[Gerald Cha]

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
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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
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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

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[Gerald Cha]

I have many years back in another healthcare facility as I’d worked on
an ID ward for a good couple of years and PPE usage was rife with the
many patients on isolation, Joe.
Boils down to knowledge deficit as these gloves will breakdown with
prolonged usage… have seen caregivers walking around with gloves
showing tiny tears as a result of shear forces or worse still, rips at
the finger tips due to long nails, all this after patient contact.
So if anyone’s gelling or washing these gloves out of convenience to
“comply” with the 5 Moments, they’re truly not helping anyone (this
practice effectively ceased through inservice education at the other
healthcare facility).
Wasn’t there an old study done to prove that the gloves aren’t 100%
hole-proof and “juice” extracts taken after contact with VRE patients
did isolate VRE (or some other pathogen) on culture plates?
Regards,
Gerald

Gerald Chan
Coordinator Infection Control

St John of God Murdoch Hospital
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>>> Joe-Anne Bendall
4/10/2012 11:14 AM >>>

Hi
Has anyone else noticed staff wearing gloves and then cleaning the
gloves with alcohol hand rub rather than removing the gloves and
performing hand hygiene?

Thanks
Joe

Joe-anne Bendall
Infection Prevention and Control CNC
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
Sydney 2000
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[Gerald Cha]

Thanks Wendy.
I would be interested to find out more about your processes for managing caregivers with skin issues/breakdowns resulting from ABHR use as well as the JD for your role.
With the increased push for Hand Hygiene with ABHRs, we are noticing a rise in caregivers reporting skin issues (which were previously >> Wendy Naisoro 6/09/2012 12:25 PM >>>
Hi Gerald,

To elaborate on Jayne O’Connor’s response from Sydney Adventist Hospital:

– The 1 FTE Staff Health and Wellbeing Advisor’s duties include(onsite we have the equivalent of 2500 heads of paid staff, 500 volunteers, 700 Visiting Medical Officers and 300 University students):

– All Immunisations, including: priorix, boostrix / adacel, Hepatitis B, Meningococcal (only for certain groups), Varilrix
– Clinical Indicators for 6.1 and 6.2
– Needlestick injuries / Body Substance Exposures
– Pre employment medicals on all new staff
– When an outbreak occurs following up of the staff only
– Radiation Monitoring
– Legislative monitoring surrounding Cytotoxic therapies
– General first aid
– Skin assessments and management of skin irritation
– Referrals to Mental Health contacts
– General first aid
– Contact officer for bullying and harrassment

Many thanks
Mrs Wendy Naisoro
Sydney Adventist Hospital
Staff Health and Wellbeing Advisor

029487 9236

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[Gerald Cha]

Thanks for the replies here as well as directly to my email address.
Apologies that I’d forgotten to include my own area’s FTE set-up!
We’ve got approximately 370 beds with an ED and an ICU/CCU (15 beds).
Infection Control here comprises of:
1.0 FTE IC Coordinator
0.6 FTE IC Clinical Nurse
0.4 FTE Immunisation Nurse
Do keep your responses coming as it’ll help out fellow ICPs planning
for future/current requirements.
Thanks once again.
Regards,
Gerald

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St John of God Murdoch Hospital
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>>> “Bartolo, Richard” 6/09/2012 8:12 AM
>>>

Hi Gerald,
I forgot to mention that Western Hospital has a 14 bed ICU and were
planning a new one for Sunshine.

Richard Bartolo
Manager Infection Prevention

Western Health
Gordon Street, Footscray VIC 3011
Tel. 03 8345 6113
Pager. 03 8345 6666 No. 506
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Behalf Of Bartolo, Richard

Hi Gerald,
I think this would be valuable information for all of us within
Infection Prevention, and would appreciate more responses from our
colleagues across Australia.
At Western Health Victoria:
Western Hospital 360 beds, 2.9 FTE
Sunshine Hospital 426 beds, 1.0 FTE
Williamstown Hospital 90 beds, 0.6 FTE
Sunbury Day Hospital 27 beds, 0.2 FTE
Reg Geary nursing home 30 high care beds
Hazeldean Transition Care 30 beds.
Total of 5.7 FTE for 963 beds including 1 FTE Hand Hygiene Nurse, we do
the influenza vaccinations annually and all NSI management.
Thanks for raising this matter.
Regards

