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Thanks John
Yes a long overdue debate on a complicated issue.I would make a few points:
– I think the term environmental disinfection is misleading and prefer environmental hygiene
– Evidence for the role of the environment in both HAI transmission and reduction is improving and I suspect more will shortly be coming. Although I am initially in favour of a concept to include environmental hygiene as part of SP, we must be confident of the evidence base. If we don’t we will end up on the same situation we have had with other IC issues.
– The NHMRC guidelines may ‘hedge their bets’, but in fact it is a major step forward when talking about issues such as the frequency of cleaning based on risk and frequently touched objects (Section B5.1). It is now for other to prove/disprove these recommendations through research. No other guideline has gone as far as this before (in relation to this specific issue of frequency). Terminology used in other guidelines (including the CDC) such has as ‘frequent’ or ‘regular’ are meaningless when trying to argue the point for increased levels of cleaning for example.
– routine management of the environment is included in SP in the NHMRC guidelines, but I think you are talking about more than that.If we go down the route of significantly increasing the profile and importance of environ hygiene then we need to consider/be prepared for
– evidence to support it
– cleaning frequencies
– cleaning products – choice
– who cleans what
– recommendations for staffing
– recommendation for evaluating cleanlinessMany aspects of the above are progressing quickly. Thanks John for raising this important issue. Personally, I agree that the role of the environment is critical in HAI prevention and reduction.
Brett Mitchell
Tasmania Infection Prevention & Control Unit
DHHS—–Original Message—–
Dear All,
In NSW there is current debate about the role of environmental disinfection. My view is that we should mandate the routine cleaning AND DISINFECTION of near patient touch sites, bathrooms and toilets. This requirement forms part of the CDC 2007 Isolation guideline Standard Precautions model which is arguably the basis for IPC practice around the world.
The NHMRC IC Guideline hedges its bets with a uninterpretable requirement (below) under use of disinfectants to determine whether there is uncertainty about the nature of soiling on the surface!! This is a nonsense. We know from many sampling studies that the near patient surfaces are frequently contaminated with MROs etc and also that unadequate management of env hygiene leads to increased risk of MRO acquisituion in patients managed later in the same room (see attached recent review for a summary of the evidence).
Over to you all! This is an issue, along with fomite management (clean between is not good enough!) that I think is overdue for local debate! Should we start to talk in detail about “Environmental Hygiene” (rather than Env Cleaning) as a companion standard to Hand Hygiene under Standard Precautions?
Kind regards
john
John Ferguson
Infectious Diseases Physician and Microbiologist,
Hunter New England Health, John Hunter Hospital, Newcastle
Conjoint Associate Professor, University of Newcastle
Tel 61 2 49214444, Fax 61 2 49214440, Mobile 0428 885573CDC 2007 Excerpt (p60 under Fundamental elements needed to prevent transmission of infectious agents in healthcare settings):
“Cleaning and disinfecting non-critical surfaces in patient-care areas are part of Standard Precautions. In general, these procedures do not need to be changed for patients on Transmission-Based Precautions. The cleaning and disinfection of all patient-care areas is important for frequently touched surfaces, especially those closest to the patient, that are most likely to be contaminated (e.g., bedrails, bedside tables, commodes, doorknobs, sinks, surfaces and equipment in close proximity to the patient) 11, 72, 73, 835. The frequency or intensity of cleaning may need to change based on the patient’s level of hygiene and the degree of environmental contamination and for certain for infectious agents whose reservoir is the intestinal tract 54. This may be especially true in LTCFs and pediatric facilities where patients with stool and urine incontinence are encountered more frequently. Also, increased frequency of cleaning may be needed in a Protective Environment to minimize dust accumulation 11. Special recommendations for cleaning and disinfecting environmental surfaces in dialysis centers have been published 18. In all healthcare settings, administrative, staffing and scheduling activities should prioritize the proper cleaning and disinfection of surfaces that could be implicated in transmission. During a suspected or proven outbreak where an environmental reservoir is suspected, routine cleaning procedures should be reviewed, and the need for additional trained cleaning staff should be assessed. Adherence should be monitored and reinforced to promote consistent and correct cleaning is performed.”
