[Glenys Harrington]

Michael,

Information below may be of interest/use:

1. J.W. Medcraft, et al. Potential hazard from spray cleaning of floors in
hospital wards. Journal of Hospital Infection, Volume 9, Issue 2, March
1987, Pages 151-157

Abstract
The potential hazard from using contaminated spray cleaning fluid to clean
hospital floors was investigated. Eight of 10 sprays in daily hospital use
failed the ‘in-use’ test of Kelsey & Maures. Contamination was due to
Gram-negative bacilli, mainly Pseudomonas spp. An experiment showed that
freshly diluted cleaning fluid in a new spray container became contaminated
in 6 days, although the route of contamination of the fluid is not clear.
Air samples and samples from bedding collected during spray cleaning with
contaminated fluid showed the presence of Pseudomonas spp. Use of freshly
diluted cleaning fluid and daily cleaning of spray containers is
recommended.

2. Remote Health Branch, Northern Territory Government – Best Practice
Communique 07 -19

Extract below:

“The primary concerns over the use of spray bottles include:

1. Infection: reported findings of heavy growths of pathogens in spray
bottles, which are of clinical significance in the hospital setting; the
inability to totally clean and dry the trigger mechanism (therefore it
remains damp and promotes bacterial growth); the dispersal of those
pathogens by the spray mechanism;

2. OH&S: the potential for the chemical to cause injury as a respiratory
irritant for staff and visitors.

3. Anecdotally most refillable bottles would appear to be poorly labelled
and dated (making it unclear what the product is and when it was mixed)

Best Practice Group discussions revealed a clear recognition of the
usefulness of spray bottles in Health Centres. However, given the risks for
the systems becoming a reservoir for infection, and the strong
recommendation from DHCS Infection Control representatives, there was
unanimous agreement to follow RDH’s lead, and remove spray bottles from RHB
Health Centre use”.

The document includes this reference but I have not been able to locate it –
perhaps someone in QLD can assist? – Reference – Abstract – ‘Trigger Happy:
Hidden dangers of spray bottles’ from the Queensland Infection Control
Association conference (2001).

3. B.M. Andersen. Et al. Floor cleaning: effect on bacteria and organic
materials in hospital rooms Original Research Article. Journal of Hospital
Infection, Volume 71, Issue 1, January 2009, Pages 57-65

Summary

Routine surface cleaning is recommended to control the spread of pathogens
in hospital environments. In Norway, ordinary cleaning of patient rooms is
traditionally performed with soap and water. In this study, four
floor-mopping methods – dry, spray, moist and wet mopping – were compared by
two systems using adenosine triphosphate (ATP) bioluminescence (Hygiena and
Biotrace). These systems assess residual organic soil on surfaces. The
floor-mopping methods were also assessed by microbiological samples from the
floor and air, before and after cleaning. All methods reduced organic
material on the floors but wet and moist mopping seemed to be the most
effective (P < 0.001, P < 0.011, respectively, ATP Hygiena). The two ATP
methods were easy to use, although each had their own reading scales.
Cleaning reduced organic material to 5-36% of the level present before
cleaning, depending upon mopping method. All four mopping methods reduced
bacteria on the floor from about 60-100 to 30-60 colony-forming units
(cfu)/20 cm2 floor. Wet, moist and dry mopping seemed to be more effective
in reducing bacteria on the floor, than the spray mopping (P = 0.007, P 0.002 and P = 0.011, respectively). The burden of bacteria in air increased
for all methods just after mopping. The overall best cleaning methods seemed
to be moist and wet mopping.

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—–
Michael Wishart

For many years I (and many of my infection control colleagues) have been
saying that using spray bottles for environmental cleaning is not a good
thing, due to potential OH&S risks (eg aerosolisation and inhalation of
chemicals) and the difficulties of keeping spray bottles and nozzles clean,
among other concerns.

Have again been asked to justify this position, and again I am having
difficulty finding actual evidence to support this best practice
recommendation (see
http://remotehealthatlas.nt.gov.au/0719_spray_bottle_communique.pdf for
someone brave enough to put this in writing). Does anyone have any
convincing studies or well-referenced guidelines to support this
recommendation?

Would also be interested in other views: is this considered best practice by
the infection control community in Australia?

Thanks for any discussion on this.

Cheers
Michael

Michael Wishart

Public Health Nurse,Communicable Disease Control Logan West Moreton PHU Ph
34131200 Fax 34131221

To contact Nursing team:
LWM_PHN@health.qld.gov.au

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[Glenys Harrington]

Joanne,

The following is a summary of findings from a literature review of Infection
Control issues associated with the use of ice machines. There are a number
of reported outbreaks and clusters of infections that have been associated
with ice machines. The two main sources of micro-organisms are from
a)potable water (the water source used to make the ice) and b)organisms from
hands of staff/patients.