Richard Bartolo
Manager Infection Prevention

Western Health
Gordon Street, Footscray VIC 3011
Tel. 03 8345 6113
Pager. 03 8345 6666 No. 506
Mob. 0438 560 441
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Behalf Of Jayne O’Connor

Hi Gerald,
We are a 350 bed private facility with two FTEs for IPC and 1 FTE for
staff health who carries out immunisations for the facility along with
other duties e.g. NSI, body substance exposures.
Hope this helps
Kind Regards
Jayne OConnor RN, BSc
IPC CNC
Sydney Adventist Hospital
Wahroonga
NSW 2076
Jayne.oconnor@sah.org.au

Behalf Of Gerald Chan

Dear all,

I’m keen to know what are the current Infection Control staffing ratios
utilised by hospitals with 300-400 beds (happy for those with more beds
to respond to this as well).

If you could specify your:

– number of beds:

– FTE:

(Does this include an immunisation nurse? Y/N)

(If yes, please specify that FTE: )

I’ve seen various reports specifying ideal IC staff to bed ratios but
would be keen to know what’s actually happening at ground level.

Thank you.

Regards,

Gerald

Gerald Chan

Coordinator Infection Control

St John of God Murdoch Hospital
100 Murdoch Drive
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[Gerald Cha]

Thanks Michael.
I’ll have a chat with our Engineering team on this as I was previously
informed that our “true” negative pressured procedural and isolation
areas dispersed the air through a separate exhaust system thus
minimising any potential risks to air re-circulation… thus, there
should be no difference in this new plan.
Will re-check though.
Thanks again.
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)
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>>> Michael Wishart 31/08/2012 11:27 AM
>>>

Hi Gerard
If you are including negative pressure you should really have HEPA
filters on the EXHAUST side of the room air handling, before circulation
through the rest of the building. Not on air inlets. This is to minimise
risk of dispersal of TB through the air handling system, which is a real
possibility. The engineers may be factoring this in as part of negative
pressure, but you should probably check.
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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Behalf Of Gerald Chan

Oh yes, Michael…

We’ve factored in negative pressure for the new room as we’ve seen a
rise in potential TB cases coming in for bronchoscopies in recent
times.

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)
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>>> Michael Wishart 31/08/2012 11:13 AM
>>>

Hi Gerard
Dont forget to factor in the usages of the room, both now and in the
foreseeable future. I think the facilities guidelines are assuming upper
and lower gastrointestinal endoscopy for the air handling
recommendation. If bronchoscopy is being performed, you should consider
the need for negative ventilation and HEPA filtration, as per Lesley
Lewis reply.
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
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au (
outbind://2-00000000322A6E77654E5647B9AFCD5D3EEDE14707004D7547DA408E2F48AB749935CC6154B000000153224E00004D7547DA408E2F48AB749935CC6154B00000015325130000/www.holyspiritnorthside.org.au
)
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Behalf Of Gerald Chan

Thanks, Glenys.

The links you’d forwarded have been most helpful.

We’re looking to build a new endoscopy room and HEPA filtration was
something that we didn’t see a need for, but we were informed by the
architects that new endoscopy rooms built these days factor that in and
they were convinced that it was a requirement.

Good to know that the filter efficiency requirements are “G4 – F8”, so
our stand remains.

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

W: http://www.sjog.org.au/murdoch

facebook.com/stjohnofgodmurdoch (
http://www.facebook.com/stjohnofgodmurdoch )

twitter.com/sjgh_murdoch ( http://www.twitter.com/sjgh_murdoch )

>>> Glenys Harrington 30/08/2012 9:10 PM >>>

Hi Gerald,
Heap filters for the ventilation system in Endoscopy Units is not a
requirement in the Department of Human Services Victoria, Design
guidelines for hospitals and day procedure centres
http://www.healthdesign.com.au/vic.dghdp/
In the full version of the Guidelines see the table VENTILATION
REQUIREMENTS FOR AREAS AFFECTING PATIENT CARE HOSPITALS AND OUTPATIENT
FACILITIES in Part E – Building Services and Environmental Design
Enclosure E1a on page 47 and 48 link below
http://www.healthdesign.com.au/vic.dghdp/dghdp_content/guidelines/dghdp_design_guidelines_complete.pdf
Table states the following:
Endoscopy Unit – Filter efficiency – G4 – F8 2
Table Foot notes
2. Filtration Efficiency: First filter listed is the
prefilter if two filters are listed, second is the main filter and the
HEPA if listed is the final terminal filter
Is the concern or query related to laser plume?
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

Behalf Of Gerald Chan

Dear all,

Are there any IC guidelines referring to the need for HEPA filtration
in Endoscopy procedure rooms?

