[Thomson, Rachel EA]

Hi all,

I think that the decision to screen for any MRO is based on a range of factors including the current prevalence of a particular pathogen as well as other factors within any individual health service. For example, it appears based on our current screening program we have in place within our organisation, including based on our program for HCWs, that our local burden of pathogens such as MRSA is quite low. Thus, we do have an ongoing MRSA screening program for selected staff, including those who have recently returned from overseas healthcare environments. This process has been carefully considered and developed in direct consultation with Infectious Disease Physicians/ Microbiologists.

Jayne I will send you our protocol off-line so that you may consider whether it contains any information of value for you.

Kind regards
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Jayne.
Im wondering why you ask this question.
I take health care workers to Vietnam and I have never heard of a requirement to screen them coming home.
We do not screen any of our employees for MRSA at anytime and I have only heard of it done as a prerequisite for working in Western Australia.
Ive only heard of it be considered as a last resort in outbreak investigation in the Eastern states
Jennifer Benjamin.
IPAC CNC
Eastern Health

G’day Brains Trust,

Does anyone have or know of a MRSA policy for staff returning to work following volunteer work overseas for charity groups delivery hands on health care?

Would love to hear from the experts.

Kind Regards

Jayne

Jayne OConnor RN, BSc.Inf.Cont.
Acting Co ordinator IPC
Sydney Adventist Hospital
185 Fox valley Rd,
Wahroonga 2076

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[Thomson, Rachel EA]

Agreed!

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Rachel,

The shared and close placement of these children is increasing the risk not only to the carer and visitors but to other child/children who are sharing the room .

The real fix is that you need more segregation (distancing) and more single rooms.

To bring this to the attention of hospital executive staff I would write an incident report each time this co-sharing is required detailing the associated potential risks.

Probably not a risk an organisation should be taking outside of a respiratory outbreak setting when there are large numbers of presentations

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

Hi Glenys,

In many circumstances the answer is yes for children and infants, I certainly don’t disagree with you. However, in our experience, rather than having a child in a room at home, which may even be a separate room, we place child and parent/care giver in very close proximity. Invariably, we seat the parent/caregiver next to the bed. In shared rooms, this is even more problematic, and the parent/ caregiver is obliged to sit very close. Our focus has been to include our parents/caregivers in our consideration for the use of PPE rather than assume that they have been exposed and then ensure that this is the case.

We certainly do focus on respiratory and hand hygiene; it is simply that we include our parents/care givers in the considerations we make, and framework we have developed here at the RHH over time.

Cheers
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Rachel,

Wouldn’t the primary care giver have already been exposed?

Probably more important to focus on good respiratory hygiene and hand hygiene.

Also less work load for nurses in terms of training primary care givers and visitors in PPE when it may not be needed.

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

Hi Mary,

I have been particularly busy, so I haven’t noticed if you have had many replies to you question. I personally find this a tricky area, but thought I would share our organisation’s approach.

We have extended the ‘privilege’ of PPE to all visitors, including parents visiting ill children. That is, we make provision for all to people entering the care zone to wear PPE. We ask our nursing staff to educate parents/carers in the role/purpose and use of PPE. We do not mandate wearing of PPE for principle care-givers for pathogens such as MRSA, VRE etc. but encourage these individuals to consider protecting their own health with use of masks and appropriate HH when the child has an acute respiratory illness, such as Influenza. For pathogens/ clinical syndromes such as;
Adenovirus (respiratory syndrome only)
Bronchiolitis
Croup
Human metapneumovirus
RSV
Rhinovirus

We make provision that only during direct contact with the child that staff need to wear PPE (mask, gown, gloves). We have adopted the principle that where the primary care giver could be at risk from infection with the pathogen that protection should be afforded to these parents/carers. We also recognise that parents/carers rooming in cannot spend all day in PPE, nor can they sleep in such equipment.

In short, we do not have a perfect solution, but very much have adopted an approach that parents/carers have a right to be protected, need to be educated in the use of PPE if they are going to use it.

Hope this helps?

Kind regards
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Everyone

I am hoping that you might be able to assist with possible guidelines/policies relating to the implementation of transmission based precautions in paediatric patients. Having recently moved to a paediatric environment I am curious to see if transmission based precautions should be applied differently/modified as children possibly have unique needs when it comes to infection prevention. For example, should droplet and contact precautions be applied to children with respiratory viruses due to the fact that children tend to put everything in their mouths and are not as good as adults with respiratory etiquette?

I understand that standard precautions must always be applied and that a risk management approach still needs to occur but would be very grateful for any advice and/or direction!

Many thanks
Mary

Mary Willimann CICP | Infection Prevention and Control Coordinator
Child and Adolescent Health Service, Roberts Road Subiaco WA 6008
T: (08) 9340 7822 | 0466 350 206
E: mary.willimann@health.wa.gov.au
Delivering a Healthy WA

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[Thomson, Rachel EA]

Hi Glenys,

In many circumstances the answer is yes for children and infants, I certainly don’t disagree with you. However, in our experience, rather than having a child in a room at home, which may even be a separate room, we place child and parent/care giver in very close proximity. Invariably, we seat the parent/caregiver next to the bed. In shared rooms, this is even more problematic, and the parent/ caregiver is obliged to sit very close. Our focus has been to include our parents/caregivers in our consideration for the use of PPE rather than assume that they have been exposed and then ensure that this is the case.

