[Claire Rickard]

Hi Fiona and Michael,

to my knowledge there is no trial to prove this one way or the other.

Given this is a hole in the skin and the blood vessel, and removal of the device may irritate the local skin thus stirring up the resident microorganisms, I would think it justified to use some form of antiseptic to clean the site prior to removal.

Particularly since this is a quick and low cost intervention, and there is commonly dried blood or moisture at the site which may potentially eight infection risk if not removed.

It’s likely then going to sit under a plastic dressing for a few days, so it would be nice to know that the microbial load had been reduced prior to applying that.
As always-important to let the antiseptic dry 1st to let it work, as well as to avoid all of the “allergies” that people blame on the dressings, which are probably more often caused by a non-dry antiseptic.

Given the device is coming out, it could be argued that 70% alcohol would be adequate (potentially we don’t need the ongoing effect of chlorhexidine), but for the sake of consistency and feasibility of what is on the shelf et cetera, probably I’d go with the chlorhexidine and alcohol.

That’s my opinion based five cents anyway, Claire

Kind regards,

Dr Claire Rickard RN PhD FAHMS FACN
Director, Alliance for Vascular Access Teaching and Research
Menzies Health Institute Queensland
and
Professor of Nursing, School of Nursing and Midwifery
Griffith University, Australia

P.S. This email may have been dictated, please excuse any errors.

Hi Fiona

Thanks for asking this, has created a discussion here!

Our policy does not specify whether to clean the skin prior to sheath removal with any agent, but on talking to our critical care staff there is quite a bit of variation in actual practice.

* Some treat as an IV access procedure, and use 2% chlorhexidine and alcohol prior to removal;
* Some cleanse with normal saline prior to removal;
* Some just wipe the skin with gauze if there is blood or fluid at the site prior to removal.
Can’t see anything glaringly obvious in a number of cath lab sheath removal protocols from around the world from a quick google search, so it might be something there is not much data on.

Will ask the vascular access researchers at AVATAR to see if they have any data to inform this.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

Hi All,

We are currently reviewing our protocols for the removal of arterial and venous sheaths, and are having discussions regarding the site being cleaned prior to removal. I am interested if other facilities undertake a skin prep / cleanse prior to removal and if you do what products do you use?

Kind regards,

Fiona De Sousa CICP-E| Nurse Manager | Infection Prevention & Control Unit
Launceston General Hospital, Level 2, Launceston TAS 7250
phone: 6777 6715 | mobile: 0408 487 197 | fax: 6777 5170 | email: fiona.de.sousa@ths.tas.gov.au |
intranet: http://www.dhhs.tas.gov.au/intranet/thon/infection_control

IPCU – ‘By working together we promote a culture of safety to reduce preventable infections and transmission of multi-resistant organisms’

________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.

______________________________________________________________________
This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return https://clicktime.symantec.com/36JsQxC23zPnvkQSL4NDBnA7Vc?uemail%2C%20delete%20the%20Email%2C%20and%20do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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 acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

______________________________________________________________________
This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return email, delete the Email, and do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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 acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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 acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

[Claire Rickard]

[Claire Rickard]

Hi Fiona

That’s exciting!!

Main decisions:

* Is this an insertion only or full service (insertion + surveillance, research, education, policy, QI, product assessment)
* Is this targeted at only 1 or 2 line types or the full spectrum
* Where does the service ‘sit’ – nursing/pharmacy/anaesthetics/ID/ICU/radiology etc – and importantly, regardless of where it sits how to keep all stakeholders involved.

Luckily there are lots of good resources out there.

This paper reviews a few difference services around Australia: Kleidon T, Alexandrou E, Mifflin N, McManus C. Vascular access services around Australia. Vascular Access Apr 2017;3(1):26-29.

This one is on NPs: Ullman AJ, Kleidon T, Rickard CM. The role of the vascular access nurse practitioner in developing evidence, promoting evidence-based vascular access practice and improving health services. Vascular Access 1(1):10-20

Here’s a few prepared by the Infusion Nurses Society who are based in USA but have members all over the world, including a chapter in NZ. https://www.ins1.org/default.aspx

J Infus Nurs. 2014 Sep-Oct;37(5):321-46. doi: 10.1097/NAN.0000000000000062.
Making the business case for infusion teams: the purpose, people, and process.
Hadaway L, Wise M, Orr M, Bayless A, Dalton L, Guerin G.

J Infus Nurs. 2013 Sep-Oct;36(5):356-60. doi: 10.1097/NAN.0b013e3182a123a9.
Infusion teams in acute care hospitals: call for a business approach: an infusion nurses society white paper.
Hadaway L, Dalton L, Mercanti-Erieg L.
Infusion Teams: Demonstrating Value to Ensure Continued Viability. Infection Control Today. 2018. Kelly Pyrek.
https://www.infectioncontroltoday.com/infusion-vascular-access/infusion-teams-demonstrating-value-ensure-continued-viability

Australia’s first NP in vascular access was Tricia Kleidon who still leads the VAMS team at QLD Children’s Hospital, I am sure she would be happy to discuss Tricia.Kleidon@health.qld.gov.au She has published a lot (just a few here)

Kleidon P, Ullman A, Chaseline B, Schoutrop J, Zhang L, Mihala G, Rickard CM. How does your PICCOMPARE? A pilot randomized controlled trial comparing various PICC materials in pediatrics. Journal of Hospital Medicine. 2018 Feb on-line. DOI: 10.12788/jhm.2911 *Editor’s pick*

Kleidon TM, Ullman AJ, Gibson V, Chaseling B, Schoutrop J, Mihala G, Rickard CM. A Pilot Randomized Controlled Trial of Novel Dressing and Securement Techniques in 101 Pediatric Patients. J Vasc Interv Radiol. 2017 Sep 18.

Ullman AJ, Cooke M, Kleidon T, Rickard CM. J Paediatr Child Health. Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care. J Paediatr Child Health. 2017 Feb;53(2):123-130. doi: 10.1111/jpc.13347. Epub 2016 Oct 6.
Ullman AJ, Kleidon T, Cooke M, Rickard CM. Substantial harm associated with failure of chronic paediatric central venous access devices. BMJ Case Rep. 2017 Jul 6;2017
Ullman AJ, Kleidon T, Gibson V, McBride CA, Mihala G, Cooke M, Rickard CM. Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trial. BMC Cancer (2017) 17:595
Kleidon T, Illing A, Fogarty G, Edwards R, Tomlinson J, Ullman A. Improving the central venous access devices maintenance process to reduce associated infections in paediatrics: evaluation of a practical multi-faceted quality-improvement initiative. Healthcare Infection.

A lot of work has been done in Sydney at Liverpool Hospital, I’m sure Evan Alexandrou (CNC) would be happy to discuss E.Alexandrou@westernsydney.edu.au. They insert the full spectrum of lines including now extending to ports! Their results in terms of clinical outcomes are impressive and they have published several papers (just a few here…PM me if you want them).

Alexandrou E, Mifflin N, McManus C, Sou V, Frost SA. Extended dwell peripheral catheters in patients with difficult venous access: Comparison of a peripheral intravenous catheter and midline catheter. Vascular Access, Volume 4 Issue 1, April 2018.

Sou V, McManus C, Mifflin M, Frost SA, Ale J, Alexandrou E. A clinical pathway for the management of difficult venous access. BMC Nursing (2017) 16:64

Alexandrou E, Ray-Barruel G, Carr PJ, Frost SA, Inwood S, Higgins N, Lin F, Alberto L, Mermel L, Rickard CM, OMG Study Group. Use of short peripheral intravenous catheters: characteristics, management, and outcomes worldwide. J Hosp Med. Online Only. May 30, 2018. doi: 10.12788/jhm.3039
Appendix_2_study_recruitment_collaborators Appendix 3 Number_of_hospitals_and_pivcs_assessed Appendix_4-1_-_pivc_dressing_gauze_tape Appendix_4-2_-_compromised_pivc_dressings Appendix_4-3_-_symptoms_of_phlebitis
Appendix_4-4_-_other_signs_of_pivc_malfunction Appendix_4-5_-_idle_pivcs Appendix_4-6_-_no_documented_pivc_insertion_date_or_time Appendix_4_-_pivc_dressing_non_sterile_tape

Central venous catheter placement by advanced practice nurses demonstrates low procedural complication and infection rates–a report from 13 years of service*.

Alexandrou E, Spencer TR, Frost SA, Mifflin N, Davidson PM, Hillman KM.

Crit Care Med. 2014 Mar;42(3):536-43. doi: 10.1097/CCM.0b013e3182a667f0.

Nurse-led central venous catheter insertion-procedural characteristics and outcomes of three intensive care based catheter placement services.

Alexandrou E, Murgo M, Calabria E, Spencer TR, Carpen H, Brennan K, Frost SA, Davidson PM, Hillman KM.

Int J Nurs Stud. 2012 Feb;49(2):162-8. doi: 10.1016/j.ijnurstu.2011.08.011. Epub 2011 Sep 23.

A review of the nursing role in central venous cannulation: implications for practice policy and research.

Alexandrou E, Spencer TR, Frost SA, Parr MJ, Davidson PM, Hillman KM.

J Clin Nurs. 2010 Jun;19(11-12):1485-94. doi: 10.1111/j.1365-2702.2009.02910.x. Epub 2009 Sep 4. Review.

Kind regards,

Dr Claire Rickard RN PhD FAHMS FACN
Director, Alliance for Vascular Access Teaching and Research
Menzies Health Institute Queensland
and
Professor of Nursing, School of Nursing and Midwifery
Griffith University, Australia

Hi Fiona,

We have had a VAS Team for the past 6 months and are now waiting on our new CEO to see if we can have the team permanently .
We partially modelled it on the Princess Alexander Hospital in Queensland but with the some changes.
Happy to share resources, J&P etc just email me off line and will get back to you on Monday.

