[Joanna Harris]

Hello Rita,
I believe that we need to be very aware of the need for our IC precaution not to challenge or interfere with a person’s identified health (and in this case, rehabilitation) needs. Where does necessary precaution end, and unnecessary discrimination begin?

In rehab settings, all clients ought to be asked to perform hand hygiene before and during participation in group activities. The equipment should be cleaned before and after each and every use by any client – not just those we ‘know’ to be colonised with an MRO.
Wounds need to be covered whether the client has an MRO or not.. incontinence needs to be managed effectively…… Hydrotherapy pools activities require particular attention to clear exclusions such as wounds etc.
Standard Precautions in essence… it is incredibly important to remember that each person with an MRO is just that.. a person with particular heath requirements that need to be effectively addressed; by doing so we can hopefully reduce their ‘length of stay’ and thereby minimise transmission risk.

Joanna Harris, Manager ISLHD Infection Management and Control Service, NSW

________________________________________

Dear All,
I am fielding this question on behalf of a colleague. How are infection control precautions for MROs to be maintained in a rehab setting when patients are doing group therapy? Especially in a private hospital where isolation signs are not allowed to be put up outside the patients room as it might upset the patient. Some of these patients have MRSA or VRE and even MRPA. They are incontinent, have weeping wounds, etc. How can minimise risk for the other patients in such conditions?

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 | Mob 0422 930 370 | Rita.Roy@health.nsw.gov.au
http://www.health.nsw.gov.au

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[Joanna Harris]

Thanks for your reply Michael. I may have not have written it clearly enough, but my question about the Sterrad relates to whether, in Australia, the Sterrad is considered a gas steriliser. My colleagues and I have always understood that the term gas steriliser refers to processing using Ethylene oxide rather than hydrogen peroxide in a Sterrad. I’m interested to hear others’ views
Jo
________________________________________

Hi Joanna

1. We process our oesophageal dilators through our Soluscope 3 machines using glutaraldehyde, only in our Endoscopy Department.

2. We use a terminal rinse in the Soluscope 3 which includes an alcohol rinse through the lumens.

3. They are stored flat in their cases, and processed immediately before use. Emergency use is extremely rare here, but it would be almost impossible to process them immediately before emergency use.

4. Sterrad does provide sterilisation, but would possibly be unsuitable for these items due to composition and lumen length/diameter. We would need to get Sterrad and dilator manufacturer agreement they could be appropriately processed in Sterrad.

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

We are currently reviewing our reprocessing of Savary-Gilliard oesophageal dilators.

Please could you tell me;

1. What process / machine / disinfectant agent are you currently using for reprocessing these items?

2. If a Steris machine is being used, do you use alcohol to flush the lumen prior to storage?

3. How do you store the items, and for how long after processing and before their re-use?

4. Do you consider the Sterrad system (using hydrogen peroxide) to be a gas steriliser?

Thanks

Joanna Harris

Manager, | Infection Management and Control Service (IMACS)
Level 1 Lawson House, Wollongong Hospital, Wollongong 2500, NSW
Tel 02 4222 5898 | Fax 02 4222 5367 | joanna.harris@sesiahs.health.nsw.gov.au
http://www.islhd.health.nsw.gov.au

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[Joanna Harris]

Hi Fiona,
Thanks for that. Beth is away today so I thought I’d clarify our enquiry on the clinical hand wash basins:

We’re specifically enquiring as to whether anyone is aware of Australian guidance stipulating that clinical hand wash basins are used for hand hygiene and hand hygiene alone ie cannot be used for the disposal of any other liquid waste (such as denture pot contents, wash bowl contents etc) or the cleaning of items such as dentures, medicine pots, enteral feeding equipment etc. We have been unable to find such a statement in our NSW, Commonwealth or AHFG reading.

The reason for asking about the washing machines is that the arguments about ‘discriminating against patients who have no family / friends / other way to get their personal items laundered’, particularly for our haem / onc fairly long term people who live a distance away, do have credence and our volunteers are particularly concerned. We want to be sure that any laundry facilities we do have comply with AS/NZS 4146 as stipulated in the IC policy and so are developing an audit tool and business rules etc.

I hope this clarifies the enquiry.
Jo

Nurse Manager, Infection Management and Control Service (IMACS)

Level 1, Lawson House
The Wollongong Hospital
LMB 8808
SCMC NSW 2521

Hi Beth,

Refer to the Australasian Health Facility Guidelines, Part D- Infection Prevention and Control http://www.healthfacilityguidelines.com.au/

This document provides information on the four different types of basins required in a hospital and their specific uses. Also the AHFG provide room layout ‘standard components’ sheets which also tell you what type of hand basin is required including its purpose.

Although you may not be undertaking any renovations / building works the infection prevention and control section is still sound advice and is mandatory for NSW (it is listed in the front of the NSW Health PD2007_036).

I can’t help you on the laundering of patient clothing as we specifically removed all patient washing machines and clothes dryers a number of years ago.

Kind Regards,

Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
185 Fox Valley Road, Wahroonga, NSW, 2076

________________________________

Hi All

Clinical Hand Basins
Does any one know of any Australian guidelines/standards/policies that state: clinical hand basins are only to be used for hand hygiene purposes?

Laundering of Patient Clothing Guidelines
Does anyone have a local policy/procedure/guideline for the laundering of patient clothing within a healthcare facility that you would like to share?

