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Hi John
Below in the reply from our facilities manager. We don’t tend to have problems with humidity in our 16 bed unit, depsite being in Brisbane
Michael
The ICU runs with a normal minimum fresh air setting of approx. 40%
The system has got Temp & humidity control with terminal HEPAs in all the patient areas
There is an automatic economy cycle that increases the fresh air & starts a variable speed extract fan.
The economy cycle is based on the external enthalpy(combined temperature & humidity) being lower than the room set point.
Both the damper & fan speed are auto adjusted to minimise chilled water use for cooling & de-humidification.
There are also two negative pressure rooms with a proper air lock however this is used as a store & staff enter the rooms directly off the main ICU
Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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________________________________Dear All
Our ICU for some time has been on a full exhaust mode this came about at the time when we faced up to an ongoing MRAB outbreak. We had some evidence (not strong) that the ventilation system might have played a role.
However this process is wasteful, particularly in the summer and it makes control of humidity very tricky some days , we cannot bring the humidity below 80% given the grunt within the air con system
I would be interested to know :
a) What sort of ventilation is used in your ICU
b) Do you recirculate air?
c) Is it filtered prior to recirculation? If so how filtered?
d) What humidity levels do you experience in the icu through the year?
Thanks !
Kind regards
JohnDr John Ferguson
Director, IPC, Hunter New England Health
Infectious Diseases & Microbiology
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Hi Lynne
I operate wherever possible on the KICK principle: Keep It Clean, Kids. 🙂 So, if you have a covered notice board (eg glass doors or something) that can be easily wiped over, that is best. If not, as long as the notice board does not shed lint, and the edges can be easily kept dust free, still Ok in common public corridors but avoid treatment and accommodation rooms. Any posters in treatment or accommodation rooms should be laminated and stuck up with blue-tac or whatever your facility allows to put stuff onto walls, and be easily wipable.
Not a hard and fast set of rules, but some guiding principles for clinical areas. With not a shred of evidence to support it, I might say. Just good old common sense.
Cheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Hi
Just wondering what approach/opinions people have to notice boards in clinical areas?
Is it better to have a dedicated notice board made from material that does not deteriorate or to have posters etc blue tacked to walls?
ThanksLynne Sinclair RN
Quality and Risk Manager Boort District Health PO Box 2 Boort 3537
‘ 03 5451 5200 | 7 03 5455 2502 | * lsinclair@bdh.vic.gov.au
VoIP 15285
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Hi Marie
Great questions to ask. I would also like to point out that reusable curtains that require regular laundering or dry cleaning also have an environmental footprint, and this must be taken in consideration when looking at environmental impacts. Since this is often outside of the health facility, sometimes it is left out of the discussions. Laundries in particular are great users of energy and their environmental impact is massive.
Cheers
Michael;Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Maree Sommerville
Sent: Tuesday, 4 March 2014 1:04 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Disposable curtains/screensI have been following the conversation in this thread and would like to raise an issue/question
My organisation is constantly looking at ways to reduce its environmental footprint.
We are a member of the Victorian Green Health Round Table Group, which provides a forum of information sharing for member organisations related to environmental concerns.
One key activity undertaken by this group is comparing waste volumes generated with the goal to reduce.
One of the major changes in providing health services since I began nursing (which was a good few years ago) is the increasing use of disposable items; from kimguard wraps, surgical drapes, suction tubing, endotracheal tubes, and surgical glovesthe list goes on.
Some of these are absolutely no-brainers when it comes to rationale.
Disposable curtains are large and take up a lot of space in a bin, hence in landfill, prior to breaking down.
How do organisations who use disposable curtains weigh up this issue in contrast to the infection control risk related to privacy screens?Maree Sommerville
Infection Control Coordinator
Mercy Hospital for Women
Heidelberg
(03) 8458 4759________________________________
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Denyer, Vicki
Sent: Tuesday, 4 March 2014 12:23 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Disposable curtains/screensHi All,
Have a small issue Disposable curtains/screens!
