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Hi Karen
If its sterile items you are talking about, then if they are stored correctly, ( designated storage area, correct storage shelving, restricted traffic, temp and humidity and air changes monitored etc) , then they should not expire, but packaging needs to be checked to ensure the item is not comprised.
Hope this assists you.
Robyn Lawson
OR ConsultingPO Box 465 Dianella
Western Australia
roblily49@gmail.com
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________________________________Good morning everyone
A few months ago, there was a conversation on here regarding expiration dates for isolation gowns and whether they can be used. I cant remember the outcome of the conversation.
We have a large supply from the Commonwealth stockpile that were very close to their expiration date at the time they were sent to us. Now there are some that are 4 months over the date.
Can they still be safely used in a covid or any other outbreak?
I appreciate any information that you can give me.
Regards
Karen Kemp OAM
Infection Control and Staff Health CNC
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KKemp@sccbh.com.au
https://www.sccbh.com.au.
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Hi Mary
A couple of hours . No more. It would also depend on if everything else was in place as required for sterile storage.
For example: designated area, restricted traffic, cleaning , educated staff, temperature and humidity compliance etcRobyn Lawson
OR Consulting
PO Box 465 Dianella WA
roblily49@gmail.com
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________________________________Hi Brains Trust
I have a really strange question but was just wondering if there is a safe amount of time that power (and therefore air handling units) can be down for in sterile storage areas before stock is compromised? I am just concerned that even if temperature and humidity was maintained that the air changes would not have been..
Any advice would be greatly appreciated!
Kind regards
Mary
Mary Willimann CICP-E | Manager Infection Control
St John of God Subiaco Hospital
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Hi All
I note all the mixed responses and its great to see the interest in this very important topic of storage of sterile items in our facilities.
Two things I would like to comment on and to keep in mind are:
Firstly- Storage of sterile items in designated sterile store rooms attached to operating suites have more rigid requirements from ward storage areas.
Secondly- Its not just ASNZS 4187 that had influence in Australian health facilities. Different states have different building standards/ requirements in regard to HEPA filtration for sterile store rooms . Some use Australasian Building guidelines, Private hospital building guidelines, and some like Western Australia and NSW and perhaps others have their own requirements, which they MUST meet.
It also would be superb to have one very clear Standard for safe sterilisation practices including the environment. Hopefully the next review of ASNZS 4187 will demonstrate evidenced based practice and be much clearer to us all , including not constantly referring to other ISO standards.
Kind regards
Robyn Lawson
OR Consulting
Business: roblily49@gmail.com
Personal: lwsnrbyn@hotmail.com
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________________________________
From: ACIPC Infexion Connexion on behalf of Kathy Dempsey (Clinical Excellence Commission)
Sent: Friday, September 24, 2021 3:12:44 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] ‘Sterile stock’ storage??Hi All,
just wanting to provide some additional content to this discussion and to clarify the original advice being discussed is from the Australian Commission on Quality and Safety in Healthcare and not the CEC.
Some essential facts about AS/NZS4187:2014 that we seem to forget over time:
1. Normative references within AS/NZS 4187:2014 require mandatory compliance when they are referred to within the Standard.
2. Informative and further reading references within AS/NZS4187:2014 do not require mandatory compliance. These references can be used to guide practices, provide clarity on the mandatory requirements or be used as references for procedures or education programs.Handling, transport and storage of released reprocessed RMDs is in Appendix A, Guidance (Informative) Section A9.5 provides the guidance on how this is achieved. It does not provide guidance on sterile consumables, the type of shelving required or the storage shelves/cupboards, drawers or containers.
The Australian Commission on Safety and Quality in Health Care Advisory A18/07:Reprocessing of reusable medical devices in health service organisationsrequires that health service organisations have completed the following mandatory key target to meet their accreditation requirements:
By 31 December 2022, the Commission expects organisations to comply with requirements in relevant national or international standards for storage of sterile stock in compliant shelving. Organisations must mitigate the risk of contamination of sterile stock in storage. This includes assessing and managing the risk of:
Humidity and temperature on stored sterile stock
The co-location of sterile and non-sterile stock in a storage area.