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 4685

E: Gerald.Chan@sjog.org.au

W: http://www.sjog.org.au/murdoch

facebook.com/stjohnofgodmurdoch (
http://www.facebook.com/stjohnofgodmurdoch )

twitter.com/sjgh_murdoch ( http://www.twitter.com/sjgh_murdoch )

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[Gerald Cha]

Oh yes, Michael…
We’ve factored in negative pressure for the new room as we’ve seen a
rise in potential TB cases coming in for bronchoscopies in recent
times.
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
W: http://www.sjog.org.au/murdoch
facebook.com/stjohnofgodmurdoch (
http://www.facebook.com/stjohnofgodmurdoch )
twitter.com/sjgh_murdoch ( http://www.twitter.com/sjgh_murdoch )
>>> Michael Wishart 31/08/2012 11:13 AM
>>>

Hi Gerard
Dont forget to factor in the usages of the room, both now and in the
foreseeable future. I think the facilities guidelines are assuming upper
and lower gastrointestinal endoscopy for the air handling
recommendation. If bronchoscopy is being performed, you should consider
the need for negative ventilation and HEPA filtration, as per Lesley
Lewis reply.
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
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au (
outbind://2-00000000322A6E77654E5647B9AFCD5D3EEDE14707004D7547DA408E2F48AB749935CC6154B000000153224E00004D7547DA408E2F48AB749935CC6154B00000015325130000/www.holyspiritnorthside.org.au
)
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Behalf Of Gerald Chan

Thanks, Glenys.

The links you’d forwarded have been most helpful.

We’re looking to build a new endoscopy room and HEPA filtration was
something that we didn’t see a need for, but we were informed by the
architects that new endoscopy rooms built these days factor that in and
they were convinced that it was a requirement.

Good to know that the filter efficiency requirements are “G4 – F8”, so
our stand remains.

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

W: http://www.sjog.org.au/murdoch

facebook.com/stjohnofgodmurdoch (
http://www.facebook.com/stjohnofgodmurdoch )

twitter.com/sjgh_murdoch ( http://www.twitter.com/sjgh_murdoch )

>>> Glenys Harrington 30/08/2012 9:10 PM >>>

Hi Gerald,
Heap filters for the ventilation system in Endoscopy Units is not a
requirement in the Department of Human Services Victoria, Design
guidelines for hospitals and day procedure centres
http://www.healthdesign.com.au/vic.dghdp/
In the full version of the Guidelines see the table VENTILATION
REQUIREMENTS FOR AREAS AFFECTING PATIENT CARE HOSPITALS AND OUTPATIENT
FACILITIES in Part E – Building Services and Environmental Design
Enclosure E1a on page 47 and 48 link below
http://www.healthdesign.com.au/vic.dghdp/dghdp_content/guidelines/dghdp_design_guidelines_complete.pdf
Table states the following:
Endoscopy Unit – Filter efficiency – G4 – F8 2
Table Foot notes
2. Filtration Efficiency: First filter listed is the
prefilter if two filters are listed, second is the main filter and the
HEPA if listed is the final terminal filter
Is the concern or query related to laser plume?
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

Behalf Of Gerald Chan

Dear all,

Are there any IC guidelines referring to the need for HEPA filtration
in Endoscopy procedure rooms?

