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Hi Michael,
Leaving aside HCWs with known sensitivities/allergic reactions to know
antibiotics what is the evidence for the use of gloves over aseptic no-touch
technique?Regards
Glenys
Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
Of Michael Wishart
preparation/administrationHi 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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Hi John,
Looks like you need to be a paying member of RSPH to access this webinar?
Regards
Glenys
Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
Hello Infexion Connexion:
Below, please find an invitation from the RSPH to register for their webinar on water safety management, presented by Dr. Susanne Lee, Chair of the RSPH Water Special Interest Group, and chaired by Dr. Claressa Lucas from the CDC.
For those of you who were not able to make it to one of our Masterclasses in March this year, this is a great opportunity to hear Susanne speak.
Please note that the webinar will be made available for 24 hours after the live presentation, but you will need to register your interest prior to the event.
Thanks, and regards
John Matthew
Marketing & Strategic Leader
Pall Medical, ANZ
M: +61 419 130 668
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June 2017
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It is now 40 years since the organism which caused the first recognised outbreak of Legionnaires disease was discovered by CDC and since then legislation and guidelines have been developed in most of the world to minimise the risks public buildings. Despite all the research that has occurred within the last 40 years across the world cases of Legionnaires disease are rising. Public building architects and building design engineers do not generally design out the potential for Legionella and other waterborne pathogens to colonise and grow within water systems.
Within complex buildings such as hospitals and hotels etc. where water is used for purposes other than for the drinking, cooking personal hygiene etc. there are additional risks from water borne infection from water used in treatment, diagnosis or recreational purposes where opportunistic pathogens, in addition to legionellae such as Pseudomonas aeruginosa are of concern. This webinar will look at how risks from water borne pathogens can be minimised by ensuring good quality point of entry water quality; good system design; installation practices; commissioning and management.
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Hi Christine,
Do you mean for disinfection of devices or disinfection of the environment?
Regards
Glenys
Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
Of Christine Taylor
Hello Everyone,
Does anyone have any information or evidence to say that wipes used for
disinfection are effective? I had thought they were unreliable for several
reasons, including operator actions which could be insufficient. I will be
interested to hear comments ,as there has been a small suggestion they might
be used here,Regards, Christine
Regards, Christine
Christine Taylor,
Network Manager,
Sterilising Services,
Coffs Clinical Network,
Coffs Harbour Base Hospital
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Hi Terry,
I would ask the hospital to provide an engineer assessment to confirm the
room air was not entrained into the clean airstream of the operating
theatre.I’d also focus on the dispersion of lint and fibre on air currents in the OR
complex – plenty of evidence for low lint OR environments.In addition I would point out to the organisation that fans may also be a
red flag to surveyors that a temperature control or ventilation problem
exists, which can impact equipment and overall patient care.Find below and attached some information that may be of interest/use.
Some information form the Joint Commission (USA) web page – Standards FAQ
DetailsFans – patient Care areas
Are fans allowed in patient care areas, laboratories, or other support areas
in an organisation?There are no specific Joint Commission standards that prohibit the use of
fans. While fans may be used for additional comfort of the patient, such as
those with respiratory distress or post cardiac surgery, they may indicate
to surveyors that a temperature control or ventilation problem exists, as
described by EC.02.06.01. Space temperature issues can impact equipment,
patient testing results, and overall patient care. This concern usually
arises after adding equipment or use of the space without increasing the
capability of space cooling/ventilation. The organization should perform a
risk assessment, per EC.02.01.01 that includes the most appropriate persons
available to the organization. Examples of assessment concerns could
include: risks pertinent to the needs of the patient; ventilation and/or
temperature concerns for equipment; airborne particles/contamination that
may impact patient care, procedure/treatment processes or equipment
operation; maintaining the cleanliness of fan blades/housing; possible