Sterile store rooms guidance for ventilation, humidity and temperature:
1. NSW Engineering Services Guideline (7.8.4)
2. AS/NZS4187:2014 (Amd 2019) Section A9.5
3. AusHFG Store – Sterile Stock, Central CoreManufacturers instructions to be followed for sterile consumables
The CEC has provided a set of guiding principles to manage the co-location of sterile and non-sterile stock in storage rooms:
* Determine how sustainable improvements can be made to storage of sterile stock RMDs and consumables
* Separate sterile RMDs from consumables.
* Consumables should be stored on the bottom shelves if they are required to be stored on the same shelf with sterile RMDs. This prevents lint/fibres falling onto the outside RMD wrap
* If any carboard boxes/cartons of consumables can be emptied do this.
* Reduce the number of carboard boxes/cartons in the room as they do generate fibres when handled.
* Set up a de-boxing area away from stored sterile RMDs
* Packaging paperboard boxes used to provide identification of the consumable, size/gauge, batch details, prevent bending/damage etc should not be decanted into another container. If removing these consumables from paperboard boxes and there is potential to cause a clinical risk or compromise the sterility of the item, keep in paperboard boxes.
* The paperboard boxes should be stored below sterile RMDs reduce the potential of lint/fibres falling on sterile RMDsWith regular quality management systems that include auditing of storage conditions, cleanliness of storage area, packaging integrity etc (to maintain the required quality) in areas that store both released reprocessed RMDs and sterile consumables, the ACSCHC requirements for co-locating sterile and non-sterile stock in a storage area will be met.
Regards
Kathy Dempsey RN, DippApSc, BSc (Nursing), MNSc (Infection Control & Hospital Epidemiology)
SHEA/CDC Cert Infection Control, Cert Med Micro, DipLdrshp&Mgt.CICP-E; Future Leaders of Healthcare DrPH Candidate
NSW Chief ICP & HAI Advisor | IPAC COVID-19 Response Clinical Lead | Clinical Excellence Commission
Infection Prevention and Control Practitioner (CICPE).The Clinical Excellence Commission continues to support safety in the NSW Health system.
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From: ACIPC Infexion Connexion On Behalf Of Terry
Sent: Friday, 24 September 2021 12:51 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] ‘Sterile stock’ storage??Thank you Andrew for providing a solid, risk based approach to the storage of clean and sterile consumable products and CSSD produced sterile items across a range of environments we see in healthcare.
I need to have my two cents worth – so please read the information below.
For commercially produced sterile products we need to remember that:
* Commercial products are sterilised in their robustly tested Sterile Barrier System. These studies include exposure to a wide range of temperature and humidity conditions and undergo accelerated ageing studies to ensure that the packaging will maintain sterility across a wide range of conditions and over time in accordance with ISO11607-1. Where there are conditions that impact on the integrity of the sterile barrier system, these will be clearly labelled on the product there are a wide range of symbols to depict avoid exposure to sunlight, moisture, temperature range and in some cases humidity range.
* Nowhere in the instructions for managing commercially sterilised products does it say STORE IN A HEPA FILTERED ENVIRONMENT. If it was important that it was, you would see this on the labelling as ISO11607-1 says that any specific storage conditions must be included in the information provided to the user / consumer, hence those symbols I mentioned in the point above.
* You may not be aware of this but most commercial products in cardboard dispenser boxes are STERILISED within their dispenser boxes, so the dispenser box itself is sterile. The external shipper or transport carton must be removed before taking the products into the clean area, however there is no reason at all to decant products from their dispenser boxes, unless the dispenser box itself has been used as the shipping carton, without other protective packaging applied.We also need to remember that for CSSD produced sterile RMDs:
* The RMDs are packaged in a Sterile Barrier System. The manufacturers of the Sterile Barrier System have performed studies exposing their product to a wide range of conditions in accordance with ISO11607-1 to ensure that the sterile barrier can maintain sterility after exposure to conditions such as shock and vibration, compression, temperature, humidity, method of transportation, pressure changes, integrity over time, including ageing studies just like the sterile barrier systems that are used for commercial packaging.
* Nowhere in the instructions for using a Sterile Barrier System that I have ever read [and I have read a lot] does it say STORE IN A HEPA FILTERED ENVIRONMENT. If it was important that it was, you would see this in the instructions for use as ISO11607-1 says that any specific storage conditions must be included in the information provided to the user / consumer.I also think it is important to remember that we are placing CSSD and commercially produced sterile products on non-sterile but [it should be] clean shelving.