We certainly do focus on respiratory and hand hygiene; it is simply that we include our parents/care givers in the considerations we make, and framework we have developed here at the RHH over time.

Cheers
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Rachel,

Wouldn’t the primary care giver have already been exposed?

Probably more important to focus on good respiratory hygiene and hand hygiene.

Also less work load for nurses in terms of training primary care givers and visitors in PPE when it may not be needed.

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

Hi Mary,

I have been particularly busy, so I haven’t noticed if you have had many replies to you question. I personally find this a tricky area, but thought I would share our organisation’s approach.

We have extended the ‘privilege’ of PPE to all visitors, including parents visiting ill children. That is, we make provision for all to people entering the care zone to wear PPE. We ask our nursing staff to educate parents/carers in the role/purpose and use of PPE. We do not mandate wearing of PPE for principle care-givers for pathogens such as MRSA, VRE etc. but encourage these individuals to consider protecting their own health with use of masks and appropriate HH when the child has an acute respiratory illness, such as Influenza. For pathogens/ clinical syndromes such as;
Adenovirus (respiratory syndrome only)
Bronchiolitis
Croup
Human metapneumovirus
RSV
Rhinovirus

We make provision that only during direct contact with the child that staff need to wear PPE (mask, gown, gloves). We have adopted the principle that where the primary care giver could be at risk from infection with the pathogen that protection should be afforded to these parents/carers. We also recognise that parents/carers rooming in cannot spend all day in PPE, nor can they sleep in such equipment.

In short, we do not have a perfect solution, but very much have adopted an approach that parents/carers have a right to be protected, need to be educated in the use of PPE if they are going to use it.

Hope this helps?

Kind regards
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Everyone

I am hoping that you might be able to assist with possible guidelines/policies relating to the implementation of transmission based precautions in paediatric patients. Having recently moved to a paediatric environment I am curious to see if transmission based precautions should be applied differently/modified as children possibly have unique needs when it comes to infection prevention. For example, should droplet and contact precautions be applied to children with respiratory viruses due to the fact that children tend to put everything in their mouths and are not as good as adults with respiratory etiquette?

I understand that standard precautions must always be applied and that a risk management approach still needs to occur but would be very grateful for any advice and/or direction!

Many thanks
Mary

Mary Willimann CICP | Infection Prevention and Control Coordinator
Child and Adolescent Health Service, Roberts Road Subiaco WA 6008
T: (08) 9340 7822 | 0466 350 206
E: mary.willimann@health.wa.gov.au
Delivering a Healthy WA

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

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CONFIDENTIALITY NOTICE AND DISCLAIMER
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[Thomson, Rachel EA]

Hi Mary,

I have been particularly busy, so I haven’t noticed if you have had many replies to you question. I personally find this a tricky area, but thought I would share our organisation’s approach.

We have extended the ‘privilege’ of PPE to all visitors, including parents visiting ill children. That is, we make provision for all to people entering the care zone to wear PPE. We ask our nursing staff to educate parents/carers in the role/purpose and use of PPE. We do not mandate wearing of PPE for principle care-givers for pathogens such as MRSA, VRE etc. but encourage these individuals to consider protecting their own health with use of masks and appropriate HH when the child has an acute respiratory illness, such as Influenza. For pathogens/ clinical syndromes such as;
Adenovirus (respiratory syndrome only)
Bronchiolitis
Croup
Human metapneumovirus
RSV
Rhinovirus

We make provision that only during direct contact with the child that staff need to wear PPE (mask, gown, gloves). We have adopted the principle that where the primary care giver could be at risk from infection with the pathogen that protection should be afforded to these parents/carers. We also recognise that parents/carers rooming in cannot spend all day in PPE, nor can they sleep in such equipment.

In short, we do not have a perfect solution, but very much have adopted an approach that parents/carers have a right to be protected, need to be educated in the use of PPE if they are going to use it.

Hope this helps?

Kind regards
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Everyone

I am hoping that you might be able to assist with possible guidelines/policies relating to the implementation of transmission based precautions in paediatric patients. Having recently moved to a paediatric environment I am curious to see if transmission based precautions should be applied differently/modified as children possibly have unique needs when it comes to infection prevention. For example, should droplet and contact precautions be applied to children with respiratory viruses due to the fact that children tend to put everything in their mouths and are not as good as adults with respiratory etiquette?

I understand that standard precautions must always be applied and that a risk management approach still needs to occur but would be very grateful for any advice and/or direction!

Many thanks
Mary

Mary Willimann CICP | Infection Prevention and Control Coordinator
Child and Adolescent Health Service, Roberts Road Subiaco WA 6008
T: (08) 9340 7822 | 0466 350 206
E: mary.willimann@health.wa.gov.au
Delivering a Healthy WA

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

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________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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[Thomson, Rachel EA]

Hi Che,

You will need to refer to manufacturers recommendations for each specific product. The time frame required will be one that allows the product to have optimal surface contact time for efficacy, which would usually be in the range of 5 -10 minutes for a sodium hypochlorite agent. The surface may also need to be wiped of bleach residue to limit the risk of damage to a surface and this will add to the time, but is not part of the ‘disinfection’ process, usually just part of the overall process.

In short there is no other recommended ‘down-time’ requirements for the environment to be safe to receive a patient

Hope this assists.

Kind regards
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi all,

I am wondering if anyone out there knows of an official documented timeframe/recommendation on placement of a patient in a single or negative pressure room post Bleach clean?

