[Michael Wishart]

Hi Lisa

I have had this discussion with architects before. Yes, we would like a ‘home-like’ facility for residential care, too, but not at the expense of resident safety.

Another argument I have heard is that the ensuite sink is not designated as a staff hand wash basin (leads to all sorts of discussion about appropriate size sinks and tap choices, not just provision of paper towels!). My counter argument would be where else can staff perform hand washing?… if you provide another handwash sink outside of the ensuite for staff handwashing (as if that is going to happen!), then fine, otherwise they need an appropriate handwash sink when providing care.

Good luck, but you have some very strong guidelines on your side, so stick to first principles.

Cheers
Michael
Michael Wishart | Infection Control Coordinator, CICP-E

St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

—–Original Message—–

Hello Everyone,

I am an ICP working fir a large metropolitan health service in Victoria. We currently have as part of our health service, 4 residential aged care facilities.

We are currently in the planning stages with architects of a new public residential aged care facility. The question around hand towels in ensuites has been raised.

The concern by planners is that not having paper towels in ensuites, will avail them with more space for storage for residents in this space. They state you would not have paper towels in your home ensuite.

Our concern is , though a home, this is also a clinical space and for safe and best practice, staff require access to a wash basin and paper towels to perform hand hygiene if their hands are soiled.

I would like to know how others are managing in this space.

Kind regards,
Lisa

Lisa Mathieu Campbell
Acting Associate Director
Infection Prevention & Control Services
Eastern Health
Victoria

Sent from my iPhone
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[Michael Wishart]

[Posted on behalf of member moderator]

We used a hydrogen peroxide vapour spray unit for several years. We have stopped using it for a number of reasons

1. It was expensive and was being over used especially after hours.

2. Those using it had a real problem with remembering that the room and equipment had to be cleaned first- it was very attractive to simply put it into a room, switch it on and close the door on it. We had incidences where the bed had not even been stripped of its linen before it was used. In short it was being seen as an easy way to terminally disinfect a room.

3. It was actually more time consuming and meant rooms were unavailable longer especially relevant in ED when they kept using in the isolation room after hours.

4. The NHMRC guidelines gave us evidence to take it out of service.

In theory it seemed a great product but as people refused to use it correctly, use of the system became more hazardous than advantageous.

Cathy Mowat
Clinical Nurse Consultant
Infection Prevention and Control
Central Gippsland Health
T. 03 5143 8518
E. cathy.mowat@cghs.com.au

From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Mayer, Jo
Sent: Monday, 9 September 2019 2:11 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Hydrogen peroxide vapour systems and NHMRC guidelines

Good Morning All,

I am still hoping for thoughts and feedback around the hydrogen peroxide vapour sprays, are any of you using these systems and if so what are your thoughts following the release of the latest NHMRC guidelines, e.g will you continue to use, and in which instances do you use it?

Looking forward in anticipation of any comments and thoughts about this.

Kind Regards
Jo
Jo Mayer
Infection Control Manager
Phone:08 9346 6479

From: Mayer, Jo
Sent: Wednesday, 28 August 2019 12:36 PM
To: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU>
Subject: Hydrogen peroxide vapour systems and NHMRC guidelines

Dear All,

I am wondering what sites that utilize disinfection systems such as hydrogen peroxide vapour as part of a two-step clean are doing since the release of the updated NHMRC Guidelines.
I would grateful for any commentary around this.

Kind Regards

Jo Mayer
Jo Mayer
Infection Control Manager
[http://www.ramsayhealth.com/~/media/Images/email/email-RHC-logo]
Hollywood Private Hospital
Infection Control
Phone:
08 9346 6479
Fax:
08 9330 2368
Email:
MayerJ@ramsayhealth.com.au
Web:
http://www.ramsayhealth.com
Address:
Monash Avenue, Nedlands WA 6009
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[Michael Wishart]

Hi Fiona

Thanks for asking this, has created a discussion here!

