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Very interesting point, Claire. Depending on state and local government policies, some home use sharps may be allowed to be placed in general household waste in certain conditions. So there may be different rules governing sharps disposal in the community in different places as well. All adds to the confusion.
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
Please consider the environment before printing this emailWe are teaching in line with Michael’s email in our cannulation and phlebotomy course.
But I wonder what is there any standard for teaching community use by patients themselves? Perhaps this is where some confusion may arise?
Best regards, Claire
Professor Claire Rickard RN PhD
c.rickard@griffith.edu.au | +61 7 3735 6460 | Skype: clairexm1 | Twitter: IVAD_Research |
http://www.griffith.edu.au/health/centre-health-practice-innovation/research/acute-critical-care/intravascular-devicesIntravascular Access Device Research Group | NHMRC Centre of Research Excellence in Nursing Interventions | Griffith Health Institute | Visiting Scholar: Royal Brisbane & Women’s Hospital | Princess Alexandra Hospital | The Prince Charles Hospital
Research frequently takes me off campus. Please contact Jenny Chan 3735 5406 j.chan@griffith.edu.au or Jo.Wright@griffith.edu.au 3735 4886 with any urgent enquiries.
It’s nice to be important, but it’s more important to be nice. John Cassis.
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H Fran
I would consider safety devices that have been activated as a sharp, but the actual agreed disposal method should be dependent upon your waste contractor arrangement. If your general waste goes to a landfill that will accept devices that have been rendered safe, and no compacting of the waste could rupture the safety containment device and thus expose the sharp again, then you could dispose of these items in general waste.
My preference from a facility policy level has always been to treat all sharps, even those safely activated and shielded, as sharps waste (or clinical waste as a minimum, as generally clinical waste is not compacted and is all sent for incineration. But your state waste management legislation may allow disposal of safety sharps like the encased lancets as general waste. In Queensland, for example, this is a local government decision for the landfill sites in under their control (or private contractors, for private landfill).
Hope this helps.
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
Please consider the environment before printing this emailHi All,
I just would like to clarify something please, the little retractable lancets (we use to prick the skin for blood when checking blood sugar level) is classified as a sharp. Correct me if I’m wrong, but I’ve always discard them in a sharps container, they didn’t use to be retractable and I’ve come across faulty ones.
I know, something like this should be the obvious, write? This question came about after someone told me that they discard it in a general bin?? (the retractable ones)
Kind Regards
Franciska Ferreira
INFECTION PREVENTION & CONTROL /WOUND MANAGEMENT CONSULTANT
Burnside War Memorial Hospital
120 Kensington Road, Toorak Gardens, SA 5056
t: 08 8202 7222 f: 08 8407 8573 e: fferreira@burnsidehospital.asn.au________________________________
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I have been reliably informed that the developer and manufacturer of the system mentioned below is actually Bioquell in the UK, and the company linked below is a local supplier. Just to clarify in case there is any misunderstanding.
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
Please consider the environment before printing this emailI thought this information pertaining to this original question would be of interest to the list. Marija Juraja saw a poster on this at APSIC 2013 (attached).
Hi Michael
I requested any information about how to spatially separate a crowed ICU environment. In particular I asked if anyone knew about Perspex wall dividers. I found some really interesting information from a company called biodeconsolutions- decontamination solutions. This company have developed ICE-pod. If you are interesting in view the product and company here’s the website. The company are really helpful and working with me to look at a potential solution. http://www.biodeconsolutions.com.au/Giulietta Pontivivo| Nurse Manager/CNC| Infection Prevention & Control/ECTP |
St Vincent’s Health Network | 390 Victoria Street Darlinghurst | NSW 2010
T: 61 2 83823284| F: 61 2 8382 3892| M: 0457 533 452 | E: gpontivivo@stvincents.com.auCheers
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
Please consider the environment before printing this emailHi
I’m looking into how it might be feasible to separate bed spaces in a very tight fitting ICU patient zone. I recall reading an article of the use of perspec walls/ dividers (which you can still visualise patients) in a patient area? Does anyone have any information on this such as company/ cost etc.
