[Michael Wishart]

Hi Jayne

Our facility recently reviewed cleaning clinical items, and have agreed on a shared process between a number of different groups of staff. This is identified with a chart that specifies whose responsibility to clean various pieces of equipment. These charts are placed in ward pan rooms as well as in ward cleaners’ cupboards. I’m not at liberty to share these, but hope you understand what I mean.

When we investigated cleaning clinical equipment in wards, we found many staff assumed someone else did it! So nurses assumed cleaners cleaned certain things, and cleaners assumed nurses cleaned certain things. That is why we came up with an agreed chart that shows who cleans what, when. Sometimes it will depend on when in the patient stay as to who cleans it. For example, IV poles and pumps are basically nursing staff responsibility to clean when taking out of an occupied patient room to use for another patient, but on discharge if IV pole and pump is in the room the cleaners will clean them as part of the discharge clean.

I would recommend you have some type of discussion forum with all the key players to agree on who does what, then make sure it is well communicated to all the relevant staff.

We also did this in theatres a while ago, and it was surprising who though who cleaned what between cases. Developing charts and flow charts to outline the process really helped make sure things were not missed.

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A627 Rode Road, Chermside QLD 4032
P(07) 3326 3068| F(07) 3607 2226| Emichael.wishart@svha.org.au| W http://www.hsnph.org.au

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—–Original Message—–
From: ACIPC Infexion Connexion On Behalf Of Jayne OConnor
Sent: Tuesday, 21 August 2018 4:10 PM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] cleaning of clinical equipment

Hi All,

Does anyone have any documents/policies around cleaning of clinical equipment, who’s responsible for the cleaning and how frequently the equipment is cleaned?

Would appreciate any help :).

Many thanks in advance.

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
http://www.sah.org.au

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[Michael Wishart]

Hi Roslyn

One of the best resources I have seen is the Scrubbing, Gowning & Glowing DVD from ACORN. You would need to purchase this, but it is a great resource, in my opinion.

https://www.acorn.org.au/education/education-shop/surgical-hand-antisepsis-gowning-gloving-dvd/

Cheers
Michael

PS I am not affiliated with ACORN in any way I just like the DVD! .

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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From: ACIPC Infexion Connexion On Behalf Of Roslyn Franklin
Sent: Tuesday, 14 August 2018 1:48 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Surgical handwash technique resources

Good afternoon everyone,

Many dentists perform implant and other surgical procedures and I am after some resources regarding surgical hand wash technique.

In particular, the 4% chlorhexidine surgical handwash where the manufacturer recommends a 30 second scrub followed by a 2 minute scrub.

Are there any videos or posters available that I could use?

Many thanks,

Dr Roslyn Franklin
BCSc, GCert IP&C, Cert IV WH&S, Cert IV TAE
Dentist and Director

Amalgamate
Millbridge WA 6232

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[Michael Wishart]

Hi Sonja

I can’t say that I am an expert in this area, but in our PICC policy it states this:

If the PICC has not been accessed for 7 days access the PICC with an empty 10ml syringe. Remove 5mls of blood and discard. Then flush with Normal saline 10mls.

Not sure exactly why that is in there, as our PICC policy is based on The Queensland Health PICC guidelines (https://www.health.qld.gov.au/__data/assets/pdf_file/0028/444493/icare-pcvc-guideline.pdf) and I cannot see this statement in there.

Not sure if this helps or not!

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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Hello,

We are reviewing our central line management policies and we trying to find evidence related to the routine practice for aspiration of blood prior to accessing the central line (especially PICC).
Our ICU team states that this is routinely performed within oncology groups.

I would be grateful for some specialist information.

Kind Regards
Sonja

Sonja Wegert | Infection Control Practitioner (ICP)
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hospital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517977
e … sonja.wegert@nt.gov.au http://www.nt.gov.au/health

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[Michael Wishart]

Hi Cate

Our facility has an orientation training module and competency, which is then repeated every three years. We use to do this every two years, but a corporate decision has been made to change this to every three years.

We also have an ongoing aseptic technique audit process which is separate to the clinical competency.

Hope this helps.

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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HI everyone
I am reviewing our Aseptic Technique policy and am interested in how your facility does aseptic technique training. I know some facilities do training and competency assessment at orientation while others do it every 1-3 years.
Can you let me what you AT training policy is, who delivers the training and whether it is competency based?
Thanks very much
cheers
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

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[Michael Wishart]

[Posted on behalf of Susan Jain Moderator]
[NB the original message from Helen Scott was sent to Susan as a personal message, but she has requested the reply to be posted here as she felt it would also be of interest to others – Moderator]

Hi Helen
Thank you for your response to our latest research. Please find the answers to your questions below.