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 4685

E: Gerald.Chan@sjog.org.au

W: http://www.sjog.org.au/murdoch

facebook.com/stjohnofgodmurdoch (
http://www.facebook.com/stjohnofgodmurdoch )

twitter.com/sjgh_murdoch ( http://www.twitter.com/sjgh_murdoch )

intended recipient. They may contain confidential or privileged
information. This information may not necessarily be the view of St John
of God Health Care Inc (SJGHC). SJGHC does not warrant, represent or
guarantee the accuracy or completeness of the information. SJGHC does
not accept liability for any loss or damage in connection with the
information. If you are not the intended recipient then any use,
reliance, interference with, disclosure, distribution or copying of this
information by you is unauthorised and prohibited. If you have received
this email in error then please notify the sender by return email and
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[Gerald Cha]

Hi Sony,
Regardless of the amount of safety features you may purchase and implement for the ABHRs, if the bottles are still able to squirt out the gel for use, a desperate patient will still be able to access the gel for consumption as they’ll find ways around whatever safety measures you have in place.
We’re always emphasizing to our staff that at the point of admission, the nurse (or any other caregiver) is expected to make a risk assessment and from there if a patient is deemed a high risk for potential ABHR consumption (e.g. patient with a Hx of substance abuse, confusion, etc.), the bottles in the room then get removed during that patient’s stay in the facility.
That then removes the potential risk from the picture.
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
E: Gerald.Chan@sjog.org.au
W: http://www.sjog.org.au/murdoch

facebook.com/stjohnofgodmurdoch ( http://www.facebook.com/stjohnofgodmurdoch )
twitter.com/sjgh_murdoch ( http://www.twitter.com/sjgh_murdoch )
>>> Sony SO 23/08/2012 9:07 PM >>>

Dear All,
In recent few weeks, we had two incidents related to patients accidental ingestion of alcohol hand rub (AHR). The ingested amount of AHR for these two cases in from a few nips to about 50 ml. Although these patients had no health harm caused, we would like to enhance our safety measures for using AHR.
To minimize the above mentioned hazards, we would like to know whether you are using AHR dispenser rack with safety locker features.
Regards,
Sony SO
Nursing Officer, Infection Control Team
Kwong Wah Hospital
Hong Kong SAR, CHINA
http://www.ha.org.hk/kwh/default.htm
Tel:+ 852 3517-2409 Fax: +852 2332-3348 email:sony@ha.org.hk
Please consider the environment before printing this e-mail

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[Gerald Cha]

Thanks Matthias for further identifying the many gaps in the eWater
system and their “research”.
It is alarming to note that Austin Health’s approval was not sought
(from its clinical departments) as the company often quotes its use
there in marketing its product.
I have declined their request to allow my organisation’s letterhead to
be used by them for the informal random swabs they’d conducted in our
catering department.
As mentioned to the rep then, there will obviously be a microbial count
reduction noted in the swab results (post-eWater) as we are not dealing
with plain water but either hypochlorous acid/hydrochloric acid or
caustic soda (depending on which tap the “water” is from).
That plus vigorous scrubbing of the surfaces to be swabbed when eWater
was applied.
I think with the discussion points raised, there is an obvious lack of
supporting evidence to pursue a trial at this stage.
Thanks Matthias and Lindsay for your feedback.
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 4685
E: Gerald.Chan@sjog.org.au
W: http://www.sjog.org.au/murdoch

facebook.com/stjohnofgodmurdoch (
http://www.facebook.com/stjohnofgodmurdoch )
twitter.com/sjgh_murdoch ( http://www.twitter.com/sjgh_murdoch )
>>> “GRAYSON, Lindsay” 26/06/2012 12:44
PM >>>

Dear All,
Further to Matthias email His point #16 is correct namely that
neither Infection Control nor Infectious Diseases know anything about
eWater and have never been asked to assess it, let alone approve it!!
Until this email I had never heard of eWater.
Needless to say, we are currently investigating how Austin Health
approved eWater, but it was not via any clinical department. I
will report back since it may be a lesson for others.
Thanks Matthias
Kind regards
Lindsay

Prof. M. Lindsay Grayson
Infectious Diseases Department,
Austin Health
Department of Medicine, University of Melbourne
Studley Rd., Heidelberg, VIC 3084
Australia

