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Hi Glenda,
I hope you’re doing well.
The reporting of sensitivities/specificities for the RATs varies
significantly depending on the source and the test brand. Studies have
shown that RATs, in general, are more accurate in symptomatic vs
asymptomatic people. And the positive predictive value varies depending on
prevalence of COVID-19. So places with relatively low prevalence (like
Australia) will naturally have more false positives. Something to keep in
mind as home tests are rolled out soon.I’ve been pulling together a position paper on RATs for Uni Melb thus the
reason I’ve been doing alot of reading about the tests. Here are a few
resources you may find useful:https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00234-0/fulltext
Overview:
https://www.cochrane.org/CD013705/INFECTN_how-accurate-are-rapid-tests-diagnosing-covid-19
and
full article:
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013705.pub2/fullCheers
Crystal*Crystal Polson, MSN, RN, NP, PGCertIPC* | Infection Control Coordinator
Public Health Network
*M*: 0434 831 715 *E: *crystal.polson@unimelb.edu.au
On Thu, Oct 28, 2021 at 6:08 PM SmartDentist
wrote:> Hi Leanne and Crystal,
> I could only find 2 articles with the stats for false positives with RAT
> in general and the articles said 6% and 8% which seems overly high.
> This isn’t in regard to people recovering from Covid but I also wonder as
> we have move into RAT for asymptomatic people in our workplace as a
> precaution, how high will false positives actually are in general.
>
> Interested also in any other information on false positives.
>
> kind regards
> Glenda Farmer
> Infection control and prevention
> Smartdentist.com.au
> smarthealthcare.com.au
>
> On 28 Oct 2021, at 12:46 pm, Crystal Polson wrote:
>
> Hi Leanne,
>
> I hope you’re doing well.
>
> People who have tested positive for SARS-CoV-2 can have detectable virus
> in upper respiratory secretions for up to 3 months. However, the virus is
> no longer replicating – and it is highly unlikely individuals are
> infectious – after around 10 (mild-moderate illness) to 20 days (severe
> illness) after developing symptoms.
>
> So people who have recently recovered from COVID-19 may test positive on
> the RAT and the result may be a true positive depending on the timeframe.
> But this doesn’t mean they are infectious (same as with PCR test).
>
> If a person who had COVID develops symptoms again, and it has been three
> months since their first infection, they should get a PCR test as it is
> possible to become reinfected with SARS-CoV-2.
>
> NSW Health recommends against asymptomatic testing (such as surveillance
> testing) for 6 months after a person has recovered from COVID due to the
> possibility of a positive result (again, could be true positive but person
> not infectious). I can’t find a similar recommendation for Victoria but I
> think this is a good guideline to use.
>
>
> Cheers
> Crystal
>
> *Crystal Polson, MSN, RN, NP, GCert IPC* | Infection Control Coordinator
> University of Melbourne | Public Health Network
> *M*: 0434 831 715 *E: *crystal.polson@unimelb.edu.au
>
>
> Please note, I do not work on Fridays
>
>
>
>
>
>
>
>
>
> On Thu, Oct 28, 2021 at 10:40 AM Leanne IAnson Leanne.IAnson@tlchealthcare.com.au> wrote:
>
>> Hi All,
>>
>>
>>
>> Just wondering if anyone has heard data regarding false positive RAT in
>> those that have had covid-19.
>>
>>
>>
>> We have been informed it is pointless to use RAT on those that have had
>> the virus as they often show false positive results ,
>>
>> Appreciate all feedback
>>
>>
>>
>> Kind Regards
>>
>>
>>
>> Leanne IAnson
>>
>> Infection Prevention and Control Manager
>>
>>
>>
>> *TLC Healthcare*
>>
>> Mobile:0487210205
>>
>> [image:
>> https://www.tlchealthcare.com.au/assets/email/tlc-healthcare-combined-2018.jpg%5D
>>
>>
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Hi Leanne,
I hope you’re doing well.
People who have tested positive for SARS-CoV-2 can have detectable virus in
upper respiratory secretions for up to 3 months. However, the virus is no
longer replicating – and it is highly unlikely individuals are infectious
– after around 10 (mild-moderate illness) to 20 days (severe illness)
after developing symptoms.So people who have recently recovered from COVID-19 may test positive on
the RAT and the result may be a true positive depending on the timeframe.
