Multiple patient use of inhalers with single-use spacers

[Meryl Jones]

Good morning everyone,

I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:

* Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.

* The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.

* The inhaler sits at the patient’s bedside before moving to the medication room and then on to another patient’s room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.

Many thanks in advance,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

[cid:image001.png@01D08E34.09FD4060][cid:image002.png@01D08E34.09FD4060][cid:image003.png@01D08E34.09FD4060][cid:image004.png@01D08E34.09FD4060]
[cid:image005.png@01D08E34.09FD4060]

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[Michael Wishart]

Hi Meryl

My concern would not be so much who has handled the inhaler (as these can be wiped over easily), but what are the risks of contamination within the inhaler by children coughing or blowing into them (despite the use of spacers, this could still be a real risk). Spreading RSV or influenza virus, as just two examples, is a real risk in my view from this possibility. Because children are the ones having these inhalers used on them, the risk of this may actually be higher than for adults (less likely to correctly follow instructions).

Just my thoughts. Not sure there are any definitive guidelines around this.

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

Good morning everyone,

I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:

* Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.

* The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.

* The inhaler sits at the patient’s bedside before moving to the medication room and then on to another patient’s room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.

Many thanks in advance,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

[cid:image001.png@01D08E34.09FD4060][cid:image002.png@01D08E34.09FD4060][cid:image003.png@01D08E34.09FD4060][cid:image004.png@01D08E34.09FD4060]
[cid:image005.png@01D08E34.09FD4060]

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Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.

If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.

If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.

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Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.

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______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the “svha.org.au” domain (or any other domain of St Vincent’s Health Australia Limited or any of its related bodies corporate) (an “SVHA Email Address”) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.
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[Helen Truscott]

HI Meryl,
I would also be interested to hear of any updates on this topic, as we regularly use an inhaler with cardboard spacer for our recruits having spirometry .
There may be some months between use of the inhaler , but each person gets a new spacer.

Regards
Helen
Helen Truscott RN, RM, MPH
Team Leader-Health and Medical
Health & Safety Branch

[Fire & Rescue NSW]

E Helen.Truscott@fire.nsw.gov.au | T 02 9265 2976| F 02 9265 2986 | M 0417 677 802
http://www.fire.nsw.gov.au
Level 8, 227 Elizabeth Street, Sydney, NSW 2000

[Fire Safety Message]

Hi Meryl

My concern would not be so much who has handled the inhaler (as these can be wiped over easily), but what are the risks of contamination within the inhaler by children coughing or blowing into them (despite the use of spacers, this could still be a real risk). Spreading RSV or influenza virus, as just two examples, is a real risk in my view from this possibility. Because children are the ones having these inhalers used on them, the risk of this may actually be higher than for adults (less likely to correctly follow instructions).

Just my thoughts. Not sure there are any definitive guidelines around this.

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

Good morning everyone,

I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:

* Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.

* The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.

* The inhaler sits at the patient’s bedside before moving to the medication room and then on to another patient’s room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.

Many thanks in advance,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

[cid:image001.png@01D08E34.09FD4060][cid:image002.png@01D08E34.09FD4060][cid:image003.png@01D08E34.09FD4060][cid:image004.png@01D08E34.09FD4060]
[cid:image005.png@01D08E34.09FD4060]

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This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.

Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.

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If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.

Although Queensland Health takes all reasonable steps to ensure this email does not contain malicious software, Queensland Health does not accept responsibility for the consequences if any person’s computer inadvertently suffers any disruption to services, loss of information, harm or is infected with a virus, other malicious computer programme or code that may occur as a consequence of receiving this email.

Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.

**********************************************************************************

______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the “svha.org.au” domain (or any other domain of St Vincent’s Health Australia Limited or any of its related bodies corporate) (an “SVHA Email Address”) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.
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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______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the “svha.org.au” domain (or any other domain of St Vincent’s Health Australia Limited or any of its related bodies corporate) (an “SVHA Email Address”) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.
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[Julie Hunt]

Hi Meryl,

I agree with Michael regarding potential risks of droplet contamination of respiratory viruses within the inhaler if used between patients.

