[Michael Wishart]

Hi Jayne

Under the Spaulding Classification, items used to manage upper airways only need to be ‘clinically clean’, because the space is not a sterile space. We used to reprocess rubber ET tubes many years ago, and they were not sterilised, just high level disinfected with heat. This table comes from the Australian Guidelines for the Prevention and control of Infection in Healthcare:

Table 7. Categories of items for patient care

Category

Description

Critical

These items confer a high risk for infection if they are contaminated with any microorganism and must be sterile at the time of use. This includes any objects that enter sterile tissue or the vascular system, because any microbial contamination could transmit disease.

Semi-critical

These items come into contact with mucous membranes or non-intact skin, and should be single use or sterilised after each use. If this is not possible, high-level disinfection is the minimum level of reprocessing that is acceptable.

Non-critical

These items come into contact with intact skin but not mucous membranes. Thorough cleaning is sufficient for most non-critical items after each individual use, although either intermediate or low-level disinfection may be appropriate in specific circumstances.

An introducer only enters this same space, which is not sterile, so only requires to be ‘clinically clean’. Sterilisation is desired if practicable, but not essential.

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]

Dear All,
Just a question in regards to whether the introducer/guidewire for assisting in paed or adult intubation, does this item need to be sterile or ‘surgically clean'( this is how it is described by manufacturer),this is a single use item?
Kind regrads

Jayne O’Connor RN ,BSc.,Inf.Cont
IPC Co-Ordinator
Sydney Adventist Hospital | 185 Fox Valley Road, Wahroonga, NSW 2076

p: +61 2 9487 9732 | f: +61 2 9473 8052 | m: +61 0406 752685 | e: jayne.oconnor@sah.org.au
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[Michael Wishart]

[Posted on behalf of member – Moderator

Read this article regarding MRSA on linen privacy curtains

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

I have been asked to investigate whether the hype re disposable curtaining and their antimicrobial properties, and whether old fashioned cloth ones are just as good. Does anyone have any articles/ research they could share with me, for either side of the argument.

Regards

Katherine Fisher

Infection Prevention Specialist |Eurobodalla

7 Pacific St Batemans Bay NSW 2536

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[Michael Wishart]

Hi Jenny

We include our volunteers (and we have a lot of them!) in our staff health program, providing access to free vaccines as required. We mainly ensure they have immunity to Hepatitis B and give annual flu vaccines to those under 65 (we encourage those over 65 to go to their GP for the free flu vaccine for that age group).

Volunteers are an integral part of our patient-centred care, and as such we believe are at as much occupational risk as other non-clinical staff having patient contact. So it makes sense to us, and adds value to their volunteering, to include them in our staff health program.

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 all
Can any one assist please
I have been asked to benchmark what other facilities do regarding vaccinations and volunteers
We are a private not for profit organisation and currently ask our volunteers to attend their Gp surgery for any vaccinations they require

Looking forward to your reply and interested to see what other organisations do
Regards Jenny
Jenny Garland RN CIPC-P
Acting Quality Risk & Safety Manager
Quality, Risk & Infection Control Officer
Mater Health Services North Queensland

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[Michael Wishart]

Thanks for the list subscriber who asked me to clarify what this discussion was about. We use acronyms and assume everyone know what they are, so apologies we did not think about explaining them.
The issue raised is ‘viral plume’ from human papilloma virus that potentially cause cervical cancer during these procedures..
https://www.cdc.gov/niosh/topics/healthcarehsps/smoke.html
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 Lee

My understanding is that the type of mask needed for those involved in the room will depend on the equipment used. Many of the diathermy and other cutting tools used for LLETZ will now be paired with local extraction kits, so the ‘viral plume’ aerosolised during the procedure will not circulate in the room. If you do a LLETZ without local exhaust being used, it is the same risk in my view of doing a diagnostic brunch on a possible TB patient.

If we did diagnostic bronchs under fume hoods then those outside the hood would not need an N95 mask, either!

So, will depend on how your surgeons do the LLETZ, and what equipment they use.

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,

Can I ask what other hospitals are doing around Australia in regards to whether a normal high filtration surgical mask is sufficient for staff when a LLETZ is being performed.

Our staff at the moment wear a normal surgical mask but I was asked the question should they need to wear a N95 or fit tested mask as they do for Bronchoscopies.

Any information would be helpful.

Lee Matthews
Clinical Nurse Infection Prevention & Control Unit
Women’s & Children’s Hospital
Adelaide

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[Michael Wishart]

Hi Lee

My understanding is that the type of mask needed for those involved in the room will depend on the equipment used. Many of the diathermy and other cutting tools used for LLETZ will now be paired with local extraction kits, so the ‘viral plume’ aerosolised during the procedure will not circulate in the room. If you do a LLETZ without local exhaust being used, it is the same risk in my view of doing a diagnostic brunch on a possible TB patient.

