[Julie Hunt]

Hi Michelle

AS 1668.2-2012 does differentiate between certain rooms/areas in regard to recycled air. In operating rooms, sterile stock and recovery AS 1668.2-2012 states that air supplied to these areas shall not be recirculated from any other enclosure type. For negative pressure rooms, autopsy & dirty utilities, air won’t be recirculated from these areas to other areas i.e should be 100% exhaust. Supply air delivered to a positive pressure room cannot be recirculated unless filtered using a Hepa filter (99.99% efficiency).

We don’t have 100% exhaust for all areas however, we do have single pass 100% outside air for all Operating Theatres, Isolation rooms and sterile areas, including a 16 bed ‘pod’ in ICU and 100% exhaust for all negative pressure rooms.

For the entire haematology unit, theatre, SSD etc. and all positive pressure rooms, the air is hepa filtered.

Our NICU is not supplied by Hepa filtered air (as IPAC recommended) however the isolation rooms are negative pressure so air exhausted 100% from those rooms.

We have not identified issues related to HAIs and the above systems.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Click Infection Prevention and Control to visit Website

We are a large tertiary referral centre with critical care, NICU etc. and our air conditioning currently runs on 100% exhaust throughout. As we are refurbishing our NICU, the engineering department have argued that the air exchange should be 20% fresh and 80% recycled in line with the AS 1668.2-2012 and the TS11. As they have now got approval for the change, they want to revert the rest of the hospital to 20/80. Has anyone had any issues with this air exchange in the past? We are very concerned of our high risk areas and negative and positive pressure rooms being affected.

Michelle Kennedy

CNC | Infection Prevention Service
John Hunter Hospital Campus
Lookout rd, New Lambton
Tel 02 4921 3129 | michelle.kennedy@hnehealth.nsw.gov.au
http://www.health.nsw.gov.au

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[Julie Hunt]

Hi Meryl,

I agree with Michael regarding potential risks of droplet contamination of respiratory viruses within the inhaler if used between patients.

In our HCF the inhalers we use are labelled as single patient use so they are only approved for more than one episode of use on one patient only. We do not reuse these items for different patients. They are cleaned with a neutral detergent when required although we do ask that staff check the manufacturer’s instructions as some are not designed to be cleaned or dismantled & have a life expectancy similar to a puffer.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Good morning everyone,

I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:

* Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.

* The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.

* The inhaler sits at the patient’s bedside before moving to the medication room and then on to another patient’s room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.

Many thanks in advance,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

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

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

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[Julie Hunt]

Dear Ruth

We have signage advising of staff and visitor restrictions to out Haematology ward, we also developed signage for visitors. I am happy to share this with you if you contact me of the list serve.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Would any member be prepared to share any protocols or policies they have for visitor restrictions specifically for a haematology or bone marrow transplant ward or unit with immunosuppressed patients. We are particularly interested in any ‘no children’ (at all policies). This has arisen as a result of a recent Pertussis outbreak.

Kind regards

Ruth

[IPC logo for email signature]

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
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!

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[Julie Hunt]

Hi Fiona,

Our Endoscopy NUM advises that they clean the sink between every scope (with enzymatic cleaner) and that ‘this is just one of those things that has always been done’.

Once the manual clean is completed the scopes then go into the automated unit for reprocessing.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Hi All,

We are currently having a discussion about the frequency of cleaning the sinks that our Endoscopes undergo their manual clean in. The question we have been asking is when should the sink be cleaned?

a) Between every scope

b) Between differing types of scope e.g. from bronchoscope to colonoscope and vice versa

c) At the end of the list

d) At the end of the day

e) Other

Once the manual clean is completed the scopes then go into the automated unit for reprocessing. Any ideas, current practices with or without evidence would be appreciated.
Kind regards,

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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[Julie Hunt]

Dear Robyn

In our new build we have installed self dispensing ice machines for ice for human consumption. The machines are sanitised 3 monthly and in addition descaled 6 monthly, this is performed by a private contractor that is AS/NZS ISO 22000:2005 and AS/NZS ISO 9001:2008 certified.

This process is coordinated by our food services manager, all ice machines are barcoded as well as the location documented, this is to ensure that each machine receives the appropriate service 3 monthly.

