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Ruth,
The theatre should have been cleaned before the next case
Did this not happen?
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
ABN 47533508426
Of Dalrymple, Ruth
Dear All,
Is anyone able to help me out. We recently had a patient come to OT who had
their procedure performed, went to Recovery, then went back to the ward. It
was then discovered that they were MRO positive. Other patients had already
followed the patient into OT. What should be done in this case? Should all
the patients that followed be swabbed? Does the OT room then gets cleaned as
well as all of Recovery before any other patients come in?Ruth Dalrymple
Registered Nurse
Hurstville Private Hospital37 Gloucester Road, Hurstville NSW 2220, Australia
T 9579 7720 F 9586 2311
E
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Hi Sony,
I think you will find that the rationale is based on the benefit of leaving
less fibers behind in a wound when using gauze versus cotton balls.My understanding is that most dressing packs in Australia no longer include
cotton balls.Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Of Sony SO
cotton wool balls are not allowedDear All,
In HONG KONG, we are preparing for hospital accreditation program by
following the AUS standards.At present, we are using the commercial prepared sterile dressing/procedures
sets, and insides the sterile sets, the manufacturer could provide sterile
cotton wool balls. However, the auditors do not allow us to use it.It seems relevant requirement is not available in the accreditation manual.
Hence, we would like to know the prevailing practices for whether such
requirement is mandatory in Aus.Regards,
Sony SO
Nursing Officer, Infection Control Team
Kwong Wah Hospital
HONG KONG SAR, CHINA
Tel:+ 852 3517-2409 Fax: +852 2332-3348 email:sony@ha.org.hk
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Hi Kathy,
Toilet seat lids:
As in your home lids for toilet are probably standard and if closed before flushing will minimise environmental contamination.
I would also be advocating the following for toilets facilities (toilet seat and other high touch areas) in healthcare settings:
routine cleaning and disinfection
more frequent cleaning and disinfection in outbreak settings (i.e. C.difficile, VRE).Setting up a new hospital:
In terms of setting up a new facility it would be wise to avoid the use of sprayers (also called aerated spray wands) in patient toilet facilities(will send you some pictures directly).
These are hoses with a nozzle which are installed at the back of the toilet and used to rinse out bed pans in the toilet bowl in anteroom toilet/shower facilities (single/multi-bed rooms) and in hoppers ( wall-mounted sinks, with deep basins, large drains, and spray arms that flush like toilets) in dirty utility rooms (see images attached).
I dont believe they are very common in Australian healthcare facilities for patient toilets although in older facilities you may still find hoppers with spray arms in dirty utility rooms.
Sprayers seem to be more common in parts of Canada and the US ( mentioned in some of Carlings publications) and have contributed in outbreaks of C.difficile in Canada Preliminary Findings with C.difficile Outbreak in Cape Breton District Health Authority (CBDHA), 21 April 2011, Department of Health and Wellness, Nova Scotia.
In Quebec it seems that some facilities dont have automated bedpan washers or macerators for processing bedpans. Where such reprocessing machines are not available oxo-biodegradable plastic hygienic bags (bed pan liners) are being used.
A June 2009 Quebec report (Comparative Analysis of Bedpan Processing Equipment) by the Agence dvaluation des technologies et des modes dintervention en sant (AETMIS now INESSS) recommended that staff must not empty bedpans into sinks or toilets and must no longer use spray wands. The report includes options in terms of appropriate reprocessing methods for bed pans and a cost analysis of each option see link.
Some years ago when reviewing plans to upgraded and retrofit wards we were asked to approve the use of sprayers in patient toilet facilities. The request came from the director of nursing who was from the US and was planning to remove the automated bedpan washers from the wards as they were located outside patient rooms and were very noisy. Because of the risk of environmental contamination they were not approved by infection control and automated bedpan washers were installed in the dirty utility rooms which in the upgrade were located away from patient bedrooms.
ICU and single rooms:
The last ICU renovation I was involved in (2008) was the Alfred health unit in Melbourne Victoria. Predominately single and 2 bedrooms.
You might like to talk to the staff at the Alfred ICU in Melbourne or even better arrange a visit. It is a state of the art 45 bed ICU facility which also has “I-glass” (switchable glass) between some of their single rooms. This glass in its normal form is clear and transparent but when an electric current is passed through it, it becomes opaque. The glass obviates infection control concerns relating to the use of blinds in ICU cubicles and sliding doors which accumulate dust in the runners and are difficult to clean. The glass also allows for easier observation during meal breaks.
The Architects for the ICU were Billard Leece Partnership Pty Ltd Architects & Urban Planners and you can find some picture of the unit at the following link.
http://www.blp.com.au/project-detail.php?pageID165&menuno0Waste disposal and ICU units:
In this it – into dirty utility rooms located at strategic positions in the unit. No pan sanitiser in rooms or near rooms as they are too noisy especially at night.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)PO Box 5202
Middle Park
Victoria, 3206
Australia
H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426—–Original Message—–
Hi All,
I’m after some information / experience with rebuild and design of Health care facilities and peoples thoughts around toilet lids or No toilet lids. For years I have been told that the toilet lids were removed because of Infection Control. Now with the rebuilds there continues to be great debate around to have a lid or not to have a lid.
So would be interested in other’s experiences.
My other question is around how many of the new ICUs are moving to single rooms and what initiatives people may have put in place around managing disposal of body wastes. these are rooms with no ensuites and the option for a pan rooms is at the furthest point at end of unit.
looking forward to responses.
