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Hi Tim
I am very interested in you PIVC Shock Slideshow…..any chance you can share it?
Cheers
BethBeth 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@01CE7EF0.F6E1FF60]
Christine,
This is a great place to start.
http://antt.org/ANTT_Site/Home.htmlAlternatively, do what I do and show clinicians the nasty effects of infection in a slideshow – shock factors always seem to work the best for me – I have a great PIVC slideshow showing a horror story of bad PIVCs.
Works every time.Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
[cid:image001.jpg@01CE7E18.8B0EA230]Hi,
Just wondering if anyone has any innovative ideas how to engage doctors in taking aseptic technique on board?
Perhaps even getting them to do some education??Regards
ChrisChristine Braden
Manager Infection Control
Djerriwarrh Health Service
Email- chrisb@djhs.org.au
Ph- 53 67 2000
Mobile – 0402 242 651_____________________________________________________________________
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Hi Michael
We offer post discharge clearance to our patients via a nurse-led clearance clinic. We did attempt active recruiting to the clearance clinics, although the results for clearance were very pleasing, it was a very labour intensive process.
We now offer this service via information provided at the time of the result or direct request from the patient. We have a well documented pathway and correspondence documents for this process which we would be happy to share.
We have tried to engage GPs with this process with limited results.
A very important factor is that MRSA screening is not covered by Medicare so healthcare facility must bare the cost of pathology tests, or if the patient chooses to have this performed by their GP the patient should pay for the pathology.
The rationale for this not being covered by medicare is that it is not a clinically indicated procedure (in the majority of instances).
Cheers
BethBeth 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
I am seeking some information on current practices on clearing patients from requiring transmission based precautions for MRO carriage on re-admission. I am aware of different guidelines about clearance for MROs, but wondered if any facilities actively tries to clear a patient after discharge to the community (not via facility outpatient visits). We are looking at trialling a program for providing patients with information and pathology forms on discharge to have specimens collected with their GP or private pathology collection centre to assist to clear them from the MRO prior to the next admission. Obviously this will need to done in conjunction with our current clearance guidelines (eg no current wounds, no antibiotic treatment within a specified time frame, no indwelling devices, correct specimen types, etc).
Is anyone doing this currently? Has anyone tried this and stopped?
I hope you this question is clear. Thanks for any responses.
Cheers
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Hi Ruth
We have been installing the all in one washer/disinfection units in our new areas and we have also installed rim-flushing sinks.
As Lynley has already described there are times when washer/disinfectors are out-of-service and alternate disposal options are necessary. There are also other occasions that require liquid waste disposable (dependent on your waste policy) such as emptying of urine or dialysis bags.
What we have removed are the hoses that are used at sluices as these produce bulk aerosolisation and contamination of the area.
We also ensure that appropriate PPE is available to staff for disposal of liquid waste.
Cheers
BethBeth 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@01CE68DF.507BCF10]
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Lynley King
Sent: Tuesday, 11 June 2013 10:25 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: use of sluice sinks or slop hoppers in new buildsHi Ruth,
We have just completed our new ED here in Alice and we did include the sluice sink as back up.
Our all in one waste disposal units do fail and can take a week or longer to repair. This may not be an issue in other areas but may be worth thinking about.Cheers,
LynleyLynley King
A/CNC
Infection Prevention and Control
Alice Springs Hospital
CAHNSent from mikala, the iPad!
On 11/06/2013, at 6:11, Ruth Barratt <Ruth.Barratt@CDHB.HEALTH.NZ> wrote:
Hi there,
We are currently planning a very big new hospital wing and wondered if many Australian new build designs continue to include a slop hopper or sluice sink for disposal of body fluids. We are moving towards the all in one washer sanitiser units for bedpans and urinals so in theory we should not need to dispose of the waste before the pan/bottle is put into the machine.However there is still concern and doubt in the minds of some nursing staff that if the machine is being used the full pan or urinal will have to sit on the dirty bench they would prefer to empty the contents first. The risk of splash is the downside of a sluice sink so we would prefer not to use them especially as we have our fair share of Norovirus outbreaks each year.
Have any of you built or refurbished without a sluice sink and if so has this been accepted by staff since they started to use this type of waste disposal?