Dear Colleagues,
The topic of the eWater System appeared on both the ACIPC and OzBug
e-mail lists (I overlooked the ACIPC one initially) and I thought it
would be worth writing a somewhat more detailed joint reply to both
lists.
I have previously posted (to ACIPC) on what seemed a similar
technology, the ActiveIon device.
I have looked at some of the available information concerning the
eWater System, and even though I cannot make any final conclusions, I
have a number of questions and issues of concern that I would like to
share. If I were to look at purchasing the device, these would be some
of the points that I would look at more closely.
(1) The description is that the system performs electrolysis of an NaCl
solution and creates two solutions, one a (probably weak) bleach (NaOCl)
and/or hypochlorous acid (HOCl) solution (not sure which one
predominates), the other a sodium hydroxide (NaOH) solution. The bleach
solution — according to the description — is microbicidal and can be
used for disinfection, including disinfection in the food industry, in
hospitals, even hand antisepsis. The NaOH solution — according to the
description — is for cleaning.
(2) The question comes: What would be the difference between using the
eWater system and just buying bleach and/or hypochlorous acid itself,
which are cheap standard chemicals that are easily available?
(3) Has the system been tested by a manufacturer-independent (!)
disinfectant testing laboratory with relevant expertise? Experience
tells us that one cannot solely rely on manufacturer-provided test
reports or manufacturer claims when it comes to disinfectants —
preferable would be at least two independent test reports from
experienced reputable labs.
(4) Has the system been tested by any of the available standardised
testing protocols for surface disinfection (or other types of
application, depending on the intended use)? There are, for example, US
ASTM standards and European EN standards. The EN standard for surface
disinfection is EN 13697, and such tests are typically done in
variations (a) with or without organic load (“dirty conditions”) and (b)
with or without mechanical action (simulating the wiping).
(5) If, for example, antimicrobial activity would fail in the presence
of organic load, then a prior cleaning step would become highly
critical. Organic load is, of course, an issue in the food industry,
where one of the advertising targets lies.
(6) FYI, disinfectant testing and assessment is usually done in two
steps, step 1 is testing in suspension — like the MBC (minimum
bactericidal concentration) for antibiotics and step 2 is testing
under simulated practice conditions, e.g. surface disinfection on a
carrier.
(7) Has any testing employed experimental controls that — in terms of
biological plausibility — leave no other conclusions than what the
machine produced killed the microorganisms and not (!) some other part
of the application? (In the ActiveIon example, the microbial reduction
achieved by one testing lab was similar to what one would expect from
applying plain inactive water and wiping, but such a control was
omitted).
(8) Is there a way to make sure that the disinfectant concentrations
coming out of the machine are kept consistent and in an antimicrobially
active range to fulfill their purpose? Meaning how are concentrations
monitored and ensured that there is active disinfectant? Is there a
testing method provided to measure the concentrations in daily use (in
analogy to checking fridge temperatures in labs on a daily basis as part
of quality control)? Apparently, electrodes age over time and may
deliver electrolysis less consistently. Is there experience with
stability of not only disinfectant concentration but also microbicidal
activity over the intended period of machine usage (I presume years)?
Also, how long are the prepared solutions stable after electrolysis and
before application?
(9) The company address given on the website is an Australian one, but
it is unclear to me if they are a distributor or the manufacturer. Some
of the documentation appears to be from Japan; this may indicate that
the Australian address may be a distributor.
(10) I saw two “research” publications on the website, both looked like
research papers, but none had proper bibliographic information (journal
name, year, volume, etc.). (I found one of these subsequently, with
journal information, by putting the title into PubMed).
(11) A table on the website showing microbial test results (citing an
article published in Japanese) misspelled quite a number of bacterial
names. If someone claiming to have microbiological expertise is unable
to spell some of the most common bacterial names, this should ring alarm
bells.
(12) On the eWater website, there are three linked documents from RMIT
University (origin: School of Civil Engineering). One is a brief
Executive Summary, another a more comprehensive multi-page document,
another what appears to be a conference poster. The Executive Summary
appears to focus on cost, environmental and social factors, the bigger
document has “report final” in its file name but has oblique “draft”
written over the pages and no authors specified. The microbiology part
is dubious. All three are written in a very positive tone, raising the
question whether they might be industry-sponsored.
(13) The claim that the system can “sterilise” medical instruments
appears unsubstantiated. From a solution like the one described, one
would expect at best (!) high-level disinfection, but not sterilisation.
Even claims for high-level disinfection would have to be substantiated
by standardised testing, and it should be specified what types of
instruments can be treated and under which conditions.
(14) It is proposed to use the electrolysed water for hand hygiene, but
it is unclear to me how it should be useful for that purpose. NaOCl
(bleach) is genuinely unsuitable (!) for hand hygiene, because in higher
concentrations it would be damaging to hands and in lower concentrations
it would take too long to kill microorganisms (alcohol hand rubs produce
several log reduction in about 30 sec). Again, results from standardised
tests would be needed.
(15) The main target is apparently the food industry, but it is also
promoted for hospitals. Even if the product were “only” intended for the
food industry, one would still expect that the system should fulfill
basic claims concerning antimicrobial efficacy. Both industries are
critical in terms of preventing infections.
(16) The company advertises with an endorsement from Austin Health.
That would raise the question whether Austin’s Infection Control
Department and/or Lindsay Grayson’s group has seen and/or endorsed this,
or whether the company only liaised with scientifically untrained
personnel, such as the housekeeping or kitchen department. The latter
would be quite inappropriate. (We had an occasion here where a
manufacturer tried to market a new product by circumventing the
Infection Control Committee and went straight to Housekeeping).
I think that this system should be properly investigated by an
institution or authority with the competency and clout to do this before
it is used in the healthcare and food industry.
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