If we did diagnostic bronchs under fume hoods then those outside the hood would not need an N95 mask, either!

So, will depend on how your surgeons do the LLETZ, and what equipment they use.

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,

Can I ask what other hospitals are doing around Australia in regards to whether a normal high filtration surgical mask is sufficient for staff when a LLETZ is being performed.

Our staff at the moment wear a normal surgical mask but I was asked the question should they need to wear a N95 or fit tested mask as they do for Bronchoscopies.

Any information would be helpful.

Lee Matthews
Clinical Nurse Infection Prevention & Control Unit
Women’s & Children’s Hospital
Adelaide

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[Michael Wishart]

Hi Jo

My facility struggles with recycling, mainly due to space constraints rather than lack of willingness. Recycling requires segregation, and that means more bins or collection points.

One project we have recently started is PVC recycling (masks, tubing, PVC flasks). We do this through a company that provides us PVC products, and they pay the transport costs, so we just have to collect PVC appropriately. It has become quite successful in our high usage areas (Cath Lab, Theatres, ICU) due mainly to individuals with a passion to help with this recycling. Facility Executive were happy to sponsor this as it is relatively cost-neutral to do.

If you want details of the company involved, please let me know. I don’t know what areas they can provide this to, but it might be worth pursuing if you don’t already.

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,

I am keen for suggestions of sustainability and recycling projects that anyone might be involved with.
Obviously and understandably there are many areas where recycling etc. is inappropriate but I would
like to think there is a way of doing things better that protects patients, society and the planet.

I would be grateful if people could share their ideas?

Kind Regards

Jo Mayer
Infection Control MANAGER (CNS/CNM)
[http://www.ramsayhealth.com/~/media/Images/email/email-RHC-logo.jpg]
Hollywood Private Hospital
Infection Control
Phone:
08 9346 6479
Email:
MayerJ@ramsayhealth.com.au
Web:
http://www.ramsayhealth.com
Address:
Monash Ave, Nedlands WA 6009
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[Michael Wishart]

Hi guys,
Can you please post this to the list.
Thanks,
Helen.

Helen Scott

*A/CNC Infection Prevention & Control*

Clinical Governance Unit

North West Hospital and Health Service *|* Queensland Government

*p:* 07 4744 4021 | m: 0429 474 493

*a:* PO Box 27 Mount Isa Qld 4825

*w:* http://www.health.qld.gov.au

*e:* Helen.Scott@health.qld.gov.au

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[Michael Wishart]

Hi Sue

We are currently using Alfuria Quad vaccines in a prefilled syringe with a pre-fitted (non-safety) needle. We have given about 400 doses so far and not seen any problems with the attached needle.

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

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[2019 conference email signature]

From: ACIPC Infexion Connexion On Behalf Of Susan Gonelli
Sent: Thursday, 2 May 2019 10:37 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: FW: Issues with Influenza Vaccination leakage

Hi All,

I would like to ask if anyone else is having issues with the AfluriaQuad Influenza vaccine and BD Eclipse needles. We have had a number of leur lock mechanism breakages as well as vaccine leaking requiring a 2nd dose. We have also had a needle stick injury post vaccination when the needle and syringe fell apart as the safety mechanism was being activated. I also have been informed that another organisation have had 3 needle stick injuries within their IC department using the same combination of vaccine and BD Eclipse needles. I have attached a photo of the broken syringe / needle combination.

This issue has been reported to TGA, BD and Seqirus

Regards

Sue Gonelli CNC Pre Employment Immunisation Coordinator
Employee Exposure Management and Immunisation Service PO Box 52, Frankston Vic 3199
Direct 9788 4568 Fax 9784 2347 Switchboard 03 9784 7777
Penisula Health

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[Michael Wishart]

Apologies everyone, here is the link that should have been with Cate’s message.

Cheers
Michael Wishart
ACIPC Infexion Connexion 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

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[2019 conference email signature]

Hi everyone
I came across this information on fans recently. Not sure of evidence behind this.
[cid:image001.png@01D4F923.1A1F56A0]

Cate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517737
e … cate.coffey@nt.gov.au http://www.nt.gov.au/health

Our Vision: Better health outcomes for all Central Australians
Our Values: Community at the Centre | Equity and Integrity | We are Accountable | We are Relevant Today and Ready for Tomorrow | We are Committed to High Quality Care | We Value our Partnerships

Central Australia Health Service is a Smoke Free Workplace

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[Michael Wishart]

Thanks Margaret

My meagre legal knowledge tells me that is a state has an Environmental Protection Act or equivalent with a definition of clinical waste, this will take precedence over an Australian Standard, until the Act is repealed or altered. Best advice would be to check with your state statutory authority.

