[Michael Wishart]

In my eagerness to post the message below, I forgot to acknowledge the original sender of this message to OzBug, Dr Benjamin Cowie. Apologies to Dr Cowie and other OzBug subscribers.

——– Original message ——–
CC:

Dear OzBug

Many will be aware of the ongoing cases of measles in returned travellers from Bali.

Please note the following health advisory from Victoria’s Acting Chief Health Officer released today – http://health.vic.gov.au/chiefhealthofficer/advisories/advisory-2013-11-measles-bali.htm

With a number of recent healthcare-associated transmissions, it may be timely to revisit the triage of returned travellers with fever and rash with our ED colleagues to avoid long shared waiting area stays.

Cheers
Ben

Cheers
Michael Wishart
ACIPC Infexion Connexion Administrator

Michael 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
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Hi Micheal,

I am wondering if we should cross post this message that has come from Ozbug as I think it is quite timely and educational.

Many will be aware of the ongoing cases of measles in returned travellers from Bali.

Please note the following health advisory from Victoria’s Acting Chief Health Officer released today – http://health.vic.gov.au/chiefhealthofficer/advisories/advisory-2013-11-measles-bali.htm

With a number of recent healthcare-associated transmissions, it may be timely to revisit the triage of returned travellers with fever and rash with our ED colleagues to avoid long shared waiting area stays.

Kind Regards

Marija Juraja |Clinical Service Coordinator (CICP) -Infection Prevention & Control Unit|
Division of Acute Care and Clinical Support
The Queen Elizabeth Hospital | Central Adelaide Local Health Network
Level 8 Tower Building | 28 Woodville Road, WOODVILLE SOUTH 5011
t: +61 8 8222 7588| p: 47757| f: +61 8 8222 6461 | DX: 465432 |e:marija.juraja@health.sa.gov.au
Care Excellence Collaboration Integrity
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[Michael Wishart]

Hi Beth

The point about Norovirus not being routinely readily transmitted during casual contact by droplet (or aerosol) is well made, but I find the difficulty is that staff are not good at saying to a patient who starts vomiting or having copious diarrhoea “Wait there whilst I find a mask and put it on”! The nature of an acute gastro illness often means vomiting and diarrhoea, the times at which droplets (or aerosols) containing Norovirus are said to be generated, are not easily anticipated. Hence I still stand by the recommendation that, during an acute illness suspected or known to be caused by Norovirus, masks should be worn by all staff having direct contact with the patient.

Just my view.

Cheers
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside,Qld4032
t: (07) 3326 3068 | f: (07) 3607 2226
e:Michael.Wishart@hsn.org.au
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—–Original Message—–

Hi Terri

Sorry about the late arrival t the debate. Just wanted to add to Donna’s comment as this is consistent with the approach that I take. We have found that staff become overly dependent on the protection afford by a mask and loose focus on the what we believe to be the “bang for buck” precautions ie: Hand hygiene and environmental and shared equipment disinfection.

My other thoughts for what they are worth is that the droplet precautions component for protections is really just standard precautions for the prevent of exposure to aerosolised body fluids. Unless I am wrong, I am pretty sure that norovirus doesn’t have inherent throat carriage like say other infections which require droplet precautions eg: influenza, pertussis etc which require universal use of a mask when within 1m of contact.

Cheers
Beth
Beth Bint

Infection Prevention and Control Clinical Nurse Consultant | Infection Management and Control Service Level 1 Lawson House Wollongong Hospital Tel 02 4222 5898 |beth.bint@SESIAHS.HEALTH.NSW.GOV.AU
http://www.health.nsw.gov.au
________________________________

Hi Terry,
We use contact precautions with standard single room only required and droplet precautions added if vomiting.
Regards,
Donna.
Donna Cameron
Manager Infection Control Team
Austin Health
P.O. Box 5555
HEIDELBERG Vic 3968
. 9496 6625
. donna.cameron@austin.org.au

Hi everyone,

Always on a Friday afternoon!
We have had a great debate here about what sort of precautions Norovirus requires and what sort of isolation room they need to be nursed in.

