[Glenys Harrington]

Thanks for the clarification and overview Sue

Do you know if the information is available on the Australian Health
Practitioner Regulation Agency (AHPRA) web page?

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Greig Sue
is in the HEALTH PRACTITIONER REGULATION (NEW SOUTH WALES) REGULATION 2010 –
SCHEDULE 1 ?? [SECUNCLASSIFIED]

Hi Joe-anne,

Originally in 1995, this legislative Standard was included in each of the
professional acts to cover different professional groups (Drs, nurses,
dental technicians, dentists, physios and podiatrists) and transferred into
the national legislation with the National Health Practitioner Act as a
specific Regulation attached to the Act.

Just shows how aware we are about the legislation that impacts upon our
practice as the 1995 Regulation was delivered to the home address of all
health professionals registered at that time to inform them of the addition
to legislation.

Currently, in addition, to Schedule 1, it also identified in Reg 5 and 6.
(see below) you can see it impacts upon other health professionals and not
just nurses. However, dentists and dental technicians are no longer included
and pharmacists have been added.

Regards,
Sue

.

Definition

5 Definition

In this Part and in Schedule 1:

“relevant health practitioner” means:

(a) a medical practitioner, and

(b) a nurse or midwife, and

(c) a pharmacist, and

(d) a physiotherapist, and

(e) a podiatrist.

HEALTH PRACTITIONER REGULATION (NEW SOUTH WALES) REGULATION 2010 – REG 6

Infection control standards

6 Infection control standards

(1) A relevant health practitioner must not, without reasonable excuse, fail
to comply with the infection control standards set out in Schedule 1 to the
extent that they apply to the health practitioner in the practice of the
health practitioners profession.

(2) In deciding whether or not a relevant health practitioner has a
reasonable excuse for failing to comply with a standard, particular
consideration is to be given to the following:

(a) whether the circumstances involved the provision of emergency treatment,

(b) whether the health practitioners employer failed to provide the
necessary equipment, including providing access to it and training in its
use, that would have enabled the health practitioner to comply with the
standard (and whether the failure to provide such equipment was reported by
the health practitioner to the Director-General).

(3) If there is any inconsistency between the infection control standards
set out in Schedule 1 and a registration standard, code or guideline
published by a National Board, the registration standard, code or guideline
prevails to the extent of the inconsistency.

Sue Greig
Senior Project Officer
National HAI Prevention Program
Usual work days: Monday to Wednesday

Australian Commission on Safety and Quality in Health Care
GPO Box 5480 Sydney NSW 2001 | Level 5, 255 Elizabeth Street, Sydney NSW
2000
( direct (02) 9126 3565 | ( switchboard (02) 9126 3600 | 6 (02) 9126 3613 |
Email
sue.greig@safetyandquality.gov.au |
http://www.safetyandquality.gov.au
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Commission-and-NSQHS-logos

Of Joe-Anne Bendall
REGULATION (NEW SOUTH WALES) REGULATION 2010 – SCHEDULE 1 ?? [SECNo
Protective Marking]

Does anyone know when this went into the legislation?

Is it in other states and territories legislation?

Part 2 – General standards applying to relevant health practitioners

2 General precautions and aseptic techniques

(1) Precautions must be taken to avoid direct exposure to a patients blood
or body substance.

(2) The requirement in subclause (1) applies regardless of whether there is
any perceived risk of infection.

(3) Aseptic techniques must be used in the course of complying with the
requirements of this Schedule.

http://www5.austlii.edu.au/au/legis/nsw/consol_reg/hprswr2010580/sch1.html

Thanks

Joe-Anne Bendall

Joe-anne Bendall

Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital

8 Macquarie St

SYDNEY NSW 2000

|( ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |

Mobile 0418984255 | *
Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

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[Glenys Harrington]

Francis and Michael,

See attached the recent publication may be of use in developing a pet
visitation policy:

. Rekha Murthy et al. Animals in Healthcare Facilities:
Recommendations to Minimize Potential Risks. Infection Control & Hospital
Epidemiology, March 2015, pp 1 – 22

Also I see that NSW Health, Central Coast Local Health Authority, have
releases a procedure titled:

. “Animal Assisted Activity in CCLHD” – document ID PR2014_007

You might like to contact them for a copy of their procedure

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Michael Wishart

Hi Fran

I agree that any animal (including Guide Dogs, by the way) should be
excluded from a clinical area in which invasive treatment is occurring. You
should probably look at the legislation in your state that refers to
registered assistance animals, and if it is similar to what is here, it will
say these animals are excluded from entering into a clinical area without
approval by the health facility.

Kangaroos are known to harbour salmonella and toxoplasma, just to name a
couple of human pathogens. The risk to immunocompromised patients would
outweigh any possible benefits, in my view.

I would be requesting an appropriate policy for the facility regarding
animal visitation, which includes a risk assessment before approval is
given.

The things we see in our clinical areas!

Cheers

Michael

Michael Wishart

Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E
michael.wishart@svha.org.au | W
http://www.hsnph.org.au
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Of Franciska Ferreira

Dear All,

I’m aware that the relationship between humans and animals brings a
significant and positive influence on the social, emotional and physical
well-being of people/patients. I’ve looked at a couple of Policies and NSW
in particular mentioned Dogs, Cats and some farm animals, but no Kangaroos.
Puppies are generally excluded from visitations until they have completed
the mandatory vaccination regime and are trained.