Please contact me directly if you would like more information on this process.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490
Email: Julie.Hunt1@health.nsw.gov.au

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Robyn Birch
Sent: Thursday, 19 February 2015 10:32 AM
To: AICALIST@AICALIST.ORG.AU
Subject: ice machines in hospital setting

Good morning,

We are currently reviewing the ice machines used in our facility and looking to upgrade if required. Does anyone have experience with ice machines ie. pros and cons, what cleaning and maintenance schedule their facility has etc. I am aware of the food safety guidelines and CHRISP information but interested in ICPs experience.
At this stage ours are not required for any medical type use such as organ transportation.

Thank you

Robyn Birch
CNC Infection Control
Redland Hospital

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[Julie Hunt]

Hi Joe

We have used a similar approach to Rachel with a preparedness trolley set up in ED, we’re also purchasing stock for a pack to be kept in a secure store area for after hours, just enough to last a few days.

I have provided ED with a list of stock required for the trolley haven’t done a list to place with the trolley although I think that is a good idea.

We’ve also developed ‘quarantine’ signage for the designated areas in ED, ICU and the designated ward. We’ve also updated our signage for donning & removing PPE.

I’m happy for you to contact me off line if you want to discuss this further.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Here is our trolley checklist too.

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Joe,

Yes we have developed a preparedness trolley. I’m attaching a photo in PDF, I hope it comes through along with a copy of our trolley checklist. Feel free to contact me to discuss if this would help.

We have essentially placed a small ‘start-up’ stock of all items onto a trolley which includes a supply of all items we are recommending for patient management. This is being stored in a secure area with access easily obtained by relevant staff. We have also developed a “Quarantine Isolation sign” which is very consistent in look to the Commission doors signs, this provides advice to staff who will be entering the care zone in how to don and doff. These are laminated and will be placed inside and outside the room as well as in the ante-room.

Feel free to contact me off-line. Would love to know how you are approaching things too.

Kind regards
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Good morning everyone

Has any hospital set up any emergency boxes of PPE in preparation for a suspected EVD patient?

Thanks

Joe-Anne Bendall
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

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[Julie Hunt]

Hi Nicola,

We clean all sides of the mattress and bed sides/base for all discharges, disinfection is added if required.

In the past I have found body fluids, other fluids, food, dust and pieces of equipment under mattresses.

For specialised beds/mattresses used in ICU i.e. electric beds with a mattress with a zip off washable ‘topper’, we send the topper for valet cleaning and disinfection.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Hi All,

The new mattresses we have, weigh in at 18kg and are difficult to manoeuvre by one person Eg ( the housekeeping staff when cleaning rooms on patient discharge)

Could anyone share what their housekeeping staff do on discharge of a patient unknown to have a multi resistant colonisation/infection. Is the mattress turned over and wiped with detergent on both sides or just the side the patient was lying on?

My thoughts were that the patient or nurse does not directly touch the underside of the mattress and therefore unless visibly soiled no need for it to be turned and wiped. Or is it that it is in the patient zone and all though not frequently touched should still be wiped over. Does anyone else have any views they can share with me.

Thank you and Kind Regards

Nicola Swindells Clinical Nurse Consultant
Infection Control / Skin Integrity
Mater Hospitals Central Queensland
Rockhampton Gladstone Yeppoon

nswindells@mercycq.com
tel 07 49313420

Clean Hands are caring hands, remember the five moments of hand hygiene

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[Julie Hunt]

Hi Lynne,

There is a product we use here and it is also used in other HCFs called a ‘Hold up’ for posters, they don’t replace signage boards but are very useful in clinical areas. It is basically a thin white metal bar with sizes to suit A4 or A3 etc.

We use the outside patient rooms for Precautions Signage, they are also used in clinics for signage. The page just rolls under, it take both laminated & non laminated pages and looks very neat, no need for Perspex holders or blue tack.