The NSW Ministry of Health Infection Control policy PD2007_036 states:
“Contact and Airborne precautions.
P2 mask when there is potential for aerosol dissemination e.g. patient vomiting or toileting (diarrhoea), disposing of faeces.
Airborne negative pressure room if available and P2 mask Contact gown/apron, gloves Ensure consistent environmental cleaning and disinfection.”

I have always advised the staff that contact and DROPLET precautions are required if the patient is vomiting or has profuse/explosive diarrhoea. I have also advised that a surgical mask is sufficient (if worn correctly). Our little ones don’t vomit and expel faeces as far as adults do too.
We do not have the luxury of having a negative pressure room for them to be nursed in either as we do not have that many.
I think CDC simply suggests single rooms and contact precautions.

Just thought I would ask the other experts out there what they think about this topic?
Also if I advise staff to follow the contact and droplet precautions and surgical mask route, am I going against policy?

Any help on this matter would be appreciated. Happy to admit I am wrong!

Terri Cripps | Clinical Nurse Consultant Infection Control | Sydney Children’s Hospital
‘: (02) 9382 1876 | fax: (02) 9382 2084 |. : terri.cripps@sesiahs.health.nsw.gov.au| “:www.sch.edu.au| page: 47140

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[Michael Wishart]

How about Vascular Access Management Team VAMT (vamped). Its catchy!!

Cheers
Michael

Michael 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
Please consider the environment before printing this email

[International Infection Prevention Week 2012]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Claire Rickard
Sent: Tuesday, 29 October 2013 3:46 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Suggestions for names for a IV/PICC teams

Have seen IVADHeroes, and VAST around….If you are ok acronym free what about WeLoveLines ?!?!

Kind regards,
Prof Claire Rickard
NHMRC Centre for Research Excellence in Nursing Interventions
Griffith University
c.rickard@griffith.edu.au

——– Original message ——–
From: Craig Boutlis <Craig.Boutlis@SESIAHS.HEALTH.NSW.GOV.AU>
Date:
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Suggestions for names for a IV/PICC teams

iVee team

Craig Boutlis

Department Head, Infectious Diseases | IMACS
LMB 8808, SCMC, NSW, 2521
Tel. 02 4222 5898 | craig.boutlis@sesiahs.health.nsw.gov.au

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Kerry Taliaferro
Sent: Monday, 28 October 2013 11:37 AM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Suggestions for names for a IV/PICC teams

Hi All
At Canberra Hospital we are implementing a Vascular Aceess Team – only the abbreviation VAT is already in use for several other medical procedures etc.
I am looking for ideas of what we should call our team/service- we will be inserting PICC lines, difficult cannulas, monitoring central lines etc. We need to make sure that staff and patients recognise what we do from the name as well!

Any suggestions for a name that can also be a catchy acronym?

Thanks Kerry Taliaferro

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[Michael Wishart]

Hi Terri

The NHMRC guidelines (table B5.2) list Norovirus as requiring contact and DROPLET precautions, and this is my understanding of how most RACF guidelines also manage Norovirus, as NONE of the RACFs have negative pressure rooms! These types of precautions have managed to curtail further spread in large outbreaks, so I would say they work fine!

Cheers
Michael

Michael 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
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[International Infection Prevention Week 2012]

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of TERRI CRIPPS
Sent: Friday, 25 October 2013 3:53 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Norovirus

Hi everyone,

Always on a Friday afternoon!
We have had a great debate here about what sort of precautions Norovirus requires and what sort of isolation room they need to be nursed in.

The NSW Ministry of Health Infection Control policy PD2007_036 states:
Contact and Airborne precautions.
P2 mask when there is potential for aerosol dissemination e.g. patient vomiting or toileting (diarrhoea), disposing of faeces.
Airborne = negative pressure room if available and P2 mask
Contact = gown/apron, gloves
Ensure consistent environmental cleaning and disinfection.