This Joey was in the Chemo Unit held by someone in a sling (I was in the
middle of a hand hygiene audit) and the patients was happy to see the cute
little Kangaroo. I personally think it is not appropriate for the small unit
with patients receiving Chemo to have any animals other than Guide dogs that
are trained and immunised.

I’m looking forward to your feedback, please.

Kind Regards

Franciska Ferreira

INFECTION PREVENTION & CONTROL /WOUND MANAGEMENT CONSULTANT

Burnside War Memorial Hospital

120 Kensington Road, Toorak Gardens, SA 5056

t: 08 8202 7222 f: 08 8407 8573 e:
fferreira@burnsidehospital.asn.au

Hosp3

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[Glenys Harrington]

Dear All,

In addition to information provided to date on the list server if there are
problems/risks with this cannula/cannula hub it should be reported to the
Therapeutics Goods Administration (TGA), Medical Device Incident and
Investigation scheme (IRIS) – see links below.

Medical Device Incident and Investigation scheme (IRIS)

https://www.tga.gov.au/form/report-medical-device-adverse-event-medical-devi
ce-user

TGA online reporting form

https://apps.tga.gov.au/prod/mdir/udir03.aspx

Reports can be submitted anomalously if needed

As I’m not a user I would recommend that some who is advise the TGA of the
issues by completing the online form.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Tim Spencer

Hi Rosie,

You are correct. The BD Venflon IV cannula has been widely used throughout
Europe and the UK (well it was when I was there many years ago). Is it the
Pro Safety or the standard ported cannula?

This style of ported cannula has been around since the early 1980’s, so
despite the recent addition of a safety aspect, it is still old technology
(in regards to the port aspect).

A ported cannula has significantly increased infection rates due to the
inability to correctly scrub the hub or decontaminate the injection port, as
well as port cap failure.

Here is an Australian publication from NT in 2013 that may help in product
purchase changes – Tay, S et al. Functional evaluation and practice survey
to guide purchasing of intravenous cannulae, BMC Anesthesiology 2013, 13:49
http://www.biomedcentral.com/1471-2253/13/49

There has also been reports from the UK of the ports failing – H. Adler, R.
Cunningham, R. Parimkayala Valve failure in an injection port, Irish Journal
of Medical Science June 2011, Volume 180, Issue 2, p 615

http://link.springer.com/article/10.1007/s11845-010-0622-z

These ported styles of cannula were likely introduced due to the higher
number of UK physicians coming to work in WA (possibly due to clinician
preference only) and have high infection and poor compliance rates, due to
the difficult nature of port location. These are primarily placed in OT only
(as you describe) and are not used in the general wards areas as far as I am
aware.

Although this may be a ‘convenient option’ for clinicians, it is not in the
best interest of the patient, due to the higher risks associated with these
types of cannulae.

From the BD Europe website;
http://www.bd.com/europe/safety/en/products/infusion/bdv_prosafety.asp

. BD VialonT – Proven easy insertion and longer in dwell times1-4

1) Maki D, Ringer M. Risk Factors for Infusion-related Phlebitis with
Small Peripheral Venous Catheters. Annals of Internal Medicine. (1991); 114:
845-854.

2) Gaukroger PB, Roberts JG, Manners TA. Infusion Thrombophlebitis: A
Prospective Comparison of 645 VialonR and TeflonR Canulae in Anesthetic and
Postoperative Use. Anesthesia and Intensive Care.August (1988); 16(3).

3) Stanley M, Meister E, Fuschuber K. Infiltration During Intravenous
Therapy in Neonates: Comparison of TeflonR and VialonR Catheters. Southern
Medical Journal.September (1992); 85(9); 883-886.

4) McKee JM, Shell JA, Warren TA, Campbell VP. Complications of
Intravenous Therapy: A Randomized Prospective Study–Vialon vs. Teflon.
Journal of Infusion Nursing. September (1989); 12: 288-2.

Considering the ongoing changes in technology and increased focus on device
and patient outcomes, these references are very old and dated. I agree with
you that this as a huge risk for contamination and a breach of AT
principles.

The BD Nexiva cannula would seem to be a far better alternative (for patient
and clinician), and still offering a safety option, various access points
and improved securement.

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

Director-at-Large, Vascular Access Certification Corporation (VACC)

Representative – WoCoVA Global Strategic Committee
M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

“Be a yardstick of quality. Some people aren’t used to an environment where
excellence is expected.” – Steve Jobs

Of Lee, Rosie

Hello

Recently I have been made aware of this practice following implementation of
Aseptic Technique Policy. It appears in our theatres the Anaesthetists use
the BD VenflonT intravenous catheter with integrated injection port and
valve for medication and this stays in the patient. I am told the caps are
either being left open in Theatres for quick access by Anaesthetists or they
popp off very frequently. In recovery nurses are observed continuing to use
this to administer medication. I see this as a huge risk for contamination
and a breach of AT principles.

The BD representative states that this type of catheter is not used in other
states of Australia but is common in UK and Europe. Is this correct?

Have you come across this in your hospitals? If so have you ceased the use
or do you advocate using the side extension tubing which has a hub that can
be scrubbed?

