[Claire Rickard]

Hello Michael

Amanda Ullman recently (2013) updated the Cochrane Review on this topic.
Extending AS use from 72 to 96 days appears safe (including for non-lipid
PN), but there are inadequate studies looking at longer periods to draw
strong conclusions. The exception to this is lipid administration to
neonates where less frequent replacement in one study was linked to
increased infections. Apart from that, all comparisons whether 24 vs 48
hour, or 48 vs 72, 72 vs 96 etc have never found any sign of increased
infection by changing sets less frequently (just reduced costs).

The CDC (2011) now advocate replacement “between 4 and 7 days” for all
lines, based on the Cochrane Review. I agree there is higher uptake in ICUs
of 7 day replacement in ICUs, this is in part due to an Australian ICU RCT
which found 4 and 7 days equivalent for infection, although some guidelines
say only to go to 7 days if you are using antimicrobial lines since that
was what was studied.

We are currently recruiting for a large NHMRC funded, multi-site RCT
comparing 4 vs 7 days, and if anyone would like to get involved please let
me know. We need 5,000 more tunneled and non-tunneled CVADs please!!

As far as haem/onc specific trials, there is one RCT of 512 patients which
compared 3 day with “between 4 and 7 day” use and found no significant
difference in infusate-related BSI. A quasi-randomised trial in 175
paediatric oncology patients found extending AS use from 3 to 7 days had no
significant impact on IVD-BSI, and achieved substantial cost savings in AS
and nursing time.
– Raad, I., et al. Optimal frequency of changing intravenous administration
sets: is it safe to prolong use beyond 72 hours? *Infection Control and
Hospital Epidemiology, *2001, 22(3):136-139.
– Simon, A., et al. Influence of prolonged use of intravenous
administration sets in paediatric cancer patients on CVAD-related
bloodstream infection rates and hospital resources. *Infection, *2006,
34(5):258-263.

Hope this is helpful and happy to discuss further if you like.

Claire

Best regards, Claire

*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 |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Australian Vascular Access Teaching and Research 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.

“By changing nothing, we hang on to what we understand, even if it is the
bars of our own jail” *John LeCarre*

On 20 February 2014 16:41, Juraja, Marija (Health) wrote:

> Hi Michael,
>
>
>
> I have these guidelines from the UK with the literature evidence on page
> 23 which may help re the infusion sets.
>
>
>
> *Kind Regards*
>
>
>
> *Marija Juraja* *|Clinical Service Coordinator (CICP) – Infection
> Prevention & Control Unit| *
>
> t: +61 8 8222 7588| p:47757| f: +61 8 8222 6461 | DX: 465432 |
> e:marija.juraja@health.sa.gov.au
>
>
>
> *Care* *Excellence* *Collaboration* *Integrity *
>
> GERMS CAN KILL…
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Michael Wishart
> *Sent:* Thursday, 20 February 2014 4:29 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* [ACIPC_Infexion_Connexion] Replacement frequency for central
> line administration sets
>
>
>
> Hi all
>
>
>
> We are reviewing our central line policies and have two different
> standards for administration set (line) changes: one for oncology
> haematology, and one for every else, including ICU. Haem/onc routinely
> change administration sets for all central devices (CVC’s and PICC’s) every
> three days (dressings and needleless access devices changed every 7 days),
> whilst everyone else routinely changes everything (administration sets,
> needleless access devices, dressings) every 7 days.
>
>
>
> Is anyone aware of any specific data supporting more frequent line changes
> for haem/onc patients? Is it standard practice in other places to change
> all administration sets for central devices every 7 days?
>
>
>
> Thanks for any discussion (and specifically supporting evidence) on this.
>
>
>
> Cheers
>
> Michael
>
>
>
> *Michael Wishart*
>
> *Infection Control Coordinator*
>
> *Holy Spirit Northside Private Hospital*
>
> 627 Rode Road, Chermside, Qld 4032
>
> *t:* (07) 3326 3068 | *f:* (07) 3607 2226
>
> *e:* Michael.Wishart@hsn.org.au
>
> *w:*www.holyspiritnorthside.org.au
>
> Please consider the environment before printing this email
>
>
>
>
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[Claire Rickard]

We did have one in Qld called VAMP until a couple of years ago (Vascular
Access Management Program) – they went all out with Black and Red Tshirts
etc…

C

On 29 October 2013 16:03, Taliaferro, Kerry (Health) wrote:

> It is catchy!
>
>
>
> *Kerry Taliaferro* *RN*
> Vascular Access Team Acting CNC
>
> Division of Medicine
>
>
>
> Canberra Hospital & Health Services
>
> Level 2, Building 5, Canberra Hospital
>
>
> *Phone: *02 6244 4102
> *E-mail: *kerry.taliaferro@act.gov.au
>
>
>
>
>
> *Care | Excellence | Collaboration | Integrity*
>
> [image: cid:image001.jpg@01CD2235.C77A3B20]
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Michael Wishart
> *Sent:* Tuesday, 29 October 2013 4:52 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Suggestions for names for a IV/PICC teams
>
>
>
> How about Vascular Access Management Team – VAMT (vamped). It’s catchy!!
>
>
>
> Cheers
>
> Michael
>
>
>
> *Michael Wishart*
>
> *CNC Infection Control*
>
> *Holy Spirit Northside Private Hospital*
>
> 627 Rode Road, Chermside, Qld 4032
>
> *t:* (07) 3326 3068 | *f:* (07) 3607 2226
>
> *e:** *Michael.Wishart@hsn.org.au
>
> *w:*www.holyspiritnorthside.org.au
>
> Please consider the environment before printing this email
>
>
>
> [image: International Infection Prevention Week 2012]
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU]
> *On Behalf Of *Claire Rickard
> *Sent:* Tuesday, 29 October 2013 3:46 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Suggestions for names for a IV/PICC teams
>
>
>
> Have seen IVADHeroes, and VAST around….If you are ok acronym free what
> about WeLoveLines ?!?!
>
>
>
>
>
>
>
> Kind regards,
>
> Prof Claire Rickard
>
> NHMRC Centre for Research Excellence in Nursing Interventions
>
> Griffith University
>
> c.rickard@griffith.edu.au
>
>
>
>
> ——– Original message ——–
> From: Craig Boutlis
> Date:
> To: AICALIST@AICALIST.ORG.AU
> Subject: Re: Suggestions for names for a IV/PICC teams
>
>
> iVee team
>
> Craig Boutlis
>
> Department Head, Infectious Diseases | IMACS
> LMB 8808, SCMC, NSW, 2521
> Tel. 02 4222 5898 | craig.boutlis@sesiahs.health.nsw.gov.au
>
>
>
>
> —–Original Message—–
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU]
> On Behalf Of Kerry Taliaferro
> Sent: Monday, 28 October 2013 11:37 AM
> To: AICALIST@AICALIST.ORG.AU
> Subject: [ACIPC_Infexion_Connexion] Suggestions for names for a IV/PICC
> teams
>
> Hi All
> At Canberra Hospital we are implementing a Vascular Aceess Team – only the
> abbreviation VAT is already in use for several other medical procedures etc.
> I am looking for ideas of what we should call our team/service- we will be
> inserting PICC lines, difficult cannulas, monitoring central lines etc. We
> need to make sure that staff and patients recognise what we do from the
> name as well!
>
> Any suggestions for a name that can also be a catchy acronym?
>
> Thanks Kerry Taliaferro
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
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—

Best regards, Claire

*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: IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Australian Vascular Access Teaching and Research 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.

