[Glenys Harrington]

Dear All,

Further to Donnas suggestion below for those looking for more information on
transrectal ultrasonography (TRUS)-guided biopsy find attached the following
Australian review published in 2014.

. Grummet et al 2014 BJU International – Sepsis and superbug:
should we favour the transperineal over transrectal approach for prostate
biopsy

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

Of Donna Cameron
CPO/CRE

Hi Ruth,

It actually isn’t a requirement in either the 2013 ACSQHC CRE guideline
(http://www.safetyandquality.gov.au/wp-content/uploads/2013/12/MRGN-Guide-En
terobacteriaceae-PDF-1.89MB.pdf ) or the recently released Victorian
guideline on carbapenemase-producing Enterobacteriaceae
(https://www2.health.vic.gov.au/public-health/infectious-diseases/infection-
control-guidelines/carbapenemase-producing-enterobacteriaceae-management) to
screen all patients for CRE/CPE with a recent travel history only. The
recommendation is, as you appear to already be doing, to screen all patients
directly transferred from overseas hospitals and all patients who have had
an overnight admission to a hospital or residential care facility in the
previous 12 months.

The ACSQHC CRE guideline is in the process of being updated and should be
released soon, but I am not aware that the screening requirements will
change to include anyone who has travelled overseas in the previous 12
months.

I am also not aware of any hospitals in Victoria that would be undertaking
this level of screening as they would also not have the ability to
pre-emptively isolate that many patients until cleared either (and it also
not required by the Vic CPE guideline). It is a huge undertaking to attempt
to screen all patients who have a recent overseas travel history. If they
really want to go down that path then it would be better to risk assess
which countries present the greatest risk of acquiring CPE from just
travelling to them and/or choose which hospital admissions it is more
relevant to (e.g. pre TRUS biopsies etc).

Regards,

Donna

………………………………………………………………….
…….
Donna Cameron | Infection Control Consultant

Microbiological Diagnostic Unit
Public Health Laboratory | Department of Microbiology & Immunology
The University of Melbourne, Building 248, Level 1, 792 Elizabeth Street,
Melbourne, 3010, VIC
Telephone +61 3 8344 3574 | Fax +61 3 8344 7833
Website
http://www.mduphl.unimelb.edu.au/

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Of Ruth Barratt

Hello to my Australian colleagues,

We have recently experienced a CRE outbreak involving 4 patients that was
not associated with any overseas hospitalisation or travel . A laboratory
colleague who recently attend a conference in Melbourne advises that it is
the norm now in Australian acute hospitals to screen all patients who have
travelled overseas for CPO/CRE as per the ACSQH 2013 guidelines for CRE. We
are coming under pressure to introduce this.

We currently screen all patients who have had an overseas hospital stay
within the previous 12 months but if we were to screen all travellers as
well, we would not be able to isolate them pending screening results and I
am not sure how cost effective the screening would be versus positive
results.

I am interested to know if most Australian acute hospitals actually do this
extended screening and if so how you were able to get buy in from the
nursing staff.

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!

****************************************************************************
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[Glenys Harrington]

Hi Ruth,

Find attached the recently released Victorian Department of Health guideline
on “Carbapenemase-producing Enterobacteriaceae” which were released on
December 2015. This document may be useful as it is more detailed than the
“ACSQH 2013 guidelines for CRE” which is currently being updated/reviewed.

Available at:
https://www2.health.vic.gov.au/public-health/infectious-diseases/infection-c
ontrol-guidelines

VICNISS organised an education seminar (19/2/2016) to describe and provide
helpful advice on the implementation of these guidelines at the local level
across Victorian hospitals – see link to speaker presentations

https://www.vicniss.org.au/news-and-updates/cpe-education-seminar/

My impression from this seminar was that most hospital where doing their
best to implement the Victorian strategies as outlined in the guidelines.

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

Of Ruth Barratt
CPO/CRE

Hello to my Australian colleagues,

We have recently experienced a CRE outbreak involving 4 patients that was
not associated with any overseas hospitalisation or travel . A laboratory
colleague who recently attend a conference in Melbourne advises that it is
the norm now in Australian acute hospitals to screen all patients who have
travelled overseas for CPO/CRE as per the ACSQH 2013 guidelines for CRE. We
are coming under pressure to introduce this.

We currently screen all patients who have had an overseas hospital stay
within the previous 12 months but if we were to screen all travellers as
well, we would not be able to isolate them pending screening results and I
am not sure how cost effective the screening would be versus positive
results.

I am interested to know if most Australian acute hospitals actually do this
extended screening and if so how you were able to get buy in from the
nursing staff.

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!

****************************************************************************
****************
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[Glenys Harrington]

Hi Megan,

No not after the Laundry practice standards (AS/NZS 4146:2000).

I’m after the frequency bed blanket getting changed and sent for laundering
in different healthcare settings.

I understand some healthcare settings don’t launder blankets on discharge
unless soiled.

Hence if this is the case how often are they changed and laundered and what
is this frequency based on?