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

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[2019 conference email signature]

Hi Michael – ASA 3816 brings states into line but if current state definition is more onerous than AS then go with state. Vic EPA will prob be reviewing theirs I understand

Regards,

Margaret Jennings
Marjen Education Services

website. http://www.marjenes.com.au
email. marjenes@optusnet.com.au

mob. 0404 088 754
fax. 03 9439 2436

Hi Lynne

Definitely a state-by-state answer for this!

Check out: https://www.health.nsw.gov.au/environment/clinicalwaste/Pages/default.aspx for definition.

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

Does anyone know where or have any good posters on what constitutes “Clinical Waste”

Regards,

Lynne Howell
Working Tuesday, Wednesday & Thursdays
Infection Prevention Specialist| Queanbeyan Health Service
Corner Collett and Erin Streets QUEANBEYAN 2620
Tel. (02) 61507230 | Fax. | Mob. | Email. Lynne.Howell@health.nsw.gov.au
http://www.snswlhd.health.nsw.gov.au/

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Virus-free. http://www.avg.com

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[Michael Wishart]

Hi Lynne

Definitely a state-by-state answer for this!

Check out: https://www.health.nsw.gov.au/environment/clinicalwaste/Pages/default.aspx for definition.

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

Does anyone know where or have any good posters on what constitutes “Clinical Waste”

Regards,

Lynne Howell
Working Tuesday, Wednesday & Thursdays
Infection Prevention Specialist| Queanbeyan Health Service
Corner Collett and Erin Streets QUEANBEYAN 2620
Tel. (02) 61507230 | Fax. | Mob. | Email. Lynne.Howell@health.nsw.gov.au
http://www.snswlhd.health.nsw.gov.au/

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[Michael Wishart]

Hi Annie

I presume you are talking about skin antisepsis? There is little hard evidence, but quite a few recommendations on the topic of the best skin antisepsis for intravascular access.

The main argument in favour of alcoholic chlorhexidine products (most commonly 2% chlorhexidine with 70% alcohol) is the potential residual effect that chlorhexidine has, thus potentially inhibiting growth around insertion sites. Alcohol itself has good initial bactericidal activity, but no residual effect.

This, if you are using a very short term peripheral IV catheter (removed immediately after a procedure, for example), then an alcohol-only swab would potentially provide appropriate disinfection of the skin surrounding the insertion site, and residual effect on the skin is not really that relevant.

But if you are inserting a longer dwelling device, say a PICC or a CVC, which will remain in-situ for a number of days or weeks, then the residual; effect of chlorhexidine on minimising bacteria around the insertion site in quite beneficial.

There have been a number of meta-analyses concerning skin disinfection prior to IV access which have not been particularly conclusive, such as https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010140.pub2/epdf/full

That is my understanding, anyway, so hope that is helpful.

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

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[2019 conference email signature]

From: ACIPC Infexion Connexion On Behalf Of Annie Hartland
Sent: Wednesday, 27 March 2019 10:33 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Swabs – Alcohol and Alcohol+Chlorhex

Good morning,

Just looking for evidence on why we use different swabs.
Does anybody have anything on this at all?

Thanks
Annie

Annie Hartland

Nursing Chief Of Modality

P (08) 8402 4401 | M 0410 877 800 | F (08) 8402 4430

Dr Jones & Partners Medical Imaging

St. Andrews Hospital, 350 South Terrace, Adelaide SA 5000

drjones.com.au

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[Michael Wishart]

Hi Katherine

The Queensland Health MRO guidelines that this:

4.2.3.2 Clearance of MROs
A health service may decide to institute a program of screening clients with MRO colonisation to determine whether the MRO has been ‘cleared’ (the client is no longer colonised with the MRO). Clearance should be undertaken in consultation with the infection prevention and control team. A client who has been cleared of MRO colonisation who subsequently returns a positive culture from either a clinical isolate or a screening specimen should be considered to be MRO colonised again. The process for clearance should then be recommenced as below. The following criteria should be satisfied prior to certifying that a client has cleared an MRO:
MRSA, MRGN and ESBL producing organisms (other than CPE)
* More than three months elapsed time from the last positive specimen
* All wounds are healed, no indwelling medical devices present * No exposure to any antibiotic or antiseptic body wash for at least two weeks prior to screening
* In the case of MRSA, no exposure to specific anti-MRSA antibiotic therapy in the past three months
* Consecutive negative screens from screening sites (refer to Table 1 for required screening sites) on two separate occasions. The screening swabs must be separated by a minimum period of one week. The period over which these swabs are collected should not be less than a week, but may be over a period of months
* Health services may consider using the evaluation of a single set of screening swabs with a broth amplification technique for clearance of clients. This process should be based on local factors and agreements with local laboratories.

