[Angela Carvosso]

Hi Sue,

With regards to staff wearing multiple masks, is there a possibility of allergy? I worked with an AIN when we were dealing with norovirus in a different health district to where I c. She came out in a rash if she wore the N95 mask on its own. Being the dedicated nurse that she was, she didnt complain, she just stuck a surgical mask underneath to protect her skin and put the N95 over the top although I do now wonder if she obtained a correct seal. It is just one possible explanation. Utter confusion I guess would be the other.

Regards Angela Carvosso
RN SCHHS

Sent from Mail for Windows 10

Thank you to all who replied to my query.
The responses received tell me that some of you are as confused about the application of droplet and airborne precautions simultaneously and how to educate HCWs to be consistent and stay safe whilst using appropriate PPE. Some have addressed the potential confusion by creating new terms for precautions e.g. ‘respiratory precautions’ to try to clarify requirements for HCWs where it does not fit with conventional transmission-based precautions.
I also note there appears to be little consistency across the country at a facility or jurisdiction level. This must make it difficult for those HCWs who work in multiple facilities.
The lack of consistent advice between the Australian Guidelines for the Prevention and Control of Infection in Health care on how to apply standard plus droplet and airborne precautions and the CDNA SoNG and then how this is applied by clinicians. Only tonight on the news, I noted several HCWs at NSW COVID screening/testing centres wearing multiple masks simultaneously. Where does it say that in the evidence!!
Many of the research evidence including the Lancet review by Chu et al discusses the benefit of protective eyewear in conjunction with the use of masks and respirators to protect the eyes, this is not new, it is part of standard precautions but hasn’t been well applied by HCWs prior to COVID-19. The research does not seem to clarify why droplet and airborne precautions are applied together or to what benefit. It makes me wonder if it is a ‘more must be better’ recommendation.
I guess we continue to problem solve the confusion and go back to first principles for providing consistent evidence-based advice to health care workers and try to minimise confusion.
On that note, stay safe and thank you again for your feedback.

Kind regards,
Sue
.
Sue Greig RN CICP-E
National Infection Prevention and Control Coordinator
Ramsay Health Care
0407 312 600

On Thu, 9 Jul 2020 at 16:39, John Ferguson (Hunter New England LHD) <John.Ferguson@health.nsw.gov.au> wrote:
Hi Sue

Technically, airborne precautions do not include eye protection whereas droplet do
And so the need to require all three contact+droplet+airborne for COVID as we believe that eye exposure is a significant risk (recent Lancet review by Chu et al)
Obviously a p2/n95 respirator or equivalent is required rather than a surgical mask when airborne required
A risk managed approach is recommended to decide on whether a gown or apron is required

Kind regards
John

Dr John Ferguson MBBS DTM&H FRACP FRCPA
Director, Infection Prevention Service | Hunter New England Local Health District
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49223725 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf
https://aimed.net.au/2020/03/28/why-are-standard-infection-control-precautions-the-best-bulwark-against-spread-of-covid-19-in-healthcare/

Dear brains trust,
I am interested in the how ICPs and educators are explaining to HCWs the application of standard plus contact plus droplet plus airborne precautions as required by CDNA latest SoNG, resources provided by the ACSQHC, and NSW Health COVID-19 Policy,
The areas I am interested in particularly are:

1. The practical application of droplet and airborne precautions simultaneously.
2. The PPE you are using fo this level of precautions and why
3. The environmental and patient placement considerations applied when droplet and airborne precautions are applied simultaneously.
Thanks in advance,

Kind regards,
Sue

Sue Greig RN CICP-E
National Infection Prevention and Control Coordinator
Ramsay Health Care
0407 312 600

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[Angela Carvosso]

Hi Jenny,

Your colleague is quite right, once tested for covid you cannot return to work unless your test result is negative. One does wonder what prompted the staff member to have the unpleasant procedure done in the first place. Not something you would expect to be done on a whim.

