[Beth Bint]

Hi Cate

As a matter of principle we have refused the installation of hoses in dirty utility rooms in all our new developments, and have removed hoses from existing dirty utilities. The rationale for this is the high risk of environmental contamination and health care worker exposure. We have addressed the problem of bedpans not being effectively cleaned by pan sanitisers by prospectively installing pan washer/disinfectors that have a detergent cycle. We have also had a planned program of replacement of old pan sanitisers with new.

Where we identify issues with pan cleanliness we engaged the supplier/manufacturer to review the situation and ensure the equipment is functioning appropriately and delivering clean and disinfected pans as per equipment purpose.

We have had to remind staff that pans should not be left on top of the washer/disinfected as this “cooks” the faeces onto the pan and makes it difficult to clean.

We undertake regular dirty utility room and pan audits and have identified that pans are being cleaned by the washer disinfectors in the absence of hoses in the room.

I hope this helps.

Beth

Beth Bint

Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House, Wollongong Hospital 2500, NSW
Tel. 02 4222 5838 |Mob. 0475 943 952 Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au

[cid:image001.jpg@01D18378.1BB66EF0]

Hi everyone
I’ve had a request to install a hose in the sluice room of new ICU to clean bedpans etc. I have issues with this as the potential for aerosolising and splashing MRO’s would increase

Any thoughts you could share?
[cid:image001.png@01D18357.A5F5D540]
Cate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
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e … cate.coffey@nt.gov.au http://www.nt.gov.au/health

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[Beth Bint]

Hi Andrea

At the risk keeping this debate going, I must express my offense at your statement to “examine their own prejudice”. This is presumptuous to say the least.

There hasn’t been any remark by Dr Murphy or my other ACIPC colleagues regarding the rights or wrongs of detention, or any other comment regarding the humanitarian crisis. All that has been stated is this should not be role of professional infection control college to be putting forth political statements on our behalf.

Regards

Beth

Beth Bint

Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House, Wollongong Hospital 2500, NSW
Tel. 02 4222 5838 |Mob. 0475 943 952 Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au

[cid:image001.jpg@01D16FAE.C51B7A40]

Also without Prejudice.

Dear members,

It is a pity Cathryn Murphy believes humanity works on a dichotomy.
That is, humanitarian issues such as are occurring on our watch as nurses and leaders only deserve comment when an infection is involved.

The issue of Children in detention in Australia or in centres managed and paid for by Australian dollars must never be relegated to politics alone. Matters of this kind go beyond the issue of politics and define us by diminishing our humanity when we are silent.

Thankfully, Professor Shaban has spoken out where perhaps others may have not. I support his comments and am grateful we, as an college , are finally making certain views known.
Is it possible those who are complaining about the recent ACIPC media release are being motivated to examine their own prejudice?

In the words of Martin Luther King

“Injustice for one is injustice for all.”

Kind regards
Andrea Menzies (an ordinary RN , no Ph D )

Regards
Andrea Menzies
RN | Infection Prevention and Control | Health Directorate
Building 10, Level 4 | The Canberra Hospital | Garran ACT 2605

The very first requirement in a hospital is that it should do the sick no harm.
Florence Nightingale

Care | Excellence | Collaboration | Integrity
[cid:image001.jpg@01D16FAA.8F9316C0]

Without Prejudice

Dear Members

I was saddened to read the recent Press Release regarding the College’s position on Children In Detention. In my 25 plus years as a member and once President of AICA and as a 7 year board member and 2010 APIC President alignment of a professional body with any non-infection prevention political issue appears unprecedented.

Regardless of where members stand personally on this contentious issue it is arrogant and perhaps even incorrect for the President to assume unilateral support of his position by all members.

Further, whilst the AMA acts as the primary industrial relations agency for medical practitioners and as such rightly has an opinion on this issue the College purpose as stated in its Constitution makes no mention of political commentary as a goal.

Informally, I have canvassed views from at least two other senior College members who are offended by the College’s action. I would request that in future the Executive and College leadership do not assume members’ positions on non infection prevention matters and instead focus solely on working within the scope of the Constitution representing members well on infection prevention matters.

Regards
Cathryn Murphy
Executive Director
Infection Control Plus Pty Ltd

Cathryn Murphy RN PhD
Executive Director
PO Box 106
West Burleigh QLD 4219
Queensland, AUSTRALIA

+61 428 154154
E: Cath@infectioncontrolplus.com.au

——– Original message ——–

[Posted on behalf of ACIPC President – Moderator]

Colleagues
Please note the attached media release from the College.

Kind regards,
Ramon

[cid:image002.jpg@01CDB058.34EB2A10]

Professor Ramon Z Shaban
PRESIDENT

Australasian College for Infection Prevention and Control

GPO Box 3254, Brisbane Qld 4001

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[Beth Bint]

Hi

Thank you to all those who took the time to provide your considered advice in such a timely manner. I really appreciated your assistance.

The information provided will be used to help inform advice that we will be providing our commissioning team.

Regards
Beth

Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House Wollongong Hospital
Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________________

Hi Beth

Chris O’Brien Lifehouse SSD outsourced cleaning and testing to an independent provider prior to opening.

We will be doing this yearly and prior to opening our operating theatres early next year.

Regards

Roel

Roel Castillo
Sterilising Services Manager
[http://26ce8fadfb6948b4a758-9559b8fa969cb9cd67545a880c32734b.r23.cf2.rackcdn.com/Lifehouse2.png]
119-143 Missenden Road
Camperdown NSW 2050
PO BOX M33 Missenden Road NSW 2050

[http://www.mylifehouse.org.au/uploadedImages/Images/facebook.png] [http://www.mylifehouse.org.au/uploadedImages/Images/linkedin.png] [http://www.mylifehouse.org.au/uploadedImages/Images/twitter.png]

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*hWK4nY*

—–Original Message—–

Beth

We have recently opened a brand new SSD in Victoria and apart from the required validation of the sterilisers, the only area that we did do air sampling was in our sterile store room where we had Hepa Filtration. In our clean/packing room no microbiological sampling was undertaken as these areas do not have Hepa Filtration.

Happy for you to discuss off-line if you have further questions.

Leanne Houston

Associate Director
INFECTION PREVENTION & CONTROL SERVICE (IPAC)

Eastern Health: Winner of the Premier’s Health Service of the Year Award (Metropolitan) at the 2013 Victorian Public Healthcare Awards

—–Original Message—–

Good Evening

I am someone within the AICALIST brains trust can provide some advice regarding the necessity for microbial sampling of newly constructed SSD. I have not been able to find any reference to this being recommended prior to opening.