From https://www.health.qld.gov.au/__data/assets/pdf_file/0026/444626/multi-resistant-organisms.pdf

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]

Hello all,

I am wondering if anyone has a resource for education re ESBL, namely what constitutes as clearance of ESBL?

Many thanks

Katherine Fisher

Eurobodalla Infection Prevention Specialist

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[Michael Wishart]

Hi Cate

True allergy to alcohol is ‘very uncommon’ according to the WHO 2009 guidelines:

Allergic reactions to antiseptic agents including QAC, iodine or iodophors, chlorhexidine, triclosan, chloroxylenol and alcohols285,330,332,339,588,592-597 have been reported, as well as possible toxicity in relation to dermal absorption of products.598,599 Allergic contact dermatitis attributable to alcohol-based handrubs is very uncommon. Surveillance at a large hospital in Switzerland where a commercial alcohol-based handrub has been used for more than 10 years failed to identify a single case of documented allergy to the product.484 In late 2001, a Freedom of Information Request for data in the FDA’s Adverse Event Reporting System regarding adverse reactions to popular alcohol-based handrubs in the USA yielded only one reported case of an erythematous rash reaction attributed to such a product (J. M. Boyce, personal communication). However, with the increasing use of such products by HCWs, it is likely that true allergic reactions to such products will occasionally be encountered. There are a few reports of allergic dermatitis resulting from contact with ethyl alcohol600-602 and one report of ethanol-related contact urticaria syndrome.331 More recently, Cimiotti and colleagues reported adverse reactions associated with an alcohol-based handrub preparation. In most cases, nurses who had symptoms were able to resume use of the product after a brief hiatus.332 This study raises the alert for possible skin reactions to alcohol-based handrub preparations. In contrast, in a double-blind trial by Kampf and colleagues582 of 27 persons with atopic dermatitis, there were no significant differences in the tolerability of alcohol-based handrubs when compared with normal controls.

Allergic reactions to alcohol-based formulations may represent true allergy to the alcohol, or allergy to an impurity or aldehyde metabolite, or allergy to another product constituent.330 Allergic contact dermatitis or immediate contact urticarial reactions may be caused by ethanol or isopropanol.330 Allergic reactions may be caused by compounds that may be present as inactive ingredients in alcohol-based handrubs, including fragrances, benzyl alcohol, stearyl or isostearyl alcohol, phenoxyethanol, myristyl alcohol, propylene glycol, parabens, or benzalkonium chloride.330,491,588,603-606

https://www.ncbi.nlm.nih.gov/books/NBK144008/
We have several staff here who do not tolerate an alcohol hand gel we provide, but are quite able to use a alcohol foam formulation.

I would recommend you seek more information on the nature of the ‘allergy’, including dermatology review if possible, and offer to supply some different formulations of alcohol hand sanitisers to see if any can be tolerated (with dermatologist approval, if possible).

I agree that only hand washing in a busy ICU would be potentially more detrimental to her skin over time, but this might be an interim measure whilst you sort out a suitable alcohol based product she can tolerate.

My thoughts, anyway.

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

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[2019 conference email signature]

Hi there
Hoping to get your advice on staff with an allergy to Alcohol in ABHR . ICU would like to employee a nurse form NZ who has an allergy to ABHR and Latex gloves. The gloves are no problem as we use latex free gloves however I am not aware of non alcohol hand rub that meets EN1500 testing standard. The person is currently using Alcohol Free Hand Sanitising Foam By Reynard Health Services which is TGA approved as a cosmetic product. It is not TGA approved as a hand hygiene product.
ICU are insistent on employing the nurse as they believe handwashing is a viable option for 5 moment of hand Hygiene which Infection Prevention and Control unit do not endorse , Alice Springs has very hard water and hand issues are a problem from time to time .
There has been no assessment by dermatologist or formal report provided regarding this sensitivity.
Can you if you have experience with clinical staff who are unable to use AHBR and what are the options?
Regards

Cate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
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[Michael Wishart]

Hi Pam

We use a detergent wipe (no rinsing or drying required) on all equipment, including beds.

We only use a detergent disinfectant one step cleaning product(accelerated hydrogen peroxide) on beds if the room had transmission based precautions in place.

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

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[2019 conference email signature]

Good morning,
We are reviewing bed cleaning procedures and products in our hospitals.
In regards to discharge bed cleaning, can anybody share;

* Do you use detergent

* Do you use detergent & disinfectant – if YES what product do you use

Thanks so much.
Cheers from Pam

Pamela Boon | Clinical Nurse Manager
Infection Prevention and Management Unit
Royal Darwin Palmerston Hospitals | Top End Health Service

Northern Territory Government
LG Floor, Royal Darwin Hospital, Rocklands Drive, Tiwi
GPO Box 41326, Casuarina, NT 0811

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