[Michael Wishart]

The only issue in my view would be from a discharge cleaning perspective. If you normally dispose of paper (non-wipeable) products after an MRO in the room, for example, this would potentially increase wastage.

Otherwise, I would agree it is not an infection control issue.

Cheers
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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________________________________

It is not something you are putting onto a sterile or even particularly clean site, so I dont really think its an infection control risk.

Kelly

Kelly Barton
Infection Prevention & Control Officer
Monday- Friday.

P Reduce, re-use, recycle. Please consider the environment before printing this e-mail.

30 ODonnell Ave
Myrtleford, Vic. 3737.

Hi everyone,
I have request by builders to put jumbo toilet roll holders that hold large round rolls- in ensuite rooms on a new ICU build. My thoughts are no it is an infection control risk but I thought I would ask my more experience learned colleagues in case you have done this?.
Yep sure am covering the big issues today!!!

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]

Not sure if the perfusionists are a chapter of CTS but they would definitely have an interest in this discussion, and should also be engaged.

In my facility the perfusionists are driving the clinical changes related to this issue.

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
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this email

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Glenys Harrington
Sent: Friday, 29 April 2016 1:38 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Mycobacterium chimaera update

Hi Irene,

No Im not aware if the ANZ Society of Cardiothoracic Surgery haven taken this issue up.

Think the issue may be bigger than just relying on a surgical society to organise action.

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

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Wilkinson, Irene (Health)
Sent: 29 April, 2016 1:09 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Mycobacterium chimaera update

Thanks for the information Glenys.
Do we know if the ANZ Society of Cardiothoracic Surgery has taken up this issue here in Australia?
I would have thought this would be the proper avenue for action, similar to the way the Gastroenterologists have taken on board the issues around duodenoscope contamination and the risk of CRE transmission.

Regards,
Irene Wilkinson BSc(Hons) MPH
Manager, Infection Control Service
Communicable Disease Control Branch
System Peformance and Service Delivery
SA Health
Government of South Australia

Ph: (08) 7425 7170 | Fax: (08) 8226 2594 | Email: Irene.Wilkinson@sa.gov.au
http://www.sahealth.sa.gov.au/infectionprevention
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From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Glenys Harrington
Sent: Friday, 29 April 2016 11:24 AM
To: AICALIST@AICALIST.ORG.AU
Subject: FW: Mycobacterium chimaera update

Dear All,

Further to below, there is another interesting posting today on Controversies in Hospital Infection Prevention titled:

More data support a common source for the M. chimaera outbreak

http://haicontroversies.blogspot.com.au/2016/04/more-data-support-common-source-for-m.html

The Eurosurveillance publication referred to on the posting notes the following:

Cases had been exposed to HCUs from one single manufacturer during open chest surgery up to five years prior to onset of symptoms. During environmental investigations, M. chimaera was detected in samples from used HCUs from three different countries and samples from new HCUs as well as in the environment at the manufacturing site of one manufacturer in Germany. See link below

Eurosurveillance, Volume 21, Issue 17, 28 April 2016
Surveillance and outbreak report
CONTAMINATION DURING PRODUCTION OF HEATER-COOLER UNITS BY MYCOBACTERIUM CHIMAERA POTENTIAL CAUSE FOR INVASIVE CARDIOVASCULAR INFECTIONS: RESULTS OF AN OUTBREAK INVESTIGATION IN GERMANY, APRIL 2015 TO FEBRUARY 2016

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22461

There are more than one manufacturing plant for these devices hence it would be important to know the following:

a) when you HCU was purchased and

b) which manufacturing plant your HCU came from.

The LivaNova group (formerly Sorin Group Deutschland GmbH) should be able to provide this information based on the serial number of your HCU.

See the link to the FDA warning letter to LivaNova

http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2015/ucm479684.htm

This posting on the FDA may also be of interest/use.

http://www.fda.gov/medicaldevices/productsandmedicalprocedures/cardiovasculardevices/heater-coolerdevices/ucm492590.htm

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

From: Glenys Harrington [mailto:infexion@ozemail.com.au]
Sent: 26 April, 2016 12:07 AM
To: Ozbug posting (asid-ozbug@burnet.edu.au)
Cc: Allen Cheng (allen.cheng@med.monash.edu.au); ‘p.bass@alfred.org.au’; Leanne Houston (Leanne.Houston@easternhealth.org.au); donna.cameron@unimelb.edu.au; Finn. Romanes (Finn.Romanes@dhhs.vic.gov.au); Rhonda Stuart (Rhonda.Stuart@monashhealth.org)
Subject: FW: Mycobacterium chimaera update: A must listen from ECCMID

Dear All,

For those following the Mycobacterium chimaera heater-cooler units you may find some of the answers you need in the following blog from the Controversies in Hospital Infection Prevention below.