Our policy does not specify whether to clean the skin prior to sheath removal with any agent, but on talking to our critical care staff there is quite a bit of variation in actual practice.

– Some treat as an IV access procedure, and use 2% chlorhexidine and alcohol prior to removal;

– Some cleanse with normal saline prior to removal;

– Some just wipe the skin with gauze if there is blood or fluid at the site prior to removal.
Can’t see anything glaringly obvious in a number of cath lab sheath removal protocols from around the world from a quick google search, so it might be something there is not much data on.

Will ask the vascular access researchers at AVATAR to see if they have any data to inform this.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

Hi All,

We are currently reviewing our protocols for the removal of arterial and venous sheaths, and are having discussions regarding the site being cleaned prior to removal. I am interested if other facilities undertake a skin prep / cleanse prior to removal and if you do what products do you use?

Kind regards,

Fiona De Sousa CICP-E| Nurse Manager | Infection Prevention & Control Unit
Launceston General Hospital, Level 2, Launceston TAS 7250
phone: 6777 6715 | mobile: 0408 487 197 | fax: 6777 5170 | email: fiona.de.sousa@ths.tas.gov.au |
intranet: http://www.dhhs.tas.gov.au/intranet/thon/infection_control

IPCU – ‘By working together we promote a culture of safety to reduce preventable infections and transmission of multi-resistant organisms’

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[Michael Wishart]

Hi Sarah

We used our volunteers to collect information directly from patients regarding hand hygiene compliance (eg who did, who didn’t, according to what the patient saw). We also used the opportunity to ask patients if they felt comfortable in asking staff if they had performed hand hygiene if they didn’t see it. That was quite interesting, as most of our patients said were happy to ask nurses and other staff, but not doctors. The main reason was that “the doctor knows what he is doing”! We used that to talk to the doctors about hand hygiene and their responsibilities for their own practice (“patients are relying upon you!”).

If you could find a way to collect that sort of information if can be quite useful, and I think patients can be easily engaged.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

Hi team,

We are in the process of updating out customer satisfaction survey and consumer response, specific to Infection Control.
I was wondering what other organisations have in place around this.
We are currently struggling to find a model that is able to;

a) gain enough interest for consumers to participate in and

b) obtain enough information that we as an organisation can utilise/improve on

Any ideas would be much appreciated!

Kind regards,

Sarah Bulzomi
Infection Control Officer
[http://www.rdhs.com.au/wp-content/uploads/2015/07/rdhs-logo.jpg]
Robinvale District Health Services
PO Box 376, Robinvale VIC 3549
Mobile:

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[Michael Wishart]

Hi list subscribers

Just to add a bit of clarity to this resubscription / renewal process, as you are aware Infection Connexion (ACIPCList) is a members only list. So, to ensure that only members have access to this great membership benefit, each financial year we need to review list membership after the closing date for renewing membership has passed. So, this email does not mean you have not renewed your membership! It is just a prompt to let you know about this process.

To make this process as simple as possible, what we do is remove all current email addresses and then re-subscribe the current member database (using the current email listing for each member). Silently, so you don’t get annoying emails saying this has happened!

What this might mean for some members is that changes you may have made to your list subscription by email may be lost. Any changes you have made for access to the web archive will remain, however, as this is a separate process.

And the other by-product of this process is that any member who had previously unsubscribed from the list and who has renewed their membership will be automatically re-subscribed. We are looking at ways to prevent this from happening in future years, but currently it is not feasible to prevent this.

If you have any questions about your College membership status, or any questions about the list resubscription process, please direct them to Sara Kirby, ACIPC Office Manager, at officemanager@acipc.org.au

Thanks for your understanding and continuing support for Infexion Connexion.

Cheers
Michael Wishart
ACIPCList Moderator.

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

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[Michael Wishart]

Hi Kylie

I won’t comment on any emotional response you might encounter (which may actively form part of any policy making), but on a purely microbiological level cadavers are not really different from live patients. All you would need to establish is that the reprocessing specified by the manufacturer was suitable for rendering the item safe for use on the next patient (live or cadaver) according to Spaulding’s classification, and follow that process after each use.

