[Gerald Cha]

Dear Karen,

The Australian Therapeutic Guidelines Antibiotic, has a specific section on Urinary tract infection in aged-care facility residents.

The direct link to the page is here (but you may need to pay to subscribe to the service):
https://tgldcdp.tg.org.au/viewTopic?topicfileurinary-tract-infection-aged-care#MPS_d1e129

It clearly articulates the assessment and treatment for this patient group with a helpful flowchart.

As youre aware, asymptomatic bacteriuria is very common for these patients and prophylactic antimicrobial treatment unnecessary.

I would suggest that you raise your concerns to these doctors through your IC/AMS committee (where applicable).

All the best.

Regards,

Gerald Chan CICP-E | Infection Control Manager
St John of God Murdoch Hospital
T: (08) 9428 8638 | M: | F: | E: Gerald.Chan@sjog.org.au
100 Murdoch Dve Murdoch WA 6150
http://www.sjog.org.au/murdoch | Twitter | LinkedIn | Facebook

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We acknowledge the Traditional Owners of Country throughout Australia and recognise their continuing connection to land, waters and community.
We pay our respect to them and their cultures and to Elders past and present.

Hi all

I just have a question regarding GP s who prescribe Antibiotics prophylactically to minimise recurrent infections. Some have had prophylactic antibiotics prescribed for recurrent UTIs for example ( more than 4-5 in previous 12 month period)
Some of our Residents have been on Prophylactic Antibiotics for > 6 months.
Predominantly for either recurrent UTI or Respiratory Tract infections (exacerbation of COPD)
Around 50 % (sometimes higher depending on others prescribed) of our Monthly data statistic in regards to Antibiotics prescribed consists of those who are on ongoing prophylactic antibiotics

Should these Residents have a specimen sent to pathology for M S & C at any time to confirm whether they have become Resistant during the 6 months plus they have been prescribed them ?
Should a GP at minimum be reviewing this in regards to ceasing at any specified time ?

Kind Regards
Karen Panzich TLRN / Infection Control Coordinator
Wynyard Care Centre
Tasmania

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[Gerald Cha]

Thanks Michael.

Had a quick read of the study’s abstract at lunchtime…

Wouldn’t having only VRE bacteraemias as a sole end indicator significantly narrow their ability to objectively evaluate any VRE spread in the unit?

Discontinuing systematic VRE surveillance at the same time cuts off all data on further VRE colonization rates in the unit.

So there may be an increase in transient VRE spread and acquisition during the 3 years they ceased isolation precautions, but no one knows unless it amounts to a symptomatic infection during their patients’ stay in the unit.

Even then, VRE infection rates from other body sites are omitted from the study.

We all know that in IC.. the more you look, the more you’ll find… and the opposite applies as well.

No surveillance… no problem! (or so it may appear initially… till it hits the fan!)

I think a risk assessment based style to managing MROs would be a logical step forward (which many facilities are already doing).

Discontinuing surveillance and precautions doesn’t mitigate the risk… it’s still there… you just can’t see it (yet).

Just my 2 cents.

Kind regards,

Gerald Chan | Infection Control Manager
St John of God Murdoch Hospital
T: (08) 9428 8638 | M: | F: | E: Gerald.Chan@sjog.org.au
100 Murdoch Dve Murdoch WA 6150
http://sjog.org.au/murdoch | http://twitter.com/sjgh_murdoch | LinkedIn | http://facebook.com/stjohnofgodmurdoch

We acknowledge the Traditional Owners of Country throughout Australia and recognise their continuing connection to land, waters and community.
We pay our respect to them and their cultures and to Elders past and present.

Thought this might provoke some discussion. The full article plus the table and all links is here: http://haicontroversies.blogspot.com.au/2016/01/rethinking-contact-precautions.html?utm_sourcefeedburner&utm_mediumemail&utm_campaignFeed:+blogspot/vutUL+(Controversies+in+Hospital+Infection+Prevention)&m1

Worth reading and voicing an opinion about, I believe.

Cheers
Michael

Michael Wishart
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
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Controversies in Hospital Infection Prevention

Controversies in Hospital Infection Prevention

Rethinking contact precautions

I’m working on a talk entitled “Rethinking Contact Precautions” for the Winter Course in Infectious Diseases. If you’ve never been to the Winter Course, it’s a great conference in a casual atmosphere with state-of-the-art lectures on a wide variety of ID topics. And there’s lots of skiing. This year, we’ll be at Big Sky, Montana, February 14-18.

This weekend, I ran across a brand new paper in Infection Control and Hospital Epidemiology on discontinuing contact precautions. This one comes from Roswell Park Cancer Center where active surveillance (weekly perianal cultures) for VRE was discontinued in March 2011. At the same time contact precautions for VRE infection and colonization were also discontinued. The investigators compared VRE bacteremia rates for the 3-year period before and the 3-year period after discontinuing active surveillance and contact precautions. The 6-year period of the study included over 1,300 patients with hematologic malignancies, bone marrow transplant and lymphoma. Over the study period there were no changes in antibiotic utilization, nurse-to-patient ratio, age, gender, underlying malignancies or length of stay. Importantly, via interrupted time series analysis, there was no significant change in the rate of VRE bacteremia (2.32 infections/1,000 patient days before vs. 1.87 after). This is the third published study and there are two more studies in abstract form all showing no change in infection rates after contact precautions were discontinued.

