Re – Aseptic Technique

[Teresa Lewis]

Hi All

I am working at a new, private small endoscopy centre.
I get to see the anaesthetists (which was not always easy when working at a busy hospital) and thought it would be great to have the discussion and look at the possibility of doing education etc. person to person.

Unfortunately, I have hit great resistance! They firmly believe that because our cannulas are in short-term – (being a day only endoscopy centre) this ANTT stuff does not apply to us.
They have asked for the evidence, which I gave them of course, but they keep saying it is not applicable to us. The other day I was talking to one of them about the importance of ANTT and that hand hygiene needs to be performed at the correct
time as per the 5 moments and I was shocked to hear….”so you expect me to perform hand hygiene each time before I administer an IV drug if I have touched the environment, my phone or another patient?”. So I think we still have a long way to go with education, especially of the practitioners who are out there in private practice (perhaps it’s just my doctors?)!!

Even though management were supportive initially, they have now said to just look at training our staff (not the doctors). This has come about since Advisory No: A13/05.
I am struggling with this, and will of course try to come up with some ideas to get around it sensitively.

While on the subject. Is Australia working on our own educational resources (I have worked hard to get rid of Lanyards and now I see them dangling in aseptic fields)?
Is everyone teaching glove use to draw up IV Medications? Is everyone sourcing a larger alcohol/chlorhexidine swab as per the educational videos?
It seems that although we all need to implement this standard, in talking to other practitioners everyone seems to be doing it a little differently, which then defeats the purpose.

Any feedback greatly accepted. Have a great week.

Teresa Lewis
Infection Control and Prevention CNC
Newcastle Endoscopy Centre

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[Matthias Maiwald (KKH)]

Dear Teresa,

This is unfortunate. While it is an important principle that everyone always should have the right to speak up and ask “where is the evidence”, I have long hypothesised that this right is often abused for the wrong reasons, particularly by people who consider adherence to good infection control practices as inconvenient. I have also long advocated that in instances where there is a strong biological (including microbiological) and scientific rationale, there should be an “evidence reversal”, i.e. a reversal of the onus to bring on evidence, such as “this is standard practice, supported by a good microbiological/scientific rationale, and now YOU show me the evidence that if this is not adhered to, this won’t lead to negative consequences for our patients”. (This also indirectly supports what I have advocated earlier, that understanding of the concepts and principles from teaching in medical schools would be important).

What would help, in my opinion, is if your institution would have an infection control committee (HICC) headed by a senior doctor (e.g. ID physician or microbiologist). For example, we here have HICC sessions once every three months, something like you describe (i.e. systematic practice breaches) would most likely be discussed there, and the chairperson of the HICC would then (most likely) issue a formal letter to the hospital CEO concerning adherence to practices.

I had a quick look at the ANTT website that Tim Spencer sent in his e-mail just before yours, and I do notice that it is very light on factual information and very heavy on management-speak (“weaselwords”).

Best regards, Matthias.

—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387

Hi All

I am working at a new, private small endoscopy centre.
I get to see the anaesthetists (which was not always easy when working at a busy hospital) and thought it would be great to have the discussion and look at the possibility of doing education etc. person to person.

Unfortunately, I have hit great resistance! They firmly believe that because our cannulas are in short-term – (being a day only endoscopy centre) this ANTT stuff does not apply to us.
They have asked for the evidence, which I gave them of course, but they keep saying it is not applicable to us. The other day I was talking to one of them about the importance of ANTT and that hand hygiene needs to be performed at the correct
time as per the 5 moments and I was shocked to hear….”so you expect me to perform hand hygiene each time before I administer an IV drug if I have touched the environment, my phone or another patient?”. So I think we still have a long way to go with education, especially of the practitioners who are out there in private practice (perhaps it’s just my doctors?)!!

Even though management were supportive initially, they have now said to just look at training our staff (not the doctors). This has come about since Advisory No: A13/05.
I am struggling with this, and will of course try to come up with some ideas to get around it sensitively.

While on the subject. Is Australia working on our own educational resources (I have worked hard to get rid of Lanyards and now I see them dangling in aseptic fields)?
Is everyone teaching glove use to draw up IV Medications? Is everyone sourcing a larger alcohol/chlorhexidine swab as per the educational videos?
It seems that although we all need to implement this standard, in talking to other practitioners everyone seems to be doing it a little differently, which then defeats the purpose.

Any feedback greatly accepted. Have a great week.

Teresa Lewis
Infection Control and Prevention CNC
Newcastle Endoscopy Centre

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[cid:kkh6700.gif]kkh

________________________________
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[Claire Rickard]

Hi Teresa

You should definitely have a chat with Prof Allan Merry in NZ – Department
of Anaesthesiology, The University of Auckland, Auckland, New Zealand.

He is a Prof of Anaesthetics and his interest is in changing behaviour to
improve quality and safety, including IC.

http://www.fmhs.auckland.ac.nz/som/staffct/staff_details.aspx?staffID616D6572303136

Also there is an anaesthetic nurse researcher here in Brisbane interested
in this, she has published an article you might be interested in. Email me
off list if you would like a copy.

A snapshot of guideline compliance reveals room for improvement: A survey
of peripheral arterial catheter practices in Australian operating
theatres.

*Reynolds* H, Dulhunty J, Tower M, Taraporewalla K, *Rickard* C.

J Adv Nurs. 2013 Jul;69(7):1584-94. doi: 10.1111/jan.12018. Epub 2012 Sep
26.

Good luck soldier!