“Science is simply common sense at its best, that is, rigidly accurate in
observation, and merciless to fallacy in logic.”
— Thomas Henry Huxley

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[Claire Rickard]

Then you need to have someone called Janet working on the service (a la
Rocky Horror Picture Show)

:0)

C

On 29 October 2013 17:10, Mary Willimann wrote:

> Wonderful!!!
>
>
>
> *Mary Willimann* *I* *Clinical Nurse Consultant – Infection Prevention &
> Control* *I* ****St John** of ****God** **Subiaco** **Hospital********
>
> Level 3, 12 Salvado Road SUBIACO WA 6008****
>
> *P:* 08 9382 6220* F:* 08 9382 6785* ** E:* mary.willimann@sjog.org.au
>
> ****
>
> >>> Tim Spencer 29/10/2013 2:41 PM >>>
>
> Here’s one more… ;-)****
>
> Department of Access Management and Infusion Therapy (DAMIT)****
>
> ** **
>
> Enjoy your evening everyone.****
>
> T..****
>
> ** **
>
> *Timothy R. Spencer**, RN, APN, DipAppSci, Bach.Health, ICCert.
> **Clinical Nurse Consultant, * Central Venous Access & Parenteral
> Nutrition Service****
>
> *Conjoint Lecturer, *South West Sydney Clinical School | Faculty of
> Medicine |* *University of NSW
> Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
> Elizabeth Street, Liverpool, 2170, NSW, Australia
> Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
> Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
> [image: 200 yeas logo white.jpg]****
>
> *”Be a yardstick of quality. Some people aren’t used to an environment
> where excellence is expected.” – Steve Jobs*****
>
> ** **
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Michael Wishart
> *Sent:* Tuesday, 29 October 2013 4:52 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Suggestions for names for a IV/PICC teams****
>
> ** **
>
> How about Vascular Access Management Team – VAMT (vamped). It’s catchy!!**
> **
>
> ** **
>
> Cheers****
>
> Michael****
>
> ** **
>
> *Michael Wishart*****
>
> *CNC Infection Control*****
>
> *Holy Spirit Northside Private Hospital*****
>
> 627 Rode Road, Chermside, Qld 4032 ****
>
> *t:* (07) 3326 3068 | *f:* (07) 3607 2226 ****
>
> *e:** *Michael.Wishart@hsn.org.au****
>
> *w:*www.holyspiritnorthside.org.au****
>
> Please consider the environment before printing this email****
>
> ** **
>
> [image: International Infection Prevention Week 2012]
> ****
>
> ** **
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU]
> *On Behalf Of *Claire Rickard
> *Sent:* Tuesday, 29 October 2013 3:46 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Suggestions for names for a IV/PICC teams****
>
> ** **
>
> Have seen IVADHeroes, and VAST around….If you are ok acronym free what
> about WeLoveLines ?!?!****
>
> ** **
>
> ** **
>
> ** **
>
> Kind regards,****
>
> Prof Claire Rickard****
>
> NHMRC Centre for Research Excellence in Nursing Interventions****
>
> Griffith University****
>
> c.rickard@griffith.edu.au****
>
>
>
>
> ——– Original message ——–
> From: Craig Boutlis
> Date:
> To: AICALIST@AICALIST.ORG.AU
> Subject: Re: Suggestions for names for a IV/PICC teams
>
>
> iVee team
>
> Craig Boutlis
>
> Department Head, Infectious Diseases | IMACS
> LMB 8808, SCMC, NSW, 2521
> Tel. 02 4222 5898 | craig.boutlis@sesiahs.health.nsw.gov.au
>
>
>
>
> —–Original Message—–
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU]
> On Behalf Of Kerry Taliaferro
> Sent: Monday, 28 October 2013 11:37 AM
> To: AICALIST@AICALIST.ORG.AU
> Subject: [ACIPC_Infexion_Connexion] Suggestions for names for a IV/PICC
> teams
>
> Hi All
> At Canberra Hospital we are implementing a Vascular Aceess Team – only the
> abbreviation VAT is already in use for several other medical procedures etc.
> I am looking for ideas of what we should call our team/service- we will be
> inserting PICC lines, difficult cannulas, monitoring central lines etc. We
> need to make sure that staff and patients recognise what we do from the
> name as well!
>
> Any suggestions for a name that can also be a catchy acronym?
>
> Thanks Kerry Taliaferro
>
> 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.
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> Replies to this message will be directed back to the list. To create a new
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> You can unsubscribe from this list be sending ‘signoff aicalist’ (without
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>
> ———————————————————————————————
>
> Illawarra Shoalhaven Local Health District, South East Sydney Local Health
> District and Sydney Children’s Hospital Network (Randwick Campus)
> Confidentiality Notice
>
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—

Best regards, Claire

*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: IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Australian Vascular Access Teaching and Research 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.

“Science is simply common sense at its best, that is, rigidly accurate in
observation, and merciless to fallacy in logic.”
— Thomas Henry Huxley

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[Claire Rickard]

[Claire Rickard]

Hi Christine

I agree, this DRIVES ME NUTS.

This was published in the RCNA magazine last year…hope it’s of some use…

*Routine disconnection of continuous intravenous therapy: implications for
your patients recovery*

*By Amanda Ullman and Nicole Marsh*

*A patient under your care who is currently receiving continuous
intravenous therapy wants to have a shower. In order to facilitate this,
you disconnect their IV from their infusion, right? No.*

Nurses who disconnect their patients IV tubing during continuous
intravenous therapy are trying to be flexible and accommodating, however
this practice may have a significant impact on the patients health and
recovery says Professor Rickard (FRCNA), a leading nurse researcher in the
field of Intravascular Device (IVD) management from the Griffith Health
Institutes NHMRC Centre of Research Excellence in Nursing.

In earlier times it was commonplace to see ambulant patients pushing their
IV drip poles around hospital corridors. Nowadays, it seems to have become
the unofficial, but standard practice to disconnect IV tubing while
patients have showers, or just go for a walk said Rickard Its really
commonplace now to see disconnected IV tubing lying on patients beds, or
hooked onto IV poles. Its quite concerning because maintaining sterility
of IV circuits is vital in preventing infection, and theres also issues in
interrupting prescribed therapy.

To overcome infection control concerns, some wards discard the disconnected
tubing, and then replace this with new sterile fluids and tubing when the
patient returns. But its still not good enough according to Professor
Rickard. She says with hospital budgets as they are, we cant afford to be
routinely discarding expensive disposable equipment, not to mention
infusion fluids and drugs, sometimes even parenteral nutrition. If we just
left the lines intact, hospitals would literally save tens of thousands of
dollars off their budgets each year.

Another trend in therapy has been for nurses to use a new 100mL normal
saline fluid bag and IV tubing set for each dose of intermittent
antibiotics. This supersedes the earlier practice of leaving a 1000mL bag
and line attached to the IVD, with a burette in the circuit used for
medication doses, with the saline infusing slowly in between doses. Again,
Rickard questions whether this has been progress or a backwards step.

Hanging a new 100ml bag and administration set for a sixth hourly
antibiotic costs $44.36, compared with leaving a 1 litre bag and line
connected which costs $9.15 says Rickard. The main problem though is not
expense, its the repeated interruptions to the circuit. This approach
means the IVD hub, a common source of infection, is handled eight times a
day, compared to no handling with the use of a keep vein open litre bag
and line. Theres no way we can guarantee that all staff are going to take
the time to properly undertake hand hygiene, decontaminate the connectors
with alcoholic chlorhexidine (plus letting it dry), before accessing the
system on all occasions.

Intravenous therapy is defined as a set of knowledge and techniques aimed
at administering solutions or drugs in the circulatory system and covers
different care aspects, ranging from the patients preparation to
intervention in the event of complications to obtaining the desired outcome
(Jacinto, Avelar, & Pedreira,
2011).
It comprises interventions that are complex and can lead to complications
that can jeopardize patient safety (Jacinto et al.,
2011
).