Unfortunately the link to the speakers talk at ECCMID only has the speaker slides.

I have written to the web page contacts to see if an audio is available and will keep you posted.

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

From: noreply+feedproxy@google.com [mailto:noreply+feedproxy@google.com]
Sent: 15 April, 2016 4:21 PM
To: infexion@ozemail.com.au
Subject: Controversies in Hospital Infection Prevention

Controversies in Hospital Infection Prevention

________________________________

Mycobacterium chimaera update: A must listen from ECCMID

Posted: 14 Apr 2016 06:33 PM PDT
[https://2.bp.blogspot.com/-nSG7E3FIOUI/VxA6EVJ7aOI/AAAAAAAABPc/yxCsKjr02FI703yFHoldb2azHpKcIXGSQCLcB/s640/cover%2Bphoto%2Bfor%2Bblog.jpg]

Weve posted several times about the horrible M. chimaera outbreak linked to heater-cooler units (HCUs) used during cardiac bypass surgery. As weve addressed the problem here at Iowa, weve become increasingly frustrated (and dumbfounded) at the lack of available information about the clinical and epidemiological features of the outbreak itself, and at the general lack of urgency about this ongoing and grave risk to patients.

Fortunately, Dr. Jakko van Ingen gave an excellent talk at ECCMID that answers several important questions weve had about this outbreak, confirming some of the things weve heard (in confidence, I assume for political or legal reasons) on various conference calls and email strings. I urge you to take 30 minutes of your time to listen to his talk, all the way to the end of the Q&A period.

Aside from being an extremely entertaining speaker, Jakko addresses several key questions, including:
Is this a clonal outbreak? YES. Slide 29 reports whole genome sequencing data that clusters the isolates from Sorin 3T units and infected patients (within just 2-3 SNPs), and further discussion (during Q&A session) confirms that isolates from other European countries are also in this cluster.
Were the HCUs already contaminated prior to being shipped to end users? YES. Listen carefully to the last question and answer.
Does this particular outbreak primarily involve one make/model of HCU? YES. While nontuberculous mycobacteria have been isolated from other types of HCUs, the specific M. chimaera cluster in this case involves Sorin 3T units.
Is the invasive, disseminated, high crude mortality form of the illness restricted to those patients with implants (e.g. valves, grafts)? YES. The life-threatening disseminated infection appears to require some prosthetic material to which the organism can adhere, protecting itself (via biofilm formation) from host defense. According to Dr. van Ingen, case finding in the Netherlands is now limited to those with implants, and does not include standard non-valve, non-implant CABG patients.
Is it possible to mount an effective, rapid national response to this urgent problem? YES. Slide 18 details the Dutch response, which involved discontinuing all non-urgent cardiac surgery until HCUs were placed outside of ORs (which was done within 48 hours). As we learned here when we did the same thing, it is amazing what you can accomplish when you are left with no other option.
Is opening up a Sorin 3T HCU a frightening experience? YES. Im sure Ill have nightmares about these water-stained, biofilm-befouled devices for a long time (see below for one image from Garvey, et al).
[https://3.bp.blogspot.com/-nrOmoURm3NQ/VxA6HaCEksI/AAAAAAAABPk/fpT7TpyENfcB4jxnEW8LZ1_qKBzRIO7LQCKgB/s640/Screen%2BShot%2B2016-04-14%2Bat%2B7.32.56%2BPM.png]