I have always advised the staff that contact and DROPLET precautions are required if the patient is vomiting or has profuse/explosive diarrhoea. I have also advised that a surgical mask is sufficient (if worn correctly). Our little ones dont vomit and expel faeces as far as adults do too.
We do not have the luxury of having a negative pressure room for them to be nursed in either as we do not have that many.
I think CDC simply suggests single rooms and contact precautions.

Just thought I would ask the other experts out there what they think about this topic?
Also if I advise staff to follow the contact and droplet precautions and surgical mask route, am I going against policy?

Any help on this matter would be appreciated. Happy to admit I am wrong!

Terri Cripps | Clinical Nurse Consultant Infection Control | Sydney Childrens Hospital
‘: (02) 9382 1876 | fax: (02) 9382 2084 | : terri.cripps@sesiahs.health.nsw.gov.au| “:www.sch.edu.au| page: 47140

[Description: Description: http://www.chw.edu.au/site/signature/schn.jpg%5D

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[Michael Wishart]

Hi Chris

It is not really the type of drug to be injected that is important, although alcohol can have a detrimental effect on vaccines if not allowed to dry. It is really about the condition of the patients skin immediately prior to injection. If it is visibly clean, it does not warrant further cleansing for SC or IM injections, basically.

Cheers
Michael

Michael 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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Thanks guys – I do have this information for immunisations – I was thinking more of in hospital – S/C or IMI narcotics or clexane/heparin.

Christine Lawson | RN

Quality and Risk Manager | Caboolture Private Hospital
Caboolture Private Hospital
McKean Street, CABOOLTURE QLD 4510
t: 07 5495 9418
e: LawsonC@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

[http://www.ramsayhealth.com.au/images/email/RHC-email-2013.jpg]

Hi Christine

The Australian Immunisation Handbook states:

2.2.4 Preparation for vaccine administration
Skin cleaning
Provided the skin is visibly clean, there is no need to wipe it with an antiseptic (e.g. alcohol wipe).3,8 If the immunisation service provider decides to clean the skin, or if the skin is visibly not clean, alcohol and other disinfecting agents must be allowed to dry before vaccine injection (to prevent inactivation of live vaccines and to reduce the likelihood of irritation at the injection site).9
http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook10-2-2

Cheers
Michael

Michael 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
Please consider the environment before printing this email

Hi all,

Wondering if anyone can guide me to reference/ evidence base re swabbing skin before s/c or imi injection is or is not recommended.

Christine Lawson | RN

Quality and Risk Manager | Caboolture Private Hospital
Caboolture Private Hospital
McKean Street, CABOOLTURE QLD 4510
t: 07 5495 9418
e: LawsonC@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

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[Michael Wishart]

Hi Christine

The Australian Immunisation Handbook states:

2.2.4 Preparation for vaccine administration
Skin cleaning
Provided the skin is visibly clean, there is no need to wipe it with an antiseptic (e.g. alcohol wipe).3,8 If the immunisation service provider decides to clean the skin, or if the skin is visibly not clean, alcohol and other disinfecting agents must be allowed to dry before vaccine injection (to prevent inactivation of live vaccines and to reduce the likelihood of irritation at the injection site).9
http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook10-2-2

Cheers
Michael

Michael 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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Hi all,

Wondering if anyone can guide me to reference/ evidence base re swabbing skin before s/c or imi injection is or is not recommended.

Christine Lawson | RN

Quality and Risk Manager | Caboolture Private Hospital
Caboolture Private Hospital
McKean Street, CABOOLTURE QLD 4510
t: 07 5495 9418
e: LawsonC@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

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[Michael Wishart]

Thanks Tim

Just to add to this, there are still possible places available in the Brisbane session on 15TH October with Dr Marcia Ryder. Contact Susan Ottley (susan.ottley@hospira.com) if you are interested in attending and haven’t already responded to an invite (see invite for actual details).

