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regards
Wendy
Wendy Grey
Nursing Director of Infection, Prevention and Control
IMB 64
PO Box 670
Townsville Hospital 4810
Fax : 4796********************************************************************************
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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 authors, and do not represent the opinion of AICA.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.auDear Wendy
Below is the abstract of the most recent peer reviewed publication on this topic. I urge you to read it carefully before you make your decision. I have several other published references that I can share with you and others offline.
The beauty of the paper below is that we attempted to control for confounders. This issue is interesting and evolving. I would also like to hear the experiences of others on or offline.
Jarvis, W. R., C. Murphy, et al. (2009). “Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors.” Clin Infect Dis 49(12): 1821-7.
BACKGROUND: Health care-associated, central venous catheter-related bloodstream infections (HA-BSIs) are a major cause of morbidity and mortality. Needleless connectors (NCs) are an important component of the intravenous system. NCs initially were introduced to reduce health care worker needlestick injuries, yet some of these NCs may increase HA-BSI risk. METHODS: We compared HA-BSI rates on wards or intensive care units (ICUs) at 5 hospitals that had converted from split septum (SS) connectors or needles to mechanical valve needleless connectors (MV-NCs). The hospitals (16 ICUs, 1 entire hospital, and 1 oncology unit; 3 hospitals were located in the United States, and 2 were located in Australia) had conducted HA-BSI surveillance using Centers for Disease Control and Prevention definitions during use of both NCs. HA-BSI rates and prevention practices were compared during the pre-MV period, MV period, and post-MV period. RESULTS: The HA-BSI rate increased in all ICUs and wards when SS-NCs were replaced by MV-NCs. In the 16 ICUs, the HA-BSI rate increased significantly when SS-NCs or needles were replaced by MV-NCs (6.15 vs 9.49 BSIs per 1000 central venous catheter [CVC]-days; relative risk, 1.54; 95% confidence interval, 1.37-1.74; [Formula: see text]). The 14 ICUs that switched back to SS-NCs had significant reductions in their BSI rates (9.49 vs 5.77 BSIs per 1000 CVC-days; relative risk, 1.65; 95% confidence interval, 1.38-1.96; p < .001). BSI infection prevention strategies were similar in the pre-MV and MV periods. CONCLUSIONS: We found strong evidence that MV-NCs were associated with increased HA-BSI rates, despite similar BSI surveillance, definitions, and prevention strategies. Hospital personnel should monitor their HA-BSI rates and, if they are elevated, examine the role of newer technologies, such as MV-NCs.
Regards
CathAssoc. Prof Cathryn Murphy RN PhD CIC
Managing Director
Infection Control Plus Pty Ltd
PO Box 106
West Burleigh 4219
Queensland
AUSTRALIA
Ph +61 7 5520 1569
Fax + 61 7 5520 1476
Mob +61 419 953 680
http://www.icp.au.comFrom: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Wendy Grey
Sent: Friday, 12 March 2010 09:17
To: AICALIST@AICALIST.ORG.AU
Subject: [AICA_Infexion_Connexion] Needleless IV admin setsHas anyone recently changed to needleless IV admin sets? We are considering some of these safety systems, but have heard anecdotal evidence of an increase in BSI rates following introduction. Does anyone have any experience of this change in systems and therefore practice??
regards
WendyWendy Grey
Nursing Director of Infection, Prevention and Control
IMB 64
PO Box 670
Townsville Hospital 4810
Phone: 4796 1182
Fax : 4796
Mobile: 0428 649 072********************************************************************************
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 authors, and do not represent the opinion of AICA. 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
No virus found in this incoming message.
Checked by AVG – http://www.avg.com
Version: 9.0.733 / Virus Database: 271.1.1/2735 – Release Date: 03/11/10 17:33:00Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aOur haemodialysis bloodlines have needleless injection ports. We have been using these bloodlines for awhile now with no recorded increase in BSI rates.
Carolyn Chenoweth
Baxter Therapy Services
Quality Assurance Coordinator
Payneham Dialysis Centre
2 Portrush Road
PAYNEHAM SA 5070
From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Wendy Grey
Sent: Friday, 12 March 2010 09:47 AM
To: AICALIST@AICALIST.ORG.AU
Subject: [AICA_Infexion_Connexion] Needleless IV admin setsHas anyone recently changed to needleless IV admin sets? We are considering some of these safety systems, but have heard anecdotal evidence of an increase in BSI rates following introduction. Does anyone have any experience of this change in systems and therefore practice??