Cheers
Ruth
[cid:image001.png@01CE667F.289E5D30]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
: ruth.barratt@cdhb.health.nz
: + 64 3 3640 083 or ext.80083
[cid:image002.jpg@01CE667F.289E5D30]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
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Hi Alison
What type of syringe are you using, a luer-slip or a luer-lock?
In principle one could argue that with careful technique it could be assured that the key part of a luer-slip syringe would only have contact with the key part of the plastic ampoule.
However, my personal opinion is that the same assurance can’t be extended to the use of a luer-lock syringe as the luer-lock part of the syringe (a key part) has direct contact with the external “non-sterile” part of the plastic ampoule.
I am not sure how this may add to any of the information you already have, but it has certainly been a discussion point on our site as well. I will be very interested to hear from other members regarding this matter.
Cheers
BethBeth 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—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Allison Hodge, CNC Infection Control, Ballarat Health Services
Sent: Friday, 17 May 2013 5:49 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Drawing up from plastic ampoules for intravenous useAllison Hodge, CNC Infection Control, Ballarat Health Services
I have seen different practices in my workplace in relation to drawing up saline from plastic ampoules deemed to be needle-less. There are differing views on the best aseptic way to do this. Some believe it acceptable to connect the syringe hub to the opened ampoule top (key part to sterile opening); others believe for hub protection a needle should be used to draw up the saline, adding a step to the procedure. My extensive research has shown both methods used but failed to give me clear rationale for either. I would appreciate any thoughts on this. Do you know of any evidence for rationale? What do you recommend in your workplace and why?
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Thank you all for the information and advice you have provided. It has been very helpful.
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@01CE4293.33FF5400]
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Beth Bint
Sent: Wednesday, 24 April 2013 2:05 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Benchtop steriliser water and steam quality specifications.Hi All
Hoping someone can offer some advice.
We have not be able to find definitive specifications for water and steam quality required for benchtop sterilisers (Dental Autoclaves).
We have two questions:
1. Some manufacturers suggest the use of distilled or de-ionised water. If a water distiller is used how is the water quality controlled when refilling the reservoir?
2. What are the steam quality specifications for benchtop sterilisers, and where is the reference for these?
Thank you for any assistance you can provide.
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@01CE40F2.33F57270]
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Hi Joan
In our facility we have adopted a risk management approach to the management of MROs, particular in outpatient and procedural areas. We have recognised that the risk of transmission is largely based on HCW compliance with standard precautions eg: hand hygiene and cleaning of equipment between patients.
In these settings the patients have short admission durations therefore environmental contamination by the patient is very limited in comparison to overnight admissions etc.
In these settings we do not isolate patients, nor do we undertaken “terminal cleans”. We have educated staff to maintain a high commitment to hand hygiene, clean between, the wearing of aprons for all patients when direct contact with the patient and the staff members clothes is anticipated, and reducing the dependence on gloves as standard PPE if contact with blood and body substances is not anticipated.
By implementing this strategy staff have a heightened awareness to the value of implementing standard precautions which reduces the risk of transmission of microorganisms regardless of their resistance status.
Patients privacy better maintained in these settings as make-shift isolation bays with signs attached are no longer indicated.
We have a draft procedure for this on trial which we hope to finalise soon.
Regards
BethBeth 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—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Cronin, Joan
Sent: Friday, 26 April 2013 11:28 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Outpatients clinics, Endoscopy clinics and Radiolgy- How are VRE and MRSA Patients dealt withHi
I would like to know what other hospitals policy and proceedures are with Micro alerted patients (VRE, CRE & MRSA positive and their contacts) coming into Outpatient clinics, Endoscopy units and Radiology?
Are they isolated and transmission based precautions used? In Endoscopy units are they recoveed in the suite or recovery room?
Any information is greatly appreciated.
Regards
Joan CroninClinical Nurse- Infection Prevention & Management | Fremantle Hospital & Health Service | Tel 08 9431 3220 | Page 4101 | Fax 08 9431 2764 | Email joan.cronin@health.wa.gov.au
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Hi Fiona
Maybe this will support your “natural inclination”
HB206-2003 HAI-Engineering down the risk
[cid:image001.png@01CE4286.E067E840]
Cheers
BethBeth 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:image002.jpg@01CE4286.E067E840]
Hi All,
We are currently reviewing the layout of our maternity rooms. Due to space requirements I have been asked by the Architects to consider combining the Clinical hand wash basin with the baby bath as is an option in the Australasian Health Facility Guidelines.
