dropped again.

It is a salient point to remember that infection is easily spread but it is also frequently easy to get the percentage, the numbers, back down. I too add a word of caution to what the Green Party member was saying about antibiotics. It is very important that antibiotics are not overprescribed, but that comes back partly to the demands that patients frequently put on their doctors. Very few people like going to the doctor unless they leave with a prescription, and frequently it is for an infection that will clear up on its own anyway. Patients often pressure doctors to prescribe something—usually an antibiotic. That practice has caused some problems with antibiotic resistance. People need to take some responsibility themselves for the pressure they put doctors under in terms of prescribing.

Again, on the issue of hospitals, we need to be very cautious in where we apportion blame. It is important that that does not happen unfairly. One of things I was a little disappointed with in the select committee inquiry was that we were not able to get the figures for individual district health boards. It would have been good to see where they are at, so that we have a measure, a yardstick, to follow up on so that when they are investigated next time, we would know exactly where they stand. Some of the district health boards have now given that information willingly during our financial review process, but some were very unwilling to do so. It would have been a good show of faith, although I suspect some were very worried about the results that would have come out.

The Green member commented in the select committee inquiry report that she was very worried about the high figures, but I think the district health boards themselves have acted very quickly to contain the problems that have been documented. It is important also to remember that that very first inquiry was carried out, I think, in 2001, which is quite some time ago now. We were very satisfied that the district health boards that did seem to have reasonably significant problems had acted very quickly to contain them. I suspect that when the investigation is done again and reported back in November this year, we will see a significant decline in the rate. It is very important to remember that people are not trying to spread infection maliciously, but it is important that they take care. Like the previous speaker, I agree that this was a worthy exercise and one that has yielded good results.

We support the three recommendations that were made. They are recommendations that, I think, stand the scrutiny of the profession and the public at large. I will not go through them as they are clearly identified. But I think it is important that we note what the conclusion of the report states, as no one has mentioned this or spelt it out, and I think it is appropriate that I do that. The Government assures the select committee of its commitment to improving the safety of public hospitals, through better management of hospital-acquired infections. Significant progress has been made in improving the consistency of data sets, and work is under way to assess cost-effective options for progressing a national surveillance system for hospital-acquired infections. District health boards, I know, will do all they can to build confidence. They do not want to have infections in their places of work, and certainly they will be going out of their way to make sure that this is not commonplace. So National has pleasure in supporting this proposition.

Motion agreed to.

The House adjourned at 9.05 p.m.