Regards

Rosie Lee | Coordinator | Infection Prevention & Management
Royal Perth Hospital

Level 6, South Block, Wellington Street PERTH WA 6000
T: (08) 9224 2805 | F: (08) 9224 1989
E: rosie.lee@health.wa.gov.au
http://www.rph.health.wa.gov.au |
http://www.healthywa.wa.gov.au

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[Glenys Harrington]

Hi Barbara,

It might be worth asking the Gastroenterology Nurses College of Australia
(GENSA) for evidence to support their statement in relation to extended hang
times.

“4. Storage

. g) Extended storage is only permitted if recent (within 12 months)
routine microbiological surveillance of the endoscope has shown negative
culture results”

If there is no good peer review evidence it is important to know the GENSA
review process and decisions around making this recommendation to their
members, which as you say is included in their Infection Control in
Endoscopy, THIRD Edition, 2010.

Contact GENCA

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Barbara Elliott (Subiaco)

Dear All,

We are interested in what other endoscopy suites are doing in relation to
storage of flexible endoscopes – GENCA guidelines recommends storage for a
maximum of 72 hours before they must be used or chemically reprocessed.
They do however, state extended storage is only permitted if recent (within
12 months) routine micro surveillance has shown negative culture results.

Has anyone looked at extended storage time or have any references or
research articles that support extended time? GENCA guidelines state ” that
studies have shown that when a scope has been correctly disinfected and
meticulously dried as per the guidelines, no growth of micro-organisms can
be detected from the channels of the endoscopes stored for up to and in some
cases longer than 7 days”

Thank you

Barbara Elliott

Barbara Elliott | Manager Infection Control
St John of God Subiaco Hospital
T: (08) 9382 6871 | M: 0413 706 384 | F: (08) 9382 6785 | E:
Barbara.Elliott@sjog.org.au
12 Salvado Road Subiaco WA 6008 | PO Box 14, Subiaco WA 6904
http://sjog.org.au/subiaco |
http://twitter.com/sjog_healthcare |
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[Glenys Harrington]

Hi Lindy,

Last year I reviewed the evidence for placing all neutropenic patients in a single room (any single room) at a healthcare facility where it had been a long standing practice over many years.

Using the following headings and questions here are my summary notes and answers to some of the questions you raise.

Subject – Protective environment rooms and placement of immunocompromised/neutropenic patients

Immunocompromised patient groups

As a general group, immunocompromised patients can be cared for in the same environment as other patients.

As with other patient groups exposure to persons with transmissible infections (i.e. influenza, respiratory viruses) should be managed by staff following Standard and Transmission based precautions

What is a protective environment room?

The specific ventilation criteria/requirements for a protective environment single room are as follows.

A room with:

>12 air exchanges per hour

Point of use Hepa filters that are capable of removing 0.3m

A pressure differential between the patient room and the anteroom or corridor to maintain positive pressure and

A room that is well sealed (i.e. around the windows, electrical outlets)

Which immunocompromised patient groups require placement in a protective environment room (as per above room ventilation criteria)?

In addition to standard precautions those patients for whom there is evidence that placing them in a single room with specific ventilation requirements (i.e. protective environment room) are those who have received an allogeneic stem cell transplant.

The need for patients receiving an autologous stem cell transplant to be placed in a single room with specific ventilation requirements (i.e. protective environment room) has not been established.

Which immunocompromised patients may require placement in a single room with negative ventilation?

In addition to standard precautions stem cell transplant recipients and other immunocompromised patients may from time to time require airborne precautions and will requiring a single room with negative ventilation (i.e. those with disseminated VZV, Mycobacterium Tuberculosis)

Which immunocompromised patients may require placement in a single room with normal ventilation?

In addition to standard precautions stem cell transplant recipients and other immunocompromised patients may from time to time require contact or droplet precautions and will require a single room with normal hospital ventilation (i.e. Pertussis, influenza, MRSA, VRE).

What other hospital infection control strategies can be used to reduce the risk of infection in severely immunocompromised patients?

Other strategies include the following:

Construction, Renovation and Building

Hospital construction and renovation has been associated with an increased risk of fungal infection, particularly aspergillosis, among severely immunocompromised patients

Persons responsible for construction and renovation should consult published recommendations regarding environmental controls during construction

Severely immunosuppressed patients, healthcare workers and visitors should avoid construction and renovation areas

Equipment and supplies used by severely immunocompromised patients and their healthcare workers should not be exposed to construction or renovation areas (i.e. areas contaminated with dust).

Cleaning

Wards caring for severely immunocompromised patients should be cleaned 1 time/day with special attention to dust control

Exhaust vents, window sills and all horizontal surfaces and high touch areas and equipment should be cleaned and disinfected daily

Water leaks should be cleaned up and repaired within 72 hours to prevent mould proliferation in floor and wall coverings, ceiling tiles and cabinetry.

Personal protective equipment

Personal protective equipment should be worn in accordance with Standard and Transmission based precautions.

Plants and dried or fresh flowers

Plants and dried or fresh flowers should not be allowed in rooms of severely immunocompromised patients as Aspergillus species have been isolated from soil of potted ornamental plants (e.g. Cati), the surfaces of dried flower arrangement (dust contamination)and fresh flowers

Addition strategies include the following:

Healthcare worker immunisations and vaccinations

Screening visitors, particularly children for potentially infectious conditions

Preventing bacterial intravascular catheter-related infections.

CDC. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. MMWR – Morbidity & Mortality Weekly Report 2000; 49(RR-10):1-125.