I am happy to send you the details if you are interested.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Hi
Just wondering what approach/opinions people have to notice boards in clinical areas?
Is it better to have a dedicated notice board made from material that does not deteriorate or to have posters etc blue tacked to walls?
Thanks

Lynne Sinclair RN
Quality and Risk Manager Boort District Health PO Box 2 Boort 3537
‘ 03 5451 5200 | 7 03 5455 2502 | * lsinclair@bdh.vic.gov.au
VoIP 15285
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[Julie Hunt]

Hi Kathy,

I have reviewed this bed for RNS, however we have not purchased it to date. I am happy to provide you with my review outside the ACIPC list.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Hi All,
I’m interested if anyone has any experience or any information with the Hill Rom – HR 900 SSR electronic bed. Obviously am particularly interested in any identified Infection Issues. I would also welcome any other feedback on any other electronic bed .
Thank you in advance for any feedback.
Cheers
Kathy

Kathy Dempsey

Clinical Nurse Consultant / CoManager
Infection Prevention & Control
PO Box 533, Wentworthville NSW 2145
Tel (02) 9845 7501 | Fax (02) 9845 9148 | Mob 0423 000 169 | kathy.dempsey@health.nsw.gov.au
http://www.health.nsw.gov.au

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[Julie Hunt]

Hi Rita,

I agree that inner cannulas are being inserted into devices that are already in place which may be heavily colonised. However, the reason for a sterile filed is to prevent the cannula itself from contamination with organisms from other parts of the patient and also from the environment.

I also agree that there is a difference between a device that goes into blood (critical device) and one which goes into the larynx (semi critical device), they are both types of invasive devices as per the TGA definition and I believe that aseptic technique applies to performing procedures related to both.

Cost effectiveness or a reusable cannula is something each HCF would have to determine and is not an argument for not using aseptic technique.

Regardless of the evidence for ANTT, to comply with Standard 3 of the National Safety and Quality Health Service Standards, HCFs have to meet requirements related both to aseptic technique and invasive devices when performing procedures such as these.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Dear Michael,
I think this discussion is important to circulate.
Many thanks,
Rita
Rita Roy

Clinical Nurse Consultant | Infection Control
Hornsby Ku ring gai Health Service, Palmerston Road, Hornsby NSW 2077
Tel (02) 9477 9232 | Fax (02) 9477 9013 | Mob 0422 930 370 | Rita.Roy@health.nsw.gov.au
http://www.health.nsw.gov.au

[Description: Description: http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Northern-Sydney-LHD.jpg%5D

Thanks Rita
The feedback is great. I would be grateful if you could send my feedback through to the group

* Thanks to the group for looking at how we can improve this practice

* At present the Trache guideline is under implementation and we wont be changing recommendations for at least a year.

o This doesn’t mean however that at a local level the ICPs couldn’t partner with the trache leads to change this practice to reflect ANTT.

o The trach guideline was reviewed by 6 NSW ICPs as well as going through the usual organisational consultation processes

o The guideline can be found at http://intensivecare.hsnet.nsw.gov.au/icwiki/index.php/Tracheostomy

* I disagree the procedure needs to be aseptic but I do acknowledge the issues with terminology

o Inner cannulas are being inserted into devices that are already in place which will be heavily colonised.

o There is a difference between a device that goes into blood and one which goes into the larynx.

o The evidence base that I have seen for the effectiveness of ANTT in reducing infections is very limited.

* A sterile dressing pack may be appropriate as a sterile field

o IF you are using a disposable inner cannulae &/or

o Doing the dressing as part of the procedure (which would be entirely appropriate where you had a patient with a large amount of sputum and were need to do the dressing frequently OR a least for one change)

o The gully pots are not large enough for cleaning inner cannulas although a sterile kidney dish would be useful.

o Disposable inner cannulas are not going to be cost effective if you are having the change them frequently.

* However this would not be cost effective if you were using reusable inner cannulas. This procedure is quite quick when changing the inner cannulae. And the dirty inner cannulae cleaning can be moved away from the patients immediate bedside.

* There were such things as trach packs (back in the day) perhaps these could be investigated.

* I would appreciate if the ICPs could provide the evidence & rationale for changing from a clean technique to an aseptic technique.

o I don’t wish to be confrontational Im always happy to review new evidence and incorporate it into practice. It is easier to change the minds of ICU clinicians with evidence.