I also re-read Kathy Kirkland’s paper, Taking Off the Gloves: Toward a Less Dogmatic Approach to the Use of Contact Isolation (free full text here). Kathy was way ahead of the curve with her thinking on this topic. Below is a table from her paper that summarizes the likelihood of benefit for contact precautions:

As I thought more about where we are in infection prevention in 2016, it seems to me that contact precautions is a decrepit concept. When introduced 50 years ago, contact precautions made sense. At that time hand hygiene rates were abysmal, alcohol-based handrubs were not available, patients weren’t bathed with chlorhexidine, there were few single-bed hospital rooms, and there was no enhanced technology for environmental disinfection.

Putting it all together, there’s little evidence that contact precautions are effective in the non-outbreak setting, and we’re learning that nothing bad happens when contact precautions are stopped. At the University of Iowa, we’re focusing on hand hygiene, stethoscope wipe down and bare below the elbows. And the list of hospitals forgoing the plague doctor suit for MRSA and VRE grows ever longer.

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[Gerald Cha]

Can the College not report this as a collective ICP concern to the TGA IRIS reporting scheme, Glenys?

This may then carry more weight in pushing for this product to be promptly reviewed (and actioned accordingly).

Ive had previous discussions with anaesthetists on this product with similar concerns raised as mentioned by Rosie.

Alternative products were discussed and suggested but oddly, the preference remained for the BD Venflons.

It proved difficult to link adverse outcomes to the Venflons design and that was the key challenge faced.

There were hardly any bacteraemias linked to the areas where Venflons were frequently used and if looking at phlebitis, there were way too many variables to point a finger specifically at the Venflons.

Thus in a discussion where the end-point is focused on infections, it proved really difficult.

Claires suggestion on culturing the ports is interesting and may reiterate the potential risks identified in this products design (if indeed positive cultures are obtained however, this may also backfire if it all ends up with negative cultures).

Keen to hear what others think or have experienced.

Kind regards,

Gerald Chan | Infection Control Manager
St John of God Murdoch Hospital
T: (08) 9366 1552 | M: 04 0549 5906 (ext 7804) | F: (08) 9311 4604 | E: Gerald.Chan@sjog.org.au
100 Murdoch Dve Murdoch WA 6150
http://www.sjog.org.au/murdoch | twitter.com/sjgh_murdoch | facebook.com/stjohnofgodmurdoch

[cid:image002.png@01D0625C.8D88F220]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Glenys Harrington
Sent: Thursday, 19 March 2015 1:41 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Use of IV Venflon Catheter

Hi Claire,

If the hub of the cannula cannot or is very difficult disinfect before accessing and the cap of the hub does not stay securely in place (as per Tim and Rosie reports/observations) there is no need to do additional QI/research.

This is a faulty product and should be reported to the supplier/manufacturer and the TGA IRIS reporting scheme.

In order for the healthcare facility to minimise the risk and their exposure in terms of litigation they should note the problem on their risk register and include their plan to replace the product with an alternative.

Regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)

PO Box 5202
Middle Park
Victoria, 3206
Australia
H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

[Description: ICC Diagram ICCversion]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Tim Spencer
Sent: Thursday, 19 March 2015 3:29 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Use of IV Venflon Catheter

That’s a great idea Claire!
Show them the evidence!!
Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Independent Vascular Access Consultant
President, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Representative – WoCoVA Global Strategic Committee
M: +1(623)326.8889 (USA)
M: +61(0)409463428 (AU)
E: tim.spencer68@icloud.com

Sent from my iPhone

On Mar 18, 2015, at 9:22 PM, Claire Rickard <c.rickard@GRIFFITH.EDU.AU> wrote:
HI Rosie
I would recommend you do a small quality improvement/research study and culture some of the used cannula. It would be great to get the ports cultured (and also check the tip culture (internal and external)). Have a talk to your micro lab senior scientist and ID physician, they might be interested in helping you and collaborating on a study? And I would get the anaesthetists on board with it too, – if they think they are good to use, let us get data and find out!!?? You would also need some control catheters (non-ported) also used in theatre for similar number of hours/accessed. And some no-used controls (from straight out of the packet).
Would be exciting and useful research to present at ACIPIC!!
PM me if you would like any advice 😀

—

Dr Claire Rickard, Professor, NHMRC Centre of Research Excellence in Nursing Interventions in Hospitalised Patients, Menzies Health Institute Queensland
Alliance for Vascular Access Teaching and Research (AVATAR)
Visiting Scholar at the Princess Alexandra, Prince Charles, and Royal Brisbane & Women’s Hospitals
Assistant: Jo.Wright@griffith.edu.au Tel: +61 7 3735 4886
[https://docs.google.com/uc?export=download&id=0B6EekFFxxg8xcDRxXzdfbWE5ZUU&revid=0B6EekFFxxg8xeWJielNGVEl0Q04rMlcyVHJjZzh0Y2pDcFpJPQ] [https://docs.google.com/uc?export=download&id=0B6EekFFxxg8xNk9ieVpOMmlxbGc&revid=0B6EekFFxxg8xYjlaR05vbkRjd3lyRmcySmEzNEJ1Q1BlSFpZPQ]
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[Gerald Cha]

Hi Louisa,

Its a temporary tattoo and shouldnt impact on hand hygiene as its used as a skin dye (Im assuming that youre referring to someone who has the actual henna staining already completed on their hands and not someone who is in the process of having the henna skin staining done in that instance, itll not work with ABHRs as the hennas normally a paste thats left to dry for a couple of hours. Mix that with ABHR and itll be a big dark mess).

