[Craig Boutlis]

Thanks Michael,

I’ve appreciated the feedback to date. Subcribers might also be interested in the recent SHEA Expert Guidance “Healthcare Personnel Attire in Non-Operating-Room Settings”, for which the free full text is available here: http://www.jstor.org/stable/10.1086/675066 It has an extensive literature review and discussion of evidence preceding that link given below.

Craig

________________________________

Moderator note: Some subscribers have noted the link to the ICHE article cited below is for subscription login only.

Here is a link to the free preview of the article (not the entire article):
http://www.jstor.org/stable/10.1086/676422
Cheers
Michael Wishart
ACIPC Infexion Connexion Administrator

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@svha.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email

[cid:image001.jpg@01CF9C1E.B26F6330]

Craig,
We have a hand hygiene policy/procedure that is waiting for approval – it has Bare Below the Elbow included and it mentions MUST a lot!

This article may be interesting – about white coats

Infection Control and Hospital Epidemiology

June 2014, Volume 35, Issue 6

740-742

Healthcare Worker Perception of Bare Below the Elbows: Readiness for Change?

James Pellerin, MD; Gonzalo Bearman, MD, MPH; Jonathan Sorah, BS; Kakotan Sanogo, MS; Michael Stevens, MD, MPH; Michael B. Edmond, MD, MPH, MPA

Thanks

Joe-Anne Bendall
(Monday/Thursday/Friday)
Joe-anne Bendall | Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

(Tuesday/Wednesday)
HAI Project Officer | Clinical Nurse Consultant Infection Prevention and Control
Clinical Governance Unit

Hi,

Hundreds of nervous medical registrars are about to fan out all over Australia for their Royal Australasian College of Physicians exams from July 25 to August 3, as they do every year. In hot pursuit will be about 150 “National Exam Panel” (NEP) members, of whom I am one. If you are wondering, it definitely is “all beer and skittles”.

Some of you can relax…I ditched my tie years ago, my jacket is left hanging on a chair, sleeves are rolled up, my pedometer has a watch, and there is no lanyard to be seen. For many others though, it is all about the grandest suit and tie they can conjure. Of interest, it’s amazing to see how easily those ties flop on to patients when candidates lean forward, but I digress.

I take it as a given that you all practice the 5 moments and cleaning of reusable equipment between patients. Do any of you in public (or some larger private) hospitals have a dress code (eg, BBE) that we NEPs and exam candidates must respect? Further, is it guidance (“should”) or actual policy (“must”)? Feel free to send on to me.

Best wishes,

Craig

Craig Boutlis

Department Head, Infectious Diseases | IMACS
LMB 8808, SCMC, NSW, 2521
Tel. 02 4222 5898 | craig.boutlis@sesiahs.health.nsw.gov.au

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[Craig Boutlis]

Hi Nicola,

I would suggest starting here, it might be all you need:

http://www.safetyandquality.gov.au/our-work/healthcare-associated-infection/antimicrobial-stewardship/book/

As Michael Leunig might say, “it’s as simple and as difficult as that”.

Craig

Craig Boutlis

Department Head, Infectious Diseases | IMACS
LMB 8808, SCMC, NSW, 2521
Tel. 02 4222 5898 | craig.boutlis@sesiahs.health.nsw.gov.au

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________________________________

Hi All,

We are a small group of hospitals (acute) with no infectious disease physician/team. I am trying to develop an AMS policy, does anyone out there have any experience with this or can share a policy.

Kind Regards

Nicola Swindells Clinical Nurse Consultant
Infection Control / Skin Integrity
Mater Hospitals Central Queensland
Rockhampton Gladstone Yeppoon

nswindells@mercycq.com
tel 07 49313420

Clean Hands are caring hands, remember the five moments of hand hygiene

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[Craig Boutlis]

iVee team

Craig Boutlis

Department Head, Infectious Diseases | IMACS
LMB 8808, SCMC, NSW, 2521
Tel. 02 4222 5898 | craig.boutlis@sesiahs.health.nsw.gov.au

—–Original Message—–

Hi All
At Canberra Hospital we are implementing a Vascular Aceess Team – only the abbreviation VAT is already in use for several other medical procedures etc.
I am looking for ideas of what we should call our team/service- we will be inserting PICC lines, difficult cannulas, monitoring central lines etc. We need to make sure that staff and patients recognise what we do from the name as well!

