[John Ferguson]

Hi Glenys

I’m not sure I’d agree that the current Australian HH audit system is broke and parliamentary records are not necessarily representative of what is really going on ! We should remember what we had before HHA came into existence. In fact the load on infection control services has been minimised by training auditors who are link nurses etc. We now have such a brace of auditors that the main problem is keeping them credentialed. Our audits go across a large number of facilities each time and work pretty well like clockwork. We all have invested a lot of work in getting things to where they are and we have seen measurable gains in terms of SAB reduction etc. I think we should focus not on revolution but rather tinkering with the system.

A huge issue to me is that we medicos are still largely allowed to operate in a parallel universe, with no real accountability system ensuring that we (in NSW at least) have even completed 5 moments training or shock/horror been competency assessed for HH, PPE or aseptic technique. Aside from the College of Surgeons, it seems that the other colleges are dodging and weaving still and that is where ACIPC and ASID should be pushing +++. For instance our medical advanced trainees still have no explicit expectation put on them by the RACP concerning expectations of inf control practice during exams etc. We allow doctors to get about in all sorts of gear (suits, coats etc) or theatre scrubs and no-one wants to say boo. Why can’t we adopt a bare below elbow standard nationally? Can we hear more about the Cognitive Institute’s recent aust. pilot into Vanderbilt style accountability systems please? Royal Melb Hosp has been part of that pilot.

Other possible improvements:

a) At one of our sites, we’ve had the experience of a well credentialed external auditor conducting most of the HH audits for the past two audits. We have seen compliance there fall considerably indicating to me that all locations should adopt an approach to auditing whereby auditors are always drawn from a different ward or hospital (proper independent auditing).

b) We know also that the initial audit figures from a session are more indicative of actual practice and so, we should not allow for auditing at any site to go on for more than say 30 mins max.

c) We should ensure that audits occur more frequently than thrice yearly and across all shifts with at least monthly feedback of data to cadres and managers

d) Integrating HH auditing with AT audits

e) More careful operational research – what is working , what is not, how valid are results, what effects are improvements in HH having, why are medicos not getting engaged with the system? etc

Best wishes
John

Dr John Ferguson MBBS DTM&H FRACP FRCPA
Director, Infection Prevention Service | HNE Local Health District
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf
[http://www.health.nsw.gov.au/images/communications/e-signatures/images/NSW-Health-Master.jpg]

Dear All,

There was a debate in the UK parliament, Westminster Hall on 15/5/2018 in relation to hand hygiene compliance.

The parliament was told that actual hand hygiene compliance is only 18% – 44% in the UK and that direct observation is grossly overestimating HH compliance rates (Hawthorn effect).

https://goo.gl/7D4zTD

The discussion has implications for direct observation of hand hygiene compliance programs in Australian healthcare settings.

It is time to review our direct observation HH compliance strategies and the significant infection control resources committed to such programs across Australia.

Regards

Glenys

Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
M: +61 404816434
E: infexion@ozemail.com.au

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[John Ferguson]

Hi all,

My colleague Dr Hema Varadhan wrote a nice guest posting the other month on blastocystis – https://aimed.net.au/2016/11/18/blastocystis-commensal-or-culprit-do-i-really-care/

Certainly no sense in isolation and no inf control issues per se

It is highly prevalent in children , dependent on what method is used to detect- probably normal flora in fact!

John

Dr John Ferguson
Infectious Diseases & Microbiology
+61 428 885573 Tw @mdjkf

Please visit http://www.aimed.net.au, an HNE Health/Pathology North website for discussions about practical antibiotic treatment issues and direct access to relevant HNE guidelines and cumulative antibiograms. You can follow the postings on twitter (@mdjkf) or via a weekly email digest (enroll your email on the site).

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Nitti
Sent: Thursday, 16 February 2017 11:36 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Blastocystis hominis infection

Dear all,

Is there any information on management of blastocystis hominis in health care facilities? particularly on isolation.

any kind of information will be helpful

Thank you
Newnit Madan
Infection Prevention Control Coordinator
Sir Moses Montefiore Jewish Home
120 High Street, Hunters Hill NSW 2110
Tel: 02 9879 2756 | Mobile: 0467 505 539
Email: nmadan@montefiorehome.com.au | Web: http://www.montefiorehome.com.au
—

Kind Regards

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Newnit Madan
Infection Prevention Control Coordinator
Sir Moses Montefiore Jewish Home
120 High Street, Hunters Hill NSW 2110
Tel: 02 9879 2756 | Mobile: 0467 505 539
Email: nmadan@montefiorehome.com.au | Web: http://www.montefiorehome.com.au