510.6.10 BABY BATHING
Depending on infection control and operational policies, if baby bathing occurs in the
mother’s bedroom, there are specially-designed basins that can be bench-set that
can also serve as the clinical hand basin.My natural inclination is to say no to this and insist on separate basins, however I am interested in what other ICPs think of this situation and what other maternity units have in place.
Kind regards,
Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
185 Fox Valley Road, Wahroonga, NSW, 2076If you are not the intended recipient you are hereby notified that any dissemination, distribution or reproduction of this message
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Hi Barbara
We are currently taking a risk assessment approach in the prioritisation for single room accommodation for contact precautions. We have both VRE faecium van B and VRE faecium van A (resistant to Teicoplanin), as in other facilities we believe that VRE van B is now endemic within our facilities, where as VRE van A is not endemic and therefore we prioritise single room accommodation for this type. As when VRE van B was the “new-kid-on-the-block” and strict contact precautions and “isolation” was implemented in an effort to prevent transmission and endemicity, we are now taking this approach with van A.
We would also prioritise MRSA over VRE van B as it is associated with higher morbidity and mortality rates.
As previous mentioned in previous responses we would certainly prefer patients colonised with VRE van B with diarrhoea to be accommodated in a single room.
We do have an evidence-based VRE clearance protocol which we have been offering to patients for a number of years with varying degrees of success. For the most part patients a very appreciative of the opportunity to try and have the stigma of a resistant organism alert connected forever to their name.
In our facility we are working with all HCWs to understand that, for the most part, it is our actions or omissions that result in the transmission of multi-resistant organisms. Missing hand hygiene moments, not cleaning equipment between patients, not providing hand hygiene opportunities for our patients, not maintaining a clean environment. When these simple activities are not adhered to in general (often before we are aware of an MRO result), placing a brick wall between the HCW and the patient doesn’t necessarily increase compliance.
In short, single room accommodation for VRE van B is not a priority in our facility.
Beth
Beth BintInfection 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,
My managers have asked me to review our current practices of isolating VRE positive patients. This is mainly due to the limited number of single rooms within our facility. I am interested to know how you manage patients who have a positive VRE screen, whether you isolate or not, what risk assessments you undertake to determine as to whether to isolate or not and whether you have introduced a yoghurt regime for these patients and how you then manage these patients.Thanking you in advance,
BarbaraBarbara May
CNC Infection Control
Hastings Macleay Clinical Network
Ph. 0255242061
Mo. 0402890677This message is intended for the addressee(s) named and may contain confidential information. If you are not the intended recipient, please delete the message and any attachments and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities. Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
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Good afternoon Rita
We have implemented the use of disposable curtains in our emergency department, day only unit and trialling tem in one of our surgical units. We currently have a draft policy awating ratification by the Executive, please do not hesitate to contact me for details off-line.
Beth
Beth BintInfection 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 list members,
Does anyone use disposable curtains in their hospitals and if so, do you have a policy/guideline on their usage that you would be willing to share?
Many thanks,
RitaCNC Infection Control | Hornsby & Ku-ring-gai Health Service
Palmerston Road,
Tel 02 9477 9232 | Pager 52533|
rroy@nsccahs.health.nsw.gov.au
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Hi Michael
We have not persued the implementation of bladeless fans, but I still have a sense of caution in regards to the use of fans in a clinical settinng.
Aiir currents created by fans may disperse dust, spores and bacteria, something that could lead to cross contamination of the enviroment.
My understandiing is that fans must be turned off when any aseptic procedure is being performed. If fans were to be instituted this would have to be considered in advice around aseptic technique.
Regards
Beth
Beth BintInfection 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 Michael,
We have slowly been replacing our blade fans for the bladeless ones.
Yes they are more expensive but the airflow works differently. They appear to create minimal dust collection and are a much easier system for cleaning. They also are a reduced hazard risk with fingers and hands, etc trying to poke the rotating blades as there are none!. The switch is lower to the ground so again less risk with tampering on the device.
