[Mitchell, Brett (TIPCU)]

Hi Maureen

VRE is a notifiable disease in Tasmania. We have seen VanA being detected in Tasmania for the past few years, however these represent a very small proportion – compared to VanB. We have not noticed any recent increase.

Thanks
Brett

Dr Brett Mitchell I Asst Director of Nursing Infection Control, TIPCU RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Population Health I Department of Health and Human Services
Post GPO Box 125 Hobart Tas 7001 | Email tipcu@dhhs.tas.gov.au
Phone (03) 6222 7779 | Fax (03) 6233 0553
A fair and healthy Tasmania

Hi Maureen,

To date we have not seen a Van A detection.

Rebecca O’Donnell | Infection Prevention and Control Co-ordinator
St Vincent’s Hospital Toowoomba | 22-36 Scott Street TOOWOOMBA 4350
T 07 4690 4042 | F 07 46904400
E rebecca.o’donnell@stvincents.org.au | W http://www.stvincents.org.au

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Dear all

We have seen an increase in the number of VRE VanA in our facility…..would be interested to know if any of you are experiencing the same?

If you have, has it occurred in any particular speciality area (e.g. renal unit).

Look forward to your comments

Regards

Maureen

Maureen McKenzie

Clinical Nurse Consultant | Infection Prevention & Control
Concord Repatriation General Hospital
C/- Microbiology Dept.
Hospital Road, Concord NSW 2139
Tel 02 9767 6898 | Fax 02 9767 7868 | maureen.mckenzie@sswahs.nsw.gov.au

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[Mitchell, Brett (TIPCU)]

Thanks Mattias,

Building on your thoughts:

– The 95% confidence intervals are 4.6-10.5 and 9.4-16.8 for HAI or colonisation in copper (7.14%) and noncopper (12.8%) respectively – noting they overlap
– My calculated odds ratio is 0.52 – statisically significant.

This made me think about the power of this study. I may be wrong, but I think this study does lack the power needed to detect a difference. I calculate 65%.

So, in summary, my thoughts are this study does provide some interesting findings, but building on your comments and the above, I would not say conclusive – yet. This needs to be replicated.

Thanks
Brett

________________________________________

Dear Colleagues, dear Michael,

Since my post last week, I had another look at the numbers in this paper. I found the following:

The measured primary outcomes, according to the paper’s Methods section, were (a) any HAIs and (b) colonization with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE).

Reported in the Results section and in Table 2 were the total (i.e. combined for both trial arms) numbers of patients who had (a) HAI, (b) colonization, (c) both HAI and colonization (i.e. meaning only those patients who had both events occurring together), (d) HAI and/or colonization (i.e. the number of patients who had either HAI or colonization or both together, meaning any event), (e) HAI only but no colonization (i.e. number of patients who had HAI minus the ones who had both HAI and colonization), and (f) colonization only but no HAI (i.e. number of patients who had colonization minus the ones who had both HAI and colonization). I know this may be confusing, but these are the numbers that were reported. They didn’t call if (a)-(f), that is what I am writing here to make the figures more distinguishable.

Separate data for outcomes in each trial arm were only reported for (d), (e) and (f). For (d), the article reported what amounted to a 49% reduction in the copper rooms vs. non-copper rooms (21 vs. 41 patients; p.02), for (e) a 62% reduction in the copper rooms (10 vs. 26; p.013), and for (f), a 67% reduction (4 vs. 12; p.063, NS). What was missing were the numbers of patients with (a) HAI and (b) colonization, listed separately for each trial arm.

The article concluded — in the Discussion section — that copper surfaces in rooms reduced the risk of HAIs by more than half.

However, arguably, (a) any HAIs and (b) any colonization events, as listed in the Methods, would be biologically and clinically most relevant, and it may not be very informative to combine these two events (under d) in the same statistical calculation, because they are biologically and clinically different from each other.

What is listed in Table 2 as “HAI only” (figure e) is actually: “number of patients with HAI minus the number of patients who had both HAI and colonization together”. This — again arguably — is an artificially constructed number without clinical/biological relevance.

Similarly, what is listed in Table 2 as “Colonization only” (figure f) is actually: “number of patients with Colonization minus the number of patients who had both HAI and colonization together”.

I extracted the missing numbers from the other numbers presented and arrived at (a) HAIs 17 vs. 29, and (b) colonization, 11 vs. 15 events. Putting these into my statistics calculator, they were — non-significant.

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 Michael,

Very interesting study. Sometimes it is difficult to get one’s head around things and figure out whether one’s own thinking is correct. I have the following thoughts concerning the study, but do not know if my thoughts are correct:

I can think of the following three routes for transmission of HAIs:

– (i) Endogenously, from within the patient’s own flora (nosocomial UTIs would be typical)
– (ii) Exogenously via direct transfer, e.g. handborne transmission
– (iii) Exogenously via surfaces and secondary transmission from contaminated surfaces

The authors assessed two (actually three) things: (a) HAIs, independent of the organism, (b, c) colonisation with MRSA and VRE.

