Crohn’s Disease: Bacteria never sleep, so look busy
CWDM are bacteria with absent or rudimentary cell structures. They exist as part of the life cycle of Mycobacterium species. Dormant CWDM are characterised by low metabolic activity and replication. and increased resistance to host/environmental stresses, including antibiotic action. Crohn’s disease is sometimes associated with the human carriage of CWDM, particularly members of the Mycobacterium avium Complex (MAC).
Reactivation of tuberculosis is also attributed to escape from dormancy.
Previous work by us suggested that carriage of dormant CWDM was ubiquitous in both IBD patients and healthy controls. This raised the possibility that variant forms of CWDM may be present in IBD patients. Here we report the findings of three studies on patients diagnosed with IBD and on healthy human controls.
Using already existing methods in combination with newly developed media we were able to demonstrate the carriage of CWDM in samples from healthy controls and IBD patients. We were also able to demonstrate and provisionally characterise variant CWDM forms present in human blood and deep ileal tissue of IBD patients but not in controls. These variant forms produced metabolites capable of causing inflammation.
The detection of variant forms of CWDM present in IBD patients may be a reliable biomarker, and several confirmatory studies have followed our preliminary observations.
To confirm pathogenicity and identity of these isolates, we are continuing with molecular testing, including next generation sequencing (NGS) on extracted DNA. Pathogenicity studies will be necessary. Demonstration of a newly described CWDM, if confirmed, may require infection control risk assessments.
John is a 68 year old free-lance medical laboratory scientist, and worked in medical microbiology for public and private providers for 43 years. He also helped to set up and run an environmental testing laboratory in my “spare time”. He currently operates a private research laboratory, Otakaro Pathways Ltd.
John is particularly interested in antimicrobial resistance, and emerging bacterial infectious diseases. Most of his work involves an understanding of the underlying relationships between microorganisms, plants, and animals.
He believes that a solution can only be found if the life cycle of the problem organism is completely understood. The rest will then follow.
His experience in bacteriology and my international research relationships with other medical laboratory scientists have been invaluable in the investigation of emerging pathogenic organisms.
As in most businesses, his work is directed towards financially and sustainable solutions to complex problems.
John is presently involved in research in four areas:
- The relationship between autoimmune diseases and Mycobacterium species.
- Bioremediation, particularly in relation to the use of naturally occurring microorganisms.
- Biodiscovery of new antibiotic compounds.
Innovate, Integrate, Motivate – Conjoint Conference Infection Prevention and Control (IPAC), Canada and International Federation of Infection Control
This year, IPAC Canada hosted a conjoint conference with the International Federation of Infection Control (IFIC) in Quebec City. The IFIC component attracted delegates from every continent, which gave it a truly international flavour. I was able to attend after receiving the BD travel award (2017) and with the support of Webber Training and my employer, Southern Cross Hospitals. I will provide an overview of the key messages from this conference provided some key learnings on behavioural approaches in Infection Prevention and the patient experience.
Jane Barnett has worked in the field of Infection Prevention and Control for over 30 years. Her experience spans three NHS trusts in the UK and both District Health Board and private surgical hospital here in NZ. She is passionate about this area of practice and believes that we need to use our influence in this field to improve patient outcomes. Jane currently works as the National IPC Lead for Southern Cross Hospitals and is based in Auckland (but remains a Cantabrian at heart!)
New Zealand CPE guidelines – 1 year on
In this talk Josh will provide an update on the national response to CPE and how the CPE IPC guidelines have contributed. He will also seek to identify strengths and weaknesses of the national response and ongoing practical measures for local IPC teams and other stakeholders to focus on.
Josh Freeman is the Clinical Director of Microbiology at Canterbury DHB and was previously the Clinical Lead of the Hand Hygiene New Zealand Programme. He has a longstanding interest in infection prevention and in particular the transmission of resistant gram negative organisms. Currently he’s working on initiatives to improve implementation of NZ’s national response to the evolving epidemic of carbapenemase-producing Enterobacteriaceae (CPE).
