[Glenys Harrington]

Thanks for the feedback and background information Mathias.

Still leaves us with the question:

. Why in clinical areas of healthcare facilities do we recommend an
antiseptic agent (i.e. alcohol-based hand rub) for hand hygiene for “visibly
clean hands”, yet for “visibly soiled hands” an antiseptic agent is no
necessarily required?

As mentioned I would be interested to know how infection control
personnel/teams are overseeing, managing and monitoring this issue to
ensure transient microbial flora are being reduced or removed from
healthcare worker hands during handwashing (i.e. when hands are visibly
soiled/dirty).

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Matthias Maiwald (SingHealth – PATH)
hand washing with an antiseptic hand hygiene product in acute health
clinical areas

Dear Glenys,

You are touching upon two interesting questions:

(1) What is the role of plain versus antiseptic soap handwashing (as an
alternative to alcohol-based hand rubs) in healthcare facilities?

(2) What is the best method to clean or disinfect hands when they are
visibly soiled?

Re. (1). According to the literature (a bit too complex and convoluted to
give references here, but I summarized some of it in a 2009 review for the
then upcoming NHMRC guideline), the order of microbial elimination on hands
is roughly: plain soap < antiseptic soap << alcohol-based hand rubs. Most
antiseptic soaps/detergent are closer to plain soaps in terms of their
microbial elimination capacity, meaning they are usually not that great.
When I reviewed the literature on plain versus antiseptic soaps, it seemed
to me that there was no clear benefit of antiseptic soaps over plain ones in
general wards, but there seemed to be potential benefits of antiseptic soaps
in critical care areas. Among the antiseptic ingredients in soaps, triclosan
(mostly used in antiseptic household soaps) is very minimal in its
antimicrobial activity, whereas chlorhexidine (CHX) is somewhat better.
However, chlorhexidine is increasingly recognised as an agent of allergies
and contact dermatitis, and so one has to weigh the minimal benefit of
having an antiseptic ingredient with the potential downsides. We here are
phasing out CHX-containing antiseptic soaps in general ward areas and are
replacing CHX-containing ABHR with CHX-free ABHR (recent paper on CHX in

Re. (2). When I moved to Australia in 2002, I initially propagated what was
taught to me in medical school in the early 1980s, i.e. when hands are
visibly soiled, use ABHR first and then wash off the "dead bacterial
carcasses" (drastic wording used to teach us medical students so that it
would stick) with soap and water in a second step. That was consistent with
the "Vienna School" of hand hygiene (around Rotter) from the 1970s. However,
in 2002 I quickly gave up on this, because (a) no one believed me, and (b) I
realized that this was in contrast with what the then-upcoming CDC and WHO
HH guidelines would propagate, and I did not want to be discordant with
these, in order to avoid confusion and different teachings.

However, when examining things closely, it becomes clear that the
recommendation to only wash hands with soap and water when they are visibly
soiled is lacking a clear rationale and also data to support it. In
contrast, the Vienna school recommendation makes a lot of sense: (a) it has
been shown in earlier experiments in the 1960s and 70s that washing heavily
contaminated hands under running water above a sink creates heavily
contaminated splashes around the sink in about one metre plus diameter, and
(b) alcohol actually retains its antimicrobial killing capacity in the
presence of moderate organic soiling, i.e. the notion that alcohol does not
work in the presence of soiling is incorrect (e.g.
http://www.pubmed.gov/1629595). However, it must be emphasized that for this
to work, relatively larger-than-usual quantities of ABHR must be used,
meaning that a 1 ml or 2 ml portion of ABHR, as HCWs can often be observed
to be using, does not work. Liberal application is the key here.

Please don't misunderstand me, I am providing this mainly for clarification
and background information. I do NOT want to counteract the WHO
recommendation. Consistency (see statement above) is also an important
consideration.

Best regards, Matthias.

—

Matthias Maiwald, MD, FRCPA

Senior 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

Of Glenys Harrington
antiseptic hand hygiene product in acute health clinical areas

Dear all,

Hand washing with plain soap versus hand washing with an antiseptic hand
hygiene product in acute care facliity clinical areas

I understand some healthcare facilities have either replaced antiseptic hand
hygiene products in clinical areas of acute care facilities with plain soap
products or have added plain soap products as an option for handwashing
(i.e. when hands are visibly soiled/dirty).

Plain soap has minimal antimicrobial activity but after 30 seconds can
reduce counts by 1.8-2.8log10, however compliance with a 30sec hand wash is
poor.

Several studies of handwashing with plain soap have shown that plain soap
failed to remove pathogens from healthcare worker hands.

Standard handwashing with soap and water removes lipids and adhering dirt,
soil and various organic substances from the hands and remains a sensible
strategy for hand hygiene in non-healthcare settings.

Alcohol-based hand rubs are the most efficacious agents for reducing the
number of bacteria on the hands of personnel, however, there will be times
when healthcare worker hands are visibly soiled/dirty and they will need to
wash their hands rather than use an alcohol-based hand rub.

What is the issues?

My understanding is that in clinical areas staff should use an antiseptic
hand hygiene product when they need to wash their hands, not a plain soap
products?

Semmelweis demonstrated that hand antisepsis (i.e. the use of chlorinated
lime) was what stopped the infections in obstetric clinics not hand washing
with soap and water.

He noted that physicians and medical student who went from performing
autopsies to the delivery suite had a disagreeable odour on their hands
despite hand washing with soap and water before entering the clinic.

Infection control concerns

My concerns include the following:

. In clinical areas of organisations where antiseptic hand hygiene
products have been replaced with a plain soap product for hand washing (i.e.
when hands are visibly soiled/dirty) transient microbial flora are not being
reduced or removed from healthcare worker hands.

. In clinical areas of organisations where plain soap products have
been added as an option for hand washing (i.e. when hands are visibly
soiled/dirty), transient microbial flora are not being reduced or removed
from healthcare worker hands when they are using a plain soap product.

. Hand washing products are generally sourced from one supplier,
hence the dispensers (antiseptic & plain soap) are similar/same and usually
located adjacent to one another in clinical areas at hand washing
facilities/sinks.

o busy staff may not necessarily be aware of the difference in the
products

o Staff generally select what they will use based on smell, consistency,
feel and colour hence an antiseptic product may not be used at all when hand
washing.

Summary

This raises the following question:

. Why in clinical areas of healthcare facilities do we recommend an
antiseptic agent (i.e. alcohol-based hand rub) for hand hygiene for "visibly
clean hands", yet for "visibly soiled hands" an antiseptic agent is no
necessarily required?

I would be interested to know how infection control personnel/teams are
overseeing, managing and monitoring this issue to ensure transient
microbial flora are being reduced or removed from healthcare worker hands
during handwashing (i.e. when hands are visibly soiled/dirty).

Regards

Glenys

Definition of an Antiseptic agent

. An antimicrobial substance that inactivates microorganisms or
inhibits their growth on living tissues.

