[Glenys Harrington]

Hi Jayne,

a) Clinical/patient equipment should be cleaned and disinfected between each
patient use

b) What clinical/patient equipment will tolerate in terms of cleaning and
disinfection agents will depend on the manufacturer’s instructions – this
should be checked

c) Who should clean – management decision of the organisation

Interesting paper by Curtis J Donskey’s and colleagues about contaminated
portable equipment which may be of interest/use.

Amrita R John et al. Contaminated portable equipment is a potential vector
for dissemination of pathogens the intensive care unit. Infect Control. Hosp
Epidemiol 2017;1-3
https://www.cambridge.org/core/journals/infection-control-and-hospital-epide
miology/article/contaminated-portable-equipment-is-a-potential-vector-for-di
ssemination-of-pathogens-in-the-intensive-care-unit/C941B9A2D242485FE0750FD5
9851A9B9

regards

Glenys

Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.au

—–Original Message—–
Of Jayne OConnor

Hi All,

Does anyone have any documents/policies around cleaning of clinical
equipment, who’s responsible for the cleaning and how frequently the
equipment is cleaned?

Would appreciate any help :).

Many thanks in advance.

Jayne O’Connor RN ,BSc.,Inf.Cont
IPC Co-Ordinator
Sydney Adventist Hospital | 185 Fox Valley Road, Wahroonga, NSW 2076

p: +61 2 9487 9732 | f: +61 2 9473 8052 | m: +61 0406 752685 | e:
jayne.oconnor@sah.org.au
http://www.sah.org.au

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[Glenys Harrington]

Agree Pene.

As with any equipment used on a given patient a washing machine should be
wiped between each patient laundry load.

Could be easily achieved by using a cleaning and disinfection wipe.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Dobell-Brown, Penelope
for patient personal use

If you don’t use either thermal or chemical disinfection for individual
patient loads, then I believe that you would then need to have a process to
clean the machine between each load.

Best Wishes

Pene Dobell-Brown
Healthcare Certification – Key Client Manager
DNV GL Business Assurance
Level 7, 124 Walker Street
North Sydney NSW 2060
http://www.dnvgl.com

_____

Glenys Harrington

Hi All,

I don’t believe there is any evidence or requirement to use a detergent that
provides chemical disinfection at low temperatures for individual patient
loads in a Domestic-type washing machine for patient personal use.

In addition from the NHMRC recommendation below individual patients loads
could be washed on either a hot or cold cycle.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Dobell-Brown, Penelope
for patient personal use

Even if you are doing individual patient loads, a complication can also
occur if the washing machine is plugged into water attached via a
thermostatic mixing valve (TMV) that restricts the temperature the wash will
reach. Unless the machine has its own heat cycle you may need to use a
detergent that provides chemical disinfection at low temperatures. These are
usually available through your normal chemical supplier.

Regards

Pene Dobell-Brown
Healthcare Certification – Key Client Manager
DNV GL Business Assurance
Level 7, 124 Walker Street
North Sydney NSW 2060
http://www.dnvgl.com

_____

Janine Egart

Hi Jenny,

We don’t have a particular procedure – however as stated in the NHMRC
Australian Guidelines for the Prevention and Control of Infection in

*Domestic-type washing machines must only be used for a patient’s
personal items (not other linen). Washing must involve the use of an
appropriate detergent and hot water. If hot water is not available, only
individual patient loads can be washed at one time. Clothes dryers should be
used for drying.
*Used linen must not be rinsed or sorted in patient-care areas or
washed in domestic washing machines

I’m sure you have already seen this but just in case!

Regards

Janine Egart
Clinical Nurse Consultant – DDHHS

Clinical Governance Unit
p: 07 46166206 | m: 0400704118 (SD: 1947)
a: Pechy Street, Toowoomba, Qld 4350
e: Janine.egart@health.qld.gov.au
| w: Darling Downs Hospital
and Health Service

DDHHS

Of Jenny Garland

Hi

I am looking for information form an infection control point of view for
domestic washing/dryer machine being installed on an acute medical ward

This is for patients own use for personal clothing as our laundry is now
being sourced from outside and personal clothing will no longer be washed
on site

I am looking for any information that will help with the smooth running of
this potential implementation of washer /dryer on the ward

I was wondering if anyone had any protocols or policy they are willing to
share

Thank you

regards jenny

Jenny Garland
Quality Risk &Infection Control Officer
Mater Health Services North Queensland

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[Glenys Harrington]

Hi All,

I don’t believe there is any evidence or requirement to use a detergent that
provides chemical disinfection at low temperatures for individual patient
loads in a Domestic-type washing machine for patient personal use.

In addition from the NHMRC recommendation below individual patients loads
could be washed on either a hot or cold cycle.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Dobell-Brown, Penelope
for patient personal use

Even if you are doing individual patient loads, a complication can also
occur if the washing machine is plugged into water attached via a
thermostatic mixing valve (TMV) that restricts the temperature the wash will
reach. Unless the machine has its own heat cycle you may need to use a
detergent that provides chemical disinfection at low temperatures. These are
usually available through your normal chemical supplier.

Regards

Pene Dobell-Brown
Healthcare Certification – Key Client Manager
DNV GL Business Assurance
Level 7, 124 Walker Street
North Sydney NSW 2060
http://www.dnvgl.com

_____

Janine Egart

Hi Jenny,

We don’t have a particular procedure – however as stated in the NHMRC
Australian Guidelines for the Prevention and Control of Infection in

*Domestic-type washing machines must only be used for a patient’s
personal items (not other linen). Washing must involve the use of an
appropriate detergent and hot water. If hot water is not available, only
individual patient loads can be washed at one time. Clothes dryers should be
used for drying.
*Used linen must not be rinsed or sorted in patient-care areas or
washed in domestic washing machines

I’m sure you have already seen this but just in case!