Any suggestions for a name that can also be a catchy acronym?

Thanks Kerry Taliaferro

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[Craig Boutlis]

Hi,

We have one that we use for our antimicrobial stewardship program (Green freely prescribable; Yellow computer approval; Red call ID). We like to joke about Red that “if you can’t spell it, you can’t have it” as it includes the mostly unfamiliar antibiotics. Our junior staff say that Yellow is “all the good stuff”.

If anyone would like it as a PDF then I am happy to send it.

Craig

Craig Boutlis

Department Head, Infectious Diseases | IMACS
LMB 8808, SCMC, NSW, 2521
Tel. 02 4222 5898 | craig.boutlis@sesiahs.health.nsw.gov.au

[http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-Health-Illawarra-Shoalhaven-LHD.jpg]

________________________________

Hi,

Can anyone direct me to the “traffic light” chart used for prescribing antimicrobials. I have one from the UK but would prefer one from Australia.

Thank you,

Helen Scott
Infection Control Co-ordinator |
Staff Educator |
Nepean Private Hospital
Kingswood, NSW.
Tel 02 4725 8758 | helen.scott@healthscope.com.au
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[Craig Boutlis]

Hi Ruth,

There is a fellow named Rod James who is part of the Guidance MS team in Melbourne who has been involved with point prevalence survey audits (including measures of compliance with guidelines and appropriateness) in public hospitals. They are also part of a research team that is looking at the challenges/opportunities in implementing stewardship programs in private hospitals. They have a presence on the web in terms of contact emails etc.

Craig Boutlis

Competing interests: We have been involved in the audits and use the Guidance MS software but I am not promoting it in any way here.

Craig Boutlis

Department Head, Infectious Diseases | IMACS
LMB 8808, SCMC, NSW, 2521
Tel. 02 4222 5898 | craig.boutlis@sesiahs.health.nsw.gov.au

[http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-Health-Illawarra-Shoalhaven-LHD.jpg]

________________________________

Dear All,
I was wondering if anyone would have a good Audit Tool to access the compliance of Doctors with the Antimicrobial Stewardship Policy of the hospital which complies with Standard 3 of the National Standards?
Regards

Ruth Dalrymple
Quality Risk/Infection Control Co-Ordinator
Hurstville Private Hospital
37 Gloucester Road, Hurstville NSW 2220, Australia
T 9579 7773 F 9586 2311
E Ruth.Dalrymple@healthecare.com.au W
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[Craig Boutlis]

Dear Lindy,

You might be interested in Googling the “Lewisham isolation priority system”

Craig Boutlis

No conflicts of interest

Infectious Diseases
Wollongong Hospital

________________________________

Dear Colleagues

I have been asked by my executive to check if anyone out there has developed a formal tool for “rating infectious control patients. For example an infectious patient with no drips /drains/ wound rated as a 1 where as a 3 for a patient with wounds /drips and drains?” that is used by their their facility/service

apparently some one has one developed hence our executive putting this forward as strategy to be considered for managing our bed block related to infection control risk pts …..I would think they are largely referring to MRSA pt’s.

anyhow any advice or if anyone knows of one or if there is any literature or research supporting this approach for categorising pts with an MRO using such a tool I would be most appreciative.
I am aware that pts without drains drips, good skin integrity etc may be lower risk of picking/spreading MROs (as we all know) a but i have not seen anything formalised or in concrete using a tool without the need for clinical/ infection control consideration which is more what I was after. I think my management are hoping for a one hat fits all approach to managing infection control issues/pts after hours when Infection control expertise is not available …hence me asking to see if anyone has developed something that is safe and workable.

many thanks for any help

have a great day all

regards

Lindy

Lindy Ryan

Infection Control Clinical Nurse Consultant | Infection Control Services, Nepean Hospital
Nepean Blue Mountains Local Health District PO Box 63 Penrith NSW 2751
Tel 02 4734 2228 | Fax 02 4734 2517 | lindy.ryan@swahs.health.nsw.gov.au
http://www.health.nsw.gov.au

Infection prevention & control is everyone’s business

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[Craig Boutlis]

Hi Michael,

This sounded interesting so I contacted HR Solutions to request more information about their study (which they kindly provided in a PowerPoint talk and a pamphlet). Of interest, I’ve attached a quote from the notes to their PowerPoint talk with more details about the study.