I have looked through the NSW environenmental cleaning policy & cannot find a timeframe. At present I am being fed back 30 minutes, but this appears more so for patient comfort in regards to fume clearence.

Regards,

Che Jarvis
Acting CNC Infection Control| Nepean Hospital
Level 2, South Block
Tel 02 4734 2228 | Fax | Mob | che.jarvis@health.nsw.gov.au
http://www.health.nsw.gov.au
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[Thomson, Rachel EA]

Hi there,

We are the designated Quarantine facility for Tasmania and we have discussed this issue at some length internally. We are not strictly following the CDC framework. The reasons for this are many and varied but include concerns that there remain opportunities for contamination of HCWs based on the video information. Concerns include;

Donning

* Buddy outside room wearing face-shield, gown and gloves – we do not see the point of this if the donning is done in a clean space, especially as they are ticking the paper wearing all the gear. We are not allowing any paper that is to be retained to interact with the patient environment

* Donning of the inner glove at the commencement of the donning procedure – we believe that this increases the risk of damage to the glove and a resultant increased potential for exposure during care (especially as the P2 has to be fitted)

* Use of alcohol on gloves – we are using an approved disinfectant wipe instead.

* Donning of face-shield at the end after donning final glove and having ‘disinfected’ them – we think it very odd to be donning the face-shield at this point all gloved up.
Doffing

* Standing on the gown is during doffing – as the gown is likely contaminated it appears that there is an increased risk of contaminating the environment. This removal method is contrary to other published and established guidelines (including those from the CDC themselves)

* Removal of boot covers shows the person them moving around with unprotected shoes and ‘wiping’ at the end, this is in conflict with the Emory guidance that suggests the use of a chemical mat. The video shows the HCW walking in the cleaned shoes over the area where the soiled gown was previously stood on, clearly a risk for contamination

* Removal of P2 – this is demonstrated in a method contrary to manufacturers recommendations, the usual method is not to brush the hands past the front of the mask

I think the key issue is the training and competency in use of PPE relevant for a Quarantine pathogen, a point verbally highlighted in the video. I think recognising that there are many opportunities for contamination and that the familiarity with and care taken with PPE is fundamentally core to safety.

Hope these few comments and observations assist?

Kind regards
Rachel
……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi All,
The Australian Government, Department of Health, Ebola Virus Disease(EVD), CDNA National Guidelines for Public Health Units and the Victorian Department of Health, Victorian Ebola Virus Disease Plan, Version 2, have recently been updated (6/11 & 12/11).

http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-ebola.htm

http://docs.health.vic.gov.au/docs/doc/Victorian-Ebola-Virus-Disease-Plan-Version-2–November-2014

Both guidelines now refer the user to the United States, Centers for Disease Control (CDC) Guidance on Personal Protective Equipment.

See extract below from the CDNA National Guidelines:

* “For hospitals managing the ongoing care of probable or confirmed EVD cases, the United States Centers for Disease Control (CDC) Guidance on Personal Protective Equipment to be use by healthcare workers during management of patients with Ebola Virus Disease in U.S. Hospitals, including procedures for putting on (donning) and removing (doffing) (http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html ) are recommended”.

Find below a link to a CDC/Medscape video PPE demonstration the USA/CDC recommendations
http://www.medscape.com/viewarticle/833907

I recall recent threads on the ACIPC listserver where members had a number of concerns relating to the CDC recommendations, in particular the PPE donning and doffing procedures?

Do members still have ongoing concerns about the CDC recommendations?

Are members implementing the CDC recommendations as per the revised Australian/Vic guidelines?

We look forward to your feedback.

Brenda White & Glenys Harrington
Clinical Nurse Consultants Infection Control
Latrobe Regional Hospital
Princes Hwy, Traralgon VIC 3844
P: 5173 8566 (leave voice messages) P: 5173 8065 (Portable)
F: 5173 8173
E: infectioncontrol@lrh.com.au

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[Thomson, Rachel EA]

Here is our trolley checklist too.

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Joe,

Yes we have developed a preparedness trolley. I’m attaching a photo in PDF, I hope it comes through along with a copy of our trolley checklist. Feel free to contact me to discuss if this would help.

We have essentially placed a small ‘start-up’ stock of all items onto a trolley which includes a supply of all items we are recommending for patient management. This is being stored in a secure area with access easily obtained by relevant staff. We have also developed a “Quarantine Isolation sign” which is very consistent in look to the Commission doors signs, this provides advice to staff who will be entering the care zone in how to don and doff. These are laminated and will be placed inside and outside the room as well as in the ante-room.

Feel free to contact me off-line. Would love to know how you are approaching things too.

Kind regards
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Good morning everyone

Has any hospital set up any emergency boxes of PPE in preparation for a suspected EVD patient?

Thanks

Joe-Anne Bendall
Joe-anne Bendall
Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

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[Thomson, Rachel EA]

Hi Joe,

Yes we have developed a preparedness trolley. I’m attaching a photo in PDF, I hope it comes through along with a copy of our trolley checklist. Feel free to contact me to discuss if this would help.

We have essentially placed a small ‘start-up’ stock of all items onto a trolley which includes a supply of all items we are recommending for patient management. This is being stored in a secure area with access easily obtained by relevant staff. We have also developed a “Quarantine Isolation sign” which is very consistent in look to the Commission doors signs, this provides advice to staff who will be entering the care zone in how to don and doff. These are laminated and will be placed inside and outside the room as well as in the ante-room.

