[Michael Wishart]

Hi Cath

Yes, cleaning effectiveness in hospitals is definitely a concern. There is a current QUT research study on how to improve cleaning effectiveness with a bundle approach without additional expensive technology, which (if demonstrated to be effective) may be an option for hospitals to adopt at a lesser cost than some of the newer technologies. Worth watching this study, I think.

It may be that a combination of this type of cleaning bundle and some newer technologies (like vapourised hydrogen peroxide) for some specific indications may be the most cost effective and efficient process.

http://reach.cre-rhai.org.au/

Cheers
Michael

Michael Wishart
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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In 2010 I pioneered Australia’s first study showing that efficiency of routine cleaning was on average about 50% meaning that half of the time hospital rooms were not cleaned properly. This was an alarming fact but identical to results from the USA and other countries who had studied the problem. Great new technologies have been developed which US and UK research proves can eliminate any bugs that remain in improperly cleaned rooms. However their cost and a general reluctance to adopt them or include them as an option is limiting their adoption and use in Australia. Today the article below from the US CDC has been published showing that in a long study of several US hospitals serious multiple drug resistant organisms (MDROs) {Superbugs} were recovered from 34% of routine cleaned room composites (range 1-13,000 CFU/100 cm2) and 17% of terminal cleaned room composites (1-524 CFU/100 cm2). MDROs were recovered from 40% of rooms. This is a very important finding and it should compel Australian policy makers to immediately relook at ways to support the use of those “waterless” systems of high level room disinfection such as pulsed Xenon, peracetic gas or ultraviolet light options. We can control antibiotic use as much as we like but if we can’t improve basics like hand hygiene compliance and staff healthcare organisations with enough, well-trained and well-supported cleaning staff we have no chance of providing staff with rooms clean enough to protect patients from being a risk of develop a serious hospital infection. Obviously I appreciate the cost and effort required to implement new methods and technologies as well as current Australian research looking at bundled approaches (hand hygiene and traditional manual cleaning – both of which are likely ineffective in their current practice) but we really can no longer bury our heads about this issue and we need to give it priority.

________________________________
Infect Control Hosp Epidemiol. 2016 Sep 13:1-7. [Epub ahead of print]
Assessment of the Overall and Multidrug-Resistant Organism Bioburden on Environmental Surfaces in Healthcare Facilities.
Shams AM1, Rose LJ1, Edwards JR1, Cali S2, Harris AD3, Jacob JT4, LaFae A4, Pineles LL3, Thom KA3, McDonald LC1, Arduino MJ1, Noble-Wang JA1.
Author information

* 11Division of Healthcare Quality Promotion,National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,Georgia.
* 22University of Illinois at Chicago School of Public Health,Chicago,Illinois.
* 33University of Maryland School of Medicine,Baltimore,Maryland.
* 44Emory University School of Medicine,Atlanta,Georgia.
Abstract
OBJECTIVE To determine the typical microbial bioburden (overall bacterial and multidrug-resistant organisms [MDROs]) on high-touch healthcare environmental surfaces after routine or terminal cleaning. DESIGN Prospective 2.5-year microbiological survey of large surface areas (>1,000 cm2). SETTING MDRO contact-precaution rooms from 9 acute-care hospitals and 2 long-term care facilities in 4 states. PARTICIPANTS Samples from 166 rooms (113 routine cleaned and 53 terminal cleaned rooms). METHODS Using a standard sponge-wipe sampling protocol, 2 composite samples were collected from each room; a third sample was collected from each Clostridium difficile room. Composite 1 included the TV remote, telephone, call button, and bed rails. Composite 2 included the room door handle, IV pole, and overbed table. Composite 3 included toileting surfaces. Total bacteria and MDROs (ie, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci [VRE], Acinetobacter baumannii, Klebsiella pneumoniae, and C. difficile) were quantified, confirmed, and tested for drug resistance. RESULTS The mean microbial bioburden and range from routine cleaned room composites were higher (2,700 colony-forming units [CFU]/100 cm2; 1-130,000 CFU/100 cm2) than from terminal cleaned room composites (353 CFU/100 cm2; 1-4,300 CFU/100 cm2). MDROs were recovered from 34% of routine cleaned room composites (range 1-13,000 CFU/100 cm2) and 17% of terminal cleaned room composites (1-524 CFU/100 cm2). MDROs were recovered from 40% of rooms; VRE was the most common (19%). CONCLUSIONS This multicenter bioburden summary provides a first step to determining microbial bioburden on healthcare surfaces, which may help provide a basis for developing standards to evaluate cleaning and disinfection as well as a framework for studies using an evidentiary hierarchy for environmental infection control. Infect Control Hosp Epidemiol 2016;1-7.
Warm regards
Cath

Cathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, Australia

E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.au

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[Michael Wishart]

[Posted on behalf of Samantha Palmby – Moderator]

Hi Glenys, the SVHM IC Study day program is attached.

Sam

Samantha Palmby | Infection Control Consultant
St Vincent’s Melbourne | 41 Victoria Parade Fitzroy VIC 3065
t: +61 3 9231 4704 | f: +61 3 9231 4068 | http://www.svha.org.au

Hi Sam,

Are you able to post the full program including speaker details

Many thanks

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 6385
Melbourne 3004
Australia
M: +61 404 816 434
E: infexion@ozemail.com.au
ABN 47533508426
Please note my new mailing address

[Description: ICC Diagram ICCversion]

Dear all Victorian members,

We would like to extend an invitation to the St Vincent’s Public Hospital Infection Control Study day.

Details:

St Vincent’s Hospital Melbourne
Infection Control Study day

Wendesday 19th October 2016
8.30-3.30pm

This program aims to broaden health professionals knowledge base about current issues/medical conditions with regard to Infection Control principles. The study day is a general study day for nursing and allied health staff working in acute/subacute and residential facilities. Topics include TB medical management & community TB based programs, the changing world of Resistant Organisms, new Hep C treatments, improving Childhood Immunisation rates, vaccine preventable illness in public health.

VENUE:

St Vincent’s Hospital

Building E

Michael Chamberlain Lecture Theatre

Ground Floor, Aikenhead Building

Victoria Pde, Fitzroy

Bookings are available through: https://www.trybooking.com/Booking/BookingEventSummary.aspx?eid177602

Thanks
Sam

Samantha Palmby | Infection Control Consultant
St Vincent’s Melbourne | 41 Victoria Parade Fitzroy VIC 3065
t: +61 3 9231 4704 | f: +61 3 9231 4068 | http://www.svha.org.au
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[Michael Wishart]

Hi Sally

I actually think that this is one of those ‘needs common sense approach’ chestnuts.

What are we actually doing when using transmission based precautions? Trying to prevent spread of something from one patient to another. What are we trying to do if we use ‘protective precautions’? Trying to stop the immunosuppressed patients from getting an infection.

My ID and micro colleagues tell me the majority of infections neutropenic and other immunosuppressed patients actually get infected with arise from within their own body flora, or even are reactivations of previous infections. Not much will help prevent that in the way of single rooms and PPE.

There is definite benefit to reducing exposure to those with an infective illness, but this is also true of the rest of our patients (and staff!). So signage of this type is better off a hospital or ward entry level.

A single room may be of benefit in reducing exposure to people (more visitors in a multi bedded room), but the haem/onc staff tell me there are other nursing reasons for placing neutropenic patients in single rooms with dedicated ensuite apart from exposure to people. So they routinely do this, but no specific signage goes on the door.

This facility does not use any specific signage for ‘protective precautions’, although we occasionally put signage at ward entries about visiting when you are symptomatic with something.

Hope this rambling discourse gives you some idea what we do here, and what my thoughts are.

Cheers
Michael

Michael Wishart
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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Dear all

A ‘ this old chestnut’ question 🙂 !

I was wondering if there might be a few people who could comment on ‘protective precautions’ for the neutropenic patient. Specifically:

* What is your workplace policy/procedure?

* If your workplace does have specific precautions, do you within your IC role monitor or have involvement with any policies relating to this?

* Do you think it is a responsibility of IC programs within a facility?

I get many questions regarding this from staff. Advice from other IC colleagues is that it doesn’t really come under infection control. Not discussed in national guidelines (that I could find) and appears good standard precautions covers risk.