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

Of Megan Reilly
settings

Hello Glenys

Not sure if you are referring to the laundering process. The only specific
reference to laundering of blankets pertains to wool blankets on page 22 of
AS/NZS 4146:2000 under 3.4.1. Otherwise Appendix A Laundering
Considerations provides guidance in relation to soil types, soil removal and
care of textiles based on the fibre type, fabric structure and garment
structure, laundering principles which would apply to all types of
healthcare linen including blankets.

Kind regards

Megan

Megan Reilly RN BN TAE40110 Cert IV Training & Assessment MHlthSc (Inf
Control) Immunise Cert MACN

Director

Hands-On Infection Control

PO Box 233 (Suite 1/120 Lake Street, Perth)

NORTH PERTH WA 6906

megan@handsoninfectioncontrol.com.au

http://www.handsoninfectioncontrol.com.au

Infection Prevention: The Responsibility is in Everyone’s Hands

HOIC

ABN 58 015 361 500

Of Glenys Harrington

Dear all,

Does anyone know of any Australian standards/guidelines for laundering
blankets in healthcare settings or alternatively what is your routine
practice?

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

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[Glenys Harrington]

Thanks for posting Ramon.

Are there any specific recommendations/guidelines coming from the college in relation to some of these topics?

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

Colleagues

For your reference.

Kind regards,

Ramon

ACIPC_Logo_Colour_RGB_Hi_Res.jpg

Professor Ramon Z Shaban
PRESIDENT

Australasian College for Infection Prevention and Control

GPO Box 3254, Brisbane Qld 4001

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As of February 1, 2016, 11 people infected with the outbreak strain of Salmonella Virchow have been reported from nine states. The epidemiologic and laboratory evidence available at this time suggests that RAW Meal Organic Shake & Meal products made by Garden of Life, LLC are a likely source of this outbreak.
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[Glenys Harrington]

Hi Hayden,

You might like to also contact VICNISS as they did a study last year looking at resources etc for vaccination season and may have a lot of the information your require.

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 All
Our organisation is putting together a proposal to employ a nurse vaccinator to coordinate and lead the flu vax campaign this year.
I’d like to hear how other services manage the flu vax period. Any information would be useful.
What EFT do you employ?
What grade are they employeed at?
Is it a permanent position or seasonal?
Anything else you think might be relevant.

Anything you can offer would be much appreicated Many thanks

Hayden McDonald
Northern Health

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[Glenys Harrington]

Hi Heather and Kelly,

Find below contact details for the researchers – might be easier to just
write to them asking for a copy of their peer review publications on
“seeding”

Assoc Professor Maria Dominguez_Bello

Department of Medicine

NYU School of Medicine

http://www.med.nyu.edu/biosketch/dominm05

Professor Rob Knight

Howard Hughes Medical Institute and Dept of Chemistry & Biochemistry and
Computer Science, and Biofrontiers Institute

University of Colorado Boulder

https://www.coursera.org/instructor/robknight

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

Of Kelly Barton

I read this news report about seeding a while back, but haven’t gotten my
hands on the research paper as yet. Fascinating stuff. We have not
experienced it at our facility as yet though.

http://www.bbc.com/news/health-34064012?hootPostID6bc1b0fb38c3962351a241a
7e3ebd3

Kelly

Kelly Barton

Workforce Training & Infection Control Officer

Monday- Friday

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Of Warfield, Heather (Health)

Dear Colleagues

It came to my notice yesterday that there is a practice called ‘seeding’
and some mothers have asked if they can do this.

I think the mother had come into our birth centre at Canberra Hospital and I
am at present finding out how common this practice is and would like your
feedback if this has occurred at your hospital

For those not aware of the practice it is when a saline soaked piece of
gauze is inserted into the vagina prior to the caesarian section. The gauze
is then put into a container and when the baby is born the gauze is wiped
inside the baby’s mouth, over its eyes and skin, supposedly to colonise the
baby with the mother flora.

I look forward to your feedback

Kind regards

Heather

Heather Warfield

Infection Prevention & Control

Surgical site surveillance

Canberra Hospital

building 10, level 4

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[Glenys Harrington]

Hi Kathy,

The attached recent publication may be if interest/use (you may have seen it
already)

. Marci Drees et al. Carrots and Sticks: Achieving High Healthcare
Personnel Influenza Vaccination Rates without a Mandate. Infect Control Hosp
Epidemiol 2015;36(6):717-724

The authors achieved a 92% vaccination rate compared with vaccination rates
of 57%-72% in the 3 years previous without mandating.

Their strategies included the following:

. Each of their forms (consent, declination and reason for
declination) included a bar code, which was scanned by a newly created
web-based application along with the HCP’s identification badge. This
automatically updated the vaccination database with vaccinated, exempt or
declined status.

. Every manager and vice president in the system began receiving
weekly lists of their employees, notated as vaccinated, not vaccinated, or
no response.

. Managers were required to follow up with employees who had not
responded. In addition, managers were aware of which employees had not been
vaccinated and, thus, were required to wear masks once the flu season began.