tripping hazard(s) created by cords; etc. Infection control should be a key
element in the assessment process. The survey process will evaluate the risk
assessment for effectiveness and validate proper implementation of the
resulting policy/practice. Adjustments to the implemented process are to be
made as needed. [EC.02.06.01]https://www.jointcommission.org/standards_information/jcfaqdetails.aspx?Stan
dardsFaqId76
&ProgramIdINFECTION PREVENTION & CONTROL COMMUNICATION FORM PORTABLE FANS – CLEANING
AND USE RESTRICTIONS – Winnipeg Regional Health Authority, Acute Care
Infection Prevention & Control Manual – DATE ISSUED: October 22, 2015“Portable fans are currently used in some sites across the region to assist
in patient comfort or to regulate a patient’s body temperature. Other sites
have chosen to disallow the use of fans in patient care areas. Staff also
use fans in their work areas, which may be near patients. This communication
form does not supersede any existing site specific policy which bans the use
of fans, nor does it include High-Efficiency Portable Air (HEPA)-filtered
fans. Fans have the potential to disperse dust and airborne-transmitted
microorganisms1 , create airborne Clostridium difficile spores3 , and alter
airflow patterns. While use of portable fans has not been proven to transmit
infection3 , these issues, as well as lack of appropriate cleaning
procedures, are infection control concerns”.DO FANS SPREAD INFECTION IN CLINICAL AREAS? Emerg Med J 2008;25:10 689
http://emj.bmj.com/content/25/10/689.1.extract
https://www.ncbi.nlm.nih.gov/pubmed/18843075
regards
Glenys
Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
Of Terry McAuley
Hi everyone,
A facility has recently purchased a large wall mounted oscillating fan and
installed it in the area where the porters remake beds / trolleys and this
area is open to the recovery room.I am concerned about disruption of the air flows and the potential risks
associated with blowing particulates [from linen used to make up the
trolleys] around the facility.However I have been challenged to provide evidence that fans pose a risk of
infection and / or evidence that fans should not be used in this
environment.A quick google search and review of ACORN Standards reveals little – so I am
hoping someone else may have come across this issue and can provide some
assistance.All feedback gratefully received.
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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Hi Sam,
Are you able to post the full program including speaker details
Many thanks
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 6385
Melbourne 3004
Australia
M: +61 404 816 434
ABN 47533508426
Please note my new mailing address
Of PALMBY Samantha
Control Study DayDear all Victorian members,
We would like to extend an invitation to the St Vincent’s Public Hospital
Infection Control Study day.Details:
St Vincent’s Hospital Melbourne
Infection Control Study day
Wendesday 19th October 2016
8.30-3.30pm
This program aims to broaden health professionals knowledge base about
current issues/medical conditions with regard to Infection Control
principles. The study day is a general study day for nursing and allied
health staff working in acute/subacute and residential facilities. Topics
include TB medical management & community TB based programs, the changing
world of Resistant Organisms, new Hep C treatments, improving Childhood
Immunisation rates, vaccine preventable illness in public health.VENUE:
St Vincent’s Hospital
Building E
Michael Chamberlain Lecture Theatre
Ground Floor, Aikenhead Building
Victoria Pde, Fitzroy
Bookings are available through:
https://www.trybooking.com/Booking/BookingEventSummary.aspx?eid7602Thanks
Sam
Samantha Palmby | Infection Control Consultant
St Vincent’s Melbourne | 41 Victoria Parade Fitzroy VIC 3065
t: +61 3 9231 4704 | f: +61 3 9231 4068 | www.
svha.org.au______________________________________________________________________
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Dear All,
Further to below Im concerned about the advisory in terms of patient safety.
Given that the advisory primarily relates to the sterility of instruments used for surgical and other invasive procedures I was surprised to see a lag time of up to 5 years (2021)to fully implementation of AS:4187:2014.
This seems like a very long lag time for such high risk instruments and equipment.
What do others think?
Kind regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426—–Original Message—–
Hi Roel,
Many thanks for the update and advice for ICPs.
I understand from some ICPs that sourcing the ISO standards as referenced in the AS:4187:2014 could be up to $10,000.
Are you saying that you can purchase specific sections of an ISO standard (i.e. the normative component of the compliance) rather than the whole standard and that this section includes specific details to enable auditing of a facility?
You mentioned independent organisation/s (comes with a price) that you can purchase audit tools from – can you provide the details and ill get some costings.
