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Hi John, just a couple of things to point out re the ‘Isolation Guidelines for Infectious Patients in Acute Settings’ (Department of Health UK) which I got to via the link on HICSIG:
The guidelines are only for isolation room design for infectious patients and the exclusions are (p8): ‘This manual does not describe the specialist facilities required in high security infectious disease units, isolation wards for cohorting groups of infectious patients,
protective isolation for severely immuno-compromised patients, critical care areas and special care baby units’. The document also states that ‘The provision of isolation rooms that are switchable from positive to negative air pressure is not recommended because of the risk to people inside and outside the room in the event of the setting being incorrect’ which is what the various guidelines in Australia also stress.
The guide outlines two options for isolation rooms – one is the ‘classic’ negative pressure ventilated room (negative pressure to the corridor) while the other is the positive pressure ventilated lobby (PPVL) room which has a positive pressure anteroom or lobby, a neutral or atmospheric pressure in the isolation room along with negative pressure in the en-suite. Both of these types are outlined as suitable for preventing airborne transmitted infections.
So I think caution needs to be used before using or quoting these guidelines in the design of rooms to provide both protective (positive pressure barrier) and isolation (negative pressure).Cheers
PS – Kevin Moon, an engineer from Victoria has done a lot of work re this issue and was one of the authors of the original Victorian Isolation Room Guidelines back in about 1998 I think. I do not know his current contact details but I could find them and send them to you off-line if you wish to chat to him.
Fiona Wilson I CNC, Infection Control, TIPCU
Population Health I Department of Health and Human Services
Post GPO Box 125 Hobart Tas 7001 | Email tipcu@dhhs.tas.gov.au
Phone (03) 6222 7684 | Fax (03) 6233 0553
A fair and healthy TasmaniaDear all,
thanks everybody for your replies – very useful!I was particularly after the design that does not require switching of ventilation
Thanks to Marija, I’ve located the design which is described in the UK document, The link has been updated on the built environment web page. The design is called a positive pressure ventilated lobby room. Would be very interested to hear from anyone with experience of this design. Donna, is this the design you have ? Rosie, your design is different – is it specified/validated anywhere?
http://hicsigwiki.asid.net.au/index.php?titleBuilt_Environment
kind regards,
John
Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org[http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-Health-Hunter-New-England-LHD.jpg]
Dear John,
We’ve got 2 dual-purpose isolation rooms currently in service that were probably based on older guidelines (before my time here).
These rooms have the ability to switch from positive to negative pressure by the flick of a key-switch (the ante-room is always positive pressured with the exhaust located in the ensuite).
Current guidelines do not support these designs owing to the huge risk they pose if activated incorrectly by staff e.g. sputum positive TB cases having positive pressure instead of negative pressure by inattentive staff, etc.
It would be preferable, from a risk perspective, that your Type 5 negative pressured rooms remain as dedicated negative pressured ones… these settings are thus pre-configured and your Engineering departments then conduct regular servicing and monitors the air pressure exchanges.
We are currently undergoing a major hospital redevelopment and have factored in dedicated Type 5 negative pressured rooms in our planning for various wards.
Airflow for these rooms come via positive pressure from the anteroom and from the doorway leading to the ward corridor (if the door is temporarily opened)… the air then flows to the negative pressured exhausts in the ensuite and the main room.
The air is exhausted out of the building immediately and does not get re-circulated (some older designs filter the exhausted air from these rooms or not at all, and re-circulate it… this is not ideal).
I’m very keen to have a look at the functional design of this novel concept isolation room should you manage to find the link, John.
Kind regards,
GeraldGerald Chan
Coordinator Infection ControlSt John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4604E: Gerald.Chan@sjog.org.au
W: http://www.sjog.org.au/murdoch[cid:UQZWZWQVZHQK.IMAGE_32.BMP]
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>>> John Ferguson <John.Ferguson@HNEHEALTH.NSW.GOV.AU> 20/08/2013 1:26 PM >>>Dear Brainstrust
Some time ago, I came across a novel configuration of a single room that provides for both protective (positive pressure barrier) and isolation (negative pressure) requirements. Extensive testing was described at the Hospital Infection Society Conference, Amsterdam 2006. It was specified under Building Note 4 by HEFMA but the link no longer works and I’ve been unsuccessful with chasing down the design. Concept involves an isolation room with a positive pressure anteroom and exhaust from the ensuite room which is entered from the main room. The design is relatively fail-safe and does not need to be manually configured.
I wondered whether anyone has come across this? Has anyone built functioning dual purpose isolation/barrier rooms? We are building a new paed ICU and we need both types of room !
thanks
John
http://hicsigwiki.asid.net.au/index.php?titleBuilt_Environment
Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health
Infectious Diseases Physician, Division of Medicine, John Hunter Hospital
Clinical Microbiologist, Hunter Area Pathology, Pathology North
Conjoint Associate Professor, University of Newcastle, Adjunct Professor, University of New England
Locked Bag 1, Newcastle Mail Centre, NSW 2310
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org
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Hello Claire, at a rough guess, the highest users of sharps in the community would be diabetics. The Diabetic Association may be the place to go in regards to queries about community use (and disposal). As far as I am aware, the recommendation is that sharps (including retractable lancets) are disposed of into sharps containers (or appropriate substitute).