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[John Ferguson]

Hi Janet

Our MRO PCP which you will know is available via the bottom of this page- http://aimed.net.au/infection-control/ – clearance criteria are there for MRSA and VRE – we’ve simplified these to a 6 mth event – excerpts below – those with chronic carriage in wounds (risk factor for chronic carriage) detected by culture of same
Allen Cheng’s recent VRE carriage paper worth a read http://www.ncbi.nlm.nih.gov/pubmed/23039285
Kluytman review worthwhile
http://www.ncbi.nlm.nih.gov/pubmed/21366406 Swiss study – similar to older Dutch literature ; however strain specific influence
http://www.ncbi.nlm.nih.gov/pubmed/24393651 MSSA carriage in UK

Kind regards
John

[cid:image001.png@01D12080.3BA3D370]

Dr John Ferguson MBBS DTM&H FRACP FRCPA
Microbiologist | Pathology North, NSW Pathology
Infectious Diseases Physician | Immunology and Infectious Diseases Unit
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf

Follow http://www.idmicnepal.net for microbiology and infectious diseases post graduate resources and discussions.
Follow http://www.biochemcase.wordpress.com for moderated case discussions from a renowned clinical biochemistry expert.
Follow http://www.aimed.net.au, the HNE Health/Pathology North site for practical discussions about antibiotic use.

[cid:image002.jpg@01D12080.3BA3D370]

[cid:image003.png@01D12080.3BA3D370]

Hi all

We are reviewing our management of multi-resistant organisms and in particular the process to determine someone is cleared (organism not expected to return) or de-activated (organism may return, particularly with antibiotic pressure).

We would be interested to know what other facilities have in place, particularly paediatrics.

Do you have any useful references which guide your practice?

Regards

Janet

Janet Wallace
Clinical Nurse Consultant
Infection Control – Infection Management and Prevention Service (IMPS)

Children’s Health Queensland Hospital and Health Service
Level 12, Lady Cilento Children’s Hospital
Children’s Health Queensland
South Brisbane QLD 4101

T: 07 3068 3989 / mobile 0408 236 266
E: janet.wallace@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

[cid:image001.png@01D11D2E.593917B0][cid:image002.png@01D11D2E.593917B0][cid:image003.png@01D11D2E.593917B0][cid:image004.png@01D11D2E.593917B0]
[cid:image005.png@01D11D2E.593917B0]

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[John Ferguson]

Here is our info sheet

Hi Kirsty

Our Current MRO/ C difficile protocol is reflected here for http://aimed.net.au/infection-control/ (bottom of page) See section E2.10 Screening of healthcare workers for MROs

We also have an info sheet for MRSA colonised staff that I just cant put my hands on

Kind regards
John

Dr John Ferguson MBBS DTM&H FRACP FRCPA
Microbiologist | Pathology North, NSW Pathology
Infectious Diseases Physician | Immunology and Infectious Diseases Unit
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf

Follow http://www.idmicnepal.net for microbiology and infectious diseases post graduate resources and discussions.
Follow http://www.biochemcase.wordpress.com for moderated case discussions from a renowned clinical biochemistry expert.
Follow http://www.aimed.net.au, the HNE Health/Pathology North site for practical discussions about antibiotic use.

[cid:image001.jpg@01D11BDC.D461CF70]

Hi all
On the Central Coast we are currently reviewing our Guidelines and Procedures on the management of healthcare workers with positive MRSA pathology.
We would really appreciate it anybody had current guidelines and procedures that they are willing to share and send to us for review. Any advice from your ID with regard to what you do if decolonisation programs are unsuccessful and what is the management for HCWs in these situations?
Thank you in advance for any information you can provide.
Kind regards

Kirsty Graham
Nurse Manager
Infection Prevention and Control Unit
Central Coast Local Health District
kirsty.graham@health.nsw.gov.au

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[John Ferguson]

Hi Kirsty

Our Current MRO/ C difficile protocol is reflected here for http://aimed.net.au/infection-control/ (bottom of page) See section E2.10 Screening of healthcare workers for MROs

We also have an info sheet for MRSA colonised staff that I just cant put my hands on

Kind regards
John

Dr John Ferguson MBBS DTM&H FRACP FRCPA
Microbiologist | Pathology North, NSW Pathology
Infectious Diseases Physician | Immunology and Infectious Diseases Unit
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf

Follow http://www.idmicnepal.net for microbiology and infectious diseases post graduate resources and discussions.
Follow http://www.biochemcase.wordpress.com for moderated case discussions from a renowned clinical biochemistry expert.
Follow http://www.aimed.net.au, the HNE Health/Pathology North site for practical discussions about antibiotic use.

