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SA Health has a fact sheet on Legionella risk in chilled water and ice machines, available from:
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/healthcare+associated+infections/prevention+and+management+of+infections+in+healthcare+settings/environmental+hygiene+in+healthcare
Irene Wilkinson
Director, Infection Control Service (Tues – Fri)
Communicable Disease Control Branch
Public Health & Clinical Systems
SA Health
Government of South Australiahttp://www.sahealth.sa.gov.au/infectionprevention
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This e-mail may contain confidential information, which also may be legally privileged. Only the intended recipient(s) may access, use, distribute or copy this e-mail. If this e-mail is received in error, please inform the sender by return e-mail and delete the original. If there are doubts about the validity of this message, please contact the sender by telephone. It is the recipient’s responsibility to check the e-mail and any attached files for viruses.Dear Kristin,
So long as they are well maintained the associated risks can be managed.
Ice-machines are installed in each ward area within our campus. These machines are on an ongoing annual maintenance schedule and includes sanitation.
Public Health Units undertake their own quarterly water sampling from across the campus and provide the results back to IPAC and engineering department. This provides qualitative water testing results to supplement the monthly testing that is undertaken by engineering.Regards,
Sharyn Hughes
Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339Hi all,
I remember there was some discussion on the efficacy of ice machines in healthcare at conference last year.
Does anyone have any fore’s or against?
Cheers
KristinKristin Ryan-Agnew
Kristin Ryan-Agnew (MPH/Grad Cert IP&C)
Infection Prevention & Control Clinical Nurse Consultant
The Tweed Hospital[cid:image001.png@01D36E89.D6B88C30] National Standard 3 : Preventing and Controlling Healthcare Associated Infections
[Description: Description: Description: Description: cid:image001.png@01CC899A.70FE88C0]
I acknowledge the Bundjalung people as traditional owners of the land on which I work and live.
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Hi Lucy,
The UK Royal College of Nursing has a very useful guide to selecting and using disinfectant wipes.
You can access it here (although I note that it is under review):
https://www.rcn.org.uk/search?KeywordDisinfectant%20wipes&SortRelevance&ScopeGlobalkind regards,
Irene Wilkinson
Director, Infection Control Service (Tues – Fri)
Communicable Disease Control Branch
Public Health & Clinical Systems
SA Health
Government of South Australiahttp://www.sahealth.sa.gov.au/infectionprevention
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We are interested to know if your facility uses wipes for routine environmental cleaning. Do you use a detergent wipe, a 2 in 1 wipe (detergent/disinfectant) or both? This includes daily and discharge cleans. How did you choose the product that you use?
Kind regards
Lucy Hughson I Clinical Nurse Consultant
Public Health Services I Department of Health
3/25 Argyle St Hobart, GPO Box 125 Hobart 7001
Phone (03) 6166 0605 | Work days Monday, Wednesday & Thursday
Prevention is better than cure
I acknowledge the traditional owners of the land on which we work and live, and respect their ongoing custodianship of the land. I pay respect to Tasmanian Aboriginal people, and Elders past and present.________________________________
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Dear colleagues,
An interesting discussion. In SA we have always taught staff that if their hands are visibly soiled they should wash with soap and water, followed by alcohol-based hand rub. This has always seemed very logical to me, so I was surprised by Matthias’ comment that this may in fact be the wrong way around!
Irene
Irene Wilkinson BSc(Hons) MPH
Manager, Infection Control Service
Communicable Disease Control Branch
System Peformance and Service Delivery
SA Health
Government of South Australiahttp://www.sahealth.sa.gov.au/infectionprevention
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This e-mail may contain confidential information, which also may be legally privileged. Only the intended recipient(s) may access, use, distribute or copy this e-mail. If this e-mail is received in error, please inform the sender by return e-mail and delete the original. If there are doubts about the validity of this message, please contact the sender by telephone. It is the recipient’s responsibility to check the e-mail and any attached files for viruses.Thanks for the feedback and background information Mathias.
Still leaves us with the question:
* Why in clinical areas of healthcare facilities do we recommend an antiseptic agent (i.e. alcohol-based hand rub) for hand hygiene for “visibly clean hands”, yet for “visibly soiled hands” an antiseptic agent is no necessarily required?
