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Hi everyone,
just after your thoughts on glove and gown use in contact precautions. We are currenlty reviewing the management of transmission based precautions in our facility. Our local profile of MROS’s include very almost no CPE, minimal MRSA, high rates of nmMRSA which is widespread in the community , increasing ESBL, minimal other gram negative MRO’s. We are reviewing the possiblilty of using standards precautions for patients who are colonised with nmMRSA. Clearance swabs are problematic as patientss often retrun to homes with overcrowding and high rates on nmMRSA. There is currently no PCR testing for MRSA/nmMRSA available in our jurisdiction, therefore 3 swabs are taken for culture.
We would also like to remove longsleeve plastic gowns and replace with plastic aprons for contact precautions unless there is a risk of blody fluid exposure. Gloves seem to poorly affect Hand Hygiene complance despite significant education and would like you views and experience on this.
The literature seems inconclusive but as this would be against NHMRC guidelines ,can you let me know if you have any advice regading the changes we would like to implement ?
Thanks everyone
?Cate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517737
e … cate.coffey@nt.gov.au http://www.nt.gov.au/healthOur Vision: Better health outcomes for all Central Australians
Our Values: Community at the Centre | Equity and Integrity | We are Accountable | We are Relevant Today and Ready for Tomorrow | We are Committed to High Quality Care | We Value our PartnershipsCentral Australia Health Service is a Smoke Free Workplace
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Hello Cate, the guidelines are just that… guidelines.
There is a growing evidence base supporting the move you are considering and your risk assessment according to your local epidemiology is sound. I believe we all need to look very carefully at what we do in this particular space, particularly when the impact that the gowns and gloves make on patients and hand hygiene compliance is considered. Also we really do need to consider the $ and the environmental costs of all those bulky gowns and gloves we use.
We have been doing this for a number of years now with no increase in MROs and a significant reduction in issues caused when single rooms are few and far between, and patient experience. If Standard Precautions are done well (and that is an important aspect to consider) they will be effective in reducing transmission of all contact transmitted pathogens. As we dont know everyone who has an MRO at any one time, and non MROs still cause HAI with sometimes devastating impact, why should we focus so hard on doing things to some kind of higher standard for some patients and not others?Jo Harris, Nurse Manager, Infection Management and Control Service,
Illawarra Shoalhaven LHD NSW.
Joanna.Harris@health.nswgov.au
0475 943494Sent from my iPhone
> On 1 Apr 2019, at 17:36, Cate Coffey wrote:
>
> Hi everyone,
> just after your thoughts on glove and gown use in contact precautions. We are currenlty reviewing the management of transmission based precautions in our facility. Our local profile of MROS’s include very almost no CPE, minimal MRSA, high rates of nmMRSA which is widespread in the community , increasing ESBL, minimal other gram negative MRO’s. We are reviewing the possiblilty of using standards precautions for patients who are colonised with nmMRSA. Clearance swabs are problematic as patientss often retrun to homes with overcrowding and high rates on nmMRSA. There is currently no PCR testing for MRSA/nmMRSA available in our jurisdiction, therefore 3 swabs are taken for culture.
> We would also like to remove longsleeve plastic gowns and replace with plastic aprons for contact precautions unless there is a risk of blody fluid exposure. Gloves seem to poorly affect Hand Hygiene complance despite significant education and would like you views and experience on this.
> The literature seems inconclusive but as this would be against NHMRC guidelines ,can you let me know if you have any advice regading the changes we would like to implement ?
> Thanks everyone
>
>
> Cate Coffey | Clinical Nurse Consultant
> Infection Prevention and Control Unit | Central Australia Health Service
> Northern Territory Government
> Alice Springs Hopsital, Gap Rd, Alice Springs
> GPO Box 2234, Suburb, NT Postcode
> p … 08 89517737
> e … cate.coffey@nt.gov.au http://www.nt.gov.au/health
>
> Our Vision: Better health outcomes for all Central Australians
> Our Values: Community at the Centre | Equity and Integrity | We are Accountable | We are Relevant Today and Ready for Tomorrow | We are Committed to High Quality Care | We Value our Partnerships
>
> Central Australia Health Service is a Smoke Free Workplace
>
> The information in this e-mail is intended solely for the addressee named. It may contain legally privileged or confidential information that is subject to copyright. If you are not the intended recipient you must not use, disclose copy or distribute this communication. If you have received this message in error, please delete the e-mail and notify the sender. No representation is made that this e-mail is free of viruses. Virus scanning is recommended and is the responsibility of the recipient.