Would appreciate feedback from areas that are using the disposable curtain/screens in their facilities
The issue is around cost of linen vs disposable curtains/screens.
We have trialed & like what we have but those who watch the pennies are questioning their use.
Originally we brought them into our ED because the poor terminal cleaning staff were frantic with attending the cleaning ( which involves the replacement of curtains).
The NUM of ED was indicating at this particular incident -that there were three ambulances waiting to off load patients onto ED beds which were being held up by the terminal cleaning required.Amongst other actions taken regarding this issue in ED-was the implementation of the disposable curtains.
Now the question being asked is who else in other health areas has disposable curtains/screens & where are they ( ie high risk areas).
Much appreciate any assistance with this.
Thank you
Vicki Denyer
Clinical Nurse Consultant | Infection Prevention & Control Unit
Lismore Base Hospital
Tel 02 6620 2385 | vicki.denyer@ncahs.health.nsw.gov.au[Description: cid:image001.png@01CE7F1B.E103A4C0]
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Paraffin wax baths are used in physiotherapy as a treatment for osteoarthritis, and also in beauty treatments.
QLD Health has some guidance on the use of paraffin wax for beauty treatments, which may be of use. See Section 3.5 of the linked guidelines.
The part that is missing in these guidelines is the contraindication of skin lesions or wounds in areas treated with paraffin wax, which also has an infection control implication.
http://www.health.qld.gov.au/ph/documents/cdb/infectcontrolguide.pdf
I cannot find any specific infection control reference for physiotherapists in Australia in regard to paraffin wax baths, but it may be useful to contact the APA directly to see if they have any guidelines.
http://www.physiotherapy.asn.au/
Cheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Sony SO
Sent: Tuesday, 4 March 2014 10:36 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: infection control for paraffin bath using in Physio DeptDear Fiona
Physiotherapist states Paraffin Wax Baths would be used for patients with rheumatoid arthritis.
Regards,
Sony SO
Nursing Officer, Infection Control Branch (Team 2)
Center for Health Protection http://www.chp.gov.hk/tc/cindex.html
HONG KONG SAR, CHINA
office phone: +852 2125-2922; fax: +852 3523-0752
HA email sony@ha.org.hk; DH email no_icb4@dh.gov.hk
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—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Fiona de Sousa
Sent: Tuesday, March 04, 2014 4:52 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: infection control for paraffin bath using in Physio DeptHi Sony,
Excuse my ignorance but what is a paffarin bath and why is it used?
Fiona De Sousa
Infection Prevention & Control Coordinator Sydney Adventist Hospital
Mobile: 0408 468 470
Office: (02) 9487 9732
Fax: (02) 9472 8053
185 Fox Valley Road, Wahroonga, NSW, 2076
—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Sony SO
Sent: Monday, 3 March 2014 11:19 PM
Subject: infection control for paraffin bath using in Physio Dept
Dear All,
Would you please share your prevailing infection control practices for the captioned issue to us for reference.
Thanks.
Sony SO
Nursing Officer, Infection Control Branch (Team 2) Center for Health Protection office phone: +852 2125-2922; fax: +852 3523-0752 HA email sony@ha.org.hk; DH email no_icb4@dh.gov.hk Please consider the environment before printing this e-mail
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Hi Margaret
Staff needlestick injuries from the use of pen needles has been an issue for some time. CHRISP produced an advisory of the use of pen needles some time ago.
http://www.health.qld.gov.au/chrisp/resources/advisory_inj_pen.pdf
There is now at least one safety pen needle on the market in Australia, which are suitable for staff to use with most types of pen delivery devices. I can provide more details if you contact me off-list.
Cheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Margaret Evans
Sent: Monday, 24 February 2014 6:25 AM
To: AICALIST@AICALIST.ORG.AU
Subject: safety of insulin pens for nursing staff use?Hi All
Our physician wants pharmacy to dispense a prefilled insulin pen to the patient and nursing staff use this to administer the required dose. This pen would then be used by both the nursing staff & patient throughout the patients admission.
