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We use plumbed in water coolers now. We recently isolated Legionella incidentally from a water cooler that was not plumbed in in our ICU as part of a Pseudomonas issue in which we were testing multiple water outlets – no Pseudomonas was found. The cooler has a charcoal pre-filter which attracts Legionella growth our microbiologist advised.
Our hospital undertakes a rigorous legionella testing regime from the hot water supply but only tests water and shower heads – not hand washing or drinking outlets.Cheers
Ruth
[IPC logo for email signature]Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
Community Liaison Infection Prevention
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!Morning,
We now only have hot & ambient water available to staff due to issues with our previous water coolers, however we are currently trialling some new water coolers that use UV lights I can’t remember the brand but I can find out for you if the trial is successful then we will install some additional units throughout the hospital & where there had been the ‘Zippy’ taps with hot & chilled water we have removed the chilled water component and installed a ambient filtered water tap instead. If these water coolers are installed then they will be put on a routine testing schedule as we do our Ice and bottled water that we provide patients with.
With kind regards,
Lynette CribbInfection Control Coordinator
Direct 07 3834 4328 | mobile 0427141223 | Fax 0738344599
SAWMH.ICC@uchealth.com.au | standrewshospital.com.au
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[Bugs-and-tear LR]
Remember to protect your patients, family and yourself by getting the Influenza vaccinationGood morning,
Just wondering if any facilities have instant chilled and boiling water systems for patients and staff to access for drinking water and hot tea/coffee in there lounges/kitchens.
If you do, how long have they been installed?
Do you undertake any legionella and bacterial micro testing on the cold and hot water from the system including the sink tap water that its connected to?
If you would be prepared to share what system you use and your results with us please contact me off line directly by email at marija.juraja@sa.gov.auKind Regards
Marija Juraja |Nurse Unit Manager -CALHN Infection Prevention & Control Unit|
Division of Acute Medicine (RN, GCNS Inf Ctrl, CICP-E)
The Royal Adelaide Hospital| Central Adelaide Local Health Network
8E Rm256 Port Road, ADELAIDE 5000
The Queen Elizabeth Hospital | Central Adelaide Local Health Network
Level 8 Tower Building | 28 Woodville Road, WOODVILLE SOUTH 5011
t: +61 8 7074 2810 (RAH) 8222 7588 (TQEH)| f: +61 8 7074 6228 (RAH) +61 8 8222 6461 (TQEH) | m: 0466 379 821|DX: 465432 (TQEH) |e:marija.juraja@sa.gov.au |web: IPCU Intranet Site and Resources
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Hi Vicki,
We would be hesitant about allowing potting mix indoors in our new paeds build as we have a high rate of Legionella from potting mix in this region. As it happens the wards didn’t want that type of play area. However I believe you can buy screened soil which has eliminated this type of infectious hazard.Cheers
Ruth[IPC logo for email signature]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
Community Liaison Infection Prevention
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!Hi All,
Need some expert advice on the following please
We are opening a new paediatric ward with a play area outside. ( the ward is situated on the 11th floor of a new building)
I have just been informed that there will be 4 large pots area with appropriately 2080 litres of potting mixture within being placed in the outdoor area ( appropriately 2080 litres of potting mixture within)
Is there is a NSW PD or other Ministry correspondence that states that we cannot have soil in an outdoor supervised area
Thanks
Vicki
Vicki Denyer
Infection Prevention & Control Clinical Nurse Consultant
Lismore Base HospitalInfection Prevention & Control is Everyone’s Business
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Hi there
We looked at the occupational hazards of drawing up antibiotics without gloves a number of years ago when The 5 Moments were first introduced. The use of gloves for drawing up ABs is indeed a normal occurrence now and it leads to continuous glove use re. The 5 Moments so non-compliance with Moment 2. With the exception of a few ‘nasty’ ABs there was no evidence we could find for occupational risks associated with drawing up ABs e.g. no increase in sensitization forwards ABs etc. One exception was if you already had a severe sensitivity towards a particular AB. We try and discourage this practice for the above reason.Cheers
Ruth[IPC logo for email signature]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
Community Liaison Infection Prevention
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!Hi all
I have been asked if we should have a policy regarding routine use of gloves when preparing and administrating IV antibiotics. My initial reaction is no, we should not be handling IV antibiotic solutions in such a way as to cause skin exposure. But having looked at some of the product information regarding the vesicant nature of some antibiotics (eg vancomycin), and the risk of adverse effects via absorption through the skin (eg gentamicin), I am wondering whether a standard approach to wearing gloves when handling antibiotic solutions should be recommended. And should we also recommend protective eyewear for this?
