[Nicky Whitehouse]

As a scrub/ scout RN I whole heartily agree with Terry.

Nicky Whitehouse RN
Ipswich Day Hostpital

> On 24 Apr 2020, at 8:37 am, Terrye wrote:
>
>
> Thankyou Rachel for raising this challenging issue.
>
> As we reintroduce elective procedures into the privately operated Day Surgery environment and where Aerosol Generating Procedures are being performed, some state and territory guidelines require P2 / N95 masks to be worn for all patients, not just those that have suspected or confirmed COVID-19.
>
> Apart from the issues with lack of supply, there is limited expertise in fit testing / fit checking in this sector healthcare and I am concerned about the risks to the personnel working in these operating rooms.
>
> In my humble opinion, there needs to be a nationally endorsed response to your questions.
>
> Kind Regards
> Terry McAuley
> Director
> MSc Medical Device Decontamination
>
> PO BOX 2249, Greenvale, VIC Australia 3059
> Mobile: +61 (0)438 109 692
> Email: terry@steamconsulting.com.au
> Website: http://www.steamconsulting.com.au
>
>
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> From: ACIPC Infexion Connexion On Behalf Of Thomson, Rachel EA
> Sent: Friday, April 24, 2020 8:06 AM
> To: ACIPCLIST@ACIPC.ORG.AU
> Subject: [ACIPC_Infexion_Connexion] Fit testing program – Can you please help?
>
> Hi all
>
> We are interested in other states/jurisdictions/facilities approaches to fit-testing, either qualitative or quantitative.
>
> We had a qualitative fit-testing program within our hospital previously and we made the decision to disband this earlier in the year for a number of reasons.
>
> We are now getting significant pressure from a particular clinical group to re-establish fit-testing again.
>
> We had a number of issues with the fit-testing program previously and our rationale for not re-establishing fit-testing currently include the following:
> Fit-testing has not been proven to provide safer P2 (N95) mask use compared with fit-checking alone
> Despite the presence of the Australian Standard, fit-testing is not mandatory and fit-checking is accepted to be the minimum standard
> There are a number of practical difficulties to be considered with the re-introduction of a fit-testing program;
> If fit-testing is offered to one craft group, all healthcare workers that require a P2 (N95) mask within their clinical role will expect a similar approach. Equitable approach would need to be considered for all.
> Some individuals will not have a successful fit-test e.g. do not taste the fit-testing solution, do not have a successful fit-test with any of the available masks. Does this equate to that healthcare worker being unsafe with an appropriately fit-checked P2 (N95) mask?
> Resources required for fit-testing program is not insignificant i.e. human resources and PPE required, with consideration for annual testing thereafter
> What to do for individuals that have not been fit-tested as yet but they are required to work with the requirement of a P2 (N95) mask?
> What to do if individuals fit-tested mask is not available at the point of care, particularly in the setting of the current PPE stock issues?
>
> We would be really keen to understand others thoughts and experiences and approaches.
>
> Your urgent advice would be much appreciated. Please feel free to email me off-line or even call me if you can
>
> Thanks in advance
> Rachel
>
> ..
> Rachel Thomson
> Nurse Unit Manager
>
> Infection Prevention & Control Unit
> Royal Hobart Hospital
> Tasmanian Health Organisation-South
>
> (: 03 6166 7882/ 6166 8658
>
> Mobile: 0400 718 574
> Email: rachel.thomson@ths.tas.gov.au
>
> Level 4, H Block
> 48 Liverpool Street
> Hobart, 7000
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[Nicky Whitehouse]

Dear All,

With the discussion of masks and so on, may I ask please, if there is any evidence of this virus in diathermy plume? A surgeon and I were discussing this recently and wondering. We dont use diathermy plume extractors routinely (though I would like to) in my work place and I trailed normal suction tubing and a yanker with no success. We are not doing known virus cases, but Im just wondering?