Following this review the practice of placing all neutropenic patients in a single room (any single room) was ceased.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Hello

Hope you are all well

Just a query & hope you can send me back your thoughts so make it simple

As we have a lot of pressure for our beds like all of you in health I was wondering what many of your facilities are doing with their neutropenia pts given the recent publication in our Journal HI 2014,19 135 140 Mitchell et al prior room occupancy increases the risk of MRSA acquisition .

I am left wondering where the risk/logic / evidence lies to insist on neutropenia pts being placed in a single room as we all used to dobut do we still now? (& often these pts remain for long time in ED whilst a single room is located anywhere in the facility to take them & ED is not always a low risk environment for this pt group ) given this information in the publication and as we know we cannot always guarantee our environmental cleaning is always at the highest standard each time ..when the push for bed and rapid bed movement occurs (no offences to our hard working cleaning team who are always under the pump intended) I was seeking your learned and expert advice with some quick questions below

1. Can I ask if your facility is currently placing all patients admitted with no neutrophils (neutropenia) in single rooms protective isolation Yes/ No

2. Can I ask if your facility is currently only placing some types of patients with no neutrophils (neutropenia) in single rooms protective isolation yes / No

If yes what is your criteria for making this call?

3. If you place a pt in protective isolation is PPE worn Yes/No/NA

4. If you place a pt in protective isolation is a sign notifying protective isolation requirement placed on the door Yes/ No/NA

5. If you do place them in a single room are these same rooms you use to accommodate MRO or pts with a communicable disease in at other times for other admissions Yes/No

If No how do you manage the use of these room from pt flow perspective (ie leave the room empty, screen all non known MRO pts admitted in these rooms to ensure they dont have an MRO, trust they are cleaned well enough etc?)

6. If you do not place neutropenia patients in single rooms then what strategies does you facility employ to reduce the risk of cross infection if not in a single room ? (do you have a dedicated ward, location or risk group they can be cohort with ,exclusion group they cant be admitted with etc)

Thank you and I look forward to any responses with eagerness and any other thoughtful advice with much appreciation . Thank you Brett et al for you interesting and thought provoking articleI am trying to think forward to the best way to advise our staff here and what folks may already have in place around this and neutropenia pts

Kind regards

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus

Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Mid-North-Coast-LHD.jpg

Wise and human management of the patient is the best safeguard against infection

(Florence Nightingale Circa 1860)

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[Glenys Harrington]

Hi Belinda,

There are Guidelines for the classification and design of isolation rooms in health care facilities, available at the following Department of Health, Victoria web page link

http://docs.health.vic.gov.au/docs/doc/4AAF777BF1B3C40BCA257D2400820414/$FILE/070303_DHS_ISO%20RoomGuide_web.pdf

They are current.

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

Hi All

Apologies if this question has already been asked.

Does anyone have local guidelines/ procedures for negative pressure rooms in your facilities?

Many thanks

Belinda

Belinda Straube

Infection Prevention and Control CNC

St George Hospital

Gray Street Kogarah

NSW

9113 1575

Page 424

cid:image004.jpg@01CFCE90.2269B840NSW Health South East Sydney LHD – col grad RGB

Belinda Straube

Infection Prevention and Control CNC

St George Hospital

Gray Street Kogarah

NSW

9113 1575

Page 424

cid:image004.jpg@01CFCE90.2269B840NSW Health South East Sydney LHD – col grad RGB

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[Glenys Harrington]

Hi Helen,

See ACIPC webpage

.
It’s all
about the toothbrush – Marija Juraja speaking on Breakfast Radio

. https://www.acipc.org.au/CMS/Uploads/file/TOOTHBRUSH%20190613.mp3

Maria may be able to assist, I recall in this radio interview she gave
advice in relation to kitchen wash cloths/dishcloths …she will probably
have a reference for the advice given re: kitchen cloths

In Victoria there is a food safety webpage and food safety guidelines some
of which are linked to legislative requirements depending on the premises
type . See text and links below

DHS Food safety program template for class 2 retail and food service
businesses, no. 1, version 3:

. “Use clean or disposable dishcloths – single-use paper towels are
better than cloths. Wash cloths in hot water and detergent after every use
and sanitise dishcloths regularly. Replace cloths regularly during each
shift”.

http://www.health.vic.gov.au/foodsafety/index.htm

http://www.health.vic.gov.au/foodsafety/pubs.htm

http://www.health.vic.gov.au/foodsafety/downloads/fspt_class_2c.pdf

http://dofoodsafely.health.vic.gov.au/topics/topic7/page3.php

regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Helen Truscott

Dear All ,

I am conducting a small research project on cleaning needs in NSW Fire
Service kitchens and infection control risks.

I would be interested to find out about suitable resources and sources of
information / education or posters that others may have used in similar
workplaces, specifically around use of dishcloths and sponges for washing
up.

Regards

Helen

Helen Truscott RN, RM, MPH
Team Leader-Health and Medical
Health & Safety Branch

Fire & Rescue NSW

E Helen.Truscott@fire.nsw.gov.au | T
02 9265 2976| F 02 9265 2986 | M 0417 677 802

http://www.fire.nsw.gov.au
Level 8, 227 Elizabeth Street, Sydney, NSW 2000

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[Glenys Harrington]

Perhaps someone from the college executive could respond?

Does seen very odd that there is not college representative on this and other AS working droups?

