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Hi Victoria,
Best practice would be single resident use – i.e. resident has their own.
When this is not possible there may be a local guideline to reflect on: below are a couple of examples with directions on how to manage, cover and clean hot packs.
Manufacturer’s instructions would guide the cleaning practice, but here is a recommendation from the WA guide:
Following use, clean with a pre-impregnated disposable neutral detergent wipe or if cleaning and disinfection is required e.g. for patient under transmission precautions, use a pre-impregnated disposable detergent and disinfectant wipe.Re pack cover/protection: WA guide – Hot and cold packs must be used with a cover and are not to be applied directly to the skin. NSW guide: Hot packs must not be placed on direct contact with the patients’ skin. Wrap the heat pack in a disposable wipe or special purpose non-woven pouch (e.g. Livingstone). Alternatively, wrap hot pack in two towels and place in pillow slip to prevent burns.
Hope this helps.
Regards Carrie
Hi All,
Some considerations around this matter:
Providers are well placed to have a HR procedure for mask exemption, including different scenarios.
There are no current Public Health Directions in effect requiring someone to wear a face mask.
However, during periods where there is high circulation of a respiratory organism, (demonstrated by increased case numbers and outbreaks in an area/region), as well as a vulnerable population (older person and RACF), care providers may risk assess the situation to require their staff to wear surgical masks in the facility – with the aim to reduce transmission. In this situation and where a staff member has requested exemption, the reason should be considered – i.e. is there a skin allergy/pressure issue -trialling differing masks and brands, or using a barrier cream, taking breaks from consistent use – i.e. risk assess when the mask is worn. Where there may be respiratory issues/asthma, consider work placement in area where there is less risk (and no requirement to wear mask) to others and person exempting.
Note: If the risk assessment has been made that masks are required, the absence of masks poses risk to resident, others and self.In the event that there is a suspected or known infection or facility outbreak of a respiratory (droplet/airborne) infection, we are guided by national, state/territory IPC guidelines to don surgical (droplet) or N95 (airborne) mask. The risk of transmission is higher in this scenario – then above. In this situation and where a staff member has requested exemption, and all avenues have been exhausted to find a suitable mask, consideration to a work location with less risk- i.e. another facility, work outdoors, work from home.
The absence of the mask poses risk to residents, others and self.Regards Carrie
Added by moderator from Infexion Conexion response
Hi Melissa
I assume this is for an outbreak situation? My understanding is that if you have an outbreak and are unable to protect yourself wearing the appropriate mask that you are not able to work in that area due to the high risk of getting the infection.
You would have to be furloughed or work somewhere else that did not require PPE for protection. It is duty of care, WHS, to protect the staff members by providing them with appropriate PPE. Unless they signed a waiver saying they are happy to work unprotected I would think this is your only option.
Kind regards
Yvonne
Yvonne Andrews
Clinical Nurse Consultant
IPC Lead
Care Development Unit
Residential
Baptist Care Canberra
14 Wormald St,
Symonston ACT 2609
P: (02) 6195 3119
M: 0482 180 333
E: YAndrews@baptistcare.org.au
“I work Monday to Friday 8am to 4pm”
Additional question:
What is the expectation for onsite? Is that everyday? The IPC lead role is daily in regards to provision of IPC advice, support and observation while undertaking the main employed role. Allocated time is required specifically for the role to undertake training, attend education/meetings, undertake audits, promotion, documentation, outbreak plans and reviews etc.
The name of the course for the IPC leads through ACIPC is the Foundations of IPC https://www.acipc.org.au/education/foundations-of-ipc/
Further questions unrelated to the IPC role:
Where is the conference: Melbourne Nov 17-20th 2024 – Sunday 17th-is the Aged Care IPC Workshop and over the main conference there are aged care sessions. The conference is online, including the workshop https://acipcconference.com.au/
Challenges have been experienced with staff claiming exemptions to wearing PPE, namely masks, challenges that escalate during outbreaks. How best to manage?
This is an OH&S matter as well as potential risks to others by not wearing a mask. It will be organistion procedure dependant. Where droplet or airbourne precautions are recomended for the protection against an organism, this is the practice should be undertaken for the safety of all. In the event of mask exemption, this would need to be risk assessed – consideration to working in an alternate area or off site where risk is reduced, or taking leave; trialing varied TGA approved masks to see whether there may be a better fit.Hi All,
The new Communicable Diseases Network Australia. National Outbreak Management Guideline for Acute Respiratory Infection (including COVID-19, influenza and RSV) in Residential Aged Care Homes. Version 2.0 June 2024 may be of assistance as discusses the use of the 3 viruses testing RATS (COVID, Influenza, RSV) for symptomatic residents and staff,
Kind regards Carrie
Hi Regina,
Thanks for reaching out.
