Infection Control Practitioners, as with all health professionals, should have a working knowledge of the legislative framework within which the health services are delivered and, for the purposes of these guidelines, the way in which an infection control program must operate. The following provides some information about various pieces of legislation that will impact on the way in which infection control programs are developed, implemented and evaluated. This is by no means an exhaustive list but is intended to provide a useful starting point for new and existing practitioners. Legislation can be accessed via http://www.legislation.qld.gov.au
Environmental Protection Act 1994
Environmental Protection (Waste Management) Policy 2000
Environmental Protection (Waste Management) Regulation 2000
All health facilities in Queensland have an obligation to comply with this Act by taking appropriate measures to minimise or eliminate environmental hazards. There are specific provisions dealing with clinical and related waste.
The Environmental Protection Agency (EPA) administers this Act and Regulations and has a key role in defining categories of waste and dealing with contraventions of the Act.
Refer to ‘waste management’ for infection control, including requirements for waste management plans.
Freedom of Information Act 1992
Freedom of Information Regulation 1992
This Act establishes a statutory avenue through which an individual can access their personal medical/health records held by a public authority. The object of this Act is to extend as far as possible the right of the community to have access to information held by Queensland government.
This Act is intended to strike a balance between these competing interests by giving members of the community a right of access to information held by government to the greatest extent possible, with limited exceptions for the purpose of preventing a prejudicial effect to the public interest of a kind mentioned above. The Queensland Act is largely consistent with the Commonwealth Act Freedom of Information Act 1992 (Cth). The latter only has effect on those agencies that come under Commonwealth control eg repatriation hospitals.
Much of the information collected by infection control practitioners in public health facilities will be accessible under FOI legislation. Some protection may be achievable via establishing Quality Assurance committees under the Health Services Act 1991. This has yet to be tested but is something that should be investigated regarding information collected at a local level.
Health Practitioners (Professional Standards) Act 1999
Health Practitioners (Professional Standards) Regulation 2000
This Act regulates the discipline of health care professionals and applies to:
Health Rights Commission Act 1991
Health Quality and Complaints Commission Act 2006
The Health Rights Commission was established by this statute and its role is to oversee, review and improve the quality of health care in Queensland. It receives complaints about all health services, including private health services. The Commission also has an educative role, to make health consumers more aware of their rights and to encourage informed participation in the management of their health problems. The Act places an emphasis on resolving complaints through conciliation and negotiation rather than through litigation.
The main objectives of the Health Quality and Complaints Commission are to provide oversight and review of, and improvement in, the quality of health services and independent review and management of health complaints.
Health Services Act 1991 (Qld)
Health Services Regulation 2002
This Act establishes legislative control over public hospitals. The stated objects of the Act are to help prevent illness and provide for the treatment of the sick. This is to be achieved primarily by:
This Act provides protection from liability, claim or demand for work done by a quality assurance committee or persons acting under the direction of committee if done in good faith and for the purpose of the exercise of the committee’s functions. The extent to which this applies to work conducted by infection control practitioners is still to be fully explored but it may provide some protection against FOI requests for raw, non-risk adjusted infection surveillance information.
Nursing Act 1992
Nursing Regulation 2005
The objective of this Act is to make provision for ensuring safe and competent nursing practice. Via this Act, the State regulates the professional activities of nurses. The Australian Health Practitioner Regulation Agency controls most of these activities.
Privacy Act 1988
The relevant amendments came into operation in December 2001. This legislation applies to private organisations only. There are no penalties attached but the Privacy Commissioner has made it clear that breaches will be advertised widely and this is likely to impact on the public image of any facility not abiding by the legislative requirements. In addition, licensing of facilities includes obligations of compliance with relevant legislation. Health fund agreements may also be affected by non-compliance.
Whilst the Act will only apply to private facilities, it will limit the ability of facilities to share information with other bodies, including government bodies, unless they can confirm that these other organisations also have similar privacy protection procedures in place and they have the patient's consent. This may impact on infection control eg transfer of a patient with MRO to a public hospital. There is an exception for emergency situations but consent needs to be obtained within a reasonable time frame.