Regards
kathyKathy Dempsey
CNC Infection Control & Hospital Epidemiology Department
ph: 61 2 9845 7501
mobile:0423 000169
pager 27230 (M,T,W,T)
Clinical pager 9868email: kathy.dempsey@swahs.health.nsw.gov.au
>>> Michael Wishart 10/29/2012 1:09 pm
>>>
[Posted on behalf of Skye Mentjox Moderator]Hi Michael – I haven’t see this come up on the AICA discussion list but I believe will be of interest to many members.
Please be advised that the period for public comment on the AS/NZ 4187 draft has been extended to Tuesday, 23 January 2013
A free Draft can be downloaded from SAI Global at the following link:
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2) Then, click on the Free Download icon directly
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in.) Then save this document.Comments from the public may be made on Standards Australia website, using the PUBLIC ACCESS icon, at the following link:
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Skye Mentjox
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Hi Fiona,
Find attached the following:
a) Recommendations from CDC – Guidelines for Environmental Infection
Control in Health-Care Facilities, June 6, 2003 / 52(RR10);1-42 andhttp://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf
b) Further discussion on page 78 79 Carpets and Floor coverings
c) A summary of some of the literature on carpets on HCF that I have
collected over the years ago which may be of use/interest.GUIDELINES FOR ENVIRONMENTAL INFECTION CONTROL IN HEALTH-CARE FACILITIES,
JUNE 6, 2003 / 52(RR10);1-42Environmental Surfaces in Health-Care Facilities – III. Carpeting and Cloth
FurnishingsA.Vacuum carpeting in public areas of health-care facilities and in
general patient-care areas regularly with well-maintained equipment designed
to minimize dust dispersion (280). Category II
B.Periodically perform a thorough, deep cleaning of carpeting as
determined by facility policy by using a method that minimizes the
production of aerosols and leaves little or no residue (44). Category II
C.Avoid use of carpeting in high-traffic zones in patient-care areas
or where spills are likely (e.g., burn therapy units, operating rooms,
laboratories, or intensive care units) (44,305,306). Category IB
D.Follow appropriate procedures for managing spills on carpeting.
1. Spot-clean blood or body substance spills promptly (293,301,304,307).
Category IC (OSHA: 29 CFR 1910.1030 d.4.ii.A, interpretation)
2. If a spill occurs on carpet tiles, replace any tiles contaminated by
blood and body fluids or body substances (307). Category IC (OSHA 29 CFR
1910.1030 d.4.ii interpretation)
E.Thoroughly dry wet carpeting to prevent the growth of fungi; replace
carpeting that remains wet after 72 hours (37
,160). Category IB
F.No recommendation is offered regarding the routine use of fungicidal
or bactericidal treatments for carpeting in public areas of a health-care
facility or in general patient-care areas. Unresolved issue
G.Do not use carpeting in hallways and patient rooms in areas housing
immunosuppressed patients (e.g., PE areas) (37
,44). Category IBLITERATURE – CARPETING IN HOSPITALS
A. CARPETING IN HOSPITALS AN EPIDEMIOLOGICAL EVALUATION
1) Carpets contain much higher levels of microbial contamination
(approx 105bacteria per square inch) than hard surfaces (approx 102
bacteria per square inch).2) Patients in carpeted room (but not the non-carpeted room) were
colonised with the same type of organisms that contaminate the carpet.3) There was no association between hospital acquired infection and
carpet contamination.4) Members of the family Enterobacteriaceae (Enterobacter Spp., K
pneumoniae and E coli) were more frequently isolated from carpet material
than from bare flooring. These varying levels of contamination
probably resultedfrom differences in floor-cleaning procedures.
Conclusion:
Because carpets are easily contaminated, costly to clean, difficult to
disinfect and do not dry as quickly as bare floors it may be wise not to
use carpets in the following areas:- intensive care units (except cardiac),
nurseries, paediatric patient care rooms, isolation rooms, operating room,
kitchens, laboratories, autopsy rooms, bathroom and utility rooms.Evaluation. Journal of Clinical Microbiology, Vol 15, 1982:408-415.
B. HOSPITAL CARPETING AND EPIDEMIOLOGY OF CLOSTRIDIUM DIFFICILE
A bacteriophage-bacteriocin typing system was used to determine the possible
significance of environmental contamination.The relationship between the prevalence of pseudomembranous enterocolitis
(PME) and room carpeting was studied.Conclusion:
1) This study did not document acquisition of Clostridium difficile
from the hospital environment in a nonepidemic setting of PME.2) Carpeted rooms were contaminated significantly more heavily and
for longer periods with clinical strains of Clostridium difficile than
non-carpeted rooms.3) There was no evidence that environmental contamination resulted
in an increased frequency of occurrence of PME in patients housed in
carpeted rooms.4) Because acquisition of Clostridium difficile from the environment
in nonepidemic settings is possible and there is evidence of exogenous
acquisition during epidemic outbreaks, carpet should be considered as a
potentialreservoir of this organism.
John P Phair. American Journal of Infection Control . August 1994. Volume
22, Number 4. Pages 212-217.C. PREVENTION AND CONTROL NOSOCOMIAL INFECTIONS
Prospective studies have not linked an increase in infection rates to use
of carpets in hospitals. Nevertheless because data have shown that carpets
contain much higher levels of microbial contamination than do hard surfaces
and are more costly and difficult to clean, it may be judicious not to use
carpets in the intensive care unit or other locations where severely ill
patients are located and heavy soiling occurs.– 489.