. Rather than relying on roving vaccinators, meetings, and
distribution of vaccine for self-vaccination, the task force decided to
adopt a “blitz” campaign during the first 2 weeks of the season. Beginning
in early October, vaccination stations were set up across all shifts at
entrances to hospitals and other outpatient/ancillary facilities.

. At each entrance, volunteer “clerks” (who ranged from
administrative assistants to leadership personnel) scanned the HCP’s
identification badge and the appropriate form (taking ~30 seconds), and then
directed him/her to the next available vaccinator (volunteer nurses and
pharmacists).

. After vaccination (or attesting to vaccination elsewhere), staff
were given hanging badges, stating “I’m vaccinated because I care.”

. Wearing the hanging badges was not mandatory, but anyone not
wearing an “I’m vaccinated” tag was required to mask while in patient care
areas, regardless of their actual vaccination status.

. ~70% of all employees were vaccinated during the initial “blitz.”

. The policy used the existing disciplinary process for employees
who either did not complete 1 of the 3 forms by November 30 (i.e., the
mandatory declination), or who were not vaccinated and repeatedly failed to
mask. While the discipline alone did not result in termination, it was
considered in performance evaluations and could result in an employee being
considered “below standard.” Employees in this status were ineligible for
annual raises or any financial incentive.

Many of these strategies could be readily implement in Australian healthcare
facility influenza vaccination programs.

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

Of Katherine Taylor
for healthcare workers

Hi Kirsten,

Thanks for your response. Sending a text message is a great idea for
contacting the casual and part timers, maybe not only asking for those who
have had their jab elsewhere, but to remind them of when clinics are being
held. We will definitely add that to our influenza vaccine planning for
next year.

Regards

Kathy

Kathy Taylor- Infection Control Manager

The Wesley Hospital | 451 Coronation Drive, Auchenflower QLD 4066
t: 07 3232 7558 |m: 0427 607 812 | f: 07 3232 6043 |e:
katherine.taylor@uchealth.com.au

Of Kirsten Amos

Hi Kathy

Where I am is small and we have a significant part time/casual workforce. We
found that MANY of our staff had been vaccinated elsewhere and weren’t
letting us know. We sent out a text message to all our part time and casual
nurses asking them to contact me if they had received their flu vax
elsewhere. We increased our compliance by over 10%!

Kirsten Amos

Nurse Consultant

Infection Prevention and Control

Gippsland Southern Health Services

Of Katherine Taylor

Thanks Cathy,

I agree that getting the managers to assist is the way to get buy-in, but I
also like your idea of a prize draw – might hit up my exec for something
good next year.

Regards

Kathy

Kathy Taylor- Infection Control Manager

The Wesley Hospital | 451 Coronation Drive, Auchenflower QLD 4066
t: 07 3232 7558 |m: 0427 607 812 | f: 07 3232 6043 |e:
katherine.taylor@uchealth.com.au

Of Cathy Mowat

Katherine, we have had a lot of support from the executive team to achieve
our current rate of 79%. We have broken down all staff into ward
/departments lists and the managers were receiving weekly updates of
progress within their department. As the number of vaccinated staff
increased we then narrowed it down to those who have not been vaccinated.
All unit managers were expected to assist us in ensuring that every staff
member has either been vaccinated or has signed the declaration form
formally declining the vaccine. We have around 950 staff on 2 sites for
purposes of the influenza campaign. We have a major prize draw at the end of
the season for staff who have been vaccinated. This has been in place for
several years and alone didn’t assist that much in reaching our target. Last
year we failed to reach 75% so the strategies this year really worked. It
has, of course, come with the expense of great time and effort on the behalf
of the infection control staff who are both nurse immunisers.

Cathy Mowat

Infection Control

Central Gippsland Health Service

Sale Victoria

Of Katherine Taylor

Dear AICALIST members,

From July last year any new starters at our hospital sign that they agree to
have the vaccines that are recommended in the Australian Immunisation
Handbook for their designation, and now our executive are toying with the
idea of making influenza vaccination compulsory for all of our staff next
year.

With a lot of effort this year -lots of flu jab clinics, lollypops & bright
stickers for ID swing tags on vaccination, “grab a snag & get a jab” BBQ
lunch, free pizza lunch for wards/areas with compliance above 80% – we have
a compliance rate of 72% of staff either vaccinated or who have signed an
opt-out form declaring that they have been offered the influenza vaccine,
but decline for whatever reason. I think this compliance rate is pretty
good – certainly better than the compliance in previous years.

I would like to know what everyone else is doing out there. What has worked
and what has not?

Is influenza vaccination compulsory at your facility? Is it something your
exec team is considering?

What do you consider to be an acceptable vaccination rate in your healthcare
facility?

Is there any penalty for staff who are not vaccinated, e.g. unimmunised
staff wearing mask at work during winter?

