[Brett, Judy]

Kate

It’s been a while since I have been in the clinical area however I believe your examples stethoscope, blood pressure cuffs, EEG/ECG leads (note: EEG electrodes may not be included in this group if the skin is abraded before attachment) would be considered non-critical items according to Spaulding, that is items that come in contact with intact skin but not mucous membranes. Most noncritical reusable items may be decontaminated where they are used and do not need to be transported to a central processing area (thus no tracking required).

Regards
Judy

_______________________________________________________________________________
Judith Brett
Infection Control Consultant, VICNISS Coordinating Centre
T +61 (0) 3 9342 9353 T +61 (0) 3 9342 9333 (Reception)
judy.brett@mh.org.au |www.vicniss.org.au
The Peter Doherty Institute for Infection and Immunity
792 Elizabeth Street | Melbourne | Victoria | Australia | 3000
doherty.edu.au
[cid:image009.jpg@01D2D3C9.3CE16F60]

Can I please ask for assistance with the following question:

How are semi-critical devices being high level disinfected in other organisations? Specifically devices (RMD) that come into contact with non-intact skin, blood or body fluid; that can’t be reprocessed in CSSD or an automatic HLD unit e.g. stethoscope, blood pressure cuffs, EEG/ECG leads etc.

Furthermore, how do you track the reprocessing of these items?

Kind regards

Kate Ryan

RMD Program Officer

[logo_austin]

0434 609 208 | 03 9496 6706

Infectious Diseases Department
Level 7, Harold Stokes Building
145 Studley Road, Heidelberg
PO Box 5555, Victoria, 3084

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[Brett, Judy]

Ruth

The Victorian Guidelines for CPE released in December 2015 state the following patients require pre-emptive isolation & screening on admission to a health service:

* Direct transfer from an overseas hospital

* Overnight stay in an overseas hospital or residential care facility in previous 12 months

* A room contact of a CPE case who has not achieved criteria for being ‘cleared’

* A ward contact of a CPE case from a transmission risk area who has not achieved criteria for being ‘cleared’

The guidelines can be found at: https://www2.health.vic.gov.au/about/publications/policiesandguidelines/carbapenemase-producing-enterobacteriaceae-guidelines

Regards
Judy

Judith Brett | Infection Control Consultant
VICNISS Coordinating Centre
Doherty Institute | Level 2
792 Elizabeth St, Melbourne, Victoria 3000
T: + 61 3 9342 9353 | F: + 61 3 9342 9355 | judy.brett@mh.org.au
T: + 61 3 9342 9333 (Reception)
W: http://www.vicniss.org.au

[cid:image001.jpg@01D17A01.ABFCEA50][cid:image002.png@01D17A01.ABFCEA50]

Hello to my Australian colleagues,
We have recently experienced a CRE outbreak involving 4 patients that was not associated with any overseas hospitalisation or travel . A laboratory colleague who recently attend a conference in Melbourne advises that it is the norm now in Australian acute hospitals to screen all patients who have travelled overseas for CPO/CRE as per the ACSQH 2013 guidelines for CRE. We are coming under pressure to introduce this.
We currently screen all patients who have had an overseas hospital stay within the previous 12 months but if we were to screen all travellers as well, we would not be able to isolate them pending screening results and I am not sure how cost effective the screening would be versus positive results.

I am interested to know if most Australian acute hospitals actually do this extended screening and if so how you were able to get buy in from the nursing staff.

Cheers

Ruth

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Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
Community Liaison Infection Prevention
:: ruth.barratt@cdhb.health.nz
(: + 64 3 3640 083 or ext.80083
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[Brett, Judy]

John

Differentiating between superficial or deep SSI for CABGs can be difficult.

A validation study of coronary artery bypass graft data completed by VICNISS during 2006 measured the accuracy of data submitted for identifying surgical site infection (SSI) following coronary artery bypass graft (CABG) surgery through a retrospective review of hospital medical records, comparing SSI data with surveillance data submitted. We found there was broad agreement on the number of infected patients, and on patients with a sternal SSI. However, discordance was frequent in the depth of sternal SSI and the identification of donor site SSI. http://www.ncbi.nlm.nih.gov/pubmed/17564983#

I believe in these cases if the fascia is exposed as you have stated below and the SSI criteria are met the infections would be classified as deep.

Regards
Judy

Judy Brett
Infection Control Consultant
VICNISS Coordinating Centre
10 Wreckyn Street
North Melbourne Vic 3051
Tel: 03 93423905
Fax: 03 9342 2633
email: judy.brett@mh.org.au

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of John Ferguson
Sent: Tuesday, 24 September 2013 10:28 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Interpretation of the NHSN surgical site infection definition for sternotomy infections

Thanks Glenys

However, there is no muscle overlaying the sternum and the deep fascia is just above the periosteum of the sternum.
For the most part there is just skin and subcut tissue in front of the sternum. These tissues overlying the sternum are very thin in most people.
And so it is nonsensical to distinguish superficial from deep based on this definition in my view

I don’t think that most surgeons put a closure layer beneath the skin once the sternum is wired- it is impossible. Effectively, then, opening or dehiscence of the incision will expose the fascia. Similarly, I cannot see that application of a vac can be done to a ‘superficial’ wound as the fascia will be exposed in these sort of wounds.
I could cope if the definition specified in this case that infection deep to the deep fascia = a deep (or organ space infection); however that is not what it says.