Feel free to contact me off-line. Would love to know how you are approaching things too.

Kind regards
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Good morning everyone

Has any hospital set up any emergency boxes of PPE in preparation for a suspected EVD patient?

Thanks

Joe-Anne Bendall
Joe-anne Bendall
Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital
8 Macquarie St
SYDNEY NSW 2000
|* ph +61 2 9382 7199 |page 22070 via switch 9382 7111| 7 Fax 93827510 |
Mobile 0418984255 | * Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

———————————————————————————————

Illawarra Shoalhaven Local Health District, South East Sydney Local Health District and Sydney Children’s Hospital Network (Randwick Campus) Confidentiality Notice

This email, and the files transmitted with it, are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you are not the intended recipient, you are not permitted to distribute or use this email or any of its attachments in any way. We also request that you advise the sender of the incorrect addressing.

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[Thomson, Rachel EA]

Thanks guys for your replies. I guess that we all recognise the need to be culturally sensitive and recognise that for some HCWs asking them to remove a beard could be very challenging.

I have discussed this with our Safety and Emergency Management Consultant who advises that not only do we have limited PAPR, but there are issues associated with wearing for prolonged periods. It seems that even if we don’t require the level of protection offered by a PAPR, that there is a real lack of alternate protection available for HCWs that offers the protection at the P2 level whilst accommodating beards.

Anyway, thanks again to those who replied.

Kind regards
Rachel

..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
T: 03 62227882/8658
Mobile: 0400 718 574
Email: rachel.thomson@dhhs.tas.gov.au

Level 4, H Block
48 Liverpool Street
Hobart, 7000

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Matthew Mason
Sent: Thursday, 4 September 2014 1:32 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Fit-testing P2 masks with beards

Hi Rachel,
Michelle has it all covered. Unfortunately the option is really only hood as all PAPR with masks that fit around the mouth/nose have the same problems. The only other option is to enforce being clean shaven, which is what industries such as fire & rescue, mining etc do or excluding the worker from that environment.
Cheers Matt

Matt Mason
Lecturer
School of Nursing & Midwifery
Faculty of Science, Health, Education and Engineering University of the Sunshine Coast
Ph: +61 7 5456 5191 | Fax: +61 7 5456 5940 | Email: mmason1@usc.edu.au | Web:www.usc.edu.au

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Thomson, Rachel EA (DHHS)
Sent: Thursday, 4 September 2014 12:34 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Fit-testing P2 masks with beards

Thanks Michelle,

Does this mean that all hospitals in Australia offer/ provide PAPR to all these staff?

Cheers
Rachel

..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
T: 03 62227882/8658
Mobile: 0400 718 574
Email: rachel.thomson@dhhs.tas.gov.au

Level 4, H Block
48 Liverpool Street
Hobart, 7000

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michele.Cullen@HEALTH.VIC.GOV.AU
Sent: Thursday, 4 September 2014 12:26 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Fit-testing P2 masks with beards

Dear Rachel

It is simple really.
You cannot fit test or fit check a single use or reusable (rubber) RPD on anyone with a beard. The same applies to most moustaches.
They must wear a Hood/PAPR.

Regards

(Embedded (Embedded image moved to file: pic13343.jpg)
image moved
to file:
pic19053.jpg)

Michele Cullen
Infection Control Consultant | Communicable Disease Prevention and
Control | Public Health
Department of Health | 50 Lonsdale Street, Melbourne, Victoria,
3000
p. 03 9096 5094 | f. 1300 651 170
e. michele.cullen@health.vic.gov.au
and
MDU PHL 03 8344 4575
e. mccullen@unimelb.edu.au

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|”Thomson, Rachel EA (DHHS)” |
>————————————————————————————————————————————————–|
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|AICALIST@AICALIST.ORG.AU, |
>————————————————————————————————————————————————–|
|————>
| Date: |
|————>
>————————————————————————————————————————————————–|
|04/09/2014 12:08 PM |
>————————————————————————————————————————————————–|
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| Subject: |
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|Fit-testing P2 masks with beards |
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|ACIPC Infexion Connexion |
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Hi all,

We have not really addressed the challenge associated with fit-testing
people with beards in our organisation, but with the increasing tendency for beards amongst male nursing and medical staff this is leading us to have to address this matter. Can I ask how others who have staff who have beards for cultural or personal reasons have addressed this?

Thanks
Rachel

..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
(: 03 62227882/8658
Mobile: 0400 718 574
Email: rachel.thomson@dhhs.tas.gov.au

Level 4, H Block
48 Liverpool Street
Hobart, 7000

CONFIDENTIALITY NOTICE AND DISCLAIMER
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[Thomson, Rachel EA]

Thanks Michelle,

Does this mean that all hospitals in Australia offer/ provide PAPR to all these staff?

Cheers
Rachel

..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
T: 03 62227882/8658
Mobile: 0400 718 574
Email: rachel.thomson@dhhs.tas.gov.au

Level 4, H Block
48 Liverpool Street
Hobart, 7000

—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michele.Cullen@HEALTH.VIC.GOV.AU
Sent: Thursday, 4 September 2014 12:26 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: Fit-testing P2 masks with beards

Dear Rachel

It is simple really.
You cannot fit test or fit check a single use or reusable (rubber) RPD on anyone with a beard. The same applies to most moustaches.
They must wear a Hood/PAPR.