Regards

Kathy

Kathy Taylor- Infection Control Manager

The Wesley Hospital | 451 Coronation Drive, Auchenflower QLD 4066
t: 07 3232 7558 |m: 0427 607 812 | f: 07 3232 6043 |e:
katherine.taylor@uchealth.com.au

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[Glenys Harrington]

Hi All,

By way of background information this recent case report may also be of
interest to those facilities undertaking BCG instillation – see attached

. Alice Fournier et al. A case of infectious endocarditis due to
BCG. International Journal of Infectious Diseases 35 (2015) 27-2

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

Of Sue Flockhart

Hi Marija,

I am also interested in your policies if you are willing to share.

Kind regards

flu shot

Sue Flockhart
Manager, Infection Prevention & Control Unit
Staff Immunisation Clinic
Ballarat Health Services
Ph-53204792
Fax-53204487
Mobile-0437856349
sueflock@bhs.org.au

Of Juraja, Marija (Health)

Hi Rita,

We do and I am happy to share this with you off line.

Kind Regards

Marija Juraja |Clinical Service Coordinator -CALHN Infection Prevention &
Control Unit|

Division of Acute Medicine (RN, GCNS Inf Ctrl, CICP)

t: +61 8 8222 7588| p: 47757| m: 0410 567 385
|e:marija.juraja@health.sa.gov.au

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Of Rita Roy

Dear All,

If this procedure is carried out in your facilities, what sort of Infection
Control meadsures do you institute? Do you have any policies or documents to
support it and are willing to share?

Many thanks in advance,

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
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[Glenys Harrington]

Hi Sony,

You would need to check some of the practical considerations such as the
following:

. Power requirements

. Can the machine be turned on remotely (by wireless) once it is
inside the aeroplane and the doors have been sealed/closed?

. Will there be adequate time to allow for pre-cleaning of dry
porous and non-porous surfaces in the sealed enclosure?

. Isolation of the planes ventilations system and closure of vents –
will this be possible?

. Reported cycle times are currently 1.5-2.5 hours (dwell time) for
a single room hence I’m assuming the cycle time for an aircraft may be
longer? Will this be practical in terms of flight schedules?

. Aeration phase following the dwell time to allow for the removal
of HPV from the area reducing the vapour concentration to <1PPM (permitted
exposure limit). Depending on the machine you are planning to use these
aeration times can be between 55min and 5hours. Will this be practical in
terms of flight schedules?

You will need to check with each HPV machine manufacturer/supplier to
determine the following;

a) is their machine suitable for an aeroplane and,

b) what are the practical issues that may be encountered such as the
turnaround time.

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

Of Wilkinson, Irene (Health)
peroxide vapor (HPV)

Dear Sony,

I have not seen any suggestion that MERS is transmitted by indirect contact
with the environment. It appears that all secondary cases so far have arisen
from direct contact with an infected person.

However, as a general method of decontamination of aircraft, it would seem
to be an ideal solution, as John suggests.

Regards,

Irene

Irene Wilkinson BSc(Hons) MPH
Manager, Infection Control Service
System Peformance and Service Delivery
SA Health
Government of South Australia
Irene.Wilkinson@sa.gov.au
http://www.sahealth.sa.gov.au/infectionprevention

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Of John Ferguson

Dear Sony

It would appear to be an ideal use of the technology – esp high vapour
pressure methods.

Proven safety with electrical gear and will decontaminate everything else it
can get to.

Being such a closed space, the process will be quicker than for a usual
room.

Regards

John

Dr John Ferguson MBBS DTM&H FRACP FRCPA

Director, Infection Prevention Service | Hunter New England Health

John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310,
Australia
Tel 61 2 49214444 | Fax 61 2 49214440 | Mobile +61428 885573 (Speed Dial
67607) | Tw @mdjkf

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Of Sony SO

Dear All,

We are exploring the feasibility for using Hydrogen peroxide vapor (HPV) to
disinfect aircraft cabin, if traveler is suspected for MERS. And we would
like to have your comment.

Regards,

Sony SO

Nursing Officer, Infection Control Branch (Team 2)

Centre for Health Protection

http://www.chp.gov.hk/tc/cindex.html

HONG KONG SAR, CHINA

office phone: +852 2125-2922; fax: +852 3523-0752

HA email sony@ha.org.hk; DH email no_icb4@dh.gov.hk

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[Glenys Harrington]

Hi Mary and Rachel,

The attached publication will be helpful in working through the issues
discussed in this thread – as you will see there is little evidence to
support the use of PPE for visitors/carers.

. L. Silvia Munoz-Price et al. Isolation Precautions for Visitors
Infection Control & Hospital Epidemiology / Volume 36 / Issue 07 / July
2015, pp 747 – 758

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

Of Glenys Harrington
paediatrics

Hi Rachel,

The shared and close placement of these children is increasing the risk not
only to the carer and visitors but to other child/children who are sharing
the room .

The real fix is that you need more segregation (distancing) and more single
rooms.

To bring this to the attention of hospital executive staff I would write an
incident report each time this co-sharing is required detailing the
associated potential risks.

