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Dear Shiella
There are a thorough and comprehensive set of surgery-specific Standards published by the Australian College of Perioperative Nurses. These are available at https://www.acorn.org.au/standards/
The USA-based ACON also have specific guidelines for the perioperative setting. They can be accessed at http://www.acon.org.au
Kind regards
Cath
Cath Murphy PhD, MPH, RN, FAPIC, FSHEA, CIC
Professional Standards Officer
Australian College of Perioperative Nurses (ACORN)
M: 0428 154 154
E: mailto:cath.murphy@acorn.org.au
Tues-Thurs.From: ACIPC Infexion Connexion On Behalf Of Mercado Sheilla
Sent: Wednesday, 30 January 2019 16:52
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] OR PREPDear All:
Anyone got a guidelines for OR preparation.
For major surgery it is normal that the patient will take all clothes and put on top the drape but for minor surgery is there any guidelines in OR that all clothes be removed as well. Are we violating patient rights? Example, the surgery is only on the shoulder, should all clothes be removed? If the surgery is at the lower part of the body, for female she should remove her bra as well? Our OR team said it is infection control. But can we provide the patient some clothes to wear instead of removing all?
I hope you can help me out.
Thanks,
[Description: Description: Logo_highres-01]
Sheilla S. Mercado
Nurse Manager
Clinical Quality and Risk Management
HP: 0766-317-8106
E-mail: mercado_sheilla@cih.com.vnBNH VIN QUC T CITY
S 3, ng 17A, P. Bnh Tr ng B
Q. Bnh Tn, TP.HCM, Vit namCITY INTERNATIONAL HOSPITAL
No.3, 17A St., Binh Tri Dong B Ward
Binh Tan Dist., HCMC Vietnamweb http://www.cih.com.vn
fax +84-8 6269 6269
tel +84-8 6280 3333 (ext: 8397)MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Tina
By way of Xmas miracle SHEA just released an IC in anaesthesia guideline. It can be freely accessed and may add info for you and others. You can access it here SHEA, in collaboration with anesthesia societies, released an expert guidance with recommendations to improve infection prevention in operating room anesthesia services. The guidance, published in Infection Control & Healthcare Epidemiology, makes recommendations in the areas of hand hygiene, environmental disinfection, and continuous improvement. The full text is available, without a login at https://doi.org/10.1017/ice.2018.303.
Regards
Cath
Cathryn Murphy RN B. Photog MPH CIC FAPIC FSHEA CICP-E PhD
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
Adjunct Associate Professor
Faculty of Health Sciences and Medicine, Bond University
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auFrom: ACIPC Infexion Connexion On Behalf Of Tina Muller
Sent: Thursday, 13 December 2018 10:00
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Reviewing management of MRO’s in perioperative unit.Morning,
Thank-you to everyone who responded with sound advice.
Im sure I will be contacting you again in the near future when fine tuning my policy.Regards,
TinaTina Muller
Clinical Nurse Consultant / Perioperative & CSD.
Mackay Hospital and Health Service
P: 07 4885 5387
E:tina.muller@health.qld.gov.au[Email Signature]
From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Robinson, Nikki
Sent: Thursday, 13 December 2018 8:12 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: Reviewing management of MRO’s in perioperative unit.Hi Tina,
Our approach is to treat all patients the same. We do not screen all patients so would have many unknown colonised patients. By adopting a one approach policy there is no confusion as per Michael & Joanna comments below.
We recover all patients in recovery. The only time we would recover a patient in theatre would be if they were on droplet precautions (only happened once with a norovirus patient with a # NOF)
We dont do bronchoscopies so dont have airborne precautions to contend with in theatre / endoscopy unit.
Thanks
NikkiNikki Robinson
Infection Control & Quality Coordinator
Noosa Hospital
07 54559206From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Michael Wishart
Sent: Thursday, 13 December 2018 7:23 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Reviewing management of MRO’s in perioperative unit.Hi Tina
Our approach is similar to that described by Joanna Harris. I did a presentation to some per-operative nurses here about this. The key was investigating current practices between patients and plugging the holes (ie who cleans what make sure everyone knows their role).
I think you need to work out what will work in your setting, though. I do not believe a one-size-fits-all approach will work.
Cheers
MichaelMichael Wishart | Infection Control Coordinator, CICP-E
St Vincents 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 http://www.hsnph.org.au[cid:image001.jpg@01D46C86.4CDB6090]
From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of The Harrises
Sent: Thursday, 13 December 2018 4:31 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: Reviewing management of MRO’s in perioperative unit.Hello Tina, and welcome.
The important thing is to thoroughly look at the risks associated with MROs in theatre balanced with the risks associated with managing patients known to be colonised. Also recognise that you do not probably know the MRO colonisation status in real time for every single patient.
Here in the Illawarra Shoalhaven in NSW we have adopted a much more horizontal approach to our infection prevention and control policies. Essentially this can be described as doing the right thing for everyone. By doing this we make things simpler for staff, prevent discriminatory practices for those patients with a history of MRO colonisation, and avoid problems such as the ones you have described with wasted theatre time and equipment issues.
I would be very happy to discuss off line, and share policies etc. if you are interested.JoannaHarris
Nurse Manager, Infection Management and Control Service,
Illawarra Shoalhaven LHD, NSW.
Joanna.Harris@health.nsw.gov.auSent from my iPhone
On 7 Dec 2018, at 15:09, Tina Muller <Tina.Muller@HEALTH.QLD.GOV.AU> wrote:
Afternoon,Im a new member, and very excited to be able to network with such a diverse body of knowledge.
Question?
We are currently reviewing our management of MROs within the perioperative Unit.
Specifically focusing on decanting theatres prior to admitting the patient into theatre.
This includes the anaesthetic drugs trolley which is kept close at hand outside the door.
Yes, we allocate an outside runner.There are two components that we are keen to focus on.
1. Decanting the Theatre we are discussing the Non-Contact vs Contact Zone
2. Recovering of patient in the theatre ( VRE / ESBL/CRE ) vs PACU (MRSA)These are the core issue that cause grief among the staff.
Ana Folk- not ready access to emergent equipment if required.
Loss of theatre time in recovering patient in Theatre.As you are aware, this implicates theatre staff and activity time.
This is addressed with allocating the MRO patients to the end of the elective lists
If we have a spare theatre – we will take the MRO patients there, so there is minimal lost time in their home theatre( while someone else cleans up or recovers the patient)
No so easy to negotiate if this is an emerg patient.Earlier this year, I emailed across QHealth via SWAPNET, and thank-you to all who responded.
This has given us much to consider, drawing us to the Contact vs Non-Contact area within the actual theatre.[cid:image001.jpg@01D48E36.7789BA40]
Before I totally re-write our Policy reflecting the changes, I would like the opinion of the ACIPC Network.
I thank-you for your time and consideration in this matter.Regards,
TinaTina Muller
Clinical Nurse Consultant / Perioperative & CSD.