Regards
Fiona Wilson I CNC, Infection Control, TIPCU
Population Health I Department of Health and Human Services
Post GPO Box 125 Hobart Tas 7001 | Email tipcu@dhhs.tas.gov.au
Phone (03) 6222 7684 | Fax (03) 6233 0553
A fair and healthy TasmaniaWe are teaching in line with Michael’s email in our cannulation and phlebotomy course.
But I wonder what is there any standard for teaching community use by patients themselves? Perhaps this is where some confusion may arise?
Best regards, Claire
Professor Claire Rickard RN PhD
c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter: IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devicesIntravascular Access Device Research Group | NHMRC Centre of Research Excellence in Nursing Interventions | Griffith Health Institute | Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra Hospital | The Prince Charles Hospital
Research frequently takes me off campus. Please contact Jenny Chan 3735 5406 j.chan@griffith.edu.au or Jo.Wright@griffith.edu.au 3735 4886 with any urgent enquiries.
It’s nice to be important, but it’s more important to be nice. John Cassis.
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Hi Timothy, maybe get them to count the seconds while they clean the IV hub instead of specifically timing them with a watch.
Fiona Wilson I CNC, Infection Control, TIPCU
Population Health I Department of Health and Human Services
Post GPO Box 125 Hobart Tas 7001 | Email tipcu@dhhs.tas.gov.au
Phone (03) 6222 7684 | Fax (03) 6233 0553
A fair and healthy TasmaniaI’m sure a fob watch would be very suitable Jayne.
I know wrist watches are a problem but what do you do if that’s all you have?
I have also been told that the clinician can always take their watch off and put it in a place where they can easily see it i.e a trolley, table, etc.
If it was a patient with an MRO, I’d prefer NOT to have my watch on surface areas where there is something a little more sinister lurking..
However, that said, I would also be wearing a full length disposable gown which the sleeves would cover my watch anyway 😉
Hmm.. food for thought still…Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
[200 yeas logo white.jpg]Hi Tim,
Why can’t a fob watch be worn? They are tax deductable and some very trendy looking ones available now?We discourage wearing of wrist watches as can impede hand hygiene. I know you’re referring to non touch technique but if they don’t remove the watch during hand hygiene how can you guarantee that hand hygiene has been carried out correctly, also the wrist may remain wet beneath the watch which poses other issues in my mind.
However this is what NSW Health policy states for hand hygiene!
Other hand, wrist or forearm jewellery must not be worn by healthcare professionals providing
direct patient care unless required for patient care (eg. watch) or medically essential (eg.
medical alert bracelet). These must be removable and able to be cleaned.Kind regards
Jayne
Jayne O’Connor, RN, BSc. Infection Control
CNC- IPC
Sydney Adventist Hospital
185 Fox Valley Rd
Wahroonga
NSW 2076
Hi Infection Controllers,
Is removing a wrist watch required for a non-sterile, non-touch procedure?
If appropriate hand hygiene has been performed (hand gel or alcohol-based hand rub) and the clinician is wearing non-sterile gloves, does the wrist watch need to be removed if its required for the procedure i.e counting seconds for the procedure
This is for a scrub the hub principles..
Thoughts, recommendations or guideline quotes are welcomed.
Regards,
Tim..Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
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Hello Louisa. Hand Hygiene Australia (HHA) have a good generic skin assessment form as well as a section on hand care issues in the HHA manual (section 3.14); both at http://www.hha.org.au/ForHealthcareWorkers/manual.aspx In addition, there is a separate link to hand care issues at http://www.hha.org.au/About/ABHRS/abhr-limitations/hand-care-issues.aspx
Regards
Fiona Wilson I CNC, Infection Control, TIPCU
Population Health I Department of Health and Human Services
Post GPO Box 125 Hobart Tas 7001 | Email tipcu@dhhs.tas.gov.au
Phone (03) 6222 7684 | Fax (03) 6233 0553
A fair and healthy Tasmania—–Original Message—–
Hi all,
I would like to ask if anyone has a hand care assessment tool for healthcare workers that are potentially having problems with the hand hygiene products supplied by the facility?
Many thanks in advance
Regards
Louisa Sasko
CNC Infection Control
Department Manager
Blacktown Mt Druitt Hospitals
WSLHD
p: 9881 8994
m: 0408 923 789
e: Louisa.Sasko@swahs.health.nsw.gov.au___________________________________
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06/20/13 – 10:28:49
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Hello Nicole, there is legislation in all States around Guide dogs.
Information for Queensland can be found here
http://www.communities.qld.gov.au/disability/key-projects/guide-hearing-
and-assistance-dogsThese dogs are certified as guide dogs or assistance dogs and are
allowed the same access as the person who relies on one.Regards
Fiona Wilson I CNC, Infection Control, TIPCU
Population Health I Department of Health and Human Services
Post GPO Box 125 Hobart Tas 7001 | Email tipcu@dhhs.tas.gov.au
Phone (03) 6222 7684 | Fax (03) 6233 0553
A fair and healthy Tasmania
Behalf Of Nicola Swindells
Hi All,
Does anyone have guidelines or a policy they would like to share with me
regarding assist/guide dogs in an acute hospital? Also is anyone aware
of any discrimination legislation attached to the visits of these dogs
in hospitals. Many thanks in advance for any assistance you may be able
to offer me.Kind Regards
Nicky Swindells CNC
Infection Control Coordinator/Wound Management
Mater Hospitals Central Queensland
Rockhampton Yeppoon Gladstone
07 49313420
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