Hi Michael
We are certain that more people out there will be having similar questions/concerns. Is there any possibility to publish our responses into the AICALIST please?

Thank you again and have great weekend

Prof Mary-Louise and Susan Jain

Kind regards

Susan Jain

Clinical Nurse Consultant CHESS, Conjoint Lecturer UNSW
Level 2, High street
Prince of Wales Hospital, Randwick, NSW 2031
phone: 02 9382 1877 fax: 02 9382 2084 page:44241
E: susan.jain@health.nsw.gov.au
G: SESLHD-POWH-InfectionPreventionControl@health.nsw.gov.au

Hi Susan,

I found your article very interesting.
With respect, I do have a few questions for you if thats ok?

One: are the three pumps of ABHR in line with the manufacturers recommendations/SDS?

A: Yes (as per the product label)

I know from previously working for one of these manufacturers, that only one pump is required, and I believe from reading instructions from others, that only one pump is required. Is this off label use then?

A: No, we have followed manufacturers instruction. As you may be aware that the amount and the coverage is the key to appropriate hand disinfection. From our observations HCWs were only using one small pump which will be less than one ml, thats why we wanted to see if two pumps is enough or not which in this case yes if you have average sized hands. As per Dr Pittet study Am J Infect Control. 2016 Dec 1;44(12):1689-1691. doi: 10.1016/j.ajic.2016.07.006. Epub 2016 Aug 24 ABHR volume and hand size matters.

This also depends on the size of the HCWs hands, as three pumps might be too much for smaller hands and vice versa for larger hands.

A:Yes it can be, thats why we tried 2 pumps and 3 pumps

Therefore, I was wondering where the use of three came from?

A: The 3 pumps came from the product manufacturers instructions we used to conduct the study.

And as two of your plates grew an MRO after only two pumps, would this lead people to think that in fact, despite manufacturers instructions, we do in fact require three pumps of ABHR or handwash to achieve desired results?

A: No, we have explained in our results section that we the HCW with positive plates tested negative on retesting, using 2 pumps of ABHR. Both of our HCWs had large sized hands, so by using 2 full pumps they managed to disinfect their hands reiterating the fact that volume and hands size matters.

Two: was the ABHR/handwash a gel, foam, cream or liquid, or did you use several different types?
A: foam

Three: with regards glove use, isnt this part of the the package of standard or additional precautions? For example, if I was to enter a room to give care to a known MRO patient wearing a gown but no gloves, how can I be certain that the dry procedure doesnt turn into an exposure? What if the patient vomits, or sneezes, or coughs? Or something else unexpected? And how then do I as an infection control specialist, ensure compliance with transmission based precautions, especially with inexperienced staff, or non compliant staff?

A: Gloves introduced to HCWs aimed at protecting them from body fluids, regardless of patients MRO status. We should not discriminate between MRO and non-MRO patients body fluids as all body fluids are potentially infectious. When a HCW performs a dry contact, meaning no body fluid contact regardless of patients MRO status, why would we need gloves when our research proved that MRSA and VRE can be successfully removed by appropriate hand hygiene. Your point about an unexpected contact (e.g. vomitus) can be cleansed from our hands with soap and water.

And how do I know when auditing, that the staff member walking into the room wearing a long sleeved gown but no gloves, is intending on performing a dry procedure for this patient, despite having contact precautions signs on their doors? Yes, that point can be clarified afterwards, but surely this is going to change all of our auditing processes, as well as the WHO and therefore HHA protocols on glove use, hand hygiene and in fact, transmission based precautions?

A: We haven’t modified contact precautions around auditing. We understand that the contact precautions sign states that HCWs must don PPE outside the room, I dont know if you have followed a HCW into a single room and closely monitored the items they touch with the same pair of gloves within the same patient zone. In fact we contaminate our patients surroundings with pathogen by using same pair of gloves. Please read this paper Glove: Use for safety or overuse? Am J Infect Control. 2017 Dec 1;45(12):1407-1410 https://doi.org/10.1016/j.ajic.2017.08.029. We have created an educational video to highlight this exact issue.

Four: your conclusion states that this improves patient safety, but didnt say how?

A: Numerous studies alluding to us that we misuse gloves in turn our hand hygiene compliance is between 38-50% when we use gloves. Please refer to following articles to answer this question.
Compliance with hand hygiene and glove change in a general hospital, Mashhad, Iran: an observational study. Am J Infect Control. 2012 Aug;40(6):e221-3. doi: 10.1016/j.ajic.2011.12.012. Epub 2012 Mar 21,
Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission? J Hosp Infect. 2004 Jun;57(2):162-9.
Cusini, Alexia, et al. “Improved hand hygiene compliance after eliminating mandatory glove use from contact precautionsIs less more?.” American journal of infection control 43.9 (2015): 922-927.

