[Michael Wishart]

Hi Jayne

Here in the QLD private sector it’s all about the relationship of the doctor as a consultant to the patient. All of the tests they order, including pre-op serology for HIV, Hep B and Hep C where they order it, are all tests undertaken in the doctor’s relationship with the patient, not the facility’s relationship. So the onus on consent for these tests is on the doctor; the nurse or phlebotomist just has to gain consent for the procedure of obtaining the blood if the test is conducted within the facility.

The only time the facility becomes involved with consent for this type of serology testing is when we actually initiate the tests (eg if the patient is a source of an exposure). Then we are required to gain informed consent prior to initiating the tests.

If you have concerns about patients being tested without informed consent by your doctors, you should raise it with your Medical Director to discuss within your medical community.

And… try not to get sucked in to the vortex of doing your medical consultant’s work for them. Informed consent is THEIR responsibility to gain if they are ordering these tests.

That’s my view, 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 Jayne OConnor
Sent: Tuesday, 3 November 2015 9:48 AM
To: AICALIST@AICALIST.ORG.AU
Subject: HIV,HEPB & HEPC consent

Dear Brains trust,

Something to think about over morning tea!

Some of our surgeons have decided to start testing patients for HIV, HepB & HepC , our concern is around consent and who gains it, rumour has that the Drs are not??, how do we stand as a healthcare facility legally? Doc’s we have read talk about the practitioner obtaining consent but not the healthcare facilities responsibility.

Does anyone have any evidence or can point me in the right direction to obtain the evidence?

Muchly appreciated

Kind regards
Jayne

Jayne OConnor RN, BSc.Inf.Cont.
IPC Co ordinator
Sydney Adventist Hospital
185 Fox valley Rd,
Wahroonga 2076
Tel: DD (02)0 9487 9732
Mobile: 0406752685

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[Michael Wishart]

Hi Tina

My interpretation of the guidelines where it says 2. Collect random samples from other locations such as wash basins, bath tubs, toilets, service taps, sinks, and other water spigots” is that it is looking a cold water inflow (where there is only cold water feed, such as a toilet), not water in the toilet bowl. So, if you want to sample these sites, try getting water from the inflow feeding these devices. And the main idea of looking at cold water would be looking at total plate counts rather than just Legionella, as well as residual chlorine levels, to ensure your water system is maintaining an appropriate disinfectant level when supplying outlets.

In my mind it is about looking at the whole water circulation system, not just the outlet, and what the water quality is that is feeding each outlet.

You could also specifically ask the Water Quality team in Queensland Health for any advice on this for your facility, as well. They are quite helpful.

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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Hello,

We are in the process of reviewing our water quality testing. Having re-read the Qld Government Guidelines (2013), I note they also suggest you sample the toilets. We are small one theatre day surgery, and only do elective surgery. We have 17 water outlets (14 x TMV / 3 x toilets). I was just wondering how many samples other similar size day surgeries are doing and their frequency. The Guidelines suggest quarterly, but the Chief Health Officer’s letter suggested annually if you were considered low risk. The Guidelines appear to be geared more towards larger public/private hospitals.

Are other sites sampling the toilets? Obviously, this isn’t a TMV and I would have to check with the lab how we do this, as you can’t do the triplicate test the Guidelines suggest.

Look forward to some feedback.

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]

I had a conversation off-line with Tim Spencer about this, and he agreed we could post it as I think it is pertinent to this discussion.

Cheers
Michael

Agreed. I went back and re-read the opening paragraphs on it and its definitely what you say.. no question about it.
It’s funny that CDC specifically mention the use of non-antimicrobial soap in other respective guidelines but not specifically in their intravascular guidelines.
Which is all the more reason why I prefer other guidelines over the current CDC version – I tend to think the 2011 version is a poor follow-on from the earlier 2002 edition, hence why I use INS and SHEA guidelines more frequently these days.
Hope all is well in sunny Brissy..
Tim..

Hi Tim

I don’t disagree, it’s just that when I looked at the attached HICPAC 2011 guidelines it had plain soap! Weird.

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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Hi Michael,
Which guideline are you quoting from? Is it a BSI specific guideline?

Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update
Jonas Marschall, MD; Leonard A. Mermel, DO, ScM; Mohamad Fakih, MD, MPH; Lynn Hadaway, MEd, RN, BC, CRNI; Alexander Kallen, MD, MPH; Naomi P. O’Grady, MD; Ann Marie Pettis, RN, BSN, CIC; Mark E. Rupp, MD; Thomas Sandora, MD, MPH; Lisa L. Maragakis, MD, MPH; Deborah S. Yokoe, MD, MPH Infection Control and Hospital Epidemiology, Vol. 35, No. 7 (July 2014), pp. 753-771

This current SHEA/HICPAC updated guideline from July 2014 states;
B: At Insertion
2. Perform hand hygiene prior to catheter insertion or manipulation (quality of evidence: II).83-87
a. Use an alcohol-based waterless product or antiseptic soap and water.
i. Use of gloves does not obviate hand hygiene.

The earlier publication from SHEA/HICPAC from 2002 also state;
III. Hand hygiene

A. Observe proper hand hygiene procedures by washing hands with either conventional antiseptic-containing soap and water or waterless alcohol-based gels or foams. Observe hand hygiene before and after palpating catheter insertion sites, as well as before and after inserting, replacing, accessing, repairing, or dressing an intravascular catheter. Palpation of the insertion site should not be done after the application of antiseptic, unless aseptic technique is maintained.2,23-28 Category IA
B. Use of gloves does not obviate the need for hand hygiene.2,26,27 Category IA

Boyce JM, Pittet D; Society for Healthcare Epidemiology of America, Association for Professionals in Infection Control, Infectious Diseases Society of America. Guideline for hand hygiene
in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
MMWR Recomm Rep 2002;51(RR-16):1-45.

This paper also states the differences in terminology when it comes to hand hygiene.
Hand antisepsis. Refers to either antiseptic handwash or antiseptic hand rub.
Hand hygiene. A general term that applies to either handwashing, antiseptic handwash, antiseptic hand rub, or surgical hand antisepsis.
Handwashing. Washing hands with plain (i.e., non-antimicrobial) soap and water.

I think the key points are also the combinations of the ‘bundles of care’ prior to any IV device insertion (checklist, appropriate hand hygiene, maximal barrier precautions, use of CHG as skin antiseptic, optimal insertion site and surveillance practices).
As long as hand hygiene compliance is being monitored, then we are working towards lowering infections and device related complications.
As a vascular access specialist, I take into consideration the specific vascular access related guidelines as well as those from the infection control realm. 🙂
Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Independent Vascular Access Consultant
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Director-at-Large, Vascular Access Certification Corporation (VACC)
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com
“Be a yardstick of quality. Some people aren’t used to an environment where excellence is expected.” – Steve Jobs

Hi Tim

Interestingly, the US HICPAC BSI guidelines has this:

Hand Hygiene and Aseptic Technique

1. Perform hand hygiene procedures, either by washing hands with conventional soap and water or with alcohol-based hand rubs (ABHR). Hand hygiene should be performed before and after palpating catheter insertion sites as well as before and after inserting, replacing, accessing, repairing, or dressing an intravascular catheter. Palpation of the insertion site should not be performed after the application of antiseptic, unless aseptic technique is maintained [12, 77-79]. Category IB

This recommendation seems to be generic for all intravascular devices from what I can see. No specific recommendation for hand cleaning with an antiseptic solution prior to CVC insertion.

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 Tim

Interestingly, the US HICPAC BSI guidelines has this:

Hand Hygiene and Aseptic Technique

1. Perform hand hygiene procedures, either by washing hands with conventional soap and water or with alcohol-based hand rubs (ABHR). Hand hygiene should be performed before and after palpating catheter insertion sites as well as before and after inserting, replacing, accessing, repairing, or dressing an intravascular catheter. Palpation of the insertion site should not be performed after the application of antiseptic, unless aseptic technique is maintained [12, 77-79]. Category IB

This recommendation seems to be generic for all intravascular devices from what I can see. No specific recommendation for hand cleaning with an antiseptic solution prior to CVC insertion.

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 Michelle,
Have you asked them for what reasons they have changed their current practice?
Maybe they can supply you with the evidence they used to stop using antiseptic hand wash.
This is currently NOT the recommendations of both a number of Australian and international guidelines and recommendations.
Currently CDC, SHEA, APIC, EPIC, ACI, INS , CNSA and NSW MoH CVAD guidelines support the use of antiseptic handwashing in all aspects of vascular access.
Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Independent Vascular Access Consultant
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Director-at-Large, Vascular Access Certification Corporation (VACC)
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com
“Be a yardstick of quality. Some people aren’t used to an environment where excellence is expected.” – Steve Jobs

Morning All, I recently found our PICC team no longer use antiseptic hand wash pre PICC insertion and use neutral soap. Can anyone tell me where to find evidence of using antiseptic hand wash prior to invasive procedures?

