[Cath Murphy]

In addition to other comments provided I would refer AICA List users to this InN Press article soon to be published in AJIC. Hopefully it adds further clarity regarding these devices.

Btaiche, I. F., D. S. Kovacevich, et al. “The effects of needleless connectors on catheter-related bloodstream infections.” American Journal of Infection Control In Press, Corrected Proof.
Needleless connectors, including the standard split septum and the luer-activated mechanical valve connectors, have been introduced into clinical practice to eliminate the risk of needlestick injuries by avoiding the use of needles when accessing the intravascular catheters. Negative and positive displacement mechanical valves have been associated with increased rates of catheter-related bloodstream infections as compared with split septum connectors. Based on available data, split septum connectors should be preferentially used instead of mechanical valves. Adequate disinfection by scrubbing the access port preferably with chlorhexidine is recommended to minimize the risk of catheter microbial contamination along with proper infection control practices. Large prospective randomized clinical trials are needed to evaluate further the possible causes and effects of different types of mechanical valve needleless connectors on bloodstream infections.

Assoc. Prof Cathryn Murphy RN PhD CIC
Managing Director
Infection Control Plus Pty Ltd
PO Box 106
West Burleigh 4219
Queensland
AUSTRALIA
Ph +61 7 5520 1569
Fax + 61 7 5520 1476
Mob +61 428 154 154
http://www.icp.au.com

From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Monday, 24 January 2011 17:13
To: AICALIST@AICALIST.ORG.AU
Subject: [AICA_Infexion_Connexion] Fwd: [asid-ozbug] Bungs on PICCs

[Cross-posted from OzBug with permission on behalf of Tony Allworth – Moderator. I will copy any list replies to him]
A question has been raised that I would appreciated consolidated opinion on (I expect total consensus as usual): We have traditionally left the positive displacement valves (“bungs”) on PICCs from the time they go in unless there is obvious blood build-up or other contamination. The basis of this is to maintain a closed system to minimise infection. It has been pointed out that the positive displacement valves according to the manufacturer should be changed either after a certain number of accesses or time frame eg 3 days. When asked for the rationale for this no answer has been forthcoming. I can find no help in the literature. I am concerned that changing them “routinely” will compromise the microbial integrity of the system.

What do others do, and think we should be advising?

Cheers,

Tony Allworth

Dr Tony Allworth
Director, Infectious Diseases
Royal Brisbane & Women’s Hospital

(No vested interest in PICCs or bungs)

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[Cath Murphy]

This is an interesting development. I am assuming it could mirror AICA’s possible intentions to make recommendations regarding its AICA.

Is anyone able to advise if there is a fee associated with completing the training and how GENCA has validated the learning package content? Was there a largescale comprehensive practice analysis of GENCA’s members work performed or was the package merely the work of GENCA or QLD Health experts?

I’m also curious as to how GENCA intends to enforce the Position and if a member is unable to commit to undertaking the training would GENCA deny that person membership (which would seem crazy from a strategic and financial point of view).

The whole issue of certification/ credentialing and on-going education is an interesting one and in the US has lead to substantial review and consideration of the most appropriate model that brings positive improvements for patients.

There are also substantial administrative burdens associated with promoting such a position.

None of these issues are new to AICA and it is very interesting to see how continuing competence is measured and moulded in Australia and beyond and in different specialities.

Thanks for sharing this with AICA members.

Regards

Cath

Cath Murphy RN PhD
Clinical Nurse Consultant
Infection Control
Robina Hospital

—–Original Message—–
From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Claire Boardman
Sent: Monday, 2 August 2010 16:35
To: AICALIST@AICALIST.ORG.AU
Subject: [AICA_Infexion_Connexion] FYI – GENCA position statement – reprocessing of felxible scopes

No doubt some of you may already have seen this but just in case please find information relating to the GENCA Position statement.

The Gastroenterological Nurses College of Australia have published a Position Statement for Education Requirements for Personnel Reprocessing Flexible Endoscopic Equipment.

The Statement is available at the following link:
http://www.genca.org/images/stories/PDFs/publications/positionstatements/position_statement_education_requirements.pdf

Claire Boardman
AICA President

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[Cath Murphy]

Dear Margaret

A dermatology consult is as you recognise ideal and probably idealistic.

Next course of action for me would be extensive review of the affected
individual’s technique, non-clinical hand care (ie. domestic products and
other harsh chemicals and moisturisers)and evaluation of HCW skin according
to a valid scale/ criteria – see WHO 2009 HH Guidelines for such a tool) –
just to rule out causes other than the CHG reaction.

I would also consider review of gloves and glove use ? inappropriate use or
over use (common in non-clinical staff such as delivers of meals)

If still no joy I would connect with the manufacturer of the CHG product
your affected HCWs are using and request their assistance and additional
information. They typically take this sort of request most seriously and are
keen to find viable solutions.

Probably you have thought of all of these issues but maybe they are worth
revisiting given the difficulties of introducing alternate or new products.

I also recall having read somewhere of seasonal variation in how hands react
to some HH solutions – a relationship with humidity if I recall properly –
perhaps Darwin is the only currently humid place in Australia this Winter.

Hope this helps
Cath

—–Original Message—–
Jennifer Benjamin
cause Chlorhexidine

Triclosan products are generally well tolerated and still has antimicrobial
properties

Jen Benjamin
Infection Control Consultant
Melbourne Pathology
M: 0402 000 590

“We take it personally”

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________________________________

Chlorhexidine

Hello all

I have had a couple of staff who are apparently sensitive to Chlorhexidine
products.

Dermatology review is difficult to access in the NT so my question is what
do other ICP recommend for hand hygiene in this case. I realise you can’t
endorse products but a few clues would be great!