Cheers
Michael

Michael 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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Please see below details for the Dr Marcia Ryder lectures being held in Melbourne and Brisbane.
Unfortunately I have not further information please contact your nominated state rep
“Be a yardstick of quality. Some people aren’t used to an environment where excellence is expected.” – Steve Jobs

Hi Tim,

I think the Vic and Qld meeting are now full, so best if anyone asked, just send on the email of the reps please.

Vic email margaret.tucker@hsopira.com
Qld email susan.ottley@hospira.com

Many thanks

Lorraine Bobosevic | Account Manager – NSW South-DDS
Customer Service T 1300 046 774 | M +61 417 944 430 | http://www.hospira.com

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[Michael Wishart]

Thanks for that, Terri; I hadnt watched the videos. Nail polish is more a facility policy; as long as it is freshly applied and not cracked nail polish by itself is not a risk (unlike bonded acrylic nails). But jewellery (other than a plain band) should definitely not be worn as it impedes hand hygiene. Will see if I can find if anyone has commented on this to them yet.

Cheers
Michael

Michael Wishart
CNC Infection Control
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
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—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Orrell, Terri
Sent: Tuesday, 24 September 2013 9:49 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: New Dialysis Infection Prevention Resources

Hi Michael
Don’t think I would use this video as there are two breaches there – nail polish and jewellery being worn by clinical staff.
Very surprised this hasn’t been noted.
Regards
Terri

Terri Orrell | Clinical Nurse Consultant

Infection Control | Peel Health Campus
110 Lakes Road, Mandurah WA 6010
t: 08 9531 8570 | f: 08 9531 8598
e: OrrellT@ramsayhealth.com.au | w: http://www.ramsayhealth.com.au

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Tuesday, 24 September 2013 6:22 AM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] CDC: New Dialysis Infection Prevention Resources

Thought this may be of interest to those with or involved in haemodialysis.

Cheers
Michael

Subject: Fwd: New Dialysis Infection Prevention Resources

Infections are a leading cause of death in hemodialysis patients. Receiving safe care and avoiding infectious complications are of utmost importance to patients. Reducing infections requires diligence from both providers and patients.
CDC is providing three new resources for preventing infections in dialysis patients: a Provider Training Video and accompanying Provider Poster and Patient Pocket Guide. Please visit CDCs Dialysis Safety website to see these exciting new materials.

Provider Training Video: Preventing Bloodstream Infections in Outpatient Hemodialysis Patients: Best Practices for Dialysis Staff http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwOTIzLjIzMjk1ODMxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDkyMy4yMzI5NTgzMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3Nzg4MzI4JmVtYWlsaWQ9bWljaGFlbC53aXNoYXJ0QGludGVybm9kZS5vbi5uZXQmdXNlcmlkPW1pY2hhZWwud2lzaGFydEBpbnRlcm5vZGUub24ubmV0JmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&103&&&http://youtu.be/_0zhY0JMGCA
The video is intended to be used by outpatient hemodialysis facilities as an educational tool to help remind their frontline staff, including technicians and nurses, about infection prevention measures. It can be used as an orientation video for new staff and as an annual in-service training tool to remind staff of proper protocols.

Provider Poster: Put Together the Pieces to Prevent Infections in Dialysis Patients http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwOTIzLjIzMjk1ODMxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDkyMy4yMzI5NTgzMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3Nzg4MzI4JmVtYWlsaWQ9bWljaGFlbC53aXNoYXJ0QGludGVybm9kZS5vbi5uZXQmdXNlcmlkPW1pY2hhZWwud2lzaGFydEBpbnRlcm5vZGUub24ubmV0JmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&104&&&http://www.cdc.gov/dialysis/PDFs/Dialysis-provider_poster.pdf
The poster can be posted in staff lounges or on the treatment floor to serve as a reminder of the messages in the video and other important ways to prevent infections.