Many thanks in anticipation
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426—–Original Message—–
Hi All
In relation to questions posted below. I will try my best to answer. Otherwise I can be contacted on my work email. Happy to help. I am lucky that the facility I work with happened to have an ISO accreditation 3 weeks ago. My role have given me the option to comply with some of the requirements of the AS 4187:2014.
– have organisations been able to access/obtain all the standards that you are required to meet in AS:4187:2014 (i.e. AS and ISO standards)? – Answer: Yes at the facility I am currently employed and at a previous facility I worked with. Please be aware that you are only required to access parts of the relevant standards specifically referred to as a normative component of the compliance. I have known managers in areas where they have purchased what is required.
– what was the cost associated with obtaining these standards (i.e. ISO standards)?
– have organisations been able to develop an audit tool that include standards (i.e. ISO standards) that are referred to in AS4187:2014?
Roel Castillo
Sterilising Services Unit Manager
Macquarie University Hospital
3 Technology Place
Macquarie University, NSW 2109, Australia Locked Bag 2231, North Ryde BC, NSW 1670T: +61 2 9812 3213 I M: +61 0 434 496 829
http://www.muh.org.auMacquarie University Hospital is Australias first and only private hospital on a University campus. We are committed to delivering superior clinical outcomes and a positive patient experience through the best available care and technology.
—–Original Message—–
Dear All,
In relation to the ACSQHS advisory posted below Im interested to know the following:
– have organisations been able to access/obtain all the standards that you are required to meet in AS:4187:2014 (i.e. AS and ISO standards)?
– what was the cost associated with obtaining these standards (i.e. ISO standards)?
– have organisations been able to develop an audit tool that include standards (i.e. ISO standards) that are referred to in AS4187:2014?
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426—–Original Message—–
[Posted on behalf of Roel Castillo – Moderator]
Hi all
Please refer to link below. ACSQHS advisory in regards to compliance to the new AS:4187:2014:
Regards
Roel Castillo
Sterilising Services Unit Manager
Macquarie University Hospital
3 Technology Place
Macquarie University, NSW 2109, Australia Locked Bag 2231, North Ryde BC, NSW 1670T: +61 2 9812 3213 I M: +61 0 434 496 829
https://apac01.safelinks.protection.outlook.com/?urlwww.muh.org.au&data01%7c01%7cRoel.Castillo%40MUH.ORG.AU%7c6923ac5e4084400687e008d38db7d5be%7cde154fbf3b664e1a9f9f3f164fdc85e1%7c1&sdataesr%2fIJ9bpB384J6hVbIxAhqpFx5FW8JB7jXGieP9US4%3dMacquarie University Hospital is Australias first and only private hospital on a University campus. We are committed to delivering superior clinical outcomes and a positive patient experience through the best available care and technology.
______________________________________________________________________
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Hi Roel,
Many thanks for the update and advice for ICPs.
I understand from some ICPs that sourcing the ISO standards as referenced in the AS:4187:2014 could be up to $10,000.
Are you saying that you can purchase specific sections of an ISO standard (i.e. the normative component of the compliance) rather than the whole standard and that this section includes specific details to enable auditing of a facility?
You mentioned independent organisation/s (comes with a price) that you can purchase audit tools from – can you provide the details and ill get some costings.
Many thanks in anticipation
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426—–Original Message—–
Hi All
In relation to questions posted below. I will try my best to answer. Otherwise I can be contacted on my work email. Happy to help. I am lucky that the facility I work with happened to have an ISO accreditation 3 weeks ago. My role have given me the option to comply with some of the requirements of the AS 4187:2014.
– have organisations been able to access/obtain all the standards that you are required to meet in AS:4187:2014 (i.e. AS and ISO standards)? – Answer: Yes at the facility I am currently employed and at a previous facility I worked with. Please be aware that you are only required to access parts of the relevant standards specifically referred to as a normative component of the compliance. I have known managers in areas where they have purchased what is required.
– what was the cost associated with obtaining these standards (i.e. ISO standards)?
– have organisations been able to develop an audit tool that include standards (i.e. ISO standards) that are referred to in AS4187:2014?