Partnering to invest and expand best practices
Updates related to the current HQSC IPC programmes, Surgical Site Infection Improvement Programme (SSIIP) and Hand Hygiene New Zealand (HHNZ), will be presented. Building on the successes and learnings of this work will inform new initiatives. As the HQSC IPC programme matures into an HAI hub, the focus during the next year will be on two areas: replicating successes of the SSIIP to other procedures and determining what quality improvement activities will be most effective and beneficial.
Nikki Grae has been the senior advisor for the infection prevention and control programme at the Health Quality & Safety Commission since 2016. She has 11 years of infection prevention, quality, and patient safety experience in the healthcare sector. Prior to working at the Commission, she managed and led the infection prevention and patient safety programmes for a health system in the U.S. Nikki has also worked as a research scientist in cancer biology and microbiology. She has a Master of Science degree in microbiology. Nikki relocated to New Zealand to enjoy the friendly people and spectacular scenery while continuing her career in infection prevention and control.
IP&C and the design process
Darryl will discuss some of the challenges faced with the interface between Infection Prevention & Control and Design Team using the above project and a recent tour of European Hospitals.
Daryl is a Registered Architect and Christchurch based Principal at Warren and Mahoney. Darryl is Project Architect for the new Christchurch Hospital Hagley Building (formerly known as Acute Services Building) for the last 7 years.
You can lead a horse to water, but you can’t make it drink: Drinking water and the “post-Havelock environment”.
Safe drinking water was described by the Walkerton Inquiry as “water posing such a negligible risk to health that a reasonable, informed consumer would be justified in not being worried about health risk”. Following the 2016 Havelock North waterborne campylobacter outbreak which affected 5,500 residents and caused 5 deaths, the Havelock Inquiry produced a number of key recommendations which the current government is putting in to place. As well as announcing the establishment of a national water regulator next year, the Ministry of Health have tightened up on risk assessment for water safety plans, including a requirement that “secure bore water status” no longer be relied on for safe drinking water and that all suppliers should disinfect their water. This has implications for many supplies across New Zealand, particularly those which currently are unchlorinated and have previously relied on the secure status of their groundwater. Although Cabinet has announced that some supplies may be eligible for an exemption from the strict rules which will shortly apply, rural supplies are unlikely to be able to afford to upgrade their infrastructure to a level which meets the criteria. There are some European countries which provide safe, unchlorinated drinking water – what will New Zealand water suppliers need to do to meet the exacting standards required to also provide unchlorinated , but safe, drinking water and will it meet the new water regulators requirements?
Dr. Alistair Humphrey is a Public Health Physician and GP in Christchurch, New Zealand. He is a Medical Officer of Health for Canterbury, designated by and responsible to the Director General of the Ministry of Health. Medical Officers of Health are senior public health physicians responsible for legislative aspects of health in a region, including alcohol licensing, drinking water regulation and other regulatory aspects of environmental health, communicable disease and emergencies.
Dr. Humphrey trained in Scotland (St. Andrews) and England (Manchester) before moving to New Zealand and Australia, where he completed his Master of Public Health at Monash University. He has also completed a Master of Health Law at the University of Sydney. He has held a post as an epidemiologist with the International Diabetes Institute, Melbourne, Australia where he carried out research into diabetes and other non-communicable diseases in Mauritius, Nauru, Samoa, Tonga and Tasmania. He has also worked with Royal Flying Doctor Service in Australia in both a clinical and public health capacity and as a consultant public health physician in East London, England.
Dr. Humphrey has worked with the World Health Organisation and other United Nations groups, including the UN International Strategy for Disaster Reduction, the Towards a Safer World (TASW) group, the One Health/Global Risk Forum, the Asia-Europe Foundation Public Health network and BBC Media Action.
Dr. Humphrey holds an honorary senior lectureship post at the University of Otago Medical School. He has been made a fellow of the Australasian Faculty of Public Health Medicine, Royal Australian College of General Practitioners, Australian College of Rural Medicine and a member of the UK Faculty of Public Health. He is currently Chair of the Canterbury Hospitals Medical Staff Association, a board member of the New Zealand Medical Association, a member of the Clinical Governance board of the Rural Canterbury Primary Health Organisation and sits on the Health Practitioners Disciplinary Tribunal.
