The 'H-Bug' epidemic: lessons from antibiotic-resistant staphylococcal outbreaks in New Zealand hospitals from 1955-1963.

Deadly outbreaks of antibiotic-resistant staphylococcal infection occurred in New Zealand from the mid-1950s to early 1960s. The 'H' or 'Hospital-Bug' epidemic was part of a pandemic wave characterised by high numbers of nosocomial staphylococcal infections and the capacity of Staphylococcus aureus to develop resistance to commonly used antibiotics. Surgical patients and childbearing women and babies proved particularly vulnerable to the predominant pathogenic strain, identified as phage type 80/81. The post-war baby boom was at its height in New Zealand, and overcrowded maternity hospitals and outdated nursing techniques increased the risks of infection. The outbreaks challenged the medical profession, which had become reliant on antibiotics for prophylaxis and treatment. The Health Department ascribed responsibility for the indiscriminate use of antibiotics to medical practitioners but had little control over their prescribing habits. Confronted by increasing infection rates and falling public confidence in the maternity services, health officials supported a fundamental change in maternity care to 'rooming-in' of mother and baby, epidemiological research on staphylococcal transmission in hospitals, notification of nosocomial infections, improved barrier nursing and heightened awareness of appropriate aseptic techniques. Phage type 80/81 waned in the early 1960s concurrent with the arrival of methicillin but the emergence of methicillin-resistant S. aureus (MRSA) in the 1980s, vancomycin-resistant S. aureus (VRSA) in the 2000s, and the rapid emergence and spread of multi-drug resistant Gram-negative bacteria over the past decade, highlights the potential for further outbreaks while the use of antimicrobials remains high. Non-pharmacological interventions such as those promoted during the 'H-Bug' epidemic are likely to be central to controlling future waves of resistant nosocomial infection.

The impact of the Hand Hygiene New Zealand programme on hand hygiene practices in New Zealand's public hospitals.

AIM: To detail the progress made by Hand Hygiene New Zealand (HHNZ) since 2011 and also describe the challenges experienced along the way and the factors required for delivery of a successful hand hygiene programme at a national level. METHOD: HHNZ is a multimodal culture-change programme based on the WHO '5 moments for hand hygiene' approach. The key components of the programme include clinical leadership, auditing of hand hygiene compliance with thrice yearly reporting of improvement in hand hygiene practice, biannual reporting of the outcome marker, healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB), effective communication with key stakeholders and the use of the front-line ownership (FLO) principles for quality improvement. RESULTS: The nationally aggregated hand hygiene compliance has increased from 62% in June 2012 to 81% in March 2016. There has been improvement across all 'moments', all healthcare worker groups and a range of different clinical specialties. The rate of HA-SAB has remained stable. CONCLUSION: The HHNZ programme has led to significant improvements in hand hygiene practice in DHBs throughout New Zealand. The principles of FLO are now widely used to drive hand hygiene improvement in New Zealand DHBs.

The Auckland City Hospital Device Point Prevalence Survey 2005: utilisation and infectious complications of intravascular and urinary devices.

BACKGROUND: In November 2005 a point prevalence survey of all inpatients at Auckland City Hospital was conducted to define the utilisation of intravascular and urinary devices; to measure the prevalence of infectious complications from these devices; and to provide quality assurance information about the use of these devices. METHODS: All 830 inpatients admitted on a single day under paediatric; adult medical; adult surgical, and women's health were visited by a member of the survey team and data regarding devices in situ was collected. RESULTS: Intravenous (IV) devices were present in 376/830 patients (45%; 95%CI 42-49), and 25/830 (3%; CI 2-4) had either confirmed infection or showed signs of infection. 33/830 patients (4%; CI 3-6) had intravascular devices in situ that were not required. Urinary devices were present in 93/830 patients (11%; CI 9-13), and 13/91 (14%; CI 8-23) had bacteriuria. A large proportion of urinary devices (19/91, 21%; CI 13-31) were found to have been inserted for inappropriate reasons. CONCLUSION: This study provides information on the current utilisation of devices in our hospital that can be extrapolated to other public hospitals in New Zealand. Healthcare workers require ongoing education to ensure prompt removal of devices that are not required for patient care.