Regards

Janine Egart
Clinical Nurse Consultant – DDHHS

Clinical Governance Unit
p: 07 46166206 | m: 0400704118 (SD: 1947)
a: Pechy Street, Toowoomba, Qld 4350
e: Janine.egart@health.qld.gov.au
| w: Darling Downs Hospital
and Health Service

DDHHS

Of Jenny Garland

Hi

I am looking for information form an infection control point of view for
domestic washing/dryer machine being installed on an acute medical ward

This is for patients own use for personal clothing as our laundry is now
being sourced from outside and personal clothing will no longer be washed
on site

I am looking for any information that will help with the smooth running of
this potential implementation of washer /dryer on the ward

I was wondering if anyone had any protocols or policy they are willing to
share

Thank you

regards jenny

Jenny Garland
Quality Risk &Infection Control Officer
Mater Health Services North Queensland

Email secured by Check Point

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[Glenys Harrington]

Hi Belinda,

A plan for cleaning and disinfection in the event of an outbreak would
depend on what type of organism was causing or suspected to be causing the
outbreak.

Can you provide more details?

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Belinda Boston (South Eastern Sydney LHD)
Cleaning

Hi all

Happy Thursday

Does anyone have a management plan for Cleaning in the event of an outbreak
that you would be happy to share?

Thanks so much

Belinda

Belinda Boston
Infection Prevention and Control CNC | Nursing

St George Public Hospital

1st Floor James Laws House

Gray Street Kogarah NSW
Tel (02) 9113 4608 | Fax (02) 9113 1575 | Mob 0429 890 544 |
belinda.boston@health.nsw.gov.au
http://www.seslhd.health.nsw.gov.au/

Click HERE to access SESLHD and SGH Infection Prevention and Control
Information and resources

http://seslhnweb/SGSHHS/Business_Rules/Clinical/Infection_Control/default.as
p

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[Glenys Harrington]

Not sure what you mean by conflict of interest Lindsay, can you clarify further?

Regards

Glenys

Dear All,

Wow it is great to see so many folk buying into a discussion about hand hygiene and HHA!

So to answer a few issues:

1. Brian yes, there are now clear Australian data showing an link between improved HH compliance (HHC) and reduced Australian SAB rates this was presented this year at ECCMID and has been submitted to Lancet Infectious Diseases (revised publication addressing reviewers comments now in preparation submission next week). In summary from an analysis of the 132 largest Australian hospitals (ie. 77% national beddays; [15.3 M of the 19.9 M nationally in 2016-17]) over the 8 years of the National Hand hygiene Initiative – for every 10% improvement in HHC nationally, there was an associated 15% decrease in HA-SAB rates. This change was independent of time ie. the change (delta) in HHC correlated with the delta in SAB rates. This is the first study on such a massive national scale that shows such an association all previous studies have been smaller (see Grayson ML, Russo PL, Cruickshank M, Bear JL et al. Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Medical Journal of Australia 2011195:615-9) or based on single hospital or State-based data. Brian I am happy to send you the ECCMID presentation, but please keep it to yourself until our publication is released let me know.

2. As a number of you have noted, HH auditing is time-consuming, but use of mobile devices and the HHCApp reduces the time burden by 50%; plus, more importantly, the value of direct auditing is in the educational role that auditors should be playing in immediately correcting poor HHC. The days of simply auditing should be gone. Obviously the current HHC data are almost certainly an over estimate since they do not control for night or weekend shifts; may be associated with a Hawthorne Effect (we estimate that to be <7% based on our data) and multiple other possible confounders but the Australian data has been collected in the same standard manner for at least 8 years, so is comparable year-to-year. Anyone who has sat with a sick relative overnight knows that the stated rates may not always apply, but the current system is standardised. The opinions of Mary-Lou McLaws and others, are noted, but what other approach do you suggest? We (and others) have looked at electronic monitoring systems but they are extremely expensive, do not allow for risk stratification according to the HH Moment being measured (e.g. Moment 2 vs Moment 5) and do not provide the educational benefits that on-the-spot human auditors provide.

3. I totally agree with John Ferguson that medical HHC is a really key issue that we need to improve on. The fact that some examiners in the FRACP exams still belittle candidates who perform HH between short-cases is pathetic and needs to be dealt with. We will be focusing on the Colleges this year. It is a credit to the RACS that they are the only College in the world to require that all surgical exam candidates must be credentialed in HHC before they can sit their Part 1 surgical exams.

4. Finally Glenys isnt it about time you declared your conflict of interest? I recall you berating Lars Ostergaard when, at the end of his sabbatical at the Alfred when he fed back that HHC rates were very poor and much worse than in Denmark (this was around the time HHA was just getting established so 10 years ago) you stated that HH had nothing to do with disease transmission or SAB rates!

A lot of hard work has gone into the National Hand Hygiene Initiative by a lot of committed HCWs over many years it is not perfect, but is better than any other national program. It also allows us to benchmark an important national infection control intervention against similar data from many other countries, which is a rather rare phenomenon in healthcare.

Kind regards

Lindsay

Prof. M. Lindsay Grayson

MB BS, MD, MS, FRACP, FAFPHM, FRCP, FRCP (Edin), FIDSA

Director, Infectious Diseases & Microbiology, Austin Health

Director, Hand Hygiene Australia

Department of Medicine, University of Melbourne

Studley Rd., Heidelberg, Melbourne, VIC, 3084

Australia

Wouldn't this suggest that we should de-link process from outcome? That is, measure the activity of the HH program (eg wards visited etc) and use independent "secret shoppers" to assess compliance?

