Course Access
Thanks Meryl for the update.
This is a great way to see how this discussion list can aid clinicians in reviewing policy, and it is great to see those policy changes then reported back to the list.
Cheers
Michael Wishart
ACIPC Infexion Connexion Administrator
Michael Wishart
Infection Control Coordinator
A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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P Please consider the environment before printing this email
Thank you all for the interest shown in the original question posed. It is obviously an issue that we are not alone in experiencing and it has been very informative to hear how other health services have approached the problem. Given the level of interest this topic has generated I thought I’d feedback the approach we have decided upon.
I found the following article very useful and have shared it with other stakeholders within our organisation:
Larson, T., Gudavalli, R., Prater, D., & Sutton, S. (2015). Critical analysis of common canister programs: a review of cross-functional considerations and health system economics. Current Medical Research & Opinion, 31(4), 853-860.
http://informahealthcare.com/doi/pdf/10.1185/03007995.2015.1016604
Following discussion between clinicians and pharmacists, it has been decided that we will use the following approach:
* It has been assumed that for our organisation, the chance of busy clinicians cleaning MDIs as per evidence-based guidelines is not reliable and the cost of cleaning outweighs the cost of throwing them away. Therefore, MDIs will be used as single-patient items: once issued, they will stay with children for the duration of their inpatient care.
* All MDIs will have labels attached to them in pharmacy to allow clinicians to add the appropriate information to them (i.e. patient name, dose) so that they can be taken home as discharge medications.
* Any MDI used during hospital stay but not required on discharge will be disposed of.
* Doctors will be advised to consider good stewardship when prescribing drugs to be taken via MDI to try and rationalise their use (e.g. not prescribing them on a “try it and see” basis to children who are probably too physiologically undeveloped to respond to salbutamol).
We have decided that the cost of the MDIs is small, but the risk of spreading infection (since many of our children who are prescribed drugs via MDI have respiratory viruses) is greater.
Many thanks again for all your responses.
Meryl
Meryl Jones
Clinical Nurse
Infection Management and Prevention Service
Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101
T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au
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Good morning everyone,
I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:
* Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.
* The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.
* The inhaler sits at the patient’s bedside before moving to the medication room and then on to another patient’s room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.
Many thanks in advance,
Meryl
Meryl Jones
Clinical Nurse
Infection Management and Prevention Service
Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101
T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au
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