Regards Angela Carvosso
IMS
Sunshine Coast Hospital and Health Service

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Hi all
I have a staff member who is feeling quite well but decided to be tested for COVID-19 at one of the shopping centre testing areas they have set up. She assumed she would have a result within 2 days but has been told it may be up to a week. One of my colleagues has told her she cannot return to work until she has her result does this sound right to everyone?
Thanks in advance for your expertise and comments
Jenny

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[Angela Carvosso]

Hi Debra,

We use probe covers or the thermometers dont work anyway. I have always wiped them down with the cleaning wipe supplied to wipe down the rest of the obs machine. Its standard practice to clean between each patient. I would of thought if proper cleaning has been used with wipes rated to kill the microorganism and use of covers sufficient for general use with dedicated equipment wherever possible for people in isolation.

Regards Angela Carvosso
RN Warwick Health Services

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Hi all,

Has anyone else been asked if oral thermometers should undergo HLD to comply with 4187, as the probe comes in contact with a mucous membrane?
There is heightened awareness around COVID 19 transmission and it was raised that a probe cover is not considered sufficient protection without HLD for other sites

If you could please let me know what processes do others use for cleaning of oral thermometer probes between each patient?

Kind regards,

Debra Lee
Clinical Nurse Consultant
Infection Management and Prevention Service
West Block Ground floor
Redcliffe Hospital
Redcliffe, Qld 4020
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[Angela Carvosso]

Hello ladies,

I did a lit review on this for uni. The most recent study I found was
Hewlett, A. L., Hohenberger, H., Murphy, C. N., Helget, L., Hausmann, H., Lyden, E., . . . Hicks, R. (2018). Evaluation of the bacterial burden of gel nails, standard nail polish, and natural nails on the hands of health care workers. AJIC: American Journal of Infection Control, 46(12), 1356-1359. doi:10.1016/j.ajic.2018.05.022
I would ask the staff members to show the scientific literature they are basing their statements on. Irrespective of that, if the policy is bare then bare it must be. When they sign their employee agreement they agree to abide by policy and procedure, you might point that out to them.

Regards
Angela Carvosso
Registered Nurse
Warwick Health Service
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From: Helen Roberts
Sent: Sunday, 1 March 2020 2:01 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Wearing of Nail Polish, Acrylic nails, SNS, Shellac on Nurses providing Clinical Care Studies

Hi Tracey,
I have the same issue with staff saying that Shellac is safe to wear when it comes to hand hygiene.
I would like to be included in any information in regards to this please.

Regrds,
Helen
Helen Roberts
Infection Control
P:
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Address:
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From: ACIPC Infexion Connexion on behalf of Wood, Tracey
Sent: Friday, 28 February 2020 2:36 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Wearing of Nail Polish, Acrylic nails, SNS, Shellac on Nurses providing Clinical Care Studies

Hello all,

I am having a hard time to get some nurses to adhere to below the elbows in regards to Nail Polish, Enhancements, SNS, Shellac etc.

Most of the staff say that because its Shellac or SNS, it doesnt chip and become a hazard.

I have given them our policies to support this fact of removal all nail enhancements.

Does anyone know of any recent studies on this topic that I read to get more information to supply to my staff?

Thanks,

Tracey Wood
Regional Infection Control Coordinator
Gosford Private Hospital

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[Angela Carvosso]

Hi Fiona,

I personally recap just to remove the needle from the syringe as I was taught to never touch the coloured hub. The premise of not recapping is to prevent transmission of infection via needlestick from needles used on people. A risk analysis would indicate that as the needle has not been used on a person then it is safe to recap.

Regards Angela Carvosso
RN Warwick Hospital

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________________________________

Hi All,

We are currently having discussions about how to safely draw up medications and whether it is suitable to recap a blunt fill drawing up needle to expel air from a syringe.

One side of the argument is that the blunt fill is recapped so that when air is expelled the contents are not aerosolised. The other side is that a needle (blunt or otherwise) should never be recapped.

I would be interested to know other peoples thoughts and what evidence if any you have for this.