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

To answer your question about who has been involved in the drafting of this standard, I think the list of bodies mentioned in the draft standard makes this clear:

The following interests are represented on the committee responsible for this draft

Australian Standard:

Australian Chamber of Commerce and Industry

Australian Medical Association

Australian Nursing and Midwifery Federation

Consumers Federation

Department of Defence

Hand Hygiene Australia

Human Factors and Ergonomics Society of Australia

Medical Technology Association of Australia

Queensland Emergency Medicine Research Foundation

Royal Australasian College of Physicians

Safety Institute of Australia

Together Queensland

University of New South Wales

Not an ICP in sight in that lot that I can see.

I would encourage all ICPs to review and provide feedback through the process outlined.

Cheers

Michael

Michael Wishart

Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
cid:image001.png@01CFD7EC.B488ED80
P Please consider the environment before printing this email

Hi Terry,

I am gobsmacked that such an important Standard could have gone unnoticed. I had no idea. Hopefully they had a good representation of Infection Preventionists as stakeholders!!

Regards, Terry

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

W: http://terrygrimmond.com

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Hi everyone,

Just came across this snippet in a Standards Australia e-newsletter – see attached. This is the first I have heard about it – so I am hoping that practitioners out there have been involved in some way.

Regards

Terry McAuley

Sterilisation & Infection Prevention and Control Consultant

STEAM Consulting

E: terry@steamconsulting.com.au

W: http://www.steamconsulting.com.au

A: PO BOX 779

Endeavour Hills

VIC Australia 3802

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[Glenys Harrington]

Hi Linda,

I don’t have a poster but do have a nice badge (quote cheap) that staff are
wearing at a regional facility I’m consulting with.

Happy to share offline if interested.

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

Of Linda McCaskill

Hi

Does anyone have a poster that they would share with me that is for the
patient to remind healthcare workers to practise hand hygiene?

Regards

Linda

Linda McCaskill

ACHA Infection Control Manager

Ashford Hospital

ph (08) 8375 5209 or ext 4209

(Mon-Thurs)

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[Glenys Harrington]

Dear All,

On behalf of the ACIPC Scientific Committee, responsible for putting
together the scientific program and inviting speakers, many thanks to all
for your feedback below.
I have copied our committee members (all voluntary) on this email.

Regards

Glenys

Glenys Harrington
Chairperson
Australasian College of Infection Prevention and Control(ACIPC)
2014 Conference Scientific Committee
https://www.acipc.org.au/

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

—–Original Message—–
Of Franciska Ferreira

To all involved,

I loved it!! Thank you to all the speakers and organisers!!

Kind Regards

Franciska Ferreira
INFECTION PREVENTION & CONTROL /WOUND MANAGEMENT CONSULTANT Burnside War
Memorial Hospital
120 Kensington Road, Toorak Gardens, SA 5056
t: 08 8202 7222 f: 08 8407 8573 e: fferreira@burnsidehospital.asn.au

—–Original Message—–
Of Belinda C Henderson

Hi All
Another wonderful conference, a program that facilitated learning,
networking, and thought provoking discussion. Well done to Rosie, Glenys and
the team. A special thanks also to our delegates.
Cheers
Belinda

ACIPC President

—–Original Message—–
Of Lee, Rosie

Hi Joe-Anne
On behalf the Organising Committee and I am sure Glenys will respond when
she gets the chance for the Scientific Committee! Thank you very much for
the lovely feedback.

If we only take home a tip each the conference is indeed successful. The
networking was fantastic. Thank you again and to all delegates, speakers,
participants and trade for supporting this event. There is no conference
without you all.
Look forward to your evaluations which will be valuable for us to
continuously improve.

Regards
Rosie Lee

Sent from my iPad

On 27 Nov 2014, at 10:28 am, Joe-Anne Bendall
<Joe-Anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU> wrote:

Hi
Can I congratulate the organising and scientific committee on the program
for the conference. I thought it was an excellent conference and has given
me some ideas, reinvigorated me to relook at some of my programs and has
made me think of why we do some things!

I am looking forward to next year

Thanks

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

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[Glenys Harrington]

Hi Lindy,

In Australia disinfectants (including wipes) are regulated by the TGA as
follows:

. a Class IIb ‘Medical Device’,

. a Class I ‘Medical Device,

. ‘Other Therapeutic Goods’ – registered with specific claims and

. ‘Other Therapeutic Goods’ – listed without specific claims.

See TGA table –
http://www.tga.gov.au/industry/disinfectants-regulation-summary.htm#.VEeyTfm
UdWU

If they are intended to be used on medical devices they must be registered
as a Class IIb ‘Medical Device’, or a Class I ‘Medical Device.

For disinfectants that are regulated as ‘Other Therapeutic Goods’ –
registered with specific claims

. The term ‘specific claims’ covers virucidal, sporicidal,
tuberculocidal, fungicidal or other biocidal activity. Except where claims
of activity against fungi (yeast and mould) for excluded products are
concerned, these claims mean a product is registered.

For disinfectants that are regulated as ‘Other Therapeutic Goods’ – listed
without specific claims.

