HH and ANTT in ED

[Anderson, Tara L (THS)]

Hi all

I wondered if I could ask others what their expectation and experiences have been with enhancing hand hygiene and aseptic non-touch technique (ANTT) practice within their Emergency Departments, particularly amongst medical staff?

* The HH compliance of the medical staff within our Emergency Department when last audited was 41%. This is in contrast to the overall HH compliance of >70% for medical staff in our hospital. It is also in contrast to the HH compliance of 70% amongst the nursing staff within the Emergency Department.

* In relation to ANTT practice, we have undertaken observations within the Emergency Department, and there was suboptimal ANTT practice, particularly amongst medical staff in relation to procedures; this related to a number of components including the following:

* Hand hygiene was undertaken but not at the appropriate times/moments within the procedure
* Inappropriate glove use e.g. donning of gloves with multiple contacts within the external environment, sterile equipment and the patient
* A work surface was not always cleaned (before or after)
* Equipment often gathered piece-meal over protracted time period
* The field was not always clearly defined nor dedicated to the procedure
* Packaged equipment were handled in manner that would increase the risk of contamination e.g. equipment placed onto patient’s bed, equipment placed onto shared bench
* Key parts were not always protected during the procedures

We have had difficulty impressing on the senior medical staff within the Emergency Department the importance of optimal HH and ANTT practice in all clinical settings including within the Emergency Department.

Today I have been informed that “no-one is doing anything like ANTT in emergency environments”; this was the impression obtained after their attendance at a Patient Safety Course during the last week with a large number of ED Directors and Senior ED Nursing Staff from around Australia.

I understand that practice may need to be modified in an ’emergency situation’ within the Emergency Department but much of the patient contact within this clinical area, does not seem be related to ’emergency care’. It is my understanding that the expectation should still be that hand hygiene and ANTT practice be undertaken within the ACSQHC framework regardless of where your patient is situated including the Emergency Department.

I wondered if others could share their thoughts and experiences with me?

* Should we be expecting HH and ANTT to be practiced within the Emergency Department similar to other clinical areas within the hospital?

* Has the ANTT program in your facility excluded the Emergency Department? If so, why? Has it been adapted or modified for this clinical area?

Thanks for your input and assistance in addressing this issue.

Tara
Tara Anderson
Infectious Diseases Physician and Microbiologist
Medical Advisor, Infection Prevention and Control, RHH
03 61667449 (direct)
03 61667391 (fax)
0417 561595 (mobile)

________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

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

[Anonymous]

Hi Tara
HH and ANTT should not be workplace specific as the fundamentals are the same throughout the acute care facility. In fact Central Lines are often inserted in ED , making this a high risk environment. I share your frustration, however complacence rates in ED in my organisation improved with engagement of the Clinical Governance Committee(CGC) and they became concerned that ED were consistently below benchmark. All audits were reported to CGC with results outside benchmark highlighted. I also got Nursing Leadership group on board to support all senior nurses N3 and above ( includes educators and Managers) as well as junior medical officers to attend General Hand Hygiene Auditors course to understand what is required. My predecessor commenced monthly auditing of 50 moments in high risk areas that were under benchmark with good effect. In my experience I have found I get the best results when I report the results to the various levels of management as it is their responsibility to ensure that best practise occurs across the organisation. It seems the more trained auditors the better the HH result
If you are reporting and you feel no one is listening as has happened to me , I stopped reporting to them and chose others with influence to report findings, who were interested and could assist . Standard 3 supports public display of audit results , perhaps you could look at as an option. We also have Hand Hygiene and ANTT as annual mandatory training with our unit delivering training to all new Medical Offices at commencement of their rotation to our organisation.
Still needs lots of education and is an ongoing concern in ED but things have improved significantly .
cheers
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.

Hi all

I wondered if I could ask others what their expectation and experiences have been with enhancing hand hygiene and aseptic non-touch technique (ANTT) practice within their Emergency Departments, particularly amongst medical staff?

* The HH compliance of the medical staff within our Emergency Department when last audited was 41%. This is in contrast to the overall HH compliance of >70% for medical staff in our hospital. It is also in contrast to the HH compliance of 70% amongst the nursing staff within the Emergency Department.

* In relation to ANTT practice, we have undertaken observations within the Emergency Department, and there was suboptimal ANTT practice, particularly amongst medical staff in relation to procedures; this related to a number of components including the following:

* Hand hygiene was undertaken but not at the appropriate times/moments within the procedure
* Inappropriate glove use e.g. donning of gloves with multiple contacts within the external environment, sterile equipment and the patient
* A work surface was not always cleaned (before or after)
* Equipment often gathered piece-meal over protracted time period
* The field was not always clearly defined nor dedicated to the procedure
* Packaged equipment were handled in manner that would increase the risk of contamination e.g. equipment placed onto patient’s bed, equipment placed onto shared bench
* Key parts were not always protected during the procedures

We have had difficulty impressing on the senior medical staff within the Emergency Department the importance of optimal HH and ANTT practice in all clinical settings including within the Emergency Department.