As mentioned I would be interested to know how infection control personnel/teams are overseeing, managing and monitoring this issue to ensure transient microbial flora are being reduced or removed from healthcare worker hands during handwashing (i.e. when hands are visibly soiled/dirty).
Regards
Glenys
Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.auDear Glenys,
You are touching upon two interesting questions:
(1) What is the role of plain versus antiseptic soap handwashing (as an alternative to alcohol-based hand rubs) in healthcare facilities?
(2) What is the best method to clean or disinfect hands when they are visibly soiled?
Re. (1). According to the literature (a bit too complex and convoluted to give references here, but I summarized some of it in a 2009 review for the then upcoming NHMRC guideline), the order of microbial elimination on hands is roughly: plain soap < antiseptic soap << alcohol-based hand rubs. Most antiseptic soaps/detergent are closer to plain soaps in terms of their microbial elimination capacity, meaning they are usually not that great. When I reviewed the literature on plain versus antiseptic soaps, it seemed to me that there was no clear benefit of antiseptic soaps over plain ones in general wards, but there seemed to be potential benefits of antiseptic soaps in critical care areas. Among the antiseptic ingredients in soaps, triclosan (mostly used in antiseptic household soaps) is very minimal in its antimicrobial activity, whereas chlorhexidine (CHX) is somewhat better. However, chlorhexidine is increasingly recognised as an agent of allergies and contact dermatitis, and so one has to weigh the minimal benefit of having an antiseptic ingredient with the potential downsides. We here are phasing out CHX-containing antiseptic soaps in general ward areas and are replacing CHX-containing ABHR with CHX-free ABHR (recent paper on CHX in ABHR: http://www.pubmed.gov/28924473).
Re. (2). When I moved to Australia in 2002, I initially propagated what was taught to me in medical school in the early 1980s, i.e. when hands are visibly soiled, use ABHR first and then wash off the "dead bacterial carcasses" (drastic wording used to teach us medical students so that it would stick) with soap and water in a second step. That was consistent with the "Vienna School" of hand hygiene (around Rotter) from the 1970s. However, in 2002 I quickly gave up on this, because (a) no one believed me, and (b) I realized that this was in contrast with what the then-upcoming CDC and WHO HH guidelines would propagate, and I did not want to be discordant with these, in order to avoid confusion and different teachings.
However, when examining things closely, it becomes clear that the recommendation to only wash hands with soap and water when they are visibly soiled is lacking a clear rationale and also data to support it. In contrast, the Vienna school recommendation makes a lot of sense: (a) it has been shown in earlier experiments in the 1960s and 70s that washing heavily contaminated hands under running water above a sink creates heavily contaminated splashes around the sink in about one metre plus diameter, and (b) alcohol actually retains its antimicrobial killing capacity in the presence of moderate organic soiling, i.e. the notion that alcohol does not work in the presence of soiling is incorrect (e.g. http://www.pubmed.gov/1629595). However, it must be emphasized that for this to work, relatively larger-than-usual quantities of ABHR must be used, meaning that a 1 ml or 2 ml portion of ABHR, as HCWs can often be observed to be using, does not work. Liberal application is the key here.
Please don't misunderstand me, I am providing this mainly for clarification and background information. I do NOT want to counteract the WHO recommendation. Consistency (see statement above) is also an important consideration.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Senior Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women's and Children's Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387Dear all,
Hand washing with plain soap versus hand washing with an antiseptic hand hygiene product in acute care facliity clinical areas
I understand some healthcare facilities have either replaced antiseptic hand hygiene products in clinical areas of acute care facilities with plain soap products or have added plain soap products as an option for handwashing (i.e. when hands are visibly soiled/dirty).
Plain soap has minimal antimicrobial activity but after 30 seconds can reduce counts by 1.8-2.8log10, however compliance with a 30sec hand wash is poor.
Several studies of handwashing with plain soap have shown that plain soap failed to remove pathogens from healthcare worker hands.
Standard handwashing with soap and water removes lipids and adhering dirt, soil and various organic substances from the hands and remains a sensible strategy for hand hygiene in non-healthcare settings.
Alcohol-based hand rubs are the most efficacious agents for reducing the number of bacteria on the hands of personnel, however, there will be times when healthcare worker hands are visibly soiled/dirty and they will need to wash their hands rather than use an alcohol-based hand rub.