I think good practice looks like:
* Storing sterile items [whether CSSD produced or commercially prepared] on separate shelves to non-sterile but clean items.
* Sterile items ideally will be placed above the non-sterile items.
* The products will be protected from direct sunlight and sources of moisture.
* The shelving or containers and the storage room / cupboards / drawers would be cleaned on a regular basis.
* Products would only be touched when necessary and with clean hands.
* The air conditioning to the room would not have been recirculated from other enclosures and would be sufficient to provide the temperature and humidity conditions required to maintain sterility of the most sensitive product noting that some commercially produced items cannot have humidity exceed 60%.I trust that the above makes some sense and when it comes time to the public review of the new Standard that will be replacing AS/NZS4187 and AS/NZS4815 that all of you will contribute comments and suggested improvements to the draft document so situations like this, that are left open to interpretation are clarified and solid, risk based guidance is included in the new Standard.
Kind Regards
Terry McAuley
Director
MSc Medical Device Decontamination
PO BOX 2249, Greenvale VIC Australia 3059
Mobile: +61 (0)438 109 692
Email: terry@steamconsulting.com.au
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From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Ellis, Andrew (Health)
Sent: Friday, 24 September 2021 11:04 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] ‘Sterile stock’ storage??Hi All,
The current SA Health Standard 3 Audit does not require that RMDs stored outside theatres/CSSD are stored on a specifically labelled shelf. In the set of questions for a ward/clinical area there is:
1. Is the sterile stock storage area dedicated to that purpose only?
sterile reusable medical devices should be stored on or in designated shelving, cupboards, drawers or containers1. Non sterile stock may be stored in the same area but segregated from sterile stock by a barrier, dividers or partition 2.
Where reference 1 is AS/NZS4187 and reference 2 is the QLD Health Guideline cited in the AusHFG and other documents.
One of our large, regional health networks recently conducted a survey with me of their sterile storage conditions across sites, including two hospitals with CSSDs/theatres, and six remoter health services which had only ward and OPD/ED areas, but may have either used RMDs reprocessed offsite, or commercial stock only. Much like an earlier response on this thread breaking down the continuum of sterile storage conditions, we broke these environments into broad categories;
1. Areas which are defined in the AusHFG, AS1668.2 etc as requiring HEPA filtration, positive pressure, minimum ACH and so on These are CSSD and Theatre sterile stores for RMDs. Patient equipment and other non-sterile items were to be eliminated but sterile consumables were acceptable if managed appropriately. FFE, finishes etc were naturally of the highest level.
2. Store rooms in clinical areas such as wards which are primarily for sterile and clean consumables We agreed on minimum elements of design and construction, FFE and access control. This included temperature and RH monitoring, noting that engineering controls per (1) were not mandated here. The health network had employed UsB dataloggers in order to determine baseline environmental conditions. Improvements generally included use of resilient, sheet-type coved flooring, wire shelving and containers, non-porous materials and relocation of equipment and deboxing activities as necessary. A lot of these rooms needed general repairs and works including installation of bulkheads and decommissioning of old fixtures including in the ceiling to reduce dust collection, as they were frequently repurposed rooms in the more remote sites.
3. Point of use storage such as in a treatment room, which was to be minimally restocked from a suitable location and to include at a minimum, compliant containers and a cleaning schedule, protection from contamination and monitoring of stock rotation and environmental conditions. RMDs were present in some of these e.g. Podiatry clinics, but one area was rationalised back to storage and issue from CSSD because the point of use storage was not able to be adequately controlled.
4. Bulk storage for not yet deboxed sterile consumables and fluids, which may also house patient equipment and unsterile personal care items (bulk boxes continence pads etc) relocated from the areas above.It was not possible in some ward/clinical areas to split these into separate rooms, so in some cases 2, 3 and 4 had to be physically separated as best we could, but design and construction were to meet the higher of the levels.
Regards,
Andrew Ellis
Sterilising and Reusable Medical Device Reprocessing State Coordinator
Infection Control Service | Communicable Disease Control Branch
Health Regulation & Protection
Department for Health and Wellbeing | Government of South AustraliaLevel 13 | 25 Grenfell Street | Adelaide SA 5000
Ph: (08) 7425 7152 | Mobile: 0435 389 541 | Email: andrew.ellis@sa.gov.au
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From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of RILEY Sinclair
Sent: Friday, 24 September 2021 8:15 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] ‘Sterile stock’ storage??Hi Michael
Im not at work today so I cant forward you a copy but the SA Health Standard 3 Store Room audit which refers to RMD items stored outside of theatre actually asks
Are RMD stored on an individual shelf and is that shelf labeled.
