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Hi Michael
Kindly forward this email to members for advise and comment, much appreciated.
Kind Regards
Verily Thomas
Clinical Nurse Consultant | Infection Prevention and Control
SWSLHD-Bankstown/Lidcombe Hospital
Eldridge Road, Bansktown.NSW 2200
Tel 02 97228000 pager 28230
Tel 02 9722 8633 | Fax 02 9722 7822 | verily.thomas@sswahs.nsw.gov.au
http://www.health.nsw.gov.au[Description: cid:image002.jpg@01CE8EA5.483A6E60]
LET’S KEEP OUR HOSPITAL ENVIRONMENT CLEAN
HAND HYGIENE SAVES LIVESHi Verily,
The chlorhexidine swabs sticks that were trialled for neuraxial blocks in perioperative services were 2% chlorhexidine in 70% Alcohol, the ANZCA guidelines on infection control in Anaesthesia PS28 state that 0.5% chlorhexidine in 70% Alcohol is to be used for neuraxial blocks, due to the neurotoxicity of chlorhexidine. We need to assess if the risk of using 2% chlorhexidine swab sticks mitigates the risk of using 0.5% Chlorhexidine liquid and gauze swabs for skin prep for neuraxial blocks. The swab sticks prevent any risk of chlorhexidine being injected into the epidural or subarachnoid space and splashing into other solutions on the sterile field. We also need to assess if the use of 2% has any benefit over 0.5% in terms of infection control and prevention.
Kind Regards,
Bridie
Bridie Treloar
Clinical Nurse Consultant Perioperative Services
Bankstown-Lidcombe Hospital
Monday Week 1 and 3, Tuesdays, Wednesdays_____________________________________________________________________
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Do you feel Hand Hygiene, although very important, is actually a back up
measure in controlling these dangerous pathogens. If MRSA, CRE or Ebola
is spread by a healthcare workers’ hands then it must have one time gotten
on these hands. The colonization of the healthcare worker would then
represent a failure in containment and control. Shouldn’t containment and
control and the prevention of exposure of the healthcare worker to these
pathogens be our primary focus??Kevin
Kevin Kavanagh, MD, MS
Health Watch USA
Somerset, Kentucky, USA
606-875-3642On Mon, May 8, 2017 at 7:45 PM, Verily Thomas wrote:
> Well done Alfred Health that video is fantasticJ, good job keep it up
> hand hygiene promotion certainly needs a boost to another level keeping up
> with the times from clean your hands.
>
>
>
> Shout out all the way from Bankstown Hospital.
>
>
>
> Kind Regards
>
>
>
> *Verily Thomas*
> Clinical Nurse Consultant | *Infection Prevention and Control*
> SWSLHD-Bankstown/Lidcombe Hospital
>
> Eldridge Road, Bansktown.NSW 2200
> Tel 02 97228000 pager 28230
>
> Tel 02 9722 8633 | Fax 02 9722 7822 | verily.thomas@sswahs.nsw.gov.au
> http://www.health.nsw.gov.au
>
> [image: Description: cid:image002.jpg@01CE8EA5.483A6E60]
>
> *LET’S KEEP OUR HOSPITAL ENVIRONMENT CLEAN*
>
> *HAND HYGIENE SAVES LIVES*
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Michael Wishart
> *Sent:* Monday, 8 May 2017 10:32 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Hand Hygiene video by Alfred Health
>
>
>
> One of my hand hygiene auditors sent me this this YouTube link, which they
> saw on social media. Not sure if many ICPs would have seen this yet.