If be more suspicious of wards reporting very high compliance esp if done by ward (link) nurses.

A.

On Fri, 22 Jun 2018, 13:05 Dale Fisher, wrote:

I think its easy (oh so easy) to find flaws in HH measures today. But do reflect on why HH auditing was invented and that is because there was a time when ABHR was not easily available and no one undertook hand hygiene. We know that moving from 10 to 30% is of enormous value compared to 30 to 50% or 70 to 90% .diminishing gains. There have been many other major gains in IPC processes such as environmental cleaning, devices and infrastructure design.

Personally I feel HH audits have changed their role into more of a reminder or a tool to talk with management (and actually whether its up or down doesnt matter). Its about a conversation to direct HAI interventions and actually caring.

For the record; hospitals in Singapore sit around 65-85% HH compliance reported. Independent covert audits we have contracted knock these down about 20% (give or take).

We need to keep audits but understand their value and why we do them today ..with a view to life before them (not good)

Dale Fisher

Singapore

Im not sure if Im rising to a good internet trolling here

Thank you Glenys for the references on recent audit validation very interesting.

These are the historical, somewhat shakey, studies used to support introduction of the NZ programme in 2012:

Johnson P, Martin R, Grayson M. L et al. Efficacy of an alcohol/chlorhexidine Hand Hygiene

programme in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus

aureus (SA) infection. Medical Journal of Australia 2005; 183: 509-514

Grayson ML, Jarvie LJ, Martin R, Jodoin ME, McMullan C, Gregory RHC, Bellis K, Cunnington

K, Wilson FL, Quin D, and Kelly A-M, on behalf of the Victorian Quality Council Hand Hygiene

Study Group and Victorian Quality Council Hand Hygiene Statewide Roll-out Group. Significant

reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates

associated with a multi-site, Hand Hygiene culture-change programme and subsequent

successful statewide rollout. Medical Journal of Australia 2008; 188:633-40

Grayson ML, Russo PL, Cruickshank M, Bear JL et al. Outcomes from the first 2 years of the

Australian National Hand Hygiene Initiative. Medical Journal of Australia 2011195:615-9

Do bear in mind that the 5 moments and the standardised auditing tools are intended as a process indicator which correlates with biological and ecological pressure, to reduce effective Reproductive Number. As such, they deserve respect for driving behavioural and operational improvements, no matter how rationally people question their direct validity and effectiveness for specific scenarios.

Anecdatally, it seems that the compliance rate recorded by our auditors, including Hawthorne effect, do correspond well to patient protection. In our hospital, small outbreaks have mostly occurred on wards with HH rates < 60%, while few have occurred elsewhere and we average around 80% overall which may not meet targets yet seems biologically fairly successful. The compliance target is very rigorous and good control of cross transmission can be achieved with rates under 90% . Our rates of detection for multiresistant MRSA (corresponding more or less to EMRSA-15 and AUS/ST239) have drifted down since 2012 while rates of Fluclox/Fusidic only non multi resistant MRSA (more or less community acquired ST5) have risen. See PLOS One Apr 2013 V8 (4) e62020 for earlier NZ epidemiology. Likewise, traditionally hospital associated ESBL K. pneumoniae rates are stable, while the more community associated ESBL E. coli rates have increased about 3 fold over 5 years. Waikato data: http://lab.waikatodhb.health.nz/assets/QCItems/MDRO-Trends-Waikato-Hospital-2013-to-2018-web-report.pdf

We are satisfied that Hand Hygiene 5 moments is beneficial and that current audit methods are well calibrated, providing actionable information.

However, further improvements would of course be appreciated.

Chris Mansell

Dr Chris Mansell MB,ChB FRCPA | Clinical Microbiologist | Waikato Hospital | 021 833 783

Hi John,

Many thanks for responding.

To continue putting $$ (mostly infection control personnel resources) into direct HH observations in the setting of gross overestimations of compliance rates should be evidence enough to review current practices.

There is a significant amount of information out there that challenges the accuracy of direct observational auditing of HH compliance, some of which has been undertaken in your own state of NSW see below.

While strides have been made by HHA since its establishment it is time to review the following given the information that is currently before use:

a) why do we continue to collect and report flawed data

b) why are we not reducing some of the current direct observation (infection control personnel /liaison nurses) auditing requirements until more accurate methods are investigated and,

c) why we are not looking at alternatives methods ( is see suggestions below – electronic devices/methods in combination with smaller observational audits).

In light of the available evidence (below) we should also be openly transparent and at this point in time when reporting direct observation compliance rates in Australia include a statement that cautions the reader that current research indicates the rates are likely to be significantly artificially inflated rather than implying to managers, CEOs and the general public that they are accurate.

Recent literature of interest

Australia – Yen Lee Angela Kwok et al. Automated hand hygiene auditing with and without an intervention. American Journal of Infection Control 44 (2016) 1475-80

*HHA rates (Hand Hygiene Australia human audits) for June 2014 were 85% and 87% on the medical and surgical wards, respectively. These rates were 55 percentage points (PPs) and 38 PPs higher than covert automation rates for June 2014 on the medical and surgical ward at 30% and 49%, respectively. During the intervention phase, average compliance did not change on the medical ward from their covert rate, whereas the surgical ward improved compared with the covert phase by 11 PPs to 60%. On average, compliance during the intervention without being refreshed did not change on the medical ward, whereas the average rate on the surgical ward declined by 9 PPs.

