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Dear Michael
National recommendations on MRGN approaches including recommended lab workup will be ready later this year
In basic terms, I would suggest routine MRGN (and MRSA, VRE) screening for patients transferred from another facility, particularly if that facility is overseas or from another jurisdiction or state location
Most labs are using an ‘ESBL’ select agar (usually has cefpodoxime) which will pick up plasmid mediated ampC.
David Paterson wrote a useful review which includes a useful algorithm – abstract as follows.
(International Journal of Infectious Diseases (2007) 11, 191197)Summary Plasmid-mediated class C b-lactamases are reported from Enterobacteriaceae with
increasing frequency. They likely originate from chromosomal AmpC of certain Gram-negative
bacterial species and subsequently are mobilized onto transmissible plasmids. There are reports
of unfavorable clinical outcomes in patients infected with these organisms and treated with
broad-spectrum cephalosporins. However, unlike class A extended-spectrum b-lactamases
(ESBLs), no screening and confirmatory tests have been uniformly established for strains that
produce class C b-lactamases. Reduced susceptibility to cefoxitin is a sensitive but not specific
indicator of class C b-lactamase production. Simple confirmatory tests including tests using
boronic acid compounds as specific class C b-lactamase inhibitors have recently been developed.
Their utilization will enable clinical microbiology laboratories to report those strains producing
plasmid-mediated class C b-lactamases as being resistant to all broad-spectrum cephalosporins,
thus allowing physicians to prescribe appropriate antimicrobial therapy.John
Dr John Ferguson
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@01CD5A93.9FAEAE50]
Hi all
Have a question about who is screening for what in regard to multiresistant gram negatives on admission. I mainly want to know about routine screening on admission to an acute facility on transfer from another facility, not specifically what you screen for in high risk units like ICU or dialysis, but all information is welcome!
Specifically, does anyone look for plasmidmediated Amp-C betalactamase producers in routine rectal screens?
Thanks
Michael (and yes, I have moved jobs yet again!)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
w:www.holyspiritnorthside.org.au
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Dear All,
I understand that CEC has not been inundated with applications for the HAI manager position.
They will consider late applications apparently. A great opportunity for someone!
The job was only circulated internally. I’ve made the ad available over internet – to see it, go to http://www.asid.net.au/hicsigwiki/index.php?titlePositions_vacant
Thanks
John
Dr John Ferguson
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@01CCFC75.CAD98D10]
Dear all
Please circulate the advertisement at for the position of Project Manager, Healthcare Associated Infections to your networks.
Note that only permanent employees or temporary employees with 12 months continuous service within NSW Health are eligible to apply, and that the closing date is 7 March 2012.
Regards
RG
Ronald Govers
Project Officer, Healthcare Associated InfectionsClinical Excellence Commission | Level 13/227 Elizabeth Street, Sydney NSW 2000
T: (02) 9269 5564 | F: (02) 9269 5599 | E: Ronald.Govers@cec.health.nsw.gov.au
http://www.cec.health.nsw.gov.au[cid:image002.jpg@01CCFC75.CAD98D10]
Dr John Ferguson
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@01CCFC75.CAD98D10]
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Posted on to OZBUG 20 October (was rejected by AICA list initially ). Some ozbug replies below. Full conversation will be on a HICSIG talk page later. Would welcome discussion!
Dear OZBUG and AICA list members,
This is what we’ve come up with in our health service and I would be interested to compare/ get comments from others about their local practices etc. Additionally, we are evolving a set of ‘House rules’ for common clerical areas in wards – also reflected below. I think it is essential that we evolve a standardised, detailed, efficient and safer standard for ward round practice etc.
One suggestion that we have re training – make it required to complete mandatory training (eg. hand hygiene) prior to sign-off of any period of education/study leave. At one of our large hospitals this has been amazingly effective! we are considering general implementation.
best wishes
JohnPRACTICE POINTS FOR MEDICOS
HAND HYGIENE
Please set a good example with this critical patient safety practice. Use the correct method for applying alcohol rub to all parts of the hand – see the last page of the attached HNE report for the action sequence. Dont forget to do your training annually! http://www.hha.org.au/LearningPackage/medicallearningpackage.aspx.