Thank you
Michelle Kennedy

CNC | Infection Prevention Service
John Hunter Hospital Campus
Lookout rd, New Lambton
Tel 02 4921 3129 | michelle.kennedy@hnehealth.nsw.gov.au
http://www.health.nsw.gov.au

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[Michael Wishart]

Hi Sony

I am not exactly sure what you are asking here. Do you want to know about storage conditions of PPE within a facility?

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

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—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Sony SO
Sent: Thursday, 6 August 2015 11:16 AM
To: AICALIST@AICALIST.ORG.AU
Subject: whether any international standards are related to PPE items should be maintained at “hygiene” level.

HI,

In general, disposable PPE should be manufactured in a “clean” working environment for preventing it from contamination.
I would like to know whether any international standards (such as ISO,EN, ASTM, AS, CAS etc.) are related to PPE items should be maintained at “hygiene” level.

Yours sincerely,

Sony SO
Nursing Officer, Infection Control Branch (Team 2) Centre for Health Protection http://www.chp.gov.hk/tc/cindex.html
HONG KONG SAR, CHINA
office phone: +852 2125-2922; fax: +852 3523-0752 HA email sony@ha.org.hk; DH email no_icb4@dh.gov.hk

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[Michael Wishart]

Congratulations to Cath for this deserved award. Personally, Cath has been a support to me throughout my career, and her passion and dedication to infection prevention and control in Australia and overseas has been an example to many Australian and overseas infection control and prevention personnel.

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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________________________________
Subject:

Colleagues

It is with great pleasure that the Australasian College for Infection Prevention and Control extends its warmest congratulations to Dr Cathryn Murphy who has been honoured by being awarded the 2015 Carole DeMille Achievement Award by the Association for Professionals in Infection Control and Epidemiology.

The award is bestowed annually to an infection preventionist who best exemplified the ideals of Carole DeMille, a pioneer in the field of Infection Prevention and Control. Dr Murphy served as APIC President and has an extensive global professional career in Infection Prevention and Control spanning more than 25 years. A copy of the APIC media release regarding this award can be located at following link: http://www.apic.org/For-Media/Announcements/Article?id12804b84-f611-4fed-bece-8372ca14d6c5

On behalf of the College Council and its members, we extend our sincerest congratulations to Dr Murphy on this high honour and achievement.

Kind regards
Ramon

Professor Ramon Z Shaban
President-Elect

Australasian College for Infection Prevention and Control

GPO Box 3254, Brisbane Qld 4001

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[Michael Wishart]

Hi Richard

We routinely resite any PIV cannula that is in insitu on admission at 24 hours, regardless of where it was inserted (we cannot be sure it was not inserted under emergency conditions). One of the changes we are making now is to routinely resite all PIV cannulas inserted into the antecubital fossa site within 24 hours. We have seen some significant infections in this site, and although we cannot generate a large enough sample to be statistically significant, we think this might reduce both the selection of the antecubital fossa as a site and also reduce the risk of PIV site infections and related bacteraemias. Our ID physician is driving this change.

PIV related bacteraemias do not occur in large enough numbers to make statistically significant observations in small sample sizes, so it may be difficult without enrolling a million or so cannulas (that’s a plug for some current research, by the way… 🙂 ).

I think making these types of changes needs to be discussed at the local level, taking all of your current local factors into account. It will be hard to power studies to provide evidence for such changes, though.

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,
At Western Health currently the procedure for Peripheral IV cannulas (PIVC) inserted by ambulance personnel in the community, and any PIVC that are inserted in a non-sterile manner in hospital (e.g. emergency situation) are resited within 24 hours. Due to an increase in cannula related infections and amongst other actions, which I’m happy to share, we are also considering to resite all PIVCs inserted by ambulance and all those inserted in the Emergency departments immediately after admission to the wards rather than within 24 hours.
Has any other hospital taken this approach?

