[Catina Eyres]

Hi Sue and colleagues,
As part of the Victorian Clean Start Program 2007-2011, we were provided with a Cepheid GeneXpert system for fully integrated real-time MRSA PCR testing. We implemented this in December 2008. Bendigo Health will have a poster about this very topic at the AICA conference in Perth, so check it out for more information.
In response to your questions,

1. We are specifically using this for patients presenting via ED who are either having surgery or likely to be admitted; the orthopaedic unit has taken this on board for their elective hips/knees as well. Issues we’ve experienced include: staff education (ensuring all staff understand this testing and it’s purpose as well as provision of education to direct users about correct collection method), continuation of staff education to capture new/changing staff, incorrect use for wounds and/or other sites (although some hospitals have had their microbiology departments validate for wounds). My tip is education, education and more education!

2. We use mupirocin ointment for nasal decolonisation and chlorhexidine for body washing.

3. For those patients colonised w/ MRSA, we advise the use antibiotics as per the Therapeutic Guidelines 13th version for Antibiotics, which state: ‘Routine use of vancomycin prophylaxis should be discouraged, to prevent selection pressure for vancomycin-resistant enterococci (VRE) and vancomycin-intermediate MRSA (VISA). However, vancomycin should replace the cephalosporin or penicillin component of the regimen in the following circumstances:

a. Preoperative patients infected or colonised with an MRSA strain (hospital-acquired or community-associated) currently or in the past.

b. Patients having major surgery who are at high risk for MRSA colonisation (eg those who have resided for longer than 5 days in a health care facility where MRSA is endemic)

c. Patients undergoing prosthetic cardiac valve, joint or vascular surgery where the procedure is a re-operation (return to theatre or revision)

d. Patients hypersensitive to penicillins and/or caphalosporins.
We do try to ensure patients get tested so as to get the correct antibiotic prophylaxis.
I hope this helps,
Cheers,
Catina

Catina Eyres
Nurse Consultant
Infectious Diseases & Infection Control
Bendigo Health
PO Box 126 Bendigo 3552
ceyres@bendigohealth.org.au
p 03 5454 8414 (Infection Control)
p 03 5454 8422 (Infectious Diseases)
f 03 5454 8419
m 0409 230 871
pager 023

Dear colleagues

We currently perform MRSA screening (culture) for all of our patients undergoing elective orthopaedic hips and knees prosthetic procedures. The swabs are taken in pre admission clinic and if they come back MRSA positive a decolonisation program is implemented and the antibiotic prophylaxis adjusted.

We now wish to extend the screening to our non elective and emergency patients with #NOF’s using the rapid Gene Expert PCR so we can get the results back quickly before the surgery. We anticipate that we would need the emergency department staff to perform the screening when the patient presents.

We would like to ask 3 questions:
1. is anybody out there using the rapid Gene Expert PCR for this type of screening and if so are there any issues or advice you could offer.
2. what do you use for your pre op decolonisation eg. nasal mupirocin, tricolan, chlorhex body washes
3. for patients colonised with MRSA do you use IV vancomycin alone or with cephazolin

Thanks for your help

Warm regards
Sue

Sue Thorpe
Clinical Nurse Consultant
Senior Infection Preventionist
Employee Exposure Management & Immunisation Services (EEMIS)
Infection Prevention and Control Unit
Peninsula Health
PO Box 52
Frankston 3199

Peninsula Health – Metropolitan Health Service of the Year 2007 & 2009
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[Catina Eyres]

Hi Lindy,
Thanks very much for the detailed answer. Much appreciated.
Cheers,
Catina

Catina Eyres
Nurse Consultant
Infectious Diseases & Infection Control
Bendigo Health
PO Box 126 Bendigo 3552
ceyres@bendigohealth.org.au
p 03 5454 8414 (Infection Control)
p 03 5454 8422 (Infectious Diseases)
f 03 5454 8419
m 0409 230 871
pager 023

