A Day In The Life Of An APIC Board Member

What a whirlwind 72 hours it’s been. On Saturday afternoon I flew 9 hours from Brisbane, Australia up to Hong Kong to attend the 3^rd International Infection Control Conference. The conference is hosted annually by the Hong Kong Infection Control Nurses’ Association and every year the speaker line-up gets more and more impressive. This year there were several global and local experts presenting. Key highlights were presentations from Professor Wing Hong Seto, Ms Patricia Ching, Dr Marty Favero, Ms Patricia Lynch,  Dr Bill Jarvis, Ms Barbara Soule and Dr Didier Pittet. Alone each of these speakers is a drawcard, collectively they make it impossible to not want to attend. More information about this conference can be found at www.mvdmc.com/icna2008 Of course the scientific content alone would be attraction enough; add into the mix the opportunity to network and be reconnected to old friends and colleagues and you have the South East Asian Regional highlight. I was thrilled to catch up with friends from Singapore, Shanghai, Hong Kong, the Philippines and even a few ex-patriot Australians enjoying career development in the Region. 

Hong Kong is an amazing place. It’s political and cultural history is interesting and its infection prevention history even more compelling. Each time I’ve flown in during the past five years I’m drawn back to my memories of April 2003 when I transited through Hong Kong enroute to Macau where I consulted to the Macanese government at the height of the SARS epidemic. Hong Kong much like Singapore was like a ghost town during the SARS outbreak. The usually jam packed streets were empty or if not empty playing host to just the occasional mask-wearing local furtively avoiding any contact with humans.

SARS impacted the South East Asian economy unlike any other phenomena yet it also lead to growth and development. Certainly the country’s infection prevention capacity increased rapidly and that rapid growth appears to have been sustainable in these past five years. There is much that those of us in countries with well-developed and mature systems of infection prevention could learn from the resilience and innovation of our partners in this Region.  

One of the most outstanding aspects of post-SARS Hong Kong has been the development of community awareness regarding transmission of infectious diseases and the importance of simple protective measures such as hand hygiene and respiratory etiquette. It’s difficult to describe how this has evolved and perhaps the picture at the top of this page from a Starbucks store at a large Hong Kong mall speaks a 1000 words. How fantastic that the people of Hong Kong expect to be able to sanitise their hands before their “Grande Venti Decaf Skinny Mocha Frappucinos – hold the whipped cream”

Safe travels, broad thinking, better hand hygiene and great coffee to you all from Hong Kong!

I am always amazed at how much we can learn from children. Some how in the innocence of their years and their ability to resist some of the challenges we face as adults like group think, peer group pressure, stress and deadlines children can make fantastic role models. There is a lot that modern healthcare could learn from watching kids’ behaviours.

Yesterday I spent the day teaching nurses the fundamentals of infection prevention. The course was run in Brisbane by AUSMED (www.ausmed.com.au) and it’s one that Sue Resnik and I teach at least twice a year. Yesterday’s group were all nurses. Our common goal was to be better at infection prevention at the end of the day compared to the beginning. Throughout the day we had a few good laughs as experiences were recounted and stories shared. Here is my favourite story of the day told to me by a very proud Grandmother working in infection prevention.

Last month this Grandmother’s 6 year old Grandson came to visit Brisbane and the Gold Coast from his home in Auckland, New Zealand. The little boy’s holiday included the sights of Brisbane city and no doubt some of thefun things for kids here on the Coast like Movie World, Sea World, Dreamworld and perhaps even a spot of whale or dolphin watching from one of our gorgeous beaches.

At some stage of his holiday the young boy watched his Grandmother pull out of her pocket and use an alcohol based hand gel, the domestic type not our hospital product. The hand gel fascinated the little boy and he asked his Grandmother to explain what she was doing, what the purpose of the gel was and what did she hope to achieve. (Imagine someone being that interested in hand hygiene – an Infection Preventionist’s dream). Like a good Grandmother she explained about germs and antisepsis and the grandchild was delighted when he had the opportunity to first use the product.

Wind forward a few weeks and the little fella returns to Auckland and attends school. It’s show and tell day and the little boy stands up in front of his peers and he proceeds to tell about the best part of his holiday to Australia. You guessed it. No mention is made of the theme parks, the beaches or any of the other tourist attractions here in Queensland. Rather the 6-year old proceeds to tell all his class mates about the gel and then he demonstrates how to use it for them and tells them why it’s important to perform hand hygiene regularly. The kids are riveted and the teacher pleased and amused.