Australia – Mary-Louise et al. Hand hygiene compliance rates: Fact or fiction? AJIC online 17th May 2018

Direct human audit rates for the medical ward were inflated by an average of 55 PPs in 2014 and 64 PPs in 2015, 2.8-3.1 times higher than automated surveillance rates. The rates for the surgical ward were inflated by an average of 32 PPs in 2014 and 31 PPs in 2015, 1.6 times higher than automated surveillance rates. Over the 6 mandatory reporting quarters, human audits collected an average of 255 opportunities, whereas automation collected 578 times more data, averaging 147,308 opportunities per quarter.

The magnitude of the Hawthorne effect on direct human auditing was not trivial and produced highly inflated compliance rates.

Mandatory compliance necessitates accuracy that only automated surveillance can achieve, whereas daily hand hygiene ambassadors or reminder technology could harness clinicians ability to hyperrespond to produce habitual compliance.

Systematic review – Kingston L et al. Hand hygiene-related clinical trials reported since 2010: a systematic review. Journal of Hospital Infection 92 (2016) 309-320

We concluded that adopting a multimodal approach to hand hygiene improvement intervention strategies, whether guided by the WHO framework or by another tested multimodal framework, results in moderate improvements in hand hygiene compliance.

Editorial – Hand hygiene compliance: are we kidding ourselves? Editorial, Journal of Hospital Infection 92 (2016) 307-308

It is clear that monitoring hand hygiene compliance using direct observation is flawed and that electronic devices/methods in combination with smaller observational audits using appropriately trained staff would enable a better assessment Hence, in an era of multi-resistant Gram-negative bacteria, it is now time to take stock and consider that we have spent a number of years performing research on hand hygiene with little evidence that any particular strategy works. Perhaps future research should be focused not on campaigns to improve hand hygiene at all costs, but on understanding when hand hygiene is most beneficial, setting reasonable, achievable targets, and then monitoring using validated, reproducible methods.

Observational study – Scheithauer S et al. Workload even affects hand hygiene in a highly trained and well-staffed setting: a prospective 365/7/24 observational study. Journal of Hospital Infection 97 (2017) 11-16

Calculated compliance was inversely associated with nurses workload. Hand-rub activities (HRA)/patient-day (PD), observer-determined compliance and amount of disinfectant dispensed were used as surrogates for compliance, but did not correlate with actual compliance and thus should be used with caution.

The use of liaison nurses to undertake direct observation of HH compliance audits is not a common practice across Australia and Im not aware of any information that using a liaison nurse is any more accurate that an infection control professional? Happy to be corrected.

Ill cross posting my response with the Australasian College of infection Prevention and Control (ACIPC) list server in order to keep infection control personnel in on the discussions.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Hi Glenys

Im not sure Id agree that the current Australian HH audit system is broke and parliamentary records are not necessarily representative of what is really going on ! We should remember what little we had before HHA came into existence. In fact the load on infection control services has been minimised by training auditors who are link nurses etc. We now have such a brace of auditors that the main problem is keeping them credentialed. Our audits go across a large number of facilities each time and work pretty well like clockwork. Across Oz we have invested a lot of work in getting things to where they are and arguably there have been measurable gains in terms of SAB reduction etc. I think we should focus not on revolution but rather tinkering with the existing system.

A huge issue to me is that we medicos are still largely allowed to operate in a parallel universe, with no real accountability system ensuring that we (in NSW at least) have even completed 5 moments training or shock/horror been competency assessed for HH, PPE or aseptic technique. Aside from the College of Surgeons, it seems that the other colleges are dodging and weaving still and that is where ACIPC and ASID should be pushing +++. For instance our medical advanced trainees still have no explicit expectation put on them by the RACP concerning expectations of inf control practice during exams etc. We allow doctors to get about in all sorts of gear (suits, coats etc) or theatre scrubs and no-one wants to say boo. Why cant we adopt a bare below elbow standard nationally? Can we hear more about the Cognitive Institutes recent aust. pilot into Vanderbilt style accountability systems please? Royal Melb Hosp has been part of that pilot.

Other possible improvements:

a) At one of our sites, weve had the experience of a well credentialed external auditor conducting most of the HH audits for the past two audits. We have seen compliance there fall considerably indicating to me that all locations should adopt an approach to auditing whereby auditors are always drawn from a different ward or hospital (proper independent auditing).

b) We know also that the initial audit figures from a session are more indicative of actual practice and so, we should not allow for auditing at any site to go on for more than say 30 mins max.

c) We should ensure that audits occur more frequently than thrice yearly and across all shifts with at least monthly feedback of data to cadres and managers

d) Integrating HH auditing with AT audits

e) More careful operational research what is working , what is not, how valid are results, what effects are improvements in HH having, why are medicos not getting engaged with the system? etc

Best wishes

John

Dr John Ferguson MBBS DTM&H FRACP FRCPA

Director, Infection Prevention Service | HNE Local Health District
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf

Error! Filename not specified.

Dear All,

There was a debate in the UK parliament, Westminster Hall on 15/5/2018 in relation to hand hygiene compliance.

The parliament was told that actual hand hygiene compliance is only 18% – 44% in the UK and that direct observation is grossly overestimating HH compliance rates (Hawthorn effect).

https://goo.gl/7D4zTD

The discussion has implications for direct observation of hand hygiene compliance programs in Australian healthcare settings.

It is time to review our direct observation HH compliance strategies and the significant infection control resources committed to such programs across Australia.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

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[Glenys Harrington]

Hi John,

Many thanks for responding.