D. ASPERGILLOSIS DUE TO CARPET CONTAMINATION
During a 9 month period in a 22 bed inpatient bone marrow
transplant/oncology unit with Hepa filtered air system (12 to 15 air
exchanges per hour) and hallway carpeted that was impregnated with a
fungistatic/bacteriostatic agent ( a durable quaternary amine complex)
there were 13 cases of Aspergillus infection, 10 had pulmonary infections,
one each had skin, bone and sinus infections. Eight of the 13 patients
survived, all who died had a relapsed or treatment resistant malignancy.The carpet was identified as the source of infection and contamination was
thought to have occurred following a fire in a nearby building during which
time a patient was known to be repeatedly opening the window of his room.No antimicrobial activity was detected in the carpet due to large amounts of
dirt, debris, wax and soap buildup. The carpet was being cleaned weekly
during the period of outbreak.It was speculated that the residual soap served to block the inorganic
bacterostatic compound in the base of the carpet from wicking up to the top
fibres and that this was the reason there was no antimicrobial activity
detected.After consultation with the manufacturer weekly water extraction of the
carpet was undertaken. Following this less debris was noted and
bacteriostatic/fungistatic activity was detected within the carpet.After institution of the water extraction method of carpet cleaning the rate
of Aspergillus species infections on the transplant/leukemia service again
fell to the level seen prior to the epidemic.Reserve University School of Medicine Cleveland, Ohio. Aspergillosis Due to
Carpet Contamination. Infection Control and Hospital Epidemiology Vol
15.No4:221-223Regards
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
ABN 47533508426
Of Fiona de Sousa
Hi List members,
At our facility we have carpeted patient care areas. We are currently
reviewing how this carpet should best be cleaned on a routine basis and
after caring for a patient on transmission based precautions. I would
appreciate hearing from other facilities who face this challenge to hear how
they have addressed this problem.I know that carpets in healthcare are a sensitive issue and I am happy for
people to contact me off line if they prefer.Kind regards,
Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
185 Fox Valley Road, Wahroonga, NSW, 2076
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Hi Jayne,
Wont it depend on the type of organisms and/or infection the patient/s have
at the time?Can you be more specific as to which organisms/infections you are referring
too?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
ABN 47533508426
Of Jayne OConnor
roomsDear Colleagues,
We are currently reviewing our cleaning protocols for infectious patients’
rooms/equipment. Could you share with us what you product is used for these
daily cleans and how the clean is carried out.Many Thanks in advance
Jayne
Jayne O’Connor RN, BSc infection Control
CNC -IPC
Sydney Adventist Hospital
Wahroonga
2076
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Hi Gerald,
This may in part answer your question although I have not been able to get hold of the full article.
Publication – M.F. King, C.J. Noakes, P.A. Sleigh, M.A. Camargo-Valero. Bioaerosol Deposition in Single and Two-Bed Hospital Rooms: A Numerical and Experimental Study. Building and Environment. 2012.
Extract about the article from Infection Control Today(ICT).
Hospital superbugs can float on air currents and contaminate surfaces far from infected patients beds, according to University of Leeds researchers. The results of the study, which was funded by the Engineering and Physical Sciences Research Council (EPSRC), may explain why, despite strict cleaning regimes and hygiene controls, some hospitals still struggle to prevent bacteria moving from patient to patient.
It is already recognized that hospital superbugs, such as MRSA and C. difficile, can be spread through contact. Patients, visitors or even hospital staff can inadvertently touch surfaces contaminated with bacteria and then pass the infection on to others, resulting in a great stress in hospitals on keeping hands and surfaces clean.
But the University of Leeds research showed that coughing, sneezing or simply shaking the bed linens can send superbugs into flight, allowing them to contaminate recently cleaned surfaces.
PhD student Marco-Felipe King used a biological aerosol chamber, one of a handful in the world, to replicate conditions in one- and two-bedded hospital rooms. He released tiny aerosol droplets containing Staphyloccus aureus from a heated mannequin simulating the heat emitted by a human body. He placed open petri dishes where other patients beds, bedside tables, chairs and washbasins might be and then checked where the bacteria landed and grew.
The results confirmed that contamination can spread to surfaces across a ward. The level of contamination immediately around the patients bed was high but you would expect that. Hospitals keep beds clean and disinfect the tables and surfaces next to beds, says Dr. Cath Noakes, from the Universitys School of Civil Engineering, who supervised the work. However, we also captured significant quantities of bacteria right across the room, up to 3.5 meters away and especially along the route of the airflows in the room.
We now need to find out whether this airborne dispersion is an important route of spreading infection, adds co-supervisor Dr. Andy Sleigh.
The researchers are hoping that computer modeling will help them determine the risk. The findings have been compared to airflow simulations of the mock hospital rooms and the research team have shown that they are able to accurately predict how airborne particles can be deposited on surfaces.
Using our understanding of airflow dynamics, we can now use these models to investigate how different ward layouts and different positions of windows, doors and air vents could help prevent microorganisms being deposited on accessible surfaces, says King.
The international design and engineering firm Arup, which designs hospitals, part sponsored the study. Phil Nedin, director and global healthcare business leader at Arup, says: We are looking at healthcare facilities of the future and it is important that we look at key issues such as infection control. Being involved in microbiological studies that inform airflow modeling in potentially infectious environments allows us to get a clear understanding of the risks in these particular environments.
The paper, Bioaerosol Deposition in Single and Two-Bed Hospital Rooms: A Numerical and Experimental Study, was published in the journal Building and Environment.
This research is funded by an EPSRC Challenging Engineering grant held by Dr. Cath Noakes. Marco-Felipe Kings PhD was also partially sponsored by Arup.
http://www.infectioncontroltoday.com/news/2012/10/superbugs-ride-air-current
regards
Glenys
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 6150P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4685W: http://www.sjog.org.au/murdoch
facebook facebook.com/stjohnofgodmurdoch
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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. CICPCoordinator Infection Prevention & Management
SMH Service – Royal Perth HospitalPh + 61 8 9224 2805 Fax + 61 8 9224 1989
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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
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
w: http://www.holyspiritnorthside.org.au
Please consider the environment before printing this email
_____
Dear all,
I’m looking for evidence to back us up on not having fans in patient rooms (especially seeing that summer is around the corner).