We are long overdue for a better NHSN SSI definition., esp for sternal wounds

John

[cid:image002.jpg@01CEB910.B1B99D30]

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:image003.jpg@01CEB90F.65088BF0]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Glenys Harrington
Sent: Tuesday, 24 September 2013 9:54 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Interpretation of the NHSN surgical site infection definition for sternotomy infections

Hi John,

Whether or not these wounds are superficial or deep depends on the first part of the definition as to what tissue is involved. This question has to be answered before progressing to the rest of the definition.

Superficial – Infection occurs within 30 days after any NHSN operative procedure and involves only skin and subcutaneous tissue of the incision

Deep – Infection occurs within 30 or 90 days after the NHSN operative procedure and involves deep soft tissues of the incision (e.g., fascial and muscle layers)

If only skin and subcutaneous tissue are involved it meets the superficial definition as from your description c below is met and, Im assuming that the patient had at least 1 of the sign or symptom below.

patient has at least 1 of the following:

a. purulent drainage from the superficial incision

b. organsims isolated from an aseptically-obtained culture of fluid or tissue from the superficial incision

c. superficial incision that is deliberately opened by a surgeon and is culture-positive or not cultured

and

patient has at least one of the following signs or symptoms of infection: pain or tenderness; localized swelling; redness; or heat. A culture negative finding does not meet this criterion

d. diagnosis of superficial incisional SSI by the surgeon or attending physician

If deep soft tissues (e.g., fascial and muscle layers) are involved it will meet the deep definition as from your description b below has been met and Im assuming that the patient has at least 1 of the sign or symptom below.

patient has at least one of the following:

a. purulent drainage from the deep incision

b. a deep incision that spontaneously dehisces or is deliberately opened by a surgeon and is culture- positive or not cultured

and

patient has at least one of the following signs or symptoms: fever (>38C); localized pain or tenderness. A culture-negative finding does not meet this criterion.

c. an abscess or other evidence of infection involving the deep incision is found on direct examination, during invasive procedure, or by histopathologic examination or imaging test.

d. diagnosis of a deep incisional SSI by a surgeon or attending physician.

Hence in the first instance you need to know what level the surgeon has opened these wounds too as VACs can be used on superficial or deep would infections.

Just on organ space infections these wounds as described would not be considered an organ space infection as such infections exclude the skin incision, fascia, or muscle layers, that is opened or manipulated during the operative procedure (i.e. the incisional wound is not involved at all). In this surgical setting an organ space infection would be something like osteomyelitis of the sternum without surgical incision/wound involvement.

I use a definition checklist (i.e. it either meets or does not meet the criteria) when training staff in the interpretation of the definitions for surveillance purposes.

Can send a copy if you like.

Regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)

PO Box 5202
Middle Park
Victoria, 3206
Australia
H: +61 3 96902216
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of John Ferguson
Sent: Monday, 23 September 2013 4:18 PM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Interpretation of the NHSN surgical site infection definition for sternotomy infections

Dear All

Would appreciate advice on interpretation of the definition (below)

In two sternotomy cases, there has been prolonged ooze post op (several days) and the surgeon concerned has opened the wound on the ward and then instituted vac dressings
The cases required prolonged nursing management but did not come to formal debridement or removal of sternal wires etc. CT scans did not show retrosternal collections (ie not organ space infection)

In my view, this constitutes a ‘deep’ wound infection. What would others say?
Our other surgeons would have usually taken such cases to theatre and performed open debridement

in one case the culture grew Serratia
in the other, culture was no growth; in that case, the determination rests then on whether we had ‘purulent drainage’ observed from the ‘deep incision’
it does beg the question as to how one gauges from what level the drainage is coming fron and also whether one should use an objective measure for what is purulent etc!
criterion b under superficial is also problematic – how does one ever get ‘aseptically-obtained’ samples from a superficial incision? wound swabs presumably not ok but I would guess are used

Would be very interested to know of how people teach surveillance staff to apply the NHSN definition, esp for sternotomies , where essentially the superficial wound is extremely close to the deep sternal structure , and also for prosthetic joints where similar problems of distinguishing the depth of infection arise

thanks
John

Dr John Ferguson
Director, Infection Prevention & Control, Hunter New England Health
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.org
[cid:image001.jpg@01CEB86A.85790C70]

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[Brett, Judy]

Liz
The Victorian Healthcare Associated Infection Surveillance System (VICNISS) monitors antibiotic prophylaxis for all surgical procedures – name, timing, duration and 2nd dose in prolonged procedures (one exception: timing is not assessed for CSEC). Antibiotic use is assessed against the Therapeutic Guidelines (version 14, 2010) and hospitals are provided a 6 monthly report. In most cases the ICP records antibiotic details from the anaesthetic record.
More information can be found on the VICNISS website; http://www.vicniss.org.au
Regards
Judy