In areas where large beautiful glass windows from an architects point looks great, they can actually create a heat trap where even commercial air-conditioning cant always work in sustained hot days, hence the use of the bladeless fan!
Kind Regards
Marija Juraja |Clinical Service Coordinator (CICP) – Infection Prevention & Control Unit|
t: +61 8 8222 7588| p:47757| f: +61 8 8222 6461 | DX: 465432 |e:marija.juraja@health.sa.gov.auCare Excellence Collaboration Integrity
GERMS CAN KILL…Hi all
The question of whether we should ban portable fans from clinical areas has raised it head again here. Conventional portable fans have blades enclosed in a cage, which makes it difficult to routinely clean the blades between uses, and dust can build up significantly on the blades themselves.
A suggestion has been to change our portable conventional fans for air multiplier type devices, which are bladeless, and much easier to clean between uses. These are considerable more expensive, so I want to ensure they would be appropriate in clinical settings, especially ICU and oncology, before recommending their purchase.
Has anyone used these devices (or looked at using) in clinical areas instead of conventional fans yet? If so, were there any clinical issues we need to note?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Hi Lincoln
I like it!
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@01CD4481.AD5AA040]
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Jackie Miley
Sent: Wednesday, 6 June 2012 5:18 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Aseptic non-touch technique AcronymHI Lincoln,
This has potential !
Well doneJackie
Jackie Miley MSc, PG Cert Public Health, Cert Infection Control, Dip Rn.
Senior Lecturer Infection Prevention and Control & Continuing Professional Development
Course Leader MSc Infection Prevention and Control
Course Leader Short Course Infection Prevention & ControlOxford Brookes University
Faculty of Health and Life Sciences
Jack Straw’s Lane
Marston
Oxford OX3 0FLOn 6 June 2012 07:59, Fowler, Lincoln <Lincoln.Fowler@health.wa.gov.au> wrote:
Hi John
Assuming the acronym is to promote using the correct steps I would suggest: LOCATE
L: Location of procedure
O: Order of procedure
C: Cleaning and disinfection
A: Aseptic field established
T: Technique non-touch
(E: evaluate performace)The last is to encourage reflective practice.
Perhaps someone can dream up something better based on this.
Cheers
Lincoln Fowler / Infection Control / CACH
Department of Health
Telephone: +61 8 9224 1407 / Fax: +61 8 9224 1612
Mobile: 0467 771 233
E: Lincoln.Fowler@health.wa.gov.au
L3 WASON, 151 Wellington St, PERTH WA 6000
http://www.health.wa.gov.au
Delivering a Healthy WA________________________________
From: ACIPC Infexion Connexion [mailto:AICALIST@aicalist.org.au] On Behalf Of John Ferguson
Sent: Monday, 4 June 2012 9:46 AM
To: AICALIST@aicalist.org.au
Subject: Aseptic non-touch technique
Importance: HighDear Aicalist members,
As you will know, the new ACSQHC Safety and Quality Standards include these (stretch) requirements:
3.10 Developing and implementing protocols for aseptic non-touch technique
3.10.1 The clinical workforce is trained in aseptic nontouch technique
3.10.2 Compliance with aseptic non-touch technique is regularly audited
3.10.3 Action is taken to increase compliance with the aseptic non-touch technique protocols
It is quite a challenge to put in place a system that goes across all practitioners as I’m sure you know!The resources attached are available from UK (we have them on order).
The Commission would be interested to know about programs around the country that have developed ANTT policies and procedures.
Has anyone started regular auditing (other than say for CL insertion)? If so would you please share your audit tool(s)?
What examples of action taken to increase compliance do you have?
Have people had experience with the above UK resources?In Hunter New England, in addition to central line insertion, we’ve chosen to focus on IV insertion, wound dressing and IV medication preparation as our initial procedures to codify and audit. We already do skills lab training for IV inserters.
We’ve also been throwing around the following guiding principles list for ANTT – would welcome your comments! Could we perhaps come up with a natty acronym for these 5 ‘moments’ of ANTT?
Aseptic non-touch technique (ANTT) : core principles of practice
1. WHERE TO PERFORM the physical environment for the procedure- where should it be performed; what are the situations where it should not be performed?