. The term a ‘non-specific claim’, is a claim which includes
general antibacterial action or activity against vegetative bacteria
(excluding mycobacteria) covered by the battery of test organisms included
in the specified test, or bacteria of the same genus. Claims for bacteria
other than these are allowable, but the specific organism against which
activity is claimed must be included as an extra organism in the test
battery e.g. E. coli O157, Salmonella spp, Streptococcus spp, etc.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Lindy Ryan
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-equi
pment.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 wipe.if 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 can’t 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 well.huge 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

http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Hea
lth-Nepean-Blue-Mountains-LHD.jpg

“Wise and human management of the patient is the best safeguard against
infection”

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[Glenys Harrington]

Thanks Helen,

In the first instance I would ask the manufacturer /supplier for their
cleaning and disinfecting recommendations. They are obliged to provide this
information to you as you are not necessarily familiar with reprocessing
procedures the item (Self Contained Breathing Apparatus) will be able to
tolerate.

Once you have this information you will need to review it in terms of its
validity (i.e. ability to clean and/or disinfect between each officer use)
or if not suitable look at alternative methods that the manufacturer or
supplier will need to endorse (on company letterhead).

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

Of Helen Truscott
Contained Breathing Apparatus for Fire fighters

Hi Glenys,

Thanks for your reply.

The instructions are included in our current infection control manual, we
are trying to also determine where the initial supporting information was
sourced from.

We do know that the HAZMAT team was consulted , but this was more about the
operational use of the masks.

Kind regards

Helen

Of Glenys Harrington
for Fire fighters

Hi Helen,

I’m a bit unclear:

. Are the details provide below the instructions of the
manufacturers/supplier for the reprocessing of the “Self Contained Breathing
Apparatus” between each fire officer use or

. Are the details below the current practice of the “Fire Brigade
Unit” you are consulting too?

Can you clarify?

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

Of Helen Truscott
Contained Breathing Apparatus for Fire fighters

Dear AICA members

I have been asked to review the need for twice daily disinfection of Self
Contained Breathing Apparatus for Fire fighters. (Made of rubber and moulded
plastic).

Currently this is being done twice a shift and after each use.

Cleaning product use is Instrumax – Benzalkonium Chloride

Following instructions:

. Perform hand hygiene. Don disposable gloves.

. Disconnect the facemask or the extension facemask from the demand
valve.

. Rinse the facemask in clean running water (not hot). Drain out excess
water.

. Spray liberally with BA disinfectant (100%), paying attention to the
facial seal and inside the orinasal cup. From the outside of the mask, open
the flap below the demand valve connector and spray inside.

. Note: The facemask does not need to be completely dry before function
checking and use.

. I would welcome your opinions as to whether cleaning the SCBA up
to possibly three times a day is any more effective than simply after each
use?

. The masks, once cleaned are stored in a calico bag, the masks
still need to be inspected once per shift, but if the checker was wearing
nitrile gloves, would this require re disinfecting?

. Would there be an increase in mould on the facemasks, with this
frequency of disinfection?

. Is storage in a Calico bag likely to pose any infection risk in
itself ?

Regards

Helen

Helen Truscott RN
Team Leader-Health and Medical
Health & Safety Branch

Fire & Rescue NSW

E Helen.Truscott@fire.nsw.gov.au | T
02 9265 2976| F 02 9265 2986 | M 0417 677 802

http://www.fire.nsw.gov.au
Level 8, 227 Elizabeth Street, Sydney, NSW 2000

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[Glenys Harrington]

Hi Helen,

I’m a bit unclear:

. Are the details provide below the instructions of the
manufacturers/supplier for the reprocessing of the “Self Contained Breathing
Apparatus” between each fire officer use or

. Are the details below the current practice of the “Fire Brigade
Unit” you are consulting too?

Can you clarify?

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

Of Helen Truscott
Contained Breathing Apparatus for Fire fighters

Dear AICA members

I have been asked to review the need for twice daily disinfection of Self
Contained Breathing Apparatus for Fire fighters. (Made of rubber and moulded
plastic).

Currently this is being done twice a shift and after each use.

Cleaning product use is Instrumax – Benzalkonium Chloride

Following instructions:

. Perform hand hygiene. Don disposable gloves.

. Disconnect the facemask or the extension facemask from the demand
valve.

. Rinse the facemask in clean running water (not hot). Drain out excess
water.

. Spray liberally with BA disinfectant (100%), paying attention to the
facial seal and inside the orinasal cup. From the outside of the mask, open
the flap below the demand valve connector and spray inside.

. Note: The facemask does not need to be completely dry before function
checking and use.

. I would welcome your opinions as to whether cleaning the SCBA up
to possibly three times a day is any more effective than simply after each
use?

. The masks, once cleaned are stored in a calico bag, the masks
still need to be inspected once per shift, but if the checker was wearing
nitrile gloves, would this require re disinfecting?

. Would there be an increase in mould on the facemasks, with this
frequency of disinfection?

. Is storage in a Calico bag likely to pose any infection risk in
itself ?

Regards

Helen

Helen Truscott RN
Team Leader-Health and Medical
Health & Safety Branch

Fire & Rescue NSW

E Helen.Truscott@fire.nsw.gov.au | T
02 9265 2976| F 02 9265 2986 | M 0417 677 802

http://www.fire.nsw.gov.au
Level 8, 227 Elizabeth Street, Sydney, NSW 2000

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[Glenys Harrington]

Hi Fiona,

Can you elaborate further on when you will be doing the air sampling?