Yes crazy I know haha
Leah
On Wed, 22 Sep 2021 at 12:33 pm, Michael Wishart <Michael.Wishart@svha.org.au> wrote:
Ive just had my mind blown by an auditor who tells me I cannot store any sterile stock on a shelf with non-sterile stock. I reply by saying that no sterile RMDs are stored on shelves with non-sterile stock, and they say, no ANYTHING that comes sterile should not be on the same shelf with something non-sterile.
Have I missed something? I have always understand that the very specific storage requirements for RMDs did not apply to most commercially sterilised single use items. Sure, there are commercially sterilised disposables that have very specific storage requirements, but the majority of high volume disposable sterile goods can be safely stored on a shelf with non-sterile stock in an appropriately air-conditioned storage room. AS4187 does not cover storage of non-RMDs, correct?
Can someone either tell me I am wrong, and I missed this big time, or that I did not miss anything, and the auditor is incorrect. Or some variation of these.
Help?
Thanks
Michael
Michael Wishart | Infection Control Coordinator, CICP-E
St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
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Hi Linda
Not sure if you have received any response to your questions regarding ventilation in the sterile store rooms.
Your situation does not appear right as other rooms air supply should not be compromised.
In Western Australia we use the Western Australian Health facility guidelines for Engineering Services. Available on the WA DOH website.
Sterile store rooms –
-4.6- supply air shall be HEPA filtered
– Rooms shall be at positive pressure relative to surroundings. A minimum ventilation rate of 10 air changes per hour shall be provided.Also 14.6.2 tells you further information about supply air and compliance with AS/NZS 1668.2 .
Best of luck
Robyn Lawson
OR Consulting Australia
roblily49@gmail.com
0408 871 624Get Outlook for iOS
________________________________Hello SSD and HVAC engineering gurus
My question is
the current configuration of one of our facilities new clinic services buildings (about to be commissioned) is that all sterile stock rooms (4 Rooms) are off the same AHU and therefore have no redundancy if the unit was to fail the would compromise all 4 rooms. The other problem with this design is that when the door is opened to the main sterile stock room it affects the other 3 rooms dropping the differential pressure across the doors below 7pa and if those door are open at the same time there would be minimal pressure with the potential for contaminated air flowing into these sterile stock rooms.
I can find in the engineering services guidelines that sterile store to corridor should be to 10pa and each pressure gradient step should be designed to 10pa however there is no clarity around:
* Should all four rooms be off the same AHU
* What is the minimal accepted pressure drop whilst a door is open or is the system to maintain 10pa across the door if open
* If there is a minimum pressure drop level, how long can this occur for before the sterile room is compromisedCan anyone advise/ help me with more useful advice as this is what we will be left with but I have my concerns and our builders are asking for evidence that what they have set up meets specs..I have concerns am I wrong?
Any feedback gratefully acknowledged as we have little time to respond and lodge a response
Kind regards
Lindy
Lindy Ryan
District Infection Prevention & Control CNC | Clinical Governance & Information Services MNCLHD
Level 1 Coffs Specialist Centre, Pacific Hwy, Coffs Harbour
Office 66911984 or Mob 0419 990 693 | lindy.ryan@health.nsw.gov.au
http://www.health.nsw.gov.auGeneral email enquires please use this email MNCLHD-InfectionControl@health.nsw.gov.au
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Wise and humane management of the patient is the best safeguard against infection
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Marija.Great to know you are working towards GENCA Standards. I know it can sometimes be difficult working towards best practice guidelines but it will be worth it in the end. After all standards are there to protect patients at all times.
In the meantime try to ensure you are managing your risks and doing all you can at this moment in time. We need to embrace standards and understand them and educate staff.