Kind regards,

Fiona De Sousa CICP-E| Nurse Manager | Infection Prevention & Control Unit
Launceston General Hospital, Level 2, Launceston TAS 7250
phone: 6777 6715 | mobile: 0408 487 197 | fax: 6777 5170 | email: fiona.de.sousa@ths.tas.gov.au |
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[Angela Carvosso]

Hi Leanne,

It is standard procedure to use a drawing up needle for saline and to swab vials and let them dry before piercing them. For flushes best practice is a pre filled saline syringe that comes in 5 and 10 mL with a 10mL bore on both. Even using a drawing up needle there is an 8.6% chance of contaminating your fluids. If they touch the outside of the ampoule with their needle they should be taught to throw it away and start again. I also teach to swab the injection port of the saline bag if hanging the drug even though it has been sterilized. Sterilisation only guarantees 97% kill so any bugs left alive may still be there. Dry time is key for swabbing as it is your kill time.

Regards Angela Carvosso
RN Warwick Hospital

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________________________________

[Posted on behalf of member Moderator]

Dear team

I have a question are your staff using drawing up needles to prepare IV flushes and ABs from plastic vials or swabbing the vials with alcohol wipes then direct connecting the syringe to draw up?
I would like to know so I can teach best practice infection control to the students.

Kind regards
Leanne Sheppard
BN, MPH, TAE, GDip Adult Ed, GC CFHN
Casual facilitator University of Newcastle Undergraduate nursing program

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[Angela Carvosso]

Hi Coralie,

I just performed a quick search and found this article for you.
Fernandez, S. (2019). Does long hair belong in a clinical setting?. Nursing, 49(8), 5355. doi: 10.1097/01.NURSE.0000558098.51162.da.
I hope this help clarify somewhat.

Regards Angela Carvosso
RN Warwick Hospital

Sent from Mail for Windows 10

________________________________

I note this email discussion with interest.
Whilst it is commonsense to have clean hair, tied back (dreadlocks or not) I am struggling to provide any guidelines (other than surgical attire and food services) that actually outlines the requirement for hair management in health care.
Lots of reference to nails limited reference to uniform.
Grateful if anyone can direct me to actual research and/or guidelines regarding hair.

Coralie

Coralie Tyrrell | Manager Infection Prevention & Control Monday-Thursday| P: 03 56230625 | E: coralie.tyrrell@wghg.com.au
West Gippsland Healthcare Group | 41 Landsborough Street | Warragul Vic 3820 | http://www.wghg.com.au

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Hi Linda,

Our uniform policy also states that hair that reaches the collar must be tied back. It does not specify that it must be above the collar. I have long hair and generally put it up in a pony tail when I am working. I hope this person is achieving their dreadlocks in a clean manner rather than by not washing their hair at all because that is just yuck. Either way if your policy is above the collar and back then the onus is on the staff member to achieve that. If we start watering down policies we get on a very slippery slope and people will just decide to not follow policies they dont agree with.

As far as the dermal piercings go we cannot prevent staff from self expression. The issue with them would be if they inadvertently touch them whilst they are caring for patients as the science shows that ear and nose piercings have an increased biological load and we could extrapolate that to other piercings.

Now as for the nails there have been incidences of artificial nails linked to neonatal deaths. The jury is still out on the shellac as there have not been much in the way of studies. It has been postulated that the UV curing reduces the biological load between the nail and the shellac. Fresh nail polish (2mm are linked to higher biological load and reduced cleaning efficiency than nail polish probably due to the difficulty getting under the nails to clean properly.

I hope this helps

Regards Angela Carvosso
Registered Nurse
Warwick Hospital

Sent from Mail for Windows 10

________________________________

Thanks Kathy

I forgot to mention that the staff member is a Registered Nurse.

As well as the potential infection control issues, I also wondered about the Work Health and Safety aspect with long hair/dreadlock and the long hair getting caught in some of the machinery (lifters, electronic beds etc) that we use.