>
>
> 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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>
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> You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.auMESSAGES 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.
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Hi Cate,
Great you are looking at your local risk re. these issues.
I can share with you my NZ experience – in most of New Zealand North Island, Auckland and upper north of NZ which has a similar epidemiology picture to yours re MRSA e.g. overcrowding , high community rates of nmMRSA etc. Most NZ North Island hospitals removed contact precautions for nmMRSA patients many years ago and have not seen an increase in hospital transmission of MRSA which is actually mostly community acquired.* Re ESBL the common community ESBL- E.coli colonised patients are not isolated either unless they have a high risk factor for spread. Again the majority of the ESBLs are community acquired. In Christchurch over 5 years ago we introduced a risk matrix for isolation of ESBL based on organism e.g. ESBL Klebsiella is always in CP, and patient risk factors for spread. Again no change in hospital transmission. Of course it freed up single rooms, improved transfer times from ED and was better for the patients.
* Re. plastic aprons versus long sleeved plastic gowns. Most of the UK routinely use plastic aprons for these types of MRO CPs where there is minimal contamination anticipated. However it may be that one type of gown stocked on the wards is better than two.
* I also think Susan Jains recent journal article presents a good argument for no gloves for dry MRO patients very well.Cheers
RuthRuth Barratt RN, BSc, MAdvPrac (Hons)
PhD Candidate and Research Assistant
Centre for Infectious Diseases and Microbiology
Westmead Institute for Medical Research
University of Sydney
Email: ruth.barratt@sydney.edu.au
rbar5856@uni.sydney.edu.au
Mobile: 0468 352 335
ORCID ID:https://orcid.org/0000-0002-8930-6414From: ACIPC Infexion Connexion on behalf of Cate Coffey
Reply-To: ACIPC Infexion Connexion
Date: Monday, April 1, 2019 at 7:24 PM
To: “ACIPCLIST@ACIPC.ORG.AU”
Subject: Gloves,gowns, contact precautions and colonised nmMRSAHi everyone,
just after your thoughts on glove and gown use in contact precautions. We are currenlty reviewing the management of transmission based precautions in our facility. Our local profile of MROS’s include very almost no CPE, minimal MRSA, high rates of nmMRSA which is widespread in the community , increasing ESBL, minimal other gram negative MRO’s. We are reviewing the possiblilty of using standards precautions for patients who are colonised with nmMRSA. Clearance swabs are problematic as patientss often retrun to homes with overcrowding and high rates on nmMRSA. There is currently no PCR testing for MRSA/nmMRSA available in our jurisdiction, therefore 3 swabs are taken for culture.
We would also like to remove longsleeve plastic gowns and replace with plastic aprons for contact precautions unless there is a risk of blody fluid exposure. Gloves seem to poorly affect Hand Hygiene complance despite significant education and would like you views and experience on this.
The literature seems inconclusive but as this would be against NHMRC guidelines ,can you let me know if you have any advice regading the changes we would like to implement ?
Thanks everyoneCate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517737
e … cate.coffey@nt.gov.au http://www.nt.gov.au/healthOur Vision: Better health outcomes for all Central Australians
Our Values: Community at the Centre | Equity and Integrity | We are Accountable | We are Relevant Today and Ready for Tomorrow | We are Committed to High Quality Care | We Value our PartnershipsCentral Australia Health Service is a Smoke Free Workplace
The information in this e-mail is intended solely for the addressee named. It may contain legally privileged or confidential information that is subject to copyright. If you are not the intended recipient you must not use, disclose copy or distribute this communication. If you have received this message in error, please delete the e-mail and notify the sender. No representation is made that this e-mail is free of viruses. Virus scanning is recommended and is the responsibility of the recipient.