Is it due to complacency when wearing gloves and our (untrue) perception that gloves protect us from everything?
Is it because glove use is abused and people either dont clean their hands properly before or after glove use, or is it because gloves are sometimes left on and continued to be worn for multiple patients? All of these possibilities are what we have seen during audits.

A: Yes, you are right, glove use sends a false sense of security. We have similar experience.

As this article was published in the AJIC, did you have any feedback from the US?-

A: It was peer reviewed and only just published so we are waiting for US based feedback

As I said, these are just musings and mean no disrespect whatsoever, just a curious mind.

We appreciate your time and interest in this very important issue and we love to hear your views and ideas.

Would love to hear others and your own feedback.

Thank you, will let you know if we hear any further.

Kind regards,
Helen Scott.

On Fri, 29 Jun 2018 at 7:41 am, Susan Jain (South East Sydney LHD) <Susan.Jain@health.nsw.gov.au> wrote:

Hi all
Please find our latest publication on safe removal of gloves for dry contact with patients under contact precautions (link below)

Jain S, Clezy K, McLaws ML. Safe removal of gloves from contact precautions: The role of hand hygiene.

Am J Infect Control. July 2018 Volume 46, Issue 7, Pages 764767 pii: S0196-6553(18)30034-8. doi: 10.1016/j.ajic.2018.01.013

Kind regards

Susan Jain

Clinical Nurse Consultant CHESS, Conjoint Lecturer UNSW
Level 2, High street
Prince of Wales Hospital, Randwick, NSW 2031
phone: 02 9382 1877 fax: 02 9382 2084 page:44241
E: susan.jain@health.nsw.gov.au
G: SESLHD-POWH-InfectionPreventionControl@health.nsw.gov.au

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[Michael Wishart]

Hi Cath

I still have not seen definitive evidence that equates hub scrubbing with chlorhexidine containing swabs as being more effective than just 70% alcohol swabs for prevention of line infections.

The 2016 INS guidelines state:

F. Perform a vigorous mechanical scrub for manual disinfection of the needleless connector prior to each VAD access and allow it to dry.
1. Acceptable disinfecting agents include 70% isopropyl alcohol, iodophors (ie, povidone-iodine), or >0.5% chlorhexidine in alcohol solution. 7,16 (II)
2. Length of contact time for scrubbing and drying depends on the design of the needleless connector and the properties of the disinfecting agent. For 70% isopropyl alcohol, reported scrub times range from 5 to 60 seconds with biocide activity occurring when the solution is wet and immediately after drying. More research is needed for other agents or combinations of agents due to conflicting reports regarding the optimal scrub time. 3,17,18 (II)
3. Use vigorous mechanical scrubbing methods even when disinfecting needleless connectors with antimicrobial properties (eg, silver coatings). 19-24 (IV)
G. Use of passive disinfection caps containing disinfecting agents (eg, isopropyl alcohol) has been shown to reduce intraluminal microbial contamination and reduce the rates of central line-associated bloodstream
infection (CLABSI). Use of disinfection caps on peripheral catheters has limited evidence but should be considered.

I do agree that staff confusion is an issue, so one product should be selected and made available. But until I see credible evidence to support use of chlorhexidine containing swabs on hubs, I will continue to promote 70% alcohol ‘scrub the hub’.

My opinion, anyway.

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D411E2.43F7A050] [cid:image002.png@01D411E2.43F7A050]
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Hi All,
Agree with Cath.

Historically we stocked both 70% alcohol & the alcohol 2% CHG swabs / solution in clinical areas
After reviewing & auditing accessing devices it became quite clear that staff were confused about what to scrub the hub with or for insertion of a PIVC etc.
There was a lack of standardisation amongst staff about what product to use on which vascular access device when asked,
More frighteningly, staff also often referred to swabs according to the colour of the packet not the antiseptic solution – ‘use the blue swabs’ / ‘use the pink swabs’ / ‘use the orange swabs’.
To further complicate things – the colours of the swab packets can change depending on the supplier of the product. & at one point the alcohol swabs were virtually the same colour as the CHG swabs.
Chinese whispers were also a problem as some staff had heard about CHG sensitivity either in a journal, TV, Dr Google or at a conference & were taking it upon themselves & influencing others to use alcohol only which was not procedure.