During clinical work, do NOT to wear anything on your hands
Wrist watches and bangles are discouraged – they must be removed prior to any procedure
Hand disinfection is still required both prior to putting gloves on & after taking them off for a procedure or body fluid exposure risk situation (eg. taking a wound dressing down)
Hand hygiene prior to patient contact should be done AFTER closing the patients curtain (or get someone else to close it- assume that it is highly contaminated)CLOTHING STANDARDS
Bare-below-the-elbows is the safest standard to follow as it facilitates good hand hygiene practice – sleeves, scarves or coats all act as fomites and become heavily contaminated quickly during average day of clinical contact. The old idea that a suit, coat and/or neck tie engenders respect is outmoded from the microbial and patient safety points of view
Wear a clean shirt/blouse every day
Launder or dry clean woollen jumpers/jacket coats at least weekly; it is best NOT to wear these during clinical care unless you can roll up the sleeves
Lanyards, neck ties, and unsecured long hair should be avoided entirely – all have a potential to act as fomites
Scarves, hijabs and other headress should be cleaned daily and their ends secured.EQUIPMENT, FOMITES, WARD ROUND PRACTICE
Use large alcohol wipes to clean and disinfect all examination equipment PRIOR to use on patients- this includes stethoscopes, tendon hammers etc.
Mobile telephones, pens, identity cards are usually heavily contaminated with hospital pathogens. Refrain from touching them during a clinical interaction and clean them frequently for your own & your patients protection
Ensure that your stethoscope is not cracked or damaged and has no cloth or plastic labels on it
Refrain from touching your hair, clothing, the curtains or the patient environment prior to contacting the patient during a clinical interaction
Avoid sitting on patient bedsideand Control Unitsms.ative bacteria and infection due to resistant pathogens such as MRSA, Clos. Avoid placing medical charts on the beds. For rounds involving a few patients, take a trolley for the clinical records. Ask one of the team to be the scribe. This person should then avoid contact with the patients environment or bedside chart.
Bedside charts are part of the contaminated patient environment and should remain at the bedside. It works best for the person who examines the patient to also look at the bedside chart.SUGGESTED HOUSE RULES FOR SHARED CLERICAL WARD AREAS
(these get discussed amongst each ward team (including JMOs/Registrars) and responsibilitities are agreed/assigned by the Nurse Manager)
These areas are highly contaminated with hospital pathogens eg. Norovirus, MRSA, VRE, multi-resistant Gram negatives and the like. For your own protection, never consume food in these areas!
1. A home for all forms and sheets: each type should have their own labelled (predictable) place- this should be standardised in every ward if possible. If the shelf labels are peeling off or absent, get the labeller and fix it! Remember this will save you time!
1. Daily clear away: loose papers, request forms, faxes, coffee cups, roles of tape, clips, used pens etc- all should go into the bin. Restore order! Remove mouse pads – little need for these. Remove old notices and any adhesive tape from the benches.
1. Daily cleaning and disinfection: once the clutter is cleared, use large alcohol wipes to clean:
* Bench tops
* Phones buttons, handset and its saddle
* Computers- keyboards, mouse, tops of screens, computer boxes and leads.kept under desk .1. Bedside charts: these are heavily contaminated with patient pathogens. They should remain at the bedside and not be jumbled with patient notes or taken to shared clerical areas.
1. Patient notes: if these are taken on a ward round, then they should be kept separate from the patient environment. Take a trolley that can act as a support for writing the notes. The note writer should not contact the patient environment.
While I am at it, Craig Boutlis and I put together a list of 10 commandments for physicians which may be of interest: http://www.asid.net.au/hicsigwiki/index.php?title10_infection_prevention_commandments_for_medicos
Clearly a long way to go.
Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health
Infectious Diseases Physician, Division of Medicine, John Hunter Hospital
Clinical Microbiologist, Hunter Area Pathology, Pathology North
Conjoint Associate Professor, University of Newcastle, University of New England
Locked Bag 1, Newcastle Mail Centre, NSW 2310
Tel 61 2 4921 4444 | Fax 61 2 4921 4440 | Mob +61 428 885 573 | john.ferguson@hnehealth.nsw.gov.au | http://www.hicsiganz.org26th October:
This posting above led to quite some debate about evidence levels etc and whether I was proposing to audit clothing standards etc.
I’d previously suggested that a plain wedding band was ok- have deleted this from above and have stopped wearing one!Additional reply from JF 20 October to OZBYG reply postings:
I think that there are persuasive reasons why a precautionary principle is indicated and I think that the medical profession (esp ID people) should get much more strongly behind processes to improve both hand hygiene compliance and other hygienic measures. The hand hygiene compliance, behaviours and clothing standards of many doctors in our health service really do let the team down; this is becoming even more evident to patients and others as the nurses improve. If doctors are to improve then I think we (ID folk) need to adopt high, consistent standards that provide that example. Without understanding that HH is one component standard precautions and a whole medical asepsis equation, practice can degenerate in to just a glib splashing of rub. It is possible to adopt a system of care that protects patients more effectively without taking any greater amt of time.