Today I have been informed that “no-one is doing anything like ANTT in emergency environments”; this was the impression obtained after their attendance at a Patient Safety Course during the last week with a large number of ED Directors and Senior ED Nursing Staff from around Australia.

I understand that practice may need to be modified in an ’emergency situation’ within the Emergency Department but much of the patient contact within this clinical area, does not seem be related to ’emergency care’. It is my understanding that the expectation should still be that hand hygiene and ANTT practice be undertaken within the ACSQHC framework regardless of where your patient is situated including the Emergency Department.

I wondered if others could share their thoughts and experiences with me?

* Should we be expecting HH and ANTT to be practiced within the Emergency Department similar to other clinical areas within the hospital?

* Has the ANTT program in your facility excluded the Emergency Department? If so, why? Has it been adapted or modified for this clinical area?

Thanks for your input and assistance in addressing this issue.

Tara
Tara Anderson
Infectious Diseases Physician and Microbiologist
Medical Advisor, Infection Prevention and Control, RHH
03 61667449 (direct)
03 61667391 (fax)
0417 561595 (mobile)

________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.
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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (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 aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

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

[James Rippey]

Dear Tara,

I’m one of the those dastardly Emergency physicians!

We live and work in a high stress, extremely high patient throughput
environment.
We strongly believe in evidence based practice and improving things for our
patients.
You are correct, most of the peripheral IV lines we place are not done in
time critical life threatening situations.

There is no doubt the focus of recent years on improving HH and ANTT has
had a positive infection control impact in our environment.

My suggestions:

*Ensure following the “rules” is easy.*
An IV trolley with all the equipment on it, always well stocked.
There must be enough IV trolleys for your department (a ratio of 1 trolley
per 3 ED bays seems to work).
The top should be clear so a dressing pack can be opened onto it.
Must have sharps bin attached… all the usual stuff.
Lots of sinks, appropriate hand cleaning stuff – all within ?10 steps of
any patient cubicle.

*Try and get and then present some absolutely relevant evidence for your
institution.*
Take photos / get results of some of the many infections we are supposedly
causing – and show us.
You won’t need many to sway opinion, and you don’t even need to demonstrate
our performance is worse than others.
You know what they say about one picture!
Don’t make it seem punitive, make sure it’s educational and supportive. We
get enough confrontation in ED.

*Get senior medical ED buy in.*
Is there an ultrasound machine in your ED?
Who is in charge of that?
That person is usually the person to approach – because finding a blood /
gel covered probe (which used to happen frequently) is what inspired my
enthusiasm to improve things.
Last week I was emailed asking why the department is now using so many
sterile probe covers…

*Make sure the medical staff know what is best practice – and standardise
it please!*
We get new doctors every 3 months. Orientation must cover a lot.
Infection control advice regarding PIVC placement is different in our
metropolitan tertiary EDs – no wonder our doctors are confused.
In one we use must sterile gloves (presumably anticipating we will palpate
the vein after the chlorhexidine dries), in the other we get in trouble if
we use sterile gloves (because they are too expensive; and anticipating we
will not palpate the vein).
A single laminated A4 page with key points is worthwhile. Put it on the
trolleys.

*Audit and wrist slapping is a negative experience,* and when our focus is
on making difficult diagnoses and meeting time related targets, and often
arguing with inpatient specialties it doesn’t help.
Gentle frequent education and demonstration would be a far better approach
in my opinion – send someone down to work with the junior doctors at the
beginning of each rotation for a couple of days.
One IV each with an infection control person showing them one on one what
to do and why will shape their practice forever.

*With central lines there should be absolutely no room for variation.*
Get an ICU consultant to come down and explain how they want us to do it.
Touch on the evidence which is strong in this arena.
The ICU consultants have our respect. They put in lots of CVCs, and most
patients with central lines to to ICU. We will listen because none wants a
line they’ve put in removed just because it may have been put in using
suboptimal technique.
We should also document clearly whether the line was put in in a true
emergency situation or whether it was a controlled situation – so good
decisions regarding CVC replacement can be made.

Just thoughts.