To continue putting $$ (mostly infection control personnel resources) into direct HH observations in the setting of gross overestimations of compliance rates should be evidence enough to review current practices.

There is a significant amount of information out there that challenges the accuracy of direct observational auditing of HH compliance, some of which has been undertaken in your own state of NSW see below.

While strides have been made by HHA since its establishment it is time to review the following given the information that is currently before use:

a) why do we continue to collect and report flawed data

b) why are we not reducing some of the current direct observation (infection control personnel /liaison nurses) auditing requirements until more accurate methods are investigated and,

c) why we are not looking at alternatives methods ( is see suggestions below – electronic devices/methods in combination with smaller observational audits).

In light of the available evidence (below) we should also be openly transparent and at this point in time when reporting direct observation compliance rates in Australia include a statement that cautions the reader that current research indicates the rates are likely to be significantly artificially inflated rather than implying to managers, CEOs and the general public that they are accurate.

Recent literature of interest

Australia – Yen Lee Angela Kwok et al. Automated hand hygiene auditing with and without an intervention. American Journal of Infection Control 44 (2016) 1475-80

*HHA rates (Hand Hygiene Australia human audits) for June 2014 were 85% and 87% on the medical and surgical wards, respectively. These rates were 55 percentage points (PPs) and 38 PPs higher than covert automation rates for June 2014 on the medical and surgical ward at 30% and 49%, respectively. During the intervention phase, average compliance did not change on the medical ward from their covert rate, whereas the surgical ward improved compared with the covert phase by 11 PPs to 60%. On average, compliance during the intervention without being refreshed did not change on the medical ward, whereas the average rate on the surgical ward declined by 9 PPs.

Australia – Mary-Louise et al. Hand hygiene compliance rates: Fact or fiction? AJIC online 17th May 2018

Direct human audit rates for the medical ward were inflated by an average of 55 PPs in 2014 and 64 PPs in 2015, 2.8-3.1 times higher than automated surveillance rates. The rates for the surgical ward were inflated by an average of 32 PPs in 2014 and 31 PPs in 2015, 1.6 times higher than automated surveillance rates. Over the 6 mandatory reporting quarters, human audits collected an average of 255 opportunities, whereas automation collected 578 times more data, averaging 147,308 opportunities per quarter.

The magnitude of the Hawthorne effect on direct human auditing was not trivial and produced highly inflated compliance rates.

Mandatory compliance necessitates accuracy that only automated surveillance can achieve, whereas daily hand hygiene ambassadors or reminder technology could harness clinicians ability to hyperrespond to produce habitual compliance.

Systematic review – Kingston L et al. Hand hygiene-related clinical trials reported since 2010: a systematic review. Journal of Hospital Infection 92 (2016) 309-320

We concluded that adopting a multimodal approach to hand hygiene improvement intervention strategies, whether guided by the WHO framework or by another tested multimodal framework, results in moderate improvements in hand hygiene compliance.

Editorial – Hand hygiene compliance: are we kidding ourselves? Editorial, Journal of Hospital Infection 92 (2016) 307-308

It is clear that monitoring hand hygiene compliance using direct observation is flawed and that electronic devices/methods in combination with smaller observational audits using appropriately trained staff would enable a better assessment Hence, in an era of multi-resistant Gram-negative bacteria, it is now time to take stock and consider that we have spent a number of years performing research on hand hygiene with little evidence that any particular strategy works. Perhaps future research should be focused not on campaigns to improve hand hygiene at all costs, but on understanding when hand hygiene is most beneficial, setting reasonable, achievable targets, and then monitoring using validated, reproducible methods.

Observational study – Scheithauer S et al. Workload even affects hand hygiene in a highly trained and well-staffed setting: a prospective 365/7/24 observational study. Journal of Hospital Infection 97 (2017) 11-16

Calculated compliance was inversely associated with nurses workload. Hand-rub activities (HRA)/patient-day (PD), observer-determined compliance and amount of disinfectant dispensed were used as surrogates for compliance, but did not correlate with actual compliance and thus should be used with caution.

The use of liaison nurses to undertake direct observation of HH compliance audits is not a common practice across Australia and Im not aware of any information that using a liaison nurse is any more accurate that an infection control professional? Happy to be corrected.

Ill cross posting my response with the Australasian College of infection Prevention and Control (ACIPC) list server in order to keep infection control personnel in on the discussions.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Hi Glenys

Im not sure Id agree that the current Australian HH audit system is broke and parliamentary records are not necessarily representative of what is really going on ! We should remember what little we had before HHA came into existence. In fact the load on infection control services has been minimised by training auditors who are link nurses etc. We now have such a brace of auditors that the main problem is keeping them credentialed. Our audits go across a large number of facilities each time and work pretty well like clockwork. Across Oz we have invested a lot of work in getting things to where they are and arguably there have been measurable gains in terms of SAB reduction etc. I think we should focus not on revolution but rather tinkering with the existing system.

A huge issue to me is that we medicos are still largely allowed to operate in a parallel universe, with no real accountability system ensuring that we (in NSW at least) have even completed 5 moments training or shock/horror been competency assessed for HH, PPE or aseptic technique. Aside from the College of Surgeons, it seems that the other colleges are dodging and weaving still and that is where ACIPC and ASID should be pushing +++. For instance our medical advanced trainees still have no explicit expectation put on them by the RACP concerning expectations of inf control practice during exams etc. We allow doctors to get about in all sorts of gear (suits, coats etc) or theatre scrubs and no-one wants to say boo. Why cant we adopt a bare below elbow standard nationally? Can we hear more about the Cognitive Institutes recent aust. pilot into Vanderbilt style accountability systems please? Royal Melb Hosp has been part of that pilot.