Regards

(Embedded (Embedded image moved to file: pic13343.jpg)
image moved
to file:
pic19053.jpg)

Michele Cullen
Infection Control Consultant | Communicable Disease Prevention and
Control | Public Health
Department of Health | 50 Lonsdale Street, Melbourne, Victoria,
3000
p. 03 9096 5094 | f. 1300 651 170
e. michele.cullen@health.vic.gov.au
and
MDU PHL 03 8344 4575
e. mccullen@unimelb.edu.au

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|”Thomson, Rachel EA (DHHS)” |
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| To: |
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>————————————————————————————————————————————————–|
|AICALIST@AICALIST.ORG.AU, |
>————————————————————————————————————————————————–|
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| Date: |
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>————————————————————————————————————————————————–|
|04/09/2014 12:08 PM |
>————————————————————————————————————————————————–|
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| Subject: |
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|Fit-testing P2 masks with beards |
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| Sent by: |
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>————————————————————————————————————————————————–|
|ACIPC Infexion Connexion |
>————————————————————————————————————————————————–|

Hi all,

We have not really addressed the challenge associated with fit-testing
people with beards in our organisation, but with the increasing tendency for beards amongst male nursing and medical staff this is leading us to have to address this matter. Can I ask how others who have staff who have beards for cultural or personal reasons have addressed this?

Thanks
Rachel

..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
(: 03 62227882/8658
Mobile: 0400 718 574
Email: rachel.thomson@dhhs.tas.gov.au

Level 4, H Block
48 Liverpool Street
Hobart, 7000

CONFIDENTIALITY NOTICE AND DISCLAIMER
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[Thomson, Rachel EA]

Hi Glenys,

Thanks so much for your comments! It is certainly interesting to me to see if there are outcomes may be able to be described in terms of costs for cleaning rather than reduction in HAIs, but it will be really interesting to see if others can share.

Cheers
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Rachel,

With the evidence for environmental cleaning and disinfection the main outcome if you were using any new infection control strategy would be a decrease in the acquisition of MROs (i.e. MRSA, VRE and Acinetobacter & Clostridium difficile).

Haven’t heard of any decrease in MROs acquisitions at site/s where it is being used (although happy to be corrected) and as per the abstract previously posted this strategy may not have good activity against C.difficile. This would be a problem in the setting of hospital transmission.

It seems this microfiber (used daily) steam (used only on discharge) is primarily a “facility lead cleaning program” rather than a targeted infection control strategy. The cost and time savings associate with this strategy primarily relate to savings generated as a result of replacing 2-step cleaning and disinfection program.

There was a nice publication from the Geelong ICT which showed that 2-step cleaning and disinfection was not necessary – have included the abstract for those who may not have seen it.

Am J Infect Control. 2013 Mar;41(3):227-31. doi: 10.1016/j.ajic.2012.03.021. Epub 2012 Sep 13.
The effectiveness of a single-stage versus traditional three-staged protocol of hospital disinfection at eradicating vancomycin-resistant Enterococci from frequently touched surfaces.
Friedman ND1, Walton AL, Boyd S, Tremonti C, Low J, Styles K, Harris O, Alfredson D, Athan E.
Author information
Abstract
BACKGROUND:
Environmental contamination is a reservoir for vancomycin-resistant enterococcus (VRE) in hospitals.
METHODS:
Environmental sampling of surfaces was undertaken anytime before disinfection and 1 hour after disinfection utilizing a sodium dichloroisocyanurate-based, 3-staged protocol (phase 1) or benzalkonium chloride-based, single-stage clean (phase 2). VRE colonization and infection rates are presented from 2010 to 2011, and audits of cleaning completeness were also analyzed.
RESULTS:
Environmental samples collected before disinfection were significantly more likely to be contaminated with VRE during phase 1 than phase 2: 25.2% versus 4.6%, respectively; odds ratio (OR), 7.01 (P < .01). Environmental samples collected after disinfection were also significantly more likely to yield VRE during phase 1 compared with phase 2: 11.2% versus 1.1%, respectively; OR, 11.73 (P < .01). Rates of VRE colonization were higher during 2010 than 2011. Cleaning audits showed similar results over both time periods.
CONCLUSION:
During use of a chlorine-based, 3-staged protocol, significantly higher residual levels of VRE contamination were identified, compared with levels detected during use of a benzalkonium chloride-based product for disinfection. This reduction in VRE may be due to a new disinfection product, more attention to the thoroughness of cleaning, or other supplementary efforts in our institution.

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
ABN 47533508426

Hi Glenys,

Yes I found that one in my research to date. I am interested in the experience of Australian Healthcare facilities, and I particularly interested in the impact (if any) on HAIs. It will be interesting to see if anyone can share some outcome data aligned to this practice change.

Thanks & speak soon
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Rachel,

This research publication may be of interest/use.

J Hosp Infect. 2012 Oct;82(2):114-21. doi: 10.1016/j.jhin.2012.06.014. Epub 2012 Aug 15.
Clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with Clostridium difficile 027.
Doan L1, Forrest H, Fakis A, Craig J, Claxton L, Khare M.

