[Belinda Straube]

Hi Marlize
There is some information in the NSW Health Infection Control policy in regards to washing patient items page 27
http://www0.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_036.pdf

thanks
Belinda

Good afternoon,

It is my understanding that it is not allowed to hand wash items in aged care facilities. I’m however unable to find the evidence for this, would any of you be able to help me with the standards or guidelines around this?

I did have a look at the laundry standard, but it doesn’t deal specifically with this

Thank you in advance
Marlize

Marlize Senekal
Infection Prevent & Control CNC – Education and Research

T (07) 3621 4545 | M 0418 866 816
E m.senekal@wmb.org.au | http://www.wmb.org.au
Central Offices – Wheller Gardens: 930 Gympie Road, Chermside QLD 4032

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[Belinda Straube]

http://www.cec.health.nsw.gov.au/__documents/programs/hand-hygiene/appendices/appendix8.pdf
Here are some poster resources, not sure if you have already received. See “it’s ok to ask”
Thanks
Belinda Straube

Belinda Straube
Infection Prevention and Control CNC
St George Hospital
Gray Street Kogarah
NSW
9113 1575
Page 424
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Hi Linda,
I have several posters that you can use (all around the 5 moments) and there is also this website that you can go to for patient information.
http://www.jointcommission.org/Speak_Up__Five_Things_You_Can_Do_To_Prevent_Infection/
http://interactivejam.com.au/ACIPC-Consumer-minisite-v2/

Kind Regards

Marija Juraja |Clinical Service Coordinator (CICP) -Infection Prevention & Control Unit|
Division of Acute Medicine
t: +61 8 8222 7588| p: 47757|

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[cid:image001.jpg@01D0146E.D24FAF20]

Hi

Does anyone have a poster that they would share with me that is for the patient to remind healthcare workers to practise hand hygiene?

Regards

Linda

Linda McCaskill
ACHA Infection Control Manager
Ashford Hospital
ph (08) 8375 5209 or ext 4209
(Mon-Thurs)

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[Belinda Straube]

Hi all
Thanks for the interesting article. This article is very timely

In relation to the spray hoses has anyone noticed that these are currently contained in the health facility guidelines for use in the dirty utility rooms as a standard component. My concern is that this is a real splash and infection control risk for staff and possibly patients if items are contaminated

This is a recent issue for us with redevelopment. Has anyone else had any issues with this?

Belinda

Belinda Straube
Infection Prevention and Control Department
St George Hospital
Kogarah
Page 424
[cid:image001.jpg@01CF84C2.167238E0]
St George/Sutherland Hospitals and Health Services
[cid:image002.png@01CF84C2.167238E0]

Hi Ruth,

I imagine the risk of contamination in toilet/anteroom facilities with bidets would be similar to the risks associated with the use of sprayers (also called aerated spray wands) in patient toilet facilities?

In terms of the sprayers/wands these are hoses with a nozzle which are installed at the back of the toilet and used to rinse out bed pans in the toilet bowl in anteroom toilet/shower facilities (single/multi-bed rooms) and in “hoppers” (wall-mounted sinks, with deep basins, large drains, and a spray arm that flush like a toilet) in dirty utility rooms (see attached an embedded images).

While they are not very common in Australian healthcare facilities for patient toilets sprayers/wands seem to be more common in parts of Canada and the US (mentioned in some of Carlings publications) and have contributed in outbreaks of C.difficile in Canada – Preliminary Findings with C.difficile Outbreak in Cape Breton District Health Authority (CBDHA), 21 April 2011, Department of Health and Wellness, Nova Scotia – attached.

A June 2009 Quebec report (Comparative Analysis of Bedpan Processing Equipment) by the Agence d’valuation des technologies et des modes d’intervention en sant (AETMIS now INESSS) recommended that “staff must not empty bedpans into sinks or toilets and must no longer use spray wands”. The report includes options in terms of appropriate reprocessing methods for bed pans and a cost analysis of each option – see link.

http://www.hygiecanada.com/img/media/Comparative%20Analysis%20of%20bedpan%20Processing%20Equipment.pdf

[cid:image001.png@01CF84A9.B8F38420][cid:image002.png@01CF84A9.B8F38420] [cid:image003.jpg@01CF84A9.B8F38420]

With this at risk population (oncology) you would need an assurance that the toilet seat and surrounding area did not become contaminated during use with the bidet water (which will be contaminated with faecal and other contaminants).