You may wish to have a look at this WA guide as well http://www.public.health.wa.gov.au/cproot/1479/2/Henna_Tattooing.pdf

Regards,

Gerald Chan | Infection Control Manager
St John of God Murdoch Hospital
T: (08) 9366 1552 | M: 04 0549 5906 (ext 7804) | F: (08) 9311 4604 | E: Gerald.Chan@sjog.org.au
100 Murdoch Dve Murdoch WA 6150
http://www.sjog.org.au/murdoch | twitter.com/sjgh_murdoch | facebook.com/stjohnofgodmurdoch

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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Wednesday, 12 November 2014 9:04 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Fwd: Hand Hygiene and Henna

[Forwarded on behalf of subscriber – moderator]

Sent from Michael’s Samsung GALAXY S5

——– Original message ——–
From: Louisa Sasko
Date:11/11/2014 14:23 (GMT+10:00)
To: aicalist-request@aicalist.org.au
Subject: Hand Hygiene and Henna

Hi all,

Just wanting to know what your thoughts are on Henna and Hand Hygiene. I was asked about this the other day and don’t really know anything about Henna.

Kind Regards

Louisa Sasko

Clinical Nurse Consultant (Manager) | IPACS – Infection Prevention & Control Service

Conjoint Associate Lectur
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[Gerald Cha]

I share Robyns concerns with regards to the recommendations for ABHR use on gloves.

Having witnessed staff do this in the past (when the Hand Hygiene Initiative was first introduced) and taking a considerable time to curb this practice through staff education, this exception for PPE doffing post Ebola patient contact may just revive this bad practice and confuse staff into thinking that its acceptable (from a 5 Moments perspective that is).

If an ABHR is to be utilized for glove decontamination, I think it would be best that a different product be selected (such as the waterless surgical hand scrubs commonly utilized in Theatre environments rather than on wards) to alleviate any confusion as theres clear product differentiation.

The waterless surgical hand scrubs, being an aqueous alcohol, could easily be sprayed on gloves should that direction be taken for its use (as an assisted spray done by the trained observer instead of dispensed through a pump).

Or alternatively, can hypochlorite be used as another option for disinfecting the first layer of PPE?

Although at 5,000 ppm, Im uncertain if thats a safe concentration should accidental contact come with skin.

I would think that the use of disinfectant wipes be only selected if the PPE used was soiled and that there was a need to remove gross soilage first and then follow that up with a liquid disinfectant (or ABHR as recommended by the CDC) for full coverage.

Kind regards,

Gerald Chan | Infection Control Manager
St John of God Murdoch Hospital
T: (08) 9366 1552 | M: 04 0549 5906 (ext 7804) | F: (08) 9311 4604 | E: Gerald.Chan@sjog.org.au
100 Murdoch Dve Murdoch WA 6150
http://www.sjog.org.au/murdoch | twitter.com/sjgh_murdoch | facebook.com/stjohnofgodmurdoch

[cid:image003.png@01CFEE00.6C926D60]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Donnellan, Robyn
Sent: Wednesday, 22 October 2014 11:42 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: CDC guidelines question re disinfection of gloved hands – any shared advice – words of wisdom?

Hi Terry
I am concerned that the CDC has recommended the use of ABHR on gloves. ABHR has skin emollients in the preparation and is classified as a skin antiseptic not a disinfectant. A straight 70% alcohol impregnated wipe (disinfectant ) should be used if an equipment surface wipe is required throughout the doffing procedure. Some staff think the use of ABHR is acceptable, I would be disappointed if this poor practice was promoted.
Kind regards
Robyn Donnellan CICP
CNC Infection Prevention & Control Service
for Northern NSW LHD
02 66207490

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Terry Grimmond
Sent: Wednesday, 22 October 2014 1:02 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: CDC guidelines question re disinfection of gloved hands – any shared advice – words of wisdom?

Hi Michael,
Given Ebola urgency, uniqueness, and common need of members, can you allow an exception in naming of disinfectant brands and types? The CDC list of EPA registered is very frustrating and not applicable in Australia.
Linda, CDNA recommends 1,000-5,000ppm hypochlorite for cleaning and spills (dependent on blood presence) it is economical, readily available and effective.
Regards,
Terry Grimmond FASM, BAgrSc, GrDpAdEd
Consultant Microbiologist
Grimmond and Associates
Ph (NZ): +64 7 855 3212
Mob (NZ): +64 274 365 140
E: terry@terrygrimmond.com
[Twitter_logo_blue]: @terrygrimmond
W: http://terrygrimmond.com
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Lindy Ryan
Sent: Wednesday, October 22, 2014 2:01 PM
To: AICALIST@AICALIST.ORG.AU
Subject: CDC guidelines question re disinfection of gloved hands – any shared advice – words of wisdom?