2. SEQUENCING the most efficient and safest sequencing of procedure preparation and performance needs to be known by the operator and followed closely
3. DISINFECTION- Hands, procedure trolley and the patient procedure site; correct disinfectant, method of application and avoidance of recontamination
4. ESTABLISH AND PROTECT ASEPTIC FIELDS sterile drapes, plastic trays, sterile glove use, correct procedure sequencing and performance
5. NON-TOUCH PROCEDURE TECHNIQUE specific to the procedureThanks!
John
Dr John Ferguson
Chair, Healthcare Infection Advisory Committee, Australian Commission on Safety and Quality in Healthcare
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.orgFrom: Stephen Rowley ANTT [mailto:stephen.rowley@antt.org.uk]
Sent: Monday, 4 June 2012 1:57 AM
To: John Ferguson
Subject: Re: Purchase of ANTT package
Importance: HighDear John,
Thank you for your email and sorry for the slow response. We will post you the ANTT Guideline CD which includes ANTT Audit Tools and the ANTT Practice Framework to the address provided.
To implement ANTT effectively it is important to blend education with practical training. To support this, The Association for Safe Aseptic Practice (ASAP) provides ANTT Accredited training resources to help support training and implementation. The Implementation Pack includes all the resources required to implement ANTT across a large organisation.
We charge a small amount for these resources to help support the ongoing development of ANTT resources. I have attached the Resource List along with a information sheet.
Please let me know if you have any further questions.
Best regards
PatPatricia Fernandes
Administrator and PA to:
Stephen RowleyClinical Director ANTT
stephen.rowley@antt.org.uk
http://www.antt.org.uk
+44 (0)7739 000597Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
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This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing.
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Hi John
What about 5 MANTTs 5 Moments for Aseptic Non-touch Techniques?? Just a crazy thought.
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@01CD4400.8D6752A0]
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of John Ferguson
Sent: Monday, 4 June 2012 11:46 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Aseptic non-touch technique
Importance: HighDear Aicalist members,
As you will know, the new ACSQHC Safety and Quality Standards include these (stretch) requirements:
3.10 Developing and implementing protocols for aseptic non-touch technique
3.10.1 The clinical workforce is trained in aseptic nontouch technique
3.10.2 Compliance with aseptic non-touch technique is regularly audited
3.10.3 Action is taken to increase compliance with the aseptic non-touch technique protocols
It is quite a challenge to put in place a system that goes across all practitioners as I’m sure you know!The resources attached are available from UK (we have them on order).
The Commission would be interested to know about programs around the country that have developed ANTT policies and procedures.
Has anyone started regular auditing (other than say for CL insertion)? If so would you please share your audit tool(s)?
What examples of action taken to increase compliance do you have?
Have people had experience with the above UK resources?In Hunter New England, in addition to central line insertion, we’ve chosen to focus on IV insertion, wound dressing and IV medication preparation as our initial procedures to codify and audit. We already do skills lab training for IV inserters.
We’ve also been throwing around the following guiding principles list for ANTT – would welcome your comments! Could we perhaps come up with a natty acronym for these 5 ‘moments’ of ANTT?
Aseptic non-touch technique (ANTT) : core principles of practice
1. WHERE TO PERFORM the physical environment for the procedure- where should it be performed; what are the situations where it should not be performed?
2. SEQUENCING the most efficient and safest sequencing of procedure preparation and performance needs to be known by the operator and followed closely
3. DISINFECTION- Hands, procedure trolley and the patient procedure site; correct disinfectant, method of application and avoidance of recontamination
4. ESTABLISH AND PROTECT ASEPTIC FIELDS sterile drapes, plastic trays, sterile glove use, correct procedure sequencing and performance
5. NON-TOUCH PROCEDURE TECHNIQUE specific to the procedureThanks!
John
Dr John Ferguson
Chair, Healthcare Infection Advisory Committee, Australian Commission on Safety and Quality in Healthcare
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.orgFrom: Stephen Rowley ANTT [mailto:stephen.rowley@antt.org.uk]
Sent: Monday, 4 June 2012 1:57 AM
To: John Ferguson
Subject: Re: Purchase of ANTT package
Importance: HighDear John,
Thank you for your email and sorry for the slow response. We will post you the ANTT Guideline CD which includes ANTT Audit Tools and the ANTT Practice Framework to the address provided.