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)

PO Box 5202
Middle Park
Victoria, 3206
Australia
H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

Has anyone had to consider the installation of bidets from an IPC perspective. We are planning a brand new surgical wing and our Oncology department want to install for patients with anal fissures and other medical conditions. There are documented health benefits but I wondered about any water or other contamination issues? I notice that the Australian IPC Guidelines include a cleaning regime for bidets so I am assuming that in principle they are acceptable.

Regards
Ruth

[cid:image004.jpg@01CF83B9.11B6E120]

Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
*: ruth.barratt@cdhb.health.nz
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[Belinda Straube]

Hi All

We have moved to single patient use blood pressure cuffs, tourniquets, antimicrobial curtains and stethoscopes as part of a research project and grant in one of our departments for high risk patients. Given that there are so many variables in our project. Hand hygiene, antimicrobial curtains, cleaning, PPE use, aseptic technique, antimicrobial stewardship, competency with invasive device management, patient and staff education. It may be difficult to make an absolute case that single patient use/ single use items alone leads to improvements.

News does spread about these changes and some departments have followed suit with some of these measures after consultation with their managers.

There has definitely been some teething problems with this approach, such as lost items, items not being labelled, leading to wastage, however staff are now more familiar with this practice in this department. There are also issues from time to time of ensuring enough stock is available, however the wards have kept mostly on top of supply. For some patients who stay for a couple of days only, they will keep their patient bag of belongings and bring them back to hospital. Otherwise they receive a new kit when re-admitted.

If at the end of the program we find overall improvements. Would it be considered ethical to go back to prior practices once the grant funding has been exhausted, due to financial constraints ??. Or do we then have an obligation to continue this practice for our patients. Early discussions regarding this issue, suggest that if improvements are identified, costing’s will need to be then absorbed by clinical areas.

A major driver for this process was to have an infection control issue that needed additional actions. A lot of attention and resources had already gone into our issue. Therefore I feel that all parties involved in this process were ready for further changes to occur.

Receiving initial funding has helped to get these changes off the ground faster.
We also had excellent support from medical staff, microbiology, infectious diseases and executive.

I agree with the last comment that there are such variances to practices in regards to cleaning patient care items.
thanks
Belinda

Belinda Straube
Infection Prevention and Control Department
St George Hospital
Kogarah
Phone: 91133862
Page 424
St George/Sutherland Hospitals and Health Services

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Joe-Anne Bendall
Sent: Thursday, 9 January 2014 11:27 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Single Use vs Reusable Pt Equipment

Hi Cath
Great debate to start the New Year
I think each hospital has different risks. For example, here we can allocate MRO pts their own BP machine, tourniquet etc. The equipment is cleaned when the patient is discharged as part of the terminal cleaning process. With the focus on the health $, I am not sure we could sustain the costs associated with the costs for purchase, storage and disposal of single use items.

We are currently developing a local health district policy for the cleaning of shared patient care equipment. This should help with reducing the risks of sharing equipment.

Thanks

Joe-Anne Bendall

(Monday/Thursday/Friday)
Joe-anne Bendall | Clinical Nurse Consultant Infection Prevention and Control Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
|| ph +61 2 9382 7199 |page 22070 via switch 9382 7111| ( Fax
|| 93827510 |(
Mobile 0418984255 | | Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Cath Murphy
Sent: Thursday, 9 January 2014 11:05 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Single Use vs Reusable Pt Equipment

Thanks Irene and Terrie
Whilst I appreciate Terrie’s position coming from his role with a provider of reusable waste equipment my question was more specifically about equipment used on patients for clinical care so things like BP cuffs, ECG leads and tourniquets. The various responses are interesting and please keep them coming as debate and expression are good for us as is an appreciation for the past (and yes I qualify and feel “oldie” as well 🙂 Cheers Cath