What are the implications?
HCUs are not safe to operate in an OR. The air exhausting from the HCU ventilation fan must be physically separated from the air in the OR, and the easiest way to do that is to remove them from the OR (and maintain the OR at positive pressure, of course).
Everyone using Sorin 3T HCUs should assume that they may have exposed patients to M. chimaera, until more is known about the details of the point-source. Contaminated units cannot be disinfected even with the more intensive protocols currently recommended. In addition, only a few labs are capable of properly performing NTM cultures of water samples, so negative water cultures are of limited value and could be falsely reassuring.
A much more active national patient and provider notification is needed. Our experience is similar to that of others: identified cases would never have been found had it not been for aggressive and active case-finding. There are undoubtedly others currently being treated with immunosuppression for sarcoidosis or some other granulomatous process of uncertain etiology who actually have undiagnosed disseminated M. chimaera disease.
Below I’ve pasted an epidemic curve, an underestimate as it involves only those cases reported to FDA from US (blue bars) and abroad (red). This outbreak isn’t over, not by a long shot, and the fact that there are still hospitals performing cardiac surgery with their Sorin 3T HCUs inside of the OR is extremely distressing.
[https://1.bp.blogspot.com/-C2f_g5YW_rM/VxA-j-6qAhI/AAAAAAAABP8/9EgqZ6WlqZcrrCfOjH_F-Bo3m34JiCndwCLcB/s640/Screen%2BShot%2B2016-04-14%2Bat%2B8.05.55%2BPM.png]

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[Michael Wishart]

Just further testing to see if replies work.

Nothing to see here, please ignore.

Thanks
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

Please consider the environment before printing this email

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Monday, 25 April 2016 7:51 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Test, please ignore

Apologies, need to do a single test email to ensure the system if functioning correctly after a major upgrade.

Please ignore, and apologies fir any inconvenience.

Cheers
Michael Wishart
ACIPC Infexion Connexion Administrator

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______________________________________________________________________
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[Michael Wishart]

Apologies, needs more testing to see if replies go to the list.

Again, please ignore.

Thanks
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

Please consider the environment before printing this email

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Monday, 25 April 2016 7:51 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Test, please ignore

Apologies, need to do a single test email to ensure the system if functioning correctly after a major upgrade.

Please ignore, and apologies fir any inconvenience.

Cheers
Michael Wishart
ACIPC Infexion Connexion Administrator

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[Michael Wishart]

Apologies, needs more testing to see if replies go to the list.

Again, please ignore.

Thanks
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email

________________________________________

Apologies, need to do a single test email to ensure the system if functioning correctly after a major upgrade.

Please ignore, and apologies fir any inconvenience.

Cheers
Michael Wishart
ACIPC Infexion Connexion Administrator

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[Michael Wishart]

As an aside to this conversation, there appears to be a difference in risk between subcutaneous injections and IM injections. There is a definite rare but documented risk of sepsis following IM injection (see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769353/ as an example).

The risk of sepsis from subcutaneous injections seems to be much lower, and possibly more to do with incorrect technique than anything.

I am not sure if universities are taking a blanket approach to injecting and teaching students not to use alcohol disinfection of the skin for all injections. Do we have any academics on the list that can answer this question?

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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P Please consider the environment before printing this email

Hi Lyn,

I’ve found the following information on the NPS website for Fragmin Single dose injections – Consumer medication information leaflet
Before you inject, make sure that the injection site is clean by wiping the area with an antiseptic swab, or by washing it with soap and water and patting it dry with a clean towel
http://www.nps.org.au/medicines/heart-blood-and-blood-vessels/anti-clotting-medicines/for-individuals/anticoagulant-medicines/for-individuals/active-ingredients/dalteparin-sodium/fragmin-single-dose-syringe-solution-for-injection

For Clexane it didn’t specify cleaning of the skin
http://www.nps.org.au/medicines/heart-blood-and-blood-vessels/anti-clotting-medicines/for-individuals/anticoagulant-medicines/for-individuals/active-ingredients/enoxaparin-sodium/clexane-solution-for-injection

When administering vaccines, provided the skin is visibly clean, there is no need to wipe it with an antiseptic.

Regards
Marlize

Marlize Senekal
Infection Prevent & Control CNC – Education and Research

T (07) 3621 4545 | M 0418 866 816
E m.senekal@wmb.org.au | http://www.wmb.org.au
Central Offices – Wheller Gardens: 930 Gympie Road, Chermside QLD 4032

[cid:image001.gif@01D19C8E.47C30FB0]
[cid:image002.gif@01D19C8E.47C30FB0] [cid:image003.gif@01D19C8E.47C30FB0] [cid:image004.gif@01D19C8E.47C30FB0] [cid:image005.gif@01D19C8E.47C30FB0] [cid:image006.gif@01D19C8E.47C30FB0] [cid:image007.gif@01D19C8E.47C30FB0]

Morning,

I was just wondering what the general consensus is with regards to the use of alcohol wipe swabbing prior to giving Clexane/Fragmin/Heparin etc.

Some of the students we are seeing come through the hospital are educated not to.