The indirect evidence equation, explained in greater detail in a recent review (In ICHE )is:
1. There is mounting evidence that even minor env contamination per se is sufficient to place patients at risk from colonisation and subsequent infection (VRE, MRSA, C diff, MRGN)
2. Contamination of clothing and fomites with similar hospital pathogens is well demonstrated, occurs quickly and is highly prevalent
3. Fomites (including clothing) are no different to a contaminated environment in terms of the potential for causing patient contamination. Actually they may have a greater potential than other room / env contamination in that they come in to close contact with patient skin etc.. Long sleeved shirts and trousers definitely come in to frequent contact with the patient and their env if care is not taken. Pinned ties still pick up hospital flora and cross contaminate the ubiquitous stethoscope around the neck, which usually dangles at crotch level.
In essence, there is really no difference between patient contact by a fomite or a transiently contaminated hand.Moreover , most patients do not wish to be contaminated with hospital pathogens- they expect hygienic care and are truly frightened by the unhygienic habits of most doctors (and others).
From another point of view, the adoption of a different dress standard, especially say for an ICU or Theatre, can make people step more easily in to a different behavioural norm. In northern Europe , many hospitals now require healthcare staff to change in to short sleeved scrubs upon arrival, wherever they work. The hospital wards do not have the feel of a usual outside environment and staff are more likely to adopt a range of other recommended behaviours. We’ve done this in our neonatal and adult ICUs and it seems to make a difference. Visiting staff have to leave their coats and paraphenalia etc at the door.
With plain wedding band , compared with a studded ring, one can still effectively spread alcohol rub over all hand and ring surfaces which is impossible otherwise. No rings definitely for procedures and a better standard is no rings at all but then again is it impt enough in comparison with other larger issues?
Trousers- daily laundering makes sense, however with care (nb stethoscopes) one can avoid contacting trousers with patients or their env (hence the need not to sit on beds etc). The only way to make it happen is to use laundered scrubs. Phones, pens etc are a potential problem if they get used by the bedside.
THe underlying politics about the house rules are that most nurses are tired of tidying up after the doctors etc and no-one wants to take responsibility for these common areas which frequently contact patient care equipment, hands, stethoscopes etc. Of course there will never be good evidence to assoc contamination of these areas with patient cross transmission. However for personal safety, work efficiency and professional reasons it makes sense for hygienic order to prevail. Mouse pads- no need for these with optical mice- the language was ambiguous!
John
I think John’s point is not to debate journal artciles and evidence and jewellery design, but that it is important to set clear expectations and standards for professional including hygiene for everyone caring for patients.
We all know that multi-pronged approaches are what is required to facilitate complex behaviour change in humans – whether that behaviour is bringing green bags to the shops, recycling or hand hygiene. This must include having good positive role models supporting clear cultural expectations (as John’s suggestion), removing barriers (like available hand rub as mentioned below), rewards for compliance and disincentives for deviation etc etc etc.
Also pretty clear that by itself, education based purely on evidence is unlikely to be very effective in supporting change for most people, and even more so when the evidence base is incomplete.
So – I’m a bit over debating evidence of sleeves, rings etc and think we should have moved on.
I think John’s examples are great ideas, love the 10 commandments, and will be trying something similar in the patch I have some influence over.
Would be great to see if anyone else has some innovative ideas for improving doctor hand hygiene – preferably that they’ve tried and evaluated – to share.
Kind regards
Helen
Helen Van Gessel
ID physician, acting regional medical director WA Country Health Service, Great Southern
On 20/10/2011, at 7:28 PM, “Trent Yarwood” <trentyarwood@gmail.com> wrote:
> An article looking at short-sleeves was presented at our journal club
> earlier this year:
>
> Burden et al, J Hosp Med 2011; 6(4),177-182 DOI: 10.1002/jhm.864
>
> They concluded that surgical scrubs (and by extension, freshly
> laundered civvies) become rapidly colonised, to the point that
> bacterial counts are not different to infrequently laundered white
> coats. Interestingly, they also measured bacterial counts on the
> inner wrists of the wearers and also found no difference; ergo it is
> washing your hands (and wrists) and not what you wear above them that
> is important.
>
> The exclusion of wedding rings from the bare-below-the-elbow policy
> has always seemed silly to me. There is no magic antibacterial
> quality of a wedding band that makes it less likely to trap bacteria
> than any other piece of jewellery and this has been confirmed in some
> trials (doi:10.1016/j.ijnurstu.2008.02.010) and refuted in others
> (doi:10.1308/003588408X242051). My wedding ring is mixed white and
> yellow gold and there is a small ridge around the join, so the
> argument that they are flat and therefore don’t trap crud is not
> always valid. It is for social reasons that wedding bands are
> excluded from these sort of policies and I think we have to
> acknowledge that.