Mackay Hospital and Health Service
P: 07 4885 5387
E:tina.muller@health.qld.gov.au[Email Signature]
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Hi Sarah
The legal requirements may vary according to state and territory legislation. You could always enquire at the Legal Branch of QLD Health. Some of the HIV or Hep B/C organisations would also probably know.
As you would appreciate there may be serious implications for anyone who is +ve in terms of insurance, workplace fitness etc so I would really caution you to seek proper info. Blame my caution on previous life at NSW Health Dept as policy adviser.
You may also want to have a look at the HCW policies and legislation.
Cheers
CathCathryn Murphy RN B. Photog MPH FSHEA FAPIC CIPC-E PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
Adjunct Assoc. Professor Faculty of Health Services & Medicine
Bond University
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auFrom: ACIPC Infexion Connexion On Behalf Of Sara Godden
Sent: Wednesday, 17 October 2018 14:21
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Patient consent post anaesthetic for Body Bluid Exposure BloodsAfternoon Brains Trust,
I am trying to update our Body Fluid Exposure consent process for patients.
If the patient has not consented to the collection of Hep B, C & HIV prior to surgery, I was lead to believe that we had to wait 24 hrs post an anaesthetic for the consent to be valid, however I do not have any written evidence to back this up. I have also been told today that this is no longer correct.
Are you able to direct me or provide any assistance with the correct information in relation to this.
Many thanks for any assistance you can provide
Regards
Sara
Sara Godden CICP
Infection Control Coordinator
Acting Stomal Therapy NurseBrisbane Private Hospital
259 Wickham Terrace, Brisbane QLD 4000
T (07) 3834 6771 | M 0404 821 418 | F (07) 3834 6234
E sara.godden@healthscope.com.au
Website http://www.brisbaneprivatehospital.com.au[image002]
Follow us: Brisbane Private [Facebook image]
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Dear Margaret
The behavioural and human factors are really important in cleaning within hospital and office-based practices as well.
The research around impregnated wipes is also interesting as there are many unresolved issues including the most appropriate tests for registration as well as variable efficacy against different potential and actual pathogens .
Personally I have looked at several different popular impregnated wipes and noted issues with degree of dampness, leakage, dispensing etc. Some have greater coverage than others. It’s great that Australian healthcare cleaning remains at the front of researchers and clinicians’ minds as it is in my honest opinion, unresolved and pre-impregnated cloths whilst useful and effective are not without issue. There is still room for improvement and it’s a difficult challenge. In some settings disposable non-pre-impregnated wipes may be superior.
Glad to know that you are helping non-acute care settings with their practices.
Regards
CathCathryn Murphy RN B. Photog MPH FSHEA FAPIC CIPC-E PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
Adjunct Assoc. Professor – Faculty of Health Services & Medicine
Bond University
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.au.
—–Original Message—–
Hi Cath I run an infection control ed service Australia wide as a microbiologist myself but not for hospitals i.e. office based and right now I am just happy if there are detergent wipes everywhere so cleaning actually happens – I find it’s the facilitation that is important (from experience) and try to steer staff away from liquid detergents and bottles that need to made up daily and paper towel
Regards,
Margaret Jennings
Marjen Education Serviceswebsite. http://www.marjenes.com.au
email. marjenes@optusnet.com.aumob. 0404 088 754
fax. 03 9439 2436—–Original Message—–
Thanks Margaret
Dr Dancer is a crack researcher in this area for sure, and there are several locals as well plus US experts like Boyce and Carling. I hace access to and a pretty good working knowledge of the research, I am actually seeking either real-life practices or written policies from within Australia and NZ.
I appreciate your response regardless.
Cheers
CathCathryn Murphy RN B. Photog MPH FSHEA FAPIC CIPC-E PhD CIC Chief Executive Officer & Creative Director Infection Control Plus Pty Ltd Adjunct Assoc.
Professor – Faculty of Health Services & Medicine Bond University QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.au—–Original Message—–
Dear Catherine – I think that Dr Stephanie Dancer, Microbiologist at Lanarkshire might have some good references and advice on this as cleaning is her thing – she is a regular contributor so you shouldn’t have any trouble finding her email
I would be surprised if lint free was mandated for environmental cleaning
Regards,
Margaret Jennings
Marjen Education Serviceswebsite. http://www.marjenes.com.au
email. marjenes@optusnet.com.aumob. 0404 088 754
fax. 03 9439 2436—–Original Message—–
Dear All
I am currently working on a project looking at variations/ uniformity in the type of cloths used to wipe surfaces in healthcare settings. Specifically I am looking for any guidelines (local/ state/ national) that make any recommendations for specific types of cloths by specific tasks or surface type. For example are there different requirements for cloths used in bathrooms vs pt environment vs high-touch objects vs non-clinical areas within a hospital.
I have access to the REACH study publications (thanks Brett) and other research from the Monash group (thanks Elisabeth Gillespie and team) but wonder if there are other requirements/ practices.
Thank you for any feedback.
Regards
CathCathryn Murphy RN B. Photog MPH FSHEA FAPIC CIPC-E PhD CIC Chief Executive Officer & Creative Director Infection Control Plus Pty Ltd Adjunct Honorary Assoc. Professor – Faculty of Health Services & Medicine Bond University QLD, Australia
E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
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Thanks Margaret
Dr Dancer is a crack researcher in this area for sure, and there are several locals as well plus US experts like Boyce and Carling. I hace access to and a pretty good working knowledge of the research, I am actually seeking either real-life practices or written policies from within Australia and NZ.
I appreciate your response regardless.
Cheers
CathCathryn Murphy RN B. Photog MPH FSHEA FAPIC CIPC-E PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
Adjunct Assoc. Professor – Faculty of Health Services & Medicine
Bond University
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.au—–Original Message—–
Dear Catherine – I think that Dr Stephanie Dancer, Microbiologist at Lanarkshire might have some good references and advice on this as cleaning is her thing – she is a regular contributor so you shouldn’t have any trouble finding her email
I would be surprised if lint free was mandated for environmental cleaning
Regards,
Margaret Jennings
Marjen Education Serviceswebsite. http://www.marjenes.com.au
email. marjenes@optusnet.com.aumob. 0404 088 754
fax. 03 9439 2436—–Original Message—–
Dear All
I am currently working on a project looking at variations/ uniformity in the type of cloths used to wipe surfaces in healthcare settings. Specifically I am looking for any guidelines (local/ state/ national) that make any recommendations for specific types of cloths by specific tasks or surface type. For example are there different requirements for cloths used in bathrooms vs pt environment vs high-touch objects vs non-clinical areas within a hospital.
I have access to the REACH study publications (thanks Brett) and other research from the Monash group (thanks Elisabeth Gillespie and team) but wonder if there are other requirements/ practices.
Thank you for any feedback.