—————quote follows:

Hand washing regulations tend to vary by organization. For the purpose of this study, hand washing compliance was defined as washing hands before and after contact with a patient. Hand washing rates were self-reported by healthcare professionals.

As hospital-acquired infection rates soar, this data could provide a new solution to healthcare facilities to manage the issue. Engaged employees truly care about their jobs and are self-motivated to achieve the very best outcomes for their patients. By Engaging their staff, healthcare organizations should see a decrease in hospital-acquired infection rates at their organization and deaths resulting from such infections.

.99 Correlation was found in a study of 45 healthcare clients

—————

Craig

Craig Boutlis
Infectious Diseases Consultant
Infection Management and Control Service
Illawarra and Shoalhaven Hospitals, NSW

—–Original Message—–

Interesting study report in Infection Control Today news. This makes sense to me on a number of levels.

One of the greatest contributors to healthcare-acquired infections (HAIs)is poor handwashing compliance by hospital staff. Yet when it comes to hand hygiene, many organizations simply post signs asking employees to wash their hands. While increased signage may have a small impact on handwashing rates, HR Solutions has uncovered a new factor that has a profound linkage to handwashing compliance — employee engagement.

New data from HR Solutions, an international human capital management consulting firm, has shown a near-perfect correlation between handwashing compliance* at healthcare facilities and employee engagement. Employee engagement can be defined as an employee putting forth extra discretionary effort, as well as the likelihood of the employee being loyal and remaining with the organization over the long haul. Research shows that engaged employees perform better, put in extra efforts to help get the job done, show a strong level of commitment to the organization, and are more motivated and optimistic about their work goals. Employers with engaged employees tend to experience low employee turnover and more impressive business outcomes.

The positive Pearson Correlation (r+.99) shows conclusively that as engagement levels rise, so does handwashing compliance. AsHAI rates increase, this data could provide a new solution to healthcare facilities to manage the issue.

*Handwashing regulations tend to vary by organization. For the purpose of this study, handwashing compliance was defined as washing hands or using antibacterial hand sanitizer before and after contact with a patient.

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
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[Craig Boutlis]

Hi Michael,

I read the review and there’s no way in a million years that I’d be looking to change our current hospitals’ policy (which is to resite peripheral cannulae after 72 hours and those inserted in ambulances as soon as practicable).

We started reviewing all our Staph aureus bacteremias in detail on 1 Jan 09. In 2009 we had 11 SABs from a P-IVC in one of our 9 hospitals (1050 beds), all of which were in for > 72 hours except one ambulance case at 40 hrs. We made some changes and this year we’ve had 1 to date (a day sixer over Xmas / New Year on 3 Jan 10).

We make an exception for pediatrics and our outpatient antibiotic service: they go longer than 72 hrs but haven’t had a SAB in living memory. If that changes, we’ll look at < 72 hrs there too.

Craig

————-
Craig Boutlis, Director
Infection Management and Control Service (IMACS)
Level 1, Lawson Hse, Wollongong Hospital
LMB 8808, SouthCoast MC, NSW 2521

—–Original Message—–

There has been a recent Australian published review of routine replacement of peripheral IV catheters as recommended in the current HIPAC guidelines. The review concludes:

The review found no conclusive evidence of benefit in changing catheters every 72 to 96 hours. Consequently, health care organisations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings and would also be welcomed by patients, who would be spared the unnecessary pain of routine re-sites in the absence of clinical indications.
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD00779
8/pdf_fs.html

[NB Here is a short link in case the longer link gets broken – http://tinyurl.com/22m4xlf ]

Have any facilities considered this recommendation and made changes to current routine replacement of peripheral IV catheters?

Personally, I am concerned that such a recommendation does not take into account the variety of settings in which peripheral IV catheters are inserted and managed. It appears possible that all of the six included studies were in settings where additional resources were available to manage peripheral IV's (eg dedicated IV teams), which could in part account for the improved outcomes of catheter management.