Merry Christmas and Happy New Year to everyone 🙂

Kind Regards

Marija Juraja |Nurse Unit Manager -CALHN Infection Prevention & Control Unit|
Division of Acute Medicine (RN, GCNS Inf Ctrl, CICP-E)
t: +61 8 7074 2810 (RAH) 8222 7588 (TQEH)| M: 0466 379 821|e:marija.juraja@sa.gov.au |
Adjunct Clinical Lecturer | University of South Australia | Division of Health Sciences
[cid:image001.jpg@01D4988C.FCB94270] [cid:image003.png@01D492DB.015F8F80]

Hi All,

We are exploring the concept of a nurse led Vascular Access Team. I was hoping there may be some wise people out there who are willing to share their experience with the setting up of such a team or else to provide contact details of someone we can speak with.

Happy for you to email me personally with details.

Kind regards,

Fiona De Sousa CICP-E| Nurse Manager | Infection Prevention & Control Unit
Launceston General Hospital, Level 2, Launceston TAS 7250
phone: 6777 6715 | mobile: 0408 487 197 | fax: 6777 5170 | email: fiona.de.sousa@ths.tas.gov.au |
intranet: http://www.dhhs.tas.gov.au/intranet/thon/infection_control

IPCU – ‘By working together we promote a culture of safety to reduce preventable infections and transmission of multi-resistant organisms’

________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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 acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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 acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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 acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

Hi Vicki
We just finished a multi-site RCT on 4 day vs 7 day replacement of IV
tubing of crystalloids and medications in crystalloid. From a BSI
perspective, there was no benefit in replacing infusion (including
non-lipid PN) tubing before 7 days. Exemptions to this (not studied) were
blood, lipids, chemo, inotropes. We recommend change of all infusions and
tubing at any time if there is suspected sepsis (even if the CVC is not
resited), just in case one of the infusions is contaminated and is the
source.
We didn’t study morphine specifically but there would have been plenty of
morph infusions in the ICUs. I’m not sure how many adhered to 24 hour
bag/syringe replacement but Emily Larsen (Project Manage) might know – she
will be presenting this at ACIPC if you would like to catch up with her you
can get her on e.larsen@griffith.edu.au

Healthy wishes
Claire

On 12 September 2017 at 12:05, Vicki Denyer wrote:

> *Hi All, *
>
>
>
>
>
> *Would appreciate any assistance with this issue*
>
>
>
>
>
> *Do you know of any policy that describes how long a prefilled IV
> medication can hang for?*
>
>
>
> *I had it in mind that ALL IV infusions should be replaced at 24 hours to
> reduce risk of infection (even if its a prefilled bag) but I cant find
> this documented anywhere.*
>
> *e.g. patient in ICU using a prefilled morphine bag, bag is stable for >24
> hours, and the dose is low enough that it would last 3 days. Nurses have
> been changing every 24 hours but someone asked me today if they *had to*.*
>
>
>
>
>
>
>
> *Thanks*
>
>
>
> *Vicki*
>
>
>
> *Vicki Denyer*
>
>
>
> Infection Prevention & Control Clinical Nurse Consultant
>
> Lismore Base Hospital
>
> Ph: 02 66 202385
>
> Fax: 02 66 202287
>
>
>
>
>
> *Infection Prevention & Control is Everyones Business*
>
>
>
>
>
>
>
> ——————————
>
> This 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 AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>

—

*Claire Rickard | RN PhD FAHMS FACN*
*Director*

*|**Alliance for Vascular Access Teaching and Research (AVATAR)*
*Professor*

*|**National Centre of Research Excellence in Nursing Interventions*

*|**Menzies Health Institute Queensland*
*Visiting Scholar*

*|**Princess Alexandra*

*|**Prince Charles*

*|**Royal Brisbane & Women’s Hospitals *
*Honorary Professor*

*|**University of Manchester*

*Assistant: Jo Wright *

*| *

*T +61 7 373 54886 | E jo.wright@griffith.edu.au
*

*School of Nursing and Midwifery*
*Ranked **#1*
* in Queensland**34th*
* in the World*2017 QS World University rankings by subject

*Interested in IV research? http://www.avatargroup.org.au
*
*Follow the AVATAR Group*

PRIVILEGED – PRIVATE AND CONFIDENTIAL

This email and any files transmitted with it are intended solely for the
use of the addressee(s) and may contain information which is confidential
or privileged. If you receive this email and you are not the addressee (or
responsible for delivery of the email to the addressee) please disregard
the contents of the email, delete the email and notify the author
immediately.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

Hi all,

Dr Gillian Ray-Barruel is doing really fantastic stuff developing and
validating a better tool for PIV assessment, called I-DECIDED. It prompts
decision-making and action (not JUST documentation) and looks beyond
phlebitis/infection to other biggies like occlusion, redundancy and
dislodgement.

Give her an email if you are keen to help!
http://www.avatargroup.org.au/i-decided.html

I pondered on the question about holding back on clinically indicated PIV
removal until we can be sure all PIVs are reliably assessed and documented.

This seems to come from an urban legend that in the trials clinical
care/documentation was pristine and perfect, and that is the only reason
clinically indicated removal was safe. Having seen the trial patients with
my own eyes, that was definitely not the case!!

In the research trials, everything except the removal policy was the same
as usual clinical care – and I can tell you that the PIVs were not always
reliably assessed and documented by clinical staff then either.

In the trials, research staff did *separate *assessments and kept these
documented separately, the bedside staff did not see those and so they
couldn’t be influenced by them.

Bedside staff carried on their own usual way of doing things, used their
own charting/forms etc – and care was not always good (particularly back
then, when less people were interested in PIV quality care).

In other words, yes the results are generalisable to your average big, busy
hospital, where PIV care is not always perfect and not always documented.

If you’re interested in this topic, The US Society for Hospital Medicine
just had an editorial on PIV removal as part of their series on Choosing
Hosp Med. 2017 Jan;12(1):42-45. Routine replacement of peripheral
intravenous catheters.

Healthy wishes

Claire

*Claire Rickard | RN PhD FAHMS FACN*
*Director*

*|**Alliance for Vascular Access Teaching and Research (AVATAR)*
*Professor*

*|**National Centre of Research Excellence in Nursing Interventions*

*|**Menzies Health Institute Queensland*
*Visiting Scholar*

*|**Princess Alexandra*

*|**Prince Charles*

*|**Royal Brisbane & Women’s Hospitals *
*Honorary Professor*

*|**University of Manchester*

*Assistant: Jo Wright *

*| *

*T +61 7 373 54886 | E jo.wright@griffith.edu.au
*

*School of Nursing and Midwifery*
*Ranked **#1*
* in Queensland**34th*
* in the World*2017 QS World University rankings by subject

*Interested in IV research? http://www.avatargroup.org.au
*
*Follow the AVATAR Group*

PRIVILEGED – PRIVATE AND CONFIDENTIAL

This email and any files transmitted with it are intended solely for the
use of the addressee(s) and may contain information which is confidential
or privileged. If you receive this email and you are not the addressee (or
responsible for delivery of the email to the addressee) please disregard
the contents of the email, delete the email and notify the author
immediately.

On 21 July 2017 at 14:27, Gonelli, Susan wrote:

> Hi Kerrie,
>
>
>
> At this stage we are focusing on getting staff to complete the form and
> document assessment each shift in the first instance. If compliance is
> good we may consider it in the future but not at this stage
>
>
>
> Regards
>
>
>
> *Sue Gonelli CNC Infection Prevention and Control Unit*
>
> Infection Prevention and Control Unit PO Box 52, Frankston Vic 3199
>
> Direct * 9784 7722 * * *Mobile* 0408 234 497 ** *Fax *9784 2347**
> *Switchboard *03* *9784 7777*
>
> *sgonelli@phcn.vic.gov.au *
>
>
>
>
>
>
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *CURTIS, Kerrie
> *Sent:* Friday, 21 July 2017 1:54 PM
>
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: PIVC Documentation
>
>
>
> Hi Sue
>
>
>
> I applaud your excellent PIV documentation!
>
>
>
> There is Cochrane evidence to support clinically indicated removal of PIVs
> compared to routine replacement are there any plans for the future to
> move to clinically indicated removal?
>
>
>
> Kind regards
> Kerrie
>
>
>
>
>
>
>
> *Kerrie Curtis |* Clinical Nurse Specialist | Day Oncology
> ——————————
>
> *Olivia Newton John Cancer and Wellness Centre / Austin Health*
> e: kerrie.curtis@austin.org.au
> w: 03 9496 3488
> a: 245 Studley Road Heidelberg VIC 3084
>
>
> Victorian rep. for *Australian Vascular Access Associatio*n (AVAS)
> Deputy Chair, *Cancer Nurses Society of Australia*, Vascular Access
> Device and Infusional Therapy SPN Victorian
> Chapter Lead for *Alliance for Vascular Access Teaching and Research*
> (AVATAR)
> Adjunct Research Fellow, *AVATAR*, Menzies Health Institute, *Griffith
> University, Queensland*
>
>
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU
> ] *On Behalf Of *Gonelli, Susan
> *Sent:* Friday, 21 July 2017 7:47 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: PIVC Documentation
>
>
>
> Hi Sonja
>
> We use this one at PH.
>
>
>
> Regards
>
>
>
> *Sue Gonelli CNC Infection Prevention and Control Unit*
>
> Infection Prevention and Control Unit PO Box 52, Frankston Vic 3199
>
> Direct * 9784 7722 * * *Mobile* 0408 234 497 ** *Fax *9784 2347**
> *Switchboard *03* *9784 7777*
>
> *sgonelli@phcn.vic.gov.au *
>
>
>
>
>
>
>
>
>
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU
> ] *On Behalf Of *sonja wegert
> *Sent:* Thursday, 20 July 2017 1:39 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* [SUSPICIOUS MESSAGE] PIVC Documentation
>
>
>
> *Possible Spam or Malicious Phishing email, If you are not sure the email
> sender, please report this to IT ServiceDesk @7815.*
>
> Hello All,
>
>
>
> We are looking to improve our compliance with documentation regarding
> insertion and removal of PIVC in our medical notes. Does anybody has any
> forms/tools or ideas which work and happy to share?
>
>
>
> Regards
>
> Sonja
>
>
>
> *Sonja Wegert | *Infection Control Practitioner (ICP)
>
> Infection Prevention and Control Unit | Central Australia Health Service
>
> Northern Territory Government
>
> Alice Springs Hospital, Gap Rd, Alice Springs
>
> GPO Box 2234, Suburb, NT Postcode
>
> *p … 08 89517977*
>
> *e … **sonja.wegert@nt.gov.au **
> http://www.nt.gov.au/health
> *
>
>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

Dear Cate, it is only recomended to do a tip culture if there is a
suspected catheter related bloodstream infection, as well as percutaneously
drawn BCs (IDSA Guidelines – attached).