With kind regards,
Lynette Cribb
Infection Control Coordinator | St Andrew’s War Memorial Hospital

457 Wickham Terrace, Spring Hill, QLD, 4001
GPO Box 764, Brisbane, QLD, 4001
P: +61 7 3834 4328 F: +61 7 3834 4599
M: 0427 141 223
E: sawmh.icc@uchealth.com.au
W: http://www.uchealth.com.au
[Bugs-and-tear LR]

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

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[Michael Wishart]

Hi Lynette

We had the same issue here, so we discussed in with our clinical educators. Our stand is that whilst we understand why the universities now teach this, for hospitalised patients we feel the possibility of increased skin flora due to being bed bound and the possible presence of MRO’s meant we cannot assume their skin is ‘clean’. So we have changed our medication administration procedure to mention specifically that our procedure includes alcohol wiping of the skin prior to each injection (regardless of whether sub-cutaneous or IM). We also emphasize it is important to allow a few seconds for the alcohol to dry before skin puncture.

I think this issue might remain somewhat controversial in acute hospitals.

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
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this email

Morning,

I was just wondering what the general consensus is with regards to the use of alcohol wipe swabbing prior to giving Clexane/Fragmin/Heparin etc.

Some of the students we are seeing come through the hospital are educated not to.

With kind regards,
Lynette Cribb
Infection Control Coordinator | St Andrew’s War Memorial Hospital

457 Wickham Terrace, Spring Hill, QLD, 4001
GPO Box 764, Brisbane, QLD, 4001
P: +61 7 3834 4328 F: +61 7 3834 4599
M: 0427 141 223
E: sawmh.icc@uchealth.com.au
W: http://www.uchealth.com.au
[Bugs-and-tear LR]

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

_________________________________________________________________

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[Michael Wishart]

Hi Daniela

We have just instituted an ‘Invasive Device Log Sheet’ for staff to track the presence of invasive devices and their removal. It is also designed to prompt discussion about removal of unnecessary devices. We will be auditing the use of the log sheet in the next few months to ensure it is being used correctly. It does not replace insertion records, but simply records the existence of all invasive devices in the patient and their removal.

This is currently a printed form, but we are moving towards an electronic clinical record and it is proposed this will form party of it.

I can send you a copy of our log sheet if you are interested. The concept behind it was provided by our ID physician from another hospital.

We also have regular ward audits on line labelling that are reported to a medication committee for action.

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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P Please consider the environment before printing this email

Dear colleagues,

We are currently reviewing best practice management of peripheral intravenous cannulas (PIVCs), central venous access devices (CVADs), and indwelling urinary catheters (IDCs).

We are interested to know what interventions and strategies other health care services have in the multidisciplinary care of these devices and how such practices are sustained.
For instance:

* How do staff undertake a daily review of an IDC and how do they know when the device is due for change or removal?
* Is your documentation electronic or written and does it feature prompts?
* Do you have patient education materials regarding these devices?
* How do you address IV line labelling in your organisation?
* What systems do you have in place to ensure best practice is being maintained by staff?
Your feedback on successful interventions in the care of PIVCs, CVADs and IDCs (we are interested in any aspects of this and not limited to the questions above) is most appreciated.

Please feel free to contact me directly via my contact information below.

With thanks in advance,
Daniela

Daniela Karanfilovska
Clinical Nurse Consultant
Infection Prevention & Healthcare Epidemiology

t 03 90762819 m 0427 703769
e D.Karanfilovska@alfred.org.au

Alfred Health
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Melbourne VIC 3004
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[Michael Wishart]

[Posted on behalf of Lindy Ryan – Moderator]

Dear Cate

I would support Beth’s response that sluice hoses DO provide a risk from aerosolising faecal & urine remnants and in contaminating the whole environment by their spray pressure mechanism (so it doesn’t matter how well they are cleaned by the pan washer disinfector if they are stored clean in a heavily contaminated environment. )

I was involved in an MRGN outbreak review in an ICU several years ago when we likely traced it back to the poor quality of bed pan cleaning in machines that did not have a detergent cycle (they were NOT clean as faecal marks were still obvious ) AND the return of the sluice hose being fixed and reinstalled for use for staff after a long time of it not working ( they were most happy that it was finally fixed they indicated to me when it was first discovered ).
All other variable risks indicators such as environmental & pt Cleaning, HH compliance & AMS, bed occupancy , pt risk groups and staffing level remained largely unchanged in the review to what may have had an impact on the outbreak. (interestingly the source pt with the MRGN used bed pans had been cleaned in this particular dirty utility room and the subsequent other cases identified had also all been located in this ICU section at one time or another & had used bed pans post this source pt admission. No pts who had only resided in the other ICU were affected )