If it is an item that only comes into contact with mucous membranes (not sterile tissue), then it would only require high level disinfection (destruction of all microorganisms except spores). The process would need to be validated to ensure that the required parameters were met, the same as any reprocessing process.

Hope this helps. Good luck!

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

Hi brains trust,
I would like to know if any of you can please point me in the right direction for guidance on whether an intra oral scanner (semi-critical camera that takes images inside the mouth to create a digital impression of the teeth) that is used on a cadaver can be then used on a live patient.
Are simply following the manufacturer’s directions for reprocessing this equipment sufficient for use on a cadaver and then a live patient? What other considerations are there or is there a blanket rule that once the equipment is used on a cadaver or animal (model) then that’s it – no more human use after this contact.
I would value your insights to learn more about this aspect of IPC.
Kylie

Kylie Robb
Practice Services Manager
MHSM (Clinical Leadership), CICP-P
Australian Dental Association NSW Branch
Level 1, 1 Atchison Street, St Leonards, New South Wales 2065
t: 02 8436 9936 m: 0438 628 664
E: kylie.robb@adansw.com.au | W: http://www.adansw.com.au

[cid:image002.png@01D256B6.FEBE80E0] [cid:image003.png@01D256B6.FEBE80E0] [cid:image004.png@01D256B6.FEBE80E0]

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[Michael Wishart]

Thanks Helen

We cant place lockers outside the rooms, as it creates traffic issues in our corridors. We had to move away from trolleys in the corridors for this reason (we use door hangers for PPE now).

The other thing to consider is at least some of our NUMs claim there is a clinical risk of not having the actual order at the bedside when administering the medication, and so they require their staff to take the medication chart into the room. Wouldnt matter where we dispensed it then, the chart would still need to go into the room.

In my mind this is a bit of a MY risk is bigger that YOUR risk situation, and I have to say as long as we reinforce good hand hygiene and cleaning of items removed from the room, they are possibly correct.

Has anyone faced this argument previously? How did you overcome it?

Thanks
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

From: ACIPC Infexion Connexion On Behalf Of Helen Roberts
Sent: Tuesday, 13 August 2019 9:26 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Bed charts and contact precautions

Hi Michael,

We place a infection control locker outside the precaution room. (They used to be the patients bedside lockers but we upgrade and kept the old ones for infection control)
It has 5 drawers in it.
We place all the PPE in the bottom drawers and medication are locked inside the top two drawer.
Medications are placed in medication cup outside room.
Nurse places a patient identification label on her blue gown so that she can still do her medication checks on entry into patients room.
Nurse carries the key.
This help solve the issues that you have outlined below.

Hope this helps,
Kind regards,
Helen

Helen Roberts
Infection Control
P:
07 4646 3106
|
F:
07 4633 7602
E:
robertsh@sath.org.au
|
W:
http://www.sath.org.au
Post:
PO Box 263, Toowoomba, QLD 4350
Address:
280 North St, Toowoomba, QLD 4350
[cid:image362010.jpg@ECC143CA.89E25C7A]

From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Michael Wishart
Sent: Tuesday, 13 August 2019 8:56 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Bed charts and contact precautions

Hi all

How do you manage bed charts under contact precautions?

Looking for some advice, as this has been an ongoing issue here for many years, and the recommendation in the guidelines has not changed in the latest version (2019), viz:

Other points relevant to patient placement include the following:

keep patient notes outside the room

keep patient bedside charts outside the room

disinfect hands upon leaving room and after writing in the chart

The issue is that many of our nurse unit managers (NUMs) require the medication and observation records to be at the bedside when medications are given or observations are taken. I know in some hospitals this will involve a second staff member standing at the door recording or verifying medication orders, but in reality in the private sector this is not resourced, so is not possible. The NUMs argue that there is a higher clinical risk of medication or documentation error than there is from infection transmission risk.