Hey all Ebola champions

just been asked by my boss here what others are considering or have to hand re the new CDC guidelines

http://www.cdc.gov/media/releases/2014/fs1020-ebola-personal-protective-equipment.html

re this point specifically

Disinfection of gloved hands using either an EPA-registered disinfectant wipe or alcohol-based hand rub between steps of taking off PPE.

Will you be considering ABHR or a disinfectant wipeif a wipe what would you use.

We are just trying to understand what specifically is in the EPA registered disinfectant wipe so we can match it with what we have TGA approved and available in Australia as there are many listed but not available in Australia

We have a disinfectant wipe here we use for environmental cleaning (I know I cant name products on this forum) here but know there are other products. Can anybody send me what they are using off line and if it comply with the EPA list as recommended by the CDC (I know you are busy so a quick reply with just a name would be great!)

Hope you are all travelling wellhuge body of work being done by us all trying to have consistency for staff and pt safety and calm another thesis for somebody in the making hey?

Thank you so much for those of you who have kindly shared so much already you are all such a wonderful group to be able to liaise and work with I love being an ICP when I get to work with such proactive resourceful sharing bunch as we all are!!

Cheers

Lindy

Lindy Ryan

Infection Prevention & Control CNC | Infection Control Service Nepean Hospital NBMLHD
PO Box 63, Penrith, 2751
Tel (02) 4734 2228 | Fax (02) 4734 2517 | lindy.ryan@health.nsw.gov.au
http://www.health.nsw.gov.au

Wise and human management of the patient is the best safeguard against infection
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[Gerald Cha]

Morning Beth,

With regards to your query, you may wish to discuss your concerns with your pharmacy and look deeper into the THERAPEUTIC GOODS REGULATIONS 1990 – SCHEDULE 5A.

There are conditions within to address and assist with your concerns regarding TGA registration.

Hope that helps.

Regards,

Gerald Chan | Infection Control Manager
St John of God Murdoch Hospital
T: (08) 9366 1552 | M: 04 0549 5906 (ext 7804) | F: (08) 9311 4604 | E: Gerald.Chan@sjog.org.au
100 Murdoch Dve Murdoch WA 6150
http://www.sjog.org.au/murdoch | twitter.com/sjgh_murdoch | facebook.com/stjohnofgodmurdoch

—–Original Message—–

Hi All

On the topic of Tinted Red Chlorhexidine 2% + alcohol surgical skin prep. The product that we currently have access to within our facility is not registered with the TGA for skin antisepsis. The company has offered to look into changing the labelling of the product to remove the reference to hard surface disinfectant and replace it with for presurgical skin preparation. My concern is that this doesn’t address the TGA registration matter.

Have any other facilities identified this issue? If so, how has this been managed? Is there more than one product on the market, and are alternate products TGA registered.

As a Local Health District we have decided to use and Alcohol and Iodine preparation for all presurgery skin preparation until this matter can be resolved. However, we do not have an alternate alcohol-based product that is suitable for use on patients with Iodine allergies.

Any advice or discussion regarding this matter is gratefully received.

Thank you
Beth
Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service Level 1 Lawson House Wollongong Hospital Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
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[Gerald Cha]

Hi Sony,

From an IC perspective, the iPads shouldnt pose that big a risk for transient contamination of the clinical environment when used appropriately I think phones are a bigger concern if we were to look in that direction (but does that truly translate directly to infection acquisition?).
A wipe down with a disposable detergent based cloth (obviously not soaking wet) should suffice in addressing your IC concerns.
If your primary issue lies with the products warranty, maybe purchase a waterproof case (readily available on the market) to allay your concerns with wiping the device down directly with any cleaning agent.
With or without the oleophobic coat, the device should still work anyway.
All the best with your final decision to the matter.

Regards,

Gerald Chan | Infection Control Manager
St John of God Murdoch Hospital
T: (08) 9366 1552 | M: 04 0549 5906 (ext 7804) | F: (08) 9311 4604 | E: Gerald.Chan@sjog.org.au
100 Murdoch Dve Murdoch WA 6150
http://www.sjog.org.au/murdoch | twitter.com/sjgh_murdoch | facebook.com/stjohnofgodmurdoch

[cid:image002.png@01CFA110.92D3B390]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Sony SO
Sent: Wednesday, 16 July 2014 12:09 PM
To: ACIPC Infexion Connexion; Gerald Chan (Murdoch)
Subject: decontaminated iPads -used in clinical areas

Dear All,

With reference to Apple website related to cleaning Apple products http://support.apple.com/kb/HT3226#ipads, proposed cleaning methods are as follows

To clean iPad, unplug all cables and turn off iPad (press and hold the Sleep/Wake button, and then slide the onscreen slider). Use a soft, slightly damp, lint-free cloth. Avoid getting moisture in openings. Don’t use window cleaners, household cleaners, aerosol sprays, solvents, ammonia, abrasives, or cleaners containing hydrogen peroxide to clean iPad. iPad has an oleophobic coating on the screen; simply wipe iPad’s screen with a soft, lint-free cloth to remove oil left by your hands. The ability of this coating to repel oil will diminish over time with normal usage, and rubbing the screen with an abrasive material will further diminish its effect and may scratch your screen.