Regards,
Richard

Richard Bartolo
Manager Infection Prevention
Western Health
Gordon Street, Footscray VIC 3011
Ph. 03 8345 6113 Pager. 03 8345 6666 No. 506
Mob. 0438 560 441
Email. richard.bartolo@wh.org.au
Web. http://www.westernhealth.org.au

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[Michael Wishart]

Hi Lindy

I don’t have any definitive evidence or guidelines here (although will possibly be something in the INS guidelines, but I don’t have them available to me currently), but we have had this discussion a few times here. One of the big non-no’s for me is leaving unconnected primed lines hanging (even with a bung on the end) in an unmonitored area, where anyone could potentially handle it.

The ‘mother test’ gets applied here: would I let this be used on my mother, not knowing if someone had handled and contaminated this setup?

So, the only places we have (tacitly, not formally) agreed can do this are very time limited anyway (cath lab, theatre) mainly for lists, as we discourage the practice but if they can guarantee it cannot be contaminated by inappropriate handling an are always under observation, we sort of turn a blind eye to it.

Hopefully someone has something more definitive for you than the ‘mother test’. 🙂

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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Hello

I have been asked the following question from an operating theatre NUM

‘How long do you recommend IV fluids be kept once they have been attached to a giving set and the line primed. Both for IVs and arterial lines?”

They are telling me the lines are being set up for use but not connected to any pt & just being set up as part of resuscitation / or urgent need & then left untouched in case of another emergency to prevent wastage & time in reality …some staff discard straight away and others think they can be kept for a few hours …so they just want to establish a time frame potentially around infection risk if not used how long they can keep them for???…does anyone have any evidence based information I could guide them with …I could say if not used straight away discard (common-sense)….but wondered if anyone had anything with more substance given this may not be useful feedback for them to just follow if I have no idea and the information I have found is a bit unclear ….

I checked the following

1. CDC Guidelines for the prevention of IVCRI’s 2011 but it had no recommendations

2.Our national 2010 NHMRC ACSQHC IC guidelines (pg 144) recommend that they may be left for intervals of up to 4 days (if not containing lipids) however I am under the impression that this is a line that is currently in use & connected to a patient and not waiting to be used???

3.2010 RCN Infusion standards recommends
2.6 Expiry dates
The maximum expiry date for any injection/ infusion prepared in a clinical area is 24 hours or less in accordance with the manufacturer’s specification of product characteristics (NPSA, 2007b).

appreciate any other leads or advice to provide staff

many thanks in advance

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

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[Michael Wishart]

Thanks Meryl for the update.

This is a great way to see how this discussion list can aid clinicians in reviewing policy, and it is great to see those policy changes then reported back to the list.

Cheers
Michael Wishart
ACIPC Infexion Connexion Administrator

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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Thank you all for the interest shown in the original question posed. It is obviously an issue that we are not alone in experiencing and it has been very informative to hear how other health services have approached the problem. Given the level of interest this topic has generated I thought I’d feedback the approach we have decided upon.

I found the following article very useful and have shared it with other stakeholders within our organisation:
Larson, T., Gudavalli, R., Prater, D., & Sutton, S. (2015). Critical analysis of common canister programs: a review of cross-functional considerations and health system economics. Current Medical Research & Opinion, 31(4), 853-860.
http://informahealthcare.com/doi/pdf/10.1185/03007995.2015.1016604

Following discussion between clinicians and pharmacists, it has been decided that we will use the following approach:

* It has been assumed that for our organisation, the chance of busy clinicians cleaning MDIs as per evidence-based guidelines is not reliable and the cost of cleaning outweighs the cost of throwing them away. Therefore, MDIs will be used as single-patient items: once issued, they will stay with children for the duration of their inpatient care.

* All MDIs will have labels attached to them in pharmacy to allow clinicians to add the appropriate information to them (i.e. patient name, dose) so that they can be taken home as discharge medications.

* Any MDI used during hospital stay but not required on discharge will be disposed of.

* Doctors will be advised to consider good stewardship when prescribing drugs to be taken via MDI to try and rationalise their use (e.g. not prescribing them on a “try it and see” basis to children who are probably too physiologically undeveloped to respond to salbutamol).

We have decided that the cost of the MDIs is small, but the risk of spreading infection (since many of our children who are prescribed drugs via MDI have respiratory viruses) is greater.
Many thanks again for all your responses.

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

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Good morning everyone,

I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:

* Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.

* The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.

* The inhaler sits at the patient’s bedside before moving to the medication room and then on to another patient’s room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.