I’m assuming:

. after Engineering ventilation parameters met and

. before any occupation of the facility (i.e. staff/stock &
equipment) and

. after the ventilation has been running in the unoccupied facility
for a 24hr period?

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

Of Fiona de Sousa

Dear members,

I know that air sampling in a new building is a contentious issue but we
are currently undergoing it as part of the commissioning process for new
operating theatres and one of the difficulties I face is people asking for
the acceptable limit of certain organisms. Aside from fungal organisms I
have been unable to find any references to guide me on specific organisms
counts.

I would like to hear people’s views on the isolation of skin or
environmental flora when doing this sampling – how many CFU would be
acceptable per air sample ?

Fiona De Sousa

Infection Prevention & Control Coordinator

Sydney Adventist Hospital

Fiona.Desousa@sah.org.au

185 Fox Valley Road, Wahroonga, NSW, 2076

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[Glenys Harrington]

Hi Marija,

I agree with the authors perspectives and evidence presented in the article.

As with SARS the risk of inadvertent contamination increases with the
introduction of overly complicated or new and unfamiliar forms of personal
protective equipment particularly when this PPE is being removed. Hence
the reason during the SARS outbreak it was recommended in may affected
countries that a second person assist and observe PPE being removed.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Juraja, Marija (Health)
With Ebola Risk

Dear all,

I would like to know what peoples comments are regarding this article.

To me it places this disease outbreak in perspective and possibly offers
some reassurance re the recommended precautions.

Again with healthcare workers and ensuring we are protecting them are we
placing them more at risk with assuming higher levels of PPE?

With this higher level could they inadvertently cross contaminate themselves
(as hazmat suits etc are not common ward PPE). Happy to hear what people
think.

Annals of internal medicine

Ideas and Opinions | 21 August 2014

Ebola Fever: Reconciling Ebola Planning With Ebola Risk in U.S. Hospitals

Michael Klompas, MD, MPH; Daniel J. Diekema, MD; Neil O. Fishman, MD; and
Deborah S. Yokoe, MD

[ +-]
Article and Author Information

Ann Intern Med. Published online 21 August 2014 doi:10.7326/M14-1918

West Africa is currently in the grip of a terrifying outbreak of Ebola virus
disease (Ebola). As of this writing, the outbreak has infected 2127 persons,
1145 (54%) of whom have died. The outbreak currently involves Sierra Leone,
Guinea, Liberia, and Nigeria; however, nations around the world are bracing
for the possible arrival of travelers, expatriates, and aid workers from
West Africa seeking care for documented Ebola or undifferentiated febrile
illnesses that might prove to be Ebola.

Hospitals in the United States are scrambling to develop plans to manage
patients with suspected or confirmed Ebola. A major emphasis of planning is
specifying measures to protect health care personnel and prevent
transmission within health care facilities. However, infection prevention
and control teams are struggling to reconcile official guidance from the
Centers for Disease Control and Prevention (CDC) with the temptation to
maximize precautions that exceed CDC recommendations.

The CDC recommends placing patients with suspected or confirmed Ebola in a
single-patient room and instituting contact and droplet precautions (
1).
These entail donning a fluid-impermeable gown, gloves, a surgical mask, and
either goggles or a face shield. If the patient has copious secretions,
the CDC also recommends shoe and leg coverings. If an aerosol-generating
procedure is planned (such as intubation or bronchoscopy), the CDC
recommends wearing an N95 mask and placing the patient in a
negative-pressure room. Despite this guidance, many hospitals are planning
to place all patients in negative-pressure rooms at all times, to compel all
personnel to wear full-body hazardous material (HazMat) suits, and to
require N95 masks or powered air-purifying respirators rather than surgical
masks at all times.

Hospitals’ decisions to maximize precautions are understandable given the
horrific mortality of this disease and reports of ongoing transmission in
African hospitals. Fears among U.S. providers are undoubtedly further
spurred by the dramatic footage of ambulance workers in Madrid, Spain, and
Atlanta, Georgia, wearing full-body HazMat suits and personal respirators to
transport infected patients. However, these excessive measures are
unwarranted.

The CDC’s guidance is evidence-based. There have been more than 20 Ebola
outbreaks in the past 40 years (
2).
Through these outbreaks, public health agencies and researchers have gained
considerable experience in the control and prevention of this disease (
3
4).
Ebola is transmitted by direct contact with patients’ bodily fluids,
especially blood. Other risk factors, such as contact with fruit bats or
eating fruit that has been nibbled by fruit bats, are not germane to U.S.
hospitals.

Sharing airspace with an infected patient is not a risk factor. Transmission
requires direct physical contact and is inefficient. Studies of household
contacts of patients with Ebola are informative in this regard. Among 173
household contacts of 27 patients with confirmed Ebola, the transmission
rate was only 16% despite none of the standard infection control precautions
routinely employed in U.S. hospitals being used (
5).
Of the 173 householders, 78 reported no physical contact with the infected
patient. None became infected. Among those who did have physical contact,
the risk for Ebola was highest after contact with patients’ blood. Other
investigators have reported similar findings (
6).

Another study evaluated contamination of the care environment (
7).
Investigators took 54 clinical specimens from 26 laboratory-confirmed Ebola
cases. The researchers were able to isolate Ebola virus from 16 of the 54
specimens, including saliva, stool, semen, breast milk, tears, blood, and
skin swabs. They then took 33 environmental samples, including swabs from a
stethoscope used to examine an infected patient, a bed frame, a bedside
chair, a patient’s food bowl, a patient’s spit bowl, the floor, intravenous
fluid tubing, and the skin of 3 patient attendants. None were positive. The
only extracorporeal specimens that tested positive for Ebola virus were a
physician’s blood-stained glove and a bloody intravenous insertion site.