Using a risk management approach – 1st rule of thumb Eliminate!
The decision was made by the LHF to remove the alcohol swabs from all patient units & only stock alcohol CHG unless the clinical area identified a specific need for just alcohol swabs.
The risk of infection due to staff not using the correct antisepsis solution to scrub the hub or insertion far out-weighs the sensitivity issue for CHG.

Cheers
Catherine Wade

Clinical Nurse Consultant | Infection Prevention & Control (IPAC)
Level 1 / 67 Holden Street, GOSFORD NSW 2250
Fax:(02) 4320 2874 | Internal Fax: 92874
Catherine.Wade@health.nsw.gov.au or CCLHD-IPAC@health.nsw.gov.au

[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Central-Coast-LHD.jpg]

Dear Daniella

I recently reviewed evidence and guidelines for best practice with vascular access devices. Below are the recommendations I made on based on the review and the supporting references.

I have never understood Australia’s reluctance to adopt scrub the hub campaigns and lack of interest in routine use of protective IV caps. As a recently hospitalised and immunosuppressed patient I worried every time my line was accessed as there was nothing uniform in any of the accesses. There are now good Australian research papers showing risk with even simple peripheral vascular catheters. IVs are inserted very commonly making them one of the most frequent infection risks in acute care settings.

With regard to CHG I also note a general reluctance to its use in Australia as evidenced by poor recommendations in the draft NHMRC IC Guidelines, questions raised previously on this discussion forum and at ACIPC meetings. Personally I disagree with Michael’s earlier comment given that it is often a long time between accesses of IV lines and if oncovered they can easily become contaminated hence an agent containing alcohol and CHG is safe to use in non CHG-sensitive populations and it gives immediacy plus residual. As you would appreciate CHG has been used extensively in healthcare and domestic settings for decades. True CHG sensitivity is extremely rare. Anaphylaxis reports typically demonstrate multi-site simultaneous exposure to CHG ie surgical skin prep + use of CHG lubricant jelly + CHG impregnated CVC insertion. The NHMRC’s recommendation that we keep risk registries of CHG containing products is salient as is the recommendation to take adequate histories from patients regarding sensitivities.

In a recent report where he considered “resistance” Kampf argued that we should use CHG cautiously and perhaps even in a stewardship way. He was smart to recognise that there is no universal agreed definition of CHG-resistance and that the mechanisms are very different to antimicrobial resistance.

I expect many will disagree with my views but I am very happy that CHG was used extensively to help prevent infection in my recent surgery and hospitalisation. I would have warmly welcomed the use of routine CHG & alcohol hub disinfection.

Recommendations based on literature and guideline review.

Care must be taken not to contaminate the lines when accessing lines and their administration sets.1,65,72

A single patient use application of 70% alcohol alone1,73 or >0.5% chlorhexidine in 70% alcohol1,10,29,72 should be used70 for 529- 15 seconds1,10,73 and allowed to dry when decontaminating the catheter hub or injection ports prior to every access of the circuit. This includes every time an infusion set is added or removed, as well as administration of medication.10,65 Supplies for disinfecting should be kept at the bedside.1

Use of disinfection caps on peripheral and central catheters should be considered.1,72

1. Gorski LA, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. J Infus Nurs. 2016;39(1S):1-256.

10. Loveday HP, Wilson JA, Pratt RJ, et al. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014;86 Suppl 1:S1-70.

29. Marschall J, Mermel LA, Fakih M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(7):753-771.

65. Society. AaNZIC. Central Line Insertion and Maintenance Guideline. 2012; http://www.anzics.com.au/Downloads/ANZICS_Insertion%26maintenance_guideline2012_04.pdf, 2017.

70. Ling ML, Apisarnthanarak A, Jaggi N, et al. APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI). Antimicrob Resist Infect Control Antimicrobial Resistance & Infection Control. 2016;5(1).

72. Nursing. RCo. Standards for infusion therapy. London.: Royal College of Nursing.; 2016.

73. (INICC). INICC. International Nosocomial Infection Control Consortium (INICC) Bundle to Prevent Central Line Associated Bloodstream Infections (CLAB) in Intensive Care Units (ICU): An International Perspective. Argentina.2017.

Cath

Cathryn Murphy RN B. Photog MPH CIC FAPIC FSHEA CICP-E PhD
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
Adjunct Associate Professor
Faculty of Health Sciences and Medicine, Bond University
QLD, Australia

E: Cath@infectioncontrolplus.com.au
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W:http://www.infectioncontrolplus.com.au

Dear colleagues,

I am interested to know if Australian hospitals are routinely using wipes containing chlorhexidine 2% with alcohol 70% to disinfect vascular access hubs (i.e. to ‘scrub the hub’). In particular, is this practised on general wards when accessing a PIVC?