In his spare time he enjoys skiing, sailing and walking his three-legged dog, Chester.
Bugs in colour
Bugs in colour is a visual educational tool. It serves as a colourful reminder of how organisms can easily be transferred from the environment, the healthcare worker and patient. The environment, healthcare worker and patient are each assigned a different colour, through the course of the video it will become evident how these colours/areas of contamination can easily be transferred to the patient.
This” transfer” places the invasive procedure at risk of contamination, which places the patient at risk of infection. We have found it a useful tool to help embed how the environment, healthcare worker and patient all play a role in the invasive procedure and if not managed correctly can lead to infection of the patient. Although this video revolves around a dressing change, the visual colourful message can also be applied to procedures such as IDC insertion, arterial line insertion, the taking of blood cultures, and many more.
Anne is a Registered Nurse, Clinical Nurse Specialist – Infection Prevention & Control (IP&C) for Counties Manukau Health. After completing her diploma from the Medical Nursing School, at the Medical Centre of the University of Bonn Germany, she worked as a registered nurse in Germany, the United Kingdom and New Zealand. She has been involved in infection prevention & control for the past 11+ years. As part of her role she holds the Surgical Site Infection (SSI) surveillance portfolio, submitting data to the National SSI Improvement Programme on behalf of the DHB. She is also the spokesperson for the IPC Nurses College, involved in the Orthopaedic and Cardiac SSI improvement Project Expert Faculty Groups.
Dr Robert Martynoga
Sepsis: a major current issue for NZ & a road-map to eliminating preventable harm
Infection remains a leading cause of hospital admissions in New Zealand. Sepsis, the serious consequence of infection resulting in multi-organ dysfunction or failure, affects more than 1 in 100 New Zealanders each year and leads to about 10% of intensive care unit admissions. Sepsis carries high morbidity and mortality and has high associated costs – to the system, to the individual and their whanau. It is recognised that survival from sepsis, although increasing, results in the need for significant rehabilitation and some patients never regain their previous health status.
The NZ Sepsis Trust has been formed to champion best practice in sepsis prevention, recognition and treatment nationwide. Robert Martynoga is an ICU Specialist in Waikato and a founder Trustee. His talk will illustrate this pressing issue with a case history and will suggest a “road map” towards eliminating preventable harm from sepsis in NZ.
Robert is a UK and ANZ-trained intensivist and anaesthetist with an interest in sepsis that has resulted in becoming a Founder Trustee of the NZ Sepsis Trust – a not-for-profit charitable trust formed to promote awareness of sepsis and its consequences in NZ and to assist healthcare professionals in delivering best-practice in identification and care of patients with sepsis. Working with Waikato DHB, the Trust has delivered a successful “Sepsis Ready” programme which has demonstrated improvement in sepsis care by a variety of metrics. Robert has been at the forefront of this, developing pathways for patients with septic shock requiring access to intensive care. More information on the Trust’s activities can be found at: https://www.sepsis.org.nz
Prof. Mary-Louise McLaws
What hand hygiene would be like if kids ran hospitals
Hand hygiene is the first infection prevention and control activity we learn in childhood during toilet training. We are asked to learn a new approach at nursing and medical school. Yet, better handwashing after patient contact and in-depth discussions with mothers and children support the view that our childhood training influences our ward based compliance. Compliance with the introduction of the World Health Organization My Five Moments for Hand Hygiene identify Moments 3, 4 and 5, after different contacts, is universally better complied than before contact, Moment 1. I will discuss behavioural theories we can use to overcome our entrenched childhood behaviours.
CLABSI – Why targeting a zero benchmark is flawed
The Pronovost aseptic insertion program was attributed to successfully reducing in CLABSIs to a median of zero CLABSI per 1000 line days in USA. All Intensive Care Units in New South Wales public hospitals introduced the Pronovost program and reduced CLABSIs by 60% and if we reached zero why is this threshold setting us up for failure?
