[Wilson, Fiona L (Infection Control)]

Dear Michael, it sounds like a sheath to me (main definition of sheath is a protective covering) and the national guidelines do make it clear that sheaths are not a substitute for high level disinfection or sterilisation of semi-critical items (bit like gloves and hand hygiene really). I would be recommending that the scope is disinfected/sterilised between patients (whether a sheath was in place or not).
I am really not sure why sheaths are used at all – if the scopes are reprocessed between patients, why put a sheath on them?
I would be interested in what the ‘hard plastic disposable cover’ is for and why it is not considered to be a ‘sheath’.
Also – it may be approved for use by TGA but they would not be saying it was s substitute for appropriate reprocessing – just that it is approved for use to cover the scope.

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

—–Original Message—–
Of Wishart, Michael

I am perplexed by a product I have just looked at. It is a video
laryngoscope which has a sterile, disposable hard plastic cover which is
placed over a flexible fibreoptic component and then placed into the
oral cavity for tracheal intubation. Once used on a patient, the hard
plastic cover is disposed of and the manufacturer’s instructions state
the flexible fibreoptic component can be wiped over with 70% alcohol to
decontaminate it.

My understanding of the current national infection control guidelines is
that fibreoptic endoscopes which are covered by sheaths still require
high level disinfection of the non-disposable component that enters a
body cavity. The supplier debated with me that this hard plastic
disposable cover is not a sheath, as it is not likely to be perforated
during normal use. TGA must agree with them as the product is fully
approved for clinical use by TGA. Most users must agree as apparently
this product has been well accepted, mainly in emergency centres and
emergency vehicles.

This made me ask the question: what is a sheath? I do agree that the
hard plastic cover of this product does look like it would resist
perforation in normal use, but at what point does a sheath not become a
sheath? Does this mean that if an ENT endoscope manufacturer comes up
with a hard wearing disposable cover it would not be considered a sheath
for the purpose of our national infection control guidelines?

I would welcome some discussion on this topic to help settle my
perplexion.

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

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[Wilson, Fiona L (Infection Control)]

As one of the areas that do clear patients, we do not ask our patients to get tested once they are discharged home or to a non-acute facility. We consider them still to be VRE positive if/when they are readmitted; our policy is that they are considered positive until they have had 3 consecutive negative specimens taken at least one week apart – the ‘at least’ is the relevant part – it may be months between their 2nd and 3rd negative swab – as long as they are consecutive we do not fuss about the time frame (apart from the ‘at least’ one week apart.
Patients who are discharged to one of our non-acute facilities (nursing home, aged care, rehab) do not have Contact Precautions in place either (unless they have diarrhoea plus incontinence); we only put the precautions in place when they are in an acute care facility.
We still use the DHS Guidelines from 1998 (which I have heard are being updated). I have asked a few acute hospitals in Melbourne what they do re precautions and clearance – we all do things a bit differently!

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

—–Original Message—–
Of Jane Hellsten
Clearance

—–Original Message—–

I have been following the VRE clearance query with interest. At Bendigo
Health we do not clear patients with VRE, they remain on the list
forever.We do however clear Dialysis patients as we can easily keep
testing them, we also use the 3 consecutive clear results one week
apart.
I am interested to know the policies to enable the testing if the
patient has been discharged or transferred ie how do you obtain the the
3 consecutive rectal swabs?
We have been considering changing our VRE policy and it is difficult
with not state or national guidelines to assist.
thanks and regards
Jane Hellsten
Manager Infection Prevention Control
Bendigo Health
jhellste@bendigohealth.org.au
22.02.10

—–Original Message—–
Behalf Of Wilson, Fiona L (Infection Control)

We clear patients when they have had 3 consecutive negative rectal swabs
taken at least one week apart.

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

—–Original Message—–
Of Michael Wishart

Posted on behalf of Toni – Moderator

*I would like to know if anyone has a protocol for clearing a patient
with VRE and are willing to share. *

Thanks, Toni.