I can’t seem to locate any supportive articles on this.
Has there been any studies done that demonstrate an increased rate of infection/colonisation (MRSA, MSSA, etc.) through fan usage in a healthcare setting?
Cheers,
Gerald
Gerald Chan
Coordinator Infection Control
St John of God Murdoch Hospital
100 Murdoch Drive
MURDOCH. WA 6150P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4685W: http://www.sjog.org.au/murdoch
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Hi Tara,
Apologies for coming in late on this thread/topic.
Contact the Infection Control Consultant for the Royal District Nursing
Service in Victoria – T (03) 98432523They have an innovative system for transporting sharps containers in
vehicles and may be able to assist.Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Of Tara Stanway
communityAfternoon
I was wondering if anyone was able to share their policy/ procedure of
transporting sharps containers within the community,eg. travel form base to
school and return or home visits.Your assistance will be greatly appreciated.
Thanks
Tara
Tara Stanway
A/ CN Infection Prevention and Control
Cape York Hospital and Health Service
tara_stanway@health.qld.gov.au
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Hi All,
Further to the posting below as currently written The NHMRC Australian
Guidelines for the Prevention and Control of Infection in Healthcare (2010)
recommends that only TGA registered products should be used.I’m assuming that this may simply have been an over site at the time or a
misunderstanding of the different model for registration and/or listing of
disinfectants and sterilants in Australian(TGA) versus the FDA model in the
USA.As mentioned previously in Australia TGA only require those products that
make virucidal, sporicidal, tuberculocidal, fungicidal claims to be “TGA
registrable”.All others products that can “kill bacterial growth or any claim against
non-spore forming bacteria provided claims supported by relevant performance
testing” are only required to be “listable”.I don’t think the authors would have intended for healthcare facilities to
“only” use those “TGA registered” products (i.e. those products that make a
virucidal, sporicidal, tuberculocidal, fungicidal claim) for all
disinfecting purposes when such products are not always necessary or
required?Unlike the USA, in Australia the TGA regulates disinfectants and sterilants
differently in that such products are either required to be registrable or
listable as follows (see TGA Guidelines for the evaluation of sterilants and
disinfectants, February 1998):Resultant classification
Common Name
Claim
Exempt
Household or commercial grade grade disinfectant
kills bacterial growth or any claim against non-spore forming bacteria
provided claims aresupported by relevant performance
testing
Listable
Hospital grade disinfectant
As above claims
Registrable
Household or commercial grade disinfectant or Hospital grade disinfectant
fungicidal, sporicidal,
grade disinfectant or tuberculocidal or virucidal
Hospital grade disinfectant
To avoid ongoing confusion and to be consistent with Australian TGA
regulations (Therapeutic Goods Act 1989 and Regulations) the Australian
Guidelines for the Prevention and Control of Infection in Healthcare (2010)
need to be revised to read as follows:. “only TGA-registered or listed disinfectant with label claims
specifying its effectiveness against specific infectious organisms” should
be utilised.This will also clarify matters for state run tender organizations who I
understand may be adopting the 2010 infection control guideline
recommendation in state wide tenders unaware of the Australia TGA
legislative requirements in tersm of “registrable” and “listable” products
(Therapeutic Goods Act 1989 and Regulations).I have flagged the discrepancy with a colleague involved with the
development of the guidelines and she has in the first instance referred my
correspondence above to the National HAI Prevention Program Australian
Commission on Safety and Quality in Health Care (ACSQHC).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
ABN 47533508426
Of Glenys Harrington
Hi Gemma and Kylie,
Find below the relevant information from the TGA web page in relation to the
TGA registration or listing requirements for disinfectants and sterilants
which includes detergent/disinfectant or disinfectant wipes.Note that only those with specific biocidal claims (virucidal, sporicidal,
tuberculocidal, fungicidal or other) must be registered, whereas those
without specific biocidal claims are only required to be listed.In terms of the Australian Guidelines for the Prevention and Control of
Infection in Healthcare (2010), Section B1.4.2 Routine environmental
cleaning, Use of disinfectants that you quote to be consistent with the TGA
regulations it should read as follows:“In acute-care settings where there is uncertainty about the nature of
soiling on the surface (e.g. blood or body fluid contamination versus
routine dust or dirt) or the presence of MROs (including C. difficile) or
other infectious agents requiring transmission-based precautions (e.g.
pulmonary tuberculosis) is known or suspected, surfaces should be physically
cleaned with a detergent solution, followed or combined with a
TGA-registered or listed disinfectant with label claims specifying its
effectiveness against specific infectious organisms.Perhaps you should flag this with the NHMRC? There is an email link under
“More information” where you can direct enquires in relation relating to the
guideline http://www.nhmrc.gov.au/node/30290TGA online information – see below
“TGA – The regulation of disinfectants and sterilants
http://www.tga.gov.au/industry/disinfectants-regulation.htmHard surface disinfectants
Hard surface disinfectants are regulated by the TGA and form part of the
group of products referred to as “other therapeutic goods” (OTGs). OTGs are
subject to the requirements for registered or listed goods under Chapter 3
of the Therapeutic Goods Act
1989. For guidance on the regulation of OTGs, please refer to
Australian Medical Device
Requirements Version 4 (DR4).Disinfectants that are OTGs are subject to
Therapeutic Goods Order 54
(Standard for Disinfectants and Sterilants) as a mandatory requirement.Hard surface disinfectants include hospital, household and commercial grade
disinfectants.Hospital grade disinfectants
Hospital grade disinfectants are suitable for general purpose disinfection
of building and fitting surfaces, and purposes not involving instruments or
surfaces likely to come into contact with broken skin:*in premises used for:
*the investigation or treatment of a disease, ailment or injury; or
*procedures that are carried out involving the penetration of the
human skin;*or in connection with:
*the business of beauty therapy or hairdressing; or
*the practice of podiatry;but do not include:
*instrument grade disinfectants
*antibacterial clothes preparations
*sanitary fluids
*sanitary powder
*sanitisers.Hospital grade disinfectants are currently either listed or registered on
the ARTG. Those with specific biocidal claims (virucidal, sporicidal,
tuberculocidal, fungicidal or other) must be registered, whereas those
without specific biocidal claims are listed.The Therapeutic Goods
Regulations 1990 are to be changed so that registered disinfectants become
listed on the ARTG. However, disinfectants with specific biocidal claims and
those containing new chemical entities will still undergo a pre-market
review.I have also included a link to a table from the TGA Guidelines for the
Evaluation of Sterilants and Disinfectants (pages 62-65) which you may find
useful.