Patient Pocket Guide: 6 Tips to Prevent Dialysis Infections http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwOTIzLjIzMjk1ODMxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDkyMy4yMzI5NTgzMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3Nzg4MzI4JmVtYWlsaWQ9bWljaGFlbC53aXNoYXJ0QGludGVybm9kZS5vbi5uZXQmdXNlcmlkPW1pY2hhZWwud2lzaGFydEBpbnRlcm5vZGUub24ubmV0JmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&105&&&http://www.cdc.gov/dialysis/PDFs/Dialysis-Patient-PocketGuide.pdf
The patient pocket guide is intended to educate patients on ways they can help prevent infections and can be shared as part of an information packet or reviewed with them by clinical staff.

The poster and pocket guide are available for order through the CDC-INFO warehouse. The DVD will be available for order this week.
Please visit CDCs Dialysis Safety website for additional infection prevention resources, including a free continuing education (CE) activity and several observation tools, checklist tools, and protocols.
http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwOTIzLjIzMjk1ODMxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDkyMy4yMzI5NTgzMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3Nzg4MzI4JmVtYWlsaWQ9bWljaGFlbC53aXNoYXJ0QGludGVybm9kZS5vbi5uZXQmdXNlcmlkPW1pY2hhZWwud2lzaGFydEBpbnRlcm5vZGUub24ubmV0JmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&107&&&http://www.cdc.gov/dialysis/

Michael 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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[Michael Wishart]

Hi all

Not sure what happened to my link…. Try this one.

http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf

Cheers
Michael

Michael 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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Hi all

I don’t think I have sent this to the list yet. The US CDC has released a threat assessment and report on antimicrobial resistance in the US.

http://www.cdc.gov/drugresistance/threat-report-2013/pdf/CACHE_DUVIEca666b56eea9e79b1fca63af356e84a4/ar-threats-2013-508.pdf

Cheers
Michael

Michael 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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[Michael Wishart]

Hi Fiona

Interesting issue. I do not think we actually use forced air warming during major orthopaedic cases, but have asked the question of our orthopaedic nursing staff.

We did have concerns from surgeons about another air powered device we use to transfer patients whose weight is greater than 100kgs onto the operating table. This device requires that a mat is left under the patient for the duration of the procedure, so that is can be inflated to allow the patient to be transferred off the operating table after the procedure. The concern of surgeons was that the instrument tables were already prepared as the patient was transferred using this device, and that contamination of the instrument sets and potentially prosthetic items could occur due to disrupted air flow. We did do a small study using a slit sampler at instrument table height to see what particle and microbial counts were like during the use of this device, and there was no discernible difference between counts when using the device and manual transfer without the device. It was quite a small study, so we did not look at publishing results, but along with other studies provided by the device manufacturer the surgeons accepted that using this device did not increase risk of PJI.

As part of searching for information about this issue I came across this review by a research group. This includes mention of a current court case in the US concerning this very issue. Not sure what the outcome was of this.

https://www.ecri.org/Documents/Reprints/Forced-Air_Warming_and_Surgical_Site_Infections(Health_Devices).pdf

Cheers
Michael

Michael 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
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[Posted on behalf of Fiona De Sousa – Moderator]

Hi All,

We are currently reviewing the methods our facility uses to maintain normothermia in surgical patients. A number of recent publications have suggested that forced air warming for joint replacement patients may contribute to deep surgical site infections.

What methods are facilities using to maintain normothermia in this patient group?
Kind regards,

Fiona De Sousa
Infection Prevention & Control Coordinator
Sydney Adventist Hospital
Fiona.Desousa@sah.org.au
185 Fox Valley Road, Wahroonga, NSW, 2076

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[Michael Wishart]

Hi JoeAnne

I have always battled to stop this in every hospital I have worked in (mostly private sector). The main argument is from those anaesthetists who are doing long cases in a list – they claim they cannot take a break! My argument to them has always been: “Do you want to explain to the patients (and the surgeon!) how they got a muffin [or insert any other food item here] granuloma in their surgical wound?!?!” It is about ensuring we restrict items from within the operating room that are unnecessary.

Trying to appeal to their risk from having to take their mask off to eat / drink doesn’t work, as many do not even wear a mask!!!