>
> While I agree with most of Prof Ferguson’s points in the OP, I think
> that our interns are already burdened with hundreds of things that
> someone from every department thinks is “the most important thing you
> need to know” and a list this long will be lost in the noise (the
> internet slang for this is tl;dr : “too long; didn’t read”).
>
> I think emphasising hand hygiene using the five moments and making
> hand-rub universally available is pragmatically going to achieve more
> than adding to the huge number of things the interns have to remember.
>
> Trent Yarwood
> ID Registrar
> Cairns
>
> Conflicts: Long-sleeves, rolled below the elbow. Clean shirt every
> day but not always new trousers. No tie (even pre-Cairns), Tie-clip on
> my lanyard. Wears wedding ring and watch. Only pinches wrapped
> chocolates from the nurses stations. Last cleaned my stethoscope this
> morning.
>
> —
> Trent Yarwood
On Thu, Oct 20, 2011 at 4:07 PM, Mary-Louise McLaws <m.mclaws@unsw.edu.au> wrote:
Dear Allen
Annette Pantle (when she was with the Clinical Excellence Commission) and I examined the evidence and politics for bare-to-the-elbow and we concluded in 2009:
Guidelines for uniforms/work clothes which was released by UK DH in Dec 2007 was based at that time on only 2 unpublished literature reviews plus expert input from HCWs and trade unions (this could be called eminence-based rather than evidence-based).
This literature was concluded that wearing short sleeves was based on cuffs become heavily contaminated and are more likely to come into contact with patients. Evidence for no ties listed as common sense that it is poor practice to. Because ties are rarely laundered but worn daily. They perform no beneficial function in patient care and have been shown to be colonised by pathogens1. Guidelines on laundering garments worn during patient care – advised that laundering should be with warm water wash with detergent will remove pathogens including MRSA. Allen, if this is good enough for shirts then I guess pants should be included!
2. Opposition to the UK policy came from 2 sources:i. Concern that public prefers to see their HCW dressed professionally (surgeons)
* Observant Muslim HCW believed that it is immodest to bare forearms in public. Female Muslim radiographer in UK resigned over requirement to comply with policy however policy supported by local Iman and trust chaplain (ref http://news.bbc.co.uk/2/hi/uk_news/england/berkshire/7593827.stm), although I believe Muslim scholars have considered this and have no objections to rolling up sleeves.
1. CDC guidelines released in 2002 recommended keeping natural fingernails trimmed and no artificial fingernails or extenders. No recommendations were made about wearing rings in healthcare settings – I believe this was due to social reasons and remained unresolved when we were looking at the evidence (back in 2009) although at the time there was evidence of bacterial colonising skin under rings which may not be removed with usual hand hygiene practices.1. We suggested that our standard should at least consider all staff to be bare below the elbows whilst undertaking hand hygiene different nuance to remaining bare below the elbows.
M-L
Professor M-L McLaws, Professor of Epidemiology in Healthcare Infection and Infectious Diseases Control
School of Public Health & Community Medicine| Samuels Building| The University of New South Wales|SYDNEY NSW 2052 AUSTRALIAI’d imagine that the reaction that our staff would have would be to ask “what is the evidence supporting these recommendations?”
For example, why would a ring on the 4th finger of the left hand be any less likely to become contaminated than a plain ring on any other finger? How often do you need to change mouse pads?! Does it really matter whether you have a new shirt each day if you don’t wear a new pair of pants each day?
(I wear a wedding ring and change my shirt each day)
Allen
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We re-examined the chestnut of the commonly stated 1m ‘rule’ in droplet precautions and found it not to be reflected in the CDC 2007 Isolation guideline which refers to to 6-10 feet in fact
The ASID/AICA statement on IC for influenza discusses this and recommended at least 2 metres with use of curtains between beds in cohorted areas to absorb droplets
http://www.mja.com.au/public/issues/191_08_191009/fer10972_fm.html
Kind regards
JohnMessages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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Dear Carien
The 2008 Surveillance review (available via the Commission for SQ website ) has an extensive chapter on costing of HAI written by Nick Graves. That would be a good starting point and provides estimates of cost.
kind regards
johnJohn Ferguson
Infectious Diseases Physician and Microbiologist,
Hunter New England Health, John Hunter Hospital, Newcastle
Conjoint Associate Professor, University of Newcastle
Tel 61 2 49214444, Fax 61 2 49214440, Mobile 0428 885573________________________________
Hi,
Does anyone know of a generic formula or assessment tool to calculate the cost of HAIs?