Given this factor of the sluice hose recommissioning & use prior to outbreak was initially the most obvious red flag to action first – (also dirty ‘clean’ pans yuk!) so it was removed & the room entirely cleaned and disinfected before reopening (and a new pan washer disinfector with detergent requested be purchased ) and of course by mere hawthorn effect or fear of infection control now residing in their ICU to investigate (so I believe all the other variables likely smartened up)….. the outbreak was contained once this one item was removed and environment cleaned…mmm

I further agree with Beth that The sluice hoses also pose and occupational exposure risk to staff if they aren’t wearing full PPE when using this from the aerosolising faecal matter.
I think the great email that Glenys sent out to us all on this forum on toilet flush and aerosolising is a great visual example of what we cant see but is happening and you don’t really want to wear it and take it home with you when you see what it is doing (thanks Glenys for the visual…it is ensconced in my brain permanently )!

A High-Speed Super Zoomed Video Of What Happens To A Toilet When You Flush
http://www.fastcoexist.com/3021884/a-high-speed-super-zoomed-video-of-what-happens-to-a-toilet-when-you-flush

hope my input of use/ interest

kind regards & good luck with hose !

kind regards

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
http://www.health.nsw.gov.au

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

Hi everyone
I’ve had a request to install a hose in the sluice room of new ICU to clean bedpans etc. I have issues with this as the potential for aerosolising and splashing MRO’s would increase

Any thoughts you could share?
[cid:image001.png@01D18357.A5F5D540]
Cate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
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[Michael Wishart]

[Posted on behalf of the original authors – Moderator}

As the University based authors of this paper, we also welcome this discussion. It was a challenging and difficult study but that made it interesting. With almost $1M of funding from the NHMRC and ACSQHC we felt a large responsibility to do the best possible study. We have no prior position or biases about the value of the NHHI.

In response to the specific points raised by Lindsay and Andrew:

o When we halved the costs of running Hand Hygiene Australia (HHA) the main result changed from $29,700 per life year gained to $25,094 per life year gained

o When we additionally reduced the estimated time spent on audits by hand hygiene auditors by 50% the main result changed from $25,094 per life year gained to $18,960 per life year gained.

o S. aureus bloodstream infections were chosen as the outcome measure by the steering committee for the project, and the reasoning was sound. The data are reliable for the states and territories, SAB is very expensive to treat and has large mortality risk. It is likely the best outcome measure to demonstrate the cost-effectiveness of the NHHI.

o We did an analysis of other infection outcomes that showed a statistically significant reduction in 11/23 infection rates, no change for 9/23 and increases for 3/23. Here is the paper http://www.publish.csiro.au/?paperHI14033

o Including quality of life changes had a negligible impact on the results.

o We responded to Lindsay’s letter in JHI here http://www.ncbi.nlm.nih.gov/pubmed/25555834

Estimating the value for money of infection prevention programmes is important, particularly in today’s climate where funding is tight. This situation of scarce resources is likely to be the new ‘normal’ for health services.

Our study, and the interest in it, highlights the need for evaluations to inform policy decisions. As a community we should take every opportunity to build a culture of evidence-based policy. We are obliged to prefer health programmes that deliver good value for money.

Prof Nick Graves, on behalf of the authors

[This post added for continuity – Moderator}

[Posted on behalf of HHA – Moderator]

We welcome discussion regarding this paper, and more broadly of the National Hand Hygiene Initiative. The QUT study was a large and complex project with many issues that warrant discussion and comment. Some of our comments have been previously published (see Grayson ML. J Hosp Infect 89: 137). We’d like to contribute the following points to today’s discussion on this list:

* The annual cost of the NHHI as assessed by this study reflects ‘start-up’ rather than ‘maintenance’ costs. The cost information used in this study is taken from the 2011-2012 financial year (Page et al. J Hosp Infect, 2014;88:141). HHA’s budget, which represented 20% of the NHHI costs, was halved in the subsequent financial year of 2012-13 (on schedule) and has since remained at this lower level.

* Other changes have been made as this program matured. For example, the costing study pre-dates introduction of the ‘HHCApp mobile’ tool. This was developed to reduce total auditing time requirements (by elimination of data entry), while also facilitating immediate feedback and minimising data entry errors. Surveyed hand hygiene auditors that have moved to mobile devices have estimated that this can reduce time spent on audits by up to 50% (we aim to publish). So the cost-effectiveness study no longer reflects current practice.