Many thanks,
Daniela

Daniela Karanfilovska
Clinical Nurse Consultant
Infection Prevention & Healthcare Epidemiology

t 03 90762819 m 0427 703 769
e D.Karanfilovska@alfred.org.au

Alfred Health
55 Commercial Road
Melbourne VIC 3004
PO Box 315 Prahran
VIC 3181 Australia
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[Michael Wishart]

Hi Daniela

We do not routinely encourage use of chlorhexidine and alcohol wipes for access device swabbing, only 70% alcohol wipes. The rationale is that no residual effect is required. We do not prevent use of chlorhexidine containing swab for access devices, but we do not encourage it.

Cheers
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
ph: 07 3326 3068 Email: michael.wishart@svha.org.au

________________________________

Dear colleagues,

I am interested to know if Australian hospitals are routinely using wipes containing chlorhexidine 2% with alcohol 70% to disinfect vascular access hubs (i.e. to scrub the hub). In particular, is this practised on general wards when accessing a PIVC?

Many thanks,
Daniela

Daniela Karanfilovska
Clinical Nurse Consultant
Infection Prevention & Healthcare Epidemiology

t 03 90762819 m 0427 703 769
e D.Karanfilovska@alfred.org.au

Alfred Health
55 Commercial Road
Melbourne VIC 3004
PO Box 315 Prahran
VIC 3181 Australia
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Alfred Health incorporates The Alfred, Caulfield Hospital, Sandringham Hospital and Melbourne Sexual Health Centre
http://www.alfredhealth.org.au

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[Michael Wishart]

Hi Cate

In my view I wouldn’t be recommending air sampling for the ceiling breach you have outlined. If there were a breach of the air handling system (eg duct work, changes of the HEPA filter box (except for routine filter changes), etc), we would request air sampling, to demonstrate the system was again providing appropriately filtered air. But in your incident, the air handling system remains unchanged. Yes, so debris would have entered the OT from the ceiling when it was breached, but provided you allowed an appropriate period of time for full air changes to occur after repair of the breach and you physically cleaned all surfaces to remove any debris, the risk of continuing air contamination is pretty small.

It would still be great to have a better national guide to performing air sampling, but no-one seems to be interested.

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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Hi everyone,
During maintenance if OT light, a holding spring broke with light hitting ceiling and damaging the ceiling yesterday. A Zip wall was put up immediately to prevent further dust contamination from ceiling and equipment was cleaned covered and/or removed. The hole has been repaired and painted.
Are you able to give advice on whether air testing is required prior to recommissioning the Operating Theatre after an incident like this? I note that there no nationally agreed standards on when to undertake microbiological air sampling in the operating theatre, or on the interpretation of sampling results. There is however reasonable evidence for air sampling when commissioning a new operating theatre.
Can you let me know your thoughts.
thanks
Cate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
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[Michael Wishart]

It seems the attachment was omitted. Trying again.

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0] [cid:image004.jpg@01D3FD8B.1757FC40]
P Please consider the environment before printing this email

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Wednesday, 6 June 2018 11:37 AM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] FW: Product Defect Alert for DBL METRONIDAZOLE INTRAVENOUS INFUSION 500mg/100mL solution for injection bag

[Posted on behalf of Donna Cameron Moderator]

Dear Infexion Connexion subscribers,

I have just seen this product recall that will be of interest to many of you.

Regards,
Donna

Donna Cameron
Infection Control Consultant
T +61 (0) 3 8344 3574 (Monday, Wednesday & Friday); +61 (0) 3 9096 5233 (Tuesday & Thursday)
donna.cameron@unimelb.edu.au
Microbiological Diagnostic Unit Public Health Laboratory
The Peter Doherty Institute for Infection and Immunity
792 Elizabeth Street | Melbourne | Victoria | Australia | 3000
doherty.edu.au
[cid:image001.gif@01D3FD7C.B4C863C0]

From:

“Australian Society for Antimicrobials” <info@asainc.net.au>

To:

“ASA” <info@asainc.net.au>,

Date:

06/06/2018 09:12 AM

Subject:

Product Defect Alert for DBL??? METRONIDAZOLE INTRAVENOUS INFUSION 500mg/100mL solution for injection bag

PO Box 8266 Angelo Street
South Perth 6151 Western Australia
ABN: 31 081 739 370

Email: info@asainc.net.au
Twitter: @AusAntibiotics

Member Update 05 Jun 2018

Pfizer Australia has informed ASA of a Product Defect Alert for DBL METRONIDAZOLE INTRAVENOUS INFUSION 500mg/100mL solution for injection bag. See attached letter.