Whilst we should review and challenge current standards, I feel we should be cautious in making changes which have the potential for harm to patients. Bacteraemias associated with peripheral IV catheters are reasonably rare events, and a rise in incidence may not be readily noted in an individual facility.

Thanks
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.

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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.
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[Craig Boutlis]

Hi Michael,

In our patch, we’ve tended to follow the famous NSW Health “Gastro pack” (http://www.health.nsw.gov.au/resources/publichealth/infectious/diseases/pdf/hospital_pack.pdf), which specifies:

CONTACT AND DROPLET PRECAUTIONS

* Contact Precautions includes wearing gloves and a plastic apron or gown when having contact
with the patient or the patient’s environment, especially when attending to patient toileting and
hygiene.

* Protective eyewear and mask must be worn when there is the potential of vomit or faecal
splashing.

* A mask should also be worn when there is the potential for aerosol dissemination. This may occur
when attending a vomiting patient, toileting an affected patient, changing and handling soiled linen
or any faecally soiled waste, attending a patient’s personal hygiene care, disposing of faeces, or
cleaning an affected patients room or environment.

Craig

————-
Craig Boutlis
Director, IMACS
Infection Management and Control Service (IMACS)
Level 1, Lawson House
The Wollongong Hospital
LMB 8808
SCMC NSW 2521

—–Original Message—–

CDC have released a draft GUIDELINE FOR THE PREVENTION AND CONTROL OF NOROVIRUS GASTROENTERITIS OUTBREAKS IN HEALTHCARE SETTINGS

It is available at:
http://www.cdc.gov/hicpac/pdf/norovirus/HICPAC_Norovirus_FR_Ver_05_20_10
_clean.pdf

One of the points I find interesting is that they do not recommend a surgical mask should be routinely worn by all staff caring for suspected viral gastroenteritis in symptomatic patients, to reduce staff exposure to potentially infective aerosols. They have the following
recommendation:

3.C.2.a Use a surgical or procedure mask, and eye protection if there is a risk of splashes to the face during the care of patients, particularly among those who are vomiting. (Category IB)

In practice, I do not think staff will actually be able to put on a mask in a timely manner every time the patient commences vomiting and the staff are in close vicinity. (“oh, just wait a minute whilst I get my mask on!”)

How many other facilities encourage all staff having direct patient contact to wear a surgical mask routinely in the care of all symptomatic patients in a suspected gastroenteritis outbreak?

Thanks
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.

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[Craig Boutlis]

Hi Fiona,

We’ve tended to avoid it along the lines that the further it is from patients and close supervision, the more likely it is perhaps to lack efficacy in preventing cross-infection and to result in unintended harm (children splashing their eyes, product causing slips on lino etc.) We do have it immediately inside our wards and some wards have put it outside in potentially public areas (which we’ve let go through to the keeper without incident).

I was initially for it, but changed my mind after reading a UK safety bulletin, which is still available at http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID61796&typefull&servicetypeAttachment

Craig

————-
Craig Boutlis
Director, IMACS
Infection Management and Control Service (IMACS)
Level 1, Lawson House
The Wollongong Hospital
LMB 8808
SCMC NSW 2521

—–Original Message—–

I would like to know if any members have placed their alcohol based hand rubs in public areas such as near lifts, entrances etc in their hospitals.
If so where have you put it and what form has this taken (bracket on wall, hand hygiene station etc) and have you had any issues with this.

Regards

Fiona Wilson
Manager, Infection Control
Western Health
email: fiona.wilson@wh.org.au

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[Craig Boutlis]

Hi,

Not that I know (someone from public health might). I doubt it would be a function of the Bureau of Health Information.

In NSW, infection control (quality and safety) and communicable diseases (public health) are in separate branches of the health department.

Craig

—–Original Message—–

Additionally, Canada has a comprehensive web site for reporting communicable diseases activity. Is NSW planning something similar?