Continuous intravenous therapy can run for hours, days or weeks. When
continuous intravenous therapy is disconnected, the nurse is altering the
patient’s ability to reach therapeutic goals (Webster, Osborne, Rickard, &
Hall, 2010).
This variation in therapy may have an adverse effect on the patients
clinical condition and long-term outcomes. This is impacted by the
medications or fluids being administered, but as a minimum it will have an
impact on the patients fluid and electrolyte balance.

The frequent disconnection of intravenous administration sets from the IVD
may also increase the ability of potentially infection-causing bacteria to
contaminate and colonise the IVD hub. This bacterium may then potentially
enter the blood-stream causing systemic infection (O’Grady et al.,
2011).

In addition to contamination, there is the risk of accidentally connecting
the wrong tubing back to the IVD. There are numerous adverse events
documented in literature, including patient deaths, from tubing
misconnections.

The main reason for disconnecting an IVD receiving a continuous infusion
should be to discontinue therapy, routinely change the administration sets
at between four and seven days, (24hourly for blood, blood products, fat
emulsions or propofol) (O’Grady et al.,
2011)
or in an emergency.

Professor Rickard says all nurses have a responsibility to provide
evidence-based practice to their patients. The routine interruption of
continuous intravenous therapy is not beneficial to our patients.

*References*

Jacinto, A., Avelar, A., & Pedreira, M. (2011). Predisposing factors for
infiltration in children submitted to peripheral venous
catheterization. *Journal
of Infusion Nursing, 34*(6), 391-398.

O’Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J.,
O’Heard, S., . . . Healthcare Infection Control Practices Advisory
Committee (HICPAC). (2011). Guidelines for the prevention of intravascular
catheter-related infections. *Clinical Infectious Diseases, 52*(9),
e162-193.

Webster, J., Osborne, S., Rickard, C., & Hall, J. (2010).
Clinically-indicated replacement versus routine replacement of peripheral
venous catheters. *Cochrane Database of Systematic Reviews, 17*(3),
CD007798.

Best regards, Claire

*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: IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Australian Vascular Access Teaching and Research 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 the School Secretary (Nathan) Jenny
Chan 3735 5406 *j.chan@griffith.edu.au* for urgent
enquiries.

*It’s nice to be important, but it’s more important to be nice. John Cassis.
*

On 23 August 2013 14:05, Chris Braden wrote:

> Hi Everyone,****
>
> ** **
>
> I have an aversion to IV giving sets being disconnected from the patient
> following intermittent antibiotic administration, connected to a hanging IV
> bag and reconnected to the patient 6 hours + when the next Anti is due.***
> *
>
> Wondering if anyone can point me in the right direction for some evidence
> for support or am I being pedantic?****
>
> ** **
>
> Regards****
>
> Chris****
>
> ** **
>
> Christine Braden****
>
> Manager Infection Control****
>
> Djerriwarrh Health Service****
>
> Email- chrisb@djhs.org.au****
>
> Ph- 53 67 2000****
>
> Mobile – 0402 242 651****
>
> ** **
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[Claire Rickard]

G’day James

Good question! I agree option 3 is best. Skin already nice and
decontaminated after your first application and drying of alcoholic CHG,
another app so you can get the line in and not wiping off all that good
stuff with its residual effect.

We use chlorhexidine impregnated CVCs and chlorhex sponge CVC dressings
after all, so a miniscule bit of clorhex (*alcoholic not aqueous, *of
course) shouldn’t do any harm in the bloodstream, and may even cheer folks
up some.

I’d rather have a drop of that injected into me than US gel, that’s for
sure…

Best regards, Claire

*Professor Claire Rickard RN PhD*
c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Intravascular Access Device Research Group | NHMRC Centre of Research
Excellence in Nursing Interventions | Griffith Health Institute | Visiting
Prince Charles Hospital

Research frequently takes me off campus. Please contact Jenny Chan 3735
5406 *j.chan@griffith.edu.au* or
Jo.Wright@griffith.edu.au 3735 4886 with any urgent enquiries.

*It’s nice to be important, but it’s more important to be nice. John Cassis.
*

On 7 August 2013 17:57, James Rippey wrote:

> Dear Wise Anti-Infection Folk,
>
> When performing vascular access using ultrasound guidance we use standard
> aseptic technique with 2% chlorhexidine for the skin, and sterile
> ultrasound probe cover.
>
> Between the skin with dried chlorhexidine, and the probe cover we need an
> ultrasound conducting medium.
>
> My question relates to what is the best sound conducting medium.
>
> Options are:
>
> 1. Sterile ultrasound gel.
> Putting the needle through gel into the patient bothers me, and the gel
> makes things slippery and awkward if needing to advance a wire for the
> Seldinger technique. Also wiping the gel off afterwards so a dressing will
> stick removes the chlorhexidine.
>
> 2. Sterile saline.
> Works well, isn’t slippery, but washes away the chlorhexidine.
>
> 3. More chlorhexidine.
> Works well, isn’t slippery, but means we put a needle through wet
> chlorhexidine into the patient.
>
> I anticipate the amount of chlorhexidine introduced if we go through wet
> chlorhexidine with a needle is miniscule, and this is probably the best
> option, but seek your advice.
>
> Many thanks in anticipation.
>
> James Rippey
>
> MBBS DDU DCH FACEM
> Specialist in Emergency Medicine
> Sub specialty Emergency Ultrasound
>
> Associate Professor
> University of Western Australia
> Sir Charles Gairdner Hospital &
> King Edward Memorial Hospital for Women
>
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[Claire Rickard]

Thanks Cath and Tim

“Without randomisation, there can be no causation”. The Bertoglio study is
very interesting but we *DEFINITELY and URGENTLY *need an *RCT *on this
topic, as well as all the many other unknowns in flushing …”how much?,
how often? technique?” etc. etc.

It *sickens *me that about 30% of PIVCs fail (infiltrate, occlude,
phlebitis, fall out), yet these are vital devices that we use EVERY day
(well in the wards anyway :D), and why have we never bothered to do RCTs on
flushing, which is probably at least 50% of the problem (the others being
dressings and securement, site and device selection, inserter
competence…etc)??

The Griffith IVAD group have recently compared prefilled versus manual
syringes in the simulated nursing labs and we were quite impressed with
them (disclosure: we had funding support from the manufacturer). This was
led by Dr Samantha Keogh and has been accepted for publication –
unfortunately the journal in question has a looong lag time and it will not
be published until 2014).

Again, a lab study is not an RCT (although helpful in designing one). But
you will be pleased to know that we plan to kick off with a pilot RCT in
QLD early next year, and then hopefully a multi-site in 2015->

OK off the soapbox now….PM me for more lowdown

Best regards, Claire

*Professor Claire Rickard RN PhD*
c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Intravascular Access Device Research Group | NHMRC Centre of Research
Excellence in Nursing Interventions | Griffith Health Institute | Visiting
Prince Charles Hospital

Research frequently takes me off campus. Please contact Jenny Chan 3735
5406 *j.chan@griffith.edu.au* or
Jo.Wright@griffith.edu.au 3735 4886 with any urgent enquiries.