Regards
CathCathryn Murphy RN B. Photog MPH FSHEA FAPIC CIPC-E PhD CIC Chief Executive Officer & Creative Director Infection Control Plus Pty Ltd Adjunct Honorary Assoc. Professor – Faculty of Health Services & Medicine Bond University QLD, Australia
E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
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Michael (thank you) and Co
There is also a good PPT that was presented at ACIPC17 available at the following link.
Regards
CathCathryn Murphy RN B. Photog MPH FSHEA FAPIC CIPC-E PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
Adjunct Assoc. Professor – Faculty of Health Services & Medicine
Bond University
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auHi all
In case you get asked a question because of what someone saw on the news today, here is a link to the latest alert about Candida auris and some CDC information.
Cheers
Michaelhttps://www.cdc.gov/fungal/candida-auris/index.html
Michael Wishart, CICP-E
Infection Control CoordinatorA 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
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Dear Sonja
The US INS Standards are world class and in Standard 40. Flushing and Locking the procedures are discussed in detail. See below.
I recall at a recent conference(s) dedicated to vascular access devices there was discussion and I believe a general consensus that blood should not be discarded. In paediatrics specifically repeated discards can lead to loss of blood volume and Hb.
Within hours I am sure Tim Spencer, Claire Rickard and perhaps even Tricia Kleidon may weigh in on this discussion. In the interim I will look for the references and hopefully it may help you.
Cath
Cathryn Murphy RN B. Photog MPH FSHEA FAPIC CIPC-E PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
Adjunct Assoc. Professor – Faculty of Health Services & Medicine
Bond University
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auStandard
40.1 Vascular access devices (VADs) are flushed and
aspirated for a blood return prior to each infusion to
assess catheter function and prevent complications.
40.2 VADs are flushed after each infusion to clear the
infused medication from the catheter lumen, thereby
reducing the risk of contact between incompatible
medications.
40.3 The VAD is locked after completion of the final
flush to decrease the risk of intraluminal occlusion and
catheter-related bloodstream infection (CR-BSI),
depending on the solution used.
Practice Criteria
A. Use single-dose systems (eg, single-dose vials or prefilled
labeled syringes) for all VAD flushing and
locking.
1. Commercially available prefilled syringes may
reduce the risk of CR-BSI and save staff time for
syringe preparation. 1-3 (IV)
2. If multiple-dose vials must be used, dedicate a
vial to a single patient (see Standard 49,
Infection ). 4 (V)
3. Do not use intravenous (IV) solution containers
(eg, bags or bottles) as a source for obtaining
flush solutions. 3-6 (IV)
4. Inform patients that disturbances in taste and
odor may occur with prefilled flush syringes and
may be related to several causes including systemic
conditions (eg, diabetes, Crohn’s disease),
medications (eg, antineoplastics), and radiation.
Leaching of substances from the plastic syringe
into the saline has been reported, although it is
not thought to be harmful to health. 7-9 (II)
B. Perform disinfection of connection surfaces (ie,
needleless connectors, injection ports) before flushing
and locking procedures (refer to Standard 34,
Needleless Connectors ).
C. Flush all VADs with preservative-free 0.9% sodium
chloride (USP).
1. Use a minimum volume equal to twice the internal
volume of the catheter system (eg, catheter
plus add-on devices). Larger volumes (eg, 5 mL
for peripheral VAD, 10 mL for central vascular
access devices [CVADs]) may remove more fibrin
deposits, drug precipitate, and other debris from
the lumen. Factors to consider when choosing
the flush volume include the type and size of
catheter, age of the patient, and type of infusion
therapy being given. Infusion of blood components,
parenteral nutrition, contrast media, and
other viscous solutions may require larger flush
volumes. 10 (IV)
2. If bacteriostatic 0.9% sodium chloride is used,
limit flush volume to no more than 30 mL in a
24-hour period to reduce the possible toxic
effects of the preservative, benzyl alcohol. 11 (V)
3. Use only preservative-free solutions for flushing
all VADs in neonates to prevent toxicity. 12 (V)
4. Use 5% dextrose in water followed by preservative-
free 0.9% sodium chloride (USP) when the
medication is incompatible with sodium chloride.
Do not allow dextrose to reside in the catheter
lumen as it provides nutrients for biofilm
growth. 13 (V)
5. Do not use sterile water for flushing VADs. 14 (V)
D. Assess VAD functionality by using a 10-mL syringe
or a syringe specifically designed to generate lower
injection pressure (ie, 10-mL-diameter syringe barrel),
taking note of any resistance.
1. During the initial flush, slowly aspirate the VAD
for blood return that is the color and consistency
of whole blood, which is an important
component of assessing catheter function prior
to administration of medications and solutions
(refer to Standard 48, Central Vascular Access
Device [CVAD] Occlusion ; Standard 53,
Central Vascular Access Device [CVAD]
Malposition ).
2. Do not forcibly flush any VAD with any syringe
size. If resistance is met and/or no blood return
noted, take further steps (eg, checking for closed
clamps or kinked sets, removing dressing, etc.) to
locate an external cause of the obstruction.
Internal causes may require diagnostic tests,
including, but not limited to, a chest radiograph
to confirm tip location and mechanical causes
(eg, pinch-off syndrome), color duplex ultrasound,
or fluoroscopy to identify thrombotic
causes (see Standard 52, Central Vascular Access
Device [CVAD]-Associated Venous Thrombosis ;
Standard 53, Central Vascular Access Device
[CVAD] Malposition ). 10 (IV)
3. After confirmation of patency by detecting no
resistance and the presence of a blood return, use
syringes appropriately sized for the medication
being injected. Do not transfer the medication to
a larger syringe. 3,15 (V)
4. Do not use prefilled flush syringes for dilution of
medications. Differences in gradation markings,
an unchangeable label on prefilled syringes,
partial loss of the drug dose, and possible contamination
increase the risk of serious medication
errors with syringe-to-syringe drug
transfer. 3,16 (V)
E. Following the administration of an IV push medication,
flush the VAD lumen with preservative-free
0.9% sodium chloride (USP) at the same rate of
injection as the medication. Use an amount of flush
solution to adequately clear the medication from the
lumen of the administration set and VAD. 3 (V)
F. Use positive-pressure techniques to minimize blood
reflux into the VAD lumen.
1. Prevent syringe-induced blood reflux by leaving
a small amount (eg, 0.5-1 mL) of flush solution
in a traditional syringe (ie, not a prefilled syringe)
to avoid compression of the plunger rod gasket
or by using a prefilled syringe designed to prevent
this type of reflux. 10,17 (IV)
2. Prevent disconnection reflux by using the appropriate
sequence for flushing, clamping, and disconnection
determined by the type of needleless
connector being used (refer to Standard 34,
Needleless Connectors ).
3. Consider using pulsatile flushing technique. In
vitro studies have shown that 10 short boluses
of 1 mL interrupted by brief pauses may be
more effective at removing solid deposits (eg,
fibrin, drug precipitate, intraluminal bacteria),
compared to continuous low-flow techniques.