Kind regards,
Carien ColemanCarien Coleman | Infection Control CNC
The Sunshine Coast Private Hospital
Syd Lingard Drive | BUDERIM QLD 4556
PO Box 5050 | Maroochydore BC QLD 4558
T: (07) 5430 3245 | F: (07) 5430 3436
E: carien.coleman@uchealth.com.au_________________________________________________________________
Uniting Care Health Email Disclaimer: http://www.uchealth.com.au/disclaimer
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Hi Raylene
We’ve had Hunter New England Health endorse the National Guidelines as our local standard as you are suggesting plan to cross reference to that as required etc.
We’ve done a gap analysis etc. We regard them as a better standard than the state ones.
It is clearly important for us all to support the national guidelines as much as possible by actively using them and complementing them with local policies/procedures as necessary; identifying gaps etc.
We can also contributing to their continual evolution …Kind regards
JohnJohn Ferguson
Infectious Diseases Physician and Microbiologist,
Hunter New England Health, John Hunter Hospital, Newcastle
Conjoint Associate Professor, University of Newcastle
Tel 61 2 49214444, Fax 61 2 49214440, Mobile 0428 885573
________________________________________Dear Raylene
Mmmm ……Have neither the time nor inclination to spend hours re write
policy’s already reviewed, widely commented on (and often that includes
myself and my colleagues ) and gone though the various committee
approvals , legal processes required/established for document
publication from national /state bodies .We have done exactly what you are considering (more than 10 years ago)
and did as an local health district service write an endorsement
document into our IC policy for our NSW health IC policy to be our LHD
IC policy (and its attached /included policy’s referenced within the
document and have hyperlinked the document & its referenced documents
to the policy) we currently have an line system for all our various
policy documents and areas can choose to print them out if they want
hard copies or just access the line versions) – as it’s a high risk
rated document we review it annually (which is easy if nothing has
changed but keeps us on top of things in ensuring we have current
information ) Also we upgrade our living on line document in line with
any changes or review of our state policy’s as needed.Like you we only added policy’s we felt were not adequately covered or
included that were relevant to our facilities/services needs (after a
gap review of our needs vs the policy ).We have been through numerous accreditations from various bodies such as
ACHS, community health ,mental health etc over the years and they have
never once been concerned that we were not addressing our policy
appropriately by not rewriting our own local policy on a state policy.In my experience the only key part of endorsing established /recognised
documents as your policy is how your service/facility will actually
implement them and who will be identified as responsible for the
implementation process (this is the fun bit).I believe It is more important to work on the development of the
implementation plan of a policy or national guidelines into your service
(rather than re writing policy’s ) with consideration in your plan for
development of KPIs or ways of how you intend to measure policy
compliance and its effectiveness in improving pt outcomes/ reducing
infection in your facility.I get that Policy’s are great to have for organisational documentation
evidence but if they are not working for your service/facility to reduce
/prevent infection the they are useless documents and time wasters.Hope you find this feedback helpful in your decision & sounds like you
are similar to most of us and have little time to be reinventing the
wheel.Kind regards
Lindy
Lindy Ryan
Nepean Hospital
Infection control Clinical Nurse ConsultantNepean Blue Mountains Local Health Network
ph: 4734 2228
email: lindy.ryan@swahs.health.nsw.gov.auInfection prevention & control is everyone’s business
—–Original Message—–
Behalf Of Raelene VineHi,
We’re looking for some advice on updating our policy and procedure
infection control manual. Instead of re-writing the majority of our
policies we are looking at hyperlinking the NHMRC guidelines where they
directly reflect our own policy. We will only make addendums for
policies that differ from the guidelines.
Is there any reason why we cannot do this? Is anyone else doing
something similar or is everyone re-writing?
Any suggstions gratefully received!Cheers
Raelene Vine
Clinical Nurse Consultant
Infection Prevention & Control Unit
Bendigo HealthMessages posted to this list are solely the opinion of the authors, and
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Dear Joanne
This is still not an area that has been well agreed. Most people would contact isolate patients who have a strain isolated that is of a demonstrated clonal pathogen eg. KPC, MBL or nosocomial ESBL. A major problem is that many MRGNs are now community organisms and we only detect the clinical tip of the iceberg. Hence isolating only those makes no sense unless one has looked further with active screening. Best generic approaches are required first and foremost- Antimicrobial stewardship, good standard precautions and environmental and equipment hygiene. Secondly need to ensure that the lab knows how to detect MRGN and have systems in place to identify clusters or outbreaks that require action. Thirdly comes selective screening and isolation. These are my views only!