Roel Castillo
Sterilising Services Unit Manager
Macquarie University Hospital
3 Technology Place
Macquarie University, NSW 2109, Australia Locked Bag 2231, North Ryde BC, NSW 1670T: +61 2 9812 3213 I M: +61 0 434 496 829
http://www.muh.org.auMacquarie University Hospital is Australias first and only private hospital on a University campus. We are committed to delivering superior clinical outcomes and a positive patient experience through the best available care and technology.
—–Original Message—–
Dear All,
In relation to the ACSQHS advisory posted below Im interested to know the following:
– have organisations been able to access/obtain all the standards that you are required to meet in AS:4187:2014 (i.e. AS and ISO standards)?
– what was the cost associated with obtaining these standards (i.e. ISO standards)?
– have organisations been able to develop an audit tool that include standards (i.e. ISO standards) that are referred to in AS4187:2014?
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426—–Original Message—–
[Posted on behalf of Roel Castillo – Moderator]
Hi all
Please refer to link below. ACSQHS advisory in regards to compliance to the new AS:4187:2014:
Regards
Roel Castillo
Sterilising Services Unit Manager
Macquarie University Hospital
3 Technology Place
Macquarie University, NSW 2109, Australia Locked Bag 2231, North Ryde BC, NSW 1670T: +61 2 9812 3213 I M: +61 0 434 496 829
https://apac01.safelinks.protection.outlook.com/?urlwww.muh.org.au&data01%7c01%7cRoel.Castillo%40MUH.ORG.AU%7c6923ac5e4084400687e008d38db7d5be%7cde154fbf3b664e1a9f9f3f164fdc85e1%7c1&sdataesr%2fIJ9bpB384J6hVbIxAhqpFx5FW8JB7jXGieP9US4%3dMacquarie University Hospital is Australias first and only private hospital on a University campus. We are committed to delivering superior clinical outcomes and a positive patient experience through the best available care and technology.
______________________________________________________________________
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Dear All,
In relation to the ACSQHS advisory posted below Im interested to know the following:
– have organisations been able to access/obtain all the standards that you are required to meet in AS:4187:2014 (i.e. AS and ISO standards)?
– what was the cost associated with obtaining these standards (i.e. ISO standards)?
– have organisations been able to develop an audit tool that include standards (i.e. ISO standards) that are referred to in AS4187:2014?
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426—–Original Message—–
[Posted on behalf of Roel Castillo – Moderator]
Hi all
Please refer to link below. ACSQHS advisory in regards to compliance to the new AS:4187:2014:
Regards
Roel Castillo
Sterilising Services Unit Manager
Macquarie University Hospital
3 Technology Place
Macquarie University, NSW 2109, Australia Locked Bag 2231, North Ryde BC, NSW 1670T: +61 2 9812 3213 I M: +61 0 434 496 829
http://www.muh.org.auMacquarie University Hospital is Australias first and only private hospital on a University campus. We are committed to delivering superior clinical outcomes and a positive patient experience through the best available care and technology.
______________________________________________________________________
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Hi All,
Im familiar with some of these products but no all.
You may find some require a 3min scrub at beginning of the day.
Best to check and follow the manufacturers instructions.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Of Tina Owens
Hi Joanne,
We have started using these products, ACORN recently updated the standards
regarding the use of these types of products, which now only require a
social hand wash with a non antimicrobial scrub product prior to use (for
surgical asepsis), rather than a 5 minute scrub with an antimicrobial scrub
(see ACORN update Feb 2016).Tina Owens
Director of Nursingcid:9E350D6D-535C-4698-891D-F55ACC3FBEB3@tci.local
M 0419 026 091 T 07 5613 2000
t.owens@thecosmeticinstitute.com.au
98 Marine Parade, Southport, QLD 4215cid:28BB8E47-FA99-4957-98F0-001299011A63@tci.local
cid:0695DACD-A5A1-4802-8717-C1B1DE0F7CFC@tci.local
cid:AA704435-49C1-4C20-AC86-9DF777D87F69@tci.localcid:3131B61C-C776-4A69-85F
F-8DD35192640A@tci.local
thecosmeticinstitute.com.auOf Joe-Anne Bendall
Hi
Is anyone using these alcohol-based hand rub products after the first
surgical scrub?Do you have specific criteria for specialities that do use it?