But this doesn’t mean they are infectious (same as with PCR test).If a person who had COVID develops symptoms again, and it has been three
months since their first infection, they should get a PCR test as it is
possible to become reinfected with SARS-CoV-2.NSW Health recommends against asymptomatic testing (such as surveillance
testing) for 6 months after a person has recovered from COVID due to the
possibility of a positive result (again, could be true positive but person
not infectious). I can’t find a similar recommendation for Victoria but I
think this is a good guideline to use.Cheers
Crystal*Crystal Polson, MSN, RN, NP, GCert IPC* | Infection Control Coordinator
University of Melbourne | Public Health Network
*M*: 0434 831 715 *E: *crystal.polson@unimelb.edu.au
Please note, I do not work on Fridays
On Thu, Oct 28, 2021 at 10:40 AM Leanne IAnson wrote:
> Hi All,
>
>
>
> Just wondering if anyone has heard data regarding false positive RAT in
> those that have had covid-19.
>
>
>
> We have been informed it is pointless to use RAT on those that have had
> the virus as they often show false positive results ,
>
> Appreciate all feedback
>
>
>
> Kind Regards
>
>
>
> Leanne IAnson
>
> Infection Prevention and Control Manager
>
>
>
> *TLC Healthcare*
>
> Mobile:0487210205
>
> [image:
> https://www.tlchealthcare.com.au/assets/email/tlc-healthcare-combined-2018.jpg%5D
>
>
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Hi Jude
I hope you’re doing well.
The cleaner is likely referring to disinfectant fogging bombs such as
this one
https://www.starhygiene.com.au/king-mist-disinfectant-fogger-250ml/?gclidCj0KCQjwv5uKBhD6ARIsAGv9a-zpjTOtkZlvbGYIkqUXJyGEFof494LVW2k1rhtVMuaAWPIH8kE0uW4aAmpCEALw_wcBThese are not appropriate, especially in a healthcare setting. In the
context of COVID, the Vic DH does not recommend the use of disinfectant
fogging in any form. You can find IPC guidelines here
that
mention fogging.And keep in mind that all cleaning/disinfectant products must be
TGA-approved.I hope this helps.
Cheers
Crystal Polson
Infection Control Coordinator
University of Melbourne
crystal.polson@unimelb.edu.auSent from my iPad
On 20 Sep 2021, at 4:03 pm, Jude Searles wrote:
Hi Folks
I have just been asked by one of our cleaners about the possibility of
getting a bomb to clean our infectious rooms. What she described was
something akin to a flea bomb that you set off and then close the door.
Does anyone know if this is a thing and how much they cost?*Cheers*
*Jude Searles RN*
*Infection Prevention & Control*
*Co-ordinator Undergraduate Education*
*Dialysis Clinical Lead*
*Cohuna District Hospital*
Committed to Excellence in Rural Healthcare
148-155 King George Street, Cohuna, Victoria, 3568
T: Wk: (03) 54565300, Mob: +61409235654, Fax: (03) 5456 2627
E: jsearles@cdh.vic.gov.au W: *www.cdh.vic.gov.au
*[image: cid:image001.jpg@01D4F518.384170A0]
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Hi Vanessa,
Here is the Vic DH position statement on AGPs:
Cheers
Crystal Polson
Infection Control Coordinator
University of Melbourne
crystal.polson@unimelb.edu.auOn Thu, Jul 1, 2021 at 1:37 PM Vanessa Davis wrote:
> Dear Experts
> Once upon a time in the recent past there were recommendations to swap
> nebuliser therapy for residents on asthma meds to puffer and spacers. Is
> this still the current recommendation?
> Can someone please direct me to the relevant document. We still have a few
> residents who simply have no respiratory effort or cognitive ability to use
> a spacer.
> Thanks in advance for your help.
