[MaryLouise McLaws]

Hi Jenny
Try the Clinical Excellence Commission NSW website for the CLABSI project.
M-L
Prof Mary-Louise McLaws
UNSW

Sent from my iPhone

On 1 Mar 2018, at 3:55 pm, Breen Jennifer <Jennifer.Breen@PETERMAC.ORG> wrote:

Good Afternoon,
We are looking to improve our aseptic technique tool and are researching many tools available on line. Does anyone have a tool they are willing to share and specifically how they are collating the information in order to provide user friendly reports .
We are happy to be contacted off-line as per email below.
Kind regards
Jenny

Jenny
Jennifer Breen
Clinical Nurse Consultant- Infection Prevention

Peter MacCallum Cancer Centre
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[MaryLouise McLaws]

Thanks Tim
Having a quick look at the recommendations it covers central lines. In NSW the CEC CLABSI project (aseptic insertion, patient preparation, physician preparation etc) reduce CLABSI to close to zero and the probability of a central line associated BSI when the CLABSI insertion protocol is adhered to remains close to zero for the first 10 days after insertion without CHG-Impregnated Dressing. Thereafter it increase exponentially. This CEC lead project was rolled out to all ICUs by ANZICS and the last time I looked the ANZICS CLABSI data since the roll-out the average infection rate for ANZICS contributors is 0.44/ 1000 line-days. However, this aggregated rate hides an even more success story as this rate includes short and long dwell times each with different probabilities for infection. Our CEC project identified 75% of ICU patients have a LOS less than the 10 days (where the probability increases) and the minority of patients with a long stay actually contribute the majority of infections to a rate. The rate should be separated at 1-10 and >10 dwell days. So for central lines an additional infection prevention intervention such as CHG-impregnated dressing may not be cost effective for the majority of ICU patients with a short dwell time. Heres the rub who will have their central line in for more than 10 days if you can predict this then this the group who will benefit from such an intervention in ICU. Otherwise, giving it to 100% of ICU patients with a central line may not result in the best outcome according to cost-benefit.

M-L

Professor Mary-Louise McLaws
Deputy President Academic Board
Professor of Epidemiology Healthcare Infection and Infectious Diseases Control
UNSW Global Water Institute lead for Water and Health
http://research.unsw.edu.au/people/professor-marylouise-mclaws
School of Public Health and Community Medicine/UNSW Medicine
UNSW SYDNEY NSW 2052 AUSTRALIA
T: +61 2 93852586
W:www.unsw.edu.au
CRICOS Provider Code 00098G
[cid:image001.png@01D2758A.1DD460C0]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Tim Spencer
Sent: Monday, 13 November 2017 5:52 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Updated Recommendations on the Use of Chlorhexidine-Impregnated Dressings for Prevention of Intravascular Catheter-Related Infections

Hi All,
Here is an updated recommendation from the CDC on the use of CHG-Impregnated Dressings for Prevention of Intravascular Catheter-Related Infections.

https://www.cdc.gov/infectioncontrol/guidelines/pdf/guidelines/c-i-dressings.pdf

Timothy R. Spencer, DipAppSc, BHSc, ICCert, RN, APRN, VA-BC

Global Vascular Access, LLC

E: tim.spencer68@icloud.com

M: +1 (623) 326 8889 (USA)

M: +61 409 463 428 (AU)

http://www.vascularaccess.com.au

http://orcid.org/0000-0002-3128-2034

Sent from my iPhone
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[MaryLouise McLaws]

Michael
There are several evidential factors that should make HCWs accept annual vaccination:
1. flu can be transmitted at least 24 hours before symptoms,
2. flu can be present even when a case is asymptomatic
3. flu can be easily transmitted while symptomatic during just tidal breathing
4. Flu particles can travel 2.6 metres
There is evidence to back up all of these that makes mandatory vaccination every HCW’s patient safety duty.

M-L
Professor Epidemiology Healthcare Associated Infection and Infectious Disease Control

Sent from my iPhone

On 8 Feb 2017, at 9:19 pm, Michael Wishart <Michael.Wishart@SVHA.ORG.AU> wrote:

[Posted on behalf of Giulietta Pontivivo Moderator]

Hi Michael

The draft update of the MoH NSW Occupational Assessment, Screening and Vaccination Against Specific Infectious Diseases PD stipulates HCWs in Category A high risk groups will be mandated to be vaccinate before 31st may each year. If unvaccinated the HCW maybe deployed permanently to other low risk working environments.

Personally I would have liked to see all HCWs in category A be mandated to have a seasonal flu vaccine. Given that in NSW there were over 270 HC facilities that experienced influenza outbreaks last year with low rates of HCW influenza vaccination in such facilities then mandatory vaccination must be seen as a patient safety requirement.