Most hospitals do seem to have protective precaution posters which cover/reinforce standard precautions (Hand Hygiene, Cleaning of equipment if not single use, to not visit if have a current infection)
And then some additions i.e.:

* Single room with door closed

* Advice to visitors to see nurse before entering

* Dedicated equipment

Looking forward to your feedback.

Kind regards,
Sally Brew

Infection Control Clinical Nurse – Broome Regional Health Campus
WA Country Health Service Kimberley
PO Box 62 | Broome WA 6725
P (08) 9194 2353 M 0438 903 210
Email:Broome.InfectionControl@health.wa.gov.au
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[Michael Wishart]

Hi Fran

Not sure if you are referring to use of alcohol hand gels/rubs in procedural areas for social handwashing, or use of waterless alcohol as a scrub agent.

We have been doing both here for a number of years. There are some surgical disciplines where the use of waterless alcohol based scrub agents has been embraced with a gusto. And some surgical disciplines where waterless alcohol based scrub agents are still frowned upon.

I would say 70% of all of our surgical scrubbing is now down with waterless alcohol based products. It has generally been well received. My only reservations are bout the professional societies not having good guidance on their use. ACORN has recently released some better guidance, but none of the surgical colleges have any specific guidance about how to use waterless agents, when you need to wash with soap and water, or anything. This to me makes to hard to enforce good practice across all disciplines. But then again, I have recently discovered that RACS doesn’t even have a procedure on how to do a water based surgical scrub!

Europeans have been using waterless based alcohol scrubbing for some time, and there has been no reported changes in SSI rates there.

So, I would give surgeons and theatre nurses the option of using these products, setting some simple ground rules for their use (like soap and water wash before the first waterless scrub of each list).

Good luck.

Cheers
Michael

Michael Wishart
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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Dear all,

How many of you out there are currently using an alcohol-based surgical hand rub in the Perioperative Suites? Some Visiting Medical Officers states that they’ve never heard of it and others can’t go without it.

Kind Regards

Franciska Ferreira
Infection Prevention & Control/Wound Management Consultant
Burnside War Memorial Hospital
120 Kensington Road, Toorak Gardens, SA 5056
t: 08 8202 7222 f: 08 8407 8573 e: fferreira@burnsidehospital.asn.au

[user] [bHand Hygiene day 16]

“Share the fun not the germs, clean your hands”

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[Michael Wishart]

Hi Carien

I have worked in private facilities that have different emphases in regard to hand hygiene audits.

One private facility provided no ward based resources for auditing, and said infection control had to do all of the auditing. The result of this was no ownership by ward managers or staff over either auditing or compliance results. Nothing changed, except infection control got less other stuff done.

Another private facility has enforced ward managers being responsible to provide a KPI for moments collected on their ward. This has resulted in multiple staff in each ward being trained as auditors, and ward managers taking ownership of the audit results and compliance results. Far more effective, in my (infection control biased) opinion. And is slowly changing the facility culture of healthcare worker hand hygiene, in my opinion.

I personally believe it is very short-sighted to say there is no financial return on hand hygiene auditing, which is often the argument not to commit resources. There is plenty of evidence that supports hand hygiene as the most likely indicator of the risk of transmission of MRO’s in a facility. If you can get wards and departments to take ownership of improving hand hygiene, it can have multiple flow on improvement effects, and have an overall impact on reduced healthcare associated infections.

All my opinion, of course.

Good luck.

Cheers
Michael

Michael Wishart
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 afternoon,

I’m seeking advice from my colleagues in the Private Health sector as to how you run an effective hand hygiene program. I’m specifically referring to the challenges related to auditing where there are no hours allocated for auditing and in a climate of reduced clinical hours therefore making it even harder to fit auditing in with a very high workload for staff in clinical areas.

Kind regards,
Carien

Carien Coleman | Infection Control CNC
The Sunshine Coast Private Hospital
Syd Lingard Drive | BUDERIM QLD 4556
PO Box 5050 | Maroochydore BC QLD 4558
T: (07) 5430 3245 | F: (07) 5430 3154
E: carien.coleman@uchealth.com.au

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[Michael Wishart]

Hi Cath

You know I am also passionate about reducing the preventable healthcare infection burden, but I just wanted to debate some of the ‘technology consumables’ in a standard bundle approach.