[cid:image001.jpg@01D11BDC.D461CF70]

Hi all
On the Central Coast we are currently reviewing our Guidelines and Procedures on the management of healthcare workers with positive MRSA pathology.
We would really appreciate it anybody had current guidelines and procedures that they are willing to share and send to us for review. Any advice from your ID with regard to what you do if decolonisation programs are unsuccessful and what is the management for HCWs in these situations?
Thank you in advance for any information you can provide.
Kind regards

Kirsty Graham
Nurse Manager
Infection Prevention and Control Unit
Central Coast Local Health District
kirsty.graham@health.nsw.gov.au

This message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.

Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
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[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

Follow http://www.aimed.net.au, a new HNE Health/Pathology North discussion site for continuously updated important information about antibiotics and their use.
[cid:image001.jpg@01D0AD08.7EEF9B00]

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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[John Ferguson]

The Dutch know the most about decolonisation
Their 2012 evidence review is here- http://www.swab.nl/swab/cms3.nsf/uploads/51DB72E670CAC33BC12579BF00342A95/$FILE/SwabrichtlijnMRSAherziening%2015022012_EN.pdf

Uncomplicated carriage gets 5days with TDS mup
Complicated carriage 7 days

Regards
John

Dr John Ferguson MBBS DTM&H FRACP FRCPA
Director, Infection Prevention Service | Hunter New England Health
Microbiologist | Hunter Area Pathology, Pathology North, NSW Pathology
Infectious Diseases Physician | Immunology and Infectious Diseases Unit
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

Follow http://www.aimed.net.au, a new HNE Health/Pathology North discussion site for continuously updated important information about antibiotics and their use.
[cid:image001.jpg@01D0545F.58F32360]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Wednesday, 25 February 2015 2:08 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Fwd: RE: [asid-ozbug] Staph decolonisation: at the coal face

[Cross-posted from ASID-OzBug with author permission – Moderator. Replies will be forwarded to author]

——– Original message ——–
On 20/02/2015 2:54 PM, Meryta May wrote:
Dear Ozbug,

Irrespective of what the literature shows, can I ask the following as a quick straw poll:

In your current favourite staph decolonisation protocol how many days do you usually recommend? If you have time to give a quick reason that would be great too (eg based on cast-iron evidence; based on previous failures; patient acceptance, a whim; etc).

Nasal mupirocin: 5, 7, 10, other?

Daily washes: 5, 7, 10, 14 , other?

Many thanks

Meryta

Regards, Dr Meryta May|Clinical Microbiologist and Paediatric Infectious Disease Specialist|Microbiology Department|Microbiology|Sullivan Nicolaides Pathology
P + 61 7 33778402| F +61 7 38705971| E meryta_may@snp.com.au

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[John Ferguson]

I think congratulations are due to Terry, Sandy Berenger and others who have been doing the hard yards on this revision- thank you!

I would suggest our College consider brokering sophisticated educational modules for ICPs that explain the important parts of the new Standard, including key concepts etc. All of us will be expected to be au fait with it after all.

John

John Ferguson
Director Infection Prevention Service
Infectious Diseases Physician and Microbiologist,
Hunter New England Health, John Hunter Hospital, Newcastle
Tel 61 2 49214444, Fax 61 2 49214440, Mobile +61428 885573

Follow http://www.aimed.net.au, a new HNE/Pathology North discussion site for antibiotics and their use.

Good morning everyone,

AS/NZS4187:2014 is due to be published today!

Unfortunately a quick check of the SAI Global website this morning revealed that it isn’t currently showing the new edition – however the Committee has been informed that it is due for publication today – so keep on checking and happy reading once you obtain your copy.

If you have any questions I would be happy to discuss them with you.

It is hard to believe that I have sat on this committeee representing AICA and now ACIPC since 1999. Where does the time go??

Kind Regards
Terry McAuley
Sterilisation & Infection Prevention and Control Consultant
STEAM Consulting
E: terry@steamconsulting.com.au
W: http://www.steamconsulting.com.au
A: PO BOX 779
Endeavour Hills
VIC Australia 3802

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[John Ferguson]

From: noreply+feedproxy@google.com [mailto:noreply+feedproxy@google.com] On Behalf Of Controversies in Hospital Infection Prevention
Controversies in Hospital Infection Prevention

________________________________

Top Papers in Infection Prevention

Posted: 13 Sep 2014 09:55 AM PDT
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Last week, Andreas Voss gave a talk on the year’s top papers in infection prevention at ICAAC. He graciously allowed us to post his slides to the blog. To see his presentation, click here. Thanks, Andreas!