To implement ANTT effectively it is important to blend education with practical training. To support this, The Association for Safe Aseptic Practice (ASAP) provides ANTT Accredited training resources to help support training and implementation. The Implementation Pack includes all the resources required to implement ANTT across a large organisation.
We charge a small amount for these resources to help support the ongoing development of ANTT resources. I have attached the Resource List along with a information sheet.
Please let me know if you have any further questions.
Best regards
PatPatricia Fernandes
Administrator and PA to:
Stephen RowleyClinical Director ANTT
stephen.rowley@antt.org.uk
http://www.antt.org.uk
+44 (0)7739 000597Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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———————————————————————————————
Illawarra Shoalhaven Local Health District, South East Sydney Local Health District and Sydney Children’s Hospital Network (Randwick Campus) Confidentiality Notice
This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing.
This email message has been virus-scanned. Although no computer viruses were detected, Illawarra Shoalhaven Local Health District, South East Sydney Local Health District and Sydney Children’s Hospital Network (Randwick Campus) accept no liability for any consequential damage resulting from email containing any computer viruses.
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Thank you
BethBeth Bint
Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House, Wollongong Hospital 2500, NSW
Tel. 02 4222 5898 | Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au[cid:image001.jpg@01CD0B47.67336F20]
Hi Beth,
The problem I see is that the scrubbed personnel will have to walk past the patient’s bed through an area open to the general corridor; entering the OT through the same door as people going in and out. There is a potential for being collided with by porters and other staff entering or leaving the theatre.
The enclosed scrub area is a good feature; but there is only one way in and out; another potential for contamination.
It would be ideal to have a flow into the scrub area and then to the OT without backtracking or having to mix with general traffic.
Regards
Prue Wright
Infection Control Co-ordinator
Hurstville PrivateGood Afternoon
We are currently undertaking the design of a new theatre suite. During this process discuss has arisen regarding the need for dedicate doorways to exit the scrub bays into the operating theatre, compared single doorway for entering and leaving the scrub bay and then using a shared corridor ‘entrance bay’ to enter the theatre. See table below for illustration of flow. Could you please advise if your theatres have this layout and if there have been any issues arise from this.
We would also be interested in opinions regarding the potential hazards associated with this design.
theatre
*
Opening doorspatient bed
anaesthetic bay
No door –>
Scrub sinks
theatre corridor
Thank you for your assistance
BethBeth Bint
Clinical Nurse Consultant | Infection Management and Control Service
Level 1 Lawson House, Wollongong Hospital 2500, NSW
Tel. 02 4222 5898 | Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au[cid:image001.jpg@01CD0825.900AA000]
———————————————————————————————
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This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing.
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Hi All
To say that this general discussion is exciting is an understatement. I have long felt the risks associated with poor environmental hygiene has been underrated. So often the risk had been dismissed by the philosophy that HCW compliance with hand hygone is the most important factor. While not negating the very important role of hand hygiene, this does not reduce the risk to the patient from self contamination after touching the environment.
One example from the NHMRC IC guidelines in regard to this matter is the recommended frequency for cleaning of patient curtains at 6 months. Although there may be a lack of published evidence, “common sense” (a term I rarely) would inform that these items have a deserved reputation as being frequently touched items and ultimately quite contaminated. My experience has been that a cleaning frequency of 6 monthly, or “when soiled”, usually means never.
Like Matthias, I hope that we don’t have to be tied down by chasing down evidence, or waiting for the results from new research, to move ahead with significant change to environmental hygiene controls that would seem supported by many in the infection control profession.
Beth Bint
Clinical Nurse Consultant | Infection Managament and Control Service
Level 1 Lawson House, Wollongong Hospital 2500, NSW
Tel. 02 4222 5898 | Fax. 02 4222 5367 | beth.bint@sesiahs.health.nsw.gov.au—–Original Message—–
From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Glenys Harrington
Sent: Friday, 16 September 2011 10:30 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Environmental hygiene and disinfection as part of Standard Precautions modelKevin,
Perhaps the answer is not to look for a “defined routine sampling technique to determine a minimum standard for environmental contamination” as there will always be problems with interpreting what the results mean given the environment is not meant to be “sterile”.