Looking forward to any information/ thought/ suggestions please.
Cheers GiuliettaGiulietta Pontivivo
Nurse Manager | Infection Control Department | St Vincent’s Health Network | 390 Victoria Street Darlinghurst NSW 2010|WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
________________________________
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I thought this information pertaining to this original question would be of interest to the list. Marija Juraja saw a poster on this at APSIC 2013 (attached).
Hi Michael
I requested any information about how to spatially separate a crowed ICU environment. In particular I asked if anyone knew about Perspex wall dividers. I found some really interesting information from a company called biodeconsolutions- decontamination solutions. This company have developed ICE-pod. If you are interesting in view the product and company here’s the website. The company are really helpful and working with me to look at a potential solution. http://www.biodeconsolutions.com.au/Giulietta Pontivivo| Nurse Manager/CNC| Infection Prevention & Control/ECTP |
St Vincent’s Health Network | 390 Victoria Street Darlinghurst | NSW 2010
T: 61 2 83823284| F: 61 2 8382 3892| M: 0457 533 452 | E: gpontivivo@stvincents.com.auCheers
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
Please consider the environment before printing this emailHi
I’m looking into how it might be feasible to separate bed spaces in a very tight fitting ICU patient zone. I recall reading an article of the use of perspec walls/ dividers (which you can still visualise patients) in a patient area? Does anyone have any information on this such as company/ cost etc.
Looking forward to any information/ thought/ suggestions please.
Cheers GiuliettaGiulietta Pontivivo
Nurse Manager | Infection Control Department | St Vincent’s Health Network | 390 Victoria Street Darlinghurst NSW 2010|—
WARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.Message protected by MailGuard: e-mail anti-virus, anti-spam and content filtering.
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Hi Terry
Difficult to answer empirically as this is not a statistic I maintain, but best guess for here would be probably 60 -70% of our sharps used in wards (eg non-procedural areas) are safety devices (needle/syringe, peripheral IV access cannulas).
Of these safety devices I would think the majority are correctly activated after use, probably running about 90%. The majority of peripheral IV access cannulas automatically sheath on insertion (passive), but our needle/syringe safety devices require active manual activation, and we do get reports of activation failure, so they at least try to activate them! Not all of our S/C or IM injection needle/syringes are safety (pre-filled syringes mostly non-safety, and larger volume syringes with needles are non-safety here – staff do not like the 5 ml or larger safety syringes of the type we use so we do not have them available).
Procedural area sharps are much more problematic, as scalpels, suture needles and many reusable cannulas/trocars are not readily available (or acceptable) as safety devices. The % in procedural areas would be much lower, probably around 20% at most of the total sharps used (pure guess!). Since the majority of peripheral IV cannulas used in procedural areas are passive safety devices, and there is very little use of safety needle/syringes, the activation rate would be very high. Not really sure what % of sharps would be procedural vs ward based, sorry.
I would also be interested to know whether this would be a common scenario in many facilities currently. Bring on some legislation requiring more attention to safety sharps!
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
Please consider the environment before printing this emailHi Michael,
With sharps safety device legislation under current consideration, I wonder if members could hazard an answer to this Q – am happy for answers to come direct to me at tg@gandassoc.com.
“Of all needles/butterflies used on patients at your hospital (Rx, phlebotomy, etc) what % would be ‘safety engineered devices’ and what % of those would be correctly activated after use?”