The above mentioned cleaning procedures implicate that use of any disinfectant is NOT allowed. And in infection prevention and control perspective, we consider using soft, slightly damp, lint-free cloth is not a decontamination method. If contaminated iPad is not disinfected, transmission risk will be increased. If disinfectant is used i.e. not following manufacturers written instructions, we may lose manufacturers warranty.

Any advice would help me out of my predicament.

Yours sincerely,

Sony SO

Nursing Officer, Infection Control Branch (Team 2)

Centre for Health Protection HONG KONG SAR, CHINA

http://www.chp.gov.hk/tc/cindex.html

office phone: +852 2125-2922; fax: +852 3523-0752

HA email sony@ha.org.hk; DH email no_icb4@dh.gov.hk
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[Gerald Cha]

Hi Paul,
It largely depends on the design of the sensor taps… I do believe this was discussed here before
and you may wish to check your email archives.
In my previous place of work, the sensor taps utilised in the ICU department (which mixed both hot
and cold water) were found to be the source for an MRPA outbreak.
I believe splash-back from staff tipping body fluids into the sinks contributed to this and also
the flawed design of the sensor taps…
These taps comprised of 2 external pipes (one hot and one cold) leading into one tap outlet.
Where they lead and connect together, there is a small reservoir of stagnant water between them
which once contaminated, becomes a pain to clean/eradicate and will require regular maintenance plus
monitoring.
I’ve not looked into newer designs which may have factored this issue into consideration… so
highly advisable that you look into the various options on the market.
All the best with your redevelopment.
Regards,
Gerald

Gerald Chan
Coordinator Infection Control

St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150

P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4604
E: Gerald.Chan@sjog.org.au
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>>> Paul Simpson 7/02/2014 11:44 AM >>>

Hi All,
My hospital has just entered into a major redevelopment phase & I have had a number questions about
installing sensor operated taps in both clinical & non-clinical environments. I have initially been
reticent about their use based on the report from the John Hopkins that suggested senor taps had
higher bacterial counts which they speculated may be due to the increased complexity of these taps.
However, a joint ASHE & APIC Statement on Recently Presented Research on Electronic Faucets (2011)
is generally supportive of their use. There isnt a heap of evidence out there to draw any absolute
conclusion on so I was wondering if anyone out there has a view or experience with installing &
using sensor taps.
Regards,
Paul Simpson, RN, MSc
Infection Control Consultant
(Mon,Tues,Thurs & Friday)
Royal Victorian Eye & Ear Hospital
32 Gisborne Street, East Melbourne, 3002, VIC

( http://home.rveeh.local/ )

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[Gerald Cha]

Hi Rita,
Have you got a Type 5 negative pressure isolation room?
Prior to the development of our current Endoscopy Unit with negative pressured procedural rooms, our management of TB sputum spear positive cases coming in for elective bronchs involved the utilisation of one of our Type 5 negative pressure isolation rooms on the wards.
This involved a lot of logistical planning and the room also had to be blocked in advance for this patient to come in the following day (thankfully these are very isolated cases).
I note that you’d mentioned suspected TB and the same plan may apply but it would save your facility heaps of hassle if you pursued x3 early morning sputum AFBs for TB as a measure for clearance for your patient with suspected pulmonary TB (the clearance criteria may vary by resp consultant or state so you’ll need to look into this further).
Have a look at the WHO Policy on TB Infection Control in Health-Care Facilities here: http://whqlibdoc.who.int/publications/2009/9789241598323_eng.pdf
If push comes to shove and you really need to use your positive pressured theatre, you’ll have to ensure that the air exchanges achieve the recommended air dilution rates and all staff members don P2 masks.
Advisable to have this patient done last on the theatre list as well… Still this is not the ideal way to go in my opinion and I would opt for either of the first 2 options above.
Hope that helps somewhat in your final planning.
Regards,
Gerald

Gerald Chan
Coordinator Infection Control

St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150

P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4604
E: Gerald.Chan@sjog.org.au
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>>> Rita Roy 3/09/2013 10:59 AM >>>

Dear Listserv members,
Here at Hornsby Hospital, we do not have a negative pressure theatre for performing bronchoscopies. So my question is:
Does anyone have guidelines for performing bronchoscopies on patients with suspected tuberculosis in the absence of a negative pressure theatre ?
Kind regards,
Rita
Rita Roy

Clinical Nurse Consultant | Infection Control
Hornsby Kuringai Health Services
Tel 02 9477 9232 | Fax 02 9477 9013 | Mob 0422 930 370 | Rita.Roy@health.nsw.gov.au
http://www.health.nsw.gov.au

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[Gerald Cha]

Perfect timing, Matthias.
Thanks.
I was just about to hunt for Nick’s articles… appreciate the links.
Have your Singapore hospitals moved to a conventional system with HEPA or are planning to?
For that matter, has anyone within Australia planned for conventional HEPA filtered air for their theatres?
If I’m not mistaken (read it somewhere), there may be an alternative system called HEPA filtered turbulent air (???) and I’m wondering if this utilises the same technology of blade-pattern air vents that apparently disperse air around the ceiling and away from the patient below?
Cheers,
Gerald

Gerald Chan
Coordinator Infection Control

St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150

P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4604
E: Gerald.Chan@sjog.org.au
W: http://www.sjog.org.au/murdoch

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>>> “Matthias Maiwald (KKH)” 3/09/2013 12:59 PM >>>

Dear Gerald,
The group from Petra Gastmeier from Germany has published some articles around this:
http://www.ncbi.nlm.nih.gov/pubmed/22011537
http://www.ncbi.nlm.nih.gov/pubmed/18948793
http://www.ncbi.nlm.nih.gov/pubmed/22579079
http://www.ncbi.nlm.nih.gov/pubmed/22828870
and also Nicholas Graves’ group from Queensland:
http://www.ncbi.nlm.nih.gov/pubmed/23434381
http://www.ncbi.nlm.nih.gov/pubmed/22999770
And it was also discussed at the recent ICPIC Infection Control meeting in Switzerland.
It now increasingly looks like laminar flow is probably not necessary in operating theatres, but of course, HEPA filtration continues to be.
Best regards, Matthias.