Does anyone know of any guidelines that apply to NSW?

Or, national or international references that may indicate that this would be recommended from a best practice point of view.

I would be grateful for any advice within the next few days, if possible.

Thank you
Beth

Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service Level 1 Lawson House Wollongong Hospital Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
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[Beth Bint]

Hi Matthias

We recommend Alcohol and Chlohexidine swabs for the insertion of peripheral IV cannula’s. The stock used for IV insertion is stored in the same zones/trolleys etc as those used for venepuncture etc and as such it is easy for staff to select the incorrect skin prep swab.

To manage Central lines etc we use larger swabs or swab sticks impregnated with chlorhexidine and alcohol.

I hope this answers your question.

Regards

Beth

Beth Bint

Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House, Wollongong Hospital 2500, NSW
Tel. 02 4222 5869 | Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au

—–Original Message—–

Hi Beth,

It seems entirely reasonable to have one unnecessary component there and use a particular preparation across the unit for the sake of standardising and rationalising the procedures.

Sorry, asking out of curiousity. While for vial tops (etc.) the small pre-packaged alcohol swabs (e.g. those used for venipuncture and blood-taking) would be sufficient in size and alcohol amount, and quite cheap (the last time I looked one cost about a cent), one would need different sizes/preparations for, e.g. inserting a central line, simply due to the greater area needing antisepsis, and the more thorough application required.

How do you manage this?

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

—–Original Message—–

Hi Kath

While acknowledging that the addition of Chlorhexidine to alcohol adds no additional benefit for the purpose of vial disinfection, having access to both combination Chlorhexidine and alcohol impregnated swabs and plain alcohol swabs increases the risk of inappropriate skin antisepsis. It is for this reason that we have removed plain alcohol based swabs completed and only stock Chlorhexidine and alcohol swabs. This does have a cost implication but on balance for considered to be insignificant compared to the risk associated with line-associated sepsis.

Regards
Beth

Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service Level 1 Lawson House Wollongong Hospital Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________________

Dear Chris,

Dr Matthias Maiwald posted a very comprehensive response in relation to a very similar query on the list Thursday last week which you may wish to access from the archives. I have pasted a paragraph from Dr Maiwald’s post for your information:

But please bear in mind that the addition of chlorhexidine to the alcohol for swabbing the vial tops is absolutely unnecessary. The chlorhexidine adds next to nothing for the purpose of disinfecting vial tops, and pure alcohol (e.g. 70% isopropanol such in sterile prepackaged alcohol pads) is all that is needed. What the chlorhexine would add would be persistency, which is an advantage for skin antisepsis for longer procedures, but you don’t need persistent antiseptic action on vial tops.

Chlorhexidine gluconate kills a range of Gram positive and Gram negative bacteria, viruses and fungi, and binds to the top layer of the skin, which results in persistent activity. Persistence of the antimicrobial effect suppresses the regrowth of residual skin flora, as well as suppressing transient micro-organisms contacting the prepped site. Alcohol has a rapid effect but no residual effect. If you would like further information regarding appropriate uses for chlorhexidine gluconate, please refer to the CHRISP website.

The TGA recommends wiping the outer surface of the rubber stopper and injection site with a suitable disinfectant wipe/swab and allowing it to dry before inserting any device into it. Queensland Health recommend the suitable disinfectant for this purpose is a 70% alcohol impregnated swab.

Please find a copy of the related poster attached to this reply.

Kind regards,
Kath

CHRISP, Communicable Diseases Unit | Chief Health Officer Branch Health Service and Clinical Innovation Division | Department of Health | Queensland Government Level 1, 15 Butterfield St, Herston, QLD 4006 PO Box 2368, Fortitude Valley, QLD 4006 t. 07 33289755 e. chrisp@health.qld.gov.au | http://www.health.qld.gov.au
[cid:image001.png@01CFC2AF.19BA7870] [cid:image002.png@01CFC2AF.19BA7870] [cid:image003.png@01CFC2AF.19BA7870]
[cid:image004.png@01CFC2AF.19BA7870]

——– Original Message ——–
CC:

[Posted on behalf of Chris Lawson – Moderator] Hi,

Following the release of the below we have had some suggestion that only alcohol swabs should be available for use. that we should remove chlorhexidine swabs altogether from practice. Can I have some feedback fro the group please.

Regards
Chris Lawson
Caboolture Private Hospital

Sent from my iPad

Begin forwarded message:

Dear All
On 7 July 2014 the Therapeutic Goods Administration (TGA) updated their website to include details of the ongoing investigation into the potential contamination with Ralstonia species of some vials of propofol 1% emulsions for injection. This website update included the advice that the exterior surfaces of injection vials are not intended to be sterile and that health professionals are reminded that proper aseptic technique must be strictly followed when administering intravenous injections to a patient. This includes wiping the outer surface of the rubber stopper and injection site with a suitable disinfectant wipe/swab and allowing it to dry before inserting any device into it. http://www.tga.gov.au/safety/alerts-medicine-provive-mct-lct-140707.htm
CHRISP have developed the attached poster to assist facilities to educate clinicians that the rubber stopper of vials under the plastic flip lid is not intended to be sterile and should be wiped with a 70% alcohol impregnated swab and allowed to dry prior to accessing. This will also be published on the CHRISP website in the near future: http://www.health.qld.gov.au/chrisp/default.asp
Please disseminate to other areas of your facility as appropriate.
Kind regards, Mareeka Gray
CHRISP
(Centre for Healthcare Related Infection Surveillance and Prevention) Communicable Diseases Unit | Chief Health Officer Branch Health Service and Clinical Innovation Division | Department of Health | Queensland Government Level 3, 15 Butterfield St, Herston QLD 4006 PO Box 2368, Fortitude Valley, QLD, 4006 t. 07 33289755 e. CHRISP_TB@health.qld.gov.au | http://www.health.qld.gov.au

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[Beth Bint]

Hi Kath

While acknowledging that the addition of Chlorhexidine to alcohol adds no additional benefit for the purpose of vial disinfection, having access to both combination Chlorhexidine and alcohol impregnated swabs and plain alcohol swabs increases the risk of inappropriate skin antisepsis. It is for this reason that we have removed plain alcohol based swabs completed and only stock Chlorhexidine and alcohol swabs. This does have a cost implication but on balance for considered to be insignificant compared to the risk associated with line-associated sepsis.