Please feel free to contact Wayne Lee if you wish to discuss this matter further:

Wayne Lee
Associate Medical Director
Pfizer Essential Health
Tel: +61 3 8744 5103
Mob: +61 401 100 383

Australian Society for Antimicrobials :: https://www.asainc.net.au
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[Michael Wishart]

Hi Jayne

No robust evidence, just an old, old document from the UK full of common sense called ‘Behaviours and Rituals in the Operating Theatre’ (attached).

Theatre footwear
The floor surface of the operating theatre should be kept clean but the effect this has on infection rates remains uncertain. Studies of bacterial contamination of the operating theatre corridor floors indicate that a change of footwear should occur as far from the operating theatre as possible.74 Well-fitting footwear
with impervious soles should be worn and regularly cleaned to remove splashes of blood and body fluid.
All footwear should be cleaned after every use, and procedures should be in place to ensure that this is undertaken at the end of every session.
Humphreys et al.75 illustrated that the use of plastic overshoes led to a significant increase in floor colony counts rather than a decrease. Carter
76 also showed that hands became contaminated when overshoes were put on or removed.
Recommendation: category 3
Special footwear should be worn in the operating department and regularly cleaned. The practice of wearing plastic overshoes should cease.

My personal thought is that provided you keep them visibly clean (no blood, no mud, etc), footwear worn in OT can be worn throughout the hospital and then worn back into OT. The way we state that in policy here is that footwear worn in OT must be cleaned after going outside the building, or outside worn shoes must either be cleaned or covered with an overshoe on entry to the operating suite.

Evidence is great if you have it, but sometimes we need to consider common sense and the epidemiology of infections.

Oh, and just a thought on those Gucci loafers the anaesthetist has on…. if you don’t want them splashed with body fluid, put some overshoes on! Nothing to do with protecting the patient, just to protect your $1000 Gucci’s.

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A627 Rode Road, Chermside QLD 4032
P(07) 3326 3068| F(07) 3607 2226| Emichael.wishart@svha.org.au| W http://www.hsnph.org.au

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—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Jayne OConnor
Sent: Tuesday, 5 June 2018 12:38 PM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Over shoes for use outside of operating theatres

Dear Brains Trust,
Does anyone know of some robust research/evidence to back up, or not, the use of over shoes for visitors to operating theatre and for theatre staff wearing them out side of the theatre environment?
Many thanks in advance.
Jayne

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
http://www.sah.org.au

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[Michael Wishart]

Hi Cate

We don’t have antiseptic soap in every inpatient room (except in oncology, where both plain soap and antiseptic soap are in very patient room), and we don’t have ward procedure rooms either. We do have 2% chlorhex and plain soap in corridors outside rooms in all wards though. If staff need a clinical handwash they can either use alcoholic hand gel within rooms, or wash hands in the corridor outside the room with 2% chlorhexidine. If they need to do a surgical scrub in a ward (very rare, but eg for emergency sternal cut-down) we have 4% chlorhexidine impregnated sponges available.

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0] [cid:image002.jpg@01D3F740.141D2BA0]
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Hi everyone
Can you tell me if you have 2% chlorhexidine clinical hand wash located at all hand basins in your patient rooms? We currently do as we do not have procedure rooms.
What are your thoughts?
cheers

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
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[Michael Wishart]

Hi Lesley

We did have some engineering staff attend similar presentations a few years ago. They did say some was very clinical and over their heads, but they also did say they did get something useful from the pipework discussions and talk of remedial works.

I’d suggest you let the engineering staff decide and see if they think the topics would be of interest to them.

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
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Hi, can anyone tell me if this forum is for IC consultants only or would maintenance staff e.g. plumbers working in a hospital setting find this useful?
Thanks you,
Kaye
Lesley Stewart, Kaye Roberts-Rundell & Carolyn Templeton
Infection Control & Wound Management
Western District Health Service
PO Box 283
Hamilton Victoria 3300
Infection.Wound@wdhs.net | http://www.wdhs.net
[cid:image001.jpg@01D271AD.19597660]

Hello Everyone:

Just a reminder about the Water SIG Forum next Thursday at The Alfred. Attached, please find an updated invitation.