Probably not a risk an organisation should be taking outside of a
respiratory outbreak setting when there are large numbers of presentations

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

Of Thomson, Rachel EA (DHHS)
paediatrics

Hi Glenys,

In many circumstances the answer is yes for children and infants, I
certainly don’t disagree with you. However, in our experience, rather than
having a child in a room at home, which may even be a separate room, we
place child and parent/care giver in very close proximity. Invariably, we
seat the parent/caregiver next to the bed. In shared rooms, this is even
more problematic, and the parent/ caregiver is obliged to sit very close.
Our focus has been to include our parents/caregivers in our consideration
for the use of PPE rather than assume that they have been exposed and then
ensure that this is the case.

We certainly do focus on respiratory and hand hygiene; it is simply that we
include our parents/care givers in the considerations we make, and framework
we have developed here at the RHH over time.

Cheers

Rachel

………………………….

Rachel Thomson

Nurse Unit Manager

Infection Prevention & Control Unit

Royal Hobart Hospital

Tasmanian Health Organisation-South

(: 03 62227882/8658

rachel.thomson@dhhs.tas.gov.au

Level 4, H Block

48 Liverpool Street

Hobart, 7000

Of Glenys Harrington

Hi Rachel,

Wouldn’t the primary care giver have already been exposed?

Probably more important to focus on good respiratory hygiene and hand
hygiene.

Also less work load for nurses in terms of training primary care givers and
visitors in PPE when it may not be needed.

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

Of Thomson, Rachel EA (DHHS)
paediatrics

Hi Mary,

I have been particularly busy, so I haven’t noticed if you have had many
replies to you question. I personally find this a tricky area, but thought
I would share our organisation’s approach.

We have extended the ‘privilege’ of PPE to all visitors, including parents
visiting ill children. That is, we make provision for all to people
entering the care zone to wear PPE. We ask our nursing staff to educate
parents/carers in the role/purpose and use of PPE. We do not mandate
wearing of PPE for principle care-givers for pathogens such as MRSA, VRE
etc. but encourage these individuals to consider protecting their own health
with use of masks and appropriate HH when the child has an acute respiratory
illness, such as Influenza. For pathogens/ clinical syndromes such as;

Adenovirus (respiratory syndrome only)

Bronchiolitis

Croup

Human metapneumovirus

RSV

Rhinovirus

We make provision that only during direct contact with the child that staff
need to wear PPE (mask, gown, gloves). We have adopted the principle that
where the primary care giver could be at risk from infection with the
pathogen that protection should be afforded to these parents/carers. We
also recognise that parents/carers rooming in cannot spend all day in PPE,
nor can they sleep in such equipment.

In short, we do not have a perfect solution, but very much have adopted an
approach that parents/carers have a right to be protected, need to be
educated in the use of PPE if they are going to use it.

Hope this helps?

Kind regards

Rachel

………………………….

Rachel Thomson

Nurse Unit Manager

Infection Prevention & Control Unit

Royal Hobart Hospital

Tasmanian Health Organisation-South

(: 03 62227882/8658

rachel.thomson@dhhs.tas.gov.au

Level 4, H Block

48 Liverpool Street

Hobart, 7000

Of Willimann, Mary

Hi Everyone

I am hoping that you might be able to assist with possible
guidelines/policies relating to the implementation of transmission based
precautions in paediatric patients. Having recently moved to a paediatric
environment I am curious to see if transmission based precautions should be
applied differently/modified as children possibly have unique needs when it
comes to infection prevention. For example, should droplet and contact
precautions be applied to children with respiratory viruses due to the fact
that children tend to put everything in their mouths and are not as good as
adults with respiratory etiquette?

I understand that standard precautions must always be applied and that a
risk management approach still needs to occur but would be very grateful for
any advice and/or direction!

Many thanks

Mary

Mary Willimann CICP | Infection Prevention and Control Coordinator

Child and Adolescent Health Service, Roberts Road Subiaco WA 6008

T: (08) 9340 7822 | 0466 350 206

E: mary.willimann@health.wa.gov.au

Delivering a Healthy WA

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[Glenys Harrington]

Hi Rachel,

The shared and close placement of these children is increasing the risk not
only to the carer and visitors but to other child/children who are sharing
the room .

The real fix is that you need more segregation (distancing) and more single
rooms.

To bring this to the attention of hospital executive staff I would write an
incident report each time this co-sharing is required detailing the
associated potential risks.

Probably not a risk an organisation should be taking outside of a
respiratory outbreak setting when there are large numbers of presentations

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

Of Thomson, Rachel EA (DHHS)
paediatrics

Hi Glenys,

In many circumstances the answer is yes for children and infants, I
certainly don’t disagree with you. However, in our experience, rather than
having a child in a room at home, which may even be a separate room, we
place child and parent/care giver in very close proximity. Invariably, we
seat the parent/caregiver next to the bed. In shared rooms, this is even
more problematic, and the parent/ caregiver is obliged to sit very close.
Our focus has been to include our parents/caregivers in our consideration
for the use of PPE rather than assume that they have been exposed and then
ensure that this is the case.