Other possible improvements:

a) At one of our sites, weve had the experience of a well credentialed external auditor conducting most of the HH audits for the past two audits. We have seen compliance there fall considerably indicating to me that all locations should adopt an approach to auditing whereby auditors are always drawn from a different ward or hospital (proper independent auditing).

b) We know also that the initial audit figures from a session are more indicative of actual practice and so, we should not allow for auditing at any site to go on for more than say 30 mins max.

c) We should ensure that audits occur more frequently than thrice yearly and across all shifts with at least monthly feedback of data to cadres and managers

d) Integrating HH auditing with AT audits

e) More careful operational research what is working , what is not, how valid are results, what effects are improvements in HH having, why are medicos not getting engaged with the system? etc

Best wishes

John

Dr John Ferguson MBBS DTM&H FRACP FRCPA

Director, Infection Prevention Service | HNE Local Health District
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf

http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-Health-Master.jpg

Dear All,

There was a debate in the UK parliament, Westminster Hall on 15/5/2018 in relation to hand hygiene compliance.

The parliament was told that actual hand hygiene compliance is only 18% – 44% in the UK and that direct observation is grossly overestimating HH compliance rates (Hawthorn effect).

https://goo.gl/7D4zTD

The discussion has implications for direct observation of hand hygiene compliance programs in Australian healthcare settings.

It is time to review our direct observation HH compliance strategies and the significant infection control resources committed to such programs across Australia.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

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Unless explicitly attributed, the opinions expressed in this email are those of the author only and do not represent the official view of Hunter New England Local Health District nor the New South Wales Government..

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[Glenys Harrington]

Dear All,

To clarify this is not a Recall it is a Product Defect Alert

The manufacturer/supplier states the following:.

………..Pfizer seeks to emphasise the need for all Healthcare Professionals involved in the handling and administration of parenteral medicines to always visually inspect product as typically specified in the relevant Product Information, including that for DBL METRONIDAZOLE IV bags, which states:

Parenteral drugs should be inspected visually for particulate matter and discolouration prior to administration, wherever solution or container permit. Do not use if the solution is cloudy or precipitated or if the seal is not intact.

In addition they recommend the following:

Manual inspection of infusion bags

As with any IV bag presentation, all DBL METRONIDAZOLE INTRAVENOUS INFUSION IV bags require a manual squeeze test immediately prior to use in order to assist in a visual check for the presence of leaks from the primary bag following removal of the secondary bag (overwrap).

I would be surprised if this squeeze test is being done routinely in clinical areas, but happy to be corrected.

I would have thought that doing a squeeze test would have been the manufacturers responsibility as part of the manufacturing process, particularly given their investigation(Product Defect Alert) has identified that this leak is the result of pre-existing damage to the polycarbonate stopper, which is supplied by a third party

Why is the product not being recalled for replacement of faulty 3rd party stoppers?

In addition if a contaminated bag(outer bag) is opened the risk of staff hand contamination with mould/other organisms has not been discussed/mentioned.

regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

It seems the attachment was omitted. Trying again.

Michael Wishart, CICP-E

Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
cid:image001.png@01D01926.61F1C2B0

P Please consider the environment before printing this email

[Posted on behalf of Donna Cameron Moderator]

Dear Infexion Connexion subscribers,

I have just seen this product recall that will be of interest to many of you.

Regards,

Donna

Donna Cameron
Infection Control Consultant
T +61 (0) 3 8344 3574 (Monday, Wednesday & Friday); +61 (0) 3 9096 5233 (Tuesday & Thursday)
donna.cameron@unimelb.edu.au

Microbiological Diagnostic Unit Public Health Laboratory

The Peter Doherty Institute for Infection and Immunity
792 Elizabeth Street | Melbourne | Victoria | Australia | 3000
doherty.edu.au

cid:image001.gif@01D3FD7C.B4C863C0

“Australian Society for Antimicrobials” < info@asainc.net.au>

“ASA” < info@asainc.net.au>,

06/06/2018 09:12 AM

Product Defect Alert for DBL??? METRONIDAZOLE INTRAVENOUS INFUSION 500mg/100mL solution for injection bag

PO Box 8266 Angelo Street
South Perth 6151 Western Australia

Member Update 05 Jun 2018

Pfizer Australia has informed ASA of a Product Defect Alert for DBL METRONIDAZOLE INTRAVENOUS INFUSION 500mg/100mL solution for injection bag. See attached letter.

Please feel free to contact Wayne Lee if you wish to discuss this matter further:

Wayne Lee
Associate Medical Director
Pfizer Essential Health

Australian Society for Antimicrobials :: https://www.asainc.net.au

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[Glenys Harrington]

Hi Cate,

My understanding with these curtains is that there is no good evidence that
they reduce HAIs. While it has been established in an ICU setting that
there is a longer median time to contamination (14 days vs 2 days, p<0.01,
reference provided by Rosie in earlier posting) there is no evidence that
theses curtains minimise or reduce transmission of pathogens.

These types of curtains have primarily been introduced into Australian HCFs
because there are significant cost savings with their use (i.e. less
frequent changes, less manpower required to change, no laundry costs).

Hence if using and in order to ensure your warranty change as per the
manufacturer's instructions and when needed as others have suggested (i.e.
when soiled, during outbreaks).