I am wondering about the safety of using insulin pens as we have had a number of needlestick injuries from them in the past. If you do use then do you have procedures in place to prevent NSI that you would be happy to share
Thanks for your thoughts
Kind regards
MargieMargaret Evans IP&C CNC
Royal Hospital for Women
Locked Mail Bag 2000
Randwick 2031
Phone 02 93826339Senior Clinical lectures,
Sydney university———————————————————————————————
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Hi Andrea
I believe some QLD Health hospitals compound their own tinted skin prep. Maybe ask someone at your local public hospital if it is available this way to them.
As far as I am aware there are no moves by the company involved to re-register the tinted red product as a skin antiseptic, unless something has changed in the last month or so. Some hospitals have entered into a specific ‘off-label’ agreement with the company to supply the product for skin antisepsis, and some hospitals have developed a specific patient consent arrangement for doctors who wish to use this product outside its TGA registration.
Happy to chat more off list if you would like.
Cheers
MichaelCheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Good morning all,
I have a very irate surgeon who would like to use a red skin prep(Chlorhexidine 0.5% in 70% Alcohol, tinted red). We no longer supply this product for skin use.
I had heard that some larger facilities are compounding their own?
Has anyone heard of any developments to this issue?All replies greatly appreciated.
Cheers, Andrea
Andrea Grimes | IC | H&S | RRTWC
Ramsay Cairns | The Cairns Clinic | Cairns Day Surgery | Cairns Private Hospital
t: 07 4052 5274 | m: 0439 392 819
e: grimesa@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au[http://www.ramsayhealth.com.au/images/email/RHC-email-2013.jpg]
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Hi Marlize
I have always been under the impression that HCW colonisation rates with MRO’S are no greater than that of the general public. The issue is transient colonisation after a shift (eg temporary hand carriage), rather than permanent colonisation. I don’t have any studies close to hand to back this up, but I think this still remains fairly accepted. Someone will no doubt correct if there has been a change in data on this.
So, we screen HCW’s here in the same way as any other patients, ie not because they are health care workers, but because of other risk factors such a recent overnight stay in a healthcare facility.
WA remains the only Australian state that screens HCW’s any differently I believe, and then only on ARRIVAL into the state, not when they have been screened and cleared after arrival into WA healthcare system. I do not think they screen HCW’s admitted as patients into healthcare facilities simply because they are HCW’s. Again, someone is very welcome to correct me if I am in error on this.
Cheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Good afternoon Everyone,
We are reviewing our screening policy and one of the questions that came up is if we need to screen Health care workers for MRO’s?
More specifically:1. HCW’s working in other facilities and are admitted to our facility or
2. HCW’s who have been inpatients in other facilities in the past ( specific timeframe – we use 6 weeks for patients) and then admitted to our facility
Does anyone know of any guidelines regarding this or what best practice is?
Thank you in advance
Marlize SenekalInfection Prevention and Control Coordinator
St. Andrew’s War Memorial Hospital_________________________________________________________________
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Hi Marie
It is EST (US), not Australian EST. Thus it will be at 2am tomorrow morning AEST I think.
I only twigged to this myself yesterday when trying to book a room to view this, and checked the website for details. Definitely EST as in New York time!
It would be great if anyone will be watching the Webinar to let the list know if it will be made available to download or view on the web. I will be sleeping at 2am AEST. 😉
Cheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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We have been trying to access the Webinar Post-Insertion Vascular access Device care scheduled for 12.00 EST which is 09.00 PST. The message kept saying the webinar is not yet open to attendees come back at scheduled time. I’m not sure why this is happening given that it is way passed 09.00 PST. Is there any way we can get a recording of the webinar when it’s finished?