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Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

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[John Ferguson]

Dear All

A few questions and comments (in advance of the ACIPC SIG starting its work)

1. Are people promoting the use of WPRO 2004 Infection Control Guidelines? These do not appear to have been updated. Are there more recent WHO- worldwide guidelines that people use? What other materials are you providing? There is a real need for us to standardise what local and national advice we give for these programs.

2. The WPRO inf control assessment tool is also there – are people using it? I’ve just been up in PNG and really even that tool is a road too far for nearly everywhere

3. Do any of your hospitals have redundant mechanical beds that still function? Goroka Hospital really needs some. They also need a replacment general ultrasound machine. Perhaps we should be putting these things on Gumtree!! Our healthservice recently sent all its old beds up to Alotau. I can arrange transport with the Air Force etc from Newcastle.

4. Re TB and DR-TB infection control in PNG , there is finally some semblance of national action with a crisis committee of experts, including key NGos meeting now. MSF have become involved with control efforts in the Port Moresby region. They are focusing on the USAID F-A-S-T control framework . I’ve updated all relevant links from this page – http://hicsigwiki.asid.net.au/index.php?title=Tuberculosis_healthcare_infection_control_in_resource_poor_settings .

5. I’d encourage all those involved with overseas work to join one of the relevant discussion communities on GHDONLINE.org . ALso encourage your in-country colleagues and NGO partner groups to join. It would be great to think about establishing a specific community on this Harvard resource for Pacific Nation inf control – perhaps this could be then moderated by experts who sit on the ACIPC SIG.

Lukim yupela!

Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

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[John Ferguson]

Hi

HNE will clear VRE (vanA or B) based on whether 2 separate swab sets are negative > 6 mths after the previous positive isolate. Wounds and urine (if catheterised) also cultured. We then re-screen based on targeted generalised adm criteria and ICU adm get screened.

Regards
John

Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health

[cid:image001.jpg@01CFD044.08AD6A90]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of CAMERON, Donna
Sent: Friday, 12 September 2014 2:56 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [asid-ozbug] VRE clearance

Hi Ravi & Michael,

At Austin Health (Melbourne) while we never remove a VRE alert from the patient record we do clear them allowing them to come out of precautions. It is dependent on how long ago their last positive VRE sample was, the ward they are admitted to and if they are being put onto a course of treatment antibiotics. We have an algorithm the bed managers use which I am happy to share if you would like to see it. This is only applicable to the acute care setting as in our non-acute beds patients with VRE are only put into contact precautions if they are incontinent (and it is uncontainable) and uncooperative.

We also have three levels of contact precautions now (Routine, Enhanced & Intensive) and for VRE it is what we term Routine Contact precautions where staff only wear a plastic apron. Gloves are only used as per standard precautions so the contact precautions are not as onerous as they once used to be.

Currently, we dont have different screening/clearance protocols for van A or van B.

Regards,
Donna.
Donna Cameron
Manager Infection Control
Austin Health
P.O. Box 5555
HEIDELBERG Vic 3968
9496 6625
Fax: 9496 6677
Pager: 6625
donna.cameron@austin.org.au

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Friday, 12 September 2014 2:30
To: AICALIST@AICALIST.ORG.AU
Subject: [asid-ozbug] VRE clearance

[Posted on behalf of Dotel Ravindra Moderator. Replies will be copied to Dr Ravindra.]

——– Original message ——–
From: Dotel Ravindra
Date:12/09/2014 11:52 (GMT+10:00)
To: asid-ozbug@malbec.burnet.edu.au
Subject: [asid-ozbug] VRE clearance

Dear Ozbuggers,

Could we ask about your practice on VRE clearance and deflagging previously VRE colonized patients?

What are your inclusion and exclusion criteria for the clearance?
Is there a differentiation according to the van type van A vs. van B?

We currently dont have a policy or procedure for clearing VRE flagged patients, but are feeling increasing pressure to do so.

With regards,
Ravi Dotel (ID registrar Liverpool Hospital)
&
Michael Maley
.

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[John Ferguson]

Dear Fiona

We also base our approach on Dharan

I did put together an approach on the WIKI – see http://hicsigwiki.asid.net.au/index.php?titleOperating_theatre_commissioning_-_Microbiological

It would be useful to agree a national standard for this!