http://www.tga.gov.au/industry/disinfectants-evaluation-guidelines.htmAs you will see in the table only those that are making a specific claim
that covers virucidal, sporicidal, tuberculocidal, fungicidal are required
to be registered.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
ABN 47533508426
Of Kylie McCarthy
Hi Gemma,
We are currently using a combined detergent/disinfectant wipe, it was
introduced with the aim of reducing workload and increasing cleaning
compliance amongst staff. The one ‘small’ issue I have with using the
combined product is that as far as I am aware, there is not a combined
product on the market that is TGA ‘Registered’, the products are ‘Listed’
only.The Australian Guidelines for the prevention and control of infection in
healthcare state the following;B1.4.2 Routine environmental cleaning
Use of disinfectants
In acute-care settings where there is uncertainty about the nature of
soiling on the surface (e.g. blood or body fluid contamination versus
routine dust or dirt) or the presence of MROs (including C. difficile) or
other infectious agents requiring transmission-based precautions (e.g.
pulmonary tuberculosis) is known or suspected, surfaces should be physically
cleaned with a detergent solution, followed or combined with a
TGA-registered disinfectant with label claims specifying its effectiveness
against specific infectious organisms.http://www.nhmrc.gov.au/book/australian-guidelines-prevention-and-control-in
fection-healthcare-2010/b1-4-2-routine-environmeRegards
Kylie
Kylie McCarthy
Infection control coordinator
Prince of Wales Private Hospital
Phone 02 9650 4034
Fax 02 9650 4688Please consider the environment before printing this message
>>> “Klintworth, Gemma” 23/08/2012 11:27 am >>>
Hi all,
We are in the process of putting together a case for the introduction of
detergent/disinfectant wipes into our organisation. I am wondering if most
other hospitals are using these wipes and if so, how they were brought into
your organisations.Any advice would be much appreciated.
Thanks
Gemma
Gemma Klintworth
CLABSI Project CoordinatorInfection Prevention and Healthcare Epidemiology
t 03 90762250 e G.Klintworth@alfred.org.au
Alfred Health
55 Commercial Road
Melbourne VIC 3004
PO Box 315 Prahran
VIC 3181 AustraliaAlfred Health incorporates The Alfred, Caulfield Hospital and Sandringham
Hospital
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Hi Gerard,
Form the discussion so far it seems that this unit will be utilised as a combined endoscopy bronchoscopy unit?
Is that correct?
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
ABN 47533508426
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 6150P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4685W: http://www.sjog.org.au/murdoch
facebook facebook.com/stjohnofgodmurdoch
twitter twitter.com/sjgh_murdoch
>>> 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
w: http://www.holyspiritnorthside.org.au
Please consider the environment before printing this email
Description: ACIPC_2012_web_banner_300x100.jpg
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 6150P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4685W: http://www.sjog.org.au/murdoch
facebook facebook.com/stjohnofgodmurdoch
twitter 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
w: http://www.holyspiritnorthside.org.au
Please consider the environment before printing this email
Description: ACIPC_2012_web_banner_300x100.jpg
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 6150P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4685W: http://www.sjog.org.au/murdoch
facebook facebook.com/stjohnofgodmurdoch
twitter 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
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
ABN 47533508426
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 6150P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4685W: http://www.sjog.org.au/murdoch
facebook facebook.com/stjohnofgodmurdoch
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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 belowhttp://www.healthdesign.com.au/vic.dghdp/dghdp_content/guidelines/dghdp_desi
gn_guidelines_complete.pdfTable 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 filterIs 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
ABN 47533508426
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 6150P: 9366 1552
M: 0405 495 906 (7804)
F: 9311 4685W: http://www.sjog.org.au/murdoch
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Hi Gemma and Kylie,
Find below the relevant information from the TGA web page in relation to the
TGA registration or listing requirements for disinfectants and sterilants
which includes detergent/disinfectant or disinfectant wipes.Note that only those with specific biocidal claims (virucidal, sporicidal,
tuberculocidal, fungicidal or other) must be registered, whereas those
without specific biocidal claims are only required to be listed.In terms of the Australian Guidelines for the Prevention and Control of
Infection in Healthcare (2010), Section B1.4.2 Routine environmental
cleaning, Use of disinfectants that you quote to be consistent with the TGA
regulations it should read as follows:“In acute-care settings where there is uncertainty about the nature of
soiling on the surface (e.g. blood or body fluid contamination versus
routine dust or dirt) or the presence of MROs (including C. difficile) or
other infectious agents requiring transmission-based precautions (e.g.