Common Organsisms

POTABLE WATER*

Legionella species, Non-Tuberculous mycobacteria, Pseudomonas species,
Burkholderia cepacia, Stenotrophomonas species and Flavobacterium.

HAND TRANSFER*

Acinetobacter species, Coagulase Negative Staphylococcus, Salmonella and
Cryptosporidium species.

*Guidelines for Environmental Infection Control In Health Care Facilities,
Centers for Disease Control and Prevention, 2003.

It is important to minimise the risk of acquiring micro-organisms from the
ice machines.

If an ice machine is purchased for a ward a regular cleaning and maintenance
schedule is required in accordance with manufacturer instructions.

The Centers for Disease Control and Prevention (CDC)1 recommend the
following cleaning and maintenance procedures for ice machines;

*If using a chest type machine on a weekly basis empty and clean the
chest with soap and water, rinse with water then a dilute solution of Sodium
Hypochlorite and allow all surfaces to dry.
*On a monthly to quarterly basis remove removable parts for cleaning
and check for breakage.
*Sanitise the machine by circulating Sodium Hypochlorite solution
through the ice making and storage system for 2 to 4 hours, then drain and
flush with fresh tap water.

In addition all staff should be instructed on appropriate handling of ice
from the machine including the following;

*Frequent hand washing
*Use a scoop to remove ice from the machine not hands
*Ice machine scoop/s should be smooth, impervious, and be kept on a
tray when not in use (i.e. dry) and routinely cleaned and disinfected.

Ice machines that dispense ice directly into a portable container provide a
more sanitary method to store and obtain ice, however they do not eliminate
the potable water as a source of contamination.

If the unit decides to purchase an ice machine (chest type or self
dispensing) the unit should liaise with Engineering Services and Cleaning
Services to ensure;

a) Recommended maintenance procedures are in place

b) Recommended cleaning procedures are in place

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

Joanne Bird

Hello All,

I am enquiring if other hospitals use bench top dispensable ice machines in
ward areas and if you may have Policy/ Guideline that you are willing to
share?

Looking forward to some responses,

Joanne Bird

Infection Control Nurse

Katherine and Gove Hospital

PH:89 739266 Mobile: 0427394492

Didya wash ya hands ? NO GERMS ON ME!

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[Glenys Harrington]

Hi Matthias,

While I have not seen the product in Australia if it is used in Australian
healthcare settings as a surface disinfectant it will need to be either be
listed or registered with the TGA as per the TGA “Guidelines for the
Evaluation of Sterilants and Disinfectants”
http://www.tga.gov.au/industry/disinfectants-evaluation-guidelines.htm

Until it is listed or registered it cannot make specific claims for being
bactericidal, fungicidal, sporicidal, tuberculocidal or virucidal.

For the Australian infection control community TGA would like to be advised
of manufacturers/suppliers who are marketing disinfectants that are not
listed or registered with the TGA via their online reporting form at the
following link:
http://www.tga.gov.au/about/form-breach-tgact.htm

Simply ask the manufacturer or supplier for their TGA ARTG CERTIFICATE.
Look for the ARTG Identifier. ARTG L = Listed only. ARTG R = Registered.
Refer to the table in the TGA Guidelines for the Evaluation of Sterilants
and Disinfectants (pg 62-65) for the claims that can be made for a
sterilant or a disinfectant that is listed verses being registered.

In addition in the 2010 “Australian Guidelines for the Prevention and
Control of Infection in Healthcare” it states the following: “Where
transmission-based precautions are required, a TGA-registered hospital grade
disinfectant must be used if a disinfectant is required”.

As a spray bottle infection control staff would also need to check any
issues relating to ” topping up” and how the nozzle itself can be cleaned
and disinfected.

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—–
Matthias.Maiwald@KKH.COM.SG

Dear Group,

Has anyone heard of a device called “Active Ion”? We learned that the
housekeeping department of our hospital (not infection control or
microbiology!) has apparently been aproached by a company wanting to sell
“ActiveIon” spray devices.

The company has websites promoting the product in several countries,
including US, UK and Australia:

http://www.activeion.com/us/Default.aspx

http://www.activeion.co.uk/

http://www.activeion.com/us/HowItWorks.aspx

http://www.activeion.com.au/

The device is apparently constructed like a spray bottle, and is supposed to
be filled with tap water. The company’s claim is that when the tap water
passes through the nozzle, it is “ionised” and filled with “nano-bubbles”,
and this is supposed to clean surfaces and kill microorganisms. The claim is
further that the water reverts back to being just water and leaves no toxic
residue on the surface that it is used on.