I have also emailed the support email at: webinair@saxecommunications.com and am awaiting a reply
Thanks for your help
[cid:image001.jpg@01CF289E.7C821F40]
Marie Murphy PhD, BSc (Hons), RN
Learning & Development
Manager
Bethesda Hospital________________________________
25 Queenslea Drive | Claremont | WA | 6010
Tel +61 8 9340 6499 | Fax +61 8 9340 6398
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Hi Paul
My only experiences with senor taps were some years ago, and the major issues were failure of the taps to discharge water (battery operated taps – kept dying at odd moments and you had to call maintenance to change the batteries), and what happened during power failure for wired in taps (no water anywhere from any hand basin!). Both of these issue may no longer be a problem with better technology, and since the advent of waterless hand hygiene agents the impact of handbasins not operating in hospitals has decreased (you no longer would have to cart water from elsewhere to keep in basins around the ward for hand washing…). But I have remained wary because of these past experiences in recommending electronic sensor taps. In our last redevelopment here we went with knee operated levers taps, which work very well once you get used to them, and has a side effect of improving those skiing muscles around your knees. 🙂 We do have some electronic sensor taps here, and they generally work well with no issues.
Cheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Hi All,
My hospital has just entered into a major redevelopment phase & I have had a number questions about installing sensor operated taps in both clinical & non-clinical environments. I have initially been reticent about their use based on the report from the John Hopkins that suggested senor taps had higher bacterial counts which they speculated may be due to the increased complexity of these taps. However, a joint ‘ASHE & APIC Statement on Recently Presented Research on Electronic Faucets (2011)’ is generally supportive of their use. There isn’t a heap of evidence out there to draw any absolute conclusion on so I was wondering if anyone out there has a view or experience with installing & using sensor taps.Regards,
Paul Simpson, RN, MSc
Infection Control Consultant
(Mon,Tues,Thurs & Friday)
Royal Victorian Eye & Ear Hospital
32 Gisborne Street, East Melbourne, 3002, VIC
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Hi all
The email address in the GOARN application attachment is incorrect: it should be communication@acipc.org.au (no ‘s’ at the end of communication)
Thanks
Michael Wishart
ACIPC Infexion Connexion AdministratorMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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[Posted on behalf of Claire Boardman – Moderator]
Dear ACIPC Members,
You may be aware that ACIPC is a partner of GOARN (Global Outbreak & Response Network – WHO). For more information on GOARN please visit the ACIPC website.
The attached letter contains application procedures for an upcoming GOARN training course that that is being organized by the WHO Regional Office for the Eastern Mediterranean (EMRO), and HQ. The course will be held in Muscat, Oman tentatively from 24 March to 1 April, 2014. ACIPC has been asked to identify appropriate candidates from the ACIPC membership who may wish to apply to the training courses. The costs of airfare and per diem for the selected participants will be covered by WHO. The deadline for applications which are to be submitted directly to ACIPC is 14th February, 2014.Please contact Claire Boardman for further information.
Many thanks,
ClaireClaire Boardman
B. App Sc (nsg), Grad Cert IC, MPH, CICP
Chair Communication Committee/Past President, ACIPC
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Hi Teresa
Your question about which antiseptic to use for access site disinfection is an important one. There is really not much evidence around which antiseptic is better for this purpose, although logic suggests that alcohol alone would be just as effective as a combination of chlorhexidine and alcohol for this use. The rational for this would be looking at the instantaneous antimicrobial activity of alcohol, which is very good, and the utility of a residual effect with chlorhexidine in this use. Since the port/hub/ access site becomes closed (should!) immediately after use, residual effect should not be important here, unlike a skin site, which will always have some access for microbes whilst a cannula is in situ, so residual effect is important.
Another factor to consider is staff compliance with specific product use. If you provide both alcohol only and chlorhexidine and alcohol swabs, you run the risk of staff choosing one or the other for any purpose. If you only supply alcohol only for chlorhexidine sensitive patients, and supply chlorhexidine and alcohol for everything else, you are more likely to have chlorhexidine and alcohol use appropriately for skin antisepsis.
I am not aware of any reports of damage to ports/access sites/hubs from chlorhexidine, so I am not aware that is a factor in this discussion, but it is worthy checking with product manufacturers.
Cheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Dear Fiona
You ask a good question.
We are a private Endoscopy Centre, so all our cannulas are peripherally inserted and insitu for <24hrs (usually in for 3 – 4.hrs max).