* The benefits of the NHHI are almost certainly under-estimated. This study only considered health and cost benefits of preventing one type of HAI: S. aureus bloodstream infections. This is because no national measures were available for other infection types or pathogens. But appropriate hand hygiene should have broader benefits, not only for other healthcare-associated infections but also to reduce the transmission of antimicrobial resistance. No assessment of patient suffering was included.

Despite these points, the summary finding of this QUT study was that the NHHI is cost-effective according to Australian standards: “This is the first cost-effectiveness evaluation of a National Hand Hygiene Initiative and shows that overall the programme was cost effective with a cost per life year gained of $29,700.”

The NHHI is unique both in Australia and globally. We believe that its successes have been the result of combining evidence-based interventions and strong collaboration between infection control professionals, jurisdictional authorities, HHA, the Australian Commission on Safety and Quality in Health Care, and other groups. But just as the program has evolved since the 2012 snapshot provided by this study, it should also continue to do so into the future. This discussion is one part of that process.

Andrew Stewardson, National Project Manager, Hand Hygiene Australia
Lindsay Grayson, Director, Hand Hygiene Australia

Thank you Mary-Louise for your response re Graves et al study and the variances.

The concerns of biased data reported for hand hygiene compliance is worth noting and I too agree with your comments here.

Costs associated with the efforts to report HH data as required which detracts from some of the critical day to day requirements of the IC nurse need further review.

Thank you
Michelle

Michelle Bibby
Infection Prevention Australia
Michelle@infectionprevention.com.au
+429071165

Dear Ramon and Glenys

Graves et al study relies on the accuracy of the 2 pivotal variables: SAB and hand hygiene compliance. The accuracy of the latter is serious limited. Our report in the Medical Journal of Australia (Med J Aust 2014; 200 (9):534-537. http://dx.doi.org/10.5694/mja13.11203) concluded the HHA program reports rates that have been biased upwards by very few high performers.

The conclusion from our findings and Graves et al is:

(1) SAB respond to multiple interventions and hand hygiene is only one of these.
(2) hygiene compliance rates have not reached a tipping point to reduce SAB and this tipping point is a long way off because
(3) the hand hygiene compliance rates are inaccurate.

It is important to have a national HH program. But the expense of the current program is too high when the cost of audits provides flawed data that reinforces a misguided belief that our hospitals are performing HH well.

Mary-Louise

Professor Mary-Louise McLaws

Professor of Epidemiology in Healthcare Infection and Infectious Diseases Control

http://research.unsw.edu.au/people/professor-marylouise-mclaws

SPHCM SAMUELS BUILDING

UNSW AUSTRALIA, SYDNEY NSW 2052 AUSTRALIA

CRICOS Provider Code 00098G

________________________________
Colleagues

The study by Graves et al. reports a range of interesting findings, and raises many issues regarding hand hygiene for broader consideration. The College is examining the paper and is preparing a media release for release in the coming days.

Kind regards,
Ramon

Professor Ramon Z Shaban
PRESIDENT

Australasian College for Infection Prevention and Control

GPO Box 3254, Brisbane Qld 4001

On 25 February 2016 at 21:16, Glenys Harrington <infexion@ozemail.com.au> wrote:
Dear All,

Find attached the following publication (February 9, 2016).

* Graves et al. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia. PLoS ONE 11(2): e0148190. doi:10.1371/journal.

The analysis was undertaken on data from 6 Australian states:

* In 2/6 states there was a 1% chance it was cost effective

* In 1/6 states there was a 26% chance it was cost effective

* In 1/6 states there was a 80% chance it was cost effective and

* In 2/6 a 100% chance it was cost effective.

Interesting figure showing cost increases and cost savings by state (fig 2).

Also some interesting points in the discussion.

Shame there was “No useable pre-implementation” data available for Victoria and hence was not able to be analysed.

Given the findings of the analysis it raises the following questions for governments:

* Shouldn’t the program be scaled back and some of the money be spent on other initiatives to reduce hospitals associated infections(HAIs)?

* Shouldn’t the program be scaled back to reduce the infection control workload associated with the program which is currently overwhelming and taking ICPs away from other core infection control activities?

A press release by the College about the findings of this study and the views of the college in terms of the allocation of limited resources would be timely.