It would be more useful to determine what are the minimum, standardised, “reliable and repeatable” environmental decontamination procedure/s (i.e. cleaning and the use of florescent markers/cleaning and the use of microfiber/cleaning and chemical disinfection/cleaning and new technologies [HPV, UV, steam, other]) that can be shown to be linked to a sustainable reduction in infection and/or colonisation in patients in non-outbreak settings.
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—–Original Message—–
From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Friday, 16 September 2011 7:12 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [AICA_Infexion_Connexion] Environmental hygiene and disinfection as part of Standard Precautions model[Moderator note: this message has been discussed with the original poster of this thread, and agreed that the content is not product specific and is worth consideration as part of this discussion.]
John
I read your post with great interest and think its a fantastic topic (and badly needed) for discussion.
I was going to reply to the list but to be honest I am coming from a slightly biased perspective and really do not want to the list to degenerate into another marketing tool (or for that matter to get into trouble with the people who manage the list.) so here is my (for what its worth) feelings on the topic. Any feedback appreciated and if you feel its not going to be taken or seen incorrectly then I am happy to reply to everyone.
Unfortunately while opinion is changing (and changing rather quickly) there is still debate in some circles as to the role of the environment in the spread of HCAIs. History tells us that the medical profession takes a while to change its mind (look at Semmelweis or John Snow)!
The historical belief that pathogens dont survive long in the hospital environment has been proven to be completely wrong with evidence that the many bacteria can survive weeks, months or even years in the environment. The feeling that the patient contaminated the environment but that the a contaminated environment was not a risk to a patient has been reassessed and found to be incorrect in some circumstances. The question is not now whether a contaminated environment makes an important contribution to transmission but how much of a contribution does it make. Related to this, what level of cleaning and disinfection is required? Is cleaning enough? Do we need disinfection? To what level?
What is exacerbating the problem is the lack of data on the actual level of contamination that exists in hospitals pre and post cleaning. Taking two or three swabs, even on a routine basis just isnt sensitive enough to give us that kind of data. How can sampling 2cm2 out of the entire surface area (even out of the high hand touch surfaces) even give us an indicative result on the level of contamination in a room? There is even some doubt as to the sensitivity of standard swabbing. If you look at a letter in AJIC in 2009, (Otter JA et al. Am J Infect Control
2009;37:517-8) standard swabbing found 2% of surfaces contaminated with C.diff but moving to the newer pre moistened cellulose sponges swabbing
1m2 found that 28% of surfaces were contaminated. This goes to show how inaccurate or lacking sensitivity our environmental testing, even when it done routinely.We all know that the environment contaminates healthcare workers hands, particularly the near patient environment. There are multiple studies that show this but the one that to me stands out is Hayden et al. Infect Control Hosp Epidemiol 2008;29:149-154 which showed that VRE touching that surface was posed the same risk of contaminating a HCW hands as touching the patient !!!
The most convincing evidence that contaminated surfaces are important in transmission comes from the fact that there is an increased risk to a patient of acquiring a MDRO if the previous patient in that room had a MDRO:
Martinez et al. Arch Intern Med 2003; 163: 1905-12 showed if VRE was cultured within the room the risk to the next patient increased by a factor of 2.6, Huang et al. Arch Intern Med 2006; 166: 1945-51 showed that if the prior room occupant had VRE the risk increased by a factor of 1.6 and for MRSA it was 1.3 Drees et al. Clin Infect Dis 2008; 46:
678-85. demonstrated that if VRE was cultured within the room that the risk increased by a factor of 1.9. prior room occupancy risk increased by a factor of 2.2 and more worryingly even with all the cleaning that if the previous room occupant at any tome in the previous 2 weeks had VRE the risk still increased by a factor of 2.
Shaughnessy. Infect Control Hosp Epidemiol 2011;32:201-206 showed that if the prior room occupant had C.diff that the risk to the next patient admitted increased by a factor of 2.4.
Nseir et al. Clin Microbiol Infect 2010 looked at the MDR Gram Negatives and showed that prior room occupancy was also a significant risk factor.
For Acinetobacter you risk increased by a factor of 3.8 and for Pseudomonas the risk factor increased by 2.1.So, having established that the environment contributes to transmission, the question is, what is the best way to reduce the contamination to a safe level?
