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Hi all
We have been doing heater-cooler (used in cardiac surgery) water testing for some time, and have always up until now had a total plate count done as well as detection of Mycobacterium chimerae. This has been problematic, as our clinical microbiology labs are not licensed to process non-clinical water specimens, but the private environmental labs we have access to do not have the capacity to perform species level Mycobacterium testing. So we had been using a environmental lab that was a subsidiary of a clinical lab to have both sets of testing done. But that environmental lab has been sold to a larger environmental lab, so now we are faced with sending two specimens off to two different labs!
The medical director of the company that owns and operates the heater cooler at our facility has suggested we can do away with the total plate count altogether, and only have the water tested for the presence of M. chimerae.
the PHLN guidelines state this about plate counts:
Heterotrophic plate counts
Heterotrophic plate counts (HPCs) can be used to monitor the integrity, cleanliness and maintenance of water systems.11 These HPCs might be performed monthly. Laboratories appear to use a range of HPC methodologies and the Australian Drinking Water Guidelines cite a number of HPC methodologies.6,11 In the absence of a standard HPC methodology and while experience accumulates with testing HCU waters, trends rather than absolute numbers of organisms should be followed for this monitoring.The survey of mycobacteriology laboratories highlighted that no relationship existed between HPCs and the isolation of M. chimaera from HCU waters (ie. M. chimaera was isolated from HCU water with low HPCs). Monitoring by HPCs therefore does not obviate the need for surveillance by mycobacteriology cultures.
There is a few can’s and might’s in there, so my question is if we only do Mycobacterial testing, with the ability to identify M. chimerae, would that still be sufficient? Should we be doing that more frequently than 3 monthly? What are other (particularly private) units doing now?
Thanks for any advice or discussion on this. Just don’t want to be caught out next accreditation round!
Cheers
Michael
PHLN guidance regarding Mycobacterium chimaera & heater-cooler units – Department of Health
Specimen collection a) The HCU should be connected and running for at least five minutes before water samples are collected. b) Sampling should occur before the HCUs disinfection cycle.
www1.health.gov.auMichael Wishart | Infection Control Coordinator, CICP-E
St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
M +61 448 954 282 | T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au|
St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT QLD 4169
M +61 448 954 282 | T +61 7 3240 1208 | F +61 7 3240 1166
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Hi Michael,
Sorry for the delay in answering, as far as I am aware everyone is still doing both. Also confirmed this with HICMR.
Kind regards
MargaretMargaret Bennett | Infection Prevention & Control CNC (Monday to Thursday)
St Vincent’s Private Hospital Sydney
406 Victoria Street, Darlinghurst NSW 2010
T 02 8382 7491 | M 0456 186 033
E margaret.bennett@svha.org.au
[cid:image008.png@01D6A6FA.09973E70]Hi all
We have been doing heater-cooler (used in cardiac surgery) water testing for some time, and have always up until now had a total plate count done as well as detection of Mycobacterium chimerae. This has been problematic, as our clinical microbiology labs are not licensed to process non-clinical water specimens, but the private environmental labs we have access to do not have the capacity to perform species level Mycobacterium testing. So we had been using a environmental lab that was a subsidiary of a clinical lab to have both sets of testing done. But that environmental lab has been sold to a larger environmental lab, so now we are faced with sending two specimens off to two different labs!
The medical director of the company that owns and operates the heater cooler at our facility has suggested we can do away with the total plate count altogether, and only have the water tested for the presence of M. chimerae.
the PHLN guidelines state this about plate counts:
Heterotrophic plate counts
Heterotrophic plate counts (HPCs) can be used to monitor the integrity, cleanliness and maintenance of water systems.11 These HPCs might be performed monthly. Laboratories appear to use a range of HPC methodologies and the Australian Drinking Water Guidelines cite a number of HPC methodologies.6,11 In the absence of a standard HPC methodology and while experience accumulates with testing HCU waters, trends rather than absolute numbers of organisms should be followed for this monitoring.The survey of mycobacteriology laboratories highlighted that no relationship existed between HPCs and the isolation of M. chimaera from HCU waters (ie. M. chimaera was isolated from HCU water with low HPCs). Monitoring by HPCs therefore does not obviate the need for surveillance by mycobacteriology cultures.
There is a few can’s and might’s in there, so my question is if we only do Mycobacterial testing, with the ability to identify M. chimerae, would that still be sufficient? Should we be doing that more frequently than 3 monthly? What are other (particularly private) units doing now?
Thanks for any advice or discussion on this. Just don’t want to be caught out next accreditation round!
Cheers
Michael
PHLN guidance regarding Mycobacterium chimaera & heater-cooler units – Department of Health
Specimen collection a) The HCU should be connected and running for at least five minutes before water samples are collected. b) Sampling should occur before the HCU’s disinfection cycle.
www1.health.gov.auMichael Wishart | Infection Control Coordinator, CICP-E
St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
M +61 448 954 282 | T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au|
St Vincent’s Private Hospital Brisbane | 411 Main Street KANGAROO POINT QLD 4169
M +61 448 954 282 | T +61 7 3240 1208 | F +61 7 3240 1166
E michael.wishart@svha.org.au|[http://i8.cmail19.com/ei/t/6C/F77/A00/141133/csfinal/StaticEmailFooter-SVPHN-Celebrating20Years-650×150-9900000000079e3c.png]
[cid:d7005ccb-69fc-45de-ad13-df415dac611a]
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 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
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 acipclist@acipc.org.au
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