Yes, we should all ensure that insertion and management of central lines is standardised, but the actual role of some technology solutions such as chlorhexidine impregnated dressings and devices, and impregnated access device caps for management, as just two examples of available technology, is still very much debatable, in my opinion, in management of all central lines.

We can throw money and resources into technological solutions, but are we really getting the ‘best bang for our buck’ with our healthcare spending by doing this? There needs to be better evidence to base these choices on, and groups like Claire Rickard’s vascular access research group with large multicentre trials will hopefully start providing some answers to these questions in the future. But to promote using these technological solutions for all central line management (eg ‘bundle approach’), is premature in my opinion. Unless I have misinterpreted what you are proposing.

In the private sector, we are already facing issues with the private health funds in regard to what they are saying is ‘preventable’. Most of their current systems are based on coding, and we all know how well clinical codes reflect the infection risk and preventability. I welcome debate about how we can reduce the risk of preventable infections, and feel the professional bodies such as ACIPC and ASID should have a role to play in developing criteria to be used by funding bodies. Maybe our professional association should be lobbying on behalf of the members for this to be discussed.

All my opinion only, of course.

Cheers
Michael

Michael Wishart
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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Here is some info on what Medibank Private has apparently done

Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.

I am unable to comment on public sector.

1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdf

My opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.

You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.

Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.

I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.

Warm regards
Cath

Cathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, Australia

E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.au

Cath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regards

Sharon

Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au

[cid:image005.png@01D0774C.C15F6A20]

Here is the companion old chestnut question that goes with better public reporting.

Is any state aware of new penalties introduced for public hospitals?

I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.

Is the public sector still tolerating CLABSIs without penalty?

https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html

Warm regards
Cath

Cathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, Australia

E: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.au

Hi Michael and Cath,

Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418

You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……

Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.

Thanks

Brett

Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, Cooranbong

Avondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia

[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]

Hi Cath,

I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.

At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.

It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.

A favourite topic of mine so happy to chat offline if I can be of assistance!

Kind regards,

Robert

Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia

—–Original Message—–

I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.

My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.

My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.

Regards and thanks

Cath

Dr Cathryn Murphy RN MPH PhD CIC

Executive Director

Infection Control Plus Pty Ltd

http://www.infectioncontrolplus.com.au

Cath@infectioncontrolplus.com.au

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[Michael Wishart]

Thanks John

I am assuming this would be at 10pm AEST? Will it be recorded and available for later download? If we register for this event, would that let us access any downloads related to this presentation?

Cheers
Michael

Michael Wishart
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 Matthew, John
Sent: Tuesday, 30 August 2016 2:46 PM
To: AICALIST@AICALIST.ORG.AU
Subject: FW: September Water Webinar: Legionnaires disease & Legionella guidelines: A global update

Hello Everyone:

Legionnaires disease & Legionella guidelines: A global update, by Dr. Susanne Lee

For those of you who may be interested in Legionella in the healthcare setting, below is an invitation to attend a free webinar being held next week by the Royal Society of Public Health (RSPH), who hold a series of water-related webinars through their summer, some of which are healthcare-related, others to do with food prep, swimming pools, spas, etc. The live webinars unfortunately occur in the middle of the night for us here in ANZ, but by registering we will still have access for 24 hours after the live presentation. After this time, the webinars are available to RSPH members only.

This particular webinar is by Dr. Susanne Lee, a well-known and respected speaker on the topic, and Chair of the RSPH Water Special Interest Group. She spoke last year at The Wesley Hospital Legionella Conference in Brisbane, and also in a Water Hygiene Workshop at The Alfred in Melbourne.

For those interested, please click on the pink Register your free place now button below.

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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From: Royal Society for Public Health [mailto:rsph@rsph-email.org.uk]
Sent: Monday, 25 July 2016 7:07 PM
To: Matthew, John <john_matthew@ap.pall.com>
Subject: September Water Webinar: Legionnaires disease & Legionella guidelines: A global update

July 2016

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Legionnaires disease & Legionella guidelines: A global update

Tuesday 6 September 2016

1-2.00 pm BST

Speaker: Dr Susanne Lee FRSPH, Director of Leegionella Ltd and Chair, RSPH Water Special Interest Group

Chaired by: Dr Birgitta De Jong, Senior Expert, European Centre for Disease Prevention and Control

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[Michael Wishart]

Hi Cath

The issue with non-ICU CLABSI data is determining denominators. Not many non-ICU areas collect line days, so getting more than single facility data is difficult. We need ANZICS-like organisations and guidance in these areas to help collate these non-ICU data.

