[Wilkinson, Irene (Health)]

Hi all,
My understanding is that the TGA has changed its registration processes for skin disinfectants so that they now need to be registered as OTC medicines. This probably involves another cost for manufacturers who may be trying to get around this by simply re-labelling their products. Consumers need to express to the product suppliers that this is not acceptable.
In the meantime, if the product has not changed its formulation, some healthcare facilities are electing to continue to use the products “off label”.
Clearly not a satisfactory situation.

Regards,
Irene

Irene Wilkinson
Manager, Infection Control Service
SA Health
Irene.wilkinson@health.sa.gov.au

I have emailed the manufacturer of 100ml 2% Chlorhexidine in 70% Alcohol with the same labeling- will share the response when it arrives

I note the 500ml bottle of 0.5% Chlorhexidine in 70% Alcohol also now has this labeling

Have had a look around the TGA website and have not seen anything about category changes

regards
Sue

Sue Borrell
Infection Prevention Nurse Consultant
Infection Prevention & Hospital Epidemiology

t 03 90763139
m 0429 806356
e S.Borrell@alfred.org.au

Alfred Health
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Hi Lindy
our generic branded liquid solution seems to now also have the ‘hospital grade disinfectant and the surface cleaning” directions, however our single use swabs and packets do not. Has anyone contacted the manufacturer yet?
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J

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>>> Lindy Ryan <Lindy.Ryan@SWAHS.HEALTH.NSW.GOV.AU> 3/07/13 9:03 >>>
Dear Colleagues

Just wondering if anyone; facilities/ service had been using 2%CHG in 70% ETOH (tinted pink /red/blue) for skin antisepsis for their pt. s for insertions of CVADs or preop skin prep? and if so were you notified of the change to the physical labelling from it previously being labelled for use as skin prep – ‘use as a preoperative treatment of unbroken skin’ to it at some date being relabelled as a “hospital grade disinfectant ” “with the direction “of apply to hard surfaces e.g walls and floors”

Can I ask then if you were aware can I ask are you still using it as a skin antisepsis even with the label change or have you stopped using for this purpose… and if so what are you now using instead?

Any advice or feedback would be grateful

Many thanks

Regards

Lindy

Lindy Ryan
Infection control CNC
Nepean Hospital NBMLHD
Phone 4724 2228
Email lindy.ryan@swahs.health.nsw.gov.au

Infection Prevention and control is everyones business

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[Wilkinson, Irene (Health)]

Thanks Cath,

Can you please provide the info that needs to be entered into the email request for the download?

Cheers,
Irene

Irene Wilkinson
Manager, Infection Control Service
SA Health
Irene.wilkinson@health.sa.gov.au
08 7245 7170

Thanks Cath,

Great session, great support for a watershed motion. And a great suggestion re all of us writing to each member who spoke – if you track down their email addresses would you mind sharing them with us?

Best regards, Terry

Terry Grimmond FASM, BAgrSc, GrDpAdEd
Consultant Microbiologist
Grimmond and Associates
Ph/Fx (NZ): +64 7 856 4042
Mob (NZ): +64 274 365 140
E: tg@gandassoc.com
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Today in the Federation Chamber sensible bipartisian behaviour and good reason from twelve Members supporting Coalition MP Dr Mal Washer’s last private member motion and the first ever to address needlestick and sharps injuries. This motion has the potential to eliminate up to 30,000 of these potentially life-threatening workplace injuries sustained by Australian healthcare workers each year. As a nurse sustaining multiple sharps and Needlestick injuries over a 30-year plus career and as a long-term researcher and advocate for mandating availability of safety engineered sharps devices that eliminate this risk, my faith in Australian politics has been somewhat restored. Too bad Australia lags at least a decade behind the US and several years behind Canada and Europe until legislation mandating safety engineered sharps devices is promulgated.

If any ACIPC members or others are interested in accessing a recording of the very interesting debate you can follow this link to request a copy. http://www.aph.gov.au/News_and_Events/Watch_Parliament/How_do_I_request_a_copy_of_Parliamentary_proceedings Within 6 hours I had received unique access to a downloadable version of the debate. It was interesting live and compelling watching post event.

The 12 MPs who spoke in support of Dr Washer’s motion are listed below. There would be great merit in the College and individual members writing or contacting these politicians to express our thanks and to request their ongoing support and commitment beyond today and September’s election. If we remain silent on this issue we may well lose this one chance which is the first one I’ve experienced in more than 25 years in the field.

* Graham Perrett. Member for Moreton, QLD
* Hon. Judi Moylan, Member for Pearce, WA
* Tony Zappia, Member for Makin, SA
* Craig Thomson, Member for Dobell
* Jill Hall, Member for Shortland
* Jane Prentice, Member for Ryan, QLD
* Michael McCormack, Member Riverina
* Hon. Shayne Neumann, Sec For Health and Ageing
* Dr Dennis Jensen, Member for Tangley
* Nick Champion, Member for Wakefield SA
* Darren Chester Member for Gippsland,
* Nola Marino, Member for Forest

Professor Cathryn Murphy RN MPH PhD
Executive Director
Infection Control Plus Pty Ltd
West Burleigh, Queensland
http://www.infectioncontrolplus.com.au
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[Wilkinson, Irene (Health)]

Thanks Michael for this discussion and the links to the articles you supplied below.

In the second article, which is a good review of the current literature on the topic, one study was noted that conducted laboratory experiments on 31 permanent markers and 30 surgical site markers (presumably specifically marketed as such). The authors seeded the tips of the pens with MRSA and then used them to inoculate agar plates at various times up to 3 weeks post-seeding. The article summarises their findings thus:

“Results showed that MRSA did not survive on the permanent marking pens after 15 minutes from inoculation; however, the MRSA survived up to 3 weeks on the surgical marking pens. The authors theorized that MRSA did not survive on the permanent marking pens because the ink contained isopropyl alcohol and ethanol but was able to survive on the surgical marking pens because the ink contained water as the main solvent.”