All the best

James Rippey

On Mon, Mar 21, 2016 at 11:49 AM, Anderson, Tara L (THS) wrote:

> Hi all
>
>
>
> *I wondered if I could ask others what their expectation and experiences
> have been with enhancing hand hygiene and aseptic non-touch technique
> (ANTT) practice within their Emergency Departments, particularly amongst
> medical staff?*
>
>
>
> The HH compliance of the medical staff within our Emergency
> Department when last audited was 41%. This is in contrast to the overall HH
> compliance of >70% for medical staff in our hospital. It is also in
> contrast to the HH compliance of 70% amongst the nursing staff within the
> Emergency Department.
>
>
>
> In relation to ANTT practice, we have undertaken observations
> within the Emergency Department, and there was suboptimal ANTT practice,
> particularly amongst medical staff in relation to procedures; this related
> to a number of components including the following:
>
>
>
> Hand hygiene was undertaken but not at the appropriate
> times/moments within the procedure
>
> Inappropriate glove use e.g. donning of gloves with multiple
> contacts within the external environment, sterile equipment and the patient
>
> A work surface was not always cleaned (before or after)
>
> Equipment often gathered piece-meal over protracted time period
>
> The field was not always clearly defined nor dedicated to the
> procedure
>
> Packaged equipment were handled in manner that would increase
> the risk of contamination e.g. equipment placed onto patients bed,
> equipment placed onto shared bench
>
> Key parts were not always protected during the procedures
>
>
>
> We have had difficulty impressing on the senior medical staff within the
> Emergency Department the importance of optimal HH and ANTT practice in all
> clinical settings including within the Emergency Department.
>
>
>
> Today I have been informed that no-one is doing anything like ANTT in
> emergency environments; this was the impression obtained after their
> attendance at a Patient Safety Course during the last week with a large
> number of ED Directors and Senior ED Nursing Staff from around Australia.
>
>
>
> I understand that practice may need to be modified in an emergency
> situation within the Emergency Department but much of the patient contact
> within this clinical area, does not seem be related to emergency care.
> It is my understanding that the expectation should still be that hand
> hygiene and ANTT practice be undertaken within the ACSQHC framework
> regardless of where your patient is situated including the Emergency
> Department.
>
>
>
> *I wondered if others could share their thoughts and experiences with me?*
>
>
>
> Should we be expecting HH and ANTT to be practiced within the
> Emergency Department similar to other clinical areas within the hospital?
>
>
>
> Has the ANTT program in your facility excluded the Emergency
> Department? If so, why? Has it been adapted or modified for this clinical
> area?
>
>
>
> Thanks for your input and assistance in addressing this issue.
>
>
>
> Tara
>
> *Tara Anderson*
>
> Infectious Diseases Physician and Microbiologist
> Medical Advisor, Infection Prevention and Control, RHH
>
> 03 61667449 (direct)
> 03 61667391 (fax)
> 0417 561595 (mobile)
>
>
>
>
>
>
>
> ——————————
>
> CONFIDENTIALITY NOTICE AND DISCLAIMER
> The information in this transmission may be confidential and/or protected
> by legal professional privilege, and is intended only for the person or
> persons to whom it is addressed. If you are not such a person, you are
> warned that any disclosure, copying or dissemination of the information is
> unauthorised. If you have received the transmission in error, please
> immediately contact this office by telephone, fax or email, to inform us of
> the error and to enable arrangements to be made for the destruction of the
> transmission, or its return at our cost. No liability is accepted for any
> unauthorised use of the information contained in this transmission.
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>

—
*James Rippey*
Emergency Physician
Sir Charles Gairdner Hospital
King Edward Memorial Hospital for Women

Mobile 0400990186

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

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

[Anonymous]

You made some salient points James, I will discuss with our ED team and hopefully implement some of your ideas
cheers

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.

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of James Rippey
Sent: Tuesday, 22 March 2016 1:01 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: HH and ANTT in ED

Dear Tara,

I’m one of the those dastardly Emergency physicians!

We live and work in a high stress, extremely high patient throughput environment.
We strongly believe in evidence based practice and improving things for our patients.
You are correct, most of the peripheral IV lines we place are not done in time critical life threatening situations.

There is no doubt the focus of recent years on improving HH and ANTT has had a positive infection control impact in our environment.

My suggestions:

Ensure following the “rules” is easy.
An IV trolley with all the equipment on it, always well stocked.
There must be enough IV trolleys for your department (a ratio of 1 trolley per 3 ED bays seems to work).
The top should be clear so a dressing pack can be opened onto it.
Must have sharps bin attached… all the usual stuff.
Lots of sinks, appropriate hand cleaning stuff – all within ?10 steps of any patient cubicle.