*It’s nice to be important, but it’s more important to be nice. John Cassis.
*

On 2 August 2013 18:18, Cath Murphy wrote:

> Tim****
>
> ** **
>
> Thanks. These syringes are well used in the US as I am sure you would know
> and appreciate. They are considered part of the CDC recommendations. This
> is a small study and the methodology not without limitation. That said its
> always exciting to look at new technologies and further explore their
> potential for improving patient safety.****
>
> ** **
>
> Do you think the reduction was due more to standardised care ie. frequent
> flushing, less handling or something else ? dressing, insertion technique,
> skin antisepsis? Proving causality and the flip side showing protection is
> always controversial. ****
>
> ** **
>
> Im keen to know why you especially found this paper compelling? Also how
> similar to Australian healthcare settings do you think Italian settings
> would be? These are the sorts of questions I always have to stop and ask
> when reviewing reports from the literature.****
>
> ** **
>
> For the record, I too think that these pre-filled syringes are the way to
> go and I just wished that as clinicians adopted new technologies we also
> had capacity, skill and time to invest in undertaking and reporting the
> much needed research to silence those opponents.****
>
> ** **
>
> Cheers****
>
> Cath****
>
> Cathryn Murphy PhD****
>
> Executive Director****
>
> Infection Control Plus Pty Ltd****
>
> Ph: +61 428 154 154****
>
> http://www.infectioncontrolplus.com.au****
>
> [image: Description: twitter logo] [image:
> Description: FB logo] [image:
> Description: icp icon] ****
>
> ** **
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Tim Spencer
> *Sent:* Friday, 2 August 2013 15:54 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Recent literature on pre-filled CVAD flush syringes and
> infection rate reduction.****
>
> ** **
>
> FYI ****
>
> For those who are interested in CLABSI reduction through the use of
> pre-filled flush syringes.****
>
> A recent publication in The Journal of Hospital Infection this past May,
> focuses on the potential for complication reduction when moving from a
> manually filled flush syringe to a pre-filled flush syringe and ultimately
> showed a 60% CRBSI reduction when utilizing a pre-filled flush syringe for
> maintenance. ****
>
> ** **
>
> *Timothy R. Spencer**, RN, APN, DipAppSci, Bach.Health, ICCert.
> Clinical Nurse Consultant, * Central Venous Access & Parenteral Nutrition
> Service****
>
> *Conjoint Lecturer, *South West Sydney Clinical School | Faculty of
> Medicine |* *University of NSW
> Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
> Elizabeth Street, Liverpool, 2170, NSW, Australia
> Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
> Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
> [image: 200 yeas logo white.jpg]****
>
>
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[Claire Rickard]

Hi Teresa

You should definitely have a chat with Prof Allan Merry in NZ – Department
of Anaesthesiology, The University of Auckland, Auckland, New Zealand.

He is a Prof of Anaesthetics and his interest is in changing behaviour to
improve quality and safety, including IC.

http://www.fmhs.auckland.ac.nz/som/staffct/staff_details.aspx?staffID616D6572303136

Also there is an anaesthetic nurse researcher here in Brisbane interested
in this, she has published an article you might be interested in. Email me
off list if you would like a copy.

A snapshot of guideline compliance reveals room for improvement: A survey
of peripheral arterial catheter practices in Australian operating
theatres.

*Reynolds* H, Dulhunty J, Tower M, Taraporewalla K, *Rickard* C.

J Adv Nurs. 2013 Jul;69(7):1584-94. doi: 10.1111/jan.12018. Epub 2012 Sep
26.

Good luck soldier!

Best regards, Claire

*Professor Claire Rickard RN PhD*
c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Intravascular Access Device Research Group | NHMRC Centre of Research
Excellence in Nursing | Griffith Health Institute | Visiting Scholar: Royal
Brisbane & Women’s Hospital | Princess Alexandra Hospital | The Prince
Charles Hospital

Research frequently takes me off campus. Please contact Jenny Chan 3735
5406 *j.chan@griffith.edu.au* or
Jo.Wright@griffith.edu.au 3735 4886 with any urgent enquiries.

*There are three stages in any scientific discovery: first, people deny
that it is true; then they deny that it is important; finally they credit
the wrong person.*

*Bryson BA. A short history of nearly everything. Broadway Books: New York.
2003, 421.*

On 15 July 2013 09:37, Teresa Lewis wrote:

> Hi All****
>
> ** **
>
> I am working at a new, private small endoscopy centre. ** **
>
> I get to see the anaesthetists (which was not always easy when working at
> a busy hospital) and thought it would be great to have the discussion and
> look at the possibility of doing education etc. person to person.****
>
> ** **
>
> Unfortunately, I have hit great resistance! They firmly believe that
> because our cannulas are in short-term (being a day only endoscopy
> centre) this ANTT stuff does not apply to us.****
>
> They have asked for the evidence, which I gave them of course, but they
> keep saying it is not applicable to us. The other day I was talking to one
> of them about the importance of ANTT and that hand hygiene needs to be
> performed at the correct ****
>
> time as per the 5 moments and I was shocked to hear.so you expect me to
> perform hand hygiene each time before I administer an IV drug if I have
> touched the environment, my phone or another patient?. So I think we still
> have a long way to go with education, especially of the practitioners who
> are out there in private practice (perhaps its just my doctors?)!!****
>
> ** **
>
> Even though management were supportive initially, they have now said to
> just look at training our staff (not the doctors). This has come about
> since Advisory No: A13/05.****
>
> I am struggling with this, and will of course try to come up with some
> ideas to get around it sensitively.****
>
> ** **
>
> While on the subject. Is Australia working on our own educational
> resources (I have worked hard to get rid of Lanyards and now I see them
> dangling in aseptic fields)? ****
>
> Is everyone teaching glove use to draw up IV Medications? Is everyone
> sourcing a larger alcohol/chlorhexidine swab as per the educational videos?
> ****
>
> It seems that although we all need to implement this *standard*, in
> talking to other practitioners everyone seems to be doing it a little
> differently, which then defeats the purpose.****
>
> ** **
>
> Any feedback greatly accepted. Have a great week.****
>
> ** **
>
> Teresa Lewis****
>
> Infection Control and Prevention CNC****
>
> Newcastle Endoscopy Centre****
>
> ** **
>
> ** **
>
> ** **
> Messages posted to this list are solely the opinion of the authors, and
> do not represent the opinion of ACIPC.
>
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[Claire Rickard]

“up here” we have a hospital where the operating theatre allows a scrub
nurse to wear a 3/4 length shirt under her scrubs (for her religious
reasons), and she just pulls them up to her elbows to scrub in.

Best regards, Claire

*Professor Claire Rickard RN PhD*
c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Intravascular Access Device Research Group | NHMRC Centre of Research
Excellence in Nursing | Griffith Health Institute | Visiting Scholar: Royal
Brisbane & Women’s Hospital | Princess Alexandra Hospital | The Prince
Charles Hospital

Research frequently takes me off campus. Please contact Jenny Chan 3735
5406 *j.chan@griffith.edu.au* or
Jo.Wright@griffith.edu.au 3735 4886 with any urgent enquiries.

*There are three stages in any scientific discovery: first, people deny
that it is true; then they deny that it is important; finally they credit
the wrong person.*

*Bryson BA. A short history of nearly everything. Broadway Books: New York.
2003, 421.*

On 15 July 2013 10:56, Michael Wishart wrote:

> Hi Margaret****
>
> ** **
>
> My comments are based on working in many private facilities with different
> uniform options. To me, it all boils down to whether appropriate hand
> hygiene and PPE use can be easily performed with the uniform choices for
> those staff groups. I worked at one facility where nursing manager uniforms
> were all sleeve. Not a problem for most ward / department managers as
> their hand hygiene requirements were all wrist and below. The problem was
> for specialised nursing managers who performed ward based procedures
> requiring a surgical scrub they had to change into surgical scrubs to
> perform a full surgical scrub for ward-based procedures, as they could not
> roll up the sleeves as the design was quite tight on the arms.****
>
>
> So in my opinion it is more about utility of the design in enabling
> required practices than anything else.****
>
> ** **
>
> Cheers****
>
> Michael****
>
> ** **
>
> *Michael Wishart*****
>
> *CNC Infection Control*****
>
> *Holy Spirit Northside Private Hospital*****
>
> 627 Rode Road, Chermside, Qld 4032 ****
>
> *t:* (07) 3326 3068 | *f:* (07) 3607 2226 ****
>
> *e:** *Michael.Wishart@hsn.org.au****
>
> *w:*www.holyspiritnorthside.org.au****
>
> Please consider the environment before printing this email****
>
> ** **
>
> ** **
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Margaret Byrne
> *Sent:* Monday, 15 July 2013 10:47 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* 3 quarter uniform sleeves****
>
> ** **
>
> Can anyone contribute to some feedback I received from a staff member
> regarding new uniforms being introduced at our facility? For the first
> time, we are giving staff the option of having a 3 quarter sleeve, both
> care staff and registered/enrolled nurses. One RN stated that she had been
> informed at an acute facility that 3 quarter sleeves are not permitted
> because of Infection Control issues. I have looked up the National
> Guidelines and in there it states: ****
>
> Given that there is limited evidence available to support many routine
> practices intended to reduce infection risk, practice is based on decisions
> made on scientific principles. Some activities, such as performing hand
> hygiene between administering care to successive patients, have a credible
> history to support their routine application in preventing cross-infection.
> Others, such as some uniform and clothing requirements, have more to do
> with the ethos of quality care and workplace culture than with a proven
> reduction of cross-infection.****
>
> From that I came to the conclusion that there is no evidence against
> having a variance in uniform style. Also given the work carried out in
> residential care vs acute care, my thoughts were that there is limited
> cross infection risk.****
>
> If anyone has any other thoughts, responses welcome****
>
> Regards****
>
> Margaret Byrne RN BN****
>
> ** **
>
> Messages posted to this list are solely the opinion of the authors, and do
> not represent the opinion of ACIPC. ****
>
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[Claire Rickard]

Dear Colleagues

Griffith Uni will be running a course on Peripheral IV cannulation and care
commencing on-line 22 July 2013 with a one day workshop including
assessment on August 1st. Could you please help me to promote this
throughout your organisations so we can promote best practice care in this
area! (Flyer attached).

Naturally there is a strong infection prevention and surveillance focus,
with input from expert clinicians, academics and industry in the area. The
course is open to RNs, RMs, RMOs, and students. Credit is available for
those who wish to progress into the Masters programs.

Please contact Dr Niall Higgins n.higgins@griffith.edu.au or 3735 7854 to
reserve a place, or for more information.

Best regards, Claire

*Professor Claire Rickard RN PhD*
c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Intravascular Access Device Research Group | NHMRC Centre of Research
Excellence in Nursing | Griffith Health Institute | Visiting Scholar: Royal
Brisbane & Women’s Hospital | Princess Alexandra Hospital | The Prince
Charles Hospital

Research frequently takes me off campus. Please contact Jenny Chan 3735
5406 *j.chan@griffith.edu.au* or
Jo.Wright@griffith.edu.au 3735 4886 with any urgent enquiries.

*There are three stages in any scientific discovery: first, people deny
that it is true; then they deny that it is important; finally they credit
the wrong person.*

*Bryson BA. A short history of nearly everything. Broadway Books: New York.
2003, 421.*

On 17 June 2013 12:42, Michael Wishart wrote:

> This series of opinion pieces on influenza vaccination and disease may
> be useful as discussion pieces within your healthcare facility as our
> influenza season ramps up.****
>
> ** **
>
> https://theconversation.com/topics/facts-about-flu****
>
> ** **
>
> I am not endorsing any of the positions within these articles per se, but
> I see them as useful discussion starters.****
>
> ** **
>
> Cheers****
>
> Michael****
>
> ** **
>
> *Michael Wishart*****
>
> *CNC Infection Control*****
>
> *Holy Spirit Northside Private Hospital*****
>
> 627 Rode Road, Chermside, Qld 4032 ****
>
> *t:* (07) 3326 3068 | *f:* (07) 3607 2226 ****
>
> *e:** *Michael.Wishart@hsn.org.au****
>
> *w:*www.holyspiritnorthside.org.au****
>
> Please consider the environment before printing this email****
>
> ** **
>
> ** **
>
> WARNING : This email contains information, which is CONFIDENTIAL, and that
> maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it
> (the “Communication”) is confidential and is for the use only of the
> intended recipient, and may not duplicated or used by any other party
> without the express consent of the sender. The Communication may contain
> copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of
> its related entities or of third parties. If you are not the intended
> recipient of the Communication, please notify the sender immediately by
> return e-mail, delete the Communication, and do not read, copy, print,
> retransmit, store or act in reliance on the Communication. Any views
> expressed in the Communication are those of the individual sender only,
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[Claire Rickard]

Hi Terry

Here’s a good one for you.
In a study of solutions used in an emergency department,

15.4% of 669 bags were colonised after connection to the administration set
but prior

to patient connection (Carrasco

*et al. *2004).

Carrasco JAP, Prieto IC, Escorza JG, Sanchez JLA, Sanchez MMC, Bouza MR.
(2004)

Physico-chemical stability and sterility of previously prepared saline
infusion

solutions for use in out-of-hospital emergencies.

*Resuscitation **62*, 199-207.

Best regards, Claire

*Professor Claire Rickard RN PhD*
c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devices

Intravascular Access Device Research Group | NHMRC Centre of Research
Excellence in Nursing | Centre for Health Practice Innovation | Griffith
Health Institute | Griffith University
Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra
Hospital | The Prince Charles Hospital

Research frequently takes me off campus. Please contact Jenny Chan 3735
5406 *j.chan@griffith.edu.au* or
Jo.Wright@griffith.edu.au 3735 4886 with any urgent enquiries.

On 13 May 2013 14:55, Terry McAuley wrote:

> Hi everyone, ****
>
> ** **
>
> I am having trouble convincing the anaesthetists and the theatre nurses
> that it is not advisable for them to set up all the lines for all the
> patients on the theatre list first thing in the morning, let alone not
> putting the prepared bags and administration sets into a fluid warming
> cabinet.****
>
> ** **
>
> They want me to provide evidence to support my recommendation that IV
> lines be set up immediately prior to each patient. The Australian
> Guidelines for Infection Prevention and Control in Healthcare does not
> specify any requirements for this.****
>
> ** **
>
> Can anyone offer any advice, guidelines or evidence on this matter? ****
>
> ** **
>
> Thanks in anticipation.****
>
> ** **
>
> Regards****
>
> *Terry McAuley*****
>
> *Sterilisation & Infection Control Consultant*****
>
> *STEAM Consulting*****
>
> *Mob: +61 (0)438 109 692*****
>
> *E: terry@steamconsulting.com.au*****
>
> *W: http://www.steamconsulting.com.au*****
>
> *A: PO BOX 779*****
>
> * Endeavour Hills *****
>
> * VIC Australia 3802*****
>
> ****
>
> *
> *****
>
> *CONFIDENTIAL COMMUNICATION:* The information contained in this message
> may contain confidential information intended only for the use of the
> individual or entity named above. If the reader of this message is not the
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[Claire Rickard]

HI Mary

I always tell people ‘I know you like to observe the site, but the
literature says that what you are doing is actually watching a BSI develop”

😀

Claire

Best regards, Claire

*Professor Claire Rickard RN PhD*

c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research | Intravascular Access Device Research Group | NHMRC Centre
of Research Excellence in Nursing | Centre for Health Practice
Innovation | Griffith
Health Institute | Griffith University

Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra
Hospital | The Prince Charles Hospital

P.S. Research frequently takes me off campus. Please contact Jenny Chan,
School Secretary 3735 5406 or *j.chan@griffith.edu.au*
with any urgent enquiries.