There is a relatively detailed (negative) review by what appears to be a
scientifically-trained person (“doctor.generosity”) on the Amazon website:

http://www.amazon.com/Activeion-ionator-Portable-Cleaner-Sanitizer/dp/B0031Q
PQN6

However, while searching I have not found anything that appears to be
scientifically valid and appears to be supporting the company’s claim. In
particular, there do not appear to be any truly independent microbicidal
test results available.

Any further insight? Anyone in hospitals being approached?

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

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[Glenys Harrington]

Kevin,

Perhaps the answer is not to look for a “defined routine sampling technique to determine a minimum standard for environmental contamination” as there will always be problems with interpreting what the results mean given the environment is not meant to be “sterile”.

It would be more useful to determine what are the minimum, standardised, “reliable and repeatable” environmental decontamination procedure/s (i.e. cleaning and the use of florescent markers/cleaning and the use of microfiber/cleaning and chemical disinfection/cleaning and new technologies [HPV, UV, steam, other]) that can be shown to be linked to a sustainable reduction in infection and/or colonisation in patients in non-outbreak settings.

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—–

[Moderator note: this message has been discussed with the original poster of this thread, and agreed that the content is not product specific and is worth consideration as part of this discussion.]

John

I read your post with great interest and think its a fantastic topic (and badly needed) for discussion.

I was going to reply to the list but to be honest I am coming from a slightly biased perspective and really do not want to the list to degenerate into another marketing tool (or for that matter to get into trouble with the people who manage the list.) so here is my (for what its worth) feelings on the topic. Any feedback appreciated and if you feel its not going to be taken or seen incorrectly then I am happy to reply to everyone.

Unfortunately while opinion is changing (and changing rather quickly) there is still debate in some circles as to the role of the environment in the spread of HCAIs. History tells us that the medical profession takes a while to change its mind (look at Semmelweis or John Snow)!

The historical belief that pathogens dont survive long in the hospital environment has been proven to be completely wrong with evidence that the many bacteria can survive weeks, months or even years in the environment. The feeling that the patient contaminated the environment but that the a contaminated environment was not a risk to a patient has been reassessed and found to be incorrect in some circumstances. The question is not now whether a contaminated environment makes an important contribution to transmission but how much of a contribution does it make. Related to this, what level of cleaning and disinfection is required? Is cleaning enough? Do we need disinfection? To what level?

What is exacerbating the problem is the lack of data on the actual level of contamination that exists in hospitals pre and post cleaning. Taking two or three swabs, even on a routine basis just isnt sensitive enough to give us that kind of data. How can sampling 2cm2 out of the entire surface area (even out of the high hand touch surfaces) even give us an indicative result on the level of contamination in a room? There is even some doubt as to the sensitivity of standard swabbing. If you look at a letter in AJIC in 2009, (Otter JA et al. Am J Infect Control
2009;37:517-8) standard swabbing found 2% of surfaces contaminated with C.diff but moving to the newer pre moistened cellulose sponges swabbing
1m2 found that 28% of surfaces were contaminated. This goes to show how inaccurate or lacking sensitivity our environmental testing, even when it done routinely.

We all know that the environment contaminates healthcare workers hands, particularly the near patient environment. There are multiple studies that show this but the one that to me stands out is Hayden et al. Infect Control Hosp Epidemiol 2008;29:149-154 which showed that VRE touching that surface was posed the same risk of contaminating a HCW hands as touching the patient !!!

The most convincing evidence that contaminated surfaces are important in transmission comes from the fact that there is an increased risk to a patient of acquiring a MDRO if the previous patient in that room had a MDRO:

Martinez et al. Arch Intern Med 2003; 163: 1905-12 showed if VRE was cultured within the room the risk to the next patient increased by a factor of 2.6, Huang et al. Arch Intern Med 2006; 166: 1945-51 showed that if the prior room occupant had VRE the risk increased by a factor of 1.6 and for MRSA it was 1.3 Drees et al. Clin Infect Dis 2008; 46:
678-85. demonstrated that if VRE was cultured within the room that the risk increased by a factor of 1.9. prior room occupancy risk increased by a factor of 2.2 and more worryingly even with all the cleaning that if the previous room occupant at any tome in the previous 2 weeks had VRE the risk still increased by a factor of 2.
Shaughnessy. Infect Control Hosp Epidemiol 2011;32:201-206 showed that if the prior room occupant had C.diff that the risk to the next patient admitted increased by a factor of 2.4.
Nseir et al. Clin Microbiol Infect 2010 looked at the MDR Gram Negatives and showed that prior room occupancy was also a significant risk factor.
For Acinetobacter you risk increased by a factor of 3.8 and for Pseudomonas the risk factor increased by 2.1.