>
>
>
> Well done Alfred Health Infection Control Team! J
>
>
>
> https://www.youtube.com/watch?vG6z5-RikOsg&featureyoutu.be
>
>
>
> Cheers
>
> Michael
>
>
>
>
>
> *Michael Wishart*
>
> Infection Control Coordinator
>
>
> *A *627 Rode Road, Chermside QLD 4032
> *P *(07) 3326 3068 | *F *(07) 3607 2226 | *E *
> michael.wishart@svha.org.au | *W * http://www.hsnph.org.au
> [image: cid:image001.png@01D01926.61F1C2B0]
>
> P *Please consider the environment before printing this email *
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>
>
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I goes without saying that if you use less central lines then you will get
less central line infections. However, it you then are using peripheral
lines, additional problems can arise from decreased patient mobility,
vascular inflammation and if a chemotheraputic agent is used, even tissue
necrosis.We also looked at improvement in rates of CLABSIs over four years using
different denominators (patient discharge and line days) each one used in
a large data set.(Partnership for patients vs NHSN). There was no
difference in the improvement observed using these two metics. This is
probably because the vast majority of CLABSIs can be prevented.This situation is unlike CAUTIs where the two data sets gave markedly
different results.Kevin
Kevin Kavanagh, MD
Health Watch USA
Lexington KY, USA
606-875-3642On Sun, Oct 25, 2015 at 9:16 PM, Claire Rickard
wrote:> aha thanks Rebecca, now I see they had mentioned ICU days higher up in the
> para…..
> there’s nothing like making a mistake on a national mailing list 😀
> C
>
>
> Claire Rickard
> RN PhD FAAHMS FACN, Professor, NHMRC Centre of Research Excellence in
> Nursing Interventions in Hospitalised Patients, Menzies Health Institute
> Queensland
> Director, Alliance for Vascular Access Teaching and Research (AVATAR)
> Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane &
> Women’s Hospitals
> Honorary Professor, University of Manchester
> Assistant: Jo.Wright@griffith.edu.au Tel: +61 7 3735 4886
>
>
>
>
> On 26 October 2015 at 10:52, McCann, Rebecca Rebecca.McCann@health.wa.gov.au> wrote:
>
>> Hi Michael
>>
>>
>>
>> I think Claire has missed that the second rates were calculated using the
>> 12,000 patient days both units had .
>>
>>
>>
>> Kind Regards
>>
>>
>>
>> Rebecca
>>
>>
>>
>>
>>
>> *R**ebecca McCann Program Manager *
>> Healthcare Associated Infection Unit (HAIU)
>> Communicable Disease Control Directorate Department of Health
>> Grace Vaughan House
>> 227 Stubbs Terrace
>> SHENTON PARK WA 6008
>> T:08 9388 4859 M:0439 920 819 F:08 9388 4888
>> E:rebecca.mccann@health.wa.gov.au
>>
>>
>> The contents of this e-mail transmission are intended for the named
>> recipients only and may contain confidential and/or privileged
>> information. If you received this message in error, you must not copy,
>> duplicate, forward, print or otherwise distribute any information contained
>> herein, but must ensure that this e-mail is permanently deleted and advise
>> the sender immediately.
>>
>>
>>
>>
>>
>> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
>> Behalf Of *Claire Rickard
>> *Sent:* Monday, 26 October 2015 6:42 AM
>> *To:* AICALIST@AICALIST.ORG.AU
>> *Subject:* Re: [ACIPC_Infexion_Connexion] FW: Controversies in Hospital
>> Infection Prevention
>>
>>
>>
>> Hi Michael, it is indeed very interesting. 2 comments:
>>
>>
>>
>> – What were they using for venous access instead?? – while some could
>> have been managed on oral treatment – are they using a lot more PIVs and
>> midlines, thus ‘hiding’ the risk of infection there?
>>
>>
>>
>> What results would we see for those 2 ICUs if they were reporting CABSI
>> in ALL vascular access devices – including arterial lines..
>>
>>
>>
>> Now that research is coming out showing (a) we don’t have to remove
>> non-symptomatic PIVs at 4 days, and (b) the risk of thromobosis/CLABS in
>> PICCs is greater than initially thought – we are seeing a switch back in
>> use to PIVs and Midlines. So that means some of our infections will move to
>> those lines. Hopefully less, but more than we have traditionally had in
>> those devices.
>>
>>
>>
>> By the way, doing the “pre-post- type studies, it would be easy for a
>> hospital in 5 years to conclude “we have seen more PIV infections since we
>> started using them longer”, when this is actually due to less PICC/CVC use,
>> in sicker more at risk patients. An RCT would control for changes in
>> general policy/practice such as the above that happen over time, and thus
>> that kind of incorrect conclusion, ..in fact Ricard (no relation LOL did a
>> PIV vs CVC trial in ICU a couple of years back). (Abstract below, although
>> note that many of what they called PIV “Serious complications” were
>> difficult insertions and they did not use ultrasound, so maybe that would
>> have helped…).