I saw the NSW Health published guideline called Peripheral Intravenous Cannula (PIVC) Insertion and Post Insertion Care in Adult Patients too.
We discussed the very point you are looking at and looked at the ANTT guidelines and the EPIC2 guidelines and like yourself we are aware of IVC related BSIs occurring when the PIVC has been insitu for <24hrs.
We came to the conclusion that unless the patient had a chlorhexidine allergy/sensitivity we would continue to use the 2 %chlorhexidine 70%V/v Isopropyl alcohol solution (prep pad).(The cannula is being inserted into a blood vessel, I hesitate to ask …. how relevant is it, that it's only insitu for a limited amount of time? Aren't we wanting to ensure that skin antisepsis is carried out as per evidence based best practice prior to the cannula being inserted? The next question I want to ask is, if we only need to use 70% alcohol for skin antisepsis for PIVCs that are in situ for 70% alcohol solutions/swabs should be used (to reduce unnecessary exposure to chlorhexidine when residual antimicrobial activity is not required”
In the guideline appendix 5 it states that
“For a cannula that is likely to be in for <24hours, skin cleaning with at least 70% alcohol is sufficient"Our facility currently uses an alcoholic chlorhexidine skin prep for all PIVC insertions unless the person has a known sensitivity. We are currently reviewing this and are inclined to continue with this product as we have known of IVC related BSIs occurring when a PIVC has been insitu for less that the 24 hours outlined in this document.
We are interested to know what other facilities are using as skin prep for this cohort of patients.
Kind regards,Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
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Hi Fiona
As Matthias noted, this issue was discussed back in about June 2012. I would be particularly concerned about any claims for using electrolysed water (which is basically hydrochlorous acid) for hand washing. Although it may be non-toxic, the defatting and denaturing of skin oils could cause major skin drying. This is one of the main reasons why our alcoholic skin sanitisers have added moisturising agents, and are not just alcohol alone. Using pure alcohol on a regular basis as a hand sanitising agent can lead to major skin problems (those of us old enough to remember using alcohol as a drying agent as part of surgical scrubbing technique may remember this). So I would be very wary of subjecting any staff to electrolysed water as a hand sanitiser.
I can’t really comment on the use of electrolysed water for sanitation of food preparation equipment or environmental surfaces, except to say: where is the evidence of efficacy under normal usage conditions?
Cheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Dear Fiona,
There was an earlier thread about this in Infexion Connexion and also in OzBug where this was discussed. Not sure when, but it might have been about 1-2 years ago. The gist was, and my take on it was, that scepticism is warranted.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387I have received a query regarding electrolysed water for use as a sanitising and cleaning agent for hand washing, environmental cleaning as well as food rinsing/cleaning. Apparently there are facilities that use this product so am wondering if anyone has a) heard about it and b) uses it for hand hygiene and environmental cleaning etc.
Regards
Fiona Wilson I CNC, Infection Control, TIPCU
Population Health Services I Department of Health and Human Services
Post GPO Box 125 Hobart Tas 7001 | Email tipcu@dhhs.tas.gov.au
Phone (03) 6222 7684 | Fax (03) 6233 0553
A fair and healthy Tasmania________________________________
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Hi Cath
We were accredited via the new Standards by ACHS late last year, and I think the process of having to demonstrate minimum requirements is good. Most of Standard 3 involves things we have been doing for a while (or should have been doing) in infection control, and most of meeting Standard 3 is just closing the loop with documentation and evaluation of what we do. So mostly good – to have all facilities measured against these Standards can only lead to improved patient outcomes, in my opinion.
My biggest gripe is AMS – AMS is an important infection prevention issue, don’t get me wrong, but ICP’s don’t prescribe antibiotics. In a facility with a standalone ICP (ie not part of a team with ID Physicians and clinical microbiologists) getting medical staff (who, in the private sector, are not even part of the workforce, really) to prescribe according to guidelines is a target way out of reach. Sure, we can audit and put up posters and stuff, but the responsibility for this part of Standard 3 should NOT be upon the facility, in my view, but put back on the medical staff, at least in the private sector. That’s my main gripe within Standard 3.