Tom Gottlieb did a survey of practice and discussed this at ASID meeting in 2009 – see
http://www.asid.net.au/hicsigwiki/index.php?titleASID_HICSIG_Sessions_March_2009Also some international approaches are linked here:
http://www.asid.net.au/hicsigwiki/index.php?titleMRGN_Infection_control_and_clinical_managementThis will become a topic for discussion at the Antimicrobial Resistance Summit next February in Sydney – open to all – Feb 7/8 at Univ of Sydney- see http://www.asid.net.au
Regards
JohnDr John Ferguson
Infectious Diseases Physician and Microbiologist,
Hunter New England Health, John Hunter Hospital, Newcastle
Senior Lecturer, University of Newcastle
Tel 61 2 49214444, Fax 61 2 49214440, Mobile 0428 885573
________________________________________Hello
As we all know,Successful control of MDROs is based on a combination of interventions. These involve continued rigorous
adherence to hand hygiene, appropriate use of personal protective equipment and implementation of
specific transmission$B!>(Bbased precautions (isolation of infected or colonised patients, increased environmental
cleaning and dedicated patient equipment) until patients are culture$B!>(Bnegative for a target MRO or have been
discharged from the facility.
What if the MDRO is in the blood??I know that souds weared,but some facilities do apply contact precautions eventhough the organism is in the blood,with a pretext that the organism may be colonized at other body site specially in icu set ups.
Any one can share his practices,experience,opinion??
thank youJoanne Daghfal Nader
Infection Control PractitionerP.O.Box 3050 Doha, Qatar
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Dear All
We are trying to scope staff health provision (immunisation, exposure management, education, injury management) requirements across our Area Health service. We have equitable and inadequate provision across our wide area- the ratio varies between 1 FTE Staff health time to 900 employees up to 1 per 4,000 and undoubtedly this causes many problems
Has anyone studied published national or international benchmarks for what number of FTE per staff body (rather than FTE) one needs to cover the bases?
Has anyone done a local survey of staff health provision in ANZ ?
Has anyone made a (un)succesful case for greater provision of resources?
Would you be happy to share your proposals with us?
If you are interested in designing an internet survey on this, please contact Janet Wallace, our Area Staff Health Coordinator via me.thanks!
JohnDr John Ferguson
Infectious Diseases Physician and Microbiologist, Hunter New England Health, John Hunter Hospital, Newcastle
Conjoint Senior Lecturer, University of Newcastle, Tel 61 2 49214444, Fax 61 2 49214440, Mobile 0428 885573Visit http://www.hicsiganz.org for healthcare infection control and antimicrobial
stewardship resources/updates/events from Australia and New Zealand.Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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Senior Infection Control Nurse Required at National University Hospital, Singapore
An interesting position has just been created in Singapore. Many of you will be aware of our MRSA programme including universal active surveillance. Furthermore we have endemic highly resistant Gram negatives as well as frequent issues arising in the management TB, chicken pox, VRE, C difficile etc
We are seeking expressions of interest from those suitably qualified and experienced to join our team. While hands on work would be important the main role will be to mentor and supervise a number of our team who are quite junior.
We remain somewhat flexible but at this stage are considering a 2 year post. It goes without saying that this person should have good people skills and be adaptable to the changes one would experience and observe working in a 1000 bed Asian hospital.
If you wish to be considered please email me your cv and a cover letter.
Many thanks
Dale Fisher;
Senior Consultant and Head of infectious diseases
Chair of infection controlPosted to AICALIST by –
Dr John Ferguson
Hunter New England Health
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Dear Sue
We’ve used a PCR method for preop, icu and hosp admission screening. This commercial assay allows us to pool swabs to reduce cost. As well it detects MSSA which is advisable for preop screens as such patients also benefit from preop load reduction measures (see NEJM 2010 paper ). We did look at genexpert and were not impressed with its cost! Our existing assay costs a fraction of that and has worked very well on extensive evaluations. And so I do think that you should ask your lab to look at the relative costs of different approaches!
Other studies show that it is only the high grade carriers that have increased risk of post op staph infection. Hence in the landmark study above they used a PCR assay that was not optimally sensitive in order not to detect low level carriers. They used load reduction with nasal mup and topical chlorhexidine body wash that commenced the day before surgery. Best to call it load reduction as one cannot document decolonisation as such in these patients. One assumes they remain colonised.
Chlorhexidine 4% aqueous for body wash best – probably less resistance than with triclosan. However isolates from Aust have not been tested against either to my knowledge. There are some chlorhex R isolates of MRSA detected in UK. The utility of preop body wash alone has never been studied. However most now accept it as part of the package
If MRSA carriage detected, would definitely recommend a glycopeptide alone for px. Note that TG: Antibiotic Edition 14 has higher doses for px – 1.5 g . Logistics considerable- the infusion needs to complete before the patient goes under. Many use teicoplanin instead as it is more able to be given at the right time etc.
