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Normalisation and the wheel and uniformity

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With any recommended introduction or change of a practice, one needs to consider how it is to be implemented, they’ve even dedicated a science to it, a journal the whole lot! One group I have enjoyed reading is Carl Mays group and their normlisation process theory For somebody new to this area, the NPT seems to be quite practical, and importantly relevant and applicable to my work. More of this to come in the future no doubt.

Have been reading some interviews conducted with some infection prevention practitioners (for a colleague) and have come across some interesting comments. Possibly not original, but worth a thought, and actually, I think they are really relevant to my work (which I guess is why I remember them)…

“Everybody says dont re-invent the wheel. Well I think we should. If we didnt re-invent the wheel, we’d still have wooden wheels”

Well yeah, I can see their point. Sometimes the answer is there right in front of you, its just needs a tweek. In fact, you are not really re-inventing the wheel, you’re improving the current design…but I’m probably being a bit technical. It’s akin to the notion of “leveraging off existing systems”. Sometimes you do have to look at what is there, and and ask is it fit for purpose, or does it need a complete redesign? On this point, Australia already has a national surveillance program, it just doesn’t include HAIs. The Communicable Diseases Network of Australia (CDNA) has been in existence now for a few decades and collates data from the States and Territories on notifiable infectious diseases. It has direct links to the Chief Medical Officer, has widespread jurisdictional buy in, and expertise in surveillance. Although not all States and Territories have identical lists of notifiable diseases, where feasible, CDNA collates data and produces national figures. This gives us an understanding of the epidemiology of these diseases in Australia. So why don’t we just tell them to start collating data on HAIs? Well I guess they could, though with the variation of practices and poor agreement already identified, the data collated would have so many footnotes and  conditions attached to it, we know it wouldn’t be worth doing. But lets just say, one day in the future, we are all doing HAI surveillance the same way, could they collate and publish it then? Most likely, with a few resources dedicated to HAI (is this starting to sound like an Australian version of CDC? Imagine!) we could have embedded a national HAI program into am already exiting structure (the wooden wheel?). But what then? With the existing CDNA, if a notifiable disease is identified it is up to the relevant State or Territory department to manage the situation, launch an outbreak investigation, inspect kitchens, notify schools, whatever. But what happens if a concern (an increase) with a HAI is identified? Who is going to look into it then? Who is the “action” arm of this process? And that’s where it all falls down. Not all of our State or Territories have an action arm. And of course, whats the point of surveillance if there is no action…

So, simply put, with no action arm, why bother collecting the data. If we are ever going to have a national surveillance program, we must not only consider the process of collecting, analysing and feeding back data, we need to also consider the who is going to govern the interventions. If its not data for action, then don’t bother.


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