* It is important to realise this change in practice will be significant. At present the vast majority of hospitals undertake this procedure using a clean technique and many others continue to use the handbasin tap (yuck)

* The ICPs are going to need to partner with the trache leads to change this practice. I would suggest opening a dialogue with your local trach teams

I do appreciate the input of the ICP community and look forward to improving this practise

(Ill leave my opinions regarding the copyrighting of a commonly used clinical term to a later date)

Kaye Rolls
Clinical Project Officer – ICCMU | Agency for Clinical Innovation
Level 4, Sage Building, 67 Albert Avenue, Chatswood NSW 2067
Postal Address: PO Box 699 Chatswood NSW 2057
Mobile 0423 607 735 | Tel. +61 2 9464 4692 | Fax. +61 2 9464 4728 | Kaye.Rolls@aci.health.nsw.gov.au
http://www.aci.health.nsw.gov.au | http://intensivecare.hsnet.nsw.gov.au

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FYI

Hi Rita,

I agree with Terry although I would use the terminology aseptic technique as the term ‘Aseptic Non
Touch Technique (ANTT)’ is copyrighted and the logo Trademarked.

This procedure must be performed using aseptic technique and staff must perform hand hygiene before and after donning non-sterile gloves and wear appropriate PPE e.g. apron, full-face visor

I agree that the use of sterile water for cleaning the inner tube is appropriate and recommend using a sterile dressing pack for the aseptic field and a sterile kidney dish to contain the water and place the inner tube when removed from the patient.

I also agree that use of a hand hygiene basin for this purpose is not appropriate due to the risk of colonisation of microorganisms from the device (hand hygiene basins should only be used for hand hygiene) and because a hand hygiene basin is not an appropriate field for aseptic technique.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Hi Rita,

I agree they should use the ANTT terminology – I have suggested an alternative

This procedure must be performed using Standard ANTT and staff must practice hand hygiene before and after donning non-sterile gloves and wear appropriate PPE e.g.; apron, full-face visor.

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

CONFIDENTIAL COMMUNICATION: The information contained in this message may contain confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or duplication of this transmission is strictly prohibited. If you have received this communication in error, please notify us by telephone or email immediately and return the original message to us or destroy all printed and electronic copies. Nothing in this transmission constitutes an agreement of any kind unless otherwise expressly indicated.

Dear All,
The Intensive Care and Coordination monitoring unit (ICCMU) is working on a tracheostomy guideline. The recommendations around cleaning of the inner cannulas are as in the table below:

Recommendations

Grade of Recommendation

1.

The inner cannula must be checked for patency, cleaned and replaced 2-4hourly. More frequent checks will depend on the volume and viscosity of secretions.

Consensus

2.

The inner cannula should be cleaned and dried according to manufacturer’s guidelines and stored in a clean dry container.

Consensus

3.

Under most circumstances the inner cannula can be cleaned with sterile water with a tracheostomy cleaning brush or a pipe cleaner (with the end turned over). Where secretions are tenacious, alternative solutions can be used; however, the tube should not be soaked for more than 15 minutes.

Consensus

4.

This procedure is a clean procedure which requires hand hygiene before and after donning appropriate PPE e.g.; gloves, apron, full-face visor.

Consensus

5.

It is inappropriate to clean or rinse the inner cannula at hand basins used for hand washing because of the risk of contaminating the basin with organisms or contamination of the inner cannula.

Consensus

6.

When placing a clean inner cannula into a TT tube it should be rinsed with sterile water immediately prior to insertion.

Consensus

Consensus means that the guideline group & external validation panel agreed on this recommendation (using a likert scale 1-9 with agreement as a median of > 7)
(The full guideline can be accessed at http://intensivecare.hsnet.nsw.gov.au/icwiki/index.php/Tracheostomy)

I would like to draw your attention in particular to Recommendation no 4 and the use of the terminology “clean procedure”.
This is because in my hospital, I am in the process of implementing the ANTT (aseptic non-touch technique) Clinical Practice Framework (The Association for Safe Clinical practice http://www.antt.org) in order to meet National Standard 3, criterion 3.10.1-3.10.3. ANTT does not recognise the term “clean procedure”. According to ANTT, the term clean refers to “free from marks and stains”. Therefore, the term clean technique and implied ‘clean’ aim can cause confusion and should be avoided; any lesser aim than asepsis for invasive clinical procedures and maintenance of invasive medical devices is potentially ethically and legally problematic.