So, having established that the environment contributes to transmission, the question is, what is the best way to reduce the contamination to a safe level?

We also know that cleaning and disinfection, even with the best technique will not reliably eradicate this environmental contamination.
As far back as 2004 Garry French French et al. J Hosp Infect
2004;57:31-37 showed that manual cleaning failed to eradicate environmental contamination from MRSA. Byers et al. Infect Control Hosp Epidemiol 1998;19:261-264 showed that it took an average of 2.8 disinfections to eradicate VRE from a room, Boyce et al. Infect Control Hosp 2008;29:723-729 showed that bleach leaning failed to eradicate C.diff (using the more sensitive Sponge testing 25% of surfaces remained contaminated after bleach cleaning).

Similarly, Farrin Manian demonstrated at SHEA in 2010 (and since part published Manian et al. Infect Control Hosp Epidemiol
2011;32(7):667-672) that even with 2 daily bleach cleans and 4 repeat bleach cleans on patient discharge that 26.6% of rooms remained contaminated by MDR Acinetobacter or MRSA !!!!! 4 repeat bleach cleans
How many hospitals currently or will ever go to that standard ??

In the same study as above, Farrin Manian showed that Hydrogen Peroxide Vapour (HPV) was more effective than the four rounds of cleaning and bleach disinfection. Furthermore he demonstrated (again in SHEA 2010 but not yet published) that by eradicating this contamination (using Hydrogen Peroxide Vapour) that there was a 54% reduction of patient acquisition rates for MDR Acinetobacter, 42% reduction on C.diff, 50% reduction in VRE and a 24% reduction in MRSA !!

Two other studies also suggest that eradicating environmental contamination reduces the acquisition of pathogens. John Boyce showed at SHEA in 2006 and since published, Boyce et al. Infect Control Hosp
2008;29:723-729 that eradicating C.diff from the environment (again using HPV) reduced patient acquisition rates for C. diff by 54%. In another study of HPV decontamination in 2008, Passaretti presented data at SHEA (still to be published and again using HPV) demonstrating that by eradicating environmental contamination from a room where the previous room occupant had a MDRO that the risk of acquisition to the next patient dropped substantially. From VRE there was a 77% reduction, for MRSA a 54% reduction for C.diff a 65% reduction and for Gram negative rods a 38% reduction. Over all the eradication of environmental contamination on patient discharge reduced the risk of acquiring a MDRO by 66%…..

So, yes, routine cleaning and disinfection of the rooms of patients on MRO precautions should be done but more may need to be done a patient discharge to eradicate pathogens for the safety of the next patient.

Regarding terminology, I tend to use environmental decontamination to encompass both cleaning and disinfection, but standardisation would be helpful here.

I think we need to define a routine sampling technique and a minimum standard for environmental contamination that must be achieved before a patient can be admitted to a room or bed-space. (I suspect different standards can be set for different areas depending on risk, for example in Oncology, ICU and Organ transplant the standard may be <1 CFU per CM2 for general medical ward it could be <2CFU per cm2.) There are some proposed guidelines (J Hosp Infect 2004; 56: 10-15 but these have not been adopted widely). We need to find a reliable and repeatable method of achieving this standard and it needs to be implemented and monitored.
And there needs to be a budget made available for this.

Regards

Kevin Griffin
Director Healthcare Solutions
Bioquell Asia Pacific Pte Ltd

T: +65 6592 5145
F: +65 6227 5878
M: +65 8511 3733
E: Kevin.Griffin@bioquell.com
W: http://www.bioquell.com

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[Glenys Harrington]

Terri,

From an infection control perspective for Droplet Precautions where single rooms are not available and you need to cohort you will need to be able to have a distance of at least 1 metre (3 feet) between each bed space.

You could also apply this distancing in all of the areas you mention below as a minimum.

In addition in the US Guidelines for the Design and Construction of Healthcare Facilities (2010) it states the following:

2.2.2 Nursing Units

2.2-2.2.2.2 Space requirements

(2) Clearance

(a) The dimensions and arrangements of rooms shall be such that there is a minimum clear dimension of 3 feet (91.44 centimetres) between the sides and the foot of the bed and any wall or any other fixed object.

(b) In multi-bed room, a minimum clear dimension of 4 feet (1.22 meters) shall be available at the foot of each bed to permit the passage of equipment and beds.