Regards
Beth

Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House Wollongong Hospital
Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________________

Dear Chris,

Dr Matthias Maiwald posted a very comprehensive response in relation to a very similar query on the list Thursday last week which you may wish to access from the archives. I have pasted a paragraph from Dr Maiwalds post for your information:

But please bear in mind that the addition of chlorhexidine to the alcohol for swabbing the vial tops is absolutely unnecessary. The chlorhexidine adds next to nothing for the purpose of disinfecting vial tops, and pure alcohol (e.g. 70% isopropanol such in sterile prepackaged alcohol pads) is all that is needed. What the chlorhexine would add would be persistency, which is an advantage for skin antisepsis for longer procedures, but you don’t need persistent antiseptic action on vial tops.

Chlorhexidine gluconate kills a range of Gram positive and Gram negative bacteria, viruses and fungi, and binds to the top layer of the skin, which results in persistent activity. Persistence of the antimicrobial effect suppresses the regrowth of residual skin flora, as well as suppressing transient micro-organisms contacting the prepped site. Alcohol has a rapid effect but no residual effect. If you would like further information regarding appropriate uses for chlorhexidine gluconate, please refer to the CHRISP website.

The TGA recommends wiping the outer surface of the rubber stopper and injection site with a suitable disinfectant wipe/swab and allowing it to dry before inserting any device into it. Queensland Health recommend the suitable disinfectant for this purpose is a 70% alcohol impregnated swab.

Please find a copy of the related poster attached to this reply.

Kind regards,
Kath

CHRISP, Communicable Diseases Unit | Chief Health Officer Branch
Health Service and Clinical Innovation Division | Department of Health | Queensland Government
Level 1, 15 Butterfield St, Herston, QLD 4006
PO Box 2368, Fortitude Valley, QLD 4006
t. 07 33289755
e. chrisp@health.qld.gov.au | http://www.health.qld.gov.au
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[cid:image004.png@01CFC2AF.19BA7870]

——– Original Message ——–
CC:

[Posted on behalf of Chris Lawson – Moderator]
Hi,

Following the release of the below we have had some suggestion that only alcohol swabs should be available for use. that we should remove chlorhexidine swabs altogether from practice. Can I have some feedback fro the group please.

Regards
Chris Lawson
Caboolture Private Hospital

Sent from my iPad

Begin forwarded message:

Dear All
On 7 July 2014 the Therapeutic Goods Administration (TGA) updated their website to include details of the ongoing investigation into the potential contamination with Ralstonia species of some vials of propofol 1% emulsions for injection. This website update included the advice that the exterior surfaces of injection vials are not intended to be sterile and that health professionals are reminded that proper aseptic technique must be strictly followed when administering intravenous injections to a patient. This includes wiping the outer surface of the rubber stopper and injection site with a suitable disinfectant wipe/swab and allowing it to dry before inserting any device into it. http://www.tga.gov.au/safety/alerts-medicine-provive-mct-lct-140707.htm
CHRISP have developed the attached poster to assist facilities to educate clinicians that the rubber stopper of vials under the plastic flip lid is not intended to be sterile and should be wiped with a 70% alcohol impregnated swab and allowed to dry prior to accessing. This will also be published on the CHRISP website in the near future: http://www.health.qld.gov.au/chrisp/default.asp
Please disseminate to other areas of your facility as appropriate.
Kind regards, Mareeka Gray
CHRISP
(Centre for Healthcare Related Infection Surveillance and Prevention)
Communicable Diseases Unit | Chief Health Officer Branch
Health Service and Clinical Innovation Division | Department of Health | Queensland Government
Level 3, 15 Butterfield St, Herston QLD 4006
PO Box 2368, Fortitude Valley, QLD, 4006
t. 07 33289755
e. CHRISP_TB@health.qld.gov.au | http://www.health.qld.gov.au

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[Beth Bint]

Sorry for the late arrival to the discussion but I have only two thoughts I would like to share.

Let’s not focus on whether to shake hands or not, rather lets just remain consistent with the message “clean your hands before and after” (if caught on the hop – both clean hands after!

Lets not become so paranoid about infection risk that we forget that we are human and touch is a natural human response and it is healing. It is this fear that is driving HCWs to be obsessed with glove use just to touch a patient.

Here ends my soapbox rant …. apologies to all.

Beth
Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House Wollongong Hospital
Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________________
From: ACIPC Infexion Connexion [AICALIST@AICALIST.ORG.AU] On Behalf Of Cath Murphy [cath@INFECTIONCONTROLPLUS.COM.AU]
Sent: Friday, 1 August 2014 8:53 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: AJIC Handshake vs Bump & Bright Lights

Rather than Infection Control Todays non-peer reviewed report on this study here is the reference, abstract and link to the brief report published today in AJIC. The forum responses here have been interesting my take is we have to keep open minds and be more innovative as we are a long long long way from solving problems, reducing, controlling and all the other words that are part of our everyday lexicon.

1. Mela S, Whitworth DE. The fist bump: A more hygienic alternative to the handshake. American Journal of Infection Control;42:916-7.

The handshake is a commonplace greeting in many cultures, but it has the potential to transmit infectious organisms directly between individuals. We developed an experimental model to assay transfer of bacteria during greeting exchange, and show that transfer is dramatically reduced when engaging in alternative so-called dap greetings known as the high five and fist bump compared with a traditional handshake. Adoption of the fist bump as a greeting could substantially reduce the transmission of infectious disease between individuals.

http://www.ajicjournal.org/article/S0196-6553(14)00659-2/abstract

For a truly innovative approach also check out the article below in AJIC released today on use of flashing red flights and how they doubled HH compliance (baseline rates were very low though). Hyperlink embedded so you should be able to click on it.

A study of the efficacy of flashing lights to increase the salience of alcohol-gel dispensers for improving hand hygiene compliance

Background
Many interventions have been implemented to improve hand hygiene compliance, each with varying effects and monetary costs. Although some previous studies have addressed the issue of conspicuousness, we found only 1 study that considered improving hand hygiene by using flashing lights.
Method
Our attention theorybased hypothesis tested whether a simple red light flashing at 2-3 Hz affixed to the alcohol gel dispensers, within the main hospital entrance, would increase hand hygiene compliance over the baseline rate. Baseline and intervention observations were completed over five 60-minute periods (Monday-Friday) from 7:30 to 8:30 AM using a covert observation method.
Results
Baseline hand hygiene compliance was 12.4%. Our intervention increased compliance to 23.5% during cold weather and 27.1% during warm weather. Overall, our pooled compliance rate increased to 25.3% (P < .0001).
Conclusions
A simple, inexpensive flashing red light affixed to alcohol gel dispensers was sufficiently salient to approximately double overall hand hygiene compliance within the main hospital entrance. We hypothesize that our intervention drew attention to the dispensers, which then reminded employees and visitors alike to wash their hands. Compliance was worse during cold days, presumably related to more individuals wearing gloves

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
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Wednesday, 30 July 2014 10:09 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Handshake vs ‘fist bump’

I have to comment that I originally posted this study in wonderment: have we all completely now given up on teaching HCWs to practise hand hygiene before touching patients? Have we lost already? And this will be the result?