Has this been identified in other facilities, and if so, how do you manage this? We have been allowing nursing staff to take the bed chart into the room for medications and observations, then wipe it over on taking it back out of the room. Obviously the paper charts themselves cannot be wiped over. Generally we try to keep the bed charts outside of the rooms outside of these activities.

Any help or advice would be gratefully accepted.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

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[Michael Wishart]

Hi Jenny

What ‘linen’ do you mean? Are they reusable washable textiles used under the patients arm at the AV fistula? Are they dry sheets, blankets and pillow cases used by the patient? Surely not towels or face washers that have had moisture on them?

It doesn’t seem to make much economic sense to me to reuse linen, and cost of storage between visits must be quite expensive (as I know the dialysis units I have been involved with were always very space poor due to the number of disposables they had to store).

More specific information on what they are reusing would allow more comment on the possible clinical risks, though.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

Good afternoon everyone
I am currently looking at infection control practises in our day renal unit and updating our policy
Does anyone have any information on

1) linen usage in renal units

2) should linen be changed after each visit

3) if patient attends x3 weekly does their linen get stored, labelled and reused

I am not happy with current practise and wish to make some changes but require evidence to support my decision
Regards jenny
Jenny Garland RN CIPC-P
Quality, Risk & Infection Control Officer
Mater Health Services North Queensland

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[Michael Wishart]

Hi Nadene

We supply disposable overshoes (with soles with grip patterns on them) but they are not mandatory. Provided outside shoes are clean with no mud or debris on them, they can be worn throughout the OT complex, including in theatres. Overshoes are mainly provided to give protection to those who don’t want to splash fluid on their Gucci loafers. 🙂

Most of our staff, including most of our regular surgeons, have inside shoes or boots they wear. It’s mainly assistants, anaesthetists and reps who use the overshoes.

We changed our policy a few years ago, recognising that the floor is not a major vector for infection during procedures, and that touching shoes (to put on overshoes) is more likely to contaminate hands that leaving them alone. We don’t ‘police’ this rigorously, and we also don’t provide ‘shoe-shine boys’ to clean or check shoes on entering the OT suite, so we let staff and visiting doctors determine what they want to do in regard to overshoes and providing inside footwear (they provide their own personal inside shoes; we don’t share any footwear like this).

To me, this is one of the lesser evils in an OT in regard to risks of infection transmission. If only we could just get all staff to wash their hands every time they enter and leave the OT suite I would be happier!

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

Hi ACIPC Folk,

Can I please get a consensus about the use of overshoes in theatres?

We don’t ordinarily use them but sometimes visiting locums don’t come prepared and end up having to use spare shoes.

What is the OSH perspective? Do overshoes (if they are used) need to have grip patterns on the sole?

Not nice to have to use someone else’s shoes either.

Thanking you in advance, regards, Nadene

Nadene Walker

Clinical Nurse Specialist
Infection Prevention and Control

WA Country Health Service – Great Southern
Albany Health Campus
Warden Ave Albany WA 6330
PO Box 252 Albany WA 6331
P (08) 98922211 F (08) 98426037
M: 0428 086 062 (Business hours)

[cid:image001.png@01D3E2D6.275113E0][cid:image002.png@01D3E2D6.275113E0][cid:image003.png@01D3E2D6.275113E0]
Healthier country communities through partnership and innovation

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[Michael Wishart]

Hi all

Please see the attached urgent quarantine notice from TGA regarding this product.

Thanks
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of McCann, Rebecca
Sent: Monday, 5 August 2019 6:16 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] FW: Burkholderia cepacia contamination of skin prep.

Hi Michael

Dr Chris Blyth asked me if I could get this posted on ACIPC discussion list

Many thanks

Rebecca
Rebecca McCann | Program Manager | Healthcare Associated Infection Unit (HAIU)
Communicable Disease Control Directorate
Department of Health

T: 08 9222 2043 M: 0439 920 819 E: rebecca.mccann@health.wa.gov.au

From: Christopher Blyth [mailto:christopher.blyth@uwa.edu.au]
Sent: Monday, 5 August 2019 4:09 PM
To: ozbug@asid.net.au
Subject: [ozbug] Burkholderia cepacia contamination of skin prep.