—–Original Message—–

Dear Catina

as per Micheal we have our cath lab use 2% CHG in 70% alchol for skin
prep.
(although We have said Ok to pts with sensitive skin & groin areas
where some pts are very sensistive & have been complaining about
burning from the alcohol to use the povidine iodine skin prep ) ……
Given that Adams et al 2005 JHI ‘Evaluation of 2% CGH in 70% isoprol
alcohol disinfectant’ indicated that a Log 10 reduction factor in cfu/ml
of S. epidimidis was 4.7 with 2%CHG in 70%IPA and 4.4 in 10% aqueous
povidine iodine (all others compared were >> WishartM@ramsayhealth.com.au 22/06/2010 2:54:06 pm >>>
Hi Catina

We recently moved over to alcoholic 2% chlorhexidine as a skin prep
for
all of our interventional cardiovascular procedures at the request of
our consultants. Apparently they had seen some evidence to support
this.
Queensland Health has provided a position paper which supported this
if
we think of cardiovascular access as intravascular, so we were happy
to
comply with our consultants’ request.

The QLD Health document can be found here:
http://www.health.qld.gov.au/chrisp/resources/rec_prac_skinprep.pdf

Hope this helps.

Cheers
Michael

Michael Wishart | GPH – Infection Control Coordinator

GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate Street, Greenslopes QLD 4120
t: 07 3394 7919 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

Ramsay Health Care is an environmentally responsible corporation,
please
consider the environment before printing this email.
________________________________________
Behalf Of Catina Eyres
preparation

Hello,
I’m wondering what other institutions use for skin preparation when
performing angiograms and placing permanent implantable devices ie.
Pacemakers, ICD, etc.
Cheers,
Catina

Catina Eyres
Nurse Consultant
Infectious Diseases & Infection Control
Bendigo Health
PO Box 126 Bendigo 3552
ceyres@bendigohealth.org.au
p 03 5454 8414 (Infection Control)
p 03 5454 8422 (Infectious Diseases)
f 03 5454 8419
m 0409 230 871
pager 023

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[Catina Eyres]

Thanks so much for the response Michael – we are trying hard to convince our unit to move over to chlorhexidine/alcohol prep for angiograms, but they are concerned about alcohol spillage into genital areas……we shall keep trying. Thanks for the information.
Cheers,
Catina

Catina Eyres
Nurse Consultant
Infectious Diseases & Infection Control
Bendigo Health
PO Box 126 Bendigo 3552
ceyres@bendigohealth.org.au
p 03 5454 8414 (Infection Control)
p 03 5454 8422 (Infectious Diseases)
f 03 5454 8419
m 0409 230 871
pager 023

—–Original Message—–

Hi Catina

We recently moved over to alcoholic 2% chlorhexidine as a skin prep for
all of our interventional cardiovascular procedures at the request of
our consultants. Apparently they had seen some evidence to support this.
Queensland Health has provided a position paper which supported this if
we think of cardiovascular access as intravascular, so we were happy to
comply with our consultants’ request.

The QLD Health document can be found here:
http://www.health.qld.gov.au/chrisp/resources/rec_prac_skinprep.pdf

Hope this helps.

Cheers
Michael

Michael Wishart | GPH – Infection Control Coordinator

GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate Street, Greenslopes QLD 4120
t: 07 3394 7919 | f: 07 3394 7985
e: WishartM@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

Ramsay Health Care is an environmentally responsible corporation, please
consider the environment before printing this email.
________________________________________
Behalf Of Catina Eyres

Hello,
I’m wondering what other institutions use for skin preparation when
performing angiograms and placing permanent implantable devices ie.
Pacemakers, ICD, etc.
Cheers,
Catina

Catina Eyres
Nurse Consultant
Infectious Diseases & Infection Control
Bendigo Health
PO Box 126 Bendigo 3552
ceyres@bendigohealth.org.au
p 03 5454 8414 (Infection Control)
p 03 5454 8422 (Infectious Diseases)
f 03 5454 8419
m 0409 230 871
pager 023

This e-mail message and any accompanying files may contain
information that is confidential and subject to privilege. If you
are not the intended recipient, and have received the e-mail
in error, you are notified that any use, dissemination,
distribution, forwarding, printing or copying of the message
and any attached files is strictly prohibited. If you have
received this e-mail message in error please immediately
advise the sender by return e-mail, or telephone 1800 243 903.
You must destroy the original transmission and its contents.
Any views expressed within this communication are those of
the individual sender, except where the sender specifically
states them to be the views of Ramsay Health Care.
This communication should not be copied or disseminated
without permission.
————————————————————————

Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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