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

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[Michael Wishart]

Hi Corinne

I do know that using the same scope for a diagnostic gastroscopy then colonoscopy on the same patient has been a common practice. But it would very much surprise me if using the same biopsy forceps, where there is actual invasion of mucosa, would be clinically appropriate. Not just from an infection control perspective of spreading viral/bacterial particles around within different body sites, but also the risk of spreading malignant cells around to different body sites. I don’t recall having seen any definitive practice guidelines to refute this practice, but would question the safety of it. Also, if biopsy tissue from various body sites is all collected with the same biopsy forceps, is there not risk of tissue contamination and not then being sure of what is actually where if positive pathology is found?

Would be keen to here form some endoscopy experts about 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
[cid:image001.png@01D01926.61F1C2B0]
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Good morning,

Just trying to trace some evidence around biopsy forceps in gastroscopy being used in colonoscopy for the same patient. Does anyone have any information for or against in regard to infection?

Corinne Egan-Hirst
Quality and Safety Manager
Rosemont Endoscopy Centre
42265499

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[Michael Wishart]

Hi Tina

Is this the Legionella guidelines you used as a template?

http://www.sahealth.sa.gov.au/wps/wcm/connect/9584a2804b1cdf74b707ff0b65544981/enHealth+Guideline+Final.pdf?MODAJPERES&CACHEID9584a2804b1cdf74b707ff0b65544981

The basic components of any WQRMP are those included as chapters in that national document. You can expand on them as much as you require.

The other point that cannot be stressed enough is that this has to be a multidisciplinary team effort. You must include your maintenance staff, contractors (eg plumbers), clinical staff (especially and infection control staff or consultants), and executive team.

The Queensland Health Private Health Regulation Unit will most likely refer to the above document when reviewing submitted WQRMPs

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
[cid:image001.png@01D01926.61F1C2B0]
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Hello,

I am presently drafting a WQRMP. I was using the template for the Legionella RMP, just wondering if anyone has a template or would share their WQRMP suitable for a small day surgery. Just finding some of the questions quite beyond my qualifications.

Regards

Tina Owens
Director of Nursing

[cid:9E350D6D-535C-4698-891D-F55ACC3FBEB3@tci.local]

M 0419 026 091 T 07 5613 2000
t.owens@thecosmeticinstitute.com.au
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[Michael Wishart]

Hmm, still no attachment…. Trying again!!

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
[cid:image001.png@01D01926.61F1C2B0]
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[Re-sent with attachment, thanks Glenys! – Moderator]

Dear All,

I would like to flag your attention the recently published article by one of our peers, Elizabeth Gillespie and her colleagues from Southern Health in Victoria.

* Gillespie E et al. The role of ultraviolet marker assessments in demonstrating cleaning efficacy. American Journal of Infection Control 43 (2015) 1347-9 – attached.

This study is important as:

* It was conducted in a number of hospitals.

* It supports the need not only for cleaning audits but also cleaning monitoring (i.e. on this occasion the utilisation of an ultraviolet marker).

* It demonstrates that visual auditing alone is inadequate to determine if a room has been cleaned or not cleaned appropriately – See Compliance percentages in Table 1 for both “Terminal and Daily Cleaning” and

[NB not sure this data will format correctly: refer to attached paper – Moderator]
Table 1
Results of UVM compared with visual auditing for November 2014
Site UVM compliance for terminal cleaning and daily cleaning, % Internal visual audit results, %
Hospital A Terminal: 58 97.5
Daily: 20
Hospital B Terminal: 65 85.9
Daily: 58
Hospital C Terminal: 70 97.4
Daily: 38
Hospital D Terminal: no discharges 95.2
Daily: 65
Hospital E Terminal: 90 98
Daily: no discharges

* It demonstrates ongoing issues health facilities face in terms of sustaining compliance with cleaning and disinfection practices.

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

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[Michael Wishart]

Oops, forgot the attachment! Still in holiday mode….

Cheers
Michael

Michael Wishart
Infection Control Coordinator
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
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________________________________________
=
=

[Posted on behalf of Elizabeth Smith – Moderator]

Hello
We have a 6 months part time IPC Coordinator position to cover for leave requirements.

Thanks

Elizabeth Smith

Infection Prevention & Control Coordinator
Sunshine Coast University Private Hospital
Infection Control

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[Michael Wishart]

Hi Tina

Unless there is something in the pendant suction system that needs protecting form overflow (doubtful there is), I would agree an inline filter in that instance is unnecessary – even for an ‘infectious patient’ actually.