Best regards, Claire

*Professor Claire Rickard RN PhD*
c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Intravascular Access Device Research Group | NHMRC Centre of Research
Excellence in Nursing | Griffith Health Institute | Visiting Scholar: Royal
Brisbane & Women’s Hospital | Princess Alexandra Hospital | The Prince
Charles Hospital

Research frequently takes me off campus. Please contact Jenny Chan 3735
5406 *j.chan@griffith.edu.au* or
Jo.Wright@griffith.edu.au 3735 4886 with any urgent enquiries.

*There are three stages in any scientific discovery: first, people deny
that it is true; then they deny that it is important; finally they credit
the wrong person.*

*Bryson BA. A short history of nearly everything. Broadway Books: New York.
2003, 421.*

On 15 July 2013 09:37, Teresa Lewis wrote:

> Hi All****
>
> ** **
>
> I am working at a new, private small endoscopy centre. ** **
>
> I get to see the anaesthetists (which was not always easy when working at
> a busy hospital) and thought it would be great to have the discussion and
> look at the possibility of doing education etc. person to person.****
>
> ** **
>
> Unfortunately, I have hit great resistance! They firmly believe that
> because our cannulas are in short-term (being a day only endoscopy
> centre) this ANTT stuff does not apply to us.****
>
> They have asked for the evidence, which I gave them of course, but they
> keep saying it is not applicable to us. The other day I was talking to one
> of them about the importance of ANTT and that hand hygiene needs to be
> performed at the correct ****
>
> time as per the 5 moments and I was shocked to hear.so you expect me to
> perform hand hygiene each time before I administer an IV drug if I have
> touched the environment, my phone or another patient?. So I think we still
> have a long way to go with education, especially of the practitioners who
> are out there in private practice (perhaps its just my doctors?)!!****
>
> ** **
>
> Even though management were supportive initially, they have now said to
> just look at training our staff (not the doctors). This has come about
> since Advisory No: A13/05.****
>
> I am struggling with this, and will of course try to come up with some
> ideas to get around it sensitively.****
>
> ** **
>
> While on the subject. Is Australia working on our own educational
> resources (I have worked hard to get rid of Lanyards and now I see them
> dangling in aseptic fields)? ****
>
> Is everyone teaching glove use to draw up IV Medications? Is everyone
> sourcing a larger alcohol/chlorhexidine swab as per the educational videos?
> ****
>
> It seems that although we all need to implement this *standard*, in
> talking to other practitioners everyone seems to be doing it a little
> differently, which then defeats the purpose.****
>
> ** **
>
> Any feedback greatly accepted. Have a great week.****
>
> ** **
>
> Teresa Lewis****
>
> Infection Control and Prevention CNC****
>
> Newcastle Endoscopy Centre****
>
> ** **
>
> ** **
>
> ** **
> Messages posted to this list are solely the opinion of the authors, and
> do not represent the opinion of ACIPC.
>
> 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 authors, and do not represent the opinion of ACIPC.

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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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[Jennifer Benjamin]

Hi Teresa
I too work for a few endoscopy units and I see the anaethetists do some pretty ordinary stuff. No hand hygiene, no gloves, drawing up a whole list of drugs, taping the cannula in instead of occlusive dressings. I keep feeding the results back in my audits so its known to management. Often in the audits this is main area of non compliance.
We are hoping that because they are sessional that each place they visit ask them for the same things and if they do it once they will get a hole lot of people off their backs… ie do the hand hygiene online competency and we will copy it for you to take everywhere and we will all stop nagging you! Some have!
I did some hh audits recently and plucked the anaethetist out as a separation and presented the results to management along with other observations. They draggged the whole team down. The onus is on management to ensure staff comply so make sure that management know that.
Good luck

Jennifer Benjamin
Infection Control Consulant
Melbourne Pathology
M: 0402000590
Quality is in our DNA
This message contains privileged and confidential information intended only for the use of the addressee named above. If you are not the intended recipient of this message you must not disseminate, copy or take any action in reliance on it.

________________________________

Hi All

I am working at a new, private small endoscopy centre.
I get to see the anaesthetists (which was not always easy when working at a busy hospital) and thought it would be great to have the discussion and look at the possibility of doing education etc. person to person.

Unfortunately, I have hit great resistance! They firmly believe that because our cannulas are in short-term – (being a day only endoscopy centre) this ANTT stuff does not apply to us.
They have asked for the evidence, which I gave them of course, but they keep saying it is not applicable to us. The other day I was talking to one of them about the importance of ANTT and that hand hygiene needs to be performed at the correct
time as per the 5 moments and I was shocked to hear….”so you expect me to perform hand hygiene each time before I administer an IV drug if I have touched the environment, my phone or another patient?”. So I think we still have a long way to go with education, especially of the practitioners who are out there in private practice (perhaps it’s just my doctors?)!!

Even though management were supportive initially, they have now said to just look at training our staff (not the doctors). This has come about since Advisory No: A13/05.
I am struggling with this, and will of course try to come up with some ideas to get around it sensitively.

While on the subject. Is Australia working on our own educational resources (I have worked hard to get rid of Lanyards and now I see them dangling in aseptic fields)?
Is everyone teaching glove use to draw up IV Medications? Is everyone sourcing a larger alcohol/chlorhexidine swab as per the educational videos?
It seems that although we all need to implement this standard, in talking to other practitioners everyone seems to be doing it a little differently, which then defeats the purpose.

Any feedback greatly accepted. Have a great week.

Teresa Lewis
Infection Control and Prevention CNC
Newcastle Endoscopy Centre

Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

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Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

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