I would like to know what your thoughts are with respect to this.
Rita Roy

Clinical Nurse Consultant | Infection Control
Hornsby Ku ring gai Health Service, Palmerston Road, Hornsby NSW 2077
Tel (02) 9477 9232 | Fax (02) 9477 9013 | Mob 0422 930 370 | Rita.Roy@health.nsw.gov.au
http://www.health.nsw.gov.au

[Description: Description: http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Northern-Sydney-LHD.jpg%5D

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[Julie Hunt]

Hi Rita,

I agree with Terry although I would use the terminology aseptic technique as the term ‘Aseptic Non
Touch Technique (ANTT)’ is copyrighted and the logo Trademarked.

This procedure must be performed using aseptic technique and staff must perform hand hygiene before and after donning non-sterile gloves and wear appropriate PPE e.g. apron, full-face visor

I agree that the use of sterile water for cleaning the inner tube is appropriate and recommend using a sterile dressing pack for the aseptic field and a sterile kidney dish to contain the water and place the inner tube when removed from the patient.

I also agree that use of a hand hygiene basin for this purpose is not appropriate due to the risk of colonisation of microorganisms from the device (hand hygiene basins should only be used for hand hygiene) and because a hand hygiene basin is not an appropriate field for aseptic technique.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Hi Rita,

I agree they should use the ANTT terminology – I have suggested an alternative

This procedure must be performed using Standard ANTT and staff must practice hand hygiene before and after donning non-sterile gloves and wear appropriate PPE e.g.; apron, full-face visor.

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

CONFIDENTIAL COMMUNICATION: The information contained in this message may contain confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or duplication of this transmission is strictly prohibited. If you have received this communication in error, please notify us by telephone or email immediately and return the original message to us or destroy all printed and electronic copies. Nothing in this transmission constitutes an agreement of any kind unless otherwise expressly indicated.

Dear All,
The Intensive Care and Coordination monitoring unit (ICCMU) is working on a tracheostomy guideline. The recommendations around cleaning of the inner cannulas are as in the table below:

Recommendations

Grade of Recommendation

1.

The inner cannula must be checked for patency, cleaned and replaced 2-4hourly. More frequent checks will depend on the volume and viscosity of secretions.

Consensus

2.

The inner cannula should be cleaned and dried according to manufacturer’s guidelines and stored in a clean dry container.

Consensus

3.

Under most circumstances the inner cannula can be cleaned with sterile water with a tracheostomy cleaning brush or a pipe cleaner (with the end turned over). Where secretions are tenacious, alternative solutions can be used; however, the tube should not be soaked for more than 15 minutes.

Consensus

4.

This procedure is a clean procedure which requires hand hygiene before and after donning appropriate PPE e.g.; gloves, apron, full-face visor.

Consensus

5.

It is inappropriate to clean or rinse the inner cannula at hand basins used for hand washing because of the risk of contaminating the basin with organisms or contamination of the inner cannula.

Consensus

6.

When placing a clean inner cannula into a TT tube it should be rinsed with sterile water immediately prior to insertion.

Consensus

Consensus means that the guideline group & external validation panel agreed on this recommendation (using a likert scale 1-9 with agreement as a median of > 7)
(The full guideline can be accessed at http://intensivecare.hsnet.nsw.gov.au/icwiki/index.php/Tracheostomy)

I would like to draw your attention in particular to Recommendation no 4 and the use of the terminology “clean procedure”.
This is because in my hospital, I am in the process of implementing the ANTT (aseptic non-touch technique) Clinical Practice Framework (The Association for Safe Clinical practice http://www.antt.org) in order to meet National Standard 3, criterion 3.10.1-3.10.3. ANTT does not recognise the term “clean procedure”. According to ANTT, the term clean refers to “free from marks and stains”. Therefore, the term clean technique and implied ‘clean’ aim can cause confusion and should be avoided; any lesser aim than asepsis for invasive clinical procedures and maintenance of invasive medical devices is potentially ethically and legally problematic.