Cheers
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@svha.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email

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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Matthew Mason
Sent: Wednesday, 30 July 2014 9:37 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Handshake vs ‘fist bump’

Maybe we should go with the chest bump and keeps hands out of it all together. With a bit of singing along the way we can turn our facilities into an episode of Scrubs! Anyone want to do a research project on it?

Cheers Matt

Matt Mason RN, CICP, BNSci, M Rural Health, M Advanced Practice (IC)
Lecturer School of Nursing & Midwifery
Faculty of Science, Health, Education and Engineering University of the Sunshine Coast
Ph: +61 7 5456 5191 | Fax: +61 7 5456 5940 | Email:mmason1@usc.edu.au | Web:www.usc.edu.au
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________________________________
From: ACIPC Infexion Connexion <AICALIST@AICALIST.ORG.AU> on behalf of Terry Grimmond <terry@TERRYGRIMMOND.COM>
Sent: 30 July 2014 08:45
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Handshake vs ‘fist bump’

Hi Michael,
I can see consultants fist-bumping if they wear their trousers low! Seriously, the research was well conducted and well-written and actually got space in our NZ newspaper Ive never had press like that with any of my papers!

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: terry@terrygrimmond.com
[cid:image001.png@01CFABE3.55EAF0A0]: @terrygrimmond
W: http://terrygrimmond.com
[cid:image002.gif@01CFABE3.55EAF0A0]
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Wednesday, July 30, 2014 10:17 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Handshake vs ‘fist bump’

We saw a call before to ban handshaking in healthcare as a way to reduce transmission of organisms. Now a study suggest fist bumping is the best greeting to replace a hand shake. Can we all see our consultants fist pumping their patients each morning?

http://www.infectioncontroltoday.com/news/2014/07/fist-bumping-beats-germspreading-handshake-study-reports.aspx

Cheers
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
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[Beth Bint]

Hi All

We have install disposable curtains throughout the facility. We use the manufacturers recommendation for hang-time which in our instance is 12months. The exceptions to this include post accommodation of patients with Clostridium difficile or confirmed or suspected infectious gastroenteritis eg: norovirus.

We do not routinely change curtains for any of our MROs.

Curtains must be changed if they become soiled or damaged. (cautionary tale: staff may not immediately recognised that soiled curtains must be changed regardless of the time of soiling and should be immediately not wait until discharge).

Curtains must be dated so that they can be monitored and audited for compliance.

They do continue to look clean crisp – visually the wards have never looked better. They can become a little worn (“fluffy”) on the leading edges over time. The manufacture recommends trimming and supplies additional labels to replace the ones that would be lost during this process.

We have developed a policy and audit tool to support this process.

I hope this is of some help.

Cheers
Beth
Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House Wollongong Hospital
Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________________

Good Morning Cath,

I’m glad you are asking about this. I was thinking of posting something this morning on the list.

I would like to ask anyone out there – do you know of any disposable curtains that can be used in ICU and disposed after the patient is discharged?

Im not necessarily looking for antimicrobial action of the curtain, just disposable and economical.

Would you be able to email me as per below

Thanks in advance

Lou

Kind Regards
Louisa Sasko

Clinical Nurse Consultant (Manager) | IPACS – Infection Prevention & Control Service

Conjoint Associate Lecturer | School of Medicine | UWS

Blacktown Mt Druitt Health
Tel (02) 9851 6102 | Fax (02) 9881 7408 | Mob 0408 923 789 |
Admin Officer | Kristy Cuthbert | Tel (02) 9881 8994 |
Louisa.Sasko@health.nsw.gov.au
http://www.health.nsw.gov.au/

[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Western-Sydney-LHD.jpg]

________________________________

Hi All,
We are about to consider trialling disposable curtains / bed screens. There are plenty available on the market, all claiming to do marvellous things e.g. waterproof can be wiped clean, antimicrobial impregnated which can last up to 18 months.
The CEC Environmental Cleaning Standards Module 3.2 / 2.3.10 Curtains & Blinds recommendations for frequency of curtain changes are quite challenging to adhere to e.g. weekly in Very high risk area such as ICU & OT.
If the claims the manufacturers are making are true, then these curtains certainly offer a many potential benefits e.g. cost saving, labour saving & possibly improve bed management as terminal cleaning of a patient room / bed space may be reduced.

Obviously these types of curtains would be used and managed according to a risk assessment.
However, I would be very interested in any feedback about any experiences with disposable curtains.
For example;
How strong / durable / easy to use have you found them?
Do the curtains maintain their sharp crisp aesthetic look?
Are the curtains replaced on discharge of every infectious patient?

Any other comments / feedback would be appreciated

Many Thanks
Cath Wade

Clinical Nurse Consultant | Infection Prevention and Control
Level 2 Pathology Building, Gosford Hospital
Tel (02) 4320 2664 | Fax (02) 4320 2874 | Pager 18885
Catherine.Wade@health.nsw.gov.au

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[Beth Bint]

Hi All

On the topic of Tinted Red Chlorhexidine 2% + alcohol surgical skin prep. The product that we currently have access to within our facility is not registered with the TGA for skin antisepsis. The company has offered to look into changing the labelling of the product to remove the reference to hard surface disinfectant and replace it with for presurgical skin preparation. My concern is that this doesn’t address the TGA registration matter.

Have any other facilities identified this issue? If so, how has this been managed? Is there more than one product on the market, and are alternate products TGA registered.

As a Local Health District we have decided to use and Alcohol and Iodine preparation for all presurgery skin preparation until this matter can be resolved. However, we do not have an alternate alcohol-based product that is suitable for use on patients with Iodine allergies.

Any advice or discussion regarding this matter is gratefully received.