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Cate Coffey

Hi everyone,

For those of you who use disposable curtains, would you share your curtain
change schedule with me?

cheers

Cate Coffey | Clinical Nurse Consultant

Infection Prevention and Control Unit | Central Australia Health Service

Northern Territory Government

Alice Springs Hopsital, Gap Rd, Alice Springs

GPO Box 2234, Suburb, NT Postcode

p … 08 89517737

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[Glenys Harrington]

Hi Kelly,

I don’t have any information about where you can hire adenosine triphosphate
(ATP) bioluminometers but would recommend you read the following peer
review article as there is quite a bit of variability of commercial ATP
bioluminometers.

. Whiteley G.S et al. The Perennial Problem of Variability In
Adenosine Triphosphate(ATP) Tests for Hygiene Monitoring Within Healthcare
Settings. Infect Control Hosp Epidemiol 2015;36(6):658-663.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Kelly Barton

Hi all,

Wondering if anyone know of where I could hire an ATP analyser?

Cheers,

Kelly

wash_your_hands_icon Hand Washing saves lives

cid:image001.png@01D3593E.B14EC410

Kelly Barton

Infection Prevention & Control Officer

P Reduce, re-use, recycle. Please consider the environment before printing
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[Glenys Harrington]

Hi Kaylene,

The device you mention is regulated by TGA as a Class 11b “Medical Device”
and is included in the TGA Australian Register of Therapeutic Goods (ARTG).
See attached TGA “Summary for ARTG entry” and “TGA Summary of Disinfectant
Regulations” at the following link
https://www.tga.gov.au/summary-disinfectant-regulation

As mentioned by Cath Murphy note the intended purpose in the “Summary for
ARTG entry” which states the following:

. “The ANTIGERMIX S1 (AS1) automaton is a dry disinfection process
for ultrasound transducers. The AS1 device performs a High Level
Disinfection on external or endocavitary ultrasound transducers. The process
is based on UVC radiation as an alternative to a chemical disinfection
process”.

Before using you should establish with the supplier/manufacturer of the
transducer/s and the supplier/manufacturer of the Class 11b “Medical Device”
[ANTIGERMIX S1 (AS1)] that they are compatible for the purposes of use and
your warranty.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of KAYLENE STYLES
UV Antigermix

Good morning all

I am looking for some assistance with managing the high level disinfection
of ultrasound probes. We currently use Trophon (hydrogen peroxide) but have
found a few new small ultrasound transducers for the renal patients that
have been brought into the system without an consultation with infection
prevention. These have not been tested with the Trophon system and we do not
have any other method to disinfect appropriately at this point.

Our biomedical team have distributed information to the teams that use
ultrasounds suggesting they implement UV Antigermix system. Is there anyone
using this?

Our team would appreciate any information that might help our choices.

Regards

Barwon Health

Kaylene Styles
Clinical Nurse Consultant | Infection Prevention Service | Barwon Health
Direct. (03) 4215 2323 |kaylenes@barwonhealth.org.au
Post. PO Box 281 Geelong 3220

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[Glenys Harrington]

Hi Suzanne,

In Victoria there have been no requirements for colour coded equipment for
environmental cleaning.

May be useful for training purposes but I’m not aware of any evidence to
support the practice (i.e. reduction in HAIs, decrease environmental
contamination)

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Suzanne Alexander

Hi all,

With the introduction of disposable cloths and microfibre, are facilities
still sticking to the colour coding of equipment for environmental cleaning?

For example:

Infectious/Isolation areas – Yellow

Toilets/Bathrooms/Dirty Utility rooms – Red

Food Service and food preparation areas – green

General cleaning – Blue

Operating theatres – white

Is it still essential when equipment is changed or discarded between zones
as per CEC Environmental Cleaning Standard Operating Procedure?

http://cec.health.nsw.gov.au/__data/assets/pdf_file/0005/258665/ecsop-module
-3-overview.pdf

Thanks

Suzanne

Suzanne Alexander

Clinical Nurse Consultant | Infection Management and Control Service

Level 1 Lawson House Wollongong Hospital, Crown Street Wollongong.
Tel. 02 4222 5898 pager:182 Mobile: 0475 943 479

Suzanne.Alexander@HEALTH.NSW.GOV.AU
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[Glenys Harrington]

Thanks Karen,

Will update on master copy and repost at the end of the week (in case I get
more feedback during he week)

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Turnbull, Karen P (THS)
[ACIPC_Infexion_Connexion] Infection Control courses (Graduate
Certificate/Masters) in Australia

Hi All,

Please note for the University of Adelaide GCert, the $16,500 fees listed is
the international student rate – domestic student fees are $3,225

Cheers,

Karen

Karen Turnbull | Nurse Manager | Infection Prevention & Control Unit

Launceston General Hospital, Level 2, Charles St, Launceston TAS 7250

email: karen.turnbull@ths.tas.gov.au

intranet: http://www.dhhs.tas.gov.au/intranet/thon/infection_control

Of Glenys Harrington
[ACIPC_Infexion_Connexion] Infection Control courses (Graduate
Certificate/Masters) in Australia

Dear All,

Further to my email below additional information/clarification has been
supplied by Megan in WA so I have updated the master document – see
attached.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Certificate/Masters) in Australia

Thanks Glenys for doing this, much appreciated. Just to let you know the WA
Grad Certificate is a 1 academic year part-time course.

Kind regards

Megan

Of Glenys Harrington
Certificate/Masters) in Australia

Dear All,

As per my posting below find attached a table of Infection Control courses
(Graduate Certificate/Masters) available in Australia.

For additional information please contact the universities or details
provided in the links column.