The only issue different from the recovery setup may be overflow valves on the suction canister you are using in theatres…. If you need to protect the external suction unit from fluid (why?) you may need an inline filter.

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
[cid:image001.png@01D01926.61F1C2B0]
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Hi Darryl

Thanks for your response to my enquiry. The in line filter is attached to suction tubing which connects directly to our theatre pendant, which would be plumbed to our external suction unit, which does have its own filtering system. This tubing then connects directly with a suction canister. All other tubing in our recovery unit is connected the same way (ie from a gas panel to the suction canister). These do not have in line filters, as when you are suctioning a patient, the contents go directly into the canister, which is then changed between patients.

I note you mention that infectious patients would need to have one, which I can understand, but we are a day surgery performing elective surgery and we would not accept patients who had a highly infectious disease.

So from my understanding of your response concerning the wall suction, the in line filter is unnecessary?

Regards

Tina Owens
Director of Nursing

[cid:9E350D6D-535C-4698-891D-F55ACC3FBEB3@tci.local]

M 0419 026 091 T 07 5613 2000
t.owens@thecosmeticinstitute.com.au
98 Marine Parade, Southport, QLD 4215
[cid:28BB8E47-FA99-4957-98F0-001299011A63@tci.local] [cid:0695DACD-A5A1-4802-8717-C1B1DE0F7CFC@tci.local] [cid:AA704435-49C1-4C20-AC86-9DF777D87F69@tci.local] [cid:3131B61C-C776-4A69-85FF-8DD35192640A@tci.local] thecosmeticinstitute.com.au

Hi Tina
The vacuum source is not clear from the enquiry but there are two cases.

Suction Pump
An inline antibacterial filter between the jar and the pump is essential for infection control as this potentially contaminated
air is exhausted to the room.
For infectious patients the filter should be replaced after each use.
Otherwise, it rather depends on the actual usage but the filter should be replaced every month or when damp or discoloured.

Wall Suction
Again, for infectious patients an antibacterial filter should be used and replaced after each use.
Otherwise, an inline antibacterial filter is not always used, as the potentially contaminated air is exhausted to the pump room
which would have its own filtering system.

There is generally a sintered bronze filter fitted to wall suction controllers and nozzles to protect the piping system from solids
and heavy fluids in the event of a jar overflow, in which case the bronze filter should be cleaned immediately.
A greenish discoloration is usually an indication that cleaning is required.
Otherwise, under normal conditions they shouldn’t require more than an annual clean or whatever local preventative maintenance
schedule is in place. The most effective method of cleaning the bronze filters is by autoclave.

Regards,

Darryl Ellis | Chief Executive Officer

[cid:image001.jpg@01CD0D13.C7B3EE10]

[cid:image002.jpg@01CD0D13.C7B3EE10] [cid:image003.jpg@01CD0D13.C7B3EE10] [cid:image005.jpg@01CD0D13.C7B3EE10]

Medical Australia Limited (ASX:MLA) incorporates:
TUTA Healthcare | BMDi TUTA Healthcare Pty Ltd | Clements Medical Equipment

Medical Australia Limited | Unit 4B, 128-130 Frances Street | Lidcombe | NSW 2141 Australia
T +61 2 9466 5300 | F +61 2 9922 7165 | M +61 417 263 854
W http://www.medaust.com | E darryl.ellis@medaust.com | I info@medaust.com

Hello Michael

We have always had an in line filter on our main suction line which connects to our suction canister (not the suction tubing we use on the patient) in the operating theatre, I was just wondering if this was a necessary practice to continue and if so, how regularly do the filters need changing? I have only generally ever used these type of filters in endoscopy.

Would appreciate some feedback.

Thanks

Tina Owens
Director of Nursing

[cid:9E350D6D-535C-4698-891D-F55ACC3FBEB3@tci.local]

M 0419 026 091 T 07 5613 2000
t.owens@thecosmeticinstitute.com.au
98 Marine Parade, Southport, QLD 4215
[cid:28BB8E47-FA99-4957-98F0-001299011A63@tci.local] [cid:0695DACD-A5A1-4802-8717-C1B1DE0F7CFC@tci.local] [cid:AA704435-49C1-4C20-AC86-9DF777D87F69@tci.local] [cid:3131B61C-C776-4A69-85FF-8DD35192640A@tci.local] thecosmeticinstitute.com.au

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