Clinical studies are needed to provide more
clarity on the true effect of this technique. 10,18
(IV)
4. When feasible, consider orienting the bevel of an
implanted port access needle in the opposite
direction from the outflow channel where the
catheter is attached to the port body. In vitro testing
demonstrates a greater amount of protein is
removed when flushing with this bevel orientation.
19 (IV)
G. Lock short peripheral catheters immediately
following each use.
1. In adults, use preservative-free 0.9% sodium
chloride (USP) for locking. 10,20-24 (I)
2. In neonates and pediatrics, use heparin 0.5 units
to 10 units per mL or preservative-free 0.9%
sodium chloride (USP). Outcome data in these
patient populations are controversial. 25,26 (II)
3. For short peripheral catheters not being used for
intermittent infusion, consider locking once every
24 hours. 27 (III)
H. There is insufficient evidence to recommend the
solution for locking midline catheters.
I. Lock CVADs with either heparin 10 units per mL or
preservative-free 0.9% sodium chloride (USP),
according to the directions for use for the VAD and
needleless connector.
1. Establish a standardized lock solution for each
patient population, organization-wide. 28,29 (V)
2. Randomized controlled trials have shown equivalent
outcomes with heparin and sodium chloride
lock solutions for multiple-lumen nontunneled
CVADs, peripherally inserted central catheters
(PICCs), and implanted ports while accessed
and when the access needle is removed. There is
insufficient evidence to recommend one lock
solution over the other. 30-33 (I)
3. Use heparin or preservative-free 0.9% sodium
chloride (USP) for locking CVADs in children. 29
(II)
4. Consider using heparin 10 units per mL for locking
PICCs in home care patients. 34 (III)
5. Volume of the lock solution should equal the
internal volume of the VAD and add-on devices
plus 20%. Flow characteristics during injection
will cause overspill into the bloodstream. Lock
solution density is less than whole blood, allowing
leakage of lock solution and ingress of blood
into the catheter lumen when the CVAD tip location
is higher than the insertion site. 10,35-37 (IV)
6. Change to an alternative locking solution when
the heparin lock solution is thought to be the
cause of adverse drug reactions from heparin;
when heparin-induced thrombocytopenia and
thrombosis (HITT) develops; and when there are
spurious laboratory studies drawn from the
CVAD that has been locked with heparin. High
concentrations of heparin used in hemodialysis
catheters could lead to systemic anticoagulation.
Heparin-induced thrombocytopenia (HIT) has
been reported with the use of heparin lock solutions,
although the exact rates are unknown (see
Standard 43, Phlebotomy ). 11,38 (II)
7. Monitoring platelet counts for HIT is not recommended
in postoperative and medical patients
receiving only heparin in the form of a catheter
lock solution due to a very low incidence of HIT
of 1% or less (see Standard 52, Central Vascular
Access Device [CVAD] – Associated Venous
Thrombosis ). 38 (II)
8. Because of conflicts with religious beliefs, inform
patients when using heparin derived from animal
products (eg, porcine, bovine), and obtain consent.
Use preservative-free 0.9% sodium chloride
(USP) instead of heparin when possible. 39 (V)
J. Lock hemodialysis CVADs with heparin lock solution
1000 units/mL, 4% citrate, or antimicrobial
lock solutions. Use recombinant tissue plasminogen
activator to lock hemodialysis catheters once per
week as a strategy to reduce CR-BSI. 40-43 (I)
K. Lock apheresis CVADs with heparin 100 units/mL,
4% citrate, acid-citrate-dextrose Formula A, or
other antimicrobial lock solutions. 40-42,44,45 (IV)
L. Use solution containing heparin (eg, 1 unit per mL
of 0.9% sodium chloride [USP]) or preservative-free
0.9% sodium chloride (USP) as a continuous flow to
maintain patency of arterial catheters used for
hemodynamic monitoring. The decision to use preservative-
free 0.9% sodium chloride (USP) instead
of heparin infusion should be based on the clinical
risk of catheter occlusion, the anticipated length of
time the arterial catheter will be required, and
patient factors such as heparin sensitivities. 46-48 (II)
M. Apply the following recommendations for neonates
and pediatrics.
1. Use a continuous infusion of heparin 0.5 units
per kg for all CVADs in neonates.
2. Use continuous infusion of heparin 0.25 to 1 unit
per mL (total dose of heparin 25-200 units per kg
per day) for umbilical arterial catheters in neonates
to prevent arterial thrombosis.
3. Use heparin 5 units per mL, 1 mL per hour as a
continuous infusion for neonates and children
with peripheral arterial catheters (see Standard
30, Umbilical Catheters ). 29 (II)
N. Use antimicrobial locking solutions for therapeutic
and prophylactic purposes. Use in patients with
long-term CVADs, patients with a history of multiple
CR-BSIs, high-risk patient populations, and in
facilities with unacceptably high rates of central lineassociated
bloodstream infection (CLABSI), despite
application of other methods of CLABSI reduction.
42,49-52 (I)
1. Antibiotic lock solutions contain supratherapeutic
concentrations of antibiotics and may be
combined with heparin. Anticipate the chosen
antibiotic to be based on the specific infecting
organism or on prevalent organisms within the
organization when prophylaxis is the goal. For
therapeutic use, start the antibiotic lock solutions
within 48 to 72 hours of diagnosis; however, the
duration of use remains controversial. 53 (II)
2. Antiseptic locking solutions include ethanol,
taurolidine, citrate, 26% sodium chloride,
methylene blue, fusidic acid, and ethylenediaminetetra-
acetic acid (EDTA) used alone or in
numerous combinations. 51 (I)
3. Follow catheter manufacturers’ instructions for
intraluminal locking with ethanol. Changes in
CVADs made of polyurethane material, but not
silicone, have led to catheter rupture and splitting.
Monitor for thrombotic lumen occlusion as
ethanol has no anticoagulant activity, hemolysis,
and hepatic toxicity. Irreversible precipitation of
plasma proteins that could add to CVAD lumen
occlusion is associated with ethanol concentrations
greater than 28%. 37,54-56 (I)
4. Monitor sodium citrate, an anticoagulant with
antimicrobial effects, for systemic anticoagulation,
hypocalcemia that could produce cardiac
arrest, and protein precipitate formation with
concentrations greater than 12%. 36,43 (I)
5. Monitor taurolidine, an amino acid with antimicrobial
effects, for thrombotic lumen occlusion
and protein precipitation, which could cause
lumen occlusion. 30,51,57 (I)
6. Use standardized formulations and licensed independent
practitioner (LIP)-approved protocols
for all antimicrobial lock solutions to enhance
patient safety. Consult with pharmacy when
combinations of antimicrobial solutions are
planned so that correct information about compatibility
and stability of the solution are
addressed. 53,58 (II)
7. The length of time that antimicrobial lock solutions
should reside inside the CVAD lumen is
unclear; up to 12 hours per day may be required.