We certainly do focus on respiratory and hand hygiene; it is simply that we
include our parents/care givers in the considerations we make, and framework
we have developed here at the RHH over time.

Cheers

Rachel

………………………….

Rachel Thomson

Nurse Unit Manager

Infection Prevention & Control Unit

Royal Hobart Hospital

Tasmanian Health Organisation-South

(: 03 62227882/8658

rachel.thomson@dhhs.tas.gov.au

Level 4, H Block

48 Liverpool Street

Hobart, 7000

Of Glenys Harrington

Hi Rachel,

Wouldn’t the primary care giver have already been exposed?

Probably more important to focus on good respiratory hygiene and hand
hygiene.

Also less work load for nurses in terms of training primary care givers and
visitors in PPE when it may not be needed.

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

Of Thomson, Rachel EA (DHHS)
paediatrics

Hi Mary,

I have been particularly busy, so I haven’t noticed if you have had many
replies to you question. I personally find this a tricky area, but thought
I would share our organisation’s approach.

We have extended the ‘privilege’ of PPE to all visitors, including parents
visiting ill children. That is, we make provision for all to people
entering the care zone to wear PPE. We ask our nursing staff to educate
parents/carers in the role/purpose and use of PPE. We do not mandate
wearing of PPE for principle care-givers for pathogens such as MRSA, VRE
etc. but encourage these individuals to consider protecting their own health
with use of masks and appropriate HH when the child has an acute respiratory
illness, such as Influenza. For pathogens/ clinical syndromes such as;

Adenovirus (respiratory syndrome only)

Bronchiolitis

Croup

Human metapneumovirus

RSV

Rhinovirus

We make provision that only during direct contact with the child that staff
need to wear PPE (mask, gown, gloves). We have adopted the principle that
where the primary care giver could be at risk from infection with the
pathogen that protection should be afforded to these parents/carers. We
also recognise that parents/carers rooming in cannot spend all day in PPE,
nor can they sleep in such equipment.

In short, we do not have a perfect solution, but very much have adopted an
approach that parents/carers have a right to be protected, need to be
educated in the use of PPE if they are going to use it.

Hope this helps?

Kind regards

Rachel

………………………….

Rachel Thomson

Nurse Unit Manager

Infection Prevention & Control Unit

Royal Hobart Hospital

Tasmanian Health Organisation-South

(: 03 62227882/8658

rachel.thomson@dhhs.tas.gov.au

Level 4, H Block

48 Liverpool Street

Hobart, 7000

Of Willimann, Mary

Hi Everyone

I am hoping that you might be able to assist with possible
guidelines/policies relating to the implementation of transmission based
precautions in paediatric patients. Having recently moved to a paediatric
environment I am curious to see if transmission based precautions should be
applied differently/modified as children possibly have unique needs when it
comes to infection prevention. For example, should droplet and contact
precautions be applied to children with respiratory viruses due to the fact
that children tend to put everything in their mouths and are not as good as
adults with respiratory etiquette?

I understand that standard precautions must always be applied and that a
risk management approach still needs to occur but would be very grateful for
any advice and/or direction!

Many thanks

Mary

Mary Willimann CICP | Infection Prevention and Control Coordinator

Child and Adolescent Health Service, Roberts Road Subiaco WA 6008

T: (08) 9340 7822 | 0466 350 206

E: mary.willimann@health.wa.gov.au

Delivering a Healthy WA

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
NOT REPRESENT THE OPINION OF ACIPC.

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_____

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to whom it is addressed. If you are not such a person, you are warned that
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If you have received the transmission in error, please immediately contact
this office by telephone, fax or email, to inform us of the error and to
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[Glenys Harrington]

Dear all,

Further to my previous correspondence re: this topic, on 4th June 2015
Olympus have released the attached URGENT Recall for Product Correction Re:
TJF-Q180V Duodenoscope (TGA Ref #: RC-2015-RN-00475-1, ARTG Number: 210858)

Please share with your colleagues working in Endoscopy Units

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

Of Glenys Harrington
Endoscopic Retrograde Cholangiopancreatography – New Reprocessing
Instructions for the Olympus TJF-Q180V duodenoscopes

Dear all,

Find below the FDA notification of the New Reprocessing Instructions for the
Olympus TJF-Q180V duodenoscopes.

Attached is the Olympus letter to customers which details the new
reprocessing instructions including;

. supplementary flushing instructions

. additional recess flushing and forceps elevator raising /lowering
steps during pre-cleaning

. manual cleaning

. manual disinfection and endoscope rinsing and alcohol flushing.