> Vanessa Watkins
> RN, Quality Manager, IPC Lead
> Donwood Community Aged Care
> Croydon, Victoria
> 9845 8500
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Hi Caroline,
I agree, the best people to advise on ventilation when it comes to HVAC
systems are engineers or occupational hygienists. HVAC systems, however,
are not the same as split-systems.Split-systems, for the most part, can only recirculate air which is not
ideal in any situation where you want to control infections. HVAC systems,
on the other hand, can often be adjusted to maximise air exchanges and
improve ventilation.Ventilation is one of the most important ways to prevent the spread of
airborne and droplet diseases but is also one of the most complex and
expensive to implement and maintain.We are dealing with split-systems at my work and trying to figure out how
to deal with them in the time of COVID!Cheers
Crystal Polson
Infection Control Coordinator | Public Health Network
University of Melbourne
crystal.polson@unimelb.edu.auOn Thu, Jan 21, 2021 at 8:27 AM Michael Wishart
wrote:> [Posted on behalf of member Moderator]
>
>
>
> Hi Everyone,
>
> The best professionals to advise on external air ventilation are
> mechanical engineers specialising in HVAC engineering.
>
> Best wishes,
>
> Caroline
>
> Dr Caroline Reed
>
> Medical Microbiologist
>
> Melbourne Pathology
>
>
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Hi Sara,
Hope all is well!
The Australasian Healthcare Facility Guidelines mention split systems (link
and excerpt below).The WHO explicitly notes on their website
that systems that recirculate air (which would include most split systems
and fans) should be avoided due to the risk of spreading droplets/aerosols
during COVID-19. This can be extrapolated to any setting where
droplets/aerosols could be potentially exacerbated by recirculated
air/strong airlows/poor ventilation.At the university where I work, we’ve been advising folks not to use split
systems wherever possible and we’ve been adjusting HVAC systems to maximise
outdoor air exchanges. Fans are prohibited. If the use of a split system is
unavoidable (i.e. extreme heat would be problematic), we advise that
furniture or patient care areas (in our GP clinics) be rearranged so that
no one is sitting or working directly in the line of the airflow.AHF Guidelines:
https://aushfg-prod-com-au.s3.amazonaws.com/Part%20D%20Whole_7_2.pdfSPLIT SYSTEMS:
The use of split system air conditioners is a common way of resolving local
cooling problems in newdevelopments or retrofitted facilities. Their use
should be avoided in patient care areas due to infection prevention issues.
The following need to be considered:routing of condensate drains; air
flow and turbulence effects; andmaintenance and adequacy of filters.The
use of split system air conditioners should be confined to process cooling
for equipment such ascomputer rooms and MRI equipment rooms, staff only and
non-patient care areas.RETICULATED WATER SYSTEMSFor further information
refer to the following documentation:ABCB, 2014, Plumbing Code of
Australia (PCA); and Standards Australia, 2011, AS/NZS 3666.1:2011Hope this helps
Cheers
Crystal Polson
Infection Control Coordinator
The University of Melbourne
crystal.polson@unimelb.edu.auOn Mon, Jan 18, 2021 at 12:40 PM Sara Nannery wrote:
> Hi everyone,
>
> Is anyone able to please provide me some clarity regarding reverse cycle
> air conditioners in patient care areas? specifically in outpatient /
> community based clinic rooms.
>
> A number of our community health centre clinical rooms (dental & podiatry)
> are looking at upgrading split system air-conditioning units, however I
> found some information in the Australian Health Facilities Guidelines
> (Physical Environment) advising that spit systems should be avoided in
> patient care areas, I couldn’t find anything in NHMRC guidelines though.
>
> Is anyone able to please provide some clarity on whether they are
> appropriate or not? we have more due to be installed this week, so there is
> a degree of urgency with this.
>
> Thanks in advance
>
> Sara Nannery
> OHS, Risk & infection control Coordinator
> Sunbury & Cobaw Community Health
>
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Thanks everyone for your feedback. Much appreciated.
Michael – we are using contactless forehead thermometers. And I have
witnessed exactly what you mentioned regarding inappropriate glove use. The
cashiers at Costco wear them for hours at a time (I know because I asked
the person ringing me up how often she was required to change them). I
emailed Costco’s health and safety director and asked about their glove use
protocol. He said the directive they received from the US head office was
to only change them if they “got dirty.” Yikes.I also noted that clinicians doing COVID tests at drive-through clinics
here in Melbourne weren’t changing gloves between tests! Which means they
weren’t performing hand hygiene, either.Rachel – I agree with you. Work Safe has introduced an unintended risk by
recommending glove use. And they don’t provide context on how to safely use
them for non-healthcare workplaces introducing temp screenings.I am hoping to convince Uni Melb to forgo gloves for temp checks, but it
may be difficult. They typically stick tight to Work Safe recommendations.Thanks again, all. Great to hear your thoughts.