Thank you
Beth

Beth Bint | Clinical Nurse Consultant Infection Prevention and Control,
Infection Management and Control Service (IMACS)
The Wollongong Hospital|* ph +61 2 4222 5869 page 182 via switch+61 2 4222 5000| * beth.bint@sesiahs.health.nsw.gov.au

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[Joanna Harris]

Hi Jane,
Here in the south of SESIAHS (Wollongong, NSW) we are keen on chlorine-releasing disinfectants for environmental disinfection. Our mattress covers state that they are not tolerant of phenolics so we stick to NaDCC it is effective against C diff including spores and Norovirus as well as the usual suspects… We are also now using a combined detergent / NaDCC product for environmental disinfection as required, as this cuts down the time needed by half without compromising effectiveness. These products are now widely used in the UK and Europe since their huge problems with C difficile emerged some years ago.
I understand that there are now two such products available in Australia that have been approved by the TGA.

Jo

Nurse Manager, Infection Management and Control Service (IMACS)

Level 1, Lawson House
The Wollongong Hospital
LMB 8808
SCMC NSW 2521

Ph: 02 4222 5892 or 4222 5898
Fax: 02 4222 5367

From: AICA Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Jane Barnett
Sent: Tuesday, 20 July 2010 7:26 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Phenolic disinfectant

Hi
Id like to find out the extent of use (if any!) of a phenolic disinfectant in Australia. We are still using it here in this District Health Board in NZ although I understand we are one of the few that still have this as part of our disinfectant policy. Our microbiologist advises us that it is still used in Australia hence the query!
Most of us would prefer to go for a single disinfectant approach based on bleach solution but the phenolic has been retained based on its effectiveness against MDRO.
Any thoughts welcome!
Thank you.

Jane Barnett
CNS IP&C
Christchurch Womens Hospital
New Zealand

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[Joanna Harris]

Hi Lindy and Mary-Rose,

We are also being asked this question as part of the discussions we are involved with for our ED refurbishment. We have had significant concerns and a number of incidents (none significant thankfully) over the past two years regarding the ‘switchable’ options that were previously authorised and are still in place in our facility.
We’re happy that the latest HSF guidelines are very clear on not permitting the use of switchable systems.

Jo

Nurse Manager, Infection Management and Control Service (IMACS)

Level 1, Lawson House
The Wollongong Hospital
LMB 8808
SCMC NSW 2521

—–Original Message—–

Dear mary – Rose,

check out Australasian health faciltiy guidelines – chapter 20 pg 8 –
combined alternating pressure isolation rooms (see link below)

http://www.healthfacilityguidelines.com.au/guidelines.htm

this document indicates that duel positive/negative pressure is not
permitted and based on previous experience with this myself (we managed
to get rid of this duel option that was in place our designated rooms
from the arc days & perhaps before adam was born I am sure……….) it
was a nightmare as no one even engineering dept was even sure or knew
which switch was which way for onor off or standby etc as the writing
had worn off, and docuemntation long lost and it was all operating via
chinese whispers of how a negative or positive prssure room was meant to
work (we had to do the old tissue against the door trick) and
eventually found that the rooms at times were not fuctioning …gladly
we got rid of these and moved to just one system of negative pressure
and a quality manitenence monitoring system which these rooms aircon
included it being attached to our BMS alarm system and also that
Infection control get quartely reports of that the checks and
functionility for allour neg pressure rooms are all working and Ok to
use (important to have this in place for future)

we do not currently have any rooms designated as postive pressure
(except in out OT of course) in the cluster I work in. We have toyed
with the idea for our oncology autologous transplants we do here but as
these rooms are multi purporse in the wards when not being used for a
transplant pt (we dont have the luxury here of closing rooms when beds
are premium) the concerns that an infection risk pt may end up in the
room (even though we ask them not too) and / or a transplant pt may also
run the risk of having an MRO colonisation and inadvertantly positive
pressure is used (in my previous exerience it didn’t matter what you
policy or processes were the switiches can get flipped on or off belfore
you know it if they are there) – so after some disucssion we believed
the risks outweighed the benfits at this time for including positive
pressure rooms (we do not do large numbers of transplant and we do not
manage severe burns pts …perhaps you may get other advice here)

i am happy to hear others thoughts on the use of positive pressure
rooms and risk and benefits they may have come across in their
experience and their frequenecy of use vs cost benefit.

hope this helps the disucssion

regards

Lindy

Lindy Ryan
Infection Control Clinical Nurse Consultant (CNC)

Nepean Hospital,
Western Cluster
Sydney West Area Health Service

email: ryanl@wahs.nsw.gov.au

“Infection Control is Everybody’s Business”

>>> WishartM@ramsayhealth.com.au 25/06/2010 5:57 pm >>>
[Posted on behalf of Mary-Rose Godsell – Moderator]

Dear All,
I have been asked to investigate the possibility of including a room
that
can have both negative pressure and then be changed into a positive
pressure isolation room – (so interchangable) for some upcoming
renovation in an ICU and ED.
I haven’t read in the literature or heard of this being a viable
option,
however would like to canvass the AICA list to gather some evidence
around this. Also the efficacy of using positive pressure isolation
rooms in the first instance.

Thank you
Regards
Mary-Rose Godsell
RGON, AFAAQHC, GDipHSM, CICP, MAdvancedPrac(Infection Control)
South West Infection Control Nurse Consultant
WA Country Health Service

‘Hand hygiene reduces the
spread of infection’

ph:08) 9722 1490
mobile 04 3996 1015
e-mail: Mary-Rose.Godsell@health.wa.gov.au

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