Air sampling – operating theratre commissioning is it still necessary

[Ryan, Lindy]

Dear brains trust

I have a Question around the validity of undertaking air sampling as part of infection control QA for commissioning of operating theatres.
I have read around current literature and guidelines attached it being recommended (& I have undertaken air sampling and had the micro lab previously read and report on the results which have been reviewed with the Clinical microbiologist/ID) I have attached a coupe I have looked data and used previously at what I thought were great documents!!

However recently I was asked to undertake this again as we will be undertaking work in OT re our air-conditioning system and was happy to progress as previous with sir sampling . however the health laboratory I am currently working with has declined to accept and undertake the analysis and reporting as they have indicated they are not NATA accredited to undertake this analysis and reporting .

So we have been looking around for an external private laboratory to undertake this analysis and reporting at great cost to us .
However in asking around my colleagues I have also been advised that there is no current NATA credentialing for air sampling (so even the private lab we will need to use won’t be accredited accredited?)

Can I clarify with anyone else working elsewhere if this is true, and /or what their experience has been in undertaken air sampling and how they have had it analysed and reported on

I am seriously wondering if I have missed anything new or different in the literature that has changed the concept of air sampling as useful tool for commissioning given if there is no there is no standard (ie NATA) of accreditation around the sample data analysis & reporting methodology and its validity then why would an air sampling need test still be recommended to be done at all if the labs are telling us the info can’t be considered accurate or correct without NATA validation

Any thoughts responses or advice greatly appreciated as we look at our next step here around value for money and safety

Kind regards

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Mid-North-Coast-LHD.jpg]

“Wise and humane management of the patient is the best safeguard against infection”
(Florence Nightingale Circa 1860)

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[Michael Wishart]

Oh boy, where to start? 🙂

I agree there is conflicting information about the validity and utility of air sampling for commissioning new (or refurbished) operating rooms. The real commissioning, in my view, is to ensure that all of the mechanicals are working appropriately, and demonstration of appropriate pressure gradients.

There is, as far as I am aware, no definitive requirement in Australia to perform air sampling of this nature. No specific requirement form any regulatory body. Please correct me if you are aware of something.

Having said that, some people (aka administrators and surgeons, mainly) like to have ‘scientific’ evidence that the theatres are ‘safe’ from things we can’t see. So, whilst not mandated, it is sometimes required, and we have to do it.

As far as accredited labs goes, there are a few around the country, I believe but very few. I would have to check what ‘accreditation’ is required form this apart from being accredited to process environmental samples, but that would be my guess as to what you need to look for.

The trick is to work with the lab about air volumes required to process, and what you are actually looking for (who many of what kind of bugs, basically). You then have to have a plan on what to do if the count is higher than you agreed on – something the4 administrators and surgeons are loath to agree to (yet more testing!??!).

I wish you luck, and I also wish someone would give us some clearer direction on where to go with this. Save us all time and money and effort.

Cheers
Michael

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
[cid:image001.png@01D01926.61F1C2B0]

P Please consider the environment before printing this email

Dear brains trust

I have a Question around the validity of undertaking air sampling as part of infection control QA for commissioning of operating theatres.
I have read around current literature and guidelines attached it being recommended (& I have undertaken air sampling and had the micro lab previously read and report on the results which have been reviewed with the Clinical microbiologist/ID) I have attached a coupe I have looked data and used previously at what I thought were great documents!!

However recently I was asked to undertake this again as we will be undertaking work in OT re our air-conditioning system and was happy to progress as previous with sir sampling . however the health laboratory I am currently working with has declined to accept and undertake the analysis and reporting as they have indicated they are not NATA accredited to undertake this analysis and reporting .

So we have been looking around for an external private laboratory to undertake this analysis and reporting at great cost to us .
However in asking around my colleagues I have also been advised that there is no current NATA credentialing for air sampling (so even the private lab we will need to use won’t be accredited accredited?)

Can I clarify with anyone else working elsewhere if this is true, and /or what their experience has been in undertaken air sampling and how they have had it analysed and reported on

I am seriously wondering if I have missed anything new or different in the literature that has changed the concept of air sampling as useful tool for commissioning given if there is no there is no standard (ie NATA) of accreditation around the sample data analysis & reporting methodology and its validity then why would an air sampling need test still be recommended to be done at all if the labs are telling us the info can’t be considered accurate or correct without NATA validation

Any thoughts responses or advice greatly appreciated as we look at our next step here around value for money and safety

Kind regards

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Mid-North-Coast-LHD.jpg]

“Wise and humane management of the patient is the best safeguard against infection”
(Florence Nightingale Circa 1860)

________________________________

This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.