Regards,

**Toni Schouten** CICP

Clinical Nurse Consultant

Infection Control

Royal Prince Alfred Hospital

Level 7, KGV Building

Missenden Road

Camperdown NSW 2050

Australia

toni.schouten@sswahs.nsw.gov.au

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[Wilson, Fiona L (Infection Control)]

We clear patients when they have had 3 consecutive negative rectal swabs taken at least one week apart.

Fiona Wilson
Manager, Infection Control
Western Health
Phone: 8345 6666 pager 506
Fax: 83456973
email: fiona.wilson@wh.org.au

—–Original Message—–
From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU]On Behalf
Of Michael Wishart
Sent: Friday, 19 February 2010 10:13 AM
To: AICALIST@AICALIST.ORG.AU
Subject: [AICA_Infexion_Connexion] VRE Clearance

Posted on behalf of Toni – Moderator

*I would like to know if anyone has a protocol for clearing a patient
with VRE and are willing to share. *

Thanks, Toni.

Regards,

**Toni Schouten** CICP

Clinical Nurse Consultant

Infection Control

Royal Prince Alfred Hospital

Level 7, KGV Building

Missenden Road

Camperdown NSW 2050

Australia

Tele: +61 2 951 59308

Pager: 80878 (via switch 9515 6111)

Fax: +61 2 951 59304

toni.schouten@sswahs.nsw.gov.au

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[Wilson, Fiona L (Infection Control)]

We use our After Hours Administrators (nurses) and have done for many years. Our process is the same no matter what time of day the incident occurs – a quick outline of our process:

NSI to staff memeber who reports to IC (in hours) or AHA (out of hours).
Staff to ED for HepBsAB level and serum for storage (we either meet up with them in ED or back in their work area and explain the risks re BBV transmission and the follow up process. We do not test the staff member for BBV at the time of incident; we have their serum in storage so we can test at a later date if this is required.

Recipient bled for HIV, Hep C and Hep B – consent done by IC in hours (as we are accredited to do HIV consents) and by the covering RMO after hours. For pts who cannot consent (due to illness) we use Schedule 3 or 4 of the Health Act 1058 (although this has recently changed to the Health and Wellbeing act and I have not quite gone through it all to ensure the relevant section is Schedule 3 or 4 yet). We use interpreters for instances where we cannot speak the patients language; we never use the patients relatives/family etc for interpreting or for gaining consent – consent has to be given by the patient (or the Senior Authorised Medical Officer in cases where the patient is unable to consent due to illness).
We do not do individual risk assessments on all of our NSI – we treat them all the same irrespective of whether they were a significant injury (hollow bore needle used for taking blood etc) or less significant injury (insulin needle). We would only do a risk assessment if the source refuses to be bled or there is an unknown source and we always refer these staff directly to ID

In terms of follow up – we do it by exception so we tell the staff member that if there are any results that of concern they will be contacted that day (or night). These are really for staff who need PEP for Hep B or HIV exposure; they are contacted by Infectious Diseases Consultant (who is notified by micro). All other staff are requested to contact a particular medical officer for their HepBsAB results the next working day.

We have had this process in place for ~10 years now and have had no major issues.

Fiona Wilson
Manager, Infection Control
Western Health
Phone: 8345 6666 pager 506
Fax: 83456973
email: fiona.wilson@wh.org.au

—–Original Message—–
From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU]On Behalf
Of Redl, Leanne
Sent: Friday, 19 February 2010 8:35 AM
To: AICALIST@AICALIST.ORG.AU
Subject: [AICA_Infexion_Connexion] Occupational Exposures

* Looking to review out of hours occupational exposure management. Which department and occupational group manage occupational exposures in (a) office hours and (b) out of office hours. For out of hours management whose responsibility is it to
* risk assess incident
* counsel and consent recipient and source (+ BBV risk assessment of source)
* follow up recipient and source

Leanne Redl
Clinical Nurse Consultant
Infection Prevention Surveillance Service
Tuesday/ Wedesday/ Friday
Ext 28325
Clinical Nurse Specialist
Intensive Care Unit
Monday/ Wednesday/ Friday
Ext 27209
Royal Melbourne Hospital

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