What this says to me is that if surgical marking pens are used, then it is imperative that they are single patient use. On the other hand, the risk of cross-contamination by reusing a permanent marker (such as a texta) is minimal if not re-used within 15 minutes. Of course, there are other considerations such as the potential toxicity of the permanent ink, durability of the marking, etc.

Regards,
Irene

Irene Wilkinson
Manager, Infection Control Service
SA Health
Irene.wilkinson@health.sa.gov.au

—–Original Message—–

Hi Lynley

If this was only about amputation of infected limbs and digits which were then discarded, it would be less concerning. But safe surgery protocols now require us to mark every site and side for every surgical procedure that has laterality (except mucous membrane areas, basically). So your professional athletes having joint surgery, your women having breast surgery, the diabetic patient having foot amputation for chronic infection: they all need the correct site marked. We obviously want to do everything we can to reduce risks of infection in all of our patients.

That is what the question is aimed at: what is the risk, and what should we do to minimise such risk?
Apologies if this sounds dictatorial, but I feel we need to focus on why we are discussing this.

Cheers
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
e: Michael.Wishart@hsn.org.au
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________________________________________

Hi All,

I would still prefer to mark the leg then have the wrong one amputated.
Happens more often then you might think!

Just a thought.

And if the leg is being amputated what is the risk of infection following surgery?
And as the leg is being amputated (usually due ti infection) isn’t the site left at increased risk anyway?

Just curious.

Lynley

ICP
Alice Springs Hospital
CAHN

Sent from mikala, the iPad!

On 05/06/2013, at 11:56, Michael Wishart wrote:

> Hi Irene
>
> Good question, some aspects of which has already been discussed in the literature, but with conflicting opinions.
>
> http://www.medpagetoday.com/MeetingCoverage/ICAAC-IDSA/11440
>
> http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2008/Dec5(4)/Pages/130.aspx
>
> Some of those referred studies seem to indicate different brands will act differently. The most interest finding I saw was that in one study, MRSA remained on all types of felt tips tested.
>
> So, the question remains: is it possible to transfer microorganisms via felt tip pens? Without doing a full study on whichever brand of felt tip pen we chose, I would be reluctant to say a definite yes for all different marking pens.
>
> Should we rely solely on antiseptic skin prep prior to the procedure? I think would much depend on where the site was marked… I have seen limbs marked prior to surgery well below where the area was be prepped with antiseptic.
>
> At the very least, the body of the marking pens should be wiped over between uses to avoid transfer of MRO’s onto the hands of whoever handles it, as these pens have direct contact with patients. Carrying a marking pen for the purpose of limb marking in one’s pocket ‘until it runs dry’ seems to be asking for problems (and not just from staining of the pockets from ink!).
>
> More discussion on this would be appreciated. I recognise that sterile marking pens have been used within the sterile field for a long time, but should we use these same disposable sterile markers for pre-operative limb marking as required for safe-site surgery protocols?
>
> Cheers
> Michael
>
> Michael Wishart
> CNC Infection Control
> Holy Spirit Northside Private Hospital
> 627 Rode Road, Chermside, Qld 4032
> t: (07) 3326 3068 | f: (07) 3607 2226
> e: Michael.Wishart@hsn.org.au
> w:www.holyspiritnorthside.org.au
> Please consider the environment before printing this email
>
>
>
> —–Original Message—–
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Wilkinson, Irene (Health)
> Sent: Wednesday, 5 June 2013 12:03 PM
> To: AICALIST@AICALIST.ORG.AU
> Subject: Re: Pens for marking skin prior to surgery
>
> Hi all,
>
> Is there any evidence that texta markers are a vehicle for transmission of microorganisms?
> Th

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[Wilkinson, Irene (Health)]

Hi all,

Is there any evidence that texta markers are a vehicle for transmission of microorganisms?
The solvents used in them would have fairly powerful antibacterial action. Isn’t the skin then well prepped before the incision is made?

Regards.

Irene Wilkinson
Manager, Infection Control Service
Communicable Disease Control Branch
SA Health
Irene.wilkinson@health.sa.gov.au

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michele.Cullen@HEALTH.VIC.GOV.AU
Sent: 04 June 2013 3:40
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Pens for marking skin prior to surgery

Dear Michael

Single use sterile pens for skin marking have been available for over thirty years.
Likewise reusable pens/inkwells and ink have been available and can be washed and sterilized between uses.

Regards

(Embedded (Embedded image moved to file: pic15046.jpg)
image moved
to file:
pic12667.jpg)

Michele Cullen
Infection Control Consultant | Communicable Disease Prevention and
Control | Public Health
Department of Health | 50 Lonsdale Street, Melbourne, Victoria,
3000
p. 03 9096 5094 | f. 1300 651 170
e. michele.cullen@health.vic.gov.au

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Hi all

What do other facilities use for marking skin prior to surgery? We currently use a reusable felt tip permanent marker that doesnt appear to be cleaned in any way between each patient. This occurs prior to the surgical procedure outside of the operating room, so does not need to enter the sterile field.

Our questions revolve around whether we should source disposable pens, or try to clean the markers between each patient use. This raises the
question: how do you clean a felt tip??

We did note some interesting discussions on possible cross-contamination using marking pens (eg
http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2008/Dec5
(4)/Pages/130.aspx ).

Any comments?

Thanks
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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