What do other facilities advise staff in regard to this? And how much of a risk would you consider this may be to staff?
Thanks for any opinions and comments.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
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Good day
I was always told by the microbiology lab that culturing the tip and getting meaningful results depends on the tip being taken aseptically e.g. cut with sterile scissors, the correct part sent to the blab and most importantly, the laboratory actually undertaking the tip culture testing according to standardised methods as described in the excerpt from Tim. Not all labs will do the latter.Cheers
Ruth[IPC logo for email signature]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
Community Liaison Infection Prevention
: ruth.barratt@cdhb.health.nz
: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Matthias Maiwald (SHHQ – KKH)
Sent: Friday, 17 March 2017 2:12 p.m.
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] CVC Tip cultureDear Tim,
What does INS stand for, and what would be the bibliographical citation/reference for the text passage you cite?
If I read the text passage correctly, the notion is routinely, i.e. do not routinely culture. But it would seem indicated in cases of clinically suspected CR-BSI, in conjunction with blood cultures, and that seems consistent with what Claire writes and with the Mermel 2009 clinical definitions (as opposed to surveillance definitions) of CR-BSI that Claire attached.
Best regards, Matthias.
—
Matthias Maiwald, MD, FRCPA
Senior Consultant in Microbiology
Adj. Assoc. Prof., Natl. Univ. Singapore
Department of Pathology and Laboratory Medicine
KK Women’s and Children’s Hospital
100 Bukit Timah Road
Singapore 229899
Tel. +65 6394 8725 (Office)
Tel. +65 6394 1389 (Laboratory)
Fax +65 6394 1387From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Tim Spencer
Sent: Thursday, 16 March, 2017 10:23 PM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: CVC Tip cultureHi Cate,
The current INS Standards of Practice (2016) recommendation not to culture the catheter tip. I have cut & pasted from the standards.
SHEA and APIC dont really address this issue clearly (or at all).
Other standards (IVNNZ, RNAO and RCN) follow the same recommendations as the INS SOP.Practice Criteria
A. Assess for signs and symptoms of a VAD-related infection which may include, but is not limited to, erythema; edema; any pain or tenderness or drain- age; fluid in the subcutaneous pocket of a totally implanted intravascular device or subcutaneous tunnel for any tunneled catheter; induration at the exit site or over the pocket; spontaneous rupture and drainage; necrosis of the overlying skin at the VAD insertion site; and/or body temperature elevation. Immediately notify the licensed independent practitioner (LIP) when signs and symptoms of a VAD- related infection are present, and implement planned interventions.1 (IV)
B. Consider site selection for VAD placement as a strategy to prevent infection. To minimize the risk of catheter-related infection with a nontunneled central vascular access device (CVAD), the subclavian vein is recommended in adult patients, rather than the jugular or femoral (refer to Standard 27, Site Selection).
C. Remove a peripheral venous catheter if the patient develops symptoms of infection (eg, erythema extending at least 1 cm from the insertion site, induration, exudate, fever with no other obvious source of infection) or the patient reports any pain or tenderness associated with the catheter.1-3 (IV)
D. Do not remove a functioning CVAD based solely on temperature elevation and the absence of confirmatory evidence of catheter-related infection. Use clinical judgment regarding the appropriateness of removing the catheter if an infection is evidenced elsewhere or if a noninfectious cause of fever is sus- pected.2,4 (IV)
E. Collaborate with the LIP and patient to collectively determine if the CVAD can be salvaged. For hemodynamically stable outpatients with catheter-related bloodstream infection (CR-BSI), catheter salvage may be a safe and appropriate strategy. Removal of the CVAD is required if there is clinical deterioration or persisting or relapsing bacteremia. The insertion of a new CVAD at a new site should be a collaborative decision based on the specific risks and benefits for each patient. Factors to consider in the decision to salvage a catheter include:
* The type of VAD (eg, percutaneous versus surgically inserted long-term catheter).