Thank you the ongoing information.
Nicky Whitehouse RN
Ipswich Day Hostpital

> On 19 Apr 2020, at 3:10 pm, Mayer, Jo wrote:
>
>
> There is much discussion around reprocessing of masks, I was also wondering if there is a push for Australia (if possible) to produce its own PPE. I am also interested to know what work is being done around maintaining skin integrity of staff wearing PPE for significant periods of time, notably masks.
>
> Kind regards
> Jo Mayer
>
> Sent from my Windows Phone
> From: Michael Wishart
> Sent: 15/04/2020 9:56 AM
> To: ACIPCLIST@ACIPC.ORG.AU
> Subject: Re: [ACIPC_Infexion_Connexion] COVID-19 theatre case
>
> We have dedicated a specific theatre for COVID-19 cases. There are gumboots for staff to wear as part of the PPE for this theatre, and they put the gum boots on as part of the PPE and remove them as part of removal of PPE.
>
> We thought about overshoes for all, but were concerned about staff forgetting they had them on and not removing/changing them. Gumboots are pretty obvious!
>
> Cheers
> Michael
>
> Michael Wishart | Infection Control Coordinator, CICP-E
>
> St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
> T +61 7 3326 3068 | F +61 7 3607 2226
> E michael.wishart@svha.org.au |
> W https://www.svphn.org.au
>
>
>
>
>
> From: Lynette Cribb
> Sent: Wednesday, 15 April 2020 10:56 AM
> To: acipclist@acipc.org.au
> Cc: Katherine Taylor ; Carien Coleman ; Michael Wishart ; ‘Scott McDonald’
> Subject: COVID-19 theatre case
> Importance: High
>
> Morning,
>
> Just wanting to find out what hospitals are doing around COVID-19 positive patients and them going to theatre in particular around the theatre staff shoes?
>
> Any information with regards to this would be greatly appreciated.
>
> thanks
>
> With kind regards,
> Lynette CribbInfection Control Coordinator
> Direct 07 3834 4328 | mobile 0427141223 | Fax 0738344599| Pager: 0328
> SAWMH.ICC@uchealth.com.au | standrewshospital.com.au
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[Nicky Whitehouse]

Dear All,

As a scrub RN in a Day surgery this is very topical for me. I have been off this week so find the ideas given so far sound most appropriate, wonderful to have access to such a wealth of knowledge. However I also think it’s important mention the risks for the aseptic team that comes from surgical plume. And just for interest I understand P2 (similar to N95?) masks are worn in ORs refer to ACORN Standards 15th edition 2018. I also understand that when using diathermy, for example, warts of a HVP positive patient ,these type of masks should be worn and fitted correctly and this surgery is still done in some Day Hospitals. If I have this wrong please let me know. Interesting what can be transferred by surgical plume and not all ORs have surgical plume evacuators on hand.

Thank you once again for the information.

Nicky Whitehouse
Scrub/scout RN
Ipswich Day Hospital.