Cheers
Michael

Michael Wishart
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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Thanks Marilyn and others I have this data – ANZICS is as you know ICU data and useful. Would be great to also know rates in non-ICU settings eg oncology, BMT etc.

Cath

The ANZICS data is available on their website

http://www.anzics.com.au/Downloads/CLABSI%20Report%202014-15.pdf

Marilyn

Professor Marilyn Cruickshank RN PhD FACN
Director National Healthcare Associated Infection Program
Professor School of Nursing and Midwifery, Griffith University
Australian Commission on Safety and Quality in Health Care
GPO Box 5480 Sydney NSW 2001 | Level 5, 255 Elizabeth Street, Sydney NSW 2000
( (02) 9126 3586 | 0423 842 897 | http://www.safetyandquality.gov.au
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Cath, you can access the Victorian data through the Department of health website here:
http://performance.health.vic.gov.au/Home/Report.aspx?ReportKey425
Ann

Dr Ann Bull | Operations Director
VICNISS Coordinating Centre
Doherty Institute | 2nd Level
792 Elizabeth St Melbourne VIC 3000
T: + 61 3 93429351 | F: +61 3 93429351 | http://www.vicniss.org.au
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Dear All

I am working on an urgent project and wondering if anyone knows of any current, valid and reliable Australian CLABSI rate data available anywhere in public domain? I am especially interested in incidence, attributable morbidity, cost etc.

I suspect that ANZICs has the best dataset but it is not freely available outside of the ANZICs network.

In the absence of this type of detailed data I am assuming extrapolation is the best approach. Grateful for any insights.

How I long for greater transparency of data for all HAIs.

Warm regards
Cath

Cathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, Australia

E: Cath@infectioncontrolplus.com.au
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W: infectioncontrolplus.com.au

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[Michael Wishart]

Thanks Terry

Where does battery waste go? Who handles it, how is it processed? I am not really familiar with this specific waste stream. And would it be managed the same for each facility/state?

Thanks
Michael

Michael Wishart
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 Terry Grimmond
Sent: Tuesday, 14 June 2016 8:44 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Explanted Pacemakers – ? disposal

Hi Michael,

What a conundrum! I note the WA Guide does not answer your Q.

Are not pacemakers sealed. If so, what is issue with,:

Remove gross soiling and organic matter with detergent

Soak in 5,000ppm hypochlorite for 10 mins

Dispose of as battery waste in sealed bag with outer label stating decontamination has taken place?

If above unacceptable, we need strongly urge mfger to accept them back after the above procedures have been performed. (manufacturer responsibility is an important avenue in healthcare sustainability)

Regards, Terry

Terry Grimmond FASM, BAgrSc, GrDpAdEd
Consultant Microbiologist
Grimmond and Associates
Ph (NZ): +64 7 855 3212
Mob (NZ): +64 274 365 140
E: terry@terrygrimmond.com
[Twitter_logo_blue]: @terrygrimmond
W: http://terrygrimmond.com
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Narrogin Infection Control
Sent: Monday, June 13, 2016 7:39 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Explanted Pacemakers – ? disposal

Hi Michael,
This WA document may be helpful.

Kind Regards
Sue

SueSimmonds CN
Infection Prevention
Narrogin Hospital
WA Country Health Service – Wheatbelt
Po Box 336 | NARROGIN WA 6312
Ph: 08 98810462 | Fax: 08 98810315
Email: narrogin.infecti.control@health.wa.gov.au
Working together for a healthier country WA
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Monday, 13 June 2016 7:55 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Explanted Pacemakers – ? disposal

Question from my CSSD manager;

How can we safely dispose of explanted pacemakers?

What can we do with them?

VMO and suppliers do not want them back (unless specified)

We cannot clean properly unless we start to disassemble

We cannot throw into rubbish as contain batteries

Cannot throw into battery recycling as theoretically are still contaminated
Now some CSDs are known to unofficially dispose of them in the sharps which is probably even more dangerous!