Mary-Louise is Professor of Epidemiology, Healthcare Associated Infection and Infectious Diseases Control at The University of New South Wales (UNSW) Australia, the Water-Health Leader for the UNSW Global Water Institute and Deputy President of the UNSW Academic Board. Her clinical epidemiology research is focused in patient safety improvement programs.
Mary-Louise has focused her research program on surveillance and hand hygiene. She performed the first Australian prevalence survey healthcare associated infections in the mid-1980s and went on to develop the first standardised semi-automated surveillance system for healthcare associated infections on behalf of the NSW Ministry of Health. In the mid-2000s she was the WHO Advisor to China and Malaysia for the development of their national HAI surveillance systems. She was a contributor to the WHO Guidelines for Hand Hygiene and an advisor to the WHO First Global Patient Safety Challenge: Clean Care is Safer Care project. Mary-Louise holds membership to the World Health Organization (WHO) Technical Steering Committee for the Infection Prevention and Control Global Unit.
As honorary epidemiologist to NSW Clinical Excellence Commission she collaborated on the first Australian hand hygiene intervention Clean Care Saves Live that preceded the national program while supervising early Australian behavioural aspects of hand hygiene intervention. She also collaborated on the NSW Clinical Excellence Commission CLABSI intervention that aimed at reducing central line associated infections in 32 intensive care units by introducing an aseptic insertion approach. This was adopted by ANZICS and rolled out nationally. She also collaborated on the Sepsis Kills intervention that aimed at early detection and treatment of sepsis in 32 emergency departments. This intervention saved over 200 lives and was awarded the Global Sepsis Alliance in the Government Category and in 2017 the Medical Journal of Australia/MDA awarded the publication Best Research Paper.
Post-SARS she collaborated with the Health Bureau to review the response to the outbreak in Beijing. In preparation of pandemic influenza the Chief Medical Officer appointed Mary-Louise to review the Australian Infection Prevention Guidelines for Healthcare Workers for evidence-based recommendations. Her capacity building in patient safety in low-medium resource settings includes ICU projects in Turkey, haemodialysis in Vietnam, hand hygiene for crowded healthcare settings in Vietnam, needlestick injury surveillance in Taiwan, water-related health in Vanuatu and Mali and understanding antibiotic prescribing practices and use of antibiotic in the community and food animals in Cambodia.
Her most recent projects have contested the reliability and validity of the human auditing used in the Australian national hand hygiene program against automation and clinicians’ behaviour around compliance.
Do infection prevention and control standards die or flourish in changing models of healthcare?
The New Zealand Health and Disability Services Standards are in review to better reflect current practice and changing models of healthcare. This includes 8134.3 2008 Infection Prevention and Control. The IPCN College has undertaken a search of international infection prevention and control standards that are similar in presentation and/or application to NZS 8134.3. This has revealed that infection prevention and control principles should be bespoke to every type of healthcare service. Can modulising the current NZ 8134.3 meet the challenge of the ever-changing models of healthcare? What has been the experience of other developed countries following a modulised infection prevention and control standard? This brief presentation will provide insights gained from the literature search work undertaken to date.
Francie resides in Auckland and has been practicing as an Infection Prevention and Control Nurse Specialist for many years in various services within the healthcare sector. Her interests include the professional development of NZ IPC Nurses; leadership styles in IPC; the surgical interface with IPC best practice principles.
Dr Ramon Pink
Just a Flight Away: Canterbury Measles Outbreak 2019
An outbreak of measles in Canterbury in February/March 2019, resulted in an ‘across system’ response, that included Infection Prevention and Control, particularly in the hospital setting. A global increase in measles outbreaks, heightens the risk of new cases being introduced into New Zealand at any time. This presentation looks at the outbreak response, and identifies some of the challenges and lessons learned.
Dr Ramon Pink, Te Aupouri Te Rarawa. Ramon is a Public Health Physcian, and Medical Officer of Health, employed by the Canterbury District Health Board. He has a special interest in Communicable Disease. He was a General Practitioner in Otara South Auckland over 10 years, before entering into public health. He is married with four children.