I had one reply of “33% and 90%” and that surprised me.Best 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
“This email (including any attachments) is intended only for the use of the individual or entity named above and may contain information that is confidential and privileged. If you are not the intended recipient, you are reminded that any dissemination, distribution or copying of this email or attachments is prohibited. If you have received this email in error, please notify me immediately by return email or telephone and destroy the original message. Thank you.”Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
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Hi Rebecca
Some of the confusion is partly my fault, as when the 2004 national guidelines were in draft I insisted on the use of both the term P2 (the Australian Standard for protective masks) and N95 (The US nomenclature), as the Australian Standard at that time had no specific biological safety component within its respiratory protection standard, and N95 did specifically address biological hazards. This is listed in Section 13.4 of the 2004 guidelines. This has been carried over to the current national guidelines (refer section B1 2.4, that contains the table you cited) with no real discussion on the different nomenclature. I havent kept up with any recent changes in the relevant Australian Standard (AS/NZS 1715 and 1716), so am unaware if this inequity has been addressed or not. Basically at the time it seemed like a good idea to allow healthcare facilities to use US standard N95 masks for respiratory protective devices, as well as those that met Australian Standard designation P2. Although the AS/NZS and US Standards are different, at the time if writing the 2004 guidelines, it was agreed by the expert group that for biological hazards there was enough evidence to suggest they would be similar in protective function.
Most of the facilities I have worked at in the past decade use respiratory protective masks based on the N95 US Standard, which seem to be more readily available on the Australian market. There are, however, masks which are also approved under AS/NZS P2 designation, and some which are approved under both AS/NZS and US Standards.
It may be worth contacting the ACSQHC to ensure further clarification of the role of the various standards designations of respiratory protection is clarified in future national guideline updates.
Someone involved in the expert group who wrote the current national guidelines may also wish to comment on this, perhaps?
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
Please consider the environment before printing this emailDear Members
I am seeking clarification over the type of respiratory protection mask currently in use in your facilities.In light of recent guidance from DoHA /CDNA over MERS-CoV, which stipulated:
Airborne transmission precautions, including routine use of a P2 respirator, disposable gown, gloves, and eye protection when entering a patient care area and refers readers to the Australian Guidelines for Prevention and Control in Healthcare 2010. This would indicate to me that P2 masks are to be used as The Guidelines refer to the use of P2 masks for airborne precautions and cite appropriate Australian Standards for P2 respirators.However, there are 3 sections in the Guidelines that cause some confusion: Table B1.6 cites an N95 respirator as being another name for a P2 respirator; Figure B2:2 shows correct process for donning a P2 respirator using a picture of what appears to be a N95 mask and Table B2.1 uses the terminology P2 (N95) respirator – which would indicate these two masks are the same.
As a P2 and an N95 are different masks and only P2 meet Australian Standards I would appreciate feedback on what others are currently using and your interpretation of the Guidelines.
Many thanks
Rebecca
Rebecca McCann Program Manager
Healthcare Associated Infection Unit (HAIU)
Communicable Disease Control Directorate Department of Health
Grace Vaughan House
227 Stubbs Terrace
SHENTON PARK WA 6008
T:08 9388 4859 M:0439 920 819 F:08 9388 4888
E:rebecca.mccann@health.wa.gov.auThe contents of this e-mail transmission are intended for the named recipients only and may contain confidential and/or privileged information. If you received this message in error, you must not copy, duplicate, forward, print or otherwise distribute any information contained herein, but must ensure that this e-mail is permanently deleted and advise the sender immediately.
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Hi Sara
Um… how should I put this… why would the surgeons be worried about what is on their shoes after going to the bathroom? Makes me wonder what they are doing in there….
I would be much, much more worried about what was on their hands!
As far as I am aware, there is little if any evidence to say shoes are a factor in surgical site infections, apart from potentially touching shoes then not performing hand hygiene. That is why disposable shoe covers have a bad reputation.
Spraying shoes with antiseptics would seem, to me, to be seeking to prevent something which is not considered a problem. I would be more inclined to respond to the surgeons and request that they consider hand hygiene as a much, much higher priority. Maybe even, tongue-in-cheek, suggesting an all-over antiseptic spray booth for them before re-entering the operating room would be more beneficial? 🙂
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
Please consider the environment before printing this emailGood Morning all,
Some of the surgeons have suggested that it would be a good idea to spray their shoes after going to the bathroom etc. prior to re-entering the theatre. Therefore the theatre Manager has asked me what could be used, so I am asking if any of you follow this practice at all and if so suggestions on brands via private email would be greatly appreciated.