The ACIPC community of practice webinar 27th June is addressing this topic and examples of duty lists, and discussion will be had in regard to creating a document suited to your facility. Could I recommend that you come along to this, as well as seeking assistance from our colleagues.
Link: https://www.acipc.org.au/acipc-aged-care-community-of-practice-webinar-series/
Regards Carrie
Posted from Infexion Conexion to Aged care Conexion by moderator.
Good afternoon, all,
We use retractable needles for most of our SC and IMs and if retractable needles cannot be used, we use standard- small yellow sharps bin to dispose of the sharp at the point of care.
Retractable needles are always used for Reusable insulin pens.
I hope this helps a bit.
Kind Regards
Fazila Sofric
Regional Support Manager- Metro South
SUPPORT SERVICES 2078 Logan Road, Upper Mt Gravatt Q 4122
T 07 3340 3200 | M 0428 926 300 | E fazila.sofric@sccqld.com.au | http://www.sccqld.com.au
Posted from Infexion Conexion to Aged care Conexion by moderator.
Hi Claire,
We use retractable devices where possible. And carry sharps containers to point of administration for disposal.
Cheers,
Melissa Ostrouhoff
Clinical Governance Manager
Palm Lake Care
melissao@palmlake.com.au
0477706665
Central Support Office, 3 Goodooga Drive, Bethania, QLD
https://palmlakecare.com.au/Hi Tanya,
Whilst nothing says “mandatory”, the language is pretty strong. I have put in link for all the documents referenced.
victorian-respiratory-protection-program-guidelines.docx (live.com)
1.2 Scope All Victorian health services where health care workers including volunteers and students on clinical placement, have the potential to be exposed to respiratory hazards are required to establish and maintain an RPP. (respiratory protection program)
National strengthened aged care standards:
5.2.2 The provider implements processes to minimise and manage infection when providing clinical care that include but are not limited to: a) performing clean procedures and aseptic techniques
b) using, managing and reviewing invasive devices including urinary catheters
c) minimising the transmission of infections and complications from infections.
Facility operators should ensure staff wearing surgical masks and respirator masks, do so in line with departmental guidance available at Personal protective equipment (PPE) <https://www.health.vic.gov.au/covid-19-infection-prevention-control-guidelines/personal-protective-equipment-ppe> and ensure there is adequate signage and staff training regarding mask usage.Personal protective equipment (PPE) | health.vic.gov.au
Respiratory protection programs (RPP)
Respiratory protection programs implement strategies designed to protect workers from workplace respiratory hazards, including COVID-19. All Victorian health services where health care workers, including volunteers and students on clinical placement, have the potential to be exposed to respiratory hazards are required to establish and maintain an RPP. See Victorian Respiratory Protection Program.
Employers are responsible for:
completing a risk assessment that identifies staff who require P2/N95 respirators ensuring users of respirators undergo AS/NZS 1715:2009 approved fit-testing. Either qualitative or quantitative methods are valid and appropriate providing education and training on the safe and appropriate use of selected PPE.
management-of-acute-respiratory-infection-outbreaks-including-covid-19-v3.1_0.docx (live.com) – Vic RAC outbreak guidelines
Implement IPC
measures A number of key measures should be employed during a COVID-19 exposure or outbreak in an RCF, including: • standard precautions: – hand hygiene – use of PPE – respiratory hygiene/cough etiquette – cleaning shared equipment – routine environmental cleaning. • transmission/airborne based precautions: – N95/P2 respiratory protection – single room isolation – dedicated equipment where possible – physical distancing should be maintained where feasible – cohorting/zoning of staff and residents where possible – ventilation/air handling
Actions Instructions – increased cleaning of frequently touched surfaces – minimising the movement of visitors into and within the facility – taking a risk-based approach to minimise risk related to admissions and transfers – displaying appropriate signage. • All staff working in RCFs should have good understanding of IPC measures required throughout a COVID-19 exposure or outbreak at their workplace. • See the following resource for further information: COVID-19 Infection Prevention and Control Guidelines <https://www.health.vic.gov.au/covid-19-infection-prevention-control-guidelines>.
Regards,
Kelly
Kelly Barton
Infection Prevention & Control Officer – Myrtleford
RN BHSc.Nursing, M.Infection Control, Grad Cert.Advanced Acute Care, Nurse Immuniser, Cert IV T&A
03 5751 9364 | 0467 275 451
kelly.barton@alpinehealth.org.au
http://www.alpinehealth.org.au
Hi Everyone
The resources and powerpoint presentation from the Community of Practice webinar are now up on the website under the aged care resource page. Provided are templates and examples of aged care IPC Program, IPC Program Plans and continuous improvement action plan.