pulmonary tuberculosis) is known or suspected, surfaces should be physically
cleaned with a detergent solution, followed or combined with a
TGA-registered or listed disinfectant with label claims specifying its
effectiveness against specific infectious organisms.Perhaps you should flag this with the NHMRC? There is an email link under
“More information” where you can direct enquires in relation relating to the
guideline http://www.nhmrc.gov.au/node/30290TGA online information – see below
“TGA – The regulation of disinfectants and sterilants
http://www.tga.gov.au/industry/disinfectants-regulation.htmHard surface disinfectants
Hard surface disinfectants are regulated by the TGA and form part of the
group of products referred to as “other therapeutic goods” (OTGs). OTGs are
subject to the requirements for registered or listed goods under Chapter 3
of the Therapeutic Goods Act
1989. For guidance on the regulation of OTGs, please refer to
Australian Medical Device
Requirements Version 4 (DR4).Disinfectants that are OTGs are subject to
Therapeutic Goods Order 54
(Standard for Disinfectants and Sterilants) as a mandatory requirement.Hard surface disinfectants include hospital, household and commercial grade
disinfectants.Hospital grade disinfectants
Hospital grade disinfectants are suitable for general purpose disinfection
of building and fitting surfaces, and purposes not involving instruments or
surfaces likely to come into contact with broken skin:*in premises used for:
*the investigation or treatment of a disease, ailment or injury; or
*procedures that are carried out involving the penetration of the
human skin;*or in connection with:
*the business of beauty therapy or hairdressing; or
*the practice of podiatry;but do not include:
*instrument grade disinfectants
*antibacterial clothes preparations
*sanitary fluids
*sanitary powder
*sanitisers.Hospital grade disinfectants are currently either listed or registered on
the ARTG. Those with specific biocidal claims (virucidal, sporicidal,
tuberculocidal, fungicidal or other) must be registered, whereas those
without specific biocidal claims are listed.The Therapeutic Goods
Regulations 1990 are to be changed so that registered disinfectants become
listed on the ARTG. However, disinfectants with specific biocidal claims and
those containing new chemical entities will still undergo a pre-market
review.I have also included a link to a table from the TGA Guidelines for the
Evaluation of Sterilants and Disinfectants (pages 62-65) which you may find
useful.
http://www.tga.gov.au/industry/disinfectants-evaluation-guidelines.htmAs you will see in the table only those that are making a specific claim
that covers virucidal, sporicidal, tuberculocidal, fungicidal are required
to be registered.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
ABN 47533508426
Of Kylie McCarthy
Hi Gemma,
We are currently using a combined detergent/disinfectant wipe, it was
introduced with the aim of reducing workload and increasing cleaning
compliance amongst staff. The one ‘small’ issue I have with using the
combined product is that as far as I am aware, there is not a combined
product on the market that is TGA ‘Registered’, the products are ‘Listed’
only.The Australian Guidelines for the prevention and control of infection in
healthcare state the following;B1.4.2 Routine environmental cleaning
Use of disinfectants
In acute-care settings where there is uncertainty about the nature of
soiling on the surface (e.g. blood or body fluid contamination versus
routine dust or dirt) or the presence of MROs (including C. difficile) or
other infectious agents requiring transmission-based precautions (e.g.
pulmonary tuberculosis) is known or suspected, surfaces should be physically
cleaned with a detergent solution, followed or combined with a
TGA-registered disinfectant with label claims specifying its effectiveness
against specific infectious organisms.http://www.nhmrc.gov.au/book/australian-guidelines-prevention-and-control-in
fection-healthcare-2010/b1-4-2-routine-environmeRegards
Kylie
Kylie McCarthy
Infection control coordinator
Prince of Wales Private Hospital
Phone 02 9650 4034
Fax 02 9650 4688Please consider the environment before printing this message
>>> “Klintworth, Gemma” 23/08/2012 11:27 am >>>
Hi all,
We are in the process of putting together a case for the introduction of
detergent/disinfectant wipes into our organisation. I am wondering if most
other hospitals are using these wipes and if so, how they were brought into
your organisations.Any advice would be much appreciated.
Thanks
Gemma
Gemma Klintworth
CLABSI Project CoordinatorInfection Prevention and Healthcare Epidemiology
t 03 90762250 e G.Klintworth@alfred.org.au
Alfred Health
55 Commercial Road
Melbourne VIC 3004
PO Box 315 Prahran
VIC 3181 AustraliaAlfred Health incorporates The Alfred, Caulfield Hospital and Sandringham
Hospital
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Jenny,
Eating or putting anything in your mouth while working in a clinical area
can result in hand contamination with mouth organisms.Given that HH compliance is not always optimal this would be a rationale
reason why eating in clinical areas is not appropriate on a routine basis
and even more important during times of gastrointestinal (usually viral)
outbreaks.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
ABN 47533508426
Of Matthias Maiwald (KKH)
areas [SEC=UNCLASSIFIED]Sue,
Out of interest, do you happen to know the reference for the OHS
regulations, and what they specifically say about food consumption in ward
areas?I agree it is a sad state that one should need evidence or even a “risk
management framework” (what a mouthful) for what should normally come with
common sense.Has anyone tried “evidence reversal” — actually in my opinion the right and
scientifically correct way to place the onus for evidence in such situations
— to say, here are the OHS regulations and here is what common sense and
microbiological principles tell you, and now YOU show me the evidence that
breaking the rules is NOT associated with an increased risk?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 Helen,
It is such a shame that you can only argue a point of common sense with
evidence.
I agree the ‘evidence’ is poor in this area but OHS (Workplace Health and
Safety) provides the opportunity for employers and employees to review real
and possible risks of eating in the work area. The Australian Infection
Control Guidelines do not address this issue specifically but do provide you
with a risk management framework to use for developing your position on this
for your organisation.