All the best.Robyn Lawson
OR Consulting Australia
roblily49@gmail.com
0408 871 624Get Outlook for iOS
________________________________living through accreditation this week (my nightmare) same issues!!!
We have scopes that are stored in a vented cupboard that have high level disinfection, yet the surveyor states we have to have them in a airdrying cupboard. The standard doesn’t state that for endoscopes, the GENCA guidelines do though (but they are a guide). We are in the start of major rebuild and in 3 years they will be in a pass through cupboard that meets all of GENCA guidelines! We test our scopes, and we also place an alcohol rinse through them before airdrying and storage hanging. We have a plan and have risk mitigated…I don’t think there is anything more we can spend our $$$ until we move.
I can’t wait until we actually have accredited Standard 3 credentialled ICP ( who truly understand the standard and all it entails) auditing the standard… my dream as a previous president and something I did try and follow through with ACHs.
Kind Regards
Marija Juraja
Nurse ConsultantCALHN Infection Prevention & Control Unit
Division of Acute Medicine (RN, GCNS Inf Ctrl, CICP)
m: 0410 567 385 |e:marija.juraja@sa.gov.au
________________________________
Hi Michael
The auditor is correct in that sterile storage for commercial sterile items has always been covered by ASNZS 4187 in the past but it seems to have got lost in the new 2014 edition .
ASNZS 4187 2003 Section 9.1.1 Sterile items states Sterile items shall be stored and handled in a manner that maintains the integrity of packs and prevents contamination from any source. This requirement applies equally to items sterilised in the health care facility AND to sterile items procured from commercial suppliersWe also know that sterile items need to be stored in a designated area so that rules out storage with unsterile items.
Sterile items can so easily be compromised if not in a DESIGNATED and restricted area
( so reduced traffic) with the correct ventilation and humidity etc. So as you know different storage is required for sterile items.
Unsterile items are so often not handled with care and are easily compromised. So we dont want them stored with sterile items.Thanks
Robyn Lawson
OR Consulting Australia
roblily49@gmail.com
0408871624Get Outlook for iOS
________________________________Ive just had my mind blown by an auditor who tells me I cannot store any sterile stock on a shelf with non-sterile stock. I reply by saying that no sterile RMDs are stored on shelves with non-sterile stock, and they say, no ANYTHING that comes sterile should not be on the same shelf with something non-sterile.
Have I missed something? I have always understand that the very specific storage requirements for RMDs did not apply to most commercially sterilised single use items. Sure, there are commercially sterilised disposables that have very specific storage requirements, but the majority of high volume disposable sterile goods can be safely stored on a shelf with non-sterile stock in an appropriately air-conditioned storage room. AS4187 does not cover storage of non-RMDs, correct?
Can someone either tell me I am wrong, and I missed this big time, or that I did not miss anything, and the auditor is incorrect. Or some variation of these.
Help?
Thanks
Michael
Michael Wishart | Infection Control Coordinator, CICP-E
St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
M +61 448 954 282 | T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT QLD 4169
M +61 448 954 282 | T +61 7 3240 1208 | F +61 7 3240 1166
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Hi Michael
The auditor is correct in that sterile storage for commercial sterile items has always been covered by ASNZS 4187 in the past but it seems to have got lost in the new 2014 edition .
ASNZS 4187 2003 Section 9.1.1 Sterile items states Sterile items shall be stored and handled in a manner that maintains the integrity of packs and prevents contamination from any source. This requirement applies equally to items sterilised in the health care facility AND to sterile items procured from commercial suppliersWe also know that sterile items need to be stored in a designated area so that rules out storage with unsterile items.
Sterile items can so easily be compromised if not in a DESIGNATED and restricted area
( so reduced traffic) with the correct ventilation and humidity etc. So as you know different storage is required for sterile items.
Unsterile items are so often not handled with care and are easily compromised. So we dont want them stored with sterile items.Thanks
Robyn Lawson
OR Consulting Australia
roblily49@gmail.com
0408871624Get Outlook for iOS
________________________________Ive just had my mind blown by an auditor who tells me I cannot store any sterile stock on a shelf with non-sterile stock. I reply by saying that no sterile RMDs are stored on shelves with non-sterile stock, and they say, no ANYTHING that comes sterile should not be on the same shelf with something non-sterile.
Have I missed something? I have always understand that the very specific storage requirements for RMDs did not apply to most commercially sterilised single use items. Sure, there are commercially sterilised disposables that have very specific storage requirements, but the majority of high volume disposable sterile goods can be safely stored on a shelf with non-sterile stock in an appropriately air-conditioned storage room. AS4187 does not cover storage of non-RMDs, correct?