Is it better to install the touch free design or autoclavable dispenser?
Any significant outcomes for patients?
What is your staff satisfaction rate?
Has it improved the efficiency in the operating theatre?
Thank you
Joe-Anne Bendall
Joe-Anne Bendall
Clinical Nurse Consultant Infection Prevention and Control
(Including vaccination and screening)
Monday Friday 0800 – 1630
Sydney Hospital and Sydney Eye Hospital8 Macquarie St
SYDNEY NSW 2000
|( ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | *
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Hi Cate,
Agree with the issue in terms of terminal/discharge cleaning and
disinfection of the unit.In addition to prevent contamination of patient hands you might want to
consider how well they work, ease of use, ply of toilet paper etcRegards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Of Cate Coffey
Hi everyone,
I have request by builders to put jumbo toilet roll holders – that hold
large round rolls- in ensuite rooms on a new ICU build. My thoughts are no
it is an infection control risk but I thought I would ask my more experience
learned colleagues in case you have done this?.Yep sure am covering the big issues today!!!
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
e … cate.coffey@nt.gov.au http://www.nt.gov.au/health
Our Vision: Better health outcomes for all Central Australians
Our Values: Community at the Centre | Equity and Integrity | We are
Accountable | We are Relevant Today and Ready for Tomorrow | We are
Committed to High Quality Care | We Value our PartnershipsCentral Australia Health Service is a Smoke Free Workplace
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Hi Irene,
No Im not aware if the ANZ Society of Cardiothoracic Surgery haven taken this issue up.
Think the issue may be bigger than just relying on a surgical society to organise action.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Thanks for the information Glenys.
Do we know if the ANZ Society of Cardiothoracic Surgery has taken up this issue here in Australia?
I would have thought this would be the proper avenue for action, similar to the way the Gastroenterologists have taken on board the issues around duodenoscope contamination and the risk of CRE transmission.
Regards,
Irene Wilkinson BSc(Hons) MPH
Manager, Infection Control Service
Communicable Disease Control Branch
System Peformance and Service Delivery
SA Health
Government of South Australia
http://www.sahealth.sa.gov.au/infectionprevention~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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Further to below, there is another interesting posting today on Controversies in Hospital Infection Prevention titled:
More data support a common source for the M. chimaera outbreak
http://haicontroversies.blogspot.com.au/2016/04/more-data-support-common-source-for-m.html
The Eurosurveillance publication referred to on the posting notes the following:
Cases had been exposed to HCUs from one single manufacturer during open chest surgery up to five years prior to onset of symptoms. During environmental investigations, M. chimaera was detected in samples from used HCUs from three different countries and samples from new HCUs as well as in the environment at the manufacturing site of one manufacturer in Germany. See link below
Eurosurveillance, Volume 21, Issue 17, 28 April 2016
Surveillance and outbreak report
CONTAMINATION DURING PRODUCTION OF HEATER-COOLER UNITS BY MYCOBACTERIUM CHIMAERA POTENTIAL CAUSE FOR INVASIVE CARDIOVASCULAR INFECTIONS: RESULTS OF AN OUTBREAK INVESTIGATION IN GERMANY, APRIL 2015 TO FEBRUARY 2016
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId22461
There are more than one manufacturing plant for these devices hence it would be important to know the following:
a) when you HCU was purchased and
b) which manufacturing plant your HCU came from.
The LivaNova group (formerly Sorin Group Deutschland GmbH) should be able to provide this information based on the serial number of your HCU.
See the link to the FDA warning letter to LivaNova
http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2015/ucm479684.htm
This posting on the FDA may also be of interest/use.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Dear All,
For those following the Mycobacterium chimaera heater-cooler units you may find some of the answers you need in the following blog from the Controversies in Hospital Infection Prevention below.
Unfortunately the link to the speakers talk at ECCMID only has the speaker slides.
I have written to the web page contacts to see if an audio is available and will keep you posted.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Controversies in Hospital Infection Prevention
_____
Mycobacterium chimaera update: A must listen from ECCMID
Weve posted several times about the horrible M. chimaera outbreak linked to heater-cooler units (HCUs) used during cardiac bypass surgery. As weve addressed the problem here at Iowa, weve become increasingly frustrated (and dumbfounded) at the lack of available information about the clinical and epidemiological features of the outbreak itself, and at the general lack of urgency about this ongoing and grave risk to patients.