Olympus advise that “these new reprocessing procedures should be implemented
as soon as possible” and that “the new cleaning procedure requires the use
of a small bristle cleaning brush (MAJ_1888) which Olympus anticipates
shipping no later than May 8, 2015”

The key differences include the following:

Pre cleaning

. During immersion, raise and lower the elevator 3 times

Manual cleaning

. Additional brushing of the forceps elevator recess area using an
additional brush (MAJ-1888 brush)

. Additional flushing of forceps elevator recess area

. Additional raising and lowering the forceps elevator

Manual high level disinfection

. Additional manual flushing steps and increased flushing volume of
the endoscope channel and forceps recess area

. Additional raising and lowering of the forceps elevator

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

Communication – New Reprocessing Instructions Validated

MedWatch logo

MedWatch – The FDA Safety Information and Adverse Event Reporting Program

Duodenoscope Model TJF-Q180V by Olympus: FDA Safety Communication – New
Reprocessing Instructions Validated

Engineering, Patient

for the TJF-Q180V duodenoscope to replace those provided in the original
labeling. The FDA has reviewed these new reprocessing instructions and the
validation data as part of its ongoing review of the 510(k), and recommends
that any facilities that are using Olympus’ TJF-Q180V duodenoscope train
staff on the new instructions and implement them as soon as possible.

disinfect or sterilize reusable devices. The FDA is closely monitoring the
possible association between reprocessed duodenoscopes and the transmission
of infectious agents, including multidrug-resistant bacterial infections
caused by Carbapenem-Resistant Enterobacteriaceae (CRE) such as Klebsiella
species and Escherichia coli. If not properly reprocessed, residual body
fluids and organic debris may remain in microscopic crevices of the device
following an attempted cleaning and high level disinfection. If these
residual fluids contain microbial contamination, subsequent patients may be
exposed to serious infections. The FDA’s investigation into the possible
association between inadequately reprocessed duodenoscopes and patient
infections, including the agency’s recommendations for health care
facilities, is more fully discussed in the following recent communications:
February 2015 Safety Communication
and FDA’s Updated Information for Healthcare Providers Regarding
Duodenoscopes issued March 4, 2015.

facilities and other users of the TJF-Q180V outlining the new, validated
reprocessing instructions, and will soon be distributing revised user
manuals. Key changes have been made to the Precleaning, Manual Cleaning,
Manual High Level Disinfection reprocessing procedures for Olympus’
TJF-Q180V duodenoscope. Please see the FDA Safety Communication
for more details. In addition, FDA has the following recommendations
for facilities and staff that use and reprocess the Olympus TJF-Q180V:

*Implement the new manual cleaning and high level disinfection
procedures for the Olympus TJF-Q180V duodenoscope in accordance with the
manufacturer’s reprocessing instructions.
*Train appropriate staff on Olympus’ new reprocessing instructions
and implement them as soon as possible.
*Contact Olympus directly with specific questions and concerns or to
schedule a site visit with their Endoscopy Support Specialists Technical
Assistance Center (TAC), 1-800-848-9024, option 1 Monday – Friday between
7AM EST – 8 PM EST.

Healthcare professionals and patients are encouraged to report adverse
events or side effects related to the use of these products to the FDA’s
MedWatch Safety Information and Adverse Event Reporting Program:

*Complete and submit the report Online: http://www.fda.gov/MedWatch/report

* Download form
or call 1-800-332-1088 to request a reporting form, then complete and
return to the address on the pre-addressed form, or submit by fax to
1-800-FDA-0178

Read the MedWatch Safety Alert, inclusing links to the FDA Safety
Communication at:
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMed
icalProducts/ucm440098.htm

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[Glenys Harrington]

Hi Rachel,

Wouldn’t the primary care giver have already been exposed?

Probably more important to focus on good respiratory hygiene and hand
hygiene.

Also less work load for nurses in terms of training primary care givers and
visitors in PPE when it may not be needed.

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

Of Thomson, Rachel EA (DHHS)
paediatrics

Hi Mary,

I have been particularly busy, so I haven’t noticed if you have had many
replies to you question. I personally find this a tricky area, but thought
I would share our organisation’s approach.

We have extended the ‘privilege’ of PPE to all visitors, including parents
visiting ill children. That is, we make provision for all to people
entering the care zone to wear PPE. We ask our nursing staff to educate
parents/carers in the role/purpose and use of PPE. We do not mandate
wearing of PPE for principle care-givers for pathogens such as MRSA, VRE
etc. but encourage these individuals to consider protecting their own health
with use of masks and appropriate HH when the child has an acute respiratory
illness, such as Influenza. For pathogens/ clinical syndromes such as;

Adenovirus (respiratory syndrome only)

Bronchiolitis

Croup

Human metapneumovirus

RSV

Rhinovirus

We make provision that only during direct contact with the child that staff
need to wear PPE (mask, gown, gloves). We have adopted the principle that
where the primary care giver could be at risk from infection with the
pathogen that protection should be afforded to these parents/carers. We
also recognise that parents/carers rooming in cannot spend all day in PPE,
nor can they sleep in such equipment.

In short, we do not have a perfect solution, but very much have adopted an
approach that parents/carers have a right to be protected, need to be
educated in the use of PPE if they are going to use it.

Hope this helps?

Kind regards

Rachel

………………………….