I would like to know what your thoughts are with respect to this.
Rita Roy

Clinical Nurse Consultant | Infection Control
Hornsby Ku ring gai Health Service, Palmerston Road, Hornsby NSW 2077
Tel (02) 9477 9232 | Fax (02) 9477 9013 | Mob 0422 930 370 | Rita.Roy@health.nsw.gov.au
http://www.health.nsw.gov.au

[Description: Description: http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Northern-Sydney-LHD.jpg%5D

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[Julie Hunt]

Dear Terry,

I have seen this organism identified twice in water sampled from a showerhead, when screening for MRPA.

In one case repeated flushing, cleaning & disinfection did not help to clear the organism and as it was in a shower in a haematology unit we ended up changing the shower head and hose, no further problems to date.

I’ve not seen it in water tested from the Automated Endoscope Reprocessors.

As water is not generally screened for these types of organisms within a HCF if is impossible to know if this occurs commonly or not, it was the only time we have found it in our sampling and we have taken hundreds of samples over the past year.

Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Hi Everyone,

I have had a recent spate where a number of my endoscopy procedure centre clients have reported culturing of “Pseudomonas species” or Gram negative bacilli after the monthly water testing of the Automated Endoscope Reprocessors.

Upon further investigation, the organism has been identified as Cupriavidis pauculus. This organism is often associated with ultra filtration systems and although it has low pathogenicity it is a risk to immunocompromised patients.

Despite repeated water line disinfections, filter changes, disinfectant dumps etc this bug keeps cropping up over and over again. We find that we have cleared it in the next test after filter changes etc etc but then a month later – we get a positive result again.

Whilst in low numbers, it is causing some concern regarding potential risks to patients. In all cases we are not growing the organism form the endoscopes.

I am wondering if anyone else has been experiencing the same issues?

If so – what did you do about it both in terms of managing the machines and the risks to patients?

If you have cultured this organism, did you manage to identify the cause of the problem?

Happy to chat offline.

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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[Julie Hunt]

Hi Lucy,

I haven’t seen any local guidance documents however there are some from the UK that recommend against the use of flow restrictors & straighteners, have a look at:

Department of Health Health Building Note 00-09: Infection control in the built environment- March 2013
Department of Health Water systems Health Technical Memorandum 04-01: Addendum Pseudomonas aeruginosa – advice for augmented care units – March 2013

Both can be accessed freely via internet
Regards

Julie Hunt

Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Recent discussions have occurred on the List surrounding the installation/ use of sensor taps in healthcare facilities. My question is in relation to the use/ maintenance of flow restrictors (not aerators) in healthcare facilities on both sensor and standard taps. The flow restrictors are at the spout to limit the flow from the taps to minimise splashing from the hand basin. These flow restrictors are able to be removed however they are an enclosed system whereby cleaning them is very difficult and soaking in a product would unlikely completely remove any residue.

Just wondering if any other facilities have taps (sensor taps or otherwise) with flow restrictors and what maintenance or replacement occurs? In addition are there any state or jurisdictionally based protocols/ standards that ACIPC List members could direct me to?
Many thanks
Lucy
Lucy Hughson
Clinical Nurse
Infection Prevention and Control Unit
Royal Hobart Hospital

Monday, Tuesday (alternate) and Thursday

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[Julie Hunt]

Dear Teresa

Have a look at the NSW Health Infection Control Policy PD2007_036, it stipulates that ‘Eyewear must be optically clear, anti fog, distortion free, close fitting, shielded at the side and conform to AS/NZS 1336 and AS/NZS 1337.

Regards

Julie Hunt
Clinical Nurse Consultant
Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264339 or 99264490

Dear All

I was approached this week and was told by one of the staff members that the eye protection that is provided by our facility does not comply with the standards.

What is provided is the coloured PVC bands with the disposable eye visor which is threaded onto the coloured PVC band. These can be placed over existing prescription glasses and each staff member knows which one is theirs. I hope everyone knows which ones I am referring to.

Is this staff member correct? Are there specific standards that I should be looking up that state that this eye protection does not comply?
I am not too happy with them myself as they are quite flimsy and if worn over glasses they do not offer protection between the forehead and the edge of the of the eyewear, and they do not provide protection at the sides either.

Any feedback will be greatly accepted. Thank you.

Teresa Lewis
Infection Control and Prevention CNC
Newcastle Endoscopy Centre

[cid:image003.png@01CEAFAE.EFBA0900]

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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[Author]

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