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 Michael,

Apologies for the delay in responding to your posting below

Just to clarify the product (disinfectant) has not been withdrawn from the
market. It can still be used on existing machines/heater cooler units while
the company are going through the process of registering the product with
the TGA.

In the interim what the TGA have done is suspended the supply of new 3T
devices (heater cooler devices/units)

See highlight below

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Michael Wishart
associated with heater-cooler devices

Thanks Glenys, very useful.

According to one of our perfusionists, Minncare has been available in
Australia as a cleaner (not TGA registered) for dialysis machines and HCUs
for years now. It seems LivaNova is now getting TGA approval for its use as
a disinfectant in their machines, so it has been withdrawn from the market
until approval is obtained.

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

P Please consider the environment before printing this email

mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Glenys Harrington
heater-cooler devices

Dear All,

Find below a link to the TGA update on Infections associated with
heater-cooler devices

https://www.tga.gov.au/alert/infections-associated-heater-cooler-devices

In summary:

A total of six Australians have been confirmed with Mycobacterium
chimaera infections following heart surgery involving heater-cooler devices

The confirmed cases of infection are associated with contaminated
Stckert Heater-Cooler 3T heater-cooler units that were manufactured before
September 2014

Testing of Stckert 3T Heater-Cooler System (3T) devices by
hospitals in Australia has identified that 25% of these devices have tested
positive for the Mycobacterium chimaera organism or other organisms. All
devices that tested positive were manufactured prior to September 2014

The TGA previously published advice regarding the potential for
water within heater-cooler units to become contaminated with bacteria, most
commonly non-tuberculous mycobacterium (NTM). There is evidence to suggest
that patients are infected when bacteria in the device’s water tank becomes
airborne

The latest recall for production correction by LivaNova, published
on the TGA Recall actions web site on 27 October 2017, is to install a
modification that reduces the risk of potential patient infection by
preventing dispersion of contaminated aerosols in the operating room:

o This correction will be implemented by onsite modification of units
currently in use

o The servicing will be undertaken in the field by LivaNova service
personnel or a local agent

Although the potential for infection is less likely when the 3T
devices water system is maintained according to the current Instructions
for Use (IFU), the disinfectant required to undertake the maintenance is not
currently included in the appropriate category of the Austrlian Register of
therapeutic Goods (ARTG)

Therefore, the TGA has suspended the supply of new 3T devices
until the disinfectant can be suitably accessed to ensure adequate
maintenance

o The suspension of the 3Ts devices ARTG entry does not preclude
LivaNova from undertaking the modifications to existing 3T devices

o The 1T devices will be replaced with 3T devices as the 1T devices are
unable to be modified to prevent aerosol dispersion

I contacted Livanova PTY LTD who advised that the disinfectant going through
the assessment process for registration with the TGA is a product called
Minncare Cold Sterilant (22% Hydrogen peroxide w/w, Peracetic acid 4.5%). I
have attached the safety data sheet.

The registration assessment process may take some months.

If you need more information you can contact Livanova PTY LTD and ask for
the Service Department

https://www.whitepages.com.au/livanova-australia-pty-limited-11933816/toowon
g-qld-11933814B

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]

Interesting summary Michael.

Do you have a link to the NSW Health requirement that you refer to below?

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Michael Wishart
disinfection wipe systems

Hi Pam

Some points for you to ponder, from myself and my CSSD Manager

. The TGA licensing (ARTG entry) will outline the basis for the use
of the product. Deviation from the licensed use is deemed non-0compliance.

. The Information For Use (IFU) for any product is to be the basis
for use.

. Note where a product requires specific timings for contact and
specific sequence of a cleaning / disinfection / neutralisation process for
the product to be effective than this process needs to be followed, and
documented.

. Non completion of the supplier recommended process will mean
noncompliance with the approved use of the product, and the product will not
have achieved the High Level Disinfection required. The operator then must
accept they are using a contaminated reusable medical device (RMD)!

. NSW Health requires where these types of product are used, a
formal education and annual competency on using these wipes for all staff
who are involved in areas such as ENT clinics where this product is known to
be used.

. If you do not have a documented training process and competency
then I believe the organisation must accept they are potentially supplying
contaminated RMD (ie no evidence the manufacturer’s process has been
followed), and wear any subsequent legal action for cross contamination. Be
warned!

. Be aware that there are specific transmittable viruses that are
not inactivated by these wipes if not used correctly.

Good luck! We have been lucky (!) enough here to steer clear of use of this
type of product thus far.

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

P Please consider the environment before printing this email

Of Pamela Ann Boon

Good afternoon everyone,

We use a 3 wipe high level disinfection process for non-channelled ENT
scopes.

We were wondering if the new 4187 standard will not permit wipe systems to
be used for high level disinfection for reusable medical devices.

Does anyone have any advice?

Thanks so much in advance.

Cheers from Pam (sweating +++ in Darwin!!)

Pamela Boon | Clinical Nurse Manager

Infection Prevention & Management Unit

Royal Darwin Hospital |Top End Health and Hospital Services
Casuarina, NT 0811
pamela.boon@nt.gov.au

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[Glenys Harrington]

Hi Cath,

Many thanks for sharing the Australasian Podiatry Council Infection
Prevention and Control Guidelines for Podiatrists 2012- they look
comprehensive.

However they don’t seem to be available nor promoted on the Podiatry Board
of Australia Web page – see attached, table below and the following link –
happy to be corrected

http://www.podiatryboard.gov.au/Policies-Codes-Guidelines.aspx

In the attached board document titled Guidelines for infection prevention
and control April 2016 – it states “The Board adopts the National Health and
Medical Research Council Australian guidelines for the prevention and
control of infection in healthcare (NHMRC guidelines) as amended from time
to time”

Given the above it would be of interest to know if the Podiatry Board of
Australia also endorses the Australasian Podiatry Council Infection
Prevention and Control Guidelines for Podiatrists 2012?

Infection control resources

Document

PDF

Accessible format

Date of effect

Infection control: Tips for patients when receiving care from a podiatrist

PDF (116 KB)

Word version
(80.6 KB,DOCX)

20 October 2017

Guidelines for infection prevention and control

PDF (70.4 KB)

Word version
(79.5 KB,DOCX)

From 4 April 2016

> NHMRC (2010) Australian guidelines for the prevention and control of
infection in healthcare, Commonwealth of Australia

PDF

Self-audit tool – Infection control obligations of podiatry practitioners

PDF (127 KB)

Word version
(91.3 KB,DOCX)

10 March 2016

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Catherine Wade
infection control

Hi Glenys,

Please find attached the current Australian Podiatry Guidelines

Cheers

Cath Wade

Clinical Nurse Consultant | Infection Prevention and Control

Level 1, 67 Holden Street Gosford Hospital

Catherine.Wade@health.nsw.gov.au or CCLHD-IPAC@health.nsw.gov.au

Of Glenys Harrington

Hi Joe,

As an information video for patients it is probably OK.