Our young recruit is very special, part of a Gifted and Talented class at his local school. Not surprisingly he ends his “show and tell” recommending that the class immediately institute a “gel-based hand hygiene programme” (my words not his). What he managed to design and achieve was the implementation of a bracket and a large bottle of gel which each child uses befre leaving the classroom for each of their play and meal breaks. The kids love the gel and use it with passion.

Your typical infection preventionist might be happy to stop at this point but your above average 6-year old isn’t. Enjoying the success of his program he goes to the administrator (school principal) puts forward his business case and requests that every classroom be supplied with a gel bottle and each student encouraged to use the gel before every break. The principal loves the idea and the school is now probably one of the most hand hygiene conscience of any in the Southern hemisphere.

What a great and inspiring story. Who says that one small boy with one bright idea and one switched on Grandma can’t make a difference? In 30 years time when I’m older and probably consuming healthcare along with the other Boomers I want this boy to be the Infection Preventionist keeping me safe. Move over Semmelweis the kids are coming through.

For more information on global hand hygiene promotion visit http://www.who.int/gpsc/tools/en/ or www.apic.org Australia is in the early stages of launching its national hand hygiene campaign. I wonder if they have room for a 6-year old Project Director.

In 2008 there are more countries with dedicated local and/or national programs designed to reduce or eliminate healthcare associated infections (HAIs) than at any other time in history. Interestingly the global infection control stage is becoming more crowded as non-traditional players including claim infection control expertise at either individual or organisational level. High level campaigns of global magnitude are becoming more common and regional organisations such as the Asia-Pacific Society of Infection Control (APSIC) continue to grow in membership size and influence. Additionally, the WHO has signalled its intention to establish multiple Infection Control Collaborating Centres. More interestingly, some see US-based organisations such as the Association for Practitioners in Infection Control and Hospital Epidemiology (APIC) and the Centers for Disease Control and Prevention (CDC) as continuing to have substantial influence in shaping our profession. Recent provocative US lead initiatives such as the impending change to reimbursement and the promulgation of the title “Infection Preventionist” will inevitably also influence the growth and direction of Australian infection control. I would strongly encourage all Australian ICPs to stay abreast of recent, critical global infection prevention trends and initiatives as well as they will inevitable impact us.      

What a great event the New Zealand (NZ) National Division of Infection Control Nurses hosted from 13^th-15^th August in Hamilton in the North Island. NZ Infection Control Practitioners (ICPs) are a really enthusiastic group of professionals. I first attended their annual conference in the early 1990s and have had the distinct pleasure of being invited back several times since. This 2008 conference was fantastic and a testimony to how much progress the ICPs have made in the past few years.

While infection prevention practice in NZ is similar to that here in Australia, the NZ ICPs have faced and conquered some unique challenges different to ours. NZ geography means that getting together for face-to-face meetings can be difficult. As a result many members make the effort to attend the annual conference and to use that as their best opportunity to network and update on cutting edge research and trends.

Being such a small country in terms of population (the old joke goes something along the lines of there are more sheep in NZ than people!) it means that NZ is an even smaller dot on the global medical industry market than Australia.  Australia is less than 1% of the global market so NZ must be closer to zero. Given that figure it is difficult for NZ to garner any overwhelming support from medical manufacturers although several do generously support the Division year after year. Interestingly, NZ does not yet have tough regulations regarding medical devices. Australia has a statutory body, the Therapeutic Goods Administration, (TGA) which tests medical devices and supportive claims prior to approving them for marketing and use in Australia. The TGA operates similarly to the US FDA. Without this safeguard NZ is often seen by manufacturers as the perfect test site – easy to enter and reasonably well developed to be useful in predicting trends. This can mean that ICPs in NZ have to be extra vigilant in their efforts to keep up with products used in their facilities to prevent inadvertent use of unsafe or harmful equipment or products. In the very near future Australia and NZ will join and harmonise their approach to medical device regulation and both countries will benefit from that process.

And there are many more stories about ICPs from “across the ditch”. Our Kiwi friends are some of the friendliest ICPs in the world. They love to party and every year their conference social event is a themed dinner. This year’s theme was “Showboat”. I have never seen so much taffeta, silk, ribbons,  bows  and ICPs all in the same place. What a great night it was.

We were also blessed to have the Immediate Past APIC President, Denise Murphy, as one of the keynote speakers at the conference. What a great job she did in “bridging the gap” too. No doubt opportunities for ICPs all around the world to meet and share their experiences will increase over the next few decades. Given it’s strong history and this most recent example, I have no doubt that the NZ annual conference will remain a constant source of inspiration to local and international ICPs. Visit them next year from 26-29^th August and you too can experience the WOW of NZ.