Thank you
Beth
Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House Wollongong Hospital
Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________________

Hello Everyone,
We are currently experiencing some difficulties with disposing of consumables with this particular skin prep on them. Therefore, I am interested to know how facilities dispose of items/consumables that have the tinted red chlorhexidine surgical skin prep on them (mainly from operating theatre complexes). In particular which waste stream (ie general or clinical waste) do you put these items in?

If you would like to contact me directly, please use my email or phone numbers listed address below.

Regards,
Barbara

Barbara May
CNC Infection Prevention and Control | Hasting Macleay Clinical Network
Port Macquarie Base Hospital, Wrights Rd, Port Macquarie NSW 2444
Tel 02 5524 2061| Fax 02 5524 2061| Mob 0402890677
Barbara.May@ncahs.health.nsw.gov.au

Clean hands saves lives are your hands clean?

[cid:image001.png@01CFA046.260A5540]

________________________________

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[Beth Bint]

Apologies for the numbing window typo.

Beth

Beth Bint

Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House, Wollongong Hospital 2500, NSW
Tel. 02 4222 5869 | Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au

[cid:image001.jpg@01CF80B2.D5F019D0]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Beth Bint
Sent: Thursday, 5 June 2014 10:29 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: isolation room window furnishings

Hi Jane

There is always a lot of discussion around the use of integral venetian blinds where the use is for patient observation and privacy.

Pros:
Anaesthetically pleasing and very tidy
Ease of cleaning

Cons:
The mechanism to close and open venetian can be easily overwound and broken
The winding mechanism can be cumbersome and therefore very hard to ensure patient privacy in an emergency

The above can be overcome by installation of magnetic slide blind adjusters. These cannot be overwound and are activated with the swipe of your hand.

The other component that needs to be consider is the mechanism to repair the blind. It must be able to be opened from the inside with the outside glazing panel remaining intact. This may be industry standard now, but still worth confirming. We have old integral blind windows that can only be repaired by external access quite problematic for multistorey buildings.

I hope this is of assistance

Beth

Beth Bint

Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House, Wollongong Hospital 2500, NSW
Tel. 02 4222 5869 | Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au

[cid:image001.jpg@01CF80A9.08A7D980]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Jane Bryant
Sent: Wednesday, 4 June 2014 4:09 PM
To: AICALIST@AICALIST.ORG.AU
Subject: isolation room window furnishings

Hello,

This is my first post, so hopefully I am following correct protocol. I was hoping to get an idea on what type of window furnishings are being used in isolation rooms. My hospital is undergoing redevelopment and there is a query relating to interstitial venetian vs. roll up blinds in an isolation room. Any advice would be welcomed.

Regards,

Jane Bryant, RN
Infection Control Co-ordinator
Royal Victorian Eye & Ear Hospital
32 Gisborne Street, East Melbourne, 3002, VIC
Tel: +613 9929 8523 | Pager: 366 | Fax: +613 9663 7203
[cid:image001.png@01CF800F.5AB10890]

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[Beth Bint]

Hi Jane

There is always a lot of discussion around the use of integral venetian blinds where the use is for patient observation and privacy.

Pros:
Anaesthetically pleasing and very tidy
Ease of cleaning

Cons:
The mechanism to close and open venetian can be easily “overwound” and broken
The winding mechanism can be cumbersome and therefore very hard to ensure patient privacy in an emergency

The above can be overcome by installation of magnetic slide blind adjusters. These cannot be overwound and are activated with the swipe of your hand.

The other component that needs to be consider is the mechanism to repair the blind. It must be able to be opened from the inside with the outside glazing panel remaining intact. This may be industry standard now, but still worth confirming. We have old integral blind windows that can only be repaired by external access – quite problematic for multistorey buildings.

I hope this is of assistance

Beth

Beth Bint

Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House, Wollongong Hospital 2500, NSW
Tel. 02 4222 5869 | Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au

[cid:image001.jpg@01CF80A9.08A7D980]

Hello,

This is my first post, so hopefully I am following correct protocol. I was hoping to get an idea on what type of window furnishings are being used in isolation rooms. My hospital is undergoing redevelopment and there is a query relating to interstitial venetian vs. roll up blinds in an isolation room. Any advice would be welcomed.

Regards,

Jane Bryant, RN
Infection Control Co-ordinator
Royal Victorian Eye & Ear Hospital
32 Gisborne Street, East Melbourne, 3002, VIC
[cid:image001.png@01CF800F.5AB10890]

______________________________________________________________________
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It is recommended as a prudent business practice the recipient perform a virus scan of any message received.
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[Beth Bint]

Good morning John

The Australian Health Facilities Guidelines illustrates very clearly operational flows and air pressure controls required for operating units – refer Part B Health Facility Briefing and Planning: 520 Operating Theatres p 41 to p 44.

Scrub bays must have negative air pressure in relation to the operating theatre which would not be possible if the scrub bays are incorporated in to the theatre room.

Regards

Beth

Beth Bint

Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House, Wollongong Hospital 2500, NSW
Tel. 02 4222 5869 | Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au

[cid:image001.jpg@01CF41BC.04870B90]

Dear Brains trust

A colleague (a healthcare architect) has been planning the perioperative suite and the surgeons have insisted on placing the scrub bay on the theatre side of the exit bay. See extract from the scheme design drawing below (attached). They seem to believe that the air pressurisation in the theatre will keep water spray/bugs etc out of the main area of the OR. Also they don’t want to have to gown then go back out scrub and then return to the theatre through the doors to glove and operate.

Placing scrub bays inside ORs is not a practice that I have seen anywhere else in the world – has anyone experience with this please?

My view is that this is not a practice to support but I’d be interested in other views and evidence please!

Kind regards
John

Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health
Infectious Diseases Physician, Division of Medicine, John Hunter Hospital
Clinical Microbiologist, Hunter Area Pathology, Pathology North
Conjoint Associate Professor, University of Newcastle, Adjunct Professor, University of New England
Locked Bag 1, Newcastle Mail Centre, NSW 2310
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

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[Beth Bint]

Hi all

Apologies for my late arrival to the discussion and if this point has already been discussed.

To comply with An aseptic approach we need to have access to a sterile cannula brush or similar, this item doesn’t appear to be readily available in Australia. I have made a number of enquiries with ICU’s in NSW and they have all indicated unique local solutions which perhaps could benefit from the availability of a standardised trache care kit. These kits are available from a number of manufactures in the US but they are distributed within Australia.

In short, I would be interested in any equipment solutions for cleaning trache internal cannulae that comply ith ANNT, AS4187 and are TGA approved.