Abstract
BACKGROUND:
Clostridium difficile spores can survive in the environment for months or years, and contaminated environmental surfaces are important sources of nosocomial C. difficile transmission.
AIM:
To compare the clinical and cost effectiveness of eight C. difficile environmental disinfection methods for the terminal cleaning of hospital rooms contaminated with C. difficile spores.
METHODS:
This was a novel randomized prospective study undertaken in three phases. Each empty hospital room was disinfected, then contaminated with C. difficile spores and disinfected with one of eight disinfection products: hydrogen peroxide vapour (HPV; Bioquell Q10) 350-700 parts per million (ppm); dry ozone at 25 ppm (Meditrox); 1000 ppm chlorine-releasing agent (Actichlor Plus); microfibre cloths (Vermop) used in combination with and without a chlorine-releasing agent; high temperature over heated dry atomized steam cleaning (Polti steam) in combination with a sanitizing solution (HPMed); steam cleaning (Osprey steam); and peracetic acid wipes (Clinell). Swabs were inoculated on to C. difficile-selective agar and colony counts were performed pre and post disinfection for each method. A cost-effectiveness analysis was also undertaken comparing all methods to the current method of 1000 ppm chlorine-releasing agent (Actichlor Plus).
FINDINGS:
Products were ranked according to the log(10) reduction in colony count from contamination phase to disinfection. The three statistically significant most effective products were hydrogen peroxide (2.303); 1000 ppm chlorine-releasing agent (2.223) and peracetic acid wipes (2.134).
CONCLUSION:
The cheaper traditional method of using a chlorine-releasing agent for disinfection was as effective as modern methods.
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
ABN 47533508426

Hi all,

We are currently undertaking a major review in relation to environmental hygiene within our own organisation. As part of this we are considering the potential infection control outcomes relating to the introduction of novel cleaning processes, with a particular interest in steam and microfibre cleaning. I am aware of the body of work being led by a number of health services, including Southern Health, but I am particularly interested in any recorded impact on patient outcomes as a result of introducing steam and microfibre cleaning by other healthcare services.

In our organisation we publicly report on a number of surveillance data including

* MRSA acquisitions (colonisation and infection) [these are reported to our State surveillance unit although not publicly reported at this time]

* VRE acquisitions (colonisation and infection)

* MRGN acquisitions (colonisation and infection)

* SAB, including HCA as separate from Community Onset

* Clostridium difficile infection, in particular HCA

I attach for the interest of subscribers the link to the publicly reported HCAI data in Tasmania, which our hospital data.
http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0013/161023/Surveillance_Report_No_21_Quarter_1_2014.pdf

My question is; are any list members able or willing to share with me their HCAI data both before and after introducing steam and microfibre cleaning?

I would be happy to receive replies off-line if this enquiry.

Thanks
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

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________________________________

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________________________________

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The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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[Thomson, Rachel EA]

Hi Glenys,

Yes I found that one in my research to date. I am interested in the experience of Australian Healthcare facilities, and I particularly interested in the impact (if any) on HAIs. It will be interesting to see if anyone can share some outcome data aligned to this practice change.

Thanks & speak soon
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

Hi Rachel,

This research publication may be of interest/use.

J Hosp Infect. 2012 Oct;82(2):114-21. doi: 10.1016/j.jhin.2012.06.014. Epub 2012 Aug 15.
Clinical and cost effectiveness of eight disinfection methods for terminal disinfection of hospital isolation rooms contaminated with Clostridium difficile 027.
Doan L1, Forrest H, Fakis A, Craig J, Claxton L, Khare M.

Abstract
BACKGROUND:
Clostridium difficile spores can survive in the environment for months or years, and contaminated environmental surfaces are important sources of nosocomial C. difficile transmission.
AIM:
To compare the clinical and cost effectiveness of eight C. difficile environmental disinfection methods for the terminal cleaning of hospital rooms contaminated with C. difficile spores.
METHODS:
This was a novel randomized prospective study undertaken in three phases. Each empty hospital room was disinfected, then contaminated with C. difficile spores and disinfected with one of eight disinfection products: hydrogen peroxide vapour (HPV; Bioquell Q10) 350-700 parts per million (ppm); dry ozone at 25 ppm (Meditrox); 1000 ppm chlorine-releasing agent (Actichlor Plus); microfibre cloths (Vermop) used in combination with and without a chlorine-releasing agent; high temperature over heated dry atomized steam cleaning (Polti steam) in combination with a sanitizing solution (HPMed); steam cleaning (Osprey steam); and peracetic acid wipes (Clinell). Swabs were inoculated on to C. difficile-selective agar and colony counts were performed pre and post disinfection for each method. A cost-effectiveness analysis was also undertaken comparing all methods to the current method of 1000 ppm chlorine-releasing agent (Actichlor Plus).
FINDINGS:
Products were ranked according to the log(10) reduction in colony count from contamination phase to disinfection. The three statistically significant most effective products were hydrogen peroxide (2.303); 1000 ppm chlorine-releasing agent (2.223) and peracetic acid wipes (2.134).
CONCLUSION:
The cheaper traditional method of using a chlorine-releasing agent for disinfection was as effective as modern methods.
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
ABN 47533508426

Hi all,

We are currently undertaking a major review in relation to environmental hygiene within our own organisation. As part of this we are considering the potential infection control outcomes relating to the introduction of novel cleaning processes, with a particular interest in steam and microfibre cleaning. I am aware of the body of work being led by a number of health services, including Southern Health, but I am particularly interested in any recorded impact on patient outcomes as a result of introducing steam and microfibre cleaning by other healthcare services.