NHMRC excerpt:
Recommendation
11 Routine cleaning of surfacesGrade
Clean frequently touched surfaces with detergent solution at least daily, and when visibly soiled and after every known contamination.
Clean general surfaces and fittings when visibly soiled and immediately after spillage.GPP
Use of disinfectants
In acute-care settings where there is uncertainty about the nature of soiling on the surface (e.g. blood or body fluid contamination versus routine dust or dirt) or the presence of MROs (including C. difficile) or other infectious agents requiring transmission-based precautions (e.g. pulmonary tuberculosis) is known or suspected, surfaces should be physically cleaned with a detergent solution, followed or combined with a TGA-registered disinfectant with label claims specifying its effectiveness against specific infectious organisms.Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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Hi all,
The issue of environmental hygiene is clearly on the national radar at
present. I would suggest that the NHMRC IC guidelines have indeed
helped to open debate in relation to management of the environment. I
would dare to suggest that the document, especially section B5.1 has
potentially raised more questions than it answers. Not a bad thing, but
creating fertile ground for ongoing discussion and research. As a
Manager in an acute care hospital the recommendations spelt out in the
guidelines are, at a practical level, difficult at best and impossible
at worst. For example the simple recommendation to clean AHR dispensers
“daily and between patient use” is difficult to interpret and I
personally wonder about the risk represented by such static items.I would like to commend the TICA who under Brett’s stewardship have
embarked on raising this very issue at the upcoming TICA conference. I
would suggest that this area is a topic that not only could be, but
should be firmly placed on the National Agenda and would see a place for
the AICA and the Commission to engage coal face clinicians and to
support a research agenda in this critical (and often under rated)
domain.Kind regards
Rachel
Rachel Thomson
Nurse Unit Manager
Infection Prevention & Control Unit
Royal Hobart Hospital
E: rachel.thomson@dhhs.tas.gov.au
________________________________
Behalf Of Mitchell, Brett (TIPCU)
Precautions modelThanks John
Yes a long overdue debate on a complicated issue.I would make a few points:
– I think the term environmental disinfection is misleading and prefer
environmental hygiene
– Evidence for the role of the environment in both HAI transmission and
reduction is improving and I suspect more will shortly be coming.
Although I am initially in favour of a concept to include environmental
hygiene as part of SP, we must be confident of the evidence base. If we
don’t we will end up on the same situation we have had with other IC
issues.
– The NHMRC guidelines may ‘hedge their bets’, but in fact it is a major
step forward when talking about issues such as the frequency of cleaning
based on risk and frequently touched objects (Section B5.1). It is now
for other to prove/disprove these recommendations through research. No
other guideline has gone as far as this before (in relation to this
specific issue of frequency). Terminology used in other guidelines
(including the CDC) such has as ‘frequent’ or ‘regular’ are meaningless
when trying to argue the point for increased levels of cleaning for
example.
– routine management of the environment is included in SP in the NHMRC
guidelines, but I think you are talking about more than that.If we go down the route of significantly increasing the profile and
importance of environ hygiene then we need to consider/be prepared for
– evidence to support it
– cleaning frequencies
– cleaning products – choice
– who cleans what
– recommendations for staffing
– recommendation for evaluating cleanlinessMany aspects of the above are progressing quickly. Thanks John for
raising this important issue. Personally, I agree that the role of the
environment is critical in HAI prevention and reduction.Brett Mitchell
Tasmania Infection Prevention & Control Unit
DHHS—–Original Message—–
disinfection as part of Standard Precautions modelPrecautions model
Dear All,
In NSW there is current debate about the role of environmental
disinfection. My view is that we should mandate the routine cleaning AND
DISINFECTION of near patient touch sites, bathrooms and toilets. This
requirement forms part of the CDC 2007 Isolation guideline Standard
Precautions model which is arguably the basis for IPC practice around
the world.The NHMRC IC Guideline hedges its bets with a uninterpretable
requirement (below) under use of disinfectants to determine whether
there is uncertainty about the nature of soiling on the surface!! This
is a nonsense. We know from many sampling studies that the near patient
surfaces are frequently contaminated with MROs etc and also that
unadequate management of env hygiene leads to increased risk of MRO
acquisituion in patients managed later in the same room (see attached
recent review for a summary of the evidence).Over to you all! This is an issue, along with fomite management (clean
between is not good enough!) that I think is overdue for local debate!