Thoughts on this? Does anyone have a policy on disposal of explanted pacemakers? Do any health authorities provide advice on this?

Thanks for any advice on this.

Cheers
Michael

Michael Wishart
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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[Michael Wishart]

Hi Fiona

We mainly use alcoholic chlorhexidine as a skin prep pre-operatively as well, but there are times our surgeons will use alcoholic povidone iodine as a skin prep. The guidelines suggest that the same antiseptic should be used for pre-operative washing as is used for the skin prep. This means we still need to have a povidone-iodine pre-op wash available.

Since the shortage of the impregnated scrub sponges started, we have been using liquid povidone iodine applied with a cloth, but this is quite messy and the staff and patients would much prefer a pre-impregnated sponge.

Is anyone aware of any currently available on the market in Australia?

Thanks
Michael

Michael Wishart
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 Rick De Sousa
Sent: Friday, 10 June 2016 8:30 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Betadine impregnated sponges

Hi Carien,
We use a chlorhexidine impregnated sponge for our joint replacement and other patient pre op washes.
Fiona De Sousa
RN, Newcastle Private Hospital

Sent from my iPhone

On 9 Jun 2016, at 3:51 pm, Carien Coleman <Carien.Coleman@UCHEALTH.COM.AU> wrote:
Hi everyone,

Ive recently been informed that betadine impregnated sponges have been discontinue. Can anyone please advise what alternative products are being considered or used for pre-operative skin washes (at home) prior to joint replacement surgery?

Thanks,
Carien

Carien Coleman | Infection Control CNC
The Sunshine Coast Private Hospital
Syd Lingard Drive | BUDERIM QLD 4556
PO Box 5050 | Maroochydore BC QLD 4558
T: (07) 5430 3245 | F: (07) 5430 3154
E: carien.coleman@uchealth.com.au

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[Michael Wishart]

Hi Lynette

Had this discussion with my link nurses just the other day. The answer is: it depends. 🙂

It depends on what they are in isolation for, whether they can (and will!) follow directions, and what the risks are to other patients in the ward.

So, we take a pragmatic approach. We don’t want to lock patients up unnecessarily, but we also must be mindful of risks to other patients. So, if they can follow simple directions, and are not likely to leak stuff, we let them mobilise around the ward, but no sitting in common areas, or entering common areas, or other patient rooms. If they are on droplet precautions and can tolerate a surgical mask, we will allow them short trips outside their room wearing a mask. If they have copious secretions, though, this may not be possible. So it is case by case, and often staff will ask me for advice if they are unsure. And always done with discussion with the patient.

If staff need to accompany patients when mobilising outside the room (eg physios) they will wear the appropriate PPE as they accompany the patient.

Hope this helps.

Cheers
Michael

Michael Wishart
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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Afternoon,

I was just wanting to find out what other facilities do with regards to patients mobilising that are on transmission based precautions?

With kind regards,
Lynette CribbInfection Control Coordinator
Direct 07 3834 4328 | mobile 0427141223 | Fax 0738344599
SAWMH.ICC@uchealth.com.au | standrewshospital.com.au
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[Bugs-and-tear LR]

Remember to protect your patients, family and yourself by getting the Influenza vaccination

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[Michael Wishart]

Hi Cate

If it is airborne dust rather than trafficked dust that is the issue, my thoughts would be to get the contractor to create a ‘negative pressure’ zone in the corridor outside the work to stop dust spreading to other areas through the air. There are mobile negative pressure extractors they can hire which can be placed strategically in the corridor.

Just a thought.

Cheers
Michael

Michael Wishart
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 trying to manage construction dust from the new ICU build- yes the same one as the jumbo toilet rolls- I am having an issue with dusty footprints in the hallway and lift near the construction zone. The wards close to the zone include Renal Dialysis, Maternity, NICU and ICU The contractors regularly mop the hallway etc but the issue is the dust leaving the zone. In the Zone there is a long piece of carpet leading to door and just before the door is another sticky matt. There is also a rubber matt outside the door. There is a sign about wiping feet etc. It is clear that these are not enough, can anyone give me some ideas on the best way to manage this. We have a good working relationship with the contractors and should be able to resolve this issue. Are there better products the contractors can purchase to prevent this dust be transported
Thanks in advance
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]

Hi Glenys

This applies to any revised or new standards. There needs to be a trade-off between best practice / safety and cost of introduction. If you are renovating or refurbishing, particularly with replacing machinery, then you must comply with the new standard as part of the changes. If, however, your department is not changing then gradual changes which can be absorbed into overall costs are preferred.