Deanna Sara and Sarah Metcalf
Clostridium difficile: one patient’s journey of rising from the ashes
Deanna will be sharing her personal journey with MRSA and C-diff, specifically how it affected her life and changed her health. Dr. Sarah Metcalf will also share in the discussion and provide relevant medical background from an specialist infectious diseases perspective.
Deanna is a 38 year old mother of one and works part time as a Speech Language Therapist for Canterbury District Health Board. She works in community stroke rehab team as well as providing awake craniotomy speech testing services to the Neurosurgical team at Christchurch Hospital. She is originally from the United States and completed both her Bachelor’s and Master’s degrees in Speech Language Pathology at U.S. institutions. Deanna has been living in the southern hemisphere for the past 12 years between Wellington, Sydney and Christchurch.
Dr Sarah Metcalf is a graduate of the University of Otago, Christchurch School of Medicine. She is an Infectious Diseases and General Physician at Christchurch Hospital and is the Clinical Director of the Department of Infectious Diseases.
She is interested in all aspects of infectious diseases, antimicrobial stewardship and infection prevention and control in health care settings.
Dr Phil Schroeder and Kelly Robertson
Canterbury Primary Response Group (CPRG)
Managing Infectious Outbreaks – the Canterbury Collaborative Approach
The Canterbury Primary Response Group (CPRG) was formed in 2005 following the threats of SARS and avian influenza worldwide. The possible impact of these virus’ alerted health care professionals that a community-wide approach was needed to manage and coordinate a response to any outbreak or potential outbreak.
Therefore CPRG took the responsibility to coordinate and manage the regional, out of hospital, planning and response coordination to annual influenza threats and the possible escalation to pandemic outbreaks.
This presentation will outline the bringing together of not only a wide range of health providers but also key community agencies to plan strategies and responses to infectious outbreaks. It will focus on what the group has learned during this journey and its future planning for seasonal influenza, and other possible infectious outbreaks.
Dr Phil Schroeder is a general practitioner with over 25 years’ experience as a rural GP initiating general practice services in the township of Rolleston, 20 kilometres South of Christchurch.
He became involved with CPRG, in 2005, when the district turned its attention to the H5N1 Avian Influenza threat. This was exercised in full when H1N1 “Swine Flu” arrived in New Zealand in late April 2009 and Dr Schroeder headed the Primary Health Response in Canterbury where there was widespread use of flu centres to both treat and protect the Canterbury population.
Since then Phil has continued to provide clinical leadership for primary and community care in responding to both natural disasters and infectious outbreaks that the region have experienced.
Kelly Robertson is a Registered Nurse, with 40 years+ experience working in both the secondary and primary health care sectors. She is currently the Nursing Advisor for the Canterbury Primary Response Group (CPRG), and has been involved with CPRG since its inception in 2005.
Kelly was part of the planning and leadership team during the H1N1 (pdm09) outbreak and also lead the nursing team at the Central Flu Center during this time. She has continued to provide nursing leadership for the group, especially during the subsequent seismic events of 2010-2011 and 2016.
Building resilience through change
This presentation explores the place of stress in modern living, the causes of it, and our default responses to it. It focuses on understanding our responses to stressful events and the coping strategies we employ. Also covered are the importance of de-escalation and self-care to prevent burn-out and build personal resilience.
The presentation will allow delegates to:
- Recognise and identify their own personal stressors
- Use the Stress Escalator Tool to help visualise the elevating nature of stress
- Identify the signs and symptoms of someone experiencing elevated and critical stress
- Understand the need to be continually de-escalating
- Incorporate practical strategies into everyday life to reduce stress and improve well-being
This presentation is interactive and shares practical ways to take ownership, be accountable and take responsibility for one’s own well-being and resilience.
Lisa Stirling works as a Staff Support Professional for Workplace Support. Through this role Lisa provides support and assistance to individuals to improve their well-being within their work environment. Support could include anything from anxiety and depression to family and relationship challenges, mental well-being and stress management.
Lisa is a sought-after workshop facilitator and adult educator who has led well-being and employment education workshops for various organisations including Canterbury District Health Board, Ministry of Social Development and Inland Revenue Department.