In my mind it is all about appropriate management of their work – just like anyone else. If you can get executive buy-in to support you, you can at least require compliance, even if these anaesthetists don’t believe they are putting the patients (or themselves) potentially at risk.

Good luck.

Cheers
Michael

Michael 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
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Good morning
We have been asked by Anaesthetists if they can eat and drink in the Anaesthetic Bays – as this is what they do in ‘private hospitals’ during long cases………..I am not sure how accurate this information is.

Does any hospital allow this practice to occur and what are the circumstances for this to occur?

PS It does not occur at this hospital for a number of reasons:

1. Infection control policy requirement

2. Community expectations

3. Workplace Health and Safety

Thanks

Joe-Anne Bendall

Joe-anne Bendall | Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

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[Michael Wishart]

Hi Marlize

This is a bit tricky, as you need to be able to identify all of the risks for CJD when asking these questions. Also confounding is the fact that the questions recommended for assessment of CJD risk in Appendix 13 of the January 2013 CJD document from the CJD ICG Working Group (http://www.health.gov.au/internet/main/publishing.nsf/content/AC9448D36D359F50CA2577C40016F0F6/$File/CJDInfectionControlGuidelinesJan2013.pdf) are recommended to be asked of the treating medical officer, not the patient. We have managed to reduce the questions to only 5 on our pre-admission assessment, and they relate to the following risks:

– Patient or two or more family members with history of CJD

– Received human pituitary hormone prior to 1985

– Received dura mater graft prior to 1986

– Recent undiagnosed rapid progressive dementia

– Involved in a ‘lookback’ for CJD exposure

We tried to reduce these questions even more, but we felt we would miss out on some risks if we did not ask explicitly. The trick is to word the questions in a way most patients will understand.

Another option is to include a very simple CJD risk assessment for all patients, and then a more comprehensive assessment for those undergoing vat-risk procedures (defined in the guidelines as: ‘eg neurosurgery, spinal cord surgery, ophthalmic surgery, pituitary surgery’). The major difficulty for this is when is this assessment done and by whom, ensuring you do not miss any eligible patients.

Hope these thoughts help.

Cheers
Michael

Michael 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
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Good morning Everyone,

We are currently reviewing our Risk assessment tool. We have added Infection Control questions, these include risks for MRO’s, wounds / devices and cCJD.
We don’t have enough space to add all the infection control risks . We have a few questions on CJD but I was hoping to reduce the number to only 2 questions.
Can anyone please share with me, your questions on the risk for CJD?

Thank you

Marlize Senekal
Infection Prevention and Control Coordinator
St. Andrew’s War Memorial Hospital
457 Wickham Terrace, Spring Hill
Brisbane
Ph. 07-3834 4444
Ext. 4328, Pg. 0328

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[Michael Wishart]

Hi John

CHRISP in QLD have a comprehensive online education module for endoscopy processing, which links into a formal competency through GENCA.

http://www.health.qld.gov.au/EndoscopeReprocessing/

What we do here is that we have a clinical trainer who has been certified competent by GENCA who then trains our Endo and CDSSD staff.

Cheers
Michael

Michael 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
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Dear All

Would anyone be able to share what they do please?
Am sure all of us are in this situation!

Additionally, as we have to credential all of our staff who work in CSSDs etc, what are people using for that?

I am aware that the UK has an excellent online program of instruction for such staff .

Thanks
John

Dr John Ferguson
Infectious Diseases & Microbiology
+61 428 885573

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[Michael Wishart]

Hi Cathy

Interesting that Victoria has legislation that covers this. I am not aware of any similar legislation in Queensland where Nicola is based.

Cheers
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
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Nicola, my understanding is that under the 2008 Health and Wellbeing Act to take blood for altruistic blood tests ( to test for blood borne virsues) from a patient who is unable to give consent, an order from a senior authorized medical officer must be issued under section 134. The form can be found in the Guidelines for post-incident testing orders and Authorisations Part 8 , Division 5 of the Health and Wellbeing Act 2008. Legally this would be a more appropriate option in the situation you have outlined.