>>
>>
>>
>> – Secondly, their comment that the actual event numbers showed ICU B as
>> the better performs is incorrect – 20/7500 and 15/3000 still converts to
>> 2.7 (ICU A) and 5.0 (ICU B) per 1000 days.
>>
>>
>>
>> C
>>
>>
>>
>>
>>
>> Crit Care Med.
>> 2013 Sep;41(9):2108-15.
>> doi: 10.1097/CCM.0b013e31828a42c5.
>> Central or peripheral catheters for initial venous access of ICU
>> patients: a randomized controlled trial.
>>
>> Ricard JD
>>
>> 1, Salomon L
>>
>> , Boyer A
>>
>> , Thiery G
>>
>> , Meybeck A
>>
>> , Roy C
>>
>> , Pasquet B
>>
>> , Le Mire E
>>
>> , Dreyfuss D
>>
>> .
>> Author information
>>
>> Abstract
>> OBJECTIVES:
>>
>> The vast majority of ICU patients require some form of venous access.
>> There are no evidenced-based guidelines concerning the use of either
>> central or peripheral venous catheters, despite very different
>> complications. It remains unknown which to insert in ICU patients. We
>> investigated the rate of catheter-related insertion or maintenance
>> complications in two strategies: one favoring the central venous catheters
>> and the other peripheral venous catheters.
>> DESIGN:
>>
>> Multicenter, controlled, parallel-group, open-label randomized trial.
>> SETTING:
>>
>> Three French ICUs.
>> PATIENTS:
>>
>> Adult ICU patients with equal central or peripheral venous access
>> requirement.
>> INTERVENTION:
>>
>> Patients were randomized to receive central venous catheters or
>> peripheralvenous catheters as initial venous access.
>> MEASUREMENTS AND RESULTS:
>>
>> The primary endpoint was the rate of major catheter-related complications
>> within 28 days. Secondary endpoints were the rate of minor catheter-related
>> complications and a composite score-assessing staff utilization and time
>> spent to manage catheter insertions. Analysis was intention to treat. We
>> randomly assigned 135 patients to receive a central venous catheter and 128
>> patients to receive a peripheral venous catheter. Major catheter-related
>> complications were greater in the peripheral venous catheter than in the
>> central venous catheter group (133 vs 87, respectively, p0.02) although
>> none of those was life threatening. Minor catheter-related complications
>> were 201 with central venous catheters and 248 with
>> peripheral venous catheters (p0.06). 46% (60/128) patients were managed
>> throughout their ICU stay with peripheral venous catheters only. There were
>> significantly more peripheral venous catheter-related complications per
>> patient in patients managed solely with peripheral venous catheter than in
>> patients that received peripheral venous catheter and at least one
>> central venous catheter: 1.92 (121/63) versus 1.13 (226/200), p> There was no difference in central venous catheter-related complications
>> per patient between patients initially randomized to
>> peripheral venouscatheters but subsequently crossed-over to
>> central venous catheter and patients randomized to the
>> central venous catheter group. Kaplan-Meier estimates of survival
>> probability did not differ between the two groups.
>> CONCLUSION:
>>
>> In ICU patients with equal central or peripheral venous access
>> requirement, central venous catheters should preferably be inserted: a
>> strategy associated with less major complications
>>
>>
>>
>>
>> Claire Rickard
>>
>> RN PhD FAAHMS FACN, Professor, NHMRC Centre of Research Excellence in
>> Nursing Interventions in Hospitalised Patients, Menzies Health Institute
>> Queensland
>>
>> Director, Alliance for Vascular Access Teaching and Research (AVATAR)
>>
>> Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane
>> & Women’s Hospitals
>>
>> Honorary Professor, University of Manchester
>>
>> Assistant: Jo.Wright@griffith.edu.au Tel: +61 7 3735 4886
>>
>>
>>
>>
>>
>>
>>
>> On 26 October 2015 at 07:58, Michael Wishart
>> wrote:
>>
>> I think is very much worthy of further consideration. In the Australian
>> context, many acute ICUs have a policy of central line access as a
>> criteria of admission to ICU. But if we can appropriately reduce the number
>> of central lines inserted, we could indeed reduce the risk of CLABSI to
>> that patient group..