Just some thoughts.
Cheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Greetings all
One year since their implementation I am wondering how most IPs are coping with the Commission’s national safety and quality standards and in particular Standard 3. As some of you may know I was personally involved in some of their development through membership on two of the Commission’s committees. Yesterday I enquired of the Commission about any publically available information on how the Standards implementation is progressing but they are unable to report anything. To my knowledge there are no papers in peer-reviewed journals either. The Commission’s timeframe for review as stated on their website is 2015.
I am especially keen to hear in IP-speak 1) the challenges, rewards and obstacles that IPs may have faced as a result of Standard 3. 2)How “usual” ways of work may have changed and 3) any assistance that would make the task of implementing them easier.
In their Annual Report and at ACIPC 2012 Conference in Sydney the Commission referred to HH compliance, C Diff rates and SAB rates as the markers they will use to assess Stdnard 3’s impact. I’m more interested in the impact on programs or the IP role. Please feel free to share your experiences good, bad or indifferent through discussion here or email me personally.
And many thanks for those of you who discussed publically or as a sidebar, the issue of single-use pt care equipment – your insights were very illuminating.
Thanks and warm regards
CathDr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty LtdAdjunct Professor
Griffith University, School of Nursing and Midwifery
http://www.infectioncontrolplus.com.au
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I will chip in as well. The biggest issue I have had over the years, and it still applies today, is the economic ‘bean-counter’ argument where the cost of consumables vs the cost of reusable is a tangible budget line, whereas the costs associated with prevention of infections is not. So when we talk about moving to disposable tourniquets, for example, everyone agrees that the infection control principles are good, but the ‘bean-counter’ mentality sees how much it will cost vs what reusable tourniquets ‘cost’, and it doesn’t get approved. Budget lines seem pretty much fixed in the ‘bean-counter’ mentality, and when a department manager sees an increase in expenditure but cannot easily see the savings in THEIR budget, then they stop supporting this even if they like the principle. I have seen it many times.
What is needed, I believe, similar to what we need in Australia for safety devices in sharps, is some form of mandatory requirement or penalties if you don’t use them. Currently there is very little from a penalty perspective to make administrators work very hard to prevent infections (like a financial penalty), although these seem to be more commonly increasing. A major change in funding methodology and accountability for infections will, I think, lead to greater use of disposables. The US health system is what I see as an example of this, flawed and damaged as it is.
Another problem is actual evidence related to infection reduction for specific disposables (eg tourniquets). Who is to say to giving all the medical staff disposable ties would have more impact on MRSA acquisition rates? Evidence related to bacterial reduction does not automatically equate with infection risk reduction; we all know that. The difficulty in saying definitely that doing x will result in y will always make the ‘bean-counter’ mentality the most prevalent, I think.
Just my (cynical) views as another ‘oldie. 🙂
Cheers
MichaelMichael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside,Qld4032
t: (07) 3326 3068 | f: (07) 3607 2226
e:Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email—–Original Message—–
Thanks Irene and Terrie
Whilst I appreciate Terrie’s position coming from his role with a provider of reusable waste equipment my question was more specifically about equipment used on patients for clinical care so things like BP cuffs, ECG leads and tourniquets. The various responses are interesting and please keep them coming as debate and expression are good for us as is an appreciation for the past (and yes I qualify and feel “oldie” as well 🙂 Cheers CathRegards
CathDr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty LtdAdjunct Professor
Griffith University, School of Nursing and Midwifery
http://www.infectioncontrolplus.com.au—–Original Message—–
Hi all,
as a fellow “oldie” I agree with Terry’s assessment of the trends over the years. I also support the final point about the issues involved in the decision making process. What has always puzzled me is how to accurately measure the environmental impact of either disposable or re-usable items?Irene Wilkinson
Manager, Infection Control Service,
Communicable Disease Control Branch
SA Health
11 Hindmarsh Square,
Adelaide SA 5000
________________________________________Hi Cath,
I had not heard of a movement back to single use items so I will be interested to hear members’ responses on this topic. For oldies like me it has been interesting to see the disposable/reusable “cycle” over the decades.* in the 60’s we reused needles, glass syringes, gowns, etc, to reduce procurement costs;
* in the 70’s the cost of labour to process reusables (and modern technology enabling economic production of disposables) moved us to disposables;
* In the 80’s and 90’s waste disposal costs together with environmental impact of disposables, caused many to move to reusables again;
* Now with staff shortages, in-house processing of reusables is being re-examined (NB. processing by external contractors can still be economical, e.g. reprocessing single-use medical devices saves USA hospitals $300m annually.