Of course some lines are not removed even if CRBSI is suspected (e.g.
Hickmans may try to be salvaged with an ethanol lock etc), so in those
cases it is recommended to take a percutaneously drawn blood culture PLUS a
CVC drawn blood culture – as you can diagnosis CRBSI that way using
differential time to positivity criteria (IDSA).

There is no benefit in routine tip culturing off all lines, as you don’t
pick up any more CRBSI, than if you do it on clinical suspicion of CRBSI
(Maki – attached). As you point out, a +ve tip culture on its own is
difficult to attribute meaning to, unless there is also a +ve BC.

In QLD we stopped doing routine tip cultures on all CVCs several years ago.
Sometimes even if CRBSI is suspected and the line removed, we keep the tip
in pathology until the BC finishes growing, and only culture it if the BC
is positive. I don’t know if anyone has validated how long that is OK to
do, but that can be a practical decision sometimes depending on lab staff
availability etc.

Healthy wishes
C

On 16 March 2017 at 12:42, Cate Coffey wrote:

> Hi everyone
>
> We are updating our policies and I notice that our CVC and Vascath polices
> recommend culturing the tip of CVC. Could you tell me if there is evidence
> to support this practice Wouldnt a blood culture be more appropriate to
> diagnose infection? Can there be a CVC tip infection without bloodstream
> infection and what is the relevance if there is?
>
> We do not have 24 hour pathology service so it means that tip cultures
> could only be sent during lab hours?
>
> Can you let me know your thoughts?
>
> *Cate Coffey | *Clinical Nurse Consultant
>
> Infection Prevention and Control Unit | Central Australia Health Service
>
> Northern Territory Government
>
> Alice Springs Hopsital, Gap Rd, Alice Springs
>
> GPO Box 2234, Suburb, NT Postcode
>
> *p … 08 89517737*
>
> *e … **cate.coffey@nt.gov.au ** http://www.nt.gov.au/health
> *
>
>
>
> *Our Vision:* *Better health outcomes for all Central Australians*
>
> *Our Values:* *Community at the Centre **| **Equity and Integrity* *| **We
> are Accountable* *| **We are Relevant Today and Ready for Tomorrow* *|* *We
> are Committed to High Quality Care* *| **We Value our Partnerships*
>
>
>
>
> *Central Australia Health Service is a Smoke Free Workplace*
>
>
>
> The information in this e-mail is intended solely for the addressee named.
> It may contain legally privileged or confidential information that is
> subject to copyright. If you are not the intended recipient you must not
> use, disclose copy or distribute this communication. If you have received
> this message in error, please delete the e-mail and notify the sender. No
> representation is made that this e-mail is free of viruses. Virus scanning
> is recommended and is the responsibility of the recipient.
>
>
>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>

—

*Claire Rickard **RN PhD FAHMS FACN*
*Director, Alliance for Vascular Access Teaching and Research
(AVATAR), & **Professor, National
Centre of Research Excellence in Nursing Interventions, Menzies Health
Institute Queensland*

*Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane &
Women’s Hospitals*
*Honorary Professor, University of Manchester*

*Interested in IV research? http://www.avatargroup.org.au
*

*Follow the AVATAR Group*

*Interested in joining AVAS? http://www.avas.org.au *

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

Hi Lindy, I agree with Tim & Carolyn, you could use 70% alcohol (and of
course let it dry :)). If this is going to be a regular patient, there is
another good agent (and generally well tolerated e.g. Used in
neonates) called octenidine which is used ++ in Europe but not currently
registered in Aust, u could get your pharmacist to get Special Access
Scheme approval from TGA and order from o/s.

Hope this helps, C

*Claire Rickard **RN PhD FAHMS FACN*
*Director, Alliance for Vascular Access Teaching and Research
(AVATAR), & **Professor, National
Centre of Research Excellence in Nursing Interventions, Menzies Health
Institute Queensland*

*Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane &
Women’s Hospitals*
*Honorary Professor, University of Manchester*

*Interested in IV research? http://www.avatargroup.org.au
*

*Follow the AVATAR Group*

*Interested in joining AVAS? http://www.avas.org.au *

On 9 December 2016 at 08:59, wrote:

> Hi Lindy,
> See below for haemodialysis access cleansing that we recommend for
> patients in our dialysis clinics across Australia and Asia Pacific.
>
> 1. Educate patients to wash their fistula with normal liquid hand soap (we
> do not use antimicrobial hand soap) at dedicated clinical hand basins (no
> liquids e.g. dialysate emptied into these sinks) on arrival.
> If patients have mobility issues and can’t access the clinical hand basins
> we offer alcohol based hand rubs to clean their hands and fistula.
>
> 2. We recommend Chlorhexidine (0.5% to 2%) combined with alcohol, swabs
> for all skin cleansing prior to cannulation.
> 2% chlorhexidine can cause skin irritation while rarely have issues with
> 0.5% or 1%chlorhexidine and alcohol.
> If chlorhexidine can’t be tolerated at all we either use povidine iodine
> or plain alcohol swabs.
> The very rare patients who are highly sensitive to everything we just
> ensure very good hand washing and washing fistula with liquid hand soap.
>
>
> With best regards
> * Carolyn Chenoweth*
> Quality & Infection Prevention and Control Manager, Australia
> Asia Pacific Quality & IPC SME. CICP
>
> Fresenius Medical Care Australia Pty Ltd
> Payneham Dialysis Clinic,
> 2 Portrush Road
> PAYNEHAM 5070
> Australia
> T: +61 (0) 8 8165 4313
> M: +61 (0) 407 810 800
> *www.fmc-ag.com*
>
>
>
>
>
> From: “EXTERN ACIPC Infexion Connexion”
> To: AICALIST@AICALIST.ORG.AU
> Date: 09/12/2016 07:59 AM
> Subject: skin prep for haemodyalisis – question
> ——————————
>
>
>
> Hello
>
> We have a pt with sensitivity to povidine /iodine and CHG who has a
> fistula & is having regular haemodialysis .
>
> Other than cleaning her skin with sterile normal saline prior to
> cannulating them for their dialysis is there any other skin antisepsis
> that could be used.
>
> I have looked at referenced from CDC and APIC but there is nothing useful
> re any other skin antisepsis just wondering if anyone out there was using
> anything else in these pts with success or is sterile normal saline the
> only best option to stick with ?
>
> Many thanks
>
> Kind regards
>
> Lindy
>
> *Lindy Ryan*
>
> Infection prevention & Control Clinical Nurse Consultant (CNC) | *Coffs
> Harbour Health Campus*
> Pacific Hwy Coffs Harbour NSW 2450
> Tel (02) 6656 7770 | *lindy.ryan@ncahs.health.nsw.gov.au*
>
> *www.health.nsw.gov.au*
>
>
>
>
> Wise and humane management of the patient is the best safeguard against
> infection
> (Florence Nightingale Circa 1860)
>
>
>
>
>
> ——————————
>
> This 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 AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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*
>
>
> To send a message to the list administrator send an email to
> *aicalist-request@aicalist.org.au* .
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to *listserv@aicalist.org.au*
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>
>

—

*Claire Rickard **RN PhD FAHMS FACN*
*Director, Alliance for Vascular Access Teaching and Research
(AVATAR), & **Professor, National
Centre of Research Excellence in Nursing Interventions, Menzies Health
Institute Queensland*

*Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane &
Women’s Hospitals*
*Honorary Professor, University of Manchester*

*Interested in IV research? http://www.avatargroup.org.au
*

*Follow the AVATAR Group*

*Interested in joining AVAS? http://www.avas.org.au *

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

HI Cath
We have data from various prospective trials and hospital databases, you
are welcome to PM me if there is something specific you would like.
In a recent trial (1 line per patient) CRBSI (not CLABSI) was PICCs
(N666) 1.5%, CVCs (N865) (pooled tunneled, non-tunneled, & ports) 2.2%,
arterial lines (N680) 0.5%, PIVs (N5907) 0.02%.
Healthy wishes
C

On 29 August 2016 at 17:08, Dr Cathryn Murphy wrote:

> Here is the companion old chestnut question that goes with better public
> reporting.
>
>
>
> Is any state aware of new penalties introduced for public hospitals?
>
>
>
> I am aware of Medibank contractual obligations with more than 120 of its
> private hospitals not to cover any additional costs that result from
> certain types of hospital complication or associated re-admissions where
> there is good evidence that these types of complication could be reduced or
> avoided.
>
>
>
> Is the public sector still tolerating CLABSIs without penalty?
>
>
>
> https://www.medibank.com.au/content/about/transforming-
> health/hospital-contracts.html
>
>
>
>
>
> Warm regards
>
> Cath
>
>
>
> Cathryn Murphy MPH PhD CIC
>
> Chief Executive Officer & Creative Director
>
> Infection Control Plus Pty Ltd
>
> PO Box 3079
>
> Burleigh Town 4220
>
> OLD, Australia
>
>
>
> E: Cath@infectioncontrolplus.com.au
>
> M: +61 428 154154
>
> W: infectioncontrolplus.com.au
>
>
>
>
>
>
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Brett Mitchell
> *Sent:* Monday, 11 May 2015 13:17 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Non-payment for non-performance and BSIs
>
>
>
> Hi Michael and Cath,
>
>
>
> Very interest topic. It is also worth noting the value of released bed
> days from infections prevented. There are some good papers on this,
> including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth –
> http://journals.cambridge.org/action/displayAbstract?
> fromPageonline&aid9497698&fileIdS0195941700094418
>
>
>
> You may be interested to hear that this theme and variations thereof, are
> being explored in ACIPC conference this year. Andrew, Nick and Stephan are
> presenting at this conference. There is also a moderated discussion being
> led by an ABC presenter which will discuss the merits and issues in a
> similar theme to the one raised. This discussion with include the CEO of
> the NHPA. More on this to come
>
>
>
> Going to the point of LOS, as you will both know, it is critical such
> calculations of excess LOS due to an infection are done correctly. All too
> often the wrong analysis is undertaken. Adrian Barnett will be talking
> about this during the conference as well.
>
>
>
> Thanks
>
>
>
> Brett
>
>
>
>
>
>
>
> *Associate Professor Brett Mitchell*
>
> Associate Professor of Nursing, *RN, BN, PhD, M.Adv.Prac, CICP, MRCNA*
> *Faculty of Nursing and Health and Director Lifestyle Research Centre**, *
> *Cooranbong*
>
>
> Avondale College Ltd trading as Avondale College of Higher Education
> ACN: 108 186 401 | ABN: 53 108 186 401 | CRICOS: 02731D | TEQSA: PRV12015
> http://www.avondale.edu.au | http://www.designedforlife.me
>
> 185 Fox Valley Road, Wahroonga NSW 2076 Australia
> Telephone: 02 9480 3613 (Sydney Campus Tues-Thurs)| 02 4980 2397 (Lake M
> Monday) Fax: 02 9487 9625
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU
> ] *On Behalf Of *Michael Wishart
> *Sent:* Friday, 8 May 2015 9:16 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: [ACIPC_Infexion_Connexion] Non-payment for non-performance
> and BSIs
>
>
>
> [Posted on behalf of Robert Lansdown, advertising material removed as per
> Rules Moderator]
>
>
>
> Hi Cath,
>
>
>
> Ive always taken a keen interest in funding mechanisms and in particular
> non-payment for non-performance mechanisms for HAIs and I researched the
> topic fairly extensively back in early 2013 prior to writing the attached
> article for our IPH Advisor newsletter (as Mayo Healthcare before our
> transformation to Teleflex Medical Australia). The article summarises the
> Australian ABF system as it was at the time and international experiences
> with performance incentives or penalties.
>
>
>
> At the time of writing (Jan 2013) I was of a similar view that such
> mechanisms were almost inevitable. The adoption of ABF systems at state
> level, introduction of NSQHS standards and increased use of CHADx groups
> (Aus developed Classification of Hospital Acquired Diagnoses) all suggest
> that were moving in the right direction towards greater accountability and
> non-payment for non-payment mechanisms. Unfortunately my experience at a
> ABF 2013 conference session with reluctance from states to embrace such
> mechanisms and the recently weakened position of the IHPA (Independent
> Hospital Pricing Authority) due to changes to the ABF system brought about
> by the 2014 budget make it seem unlikely in the foreseeable future.
>
>
>
> Its my view that a reduction in ALOS will continue to be the most
> compelling argument for investment in HAI prevention strategies for some
> time to come. Its a simple concept but with credit to Prof Stephen Duckett
> and the ABF 2013 conference for the slide, the current ABF system and
> payment based on DRG groups enables units to take any patient movement
> before the mean LOS (i.e. discharge between the low boundary inlier and
> mean) as a profit day by freeing up bed space for extra admissions.
>
>
>
> A favourite topic of mine so happy to chat offline if I can be of
> assistance!
>
>
>
> Kind regards,
>
>
>
> Robert
>
>
>
> *Robert Lansdown* | Product Manager
> *Teleflex Medical Australia & New Zealand*
> M: +61 448 115 274 | Customer Service: 1300 360 226 | W:
> http://www.teleflexmedical.com.au
>
> Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia
>
>
>
> —–Original Message—–
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU
> ] On Behalf Of Cath Murphy
> Sent: Sunday, 3 May 2015 8:41 AM
> To: AICALIST@AICALIST.ORG.AU
> Subject: Non-payment for non-performance and BSIs
>
>
>
> I have recently been asked about current financial incentives and
> disincentives related to bloodstream infection. Ducker and colleagues
> published some great articles around this issue about 2 years ago in MJA
> and suggested it was likely if not assured that hospital funding would soon
> be linked to performance data including HAIs and in particular BSIs. I have
> references if anyone is interested. This is reminiscent of the route the US
> Centers for Medicare and Medicaid adopted during my APIC Presidency.
>
>
>
> My understanding of this so far is that perhaps Queensland is the only
> state in which public hospitals are financially rewarded or penalised for
> being within or outside of BSI thresholds respectively. Could QLD members
> please confirm if this is the case and if so describe the incentive/
> penalty. I am also keen to here if other states have adopted or plan to
> adopt a similar approach for BSI and/or other HAIs.
>
>
>
> My understanding could be very flawed but I would appreciate insights and
> clarification around the process. I am happy to discuss the pros and cons
> of this approach and how APIC responded and the role it adopted offline, my
> contact details are below.
>
>
>
> Regards and thanks
>
> Cath
>
>
>
> Dr Cathryn Murphy RN MPH PhD CIC
>
> Executive Director
>
> Infection Control Plus Pty Ltd
>
> http://www.infectioncontrolplus.com.au
>
> Cath@infectioncontrolplus.com.au
>
>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
>
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
>
>
> 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
>
>
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
>
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>
>
> ______________________________________________________________________
> For the purposes of protecting the integrity and security of the SVHA
> network and the information held on it, all emails to and from any email
> address on the svha.org.au domain (or any other domain of St Vincents
> Health Australia Limited or any of its related bodies corporate) (an SVHA
> Email Address) will pass through and be scanned by the Symantec.cloud anti
> virus and anti spam filter service. These services may be provided by
> Symantec from locations outside of Australia and, if so, this will involve
> any email you send to or receive from an SVHA Email Address being sent to
> and scanned in those locations.
>
> Click here
>
> to report this email as spam.
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>

—

*Claire Rickard **RN PhD FAAHMS FACN*
*Professor, NHMRC Centre of Research Excellence in Nursing Interventions,
Menzies Health Institute Queensland*

*Director, Alliance for Vascular Access Teaching and Research (AVATAR)*

*Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane &
Women’s Hospitals*
*Honorary Professor, University of Manchester*

*Interested in IV research? http://www.avatargroup.org.au
*

*Follow the AVATAR Group*

*Interested in joining AVAS? http://www.avas.org.au *

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

aha thanks Rebecca, now I see they had mentioned ICU days higher up in the
para…..
there’s nothing like making a mistake on a national mailing list 😀
C

Claire Rickard
RN PhD FAAHMS FACN, Professor, NHMRC Centre of Research Excellence in
Nursing Interventions in Hospitalised Patients, Menzies Health Institute
Queensland
Director, Alliance for Vascular Access Teaching and Research (AVATAR)
Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane &
Women’s Hospitals
Honorary Professor, University of Manchester

On 26 October 2015 at 10:52, McCann, Rebecca wrote:

> Hi Michael
>
>
>
> I think Claire has missed that the second rates were calculated using the
> 12,000 patient days both units had .
>
>
>
> Kind Regards
>
>
>
> Rebecca
>
>
>
>
>
> *R**ebecca McCann Program Manager *
> Healthcare Associated Infection Unit (HAIU)
> Communicable Disease Control Directorate Department of Health
> Grace Vaughan House
> 227 Stubbs Terrace
> SHENTON PARK WA 6008
> T:08 9388 4859 M:0439 920 819 F:08 9388 4888
> E:rebecca.mccann@health.wa.gov.au
>
>
> The contents of this e-mail transmission are intended for the named
> recipients only and may contain confidential and/or privileged
> information. If you received this message in error, you must not copy,
> duplicate, forward, print or otherwise distribute any information contained
> herein, but must ensure that this e-mail is permanently deleted and advise
> the sender immediately.
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Claire Rickard
> *Sent:* Monday, 26 October 2015 6:42 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: [ACIPC_Infexion_Connexion] FW: Controversies in Hospital
> Infection Prevention
>
>
>
> Hi Michael, it is indeed very interesting. 2 comments:
>
>
>
> – What were they using for venous access instead?? – while some could have
> been managed on oral treatment – are they using a lot more PIVs and
> midlines, thus ‘hiding’ the risk of infection there?
>
>
>
> What results would we see for those 2 ICUs if they were reporting CABSI in
> ALL vascular access devices – including arterial lines..
>
>
>
> Now that research is coming out showing (a) we don’t have to remove
> non-symptomatic PIVs at 4 days, and (b) the risk of thromobosis/CLABS in
> PICCs is greater than initially thought – we are seeing a switch back in
> use to PIVs and Midlines. So that means some of our infections will move to
> those lines. Hopefully less, but more than we have traditionally had in
> those devices.
>
>
>
> By the way, doing the “pre-post- type studies, it would be easy for a
> hospital in 5 years to conclude “we have seen more PIV infections since we
> started using them longer”, when this is actually due to less PICC/CVC use,
> in sicker more at risk patients. An RCT would control for changes in
> general policy/practice such as the above that happen over time, and thus
> that kind of incorrect conclusion, ..in fact Ricard (no relation LOL did a
> PIV vs CVC trial in ICU a couple of years back). (Abstract below, although
> note that many of what they called PIV “Serious complications” were
> difficult insertions and they did not use ultrasound, so maybe that would
> have helped…).
>
>
>
> – Secondly, their comment that the actual event numbers showed ICU B as
> the better performs is incorrect – 20/7500 and 15/3000 still converts to
> 2.7 (ICU A) and 5.0 (ICU B) per 1000 days.
>
>
>
> C
>
>
>
>
>
> Crit Care Med.
> 2013 Sep;41(9):2108-15.
> doi: 10.1097/CCM.0b013e31828a42c5.
> Central or peripheral catheters for initial venous access of ICU patients:
> a randomized controlled trial.
>
> Ricard JD
>
> 1, Salomon L
>
> , Boyer A
>
> , Thiery G
>
> , Meybeck A
>
> , Roy C
>
> , Pasquet B
>
> , Le Mire E
>
> , Dreyfuss D
>
> .
> Author information
>
> Abstract
> OBJECTIVES:
>
> The vast majority of ICU patients require some form of venous access.
> There are no evidenced-based guidelines concerning the use of either
> central or peripheral venous catheters, despite very different
> complications. It remains unknown which to insert in ICU patients. We
> investigated the rate of catheter-related insertion or maintenance
> complications in two strategies: one favoring the central venous catheters
> and the other peripheral venous catheters.
> DESIGN:
>
> Multicenter, controlled, parallel-group, open-label randomized trial.
> SETTING:
>
> Three French ICUs.
> PATIENTS:
>
> Adult ICU patients with equal central or peripheral venous access
> requirement.
> INTERVENTION:
>
> Patients were randomized to receive central venous catheters or
> peripheralvenous catheters as initial venous access.
> MEASUREMENTS AND RESULTS:
>
> The primary endpoint was the rate of major catheter-related complications
> within 28 days. Secondary endpoints were the rate of minor catheter-related
> complications and a composite score-assessing staff utilization and time
> spent to manage catheter insertions. Analysis was intention to treat. We
> randomly assigned 135 patients to receive a central venous catheter and 128
> patients to receive a peripheral venous catheter. Major catheter-related
> complications were greater in the peripheral venous catheter than in the
> central venous catheter group (133 vs 87, respectively, p0.02) although
> none of those was life threatening. Minor catheter-related complications
> were 201 with central venous catheters and 248 with
> peripheral venous catheters (p0.06). 46% (60/128) patients were managed
> throughout their ICU stay with peripheral venous catheters only. There were
> significantly more peripheral venous catheter-related complications per
> patient in patients managed solely with peripheral venous catheter than in
> patients that received peripheral venous catheter and at least one
> central venous catheter: 1.92 (121/63) versus 1.13 (226/200), p There was no difference in central venous catheter-related complications
> per patient between patients initially randomized to
> peripheral venouscatheters but subsequently crossed-over to
> central venous catheter and patients randomized to the
> central venous catheter group. Kaplan-Meier estimates of survival
> probability did not differ between the two groups.
> CONCLUSION:
>
> In ICU patients with equal central or peripheral venous access
> requirement, central venous catheters should preferably be inserted: a
> strategy associated with less major complications
>
>
>
>
> Claire Rickard
>
> RN PhD FAAHMS FACN, Professor, NHMRC Centre of Research Excellence in
> Nursing Interventions in Hospitalised Patients, Menzies Health Institute
> Queensland
>
> Director, Alliance for Vascular Access Teaching and Research (AVATAR)
>
> Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane &
> Women’s Hospitals
>
> Honorary Professor, University of Manchester
>
> Assistant: Jo.Wright@griffith.edu.au Tel: +61 7 3735 4886
>
>
>
>
>
>
>
> On 26 October 2015 at 07:58, Michael Wishart
> wrote:
>
> I think is very much worthy of further consideration. In the Australian
> context, many acute ICUs have a policy of central line access as a
> criteria of admission to ICU. But if we can appropriately reduce the number
> of central lines inserted, we could indeed reduce the risk of CLABSI to
> that patient group..
>
>
>
> Comments anyone? Any epidemiologists/statisticians out there who have a
> view on this?
>
>
>
> Cheers
>
> Michael
>
>
>
>
>
> *Michael Wishart*
>
> Infection Control Coordinator
>
>
> *A *627 Rode Road, Chermside QLD 4032
> *P *(07) 3326 3068 | *F *(07) 3607 2226 | *E *
> michael.wishart@svha.org.au | *W * http://www.hsnph.org.au
>
> P *Please consider the environment before printing this email*
>
>
>
> *From:* noreply+feedproxy@google.com [mailto:noreply+feedproxy@google.com]
>
> *Sent:* Sunday, 25 October 2015 4:34 PM
> *To:* Michael Wishart
> *Subject:* Controversies in Hospital Infection Prevention
>
>
> Controversies in Hospital Infection Prevention
>
> ——————————
>
> *Denominators matter*
>
>
> Posted: 24 Oct 2015 07:12 PM PDT
>
>
> Let’s perform a thought experiment. At *St. Eligius Hospital*
> there are two ICUs. These
> two ICUs have the same number of beds, the same number of patient days
> (12,000/year), and the same case mix index. In fact, they’re essentially
> identical, except that ICU A has an annual CLABSI rate of 2.7/1,000 central
> line days and ICU B has a CLABSI rate of 5.0/1,000 central line days. Which
> ICU is better performing with regards to CLABSI? Well, without any other
> data to consider, we’d be greatly tempted to conclude that ICU A is the
> better performer since it’s CLABSI rate is nearly one-half that of ICU B.
> Now, let’s add another piece of information: ICU B focused on reducing
> central line placement as a safety intervention–so at year’s end, ICU A
> had 7,500 central line days and ICU B had 3,000 central line days. This
> means that ICU A finished the year with 20 CLABSIs, and ICU B had 15. Now
> it’s clear that ICU B is the better performer despite having the higher
> rate.
>
> This is not just a theoretical problem. During my first rotation on the
> Infectious Diseases Consultation Service at the University of Iowa last
> year, I was struck by the low prevalence of central lines in the medical
> ICU. Turns out my perception was spot on–when I looked at our NHSN data, I
> saw that 3 of our 5 adult ICUs have central line utilization ratios less
> than the 15th percentile nationally. This is not an accidental occurrence;
> clinicians in those ICUs have worked hard to avoid placement of devices
> that are associated with infection. The problem is that the central lines
> that do get placed in these units are concentrated in a group of patients
> that are sicker and more likely to develop CLABSI, since the less sick
> patients will be managed without a central line. Moreover, the denominator
> is reduced. And the result is higher CLABSI rates. Here, no good deed goes
> unpunished.
>
> But there’s an easy fix. Instead of using device days as the denominator,
> use patient days. In our thought experiment, we would see that ICU A would
> have a CLABSI rate of 1.7/1,000 patient days and ICU B would have a rate of
> 1.2/1,000 patient days. The better performer (ICU B) will now have the
> lower rate, as expected. Makes sense, no? CDC should move to address this
> given the financial penalties hospitals now face based on CLABSI rates.
> Changing the denominator would provide an incentive for hospitals to
> aggressively reduce device insertion. And since NHSN has collected patient
> days for decades, there would be no loss of long-term trending. Lastly, use
> of patient-days as a denominator produces a patient-centered metric. Think
> about it: do we really care what fraction of catheters become infected? No!
> Our focus should be on what fraction of and how many *patients* become
> infected, which is also more intuitive for providers at the sharp edge of
> patient care.
>
>
>
>
>
>
> You are subscribed to email updates from Controversies in Hospital
> Infection Prevention .
> To stop receiving these emails, you may unsubscribe now
>
> .
>
> Email delivery powered by Google
>
>
>
>
> ______________________________________________________________________
> For the purposes of protecting the integrity and security of the SVHA
> network and the information held on it, all emails to and from any email
> address on the svha.org.au domain (or any other domain of St Vincents
> Health Australia Limited or any of its related bodies corporate) (an SVHA
> Email Address) will pass through and be scanned by the Symantec.cloud anti
> virus and anti spam filter service. These services may be provided by
> Symantec from locations outside of Australia and, if so, this will involve
> any email you send to or receive from an SVHA Email Address being sent to
> and scanned in those locations.
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>
>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

Hi Michael, it is indeed very interesting. 2 comments:

– What were they using for venous access instead?? – while some could have
been managed on oral treatment – are they using a lot more PIVs and
midlines, thus ‘hiding’ the risk of infection there?

What results would we see for those 2 ICUs if they were reporting CABSI in
ALL vascular access devices – including arterial lines..

Now that research is coming out showing (a) we don’t have to remove
non-symptomatic PIVs at 4 days, and (b) the risk of thromobosis/CLABS in
PICCs is greater than initially thought – we are seeing a switch back in
use to PIVs and Midlines. So that means some of our infections will move to
those lines. Hopefully less, but more than we have traditionally had in
those devices.

By the way, doing the “pre-post- type studies, it would be easy for a
hospital in 5 years to conclude “we have seen more PIV infections since we
started using them longer”, when this is actually due to less PICC/CVC use,
in sicker more at risk patients. An RCT would control for changes in
general policy/practice such as the above that happen over time, and thus
that kind of incorrect conclusion, ..in fact Ricard (no relation LOL did a
PIV vs CVC trial in ICU a couple of years back). (Abstract below, although
note that many of what they called PIV “Serious complications” were
difficult insertions and they did not use ultrasound, so maybe that would
have helped…).