Dear all

I am keen to alert you to an emerging concern we have seen in our hospital.

Case: we have a neonate with severe scalp infection secondary to Burkholderia cepacia.

Investigation: given the unusual nature of this organism in this population, we have looked for environmental sources. The wound followed an EEG – the scalp was prepared with an abrasive skin prepping lotion.

Lemon Prep
Product Code MD0019
Supplier Address Mavidon Medical Products 6625 White Dr Riviera Beach, FL 33407 USA

This is a multiuse produce supplied in 114gm tubes.

We have tested a number of these and identified B cepecia in both open and unopened tubes. Clonality has not yet been determined. Other pathogens have not been identified in the prep.

The lot numbers that are positive (so far) are 30145, 29824, 30006 and 30236.

This abrasive preparation is used to prepare the skin, reducing the skin impedance.

The TGA and the manufacturer have been notified.

We are using alternative products pending further investigation.

My understanding is that this skin prep is used extensively throughout Australia and the extent of the contamination is not yet known. Could you please inform your infection prevention and neurology colleagues

Best wishes

Chris

Dr Christopher Blyth MBBS(Hons), DCH, FRACP, FRCPA, PhD

Paediatrician, Infectious Diseases Physician and Clinical Microbiologist.

Associate Professor | Division of Paediatrics, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia
Head of Department | Department of Infectious Diseases, Perth Childrens Hospital
Clinical Microbiologist | Department of Microbiology, PathWest Laboratory Medicine WA, QEII Medical Centre
Co-Director | Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute
NHMRC Career Development Fellow | National Health and Medical Research Council

P: GPO Box D184, Perth, Western Australia 6840
T: +61 8 6456 5614 | M: +61 418827009 | E: christopher.blyth@uwa.edu.au

Compassion | Collaboration | Equity | Respect | Excellence | Accountability

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[Michael Wishart]

Hi Fiona

If you think about the transmissibility of the varicella-zoster virus via shingles lesions, unless the vesicles are draining and you subject them to high pressure or an aerosol generating procedure (like diathermy), the only mechanism of transmission is direct contact with the draining vesicles and subsequent transfer to mucous membranes or non-intact skin of a susceptible person (you basically have to stick your fingers in a lesion and lick ’em! 🙂 ). So Standard Precautions is actually quite suitable in most instances, although if you are performing aerosol generating procedures on lesions, airborne precautions is required (as it should be for any aerosol generating procedure anyway).

To mitigate risk even further, we say for known non-immune staff they should not come into direct contact with draining shingles lesions even wearing gloves, as an added precaution, and I note the guidelines also recommend that.

Disseminated shingles is totally different as the likelihood of lesions in the respiratory tree is very high (like chickenpox). So Airborne and Contact Precautions are definitely required.

We have been following these recommendations for many years and have never had a known transmission of varicella-zoster virus from a patient with shingles to a staff member.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

Hi All,

We are currently reviewing our Transmission Based Precautions for Herpes Zoster (shingles). Traditionally we have cared for people using contact precautions and added in airborne precautions if the patient has disseminated shingles or respiratory involvement.

However the 2019 edition of the Australian Guidelines for the Prevention and Control of Infection in Healthcare, whilst acknowledging airborne transmission is recommending Standard precautions and adding in contact and airborne precautions in the case of disseminated disease.
[cid:image003.jpg@01D54919.17F15680]

I am interested to know how other facilities / jurisdictions manage herpes zoster.