Rachel Thomson

Nurse Unit Manager

Infection Prevention & Control Unit

Royal Hobart Hospital

Tasmanian Health Organisation-South

(: 03 62227882/8658

rachel.thomson@dhhs.tas.gov.au

Level 4, H Block

48 Liverpool Street

Hobart, 7000

Of Willimann, Mary

Hi Everyone

I am hoping that you might be able to assist with possible
guidelines/policies relating to the implementation of transmission based
precautions in paediatric patients. Having recently moved to a paediatric
environment I am curious to see if transmission based precautions should be
applied differently/modified as children possibly have unique needs when it
comes to infection prevention. For example, should droplet and contact
precautions be applied to children with respiratory viruses due to the fact
that children tend to put everything in their mouths and are not as good as
adults with respiratory etiquette?

I understand that standard precautions must always be applied and that a
risk management approach still needs to occur but would be very grateful for
any advice and/or direction!

Many thanks

Mary

Mary Willimann CICP | Infection Prevention and Control Coordinator

Child and Adolescent Health Service, Roberts Road Subiaco WA 6008

T: (08) 9340 7822 | 0466 350 206

E: mary.willimann@health.wa.gov.au

Delivering a Healthy WA

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[Glenys Harrington]

Hi Brett,

Congratulations on the work undertaken.

Great to get an overview/update on the list server.

As with most other ICPs I’m looking forward to your final publication
describing recommended resourcing for hospital infection control teams in
Australia.

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

Of Brett Mitchell
resourcing

Hi,

Last year, many of you participated in a piece of work exploring infection
control professionals and infection control units in Australia. Part of this
work was advertised on this list. On behalf of the research team, we are
grateful for your assistance.

By way of feedback, I thought I would provide you with a quick update, given
this list was critical to one component of the study. To date, we have two
articles published from this work (summarised below), with three more in the
wings. We have presented some of this work at the ACIPC conference last
year, with more to come. Some work was also presented at ECCMID in
Copenhagen a few weeks ago.

Our work will culminate, as planned, in a final paper describing recommended
resourcing for hospital infection control units in Australia. We hope that
this will occur in late this year or early next. We have considerable work
to do, digesting the findings from the three different data collection
processes employed.

The two papers to date:

. Roles, responsibilities and scope of practice: describing the
‘state of play’ for infection control professionals in Australia and New
Zealand. Healthcare Infection (2015), 20 (1), 29-35

o This is the first study >10 years to comprehensively describe the ICP
workforce in Australia and New Zealand, and their scope of practice.

o ICPs have a varied scoped of practice. Most ICPs have a large number and
variety of responsibilities.

o ICPs in the private sector were more likely to operate as sole
practitioners or small teams

o This article is open access i.e. free for downloading from the
Healthcare Infection website.

. Hospital infection control units: Staffing, costs, and priorities.
American Journal of Infection Control (2015), 43(6), 612-616

o The mean number of infection control professionals was 0.66 per 100
overnight beds (1 FTE per 152 beds)

o Approximately $76 million is allocated annually to infection control
nurse staffing.

o Improved information technology systems were reported as a resource
priority.

o This article can currently be viewed freely, from the AJIC website.

We will keep you updated on this project.

Kind regards

Brett

Associate Professor Brett Mitchell

Associate Professor of Nursing RN, BN, PhD, M.Adv.Prac, MRCNA
Faculty of Nursing and Health

And

Director, Lifestyle Research Centre, Cooranbong

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[Glenys Harrington]

Hi Claire,

If the hub of the cannula cannot or is very difficult disinfect before accessing and the cap of the hub does not stay securely in place (as per Tim and Rosie reports/observations) there is no need to do additional QI/research.

This is a faulty product and should be reported to the supplier/manufacturer and the TGA IRIS reporting scheme.

In order for the healthcare facility to minimise the risk and their exposure in terms of litigation they should note the problem on their risk register and include their plan to replace the product with an alternative.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

That’s a great idea Claire!

Show them the evidence!!

Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Independent Vascular Access Consultant

President, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW

Representative – WoCoVA Global Strategic Committee
M: +1(623)326.8889 (USA)

M: +61(0)409463428 (AU)
E: tim.spencer68@icloud.com

Sent from my iPhone

On Mar 18, 2015, at 9:22 PM, Claire Rickard wrote:

HI Rosie

I would recommend you do a small quality improvement/research study and culture some of the used cannula. It would be great to get the ports cultured (and also check the tip culture (internal and external)). Have a talk to your micro lab senior scientist and ID physician, they might be interested in helping you and collaborating on a study? And I would get the anaesthetists on board with it too, – if they think they are good to use, let us get data and find out!!?? You would also need some control catheters (non-ported) also used in theatre for similar number of hours/accessed. And some no-used controls (from straight out of the packet).

Would be exciting and useful research to present at ACIPIC!!

PM me if you would like any advice 😀

—

Dr Claire Rickard, Professor, NHMRC Centre of Research Excellence in Nursing Interventions in Hospitalised Patients, Menzies Health Institute Queensland

Alliance for Vascular Access Teaching and Research (AVATAR)

Visiting Scholar at the Princess Alexandra, Prince Charles, and Royal Brisbane & Women’s Hospitals

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[Author]

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