– Secondly, their comment that the actual event numbers showed ICU B as the
better performs is incorrect – 20/7500 and 15/3000 still converts to 2.7
(ICU A) and 5.0 (ICU B) per 1000 days.

C

Crit Care Med.
2013
Sep;41(9):2108-15.
doi: 10.1097/CCM.0b013e31828a42c5.
Central or peripheral catheters for initial venous access of ICU patients:
a randomized controlled trial.
Ricard JD

1, Salomon L

, Boyer A

, Thiery G

, Meybeck A

, Roy C

, Pasquet B

, Le Mire E

, Dreyfuss D

.
Author information

Abstract
OBJECTIVES:

The vast majority of ICU patients require some form of venous access. There
are no evidenced-based guidelines concerning the use of either central or
peripheral venous catheters, despite very different complications. It
remains unknown which to insert in ICU patients. We investigated the rate
of catheter-related insertion or maintenance complications in two
strategies: one favoring the central venous catheters and the other
peripheral venous catheters.
DESIGN:

Multicenter, controlled, parallel-group, open-label randomized trial.
SETTING:

Three French ICUs.
PATIENTS:

Adult ICU patients with equal central or peripheral venous access
requirement.
INTERVENTION:

Patients were randomized to receive central venous catheters or peripheral
venous catheters as initial venous access.
MEASUREMENTS AND RESULTS:

The primary endpoint was the rate of major catheter-related complications
within 28 days. Secondary endpoints were the rate of minor catheter-related
complications and a composite score-assessing staff utilization and time
spent to manage catheter insertions. Analysis was intention to treat. We
randomly assigned 135 patients to receive a central venous catheter and 128
patients to receive a peripheral venous catheter. Major catheter-related
complications were greater in the peripheral venous catheter than in the
central venous catheter group (133 vs 87, respectively, p0.02) although
none of those was life threatening. Minor catheter-related complications
were 201 with central venous catheters and 248 with peripheral venous catheters
(p0.06). 46% (60/128) patients were managed throughout their ICU stay with
peripheral venous catheters only. There were significantly more peripheral
venous catheter-related complications per patient in patients managed
solely with peripheral venous catheter than in patients that received
peripheral venous catheter and at least one central venous catheter: 1.92
(121/63) versus 1.13 (226/200), p<0.005. There was no difference in central
venous catheter-related complications per patient between patients
initially randomized to peripheral venouscatheters but subsequently
crossed-over to central venous catheter and patients randomized to the
central venous catheter group. Kaplan-Meier estimates of survival
probability did not differ between the two groups.
CONCLUSION:

In ICU patients with equal central or peripheral venous access requirement,
central venous catheters should preferably be inserted: a strategy
associated with less major complications

Claire Rickard
RN PhD FAAHMS FACN, Professor, NHMRC Centre of Research Excellence in
Nursing Interventions in Hospitalised Patients, Menzies Health Institute
Queensland
Director, Alliance for Vascular Access Teaching and Research (AVATAR)
Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane &
Women's Hospitals
Honorary Professor, University of Manchester

On 26 October 2015 at 07:58, Michael Wishart
wrote:

> I think is very much worthy of further consideration. In the Australian
> context, many acute ICUs have a policy of central line access as a
> criteria of admission to ICU. But if we can appropriately reduce the number
> of central lines inserted, we could indeed reduce the risk of CLABSI to
> that patient group..
>
>
>
> Comments anyone? Any epidemiologists/statisticians out there who have a
> view on this?
>
>
>
> Cheers
>
> Michael
>
>
>
>
>
> *Michael Wishart*
>
> Infection Control Coordinator
>
>
> *A *627 Rode Road, Chermside QLD 4032
> *P *(07) 3326 3068 | *F *(07) 3607 2226 | *E *
> michael.wishart@svha.org.au | *W * http://www.hsnph.org.au
> [image: cid:image001.png@01D01926.61F1C2B0]
> P *Please consider the environment before printing this email*
>
>
>
> *From:* noreply+feedproxy@google.com [mailto:noreply+feedproxy@google.com]
>
> *Sent:* Sunday, 25 October 2015 4:34 PM
> *To:* Michael Wishart
> *Subject:* Controversies in Hospital Infection Prevention
>
>
> Controversies in Hospital Infection Prevention
>
> ——————————
>
> *Denominators matter*
>
>
> Posted: 24 Oct 2015 07:12 PM PDT
>
>
> Let’s perform a thought experiment. At *St. Eligius Hospital*
> there are two ICUs. These
> two ICUs have the same number of beds, the same number of patient days
> (12,000/year), and the same case mix index. In fact, they’re essentially
> identical, except that ICU A has an annual CLABSI rate of 2.7/1,000 central
> line days and ICU B has a CLABSI rate of 5.0/1,000 central line days. Which
> ICU is better performing with regards to CLABSI? Well, without any other
> data to consider, we’d be greatly tempted to conclude that ICU A is the
> better performer since it’s CLABSI rate is nearly one-half that of ICU B.
> Now, let’s add another piece of information: ICU B focused on reducing
> central line placement as a safety intervention–so at year’s end, ICU A
> had 7,500 central line days and ICU B had 3,000 central line days. This
> means that ICU A finished the year with 20 CLABSIs, and ICU B had 15. Now
> it’s clear that ICU B is the better performer despite having the higher
> rate.
>
> This is not just a theoretical problem. During my first rotation on the
> Infectious Diseases Consultation Service at the University of Iowa last
> year, I was struck by the low prevalence of central lines in the medical
> ICU. Turns out my perception was spot on–when I looked at our NHSN data, I
> saw that 3 of our 5 adult ICUs have central line utilization ratios less
> than the 15th percentile nationally. This is not an accidental occurrence;
> clinicians in those ICUs have worked hard to avoid placement of devices
> that are associated with infection. The problem is that the central lines
> that do get placed in these units are concentrated in a group of patients
> that are sicker and more likely to develop CLABSI, since the less sick
> patients will be managed without a central line. Moreover, the denominator
> is reduced. And the result is higher CLABSI rates. Here, no good deed goes
> unpunished.
>
> But there’s an easy fix. Instead of using device days as the denominator,
> use patient days. In our thought experiment, we would see that ICU A would
> have a CLABSI rate of 1.7/1,000 patient days and ICU B would have a rate of
> 1.2/1,000 patient days. The better performer (ICU B) will now have the
> lower rate, as expected. Makes sense, no? CDC should move to address this
> given the financial penalties hospitals now face based on CLABSI rates.
> Changing the denominator would provide an incentive for hospitals to
> aggressively reduce device insertion. And since NHSN has collected patient
> days for decades, there would be no loss of long-term trending. Lastly, use
> of patient-days as a denominator produces a patient-centered metric. Think
> about it: do we really care what fraction of catheters become infected? No!
> Our focus should be on what fraction of and how many *patients* become
> infected, which is also more intuitive for providers at the sharp edge of
> patient care.
>
>
>
>
> [image: Image removed by sender.]
>
>
>
> You are subscribed to email updates from Controversies in Hospital
> Infection Prevention .
> To stop receiving these emails, you may unsubscribe now
>
> .
>
> Email delivery powered by Google
>
>
>
> ______________________________________________________________________
> For the purposes of protecting the integrity and security of the SVHA
> network and the information held on it, all emails to and from any email
> address on the svha.org.au domain (or any other domain of St Vincents
> Health Australia Limited or any of its related bodies corporate) (an SVHA
> Email Address) will pass through and be scanned by the Symantec.cloud anti
> virus and anti spam filter service. These services may be provided by
> Symantec from locations outside of Australia and, if so, this will involve
> any email you send to or receive from an SVHA Email Address being sent to
> and scanned in those locations.
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

What valuable data, glad you are doing this work.

Congratulations,

C

Claire Rickard RN PhD, Professor, NHMRC Centre of Research Excellence in
Nursing Interventions in Hospitalised Patients, Menzies Health Institute
Queensland, Griffith University
Alliance for Vascular Access Teaching and Research (AVATAR)
Visiting Scholar at the Princess Alexandra, Prince Charles, and Royal
Brisbane & Women’s Hospitals

On 7 June 2015 at 19:29, Michael Wishart
wrote:

> [Posted on behalf of ACIPC President, Belinda Henderson – Moderator]
>
> Thanks for the update Brett – such an important piece of work.
> Congratulations to your team and we certainly look forward to the final
> paper.
> cheers
> Belinda
>
>
> On 2/06/2015 8:22 AM, Brett Mitchell wrote:
>
> Hi,
>
>
>
> Last year, many of you participated in a piece of work exploring infection
> control professionals and infection control units in Australia. Part of
> this work was advertised on this list. On behalf of the research team, we
> are grateful for your assistance.
>
>
>
> By way of feedback, I thought I would provide you with a quick update,
> given this list was critical to one component of the study. To date, we
> have two articles published from this work (summarised below), with three
> more in the wings. We have presented some of this work at the ACIPC
> conference last year, with more to come. Some work was also presented at
> ECCMID in Copenhagen a few weeks ago.
>
>
>
> Our work will culminate, as planned, in a final paper describing
> recommended resourcing for hospital infection control units in Australia.
> We hope that this will occur in late this year or early next. We have
> considerable work to do, digesting the findings from the three different
> data collection processes employed.
>
>
>
> The two papers to date:
>
> Roles, responsibilities and scope of practice: describing the
> state of play for infection control professionals in Australia and New
> Zealand. *Healthcare Infection* (2015), 20 (1), 29-35
>
> o This is the first study >10 years to comprehensively describe the ICP
> workforce in Australia and New Zealand, and their scope of practice.
>
> o ICPs have a varied scoped of practice. Most ICPs have a large number
> and variety of responsibilities.
>
> o ICPs in the private sector were more likely to operate as sole
> practitioners or small teams
>
> o This article is open access i.e. free for downloading from the *Healthcare
> Infection* website.
>
> Hospital infection control units: Staffing, costs, and
> priorities*. American Journal of Infection Control *(2015), 43(6), 612616
>
> o The mean number of infection control professionals was 0.66 per 100
> overnight beds (1 FTE per 152 beds)
>
> o Approximately $76 million is allocated annually to infection control
> nurse staffing.
>
> o Improved information technology systems were reported as a resource
> priority.
>
> o This article can currently be viewed freely, from the AJIC website.
>
>
>
> We will keep you updated on this project.
>
>
>
> Kind regards
>
>
>
> Brett
>
>
>
> *Associate Professor Brett Mitchell*
>
> Associate Professor of Nursing *RN, BN, PhD, M.Adv.Prac, MRCNA*
> *Faculty of Nursing and Health*
>
> *And*
>
> *Director, Lifestyle Research Centre**, **Cooranbong*
>
>
>
>
>
>
> ——————————
>
>
> This email has been checked for viruses by Avast antivirus software.
> http://www.avast.com
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

HI Michael
Interesting…
I know this list is interested in infection 🙂 but I think we would see
better PIV results overall with that approach Michael – compared to a
forearm insertion, ACF insertion HR 1.3 times the risk of
occlusion/infiltration and HR *1.7 times the risk of the accidental
removal. *The hand is even worse…(Wallis et al ICHE 2014, attached)
Of course, it would be optimal if the PIV was placed in the forearm, using
aseptic non touch technique and correct skin preparation, in the first
place 😀 I am talking about PIVs we want to use for ongoing
medicine/infusion of course. Procedural PIVs could still be in the hand/ACF
as long as they are removed afterwards.

Glad PIVs are getting emphasis these days, as well as CVADs!!

C

Claire Rickard RN PhD, Professor, NHMRC Centre of Research Excellence in
Nursing Interventions in Hospitalised Patients, Menzies Health Institute
Queensland, Griffith University
Alliance for Vascular Access Teaching and Research (AVATAR)
Visiting Scholar at the Princess Alexandra, Prince Charles, and Royal
Brisbane & Women’s Hospitals

On 4 June 2015 at 09:57, Michael Wishart
wrote:

> Hi Richard
>
>
>
> We routinely resite any PIV cannula that is in insitu on admission at 24
> hours, regardless of where it was inserted (we cannot be sure it was not
> inserted under emergency conditions). One of the changes we are making now
> is to routinely resite all PIV cannulas inserted into the antecubital fossa
> site within 24 hours. We have seen some significant infections in this
> site, and although we cannot generate a large enough sample to be
> statistically significant, we think this might reduce both the selection of
> the antecubital fossa as a site and also reduce the risk of PIV site
> infections and related bacteraemias. Our ID physician is driving this
> change.
>
>
>
> PIV related bacteraemias do not occur in large enough numbers to make
> statistically significant observations in small sample sizes, so it may be
> difficult without enrolling a million or so cannulas (thats a plug for
> some current research, by the way J ).
>
>
>
> I think making these types of changes needs to be discussed at the local
> level, taking all of your current local factors into account. It will be
> hard to power studies to provide evidence for such changes, though.
>
>
>
> Cheers
>
> Michael
>
>
>
>
>
> *Michael Wishart*
>
> Infection Control Coordinator
>
>
> *A *627 Rode Road, Chermside QLD 4032
> *P *(07) 3326 3068 | *F *(07) 3607 2226 | *E *
> michael.wishart@svha.org.au | *W * http://www.hsnph.org.au
> [image: cid:image001.png@01D01926.61F1C2B0]
> P *Please consider the environment before printing this email*
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Bartolo, Richard
> *Sent:* Thursday, 4 June 2015 7:14 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Peripheral IV cannulas inserted in unfavourable conditions
>
>
>
> Hi Everyone,
>
> At Western Health currently the procedure for Peripheral IV cannulas
> (PIVC) inserted by ambulance personnel in the community, and any PIVC that
> are inserted in a non-sterile manner in hospital (e.g. emergency situation)
> are resited within 24 hours. Due to an increase in cannula related
> infections and amongst other actions, which Im happy to share, we are also
> considering to resite all PIVCs inserted by ambulance and all those
> inserted in the Emergency departments immediately after admission to the
> wards rather than within 24 hours.
>
> Has any other hospital taken this approach?
>
>
>
> Regards,
>
> Richard
>
>
>
> *Richard Bartolo*
> *Manager Infection Prevention*
>
> Western Health
>
> Gordon Street, Footscray VIC 3011
> Ph. 03 8345 6113 Pager. 03 8345 6666 No. 506
> Mob. 0438 560 441
>
> Email. richard.bartolo@wh.org.au
> Web. http://www.westernhealth.org.au
>
>
> [image: 2010wh_logo]
>
> *C* *ompassion**, **A* *ccountability**, **R* *espect**, **E **xcellence**,
> **S* *afety*
>
>
>
> [image: cid:image001.png@01CF0875.78B557E0]
>
>
>
> Notice:
> This email (and any attachment) is for the exclusive use of the addressee
> and may contain information that is privileged, confidential or protected
> by copyrights. If you are not the addressee or the person responsible for
> delivering this email to the addressee, you must not disclose, distribute,
> print or copy this email and the contents must be kept strictly
> confidential. If this email has been sent to you in error, kindly notify us
> immediately on 03 8345 56113 and destroy the original. Electronic mail is
> not secure and there is also a risk that it may be corrupted in
> transmission. It is therefore your responsibility to check this email (and
> any attachment) carefully and if there are any errors to contact us
> immediately. We do not accept liability for any loss or damage caused by
> such lack of security or transmission errors.
>
>
>
>
> ______________________________________________________________________
> For the purposes of protecting the integrity and security of the SVHA
> network and the information held on it, all emails to and from any email
> address on the svha.org.au domain (or any other domain of St Vincents
> Health Australia Limited or any of its related bodies corporate) (an SVHA
> Email Address) will pass through and be scanned by the Symantec.cloud anti
> virus and anti spam filter service. These services may be provided by
> Symantec from locations outside of Australia and, if so, this will involve
> any email you send to or receive from an SVHA Email Address being sent to
> and scanned in those locations.
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>
> ______________________________________________________________________
> For the purposes of protecting the integrity and security of the SVHA
> network and the information held on it, all emails to and from any email
> address on the svha.org.au domain (or any other domain of St Vincents
> Health Australia Limited or any of its related bodies corporate) (an SVHA
> Email Address) will pass through and be scanned by the Symantec.cloud anti
> virus and anti spam filter service. These services may be provided by
> Symantec from locations outside of Australia and, if so, this will involve
> any email you send to or receive from an SVHA Email Address being sent to
> and scanned in those locations.
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

Dear Richard, I’m interested to know what you think is behind this increase
in infections? Is it for example the skin prep, hand hygiene, or the
re-palpation after skin prep?

We discovered a few years ago that the ambulance were not using CHG in
alcohol for their skin prep, even though the hospital had moved to that.
Once this came to the ambulance’s attention they swiftly moved to implement
it in the pre-hospital as well.

In our older, fatter population, preserving veins is important, and in our
analysis of nearly 6000 PIVs (ICHE 2014 Wallis et al), once the first
catheter is removed for whatever reason, the subsequent ones had a
statistically significant 20% higher rate of failure
(occlusion/infiltration etc), presumably due to the ‘best vein’ being
chosen first.

While stop-gap measures may be needed during a ‘spike’, my personal belief
is that it is important to get to the root of the problem, ideally patients
should only need one PIV for the course of their entire admission. It’s our
job to find safe ways of providing that venous access, and we need to work
throughout our departments rather than ending up with the ambulance PIV, ED
PIV, Radiology PIV and Anaesthetic PIV (no joke, we see thisfrequently,
with all lines still being in).

Good luck with this interesting problem 🙂 PM me if you would like to chat
off-line.

All the best

Claire

Claire Rickard RN PhD, Professor, NHMRC Centre of Research Excellence in
Nursing Interventions in Hospitalised Patients, Menzies Health Institute
Queensland, Griffith University
Alliance for Vascular Access Teaching and Research (AVATAR)
Visiting Scholar at the Princess Alexandra, Prince Charles, and Royal
Brisbane & Women’s Hospitals

On 4 June 2015 at 07:14, Bartolo, Richard wrote:

> Hi Everyone,
>
> At Western Health currently the procedure for Peripheral IV cannulas
> (PIVC) inserted by ambulance personnel in the community, and any PIVC that
> are inserted in a non-sterile manner in hospital (e.g. emergency situation)
> are resited within 24 hours. Due to an increase in cannula related
> infections and amongst other actions, which Im happy to share, we are also
> considering to resite all PIVCs inserted by ambulance and all those
> inserted in the Emergency departments immediately after admission to the
> wards rather than within 24 hours.
>
> Has any other hospital taken this approach?
>
>
>
> Regards,
>
> Richard
>
>
>
> *Richard Bartolo*
> *Manager Infection Prevention*
>
> Western Health
>
> Gordon Street, Footscray VIC 3011
> Ph. 03 8345 6113 Pager. 03 8345 6666 No. 506
> Mob. 0438 560 441
>
> Email. richard.bartolo@wh.org.au
> Web. http://www.westernhealth.org.au
>
>
> [image: 2010wh_logo]
>
> *C* *ompassion**, **A* *ccountability**, **R* *espect**, **E **xcellence**,
> **S* *afety*
>
>
>
> [image: cid:image001.png@01CF0875.78B557E0]
>
>
>
> Notice:
> This email (and any attachment) is for the exclusive use of the addressee
> and may contain information that is privileged, confidential or protected
> by copyrights. If you are not the addressee or the person responsible for
> delivering this email to the addressee, you must not disclose, distribute,
> print or copy this email and the contents must be kept strictly
> confidential. If this email has been sent to you in error, kindly notify us
> immediately on 03 8345 56113 and destroy the original. Electronic mail is
> not secure and there is also a risk that it may be corrupted in
> transmission. It is therefore your responsibility to check this email (and
> any attachment) carefully and if there are any errors to contact us
> immediately. We do not accept liability for any loss or damage caused by
> such lack of security or transmission errors.
>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Claire Rickard]