Cheers
CrystalCrystal Polson, RN, MSN
Infection Control Coordinator
University of Melbourne
crystal.polson@unimelb.edu.auOn Thu, Sep 10, 2020 at 9:38 AM Michael Wishart
wrote:> I had a discussion with someone performing temp screening at an airport
> about this. They were wearing gloves, and doing tympanic temperature
> readings. They quite frequently had to manipulate either the persons hair
> or their pinna to get a reading, but were not changing gloves nor
> performing hand hygiene between patients! They said that is what they had
> been instructed to do.
>
>
>
> It will depend on what devices you are using, and whether you actually
> have to have physical contact with each person, etc. Tympanic temperature
> readings will probably have the most contact with each person, and thus
> hand hygiene after each patient contact without gloves being worn would be
> the most practical. Using a non-touch infrared device will mean the
> likelihood of having physical contact with patients will be much lower, and
> gloves could be worn for longer between hand hygiene opportunities..
> Certainly not a one-size-fits-all type situation.
>
>
>
> We have thermal scanners at the entrances to our hospitals, and thus no
> direct contact with most people. If the thermal scanner detects a high
> temperature, we then take the person aside and perform tympanic readings to
> verify. In that instance gloves are worn and discarded and hand hygiene
> performed for each patient.
>
>
>
> Interesting discussion, thanks.
>
>
>
> Cheers
>
> Michael
>
>
>
> *Michael Wishart *| Infection Control Coordinator, CICP-E
>
>
> St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD
> 4032
>
> *M *+61 448 954 282 | *T *+61 7 3326 3068 |* F* +61 7 3607 2226
>
> *E* michael.wishart@svha.org.au |
>
> *W *https://www.svphn.org.au
>
>
>
>
>
>
> St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT
> QLD 4169
> *M* +61 448 954 282 | *T *+61 7 3240 1208 |* F* +61 7 3240 1166
> *E* michael.wishart@svha.org.au |
>
> *W *https://www.svphb.org.au
>
>
>
>
> [image: SVPHN sig]
>
>
>
> [image: Stop the Flu before it stops you]
>
>
>
> *From:* ACIPC Infexion Connexion *On Behalf Of *Crystal
> Polson
> *Sent:* Wednesday, 9 September 2020 4:44 PM
> *To:* ACIPCLIST@ACIPC.ORG.AU
> *Subject:* [ACIPC_Infexion_Connexion] PPE for Temp Screenings
>
>
>
> Hi all,
>
>
>
> Hope everyone is doing well.
>
>
>
> Just wondering – if your facility is doing temperature screenings, what
> is your PPE protocol?
>
>
>
> I am in Victoria. Work Safe guidelines mention that gloves and masks
> should be worn. My question is, how often should the gloves be changed?
>
>
>
> We’re using non-contact forehead thermometers so the screener is not
> touching the person being screened.
>
>
>
> Cheers
>
> Crystal
>
>
>
> Crystal Polson
>
> Infection Control Coordinator
>
> University of Melbourne
>
> crystal.polson@unimelb.edu.au
>
>
>
>
>
>
>
>
>
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Hi all,
Thanks for sharing, Chris.
The Australian Nursing and Midwifery Federation just released their
position on fit testing:
http://www.anmf.org.au/documents/ANMF_Evidence_Brief_COVID-19-Fit_testing_and_fit_checking_for_respirators.pdfIn Australia, the Commonwealth Department of Health, National Medical
Research Council, and the Australian Commission of Healthcare Safety and
Quality recommend that both fit testing and fit checking are required for
P2 and N95 respirators. AS/NZS 1715 specifies that users of respirators
are to be fit tested prior to starting work and annually after that. The
NSW CEC also endorses fit testingduring
COVID19.At the very least, I believe frontline healthcare workers, especially those
working in COVID wards, should undergo fit testing (if they’re lucky enough
to have an N95 or P2 mask).Crystal Polson, RN, NP
Infection Control Coordinator
University of Melbourne
crystal.polson@unimelb.edu.auOn Thu, Sep 3, 2020 at 8:52 AM Chris Pollard
wrote:> Hi All,
>
>
>
> On ABC last night.