Regards Giulietta

Giulietta Pontivivo CICP RN/RM/MPH| NM Infection Prevention Management and Staff Health Services- St Vincents Hospital (Unit Level 6, DeLacy Building), 390 Victoria Street Darlinghurst NSW 2010
Contact Details: t: 61 2 8382 3284 | f: 61 2 8382 3892 |M-0457 533 452 e: Giulietta.Pontivivo@svha.org.au

There has been an interesting discussion of the 2010 SHEA position paper on mandated influenza vaccination in the US on the Controversies in Hospital Infection Control blog (http://haicontroversies.blogspot.com.au/). The key blog posts are from Jan 29th, Feb 5th and Feb 6th.

For those who do not regularly follow this blog, it is an interesting debate. It is a discussion on evidence vs opinion for prescription of practice.

I agree with the original blog author: it is fine to state opinion and plausibility to recommend something, but if we want to mandate something, there needs to be clear evidence.

Would be interested to hear other ICPs opinion on this topic.

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

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[MaryLouise McLaws]

Hi Cath and Michael

The Clinical Excellence Commission undertook a CLABSI prevention bundle project (Burrell A, et al. Aseptic insertion of central lines reduces bacteraemia. Med J Aust 2011; 194 (11): 583-587.) using the Pronovost Bundle and it was so successful that it was rolled out by ANZICS to all ICUs across Australia. I accept that ICUs is not the source for all CLABSI but our review of where the Insertion Bundle worked found that for the first 9 days of dwell time if a central line is inserted with full aseptic technique then it remains uninfected, mostly (McLaws ML, Burrell A. Zero-risk for Central Line Associated Bloodstream Infection: Are we there yet? Crit Care Med 2012 Feb;40(2):388-93.)
Where a Technology Bundle would improve patient safety is for patients expected to have a dwell time >9 days. This may need a crystal ball but these patients benefit from the aseptic insertion for the first 9 days but then risk rises dramatically and they need additional assistance (perhaps from the Technology Bundle as well as an aseptic management/access approach for HCWs).
M-L
Professor Mary-Louise McLaws
Professor of Epidemiology Healthcare Infection and Infectious Diseases Control
Academic Board Member
UNSW Higher Research Degrees Committee Member
UNSW Instititue of Water lead on Health & Water
UNSW Medicine, UNSW, SYDNEY NSW 2052 AUSTRALIA
T: +61 2 93852586
UNSW ABN 57195873179 CRICOS Provider Code 00098G
________________________________

Hi Cath

You know I am also passionate about reducing the preventable healthcare infection burden, but I just wanted to debate some of the ‘technology consumables’ in a standard bundle approach.

Yes, we should all ensure that insertion and management of central lines is standardised, but the actual role of some technology solutions such as chlorhexidine impregnated dressings and devices, and impregnated access device caps for management, as just two examples of available technology, is still very much debatable, in my opinion, in management of all central lines.

We can throw money and resources into technological solutions, but are we really getting the ‘best bang for our buck’ with our healthcare spending by doing this? There needs to be better evidence to base these choices on, and groups like Claire Rickard’s vascular access research group with large multicentre trials will hopefully start providing some answers to these questions in the future. But to promote using these technological solutions for all central line management (eg ‘bundle approach’), is premature in my opinion. Unless I have misinterpreted what you are proposing.

In the private sector, we are already facing issues with the private health funds in regard to what they are saying is ‘preventable’. Most of their current systems are based on coding, and we all know how well clinical codes reflect the infection risk and preventability. I welcome debate about how we can reduce the risk of preventable infections, and feel the professional bodies such as ACIPC and ASID should have a role to play in developing criteria to be used by funding bodies. Maybe our professional association should be lobbying on behalf of the members for this to be discussed.

All my opinion only, of course.

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
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Here is some info on what Medibank Private has apparently done

Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.

I am unable to comment on public sector.

1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdf

My opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.

You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.

Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.

I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.

Warm regards
Cath

Cathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, Australia

E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.au

Cath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regards

Sharon

Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au

[cid:image005.png@01D0774C.C15F6A20]

Here is the companion old chestnut question that goes with better public reporting.

Is any state aware of new penalties introduced for public hospitals?

I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.

Is the public sector still tolerating CLABSIs without penalty?

https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html

Warm regards
Cath

Cathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, Australia

E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.au

Hi Michael and Cath,

Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418

You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……

Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.

Thanks

Brett

Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, Cooranbong

Avondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia

[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]

Hi Cath,

I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.

At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.

It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.

A favourite topic of mine so happy to chat offline if I can be of assistance!

Kind regards,

Robert

Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia

—–Original Message—–

I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.

My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.

My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.