Thanks
Beth
Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House Wollongong Hospital
Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________________

Dear Julie,
Thank you as always for your invaluable comments and advice. I had not had a chance to read Kayes response closely, but now have. Here at HKH, we have always done changing of inner cannulas of tracheostomies using aseptic technique and like you, I believe it is essential. Yes, the inner cannulas might be going into devices which are already heavily colonised, which is all the more reason not to increase that microbial load further and with possibly newer pathogens.
Again use of terminology such as sterile field will have to be replaced by terminology such as Critical Aseptic field and the like as according to ANTT, a sterile (definition: free from all living microorganisms) field cannot be typically achieved or maintained in healthcare settings.
So yes, a lot of food for thought.
Rita

Hi Rita,

I agree that inner cannulas are being inserted into devices that are already in place which may be heavily colonised. However, the reason for a sterile filed is to prevent the cannula itself from contamination with organisms from other parts of the patient and also from the environment.

I also agree that there is a difference between a device that goes into blood (critical device) and one which goes into the larynx (semi critical device), they are both types of invasive devices as per the TGA definition and I believe that aseptic technique applies to performing procedures related to both.

Cost effectiveness or a reusable cannula is something each HCF would have to determine and is not an argument for not using aseptic technique.

Regardless of the evidence for ANTT, to comply with Standard 3 of the National Safety and Quality Health Service Standards, HCFs have to meet requirements related both to aseptic technique and invasive devices when performing procedures such as these.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Dear Michael,
I think this discussion is important to circulate.
Many thanks,
Rita
Rita Roy

Clinical Nurse Consultant | Infection Control
Hornsby Ku ring gai Health Service, Palmerston Road, Hornsby NSW 2077
Tel (02) 9477 9232 | Fax (02) 9477 9013 | Mob 0422 930 370 | Rita.Roy@health.nsw.gov.au
http://www.health.nsw.gov.au

[cid:image002.jpg@01CF32C6.CFF81850]

Thanks Rita
The feedback is great. I would be grateful if you could send my feedback through to the group

Thanks to the group for looking at how we can improve this practice

At present the Trache guideline is under implementation and we wont be changing recommendations for at least a year.

o This doesnt mean however that at a local level the ICPs couldnt partner with the trache leads to change this practice to reflect ANTT.

o The trach guideline was reviewed by 6 NSW ICPs as well as going through the usual organisational consultation processes

o The guideline can be found at http://intensivecare.hsnet.nsw.gov.au/icwiki/index.php/Tracheostomy

I disagree the procedure needs to be aseptic but I do acknowledge the issues with terminology

o Inner cannulas are being inserted into devices that are already in place which will be heavily colonised.

o There is a difference between a device that goes into blood and one which goes into the larynx.

o The evidence base that I have seen for the effectiveness of ANTT in reducing infections is very limited.

A sterile dressing pack may be appropriate as a sterile field

o IF you are using a disposable inner cannulae &/or

o Doing the dressing as part of the procedure (which would be entirely appropriate where you had a patient with a large amount of sputum and were need to do the dressing frequently OR a least for one change)

o The gully pots are not large enough for cleaning inner cannulas although a sterile kidney dish would be useful.

o Disposable inner cannulas are not going to be cost effective if you are having the change them frequently.

However this would not be cost effective if you were using reusable inner cannulas. This procedure is quite quick when changing the inner cannulae. And the dirty inner cannulae cleaning can be moved away from the patients immediate bedside.

There were such things as trach packs (back in the day) perhaps these could be investigated.

I would appreciate if the ICPs could provide the evidence & rationale for changing from a clean technique to an aseptic technique.

o I dont wish to be confrontational Im always happy to review new evidence and incorporate it into practice. It is easier to change the minds of ICU clinicians with evidence.

It is important to realise this change in practice will be significant. At present the vast majority of hospitals undertake this procedure using a clean technique and many others continue to use the handbasin tap (yuck)

The ICPs are going to need to partner with the trache leads to change this practice. I would suggest opening a dialogue with your local trach teams

I do appreciate the input of the ICP community and look forward to improving this practise

(Ill leave my opinions regarding the copyrighting of a commonly used clinical term to a later date)

Kaye Rolls
Clinical Project Officer – ICCMU | Agency for Clinical Innovation
Level 4, Sage Building, 67 Albert Avenue, Chatswood NSW 2067
Postal Address: PO Box 699 Chatswood NSW 2057
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[cid:image001.jpg@01CF32C0.6183A200][cid:image003.jpg@01CF32C5.33967C00]

FYI

Hi Rita,

I agree with Terry although I would use the terminology aseptic technique as the term Aseptic Non
Touch Technique (ANTT) is copyrighted and the logo Trademarked.

This procedure must be performed using aseptic technique and staff must perform hand hygiene before and after donning non-sterile gloves and wear appropriate PPE e.g. apron, full-face visor

I agree that the use of sterile water for cleaning the inner tube is appropriate and recommend using a sterile dressing pack for the aseptic field and a sterile kidney dish to contain the water and place the inner tube when removed from the patient.

I also agree that use of a hand hygiene basin for this purpose is not appropriate due to the risk of colonisation of microorganisms from the device (hand hygiene basins should only be used for hand hygiene) and because a hand hygiene basin is not an appropriate field for aseptic technique.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Hi Rita,

I agree they should use the ANTT terminology I have suggested an alternative

This procedure must be performed using Standard ANTT and staff must practice hand hygiene before and after donning non-sterile gloves and wear appropriate PPE e.g.; apron, full-face visor.

Regards
Terry McAuley
Sterilisation & Infection Prevention and Control Consultant
STEAM Consulting
E: terry@steamconsulting.com.au
W: http://www.steamconsulting.com.au
A: PO BOX 779
Endeavour Hills
VIC Australia 3802

CONFIDENTIAL COMMUNICATION: The information contained in this message may contain confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or duplication of this transmission is strictly prohibited. If you have received this communication in error, please notify us by telephone or email immediately and return the original message to us or destroy all printed and electronic copies. Nothing in this transmission constitutes an agreement of any kind unless otherwise expressly indicated.

Dear All,
The Intensive Care and Coordination monitoring unit (ICCMU) is working on a tracheostomy guideline. The recommendations around cleaning of the inner cannulas are as in the table below:

Recommendations

Grade of Recommendation

1.

The inner cannula must be checked for patency, cleaned and replaced 2-4hourly. More frequent checks will depend on the volume and viscosity of secretions.

