[RUSSO, Philip]

Hi Lyn

We have recently released the latest version of the Hand Hygiene
Australia Manual.

http://www.hha.org.au/UserFiles/file/Manual/HHAManual_2010-11-23.pdf

In Section 3.2 we state:

Both soap and ABHR products are necessary for the introduction of a HH
program;

a soap and water wash is required if hands are visibly soiled, and
either product

can be used if hands are visibly clean. As wet hands can more readily
acquire and spread microorganisms, the proper drying of hands is an
integral part of routine

hand hygiene (1).

Paper towels, cloth towels, and air dryers are commonly used to dry
washed hands. There is currently conflicting evidence as to the
efficacy of each method for removing bacteria from washed hands (23-25).
Ideally, hands should be dried using either individual paper towels, or
hand driers which can dry hands as effectively and as quickly as it can
be done with paper towels (26). Hand driers used in healthcare should be
proven not to be associated with the aerosolisation of pathogens (1),
for example using hospital grade HEPA filtration to minimise airborne
microorganisms (27).

(References are listed in the manual)

I would also support Maries comments regarding noise (day and night),
and also add that regular cleaning and maintenance of these machines
must also be considered.

Hope this helps your decision.

Kind regards
Phil Russo, M.Clin.Epid
Hand Hygiene Australia
National Project Manager
P: +61 3 9496 3587 | M: +61 411 659 486 |E: philip.russo@austin.org.au
http://www.hha.org.au/
Hand Hygiene Australia, c/- Austin Health Infectious Diseases Dept. PO
5555 Heidelberg, VIC, Australia 3084

Behalf Of Lyn A. Golden

Has anybody had any experience with installation of hand dryers (warm
blowing air) in clinical areas?
We are building a new facility, the question has been raised can we
install hand dryers instead of paper towel in clinical areas at the hand
washing sinks?

Does anyone have any thoughts on this?

Lyn

Infection Prevention and Control Manager

Echuca Regional Health
17 Francis Street
Echuca 3564

Helping Everyone To Be And Stay Healthy

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[RUSSO, Philip]

[RUSSO, Philip]

Nice summary Matthias. We are not aware of any evidence that would
suggest the first wash of the day in OR be done with anything but soap
and water. Certainly subsequent to that, but not the first.

Surgical hand preparation: State of the art.
Widmer AF, Rotter M, Voss A, Nthumba P, Allegranzi B, Boyce J, Pittet D.
J Hosp Infect. 2010 Feb;74(2):112-22. Epub 2009 Aug 28. Review.

Regards
Phil Russo, M.Clin.Epid
Hand Hygiene Australia
National Project Manager
P: +61 3 9496 3587 | M: +61 411 659 486 |F: +61 3 9496 6677 |E:
philip.russo@austin.org.au
http://www.hha.org.au/
Hand Hygiene Australia, c/- Austin Health Infectious Diseases Dept. PO
5555 Heidelberg, VIC, Australia 3084

—–Original Message—–
Behalf Of Matthias.Maiwald@KKH.COM.SG

Dear Cath, dear Group,

“Waterless surgical scrubs” or alcohol-based surgical hand/arm
antisepsis (as it is better called) has been the standard of care in
Europe (especially Germany, Austria, Switzerland) for about 30 years or
longer.
(In fact, one now retired author describes in a book chapter [Groeschel
& Pruett, Surgical Antisepsis, in Block 1991] that it has already been
in use in the 1950s). How it is done (at least in the 80s when did my
surgical
internship) is to do a soap-based handwash (plus arms) and to scrub with
a brush only under fingernails (not on other skin) for the first scrub
of the day, followed by drying of hands/arms with a sterile towel (not
paper) and followed by rubbing the alcohol-based hand disinfectant onto
hands and arms and keeping them ‘wet’ with alcohol for 5 minutes. Then
letting the alcohol dry (as for a normal alcohol hand rub) before
gowning and gloving. One of the speakers at the recent Infection Control
Course in Port Douglas, Andreas Widmer from Switzerland, has been
presenting on this topic at ICAAC meetings, and it appears that the
tendency goes towards shorter scrubbing times now (than in the 80s), and
about 3 min is consideres satisfactory.

There are two main advantages: (a) it is more gentle to skin, consistent
with alcohol-based hand antiseptics having emollients, and (b) it
achieves far greater microbial reduction. While water-based surgical
scrubbing achieves a microbial reduction typically by about 1-2 log
(factor 10-100), alcohol-based surgical hand antisepsis achieves about
3-4 log reduction (factor 1000-10000, that is a factor 10-100 better
than water-based scrubbing. When agents for persistence are added, then
there is no or only minimal regrowth of microorganisms under the
surgical gloves for the duration of the operation. In fact, the lack of
significant regrowth is assessed as part of the European standard EN
12791 for surgical hand antiseptics. Note that no aqueous surgical scrub
stands a chance of passing this stringent testing standard.