* Difficulty with inserting a new CVAD.
* Presence of bleeding disorders.
* The infecting organism(s) as confirmed by paired
* blood cultures.
* The presence of other complicating conditions
* including, but not limited to, severe sepsis, suppurative thrombophlebitis, endocarditis, or the presence of vascular or other hardware (eg, a pacemaker).1,5-8 (IV)F. Anticipate the removal of a short-term CVAD (in situ less than or equal to 14 days) in a pediatric patient with an uncomplicated CR-BSI and treat with systemic antibiotics for at least 7 to 14 days based on the pathogen. Infections with Staphylococcus aureus, gram-negative bacilli, or Candida require immediate removal of the infected CVAD and a defined course of systemic antibiotic therapy, except in rare circumstances when no alter- native venous access is available. Patients with a long-term CVAD and an uncomplicated CR-BSI because of coagulase-negative Staphylococcus or Enterococcus may retain the CVAD and complete a course of systemic antibiotics with the use of antibiotic lock therapy. Closely monitor and clinically evaluate pediatric patients treated without catheter removal, including additional blood cultures and the use of antibiotic lock therapy with systemic therapy for catheter salvage.8 (V)
G. Consider the use a prophylactic antimicrobial lock solution in a patient with a long-term CVAD who has a history of multiple CR-BSIs despite optimal maximal adherence to aseptic technique. Aspirate all antimicrobial locking solutions from the CVAD lumen at the end of the locking period (refer to Standard 40, Flushing and Locking).
H. Remove a CVAD from a patient with CR-BSI associated with any of the following conditions: severe sepsis; suppurative thrombophlebitis; endocarditis; bloodstream infection that continues despite greater than 72 hours of antimicrobial therapy to which the infecting microbes are susceptible; or infections due to S. aureus, P. aeruginosa, fungi, or mycobacteria following collaboration with the LIP.1,4 (IV)
I. Do not use a guidewire exchange to replace a non-tunneled catheter suspected of infection.2 (V)
J. Consider a catheter exchange procedure when other vascular access sites are limited and/or bleeding dis- orders are present. Consider an antimicrobial- impregnated catheter with an anti-infective intraluminal surface for catheter exchange.1 (IV)
K. Collect a specimen of purulent exudates from a peripheral or CVAD exit site for culture and gram staining to determine the presence of gram-negative or gram-positive bacteria as ordered by an LIP.1 (IV)
L. Do not routinely culture the CVAD tip upon removal unless the patient has a suspected CR-BSI. Catheter colonization may be detected but does not indicate the presence of a bloodstream infection. This practice results in inappropriate use of anti-infective medications, thus increasing the risk of emergence of antimicrobial resistance. Recognize that the catheter tip culture will identify microorganisms on the external catheter and not microorganisms located on the intraluminal surface.1 (IV)
M. Culture the tip of short-term central vascular and arterial catheters suspected of being the cause of a CR-BSI using a semiquantitative (roll-plate) method or quantitative (sonication) method upon removal. Culture the introducer/sheath tip from a pulmonary artery catheter when a CR-BSI is suspected.1 (IV)
N. Culture the reservoir contents of a port body of an implanted port and the catheter tip when it is removed for suspected CR-BSI.1 (IV)
O. Consider contamination of the infusate (such as par- enteral solution, intravenous medications, or blood products) as a source of infection. This is a rare event, but an infusate can become contaminated during the manufacturing process (intrinsic contamination) or during its preparation or administration in the patient care setting (extrinsic contamination). An infusate-related bloodstream infection is the isolation of the same organism from the infusate and from separate percutaneous blood cultures, with no other identifiable source of infection.2,7-9 (IV) (see Standard 43, Phlebotomy).P. For a suspected CR-BSI, obtain paired blood samples for culture, drawn from the catheter and a peripheral vein, before the initiation of antimicrobial therapy. Blood cultures from both the catheter and venipuncture must be positive for the same organism with clinical signs and symptoms and no other recognized source. Consider quantitative blood cultures or the differential period of central line culture versus peripheral blood culture positivity >2 hours for the diagnosis of CR-BSI (see Standard 43, Phlebotomy).1,6,10,11 (IV)
REFERENCES
Note: All electronic references in this section were accessed October 5, 2015.1. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter- related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1-45. Erratum in: Clin Infect Dis. 2010;50(3):457; Clin Infect Dis. 2010;50(7):1079.