However if it were to be used as an infection control instructional video
for podiatrists or student podiatrist it is lacking detail – (i.e. cleaning
& packing before sterilisation, sterile stock storage and rotation,
environmental cleaning and disinfection, cleaning and disinfection of
reusable instrument used on intact skin close to wounds, ulcers).

Like other healthcare speciality groups they probably need their own set of
infection control guidelines that complement the NHMRC guidelines. Such
guidelines would cover things like the correct use of drills that can
airborne dispersion of human nail dust which may contain fungi and so on…

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Michael Wishart
infection control

Hi Joe

I had a quick look at the video and their other documents, and they
reference the right things (NHMRC guidelines and AS/NZS 4815), and nothing
seems inappropriate or glaringly omitted on a quick scan. My only criticism
would be that they do not list in their policy any specific infection
control requirements for podiatrists, merely refer to the NHMRC guidelines.
The audit tool they do have does seem to cover the important issues, though.

But there is no reference to any infection control professionals being
consulted on these infection control documents from the Podiatry Board that
I can see, so maybe there is an opportunity for ACIPC to offer ‘endorsement’
of these guidelines?

Would be useful to suggest this to the Board through the national office
manager I would think.

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

Good morning

Has anyone had a chance to view the video from the Podiatry Board of
Australia. It was produced with APHRA.

I don’t think there was any IP&C consultation?

http://www.podiatryboard.gov.au/News/2017-10-20-media-release-tips.aspx

Thanks

Joe

Joe-Anne Bendall

HAI Program Manager | Governance and Assurance

Level 17, 2-24 Rawson Place, Haymarket, NSW 2000
Tel (02) 9269 5614 | Fax (02) 9269 5599 | Joe-Anne.Bendall@health.nsw.gov.au
http://www.cec.health.nsw.gov.au/patient-safety-programs/assurance-governanc
e/healthcare-associated-infections

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[Glenys Harrington]

Hi Joe,

As an information video for patients it is probably OK.

However if it were to be used as an infection control instructional video
for podiatrists or student podiatrist it is lacking detail – (i.e. cleaning
& packing before sterilisation, sterile stock storage and rotation,
environmental cleaning and disinfection, cleaning and disinfection of
reusable instrument used on intact skin close to wounds, ulcers).

Like other healthcare speciality groups they probably need their own set of
infection control guidelines that complement the NHMRC guidelines. Such
guidelines would cover things like the correct use of drills that can
airborne dispersion of human nail dust which may contain fungi and so on…

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Michael Wishart
infection control

Hi Joe

I had a quick look at the video and their other documents, and they
reference the right things (NHMRC guidelines and AS/NZS 4815), and nothing
seems inappropriate or glaringly omitted on a quick scan. My only criticism
would be that they do not list in their policy any specific infection
control requirements for podiatrists, merely refer to the NHMRC guidelines.
The audit tool they do have does seem to cover the important issues, though.

But there is no reference to any infection control professionals being
consulted on these infection control documents from the Podiatry Board that
I can see, so maybe there is an opportunity for ACIPC to offer ‘endorsement’
of these guidelines?

Would be useful to suggest this to the Board through the national office
manager I would think.

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

P Please consider the environment before printing this email

Of Joe-Anne Bendall

Good morning

Has anyone had a chance to view the video from the Podiatry Board of
Australia. It was produced with APHRA.

I don’t think there was any IP&C consultation?

http://www.podiatryboard.gov.au/News/2017-10-20-media-release-tips.aspx

Thanks

Joe

Joe-Anne Bendall

HAI Program Manager | Governance and Assurance

Level 17, 2-24 Rawson Place, Haymarket, NSW 2000
Tel (02) 9269 5614 | Fax (02) 9269 5599 | Joe-Anne.Bendall@health.nsw.gov.au
http://www.cec.health.nsw.gov.au/patient-safety-programs/assurance-governanc
e/healthcare-associated-infections

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[Glenys Harrington]

Dear All,

Product looks interesting and is probably a cheaper alternative than Mupirocin. Also using an antiseptic like this would have some practical advantages, no scripts, shorter period of application time etc..

In the SSI paper I posted in the pre-intervention period patients were responsible for applying topical mupirocin in the pre-intervention period (preoperatively). Data was not shown but sound like there was very poor compliance.

In the intervention period staff applied the Nozin and compliance was good. In addition to the antiseptic properties of the product compliance with application may have impacted the results in the intervention period.

Studying 2 interventions at the same time is not ideal (staff and patient use of Norzin).

Needs a study (on patients only) to show same or better reduction in Staphylococcus aureus SSIs reduction when used with other evidence based interventions (i.e. bathe daily with chlorhexidine-gluconate (CHG) before operations, screening for Staphylococcus aureus and topical mupirocin preoperatively).

Schweizer ML et al. Association of a Bundled Intervention With Surgical Site Infections Among Patients Undergoing Cardiac, Hip, or Knee Surgery. JAMA. 2015;313(21):2162-2171.

Bailey RR et al. Economic Value of Dispensing Home-Based Preoperative Chlorhexidine Bathing Cloths to Prevent Surgical Site Infection. Infect Control Hosp Epidemiol. 2011 May ; 32(5): 465471

Definitely an area that needs more research as last time I checked the Vic figures (2012), 29% of THRs and 36% of TKR were associated with Staphylococcus aureus (including MRSA). Hopefully the above evidence based strategies have been implemented in Vic and across Australia since 2012?

In addition these infections are costly – In 2006 VICNISS established that the average cost following a THR infection was $34,138 and following a TKR infection was $40,940 (VICNISS Hospital Acquired Infection Project Year 4 report August 2006).

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Hi Michael,

Exactly, if it causes a temporary 10-h (or so) drop in S. aureus numbers in the nose in the perioperative phase, and the nose is a seeding source for SSIs, then it would be useful for the purpose of SSI prevention. But let us see if this is confirmed/supported in further investigations.

In the Mullen et al. paper that Glenys sent, I do notice a 81% reduction in SSI incidence allegedly due mostly to the nasal treatment protocol, which is a big number, and this just seems a bit on the high side to be caused by nasal decolonisation alone.

A remaining concern clearly is the claim of sustained decolonization (see below). This is clearly an exaggerated claim, given that only 10 hours have been examined. Now, in my opinion, exaggerated claims of any kind, particularly associated with the impetus to sell/market products, should raise alarm bells in any of us from the medical/scientific community. Such matters should not be downplayed or taken as trivial offences.

Best regards, Matthias.

—

Matthias Maiwald, MD, FRCPA

Senior Consultant in Microbiology

Adj. Assoc. Prof., Natl. Univ. Singapore

Department of Pathology and Laboratory Medicine

KK Women’s and Children’s Hospital

100 Bukit Timah Road

Singapore 229899

Tel. +65 6394 8725 (Office)

Tel. +65 6394 1389 (Laboratory)

Fax +65 6394 1387

Hi Matthias

In regard to an attempt to minimise self-inoculation with Staph aureus in the peri and early post-operative phase, would not 10 hours be a reasonable target?