kkh

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[Gerald Cha]

Thanks for this most interesting information, Matthias.
Very alarming that the article found “B. cereus and other Bacillus species were cultured from the internal contents of 63.3% of APPs”.
We are currently reviewing our 1% CHG swab-sticks with a view to increasing that concentration to 2% in an area that’s recently seeing a rise in IVD related bacteraemias (that plus introducing other infection minimisation bundle/strategies).
In view of what’s been highlighted, we’ll probably head down the path of the (small) bottled CHG 2% in ethanol 70% (that’s practically single-use only due to its volume) until further clarification is acquired with regards to the swab sticks manufacturing process.
If you’re alright with it, could you kindly forward your correspondence with SoluMed to me as well?
Much appreciated.
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
E: Gerald.Chan@sjog.org.au
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>>> “Matthias Maiwald (KKH)” 15/06/2012 11:25 AM >>>

Hi Tim,
Alcohol-based products (in appropriate concentrations) are effectively “auto-sterile” except for bacterial spores. That is why they have to be filtered (a standard procedure) but not sterilised in a classical sense (such as autoclaving). For a product like the Solu IV sticks one would (I think) therefore have to postulate that the plastic sticks and swabs would have to be radiation-sterilised (a standard procedure for plasticware like syringes) and the CHG-ALC solution filtered separately and then combined under sterile conditions (although I am not familiar with the details of such pharmaceutical manufacturing processes). The problem with the SoluMed response was that they were not forthcoming with relevant information (e.g. whether above had been done) and the person that I corresponded with did not have the slightest clue about the underlying concepts of sterility.
I will have to dig in my old e-mails to find this.
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

Hi Matthias,
This has come up often about the fact that swabsticks are not “sterile”. I get asked about it alot.
The inability to heat treat for sterilisation with IPA is obviously a combustable issue. 😉
However, the sterilisation process also has some destabilisation of the CHG (from what I have heard only).
I am unawwre of ANY other product on the market at the moment that is completely sterilised for use (that contains CHG and IPA)

If you are happy, would you mind forwarding me the correspondence with SoluMed as I would like to also investigate this.

Regards,

Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel 02 8738 3603 | Fax 02 8738 3551 | Mob 0409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au

Dear Tim, dear Colleagues,
The use of 2% CHG with isopropanol versus 0.5 or 1% makes perfect biological and microbiological sense, but there are currently no data available from clinical trials (i.e. outcomes-based research) having compared the higher versus the lower concentration.
I wonder about the Solu IV swabsticks that are being mentioned. Earlier, in 2008, someone mentioned that they are not labelled as sterile. I looked into this a little further and contacted the Canadian headquarters, and they also stated that they are not sterile in a strict sense. It became obvious that the person from the headquarters who I was corresponding with had absolutely not the slightest clue about the concepts of sterility.
It is well known that alcohol products need to be filtered in the process of production, in order to exclude bacterial spores. This is a well-established standard process, and most companies just simply do it. A recent article in ICHE highlighted problems with alcohol pads where this apparently had not been done:
http://www.ncbi.nlm.nih.gov/pubmed/22669227
For items like the single-use swabsticks (soeaked with alcohol) that are packaged, I would assume (but I don’t know for certain) that the plastic sticks would have to be irradiated for sterility separately in the production process and the alcohol filtered (as stated above).
At the time, I ended up not following through with the correspondence (somewhat frustrated by the Canadian response), but I wonder if anyone from this list has looked at this issue (?).
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