Thank you for any thoughts on this matter
Regards
Sara
Sara Godden
Infection Control Coordinator – CICP
Acting Stomal Therapy Nurse
Brisbane Private hospital
259 Wickham Terrace
Brisbane QLD 4000
Sara.Godden@healthscope.com.auPlease consider the environment before printing this message
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Hi Lindy
Andrea had sent a number of large attachments (PDFs) which would make the email too large to send, however all of the pictures are freely available from the following download link:
http://webbertraining.com/freeposterdownloadsc97.php
Note the download site states:
COPYRIGHT … These poster files are intended to be downloaded and/or printed, and you may do so without further need of permission provided that the files are unaltered.Thanks to Andrea for sharing this great resource.
Cheers
Michael Wishart
ACIPC Infexion Connexion AdministratorMichael 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 emailHi Lindy
These might help they are a little different.
Regards AndreaDear Colleagues
We are in the process of upgrading our wayfinding signage …Just wondering if anyone out there was able/ willing to share/ forward me any innovative hand hygiene message/slogan/pictogram you may have come across or are in place that I could put forward to our management would to be incorporated ….they have provided one boring looking one to date but figured some of you may have some better ones out there (especially in new buildings) that may get our HH message across more effectively
Hope everyone is surviving the busy winter OK!!??
Regards
Lindy
Lindy Ryan
Infection control CNC
Nepean Hospital NBMLHD
Phone 4734 2228
Email lindy.ryan@swahs.health.nsw.gov.auInfection Prevention and control is everyones business
Clean hands – safest care….take a moment & practice the five moments___________________________________
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07/24/13 – 18:35:33
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Thanks Cath, very interesting. But this appears to be about pre-op antiseptic body wash rather than pre-op skin antisepsis. Is there any proposed change to the HICPAC guidelines about skin antisepsis? Presume they will at least have a statement about following antiseptic manufacturer’s instructions for application?
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
Please consider the environment before printing this emailMichael and all
In my research I am currently reviewing the draft US CDC Surgical Site Infection Guidelines which are due to be released in Nov 2013. They include comprehensive review of literature and rigorous grading of evidence for every recommendation. Guidance in this issue like many areas of infection prevention often becomes outdated due to new technologies and formulations. Misinterpretation, multi-resistant attitudes and holding onto sacred cows continue to plague effective clinical practice. The CDC draft statement regarding skin antisepsis suggests that multi applications may be one such sacred cow. The draft recommendation below is subject to normal HICPAC consultation processes.
Always interesting to see how public policy evolves, usually much slower and less responsive than technology and adoption of trends and fads. All of this keeps our role exciting and very necessary.
JUNE 2013 NEW
8A. Require patients to shower or bathe (full body-including scalp) on at least the night before the operative day (Category IB)
8A.1. No recommendation can be made regarding the safety and effectiveness of specific body cleansing products, the optimal timing or number of product applications. (No recommendation/unresolved issue)Cath
Cathryn Murphy PhD
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
[Description: twitter logo][Description: FB logo][Description: icp icon]Hi all
Can I ask a question which may seem naive to those with a recent theatre background? When applying antiseptic solution as part of a surgical skin preparation prior to a procedure, is it best practice to apply two ‘coats’ of antiseptic solution, one immediately on top of the other, using different swabs?
I can see not real benefit in doing this from an antiseptic action viewpoint (apart from mechanical friction) Can also not see this mentioned in a cursory review of any SSI prevention best practice guidelines.
Any comments? Any references to get me up-to-date if I need to be updated?
Thanks
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
Please consider the environment before printing this emailWARNING : This email contains information, which is CONFIDENTIAL, and that maybe subject to LEGAL PRIVILEGE. This e-mail and any attachments to it (the “Communication”) is confidential and is for the use only of the intended recipient, and may not duplicated or used by any other party without the express consent of the sender. The Communication may contain copyright material of St Vincent’s Health & Aged Care(“SVHAC”), or any of its related entities or of third parties. If you are not the intended recipient of the Communication, please notify the sender immediately by return e-mail, delete the Communication, and do not read, copy, print, retransmit, store or act in reliance on the Communication. Any views expressed in the Communication are those of the individual sender only, unless expressly stated to be those of SVHAC. SVHAC does not guarantee the integrity of the Communication, or that it is free from errors, viruses or interference. Thank-you.