Fortunately, Dr. Jakko van Ingen gave an excellent talk at ECCMID that answers several important questions weve had about this outbreak, confirming some of the things weve heard (in confidence, I assume for political or legal reasons) on various conference calls and email strings. I urge you to take 30 minutes of your time to listen to his talk, all the way to the end of the Q&A period.
Aside from being an extremely entertaining speaker, Jakko addresses several key questions, including:
Is this a clonal outbreak? YES. Slide 29 reports whole genome sequencing data that clusters the isolates from Sorin 3T units and infected patients (within just 2-3 SNPs), and further discussion (during Q&A session) confirms that isolates from other European countries are also in this cluster.
Were the HCUs already contaminated prior to being shipped to end users? YES. Listen carefully to the last question and answer.
Does this particular outbreak primarily involve one make/model of HCU? YES. While nontuberculous mycobacteria have been isolated from other types of HCUs, the specific M. chimaera cluster in this case involves Sorin 3T units.
Is the invasive, disseminated, high crude mortality form of the illness restricted to those patients with implants (e.g. valves, grafts)? YES. The life-threatening disseminated infection appears to require some prosthetic material to which the organism can adhere, protecting itself (via biofilm formation) from host defense. According to Dr. van Ingen, case finding in the Netherlands is now limited to those with implants, and does not include standard non-valve, non-implant CABG patients.
Is it possible to mount an effective, rapid national response to this urgent problem? YES. Slide 18 details the Dutch response, which involved discontinuing all non-urgent cardiac surgery until HCUs were placed outside of ORs (which was done within 48 hours). As we learned here when we did the same thing, it is amazing what you can accomplish when you are left with no other option.
Is opening up a Sorin 3T HCU a frightening experience? YES. Im sure Ill have nightmares about these water-stained, biofilm-befouled devices for a long time (see below for one image from Garvey, et al).
What are the implications?
HCUs are not safe to operate in an OR. The air exhausting from the HCU ventilation fan must be physically separated from the air in the OR, and the easiest way to do that is to remove them from the OR (and maintain the OR at positive pressure, of course).
Everyone using Sorin 3T HCUs should assume that they may have exposed patients to M. chimaera, until more is known about the details of the point-source. Contaminated units cannot be disinfected even with the more intensive protocols currently recommended. In addition, only a few labs are capable of properly performing NTM cultures of water samples, so negative water cultures are of limited value and could be falsely reassuring.
A much more active national patient and provider notification is needed. Our experience is similar to that of others: identified cases would never have been found had it not been for aggressive and active case-finding. There are undoubtedly others currently being treated with immunosuppression for sarcoidosis or some other granulomatous process of uncertain etiology who actually have undiagnosed disseminated M. chimaera disease.
Below I’ve pasted an epidemic curve, an underestimate as it involves only those cases reported to FDA from US (blue bars) and abroad (red). This outbreak isn’t over, not by a long shot, and the fact that there are still hospitals performing cardiac surgery with their Sorin 3T HCUs inside of the OR is extremely distressing.
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Hi Heidi,
I have recommended these types of cleaner/environmental services staff checklists.
They can be kept inside or outside the room using a transparency sheet protector secured with blue tack.
Each day the responsible cleaner ticks what was cleaned – see attached sample I recently prepared for a clinical area (room) in a community health setting.
In addition the requirement to complete the checklist is included in the organisations cleaning policy.
Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426—–Original Message—–
Our environmental services manager would like to implement a system where a checklist is kept behind the patients room door (all our rooms are single rooms) for the month to document cleaning has been completed. Our staff currently complete detailed checklists when undertaking daily or terminal cleaning but these are stored in the cleaners office. The list behind the door suggestion arose following feedback from a patient that they suggested their room had not been cleaned during the length of their stay as they had not seen a “cleaner”. I was wondering if anyone else has implemented a similar system and how they manage it to prevent the pages becoming damaged. Does anyone have a better suggestion?