>>
>>
>>
>> Comments anyone? Any epidemiologists/statisticians out there who have a
>> view on this?
>>
>>
>>
>> Cheers
>>
>> Michael
>>
>>
>>
>>
>>
>> *Michael Wishart*
>>
>> Infection Control Coordinator
>>
>>
>> *A *627 Rode Road, Chermside QLD 4032
>> *P *(07) 3326 3068 | *F *(07) 3607 2226 | *E *
>> michael.wishart@svha.org.au | *W * http://www.hsnph.org.au
>>
>> P *Please consider the environment before printing this email*
>>
>>
>>
>> *From:* noreply+feedproxy@google.com [mailto:noreply+feedproxy@google.com]
>>
>> *Sent:* Sunday, 25 October 2015 4:34 PM
>> *To:* Michael Wishart
>> *Subject:* Controversies in Hospital Infection Prevention
>>
>>
>> Controversies in Hospital Infection Prevention
>>
>> ——————————
>>
>> *Denominators matter*
>>
>>
>> Posted: 24 Oct 2015 07:12 PM PDT
>>
>>
>> Let’s perform a thought experiment. At *St. Eligius Hospital*
>> there are two ICUs. These
>> two ICUs have the same number of beds, the same number of patient days
>> (12,000/year), and the same case mix index. In fact, they’re essentially
>> identical, except that ICU A has an annual CLABSI rate of 2.7/1,000 central
>> line days and ICU B has a CLABSI rate of 5.0/1,000 central line days. Which
>> ICU is better performing with regards to CLABSI? Well, without any other
>> data to consider, we’d be greatly tempted to conclude that ICU A is the
>> better performer since it’s CLABSI rate is nearly one-half that of ICU B.
>> Now, let’s add another piece of information: ICU B focused on reducing
>> central line placement as a safety intervention–so at year’s end, ICU A
>> had 7,500 central line days and ICU B had 3,000 central line days. This
>> means that ICU A finished the year with 20 CLABSIs, and ICU B had 15. Now
>> it’s clear that ICU B is the better performer despite having the higher
>> rate.
>>
>> This is not just a theoretical problem. During my first rotation on the
>> Infectious Diseases Consultation Service at the University of Iowa last
>> year, I was struck by the low prevalence of central lines in the medical
>> ICU. Turns out my perception was spot on–when I looked at our NHSN data, I
>> saw that 3 of our 5 adult ICUs have central line utilization ratios less
>> than the 15th percentile nationally. This is not an accidental occurrence;
>> clinicians in those ICUs have worked hard to avoid placement of devices
>> that are associated with infection. The problem is that the central lines
>> that do get placed in these units are concentrated in a group of patients
>> that are sicker and more likely to develop CLABSI, since the less sick
>> patients will be managed without a central line. Moreover, the denominator
>> is reduced. And the result is higher CLABSI rates. Here, no good deed goes
>> unpunished.
>>
>> But there’s an easy fix. Instead of using device days as the denominator,
>> use patient days. In our thought experiment, we would see that ICU A would
>> have a CLABSI rate of 1.7/1,000 patient days and ICU B would have a rate of
>> 1.2/1,000 patient days. The better performer (ICU B) will now have the
>> lower rate, as expected. Makes sense, no? CDC should move to address this
>> given the financial penalties hospitals now face based on CLABSI rates.
>> Changing the denominator would provide an incentive for hospitals to
>> aggressively reduce device insertion. And since NHSN has collected patient
>> days for decades, there would be no loss of long-term trending. Lastly, use
>> of patient-days as a denominator produces a patient-centered metric. Think
>> about it: do we really care what fraction of catheters become infected? No!
>> Our focus should be on what fraction of and how many *patients* become
>> infected, which is also more intuitive for providers at the sharp edge of
>> patient care.
>>
>>
>>
>>
>>
>>
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The California Nurses Association, and the associated National Nurses
United in the U.S. has done the extensive work on Staffing Ratios. Linda
Akens also has been quite active in the field of research. Most of the
below will contain references to articles dealing with infections.A very good reference is:
Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Nurse staffing, burnout, and
health care-associated infection. Am J Infect Control. 2012
Sep;40(7):680 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509207/
News release:
http://www.eurekalert.org/pub_releases/2012-07/afpi-nsb072612.phpOther related references are:
Aiken, L. H., Cimiotti, J. P., Sloane, D. M., Smith, H. L., Flynn, L., &
Neff, D. F. (2011). Effects of nurse staffing and nurse education on
patient deaths in hospitals with different nurse work environments. *Medical
Care*, *49*(12), 1047-1053.Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H.