(3) Where renovation work is undertaken, every effort shall be made to meet the above minimum standards. If it is not possible to meet the above standards, authorities that have jurisdiction shall be permitted to grant approval to deviate from this requirement. In such cases, patient rooms shall have a minimum clear floor area of 100 square feet (9.29 square meters) in single-bed rooms and 80 square feet (7.43 square meters) per bed in multi-bed rooms.

3.7 -3.4 Pre and Post-operative Holding areas

3.7-3.4.2.2 Post – anaesthesia recovery positions

(b) Clearance. Each post- anaesthesia recovery area shall provide a minimum clear dimension of 5 feet (1.52 meters) between patient stretchers or beds, 4 feet (1.22 meters) between patient stretchers or beds and adjacent walls (at the stretchers sides and foot), and the foot of the stretcher or bed to the closed cubical curtain.

3.7-3.4.2.3 Phase II Recovery Areas

(B) Clearance

(i) The design shall provide a minimum clear dimension of 4 feet (1.22meters) between the side of adjacent lounge chairs and nearest obstruction.

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,

Just wondering if anyone has a reference for the dimensions that ward beds should be apart from each other in a 2bed or more room. I have looked at the Australasian Health Facility Guideline and cant seem to find it. If it is in there can you tell me where?

Also, in an ambulatory care setting, how far apart should the patient chairs be? I have a post op day surgery area that is doing away with beds and putting chairs in and they want to have chairs in an area with 1.7m apart (measured centre of chair to centre of chair) and I think that would be too tight for my paediatric patients who come with parents. Any ideas? Any references?

Thanks,

Terri Cripps | CNC Infection Control | Sydney Childrens Hospital
‘: (02) 9382 1876 | fax: (02) 9382 2084 |8 : terri.cripps@sesiahs.health.nsw.gov.au| “:www.sch.edu.au| page: 47140

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[Glenys Harrington]

Tony,

The papers and discussion in the articles below may help you work your way through the issues relating to some of these valves (negative- or positive-pressure or displacement mechanical valve needleless connectors). To comment further I would need to know which valve you are using.

Problems can include the following; stagnant fluid in the bung chamber(not always visible as the chambers are not always transparent), some bungs with concertina valves which fit snugly over the internal channel in the bung chamber are not sealed and this may result in communication between the stagnant fluid in the bung chamber with the fluid in the infusion channel when the hydrostatic pressure in the system is increased, accumulation of fluid(wet) on the bung surface after accessing a bung(after removal of the syringe), risk of user contamination when accessing the bung(some bung surfaces are smooth and the syringe tip can slip off the surface when trying to access), some bungs surfaces cannot be adequately disinfected before accessing and finally poor technique.

Stagnant fluid in a dead space of any component of an intravascular device is vulnerable to contamination either during manipulation or when accessing the system with a syringe. Best to aseptically change the bungs on a regular basis to reduce the risk of microbial growth as microorganisms can migrate along a stagnant fluid pathway.

A case I followed up in the past was a transplant patient who represented to hospital with Chryseobacterium sepsis. On investigation the patient had a multilumen hickmans catheter insitu. The patient had repeated positive BCs and was noted to spike a fever following flushing or accessing the lines. When I spoke with the patient about how the line was being managed at home it was established that the patient had not received the instruction to change the bungs and they had remained in situ since discharge(3-4 weeks). The patient had also been showering but was covering the Hickman and lines as instructed. All bungs were removed and cultured and all grew Chryseobacterium. Assume the bungs had become contaminated during showering as it is difficult to keep something covered and dry on the chest wall during showering.

Jarvis et al. Health CareAssociated Bloodstream Infections Associated with Negative- or Positive-Pressure or Displacement Mechanical Valve Needleless Connectors
Clin Infect Dis. (2009) 49 (12): 1821-1827.
http://cid.oxfordjournals.org/content/49/12/1821.abstract

Menyhay SZ, Maki DG. Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap. Infect Control Hosp Epidemiol 2006; 27:238.

Happy to discuss further off line if needed.

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—–

[Cross-posted from OzBug with permission on behalf of Tony Allworth – Moderator. I will copy any list replies to him.
NB I tried posting this a few days ago but it seems not to have been emailed?]

A question has been raised that I would appreciated consolidated opinion on (I expect total consensus as usual): We have traditionally left the positive displacement valves (“bungs”) on PICCs from the time they go in unless there is obvious blood build-up or other contamination. The basis of this is to maintain a closed system to minimise infection. It has been pointed out that the positive displacement valves according to the manufacturer should be changed either after a certain number of accesses or time frame eg 3 days. When asked for the rationale for this no answer has been forthcoming. I can find no help in the literature. I am concerned that changing them “routinely” will compromise the microbial integrity of the system.
What do others do, and think we should be advising?
Cheers,
Tony Allworth

Dr Tony Allworth
Director, Infectious Diseases
Royal Brisbane & Women’s Hospital

(No vested interest in PICCs or bungs)

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[Glenys Harrington]

Hi All,

This posting raises the question why are we looking at antimicrobial patient
curtains/shower curtains at all?