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Apologies to the two Helens, I mixed them up! Helen Scott was the brave soul who noted that singing Enterobacteriaceae did not fit.
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
Please consider the environment before printing this emailIt has been pointed out (thanks Helen Truscott!) that the rhyme has problems in the third line… ‘Enterobacteriaceae’ has too many syllables, so how about:
Scrub a hub-hub
To kill all the bugs
The staphs and the killer disease….
Make sure that you scrub
All bits of the hub
and render that hub bug free!It may be less biologically accurate, but rolls off the tongue better and keeps the rhyme, Apologies to the microbiological and epidemiological purists. 🙂
Any other suggestions?
Thanks
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
Please consider the environment before printing this emailHi Tim
Maybe we could get them to sing a little ditty? We tried this with timing hand washing (sing happy birthday to yourself 3 times!) with varied success. Works with no timing device if done correctly.
So, we could invent a little ditty dependent upon how long you need.
Here’s my effort (to the tune of Rub-a-dub-dub)
Scrub a hub-hub
To kill all the bugs
The staphs and Enterobacteriaecae…
Make sure that you scrub
All bits of the hub
and render that hub bug free![Add verses or repeat as needed to make up to time required]
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
Please consider the environment before printing this email[Posted on behalf of Jayne O’Connor – moderator]
Hi Tim,
Maybe a wall clock with a second hand could be installed in the room if this is a procedure that is performed on a regular basis? Just a thought:)
Jayne O’Connor, RN, BSc. Infection Control
CNC- IPC
Sydney Adventist Hospital
185 Fox Valley Rd
Wahroonga
NSW 2076
I’m sure a fob watch would be very suitable Jayne.
I know wrist watches are a problem but what do you do if that’s all you have?
I have also been told that the clinician can always take their watch off and put it in a place where they can easily see it i.e a trolley, table, etc.
If it was a patient with an MRO, I’d prefer NOT to have my watch on surface areas where there is something a little more sinister lurking..
However, that said, I would also be wearing a full length disposable gown which the sleeves would cover my watch anyway 😉
Hmm.. food for thought still…Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
[200 yeas logo white.jpg]Hi Tim,
Why can’t a fob watch be worn? They are tax deductable and some very trendy looking ones available now?We discourage wearing of wrist watches as can impede hand hygiene. I know you’re referring to non touch technique but if they don’t remove the watch during hand hygiene how can you guarantee that hand hygiene has been carried out correctly, also the wrist may remain wet beneath the watch which poses other issues in my mind.
However this is what NSW Health policy states for hand hygiene!
Other hand, wrist or forearm jewellery must not be worn by healthcare professionals providing
direct patient care unless required for patient care (eg. watch) or medically essential (eg.
medical alert bracelet). These must be removable and able to be cleaned.Kind regards
Jayne
Jayne O’Connor, RN, BSc. Infection Control
CNC- IPC
Sydney Adventist Hospital
185 Fox Valley Rd
Wahroonga
NSW 2076
Hi Infection Controllers,
Is removing a wrist watch required for a non-sterile, non-touch procedure?
If appropriate hand hygiene has been performed (hand gel or alcohol-based hand rub) and the clinician is wearing non-sterile gloves, does the wrist watch need to be removed if its required for the procedure i.e counting seconds for the procedure
This is for a scrub the hub principles..
Thoughts, recommendations or guideline quotes are welcomed.
Regards,
Tim..Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
[200 yeas logo white.jpg]_____________________________________________________________________
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It has been pointed out (thanks Helen Truscott!) that the rhyme has problems in the third line… ‘Enterobacteriaceae’ has too many syllables, so how about:
Scrub a hub-hub
To kill all the bugs
The staphs and the killer disease….