One should mention that there are no clinical trials with surgical
infection rates as the outcome that show a difference in infection rates
between water-based and alcohol-based scrubs, however, the much lower
residual microorganisms provide a strong microbiological and
pathophysiological rationale that at least there is a greater safety
margin in case of accidental glove leaks or rupture (which is what
surgical acrubbing is designed for).

And yes, there is a section on surgical scrubbing, including alcohol
formulations, in the new 2009 WHO hand hygiene guideline.

I would personally strongly advocate NOT to use gels for that purpose,
because most gels have distinctly less antimicrobial activity than
liquids, because surface coverage is more difficult to achieve with the
more viscous gels, and because gels often leave a sticky residue, which
will be uncomfortable under the surgical gloves. There are a number of
European companies that have alcohol-based surgical hand antiseptics in
their product range; they are specially formulated for that purpose and
pass the stringent EN 12791. Not to make undue advertisements, but among
the European companies with such products in their range and an
established distribution network in Australia is B. Braun. (Of course,
there are several other possibilities with equally good products).

And yes, TGA should look at approving some of these, in my opinion.

I do have some literature about this, which I am certainly offering to
share.

Best regards, Matthias.

—
Matthias Maiwald, MD, FRCPA
Consultant in Microbiology
Department of Pathology and Laboratory Medicine KK Women’s and
Children’s Hospital 100 Bukit Timah Road Singapore 229899 Tel. +65 6394
1389 Fax +65 6394 1387

Cath Murphy

To
Sent by: AICA AICALIST@AICALIST.ORG.AU

Infexion
cc
Connexion

Waterless Surgical Scrubs

09/08/2010 06:01

PM

Please respond to

AICA Infexion

Connexion

Dear AICA, ACSQHC and ACORN Colleagues

I have been asked about the suitability of using “waterless surgical
scrubs” as an alternative to the first ‘soap and water’ wash of the day
in the operating theatre or surgical procedural unit. Does anybody know
if this is common? Acceptable? Widespread and based on credible evidence
or policy?

Any commentary welcomed. Thanks.

Cath

Assoc. Prof Cathryn Murphy RN PhD CIC
CNC Infection Control
Gold Coast Health Service District
Robina Hospital
Gold Coast

http://www.icp.au.com

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[RUSSO, Philip]

I concur with Glenys’ comments. Good infection prevention practices and
hand hygiene will prevent any transfer of pathogens to patients.

Regards
Phil Russo, M.Clin.Epid
Hand Hygiene Australia
National Project Manager
P: +61 3 9496 3587 | M: +61 411 659 486 |F: +61 3 9496 6677 |E:
philip.russo@austin.org.au
http://www.hha.org.au/
Hand Hygiene Australia, c/- Austin Health Infectious Diseases Dept. PO
5555 Heidelberg, VIC, Australia 3084

________________________________

Behalf Of Glenys Harrington

Hi All,

This posting raises the question why are we looking at antimicrobial
patient curtains/shower curtains at all?

I’m not aware of any evidence that such items have been identified as
source of HAIs or show to reduce HAIs?

If this is a cost saving initiative (i.e. the cost of disposal is less
than laundering/dry-cleaning non disposable items) then this is an issue
for the supply manager.

Perhaps we as infection control should be asking for the evidence to
support their use over routine laundering practices?

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

H: +61 3 96902216

M: +61 404 816 434

infexion@ozemail.com.au

Behalf Of Angela Conte

Dear All,

Does anyone use disposable antimicrobial patient curtains or disposable
shower curtains?

If so, has the product met expectations?

Is there any information available re: cost, recycling, infection
control benefits?

Regards,

Angela Conte

Infection Control

Balmain Hospital

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[RUSSO, Philip]

Short of running a guillotine across the knuckles, I’d suggest they
would need to be removed from the clinical area until a/nails removed

Regards
Phil Russo

On 22/03/2010, at 3:35, “Wilson, Fiona L (Infection Control)” wrote:

> As per Hand Hygiene Australia and WHO consensus recommendations, we
> do not recommend that HCW have artificial fingernails while working
> in the clinical area. I am wondering how you ‘police’ this (for want
> of a better term) and does anyone have a HR process for HCW’s who
> refuse to remove artificial fingernails.
> Regards
>
> Fiona Wilson
> Manager, Infection Control
> Western Health
> Phone: 8345 6666 pager 506
> Fax: 83456973
> email: fiona.wilson@wh.org.au
>
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