Robert,
We have done so and do so for EVERY IV device, not just PIVs.
2% CHG in 70% IPA – its all evidence based and there is plenty of literature to support it as well.
We previously used 0.5% CHG in 70% IPA.
We use Solu-IV swabsticks (tinted for insertion and clear for maintenance) and the large wipes.
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel 02 8738 3603 | Fax 02 8738 3551 | Mob 0409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au

Good morning
I would like to know from those facilities who currently uses 70% Isopropyl alcohol v/v in 0.5% to 1% Chlorhexidine, and are moving towards or have now changed to using 2% Chlorhexidine in alcohol specifically for insertion of an Peripheral IVC.
I am aware of the current recommendations surrounding this but would like others comments on this matter.
regards

Robert Robinson

Clinical Nurse Consultant | Infection Control
Blacktown/Mt. Druitt Hospitals
Tel 02 9881 8994 | Mob 0408 923 789 | robert.robinson@swahs.health.nsw.gov.au

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[Gerald Cha]

That’s my key concern as well, Kevin… thus the need for the MSDS.
I recognise the effectiveness of this system from a catering
perspective.
However, if prolonged hand washing is done with diluted bleach/caustic
soda, that may result in compromised skin integrity over the long-term
as you’d mentioned.
Keen to know the strategies other hospitals have implemented to
minimise this potential risk.
Thanks
Gerald

>>> Kevin Griffin 14/06/2012 2:35 PM >>>

Hi Gerald
I certainly wouldnt use a Sodium Hypochlorite solution or a caustic
Soda for routine had washing.
Bleach can cause skin de-fatting, irritation and a number of other
issues. Caustic soda will cause skin irritation.
Bleach is nasty stuff. We see every day the skin damage caused by some
hand runs and frequent hand washing with products designed for skin use
Imagine how much worse bleach would make things.
Regards
Kevin

Behalf Of Gerald Chan

Thanks Kevin.

I’ve asked for the MSDS to have a look at the bleach concentrations
churned out by this system as that’ll better guide our planning (from an
OSH and IC perspective).

In terms of solely using the eWater for handwashing, has anyone
encountered issues with this?

Would appreciate any feedback you’ve had from your catering staff.

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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>>> Kevin Griffin 13/06/2012 2:38 PM >>>

Gerald
As you said the chemistry is pretty clear.
The resultant sodium Hypochlorite is basically that, normal Sodium
Hypochlorite and should have stability and efficacy the same as that as
a standard weak bleach solution.
Regards
Kevin

Kevin Griffin
Bioquell Asia Pacific Pte Ltd
207 Henderson Road,#01-05
Singapore 159550
T: +65 6592 5145
F: +65 6227 5878
M: +65 8511 3733
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Behalf Of Gerald Chan

Dear all,

I’m keen to obtain feedback from hospitals currently using the eWater
system and from anyone with a good grasp of electrolysed water.

Having seen a demo, I note that the system utilizes dissolved sodium
chloride (stored in a separate container) which is then pumped into a
wall mounted unit (eWater system), gets mixed with tap H2O which then
goes through electrolysis… thus giving us 2 distinct byproducts
comprising of sodium hypochlorite and sodium hydroxide (which the system
spits out in 2 separate taps marketed as “sanitising” and “cleaning”
solutions respectively).

The chemistry bit is rather clear, plain water with added salt, gets
zapped and we get a weak bleach as well as caustic soda.

These mild solutions are ideal for sanitising fruits/veggies/meat in
the catering industry… and that’s where they’re promoting its key
use.

Aside from washing produce, the rep promoted the use of the supplied
spray bottles which you then fill with eWater for disinfecting surfaces
in the catering department.

They were keen on proving the effectiveness of eWater in this respect
by doing swabs.

Obviously culture swabs taken before spraying the surface would yield a
higher microbial count as we’re not just spraying plain water but a
solution containing either bleach or caustic soda (that plus the rep was
scrubbing the surfaces vigorously).

Where I start questioning this all is when the rep informs me that the
eWater solution can be kept for >7 days in the spray bottles without
losing its efficacy (these spray bottles get decanted each time).