All three pathways can lead to (a), while only the exogenous pathways can lead to (b, c), because MRSA and VRE cannot arise spontaneously in a non-colonised patient.

The copper surfaces would only reduce the proportion of (a, b, c) due to the second exogenous pathway (iii), but not due to the others (they simply cannot).

If there is a 58% reduction of HAIs through copper surfaces, that would potentially mean that the overall proportion of transmission pathways (i) and (ii) among all HAIs would only be 42% (is that correct?).

My impression always used to be that the endogenous pathway and the exogenous pathway via direct transmission are important, but I have not seen recent estimates of the proportions of all three.

Other observations are that the overall number of HAIs is relatively small, that among the bloodstream infections in the non-copper rooms, there are 3 with coag.-neg. staphs, that among the HAIs in the non-copper rooms are 5 “other” undefined HAIs (among a total of only 26), and that the authors in the abstract combine both HAIs and colonisation events in the same statistics (one p value for both events). A friend who knows about statistics tells me that one should not combine things that are biologically different in the same statistical calculation, and HAIs and colonisations are biologically different.

Any additional thoughts? Again, not sure if my line of thinking is correct.

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—–

I would be interested in other infection control and prevention professionals’ thoughts about the article below. I must admit a healthy dose of scepticism to any study mainly funded by a lobby group (Copper Development Foundation), but the science and methods seems reasonable to me. What is the considered role of the ICU environment in HAI’s? More studies of these effects seem warranted. Are there any similar studies being conducted in Australia currently?

Cheers
Michael

Michael 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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US Study Shows Copper Cuts Hospital Infections by 58%

A 4-year study in the U.S. has shown that using Antimicrobial Copper surfaces in hospital rooms reduced the number of Healthcare Acquired Infections (HAIs) by 58% compared to rooms without Antimicrobial Copper.

The U.S. Department of Defense funded study compared rooms with and without Antimicrobial Copper objects in Intensive Care Units at three major hospitals-The Medical University of South Carolina, Memorial Sloan-Kettering Cancer Center in New York City and the Ralph H. Johnson Veterans Affairs Medical Center in Charleston, South Carolina.

The results, which have been published online in the Infection Control and Hospital Epidemiology (ICHE) Journal, compared copper to equivalent non-copper touch surfaces during active patient care between routine cleaning and sanitizing.

The study confirmed that Antimicrobial Copper surfaces can continuously kill 83% of bacteria that cause HAIs within 2 hours, including drug resistant strains that are often called ‘superbugs’.

“Because the antimicrobial effect is a continuous property of copper, the re-growth of deadly bacteria is significantly less on these surfaces, making a safer environment for hospital patients, “said Dr. Michael Schmidt, Vice Chairman of Microbiology and Immunology at the Medical University of South Carolina and one of the authors of the study.

HAI’s are a major and growing problem worldwide. Here in Australia around 9,000 people die as a result of picking one up in hospital.

“We’ve known for a while that copper and copper alloy surfaces can kill off bacteria and viruses within hours of contact, but we now have proof that they also cut the risk of picking up an infection and that will save lives and cut health care costs,” John Fennell from the International Copper Association said.

“Antimicrobial Copper surfaces and products are now being manufactured worldwide, and there’s been a growing number of hospital, medical clinics, aged care facilities and even kindergartens that have installed them as part of their infection control strategies.”

The [full] study can be found at: http://www.jstor.org/stable/10.1086/670207
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[Mitchell, Brett (TIPCU)]

Dear Hayden,

The AICA/ASID position statement makes a point on this and details the references if you need to source additional information.

See – http://www.publish.csiro.au/paper/HI11007.htm

The specific point in question is:
“Do not use systemic antimicrobials routinely as prophylaxis in patients requiring either short or long-term catheterisation unless indications exist.2,8 There are studies suggesting the incidence of catheter-associated bacteruria may be reduced by antimicrobial prophylaxis;11,16 however, this protective effect is transient (lasts only a few days) and is associated with the selection of resistant organisms. Prophylaxis is not indicated for patients at low risk for acquired bacteruria and in whom the sequelae of catheter associated infections are infrequent.16”

The CDC (HICPAC) guidelines provide additional information on this point as well.