Regards and thanks

Cath

Dr Cathryn Murphy RN MPH PhD CIC

Executive Director

Infection Control Plus Pty Ltd

http://www.infectioncontrolplus.com.au

Cath@infectioncontrolplus.com.au

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[MaryLouise McLaws]

Dear Ramon and Glenys

Graves et al study relies on the accuracy of the 2 pivotal variables: SAB and hand hygiene compliance. The accuracy of the latter is serious limited. Our report in the Medical Journal of Australia (Med J Aust 2014; 200 (9):534-537. http://dx.doi.org/10.5694/mja13.11203) concluded the HHA program reports rates that have been biased upwards by very few high performers.

The conclusion from our findings and Graves et al is:

(1) SAB respond to multiple interventions and hand hygiene is only one of these.
(2) hygiene compliance rates have not reached a tipping point to reduce SAB and this tipping point is a long way off because
(3) the hand hygiene compliance rates are inaccurate.

It is important to have a national HH program. But the expense of the current program is too high when the cost of audits provides flawed data that reinforces a misguided belief that our hospitals are performing HH well.

Mary-Louise

Professor Mary-Louise McLaws

Professor of Epidemiology in Healthcare Infection and Infectious Diseases Control

http://research.unsw.edu.au/people/professor-marylouise-mclaws

SPHCM SAMUELS BUILDING

UNSW AUSTRALIA, SYDNEY NSW 2052 AUSTRALIA

CRICOS Provider Code 00098G

________________________________

Colleagues

The study by Graves et al. reports a range of interesting findings, and raises many issues regarding hand hygiene for broader consideration. The College is examining the paper and is preparing a media release for release in the coming days.

Kind regards,
Ramon

Professor Ramon Z Shaban
PRESIDENT

Australasian College for Infection Prevention and Control

GPO Box 3254, Brisbane Qld 4001

On 25 February 2016 at 21:16, Glenys Harrington <infexion@ozemail.com.au> wrote:
Dear All,

Find attached the following publication (February 9, 2016).

Graves et al. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia. PLoS ONE 11(2): e0148190. doi:10.1371/journal.

The analysis was undertaken on data from 6 Australian states:

In 2/6 states there was a 1% chance it was cost effective

In 1/6 states there was a 26% chance it was cost effective

In 1/6 states there was a 80% chance it was cost effective and

In 2/6 a 100% chance it was cost effective.

Interesting figure showing cost increases and cost savings by state (fig 2).

Also some interesting points in the discussion.

Shame there was No useable pre-implementation data available for Victoria and hence was not able to be analysed.

Given the findings of the analysis it raises the following questions for governments:

Shouldnt the program be scaled back and some of the money be spent on other initiatives to reduce hospitals associated infections(HAIs)?

Shouldnt the program be scaled back to reduce the infection control workload associated with the program which is currently overwhelming and taking ICPs away from other core infection control activities?

A press release by the College about the findings of this study and the views of the college in terms of the allocation of limited resources would be timely.

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

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[MaryLouise McLaws]

I am pleased that the College has posted this message as it demonstrates the democratic function of debate.

I agree with Cath. The function of the College must remain setting standards for training, discussing infection control research and practices and related issues only.

Professor Mary-Louise McLaws
Professor of Epidemiology in Healthcare Infection and Infectious Diseases Control
UNSW Medicine, UNSW, SYDNEY NSW 2052 AUSTRALIA
T: +61 2 93852586
UNSW ABN 57195873179 CRICOS Provider Code 00098G
________________________________

Without Prejudice

Dear Members

I was saddened to read the recent Press Release regarding the College’s position on Children In Detention. In my 25 plus years as a member and once President of AICA and as a 7 year board member and 2010 APIC President alignment of a professional body with any non-infection prevention political issue appears unprecedented.

Regardless of where members stand personally on this contentious issue it is arrogant and perhaps even incorrect for the President to assume unilateral support of his position by all members.

Further, whilst the AMA acts as the primary industrial relations agency for medical practitioners and as such rightly has an opinion on this issue the College purpose as stated in its Constitution makes no mention of political commentary as a goal.

Informally, I have canvassed views from at least two other senior College members who are offended by the College’s action. I would request that in future the Executive and College leadership do not assume members’ positions on non infection prevention matters and instead focus solely on working within the scope of the Constitution representing members well on infection prevention matters.

Regards
Cathryn Murphy
Executive Director
Infection Control Plus Pty Ltd

Cathryn Murphy RN PhD
Executive Director
PO Box 106
West Burleigh QLD 4219
Queensland, AUSTRALIA

+61 428 154154
E: Cath@infectioncontrolplus.com.au

——– Original message ——–

[Posted on behalf of ACIPC President – Moderator]

Colleagues
Please note the attached media release from the College.

Kind regards,
Ramon

[ACIPC_Logo_Colour_RGB_Hi_Res.jpg]

Professor Ramon Z Shaban
PRESIDENT

Australasian College for Infection Prevention and Control

GPO Box 3254, Brisbane Qld 4001

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