Can someone either tell me I am wrong, and I missed this big time, or that I did not miss anything, and the auditor is incorrect. Or some variation of these.
Help?
Thanks
Michael
Michael Wishart | Infection Control Coordinator, CICP-E
St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
M +61 448 954 282 | T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT QLD 4169
M +61 448 954 282 | T +61 7 3240 1208 | F +61 7 3240 1166
E michael.wishart@svha.org.au |[http://i8.cmail19.com/ei/t/6C/F77/A00/141133/csfinal/StaticEmailFooter-SVPHN-Celebrating20Years-650×150-9900000000079e3c.png]
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Well said Terry. Totally agree.
With list and team planning there is always a solution to this issue. …….and it works! There has to be a culture of taking a break and it needs to come from management level.
ACORN has considered this issue in the staffing standard . Lets make it happen!Robyn Lawson
OR Consulting
roblily49@gmail.com
0408 871 624Sent from my iPhone
On 12 Jul 2019, at 1:37 pm, Terry <terry@steamconsulting.com.au> wrote:
Hi everyone,
Jo while I appreciate your point of view I think there is another facet to the workplace health and safety argument, that is that all team members should be able to have adequate breaks and expect to be relieved from duty to do so. It is after all, a condition of employment for an employer to ensure staff are given appropriate rest breaks.
In the perioperative setting it might mean that anaesthetists; nursing staff and technicians are relieved by one of their colleagues to have a break, although this may only be realistic in a public hospital setting.
The surgeons are more challenging to relieve in these cases, it would be beneficial to the ENTIRE team for there to be a BREAK in the list between cases, so doctors, nurses and technicians can have a tea break or lunch break as the situation might warrant. This should certainly be the case in a private setting where medical officers and staff may not be able to take a break during a case as there is no-one else available to relieve them.
In prolonged cases, if a surgeon needed to have a break they would need to scrub out in which case it would be entirely reasonable to ask them to have a break in the tearoom and not eat in the OR.
I think a cultural shift is needed the current thinking that you must be able to eat and drink whilst still performing your work is unreasonable.
Let me put it another way would you think it acceptable for an ICU, A&E or ward nurse, consultant or registrar to sit in the patient bay / patient room and have their break?
Or as a consumer, would you be happy being served in a restaurant or in a retail setting while staff were chewing on a sandwich and slurping from a coffee cup?
I wonder what the people at Work Safe would think?
Kind Regards
Terry McAuley
Director
MSc Medical Device DecontaminationPO BOX 2249, Greenvale, VIC Australia 3059
Mobile: +61 (0)438 109 692
Email: terry@steamconsulting.com.au
Website: http://www.steamconsulting.com.au[cid:image001.png@01D538C7.B175C370]
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From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of joe.bendall@BIGPOND.COM
Sent: Friday, July 12, 2019 1:43 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] evidence to stop doctors taking food and drink into the operating theatreHi
I usually try and stay out of this argument but I think we need to refocus this question.
It is important that surgeons and anaesthetists who are performing long cases or sessions have access to nutrition and fluids. It is a workplace health and safety issue. We need to make sure that they are looked after to keep patients safe.I have suggested to some theatres, instead of making it a black and white issue, why not work with the medical officers. Is there a little corner that could be quarrantined where they could eat/drink, be comfortable and not be worried about breaching infection prevention and control? Do you need to put some caveats around it eg no hot food that fasting patients can smell?
You will win some respect with the surgeons.
I expect some opposition to my thoughts but I am proposing another view!
Thank you
JoeINFECTION CONTROL REVIEW PTY LTD
Joe-Anne Bendall Consulting
ABN 98630512284Joe.bendall@bigpond.com
Phone: 0419638342
[Infection Control Review Logo – small2]From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Helen Roberts
Sent: Friday, 12 July 2019 12:55 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] evidence to stop doctors taking food and drink into the operating theatreHI Pam,
We have the same problems. I would like the evidence as well or any suggestions on how to stop this practice.Kind regards,
HelenHelen Roberts
Infection Control
P:
07 4646 3106
|
F:
07 4633 7602
E:
robertsh@sath.org.au
|
W:
http://www.sath.org.au
Post:
PO Box 263, Toowoomba, QLD 4350
Address:
280 North St, Toowoomba, QLD 4350
[cid:image347663.jpg@B5E41322.6DD5DBA9]
From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Pamela Ann Boon
Sent: Friday, 12 July 2019 12:16 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] evidence to stop doctors taking food and drink into the operating theatreGood morning.