In our organisation we publicly report on a number of surveillance data including

* MRSA acquisitions (colonisation and infection) [these are reported to our State surveillance unit although not publicly reported at this time]

* VRE acquisitions (colonisation and infection)

* MRGN acquisitions (colonisation and infection)

* SAB, including HCA as separate from Community Onset

* Clostridium difficile infection, in particular HCA

I attach for the interest of subscribers the link to the publicly reported HCAI data in Tasmania, which our hospital data.
http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0013/161023/Surveillance_Report_No_21_Quarter_1_2014.pdf

My question is; are any list members able or willing to share with me their HCAI data both before and after introducing steam and microfibre cleaning?

I would be happy to receive replies off-line if this enquiry.

Thanks
Rachel

……………………………………………………………………………..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658

Level 4, H Block
48 Liverpool Street
Hobart, 7000

________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au

To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.

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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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________________________________

CONFIDENTIALITY NOTICE AND DISCLAIMER
The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission.

MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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[Thomson, Rachel EA]

Hi Craig,

Thank you for bringing a smile to my face in the morning (especially mid flu season)!! In Tasmania for the Public sector we do have a departmental policy. This is readily available through the following link
http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0006/72393/Hand_Hygiene_Policy_2010.pdf The Tassie approach is aligned very much to the NHS approach.

At a local hospital level we have developed a supporting promotional poster, happy to send this if you are interested. On a practical real-level engagement with our medical staff we have found that many clinicians are very wedded to their watches. We have negotiated at an implementation level that watches may be worn in the workplace by medical staff but during patient examination and, of course, any activity requiring aseptic technique the watch must be removed. Some may argue that this will not work, but our experience has been that if we were able to respond to this consideration then other elements of bare-below-the-elbows were more readily implemented with clinicians. Perhaps its a case of note losing all engagement through being bloody minded.

Kind regards
Rachel

..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
: 03 62227882/8658
Mobile: 0400 718 574
Email: rachel.thomson@dhhs.tas.gov.au

Level 4, H Block
48 Liverpool Street
Hobart, 7000

From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Craig Boutlis
Sent: Wednesday, 9 July 2014 7:28 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Bare below the elbows etc. and the RACP exams – do you have a policy?

Hi,

Hundreds of nervous medical registrars are about to fan out all over Australia for their Royal Australasian College of Physicians exams from July 25 to August 3, as they do every year. In hot pursuit will be about 150 “National Exam Panel” (NEP) members, of whom I am one. If you are wondering, it definitely is “all beer and skittles”.

Some of you can relax…I ditched my tie years ago, my jacket is left hanging on a chair, sleeves are rolled up, my pedometer has a watch, and there is no lanyard to be seen. For many others though, it is all about the grandest suit and tie they can conjure. Of interest, it’s amazing to see how easily those ties flop on to patients when candidates lean forward, but I digress.

I take it as a given that you all practice the 5 moments and cleaning of reusable equipment between patients. Do any of you in public (or some larger private) hospitals have a dress code (eg, BBE) that we NEPs and exam candidates must respect? Further, is it guidance (“should”) or actual policy (“must”)? Feel free to send on to me.

Best wishes,

Craig

Craig Boutlis

Department Head, Infectious Diseases | IMACS
LMB 8808, SCMC, NSW, 2521
Tel. 02 4222 5898 | craig.boutlis@sesiahs.health.nsw.gov.au

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[Thomson, Rachel EA]

Hi John,

I forwarded these questions to our guru engineering people and received the following reply. I have included the initial preamble too as I think these comments are relevant to the overall answers.

Kind regards
Rachel

Rachel Thomson

Nurse Unit Manager
Infection Prevention & Control Unit
Royal Hobart Hospital
E: rachel.thomson@dhhs.tas.gov.au

To give an accurate understanding of how the mechanical systems work in our ICU it is important to understand that there is on old section and a new infill section, both of which have new (but separate) plant. There are several (6 off) units that serve both areas. This does not include the isolation room, which really is a separate item.

I’ll start by qualifying that Hobart’s ambient conditions are fairly different from NSW, not just in temperature, but in humidity. When we have warmer conditions, we are usually very dry (10-50% RH). In winter we also experience low RH, unless it’s raining. We therefore rarely require dehumidification and don’t design for it.

Another thing to note is that Tasmania has ideal ambient conditions for economy cycle, the practice of using 100% outdoor air (OA) if it is between 13-18C when the system calls for cooling.

For the old ICU ward (and offices, waiting, reception, etc.) and the new ICU bed bays we are running air to air heat exchangers on a 100% outdoor air system. Each zone has its own exhaust system, which balances the system so as to not recirculate the bed bay air into the general communal spaces.

These units contain heat exchanges (HX) to counter the less efficient practice of utilising 100% OA, and the HX is packaged into a single, larger, unit with the fan and associated heating and cooling coils. These systems contain in duct steam humidifiers to give more moisture to the supply air, when required (most of the time).

The new ICU corridor, write-up room, office, pharmacy, sterile store and equipment rooms are serviced by a multi zone, common return air handling unit. It uses the multi zone unit to achieve better internal thermal comfort with different thermal profiles. This unit also utilises economy cycle if the conditions are correct.

All of the units supplying the new and old ICU areas have the following filtration:

Pre-filter on OA and exhaust air; Grade G4;

Deep bed supply air filter: Grade F8;

And to the sterile store, a terminal HEPA filter (Grade H13 from memory).