None of the ‘changes’ in AS4187:2014 are really, new, to my mind. Most have been preferred best practice for some time. The question is really: when should the requirements of this standard by enforced by accreditation?

If you take that view, I think an overall 5 year plan is quite reasonable. In my opinion, anyway.

Cheers
Michael

Michael Wishart
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 Glenys Harrington
Sent: Monday, 6 June 2016 3:24 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Advisory No. A16/03AS: Reprocessing of reusable medical devices in health service organisations

Dear All,

Further to below Im concerned about the advisory in terms of patient safety.

Given that the advisory primarily relates to the sterility of instruments used for surgical and other invasive procedures I was surprised to see a lag time of up to 5 years (2021)to fully implementation of AS:4187:2014.

This seems like a very long lag time for such high risk instruments and equipment.

What do others think?

Kind regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Glenys Harrington
Sent: 6 June, 2016 2:31 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Advisory No. A16/03AS: Reprocessing of reusable medical devices in health service organisations

Hi Roel,

Many thanks for the update and advice for ICPs.

I understand from some ICPs that sourcing the ISO standards as referenced in the AS:4187:2014 could be up to $10,000.

Are you saying that you can purchase specific sections of an ISO standard (i.e. the normative component of the compliance) rather than the whole standard and that this section includes specific details to enable auditing of a facility?

You mentioned independent organisation/s (comes with a price) that you can purchase audit tools from – can you provide the details and ill get some costings.

Many thanks in anticipation

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Roel Castillo
Sent: 6 June, 2016 1:32 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Advisory No. A16/03AS: Reprocessing of reusable medical devices in health service organisations

Hi All

In relation to questions posted below. I will try my best to answer. Otherwise I can be contacted on my work email. Happy to help. I am lucky that the facility I work with happened to have an ISO accreditation 3 weeks ago. My role have given me the option to comply with some of the requirements of the AS 4187:2014.

– have organisations been able to access/obtain all the standards that you are required to meet in AS:4187:2014 (i.e. AS and ISO standards)? – Answer: Yes at the facility I am currently employed and at a previous facility I worked with. Please be aware that you are only required to access parts of the relevant standards specifically referred to as a normative component of the compliance. I have known managers in areas where they have purchased what is required.

– what was the cost associated with obtaining these standards (i.e. ISO standards)?
Answer: I wouldnt worry much about the cost of the ISO standards. It would be more on the equipment compliance, monitoring and contingencies attached to gaps if the required monitoring suggests resolution of issues ( how do you manage them?). An example is specific to Table 7.2 where are the requirements of water quality, endotoxin, among others are specified. Also too the AS 4187:2003 is referring to “older” AS standards compliance whereas the AS 4187:2014 refers to a more current and ISO (at that level) which is more stringent and technically demanding, so there are, unfortunately dollar values involved as with other compliance.

– have organisations been able to develop an audit tool that include standards (i.e. ISO standards) that are referred to in AS4187:2014?
Answer: There are independent organisation/s (comes with a price) that have prepared but I am not aware of the sufficiency of the audit. It would be interesting if the college would fund such an audit tool which I think many of us will be happy to be part of.

Roel Castillo

Sterilising Services Unit Manager

Macquarie University Hospital
3 Technology Place
Macquarie University, NSW 2109, Australia Locked Bag 2231, North Ryde BC, NSW 1670

T: +61 2 9812 3213 I M: +61 0 434 496 829
Email: roel.castillo@muh.org.au
http://www.muh.org.au

Macquarie University Hospital is Australias first and only private hospital on a University campus. We are committed to delivering superior clinical outcomes and a positive patient experience through the best available care and technology.
Disclaimer: This message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender. Views expressed in this message are those of the individual sender, and are not necessarily the views of Macquarie University Hospital.

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Glenys Harrington
Sent: Monday, 6 June 2016 12:14 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Advisory No. A16/03AS: Reprocessing of reusable medical devices in health service organisations

Dear All,

In relation to the ACSQHS advisory posted below Im interested to know the following:

– have organisations been able to access/obtain all the standards that you are required to meet in AS:4187:2014 (i.e. AS and ISO standards)?