Many thanks in advance,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

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[cid:image005.png@01D08E34.09FD4060]

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[Michael Wishart]

Hi Meryl

My concern would not be so much who has handled the inhaler (as these can be wiped over easily), but what are the risks of contamination within the inhaler by children coughing or blowing into them (despite the use of spacers, this could still be a real risk). Spreading RSV or influenza virus, as just two examples, is a real risk in my view from this possibility. Because children are the ones having these inhalers used on them, the risk of this may actually be higher than for adults (less likely to correctly follow instructions).

Just my thoughts. Not sure there are any definitive guidelines around 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]
P Please consider the environment before printing this email

Good morning everyone,

I have been approached our ED to find out the risks of cross-infection through use of an inhaler with a spacer. To put this into context, the use of spacers is restricted to individual patients, but the inhalers are currently used for multiple patients. My concerns are as follows:

* Children in ED are usually undifferentiated as and such we do not know what infection they have or what kind of additional transmission-based precautions might be required.

* The valve in the spacer is a valve not a filter thus there is the possibility of contamination of the inhaler through the valve of the spacer.

* The inhaler sits at the patient’s bedside before moving to the medication room and then on to another patient’s room, being handled by children, parents and nursing staff along the way.
Thus far I have not been able to find any literature on this but was wondering if anyone could inform me what their local practice is and the rationale behind it.

Many thanks in advance,

Meryl

Meryl Jones
Clinical Nurse
Infection Management and Prevention Service

Children’s Health Queensland Hospital and Health Service
Level 12
Lady Cilento Children’s Hospital, South Brisbane QLD 4101

T: 07 3068 4145.
E: meryl.jones@health.qld.gov.au
W: http://www.childrens.health.qld.gov.au

[cid:image001.png@01D08E34.09FD4060][cid:image002.png@01D08E34.09FD4060][cid:image003.png@01D08E34.09FD4060][cid:image004.png@01D08E34.09FD4060]
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[Michael Wishart]

Hi Belinda

We currently are using surveillance software for surgical site surveillance, but you should have a look at the Queensland Health surveillance tools as they are quite useful (note: the old eICAT software is no longer supported or available).

Surveillance protocol: http://www.health.qld.gov.au/qhpolicy/docs/gdl/qh-gdl-321-7-1.pdf (note the surveillance manual is no longer available)

Signal surveillance: http://www.health.qld.gov.au/chrisp/signal_infection/manual.asp (great for smaller facilities with low numbers of SSIs)

Hope these are useful.

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 Belinda Straube
Sent: Wednesday, 13 May 2015 10:12 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Surgical site surveillance tools

Dear all
We would appreciate it if anyone is happy to share elements of their SSI surveillance programs including surveillance forms and procedures for monitoring SSIs

Many thanks
Belinda

Belinda Straube
Infection Prevention and Control CNC
St George Hospital
Gray Street Kogarah
NSW
9113 1575
Mobile: 0429 890 544
Page 424
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Belinda Straube
Infection Prevention and Control CNC
St George Hospital
Gray Street Kogarah
NSW
9113 1575
Mobile: 0429 890 544
Page 424
[cid:image004.jpg@01CFCE90.2269B840][NSW Health South East Sydney LHD – col grad RGB]

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[Michael Wishart]

[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]

Hmmm.. no attachment trying again. It is available via the link, if this doesnt work

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 Michael Wishart
Sent: Friday, 1 May 2015 12:58 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Administering adrenaline for anaphylaxis following ‘flu vaccination

[Posted on behalf of Sue Atkins Moderator]

Maree,
I would not wait.
The attached secretary approval document covers the administration of adrenaline by the nurse immuniser in Victoria, and who can and can not administer.

This is the link to the other relevant documents relevant to Victoria

Cheers
Sue

Sue Atkins
Regional Infection Control Consultant | CICP | Service & Workforce Development | Grampians Region
Department of Health & Human Services
35 Armstrong Street South, Ballarat, Victoria, 3350
p. 03 5333 6023 | f. 03 5333 6093 | m. 0438 227 989
e. sue.e.atkins@dhhs.vic.gov.au | http://www.grhc.org.au

From:

Maree Sommerville <MSommerville@MERCY.COM.AU>

To:

AICALIST@AICALIST.ORG.AU

Date:

01/05/2015 11:50 AM

Subject:

Administering adrenaline for anaphylaxis following ‘flu vaccination

Sent by:

ACIPC Infexion Connexion <AICALIST@AICALIST.ORG.AU>

________________________________

Dear all.
This is a question relevant to nurse immunisers
We are now in the middle of our employee flu vaccination campaign and the question has arisen about administering adrenaline.
If an employee has a reaction following administration of the vaccine and the health service has a 24 hour anaesthetic service and a code blue team, should the nurse immuniser wait to administer adrenaline until the team arrives?