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 acipclist@acipc.org.au
To send a message to the list administrator send an email to admin@acipc.org.au
You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au
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 acipclist@acipc.org.au
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You can unsubscribe manually from this list by sending ‘signoff acipcl
Thank you Ruth
Happy for anyone to use the attached poster.Kind Regards
Susan Jain RN MN PhD candidate
Infection Prevention and Control Practitioner, Conjoint Lecturer UNSW
HAI Program Project Officer | Clinical Excellence Commission
Level 17, 2-24 Rawson Place, Haymarket NSW 2000
p. (02) 9269 5552 | e. susan.jain@health.nsw.gov.au
[In-White-48px-R][In-White-48px-R]From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Ruth Barratt
Sent: Tuesday, 2 April 2019 8:57 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Gloves,gowns, contact precautions and colonised nmMRSAHi Cate,
Great you are looking at your local risk re. these issues.
I can share with you my NZ experience – in most of New Zealand North Island, Auckland and upper north of NZ which has a similar epidemiology picture to yours re MRSA e.g. overcrowding , high community rates of nmMRSA etc. Most NZ North Island hospitals removed contact precautions for nmMRSA patients many years ago and have not seen an increase in hospital transmission of MRSA which is actually mostly community acquired.* Re ESBL the common community ESBL- E.coli colonised patients are not isolated either unless they have a high risk factor for spread. Again the majority of the ESBLs are community acquired. In Christchurch over 5 years ago we introduced a risk matrix for isolation of ESBL based on organism e.g. ESBL Klebsiella is always in CP, and patient risk factors for spread. Again no change in hospital transmission. Of course it freed up single rooms, improved transfer times from ED and was better for the patients.
* Re. plastic aprons versus long sleeved plastic gowns. Most of the UK routinely use plastic aprons for these types of MRO CPs where there is minimal contamination anticipated. However it may be that one type of gown stocked on the wards is better than two.
* I also think Susan Jains recent journal article presents a good argument for no gloves for dry MRO patients very well.Cheers
RuthRuth Barratt RN, BSc, MAdvPrac (Hons)
PhD Candidate and Research Assistant
Centre for Infectious Diseases and Microbiology
Westmead Institute for Medical Research
University of Sydney
Email: ruth.barratt@sydney.edu.au
rbar5856@uni.sydney.edu.au
Mobile: 0468 352 335
ORCID ID:https://orcid.org/0000-0002-8930-6414From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> on behalf of Cate Coffey <Cate.Coffey@NT.GOV.AU>
Reply-To: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU>
Date: Monday, April 1, 2019 at 7:24 PM
To: “ACIPCLIST@ACIPC.ORG.AU” <ACIPCLIST@ACIPC.ORG.AU>
Subject: Gloves,gowns, contact precautions and colonised nmMRSAHi everyone,
just after your thoughts on glove and gown use in contact precautions. We are currenlty reviewing the management of transmission based precautions in our facility. Our local profile of MROS’s include very almost no CPE, minimal MRSA, high rates of nmMRSA which is widespread in the community , increasing ESBL, minimal other gram negative MRO’s. We are reviewing the possiblilty of using standards precautions for patients who are colonised with nmMRSA. Clearance swabs are problematic as patientss often retrun to homes with overcrowding and high rates on nmMRSA. There is currently no PCR testing for MRSA/nmMRSA available in our jurisdiction, therefore 3 swabs are taken for culture.
We would also like to remove longsleeve plastic gowns and replace with plastic aprons for contact precautions unless there is a risk of blody fluid exposure. Gloves seem to poorly affect Hand Hygiene complance despite significant education and would like you views and experience on this.
The literature seems inconclusive but as this would be against NHMRC guidelines ,can you let me know if you have any advice regading the changes we would like to implement ?
Thanks everyoneCate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517737
e … cate.coffey@nt.gov.au http://www.nt.gov.au/healthOur Vision: Better health outcomes for all Central Australians
Our Values: Community at the Centre | Equity and Integrity | We are Accountable | We are Relevant Today and Ready for Tomorrow | We are Committed to High Quality Care | We Value our PartnershipsCentral Australia Health Service is a Smoke Free Workplace
The information in this e-mail is intended solely for the addressee named. It may contain legally privileged or confidential information that is subject to copyright. If you are not the intended recipient you must not use, disclose copy or distribute this communication. If you have received this message in error, please delete the e-mail and notify the sender. No representation is made that this e-mail is free of viruses. Virus scanning is recommended and is the responsibility of the recipient.
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 acipclist@acipc.org.au
To send a message to the list administrator send an email to admin@acipc.org.au
You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au
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.
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You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au
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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 acipclist@acipc.org.au
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Afternoon,
I was wondering if anyone could give me some advice on ESBL Klebsiella.