Should we start to talk in detail about “Environmental Hygiene” (rather
than Env Cleaning) as a companion standard to Hand Hygiene under
Standard Precautions?Kind regards
john
John Ferguson
Infectious Diseases Physician and Microbiologist,
Hunter New England Health, John Hunter Hospital, Newcastle
Conjoint Associate Professor, University of Newcastle
Tel 61 2 49214444, Fax 61 2 49214440, Mobile 0428 885573CDC 2007 Excerpt (p60 under Fundamental elements needed to prevent
transmission of infectious agents in healthcare settings):“Cleaning and disinfecting non-critical surfaces in patient-care areas
are part of Standard Precautions. In general, these procedures do not
need to be changed for patients on Transmission-Based Precautions. The
cleaning and disinfection of all patient-care areas is important for
frequently touched surfaces, especially those closest to the patient,
that are most likely to be contaminated (e.g., bedrails, bedside tables,
commodes, doorknobs, sinks, surfaces and equipment in close proximity to
the patient) 11, 72, 73, 835. The frequency or intensity of cleaning may
need to change based on the patient’s level of hygiene and the degree of
environmental contamination and for certain for infectious agents whose
reservoir is the intestinal tract 54. This may be especially true in
LTCFs and pediatric facilities where patients with stool and urine
incontinence are encountered more frequently. Also, increased frequency
of cleaning may be needed in a Protective Environment to minimize dust
accumulation 11. Special recommendations for cleaning and disinfecting
environmental surfaces in dialysis centers have been published 18. In
all healthcare settings, administrative, staffing and scheduling
activities should prioritize the proper cleaning and disinfection of
surfaces that could be implicated in transmission. During a suspected or
proven outbreak where an environmental reservoir is suspected, routine
cleaning procedures should be reviewed, and the need for additional
trained cleaning staff should be assessed. Adherence should be monitored
and reinforced to promote consistent and correct cleaning is performed.”NHMRC excerpt:
Recommendation
11 Routine cleaning of surfacesGrade
Clean frequently touched surfaces with detergent solution at least
daily, and when visibly soiled and after every known contamination.
Clean general surfaces and fittings when visibly soiled and immediately
after spillage.GPP
Use of disinfectants
In acute-care settings where there is uncertainty about the nature of
soiling on the surface (e.g. blood or body fluid contamination versus
routine dust or dirt) or the presence of MROs (including C. difficile)
or other infectious agents requiring transmission-based precautions
(e.g. pulmonary tuberculosis) is known or suspected, surfaces should be
physically cleaned with a detergent solution, followed or combined with
a TGA-registered disinfectant with label claims specifying its
effectiveness against specific infectious organisms.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.auTo 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.auWant to Get Healthy?
The Tasmanian Government’s Get Healthy Information and Coaching Service
provides free information and coaching support to Tasmanian adults who
would like to learn healthier eating habits, be more active or achieve
and maintain a healthy weight. Call 1300 806 258 between 8am and 8pm,
Monday to Friday or visit http://www.gethealthy.tas.gov.au for more
information.”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.If the transmission contains advice, the advice is based on instructions
in relation to, and is provided to the addressee in connection with, the
matter mentioned above. Responsibility is not accepted for reliance upon
it by any other person or for any other purpose.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.auTo 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.auWant to Get Healthy?
The Tasmania Government’s Get Healthy Information and Coaching Service provides free information and coaching support to Tasmanian adults who would like to learn healthier eating habits, be more active or achieve and maintain a healthy weight. Call 1300 806 258 between 8am and 8pm, Monday to Friday or visit http://www.gethealthy.tas.gov.au for more information.
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. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose.
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
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