—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387

Dear all,

There has been recent studies disputing the use of laminar air flow in theatres and some indicating its contribution to severe surgical site infections…

I’m interested to find out if anyone’s looked into this in further detail and if anyone’s implemented any changes to their current or future theatre designs?

I’m aware that current building guidelines recommend laminar flow systems but is this now due for a review based on what’s being published?

Keen to hear everyone’s comments.

Cheers,

Gerald

Gerald Chan

Coordinator Infection Control

St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150

P: 9366 1552

M: 0405 495 906 (7804)
F: 9311 4604

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kkh

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[Gerald Cha]

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,
Gerald

Gerald Chan
Coordinator Infection Control

St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150

P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4604
E: Gerald.Chan@sjog.org.au
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>>> John Ferguson 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 ( http://www.hefma.org.uk/news/hbn4consult.pdf ) 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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[Gerald Cha]

Hi Lyn,
I’ve recently reviewed the proposed use of “ultra-rapid” hand dryers for my hospital for clinical areas (my comments are thus specific to this area and do not cover its use in general public areas such as public toilets, etc).
The use of HEPA filter filtration for the new hand dryers has to be seen in the proper context…
If the machine (“ultra-rapid” discussed here and not the conventional hand dryers) produces high velocity filtered air within a small confined area, that air needs to have an avenue to be exhausted out otherwise it gets channeled back at the user’s face (this based on the current “hands facing downwards” design)… thus the sides to the machine are left exposed to allow air (with water droplets from the user’s hands) to be channeled away from the user.
This would result in potential contamination of the immediate area surrounding the hand dryer (floor, wall, etc.) as water from the user’s hands gets aerosolised or propelled off.
The HEPA filtration in the dryer filters the propelled air but not the air that gets exhausted post contact with the user’s hands to the surrounding environment (so if you get users with extremely bad hand washing techniques i.e. no soap used post contact with gastro patient… this will then be an issue in a clinical environment).
Some studies such as:
Comparative evaluation of the hygienic efficacy of an ultra-rapid hand dryer vs conventional warm air hand dryers. (English) By: Snelling AM; Saville T; Stevens D; Beggs CB, Journal Of Applied Microbiology [J Appl Microbiol], ISSN: 1365-2672, 2011 Jan; Vol. 110 (1), pp. 19-26; PMID: 20887403
speak favorably regarding the new “ultra-rapid” hand dryers (kindly note that the study was funded by Dyson Limited, Malmesbury, UK.).
A comparative study of different hand drying methods: paper towel, warm air dryer, jet air dryer (2009). By: Redway K & Fawdar S. School of Biosciences, University of Westminster, London.

compared paper towels vs conventional warm air dryers vs the newer “ultra rapid” hand dryers and found paper towels to be the superior option (also note that this study was sponsored by the European Tissue Symposium (ETS) Brussels).
The Mayo Clinic did an extensive review of current evidence in 2012:
The hygienic efficacy of different hand-drying methods: a review of the evidence. (English) By: Huang C; Ma W; Stack S, Mayo Clinic Proceedings. Mayo Clinic [Mayo Clin Proc], ISSN: 1942-5546, 2012 Aug; Vol. 87 (8), pp. 791-8; PMID: 22656243
and is a great read as you explore the various options available.
Hope that helps and all the best with your hospital’s final decision to the matter.
Kind regards,
Gerald

Gerald Chan
Coordinator Infection Control

St John of God Murdoch Hospital
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MURDOCH. WA 6150

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>>> Glenys Harrington 19/06/2013 6:06 PM >>>

Hi Lyn,
My understanding is that they are too noisy for clinical areas particularly at night.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au
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Has anybody had any experience with installation of hand dryers (warm blowing air) in clinical areas?
We are building a new facility, the question has been raised can we install hand dryers instead of paper towel in clinical areas at the hand washing sinks?
Does anyone have any thoughts on this?
Lyn
Infection Prevention and Control Manager
Echuca Regional Health
17 Francis Street
Echuca 3564
Helping Everyone To Be And Stay Healthy
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[Gerald Cha]