This will limit use in patients receiving continuous
or frequent intermittent infusions. 53 (II)
8. Aspirate all antimicrobial locking solutions from
the CVAD lumen at the end of the locking period.
Do not flush the lock solution into the
patient’s bloodstream, as this could increase
development of antibiotic resistance and other
adverse effects. Gentamicin-resistant bacteria
from gentamicin lock solution have been reported
to increase CLABSI rates. 42,58,59 (II)Hello,
We are reviewing our central line management policies and we trying to find evidence related to the routine practice for aspiration of blood prior to accessing the central line (especially PICC).
Our ICU team states that this is routinely performed within oncology groups.I would be grateful for some specialist information.
Kind Regards
SonjaSonja 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
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Hi Belinda
Like Glenys Harrington, I would also suspect that the need for additional cleaning and possibly even disinfection of a room would be organism-dependent.
Ideally one would like to think that the routine cleaning in non-outbreak situations would be sufficient with ramped up additional cleaning and/or disinfection (ideally using a waterless technology like UV) would be in cases where the environmental bioburden would logically be higher than “normal”. A classic example would be C. diff infection in a patient who was faecally incontinent.
Check out the current and draft revised NHMRC Guidelines and they should be instructive. Unfortunately, the draft guidelines version that was available for public comment was very conservative recommending sodium hypochlorite rather than UV disinfection. There will be many who argue against my view (including the systematic reviews NMHRC sponsored) but many of our US colleagues have had great success with implementing UV and other waterless systems of room disinfection. In many US organisations the use of these systems is now standard not just in outbreak situations. Hopefully, one day that will be the case in Australia.
Regards
CathCathryn Murphy RN B. Photog MPH CIC FAPIC FSHEA CICP-E PhD
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
Adjunct Associate Professor
Faculty of Health Sciences and Medicine, Bond University
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auHi all
Happy ThursdayDoes anyone have a management plan for Cleaning in the event of an outbreak that you would be happy to share?
Thanks so much
BelindaBelinda Boston
Infection Prevention and Control CNC | Nursing
St George Public Hospital
1st Floor James Laws House
Gray Street Kogarah NSW
Tel (02) 9113 4608 | Fax (02) 9113 1575 | Mob 0429 890 544 | belinda.boston@health.nsw.gov.au
http://www.seslhd.health.nsw.gov.au/
Click HERE to access SESLHD and SGH Infection Prevention and Control Information and resources
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Hi Pamela
What topics are you looking for? Do they need to be specific for NT govt policy, national or generic?
I have many that I may be able to share with you and you could adapt them for local use.
Regards
Cathryn Murphy RN B. Photog MPH FSHEA FAPIC CIPC-E PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
Adjunct Assoc. Professor – Faculty of Health Services & Medicine
Bond University
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auGood morning everyone,
Can anyone advise me where a good infection control presentation for nurses and assistant nurses may be found?
Kind regards,
PamPamela Boon | Clinical Nurse Manager
Infection Prevention and Management Unit | Royal Darwin Hospital | Top End Health ServiceNorthern Territory Government
LG Floor, Royal Darwin Hospital, Rocklands Drive, Tiwi
GPO Box 41326, Casuarina, NT 0811p …08 892 28045
f … 08 892 28889
e … Pamela.Boon@nt.gov.au
w… http://www.nt.gov.au/healthOur Vision: Building Better Care | Better Health | Better Communities Together
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Dear Daniella
I recently reviewed evidence and guidelines for best practice with vascular access devices. Below are the recommendations I made on based on the review and the supporting references.
I have never understood Australia’s reluctance to adopt scrub the hub campaigns and lack of interest in routine use of protective IV caps. As a recently hospitalised and immunosuppressed patient I worried every time my line was accessed as there was nothing uniform in any of the accesses. There are now good Australian research papers showing risk with even simple peripheral vascular catheters. IVs are inserted very commonly making them one of the most frequent infection risks in acute care settings.
With regard to CHG I also note a general reluctance to its use in Australia as evidenced by poor recommendations in the draft NHMRC IC Guidelines, questions raised previously on this discussion forum and at ACIPC meetings. Personally I disagree with Michael’s earlier comment given that it is often a long time between accesses of IV lines and if oncovered they can easily become contaminated hence an agent containing alcohol and CHG is safe to use in non CHG-sensitive populations and it gives immediacy plus residual. As you would appreciate CHG has been used extensively in healthcare and domestic settings for decades. True CHG sensitivity is extremely rare. Anaphylaxis reports typically demonstrate multi-site simultaneous exposure to CHG ie surgical skin prep + use of CHG lubricant jelly + CHG impregnated CVC insertion. The NHMRC’s recommendation that we keep risk registries of CHG containing products is salient as is the recommendation to take adequate histories from patients regarding sensitivities.
In a recent report where he considered “resistance” Kampf argued that we should use CHG cautiously and perhaps even in a stewardship way. He was smart to recognise that there is no universal agreed definition of CHG-resistance and that the mechanisms are very different to antimicrobial resistance.
I expect many will disagree with my views but I am very happy that CHG was used extensively to help prevent infection in my recent surgery and hospitalisation. I would have warmly welcomed the use of routine CHG & alcohol hub disinfection.
Recommendations based on literature and guideline review.
Care must be taken not to contaminate the lines when accessing lines and their administration sets.1,65,72
A single patient use application of 70% alcohol alone1,73 or >0.5% chlorhexidine in 70% alcohol1,10,29,72 should be used70 for 529- 15 seconds1,10,73 and allowed to dry when decontaminating the catheter hub or injection ports prior to every access of the circuit. This includes every time an infusion set is added or removed, as well as administration of medication.10,65 Supplies for disinfecting should be kept at the bedside.1
Use of disinfection caps on peripheral and central catheters should be considered.1,72
1. Gorski LA, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. J Infus Nurs. 2016;39(1S):1-256.
10. Loveday HP, Wilson JA, Pratt RJ, et al. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014;86 Suppl 1:S1-70.
29. Marschall J, Mermel LA, Fakih M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(7):753-771.
65. Society. AaNZIC. Central Line Insertion and Maintenance Guideline. 2012; http://www.anzics.com.au/Downloads/ANZICS_Insertion%26maintenance_guideline2012_04.pdf, 2017.
70. Ling ML, Apisarnthanarak A, Jaggi N, et al. APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI). Antimicrob Resist Infect Control Antimicrobial Resistance & Infection Control. 2016;5(1).
72. Nursing. RCo. Standards for infusion therapy. London.: Royal College of Nursing.; 2016.
73. (INICC). INICC. International Nosocomial Infection Control Consortium (INICC) Bundle to Prevent Central Line Associated Bloodstream Infections (CLAB) in Intensive Care Units (ICU): An International Perspective. Argentina.2017.