Regards
Cath

Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd

Adjunct Professor
Griffith University, School of Nursing and Midwifery
Ph: +61 428 154 154
http://www.infectioncontrolplus.com.au

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Wilkinson, Irene (Health)
Sent: Thursday, 9 January 2014 9:24 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Single Use vs Reusable Pt Equipment

Hi all,
as a fellow “oldie” I agree with Terry’s assessment of the trends over the years. I also support the final point about the issues involved in the decision making process. What has always puzzled me is how to accurately measure the environmental impact of either disposable or re-usable items?

Irene Wilkinson
Manager, Infection Control Service,
Communicable Disease Control Branch
SA Health
11 Hindmarsh Square,
Adelaide SA 5000
Ph: 08 7425 7170
________________________________________
From: ACIPC Infexion Connexion [AICALIST@AICALIST.ORG.AU] On Behalf Of Terry Grimmond [tg@GANDASSOC.COM]
Sent: 08 January 2014 13:03
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Single Use vs Reusable Pt Equipment

Hi Cath,
I had not heard of a movement back to single use items so I will be interested to hear members’ responses on this topic. For oldies like me it has been interesting to see the disposable/reusable “cycle” over the decades.

* in the 60’s we reused needles, glass syringes, gowns, etc, to reduce procurement costs;

* in the 70’s the cost of labour to process reusables (and modern technology enabling economic production of disposables) moved us to disposables;

* In the 80’s and 90’s waste disposal costs together with environmental impact of disposables, caused many to move to reusables again;

* Now with staff shortages, in-house processing of reusables is being re-examined (NB. processing by external contractors can still be economical, e.g. reprocessing single-use medical devices saves USA hospitals $300m annually.
As you point out, there have been relatively few evidence-based articles implicating disease transmission with either protocol.
The decision to use disposables or reusables must be evidence-based encompassing patient and staff safety, labour costs, procurement costs, and environmental impact. I look forward to members’ comments

Best regards, Terry

Terry Grimmond FASM, BAgrSc, GrDpAdEd
Consultant Microbiologist
Grimmond and Associates
Ph/Fx (NZ): +64 7 856 4042
Mob (NZ): +64 274 365 140
E: tg@gandassoc.com
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Cath Murphy
Sent: Wednesday, January 08, 2014 12:53 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Single Use vs Reusable Pt Equipment

Happy new year all

As you may know there’s a subtle movement in Australia towards more widespread adoption of single-use items such as venepuncture tourniquets, lower limb surgical tourniquets, BP cuffs and ECG leads. Tom Gottlieb recently did some elegant research on venepuncture tourniquets and AT ACIPC 2013 Karen Vickery presented new perspectives on biofilm on reusable equipment. Single-use items have been adopted widely in the US for some years and recommendations to that effect are included in many Standards published by relevant professional associations eg AORN.

Whilst appreciating that demonstrating causality between reusable equipment and transmission of colonising organisms or infection is difficult either is biologically plausible. There are also issues of non-cleaning, lack of clarity about who’s role it actually is to clean reusable equipment, how frequently they need to be cleaned or reprocessed etc. These issues have plagued us for at least 3 decades that I know of and likely longer. I’m wondering what others in Australia and beyond think about single-use pt care items

So my questions are:

1. Has any ACIPC colleague successfully built a business case to convert their facility to single-use pt equipment? If so who was involved in that process?;

2. Which pieces of pt equipment do folks think are most in need of single-use alternative options?;

3. Other than price, storage, supply and environmental/waste issues and lack of detailed science what other factors would need to be addressed to help convince you or your organisation’s decision makers to invest in specific single-use equipment?.

I’d be grateful for any discussion here or as PMs on the email address below. If anyone is interested in my further work around this issue please email me.

Regards
Cath

Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
Cath@infectioncontrolplus.com.au

Adjunct Professor
Griffith University, School of Nursing and Midwifery
Ph: +61 428 154 154 http://www.infectioncontrolplus.com.au

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