I dont disagree with your terminology assessment, but, terminology aside, if we are attempting to prevent early-onset SSI with Staph aureus, would not this claim be reasonable in that context?

One of the posters cited on that website also suggested that peri-operative staff use of this product (voluntary, of course!) also could result in lower incidence of Staph aureus SSI. If there any biological plausibility in that concept?

Just wondering if this product does have a use, albeit not as a decoloniser.

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

P Please consider the environment before printing this email

Hi Cath, hi Michael,

Thank you so much!

It was in fact exactly the Steed et al. 2014 paper and also the Infection Control Today White Paper that I had seen earlier (a while ago see my comment) and that I found unconvincing.

Similarly, what is written on the Nozin webpage is unconvincing.

Most of us, when we talk about, or read about decolonisation, we understand or imply that the effect is sustained for some time, e.g. weeks or months, or ideally permanently in the absence of external re-exposure. If I am not wrong, I think the historical origins of the modern S. aureus or MRSA decolonisation lie in the 1960s and 1970s in efforts to (a) reduce S. aureus infections affecting neonates in nurseries, and (b) to end the cycle of endogenous reinfection that is driving furunculosis.

The Steed paper is astonishing in its claims. It tests a reduction of S. aureus nasal bacterial counts up to 10 hours after application, but not any follow-up beyond these 10 hours. That is not what most of us in the profession would understand as decolonisation.

Neither the ICT White Paper nor the Website nor the Steed article seems to provide any data that go beyond these 10 hours, and yet, claims are made (e.g. page 5, White Paper) of sustained decolonization. The website describes it as long lasting and unlike the fleeting effect of hand sanitizers. Again, there is nothing to support this claim.

Combined with the problems of applying alcohol to mucous membranes (see my earlier e-mail), I would say that biological plausibility of how this agent is supposed to provide sustained decolonisation in the sense of what we usually understand as decolonisation is not established.

Best regards, Matthias.

—

Matthias Maiwald, MD, FRCPA

Senior Consultant in Microbiology

Adj. Assoc. Prof., Natl. Univ. Singapore

Department of Pathology and Laboratory Medicine

KK Women’s and Children’s Hospital

100 Bukit Timah Road

Singapore 229899

Tel. +65 6394 8725 (Office)

Tel. +65 6394 1389 (Laboratory)

Fax +65 6394 1387

Hi Cath

This product is not available in Australia, either. I would be surprised if there are any centres in Australia using formulations of ethanol or povidone iodine for nasal decolonisation currently, but would love to hear from anyone that can source appropriate nasal decolonisation products of this type in Australia.

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

P Please consider the environment before printing this email

Hi Matthias

I was loathe to use trade names on this site. However, I will to respond. There is a growing body of US evidence around a product called Nozin. More details are at nozinpro.com

When I was at APIC in June 2017 there was a lot of interest in the product in healthcare and other settings.

Thanks for your view on the existing literature Matthias, I always enjoy your responses.

Yours sincerely

Cath

Cathryn Murphy RN B. Photog MPH PhD CIC

Chief Executive Officer & Creative Director

Infection Control Plus Pty Ltd

QLD, Australia

E: Cath@infectioncontrolplus.com.au

M: +61 428 154154

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

Hi Cath, hi Michael,

I am curious about the remark below concerning ethanol for nasal decolonisation. The last time I looked (which is a while ago), the results achieved were not convincing.

From a physiological and/or conceptual point of view, while alcohol is a fantastic antiseptic/disinfectant for superficial skin, it is usually deemed unsuitable for mucous membranes (which the inside of the nose consists of), due to its more aggressive nature than aqueous antiseptics.

Best regards, Matthias.

—

Matthias Maiwald, MD, FRCPA

Senior Consultant in Microbiology

Adj. Assoc. Prof., Natl. Univ. Singapore

Department of Pathology and Laboratory Medicine

KK Women’s and Children’s Hospital

100 Bukit Timah Road

Singapore 229899

Tel. +65 6394 8725 (Office)

Tel. +65 6394 1389 (Laboratory)

Fax +65 6394 1387

Hi Cath

Just a comment: the povidone iodine nasal cream commonly used pre-op in the US is not yet available in Australia, as far as I am aware. I wish it was, as getting traditional pre-admission nasal decolonisation (5 days of mupuricin or the like) done in a private hospital is not easy!

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

P Please consider the environment before printing this email

Dear All

I am interested in learning more about the adoption and use of nasal decolonisation in Australia and New Zealand. In the US this appears to be being used sometimes in place of Contact Precautions. There is a download from IC Today to that effect plus some recent papers. Happy to share if anyone wants it, please email me. So would any of you be able to comment on these questions and if and how you use nasal decolonisation in your organisations please. Thanks in advance.

a) other than ethanol and povidone iodine (e.g.: 3M and others) what else is used for nasal decolonisation right before surgery?

b) which are the most commonly used products?

c) what are the surgery profiles where these are used? (e.g.: ortho, open heart, hernia repair etc)

d) what is the adoption rate for using something like this? Is it universal or a % of surgeons opt to do it?

Yours sincerely

Cath

Cathryn Murphy RN B. Photog MPH PhD CIC

Chief Executive Officer & Creative Director

Infection Control Plus Pty Ltd

QLD, Australia

E: Cath@infectioncontrolplus.com.au

M: +61 428 154154

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

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[Glenys Harrington]

Hi Katherine,

Information below and attached may be of interest/use in relation to your
query

1. Body R. FANS SPREAD INFECTION IN CLINICAL AREAS? Emergency Medicine
Journal 2008; 25 623-623 Published Online First: 08 Oct 2008.

http://emj.bmj.com/content/25/10/689.1

2. Construction and Renovation.
Judene Bartley,
Russell Olmsted APIC, 30 Jun. 2007 page 324- 326.

Includes Recommendations and suggested elements for a site specific fan
policy

See if your library can access/borrow or get copies of the pages/chapter of
the text book for you.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Cathryn Murphy

Hi Katherine

There has been some amazing new research done on air turbulence in operating
theatres where a HEPA/ Ultraviolet air recirculation system (HUAIRS) is in
use. I saw it presented at an Australian Orthopaedic Association Conference
in Adelaide 3 weeks ago.

The results may not yet be published but they are disturbing given that
there were very large increases in turbulence even when just one person
entered the OR. Air turbulence is an invisible issue and as such one we may
not have ever given it enough consideration. Some of the issues raised in
the research may be able to be generalised to support your argument.

I am happy to put you in contact with the researcher if you think that it
would help. In the interim here are a couple of general papers on air and
spread.

Yours sincerely

Cath

Cathryn Murphy RN B. Photog MPH PhD CIC

Chief Executive Officer & Creative Director

Infection Control Plus Pty Ltd

QLD, Australia

E:
Cath@infectioncontrolplus.com.au

M: +61 428 154154

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

Of McKay, Katherine

Greetings!