Make sure that you scrub
All bits of the hub
and render that hub bug free!It may be less biologically accurate, but rolls off the tongue better and keeps the rhyme, Apologies to the microbiological and epidemiological purists. 🙂
Any other suggestions?
Thanks
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
Please consider the environment before printing this emailHi Tim
Maybe we could get them to sing a little ditty? We tried this with timing hand washing (sing happy birthday to yourself 3 times!) with varied success. Works with no timing device if done correctly.
So, we could invent a little ditty dependent upon how long you need.
Here’s my effort (to the tune of Rub-a-dub-dub)
Scrub a hub-hub
To kill all the bugs
The staphs and Enterobacteriaecae…
Make sure that you scrub
All bits of the hub
and render that hub bug free![Add verses or repeat as needed to make up to time required]
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
Please consider the environment before printing this email[Posted on behalf of Jayne O’Connor – moderator]
Hi Tim,
Maybe a wall clock with a second hand could be installed in the room if this is a procedure that is performed on a regular basis? Just a thought:)
Jayne O’Connor, RN, BSc. Infection Control
CNC- IPC
Sydney Adventist Hospital
185 Fox Valley Rd
Wahroonga
NSW 2076
I’m sure a fob watch would be very suitable Jayne.
I know wrist watches are a problem but what do you do if that’s all you have?
I have also been told that the clinician can always take their watch off and put it in a place where they can easily see it i.e a trolley, table, etc.
If it was a patient with an MRO, I’d prefer NOT to have my watch on surface areas where there is something a little more sinister lurking..
However, that said, I would also be wearing a full length disposable gown which the sleeves would cover my watch anyway 😉
Hmm.. food for thought still…Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
[200 yeas logo white.jpg]Hi Tim,
Why can’t a fob watch be worn? They are tax deductable and some very trendy looking ones available now?We discourage wearing of wrist watches as can impede hand hygiene. I know you’re referring to non touch technique but if they don’t remove the watch during hand hygiene how can you guarantee that hand hygiene has been carried out correctly, also the wrist may remain wet beneath the watch which poses other issues in my mind.
However this is what NSW Health policy states for hand hygiene!
Other hand, wrist or forearm jewellery must not be worn by healthcare professionals providing
direct patient care unless required for patient care (eg. watch) or medically essential (eg.
medical alert bracelet). These must be removable and able to be cleaned.Kind regards
Jayne
Jayne O’Connor, RN, BSc. Infection Control
CNC- IPC
Sydney Adventist Hospital
185 Fox Valley Rd
Wahroonga
NSW 2076
Hi Infection Controllers,
Is removing a wrist watch required for a non-sterile, non-touch procedure?
If appropriate hand hygiene has been performed (hand gel or alcohol-based hand rub) and the clinician is wearing non-sterile gloves, does the wrist watch need to be removed if its required for the procedure i.e counting seconds for the procedure
This is for a scrub the hub principles..
Thoughts, recommendations or guideline quotes are welcomed.
Regards,
Tim..Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
[200 yeas logo white.jpg]_____________________________________________________________________
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Hi Tim
Maybe we could get them to sing a little ditty? We tried this with timing hand washing (sing happy birthday to yourself 3 times!) with varied success. Works with no timing device if done correctly.
So, we could invent a little ditty dependent upon how long you need.
Here’s my effort (to the tune of Rub-a-dub-dub)
Scrub a hub-hub
To kill all the bugs
The staphs and Enterobacteriaecae…
Make sure that you scrub
All bits of the hub
and render that hub bug free![Add verses or repeat as needed to make up to time required]
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
Please consider the environment before printing this email[Posted on behalf of Jayne O’Connor – moderator]
Hi Tim,
Maybe a wall clock with a second hand could be installed in the room if this is a procedure that is performed on a regular basis? Just a thought:)
Jayne O’Connor, RN, BSc. Infection Control
CNC- IPC
Sydney Adventist Hospital
185 Fox Valley Rd
Wahroonga
NSW 2076
I’m sure a fob watch would be very suitable Jayne.
I know wrist watches are a problem but what do you do if that’s all you have?