It is possible to address obligations by developing a consent form that all patients must read and sign at admission or soon after in emergency cases. The consent form does not have to list the uses specifically as it can detail in general terms how information from the medical chart etc will be used, for example, to provide a high standard of care, improve procedures where there are gaps and protect both the patient, other patients and staff. This must be informed consent and must be a separate process to consent obtained for other action eg surgical procedures.
Using infection control alerts, such as MRO alerts, is not an issue because this is part of the medical record and relates to direct patient management. However, using the information to look at trends or infection rates requires the consent of the patient. Where infection rates are used merely as trending information and are de-identified, the provisions of the legislation will not apply. However, at the facility level where numbers are usually relatively small and where medical officers often want to know which patients make up those deemed 'infected', the information is kept in 'identifiable' form. In this case, patient consent will be needed (see above regarding general words of consent). Information provided to the Office of the Chief Health Officer of Queensland Health is not covered by the Act if it is provided in de-identified form.
Similar requirements will apply to public facilities but the recommendations will appear in the form of guidelines, such as those developed by the National Health and Medical Research Council. Each facility needs to obtain advice regarding the implications for their individual operations. The Australian Private Hospitals Association may be able to provide further assistance.
Private Health Facilities Act 1999
Private Health Facilities (Standards) Notice 2000
Private Health Facilities Regulations 2000
The main object of this Act is to provide a framework for protecting the health and wellbeing of patients receiving health services at private health facilities. The object is to be achieved mainly by:
Information regarding licensing of private health facilities and the Standards against which best practice will be measured can be accessed via the Office of the Chief Health Officer.
Public Health Act 2005
Health Regulations 1996
Health (Drugs and Poisons) Regulations 1996
This is the primary piece of legislation regarding the regulation of public health within Queensland. The Act is divided into 7 parts and deals with issues including powers of government officers, responsibilities of local and state government in relation to public health, prevention/notification/treatment of disease/disability, and a number of miscellaneous provisions.
Quarantine Act 1908
Section 51(ix) of the Commonwealth Constitutions has been used to support the Quarantine Act 1908. Section 4 of that Act states:
‘Quarantine has relation to measures for the inspection, exclusion, detention, observation, segregation, isolation, treatment, sanitary regulation and disinfection of vessels, persons, goods, things, animals or plants, and having their object the prevention of the introduction or spread of diseases or pests affecting man, animals or plants.’
The Commonwealth government has allocated funds to each state/territory to determine facilities that will have ‘quarantine status’ and this includes an expectation that these facilities will be suitably resourced to manage patients.
Therapeutic Goods Act 1989
Therapeutic Goods Amendment Act (No.1) 2003
The objects of this Act are to do the following, so far as the Constitution permits:
Provide for the establishment and maintenance of a national system of controls relating to the quality, safety, efficacy and timely availability of therapeutic goods that are:
To provide a framework for the States and Territories to adopt a uniform approach to control the availability and accessibility, and ensure the safe handling, of poisons in Australia.
This Act is therefore not intended to apply to the exclusion of a law of a State, of the Australian Capital Territory or of the Northern Territory to the extent that the law is capable of operating concurrently with this Act. Before goods can be supplied in Australia, most will have to be entered in the Australian Register of Therapeutic Goods. This may require manufactures to obtain and produce extensive data to support quality, safety and efficacy of the item. A group of professional personnel are charged with the responsibility of assessing this data, the Therapeutic Goods Administration (TGA).
With the powers established by this Act the TGA undertakes the following:
Workplace Health and Safety Act 1995
Workplace Health and Safety Revision Notice 1995
Workplace Health and Safety (Codes of Practice) Notice 2005
Workplace Health and Safety Regulation 2008
There is a growing trend towards statutory provisions concerning workplace health and safety. In Queensland this area is regulated by the Workplace Health and Safety Act 1995. The application of the Act extends to all hospitals and health care agencies, whether private or public. The overall object of the Act is to ensure freedom from the risk of disease or injury created by workplaces, workplace operations or specific high-risk plant.