> On 1 Feb 2020, at 9:31 am, Michael Wishart wrote:
>
> Hi Terry
> My thought to conserve appropriate use of mask would to look at alternative forms of protection for staff, based on risk. For example scrub team at the table should be given priority. For circulating and anaesthetic staff, face shields or visors may be appropriate with the shortage of masks.
>
> This would obviously need to be reviewed with the level of air contamination risk of the surgery (eg prosthetic implants) but would still send the message that staff protection in the OT is important.
>
> Cheers
> Michael
>
>
> Michael Wishart | Infection Control Coordinator, CICP-E
>
>
> St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
>
> T +61 7 3326 3068 | F +61 7 3607 2226
>
> E michael.wishart@svha.org.au |
>
> W https://www.svphn.org.au
>
> Get Outlook for Android
> From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU > on behalf of Terry <terry@STEAMCONSULTING.COM.AU >
> Sent: Saturday, February 1, 2020 8:25:04 AM
> To: ACIPCLIST@ACIPC.ORG.AU <ACIPCLIST@ACIPC.ORG.AU >
> Subject: Re: [ACIPC_Infexion_Connexion] Mask shortages and the Operating Suite
>
> Hi Everyone,
>
> We are experiencing difficulty in having orders filled for surgical masks.
>
> My question was not about access to N95 masks for us in the OR just the usual Type 2 and Type 3 masks that we need to wear when working in the Operating Room during surgical procedures to protect the patient from the scrub teams respiratory tract flora and to protect the scrub team from exposure to blood and body substances.
>
> Hopefully that provides clarification re my question.
> Kind Regards
> Terry McAuley
> Director
> MSc Medical Device Decontamination
>
> PO BOX 2249, Greenvale, VIC Australia 3059
> Mobile: +61 (0)438 109 692
> Email: terry@steamconsulting.com.au
> Website: http://www.steamconsulting.com.au
>
>
>
>
> I endeavour to achieve a sensible work-life balance: There is no need to reply to this email from you outside of your normal working hours. Please expect the same from me.
>
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> CONFIDENTIAL COMMUNICATION: The information contained in this message may contain confidential information intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or duplication of this transmission is strictly prohibited. If you have received this communication in error, please notify us by telephone or email immediately and return the original message to us or destroy all printed and electronic copies. Nothing in this transmission constitutes an agreement of any kind unless otherwise expressly indicated.
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> From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU > On Behalf Of Jenny McCarthy
> Sent: Friday, January 31, 2020 6:31 PM
> To: ACIPCLIST@ACIPC.ORG.AU
> Subject: Re: [ACIPC_Infexion_Connexion] Mask shortages and the Operating Suite
>
> Hi Terry- am I missing something here? Why are theatre staff using N95 masks in the OR?
>
> Sent from my iPhone
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> On 31 Jan 2020, at 4:26 pm, Lincoln Fowler <Lincoln.Fowler@calvary-act.com.au > wrote:
>
> Hi Terry
> Maybe there are some useful ideas in this article:
> https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
>
> Lincoln Fowler
> Infection Control and Staff Health Coordinator CBPH
> Infection Prevention, Control & Staff Health Department
>
> Calvary
> Public Hospital Bruce
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> From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU > On Behalf Of Terry
> Sent: Friday, 31 January 2020 11:03 AM
> To: ACIPCLIST@ACIPC.ORG.AU
> Subject: [ACIPC_Infexion_Connexion] Mask shortages and the Operating Suite
>
> Hi Everyone,
>
> I am hearing about mask shortages and this is impacting on my Day Surgery clients, as they are being told that their orders may not be able to be filled because demand is outstripping supply.
>
> Consequently, I am being asked what strategies could be implemented to conserve masks to avoid running out and not being able to perform surgical procedures.
>
> There are obvious conservation strategies we could implement such as anaesthetic team members not wearing masks unless in close proximity to the sterile field or at risk from aerosols or plume; wearing the same mask for more than one patient for short cases such as ophthalmic surgery etc; however I am concerned that if we enact these interim conservation measures there will be push back to correct usage of surgical masks when we return to business as usual.
>
> Do the brains trust have any thoughts re this or other conservation strategies that are being implemented in other Operating Suites?
>
> Kind Regards
> Terry McAuley
> Director
> MSc Medical Device Decontamination
>
> PO BOX 2249, Greenvale, VIC Australia 3059
> Mobile: +61 (0)438 109 692
> Email: terry@steamconsulting.com.au
> Website: http://www.steamconsulting.com.au
>
>
>
>
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[Nicky Whitehouse]

Well said Michelle my congratulations too. Fantastic!