I have also been told that the clinician can always take their watch off and put it in a place where they can easily see it i.e a trolley, table, etc.
If it was a patient with an MRO, I’d prefer NOT to have my watch on surface areas where there is something a little more sinister lurking..
However, that said, I would also be wearing a full length disposable gown which the sleeves would cover my watch anyway 😉
Hmm.. food for thought still…Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
[200 yeas logo white.jpg]Hi Tim,
Why can’t a fob watch be worn? They are tax deductable and some very trendy looking ones available now?We discourage wearing of wrist watches as can impede hand hygiene. I know you’re referring to non touch technique but if they don’t remove the watch during hand hygiene how can you guarantee that hand hygiene has been carried out correctly, also the wrist may remain wet beneath the watch which poses other issues in my mind.
However this is what NSW Health policy states for hand hygiene!
Other hand, wrist or forearm jewellery must not be worn by healthcare professionals providing
direct patient care unless required for patient care (eg. watch) or medically essential (eg.
medical alert bracelet). These must be removable and able to be cleaned.Kind regards
Jayne
Jayne O’Connor, RN, BSc. Infection Control
CNC- IPC
Sydney Adventist Hospital
185 Fox Valley Rd
Wahroonga
NSW 2076
Hi Infection Controllers,
Is removing a wrist watch required for a non-sterile, non-touch procedure?
If appropriate hand hygiene has been performed (hand gel or alcohol-based hand rub) and the clinician is wearing non-sterile gloves, does the wrist watch need to be removed if its required for the procedure i.e counting seconds for the procedure
This is for a scrub the hub principles..
Thoughts, recommendations or guideline quotes are welcomed.
Regards,
Tim..Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.au
[200 yeas logo white.jpg]_____________________________________________________________________
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Hi Cathy
These replies to a similar question on a ICU discussion list have been provided by Tim Spencer (who is a member of this discussion list as well). Please contact him for any further information. I have removed the names of the respondents (except for Tim’s reply).
Reply 1
ANZICS and ANZCA both recommend full precautions in their guidelines, if your physicians refuse to gown up including mask and hat then send them back to their peers!Hat and mask were initially the greatest hurdles when I instituted a CLAB prevention campaign here in the late 2000’s. This only improved with use of a champion (HOD was on posters), passive eduation – posters and flyers, and unadulterated bribery -> when nurses audited an insertion the form was collected and then there was a prize (bottle of wine or movie tix) for the physician with first 100% compliant insertion drawn each month. This lasted for about a year until compliance became standard practice. We had 18 months CLAB free at once stage during the program, and our rate remains around the benchmark.
Formal education with medical staff was initally met with resistance and some very strong personalities. I can not oversell the importance of stressing the levels of evidence for your recommendations in the bundle during such sessions!
Nursing staff were intially fearful of becomming “insertion police” but recognised the importance of full barrier precautions and quickly took up the gauntlet to assist with insertion auditing. Nurses who participated in quizzes and crosswords were also awarded prizes for 100% correct responses, these were simply freddo frogs and the like with regular movie ticket draws.
The ANZICS insertion guidelines are attached. ANZICS have a CLAB prevention project, head to their site -> http://www.anzics.com.au/safety-quality/clab
Reply 2
Cap, mask and protective eyewear (for the head) is a minimum in CVAD care bundles.
CRBSI rates have been significantly reduced utilising these 3 accessories, along with sterile gown and gloves. Plenty of literature published and on the web.
Along with maximal barrier precautions of a full body drape, this protects patient and proceduralist.Also of note is that if another clinician enters the room, they must do so with a cap and mask minimum.
All important considerations in reducing CLABSI.
Regards,
Tim..Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert.