Consensus

2.

The inner cannula should be cleaned and dried according to manufacturers guidelines and stored in a clean dry container.

Consensus

3.

Under most circumstances the inner cannula can be cleaned with sterile water with a tracheostomy cleaning brush or a pipe cleaner (with the end turned over). Where secretions are tenacious, alternative solutions can be used; however, the tube should not be soaked for more than 15 minutes.

Consensus

4.

This procedure is a clean procedure which requires hand hygiene before and after donning appropriate PPE e.g.; gloves, apron, full-face visor.

Consensus

5.

It is inappropriate to clean or rinse the inner cannula at hand basins used for hand washing because of the risk of contaminating the basin with organisms or contamination of the inner cannula.

Consensus

6.

When placing a clean inner cannula into a TT tube it should be rinsed with sterile water immediately prior to insertion.

Consensus

Consensus means that the guideline group & external validation panel agreed on this recommendation (using a likert scale 1-9 with agreement as a median of > 7)
(The full guideline can be accessed at http://intensivecare.hsnet.nsw.gov.au/icwiki/index.php/Tracheostomy)

I would like to draw your attention in particular to Recommendation no 4 and the use of the terminology clean procedure.
This is because in my hospital, I am in the process of implementing the ANTT (aseptic non-touch technique) Clinical Practice Framework (The Association for Safe Clinical practice http://www.antt.org) in order to meet National Standard 3, criterion 3.10.1-3.10.3. ANTT does not recognise the term clean procedure. According to ANTT, the term clean refers to free from marks and stains. Therefore, the term clean technique and implied clean aim can cause confusion and should be avoided; any lesser aim than asepsis for invasive clinical procedures and maintenance of invasive medical devices is potentially ethically and legally problematic.

I would like to know what your thoughts are with respect to this.
Rita Roy

Clinical Nurse Consultant | Infection Control
Hornsby Ku ring gai Health Service, Palmerston Road, Hornsby NSW 2077
Tel (02) 9477 9232 | Fax (02) 9477 9013 | Mob 0422 930 370 | Rita.Roy@health.nsw.gov.au
http://www.health.nsw.gov.au

[cid:image001.jpg@01CF316A.57430C60]

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[Beth Bint]

Good morning All

Probably the most fundamental question that should asked about any piece of equipment for reuse is: “Can it be effectively cleaned?”

In the case of the fabric tourniquets used for venous access the answer is a resounding no, we often come across our ever adaptive nurse inventing new and “improved” ways to clean these eg: clinical hand basins.

Other items are not as clear to define as seemingly identical products are released onto the market with same specifications yet is appears to be at the “whim” of the manufacturer as to how they are labelled i.e. single use, vs single patient use, vs reusable.

Another “gold” standard I apply when discussing the necessity for clean equipment and perhaps identifying if single use item is required, is in the form of another question. ” Are you comfortable to have this piece of equipment used on you after it has been used on multiple patients?”

If the answer is no, there are two possible issues

1. There isn’t a routine cleaning program for this item, or

2. The item cannot be effectively cleaned.

Sorry for the ramblings of another sef-confessed “oldie”.

My answer to your final question “what would influence decision makers to invest in single-use only equipment. This may sound trite but, an admission to a general ward in a facility where their “status” is unknown, and they really see what patients have to in many instances – tolerate.

Apologies again if I am sound a little jaded.

Beth

Beth Bint

Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House, Wollongong Hospital 2500, NSW
Tel. 02 4222 5869 | Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au

[cid:image001.jpg@01CF11D4.E23951E0]

Certainly Glenys

Here they are

Gurses AP, Siedi K, Vaidya V, Bochicchio G, Harris A, Hebden J, and Xiao Y (2008) Systems ambiguity and guidance compliance: a qualitative study of how intensive care units follow evidence based guidelines to reduce healthcare-associated infections. Quality and Safety in Healthcare 2008. 17:351-359.

Morton A, Cook D, Mengersen K, and Waterhouse M (2010) Limiting risk of hospital adverse events: avoiding train wrecks is more important than counting and reporting them. Journal of Hospital Infection. Volume 76, Issue 4 283-286

Kind regards
Jackie

Jackie Miley MSc, PG Cert Public Health, Cert Infection Control, Dip Rn. Practice Educator

Senior Lecturer Infection Prevention and Control
Subject Coordinator MSc Infection Prevention and Control
Oxford Brookes University
Faculty of Health and Life Sciences
Room S1/12
Department of Biological and Medical Sciences
Gipsy Lane Campus
Headington
Oxford OX3 0BP
jmiley@brookes.ac.uk

Coordinator – Audit and Surveillance Forum. Infection Prevention Society UK
Have you seen?
Publication of the IPS audit and surveillance competences

Jane McNeish, Catharine Pym, Sandra Beaumont, Jackie Miley
Journal of Infection Prevention July 2013 14: 122-124, first published on May 14, 2013 doi:10.1177/1757177413486736

On 12 January 2014 23:04, Glenys Harrington <infexion@ozemail.com.au> wrote:
Hi Jackie,

Is it possible for you to y include the full references details with your comments?

Regards

Glenys

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

Dear All
An interesting and useful dialogue. From my recent experience in the UK, financial penalties certainly focus the executive mind on outcomes.
The Gurses et al paper has some interesting and informative perspectives to offer our “industry”!
Shifting approaches without financial penalties appears to be problematic, though targets can lead to ‘train wrecks’ (Morton et al 2010) and there are lots of these.
Reuse of single use items must surely be one of our more difficult battles
Cheers

Jackie Miley
Project Coordinator Infection Prevention
Infection Prevention and Epidemiology

The Alfred
55 Commercial Road
Melbourne VIC 3004
PO Box 315 Prahran
VIC 3181 Australia

Melbourne 3000 Australia

Jackie

Jackie Miley MSc, PG Cert Public Health, Cert Infection Control, Dip Rn. Practice Educator

Senior Lecturer Infection Prevention and Control
Subject Coordinator MSc Infection Prevention and Control
Oxford Brookes University
Faculty of Health and Life Sciences
Room S1/12
Department of Biological and Medical Sciences
Gipsy Lane Campus
Headington
Oxford OX3 0BP
jmiley@brookes.ac.uk

Coordinator – Audit and Surveillance Forum. Infection Prevention Society UK
Have you seen?
Publication of the IPS audit and surveillance competences

Jane McNeish, Catharine Pym, Sandra Beaumont, Jackie Miley
Journal of Infection Prevention July 2013 14: 122-124, first published on May 14, 2013 doi:10.1177/1757177413486736

On 9 January 2014 11:26, Joe-Anne Bendall <Joe-Anne.Bendall@sesiahs.health.nsw.gov.au> wrote:
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—–

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
http://www.infectioncontrolplus.com.au

—–Original Message—–

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
________________________________________

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<mailto:tg@gandassoc.com>
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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<mailto:Cath@infectioncontrolplus.com.au>

Adjunct Professor
Griffith University, School of Nursing and Midwifery

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[Beth Bint]

Hi Terri

Sorry about the late arrival t the debate. Just wanted to add to Donna’s comment as this is consistent with the approach that I take. We have found that staff become overly dependent on the protection afford by a mask and loose focus on the what we believe to be the “bang for buck” precautions ie: Hand hygiene and environmental and shared equipment disinfection.