Please also note a change in topic title for Noel’s talk:

Mr. Noel Cleaves – “What’s Next for the Regulation of Legionella Risk Management?”
Manager, Environmental Health Regulation & Compliance, Health Protection Branch, DHHS, VIC

Thanks, and regards

John Matthew
Marketing & Strategic Leader
Pall Medical, ANZ
M: +61 419 130 668
E: john_matthew@pall.com
W: http://www.pall.com

[cid:image001.png@01D24FB0.842C9B80]

Hello Everyone:

Just a heads up to save the date for our next Water Special Interest Group meeting in Melbourne: Thu 19 April 2018, 3pm – 6pm. Attached, please find the invitation. There will be a Q&A Panel session at the end.

Speakers:

Mr. Noel Cleaves – “Legionella Guidelines Review & Discussion Paper”
Manager, Environmental Health Regulation & Compliance, Health Protection Branch, DHHS, VIC

Prof. Elizabeth Hartland – “Legionella Biology and Environmental Persistence”
Director & CEO, Hudson Institute of Medical Research
Head of Department, Molecular & Translational Science, Monash University)

Mr. Neil Caughey – “Epworth HealthCare – Case Study: Water System Management”
Group Director Redevelopment, Epworth HealthCare

Ms. Anne-Rita Vleugel – “Healthcare Water Filtration from POE to POU”
Business Manager, Pall Medical ANZ

Thanks, and regards

John Matthew
Marketing & Strategic Leader
Pall Medical, ANZ
M: +61 419 130 668
E: john_matthew@pall.com
W: http://www.pall.com

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[Michael Wishart]

Hi Kathy

We change our antimicrobial disposable curtains every 12 months unless stained or torn. We do not change them more frequently for patients with respiratory viruses; however we did not routinely do this after most respiratory viruses (including seasonal influenza) either.

Verily was correct in her previous message; you should check the claims of the curtain manufacturer against organisms and time. Those manufacturers who provide independently verified data are best, and you should check for both anti-viral and antibacterial claims. Real world testing (ie testing after actual use) is preferred over lab only testing.

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Kathy Mcdowell
Sent: Monday, 9 April 2018 4:47 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Disposable curtains

I also have a question in regards to Influenza.
None of the curtains claim to be effective against Influenza do you replace curtains for these patients or stay with the schedule??

Kathy McDowell
Clinical Nurse Consultant | Infection Prevention And Control Service (IPACS)
Blacktown and Mount Druitt hospitals
Mob 0407 264 379 | Kathy.mcdowell@health.nsw.gov.au
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Verily Thomas
Sent: Monday, 9 April 2018 10:39 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Disposable curtains

Hi All

We have had our disposable curtains for about 3 years now. The decision we made following an actual trial in high risk MRO areas where the curtains were left for a period of 7months and then tested with no growth (VRE or MRSA or other except an ESBL in ICU:

1. 6months for high to medium to high risk areas (which would be most of our ED, acute wards and peri-op here.

2. 12months for low risk areas (outpatient departments and clinics.

We only came out with this after an actual trial to support claims made by the supplier. I would recommend there are a whole lot of different brands out there so be careful when deciding I have observed some questionable advertising.

Kind Regards
Verily Thomas

Clinical Nurse Consultant, Infection Prevention & Control | Bankstown-Lidcombe Hospital
68 Eldridge Road, Bankstown, New South Wales 2200
Tel (02)97228000 pager 28230
Tel (02) 9722 8633 | Fax (02) 9722 7822 | Verily.Thomas@health.nsw.gov.au
http://www.health.nsw.gov.au

[http://internal.health.nsw.gov.au/communications/e-signatures/images/NSW-Health-Master.jpg]
HAND HYGIENE SAVES LIVES
CLEANER ENVIRONMENT BETTER OUTCOMES

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Juraja, Marija (Health)
Sent: Monday, 9 April 2018 9:54 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Disposable curtains

We replace every 12 months.
The exception being if its a CRO patient, or an outbreak then changed on discharge.

Kind Regards

Marija Juraja |Nurse Unit Manager CALHN Infection Prevention & Control Unit|
Division of Acute Medicine (RN, GCNS Inf Ctrl, CICP-E)
t: +61 8 7074 2810 (RAH) 8222 7588 (TQEH)| M: 0466 379 821|e:marija.juraja@sa.gov.au |
Adjunct Clinical Lecturer | University of South Australia | Division of Health Sciences
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Marie Sheehan
Sent: Friday, 6 April 2018 1:47 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Disposable curtains

Every 6 months

Marie Sheehan
CEO/DON CSDS | Business Manager MAS
Colin Street Day Hospital

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T:
F:
M:
E:

08 9321 4256
08 9321 1769
0411 738 809
marie@csds.com.au

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T:
F:
M:
E:

08 9321 7746
08 9481 1917
0411 738 809
marie@csds.com.au

Address : 51 Colin Street, West Perth, WA 6005

Please consider the environment before printing this email 1 ream of paper = 6% of a tree and 5.4kg CO2 in the atmosphere 3 sheets of A4 paper = 1 litre of water