2. OGrady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. http:// http://www.cdc.gov/hicpac/BSI/BSI-guidelines-2011.html. Published April 2011.
3. Rickard CM, Webster J, Wallis MC, et al. Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial. Lancet. 2012;380(9847):1066-1074.
4. Chopra V, Flanders SA, Saint S, et al. The Michigan appropriate- ness guide for intravenous catheters (MAGIC): results from an international panel using the RAND/UCLA appropriateness method. Ann Intern Med. 2015;163(suppl 6):S1-S39.
5. Caroff D, Norris A, Keller S, et al. Catheter salvage in home infusion patients with central line-associated bloodstream infection. Am J Infect Control. 2014;42(12):1331-1333.
6. Chopra V, Anand S, Krein SL, Chenoweth C, Saint S. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med. 2012;125(8): 733-741.
7. Kumar A, Kethireddy S, Darovic GO. Catheter-related and infusion-related sepsis. Crit Care Clin. 2013;29(4):989-1015.
8. Huang EY, Chen C, Abdullah F, et al. Strategies for the prevention of central venous catheter infections: an American Pediatric Surgical Association Outcomes and Clinical Trials Committee systematic review. J Pediatr Surg. 2011;46(10):2000-2011.
9. The Joint Commission. Preventing central line-associated blood- stream infections: a global challenge, a global perspective. http:// http://www.jointcommission.org/preventing_clabsi. Published May 2012.
10. Septimus E. Clinician guide for collecting cultures. http://www.cdc.gov/getsmart/healthcare/implementation/clinicianguide.html. Published April 7, 2015.
11. Garcia RA, Spitzer DE, Beaudry J, et al. Multidisciplinary team review of best practices for collection and handling of blood cultures to determine effective interventions for increasing the yield of true-positive bacteremias, reducing contamination, and eliminating false-positive central line-associated bloodstream infections. Am J Infect Control. 2015;43(11):1222-1237.
APIC Guide 2009 – ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL AND EPIDEMIOLOGY
Guide to the Elimination of Catheter-Related Bloodstream Infections1. A CLABSI as defined by CDC, is a primary (i.e., no apparent infection at another site) BSI in a patient that had a central line within the 48-hour period before the development of the BSI. BSI is defined using either laboratory- confirmed bloodstream infection (LCBI) or clinical sepsis (CSEP) definitions (see Definition of Terms). In the CDC/NHSN definition of CLABSI, there is no minimum period of time that the central line must be in place in order for the BSI to be considered central lineassociated. The culture of the catheter tip is not a criterion for CLABSI.
Timothy R. Spencer, RN, APN, DipAppSci, BHealth, ICCert, VA-BC
Vascular Access Consultant
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
ABN: 51606547370
http://orcid.org/0000-0002-3128-2034On Mar 15, 2017, at 10:42 PM, Cate Coffey <Cate.Coffey@NT.GOV.AU> wrote:
Hi everyone
We are updating our policies and I notice that our CVC and Vascath polices recommend culturing the tip of CVC. Could you tell me if there is evidence to support this practice Wouldnt a blood culture be more appropriate to diagnose infection? Can there be a CVC tip infection without bloodstream infection and what is the relevance if there is?
We do not have 24 hour pathology service so it means that tip cultures could only be sent during lab hours?
Can you let me know your thoughts?