Cath
Cathryn Murphy RN B. Photog MPH CIC FAPIC FSHEA CICP-E PhD
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
Adjunct Associate Professor
Faculty of Health Sciences and Medicine, Bond University
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auDear colleagues,
I am interested to know if Australian hospitals are routinely using wipes containing chlorhexidine 2% with alcohol 70% to disinfect vascular access hubs (i.e. to ‘scrub the hub’). In particular, is this practised on general wards when accessing a PIVC?
Many thanks,
DanielaDaniela Karanfilovska
Clinical Nurse Consultant
Infection Prevention & Healthcare Epidemiologyt 03 90762819 m 0427 703 769
e D.Karanfilovska@alfred.org.auAlfred Health
55 Commercial Road
Melbourne VIC 3004
PO Box 315 Prahran
VIC 3181 Australia
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Dear Glenys
Thank you having the courage to question the value of our current Hand Hygiene system rather than just accepting it.
As you will be aware from all of your discussions with peers and your own work supporting IC&P programs the HHA auditing requirements are very resource intensive. Regardless of who collects data manually, who inputs it, who analyses it and responds to it at a local level it is resource intensive. Right back in the early days in an ACIPC journal Shabon and Stackelroth questioned its value. Macbeth and I also discussed its value. I have personally heard and held concerns that its demands force ICPs to focus overly on HH and sometimes at the risk of not paying attention to serious other issues including outbreaks, environmental cleaning, safe and appropriate use of PPE, vaccinations etc.
Cynically I recognise that from Australian govt perspectives both state and federal jurisdictions have invested millions of dollars into HH. Some of our peers have niched out their academic careers and multiple publications based on HH. Neither govt nor our HH “leaders” could ever fathom a change of tactic.
Inherently HH can’t hurt our efforts to reduce HAIs. Ongoing blind acceptance of HH promotion and onerous manual auditing requirements and questionable data (likely over reported) without reasonable review and reconsideration of their necessity perhaps stagnates our work. I would even go so far as to suggest that perhaps all of these requirements for data collection may be leading to a decline in staff interested in working in IC&P programs. Never before have I seen so many ads for IC&P positions.
Anyway I appreciate you raising these issues Glenys. Your views may not be mainstream but it’s important that we can all be challenged and our status quo questioned. I regret that you have been personally attacked on another forum for raising these concerns.
And, it would be great to see automated systems for monitoring if they bring more accurate, valid, reliable HH data and more reasonable recognition that HH alone will not solve the many challenges contemporary ICPs face.
Regards
Cath
Cathryn Murphy RN Bach. Photog. MPH. PhD. CIC
Chief Executive Officer
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Ph:+61 428 154 154——– Original message ——–
Hi John,
Many thanks for responding.
To continue putting $$ (mostly infection control personnel resources) into direct HH observations in the setting of gross overestimations of compliance rates should be evidence enough to review current practices.
There is a significant amount of information out there that challenges the accuracy of direct observational auditing of HH compliance, some of which has been undertaken in your own state of NSW see below.
While strides have been made by HHA since its establishment it is time to review the following given the information that is currently before use:
a) why do we continue to collect and report flawed data
b) why are we not reducing some of the current direct observation (infection control personnel /liaison nurses) auditing requirements until more accurate methods are investigated and,
c) why we are not looking at alternatives methods ( is see suggestions below – electronic devices/methods in combination with smaller observational audits).
In light of the available evidence (below) we should also be openly transparent and at this point in time when reporting direct observation compliance rates in Australia include a statement that cautions the reader that current research indicates the rates are likely to be significantly artificially inflated rather than implying to managers, CEOs and the general public that they are accurate.
Recent literature of interest
Australia – Yen Lee Angela Kwok et al. Automated hand hygiene auditing with and without an intervention. American Journal of Infection Control 44 (2016) 1475-80
* HHA rates (Hand Hygiene Australia human audits) for June 2014 were 85% and 87% on the medical and surgical wards, respectively. These rates were 55 percentage points (PPs) and 38 PPs higher than covert automation rates for June 2014 on the medical and surgical ward at 30% and 49%, respectively. During the intervention phase, average compliance did not change on the medical ward from their covert rate, whereas the surgical ward improved compared with the covert phase by 11 PPs to 60%. On average, compliance during the intervention without being refreshed did not change on the medical ward, whereas the average rate on the surgical ward declined by 9 PPs.
Australia – Mary-Louise et al. Hand hygiene compliance rates: Fact or fiction? AJIC online 17th May 2018
Direct human audit rates for the medical ward were inflated by an average of 55 PPs in 2014 and 64 PPs in 2015, 2.8-3.1 times higher than automated surveillance rates. The rates for the surgical ward were inflated by an average of 32 PPs in 2014 and 31 PPs in 2015, 1.6 times higher than automated surveillance rates. Over the 6 mandatory reporting quarters, human audits collected an average of 255 opportunities, whereas automation collected 578 times more data, averaging 147,308 opportunities per quarter.
The magnitude of the Hawthorne effect on direct human auditing was not trivial and produced highly inflated compliance rates.
Mandatory compliance necessitates accuracy that only automated surveillance can achieve, whereas daily hand hygiene ambassadors or reminder technology could harness clinicians ability to hyperrespond to produce habitual compliance.
Systematic review – Kingston L et al. Hand hygiene-related clinical trials reported since 2010: a systematic review. Journal of Hospital Infection 92 (2016) 309-320
We concluded that adopting a multimodal approach to hand hygiene improvement intervention strategies, whether guided by the WHO framework or by another tested multimodal framework, results in moderate improvements in hand hygiene compliance.
Editorial – Hand hygiene compliance: are we kidding ourselves? Editorial, Journal of Hospital Infection 92 (2016) 307-308
It is clear that monitoring hand hygiene compliance using direct observation is flawed and that electronic devices/methods in combination with smaller observational audits using appropriately trained staff would enable a better assessment Hence, in an era of multi-resistant Gram-negative bacteria, it is now time to take stock and consider that we have spent a number of years performing research on hand hygiene with little evidence that any particular strategy works. Perhaps future research should be focused not on campaigns to improve hand hygiene at all costs, but on understanding when hand hygiene is most beneficial, setting reasonable, achievable targets, and then monitoring using validated, reproducible methods.
Observational study – Scheithauer S et al. Workload even affects hand hygiene in a highly trained and well-staffed setting: a prospective 365/7/24 observational study. Journal of Hospital Infection 97 (2017) 11-16
Calculated compliance was inversely associated with nurses workload. Hand-rub activities (HRA)/patient-day (PD), observer-determined compliance and amount of disinfectant dispensed were used as surrogates for compliance, but did not correlate with actual compliance and thus should be used with caution.
The use of liaison nurses to undertake direct observation of HH compliance audits is not a common practice across Australia and Im not aware of any information that using a liaison nurse is any more accurate that an infection control professional? Happy to be corrected.