What is the issues?
My understanding is that in clinical areas staff should use an antiseptic hand hygiene product when they need to wash their hands, not a plain soap products?
Semmelweis demonstrated that hand antisepsis (i.e. the use of chlorinated lime) was what stopped the infections in obstetric clinics not hand washing with soap and water.
He noted that physicians and medical student who went from performing autopsies to the delivery suite had a disagreeable odour on their hands despite hand washing with soap and water before entering the clinic.
Infection control concerns
My concerns include the following:
* In clinical areas of organisations where antiseptic hand hygiene products have been replaced with a plain soap product for hand washing (i.e. when hands are visibly soiled/dirty) transient microbial flora are not being reduced or removed from healthcare worker hands.
* In clinical areas of organisations where plain soap products have been added as an option for hand washing (i.e. when hands are visibly soiled/dirty), transient microbial flora are not being reduced or removed from healthcare worker hands when they are using a plain soap product.
* Hand washing products are generally sourced from one supplier, hence the dispensers (antiseptic & plain soap) are similar/same and usually located adjacent to one another in clinical areas at hand washing facilities/sinks.
o busy staff may not necessarily be aware of the difference in the products
o Staff generally select what they will use based on smell, consistency, feel and colour hence an antiseptic product may not be used at all when hand washing.
Summary
This raises the following question:
* Why in clinical areas of healthcare facilities do we recommend an antiseptic agent (i.e. alcohol-based hand rub) for hand hygiene for "visibly clean hands", yet for "visibly soiled hands" an antiseptic agent is no necessarily required?
I would be interested to know how infection control personnel/teams are overseeing, managing and monitoring this issue to ensure transient microbial flora are being reduced or removed from healthcare worker hands during handwashing (i.e. when hands are visibly soiled/dirty).
Regards
Glenys
Definition of an Antiseptic agent
* An antimicrobial substance that inactivates microorganisms or inhibits their growth on living tissues.
Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.auMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Dear Heather,
All public hospitals and most private hospitals in South Australia do whole of hospital BSI surveillance, and the larger ones have been doing so since 1997.
For our current surveillance definitions and BSI annual report see: http://www.sahealth.sa.gov.au/HAIstatisticsRegards,
Irene Wilkinson BSc(Hons) MPH
Manager, Infection Control Service
Communicable Disease Control Branch
System Peformance and Service Delivery
SA Health
Government of South Australiahttp://www.sahealth.sa.gov.au/infectionprevention
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Thank you for your great response to my question regarding the change in definition of SSI’s.
Another question for you.
At Canberra Hospital we have been collecting whole of hospital blood stream infection data since 1998.
Would any IC’s be willing to share what other hospitals in Australia also do whole of hospital blood stream surveillance.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
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Dear Colleagues,
There is a recent review by Dr John Boyce on modern methods of environmental cleaning and disinfection which is open access:
http://aricjournal.biomedcentral.com/articles/10.1186/s13756-016-0111-x
It presents a very good summary of the state of the art and has an extensive reference list.
Regards,
Irene Wilkinson BSc(Hons) MPH
Manager, Infection Control Service
Communicable Disease Control Branch
System Peformance and Service Delivery
SA Health
Government of South Australiahttp://www.sahealth.sa.gov.au/infectionprevention
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This e-mail may contain confidential information, which also may be legally privileged. Only the intended recipient(s) may access, use, distribute or copy this e-mail. If this e-mail is received in error, please inform the sender by return e-mail and delete the original. If there are doubts about the validity of this message, please contact the sender by telephone. It is the recipient’s responsibility to check the e-mail and any attached files for viruses.Hi Kristie
A/Prof Mitchell raises some good points in relation to the CDC study and which should be considered in future studies. I have always been concerned that ICPs who read the CDC study results will assume that the system used in that study is in some way superior to other brands and types of non-liquid surface disinfection. Please note that there is a plethora of research using other systems and brands and the evidence is increasing very quickly.
I have close relationships with a large group of US ICPs who manage large corporate IC programs across the country. They report using various systems with various results. When talking to them they discuss the importance still of routine cleaning and terminal cleaning before disinfection. They also discussed issues regarding implementation (storage, designated users, capital outlay/ return on investment, cycle time, impact on operating time/ access to patient rooms etc).
