Mona Schousboe, MPH 2010
Abstract
An infection control service was introduced in Canterbury hospitals in 1978 with the employment of an infection control nurse. The development was in keeping with international trends and was initially requested by the Department of Health. Hospital infection was acknowledged as a public health issue with international research showing that up to 10% of patients develop a nosocomial infection in public hospitals.
The overall aim of this thesis is to evaluate the forces which shaped the development and performance of infection control in Canterbury public hospitals during 1978-2008 including governance by the state and hospital administration, hospital management and professional influences.
The research is an historical evaluation, based on mainly written material related to the operation of the Infection Control Committee and Infection Control Service in Canterbury Hospitals 1978-2008. Documents included ICC minutes and Annual Reports, correspondence to and from the Infection Control Committee and the operational group, and reports on incidences and investigations. Key informant interviews supplemented documentary sources.
Five time periods were identified in this project (A: 1978-89 Medical management with early introduction to managerial approach; B: 1989-93 Conversion of hospital boards to area health boards; C: 1993-96 Introduction of Crown health enterprises and a market approach; D: 1996-2000 A coalition of political parties and retreat from the market approach and E: 2000-08 Introduction of district health boards). These periods reflect changes in public policy and the structure of the health services. Material collected for each period was analysed according to identified themes, including the development of the service according to progress towards New Zealand Standard on Infection Control NZS 8142:2000.
The research shows that the infection control nurse(s) and the medical microbiologist formed the infection team throughout the total period and received support from professional groups on the infection control committee and other groups of staff. Within a few years of operation the infection control team's work developed, from providing surveillance, education and guidelines, into multiple areas of hospital operation.
The governance structure represented by the Department/Ministry of Health encouraged infection control throughout the period with an initial support for education, but changing over time, from direct communication and requirements for surveillance data, to assessment of infection control performance at hospital certification via the hospitals' quality systems. The research showed that the political changes in health also had an impact on infection control.
Institutional management provided varying support across the time periods studied, but generally management acknowledged that infection control was essential for the hospitals quality system and service effectiveness.
The infection control services were also shaped by responding to regular outbreaks, with the largest and most intense outbreaks occurring during the period when the Canterbury hospitals were divided into two CHEs. Outbreaks with viral organisms, especially norovirus, became prominent during the last period (2000-2008).
The research demonstrates infection control's involvement in the development of the occupational health services and discusses the professional education of the infection control staff during the periods.
Supervisors: Pauline Barnett, Cheryl Brunton