I am seeking information on the use of oscillating, portable fans for
patient cooling in ICU settings. Our units are very enthusiastic to
purchase said items, however we are not keen due to the risk of turbulent
airflow, aerosolization of pathogens etc. The ICU teams are requesting
documentation/studies/evidence to support our stance – a brief look has
failed to find anything but we are wondering, before I dig deeper, if
anyone had had to respond to this issue and was able to share this
information.

Katherine McKay

Clinical Nurse Consultant

Hand Hygiene Portfolio

Infection Prevention and Control Services

Box Hill Hospital

Eastern Health

P: (03) 9895 3480

E:
katherine.mckay@easternhealth.org.au

http://www.easternhealth.org.au

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[Glenys Harrington]

Hi All,

For those following this thread the following information is available and
in the public domain.

The two main reference in the IC Today article that relate to the use of the
nasal antiseptic (Nozin) for decolonisation of staff and patients are as
follows:

. SteedLL et al. Reduction of nasal Staphylococcus aureus carriage
in health care professionals by treatment with a nonantibiotic,
alcohol-based nasal antiseptic. American Journal of Infection Control 42
(2014) 841-6

Full paper – http://www.ajicjournal.org/article/S0196-6553(14)00651-8/pdf

. Perioperative participation of orthopedic patients and surgical
staff in a nasal decolonization intervention to reduce Staphylococcus spp
surgical site infections. Am
J Infect Control. 2017 May 1;45(5):554-556

Full paper – http://www.ajicjournal.org/article/S0196-6553(17)30006-8/pdf

and hence should be read with caution – see link

http://www.infectioncontroltoday.com/~/media/Files/Medical/Whitepapers/2017/
10/20170922-ND-broadening-application-CP-.pdf

From the manufacturer/supplier web page:

. The product is FDA approved (OTC Drug Regulation) and it contains
the following ingredients:

. Ingredients for Nozin Nasal Sanitizer antiseptic

. Active Ingredients:
Alcohol (62% antiseptic)

. Inactive Ingredients:
jojoba, orange oil, coconut oil, lauric acid, benzalkonium chloride, vitamin
E

https://www.nozin.com/

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Cathryn Murphy

Hi Matthias

I was loathe to use trade names on this site. However, I will to respond.
There is a growing body of US evidence around a product called Nozin. More
details are at nozinpro.com

When I was at APIC in June 2017 there was a lot of interest in the product
in healthcare and other settings.

Thanks for your view on the existing literature Matthias, I always enjoy
your responses.

Yours sincerely

Cath

Cathryn Murphy RN B. Photog MPH PhD CIC

Chief Executive Officer & Creative Director

Infection Control Plus Pty Ltd

QLD, Australia

E: Cath@infectioncontrolplus.com.au

M: +61 428 154154

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

Of Matthias Maiwald (SingHealth – PATH)

Hi Cath, hi Michael,

I am curious about the remark below concerning ethanol for nasal
decolonisation. The last time I looked (which is a while ago), the results
achieved were not convincing.

From a physiological and/or conceptual point of view, while alcohol is a
fantastic antiseptic/disinfectant for superficial skin, it is usually deemed
unsuitable for mucous membranes (which the inside of the nose consists of),
due to its more aggressive nature than aqueous antiseptics.

Best regards, Matthias.

—

Matthias Maiwald, MD, FRCPA

Senior 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

Of Michael Wishart

Hi Cath

Just a comment: the povidone iodine nasal cream commonly used pre-op in the
US is not yet available in Australia, as far as I am aware. I wish it was,
as getting traditional pre-admission nasal decolonisation (5 days of
mupuricin or the like) done in a private hospital is not easy!

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

P Please consider the environment before printing this email

Of Cathryn Murphy

Dear All

I am interested in learning more about the adoption and use of nasal
decolonisation in Australia and New Zealand. In the US this appears to be
being used sometimes in place of Contact Precautions. There is a download
from IC Today to that effect plus some recent papers. Happy to share if
anyone wants it, please email me. So would any of you be able to comment on
these questions and if and how you use nasal decolonisation in your
organisations please. Thanks in advance.

a) other than ethanol and povidone iodine (e.g.: 3M and others) what else is
used for nasal decolonisation right before surgery?

b) which are the most commonly used products?

c) what are the surgery profiles where these are used? (e.g.: ortho, open
heart, hernia repair etc)

d) what is the adoption rate for using something like this? Is it universal
or a % of surgeons opt to do it?

Yours sincerely

Cath

Cathryn Murphy RN B. Photog MPH PhD CIC

Chief Executive Officer & Creative Director

Infection Control Plus Pty Ltd

QLD, Australia

E: Cath@infectioncontrolplus.com.au

M: +61 428 154154

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

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[Glenys Harrington]

Interesting paper Cath.

Would be interesting to know if the suggested EUWorld Health Organization (Fig 1) permissible levels of microbial contamination are current (reference is from 2008)? http://www.tandfonline.com/doi/pdf/10.1080/10803548.2008.11076783?needAccesstrue )?

If current, general ORs [class II] will have an allowable number of bacterial CFU of <50 CFU/m3 , and orthopedic, cardiac, and transplant ORs an allowable number of bacterial CFU of <10 CFU/m3 [class I]).

It is important to establish when the taking of samples in ORs is recommended. For example should samples be taken:

a) At rest – i.e. with all services functioning and equipment installed and operable or operating, but without surgical and healthcare staff and the patient); or

b) When operational – i.e. all services and equipment functioning, medical staff surrounding the patient lying on the operating table and surgical procedure underway, door opening and closing.

It would be unlikely that a permissible limits of <10 CFU/m3 would be achievable with current OR air quality requirements in Australian if the sampling is undertaken when the ORs are operational.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Hi Terry and All

A little relatedI have been working on a project in relation to ultra-clean OR particularly in relation to implants and as an adjunct to all the other standard approaches asepsis, surgical skill, environmental cleaning and surgical hand asepsis.

This is an incredibly interesting paper from AJIC that infers our current approaches can be improved. It is particularly encouraging to see Australia mentioned. The paper is worth a read in my opinion anyway.

Yours sincerely

Cath

Cathryn Murphy RN B. Photog MPH PhD CIC

Chief Executive Officer & Creative Director

Infection Control Plus Pty Ltd

QLD, Australia

E: Cath@infectioncontrolplus.com.au

M: +61 428 154154

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

Thanks Michael,

I’ve suggested a waiting period between cases based on the time taken to achieve a full air exchange in the OR and of course cleaning thoroughly between cases (as they should already be).

Kind Regards

Terry McAuley

Director

STEAM Consulting Pty Ltd

M: 0438109692

Sent from my Samsung Mobile on the Telstra Mobile Network

——– Original message ——–

Hi Terry

We had this question many years ago at St Elsewheres when we opened a new imaging procedure room that was used for vascular grafts. Because the imaging was so good, a gastroenterologist wanted to do so specific colonoscopy procedures requiring imaging in it. The vascular surgeons kicked up a big stink, but the ID/micro people supported it with the appropriate cleaning between cases and use of the procedure room (it was HEPA filtered) for both types of cases.