Heidi Gettons
Infection Control
The Bays Healthcare
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Hi Sharyn,
I’m assuming the MRI procedure room itself had dedicated ventilation that is
not shared with other areas?If so the patient can be managed in airborne precautions during the MRI
procedure and the patient does not need to wear a P2/N95 mask (which
contains metal).After entering the room the patient can remove the mask and this can be
taken out of the room by staff who would be wearing a P2/N95 mask.Once the procedure is completed the patient can be given another P2/N95 mask
for transfer back to their ward/unit. This is assuming that the patient can
tolerate P2/N95 mask.If not then the same would apply if the patient was only able to wear a
surgical mask (which also has metal).Depending on the ventilation air exchange per hour in the MRI room you would
also want to allow time for the ventilation to clear possible airborne
contaminates from the room (i.e. TB).See Appendix B, Table B1 – Air change/hour and time required for airborne
contaminant removal efficiencies of 99% and 99.9%.This table is in the from the USA Centers for Disease Control and Prevention
– Guidelines for Environmental Infection Control in Health-Care Facilities –
extract attachedRegards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Of Sharyn Hughes
on Airborne PrecautionsDear All,
I am seeking responses (actual or hypothetical) in relation the possibility
of needing to MRI scan a patient on Airborne Precautions. What processes are in place within your MRI departments for
patients on Airborne Precautions that require scanning?. Do you know of any manufacturers that have P2/N95 mask that MRI
compatibleLooking forward to your responses
Sharyn
Sharyn Hughes
Acting Clinical Nurse Consultant |Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264490
Sharyn.Hughes@health.nsw.gov.au
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Hi Cate,
In terms of setting up a new facility it is wise to avoid the use of
sprayers (also called aerated spray wands) in patient toilet facilities.These are hoses with a nozzle which are installed at the back of the toilet
and used to rinse out bed pans in the toilet bowl in anteroom toilet/shower
facilities (single/multi-bed rooms) and in hoppers ( wall-mounted sinks,
with deep basins, large drains, and spray arms that flush like toilets) in
dirty utility rooms (see images attached).Sprayers seem to have been common in parts of Canada and the US (mentioned
in some of Carlings publications) and have contributed in outbreaks of
C.difficile in Canada Preliminary Findings with C.difficile Outbreak in
Cape Breton District Health Authority (CBDHA), 21 April 2011, Department of
Health and Wellness, Nova Scotia – see attached.At the time and in Quebec it seems that some healthcare facilities had
neither automated bedpan washers or macerators for processing bedpans. Where
such reprocessing machines were not available oxo-biodegradable plastic
hygienic bags (bed pan liners) were used, not sure if this is still the
case.A June 2009 Quebec report (Comparative Analysis of Bedpan Processing
Equipment) by the Agence dvaluation des technologies et des modes
dintervention en sant (AETMIS now INESSS) recommended that staff must not
empty bedpans into sinks or toilets and must no longer use spray wands. The
report includes options in terms of appropriate reprocessing methods for bed
pans and a cost analysis of each option see attached.Some years ago when reviewing plans to upgraded and retro-fit wards at a
healthcare facility I worked at we were asked to approve the use of sprayers
in patient ensuites to rinse out bed pans in the toilet bowl. The request
came from a USA director of nursing who was planning to remove the automated
bedpan washers from the wards as they were located outside patient rooms and
were very noisy.Because of the risk of environmental contamination they were not approved by
infection control and automated bedpan washers were installed in designated
ward dirty utility rooms (1-2 per ward) which in the upgrade were located
away from patient bedrooms.Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Of Cate Coffey
Hi everyone
Ive had a request to install a hose in the sluice room of new ICU to clean
bedpans etc. I have issues with this as the potential for aerosolising and
splashing MROs would increaseAny thoughts you could share?
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
e … cate.coffey@nt.gov.au http://www.nt.gov.au/health
Our Vision: Better health outcomes for all Central Australians
Our Values: Community at the Centre | Equity and Integrity | We are
Accountable | We are Relevant Today and Ready for Tomorrow | We are
Committed to High Quality Care | We Value our PartnershipsCentral Australia Health Service is a Smoke Free Workplace
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Hi Kelly,
I wonder about the validity of such audits in terms of the Hawthorn effect.