Kind regards,

Fiona De Sousa CICP-E| Nurse Manager | Infection Prevention & Control Unit
Launceston General Hospital, Level 2, Launceston TAS 7250
phone: 6777 6715 | mobile: 0408 487 197 | fax: 6777 5170 | email: fiona.de.sousa@ths.tas.gov.au |
intranet: http://www.dhhs.tas.gov.au/intranet/thon/infection_control

IPCU – ‘By working together we promote a culture of safety to reduce preventable infections and transmission of multi-resistant organisms’

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[Michael Wishart]

Hi Richard

Well, where should I start? This, admittedly, if from quite a few years ago, but anything above 1000ppm available chlorine was problematic for my staff at the time. We initially tried 10000ppm available chlorine, and saw severe cases of skin problems, and some respiratory sensitisation. And the surfaces showed a very rapid decline… even stainless steel benches showed rapid wear! So we moved down to 5000pmm and saw less respiratory sensitisation, still had multiple cases of skin problems, and still had surface wear. This was over a period of several years, mind you. So, after that, I abandoned sodium hypochlorite unless I had absolutely no alternative, and then only at level 1000ppm or less.

There are other disinfectants now available, although bleach remains easy to obtain and cheap, making it desirable from a cost perspective. But I would strongly argue that wide use of bleach is a definite hazard to staff that is very hard to control.

My opinion, at any rate.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

—–Original Message—–
From: ACIPC Infexion Connexion On Behalf Of Bartolo, Richard
Sent: Wednesday, 31 July 2019 3:58 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Higher concentration dilution of sodium hypochlorite

Hi Everyone,
We are looking at higher concentration dilution of sodium hypochlorite (10% bleach solution) (1:10 solution = 1 part bleach for every 9 parts water) for terminal cleaning. This concentration is 5 times the currently used dose 5000 ppm vs 1000ppm. The higher concentrations of chlorine are deemed respiratory sensitizers which have the potential to trigger reactions in some staff. Has anyone had issues?

Kind Regards,

Richard

Richard Bartolo
Manager Infection Prevention

Western Health
Gordon Street, Footscray VIC 3011
Ph. 03 8345 6113
Mob. 0438 560 441
Email. richard.bartolo@wh.org.au
Web. https://clicktime.symantec.com/3T9CBetsUTQQ1UEyZRZusdP7Vc?u=www.westernhealth.org.au

This was sent from my iPhone.
Kind Regards,

Richard Bartolo
Manager Infection Prevention

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[Michael Wishart]

Hi Robyn

An upfront disclaimer: I work directly at my facility with Dr Ben Devereaux, lead author of this statement.

We have continued use of very low dose simethicone in our endoscopy unit for many years. We recognise that simethicone may enhance biofilm build up, like many fluids that can travel though an endoscope channel. So we have good chemical and physical processes in place to try and minimize biofilm build up and help remove biofilm, including use of cleaning chemicals that enhance biofilm removal, and prompt bedside flushing of all channels post procedure.

I support the clinical use of simethicone in my endoscopy unit as we have very good cleaning, reprocessing and storage processes here, and our biological testing regimes follow all current GENCA and AS4187 guidelines.

I would recommend that any unit using or wishing to use simethicone should review their own endoscope cleaning and reprocessing processes, and their biological testing regimes.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

—–Original Message—–
From: ACIPC Infexion Connexion On Behalf Of Robyn Freeman
Sent: Wednesday, 24 July 2019 11:05 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Simethicone Use During Gastrointestinal Endoscopy: Position Statement of the Gastroenterological Society of Australia

Hello All,

Looking for your clinical opinion on the current Position Statement of the Gastroenterological Society of Australia (GESA) on the use of simethicone as a de-foaming agent during gastrointestinal endoscopy. GESA conclude that,

given the evidence of improved quality of endoscopic imaging and polyp detection, without evidence of clinical adverse events over decades of use , we believe that continued use of simethicone is appropriate and it can be administered through any endoscope channel. We also emphasise the strict adherence to instrument reprocessing protocols is essential.

Has any endoscope units ceased or commenced the use of simethicone? If you use simethicone, do you do any increased surveillance / testing?