Wouldn’t electrolyzed water lose its potency rather quickly? Or is it
because we’ve added sodium chloride to the mix that we’ve now obtained a
relatively stable bleach solution?

From the papers provided by the company, it is reported that eWater
offers a higher sanitising efficiency due to its “significantly higher
Oxidation-Reduction Potential (ORP)”.

This “significantly higher ORP” apparently offers a higher kill rate
when compared to an un-electrolyzed comparable solution of bleach (with
similar ppm counts).

They were also keen to promote the use of eWater as a replacement to
handwashing with soap and water (in clinical areas as well!)… eWater
does not contain emollients and with prolonged usage (fervent observance
of the 5 Moments), IMO there would most definitely be reported skin
issues relating to dryness. You can’t replace the effectiveness and
convenience of ABHRs.

I recognise the potential of eWater in the kitchens (from a convenience
perspective, space-saving, environmental, etc. compared to current
processes) but do not see its use beyond that in a hospital setting.

Keen to hear the views from hospitals who’ve trialed this system…
what’s your experience and has it been used out of the kitchen setting.

Thanks, all.

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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[Gerald Cha]

Thanks Kevin.
I’ve asked for the MSDS to have a look at the bleach concentrations churned out by this system as that’ll better guide our planning (from an OSH and IC perspective).
In terms of solely using the eWater for handwashing, has anyone encountered issues with this?
Would appreciate any feedback you’ve had from your catering staff.
Cheers,
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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>>> Kevin Griffin 13/06/2012 2:38 PM >>>

Gerald
As you said the chemistry is pretty clear.
The resultant sodium Hypochlorite is basically that, normal Sodium Hypochlorite and should have stability and efficacy the same as that as a standard weak bleach solution.
Regards
Kevin

Kevin Griffin
Bioquell Asia Pacific Pte Ltd
207 Henderson Road,#01-05
Singapore 159550
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Dear all,

I’m keen to obtain feedback from hospitals currently using the eWater system and from anyone with a good grasp of electrolysed water.

Having seen a demo, I note that the system utilizes dissolved sodium chloride (stored in a separate container) which is then pumped into a wall mounted unit (eWater system), gets mixed with tap H2O which then goes through electrolysis… thus giving us 2 distinct byproducts comprising of sodium hypochlorite and sodium hydroxide (which the system spits out in 2 separate taps marketed as “sanitising” and “cleaning” solutions respectively).

The chemistry bit is rather clear, plain water with added salt, gets zapped and we get a weak bleach as well as caustic soda.

These mild solutions are ideal for sanitising fruits/veggies/meat in the catering industry… and that’s where they’re promoting its key use.

Aside from washing produce, the rep promoted the use of the supplied spray bottles which you then fill with eWater for disinfecting surfaces in the catering department.

They were keen on proving the effectiveness of eWater in this respect by doing swabs.

Obviously culture swabs taken before spraying the surface would yield a higher microbial count as we’re not just spraying plain water but a solution containing either bleach or caustic soda (that plus the rep was scrubbing the surfaces vigorously).

Where I start questioning this all is when the rep informs me that the eWater solution can be kept for >7 days in the spray bottles without losing its efficacy (these spray bottles get decanted each time).

Wouldn’t electrolyzed water lose its potency rather quickly? Or is it because we’ve added sodium chloride to the mix that we’ve now obtained a relatively stable bleach solution?

From the papers provided by the company, it is reported that eWater offers a higher sanitising efficiency due to its “significantly higher Oxidation-Reduction Potential (ORP)”.

This “significantly higher ORP” apparently offers a higher kill rate when compared to an un-electrolyzed comparable solution of bleach (with similar ppm counts).

They were also keen to promote the use of eWater as a replacement to handwashing with soap and water (in clinical areas as well!)… eWater does not contain emollients and with prolonged usage (fervent observance of the 5 Moments), IMO there would most definitely be reported skin issues relating to dryness. You can’t replace the effectiveness and convenience of ABHRs.

I recognise the potential of eWater in the kitchens (from a convenience perspective, space-saving, environmental, etc. compared to current processes) but do not see its use beyond that in a hospital setting.

Keen to hear the views from hospitals who’ve trialed this system… what’s your experience and has it been used out of the kitchen setting.

Thanks, all.

Regards,

Gerald

Gerald Chan

Coordinator Infection Control

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

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