We have an issue we need to address with some (special) doctors taking food and coffees into operating theatres (despite this being banned).
They also take their grubby bags in there as wellWhen we crack down on this I am sure I will be told by the doctors to show me the evidence .. blah blah blah!!!!
If anyone can refer me to any evidence or documents that support my position of No food or drink in the OT I would be eternally grateful.
Kind regards,
PamPamela Boon | Clinical Nurse Manager
Infection Prevention and Management Unit
Royal Darwin Palmerston Hospitals | Top End Health ServiceNorthern Territory Government
LG Floor, Royal Darwin Hospital, Rocklands Drive, Tiwi
GPO Box 41326, Casuarina, NT 0811p …08 892 28045
f … 08 892 28889
e … Pamela.Boon@nt.gov.au
w http://www.nt.gov.au/healthOur Vision: Building Better Care | Better Health | Better Communities Together
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Great response Mandy and I totally agree with your comments. Nothing sits alone. The near future will be sterilisation for scopes.
Robyn Lawson
OR Consulting
PO Box 465
Dianella
Western Australia0408871624
roblily49@gmail.com
Fellow ACORNSent from my iPhone
On 27 Feb 2019, at 6:22 am, Mandy DAVIDSON <Mandy.DAVIDSON@health.qld.gov.au> wrote:
Michelle
I will attempt to answer some of this for you. I can understand if it does seem like overkill, I am still learning 6 months into a project on helping my organisation become compliant.
First you mention that you are only going gastroscopies & colonoscopies I take it to mean that you are looking only? The challenge comes further if you are doing biopsies, injections, polyp removals etc, as these procedures then become critical procedures under Spauldings Classification. This changes the ball game with how we look at endoscopy. At the FSRACA conference last year, Alberto Csap from Vancouver spoke about how they have moved to sterilisation (low temperature) of all endoscopes. While slightly different from your question, he did pose the very interesting question of – if biopsy forceps are considered to be critical devise and need to be sterile, how can we then thread them down a HLD only device and expect that they remain sterile? (a copy of his presentation is available on the FRSACA site).
As to the use of a WD, I can understand some of your frustration, but it is not until you start to look at some of the literature, that we begin to understand. There are a number of studies that explain why automated cleaning is better than manual cleaning. I have attached a couple of references. While they are not specific to endoscopy, the concepts can be extrapolated. Manual cleaning involves the human element, which is difficult to control. People invariably take short cuts, or forget all steps required, and endoscopy cleaning is very complex!. Your validation processes will either support continued manual washing, or identify that automated processes are better. Plus has the manufacturers provided you with validated cleaning instructions, and is manual cleaning acceptable in these instructions?
* Alfa, M. J., & Nemes, R. (2004). Manual versus automated methods for cleaning reusable accessory devices used for minimally invasive surgical procedures. Journal of Hospital Infection, 58(1), 50-58. doi:https://doi.org/10.1016/j.jhin.2004.04.025
* Lopes, L. K. O., Costa, D. M., Tipple, A. F. V., Watanabe, E., Castillo, R. B., Hu, H., . . . Vickery, K. (2018). Complex design of surgical instruments as barrier for cleaning effectiveness, favouring biofilm formation. The Journal Of Hospital Infection. doi:10.1016/j.jhin.2018.11.001Finally water quality, we are all eagerly awaiting an update to the water quality component (table 7.2) in the Standards. As the is variability in water quality from site to site, you wont know unless if you test. The purpose of the testing is to:
1. ensure that the process does not add to the contamination of the reusable medical devices (RMD) you need to know if your final rinse water has microbial contamination
2. water quality will affect your cleaning process including chemical consumption, temperature and overall cleaning time
3. That the water is not causing damage to the RMD or the reprocessing equipmentSorry about the length response. I agree it is all about patient safety, I hope this helps.