Try and get and then present some absolutely relevant evidence for your institution.
Take photos / get results of some of the many infections we are supposedly causing – and show us.
You won’t need many to sway opinion, and you don’t even need to demonstrate our performance is worse than others.
You know what they say about one picture!
Don’t make it seem punitive, make sure it’s educational and supportive. We get enough confrontation in ED.

Get senior medical ED buy in.
Is there an ultrasound machine in your ED?
Who is in charge of that?
That person is usually the person to approach – because finding a blood / gel covered probe (which used to happen frequently) is what inspired my enthusiasm to improve things.
Last week I was emailed asking why the department is now using so many sterile probe covers…

Make sure the medical staff know what is best practice – and standardise it please!
We get new doctors every 3 months. Orientation must cover a lot.
Infection control advice regarding PIVC placement is different in our metropolitan tertiary EDs – no wonder our doctors are confused.
In one we use must sterile gloves (presumably anticipating we will palpate the vein after the chlorhexidine dries), in the other we get in trouble if we use sterile gloves (because they are too expensive; and anticipating we will not palpate the vein).
A single laminated A4 page with key points is worthwhile. Put it on the trolleys.

Audit and wrist slapping is a negative experience, and when our focus is on making difficult diagnoses and meeting time related targets, and often arguing with inpatient specialties it doesn’t help.
Gentle frequent education and demonstration would be a far better approach in my opinion – send someone down to work with the junior doctors at the beginning of each rotation for a couple of days.
One IV each with an infection control person showing them one on one what to do and why will shape their practice forever.

With central lines there should be absolutely no room for variation.
Get an ICU consultant to come down and explain how they want us to do it.
Touch on the evidence which is strong in this arena.
The ICU consultants have our respect. They put in lots of CVCs, and most patients with central lines to to ICU. We will listen because none wants a line they’ve put in removed just because it may have been put in using suboptimal technique.
We should also document clearly whether the line was put in in a true emergency situation or whether it was a controlled situation – so good decisions regarding CVC replacement can be made.

Just thoughts.

All the best

James Rippey

On Mon, Mar 21, 2016 at 11:49 AM, Anderson, Tara L (THS) <tara.anderson@ths.tas.gov.au> wrote:
Hi all

I wondered if I could ask others what their expectation and experiences have been with enhancing hand hygiene and aseptic non-touch technique (ANTT) practice within their Emergency Departments, particularly amongst medical staff?

The HH compliance of the medical staff within our Emergency Department when last audited was 41%. This is in contrast to the overall HH compliance of >70% for medical staff in our hospital. It is also in contrast to the HH compliance of 70% amongst the nursing staff within the Emergency Department.

In relation to ANTT practice, we have undertaken observations within the Emergency Department, and there was suboptimal ANTT practice, particularly amongst medical staff in relation to procedures; this related to a number of components including the following:

Hand hygiene was undertaken but not at the appropriate times/moments within the procedure
Inappropriate glove use e.g. donning of gloves with multiple contacts within the external environment, sterile equipment and the patient
A work surface was not always cleaned (before or after)
Equipment often gathered piece-meal over protracted time period
The field was not always clearly defined nor dedicated to the procedure
Packaged equipment were handled in manner that would increase the risk of contamination e.g. equipment placed onto patients bed, equipment placed onto shared bench
Key parts were not always protected during the procedures

We have had difficulty impressing on the senior medical staff within the Emergency Department the importance of optimal HH and ANTT practice in all clinical settings including within the Emergency Department.

Today I have been informed that no-one is doing anything like ANTT in emergency environments; this was the impression obtained after their attendance at a Patient Safety Course during the last week with a large number of ED Directors and Senior ED Nursing Staff from around Australia.

I understand that practice may need to be modified in an emergency situation within the Emergency Department but much of the patient contact within this clinical area, does not seem be related to emergency care. It is my understanding that the expectation should still be that hand hygiene and ANTT practice be undertaken within the ACSQHC framework regardless of where your patient is situated including the Emergency Department.

I wondered if others could share their thoughts and experiences with me?

Should we be expecting HH and ANTT to be practiced within the Emergency Department similar to other clinical areas within the hospital?

Has the ANTT program in your facility excluded the Emergency Department? If so, why? Has it been adapted or modified for this clinical area?

Thanks for your input and assistance in addressing this issue.

Tara
Tara Anderson
Infectious Diseases Physician and Microbiologist
Medical Advisor, Infection Prevention and Control, RHH
03 61667449 (direct)
03 61667391 (fax)
0417 561595 (mobile)

________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.
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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

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

—
James Rippey
Emergency Physician
Sir Charles Gairdner Hospital
King Edward Memorial Hospital for Women

Mobile 0400990186

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (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 aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) t

[Author]

Posts