Similar concept. Not sure if there would be a need to be a waiting period to ensure appropriate air changes before ophthalmic procedures that followed endoscopies (eg possible aerosolized viruses?).

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

P Please consider the environment before printing this email

Hi Everyone,

I have been asked if there is any evidence available that would indicate that you should not perform ophthalmic procedures in a correctly ventilated Operating Room after the OR has been used for endoscopy procedures.

I havent been able to locate anything suggesting that this is an issue however before making a recommendation I thought I would ask the Brain Bank if they have ever researched this question and if so have they found an answer?

Kind Regards

Terry McAuley

Sterilisation & Infection Prevention and Control Consultant

STEAM Consulting Pty Ltd ACN 604 439 698

E: terry@steamconsulting.com.au

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

A: PO BOX 779

Endeavour Hills

VIC Australia 3802

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[Glenys Harrington]

Hi Terry,

The following information from the Industry Code of Practice for the Management of Biohazardous Waste (including clinical & related wastes) 7th E D I T I O N, 2014 may be of interest/use:

Glossary of terms and definitions

Container – This refers to any rigid walled receptacle designed for biohazardous waste (or other wastes) to be deposited into it

4. Management responsibilities

4.4 waste handling techniques

o 4.4.3 All biohazardous waste containers removed from any premises for treatment and/or disposal of the contents shall have the lids of the containers secured prior to transport.

6. Waste containment

6.1 containers and packaging

o 6.1.1. The correct packaging of wastes is the responsibility of the generator. The waste transporter, however, should advise the generator of any problems associated with the packaging of waste.

o 6.1.2. All outer containers used for biohazardous waste shall be of a rigid design with a lid that is able to be secured and prevent spillage of the contents during transport under normal operating conditions. This container should be designed to be easily handled or moved, and be easily identifiable by its colour, with the correct labelling and symbols for the waste type contained within.

o 6.1.3. All generator facilities shall, as a minimum:

(a) Use containers which meet the requirements as specified by Australian/New Zealand Standards and/or Australian/New Zealand Dangerous Goods Code and/or any regulatory authority (where applicable), for each type of biohazardous waste that they

generate;

The following information will be relevant to open containers in clinical areas (i.e. ICU):

4. Management responsibilities

4.4.2. For safety and risk minimisation purposes, waste transport/treatment/disposal companies shall:

o Reduce human contact with biohazardous waste (e.g. by using non-manual handling techniques and not decanting uncontained waste into larger containers);

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Dear All,

I came across this ‘rule’ while working in the NHS in England some years ago, no evidence at all and disruptive to the flow in the operating and recovery rooms, but they were non-negotiable on this.

Kind regards

Jackie

Jackie Miley

RN MSc PGCert Public Health, Cert Infection Control

PRACTICE MANAGER ERIN STREET ORTHOPAEDICS

NURSE CONSULTANT

On 21 August 2017 at 08:21, Mandy DAVIDSON wrote:

Morning

I have checked this before my previous conversations with the waste manager identified that – public thoroughfares open ward environments the bins need to meet the Australian standards and be leak proof and Vermin proof.

The other benefits of having lids is

1. Assist in segregation of rubbish it is easy to see what type of bin it is and you have to think about what you put in because you activate a pedal.

2. It SHOULD stop people from retrieving items that they have accidently placed in a bin.

My waste manager identified that you can go for the option without a lid

in closed practice environments (ICU, Theatres etc),

In other open practice environments (wards etc) this may also be an option, but you should have more frequent waste audits to ensure that segregation practices are remain compliant and associated waste costs dont sky rocket.

It may also be dependent on state environmental and local waste regulations as well. I hope this helps

Thanks

Mandy Davidson

RN DipPHTM MPHTM JCU

Cert III Sterilisation services; Cert IV TAE; Immunisation credentialed

CNC Infection Prevention & Control

Townsville Hospital & Health Service

Pathology Building

IMB 38

P: 4433 3567

Mandy.Davidson@health.qld.gov.au

Hi Terry Mc and others,

Not sure about having to have a lid but there is NO scientific evidence the lid must be closed. I suspect it is the accrediting agency that is over-zealous.

*In terms of sharps bins in OR there have been two cases reported in the worlds literature where staff have stumbled and placed hand in open bin but there are numerous others where staff have been injured opening lid with sharps in hand.
*In terms of CW bins, there is no evidence that an open top bin causes increased risk to staff or patients. With 15-20 air changes per hour, any wafted pathogens are likely to be entrained and removed before they get to patient or sterile field.
*It stands to reason if you move a bin, you close it first (OSHA law in USA) but best if bins open during a procedure (or foot operated). Organisms do not waft out when open-top bin is unused only when waste is being inserted (piston effect).
*We know that the staff and patient are a far greater source of organisms than a CW bin.

I would ask accrediting agency to produce the reasoning/evidence and then we should communicate with their source and discuss.

Hope this helps, Best regards, TerryG.

Terry Grimmond FASM, BAgrSc, GrDpAdEd

Consultant Microbiologist

Grimmond and Associates

Ph (NZ): +64 7 855 3212

Mob (NZ): +64 274 365 140

E: terry@terrygrimmond.com

: @terrygrimmond

W: http://terrygrimmond.com

“This email (including any attachments) is intended only for the use of the individual or entity named above and may contain information that is confidential and privileged. If you are not the intended recipient, you are reminded that any dissemination, distribution or copying of this email or attachments is prohibited. If you have received this email in error, please notify me immediately by return email or telephone and destroy the original message. Thank you.”

Hi Everyone,

I have a client that has been told by an accreditor that they MUST have waste bins with lids.

I have been scouring the NHMRC Guidelines, AS3816 and other state based guidelines available in the public domain, however I am yet to come across a statement where it mandates that waste bins must have lids.

I can appreciate in ward area it is aesthetically pleasing to have lidded bins, with hands free operation of course.

However in the Operating Suite, Recovery Room and also in dental procedure rooms, it makes no sense to me at all to have lids on the waste bins. In fact it adds to the complication of safe patient care and waste disposal.

Can anybody point me in the direction of a published Standard or Guideline that mandates that lids must be on waste bins in Health Services Organisations?

Thanks in anticipation.

Kind Regards

Terry McAuley

Sterilisation & Infection Prevention and Control Consultant

STEAM Consulting Pty Ltd ACN 604 439 698

E: terry@steamconsulting.com.au

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

A: PO BOX 779

Endeavour Hills

VIC Australia 3802

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[Glenys Harrington]

Hi all,

A picture often helps to tell a story.