Thanks in anticipation
Maree

Maree Sommerville
Infection Control Coordinator
Mercy Hospital for Women

163 Studley Road
Heidelberg 3084
Phone: 8458 4759
Mob: 0408 789 798
Fax: 8458 4751

______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the svha.org.au domain (or any other domain of St Vincents Health Australia Limited or any of its related bodies corporate) (an SVHA Email Address) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.

______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the svha.org.au domain (or any other domain of St Vincents Health Australia Limited or any of its related bodies corporate) (an SVHA Email Address) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.
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[Michael Wishart]

Hi Maree

I think this question needs to be considered around your state legislation / guidance for nurse immunisers and staff vaccination programs, and also your local facility/ health department policies.

I would personally not hesitate to give adrenaline in the light of an obvious anaphylactic reaction to vaccination, but this is covered in my facility standing order for our staff vaccination program. Whilst adrenaline is unlikely to be the cause of an adverse event in this situation, I would hate to be working outside my scope of practice and legislation with 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]
P Please consider the environment before printing this email

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Maree Sommerville
Sent: Friday, 1 May 2015 11:40 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Administering adrenaline for anaphylaxis following ‘flu vaccination

Dear all.
This is a question relevant to nurse immunisers
We are now in the middle of our employee flu vaccination campaign and the question has arisen about administering adrenaline.
If an employee has a reaction following administration of the vaccine and the health service has a 24 hour anaesthetic service and a code blue team, should the nurse immuniser wait to administer adrenaline until the team arrives?

Thanks in anticipation
Maree

Maree Sommerville
Infection Control Coordinator
Mercy Hospital for Women

[cid:image001.jpg@01CF7A4D.FAAAC600]

163 Studley Road
Heidelberg 3084
Phone: 8458 4759
Mob: 0408 789 798
Fax: 8458 4751

______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the svha.org.au domain (or any other domain of St Vincents Health Australia Limited or any of its related bodies corporate) (an SVHA Email Address) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.

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Mercy Health at http://www.mercyhealth.com.au

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[Michael Wishart]

Hi Verily

Yes, it is vexing that the majority of infection risk is within acute care. My understanding of previous studies seems to indicate that decolonisation as a strategy is useful to minimise short term risk (ie decolonisation prior to a major procedure), but is not as useful as a long term carrier-eradication strategy. This study would support that idea.

This may suggest that acute care facilities need to continue look at checking carrier status and then providing appropriate decolonisation/antibiotic prophylaxis regimes prior to high risk procedures, rather than depend upon residential care decolonisation strategies.

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

It is interesting indeed that even though this being said the majority of patients presenting to acute care facilities and now an even greater burden on healthcare than healthcare associated staphylococcus aureus (MRSA & MSSA) blood stream infections seem to come from the community with a significant number of these coming from long term care residential facilities.

Makes me wonder whether these infections are being costed to, LTCRF or to acute care facilities, just saying.Isnt this the whole idea of decolonisation to9 prevent simple colonisations turning into life threatening and debilitating infections?

Kind Regards

Verily Thomas
Clinical Nurse Consultant | Infection Prevention and Control
SWSLHD-Bankstown/Lidcombe Hospital
Eldridge Road, Bansktown.NSW 2200
Tel 02 97228000 pager 28230
Tel 02 9722 8633 | Fax 02 9722 7822 | verily.thomas@sswahs.nsw.gov.au
http://www.health.nsw.gov.au

[Description: cid:image002.jpg@01CE8EA5.483A6E60]
LET’S KEEP OUR HOSPITAL ENVIRONMENT CLEAN
HAND HYGIENE SAVES LIVES

This recently published study on nursing home MRSA in Switzerland demonstrated a screening and decolonisation programme had no effect on MRSA carriage rates.

http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9611081&fulltextTypeRA&fileIdS0899823X14000749

Great to see such a negative study published from the non-acute sector.

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

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