Some of the risks to be considered include – vermin, food/drink
contamination, odour, spills that can create slip and trip hazards,
professionalism, hand hygiene, cleaning (increased requirements),
disease/infection transmission.
Options to consider – provision of a designated place to consume
food/drinks, staffing allocation sufficient to cover breaks, governance of
decisions made, consultation with those affected.Good luck,
SueSue Greig
Senior Project Officer
Australian Commission on Safety and Quality in Health Care
GPO Box 5480 Sydney NSW 2001 | Level 7, 1 Oxford Street, Darlinghurst NSW
2010
( direct (02) 9126 3565 | ( switchboard (02) 9126 3600 | 6 (02) 9126 3613 |
Email
sue.greig@safetyandquality.gov.au |
http://www.safetyandquality.gov.auHelen Scott
Sent by: ACIPC Infexion Connexion31/07/2012 08:56 AM
Please respond to
ACIPC Infexion ConnexionTo
cc
Subject
Has anyone got anymore information on this please? I’d like to provide
evidence and documentation to follow up my concerns about the same thing.Thanks,
Helen.Helen Scott
Clinical Nurse Specialist |
Infection Control |
Anaesthetics & Recovery
Nepean Private Hospital
Kingswood, NSW.
Tel 02 4732 7333 |
helen.scott@healthscope.com.auPlease consider the environment before printing this message
>>> On 10/07/2012 at 12:57 pm, in message
, “Breen,
Jennifer (MH)” wrote:
Hi All,We are having some issues with staff consuming food in their ward area,
particularly at the staff base and in the corridors. We have located
articles about transmission of Hepatitis A but are hoping to source articles
to provide further evidence . Our current hospital guidelines are fairly
general in this area and pertain more to an outbreak of gastro .Kind Regards
Jenny Breen
Clinical Nurse Consultant
Infection Control
Maroondah Hospital
Tel: 98713175 Pager 0111
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Rachel,
Your comments summarize well the questions and concerns being raised in the
discussion to date:1. Is there a risk of human error (behavioural risks) with the use of
these types of wipes on medical devices?2. Do such wipes remove bacteria from a surface by the mechanical
action of wiping or is the bacteria being removed from a surface by the
bactericidal action of the ingredient in the wipes?3. Is the current microbiological testing (a suspension tests versus a
3-step wipe testing method) for wipes registered for use on medical devices
adequate?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
ABN 47533508426
Of Thomson, Rachel EA
disinfectionHi all,
Strange things happen – clearly this technology is being marketed quite
heavily at present as my organisation has also had an approach and are
giving serious consideration to this technology. I felt I would like to put
my views out there having now thought about this during the last week.I hate being seen as the “negative” ICP, but I really harbour concerns over
rapidly adopting newer approaches/technologies without giving due
consideration to the risks, which I think is one of our central challenges!
I summarise my thoughts on this matter below*Validation – any system which relies on high-level disinfection
through any method, either heat or chemical, would do well it seems, to be
one that is able to be validated. I am unaware that this system of wipes
is, as yet, able to provide validation for each “cycle” as it relies rather
on pure compliance with a system
*Test environment vs clinical environment – the system has been
validated in approved test conditions, as you would expect any system to be.
This generally means products are tested against target organisms in
controlled laboratory conditions. This far from reflects the reality of a
busy clinical setting where use may not reflect the test environment.
Issues that may influence the effectiveness of the system include;*The concentration of the biocidal agent reaching all parts of the
surface of the item (certainly inhibited by residual bioburden)
*The contact time allowed for the biocidal agent being sufficient (a
human controlled system rather than an automated system)
*The actual organisms present on the device, the inoculum of these
pathogens and whether the challenge testing was focussed on all relevant
pathogens.*The conditions of use – I think this is almost the most important
question or concern I have with a manual system with no validation. A
system that relies on ALL users using the system of manual wiping perfectly,
without deviation and without the assurance of a validation should be a
concern to those who focus of safer patient systems – especially as the
focus of the marketing is the “speed” of disinfection.These concerns may be able to be answered but I feel strongly that manual
systems such as this should be subject to higher levels of scrutiny and that
where the system is adopted that these questions should be thoroughly and
completely answered to the satisfaction of those briefed with such
responsibility.Kind regards
Rachel
Rachel Thomson
Nurse Unit Manager
Infection Prevention & Control Unit
Royal Hobart Hospital
E: rachel.thomson@dhhs.tas.gov.au
_____
Of VANDERLINDE, Liz
Dear Jayne
Would this be the Tristel Wipes System? AshMed are canvassing all hospitals
I believe. We have a trophon EPR and prcessor. We have been canvassed but I
am a little trepiditious despite the supporting literature re introducing.
Would love it if you would be happy to share your protocol?….and any other
feedback/evidence of efficacy etc.Cheers
Liz Vanderlinde
Infection Control Officer
North West Private HospitalBrickport Road, Burnie TAS 7320, Australia
T +61 3 6432 6022 F +61 3 6431 6158
E
Liz.Vanderlinde@healthecare.com.au Wintended only for the use of the addressee(s) named above and may contain
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intended recipient of this message you are hereby notified that you must not
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Jane Barnett
Hi
We introduced this into our radiology dept for the US probes over a year ago
now and it seems to work well. The previous processes were really
inadequate for these items and the chlorine dioxide does achieve high level
disinfection options without exposure to staff of liquid chemicals. The
company provided good training to the staff who carry this out plus we
ensured that there were laminated instruction charts with all mobile
equipment e.g. used in our gynae emergency area.Happy to share the protocol if you contact me.