Hi Fiona,
Aside from the Australasian Health Facility Guidelines that Denise quoted, you need to consider the cleaning of the vents and the risks associated with its direct placement above the patient.
I’m not sure if you are referring to the newer circular vents that come in a fixed blade-like design (unlike the conventional square ones)… apparently improving airflow (but appear harder to clean).
Airflow may be improved to the older designs but dust will still accumulate if cleaning schedules are not adhered to strictly.
Your cleaning teams may do a good thorough external clean to eliminate visible external dust accumulation, but internally dust will still accumulate and maintenance/cleaning for that part of the ventilation system is normally in Engineering’s territory.
Thus, if poorly maintained by Engineering, the vents become a reservoir of dust ready to drop in clumps on an unsuspecting patient (worst scenario: whilst a wound dressing is being conducted).
I do recall reading a paper from Germany (or another European country) a couple of years back whereby propionibacterium acnes infections were being identified post-operatively in surgical sites.
This was then investigated and traced back to the ventilation system in theatre suites which were poorly maintained (and that’s with HEPA filtration).
I’m not an architect/engineer but wouldn’t it be more effective to place your air vents (in long horizontal strips) parallel to the windows to counter the external heat/cold?
That design also poses a much lower IC risk to your patients.
Kind regards,
Gerald

Gerald Chan
Coordinator Infection Control

St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150

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>>> Fiona de Sousa 15/03/2013 9:24 AM >>>

Hi List Members,
We are currently undertaking a new building project and I have been asked to consider air conditioning vents located directly above the patient bed in the middle of the room.
I was concerned that this may blow air directly onto the patient and potentially increase risk associated with procedures, such as dressings, but I have been told that new air conditioning vent designs have air currents that hug the ceiling of the room and would not blow directly onto patients.
Does anyone have any experience of installing air conditioning vents directly above patients and has this led to a change in such things as surgical site infection rates or healthcare associated wound infections?
Kind Regards,
Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au ( blocked::mailto:Fiona.Desousa@sah.org.au )
185 Fox Valley Road, Wahroonga, NSW, 2076

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[Gerald Cha]

Hi Maureen,
Please refer to the Australasian Health facility Guidelines (AusHFG) at this direct link…
http://www.healthfacilityguidelines.com.au/default.aspx
It’s an excellent resource to refer to for building works with a focus on very relevant IC factors that you’d need to consider.
With regards to toilet seats and covers, it’s a contentious issue and can be a pain in the b** (pardon the pun… couldn’t resist!).
When looking into new building works or renovations, it would always be the preferred choice from an IC perspective to have the covers for the obvious IC reasons… splashback and aerosolisation of waste material.
Toilet bowls already fitted without lids can be an issue to upgrade (depends on the design and model) as they may not have the ability to be “upgraded” to having covers.
Sometimes, certain seats are chosen without the covers due to OSH/WHS considerations… select commodes may not fit over the ones with covers or their height may be too high (thus that product selection process should include Infection Control).
These factors have to considered but Infection Control considerations should always take precedence in the final decision.
Hope that helps.
Kind regards,
Gerald

Gerald Chan
Coordinator Infection Control

St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150

P: 9366 1552
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>>> “Cremin, Maureen” 13/03/2013 10:18 AM >>>

Hi All
If CSSD is attached to the theatre suite, which areas in CSSD and OR should have HEPA filters in a new building?
What is the recommendation for toilet seat lids on patient toilets given the we are dealing with more enteric MROs?
Regards
Maureen
Maureen Cremin
Regional Infection Prevention and Control Co-ordinator,
WACHS Great Southern
Department of Health
Albany Health Campus Hastie St, ALBANY WA 6330
T: (08) 9892 2211 | F: (08) 9892 2581
E: maureen.cremin@health.wa.gov.au
http://www.health.wa.gov.au
Delivering a Healthy WA
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[Gerald Cha]

Thanks once again, Glenys.
It’s great to know that a study was already done that took a step
further in looking into air currents and surface contamination in a
controlled environment.
Awesome to know that they’d actually utilised a biological aerosol
chamber as that knocks off the bulk of variables that may influence the
outcome.
This study would positively influence (especially from an Infection
Prevention perspective) the way patient rooms of the future are designed
and how airflow systems are engineered.
I’ll hunt down the full article.
Now if only they’d added carpet to the study!
Cheers,
Gerald

Gerald Chan
Coordinator Infection Control

St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150

P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4685
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>>> Glenys Harrington 28/10/2012 10:10 AM
>>>