Judy Brett
Infection Control Consultant
VICNISS Coordinating Centre
10 Wreckyn Street
North Melbourne Vic 3051
Tel: 03 93423905
Fax: 03 9342 2633
email: judy.brett@mh.org.au

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of VANDERLINDE, Liz
Sent: Tuesday, 17 July, 2012 9:48 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Dressings for CVADs

Good Morning All,

On the subject of Antimicrobial Stewardship I am just wondering what other institutions are doing regarding the monitoring of prophylactic antibiotic usage in specific surgical specialties i.e orthopaedics and LUSCS to determine compliance with Therapeutic Guidelines (version 14 2010). I would be interested in how and who you have monitor this? Would be grateful if you were happy to share any auditing proforma, policy, procedural documentation.

WithThanks

Liz Vanderlinde
Infection Control Officer
North West Private Hospital

Brickport Road, Burnie TAS 7320, Australia
T +61 3 6432 6022 F +61 3 6431 6158
E Liz.Vanderlinde@healthecare.com.au W

Disclaimer: This message including any attachments is confidential. It is intended only for the use of the addressee(s) named above and may contain information that is privileged or subject to copyright. If you are not the intended recipient of this message you are hereby notified that you must not disseminate, copy or take any action based upon it. Please delete and destroy the message from your computer. If you received this message in error please notify Healthe Care Australia immediately.

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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Tim Spencer
Sent: Thursday, 12 July 2012 2:38 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Dressings for CVADs
Hi Jayne,
It’s interesting to hear this remark often about ‘allergies’ to hypoallergenic dressings, such as S+N IV3000 or 3M’s Tegaderm range.

In many cases, it is a reaction between the skin prep/antiseptic and the adhesive on the dressing because the antiseptic has not been allowed to dry correctly, and therefore creates a reaction with the dressing adhesive.
Many people believe this to be an allergy to the dressing!
It is most often likely not.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant | Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel 02 8738 3603 | Fax 02 8738 3551 | Mob 0409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
[cid:838553503@12072012-1EF5][cid:838553503@12072012-1EFC]

________________________________
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Jayne O’Connor
Sent: Thursday, July 12, 2012 1:25 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Dressings for CVADs
Hi All,

We are currently reviewing our CVAD policies and a question arose around the use of sterile gauze and tape for those patients who have allergies to transparent semi permeable dressings. Does anyone have advise on how frequent the gauze & tape should be changed, apart from the obvious soiling etc.

Look forward to your responses.

Kind regards

Jayne

Jayne O’Connor RN, BSc.
Clinical Nurse Consultant- Infection Prevention & Control
Sydney Adventist Hospital,
185 Fox Valley Rd,.
Wahroonga,
NSW 2076.

Tel: (02) 9487 9433
Mobile: 0406 752 685
Email: jayne.oconnor@sah.org.au

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[Brett, Judy]

Michael

The Victorian Healthcare Associated Infection Surveillance (VICNISS) counts bilateral hip (and knee) prosthesis operations as two procedures. This is consistent with CDC NHSN.

In regards to coronary artery bypass graft procedures (chest and donor site) this is counted as one procedure however each infection is reported separately. Thus it is possible for one patient to have as many as four or more infections for the one procedure however this is certainly taken into consideration when analysing the data if a high infection rate is reported.

Regards
Judy

Judy Brett
Infection Control Consultant
VICNISS Coordinating Centre
10 Wreckyn Street
North Melbourne Vic 3051
Tel: 03 93423905
Fax: 03 9342 2633
email: judy.brett@mh.org.au

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Friday, 13 July, 2012 3:08 PM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] ACHS CI for SSI

Hi all

Another question on something different at a new employer. This one may just be me not being up to date, though.

For the purposes of ACHS Infection Control Clinical Indicators 1.1-1.4 (hip and knee prostheses) how many facilities report bilateral prosthesis procedures as TWO procedures in their denominator (not a single procedure). ACHS have confirmed to us this is what they expect, which surprised me a bit.

Since there is a single CMBS / ICD-10 code for bilateral procedures such as these, I have only ever known reporting these as one procedure, and I wondered whether other ICPs are familiar with this ACHS requirement. Might be worth checking with whoever collates your denominator for these indicators if you are unsure.

I have to then wonder about coronary artery bypass graft procedures. does anyone report these by the number of grafts performed, or only as one procedure regardless of the number of grafts? We didnt specifically ask ACHS about this, but looking at the interpretation of procedure for hip and knee prostheses, I have to wonder. Ie

Multiple procedures on an individual patient should be counted separately (eg hip
prosthesis and knee prosthesis);

Looking at the way the indicators are worded, note:

1.1 Total number of hip prothesis procedures performed

And

1.5 Total number of coronary artery bypass graft procedures
performed,

Thanks for any thoughts (including letting me know I am way behind the times here!).

Cheers
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

You can unsubscribe from this list be sending ‘signoff aicalist’ (

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