>
>
>
>
> https://www.abc.net.au/news/2020-09-02/n95-p2-masks-fit-tested-to-increase-coronavirus-protection/12617640?nw=0
>
>
>
> Kind regards
>
>
>
>
>
>
> *Chris Pollard *Sales Engineer
>
> Kenelec Scientific Pty Ltd, 23 Redland Drive, Mitcham VIC 3132
> d 03 9872 9929 | m 0437 007 810 | e chris.pollard@kenelec.com.au
>
> Visit our website | View our Terms and
> Conditions
>
>
>
>
>
>
>
>
>
>
>
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Great assessment, Glenys. Your findings underline the necessity of proper
fit testing – and not just fit checking – when using respirators.Here’s a great article on fit testing:
https://www.mja.com.au/journal/2020/fit-testing-n95p2-masks-protect-health-care-workers#:~:textThe%20Australian%20Standard%20AS%2FNZS,fit%2Dtesting%20(9).Cheers
Crystal Polson
Infection Control Coordinator
University of Melbourne
crystal.polson@unimelb.edu.auOn Mon, Aug 31, 2020 at 10:43 PM Glenys Harrington
wrote:> Hi All,
>
>
>
> With the change in guidelines in relation to the use of N95s in VIC I have
> been assisting a HCF to identify a suitable N95 masks.
>
>
>
> As a start I have reviewed a number of N95 masks on the market to see if
> they pass a *seal check (fit check) on myself*.
>
>
>
> Note: Im assuming that if worn correctly and with correct/recommend
> adjustments a mask that fails a *seal check (fit check) on myself* will
> also fail *fit check*.
>
>
>
> *A user seal check *should be done every time a N95 mask is to be worn to
> ensure an adequate seal is achieved.
>
>
>
> In the last 2 weeks I have obtained and reviewed six N95 masks. Four have
> been supplied to healthcare facilities from stockpiles (i.e. hospitals
> and/or aged care facilities), one masks was supplied by a manufacture and
> one mask was provided by a distributor.
>
>
>
> Of the 6 masks only 1 passed a *seal check (fit check) on myself.*
>
>
>
> Happy to share my assessment to date which includes details and images of
> failure issues I noted see attached.
>
>
>
> In addition I have attached two recent articles (MAGAZINE OF THE
> AUSTRALIAN SOCIETY OF ANAESTHETISTS, SEPTEMBER 2020 and *JAMA Intern
> Med. *Published online August 11, 2020.
> doi:10.1001/jamainternmed.2020.4221) in relation to this issue which may
> also be of interest/assistance if you are reviewing such masks.
>
>
>
> Regards
>
>
>
> Glenys
>
>
>
> Glenys Harrington
>
> Consultant
>
> Infection Control Consultancy (ICC)
>
> P.O. Box 6385
>
> Melbourne
>
> Australia, 3004
>
> M: +61 404816434
>
> E: infexion@ozemail.com.au
>
>
>
>
>
>
>
>
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Hi Lori
Heres a link to a review article on face shields.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015006/#!po1.02041
Cheers,
Crystal Polson, RN, NP>> On 11 Apr 2020, at 10:40 pm, Lori McLeod-Mills wrote:
>
> Dear Colleagues,
>
> I have been tasked with looking into the purchasing face shields for our frontline clinical staff. I have not been able to find any published literature review or clinical evidence assessment of the effectiveness of face shields.
>
> Does anyone know of any published evidence?
>
> Kind regards
>
> Lori
>
>
> Lori McLeod-Mills
> National Quality Governance Officer
> Healthcare Imaging
> Healius Limited
> +61 (0) 414 542 483
> +61 (0) 3 9211 1220
>
> Suite 8b 486 Lower Heidelberg Rd,
> Heidelberg VIC 3084
> lori.mcleod@healthcareimaging.com.au
> http://www.healius.com.au
>
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