On 18 April 2013 13:20, Tim Spencer wrote:

> ****
>
> Hi Mary,****
>
> This is a wise move gauze square under dressing and change to CHG sponge
> at 24hrs post insertion. Quite widely practised within the USA also.****
>
> It saves wastage costs in changing CHG sponge dressing twice in 24hrs if
> its contaminated with blood post insertion, etc.****
>
> ** **
>
> We have just implemented hospital-wide use of a CHG sponge dressing after
> using in ICU and Haem/Onc for the last 4 years.****
>
> CLAB rates are quite low already, but we standardised its use to give
> every patient the benefit, rather than just using it on specific
> groups/types of patients and devices.****
>
> This also allows for greater compliance with using the device in the care
> and maintenance when the patient goes to the ward.****
>
> There is much supportive literature that supports the use of a CHG
> impregnated sponge on an insertion site, including 2 good RCTs.****
>
> Using the literature to support your case will be imperative. J****
>
> ** **
>
> Getting past the covered exit site is hard, but there needs to be faith in
> the product that it is doing its job correctly this will show in an
> infection rate reduction generally.****
>
> PICC lines are well documented to have LOWER infection rates than your
> standard chest CVCs (IJ/Subclavian/Axillary Vein), so I would consider its
> use based on your overall infection rates for both CVC and PICCs.****
>
> Do you happen to use impregnated CVCs at all?****
>
> Tim..****
>
> ** **
>
> *Timothy R. Spencer**, RN, APN, DipAppSci, Bach.Health, ICCert.
> **Clinical Nurse Consultant, * Central Venous Access & Parenteral
> Nutrition Service****
>
> *Conjoint Lecturer, *South West Sydney Clinical School | Faculty of
> Medicine |* *University of NSW
> Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital,
> Elizabeth Street, Liverpool, 2170, NSW, Australia
> Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 |
> Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
> [image: 200 yeas logo white.jpg]****
>
> ** **
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Mary Willimann
> *Sent:* Thursday, 18 April 2013 12:45 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: PICC Line Dressings****
>
> ** **
>
> Hi Phillipa****
>
> ****
>
> I was just about to put something on the AICA list myself as we are having
> similar issues particularly around the use of chlorhexidine-impregnated
> sponges or dressings. Whilst we are using them routinely in ICU for CVCs,
> we are meeting with resistance from our oncology staff about using them
> routinely for all PICC line dressings in our oncology and haematology
> patients. In ICU we have the option of both the sponges and the transparent
> dressings depending on clinician preference – as you have stated some
> people like to able to view the exit site. Also we are wondering if it
> might be more sensible to dress PICC lines with a gauze dressing when they
> are inserted but changing to a chlorhexidine-impregnated sponges or
> dressings when changing the dressing 24 hours later? All advice would be
> gratefully received!!****
>
> ****
>
> Kind regards****
>
> Mary****
>
> ****
>
> ****
>
> *Mary Willimann* *I* *Clinical Nurse Consultant – Infection Prevention &
> Control* *I* St John of God Subiaco Hospital****
>
> Level 3, 12 Salvado Road SUBIACO WA 6008****
>
> *P:* 08 9382 6220* F:* 08 9382 6785* E:* mary.willimann@sjog.org.au****
>
> ********
>
> >>> “Parsons, Phillipa” 18/04/2013 9:18 AM >>>**
> **
>
> ** **
>
> Dear All,****
>
> ** **
>
> Could people please advise on the management of PICC line dressings when
> an antiseptic impregnated patch is used in regards to****
>
> a) frequency of PICC line dressings****
>
> b) antiseptic impregnated patches****
>
> ** **
>
> We have two streams guiding our discussion and management of PICC lines at
> the moment.****
>
> I am receiving arguments that the exist site cannot be observed properly
> with the patch insitu and the patch always requires changing next day as
> blood soaked. The patch product use recommends changing if blood stained.*
> ***
>
> ** **
>
> Is anyone dealing with a similar issue and how have they managed this?****
>
> ** **
>
> Regards****
>
> ** **
>
> *Phillipa Parsons*
>
> *Infection Prevention and Control Clinical Coordinator*
>
> *Cabrini Health*
>
> *183 Wattletree Rd*
>
> *Malvern Vic 3144*
>
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[Claire Rickard]

in fact, I have quite a nice bruise the size of a 5c piece after my flu
needle, which bears out my theory that supposed IM injections can be
exposed directly to the bloodstream quite nicely! (although I would rather
they didn’t)

Best regards, Claire

*Professor Claire Rickard RN PhD*

c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research | Intravascular Access Device Research Group | NHMRC Centre
of Research Excellence in Nursing | Centre for Health Practice
Innovation | Griffith
Health Institute | Griffith University

Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra
Hospital | The Prince Charles Hospital

P.S. Research frequently takes me off campus. Please contact Jenny Chan,
School Secretary 3735 5406 or *j.chan@griffith.edu.au*
with any urgent enquiries.

On 25 March 2013 12:48, Claire Rickard wrote:

> True enough Michael…although all sorts of tiny vessels lie within the
> subcutaneous and muscle tissue…who’s to say we are not injecting directly
> into some of these when we gve an IM/SC?
>
> As you say, better to err on the side of caution since the consequences
> are so catastrophic…as your cost-benefit analysis bears out 🙂
>
> Best regards, Claire
>
> *Professor Claire Rickard RN PhD*
>
> c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
> IVAD_Research | Intravascular Access Device Research Group | NHMRC Centre
> of Research Excellence in Nursing | Centre for Health Practice Innovation
> | Griffith Health Institute | Griffith University
>
> Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra
> Hospital | The Prince Charles Hospital
>
> P.S. Research frequently takes me off campus. Please contact Jenny Chan,
> School Secretary 3735 5406 or *j.chan@griffith.edu.au*
> with any urgent enquiries.
>
>
> On 25 March 2013 12:17, Michael Wishart wrote:
>
>> Hi Claire****
>>
>> ** **
>>
>> I, too, agree with Matthias, but I do not think your comparison with IV
>> access is correct. Giving a sub-cut or IM injection has a much lesser risk
>> of infective complications than any direct access to the blood stream (such
>> as IV access or phlebotomy, for example). In my own practice I currently
>> still use alcohol swabs prior to IM vaccination as it is quick, cheap and
>> not worth the potential infective risk (which is yet to be well quantified
>> as pointed out by Matthias).****
>>
>> ** **
>>
>> If patients are self-injecting (either sub-cut or IM), then the risk from
>> auto-inoculation with their own flora may be even lower (viz
>> self-catheterisation guidelines), so I would have no issues with teaching
>> patients not to swab their own skin prior to a simple injection (as long as
>> they were not directly injecting into a vein or device, though). The
>> evidence supporting this is also pretty scant, though.****
>>
>> ** **
>>
>> Cheers****
>>
>> Michael****
>>
>> ** **
>>
>> *Michael Wishart*****
>>
>> *CNC Infection Control*****
>>
>> *Holy Spirit Northside Private Hospital*****
>>
>> 627 Rode Road, Chermside, Qld 4032 ****
>>
>> *t:* (07) 3326 3068 | *f:* (07) 3607 2226 ****
>>
>> *e:** *Michael.Wishart@hsn.org.au****
>>
>> *w:*www.holyspiritnorthside.org.au****
>>
>> Please consider the environment before printing this email****
>>
>> ** **
>>
>> ** **
>>
>> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
>> Behalf Of *Claire Rickard
>> *Sent:* Monday, 25 March 2013 11:42 AM
>> *To:* AICALIST@AICALIST.ORG.AU
>> *Subject:* Re: RE; Alcohol swab before injections****
>>
>> ** **
>>
>> I completely agree with you Matthias.****
>>
>> ****
>>
>> With injections into IV ports we are now encouraged to “scrub the hub”
>> for 30 seconds with either isopropyl alchol or alcoholic chlrohexidine etc!
>> ****
>>
>> ****
>>
>> Yet for the skin, which is nice and warm and moist – capable of
>> supporting much higher microbe counts than a dry cool rubber bung, we use
>> nothing…bizarre!!!
>> ****
>>
>>
>> Best regards, Claire
>>
>> *Professor Claire Rickard RN PhD*
>>
>> c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype:
>> clairexm1 | Twitter: IVAD_Research | Intravascular Access Device Research
>> Group | NHMRC Centre of Research Excellence in Nursing | Centre for
>> Health Practice Innovation | Griffith Health Institute | Griffith University
>> ****
>>
>> ****
>>
>> Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra
>> Hospital | The Prince Charles Hospital
>>
>> P.S. Research frequently takes me off campus. Please contact Jenny Chan,
>> School Secretary 3735 5406 or j.chan@griffith.edu.au with any urgent
>> enquiries.****
>>
>> ** **
>>
>> On 25 March 2013 11:29, Matthias Maiwald (KKH) > matthias.maiwald@kkh.com.sg> wrote:****
>>
>> Dear Franciska, ****
>>
>> ****
>>
>> Not sure about clexane and insulin (s.c. injections), but I have looked
>> in some detail into the current Australian recommendations concerning
>> vaccinations. Most vaccinations are i.m. injections, which are biologically
>> quite different from s.c. injections and also from venipuncture. The
>> official recommendation by the Australian Immunisation Handbook is not to
>> swab (so if you follow that, you are following official recommendations),
>> and only to swab if the injection area is visibly dirty, but the problem is
>> that these recommendation are severely misguided and intellectually flawed.
>> ****
>>
>> ****
>>
>> (1) Much of it is based on a short 2001 article in the MJA, examining a
>> few hundred s.c. injections and venipunctures, and concluding that swabbing
>> for ANY type of injection is not necessary, including i.m. injections.
>> There are two fatal flaws with this assumption. (a) The article did not
>> examine even a single i.m. injection and made conclusions pertaining to
>> these (which is inconsistent with the principles of evidence-based
>> medicine, which the article purported to adhere to), and (b) the natural
>> infection rate after i.m. injections is very low, estimated to be in the
>> range of 1:5000 to 1:10000 or less (which is reassuring), but if you study
>> a smaller population than is needed to capture the natural incidence of an
>> event, then you cannot make conclusions that the intervention has no effect
>> on the occurrence of the event. ****
>>
>> ****
>>
>> (2) The recommendation to swab only if visibly soiled is not justified
>> either, because microorganisms are invisible, and implementing this as a
>> cutoff between swabbing and non-swabbing is arbitrary without a scientific
>> base or evidence base. Imagine you sit in front of a patient with a darker
>> skin colour and want to give an injection. When would you be confident that
>> the skin is NOT visibly dirty? ****
>>
>> ****
>>
>> In summary, if you don’t swab, you are consistent with the guidelines,
>> but the guidelines are seriously flawed (at least you won’t be responsible
>> then). It is certainly reassuring that the natural infection rate is very
>> low, and statistically you are unlikely (but it is possible) to see any
>> adverse event. It is clear that i.m. injections and other types of
>> injections are biologically and clinically different and bear a different
>> infection risk. Also, the deeper an injection is, the more complicated
>> infections can get (examples on the complicated end are joint injections,
>> corticosteroid injections, or more complicated injections). ****
>>
>> ****
>>
>> 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 *Franciska Ferreira
>> *Sent:* Monday, 25 March, 2013 8:54 AM
>> *To:* AICALIST@AICALIST.ORG.AU
>> *Subject:* RE; Alcohol swab before injections****
>>
>> ****
>>
>> Hi All,****
>>
>> ****
>>
>> There is still an ongoing debate whether we should use an alcohol swab
>> before administering clexane, vaccines and insulin. Any ideas please?****
>>
>> I know the latest practice in regards administering clexane is to not
>> swab.****
>>
>> ****
>>
>> I just want to advise my team from a infection control point of view with
>> facts to stand on.****
>>
>> ****
>>
>> Kind Regards****
>>
>> ****
>>
>> *Franciska Ferreira*****
>>
>> *INFECTION PREVENTION & CONTROL /WOUND MANAGEMENT CONSULTANT*****
>>
>> Burnside War Memorial Hospital****
>>
>> 120 Kensington Road, Toorak Gardens, SA 5056****
>>
>> *t:** *08 8202 7222 *f:** *08 8407 8573 e:
>> fferreira@burnsidehospital.asn.au****
>>
>> ****
>>
>> ****
>> ——————————
>>
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[Claire Rickard]

True enough Michael…although all sorts of tiny vessels lie within the
subcutaneous and muscle tissue…who’s to say we are not injecting directly
into some of these when we gve an IM/SC?

As you say, better to err on the side of caution since the consequences are
so catastrophic…as your cost-benefit analysis bears out 🙂

Best regards, Claire

*Professor Claire Rickard RN PhD*

c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research | Intravascular Access Device Research Group | NHMRC Centre
of Research Excellence in Nursing | Centre for Health Practice
Innovation | Griffith
Health Institute | Griffith University

Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra
Hospital | The Prince Charles Hospital

P.S. Research frequently takes me off campus. Please contact Jenny Chan,
School Secretary 3735 5406 or *j.chan@griffith.edu.au*
with any urgent enquiries.

On 25 March 2013 12:17, Michael Wishart wrote:

> Hi Claire****
>
> ** **
>
> I, too, agree with Matthias, but I do not think your comparison with IV
> access is correct. Giving a sub-cut or IM injection has a much lesser risk
> of infective complications than any direct access to the blood stream (such
> as IV access or phlebotomy, for example). In my own practice I currently
> still use alcohol swabs prior to IM vaccination as it is quick, cheap and
> not worth the potential infective risk (which is yet to be well quantified
> as pointed out by Matthias).****
>
> ** **
>
> If patients are self-injecting (either sub-cut or IM), then the risk from
> auto-inoculation with their own flora may be even lower (viz
> self-catheterisation guidelines), so I would have no issues with teaching
> patients not to swab their own skin prior to a simple injection (as long as
> they were not directly injecting into a vein or device, though). The
> evidence supporting this is also pretty scant, though.****
>
> ** **
>
> Cheers****
>
> Michael****
>
> ** **
>
> *Michael Wishart*****
>
> *CNC Infection Control*****
>
> *Holy Spirit Northside Private Hospital*****
>
> 627 Rode Road, Chermside, Qld 4032 ****
>
> *t:* (07) 3326 3068 | *f:* (07) 3607 2226 ****
>
> *e:** *Michael.Wishart@hsn.org.au****
>
> *w:*www.holyspiritnorthside.org.au****
>
> Please consider the environment before printing this email****
>
> ** **
>
> ** **
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Claire Rickard
> *Sent:* Monday, 25 March 2013 11:42 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: RE; Alcohol swab before injections****
>
> ** **
>
> I completely agree with you Matthias.****
>
> ****
>
> With injections into IV ports we are now encouraged to “scrub the hub” for
> 30 seconds with either isopropyl alchol or alcoholic chlrohexidine etc!***
> *
>
> ****
>
> Yet for the skin, which is nice and warm and moist – capable of supporting
> much higher microbe counts than a dry cool rubber bung, we use
> nothing…bizarre!!!
> ****
>
>
> Best regards, Claire
>
> *Professor Claire Rickard RN PhD*
>
> c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
> IVAD_Research | Intravascular Access Device Research Group | NHMRC Centre
> of Research Excellence in Nursing | Centre for Health Practice Innovation |
> Griffith Health Institute | Griffith University****
>
> ****
>
> Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra
> Hospital | The Prince Charles Hospital
>
> P.S. Research frequently takes me off campus. Please contact Jenny Chan,
> School Secretary 3735 5406 or j.chan@griffith.edu.au with any urgent
> enquiries.****
>
> ** **
>
> On 25 March 2013 11:29, Matthias Maiwald (KKH) matthias.maiwald@kkh.com.sg> wrote:****
>
> Dear Franciska, ****
>
> ****
>
> Not sure about clexane and insulin (s.c. injections), but I have looked in
> some detail into the current Australian recommendations concerning
> vaccinations. Most vaccinations are i.m. injections, which are biologically
> quite different from s.c. injections and also from venipuncture. The
> official recommendation by the Australian Immunisation Handbook is not to
> swab (so if you follow that, you are following official recommendations),
> and only to swab if the injection area is visibly dirty, but the problem is
> that these recommendation are severely misguided and intellectually flawed.
> ****
>
> ****
>
> (1) Much of it is based on a short 2001 article in the MJA, examining a
> few hundred s.c. injections and venipunctures, and concluding that swabbing
> for ANY type of injection is not necessary, including i.m. injections.
> There are two fatal flaws with this assumption. (a) The article did not
> examine even a single i.m. injection and made conclusions pertaining to
> these (which is inconsistent with the principles of evidence-based
> medicine, which the article purported to adhere to), and (b) the natural
> infection rate after i.m. injections is very low, estimated to be in the
> range of 1:5000 to 1:10000 or less (which is reassuring), but if you study
> a smaller population than is needed to capture the natural incidence of an
> event, then you cannot make conclusions that the intervention has no effect
> on the occurrence of the event. ****
>
> ****
>
> (2) The recommendation to swab only if visibly soiled is not justified
> either, because microorganisms are invisible, and implementing this as a
> cutoff between swabbing and non-swabbing is arbitrary without a scientific
> base or evidence base. Imagine you sit in front of a patient with a darker
> skin colour and want to give an injection. When would you be confident that
> the skin is NOT visibly dirty? ****
>
> ****
>
> In summary, if you don’t swab, you are consistent with the guidelines, but
> the guidelines are seriously flawed (at least you won’t be responsible
> then). It is certainly reassuring that the natural infection rate is very
> low, and statistically you are unlikely (but it is possible) to see any
> adverse event. It is clear that i.m. injections and other types of
> injections are biologically and clinically different and bear a different
> infection risk. Also, the deeper an injection is, the more complicated
> infections can get (examples on the complicated end are joint injections,
> corticosteroid injections, or more complicated injections). ****
>
> ****
>
> 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 *Franciska Ferreira
> *Sent:* Monday, 25 March, 2013 8:54 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* RE; Alcohol swab before injections****
>
> ****
>
> Hi All,****
>
> ****
>
> There is still an ongoing debate whether we should use an alcohol swab
> before administering clexane, vaccines and insulin. Any ideas please?****
>
> I know the latest practice in regards administering clexane is to not
> swab.****
>
> ****
>
> I just want to advise my team from a infection control point of view with
> facts to stand on.****
>
> ****
>
> Kind Regards****
>
> ****
>
> *Franciska Ferreira*****
>
> *INFECTION PREVENTION & CONTROL /WOUND MANAGEMENT CONSULTANT*****
>
> Burnside War Memorial Hospital****
>
> 120 Kensington Road, Toorak Gardens, SA 5056****
>
> *t:** *08 8202 7222 *f:** *08 8407 8573 e:
> fferreira@burnsidehospital.asn.au****
>
> ****
>
> ****
> ——————————
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[Claire Rickard]

I completely agree with you Matthias.

With injections into IV ports we are now encouraged to “scrub the hub” for
30 seconds with either isopropyl alchol or alcoholic chlrohexidine etc!

Yet for the skin, which is nice and warm and moist – capable of supporting
much higher microbe counts than a dry cool rubber bung, we use
nothing…bizarre!!!

Best regards, Claire

*Professor Claire Rickard RN PhD*

c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter:
IVAD_Research | Intravascular Access Device Research Group | NHMRC Centre
of Research Excellence in Nursing | Centre for Health Practice
Innovation | Griffith
Health Institute | Griffith University

Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra
Hospital | The Prince Charles Hospital

P.S. Research frequently takes me off campus. Please contact Jenny Chan,
School Secretary 3735 5406 or *j.chan@griffith.edu.au*
with any urgent enquiries.

On 25 March 2013 11:29, Matthias Maiwald (KKH)
wrote:

> Dear Franciska, ****
>
> ** **
>
> Not sure about clexane and insulin (s.c. injections), but I have looked in
> some detail into the current Australian recommendations concerning
> vaccinations. Most vaccinations are i.m. injections, which are biologically
> quite different from s.c. injections and also from venipuncture. The
> official recommendation by the Australian Immunisation Handbook is not to
> swab (so if you follow that, you are following official recommendations),
> and only to swab if the injection area is visibly dirty, but the problem is
> that these recommendation are severely misguided and intellectually flawed.
> ****
>
> ** **
>
> (1) Much of it is based on a short 2001 article in the MJA, examining a
> few hundred s.c. injections and venipunctures, and concluding that swabbing
> for ANY type of injection is not necessary, including i.m. injections.
> There are two fatal flaws with this assumption. (a) The article did not
> examine even a single i.m. injection and made conclusions pertaining to
> these (which is inconsistent with the principles of evidence-based
> medicine, which the article purported to adhere to), and (b) the natural
> infection rate after i.m. injections is very low, estimated to be in the
> range of 1:5000 to 1:10000 or less (which is reassuring), but if you study
> a smaller population than is needed to capture the natural incidence of an
> event, then you cannot make conclusions that the intervention has no effect
> on the occurrence of the event. ****
>
> ** **
>
> (2) The recommendation to swab only if visibly soiled is not justified
> either, because microorganisms are invisible, and implementing this as a
> cutoff between swabbing and non-swabbing is arbitrary without a scientific
> base or evidence base. Imagine you sit in front of a patient with a darker
> skin colour and want to give an injection. When would you be confident that
> the skin is NOT visibly dirty? ****
>
> ** **
>
> In summary, if you don’t swab, you are consistent with the guidelines, but
> the guidelines are seriously flawed (at least you won’t be responsible
> then). It is certainly reassuring that the natural infection rate is very
> low, and statistically you are unlikely (but it is possible) to see any
> adverse event. It is clear that i.m. injections and other types of
> injections are biologically and clinically different and bear a different
> infection risk. Also, the deeper an injection is, the more complicated
> infections can get (examples on the complicated end are joint injections,
> corticosteroid injections, or more complicated injections). ****
>
> ** **
>
> 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 *Franciska Ferreira
> *Sent:* Monday, 25 March, 2013 8:54 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* RE; Alcohol swab before injections****
>
> ** **
>
> Hi All,****
>
> ** **
>
> There is still an ongoing debate whether we should use an alcohol swab
> before administering clexane, vaccines and insulin. Any ideas please?****
>
> I know the latest practice in regards administering clexane is to not
> swab.****
>
> ** **
>
> I just want to advise my team from a infection control point of view with
> facts to stand on.****
>
> ** **
>
> Kind Regards****
>
> ** **
>
> *Franciska Ferreira*
>
> *INFECTION PREVENTION & CONTROL /WOUND MANAGEMENT CONSULTANT*
>
> Burnside War Memorial Hospital****
>
> 120 Kensington Road, Toorak Gardens, SA 5056****
>
> *t:** *08 8202 7222 *f:** *08 8407 8573 e:
> fferreira@burnsidehospital.asn.au****
>
> ** **
>
> ** **
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