Nicky Whitehouse RN, Grad Dip Periop
Scrub/ Scout IDH

> On 9 Mar 2019, at 10:59 am, Michelle Bibby wrote:
>
> Congratulations to the team involved!
>
> Michelle Bibby
> Infection Prevention Australia
> +61 429 071 165
> Michelle@infectionprevention.com.au
> http://www.infectionprevention.com.au
>
>
>
>
>
> From: ACIPCLIST on behalf of “Susan Jain (Clinical Excellence Commission)”
> Reply-To: ACIPCLIST
> Date: Friday, 8 March 2019 at 6:18 pm
> To: ACIPCLIST
> Subject: [ACIPC_Infexion_Connexion] FW: Our new publication
>
> Hi all
> Please find another home grown ground breaking research just got published in AJIC.
> Attached a copy for you to embrace long due practice change.
>
>
> Kind Regards
>
> Susan Jain RN MN PhD candidate
> Infection Prevention and Control Practitioner, Conjoint Lecturer UNSW
> HAI Program Project Officer | Clinical Excellence Commission
> Level 17, 2-24 Rawson Place, Haymarket NSW 2000
> p. (02) 9269 5552 | e. susan.jain@health.nsw.gov.au
>
>
> http://www.cec.health.nsw.gov.au
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[Nicky Whitehouse]

Hi Emma,

Sorry for the late reply but I was wondering why the Surgeons place linen drapes down first with the impervious disposable drapes on top. Do they have evidence to support this? and how are they securing the linen drapes in place? Adhesive drape tape? More sticky substance on the patients skin adding to that on the disposable drape and if an steri drape is used as well. Towel clips? Ball and socket type or sharp ones which have the potential to make holes in linen drapes and compromise the aseptic field, not to mention piercing the patient . As I understand once a surgical drape is in place there it remains and is not moved until after the dressing is in place, but Im wondering, if the Surgeons are double draping a limb then the linen drape is being moved which could cause linen fibres to raise into the air and potentially land at the incision site. Also the overall thickness integrity of a linen drape could not be 100% due to multiple washing and resterilizations. Good luck, I’m interested to hear how you go.