We also know that cleaning and disinfection, even with the best technique will not reliably eradicate this environmental contamination.
As far back as 2004 Garry French French et al. J Hosp Infect
2004;57:31-37 showed that manual cleaning failed to eradicate environmental contamination from MRSA. Byers et al. Infect Control Hosp Epidemiol 1998;19:261-264 showed that it took an average of 2.8 disinfections to eradicate VRE from a room, Boyce et al. Infect Control Hosp 2008;29:723-729 showed that bleach leaning failed to eradicate C.diff (using the more sensitive Sponge testing 25% of surfaces remained contaminated after bleach cleaning).Similarly, Farrin Manian demonstrated at SHEA in 2010 (and since part published Manian et al. Infect Control Hosp Epidemiol
2011;32(7):667-672) that even with 2 daily bleach cleans and 4 repeat bleach cleans on patient discharge that 26.6% of rooms remained contaminated by MDR Acinetobacter or MRSA !!!!! 4 repeat bleach cleans
How many hospitals currently or will ever go to that standard ??In the same study as above, Farrin Manian showed that Hydrogen Peroxide Vapour (HPV) was more effective than the four rounds of cleaning and bleach disinfection. Furthermore he demonstrated (again in SHEA 2010 but not yet published) that by eradicating this contamination (using Hydrogen Peroxide Vapour) that there was a 54% reduction of patient acquisition rates for MDR Acinetobacter, 42% reduction on C.diff, 50% reduction in VRE and a 24% reduction in MRSA !!
Two other studies also suggest that eradicating environmental contamination reduces the acquisition of pathogens. John Boyce showed at SHEA in 2006 and since published, Boyce et al. Infect Control Hosp
2008;29:723-729 that eradicating C.diff from the environment (again using HPV) reduced patient acquisition rates for C. diff by 54%. In another study of HPV decontamination in 2008, Passaretti presented data at SHEA (still to be published and again using HPV) demonstrating that by eradicating environmental contamination from a room where the previous room occupant had a MDRO that the risk of acquisition to the next patient dropped substantially. From VRE there was a 77% reduction, for MRSA a 54% reduction for C.diff a 65% reduction and for Gram negative rods a 38% reduction. Over all the eradication of environmental contamination on patient discharge reduced the risk of acquiring a MDRO by 66%…..So, yes, routine cleaning and disinfection of the rooms of patients on MRO precautions should be done but more may need to be done a patient discharge to eradicate pathogens for the safety of the next patient.
Regarding terminology, I tend to use environmental decontamination to encompass both cleaning and disinfection, but standardisation would be helpful here.
I think we need to define a routine sampling technique and a minimum standard for environmental contamination that must be achieved before a patient can be admitted to a room or bed-space. (I suspect different standards can be set for different areas depending on risk, for example in Oncology, ICU and Organ transplant the standard may be <1 CFU per CM2 for general medical ward it could be <2CFU per cm2.) There are some proposed guidelines (J Hosp Infect 2004; 56: 10-15 but these have not been adopted widely). We need to find a reliable and repeatable method of achieving this standard and it needs to be implemented and monitored.
And there needs to be a budget made available for this.Regards
Kevin Griffin
Director Healthcare Solutions
Bioquell Asia Pacific Pte LtdT: +65 6592 5145
F: +65 6227 5878
M: +65 8511 3733
E: Kevin.Griffin@bioquell.com
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Hi Wendy
Here at Wollongong Hospital we support the practice outlined by Helen Scott at the Nepean Hospital.
Another risk factor that needs to be consider when lines are disconnected is the risk of these lines being reconnected to the wrong patient. Although this represents a low risk of blood borne pathogen transmission, it is not now risk, and can lead to unnecessary anxiety for all those involved.
Beth Bint
CNC Infeciton Prevention and Control
The Wollongong Hosptal, NSW________________________________
Good morning
Our question is: does anyone have a policy on when to change IV lines that are used for antibiotics and then left to hang disconnected by the patients bed side?
Would love to hear from you if you do.
Wendy Beckingham
CNC Infection Prevention and Control
ph. (02) 6244 3695 or pager 50390
e. wendy.beckingham@act.gov.au
Care Excellence Collaboration Integrity
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