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From: ACIPC Infexion Connexion <AICALIST@AICALIST.ORG.AU> On Behalf Of Cate Coffey
Sent: Friday, 6 April 2018 12:01 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Disposable curtains

Hi everyone,
For those of you who use disposable curtains, would you share your curtain change schedule with me?
cheers

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]

For anyone that missed Martin Kiernan’s webinar from last week, it can be accessed here, thanks to GAMA Healthcare Australia.

https://edge.media-server.com/m6/go/infection-prevention

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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[Posted on behalf of the ACIPC Secretariat – Moderator]

GAMA Healthcare Australia invite ACIPC members to join a webinar focusing on current issues in Infection Prevention and Control, hosted by Martin Kiernan.

Martin Kiernan is a Visiting Clinical Fellow at the University of West London and the Clinical Director at GAMA Healthcare Ltd. Martin has over 26 years’ experience in Infection Prevention and Control, is a past president of the UK Infection Prevention Society, current Scientific Chair of the Healthcare Infection Society Meeting and sits on the UK Department of Health Advisory board.

Please join Martin for this webinar and circulate this invitation to any colleagues who may be interested.

To join the webinar please use the following link: https://edge.media-server.com/m6/go/gama-610155

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[Michael Wishart]

Hi Helen

I can’t say I have reviewed this product at all, but I have several questions/concerns about how this product would meet the storage requirements we are being asked to meet for flexible endoscopes.

1. Is the ‘activated air’ filtered to such an extend as to be considered the same standard as HEPA filtered air?

2. How does sealing in a bag reduce growth within the scope? The principle of HEPA filtered endoscope storage cabinets, if memory serves me correctly, is to provide continuous HEPA filtered air flow through the ‘scope lumens to reduce the formation of biofilms and discourage bacteria from staying on lumen surfaces. This doesn’t seem to me to meet this principle.

3. Has the manufacturer stated this process would negate the need for re-sterilization of the endoscopes prior to use after storage over a set number of days, and is this a claim TGA has endorsed?

I would like to think this is a magic solution to having to buy HEPA filtered storage cabinets for our endoscopes, but the cynic in me doesn’t think this is such a solution.

Be interested in the feedback of anyone from GENCA or GESA, actually. I might try and make some enquiries.

Cheers
Michael

Michael Wishart, CICP-E
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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Good morning all,

I have been approached regarding introducing a new technology for endoscope reprocessing. This device enables fast scope channel drying and storage using “activated air”. The scope is stored in a dedicated sealed bag which can also be used for transport with barcode traceability. The facility currently does not have HEPA filtered forced air drying cabinets and sees this new technology as a possible alternative process to meet GESA/GNECA and AS:4187 compliance.

The device has recently been granted a ATG certificate.

I would love to hear thoughts from anyone who has also reviewed this product. Happy to provide product name off line.

Have a nice day,
Helen

Helen Newman

Infection Prevention and Control CNC CICP| Infection Management and Control Service
Shellharbour and Kiama Hospitals
Tel 02 4295 2416 | Mobile 0475823959 | Fax 02 4295 2497 | Helen.Newman@health.nsw.gov.au
http://www.health.nsw.gov.au

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This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return https://clicktime.symantec.com/a/1/fPGdqe_2pjHSX7MvOYl1GyywrkPjLHMp9Vjxs_Orngw?doMW15ejg74nj4VvePDQ1iLMX-NRKPAEkknd53NF25VR5UCNAoGmTwQFEBCg5cTf-TQPLODHlbtamf2xxrBLc_kOjbAUnUMkvUayvlpUsRgT3d6RdbPGmtTWodwx_cw24me4GZJ10jpE8vYQSqywORuj5LeDzPReVPywsngmZKmwWHiFdGETTFaT5irN0UElJVQybDTOtc3SMJt2W6fR3r277HZrdniHoc6lsO8EuuRFFLrERDu8gRTtlYGORWGoPgTsZMZgyPaSUlruexqxjuIXE97nGRd7gT88aOSHKSBG0n6AF_E0jq-hZO5gGTvsjRwqVTqULo2405vN56U-XYZbHJo6wlOhaWeHjJ0mq2p5aCl8OIX2gQl6SpO2DGomeYrbKnuM8EvFplJ9NZlOjzrSzHgOIPAo2rLUQZX4ZQwVUTPnKWtA%3D&uemail%2C%20delete%20the%20Email%2C%20and%20do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia.
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This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return email, delete the Email, and do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

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