Hopefully this helps answer John’s queries:

What sort of ventilation is used in your ICU? Multiple Air Handling Units, mostly 100% OA.

Do you recirculate air? Only for a small percentage of the areas.

Is it filtered prior to recirculation? If so how filtered? Yes, pre-filter and deep bed, plus local HEPA where required.

What humidity levels do you experience in the ICU through the year? Relatively dry, so humidification is required.

Kind regards

Scott Ellis
Facilities Assets & Projects Officer
Facilities & Engineering
Tasmanian Health Organisation – South

Dear All

Our ICU for some time has been on a full exhaust mode – this came about at the time when we faced up to an ongoing MRAB outbreak. We had some evidence (not strong) that the ventilation system might have played a role.

However this process is wasteful, particularly in the summer and it makes control of humidity very tricky – some days , we cannot bring the humidity below 80% given the grunt within the air con system

I would be interested to know :

a) What sort of ventilation is used in your ICU

b) Do you recirculate air?

c) Is it filtered prior to recirculation? If so how filtered?

d) What humidity levels do you experience in the icu through the year?

Thanks !

Kind regards
John

Dr John Ferguson
Director, IPC, Hunter New England Health
Infectious Diseases & Microbiology
+61 428 885573

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[Thomson, Rachel EA]

Hi all,

I would like to put out there some thoughts and observations in relation to disposable biocidal curtains from a personal perspective.

The biocidal curtains currently on the market have one property that has got nothing to do with Infection Prevention & Control, but a property that makes these items very appealing to organisations (and managers within them). That is, that they are light weight and relatively easy to change. This would seem to have a couple of distinct advantages therefore over traditional cloth curtains, that is;

* Reduced risk of injury during curtain change

* Likely increased compliance with a request to change
(I am aware that others have now commented on these benefits)

There is then the infection prevention and control perspective. I would like to comment on this.

I do not believe that the product information and the available literature is as clear in relation to the Infection Prevention & Control properties as we might like it to be (or might think it to be). The testing that is applied to these curtains, as I understand it, is a ‘modified Kirby-Bauer test’. This test (again as I understand it) measures disinfectant or antiseptic susceptibility of various organisms on a modified agar plate. Bacteria are applied to the agar and, for the purposes of these tests, a square centimetre of the biocidal fabric is placed on the plate and inhibition zones are measured in millimetres. These measurements are taken with the use of ultra-violet light to increase the exposure rate and extrapolated results are taken from these findings. This may be a simplistic interpretation of this test and I would welcome comment from the more ‘microbiologically-minded’ subscribers to the list. My comments on this testing methodology for the efficacy of the curtains are the following;

* Testing does not include ‘real world’ data. The transferability and reliability of the modelling and results achieved from the modified Kirby-Bauer testing is not clear to me.

* Whilst a known quantity of a known pathogen is tested with this fabric, there is no capacity to understand if this actually relates to alternate inoculation methodologies. E.g. From multiple contaminated hand touching of the curtain on the leading edge through to faeces splattered onto fabric etc.

* Testing against agents such as non-enveloped viruses (e.g. norovirus) is not documented or reported on in the product literature. If there is no testing data, what action will need to be taken to ensure safety?

One company recommends that their biocidal curtains are changed after patients with known or suspected infectious agents, including MROs especially in the higher risk settings. Whist another company make no such recommendation. The cost of regular replacement will surely not be insubstantial in some settings, especially the more acute services. As mentioned, if the testing does not include a number of important pathogens then can it be reasonably assumed that the agents not tested for will be controlled or eliminated with the biocidal curtains in place?

It is accepted that the manufacturers clearly recommend that biocidal curtains should be changed if there is evidence of soiling. The question must be asked, though, who will validate this process? If curtains are left hanging for very prolonged periods (potentially substantially longer than standard cloth curtains), has the risk of this been established or even fully considered?

I am not suggesting that biocidal curtains represent a ‘less safe’ environment than cloth curtains; indeed this would appear patently untrue. I think, however, that a number of facilities and staff within them are seeing these curtains as the ‘holy-grail’ of a prevention/control measure. I would certainly suggest that there is a place for enhanced research and subsequent publication in peer reviewed literature to add to the body of current knowledge.

Just some thoughts!

Cheers
Rachel

Rachel Thomson

Nurse Unit Manager
Infection Prevention & Control Unit
Royal Hobart Hospital
E: rachel.thomson@dhhs.tas.gov.au

Hi All,

Have a small issue – Disposable curtains/screens!

Would appreciate feedback from areas that are using the disposable curtain/screens in their facilities

The issue is around cost of linen vs disposable curtains/screens.

We have trialed & like what we have but those who watch the pennies are questioning their use.

Originally we brought them into our ED because the poor terminal cleaning staff were frantic with attending the cleaning ( which involves the replacement of curtains).
The NUM of ED was indicating at this particular incident -that there were three ambulances waiting to off load patients onto ED beds which were being held up by the terminal cleaning required.

Amongst other actions taken regarding this issue in ED-was the implementation of the disposable curtains.

Now the question being asked is who else in other health areas has disposable curtains/screens & where are they ( ie high risk areas).

Much appreciate any assistance with this.

Thank you

Vicki Denyer

Clinical Nurse Consultant | Infection Prevention & Control Unit
Lismore Base Hospital
Tel 02 6620 2385 | vicki.denyer@ncahs.health.nsw.gov.au

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