Cathy Mowat
Infection Control
Central Gippsland Health Service
0351438518
cathy.mowat@cghs.com.au
Sale

Hi All,

I would like some advice from the group on gaining informed consent from the source of a blood and body fluid exposure and timeliness of bloods being sent for testing, in particular if the patient is aneasthetised.

Our current situation:

On our generic consent form for procedures it has a ‘sentence’ regarding bloods being taken from them whilst anaesthetised for the purpose of testing re if there is a needlestick injury during their procedure. I have never been comfortable with this as there is no risk assessment, discussion regarding what tests or how we keep that information confidential. Although there has been a signed consent, I do not see it as an informed consent. Also if Drs use their own consent forms this ‘sentence’ is not included.

If we wait 24 hours post anaesthetic then potentially you could miss the window for administration of post exposure prophylaxis .

If the patient is not anaesthetised then the management is completed using a signed consent and discussion regarding results of tests with treating Dr or infection control.

Thank you for your assistance in advance

Kind Regards

Nicola Swindells
Infection Control /Quality and Risk Manager
Mater Hospitals Central Queensland
Rockhampton Yeppoon Gladstone
nswindells@mercycq.com
07 49313420

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[Michael Wishart]

Hi Nicola

Yes, always difficult, this question. I agree than a generic statement on a generic consent where no discussion of tests occurs is not valid, and so did all of the lawyers I have heard that have been asked this over the years.

That then raises the issue of when you can get consent, and what type of consent it required (implicit, verbal, written?). If you wait 24 hours after the procedure you potentially increase risks to the HCW exposed, so that is a poor option. If you gain consent when the patient is not considered legally competent it would again potentially be an issue if the patient ever complained about the testing. Not sure what the perfect answer is, but my common practice has been to ask the surgeon or treating doctor if we can ask the patient for verbal consent for the testing after they have woken from the anaesthetic, or if we need to involve next-of-kin in any discussions. Most surgeons will readily agree to asking the patient, but at least we have asked for medical advice on their ability to consent to the testing. For patients who are intubated and sedated for a period post op (eg cardiac surgery), we ask this question of the intensivists treating the patient. Not perfect, not a signed record, but a common practice when we often get only verbal consent for various things, including major tests for cancer (potentially more life changing), within 24 hours after an anaesthetic. Using a simple printed sheet that explains the basics of the tests also may help.

I can’t provide any legal advice on this obviously, but suggest you discuss with your facility medical director as to the best approach that will be considered good practice. If you and the medical director are agreed on how the process should work, then at least the facility could respond to any legal enquiries relating to complaints from patients with a united front. You might also want to seek further legal advice from facility legal staff. As always, a written protocol for all to follow, and even printed information to give patients they can keep, can be useful with this.

Look forward to more discussions and opinion on this.

Cheers
Michael

Michael 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
Please consider the environment before printing this email

Hi All,

I would like some advice from the group on gaining informed consent from the source of a blood and body fluid exposure and timeliness of bloods being sent for testing, in particular if the patient is aneasthetised.

Our current situation:

On our generic consent form for procedures it has a ‘sentence’ regarding bloods being taken from them whilst anaesthetised for the purpose of testing re if there is a needlestick injury during their procedure. I have never been comfortable with this as there is no risk assessment, discussion regarding what tests or how we keep that information confidential. Although there has been a signed consent, I do not see it as an informed consent. Also if Drs use their own consent forms this ‘sentence’ is not included.

If we wait 24 hours post anaesthetic then potentially you could miss the window for administration of post exposure prophylaxis .

If the patient is not anaesthetised then the management is completed using a signed consent and discussion regarding results of tests with treating Dr or infection control.

Thank you for your assistance in advance

Kind Regards

Nicola Swindells
Infection Control /Quality and Risk Manager
Mater Hospitals Central Queensland
Rockhampton Yeppoon Gladstone
nswindells@mercycq.com
07 49313420

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