In our HCF the inhalers we use are labelled as single patient use so they are only approved for more than one episode of use on one patient only. We do not reuse these items for different patients. They are cleaned with a neutral detergent when required although we do ask that staff check the manufacturer’s instructions as some are not designed to be cleaned or dismantled & have a life expectancy similar to a puffer.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Good morning everyone,

I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:

* Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.

* The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.

* The inhaler sits at the patient’s bedside before moving to the medication room and then on to another patient’s room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.

Many thanks in advance,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

[cid:image001.png@01D08E34.09FD4060][cid:image002.png@01D08E34.09FD4060][cid:image003.png@01D08E34.09FD4060][cid:image004.png@01D08E34.09FD4060]
[cid:image005.png@01D08E34.09FD4060]

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This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.

Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.

If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.

If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.

Although Queensland Health takes all reasonable steps to ensure this email does not contain malicious software, Queensland Health does not accept responsibility for the consequences if any person’s computer inadvertently suffers any disruption to services, loss of information, harm or is infected with a virus, other malicious computer programme or code that may occur as a consequence of receiving this email.

Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.

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[Che Jarvis]

Hi Meryl,

I agree with Michael, & Julie on the potential risk for transmission of droplet based organisms.

Our HCF only utilises inhalers as single patient use, & even our spacers are for single patient use & are purchased by the patient’s/parents.

Regards,

Che Jarvis
Acting CNC Infection Control| Nepean Hospital
Level 2, South Block
Tel 02 4734 2228 | Fax | Mob | che.jarvis@health.nsw.gov.au
http://www.health.nsw.gov.au
[http://www0.health.nsw.gov.au/images/communications/e-signatures/images/NSW-Health-Nepean-Blue-Mountains-LHD.jpg]
________________________________

Hi Meryl,

I agree with Michael regarding potential risks of droplet contamination of respiratory viruses within the inhaler if used between patients.

In our HCF the inhalers we use are labelled as single patient use so they are only approved for more than one episode of use on one patient only. We do not reuse these items for different patients. They are cleaned with a neutral detergent when required although we do ask that staff check the manufacturers instructions as some are not designed to be cleaned or dismantled & have a life expectancy similar to a puffer.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Good morning everyone,

I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:

Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.

The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.

The inhaler sits at the patients bedside before moving to the medication room and then on to another patients room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.

Many thanks in advance,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Childrens Health Queensland Hospital and Health Service
Level 12
Lady Cilento Childrens Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

********************************************************************************

This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.

Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.

If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.

If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.

Although Queensland Health takes all reasonable steps to ensure this email does not contain malicious software, Queensland Health does not accept responsibility for the consequences if any person’s computer inadvertently suffers any disruption to services, loss of information, harm or is infected with a virus, other malicious computer programme or code that may occur as a consequence of receiving this email.

Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.

**********************************************************************************
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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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This message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it 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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This message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.

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[Meryl Jones]

Thank you all for the interest shown in the original question posed. It is obviously an issue that we are not alone in experiencing and it has been very informative to hear how other health services have approached the problem. Given the level of interest this topic has generated I thought I’d feedback the approach we have decided upon.

I found the following article very useful and have shared it with other stakeholders within our organisation:
Larson, T., Gudavalli, R., Prater, D., & Sutton, S. (2015). Critical analysis of common canister programs: a review of cross-functional considerations and health system economics. Current Medical Research & Opinion, 31(4), 853-860.
http://informahealthcare.com/doi/pdf/10.1185/03007995.2015.1016604

Following discussion between clinicians and pharmacists, it has been decided that we will use the following approach:

* It has been assumed that for our organisation, the chance of busy clinicians cleaning MDIs as per evidence-based guidelines is not reliable and the cost of cleaning outweighs the cost of throwing them away. Therefore, MDIs will be used as single-patient items: once issued, they will stay with children for the duration of their inpatient care.

* All MDIs will have labels attached to them in pharmacy to allow clinicians to add the appropriate information to them (i.e. patient name, dose) so that they can be taken home as discharge medications.

* Any MDI used during hospital stay but not required on discharge will be disposed of.

* Doctors will be advised to consider good stewardship when prescribing drugs to be taken via MDI to try and rationalise their use (e.g. not prescribing them on a “try it and see” basis to children who are probably too physiologically undeveloped to respond to salbutamol).