J Granville-Chapman and R L Dunne review the etiquette of sneezing in surgical masks. BMJ | 22-29 December 2007 | Volume 335

This surgical team looked at sneezing etiquette and the efficacy of masks in the operating theatre. The images on page 1293 of the attached article (and at the link below) will help demonstrate how a mask worn during an operating procedure can help protect the patient. i.e. Surgical masks are effective at containing a lot of droplets.

http://www.bmj.com/content/335/7633/1293

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Dear Cathryn and Michael, agree wholeheartedly have had to fit this fight for to many years, found it helpful ( and typical not to see the value to the patient) to focus on the wearer not the patient safety. I use the example would they do procedures without glove – of course not!!!!! Same applies to masks and eye protection.

Lesley Alway

Director

Strategic Health Resources.

Post Graduate Education Services.

0408 324 727

03 94390534

Director Australian Health Design Council

Logowithtxt_AHDC

Dear All

I agree with Michaels rationale and agree there are cases of occupational transmission of serious bloodborne illness from mucousal splashes reported in the literature. So from an OCH&S obligation the HCW should comply.

This is one of those frustrating issues that come up from time to time and they drive me crazy. They are like the ? of eating in theatres/ anaesthetists wearing masks/ OT staff changing attire etc. Why IC professionals continually have to fight these causes is exhausting and sad but back to the science.whilst Michael provides a meta-analysis it is a few years old and it is based on very few reports probably because the issue hasnt been well studied not that the issue isnt important.

I would also draw attention to the increasing use of air-purifying systems in the US and other countries. Some of the data related to validation studies are very compelling and show how CFU counts of bacteria rise (sometimes to extremes) when speaking (behind masks) happens. Obviously showing causation between high counts/ speaking and actual wound infection is difficult given to the many confounders (# of people in the room/ traffic/ movement/ +/- measures like laminar flow/ skin prep etc etc) but surely it just makes sense for people in the OR to wear masks for everyones sake.

Off track..but I recall being asked this exact question by a group of anaesthetists at a scientific meeting in the late 1990s and after responding seriously and scientifically I then added mask wearing depends on how good looking you are and in your case I wouldas you can imagine it went down like a lead balloon but it silenced the question asker.

I seriously wish you good luck in fighting these battles and I wish the people we served relaised the very serious and very real issues we fight daily and perhaps then they would stop creating distractions like this.

With respect

Cath

Cathryn Murphy RN B. Photog MPH PhD CIC

Chief Executive Officer & Creative Director

Infection Control Plus Pty Ltd

QLD, Australia

E: Cath@infectioncontrolplus.com.au

M: +61 428 154154

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

Hi Fran

This topic has received a fair bit of attention over the years, and yes, your doctors are correct: there is no compelling evidence to suggest surgical face masks reduce surgical site infection rates. See this meta-analysis conclusion: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0064347/

Having said that, my own rationale for staff wearing surgical face masks during procedures is for protection of their mucous membranes from splashing of potentially infectious material. In my view, the strike resistance for surgical face masks is of high importance, and has little to do with preventing contamination of the surgical wound.

To suggest staff in a room during a procedure dont wear masks would in my opinion be asking for trouble. From a occupational health and safety perspective, I would always recommend everyone in a room during a surgical procedure should be wearing a surgical face mask, and eye protection as well.

In my view, anyway.

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

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Afternoon All,

I require some assistance please.

Weve had interesting discussions amongst some of Visiting Medical Officers regarding the effectiveness of wearing surgical masks in the operating room to decrease the likelihood of postoperative surgical site infections. The practice of wearing masks is believed to minimize the transmission of oro-and nasopharyngeal bacteria from Theatre Operating staff to patients wounds. However a couple of individuals believe there is not enough evidence to support this and therefore dont think it is necessary to wear surgical masks while operating.

Im aware of the requirements as per the ACORN Standards and the National Infection Control Guidelines (2016 Draft version), which our Staff complies by, however I cannot find current best practice or evidence to provide to those two individuals.

Any suggestions please? And if youre willing to share, what is the Policy in regards this matter at your facilities?

Kind Regards

Franciska Ferreira

Infection Prevention & Control/Wound Management Consultant

Burnside War Memorial Hospital

120 Kensington Road, Toorak Gardens, SA 5056

t: 08 8202 7231 f: 08 8407 8573 e: fferreira@burnsidehospital.asn.au

technology_to_control_infections

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[Glenys Harrington]

Hi Verily,

The 2015 Australian ANZCA guideline is similar to the 2014 UK safety
guideline which is specific to central neuraxial blockade(CNB) and states
the following:

. “Given the lack of convincing evidence of the antimicrobial
superiority of a 2% solution of chlorhexidine in alcohol over a 0.5%
solution, but the presence of clear evidence of the neurotoxicity of
chlorhexidine, the Working Party has concluded that the use of a 0.5%
solution should be preferred over a 2% solution for skin antisepsis before
CNB”.

The UK document also includes and extensive review of chlorhexidine, alcohol
and neurotoxicity and methods of application.

In terms of the type of applicator you mention the document states the
following:

. “The applicators are manufactured with a reservoir containing 3 ml
or 10.5 ml of antiseptic, and the solution may be dyed to allow
identification of the area of prepared skin. Because the antiseptic solution
is contained within the hollow of the handle, crossover errors are
impossible and fluid spillage should be minimised. However, it has been
observed that leakage of antiseptic solution over the operator’s gloves may
occur via a hole at the end of the handle when the device is held upside
down (the hole below the level of the antiseptic reservoir) to clean a
patient’s back [19]”.

Hence it seems there are some risks with these types of applicators not just
that the concentration of chlorhexidine is higher than recommended in the
device you are currently utilising.

See attached and link below:

. Association of Anaesthetists of Great Britain & Ireland. Safety
guideline: skin antisepsis for central neuraxial blockade. Anaesthesia 2014,
69, 1279-1286

https://www.aagbi.org/sites/default/files/skin%20antisepsis%20for%20central%
20neuraxial%20blockade_0.pdf

regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Verily Thomas

Hi Michael

Kindly forward this email to members for advise and comment, much
appreciated.

Kind Regards

Verily Thomas
Clinical Nurse Consultant | Infection Prevention and Control
SWSLHD-Bankstown/Lidcombe Hospital

Eldridge Road, Bansktown.NSW 2200
Tel 02 97228000 pager 28230

Tel 02 9722 8633 | Fax 02 9722 7822 | verily.thomas@sswahs.nsw.gov.au
http://www.health.nsw.gov.au

LET’S KEEP OUR HOSPITAL ENVIRONMENT CLEAN

HAND HYGIENE SAVES LIVES

Hi Verily,

The chlorhexidine swabs sticks that were trialled for neuraxial blocks in
perioperative services were 2% chlorhexidine in 70% Alcohol, the ANZCA
guidelines on infection control in Anaesthesia PS28 state that 0.5%
chlorhexidine in 70% Alcohol is to be used for neuraxial blocks, due to the
neurotoxicity of chlorhexidine. We need to assess if the risk of using 2%
chlorhexidine swab sticks mitigates the risk of using 0.5% Chlorhexidine
liquid and gauze swabs for skin prep for neuraxial blocks. The swab sticks
prevent any risk of chlorhexidine being injected into the epidural or
subarachnoid space and splashing into other solutions on the sterile field.
We also need to assess if the use of 2% has any benefit over 0.5% in terms
of infection control and prevention.