We are trying to canvas general opinion to make a sound clinical judgement on the use of simethicone in our endoscopy unit given the risk of simethicone residue in endoscopes channels despite high level disinfection , which can promote biofilm and thereby increase the risk of transmission of micro-organism, and the lack of evidence to support the position statement and the recommendation to conduct further research.

Regards
Robyn Freeman

Clinical Nurse Consultant Infection Prevention and Control | Kyneton District Health
7-25 Caroline Chisholm Drive, PO Box 34, Kyneton VIC 3444

Please Note: I work Wednesday &Thursday

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[Michael Wishart]

Hi Joe

I will confess to not having placed a flash sterilizer in an OT for many, many years (have removed them all!), but if one was required one of the main factors to consider is how the ‘flashed’ instruments get transported from the steriliser into the OT.

If you use a container system of some sort, the instruments inside will be protected from the environment and handling once sterilised, and so the transport from the steriliser to the OR is not as compromised (although it is very difficult to validate this consistently). The other option is ‘open’ trays or racks that are carried from the steriliser to the OR. This would mean that you need to safeguard the instruments from environmental and handling contamination for the whole passage from the steriliser to the OR. That is fraught with difficulties (opening doors, scrubbed staff walking through ancillary areas), Almost impossible to validate a process like that and is one of the reasons we stopped doing flash sterilisation in OT.

I know this is probably not helpful to you here, but I personally would do everything in my power NOT to support a flash sterilization process, as I believe they compromise the sterility of critical instruments, and cannot be easily validated. More instrument availability would be what I would look at exploring to try and reduce the likelihood of needing a process like this..

Isn’t this forum great for getting opinions of others? That’s mine. 🙂

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

Good morning

Just wondering if anyone has set up an area in the operating theatre for a benchtop ‘flash’ steriliser? This would be used if reprocessing was performed offsite (outsourced). It would only be used for a dropped or suspected compromised sterility RMD that is of limited supply. Not routinely used.

I have heard some conflicting opinions on what is required.

I believe from reading AS/NZS 4187:2014 that a designated area must include an area for cleaning, drying and the sterility would not be compromised when it is removed from the benchtop ‘flash’ steriliser. This would not be an endoscopy reprocessing room as has been suggested (but I will accept another opinion)!

I am uncertain on what the air handling system should be eg HEPA filtration and the same as recommended for sterilisation areas.

AS/NZS 4187:2014 continues to put challenges in our path……………….it is all down to interpretation of the whole document and not just little sections!

I would value some advice from a colleague who has installed a benchtop ‘flash’ steriliser in the operating theatre.

Thank you
Joe

INFECTION CONTROL REVIEW PTY LTD
Joe-Anne Bendall Consulting
ABN 98630512284

Joe.bendall@bigpond.com
[Infection Control Review Logo – small2]

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[Michael Wishart]

Hi Jill

I would support the consultant’s opinion. If the dishwasher is only for use of staff crockery, it would be fine. But if it is used for any crockery shared by patients, it needs to meet the appropriate food service standards within a HACCP system.

It sounds like the domestic dishwasher you have does not meet the required parameters, and probably has no way of confirming it reaches the appreciate temperatures for the appropriate time frames. So a new dishwasher is required to reprocess these patient items.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincent’s Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

[cid:image001.jpg@01D46C86.4CDB6090]
[2019 conference email signature]

Good Morning,
Re implementation of domestic dishwashers in aged care facility
A local facility has implemented a domestic dishwasher primarily for tea/coffee cups and small plates however, a highly
regarded consultant has confirmed that a domestic dishwasher is not appropriate for a residential care facility.
due to the dishwasher being unable to obtain temperatures greater than 82 degrees (which is the required temperature)
for a prolonged periods. In order to thermal disinfect. Hence, a domestic dishwasher is unable to thermal disinfect the
dishes and cutlery.
Any thoughts or further information would be appreciated
thank you

Jill

[cid:image001.png@01D4FE78.B264FB40]

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