A case investigation from South Africa further affirms both the
effectiveness of standard precautions and the very real risk for
transmission through body fluid exposures (
8).
About 18 years ago, an anesthetics assistant in Johannesburg developed
fever, headaches, and mental status changes associated with
thrombocytopenia, hepatitis, and progressive renal failure. She was
eventually diagnosed with Ebola 12 days after hospitalization. A case
investigation was initiated, and her disease was ultimately attributed to
care she had provided for a patient 3 days before the onset of her illness.
She had helped to insert a central venous catheter in a patient with a
febrile, multisystem disease of unknown etiology. The index patient had
already recovered and been discharged, but investigators were able to locate
him and retroactively confirm Ebola by isolating the virus from a semen
specimen. The investigators estimated that more than 300 health care
personnel provided care to these 2 patients, including invasive procedures,
before Ebola was diagnosed, yet there were no additional transmissions
despite the lack of Ebola-specific precautions.

These investigations affirm the appropriateness of the infection control
practices recommended by the CDC. A fluid-impervious gown, gloves, a
surgical mask, and a face shield are adequate to protect health care
personnel from direct contact with blood or other body fluids during routine
care. N95 masks or personal respirators are only necessary during
aerosol-generating procedures.

Exceeding these recommendations may paradoxically increase risk. Introducing
new and unfamiliar forms of personal protective equipment could lead to
self-contamination during removal of such gear. Requiring HazMat suits and
respirators will probably decrease the frequency of providerpatient
contacts, inhibit providers’ ability to examine patients, and curtail the
use of diagnostic tests. Patients without Ebola may also inadvertently be
harmed because Ebola precautions will be required for all suspected cases
even though malaria and other infections are more likely in patients from
West Africa presenting with fever. Using extra gear inflates patients’ and
caregivers’ anxiety levels, increases costs, and wastes valuable resources.
More insidiously, requiring precautions that exceed the CDC’s
recommendations fans a culture of mistrust and cynicism about our nation’s
public health agency.

As health care professionals, we strive to provide evidence-based care
driven by science rather than by the media or mass hysteria. We need to
apply these principles to planning for Ebola as well.

References

1

Centers for Disease Control and Prevention. Infection Prevention and
Control Recommendations for Hospitalized Patients With Known or Suspected
Ebola Hemorrhagic Fever in U.S. Hospitals. Atlanta, GA: Centers for Disease
Control and Prevention; 2014. Accessed at

http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.h
tml on 11 August 2014.

2

Centers for Disease Control and Prevention. Outbreaks Chronology: Ebola
Hemorrhagic Fever. Atlanta, GA: Centers for Disease Control and Prevention;
2014. Accessed at

http://www.cdc.gov/vhf/ebola/resources/outbreak-table.html on 11 August 2014.

3

Kerstins B, Matthys F. Interventions to control virus transmission during
an outbreak of Ebola hemorrhagic fever: experience from Kikwit, Democratic
Republic of the Congo, 1995. J Infect Dis. 1999;179 Suppl 1:S263-7. [PMID:
9988193]

4

Muyembe-Tamfum JJ, Kipasa M, Kiyungu C, Colebunders R. Ebola outbreak in
Kikwit, Democratic Republic of the Congo: discovery and control measures. J
Infect Dis. 1999;179 Suppl 1:S259-62. [PMID: 9988192]

5

Dowell SF, Mukunu R, Ksiazek TG, Khan AS, Rollin PE, Peters CJ.
Transmission of Ebola hemorrhagic fever: a study of risk factors in family
members, Kikwit, Democratic Republic of the Congo, 1995. Commission de Lutte
contre les Epidmies Kikwit. J Infect Dis. 1999;179 Suppl 1:S87-91. [PMID:
9988169]

6

Francesconi P, Yoti Z, Declich S, Onek PA, Fabiani M, Olango J, et al.
Ebola hemorrhagic fever transmission and risk factors of contacts, Uganda.
Emerg Infect Dis. 2003;9:1430-7. [PMID: 14718087]

7

Bausch DG, Towner JS, Dowell SF, Kaducu F, Lukwiya M, Sanchez A, et al.
Assessment of the risk of Ebola virus transmission from bodily fluids and
fomites. J Infect Dis. 2007;196 Suppl 2:S142-7. [PMID: 17940942]

8

Richards GA, Murphy S, Jobson R, Mer M, Zinman C, Taylor R, et al.
Unexpected Ebola virus in a tertiary setting: clinical and epidemiologic
aspects. Crit Care Med. 2000;28:240-4. [PMID: 10667531]

Kind Regards

Marija Juraja |Clinical Service Coordinator (CICP) -Infection Prevention &
Control Unit|

Division of Acute Medicine

The Queen Elizabeth Hospital | Central Adelaide Local Health Network

Level 8 Tower Building | 28 Woodville Road, WOODVILLE SOUTH 5011

t: +61 8 8222 7588| p: 47757| f: +61 8 8222 6461 | DX: 465432
|e:marija.juraja@health.sa.gov.au

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