(2002). Hospital nurse staffing and patient mortality, nurse burnout, and
job dissatisfaction. *Journal of the American Medical Association*, *288*(16),
1987-1993.Aiken, L. H., Sloane, D. M., Cimiotti, J. P., Clarke, S. P., Flynn, L.,
Seago, J. A., Spetz, J., & Smith, H. L. (2010). Implications of the
California nurse staffing mandate for other states. *Health Services
Research, 45*(4), 904-921.Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K.
(2002). Nurse-staffing levels and the quality of care in hospitals. *New
England Journal of Medicine, 346*(22), 1715-1722.Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S.
R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. *New
England Journal of Medicine, 364*(11), 1037-1045.Needleman, J., Buerhaus, P. I., Stewart, M., Zelevinsky, K., & Mattke, S.
(2006) Nurse staffing in hospitals: is there a business case for
quality? *Health
Affairs (Millwood), 25*(1), 204-211.Stanton, M. W., & Rutherford M. (2004). *Hospital nurse staffing and
quality of care*. Rockville, MD: Agency for Healthcare Research and
Quality. http://archive.ahrq.gov/research/findings/factsheets/services/nursestaffing/nursestaff.pdfKevin T. Kavanagh, MD, MS
Health Watch USA
Lexington, KY
606-875-3642On Mon, Jul 6, 2015 at 2:03 AM, Rita Roy wrote:
> Dear ICPs,
>
> I am seeking your advice or any information/research/journal
> article/documentation you might have when considering the staffing ratio of
> nurse to patients with infection control precautions. For example,
>
> In our new hospital our wards have 12 single rooms. If all these rooms
> were to be occupied by patients who needed to be managed with transmission
> based precautions, does this mean that there is a need to increase the
> number of nurses to patients to cope with the additional requirements that
> are needed when caring for these patients (e.g., donning and doffing PPE ,
> comorbidities,). Obviously I feel that there is a risk of having
> transmission as staff who are already burdened may not be able to strictly
> adhere to the Infection control recommendations for caring for these
> patients. Do you have any such rule in place or how do you manage if this
> occurs in your hospitals?
>
> Many thanks in advance,
>
> Rita
>
>
>
> *Rita Roy*
>
> Clinical Nurse Consultant | *Infection Control*
>
> Hornsby Ku ring gai Health Service, Palmerston Road, Hornsby NSW 2076
> Tel (02) 9477 9232 | Fax (02) 9477 9013 Rita.Roy@health.nsw.gov.au
> http://www.health.nsw.gov.au
>
>
>
> Click here to visit the Infection Prevention and Control
>
> page on the Intranet
>
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>
>
>
> [image: Description: 5 moments hand hygiene]
>
>
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I believe the key here is that device utilization did not change over
time. However, if for example urinary catheter utilization would have
dropped, then there would be less infections and the two metrics would have
had different results.Kevin
Kevin Kavanagh, MD, MS
Health Watch USA
Lexington Kentucky, USA
606-874-3642———- Forwarded message ———-
Infection Rates by Bed Days or Device Days.Interesting paper where the findings show that device days and bed days are
equally effective for comparing HCAI rates between hospitals with device
utilisation i.e. CLABSI.http://www.ncbi.nlm.nih.gov/pubmed/25782986
*Kind Regards*
*Marija Juraja* *|Clinical Service Coordinator **(RN, GCNS Inf Ctrl, CICP)*
*Infection Prevention & Control Unit| Division of Acute Medicine *
The Queen Elizabeth Hospital | Central Adelaide Local Health Network
Level 8 Tower Building | 28 Woodville Road, WOODVILLE SOUTH 5011
t: +61 8 8222 7588| p: 47757| f: +61 8 8222 6461 | DX: 465432 |
e:marija.juraja@health.sa.gov.au[image: Infection%20Control%202013%20banner-01]
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