I’m not aware of any evidence that such items have been identified as source
of HAIs or show to reduce HAIs?

If this is a cost saving initiative (i.e. the cost of disposal is less than
laundering/dry-cleaning non disposable items) then this is an issue for the
supply manager.

Perhaps we as infection control should be asking for the evidence to support
their use over routine laundering practices?

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

Angela Conte

Dear All,

Does anyone use disposable antimicrobial patient curtains or disposable
shower curtains?

If so, has the product met expectations?

Is there any information available re: cost, recycling, infection control
benefits?

Regards,

Angela Conte

Infection Control

Balmain Hospital

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[Glenys Harrington]

Margaret,

I have used the following process in conjunction with Pharmacy and Nurse
Managers(NMs) to minimise and standardise the number of HH products
throughout the hospital.

HCWs with skin problems were asked to have their skin problem assessed by
staff health service or their own GP – we advised staff that this was
important particularly in the event that the condition worsened/workcover
issues etc.

IC reviewed the HCWs HH practices (observation)- I often found staff were
over washing.

If HCW HH practices were OK (i.e. not over washing) HCWs were issued with 1
bottle of an alternative product for sensitive skin (a Triclosan product) to
try for 1 week.

If after 1 week their skin condition had improved we arranged for the NM to
order a personal supply for HCW.

HCWs were instructed that to: a) use a new dispenser (may need to order
separately as not always distributed with HH product by
supplier/manufacturer) with each new bottle and b) ask other staff not to
used their product to minimise the risk of contamination of the
pump/dispenser.

If no improvement after 1 week they were referred via staff clinic to the
allergy clinic for assessment.

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—–
Jennifer Benjamin
cause Chlorhexidine

Triclosan products are generally well tolerated and still has antimicrobial
properties

Jen Benjamin
Infection Control Consultant
Melbourne Pathology
M: 0402 000 590

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Chlorhexidine

Hello all

I have had a couple of staff who are apparently sensitive to Chlorhexidine
products.

Dermatology review is difficult to access in the NT so my question is what
do other ICP recommend for hand hygiene in this case. I realise you can’t
endorse products but a few clues would be great!

Margaret Gleeson | Clinical Nurse Specialist, Hand Hygiene Compliance
Infection Prevention & Management Unit, Royal Darwin Hospital | Department
of Health and Families
Rocklands Drive, Tiwi, NT 0811| PO Box 41326, Casuarina, NT 0811
p… (08) 89227694 Pager # 238 | f… (08) 89228889|
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[Glenys Harrington]

Linda,

As per the Victorian Department of Health, “Guidelines for the
classification and design of isolation rooms in health care facilities,
Victorian Advisory Committee on Infection Control 2007”, rooms with
reversible airflow mechanisms enabling the room to be either negative or
positive pressure are not recommended. Problems with such rooms include the
difficulty of configuring appropriate airflow for two fundamentally
different purposes, the risk of operator error, complex engineering and fail
safe mechanisms.

Ref 1. Guidelines for the classification and design of isolation
rooms in health care facilities, Victorian Advisory Committee on Infection
Control 2007

http://www.health.vic.gov.au/infectionprevention/publications/design_isolati
on_rooms.htm

A busy ED department, staff with no training in air handling and
ventilation systems for hospitals and a switch that is will be used
infrequently is probably not a good mix!

Prior to the above guidelines in Victoria the hospital I worked at had some
rooms with these switches – outcome – often turned on the wrong way and not
recognised until some hours later(staff in ED, ICUs etc have other
priorities when admitting very unwell pts). These human errors result in
staff and patient exposures and significant increased workload for all
concerned.

In addition outside of patients who have had a bone marrow transplant the
evidence for the use of positive pressure rooms is also limited.

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—–
Joanna Harris
room

Hi Lindy and Mary-Rose,

We are also being asked this question as part of the discussions we are
involved with for our ED refurbishment. We have had significant concerns and
a number of incidents (none significant thankfully) over the past two years
regarding the ‘switchable’ options that were previously authorised and are
still in place in our facility.
We’re happy that the latest HSF guidelines are very clear on not permitting
the use of switchable systems.

