[Hobbs, Louise]

Thank you for sharing this information Glenys

Does anyone know how the TGA recognises and responds to these types of overseas reports of equipment cleaning failures which have resulted in a number of adverse event outcomes and subsequently offers advice response to the Australian community? Is this the responsibility of another national body?

Regards

Louise Hobbs PhD | Manager Infection Prevention and Surveillance Service
Melbourne Health | Royal Melbourne Hospital – City Campus | Level 9 Royal Melbourne Hospital
Grattan Street, Parkville Victoria 3052
T: + 61 3 9342 8328 | F: + 61 3 9342 7277 | e: louise.hobbs@mh.org.au
[cid:image001.png@01D1A164.7D89F610]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Glenys Harrington
Sent: Thursday, 28 April 2016 2:34 PM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] FW: Mycobacterium chimaera update: A must listen from ECCMID [WARNING: SPF validation unavailable]

Dear All,

For those following the Mycobacterium chimaera heater-cooler units you may find some of the answers you need in the following blog from the Controversies in Hospital Infection Prevention below.

The link to the presentation by Dr. Jakko van Ingen at ECCMID is well worth looking at – see link below.

Regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

From: noreply+feedproxy@google.com [mailto:noreply+feedproxy@google.com]
Sent: 15 April, 2016 4:21 PM
To: infexion@ozemail.com.au
Subject: Controversies in Hospital Infection Prevention

Controversies in Hospital Infection Prevention

________________________________

Mycobacterium chimaera update: A must listen from ECCMID

Posted: 14 Apr 2016 06:33 PM PDT
[https://2.bp.blogspot.com/-nSG7E3FIOUI/VxA6EVJ7aOI/AAAAAAAABPc/yxCsKjr02FI703yFHoldb2azHpKcIXGSQCLcB/s640/cover%2Bphoto%2Bfor%2Bblog.jpg]

Weve posted several times about the horrible M. chimaera outbreak linked to heater-cooler units (HCUs) used during cardiac bypass surgery. As weve addressed the problem here at Iowa, weve become increasingly frustrated (and dumbfounded) at the lack of available information about the clinical and epidemiological features of the outbreak itself, and at the general lack of urgency about this ongoing and grave risk to patients.

Fortunately, Dr. Jakko van Ingen gave an excellent talk at ECCMID that answers several important questions weve had about this outbreak, confirming some of the things weve heard (in confidence, I assume for political or legal reasons) on various conference calls and email strings. I urge you to take 30 minutes of your time to listen to his talk, all the way to the end of the Q&A period.

Aside from being an extremely entertaining speaker, Jakko addresses several key questions, including:
Is this a clonal outbreak? YES. Slide 29 reports whole genome sequencing data that clusters the isolates from Sorin 3T units and infected patients (within just 2-3 SNPs), and further discussion (during Q&A session) confirms that isolates from other European countries are also in this cluster.
Were the HCUs already contaminated prior to being shipped to end users? YES. Listen carefully to the last question and answer.
Does this particular outbreak primarily involve one make/model of HCU? YES. While nontuberculous mycobacteria have been isolated from other types of HCUs, the specific M. chimaera cluster in this case involves Sorin 3T units.
Is the invasive, disseminated, high crude mortality form of the illness restricted to those patients with implants (e.g. valves, grafts)? YES. The life-threatening disseminated infection appears to require some prosthetic material to which the organism can adhere, protecting itself (via biofilm formation) from host defense. According to Dr. van Ingen, case finding in the Netherlands is now limited to those with implants, and does not include standard non-valve, non-implant CABG patients.
Is it possible to mount an effective, rapid national response to this urgent problem? YES. Slide 18 details the Dutch response, which involved discontinuing all non-urgent cardiac surgery until HCUs were placed outside of ORs (which was done within 48 hours). As we learned here when we did the same thing, it is amazing what you can accomplish when you are left with no other option.
Is opening up a Sorin 3T HCU a frightening experience? YES. Im sure Ill have nightmares about these water-stained, biofilm-befouled devices for a long time (see below for one image from Garvey, et al).
[https://3.bp.blogspot.com/-nrOmoURm3NQ/VxA6HaCEksI/AAAAAAAABPk/fpT7TpyENfcB4jxnEW8LZ1_qKBzRIO7LQCKgB/s640/Screen%2BShot%2B2016-04-14%2Bat%2B7.32.56%2BPM.png]