Regards

Linda

Hi Linda,

Our uniform policy states the same as yours short hair or if long tied back when working, dreadlocks I believe are an infection risk because they can not be tied up adequately when they are that long. Our staff have an obligation to adhere to the uniform policy to be employed at the hospital. Having said that we have a lot of staff with dermal piercings in different spots, and artificial nails with shellac or SNS is also a problem. Not sure how we are going to police these things. So in short no I dont think the policy encompases dreadlock hair!!

Kind regards

Kathy ODonnell
CNC IPAC Westmead Hospital

On 9 Sep 2019, at 5:39 pm, Linda Mccaskill <Linda.McCaskill@ACHA.ORG.AU> wrote:

Hi

Just wondering if anyone has a policy that covers dreadlock hair.

We have a staff member whose dreadlocks have grown very long (when left long they are past her shoulders down her back) and are too long and big to wrap into a bun.

Our currently hospital policy is that hair should be above shoulder height and that long/medium length hair must be tied back.

My feeling is that they need to be trimmed to a shorter length but welcome any thoughts on this?

Kind Regards

Linda McCaskill (RN, BN, GC NSC Inf Ctrl)

Infection Control Manager
Ashford Hospital
55 Anzac Highway, Ashford, SA 5035
T : 8375 5209 (external) or ext 4209 (internal)
E : linda.mccaskill@acha.org.au

Please note I work Monday to Thursday

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[Angela Carvosso]

Hi Linda,

Our uniform policy also states that hair that reaches the collar must be tied back. It does not specify that it must be above the collar. I have long hair and generally put it up in a pony tail when I am working. I hope this person is achieving their dreadlocks in a clean manner rather than by not washing their hair at all because that is just yuck. Either way if your policy is above the collar and back then the onus is on the staff member to achieve that. If we start watering down policies we get on a very slippery slope and people will just decide to not follow policies they dont agree with.

As far as the dermal piercings go we cannot prevent staff from self expression. The issue with them would be if they inadvertently touch them whilst they are caring for patients as the science shows that ear and nose piercings have an increased biological load and we could extrapolate that to other piercings.

Now as for the nails there have been incidences of artificial nails linked to neonatal deaths. The jury is still out on the shellac as there have not been much in the way of studies. It has been postulated that the UV curing reduces the biological load between the nail and the shellac. Fresh nail polish (2mm are linked to higher biological load and reduced cleaning efficiency than nail polish probably due to the difficulty getting under the nails to clean properly.

I hope this helps

Regards Angela Carvosso
Registered Nurse
Warwick Hospital

Sent from Mail for Windows 10

________________________________

Thanks Kathy

I forgot to mention that the staff member is a Registered Nurse.

As well as the potential infection control issues, I also wondered about the Work Health and Safety aspect with long hair/dreadlock and the long hair getting caught in some of the machinery (lifters, electronic beds etc) that we use.

Regards

Linda

Hi Linda,

Our uniform policy states the same as yours short hair or if long tied back when working, dreadlocks I believe are an infection risk because they can not be tied up adequately when they are that long. Our staff have an obligation to adhere to the uniform policy to be employed at the hospital. Having said that we have a lot of staff with dermal piercings in different spots, and artificial nails with shellac or SNS is also a problem. Not sure how we are going to police these things. So in short no I dont think the policy encompases dreadlock hair!!

Kind regards

Kathy ODonnell
CNC IPAC Westmead Hospital

On 9 Sep 2019, at 5:39 pm, Linda Mccaskill <Linda.McCaskill@ACHA.ORG.AU> wrote:

Hi

Just wondering if anyone has a policy that covers dreadlock hair.

We have a staff member whose dreadlocks have grown very long (when left long they are past her shoulders down her back) and are too long and big to wrap into a bun.

Our currently hospital policy is that hair should be above shoulder height and that long/medium length hair must be tied back.

My feeling is that they need to be trimmed to a shorter length but welcome any thoughts on this?

Kind Regards

Linda McCaskill (RN, BN, GC NSC Inf Ctrl)

Infection Control Manager
Ashford Hospital
55 Anzac Highway, Ashford, SA 5035
T : 8375 5209 (external) or ext 4209 (internal)
E : linda.mccaskill@acha.org.au

Please note I work Monday to Thursday

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