We have decided that the cost of the MDIs is small, but the risk of spreading infection (since many of our children who are prescribed drugs via MDI have respiratory viruses) is greater.
Many thanks again for all your responses.

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

[cid:image001.png@01D09172.12DA4CA0][cid:image002.png@01D09172.12DA4CA0][cid:image003.png@01D09172.12DA4CA0][cid:image004.png@01D09172.12DA4CA0]
[cid:image005.png@01D09172.12DA4CA0]

Good morning everyone,

I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:

* Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.

* The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.

* The inhaler sits at the patient’s bedside before moving to the medication room and then on to another patient’s room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.

Many thanks in advance,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

[cid:image001.png@01D08E34.09FD4060][cid:image002.png@01D08E34.09FD4060][cid:image003.png@01D08E34.09FD4060][cid:image004.png@01D08E34.09FD4060]
[cid:image005.png@01D08E34.09FD4060]

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[Michael Wishart]

Thanks Meryl for the update.

This is a great way to see how this discussion list can aid clinicians in reviewing policy, and it is great to see those policy changes then reported back to the list.

Cheers
Michael Wishart
ACIPC Infexion Connexion Administrator

Michael Wishart
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this email

Thank you all for the interest shown in the original question posed. It is obviously an issue that we are not alone in experiencing and it has been very informative to hear how other health services have approached the problem. Given the level of interest this topic has generated I thought I’d feedback the approach we have decided upon.

I found the following article very useful and have shared it with other stakeholders within our organisation:
Larson, T., Gudavalli, R., Prater, D., & Sutton, S. (2015). Critical analysis of common canister programs: a review of cross-functional considerations and health system economics. Current Medical Research & Opinion, 31(4), 853-860.
http://informahealthcare.com/doi/pdf/10.1185/03007995.2015.1016604

Following discussion between clinicians and pharmacists, it has been decided that we will use the following approach:

* It has been assumed that for our organisation, the chance of busy clinicians cleaning MDIs as per evidence-based guidelines is not reliable and the cost of cleaning outweighs the cost of throwing them away. Therefore, MDIs will be used as single-patient items: once issued, they will stay with children for the duration of their inpatient care.

* All MDIs will have labels attached to them in pharmacy to allow clinicians to add the appropriate information to them (i.e. patient name, dose) so that they can be taken home as discharge medications.

* Any MDI used during hospital stay but not required on discharge will be disposed of.

* Doctors will be advised to consider good stewardship when prescribing drugs to be taken via MDI to try and rationalise their use (e.g. not prescribing them on a “try it and see” basis to children who are probably too physiologically undeveloped to respond to salbutamol).

We have decided that the cost of the MDIs is small, but the risk of spreading infection (since many of our children who are prescribed drugs via MDI have respiratory viruses) is greater.
Many thanks again for all your responses.

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

[cid:image001.png@01D09172.12DA4CA0][cid:image002.png@01D09172.12DA4CA0][cid:image003.png@01D09172.12DA4CA0][cid:image004.png@01D09172.12DA4CA0]
[cid:image005.png@01D09172.12DA4CA0]

Good morning everyone,

I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:

* Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.

* The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.

* The inhaler sits at the patient’s bedside before moving to the medication room and then on to another patient’s room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.

Many thanks in advance,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

[cid:image001.png@01D08E34.09FD4060][cid:image002.png@01D08E34.09FD4060][cid:image003.png@01D08E34.09FD4060][cid:image004.png@01D08E34.09FD4060]
[cid:image005.png@01D08E34.09FD4060]

********************************************************************************

This email, including any attachments sent with it, is confidential and for the sole use of the intended recipient(s). This confidentiality is not waived or lost, if you receive it and you are not the intended recipient(s), or if it is transmitted/received in error.

Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.

If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.

If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.

Although Queensland Health takes all reasonable steps to ensure this email does not contain malicious software, Queensland Health does not accept responsibility for the consequences if any person’s computer inadvertently suffers any disruption to services, loss of information, harm or is infected with a virus, other malicious computer programme or code that may occur as a consequence of receiving this email.

Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.

**********************************************************************************
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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