Link: https://www.acipc.org.au/aged-care/resources-australasian-aged-care/
All feed back and requests for future webinars are welcome to the ACIPC Office – learning@acipc.org.au
Kind regards Carrie
Hi Michelle,
Great question – Hope this assists.
Aged care is not quite like the acute sector in regard to how we manage MRO.
Signage and precautions are only required if a resident is being isolated for an acute infection. As I’m sure you would agree – there is no benefit to using PPE in a resident’s room if the resident is mobilising around the facility – and we would not isolate a resident for the rest of their lives as a result of an MRO diagnosis.
The first question is – what is the organism and where is it? Precautions and signage are dependent on the risk and means of transmission.
For example:
If the organism is MRSA in a wound and the wound is covered with a dressing – the risk of transmission is low. The only time that contact precaution PPE would be required is when the wound was being dressed or if the dressing came down – at this time the wound is exposed, increasing the risk of transmission. Standard precautions remain consistently. No isolation and no signage required.Another example:
If the organism is C. diff, but the resident is asymptomatic and the infection not acute – transmission risk is low – no isolation and standard precautions is all that is required. No signage.
If the resident has an active C. diff infection and is symptomatic – risk of transmission is higher – isolation required and standard, contact and droplet precautions are required. Signage to these transmission means is required.Another example:
If the organism was VRE in the urine and the resident had active UTI symptoms – transmission risk is higher – isolation and standard and contact precautions would be require – increase to standard, contact and droplet if there is droplet risk. Signage in accordance with the transmission means would be required.If a resident is identified to be colonised with an MRO – transmission risk is low. Isolation is not required, transmission precautions are not required, and signage is not required. Standard precautions remain consistently.
For example:
MRSA located groin or armpit – no signs of active infection.Agree – Using symbols can be confusing to those not aware of their meaning – i.e. agency or new staff. Using the correct transmission signage is the safest way forward on the door.
Infectious rooms requiring daily clean can be made known to the cleaning staff at the commencement of shift – understanding that these rooms are cleaned last and with TGA approved neutral and disinfectant product.
Feel free to keep the discussion going.
Kind regards Carrie
Hi Everyopne,
Here is a great HH resource for assisting others to perform HH by the Aged Care Commission. This may answer the HH question above.
https://www.agedcarequality.gov.au/resource-library/hand-hygiene-helping-others-hand-hygiene
Regards Carrie
Hi Kathy
Absolutely and the PowerPoints and resources will all be put up on the website in the aged care CoP webinar resource section.
Be great to see you on in June.
Regards Carrie
Hi everyone,
Please be aware that there are many resources now sitting under the ‘resource’ heading on the top of the ACIPC webpage – simply hover over the word and let the drop box come out.
IPC collaborative resources, by country/region and specific settings: https://www.acipc.org.au/
or
Aged Care specifically: https://www.acipc.org.au/aged-care/resources-australasian-aged-care/No longer do you have to go search it’s all in one easy place.
Kind regards Carrie
Hi Catherine,
I can only speak from working in previous organisations.
We had an alert system that came up when first opening the residents electronic file, was quite bold and needed to be closed to move on. All required alerts presented like this – falls risk, cytotoxic treatment etc.
Note: Electronic alerts were only put into place for MRO infections, and these remained whether the infection was active or colonized- i.e. they were never closed off. For active MRO infections, management and precautions were addressed in the infection report. If colonised, then a risk assessment was in place to identify future potential risk of active infection with this MRO, directions as to what to watch, as well as immediate management and precaution measures to implement should active infection present.
Once an electronic infection (of any kind) report had been established, alerts were set within the system for RN follow up – this included infection management, signs and symptoms and antimicrobial review – usually 24hr.
In regard to all other infections, alerts were made through clinical hand overs – both verbal and written for clinical staff. A daily infection alert form was provided to kitchen, laundry, maintenance, cleaning, admin, allied health etc. These forms were provided to teams in the facility morning huddle where there was representation from all areas – form was usually collaborated by the clinical lead or IPC lead or RN in charge. This system was consistent and well known through outbreaks.
Re: The IPC Lead the scope of their role was facility determined – but the expectation of infection management and resident cases oversight, was certainly there.
Hope that is a little helpful
Kind regards Carrie
ACIPC
ACIPC IPC Consultant
Hobart