Jo

Nurse Manager, Infection Management and Control Service (IMACS)

Level 1, Lawson House
The Wollongong Hospital
LMB 8808
SCMC NSW 2521

—–Original Message—–
Lindy Ryan

Dear mary – Rose,

check out Australasian health faciltiy guidelines – chapter 20 pg 8 –
combined alternating pressure isolation rooms (see link below)

http://www.healthfacilityguidelines.com.au/guidelines.htm

this document indicates that duel positive/negative pressure is not
permitted and based on previous experience with this myself (we managed
to get rid of this duel option that was in place our designated rooms
from the arc days & perhaps before adam was born I am sure……….) it
was a nightmare as no one even engineering dept was even sure or knew
which switch was which way for onor off or standby etc as the writing
had worn off, and docuemntation long lost and it was all operating via
chinese whispers of how a negative or positive prssure room was meant to
work (we had to do the old tissue against the door trick) and
eventually found that the rooms at times were not fuctioning …gladly
we got rid of these and moved to just one system of negative pressure
and a quality manitenence monitoring system which these rooms aircon
included it being attached to our BMS alarm system and also that
Infection control get quartely reports of that the checks and
functionility for allour neg pressure rooms are all working and Ok to
use (important to have this in place for future)

we do not currently have any rooms designated as postive pressure
(except in out OT of course) in the cluster I work in. We have toyed
with the idea for our oncology autologous transplants we do here but as
these rooms are multi purporse in the wards when not being used for a
transplant pt (we dont have the luxury here of closing rooms when beds
are premium) the concerns that an infection risk pt may end up in the
room (even though we ask them not too) and / or a transplant pt may also
run the risk of having an MRO colonisation and inadvertantly positive
pressure is used (in my previous exerience it didn’t matter what you
policy or processes were the switiches can get flipped on or off belfore
you know it if they are there) – so after some disucssion we believed
the risks outweighed the benfits at this time for including positive
pressure rooms (we do not do large numbers of transplant and we do not
manage severe burns pts …perhaps you may get other advice here)

i am happy to hear others thoughts on the use of positive pressure
rooms and risk and benefits they may have come across in their
experience and their frequenecy of use vs cost benefit.

hope this helps the disucssion

regards

Lindy

Lindy Ryan
Infection Control Clinical Nurse Consultant (CNC)

Nepean Hospital,
Western Cluster
Sydney West Area Health Service

email: ryanl@wahs.nsw.gov.au

“Infection Control is Everybody’s Business”

>>> WishartM@ramsayhealth.com.au 25/06/2010 5:57 pm >>>
[Posted on behalf of Mary-Rose Godsell – Moderator]

Dear All,
I have been asked to investigate the possibility of including a room
that
can have both negative pressure and then be changed into a positive
pressure isolation room – (so interchangable) for some upcoming
renovation in an ICU and ED.
I haven’t read in the literature or heard of this being a viable
option,
however would like to canvass the AICA list to gather some evidence
around this. Also the efficacy of using positive pressure isolation
rooms in the first instance.

Thank you
Regards
Mary-Rose Godsell
RGON, AFAAQHC, GDipHSM, CICP, MAdvancedPrac(Infection Control)
South West Infection Control Nurse Consultant
WA Country Health Service

‘Hand hygiene reduces the
spread of infection’

ph:08) 9722 1490
mobile 04 3996 1015
e-mail: Mary-Rose.Godsell@health.wa.gov.au

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[Glenys Harrington]

Melinda,

Can you clarify – are you talking about mixing valves?

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—–

I now have a number of building related guidelines (thanks everyone who responded to the last question), but now I am investigating risk associated with inserting flow restricting washers into the water supply for the showers and the handbasins. My concern is that it may promote microbial growth in the fixtures – but I have been unable to find reference to that specific issue.

Melinda Grififths
CNC Infection Control
Alice Springs Hospital
08 89517737

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[Glenys Harrington]

Melinda,

I’m assuming that operating theatres are going to remain operational during the renovations that the area being renovated can be completely sealed off from the rest of the complex?

The purpose of air sampling under these circumstances is to qualitatively detect breaks in environmental infection control measures.

In terms of air sampling I would do rank order air sampling.

The objective of rank order air sampling is to monitor the efficacy of dust control measures by measuring and comparing the count of fungi in the area before, during and after the works. This approach determines the rank order of air quality from dirty (i.e. the outdoor air) to clean (i.e. air filtered through high-efficiency filters [90%-95% filtration]) to cleanest (i.e. HEPA-filtered air – the operating theatres).

As an example rank order microbiological air sampling involves a standard number of samples taken on a routine, regular basis over a specified time in specific areas such as the following:

Outdoors (dirty).
An indoor area not under construction and away from construction site(clean).
The Operating Theatre/Operating Theatre Complex(cleanest).