Kind regards
John

Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health

[cid:image001.jpg@01CFC5FB.5251CEF0]

Dear Fiona,

Here at our institution, we are currently using this reference:

Dharan S, Pittet D. Environmental controls in operating theatres. J Hosp Infect. 2002 Jun;51(2):79-84.
http://www.ncbi.nlm.nih.gov/pubmed/12090793

Realising that it is very difficult to set and apply acceptable CFU limits, and there always will be an arbitrary component to this.

Best regards, Matthias.

—
Matthias Maiwald, MD, FRCPA
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 1387

Dear members,

I know that air sampling in a new building is a contentious issue but we are currently undergoing it as part of the commissioning process for new operating theatres and one of the difficulties I face is people asking for the acceptable limit of certain organisms. Aside from fungal organisms I have been unable to find any references to guide me on specific organisms counts.

I would like to hear people’s views on the isolation of skin or environmental flora when doing this sampling – how many CFU would be acceptable per air sample ?

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

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[John Ferguson]

This is ours Joe
cheers

Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

[cid:image001.jpg@01CFC10E.02B234D0]

Good morning
If you were to include the principles on decision making priorities for single room accommodation and cohorting in a policy document, what would you include?

Thanks

Joe

Joe-Anne Bendall
(Monday/Thursday/Friday)
Joe-anne Bendall | Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
| ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

(Tuesday & Wednesday)
HAI Project Officer | Clinical Nurse Consultant Infection Prevention and Control
Clinical Governance Unit

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[John Ferguson]

Dear Jenny

The critical point is that when chlorhex is mixed with alcohol , there is no apparent benefit from exceeding 0.5%.

The old literature on 2% C and lines related to an aqueous preparation.
Furthermore, we found an increase in skin reactions to the more concentrated products (went to a poster).

Matthias M will comment no doubt – he has recently published this piece that is of relevance – Maiwald M, Chan ESY. Pitfalls in evidence assessment: the case of chlorhexidine and alcohol in skin antisepsis (Leading Article). J. Antimicrob. Chemother. (2014) Advance Access.
http://jac.oxfordjournals.org/content/early/2014/04/28/jac.dku121.abstract

Kind regards
John

Dr John Ferguson
Infectious Diseases & Microbiology
+61 428 885573

Hi Jenny,
There is lots of supportive evidence for 2%CHG in 70%IPA, particularly for invasive device skin preparation (CVC/PICC/PIVC,ICC/Epidural, etc,etc..)
Here is a link to Dr William Jarvis discussing the differences of various skin preps.
http://www.medscape.com/viewarticle/761489
There is both a video of the discussion..
To cut to the conclusion;
The findings were very interesting. Of greatest importance, the investigators found that all products (0.5% chlorhexidine with ethanol, 1% chlorhexidine with ethanol, and 2% chlorhexidine with isopropyl alcohol) were equally effective. This will be very helpful information when you are trying to select a product for preparation of the insertion site for intravascular catheters or for a preoperative surgical antiseptic. Chlorhexidine is effective, and different concentrations of chlorhexidine are equally effective, with no statistically significant difference in colony counts. All of these products should be equally beneficial to patients in preventing central line-associated bloodstream infections or surgical site infections.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
President, Australian Vascular Access Society
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au

“Be a yardstick of quality. Some people aren’t used to an environment where excellence is expected.” – Steve Jobs
________________________________

Hi all – not sure if this has already been discussed and apologies if it has – one of the orthopaedic surgeons here is requesting Chlorhexidine 2% with 70% alcohol (tinted red) as opposed to the 0.5% with 70% alcohol for skin prep. Firstly, is there an advantage to using the 2% as opposed to the 0.5% and if so would anyone have any literature to support this

Thanks
Jenny McCarthy
Maryvale Private Hospital

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[John Ferguson]

Dear All,

My views would be
a) Contact precautions – YES – glove and gown, cohort or isolate with ensuite facilities
b) Add eye safety wear and fluid- repellant filter (surgical) mask as required by Standard Precautions – ie dealing with a vomiting patient , bagging contaminated linen or dealing with vomitus etc

CDNA and CDC do not see a rationale for particulate filter mask use. Where is the evidence for that?

http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda-cdna-norovirus.htm-l~cda-cdna-norovirus.htm-l-8

http://www.cdc.gov/hai/pdfs/norovirus/229110A-NorovirusControlRecomm508A.pdf
http://www.cdc.gov/hai/pdfs/norovirus/229110-ANoroCaseFactSheet508.pdf

Best wishes
John

Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org

[cid:image001.jpg@01CEE094.E5960980]

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