My other thoughts for what they are worth is that the droplet precautions component for protections is really just standard precautions for the prevent of exposure to aerosolised body fluids. Unless I am wrong, I am pretty sure that norovirus doesn’t have inherent throat carriage like say other infections which require droplet precautions eg: influenza, pertussis etc which require universal use of a mask when within 1m of contact.

Cheers
Beth
Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House Wollongong Hospital
Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________

Hi Terry,
We use contact precautions with standard single room only required and droplet precautions added if vomiting.
Regards,
Donna.
Donna Cameron
Manager Infection Control Team
Austin Health
P.O. Box 5555
HEIDELBERG Vic 3968
9496 6625
donna.cameron@austin.org.au

Hi everyone,

Always on a Friday afternoon!
We have had a great debate here about what sort of precautions Norovirus requires and what sort of isolation room they need to be nursed in.

The NSW Ministry of Health Infection Control policy PD2007_036 states:
Contact and Airborne precautions.
P2 mask when there is potential for aerosol dissemination e.g. patient vomiting or toileting (diarrhoea), disposing of faeces.
Airborne negative pressure room if available and P2 mask
Contact gown/apron, gloves
Ensure consistent environmental cleaning and disinfection.

I have always advised the staff that contact and DROPLET precautions are required if the patient is vomiting or has profuse/explosive diarrhoea. I have also advised that a surgical mask is sufficient (if worn correctly). Our little ones dont vomit and expel faeces as far as adults do too.
We do not have the luxury of having a negative pressure room for them to be nursed in either as we do not have that many.
I think CDC simply suggests single rooms and contact precautions.

Just thought I would ask the other experts out there what they think about this topic?
Also if I advise staff to follow the contact and droplet precautions and surgical mask route, am I going against policy?

Any help on this matter would be appreciated. Happy to admit I am wrong!

Terri Cripps | Clinical Nurse Consultant Infection Control | Sydney Childrens Hospital
‘: (02) 9382 1876 | fax: (02) 9382 2084 | : terri.cripps@sesiahs.health.nsw.gov.au| “:www.sch.edu.au| page: 47140

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[Beth Bint]

Hi All

This is the advice we have received from our pharmacy regarding this matter.

“Chlorhexidine 2% in Alcohol 70% was a hospital only product before but is now available to everybody so labelling was changed to accommodate this broader group. Its still the same product still safe to use on skin. The manufacturer (name available on request) is aware of hospitals concerns and by the end of this month (hopefully) will be rolling out hospital only labelled bottles that will have the original directions on them and would only be available to hospitals.”

We will be seeking written advice from this company regarding this as assurance of safe use under the current labelling until the relabelled product is available.

Regards
Beth

Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House Wollongong Hospital
Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________

Hi all,
My understanding is that the TGA has changed its registration processes for skin disinfectants so that they now need to be registered as OTC medicines. This probably involves another cost for manufacturers who may be trying to get around this by simply re-labelling their products. Consumers need to express to the product suppliers that this is not acceptable.
In the meantime, if the product has not changed its formulation, some healthcare facilities are electing to continue to use the products off label.
Clearly not a satisfactory situation.

Regards,
Irene

Irene Wilkinson
Manager, Infection Control Service
SA Health
Irene.wilkinson@health.sa.gov.au

I have emailed the manufacturer of 100ml 2% Chlorhexidine in 70% Alcohol with the same labeling- will share the response when it arrives

I note the 500ml bottle of 0.5% Chlorhexidine in 70% Alcohol also now has this labeling

Have had a look around the TGA website and have not seen anything about category changes

regards
Sue

Sue Borrell
Infection Prevention Nurse Consultant
Infection Prevention & Hospital Epidemiology

t 03 90763139
m 0429 806356
e S.Borrell@alfred.org.au

Alfred Health
55 Commercial Road
Melbourne VIC 3004
PO Box 315 Prahran
VIC 3181 Australia

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Hi Lindy
our generic branded liquid solution seems to now also have the ‘hospital grade disinfectant and the surface cleaning” directions, however our single use swabs and packets do not. Has anyone contacted the manufacturer yet?
regards
J

We Passed Accreditation – met with merit for standard 3 Infection Prevention – many thanks for your assistance and great work

Jane Tomlinson RN
Clinical Nurse Consultant
Infection Management and Prevention Service
Royal Children’s Hospital
Children’s Health Queensland
T: 07 3636 7856 | M: 0408 236 266
| F: 3636 5505
E: jane_tomlinson@health.qld.gov.au
Ground Floor, South Tower
Herston Rd, HERSTON QLD 4029
http://www.health.qld.gov.au/childrenshealth

>>> Lindy Ryan <Lindy.Ryan@SWAHS.HEALTH.NSW.GOV.AU> 3/07/13 9:03 >>>
Dear Colleagues

Just wondering if anyone; facilities/ service had been using 2%CHG in 70% ETOH (tinted pink /red/blue) for skin antisepsis for their pt. s for insertions of CVADs or preop skin prep? and if so were you notified of the change to the physical labelling from it previously being labelled for use as skin prep – use as a preoperative treatment of unbroken skin to it at some date being relabelled as a hospital grade disinfectant with the direction of apply to hard surfaces e.g walls and floors

Can I ask then if you were aware can I ask are you still using it as a skin antisepsis even with the label change or have you stopped using for this purpose and if so what are you now using instead?

Any advice or feedback would be grateful

Many thanks

Regards

Lindy

Lindy Ryan
Infection control CNC
Nepean Hospital NBMLHD
Phone 4724 2228
Email lindy.ryan@swahs.health.nsw.gov.au

Infection Prevention and control is everyones business

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