Hi Gerald,
This may in part answer your question although I have not been able to
get hold of the full article.
Publication – M.F. King, C.J. Noakes, P.A. Sleigh, M.A. Camargo-Valero.
Bioaerosol Deposition in Single and Two-Bed Hospital Rooms: A Numerical
and Experimental Study. Building and Environment. 2012.
Extract about the article from Infection Control Today(ICT).
Hospital superbugs can float on air currents and contaminate surfaces
far from infected patients beds, according to University of Leeds
researchers. The results of the study, which was funded by the
Engineering and Physical Sciences Research Council (EPSRC), may explain
why, despite strict cleaning regimes and hygiene controls, some
hospitals still struggle to prevent bacteria moving from patient to
patient.
It is already recognized that hospital superbugs, such as MRSA and C.
difficile, can be spread through contact. Patients, visitors or even
hospital staff can inadvertently touch surfaces contaminated with
bacteria and then pass the infection on to others, resulting in a great
stress in hospitals on keeping hands and surfaces clean.
But the University of Leeds research showed that coughing, sneezing or
simply shaking the bed linens can send superbugs into flight, allowing
them to contaminate recently cleaned surfaces.
PhD student Marco-Felipe King used a biological aerosol chamber, one of
a handful in the world, to replicate conditions in one- and two-bedded
hospital rooms. He released tiny aerosol droplets containing
Staphyloccus aureus from a heated mannequin simulating the heat emitted
by a human body. He placed open petri dishes where other patients beds,
bedside tables, chairs and washbasins might be and then checked where
the bacteria landed and grew.
The results confirmed that contamination can spread to surfaces across
a ward. The level of contamination immediately around the patients bed
was high but you would expect that. Hospitals keep beds clean and
disinfect the tables and surfaces next to beds, says Dr. Cath Noakes,
from the Universitys School of Civil Engineering, who supervised the
work. However, we also captured significant quantities of bacteria
right across the room, up to 3.5 meters away and especially along the
route of the airflows in the room.
We now need to find out whether this airborne dispersion is an
important route of spreading infection, adds co-supervisor Dr. Andy
Sleigh.
The researchers are hoping that computer modeling will help them
determine the risk. The findings have been compared to airflow
simulations of the mock hospital rooms and the research team have shown
that they are able to accurately predict how airborne particles can be
deposited on surfaces.
Using our understanding of airflow dynamics, we can now use these
models to investigate how different ward layouts and different positions
of windows, doors and air vents could help prevent microorganisms being
deposited on accessible surfaces, says King.
The international design and engineering firm Arup, which designs
hospitals, part sponsored the study. Phil Nedin, director and global
healthcare business leader at Arup, says: We are looking at healthcare
facilities of the future and it is important that we look at key issues
such as infection control. Being involved in microbiological studies
that inform airflow modeling in potentially infectious environments
allows us to get a clear understanding of the risks in these particular
environments.
The paper, Bioaerosol Deposition in Single and Two-Bed Hospital Rooms:
A Numerical and Experimental Study, was published in the journal
Building and Environment.
This research is funded by an EPSRC Challenging Engineering grant held
by Dr. Cath Noakes. Marco-Felipe Kings PhD was also partially sponsored
by Arup.
Bioaerosol Deposition in Single and Two-Bed Hospital Rooms: A Numerical
and Experimental Study. Building and Environment. 2012.
http://www.infectioncontroltoday.com/news/2012/10/superbugs-ride-air-current
regards
Glenys

Behalf Of Gerald Chan

Thanks Rosie, Michael and all for your responses.

I was hoping for a study that at least attempted to demonstrate that
common skin pathogens do get dispersed quite significantly by fans…
understandably, this is an obvious “common sense” thing to ICPs but
surprisingly, to the general public (and even for some nurses), this
doesn’t click.

This generation demands for evidence for everything (and rightly so if
we can back ourselves up with that).

It would be great if a study was done whereby MSSA/MRSA positive
patients cared for in 2 controlled environments, either a vinyl floor
single room or a carpeted single room, then utilised fans (which have
been cleaned) and we compared culture plates (or an air sampling device
fit for this) placed vertically in the direct air stream of the fans
(one at a closer proximity to the fan and maybe another placed past the
patient)… obviously this needs more looking into! 🙂

I am not a fan (pardon the pun!) of fans nor do I like carpets in a
healthcare setting but there hasn’t been any strong supportive evidence
to support what would be seen as obvious IC concerns.

I guess cleaning and a risk assessment would be the way to go for now.

Thanks again for all comments/feedback.

Regards,

Gerald

Gerald Chan

Coordinator Infection Control

St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150

P: 9366 1552

M: 0405 495 906 (7804)
F: 9311 4685

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>>> “Lee, Rosie” 26/10/2012 7:46 AM >>>

Hi Gerald
I would agree Michael. It is not possible to have a study proving every
item does not result in infection. Using infection control principles
blowing air in a ward environment cannot be a good principle. If a
patient is heavily colonised with an antibiotic resistant organism (ARO)
then blowing skin squames will result in contamination. There are many
studies indicating contamination linked to AROs in particular MRSA
across the ward. Risk assessment may have to be used.

Regards
Rosie
Rosie Lee
RN. BSc. CICP
Coordinator Infection Prevention & Management
SMH Service – Royal Perth Hospital
Ph + 61 8 9224 2805 Fax + 61 8 9224 1989
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Behalf Of Michael Wishart

Hi Gerard

I recall seeing a study years ago, I think UK based so maybe in JHI,
that showed MRSA in dust on portable fans. Never have seen anything that
linked increase in MRSA or HAI directly to portable fans, though; that
would be epidemiologically difficult to show, I think. Too many other
variables.

Doesn’t mean fans are not bad, though. 🙂 Especially when not
maintained well. Ask if they cleaned thoroughly (meaning the fan blades)
between each patient use. I suspect not!

Cheers
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
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Gerald Chan [Gerald.Chan@SJOG.ORG.AU]

Dear all,

I’m looking for evidence to back us up on not having fans in patient
rooms (especially seeing that summer is around the corner).

I can’t seem to locate any supportive articles on this.

Has there been any studies done that demonstrate an increased rate of
infection/colonisation (MRSA, MSSA, etc.) through fan usage in a
healthcare setting?

Cheers,

Gerald

Gerald Chan

Coordinator Infection Control

St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150

P: 9366 1552

M: 0405 495 906 (7804)
F: 9311 4685

E: Gerald.Chan@sjog.org.au

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