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[Jones, Catherine (KEMH)]

Hi Lindy,
I agree there is conflicting advice on this subject. I am currently am on the commissioning team for the new Perth Children’s Hospital, which has 11 operating theatres, including MRI and hybrid theatres. In Western Australia we have an Operational Directive from the Department of Health on Microbiological Air Sampling in Operating Rooms in Western Australia.

This directive is mandatory for all WA public healthcare facilities, which makes the requirements very straight forward for me . It is also a requirement that NATA accredited laboratory must be employed for processing and provision of results. We are using a private NATA accredited laboratory here in WA.

Feel free to contact me if you have any questions. Email and mobile number below.

Regards
Cathy

Catherine Jones
Senior Project Officer Infection Control | Operational Readiness | Perth Children’s Hospital Project
Child and Adolescent Health Service
GPO Box D184 Perth WA 6840
E catherine.jones@health.wa.gov.au
W http://www.perthchildrenshospitalproject.health.wa.gov.au
[cid:image001.png@01CF4F51.DA3DEB30]
A West Australian State Government Initiative

Dear brains trust

I have a Question around the validity of undertaking air sampling as part of infection control QA for commissioning of operating theatres.
I have read around current literature and guidelines attached it being recommended (& I have undertaken air sampling and had the micro lab previously read and report on the results which have been reviewed with the Clinical microbiologist/ID) I have attached a coupe I have looked data and used previously at what I thought were great documents!!

However recently I was asked to undertake this again as we will be undertaking work in OT re our air-conditioning system and was happy to progress as previous with sir sampling . however the health laboratory I am currently working with has declined to accept and undertake the analysis and reporting as they have indicated they are not NATA accredited to undertake this analysis and reporting .

So we have been looking around for an external private laboratory to undertake this analysis and reporting at great cost to us .
However in asking around my colleagues I have also been advised that there is no current NATA credentialing for air sampling (so even the private lab we will need to use won’t be accredited accredited?)

Can I clarify with anyone else working elsewhere if this is true, and /or what their experience has been in undertaken air sampling and how they have had it analysed and reported on

I am seriously wondering if I have missed anything new or different in the literature that has changed the concept of air sampling as useful tool for commissioning given if there is no there is no standard (ie NATA) of accreditation around the sample data analysis & reporting methodology and its validity then why would an air sampling need test still be recommended to be done at all if the labs are telling us the info can’t be considered accurate or correct without NATA validation

Any thoughts responses or advice greatly appreciated as we look at our next step here around value for money and safety

Kind regards

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Mid-North-Coast-LHD.jpg]

“Wise and humane management of the patient is the best safeguard against infection”
(Florence Nightingale Circa 1860)

________________________________

This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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[Anonymous]

Could I ask is air sampling required for commissioning of new ICU or just Opersting Theatre?
Thanks
Cate Coffey__________________________
From: ACIPC Infexion Connexion [AICALIST@AICALIST.ORG.AU] on behalf of Michael Wishart [Michael.Wishart@SVHA.ORG.AU]
Sent: Tuesday, October 25, 2016 5:02 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Air sampling – operating theratre commissioning is it still necessary

Oh boy, where to start?

I agree there is conflicting information about the validity and utility of air sampling for commissioning new (or refurbished) operating rooms. The real commissioning, in my view, is to ensure that all of the mechanicals are working appropriately, and demonstration of appropriate pressure gradients.

There is, as far as I am aware, no definitive requirement in Australia to perform air sampling of this nature. No specific requirement form any regulatory body. Please correct me if you are aware of something.

Having said that, some people (aka administrators and surgeons, mainly) like to have scientific evidence that the theatres are safe from things we cant see. So, whilst not mandated, it is sometimes required, and we have to do it.

As far as accredited labs goes, there are a few around the country, I believe but very few. I would have to check what accreditation is required form this apart from being accredited to process environmental samples, but that would be my guess as to what you need to look for.

The trick is to work with the lab about air volumes required to process, and what you are actually looking for (who many of what kind of bugs, basically). You then have to have a plan on what to do if the count is higher than you agreed on something the4 administrators and surgeons are loath to agree to (yet more testing!??!).

I wish you luck, and I also wish someone would give us some clearer direction on where to go with this. Save us all time and money and effort.

Cheers
Michael

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
[cid:image001.png@01D01926.61F1C2B0]

P Please consider the environment before printing this email

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Ryan, Lindy
Sent: Tuesday, 25 October 2016 4:10 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Air sampling – operating theratre commissioning is it still necessary

Dear brains trust

I have a Question around the validity of undertaking air sampling as part of infection control QA for commissioning of operating theatres.
I have read around current literature and guidelines attached it being recommended (& I have undertaken air sampling and had the micro lab previously read and report on the results which have been reviewed with the Clinical microbiologist/ID) I have attached a coupe I have looked data and used previously at what I thought were great documents!!

