Revised/Updated – Australian Government Department of health The Ebola Virus Disease (EVD) CDNA National Guidelines for Public Health Units

[Brenda White]

Hi All,
The Australian Government, Department of Health, Ebola Virus Disease(EVD), CDNA National Guidelines for Public Health Units and the Victorian Department of Health, Victorian Ebola Virus Disease Plan, Version 2, have recently been updated (6/11 & 12/11).

http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-ebola.htm

http://docs.health.vic.gov.au/docs/doc/Victorian-Ebola-Virus-Disease-Plan-Version-2–November-2014

Both guidelines now refer the user to the United States, Centers for Disease Control (CDC) Guidance on Personal Protective Equipment.

See extract below from the CDNA National Guidelines:

* “For hospitals managing the ongoing care of probable or confirmed EVD cases, the United States Centers for Disease Control (CDC) Guidance on Personal Protective Equipment to be use by healthcare workers during management of patients with Ebola Virus Disease in U.S. Hospitals, including procedures for putting on (donning) and removing (doffing) (http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html ) are recommended”.

Find below a link to a CDC/Medscape video PPE demonstration the USA/CDC recommendations
http://www.medscape.com/viewarticle/833907

I recall recent threads on the ACIPC listserver where members had a number of concerns relating to the CDC recommendations, in particular the PPE donning and doffing procedures?

Do members still have ongoing concerns about the CDC recommendations?

Are members implementing the CDC recommendations as per the revised Australian/Vic guidelines?

We look forward to your feedback.

Brenda White & Glenys Harrington
Clinical Nurse Consultants Infection Control
Latrobe Regional Hospital
Princes Hwy, Traralgon VIC 3844
P: 5173 8566 (leave voice messages) P: 5173 8065 (Portable)
F: 5173 8173
E: infectioncontrol@lrh.com.au

________________________________

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[Thomson, Rachel EA]

Hi there,

We are the designated Quarantine facility for Tasmania and we have discussed this issue at some length internally. We are not strictly following the CDC framework. The reasons for this are many and varied but include concerns that there remain opportunities for contamination of HCWs based on the video information. Concerns include;

Donning

* Buddy outside room wearing face-shield, gown and gloves – we do not see the point of this if the donning is done in a clean space, especially as they are ticking the paper wearing all the gear. We are not allowing any paper that is to be retained to interact with the patient environment

* Donning of the inner glove at the commencement of the donning procedure – we believe that this increases the risk of damage to the glove and a resultant increased potential for exposure during care (especially as the P2 has to be fitted)

* Use of alcohol on gloves – we are using an approved disinfectant wipe instead.

* Donning of face-shield at the end after donning final glove and having ‘disinfected’ them – we think it very odd to be donning the face-shield at this point all gloved up.
Doffing

* Standing on the gown is during doffing – as the gown is likely contaminated it appears that there is an increased risk of contaminating the environment. This removal method is contrary to other published and established guidelines (including those from the CDC themselves)

* Removal of boot covers shows the person them moving around with unprotected shoes and ‘wiping’ at the end, this is in conflict with the Emory guidance that suggests the use of a chemical mat. The video shows the HCW walking in the cleaned shoes over the area where the soiled gown was previously stood on, clearly a risk for contamination

* Removal of P2 – this is demonstrated in a method contrary to manufacturers recommendations, the usual method is not to brush the hands past the front of the mask

I think the key issue is the training and competency in use of PPE relevant for a Quarantine pathogen, a point verbally highlighted in the video. I think recognising that there are many opportunities for contamination and that the familiarity with and care taken with PPE is fundamentally core to safety.

Hope these few comments and observations assist?

Kind regards
Rachel
……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi All,
The Australian Government, Department of Health, Ebola Virus Disease(EVD), CDNA National Guidelines for Public Health Units and the Victorian Department of Health, Victorian Ebola Virus Disease Plan, Version 2, have recently been updated (6/11 & 12/11).

http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-ebola.htm

http://docs.health.vic.gov.au/docs/doc/Victorian-Ebola-Virus-Disease-Plan-Version-2–November-2014

Both guidelines now refer the user to the United States, Centers for Disease Control (CDC) Guidance on Personal Protective Equipment.

See extract below from the CDNA National Guidelines:

* “For hospitals managing the ongoing care of probable or confirmed EVD cases, the United States Centers for Disease Control (CDC) Guidance on Personal Protective Equipment to be use by healthcare workers during management of patients with Ebola Virus Disease in U.S. Hospitals, including procedures for putting on (donning) and removing (doffing) (http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html ) are recommended”.

Find below a link to a CDC/Medscape video PPE demonstration the USA/CDC recommendations
http://www.medscape.com/viewarticle/833907

I recall recent threads on the ACIPC listserver where members had a number of concerns relating to the CDC recommendations, in particular the PPE donning and doffing procedures?

Do members still have ongoing concerns about the CDC recommendations?

Are members implementing the CDC recommendations as per the revised Australian/Vic guidelines?

We look forward to your feedback.

Brenda White & Glenys Harrington
Clinical Nurse Consultants Infection Control
Latrobe Regional Hospital
Princes Hwy, Traralgon VIC 3844
P: 5173 8566 (leave voice messages) P: 5173 8065 (Portable)
F: 5173 8173
E: infectioncontrol@lrh.com.au

________________________________

Please consider the environment before printing this email
“Totally Smokefree from 1 July 2007”
____________________________________________________________
COMMERCIAL-in-CONFIDENCE
This document is confidential and may contain privileged information intended for the addressee only.
If you are not the addressee or an authorised recipient of this document, you may not read, copy, disseminate or act in reliance on any of the information contained herein. If you receive this electronic document in error, please return it to the sender.
If you are the addressee or an authorised recipient of this document, you may not copy or disseminate any of the information contained herein without prior approval from the sender.
There is no guarantee that this communication is free of virus or that it has not been intercepted or interfered with.
____________________________________________________________
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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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

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