Margaret Gleeson | Clinical Nurse Specialist, Hand Hygiene Compliance
Infection Prevention & Management Unit, Royal Darwin Hospital | Department
of Health and Families
Rocklands Drive, Tiwi, NT 0811| PO Box 41326, Casuarina, NT 0811
p… (08) 89227694 Pager # 238 | f… (08) 89228889|
e…margaret.gleeson@nt.gov.au | http://www.nt.gov.au/health

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[Cath Murphy]

There are two other important pieces of information in this debate:
The CDC, US currently has a draft IV Guideline which address this issue by recommending the following (as reproduced from HICPAC website):
5. Use a needleless system to access IV tubing. Category 1C
6. When needleless systems are used, the split septum valve is preferred over the mechanical valve due to increased risk of infection
Further the language used to describe different needleless connectors is confusing and often discussion collectively refers to all mechanical valved access devices as needleless technologies which is confusing to readers familiar with this technology as described in several reports of related CR-BSI and other international guidelines and standards. A paper published in January 2010 by Haddaway in Journal of Infusion Nursing Vol 33 No 1 conveniently offers simple, practical definitions and distinguishes between the various technologies. I would commend AICA Members and list users adopt Haddaways terminology when describing experiences with these devices. Again I can happily provide copies of the Haddaway manuscript offline.
With regard to doing a trial comparing each system there are obvious ethical issues involved given the reports of increased CR-BSI associated with complex valves (see Haddaway for the definitions of simple vs complex valves).
Regards

Assoc. Prof Cathryn Murphy RN PhD CIC
Managing Director
Infection Control Plus Pty Ltd
PO Box 106
West Burleigh 4219
Queensland
AUSTRALIA
Ph +61 7 5520 1569
Fax + 61 7 5520 1476
Mob +61 419 953 680
http://www.icp.au.com

From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Wendy Grey
Sent: Friday, 12 March 2010 09:17
To: AICALIST@AICALIST.ORG.AU
Subject: [AICA_Infexion_Connexion] Needleless IV admin sets

Has anyone recently changed to needleless IV admin sets? We are considering some of these safety systems, but have heard anecdotal evidence of an increase in BSI rates following introduction. Does anyone have any experience of this change in systems and therefore practice??
regards
Wendy

Wendy Grey
Nursing Director of Infection, Prevention and Control
IMB 64
PO Box 670
Townsville Hospital 4810
Phone: 4796 1182
Fax : 4796
Mobile: 0428 649 072

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[Cath Murphy]

Dear Wendy

Below is the abstract of the most recent peer reviewed publication on this topic. I urge you to read it carefully before you make your decision. I have several other published references that I can share with you and others offline.

The beauty of the paper below is that we attempted to control for confounders. This issue is interesting and evolving. I would also like to hear the experiences of others on or offline.

Jarvis, W. R., C. Murphy, et al. (2009). “Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors.” Clin Infect Dis 49(12): 1821-7.

BACKGROUND: Health care-associated, central venous catheter-related bloodstream infections (HA-BSIs) are a major cause of morbidity and mortality. Needleless connectors (NCs) are an important component of the intravenous system. NCs initially were introduced to reduce health care worker needlestick injuries, yet some of these NCs may increase HA-BSI risk. METHODS: We compared HA-BSI rates on wards or intensive care units (ICUs) at 5 hospitals that had converted from split septum (SS) connectors or needles to mechanical valve needleless connectors (MV-NCs). The hospitals (16 ICUs, 1 entire hospital, and 1 oncology unit; 3 hospitals were located in the United States, and 2 were located in Australia) had conducted HA-BSI surveillance using Centers for Disease Control and Prevention definitions during use of both NCs. HA-BSI rates and prevention practices were compared during the pre-MV period, MV period, and post-MV period. RESULTS: The HA-BSI rate increased in all ICUs and wards when SS-NCs were replaced by MV-NCs. In the 16 ICUs, the HA-BSI rate increased significantly when SS-NCs or needles were replaced by MV-NCs (6.15 vs 9.49 BSIs per 1000 central venous catheter [CVC]-days; relative risk, 1.54; 95% confidence interval, 1.37-1.74; [Formula: see text]). The 14 ICUs that switched back to SS-NCs had significant reductions in their BSI rates (9.49 vs 5.77 BSIs per 1000 CVC-days; relative risk, 1.65; 95% confidence interval, 1.38-1.96; p < .001). BSI infection prevention strategies were similar in the pre-MV and MV periods. CONCLUSIONS: We found strong evidence that MV-NCs were associated with increased HA-BSI rates, despite similar BSI surveillance, definitions, and prevention strategies. Hospital personnel should monitor their HA-BSI rates and, if they are elevated, examine the role of newer technologies, such as MV-NCs.

Regards
Cath

Assoc. Prof Cathryn Murphy RN PhD CIC
Managing Director
Infection Control Plus Pty Ltd
PO Box 106
West Burleigh 4219
Queensland
AUSTRALIA
Ph +61 7 5520 1569
Fax + 61 7 5520 1476
Mob +61 419 953 680
http://www.icp.au.com

From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Wendy Grey
Sent: Friday, 12 March 2010 09:17
To: AICALIST@AICALIST.ORG.AU
Subject: [AICA_Infexion_Connexion] Needleless IV admin sets

Has anyone recently changed to needleless IV admin sets? We are considering some of these safety systems, but have heard anecdotal evidence of an increase in BSI rates following introduction. Does anyone have any experience of this change in systems and therefore practice??
regards
Wendy

Wendy Grey
Nursing Director of Infection, Prevention and Control
IMB 64
PO Box 670
Townsville Hospital 4810
Phone: 4796 1182
Fax : 4796
Mobile: 0428 649 072

********************************************************************************

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If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.

If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.

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Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.

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