Needless to say, HICSIG site has protocols for preoperative staph management – see for instance-
http://www.asid.net.au/hicsigwiki/index.php?titlePatient_Staphylococcus_aureus_preoperative_decolonisation_instructionsWe currently try to complete the 5 day protocol within the 2 wk period prior to surgery. However the Dutch study above shows that immediate preop load reduction is effective and so we are reconsidering our approach. The ability of day before treatment to work makes load reduction also feasible for emergency cases etc.
One does need to ensure that the lab tests isolates of staph for mupirocin resistance.
Best wishes
John
Dr John Ferguson
Microbiologist and Inf Diseases Physician
Hunter New England Health
Newcastle________________________________
Hi Sue,
Our facility introduced rapid PCR for MRSA swabs for all our patient groups. However there are high costs associated with this introduction and we have had to revise the groups that use this method. We are now using a combination of culture and PCR. PCR is used for any patient identified in the Emergency dept as being a high risk MRO, this includes our #NOF patients, it is also used in the ICU.
I am happy to speak with you off line about our facility experience.
In relation to the decolonisation for pre-op patients this is done on the advice of the ID physician to the surgeon prior to admission. Generally colonised patients having surgery have vancomycin alone for prophylaxis but this can vary depending on the surgeon.
Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
185 Fox Valley Road, Wahroonga, NSW, 2076________________________________
Dear colleagues
We currently perform MRSA screening (culture) for all of our patients undergoing elective orthopaedic hips and knees prosthetic procedures. The swabs are taken in pre admission clinic and if they come back MRSA positive a decolonisation program is implemented and the antibiotic prophylaxis adjusted.
We now wish to extend the screening to our non elective and emergency patients with #NOF’s using the rapid Gene Expert PCR so we can get the results back quickly before the surgery. We anticipate that we would need the emergency department staff to perform the screening when the patient presents.
We would like to ask 3 questions:
1. is anybody out there using the rapid Gene Expert PCR for this type of screening and if so are there any issues or advice you could offer.
2. what do you use for your pre op decolonisation eg. nasal mupirocin, tricolan, chlorhex body washes
3. for patients colonised with MRSA do you use IV vancomycin alone or with cephazolinThanks for your help
Warm regards
SueSue Thorpe
Clinical Nurse Consultant
Senior Infection Preventionist
Employee Exposure Management & Immunisation Services (EEMIS)
Infection Prevention and Control Unit
Peninsula Health
PO Box 52
Frankston 3199Peninsula Health – Metropolitan Health Service of the Year 2007 & 2009
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I agree that we should not go for switchable rooms!
I should clarify my posting- the design that I was speaking of is not a reversible configuration.
It is a set up that achieves both isolation AND barrier requirements.
It would be good to assess existing research and practice in this area internationally as these new room types are being implemented successfully overseas as Jane Carthey mentions.John
Dr John Ferguson
Director, Infection Prevention and Control Unit
Microbiologist and Infectious Diseases Physician
HUNTER NEW ENGLAND HEALTH
Locked Bag 1, Newcastle, NSW 2310, Australia
tel 61 2 49214422, fax 61 2 49214440
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You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.auDear All
Could I ask:
a) whether people follow the practices recommended in this document for documenting clearance to the letter?
http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/F22384CCE74A9F01CA257483000D845E/$File/mroscreenjun05.pdf (excerpt below).
b) If not what modifications do you include? Please justify/reference if possible.
c) What sites you screen for MRSA clearance swabs? Specifically, do you include a perianal swab in clearance screens?
d) If you perform perianal, groin or perineal swabs, how do you instruct for the sample to be taken? I’ve never seen a clear instruction! Please share yours!
Thanks
John
A variety of resources and discussion is at
http://www.asid.net.au/hicsigwiki/index.php?titleScreening_and_Clearance_Process-MRSAEXCERPTS FROM ORIGINAL NATIONAL REC ON CLEARANCE AND SCREENING FOR MROs
The document recommended screening of the following sites for MRSA-
Nose swab
Wound(s) tissue/swab
Clinical specimens (wounds, catheter urine, respiratory, other as clinically indicated)
During an identified hospital outbreak, the addition of a perineal or groin swab is recommended.