Regards
Brett

Dr Brett Mitchell
Tasmanian Infection Prevention and Control Unit
Department of Health and Human Services

________________________________________

Does anyone have any evidence for or against the use of prophylactic antibiotics when inserting or removing a urinary catheter (particularly in a patient that has undergone/will undergo an orthopaedic procedure)? I am struggling to find any specific recommendations with evidence.
Many thanks

Hayden McDonald
Antimicrobial Stewardship (AMS) Liaison Nurse

St Vincents Private Melbourne
59-61 Victoria Parade, Fitzroy Victoria 3065
T +61 3 9411 7449
F +61 3 9411 7669
http://www.svpm.org.au/

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[Mitchell, Brett (TIPCU)]

Hi Rita

An article published in Healthcare Infection earlier this year may be interest to you (“Disposable biocidal cubical curtains: can they prevent the transfer of bacterial pathogens”) – http://www.publish.csiro.au/paper/HI12015.htm

Thanks
Brett

Brett Mitchell I Asst Director of Nursing Infection Control, TIPCU RN, BN, M.Adv.Prac, CICP, MRCNA
Population Health I Department of Health and Human Services
Post GPO Box 125 Hobart Tas 7001 | Email tipcu@dhhs.tas.gov.au
Phone (03) 6222 7779 | Fax (03) 6233 0553
A fair and healthy Tasmania

—–Original Message—–

Hi Rita,

I have had disposable curtains in place across the whole of hospital for over 1-2 years. I have a procedure for disposable curtains also. If you would like to contact me via my email address, I will send it through to you.

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.au Care Excellence Collaboration Integrity GERMS CAN KILL…

—–Original Message—–

Dear list members,
Does any of you use disposable curtains in your facility? Do you have a policy or guideline for their use which you might be willing to share?
Kind regards,
Rita

CNC Infection Control | Hornsby & Ku-ring-gai Health Service Palmerston Road, Tel 02 9477 9232 | Pager 52533| rroy@nsccahs.health.nsw.gov.au http://www.health.nsw.gov.au

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[Mitchell, Brett (TIPCU)]

Thanks Michael. This is clearly a topic of interest for many. Following on from Rachels post, which I agree with, perhaps, rather than emailing the entire ACIPC list to request a copy of something, people could contact the relevant person directly – an email is provided when you post a message.

Thanks
Brett

Brett Mitchell I Asst Director of Nursing Infection Control, TIPCU RN, BN, M.Adv.Prac, CICP, MRCNA
Population Health I Department of Health and Human Services
Post GPO Box 125 Hobart Tas 7001 | Email tipcu@dhhs.tas.gov.au
Phone (03) 6222 7779 | Fax (03) 6233 0553
A fair and healthy Tasmania

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Thursday, 15 November 2012 10:42 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Observational Audit Tools for IV Cannulation

Hi Rachel

I really think sharing such tools is a great idea!

Unfortunately Infexion Connexion does not support attachments, so unless any files are hosted elsewhere, we cannot share them through this list.

Maybe ACIPC could be approached to develop a portal that resources could be uploaded to, and then links could be posted on the list?

Cheers
Michael Wishart
ACPCI Infexion Connexion Administrator

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Thomson, Rachel EA (DHHS)
Sent: Thursday, 15 November 2012 8:31 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Observational Audit Tools for IV Cannulation

Hi Rhea and others,

So here is a thingit seems to me that quite a number of people may have a genuine interest in looking at your tool as discussed in a number of forums including the recent IC day in Melbourne. I wonder if you would be willing to post the tool through the Infexion Connexion list? Maybe others might like to do a similar thing so that people can build on their resources, share etc. Just a thought!!

Cheers for now
Rachel

Rachel Thomson

Nurse Unit Manager
Infection Prevention & Control Unit
Royal Hobart Hospital
Ph: 03 62227882/8658
E: rachel.thomson@dhhs.tas.gov.au

[cid:image001.png@01CDC313.CF515020]
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Helen Scott
Sent: Thursday, 15 November 2012 8:34 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Observational Audit Tools for IV Cannulation

Hi, Can I also please have a look,
Thanks,

Helen Scott
Infection Control Co-ordinator |
Nurse Educator |
Nepean Private Hospital
Kingswood, NSW.
Tel 02 4725 8758 | helen.scott@healthscope.com.au

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>>> On 14/11/2012 at 5:08 pm, in message <0C876A281769DB4A91C9CFC6E68C65E80B704FCCA2@EMSCM006.sagemsmrd01.sa.gov.au>, “Moore, Genevieve (Health)” <Genevieve.Moore@HEALTH.SA.GOV.AU> wrote:
Hi Rhea
Can you please share these audit tools with me also as I have looking for an audit tool for IV for a while
Thanks
Genevieve

Genevieve Moore

Diabetes Educator

Clinical Placement Coordinator

Infection Control Link Nurse

Southern Flinders Health – Crystal Brook Campus
Country Health SA Local Health Network
Edmund Terrace
Crystal Brook SA 5523

Tel: (08) 8636 1164

Fax: (08) 8636 2077
Email: Genevieve.moore@health.sa.gov.au

This email may contain confidential information, which also may be legally privileged. Only the intended recipient(s) may access, use, distribute or copy this email. If this email is received in error, please inform the sender by return email and delete the original. If there are doubts about the validity of this message, please contact the sender by telephone. It is the recipients responsibility to check the email and any attached files for viruses.