Regards

Ingrid Tribe
RN,BN,GDip QI HlthCare, MMedSci(ClinEpid) Coordinator, Infection Control Service Flinders Medical Centre Bedford Park South Australia 5042 Australia

T: 61-(0)8-8204 5051
F: 61-(0)8-8204 4733
W: ingrid.tribe@health.sa.gov.au

The information contained in this email may be confidential and may also be the subject of legal professional privilege or public interest immunity. If you are not the intended recipient, use, disclosure or copying of this email and / or its attachments is unauthorised. If you have received this email in error, please email or telephone the above signatory.

—–Original Message—–

Hello again Ingrid,

Forgive my second post, but I’ve just come across the best example of accessible public reporting that I’ve ever seen anywhere (suggest start with hospital reports / maps). What’s more, they’ve routinely included one of the most controversial indicators of performance routinely (the health standardised mortality rate). It’s well worth a look and I think it’s a worthy aspirational goal for all of us.

Craig

—–Original Message—–

Are there any healthcare facilities publicly reporting infection rates? If so, how are you reporting this information? Is anyone using the internet for this purpose?
>
> Kind Regards
>
> Ingrid Tribe
RN,BN,GDip QI HlthCare, MMedSci(ClinEpid)
Coordinator, Infection Control Service
Flinders Medical Centre
Bedford Park
South Australia 5042
Australia
T: 08-8204 5051
F: 08-8204 4733
W: ingrid.tribe@health.sa.gov.au

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[Craig Boutlis]

Hello again Ingrid,

Forgive my second post, but I’ve just come across the best example of accessible public reporting that I’ve ever seen anywhere (suggest start with hospital reports / maps). What’s more, they’ve routinely included one of the most controversial indicators of performance routinely (the health standardised mortality rate). It’s well worth a look and I think it’s a worthy aspirational goal for all of us.

Craig

—–Original Message—–

Are there any healthcare facilities publicly reporting infection rates? If so, how are you reporting this information? Is anyone using the internet for this purpose?
>
> Kind Regards
>
> Ingrid Tribe
RN,BN,GDip QI HlthCare, MMedSci(ClinEpid)
Coordinator, Infection Control Service
Flinders Medical Centre
Bedford Park
South Australia 5042
Australia
T: 08-8204 5051
F: 08-8204 4733
W: ingrid.tribe@health.sa.gov.au

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[Craig Boutlis]

Hi Ingrid,

I’m not aware of anyone in NSW who has been able to negotiate this successfully but like you, would be interested to hear.

NSW recently had a “Garling Report” into our acute hospitals that has recommended every ward publically display new infection rates and hand hygiene rates on a monthly basis (these recommendations [reprinted below] were accepted by NSW Health and we are all obliged to implement them but it seems to me as though progress has been slow).

The other big ticket item from the Garling report was the creation of a “Bureau of Health Information” that is tasked with becoming the interface between NSW Health and the public on reporting. They have only just appointed a Canadian CEO (Diane Watson) who is busily compiling lists of how and what people would like to see reported. She’s actively recruiting analysts and research officers currently – I have the job applications if anyone wants them.

Craig

—–

Recommendation 90 (c):

NSW Health to consider PD2007-084 and if
appropriate, to rewrite it, to include material about and requirements for
infection prevention which needs to include as a minimum, the following:

(c) each ward must publicly display statistics and results compiled
monthly and updated throughout the year showing, at least:

(i) the rate of hospital acquired infection per patient on the ward;

(ii) the rate of compliance with hand washing techniques (and any
other applicable hygiene techniques)separately for each group of
health care workers caring for patients.

————-
Craig Boutlis
Director, IMACS
Infection Management and Control Service (IMACS)
Level 1, Lawson House
The Wollongong Hospital
LMB 8808
SCMC NSW 2521

—–Original Message—–

Are there any healthcare facilities publicly reporting infection rates? If so, how are you reporting this information? Is anyone using the internet for this purpose?
>
> Kind Regards
>
> Ingrid Tribe
RN,BN,GDip QI HlthCare, MMedSci(ClinEpid)
Coordinator, Infection Control Service
Flinders Medical Centre
Bedford Park
South Australia 5042
Australia
T: 08-8204 5051
F: 08-8204 4733
W: ingrid.tribe@health.sa.gov.au

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[Author]

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