Ill cross posting my response with the Australasian College of infection Prevention and Control (ACIPC) list server in order to keep infection control personnel in on the discussions.
Regards
Glenys
Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.auHi Glenys
Im not sure Id agree that the current Australian HH audit system is broke and parliamentary records are not necessarily representative of what is really going on ! We should remember what little we had before HHA came into existence. In fact the load on infection control services has been minimised by training auditors who are link nurses etc. We now have such a brace of auditors that the main problem is keeping them credentialed. Our audits go across a large number of facilities each time and work pretty well like clockwork. Across Oz we have invested a lot of work in getting things to where they are and arguably there have been measurable gains in terms of SAB reduction etc. I think we should focus not on revolution but rather tinkering with the existing system.
A huge issue to me is that we medicos are still largely allowed to operate in a parallel universe, with no real accountability system ensuring that we (in NSW at least) have even completed 5 moments training or shock/horror been competency assessed for HH, PPE or aseptic technique. Aside from the College of Surgeons, it seems that the other colleges are dodging and weaving still and that is where ACIPC and ASID should be pushing +++. For instance our medical advanced trainees still have no explicit expectation put on them by the RACP concerning expectations of inf control practice during exams etc. We allow doctors to get about in all sorts of gear (suits, coats etc) or theatre scrubs and no-one wants to say boo. Why cant we adopt a bare below elbow standard nationally? Can we hear more about the Cognitive Institutes recent aust. pilot into Vanderbilt style accountability systems please? Royal Melb Hosp has been part of that pilot.
Other possible improvements:
a) At one of our sites, weve had the experience of a well credentialed external auditor conducting most of the HH audits for the past two audits. We have seen compliance there fall considerably indicating to me that all locations should adopt an approach to auditing whereby auditors are always drawn from a different ward or hospital (proper independent auditing).
b) We know also that the initial audit figures from a session are more indicative of actual practice and so, we should not allow for auditing at any site to go on for more than say 30 mins max.
c) We should ensure that audits occur more frequently than thrice yearly and across all shifts with at least monthly feedback of data to cadres and managers
d) Integrating HH auditing with AT audits
e) More careful operational research what is working , what is not, how valid are results, what effects are improvements in HH having, why are medicos not getting engaged with the system? etc
Best wishes
JohnDr John Ferguson MBBS DTM&H FRACP FRCPA
Director, Infection Prevention Service | HNE Local Health District
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf
[http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-Health-Master.jpg]Dear All,
There was a debate in the UK parliament, Westminster Hall on 15/5/2018 in relation to hand hygiene compliance.
The parliament was told that actual hand hygiene compliance is only 18% – 44% in the UK and that direct observation is grossly overestimating HH compliance rates (Hawthorn effect).
The discussion has implications for direct observation of hand hygiene compliance programs in Australian healthcare settings.
It is time to review our direct observation HH compliance strategies and the significant infection control resources committed to such programs across Australia.
Regards
Glenys
Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.au
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Hi Kaylene
With further thinking I would also suggest contacting the probe manufacturer/probe rep and ask them if that model has been validated for HLD in trophon. In my experience trophon is approved for use with an extensive range of probes by the probe manufacturers, but sometimes probe IFUs listing approved disinfectants are not always up to date. So it can be worth a call. If the probe is not validated, it’s a good idea to put in a request for validation with trophon.
Similar train of thought would apply for Antigermix. If people want to use UVC disinfection for probes, they should consult the probe manufacturer to ensure high doses of UVC are compatible with the probe plastic, and wont shorten the probe’s lifetime over multiple disinfection cycles.
The importance of checking the IFU is closing the loop – a disinfection device may be approved by the regulator, but to ensure probe warranty is not voided the probe IFUs need to be checked. The link Glenys provided is for external/endocavitary probes:
https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbidebs%2FPublicHTML%2FpdfStore.nsf&docidEEC91A0005BF8C44CA257D2E00425DF5&agid(PrintDetailsPublic)&actionid1Thanks for the opportunity to consider contemporary clinical issues – it’s an interesting way to kick off the new week and your question is one I’m sure others, including me can learn from.
Yours sincerely
Cath
Cathryn Murphy RN B. Photog MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auHi Kaylene/ Glenys
In response to Glenys’s recent posting compared to my earlier posting please note the distinction between two products. In my reply the link provided is for ANTIGERMIX E1 (AE1) – Light, germicidal, ultraviolet. (now attached) In Glenys’s attachment the listed device is for ANTIGERMIX S1 (AS1) – Light, germicidal, ultraviolet Product Type Medical device system Effective.
I cannot quickly determine if the devices are the same as their indications are different ie. one is indicated for TOE probes and the other seems for general. It’s a good example of not having a carte blanche approach but rather closely looking at device registration, device models, details and indications.
In your original email you didn’t differentiate to which ANTIGeRMIX model you are referring. Hopefully our respective views and others will help you find a safe solution to your original query.
Yours sincerely
Cath
Cathryn Murphy RN B. Photog MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auHi Kaylene,
The device you mention is regulated by TGA as a Class 11b “Medical Device” and is included in the TGA Australian Register of Therapeutic Goods (ARTG). See attached TGA “Summary for ARTG entry” and “TGA Summary of Disinfectant Regulations” at the following link https://www.tga.gov.au/summary-disinfectant-regulation
As mentioned by Cath Murphy note the intended purpose in the “Summary for ARTG entry” which states the following:
* “The ANTIGERMIX S1 (AS1) automaton is a dry disinfection process for ultrasound transducers. The AS1 device performs a High Level Disinfection on external or endocavitary ultrasound transducers. The process is based on UVC radiation as an alternative to a chemical disinfection process”.
Before using you should establish with the supplier/manufacturer of the transducer/s and the supplier/manufacturer of the Class 11b “Medical Device” [ANTIGERMIX S1 (AS1)] that they are compatible for the purposes of use and your warranty.
Regards
Glenys
Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.au
[Description: ICC Diagram ICCversion]Good morning all
I am looking for some assistance with managing the high level disinfection of ultrasound probes. We currently use Trophon (hydrogen peroxide) but have found a few new small ultrasound transducers for the renal patients that have been brought into the system without an consultation with infection prevention. These have not been tested with the Trophon system and we do not have any other method to disinfect appropriately at this point.
Our biomedical team have distributed information to the teams that use ultrasounds suggesting they implement UV Antigermix system. Is there anyone using this?
Our team would appreciate any information that might help our choices.
Regards[Barwon Health]
Kaylene Styles
Clinical Nurse Consultant | Infection Prevention Service | Barwon Health
Direct. (03) 4215 2323 |kaylenes@barwonhealth.org.au
Post. PO Box 281 Geelong 3220
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Hi Kaylene/ Glenys
In response to Glenys’s recent posting compared to my earlier posting please note the distinction between two products. In my reply the link provided is for ANTIGERMIX E1 (AE1) – Light, germicidal, ultraviolet. (now attached) In Glenys’s attachment the listed device is for ANTIGERMIX S1 (AS1) – Light, germicidal, ultraviolet Product Type Medical device system Effective.