The more data you have before works commence (i.e. baseline data) the better.

You will need to take care in terms of interpreting the air sample results as air sampling can be problematic for the following reasons:
Lack of standards linking fungal spore levels with infection rates.
Lack of standards/protocols for testing (sampling intervals, number/location).
Resource intensive (if you are to undertake this sampling for a long or protracted period the resource implications for an ICP or a team can be significant).
Substantial laboratory support required.
Unknown incubation period of Aspergillus infection.
Variability of sampling circumstances.

In addition there should be a risk assessment undertaken before works commence and the barriers should be checked on a routine regular basis for breaches. If breaches are identified works should cease until the breaches are rectified along with the theatres being notified that unfiltered air from an adjacent construction site may be entering the theatre complex.

References
1. Centres for Disease Control and prevention. Guideline for Environmental Infection Control in Health-Care Facilities: recommendations of CDC and healthcare Infection control Practices Advisory Committee (HICPAC). MMWR 2003; 52(no.RR-10): 1-48
2. Microbiological Commissioning and Monitoring of Operating Theatre Suites, A report of a working party of the Hospital Infection Society UK, Sept 2005

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—–

My Facility is currently planning to close a part of the Operating Theatre down to do some renovations. The hospital executive have asked me to devise an “air quality” program. Can anyone share their experience or steer me in the right direction.

Melinda Griffiths
CNC Infection Control
Alice Springs Hospital
08 89517737

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[Glenys Harrington]

Fiona,

To support your policy/practice change or management strategies around this
issue some additional evidence relating to nail damage and use of acrylic
nails may be useful. See 2008 Shemer et al findings below:

Shemer A et al. Onycomycosis due to artificial nails. J Eur Acad Dermatology
Venereol. 2008 Aug;22(8):998-1000.
Summary of Findings:

68 pts suffering from nail changes and paronychia which appeared after
removal of artificial nails
Culture was positive in 67/68 patients (98.5%).
Candida spp. were the most common pathogen

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—–
RUSSO, Philip

Short of running a guillotine across the knuckles, I’d suggest they
would need to be removed from the clinical area until a/nails removed

Regards
Phil Russo

On 22/03/2010, at 3:35, “Wilson, Fiona L (Infection Control)”
wrote:

> As per Hand Hygiene Australia and WHO consensus recommendations, we
> do not recommend that HCW have artificial fingernails while working
> in the clinical area. I am wondering how you ‘police’ this (for want
> of a better term) and does anyone have a HR process for HCW’s who
> refuse to remove artificial fingernails.
> Regards
>
> Fiona Wilson
> Manager, Infection Control
> Western Health
> Phone: 8345 6666 pager 506
> Fax: 83456973
> email: fiona.wilson@wh.org.au
>
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[Glenys Harrington]

John,

I would include mention of aseptic technique or no-touch techniques in
Standard Precautions guidelines. The terms would need to be defined in the
context of a non-surgical environment.

Aseptic technique and no-touch techniques are important aspects of basic
infection prevention practice.

Unfortunately aseptic technique and no-touch techniques are rarely mentioned
in guidelines. Why is this? Is it assumed that such practices are good?
My experience tells me that this is not the case. Many staff are either not
trained or have received inadequately training in these areas.

Unlike hand hygiene there is little or no credentialing or ongoing
monitoring in place yet these practices are probably of more importance in
terms preventing infection.

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—–
John Ferguson
Precautions?

Dear Colleagues

Further to the recent Draft Aust ICG reviews, we’ve been discussing what is
inlcuded in the SP standard.
I’ve usually referred to the CDC 2007 Guideline for Isolation Precautions as
the bible in this regard. Table 4 on page 129 details SP – see
http://www.asid.net.au/hicsigwiki/index.php?title=Standard_infection_control
_precautions

My questions are –
– do others agree that this is the correct list?
– does/should SP also extend to include the range of practices associated
with medical and surgical asepsis? The AICA Standard 11 specifies ‘Aseptic
technique is to be performed when indicated’ and references AICA Standard
22, Invasive Devices.

I look forward to your views!

The other suggestion I have is that we make it clearer that SP is in fact a
base-level contact precaution standard and that Transmission -based Contact
Prec are only used in addition when it has been demonstrated that SP are
insufficient to prevent transmission.

Best wishes
John

Dr John Ferguson
Director, Infection Prevention and Control Unit
Microbiologist and Infectious Diseases Physician
Hunter New England Health Service
Locked Bag 1, Newcastle, NSW 2310, Australia
tel 61 2 49214422, fax 61 2 49214440

Go to http://www.hicsiganz.org for ANZ healthcare infection control resources and
networking.

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