Clinical Nurse Consultant, Central Venous Access & Parenteral Nutrition Service
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Dept of Intensive Care, Level 2, Clinical Building, Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia
Tel (+61) 2 8738 3603 | Fax (+61) 2 8738 3551 | Mob +61 (0)409 463 428 | Tim.Spencer@sswahs.nsw.gov.au | Timothy.Spencer@unsw.edu.auReply 3
Use of full barrier precautions not only includes patient but also clinician, so mask / cap etc. are part of the fashionable attire.We introduced this state wide here in NSW during the CLAB ICU project
Lots of stuff on the CEC website:
http://www.cec.health.nsw.gov.au/home
Also look at http://www.clabsi.com.au – the ANZICS site on all of this stuff (hopefully still works although I had trouble getting on the other day)
I hope these replies are useful. Cross posting between specialty discussion lists can certainly be interesting!
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
Please consider the environment before printing this emailWe are in the process of developing a CVC insertion checklist /bundle. We have sourced a few checklists from major metropolitan hospitals which state that a theatre-type hat should be donned along with mask, gown and gloves prior to insertion. Currently hats are not a part of the standard required attire for those inserting CVCs at this hospital. What are other people doing and if it is part of your procedure is it enforced and are staff complying? Does anyone has any definitive evidence to support wearing of hats to cover hair as improving outcomes for patients and resulting in a reduction of infections?
Cathy Mowat
Infection Control
Central Gippsland Health Service
Sale 3850
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Hi Margaret
My comments are based on working in many private facilities with different uniform options. To me, it all boils down to whether appropriate hand hygiene and PPE use can be easily performed with the uniform choices for those staff groups. I worked at one facility where nursing manager uniforms were all sleeve. Not a problem for most ward / department managers as their hand hygiene requirements were all wrist and below. The problem was for specialised nursing managers who performed ward based procedures requiring a surgical scrub – they had to change into surgical scrubs to perform a full surgical scrub for ward-based procedures, as they could not roll up the sleeves as the design was quite tight on the arms.
So in my opinion it is more about utility of the design in enabling required practices than anything else.
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
Please consider the environment before printing this emailCan anyone contribute to some feedback I received from a staff member regarding new uniforms being introduced at our facility? For the first time, we are giving staff the option of having a 3 quarter sleeve, both care staff and registered/enrolled nurses. One RN stated that she had been informed at an acute facility that 3 quarter sleeves are not permitted because of Infection Control issues. I have looked up the National Guidelines and in there it states:
Given that there is limited evidence available to support many routine practices intended to reduce infection risk, practice is based on decisions made on scientific principles. Some activities, such as performing hand hygiene between administering care to successive patients, have a credible history to support their routine application in preventing cross-infection. Others, such as some uniform and clothing requirements, have more to do with the ethos of quality care and workplace culture than with a proven reduction of cross-infection.
From that I came to the conclusion that there is no evidence against having a variance in uniform style. Also given the work carried out in residential care vs acute care, my thoughts were that there is limited cross infection risk.
If anyone has any other thoughts, responses welcome
Regards
Margaret Byrne RN BN
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Hi Kate
Infection control here coordinates staff body fluid exposure management (initial assessment is performed by MO’s in ICU) and staff vaccinations (230 bed acute private facility). No staff health service, just 1.0FTE infection control.
In my opinion, staff who manage occupational exposures should have an understanding of blood borne virus transmission risks and have undertaken some basic training in pre-and-post blood borne viral serology counselling – there was a previous series of emails about this on this forum in March this year if you can check the archives.
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
Please consider the environment before printing this emailDear all,
We are currently looking at our service provision and model of care and specifically what other Infection control departments provide in the way of management of occupational exposures.Our department covers two campuses and as well as running the infection control programme we are responsible for the management of occupational exposures despite there being a staff health service for the LHD, they do not provide a occupational exposure service to our facility but they do to other facilities in the LHD.
What do people feel should be the basic level of knowledge for staff to provide a service? and do you feel we should have priorty access to other support services?
any information would be greatly appreciated and anyone that wants to share there programme that would be great.
Thankyou
KateKate Reid
CNC Infection Control | Blacktown Mt Druitt
Blacktown Road, Blacktown, NSW, 2148
Tel 02 9881 1546 | Mob 0407 264 379 | Kate.Reid@swahs.health.nsw.gov.au
http://www.health.nsw.gov.au
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