Jane Barnett
Clinical Nurse Specialist
Infection Prevention & Control
Christchurch Women’s Hospital
Private Bag 4711, Christchurch
Infection Prevention and Control is Everyone’s Business
Fiona de Sousa
disinfectionHi All,
I have been asked to review a new cleaning and disinfection system for
reprocessing transvaginal ultrasound probes especially those used in IVF
related pregnancies where chemical residues are a high concern.The system consists of three separate pre-packaged wipes (a cleaner, a
disinfectant and a rinse wipe) which I believe is currently used in he UK.
The active ingredient in the disinfectant wipe is chlorine dioxide in
aqueous solution.Has anyone got any experience with this type of system that they would be
willing to share with me?Kind Regards,
Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
185 Fox Valley Road, Wahroonga, NSW, 2076
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Maree,
An interesting observation made by your colleagues.
With the introduction of any new system/equipment it is important to evaluate any potential risks that may be associated with human error and where possible consider alternative engineering controls that have been designed to engineer out such risks.
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
ABN 47533508426
My organisation made a decision very recently on this subject.
The 2 choices were the Tristel Wipe system and the Trophon system.
Both systems are listed on the ARTG and are readily searchable.
I prepared a paper to present to my committee in order for the committee to make a decision as to which is the best choice for us.
I can send an edited version of this paper upon request. I tried to be as unbiased as possible in order for my committee to make an impartial decision.
The decision made was for the Trophon and the rationale was because it was automated.
The weakness with the Tristel system is user fallibility.
There is no doubt the Tristel is easy and significantly cheaper. However it is harder to measure that correct contact time for the active ingredient to be effective. What happens in a busy unit with a doctor/ sonographer in a hurry to complete the list?
Trophon has significant ongoing cost implications with consumables and once the warranty is expired, ongoing service costs.
It is a tough decision. Cost of product versus a guarantee of user compliance with the process.
As one of my colleagues said if we cant get hand hygiene right among some staff, can we expect them to get this right!!!
Maree Sommerville
Infection Control Nurse Consultant
Mercy Hospital for Women
8458 4759
_____
Hi All,
I have been asked to review a new cleaning and disinfection system for reprocessing transvaginal ultrasound probes especially those used in IVF related pregnancies where chemical residues are a high concern.
The system consists of three separate pre-packaged wipes (a cleaner, a disinfectant and a rinse wipe) which I believe is currently used in he UK. The active ingredient in the disinfectant wipe is chlorine dioxide in aqueous solution.
Has anyone got any experience with this type of system that they would be willing to share with me?
Kind Regards,
Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
185 Fox Valley Road, Wahroonga, NSW, 2076
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Hi Fiona,
Three points to add to the discussion:
1.The particular product under discussion in this thread is categorised as a
“medical device” as it is “intended to be used on medical devices”. Such
products must be included on the Australian Register of Therapeutic Goods
Devices (ARTG) before they can be supplied in Australia. The ARTG form will
state the following: “Product type: Medical Device – Class …… –
Included” The key word is “included” which confirms that the product is
suitable for the ” intended purpose” which is also included on the ARTG
form. For the particular product that has been named in the thread the
intended purpose on the ARTG form is as follows:“Intended purpose: The ….. disinfecting wipes system is intended to
decontaminate and disinfect non-lumened medical devices that cannot be fully
immersed in liquid disinfectant or sterilant and cannot be sterilised by
heat. It allows high level disinfection of instruments where automated
dishwashers, sinks and water supplies are unavailable. The system provides
high-level disinfection in less than two minutes. The Tristel system is not
intended for high level disinfection of critical medical devices which must
be sterilised prior to use on patients”.2. Another point I would like to raise is do such wipes remove bacteria from
a surface by the mechanical action of wiping or is the bacteria being
removed from a surface by the bactericidal action of the ingredient in the
wipes?Microbiological testing results available online indicate that the
ingredient in the wipes was active against the target organisms that were
tested in what looks like a suspension tests not a testing method that
mimics an in use environment/situation. A presentation recently by Dr
Jean-Yves Maillard in a webber training telecast (
http://webbertraining.com/index.php
“Innate Resistance to Sporicides and Potential Failure to Decontaminate”)
included discussion relating to a 3-step test method to determine efficacy
of disinfectant wipes using a method described by Williams et al. J Hosp
Infect 2007;67:329-35. It seems from this presentation that wipes should
undergo a “3-step wipe testing method” not a suspension test method.This would seem reasonable to me particularly for those wipes that are going
to be used on medical devices and hence have to be registered as a medical
device.3. As you mention in additional to using the “Sporicidal Wipe” you are
required to use the following:. Activated Sporicidal Wipes using a reusable foam pump (? is this
a time dependent procedure). Pre-Clean Wipe/s and
. Rinse Wipe/s
All the wipes are packaged in the one box.
The method of use as described online would raise the following questions
for me:a) Is there a risk of human error in selecting the wrong wipe during a
procedure?b) The Sporicidal Wipes is activated with what looks like a reusable
foam pump – is there any risk that this reusable pump can become
contaminated during use?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
ABN 47533508426
Fiona de Sousa
disinfectionHi All,
I have been asked to review a new cleaning and disinfection system for
reprocessing transvaginal ultrasound probes especially those used in IVF
related pregnancies where chemical residues are a high concern.The system consists of three separate pre-packaged wipes (a cleaner, a
disinfectant and a rinse wipe) which I believe is currently used in he UK.
The active ingredient in the disinfectant wipe is chlorine dioxide in
aqueous solution.Has anyone got any experience with this type of system that they would be
willing to share with me?Kind Regards,
Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
185 Fox Valley Road, Wahroonga, NSW, 2076
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sender, except where the sender is specifically authorised
by Sydney Adventist Hospital to state that they are the views of Sydney
Adventist Hospital.
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