Dear Matthias
It is always such a pleasure to read your posts. You exemplify the approach
to evidence based practice that we all aspire to!!
C

On 21 August 2014 17:56, Matthias Maiwald (KKH) wrote:

> Dear Rachel,
>
>
>
> In response to your question, I would first like to address the primary
> question, then go on to skin antisepsis for spinal procedures.
>
>
>
> If the vials are indeed contained within a sterile package, and the
> sterility of the packaging can be verified, then there is absolutely no
> need to swab the tops of the vials, unless there is a potential
> contamination between unpackaging and use.
>
>
>
> For most vials (that I know — that are NOT contained within sterile
> packaging) I would exactly support the TGA’s statement as cited in italics
> in your e-mail.
>
>
>
> 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.
>
>
>
> The use of skin antiseptics before spinal/epidural anaesthesia is another
> issue. There are a handful of reported cases of severe adhesive
> arachnoiditis (and permanent disability) following the use of
> chlorhexidine/alcohol skin antiseptic before spinal/epidural anaesthesia,
> some of which are discussed in Bogod’s editorial that you have attached.
>
>
>
> As Bogod is discussing, in some cases the causation is obvious. The
> CHG/ALC has been confused with the anaesthetic and a significant quantity
> been injected in the spinal canal. The pathogenesis in these cases is very
> obvious. CHG is known to be neurotoxic, and 70% alcohol is a very
> aggressive substance when coming into contact with mucous membranes or when
> entering body cavities. In this regard, the alcohol probably contributed
> significantly to the pathogenesis. What this means is that in the cases
> where CHG/ALC was injected, the pathogenesis is clear, biological
> plausibility is established, and this would have happened with any (not
> just CHG-containing) skin antiseptic.
>
>
>
> Several other cases remain unclear, where it is NOT obvious and/or has not
> been able to be clarified whether any skin antiseptic has actually been
> injected in the spinal canal, or whether the skin antiseptic was just (!)
> present on the skin surface before injection, mainly because the events
> leading up to the incident would not be properly reconstructed. In one of
> the cases (cited by Bogod) it was reconstructed that about 0.1 mL (100 uL,
> a non-trivial amount) was apparently accidentally injected.
>
>
>
> For cases where CHG/ALC has been properly applied and dried (as per usual
> recommendations) before spinal/epidural injections, biological plausibility
> for linking CHG/ALC with the pathogenesis is — in my personal opinion —
> not clearly established.
>
>
>
> In a hypothetical scenario where the skin antiseptic has not yet dried, I
> have calculated previously (that was in an earlier Infexion Connexion
> e-mail concerning skin antisepsis before injections) that the amount that
> can be brought in with a needle bore would be in the nanolitre range (one
> nanolitre is 0.000001 mL).
>
>
>
> In another hypothetical scenario where the skin antiseptic has dried, the
> amount should be orders of magnitude lower than that.
>
>
>
> A similar calculation (but with a bigger epidural needle bore) has been
> made by Tilakaratna in a letter to the editor in 2009:
>
>
>
> http://bja.oxfordjournals.org/content/103/3/456.full/reply#brjana_el_5066
>
>
>
> As an unexplored issue remains whether potential capillary action along
> the sides of the needles could suck in a solution, but this would only
> apply if the antiseptic has not dried.
>
>
>
> So, these are some of my points.
>
>
>
> Some additional points regarding CHG + ALC and/or persistency requirements
> on skin (see also above, concerning persistency required on vial tops) are
> made in our recent commentary article in JAC:
>
>
>
> Maiwald M, Chan ESY (2014) Pitfalls in evidence assessment: the case of
> chlorhexidine and alcohol in skin antisepsis (Leading Article). J.
> Antimicrob. Chemother 69: 2017-21.
>
> http://dx.doi.org/10.1093/jac/dku121
>
>
>
> It would in turn be interesting to hear what you briefly touch upon, what
> recommendations ANTT frameworks have in terms of alcohol + CHG, and what
> ANTT recommends concerning epidural/ nerve infusion management.
>
>
>
> 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
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Thomson, Rachel EA (DHHS)
> *Sent:* Thursday, 21 August, 2014 11:38 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Use of alcoholic CHG wipes in relation to Epidurals
>
>
>
> Hi all,
>
>
>
> I am very interested in input from list subscribers to the issue
> surrounding use of wipes containing 70% alcohol and 2% CHG to clean the
> tops of vials prior to injecting or drawing up. Most subscribers would be
> aware of the adverse events reported in relation to injection of alcoholic
> CHG into an epidural that has altered practices in relation to insertion
> and management of epidurals. This concern has resulted; it appears, in a
> real concern in relation to the use of wipes on any equipment used in the
> management of epidurals. Please refer to the attached editorial. As the
> bottles of solution used are presented in a sterile form (sealed sterile
> packaging) we have recommended that the tops of these vials do not need
> swabbing prior to use. There do appear, however, to other real concerns
> relating to the potential for adverse events relating to both epidural and
> nerve infusions and possible contamination with chlorhexidine residues.
>
>
>
> Can I ask if anyone would like to make comment on your approach to this
> concern?
>
>
>
> I flag for those who may not be aware the information provided from the
> TGA in July 2014 when the TGA investigated a number of reported cases of an
> unusual infection that were associated with propofol (*Ralstonia* spp.).
> As a result of this specific investigation the TGA issued a statement which
> included the following general information;
>
>
>
> *The exterior surfaces of injection vials are not intended to be sterile.
> Most protective lids do not guarantee sterility of the outer surface of a
> vial rubber stopper/aluminium crimp seal. This lid is intended to act as a
> shield for the rubber stopper and to keep dust and other physical
> contaminants away from it. *
>
> *Noting this, 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 its injection site with a suitable disinfectant
> wipe/swab and allowing it to dry before inserting any device into the vial.
> *
>
>
>
>
> http://www.tga.gov.au/safety/alerts-medicine-provive-mct-lct-140707.htm#.U8h3DZSSxQE
>
>
>
> As ANTT frameworks recommend the use of alcohol + CHG, any comments or
> advice pertaining to ANTT and epidural/ nerve infusion management and your
> organisations/ health service risk management approach would be most
> appreciated .
>
>
>
> Many thanks in advance
>
> Kind regards
>
> Rachel
>
>
>
>
>
> ..
>
> *Rachel Thomson*
>
> Nurse Unit Manager
>
>
>
> *Infection Prevention & Control Unit*
>
> Royal Hobart Hospital
>
> Tasmanian Health Organisation-South
>
> (: 03 62227882/8658
>
> *Mobile*: 0400 718 574
>
> *Email:* rachel.thomson@dhhs.tas.gov.au
>
>
>
> Level 4, H Block
>
> 48 Liverpool Street
>
> Hobart, 7000
>
>
>
>
> ——————————
>
>
> CONFIDENTIALITY NOTICE AND DISCLAIMER
> The information in this transmission may be confidential and/or protected
> by legal professional privilege, and is intended only for the person or
> persons to whom it is addressed. If you are not such a person, you are
> warned that any disclosure, copying or dissemination of the information is
> unauthorised. If you have received the transmission in error, please
> immediately contact this office by telephone, fax or email, to inform us of
> the error and to enable arrangements to be made for the destruction of the
> transmission, or its return at our cost. No liability is accepted for any
> unauthorised use of the information contained in this transmission.
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>
>
>
> kkh
>
> ——————————
> The information contained in this e-mail and the attachments (if any) may
> be privileged and confidential and is intended solely for the named
> addressee. If you are not the intended recipient, please do not print,
> retain copy, disseminate, distribute, or use this e-mail or any part
> thereof. Please notify the sender immediately by replying to this e-mail
> and delete all copies of this e-mail and the attachments.
>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
> 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
>
> To send a message to the list administrator send an email to
> aicalist-request@aicalist.org.au.
>
> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
> the quotes) to listserv@aicalist.org.au
>

—

Best regards, Claire

Interested in IV research? Join us at http://www.omgpivc.org

*Professor Claire Rickard RN PhD*
*Assistant: Jo Wright *Jo.Wright@griffith.edu.au +61 (0)7 3735 4886 (ext
54886)

c.rickard@griffith.edu.au | +61 (0)7 3735 6460 | Skype:
clairexm1 | Twitter: AVATAR_Grp |

Alliance for Vascular Access Teaching and Research (AVATAR Group) | NHMRC
Centre of Research Excellence in Nursing Interventions | Griffith Health
Institute Centre for Health Practice Innovation | Royal Brisbane & Women’s
Hospital | Princess Alexandra Hospital | The Prince Charles Hospital

Research frequently takes me off campus. Please contact
Jo.Wright@griffith.edu.au 3735 4886, or School Secretary (Nathan) Jenny
Chan 3735 5406 *j.chan@griffith.edu.au* for urgent
enquiries.

“I’m not telling you it’s going to be easy. I’m telling you it’s going to
be worth it.” Art Williams*.*

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

[Author]

Posts