Wouldn’t it be more appropriated and less time consuming to assess
competency by doing just-in-time peer review on employment and bi-annually
or annually?Regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
Of Kelly Barton
effectiveness publicationWhile HH audits can be time consuming, I find them paling in comparison in
the time it takes to audit Aseptic Technique, where “moments” for our health
service can go for well over 30 minutes. I’m wondering how other health
services manage their Aseptic Technique audits. I can spend a whole day
auditing and only get 5-6 audits done.Kelly
Kelly Barton
Infection Prevention & Control Officer
Monday- Friday
P Reduce, re-use, recycle. Please consider the environment before printing
this e-mail.Of Michelle Bibby
Thank you Mary-Louise for your response re Graves et al study and the
variances.The concerns of biased data reported for hand hygiene compliance is worth
noting and I too agree with your comments here.Costs associated with the efforts to report HH data as required which
detracts from some of the critical day to day requirements of the IC nurse
need further review.Thank you
Michelle
Michelle Bibby
Infection Prevention Australia
Michelle@infectionprevention.com.au
+429071165
Dear Ramon and Glenys
Graves et al study relies on the accuracy of the 2 pivotal variables: SAB
and hand hygiene compliance. The accuracy of the latter is serious limited.
Our report in the Medical Journal of Australia (Med J Aust 2014; 200
(9):534-537.
http://dx.doi.org/10.5694/mja13.11203) concluded the HHA program reports
rates that have been biased upwards by very few high performers.The conclusion from our findings and Graves et al is:
(1) SAB respond to multiple interventions and hand hygiene is only one of
these.(2) hygiene compliance rates have not reached a tipping point to reduce SAB
and this tipping point is a long way off because(3) the hand hygiene compliance rates are inaccurate.
It is important to have a national HH program. But the expense of the
current program is too high when the cost of audits provides flawed data
that reinforces a misguided belief that our hospitals are performing HH
well.Mary-Louise
Professor Mary-Louise McLaws
Professor of Epidemiology in Healthcare Infection and Infectious Diseases
Controlhttp://research.unsw.edu.au/people/professor-marylouise-mclaws
SPHCM SAMUELS BUILDING
UNSW AUSTRALIA, SYDNEY NSW 2052 AUSTRALIA
CRICOS Provider Code 00098G
_____
Professor Ramon Shaban, ACIPC President [president@ACIPC.ORG.AU]
Colleagues
The study by Graves et al. reports a range of interesting findings, and
raises many issues regarding hand hygiene for broader consideration. The
College is examining the paper and is preparing a media release for release
in the coming days.Kind regards,
Ramon
Professor Ramon Z Shaban
PRESIDENTAustralasian College for Infection Prevention and Control
GPO Box 3254, Brisbane Qld 4001
On 25 February 2016 at 21:16, Glenys Harrington
wrote:Dear All,
Find attached the following publication (February 9, 2016).
. Graves et al. Cost-Effectiveness of a National Initiative to
Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated
Staphylococcus aureus Bacteraemia. PLoS ONE 11(2): e0148190.
doi:10.1371/journal.The analysis was undertaken on data from 6 Australian states:
. In 2/6 states there was a 1% chance it was cost effective
. In 1/6 states there was a 26% chance it was cost effective
. In 1/6 states there was a 80% chance it was cost effective and
. In 2/6 a 100% chance it was cost effective.
Interesting figure showing cost increases and cost savings by state (fig 2).
Also some interesting points in the discussion.
Shame there was “No useable pre-implementation” data available for Victoria
and hence was not able to be analysed.Given the findings of the analysis it raises the following questions for
governments:. Shouldn’t the program be scaled back and some of the money be
spent on other initiatives to reduce hospitals associated infections(HAIs)?. Shouldn’t the program be scaled back to reduce the infection
control workload associated with the program which is currently overwhelming
and taking ICPs away from other core infection control activities?A press release by the College about the findings of this study and the
views of the college in terms of the allocation of limited resources would
be timely.regards
Glenys
Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
ABN 47533508426
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