Personally, I expect and hope that non-liquid surface disinfection will become the routine standard in Australian in and out patient settings. My early work with Dr Macbethh from 2011 was the first Australian publication to show the inadequacy of routine cleaning and I would suspect that the typical healthcare setting would yield similar results even now unless there has been serious campaigning to raise awareness of the envionrmental burden.
I have a database of many published papers on non-liquid disinfection and am happy to share with you offline if needed.
Good luck with your decisions and I hope members support Brett’s important research around this issue.
Regards
Cath
Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus.
Cath@infectioncontrolplus.com.auHi Kristie
Here is a link to a CDC funding study on this point. https://idsa.confex.com/idsa/2015/webprogram/Paper53062.html
There are a few questions that in my mind remain unanswered and or request some further discussion:
* Was this intervention cost effective?
* There were reductions in arms B, C and D, in comparison to A (reference group), just because something isn’t statistically significant, it doesn’t mean it isn’t clinically relevant. For example, arm C (bleach only) showed a reduction
* Is a quaternary ammonium a suitable reference group, especially in Australia?
* It is a shame one of the arms was not just detergent
I am certainly not wanting to be critical of this study. This was a large complex study and the first of its kind in many instances. Those involved are to be congratulated. We need more of these types of studies conducted, not only in the cleaning area, but also IP&C more generally. I raise these questions in the interest of sparking some debate and ensuring we take a considered approach before jumping wholeheartedly into UV. These are questions you are likely to face. There are also a number of implementation issues that remain central to any cleaning intervention. This is one thing the REACH study (randomised stepped wedge cluster control study in 11 Australian hospitals) is seeking to explore, in addition to effectiveness and cost effectiveness of a cleaning bundle. http://reach.cre-rhai.org.au/
Thanks
BrettAssociate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 AustraliaHello,
We are interested in hearing from sites who currently use UV light as a part of their cleaning package to decontaminate the environment and the equipment to a high level of efficacy.
If you could please make contact with me if you use UV light, we have some questions we’d like to ask.
Thank you.
Kind regards,
Kristie
Kristie Popkiss
Infection Prevention and Management Lead SERCO – Fiona Stanley Hospital
M 0437 358 042
CD012 Main Hospital
Barry Marshall Drive, Murdoch WA 6160
kristie.popkiss@serco-ap.com.au kristie.popkiss@health.wa.gov.auNext Organisation Wide Survey June 2016
Standard 3
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Dear Sue,
“Laminar flow” is a particular type of high volume airflow that creates a “curtain” of sterile air around the operating field, and has been specifically designed for use in orthopaedic surgery. As you say, the evidence for the association of this type of air system with reduction in post-surgical infection is mixed. The rationale for use of this system of air delivery is because in most major orthopaedic surgery the wound is large and open to the air for an extended period of time. Laminar flow is designed to prevent the entry of airborne contaminants (mainly originating from the operating team) into the wound.
Cardiac catheter labs do not undergo such extensive procedures, therefore the rationale for laminar flow is not there. The optimum air supply in such areas is HEPA filtration at the point of supply to the room, with a net positive air flow to surrounding areas.
AS 1668:2-2012 section 5.3 deals with the air supply requirements for operating theatres.
Irene Wilkinson BSc(Hons) MPH
Manager, Infection Control Service
Communicable Disease Control Branch
System Peformance and Service Delivery
SA Health
Government of South AustraliaPh:(08) 7425 7170 | Fax: (08) 8226 2594 | Email: Irene.Wilkinson@sa.gov.au
http://www.sahealth.sa.gov.au/infectionprevention
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Sue Flockhart
Sent: Monday, 6 July 2015 4:16 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Hybrid Cardiac Cath LabsDear ICPs,
I am seeking your advice or any information you might have in relation to the use of laminar flow in hybrid cardiac cath labs. Our hospital is in the early stages of planning for a second cardiac cath lab to be built that potentially will also complete interventional radiology procedures. I have researched the topic on line and have found as many articles for laminar flow as there are against. None of the articles have referred specifically to a cardiac cath lab.Thank you in advance.
Sue
Sue Flockhart
Manager, Infection Prevention & Control
Staff Immunisation Clinic
Ballarat Health Services
Ph-53204792
Fax-53204487
Mobile-0437856349
sueflock@bhs.org.auMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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