Kind Regards,

Bridie

Bridie Treloar

Clinical Nurse Consultant Perioperative Services

Bankstown-Lidcombe Hospital

Monday Week 1 and 3, Tuesdays, Wednesdays

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[Glenys Harrington]

Hi Terry,

Leaving aside the issue of detergents versus disinfectant for routine
cleaning purposes (floors) in healthcare facilities my comments are as
follows:

Mops with detergent or disinfectant dispensed from the internal channel of
the mop handle

. I have seen these mops many years ago. The channel in the mop
handles could not be adequately cleaned or disinfected. When we cultured the
channels they were contaminated as fluid had remained stagnant in the
channel over long periods of time and cleaning agents were simply being
topped up. Think you will find the same if you sample the channels of such
mops today.

. Such mops are not suitable for use in healthcare facility.

Disposable microfiber wipe system

. I’m assuming the wipes are attached to the base of a mop (?
Velcro) and disposed of after so many uses?

. Microfiber will do a better job at cleaning over other types of
mopping materials (cotton/foam mop heads).

It is probably a matter of what is practical, easy and the most cost
effective option for an organisation i.e. disposable microfiber or standard
non microfiber mop heads which can be reusable or disposable.

Regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Michael Wishart

Hi Terry

I have seen similar systems for use in hospitals. I don’t think they are
unsuitable, it’s just a matter of if they are cost-effective or not. If the
microfibre wipes are truly charged microfibre material, they don’t need
detergents to collect dirt and debris. The addition of a disinfectant is
simply to reduce bioburden more that simple cleaning will do. In my view
this is unnecessary, but not inappropriate, if you understand what I mean.

Cleaning with a normal cloth dipped only in disinfectant with no detergency
properties would be inappropriate, but that is not what I have seen with
microfibre cleaning with the addition of disinfectants. Microfibre charged
cloths will attract soils and debris, so do not need a detergent.

I am not 100% sure I am actually addressing your question though, as I will
admit I am not 100% sure what you are asking.

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

Hi Everyone,

I’m coming across environmental cleaning service providers in the Day
Surgery sector that are wanting to ‘mop’ floors with a disposable microfiber
wipe system used in conjunction with a disinfectant that is either supplied
by dipping the wipe in the disinfectant solution or alternatively having the
disinfectant poured into the handle of the mop and discharged by the press
of a button.

The disposable microfiber wipe is discarded between cleaning different
areas, however I am not convinced that this method of cleaning is suitable.

I’d appreciate some feedback from the brains trust please.

Kind Regards

Terry McAuley

Sterilisation & Infection Prevention and Control Consultant

STEAM Consulting Pty Ltd ACN 604 439 698

E: terry@steamconsulting.com.au

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

A: PO BOX 779

Endeavour Hills

VIC Australia 3802

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[Glenys Harrington]

Hi Rita,

These Victorian resources may be of interest/use

Respiratory illness in residential and aged care facilities Guidelines and
information kit

file:///C:/Users/Glenys/Downloads/Respiratory%20illness%20in%20residential%2
0and%20aged%20care%20facilities%20-%20Guidelines%20and%20information%20kit.p
df

https://www2.health.vic.gov.au/public-health/infectious-diseases/infection-c
ontrol-guidelines/respiratory-illness-management-in-aged-care-facilities

Influenza

https://www2.health.vic.gov.au/public-health/infectious-diseases/disease-inf
ormation-advice/influenza

regards

Glenys

Glenys Harrington

Infection Control Consultancy (ICC)

P.O. Box 6385

Melbourne

Australia, 3004

M: +61 404816434

E: infexion@ozemail.com.au

Of Michael Wishart
setting

Hi Rita

I haven’t seen any specific for hospital settings (apart from generic
outbreak management plans, or pandemic influenza plans) but there are
several recent guidelines for aged care influenza outbreaks, which may
provide some guidance for a hospital-specific plan.

http://www.health.gov.au/internet/main/publishing.nsf/Content/27BE697A7FBF5A
B5CA257BF0001D3AC8/$File/RCF_Guidelines.pdf

https://www.health.qld.gov.au/__data/assets/pdf_file/0024/653631/flu-communi
que-june-17.pdf

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

P Please consider the environment before printing this email

Of Rita Roy

Dear All,

Do you have an “Management of Influenza outbreak in a hospital setting”
procedure or policy that you would be happy to share?

Many thanks,

Rita

Rita Roy

Clinical Nurse Consultant | Infection Control

Hornsby Ku ring gai Health Service, Palmerston Road, Hornsby NSW 2076
Tel (02) 9477 9232 | Fax (02) 9477 9013 Rita.Roy@health.nsw.gov.au
http://www.health.nsw.gov.au

Click here to visit the Infection Prevention and Control
page on the Intranet

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[Glenys Harrington]

Hi All,

I agree with Ruth. If there is no evidence the practice should be
discouraged.

In addition many healthcare workers who wear gloves do so to “protect
themselves” and ignore the principles of aseptic no-touch technique when
wearing gloves increasing the risk of potential 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 Ruth Barratt
antibiotic preparation/administration

Hi there

We looked at the occupational hazards of drawing up antibiotics without
gloves a number of years ago when The 5 Moments were first introduced. The
use of gloves for drawing up ABs is indeed a normal occurrence now and it
leads to continuous glove use re. The 5 Moments so non-compliance with
Moment 2. With the exception of a few ‘nasty’ ABs there was no evidence we
could find for occupational risks associated with drawing up ABs e.g. no
increase in sensitization forwards ABs etc. One exception was if you already
had a severe sensitivity towards a particular AB. We try and discourage this
practice for the above reason.

Cheers

Ruth

IPC logo for email signature

Ruth Barratt RN, BSc, MAdvPrac (Hons)

Clinical NurseSpecialist Infection Prevention and Control

Community Liaison Infection Prevention

:: ruth.barratt@cdhb.health.nz

(: + 64 3 3640 083 or ext.80083

1098272744j4O36h: 0275 263175

Level 5, Riverside Building

Christchurch Hospital | Private Bag 4710, Christchurch

Clean Hands Save Lives!

Of Michael Wishart
preparation/administration

Hi all

I have been asked if we should have a policy regarding routine use of gloves
when preparing and administrating IV antibiotics. My initial reaction is no,
we should not be handling IV antibiotic solutions in such a way as to cause
skin exposure. But having looked at some of the product information
regarding the vesicant nature of some antibiotics (eg vancomycin), and the
risk of adverse effects via absorption through the skin (eg gentamicin), I
am wondering whether a standard approach to wearing gloves when handling
antibiotic solutions should be recommended. And should we also recommend
protective eyewear for this?

What do other facilities advise staff in regard to this? And how much of a
risk would you consider this may be to staff?

Thanks for any opinions and comments.

Cheers

Michael

Michael Wishart

Infection Control Coordinator

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

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