On 26th and 27th June I had the distinct pleasure of meeting with old friends and peers at the World Health Organization headquarters in Geneva, Switzerland. The meeting involved invited members of WHO’s Informal Panel of Infection Control Technical Experts and the main work undertaken on those two days was in relation to defining and scoping the core elements of an infection control program and the key role of infection control professionals.

The meeting was incredibly interesting not just from a technical point of view but largely because it involved internal and external representatives from each of the WHO’s Regions. 

I was thrilled to work alongside experts such as Prof. Wing Hong Seto (Hong Kong), Prof Ziad Memish (Saudi Arabia), Dr Mike Bell (CDC USA), Ms Shirley Paton (Canada) and WHO’s Program champions Drs Carmem Pessoa da Silva and Fernando Otazia. As I understand it a Report of the meeting will be forthcoming and once it has official WHO approval I suspect that it will be made publicly available.

As well as the 2 days of hard work the group also managed to enjoy some social down time at the Le Chateau de Penthes which is located close to WHO. In the photo above you will see Dr Bell and me outside of the Geneva School of Diplomacy & International Relations. I will leave it up to you to determine whether Mike and I were guest lecturers or students at the school????? Stay tuned for further stories from Australia and abroad.

Many APIC members ask me how do I manage to contribute to APIC activities and discussions when my base in Australia is at least 14,000 miles from APIC’s head office in Washington, DC. It’s actually much easier than you would imagine. For a start, my day is already more than 12 hours long when the first APIC staff and other Board members begin the same day. For example it’s now almost 7pm here in Queensland and it’s almost 5am the same day in DC. So my Monday in-box is almost empty and ready for all that APIC can throw at it while I rest up.

When I wake up and check my Blackberry I always have enough time to respond to any urgent requests and still make the end of the DC business day. It’s remarkable actually.

Probably the most difficult thing has been having to get up sometimes at 5am to start a 2-hour Board call. Or perhaps even worse has been staying awake to start an all-day conference call meeting in DC which starts at 11pm my time. Thankfully the few times I’ve needed to do that I’ve been up for the challenge and thankfully no-one on the other end gets to see my pyjamas!

Strangely the way that I do business with many of my peers in Australia now is by phone or occasional meeting. The rest of the time e-mails and Blackberries work wonderfully for us. I honestly think that time zones are irrelevant because if you really care about your role on the Board, as all the current Board members, we all make sure where there for when it matters.

That said, it’s always great to meet my Board colleagues face to face and I am excited about that opportunity late next week in Denver. 

From the 18th - 22nd of May I was fortunate enough to be invited to present to delegates at the Joint Meeting of the 17th National Conference on Nosocomial Infection of Chinese Preventative Medicine Association and the 4th Shanghai International Forum on Infection Control (SIFIC) in Shanghai, China. What an amazing event!

Despite having suffered a major and catastrophic earthquake just a week prior to the conference more than 700 Chinese delegates gathered for the 3-day meeting. The Chinese ICPs and high level officials kept apologising for the 300 or so delegates who were on stand-by or who had already left to provide aid to the earthquake region. Imagine the challenges those aid workers faced. The Chinese papers reported major problems with no running water and several cases of “gas gangrene”. It made me again appreciate my own good fortune to live and work in a country where infection prevention is valued and fairly well understood. I also wondered how an organisation like APIC could help these ICPs. Maybe through provision of training materials or contingency plans. International infection control aid is a really important area where we can all potentially contribute. Please let me know if you have an interest in this area.

The majority of the Chinese conference was delivered in Mandarin or Cantonese. As neither are languages I use I had to rely on the excellent services of an interpretor for my presentations. Several of the abstracts and talk titles were printed in English and I was fascinated to see the speed with which Chinese hospitals are implementing best infection prevention practices. This was especially evident in relation to their interests in safe handling, use and disposal of sharps, prevention of catheter-related bloodstream infections and ventilator-associated pneumonia.

APIC members may also be interested to note that Chinese ICPs have developed and routinely make use of their own Chinese Electronic List Serv similar to the APIC List. The list is facilitated by my friend and colleague Dr Hu from Shanghai. Dr Hu is the List’s official Grand Master and more than 100 ICPs across China participate as sub-Master moderators. It’s really amazing to see how APIC’s influence and ideas have touched and fertilised the far ends of the world. I hope to soon add some photos from the trip to this site. Please let me know if you have any interest in learning more about the conference or Chinese infection control. E-mail me at cmurp@icp.au.com