Kind regards,
Mandy Davidson
RN; GCert Inf Pre & Cont; MPHTM; Cert III Sterilisation; Cert IV TAE; Immunisation cred; CICP-AClinical Nurse Consultant 4187 Implementation project
Infection Prevention & Control
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From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Michelle Bibby
Sent: Tuesday, 26 February 2019 11:44 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] seeking clarification on WD versus manual wash for scope accessories in an endoscopy day procedure centreHI Team
You may or may not be able to assist but I am seeking some clarification if possible please?
I have also posed this question to GENCA and NSQHS as I believe we have some duty of care to support these centres with best practice but not irrational over expenditure on unnecessary equipment and water testing.
With regard to a free standing endoscope day procedure centre, only doing gastroscopes and colonoscopes, what is the rationale for installation of a WD when all that is being washed are scope accessories?
Whilst I appreciate the push for the implementation of single use, for some centres this is not a cost effective alternative at this point in time, not until the market is held accountable.
The scope accessories are a semi critical device and the scope itself is undergoing HLD, so how can we rationalise installation of a WD and associated RO water systems and water quality testing?
Currently the accessories are manually washed, then go through an U/S, rinsed with RO water then visually inspected, dried and then sterilized.
The WDs can not actually improve the cleaning process, can they, other than the statement in 4187 which says along the lines of automated is more reproduceable
Whilst AS/NZS4187:2014 states that the correct cleaning pathway should be chosen, and manufacturers instructions are followed, it also goes on to say that manual cleaning of an RMD shall only be used where the manufacturers validated cleaning instruction requires manual cleaning and as a pre treatment.
Many of the man instructions are lacking in detail and open for interpretation.
I am providing advise, I would like to be able to provide a sensible rationale as to how installation of a WD will actually improve the cleaning process, but more importantly improve the patient outcome.
Any advise/opinions gratefully accepted
Michelle
Michelle Bibby
Infection Prevention Australia
+61 429 071 165
Michelle@infectionprevention.com.au
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Hi Pam
Australian Standard AS/NZS 4187
Section A9.5 page 103
Handling, transport and storage of released processed RMD’s.
(f) and (g) and (h)Robyn Lawson
Perioperative Services Health Consultant PO Box 465 Dianella WA 6059
Roblily49@gmail.com
0408 871 624Sent from my Samsung GALAXY S5 on the Telstra Mobile Network
——– Original message ——–
Good morning everyone.
Could someone please direct me to where general sterile stock storage temperature and humidity requirements are stated in the Australian Standards.
Thanks so much.
Cheers from PamPamela Boon | Clinical Nurse Manager
Infection Prevention and Management Unit
Royal Darwin Palmerston Hospitals | Top End Health ServiceNorthern Territory Government
LG Floor, Royal Darwin Hospital, Rocklands Drive, Tiwi
GPO Box 41326, Casuarina, NT 0811p …08 892 28045
f … 08 892 28889
e … Pamela.Boon@nt.gov.au
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Hi Jayne
Just clean clean clean. …then open your OR.Regards
Robyn LawsonOR Consulting
PO Box 465
Dianella
Western Australia 6059
roblily49@gmail.comSent from my Samsung GALAXY S5 on the Telstra Mobile Network
——– Original message ——–
Hi Jayne
Can I ask for what reason you would want to rest an OT after an MRO or dirty case? Once appropriate cleaning has occurred, you can safely use the OT for another case after surfaces are dry.
The only times we would delay the start of the next case after cleaning is either in the case of a known or suspected airborne pathogen like measles, or to allow latex particles to settle prior to a latex allergic case.
I am not sure what you are trying to achieve with a rest for environmental contamination that has been appropriately cleaned. Maybe I am missing something, though?
Cheers
MichaelMichael Wishart, CICP-E
Infection Control CoordinatorA 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
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P Please consider the environment before printing this emailDear Brains Trust,
I am sure I have asked this question before?? Regarding resting theatre following a dirty/MRO case.
We are currently debating this issue again, does anyone rest the theatre after the clean has taken place and for how long? Where possible the cases are last on the list, but we appreciate that not all MRO cases/dirty cases can go last on the list.
Advise on this matter would be greatly received.
Many thanks in advance
Jayne O’Connor RN ,BSc.,Inf.Cont
IPC Co-Ordinator
Sydney Adventist Hospital | 185 Fox Valley Road, Wahroonga, NSW 2076p: +61 2 9487 9732 | f: +61 2 9473 8052 | m: +61 0406 752685 | e: jayne.oconnor@sah.org.au
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