I cannot quickly determine if the devices are the same as their indications are different ie. one is indicated for TOE probes and the other seems for general. It’s a good example of not having a carte blanche approach but rather closely looking at device registration, device models, details and indications.
In your original email you didn’t differentiate to which ANTIGeRMIX model you are referring. Hopefully our respective views and others will help you find a safe solution to your original query.
Yours sincerely
Cath
Cathryn Murphy RN B. Photog MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auHi Kaylene,
The device you mention is regulated by TGA as a Class 11b “Medical Device” and is included in the TGA Australian Register of Therapeutic Goods (ARTG). See attached TGA “Summary for ARTG entry” and “TGA Summary of Disinfectant Regulations” at the following link https://www.tga.gov.au/summary-disinfectant-regulation
As mentioned by Cath Murphy note the intended purpose in the “Summary for ARTG entry” which states the following:
* “The ANTIGERMIX S1 (AS1) automaton is a dry disinfection process for ultrasound transducers. The AS1 device performs a High Level Disinfection on external or endocavitary ultrasound transducers. The process is based on UVC radiation as an alternative to a chemical disinfection process”.
Before using you should establish with the supplier/manufacturer of the transducer/s and the supplier/manufacturer of the Class 11b “Medical Device” [ANTIGERMIX S1 (AS1)] that they are compatible for the purposes of use and your warranty.
Regards
Glenys
Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.au
[Description: ICC Diagram ICCversion]Good morning all
I am looking for some assistance with managing the high level disinfection of ultrasound probes. We currently use Trophon (hydrogen peroxide) but have found a few new small ultrasound transducers for the renal patients that have been brought into the system without an consultation with infection prevention. These have not been tested with the Trophon system and we do not have any other method to disinfect appropriately at this point.
Our biomedical team have distributed information to the teams that use ultrasounds suggesting they implement UV Antigermix system. Is there anyone using this?
Our team would appreciate any information that might help our choices.
Regards[Barwon Health]
Kaylene Styles
Clinical Nurse Consultant | Infection Prevention Service | Barwon Health
Direct. (03) 4215 2323 |kaylenes@barwonhealth.org.au
Post. PO Box 281 Geelong 3220
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Hi Kaylene
As always I would encourage users to refer to TGA and listing, or not, of any product on the Australian Register of Therapeutic Goods. https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbidebs/PublicHTML/pdfStore.nsf&docid233098&agid(PrintDetailsPublic)&actionid1
An important part of checking listing is making sure that the way any product or good listed on the ARTG is used according to its listed “indications”. Healthcare workers can very creatively find uses for listed products that are not approved uses. In a practical sense that means that the comprehensive testing a manufacturer or provider has to undertake and prove to TGA prior to listing is most likely that ONLY approved use of products on the TGA.
I checked the above link and I don’t see U/S disinfection of U/S used in renal populations as indication.
It’s perhaps a pedantic point but guidelines and regulations and manufacturer’s instructions are all useful and should be adhered to.
Happy to discuss this further off line if anyone is interested.
Yours sincerely
Cath
Cathryn Murphy RN B. Photog MPH PhD CIC CICP-E
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auGood morning all
I am looking for some assistance with managing the high level disinfection of ultrasound probes. We currently use Trophon (hydrogen peroxide) but have found a few new small ultrasound transducers for the renal patients that have been brought into the system without an consultation with infection prevention. These have not been tested with the Trophon system and we do not have any other method to disinfect appropriately at this point.
Our biomedical team have distributed information to the teams that use ultrasounds suggesting they implement UV Antigermix system. Is there anyone using this?
Our team would appreciate any information that might help our choices.
Regards[Barwon Health]
Kaylene Styles
Clinical Nurse Consultant | Infection Prevention Service | Barwon Health
Direct. (03) 4215 2323 |kaylenes@barwonhealth.org.au
Post. PO Box 281 Geelong 3220
[Barwon Health Facebook][Barwon Health Twitter]
[Barwon Health LinkedIn]
[raditional Owners Flags]
We, Barwon Health, acknowledge the Traditional Owners of the land, the Wadawurrung people of the Kulin Nation.
We pay our respects to the Elders both past and present.[Barwon Health]
[Barwon Health]
E-MAIL IS CONFIDENTIAL. If you have received this e-mail in error, please notify us by return e-mail and delete the document. If you are not the intended recipient you are hereby notified that any disclosure, copying, distribution or taking any action in reliance on the contents of this information is strictly prohibited and may be unlawful. Barwon Health is not liable for the proper and complete transmission of the information contained in this communication or for any delay in its receipt.
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.
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Tim
Thats an interesting development from the CDC whereby they are now recommending the use of CHG-impregnated dressing (FDA-cleared) for short-term, non-tunnelled CVCs. Its an upgrade from their previous recommendation where those dressings were only recommended when the institutional CVC-related BSI rate was high.
I am curious at and when other US organisation like SHEA, APIC and INS will revise their positions.
Hopefully in the current review of the Australian NHMRC IC Guidelines the committee responsible for the review will follow this update.
As you know in Australia it is difficult to get a true sense of prospective CVC-related or even short term peripheral IV-related BSI given that the data is not available in the public domain. S. aureus BSI is sometimes used as a proxy measure however given the increasing pay for performance adoption in Australia I suspect Australian hospitals will now be looking for every additional measure to reduce CLABSI and vascular device-related BSI.
The estimated rates that any point prevalence survey will deduce will be difficult to validate and generalize especially when the sample size of next years national point prevalence surveys which will be collected from 20 public hospitals classified as either Principal Referral or Group A hospitals will be a gross underestimation of the true extent of the CLABSI burden.
Its such an important aspect of our work and that of the AVAS group I hope we can continue to respond appropriately to the problem. Part of that response should be careful consideration of new technologies and approaches to care.
Yours sincerely
Cath
Cathryn Murphy RN B. Photog MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
QLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W:http://www.infectioncontrolplus.com.auFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Tim Spencer
Sent: Monday, 13 November 2017 16:52
To: AICALIST@AICALIST.ORG.AU
Subject: Updated Recommendations on the Use of Chlorhexidine-Impregnated Dressings for Prevention of Intravascular Catheter-Related InfectionsHi All,
Here is an updated recommendation from the CDC on the use of CHG-Impregnated Dressings for Prevention of Intravascular Catheter-Related Infections.https://www.cdc.gov/infectioncontrol/guidelines/pdf/guidelines/c-i-dressings.pdf
Timothy R. Spencer, DipAppSc, BHSc, ICCert, RN, APRN, VA-BC
Global Vascular Access, LLC
M: +1 (623) 326 8889 (USA)
M: +61 409 463 428 (AU)
http://www.vascularaccess.com.au
http://orcid.org/0000-0002-3128-2034
Sent from my iPhone
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