________________________________
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of MARTIN, Rhea
Sent: Wednesday, 14 November 2012 16:19
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Observational Audit Tools for IV Cannulation

Hi Craig,
Would be happy to share audit tool with you. We use two, one audits insertion (use this in ED where there is plenty of action) and the other is a ward based audit tool which looks at management of IVs on the ward
Rhea

Rhea Martin
Manager Infection Control Team
Austin Health
Studley Rd., Heidelberg
Victoria, Australia 3084
Phone 9496 5801
Page 2556
Mobile 0407 806 299

From: Craig Boutlis [mailto:Craig.Boutlis@SESIAHS.HEALTH.NSW.GOV.AU]
Sent: Wednesday, 14 November 2012 16:37
To: MARTIN, Rhea
Subject: FW: Observational Audit Tools for IV Cannulation

Hi Rhea,

I’m pretty sure that you would be on this email list but I thought I should forward this to you just in case. Would you be happy to share the audit tool that you presented at the recent Melbourne Infection Control education day? If so, would you mind cc’ing me in too?

The NSW policy is out for review at the moment and I’m going to make sure that I contribute that we should be moving to credentialling statewide along the lines of your program (thanks for making me aware of it).

Craig

________________________________
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Joe-Anne Bendall
Sent: Wednesday, 14 November 2012 4:12 PM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Observational Audit Tools for IV Cannulation
Hi everyone

I have a very keen medical officer who wants to be a champion for improving IV cannula insertion. Does anyone have an observational audit tool they would like to share?

I have an observational audit tool for aseptic technique wound dressing I would be willing to swap for IV cannula insertion!

Thanks

Joe

Joe-anne Bendall
Infection Prevention and Control CNC
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
Sydney 2000

Phone: 93827199
Mobile: 0418984255
Fax: 93827510
Page: 21552

Joe-Anne.Bendall@sesiahs.health.nsw.gov.au

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[Mitchell, Brett (TIPCU)]

Hi Carien

Yes – please see –
http://www.dhhs.tas.gov.au/peh/tasmanian_infection_prevention_and_contro
l_unit/information_for_healthcare_workers/guidance_and_policies_for_heal
thcare_workers

In the Guidance for the management of MRSA… and Guidance for the
management of VRE…. are sections related to screening and precautions
etc. This is what we generally use the majority of mental health
services in Tasmania.

Thanks

Brett

Brett Mitchell | RN, BN, M.Adv.Prac, CICP, MRCNA

Infection Prevention & Control Unit

Population Health | Department of Health and Human Services

Phone (03) 6222 7779 | Fax (03) 6233 0553

GPO Box 125, Hobart, Tasmania, 7001, 3rd Floor, 25 Argyle St, Hobart

http://www.dhhs.tas.gov.au/tipcu

Behalf Of Carien Coleman

Hi,

We have a Mental health unit as part of our facility. Does anyone have
information re the screening of mental health patients for MRO’s and if
positive what precautions do you instigate? Same as for clinical areas?

Kind regards,

Carien

Carien Coleman | Infection Control CNC

The Sunshine Coast Private Hospital

Syd Lingard Drive | BUDERIM QLD 4556

PO Box 5050 | Maroochydore BC QLD 4558

T: (07) 5430 3245 | F: (07) 5430 3436

E: carien.coleman@uchealth.com.au

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[Mitchell, Brett (TIPCU)]

Hi Ingrid
In Tasmania, acute hospitals have infections rates for SAB, CDI, VRE,
hand hygiene etc published publicly. There are published on the
Tasmanian Infection Prevention & Control Unit’s website, which is
publicly available. The web address is very long so just do a search for
the unit on Google.

For the first few reports, we did media releases and worked with the
media in understanding the reports e.g. we gave them a presentation!

Thanks
Brett

Mr Brett Mitchell (RN, BN, MSc, CICP, MRCNA)
Director of Tasmanian Infection Prevention & Control Unit (TIPCU)

—–Original Message—–
Behalf Of Tribe, Ingrid (Health)

Are there any healthcare facilities publicly reporting infection rates?
If so, how are you reporting this information? Is anyone using the
internet for this purpose?
>
> Kind Regards
>
> Ingrid Tribe
RN,BN,GDip QI HlthCare, MMedSci(ClinEpid)
Coordinator, Infection Control Service
Flinders Medical Centre
Bedford Park
South Australia 5042
Australia
T: 08-8204 5051
F: 08-8204 4733
W: ingrid.tribe@health.sa.gov.au

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