However recently I was asked to undertake this again as we will be undertaking work in OT re our air-conditioning system and was happy to progress as previous with sir sampling . however the health laboratory I am currently working with has declined to accept and undertake the analysis and reporting as they have indicated they are not NATA accredited to undertake this analysis and reporting .

So we have been looking around for an external private laboratory to undertake this analysis and reporting at great cost to us .
However in asking around my colleagues I have also been advised that there is no current NATA credentialing for air sampling (so even the private lab we will need to use wont be accredited accredited?)

Can I clarify with anyone else working elsewhere if this is true, and /or what their experience has been in undertaken air sampling and how they have had it analysed and reported on

I am seriously wondering if I have missed anything new or different in the literature that has changed the concept of air sampling as useful tool for commissioning given if there is no there is no standard (ie NATA) of accreditation around the sample data analysis & reporting methodology and its validity then why would an air sampling need test still be recommended to be done at all if the labs are telling us the info cant be considered accurate or correct without NATA validation

Any thoughts responses or advice greatly appreciated as we look at our next step here around value for money and safety

Kind regards

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Mid-North-Coast-LHD.jpg]

Wise and humane management of the patient is the best safeguard against infection
(Florence Nightingale Circa 1860)

________________________________

This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.

______________________________________________________________________
This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return email, delete the Email, and do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

______________________________________________________________________
This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return email, delete the Email, and do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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[Sarah Bailey]

Hi Everyone,

We carry out OT testing using the guidelines in the WA Circular, which is pretty clear on the need to carry out testing and when to do it. The guidelines here state that it should be carried out at commissioning, and after significant building/maintenance works that generate dust. The WA Guidelines state that a microbial count (bacteria and fungi combined) of <10cfu/m3 are required for the unit to pass.

I've been reliably informed that many other states use the WA Guidelines as these are stricter than others available. The ASID Guidelines still use a cut off of 35cfu/m3 bacteria with specific testing for fungi if required (WA Guidelines used this level until June last year too).

ASID Guidelines can be found here:
http://hicsigwiki.asid.net.au/index.php?titleOperating_theatre_commissioning_-_Microbiological

We recommend microbial testing to our clients as good microbial air quality, and ultimately not infecting the patient on the table is what you are trying to achieve by using your HEPA filters. Particle counting and all of the other methods are great, but if you pass the particle count, but all of the particles you do have coming through are viable bacteria and fungi, you still have a problem that needs fixing. We also do some annual testing for theatres, which could be argued to be a duty of care requirement.

We also recommend the same method for HEPA filtered rooms for BMT patients/positive pressure HEPA filtered isolation rooms (Class P), but does anyone have any thoughts on this?

As regards the NATA accreditation, any lab that is NATA accredited to do air sampling counts should be accredited to count your theatre plates. As far as I'm aware, it's not a separate special category for 'Theatre testing' – it is just a matter or counting colonies on plates after incubation and reporting a number. But with it being a more 'sensitive' area, the lab manager may not be happy signing off on it, which is a different matter.

Regards,

Sarah Bailey MSc PGDip Med Myc
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Dear brains trust

I have a Question around the validity of undertaking air sampling as part of infection control QA for commissioning of operating theatres.
I have read around current literature and guidelines attached it being recommended (& I have undertaken air sampling and had the micro lab previously read and report on the results which have been reviewed with the Clinical microbiologist/ID) I have attached a coupe I have looked data and used previously at what I thought were great documents!!

However recently I was asked to undertake this again as we will be undertaking work in OT re our air-conditioning system and was happy to progress as previous with sir sampling . however the health laboratory I am currently working with has declined to accept and undertake the analysis and reporting as they have indicated they are not NATA accredited to undertake this analysis and reporting .

So we have been looking around for an external private laboratory to undertake this analysis and reporting at great cost to us .
However in asking around my colleagues I have also been advised that there is no current NATA credentialing for air sampling (so even the private lab we will need to use won’t be accredited accredited?)

Can I clarify with anyone else working elsewhere if this is true, and /or what their experience has been in undertaken air sampling and how they have had it analysed and reported on

I am seriously wondering if I have missed anything new or different in the literature that has changed the concept of air sampling as useful tool for commissioning given if there is no there is no standard (ie NATA) of accreditation around the sample data analysis & reporting methodology and its validity then why would an air sampling need test still be recommended to be done at all if the labs are telling us the info can’t be considered accurate or correct without NATA validation

Any thoughts responses or advice greatly appreciated as we look at our next step here around value for money and safety

Kind regards

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Mid-North-Coast-LHD.jpg]

“Wise and humane management of the patient is the best safeguard against infection”
(Florence Nightingale Circa 1860)

________________________________

This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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