As you point out, there have been relatively few evidence-based articles implicating disease transmission with either protocol.
The decision to use disposables or reusables must be evidence-based encompassing patient and staff safety, labour costs, procurement costs, and environmental impact. I look forward to members’ commentsBest regards, Terry
Terry Grimmond FASM, BAgrSc, GrDpAdEd
Consultant Microbiologist
Grimmond and Associates
Ph/Fx (NZ): +64 7 856 4042
Mob (NZ): +64 274 365 140
E: tg@gandassoc.com
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As you may know there’s a subtle movement in Australia towards more widespread adoption of single-use items such as venepuncture tourniquets, lower limb surgical tourniquets, BP cuffs and ECG leads. Tom Gottlieb recently did some elegant research on venepuncture tourniquets and AT ACIPC 2013 Karen Vickery presented new perspectives on biofilm on reusable equipment. Single-use items have been adopted widely in the US for some years and recommendations to that effect are included in many Standards published by relevant professional associations eg AORN.
Whilst appreciating that demonstrating causality between reusable equipment and transmission of colonising organisms or infection is difficult either is biologically plausible. There are also issues of non-cleaning, lack of clarity about who’s role it actually is to clean reusable equipment, how frequently they need to be cleaned or reprocessed etc. These issues have plagued us for at least 3 decades that I know of and likely longer. I’m wondering what others in Australia and beyond think about single-use pt care items
So my questions are:
1. Has any ACIPC colleague successfully built a business case to convert their facility to single-use pt equipment? If so who was involved in that process?;
2. Which pieces of pt equipment do folks think are most in need of single-use alternative options?;
3. Other than price, storage, supply and environmental/waste issues and lack of detailed science what other factors would need to be addressed to help convince you or your organisation’s decision makers to invest in specific single-use equipment?.
I’d be grateful for any discussion here or as PMs on the email address below. If anyone is interested in my further work around this issue please email me.
Regards
CathDr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
Cath@infectioncontrolplus.com.auAdjunct Professor
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Hi Verily
The problem with this question is it is local legislation and local waste management regulation specific. It will depend upon what your state legislation requires, and also what your local waste management regulations (eg local council area or landfill site) requires.
In principle, the ‘spigot end’ of an IV giving set is not a sharp designed to penetrate skin, or to be used for that purpose, and thus may not meet the definition for sharp in some jurisdictions. But your local legislation and regulations may have specific guidance for this, so that should be your first line of enquiry.
Most regulations allow facilities to develop their own polices with in the guidance of the regulations. Thus, if you want to consider all IV administration sets as clinical waste, it can be a facility decision. You could not decide to allow used clinical sharps to be placed in general waste, though, if this would be a breach of the regulations.
Hope these thoughts help.
Cheers
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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Dear All
I wonder if anyone out there can assist with a good response to feedback to staff regarding this question I am so often asked. I have tried with reason to advise however I would appreciate any further input from out there to address this issue:
The question:
‘During one of the COPS meetings a question was raised around how to appropriately dispose of peritoneal dialysis fluid and whether the spigot of an IV line is classified as a sharp. Some wards believe that if they separate a used IV bag from the line, they must cut the spigot end off and put this in the sharps bin and dispose of the rest of the line in the clinical waste bin. I was hoping to get some clarification on these issues so I can feed it back to the COPS group.’
Thanks for your assistance.
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
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