regards
WendyWendy Grey
Nursing Director of Infection, Prevention and Control
IMB 64
PO Box 670
Townsville Hospital 4810
Phone: 4796 1182
Fax : 4796
Mobile: 0428 649 072********************************************************************************
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 authors, and do not represent the opinion of AICA. 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
The information transmitted is intended only for the person(s)or entity to which it is addressed and may contain confidential and/or legally privileged material. Delivery of this message to any person other than the intended recipient(s) is not intended in any way to waive privilege or confidentiality. Any review, retransmission, dissemination or other use of , or taking of any action in reliance upon, this information by entities other than the intended recipient is prohibited. If you receive this in error, please contact the sender and delete the material from any computer.For Translation:
http://www.baxter.com/email_disclaimer
Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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’ (withoThere are two other important pieces of information in this debate:
The CDC, US currently has a draft IV Guideline which address this issue by recommending the following (as reproduced from HICPAC website):
5. Use a needleless system to access IV tubing. Category 1C
6. When needleless systems are used, the split septum valve is preferred over the mechanical valve due to increased risk of infection
Further the language used to describe different needleless connectors is confusing and often discussion collectively refers to all mechanical valved access devices as needleless technologies which is confusing to readers familiar with this technology as described in several reports of related CR-BSI and other international guidelines and standards. A paper published in January 2010 by Haddaway in Journal of Infusion Nursing Vol 33 No 1 conveniently offers simple, practical definitions and distinguishes between the various technologies. I would commend AICA Members and list users adopt Haddaways terminology when describing experiences with these devices. Again I can happily provide copies of the Haddaway manuscript offline.
With regard to doing a trial comparing each system there are obvious ethical issues involved given the reports of increased CR-BSI associated with complex valves (see Haddaway for the definitions of simple vs complex valves).
RegardsAssoc. Prof Cathryn Murphy RN PhD CIC
Managing Director
Infection Control Plus Pty Ltd
PO Box 106
West Burleigh 4219
Queensland
AUSTRALIA
Ph +61 7 5520 1569
Fax + 61 7 5520 1476
Mob +61 419 953 680
http://www.icp.au.comFrom: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Wendy Grey
Sent: Friday, 12 March 2010 09:17
To: AICALIST@AICALIST.ORG.AU
Subject: [AICA_Infexion_Connexion] Needleless IV admin setsHas anyone recently changed to needleless IV admin sets? We are considering some of these safety systems, but have heard anecdotal evidence of an increase in BSI rates following introduction. Does anyone have any experience of this change in systems and therefore practice??
regards
WendyWendy Grey
Nursing Director of Infection, Prevention and Control
IMB 64
PO Box 670
Townsville Hospital 4810
Phone: 4796 1182
Fax : 4796
Mobile: 0428 649 072********************************************************************************
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 authors, and do not represent the opinion of AICA. 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
No virus found in this incoming message.
Checked by AVG – http://www.avg.com
Version: 9.0.733 / Virus Database: 271.1.1/2735 – Release Date: 03/11/10 17:33:00Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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You can unsubscribe from this list be sending ‘signoff aicalistDear All
Could I ask:
a) whether people follow the practices recommended in this document for documenting clearance to the letter?
http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/F22384CCE74A9F01CA257483000D845E/$File/mroscreenjun05.pdf (excerpt below).
b) If not what modifications do you include? Please justify/reference if possible.
c) What sites you screen for MRSA clearance swabs? Specifically, do you include a perianal swab in clearance screens?
d) If you perform perianal, groin or perineal swabs, how do you instruct for the sample to be taken? I’ve never seen a clear instruction! Please share yours!
Thanks
John
A variety of resources and discussion is at
http://www.asid.net.au/hicsigwiki/index.php?titleScreening_and_Clearance_Process-MRSAEXCERPTS FROM ORIGINAL NATIONAL REC ON CLEARANCE AND SCREENING FOR MROs
The document recommended screening of the following sites for MRSA-
Nose swab
Wound(s) tissue/swab
Clinical specimens (wounds, catheter urine, respiratory, other as clinically indicated)
During an identified hospital outbreak, the addition of a perineal or groin swab is recommended.
GUIDELINES FOR MRO CLEARANCE
All the following criteria should be satisfied prior to certifying that a patient has cleared a particular MRO:
More than 3 months elapsed time from the last positive specimen;
All wounds healed, no indwelling medical devices present;
No exposure to any antibiotic or antiseptic body wash for at least 2 weeks prior to screening;
In the case of MRSA, no exposure to specific anti-MRSA antibiotic therapy in the past 3 months; and
Consecutive negative screens from above screening sites on two separate occasions OR evaluation of
a single set of screening swabs with a broth amplification technique.Dr John Ferguson
Director, Infection Prevention and Control Unit
Microbiologist and Infectious Diseases Physician
HUNTER NEW ENGLAND HEALTH
Locked Bag 1, Newcastle, NSW 2310, Australia
tel 61 2 49214422, fax 61 2 49214440Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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