Many thanks to ACIPC members who assisted with providing information.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Glenys Harrington

Hi All,

I’m often asked for details of infection control course (i.e. certificate,
graduate diploma, masters) in Australia.

Does anyone have a list?

If not I’m happy to compile a list and share on infexion-connexion if
colleagues can send me through the details or links.

Many thanks in anticipation.

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

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[Glenys Harrington]

Hi Fiona,

See the following links, you may be able to follow up with the
manufacturers/suppliers:

. smiles kids toothbrush: surgical mask

http://www.adeevee.com/2006/10/colgate-palmolive-germany-smiles-kids-toothbr
ushes-surgical-masks-media/

. Child size masks with Disney characters – ask if they can make in
adult size?

https://www.halyardhealth.com/solutions/infection-prevention/facial-respirat
ory-protection/child-masks.aspx

https://www.businesswire.com/news/home/20040920005497/en/Kimberly-Clark-Intr
oduces-Child-Size-Face-Mask-Properly-Protect

Also saw the attached image where you can draw on the masks – do you have an
arts/edu department for kids? Might be an alternative as long as the
integrity of the mask is not damaged?

regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Kimber, Fiona (Health)
[SEC=UNOFFICIAL]

Happy New Year all!

We are trying (so far unsuccessfully) to source a fun colourful or printed
preferably ear loop surgical mask for staff to wear, when required, for our
paediatric patients requiring droplet precautions.

Does anyone use these and can point me in the right direction to find a
supplier?

Please email me privately if you do not want to name brands or manufacturers
in this discussion.

Thanks in advance

Kind regards,

Fiona Kimber RN

Infection Prevention and Control | ACT Health

T: 02 61745352 | M: 0466 358 475 E:
fiona.kimber@act.gov.au

Canberra Hospital

Building 10 Level 4

Garran ACT 2605

CHHS_Health – Co-Branded (Colour_Low)

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[Glenys Harrington]

Hi Fiona,

See the following links, you may be able to follow up with the
manufacturers/suppliers:

. smiles kids toothbrush: surgical mask

http://www.adeevee.com/2006/10/colgate-palmolive-germany-smiles-kids-toothbr
ushes-surgical-masks-media/

. Child size masks with Disney characters – ask if they can make in
adult size?

https://www.halyardhealth.com/solutions/infection-prevention/facial-respirat
ory-protection/child-masks.aspx

https://www.businesswire.com/news/home/20040920005497/en/Kimberly-Clark-Intr
oduces-Child-Size-Face-Mask-Properly-Protect

Also saw the attached image where you can draw on the masks – do you have an
arts/edu department for kids? Might be an alternative as long as the
integrity of the mask is not damaged?

regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Kimber, Fiona (Health)
[SEC=UNOFFICIAL]

Happy New Year all!

We are trying (so far unsuccessfully) to source a fun colourful or printed
preferably ear loop surgical mask for staff to wear, when required, for our
paediatric patients requiring droplet precautions.

Does anyone use these and can point me in the right direction to find a
supplier?

Please email me privately if you do not want to name brands or manufacturers
in this discussion.

Thanks in advance

Kind regards,

Fiona Kimber RN

Infection Prevention and Control | ACT Health

T: 02 61745352 | M: 0466 358 475 E:
fiona.kimber@act.gov.au

Canberra Hospital

Building 10 Level 4

Garran ACT 2605

CHHS_Health – Co-Branded (Colour_Low)

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[Glenys Harrington]

Hi Lincoln,

Flusher disinfectors that are used for emptying, washing and disinfection of
human waste containers should be in a dedicated dirty utility room/area and
not located in a clinical patient care area such as a high dependence unit
(HDU).

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Lincoln Fowler @BRHS

Thank you everyone for your consideration and responses.

I’ll ask another question: Do the standards/codes state, imply, require that
a “Flusher Disinfector” must not be in a patient area such as a high
dependency unit and should only be in a dirty utility room?

I’m mindful that aerosols could be a potential problem although the risks
around using open disposal areas with splashing is probably much higher.

I’d be interested to know of anyone who has direct experience of this type
of installation.

Cheers

Lincoln Fowler

Infection Prevention Nurse Consultant

Bairnsdale Regional Health Service

http://www.brhs.com.au

Think Green, read it from the screen.

Bairnsdale Regional Health Service acknowledges the Gunaikurnai people as
the traditional owners of the land on which the health service is located.

We recognise and respect their cultural heritage, beliefs and relationship
with the lands. We pay our respects to elders both past and present and
thank them for their contribution to the health service.

This communication is intended only to be read or used by the addressee.
Information contained in this communication may be confidential information.
If you are not the intended recipient, any use, interference with,
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Of Lincoln Fowler @BRHS

Hi Everyone

In developing an HDU the staff would like to have a pan sanitiser installed.
Has anyone else had experience with this?

Are there any development guidelines that refer to the requirements around
pan sanitisers?

Are they supposed to be located in a separate room, for example? Do they
produce aerosols so require a separate room?

The AusHFG do not seem to provide that kind of detail so your assistance
would be welcome.

Cheers

Lincoln Fowler

Infection Prevention Nurse Consultant

Bairnsdale Regional Health Service

http://www.brhs.com.au

Think Green, read it from the screen.

Bairnsdale Regional Health Service acknowledges the Gunaikurnai people as
the traditional owners of the land on which the health service is located.

We recognise and respect their cultural heritage, beliefs and relationship
with the lands. We pay our respects to elders both past and present and
thank them for their contribution to the health service.

This communication is intended only to be read or used by the addressee.
Information contained in this communication may be confidential information.
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