Lisa’s workshops are engaging, informative, practical and relevant. She is personable and authentic and draws on her rich life experience. Lisa is relatable and down to earth, has a great sense of humour and the ability to relay complex concepts into everyday language that people can grasp and implement into their daily lives.
On your best behaviours
Is leadership more about behaviour than style? What are the leader behaviours which motivate and empower first line clinical staff to ‘get things done’? This session draws on recent research exploring the relationship between leader empowering behaviours and first line clinical staff perceptions of empowerment. IPCNs will explore the complex clinical environments in which they practice, in positons where they are often negotiating between management and firstline staff to bring IPC policies and procedures to life in the clinical context. IPCNs are challenged, given the context and their position to think about those leader behaviours which empower and motivate firstline clinical staff, to get ‘infection prevention & control things’ done.
National Organisational Development Manager, Learning Solution Developer, Speaker, Trainer LMS Manager, Instructional Designer…Southern Cross Hospitals
Recognised for her many and varied roles in the area of health workforce capability development, Caro is on a mission to dramatically improve the way we develop and support our health workforce. Caro draws on her extensive experience in tertiary education and also in the public and private health care delivery sector to develop integrated, applied – ‘real’ people development solutions.
Caro has completed a Masters of Social Science and recently a Masters in Business Administration with the University of Waikato. Her Masters of Business Administration focused on Capability and Leadership development.
Wednesday 13th March – a day I will not forget
Wednesday 13th March a day I shall not forget in a hurry. The day sterile services in NZ came under the spotlight and it all happened when I was sitting at a workshop in the ministry of health.
This presentation looks at events of the day, how it was reported, the ministries response, all of NZ DHB’s responses the investigation that took place at Hawkes Bay, the outcomes and what is happening going forward.
Shelagh is a Registered Sterile Technician and a Registered Nurse. She has been the CSSD manager at Hutt Valley DHB for 12 years. During that time she also acted as theatre manager and CSSD manager at Wairarapa DHB. Prior to her CSSD roles she was a theatre nurse at HVDHB. She is currently president of the NZSSA. She has also worked as a theatre nurse in rural South Africa. In her role at HVDHB she has full governance over all matters relating to reprocessing and purchasing of reusable medical devices and reprocessing equipment.
It has been her mission over the past 12 years to develop the role of sterile technicians through education, as an outcome of this sterile technicians are now professionals in their own right. The sterile technicians are now members of Allied Health NZ and are now being fully supported by the Allied Health Directorates within the DHB system.
When not living “Sterile Services and the NZSSA”, she enjoys travelling and spending time with my six grandchildren or trying to avoid them.
Illness and recovery – Living to tell the tale
After a weekend away hunting, and thinking I was reasonably fit and healthy, nothing could have prepared him for what would unfold in the weeks and months ahead. From the initial doctor’s visit, to the mother’s lifesaving instincts, the baffled experts and the prompt medivac.
In an induced coma on life support, he couldn’t respond to any questions or give any information that might help the medical team. His family who never left his bedside were the ones that had to endure the daily struggle of the updates from the ICU staff, see his body go through some horrific things and literally watch him fade away. He’ll never forget the relief he could see on their faces when he was finally able to talk to them again after so many potential complications.
However, as we would learn, the road to recovery is a long and arduous one.
Chris is a 36 years old and self-employed engineer based near Ashburton, Mid-Canterbury. He was born and raised in Mid-Canterbury, educated at Christchurch Boys High School, and qualified with a NZ Diploma in Mechanical Engineering from CPIT.
He is one of three siblings, an uncle to a niece and two nephews and enjoy making time for friends and family.
As a keen outdoorsman, with a passion for hunting, fishing, and the great outdoors which means he is often found up a mountain, down a river or out on a lake. With an extensive background in agriculture, his business focusses on fabrication, manufacturing, design and consultation for the agricultural and general engineering industries.
Prior to falling ill in 2018, besides back surgeries, he had never been hospitilised for a serious medical condition and would consider myself to be in fairly good health.
He looks forward to sharing with you my experiences of before, during and after his illness, and he hopes what he shares will further your understanding from a patient’s perspective.