GUIDELINES FOR MRO CLEARANCE
All the following criteria should be satisfied prior to certifying that a patient has cleared a particular MRO:
More than 3 months elapsed time from the last positive specimen;
All wounds healed, no indwelling medical devices present;
No exposure to any antibiotic or antiseptic body wash for at least 2 weeks prior to screening;
In the case of MRSA, no exposure to specific anti-MRSA antibiotic therapy in the past 3 months; and
Consecutive negative screens from above screening sites on two separate occasions OR evaluation of
a single set of screening swabs with a broth amplification technique.Dr John Ferguson
Director, Infection Prevention and Control Unit
Microbiologist and Infectious Diseases Physician
HUNTER NEW ENGLAND HEALTH
Locked Bag 1, Newcastle, NSW 2310, Australia
tel 61 2 49214422, fax 61 2 49214440Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.auDear Colleagues
HICSIG is facilitating the development of a guideline for the infection prevention & control of MRSA in Australian residential aged care facilities, as it has been noted that this issue is not specifically addressed under any Australian national guideline and that there is need for a well-considered evidence-based risk-appropriate approach.
A small group with representatives from AICA, ASID and other stakeholders commenced work in late 2009. We would really like to expand the group and would welcome all volunteers, especially from Victoria and the Northern Territory.
The Terms of Reference for the group are at http://www.asid.net.au/hicsigwiki/index.php?titleTerms_of_Reference_-_RCF_MRSA_working_group.
We meet by teleconference once a month week for one hour and some additional work will be required- currently this involves evaluation of existing guidelines using the AGREE instrument.
Please let Michelle Taylor (hicsig1@gmail.com) know if you are interested in joining the group!
Thanks
johnDr John Ferguson
Director, Infection Prevention and Control Unit
Microbiologist and Infectious Diseases Physician
HUNTER NEW ENGLAND HEALTH
Locked Bag 1, Newcastle, NSW 2310, Australia
tel 61 2 49214422, fax 61 2 49214440
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You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.auDear Colleagues
Might AICA discuss the following proposal?
We all particularly struggle to get medical staff to learn about correct hand hygiene practices. They either know it all or profess not to have the time etc. Furthermore in order to enforce the standard, one needs to ensure that the person is aware of the expectations etc.
My proposal is that AICA (together with ASID- I have suggested this to them) makes a formal request to the new National Registration and Accreditation scheme (Health Workforce) to require completion of a specified online hand hygiene elearning program and assessment PRIOR to issue of registration renewal for all health professionals.
Furthermore, we should require them to include safe practice of hand hygiene in the relevant codes of conduct for each cadre of health staff.
Best wishes
JohnDr John Ferguson
Director, Infection Prevention and Control Unit Microbiologist and Infectious Diseases Physician HUNTER NEW ENGLAND HEALTH Locked Bag 1, Newcastle, NSW 2310, Australia
tel 61 2 49214422, fax 61 2 49214440
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You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.auDear Colleagues,
HICSIG will be sending out a selection of protocols inviting review
from OZBUG and AICA list members.The initial 4 for review can be accessed via
http://www.asid.net.au/hicsigwiki/index.php?title=Category:For_review_April_2010* Operating theatre commissioning – Microbiological
* Patient MRSA decolonisation instructions
* Recurrent staphylococcal infection
* Routine Skin CareThanks
John FergusonBackground
The primary aim of the Infection Control Special Interest Group
(HICSIG), a special interest
group of the Australasian Society of Infectious Diseases (ASID), is to
facilitate collaboration
and consensus amongst Infectious Diseases Physicians, Clinical
Microbiologists, Infection
Control nurse professionals, Pharmacists and other relevant groups
about approaches to
Healthcare Infection Prevention and Control (IPC) and Antibiotic
Stewardship.The most visible aspect of HICSIG is its *wiki* website –
http://www.hicsiganz.org. This is the
place where significant IPC publications, developments and news from
around Australia,
New Zealand and the world are identified and shared. Interested parties
may also upload their own
materials and news or add to a discussion on a particular topicSome of HICSIG activities of the past year include:
* Developing the Influenza infection control position statement,
which was published
in the Medical Journal of Australia in 2009
* Developing ASID/HICSIG Multi-dose vial use position statement,
currently in its
final draft
* Organisation of a successful healthcare-associated infections (HAI)
Workshop at
ASID 2009 that focused on Methicillin-resistant Staphylococcus aureas
(MRSA) and
Vancomycin-resistant Enterococcus (VRE)
* Hosting the ASID Guidelines group
* Development of extensive online antibiotic stewardship and MRSA
resources
* Archiving relevant and appropriate OZBUG and ASPID discussions so
they are
available for later viewing and searchingDr John Ferguson
Convenor, HICSIG, ASIDHUNTER NEW ENGLAND HEALTH
Locked Bag 1, Newcastle, NSW 2310, AustraliaMessages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
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