I was under the understanding that all Klebsiella should be place in contact precautions.
Staff are arguing this point and saying if it is in the blood culture test or if the wound is closed over or they are no longer coughing (sputum), they dont need to be on precautions.
Any help would be appreciated.
Kind regards
HelenHelen Roberts
Infection Control
P: 07 4646 3106 |
F: 07 4633 7602
E: robertsh@sath.org.au |
W: http://www.sath.org.auHi Ruth
I am currently looking at the risks associated with ESBL and the need to isolate.
Would you be able to send through the risk matrix that you use.
Kind regards
Sharon Deen
Infection Control Nurse[http://www.ramsayhealth.com/~/media/Images/email/email-RHC-logo]
Peel Health Campus
Infection Control
Phone:08 9531 8570
Fax:
08 9531 8409
Email:
DeenSharon@ramsayhealth.com.au
Web:
Address:
110 Lakes Road, Mandurah WA 6210
[http://www.ramsayhealth.com/~/media/Images/email/email-social-mediaPCP.jpg]
Hi Cate,
Great you are looking at your local risk re. these issues.
I can share with you my NZ experience – in most of New Zealand North Island, Auckland and upper north of NZ which has a similar epidemiology picture to yours re MRSA e.g. overcrowding , high community rates of nmMRSA etc. Most NZ North Island hospitals removed contact precautions for nmMRSA patients many years ago and have not seen an increase in hospital transmission of MRSA which is actually mostly community acquired.* Re ESBL the common community ESBL- E.coli colonised patients are not isolated either unless they have a high risk factor for spread. Again the majority of the ESBLs are community acquired. In Christchurch over 5 years ago we introduced a risk matrix for isolation of ESBL based on organism e.g. ESBL Klebsiella is always in CP, and patient risk factors for spread. Again no change in hospital transmission. Of course it freed up single rooms, improved transfer times from ED and was better for the patients.
* Re. plastic aprons versus long sleeved plastic gowns. Most of the UK routinely use plastic aprons for these types of MRO CPs where there is minimal contamination anticipated. However it may be that one type of gown stocked on the wards is better than two.
* I also think Susan Jains recent journal article presents a good argument for no gloves for dry MRO patients very wellCheers
RuthRuth Barratt RN, BSc, MAdvPrac (Hons)
PhD Candidate and Research Assistant
Centre for Infectious Diseases and Microbiology
Westmead Institute for Medical Research
University of Sydney
rbar5856@uni.sydney.edu.au
ORCID ID:https://orcid.org/0000-0002-8930-6414Hi everyone,
just after your thoughts on glove and gown use in contact precautions. We are currenlty reviewing the management of transmission based precautions in our facility. Our local profile of MROS’s include very almost no CPE, minimal MRSA, high rates of nmMRSA which is widespread in the community , increasing ESBL, minimal other gram negative MRO’s. We are reviewing the possiblilty of using standards precautions for patients who are colonised with nmMRSA. Clearance swabs are problematic as patientss often retrun to homes with overcrowding and high rates on nmMRSA. There is currently no PCR testing for MRSA/nmMRSA available in our jurisdiction, therefore 3 swabs are taken for culture.
We would also like to remove longsleeve plastic gowns and replace with plastic aprons for contact precautions unless there is a risk of blody fluid exposure. Gloves seem to poorly affect Hand Hygiene complance despite significant education and would like you views and experience on this.
The literature seems inconclusive but as this would be against NHMRC guidelines ,can you let me know if you have any advice regading the changes we would like to implement ?
Thanks everyoneCate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517737
e … cate.coffey@nt.gov.au http://www.nt.gov.au/healthOur Vision: Better health outcomes for all Central Australians
Our Values: Community at the Centre | Equity and Integrity | We are Accountable | We are Relevant Today and Ready for Tomorrow | We are Committed to High Quality Care | We Value our PartnershipsCentral Australia Health Service is a Smoke Free Workplace
The information in this e-mail is intended solely for the addressee named. It may contain legally privileged or confidential information that is subject to copyright. If you are not the intended recipient you must not use, disclose copy or distribute this communication. If you have received this message in error, please delete the e-mail and notify the sender. No representation is made that this e-mail is free of viruses. Virus scanning is recommended and is the responsibility of the recipient.
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 acipclist@acipc.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.
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 acipclist@acipc.org.au
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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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