– what was the cost associated with obtaining these standards (i.e. ISO standards)?

– have organisations been able to develop an audit tool that include standards (i.e. ISO standards) that are referred to in AS4187:2014?

Regards

Glenys

Glenys Harrington
Consultant
Infection Control Consultancy (ICC)
PO Box 5202
Middle Park
Victoria, 3206
Australia
M: +61 404 816 434
infexion@ozemail.com.au
ABN 47533508426

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: 6 June, 2016 9:48 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Advisory No. A16/03AS: Reprocessing of reusable medical devices in health service organisations

[Posted on behalf of Roel Castillo – Moderator]

Hi all

Please refer to link below. ACSQHS advisory in regards to compliance to the new AS:4187:2014:

https://apac01.safelinks.protection.outlook.com/?url=http%3a%2f%2fwww.safetyandquality.gov.au%2fpublications%2fadvisory-a1603-reprocessing-of-reusable-medical-devices-in-health-service-organisations%2f&data=01%7c01%7cRoel.Castillo%40MUH.ORG.AU%7c6923ac5e4084400687e008d38db7d5be%7cde154fbf3b664e1a9f9f3f164fdc85e1%7c1&sdata=vnzV3DmdelaFfK88P6Gy%2bJAvJKk4bmwFSDILFhyQJw8%3d

Regards

Roel Castillo

Sterilising Services Unit Manager

Macquarie University Hospital
3 Technology Place
Macquarie University, NSW 2109, Australia Locked Bag 2231, North Ryde BC, NSW 1670

T: +61 2 9812 3213 I M: +61 0 434 496 829
Email: roel.castillo@muh.org.au
https://apac01.safelinks.protection.outlook.com/?url=www.muh.org.au&data=01%7c01%7cRoel.Castillo%40MUH.ORG.AU%7c6923ac5e4084400687e008d38db7d5be%7cde154fbf3b664e1a9f9f3f164fdc85e1%7c1&sdata=esr%2fIJ9bpB384J6hVbIxAhqpFx5FW8JB7jXGieP9US4%3d

Macquarie University Hospital is Australias first and only private hospital on a University campus. We are committed to delivering superior clinical outcomes and a positive patient experience through the best available care and technology.
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[Michael Wishart]

Hi Rita

In my opinion you are opening Pandora’s fabled box if you take this path of ‘ring-fencing’ You are basically saying that contact precautions are not sufficient. I have seen this attempted and it made no difference in a large hospital already endemic with MROs. And one of the spinoffs can be suboptimal care for orthopaedic patients who are excluded from orthopaedic wards.

In my opinion, anyway. Someone may have some studies to support either position. Just be careful the path you take, in my experience.

Cheers
Michael

Michael Wishart
Infection Control Coordinator

A 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226

P Please consider the environment before printing this email

Sent by Outlook for Android on a Galaxy S5

On Mon, May 30, 2016 at 10:14 PM -0700, “Rita Roy” <Rita.Roy@HEALTH.NSW.GOV.AU> wrote:

Dear All,
Does any hospital have a guideline for admission of patients to orthopaedic wards? More specifically, are there any criteria that you might be following, for example: no patients with MROs, wounds, ulcers, etc. to be allowed admission into orthopaedic wards, even if the presentation is related to orthopaedics?
Many thanks in advance,
Rita
Rita Roy

Clinical Nurse Consultant | Infection Control
Hornsby Ku ring gai Health Service, Palmerston Road, Hornsby NSW 2076
Tel (02) 9477 9232 | Fax (02) 9477 9013 Rita.Roy@health.nsw.gov.au
http://www.health.nsw.gov.au

Click here to visit the Infection Prevention and Control page on the Intranet
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[Michael Wishart]

[Posted on behalf of member – Moderator]

Hi Cate,
I am under the impression that the toilet paper leaflet dispensers are more cost effective, available in single and multiple ply. These dispensers have no possibility of contamination and the dispenser is cleanable.

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. http://www.westernhealth.org.au

[2010wh_logo]
C ompassion, A ccountability, R espect, E xcellence, S afety

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