Nicky Whitehouse RN
Perioperative Nurse Ipswich Day Hospital

> On 30 Nov 2018, at 1:05 pm, Michael Wishart wrote:
>
> Hi again Emma
>
> Not much more helpful, but apparently the Consensus Proceedings have been updated this year (thanks to Dr Tammy Wijesuriya for letting me know)
>
> Question 7: Does the type of surgical drape (disposable vs. nondisposable) used affect the risk of subsequent SSIs/PJIs in patients undergoing orthopedic surgery? Recommendation: Unknown. The data from nonorthopedic procedures suggest that disposable drapes resist bacterial passage and reduce the risks of subsequent SSIs. Impermeable barriers should be used regardless of whether disposable or nondisposable drapes are used. Level of Evidence: Limited Delegate Vote: Agree: 90%, Disagree: 3%, Abstain: 7% (Super Majority, Strong Consensus) Rationale: Surgical drapes act as a barrier to prevent the contamination of the surgical field during a procedure. They are used to isolate the prepared surgical field from the nonsterile, nonsurgical area. Reusable drapes are made of a woven material and are laundered and sterilized between procedures. In contrast, disposable drapes are usually made of nonwoven material and are disposed of after each operation. Various physical properties of drapes and surgical conditions can affect the bacterial permeability of drapes. For example, it is known that there is increased bacterial passage when drapes are made wet by normal saline or blood [73,74]. Disposable drapes have been shown to decrease rates of bacterial passage, even when made wet by normal saline; however, this decreased bacterial transmission does not clearly indicate decreased risks of SSIs/PJIs [75,76]. We performed a systematic review using PUBMED, Medline, Web of Science, Embase, Google Scholar, and the Cochrane Library of studies in English. We included journal articles, communications, and conference proceedings. Unfortunately, there is a paucity of studies relating specifically to orthopedic surgery on this topic. Randomized controlled trials in cardiac surgery and general surgery demonstrated no statistically significant differences in infection rates between the 2 types of drapes [77,78]. However, a different prospective randomized study of 102 reconstructive breast surgeries demonstrated a statistically significant lower rate of infection 30 days after surgery in the disposable drape cohort (0 vs. 12%) [79]. The current literature on this topic is inconclusive, and there are no studies involving orthopedic or spine surgery patients; future research efforts should be focused on this topic.
>
> Here: https://www.arthroplastyjournal.org/article/S0883-5403(18)30840-4/pdf
>
> Cheers
> Michael
>
> Michael Wishart | Infection Control Coordinator, CICP-E
>
> St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
> T +61 7 3326 3068 | F +61 7 3607 2226
> E michael.wishart@svha.org.au |
> W http://www.hsnph.org.au
>
>
>
> From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU > On Behalf Of Michael Wishart
> Sent: Friday, 30 November 2018 11:05 AM
> To: ACIPCLIST@ACIPC.ORG.AU
> Subject: Re: re Linen in Theatres
>
> Hi Emma
>
> A large Consensus forum by Orthopods in 2013 did not find type of drape an issue:
>
> Question 29: What type of draping should be used (reusable or disposable)?
> Consensus: We recognize that penetration of drapes by liquids is believed to be equivalent to contamination and recommend impervious drapes. In the absence of data on disposable versus cloth drapes, we make no recommendation except for further study.
> Delegate Vote: Agree: 90%, Disagree: 6%, Abstain: 4% (Strong Consensus)
> Justification: The available evidence is solely experimental. Most of the studies have been performed in models with rigorous conditions that are unusual in real-life situations. Clinical trials with PJI as an endpoint are lacking. 139
>
> Literature: In addition to the physical properties of material applied for fabricating drapes, factors such as pressure, friction, contact time with contaminated material, state of moisture/dryness, and the moisturizing agent (blood, normal saline, or antiseptic solutions) can affect bacterial permeability of drapes.149, 150 While passage of bacteria through dry drapes does happen, the strike-through rate of bacteria is enhanced when wetted by normal saline or blood and diminished when wetted by antiseptic solutions (iodine or chlorhexidine).149 Moreover, drape material may demonstrate different levels of impermeability depending on the penetrating particle (aqueous fluids, albumin, or bacteria).151-153 Woven and non-woven materials vary in their ability to resist bacterial strikethrough. Disposable nonwoven drapes are superior to reusable woven cotton/linen drapes in resisting bacterial penetration. When wetted by normal saline, reusable woven drapes were penetrated by bacteria within 30 minutes, while the majority of disposable nonwoven drapes were not.151 Being impervious does not necessarily mean being absolutely impenetrable to bacteria and impermeability can vary between different disposable drape brands. However, disposable drapes considerably decrease bacterial load passing through them.154
> Two RCTs were conducted comparing reusable and disposable drapes and gowns in coronary artery bypass graft and elective abdominal surgery, with SSI as their main outcome. None of these studies found differences between the two types of gowns and drapes.155, 156
>
> The whole document can be found here: https://www.efort.org/wp-content/uploads/2013/10/philadelphia_consensus.pdf
>
> Not sure it will be easy to convince them
>
> Cheers
> Michael
>
>
> Michael Wishart | Infection Control Coordinator, CICP-E
>
> St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
> T +61 7 3326 3068 | F +61 7 3607 2226
> E michael.wishart@svha.org.au |
> W http://www.hsnph.org.au
>
>
>
> From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU > On Behalf Of Emma Trippe
> Sent: Friday, 30 November 2018 10:28 AM
> To: ACIPCLIST@ACIPC.ORG.AU
> Subject: re Linen in Theatres
>
> Dear Brains Trust,
> In line with AS4187 we are trying to get linen out of our lives in Theatres!! Im nearly there except for Orthopaedics
>
> It seems to be in joint theatres where they still like to use linen as a base cover to ensure asepsis before they place on the impervious disposable drapes.
> My two questions are;
> 1. Has anyone found a disposable drape that potentially handles like linen?? we have trialled various brands but the Orthopods have not found one they like – you may need to privately email me with this info re company names ect
> 2. Does anyone have any recent literature I can give to our Linen loving Surgeons re why not to use it for surgical procedures? !! I realise its seen as a foreign body lint ect but need some firm evidence to assist with our hopeful conversion!
>
> So appreciated & lovely to see you all at the Conference!!
>
> Emma Trippe
> Infection Control Consultant
>
>
> Calvary Riverina Hospital
> Hardy Avenue Wagga Wagga NSW 2650
> P: 02 6932 1628
> E: Emma.Trippe@calvarycare.org.au
> http://www.calvary-wagga.com.au
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