What are the implications?
HCUs are not safe to operate in an OR. The air exhausting from the HCU ventilation fan must be physically separated from the air in the OR, and the easiest way to do that is to remove them from the OR (and maintain the OR at positive pressure, of course).
Everyone using Sorin 3T HCUs should assume that they may have exposed patients to M. chimaera, until more is known about the details of the point-source. Contaminated units cannot be disinfected even with the more intensive protocols currently recommended. In addition, only a few labs are capable of properly performing NTM cultures of water samples, so negative water cultures are of limited value and could be falsely reassuring.
A much more active national patient and provider notification is needed. Our experience is similar to that of others: identified cases would never have been found had it not been for aggressive and active case-finding. There are undoubtedly others currently being treated with immunosuppression for sarcoidosis or some other granulomatous process of uncertain etiology who actually have undiagnosed disseminated M. chimaera disease.
Below I’ve pasted an epidemic curve, an underestimate as it involves only those cases reported to FDA from US (blue bars) and abroad (red). This outbreak isn’t over, not by a long shot, and the fact that there are still hospitals performing cardiac surgery with their Sorin 3T HCUs inside of the OR is extremely distressing.
[https://1.bp.blogspot.com/-C2f_g5YW_rM/VxA-j-6qAhI/AAAAAAAABP8/9EgqZ6WlqZcrrCfOjH_F-Bo3m34JiCndwCLcB/s640/Screen%2BShot%2B2016-04-14%2Bat%2B8.05.55%2BPM.png]

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[Hobbs, Louise]

Hi Karen
You many find this article of interest;
Infection prevention and control competencies for hospital-based health
care personnel. AJIC: American Journal of Infection Control
Volume 36, Issue 10
,
Pages 691-701, December 2008

Regards

Louise Hobbs
Manager
Infection Prevention and Surveillance Service
Melbourne Health
Telephone 934 28325
Fax. 934 28484

________________________________

Behalf Of Turnbull, Karen P
tool for IP&C

Dear All,

I am starting the development of a survey tool for a ‘primary health
care worker training needs assessment’ – covering district hospital,
long term care & community settings + both nurses & carers. I know that
sounds rather broad but it may yet be segmented into different settings
and HCW groups as it evolves…

It seems that most IC assessment or audit tools I can find focus on
system characteristics such as reporting and governance, rather than
what I’m attempting as a ground level educator, looking at the current
knowledge base & competencies of the workforce and figuring out what
needs addressing the most urgently, for which groups and where they are
– all on a local level.

I have taken my inspiration from Bush Knapp, et al.’s description of
their approach using both directed and scenario based questions to
elicit underpinning knowledge. I’m not aware of any further work
following this pilot study, and have submitted an info request to the
contact email provided.

All ideas gratefully received,

Ref – Bush Knapp, M, McIntyre, R, Sinkowitz-Cochran, R, Pearson, M 2008,
‘Assessment of healthcare personnel needs for training in infection
control: One size does not fit all’, American Journal of Infection
Control, 36(10):757-760

Many Thanks,

Karen Turnbull

Clinical Nurse Educator

Infection Prevention & Control

Level 2, Launceston General Hospital

Charles Street 7250

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[Hobbs, Louise]

The Garling Report which was published in NSW certainly articulated a
very clear punitive approach toward healthcare workers who did not
comply with infection control guidelines.

I am not sure how successfully it has been implemented. Maybe someone
from NSW could provide some comment

Regards

Louise Hobbs

Manager
Infection Prevention and Surveillance Service
Melbourne Health
Ph 93428324

—–Original Message—–
Behalf Of Wilson, Fiona L (Infection Control)

As per Hand Hygiene Australia and WHO consensus recommendations, we do
not recommend that HCW have artificial fingernails while working in the
clinical area. I am wondering how you ‘police’ this (for want of a
better term) and does anyone have a HR process for HCW’s who refuse to
remove artificial fingernails.
Regards

Fiona Wilson
Manager, Infection Control
Western Health
email: fiona.wilson@wh.org.au

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