Cate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517737
e … cate.coffey@nt.gov.au http://www.nt.gov.au/healthOur Vision: Better health outcomes for all Central Australians
Our Values: Community at the Centre | Equity and Integrity | We are Accountable | We are Relevant Today and Ready for Tomorrow | We are Committed to High Quality Care | We Value our PartnershipsCentral Australia Health Service is a Smoke Free Workplace
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Hi Sally,
Our IPC Service does manage the ‘protective isolation’ signage but this is mainly used on general wards as the adult and child haematology specialist wards have HEPA filtration and/or positive pressure single rooms with ensuites. So they do not always need to use the signage for the same reasons that Michael Wishart outlines. Many staff think you need to wear a droplet mask and gown when entering a protective isolation staff but anyone with an upper respiratory tract infection should not enter at all. So routine Protective isolation precautions with us is a single room, focus on hand hygiene, dedicated or cleaned shared equipment and the patient to wear a droplet mask if visiting other investigation departments. Plus the other statements about visitors reporting and not to enter if unwell etc. Happy to share our poster with you to see.Cheers
Ruth
[IPC logo for email signature]Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
Community Liaison Infection Prevention
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!Dear all
A ‘ this old chestnut’ question 🙂 !
I was wondering if there might be a few people who could comment on ‘protective precautions’ for the neutropenic patient. Specifically:
* What is your workplace policy/procedure?
* If your workplace does have specific precautions, do you within your IC role monitor or have involvement with any policies relating to this?
* Do you think it is a responsibility of IC programs within a facility?
I get many questions regarding this from staff. Advice from other IC colleagues is that it doesn’t really come under infection control. Not discussed in national guidelines (that I could find) and appears good standard precautions covers risk.
Most hospitals do seem to have protective precaution posters which cover/reinforce standard precautions (Hand Hygiene, Cleaning of equipment if not single use, to not visit if have a current infection)
And then some additions i.e.:* Single room with door closed
* Advice to visitors to see nurse before entering
* Dedicated equipment
Looking forward to your feedback.
Kind regards,
Sally BrewInfection Control Clinical Nurse – Broome Regional Health Campus
WA Country Health Service Kimberley
PO Box 62 | Broome WA 6725
P (08) 9194 2353 M 0438 903 210
Email:Broome.InfectionControl@health.wa.gov.au
Working together for a healthier country WA
Our Values: Community | Compassion | Quality | Integrity | Justice
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Hi Heather,
In New Zealand the national programme for SSI surveillance (http://www.hqsc.govt.nz/our-programmes/infection-prevention-and-control/projects/surgical-site-infection-improvement/) now uses this 90 day CDC surveillance for its deep and organ space infections for joint surgery and cardiac surgery surveillance programmes. Superficial SSIs are only counted up to 30 days post surgeryI believe that the rationale taken by the NZ Clinical leads (and this may be the CDC rationale) was that it would be difficult to attribute a deep or organ space infection at one year back to the original surgery even if it is a joint piece of metalwork.
Cheers
Ruth[IPC logo for email signature]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
Community Liaison Infection Prevention
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!Dear Colleagues
The CDC changed the definition of a hospital acquired surgical site infection of a joint replacement from 1 year to 90 days.
Have all hospitals adopted this new protocol?
I would also be interested to know what brought about this change, and is this generally considered a positive change.Kind regards
Heather
Heather Warfield
Infection Prevention & Control
Surgical site surveillance
Canberra Hospital
building 10, level 4———————————————————————–
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Hi Heidi
In New Zealand it is Maori custom or Tikanga to return the umbilical cord and placenta to the family. We have clear cultural protocols and a policy for this as it is a common occurrence.
Happy to share the policy if you email me directly.Cheers
RuthRuth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
e: ruth.barratt@cdhb.health.nz
t: + 64 3 3640 083 or ext.80083
Pager: 8331
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Heidi Gettons
Sent: Tuesday, 24 May 2016 6:09 p.m.
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Placenta EncapsulationOur midwifery staff are seeing an increase in requests from patients to have their placentas collected for encapsulation. I was wondering if anyone has a policy or information they would like to share regarding this, in particular how they store the placenta until collected by the encapsulator, which in some cases could be the following day.
Any information would be appreciated.
Thanks in advance
Heidi Gettons
Infection Control Coordinator
The Bays Healthcare
Mornington Victoria 3931
heidigettons@thebays.com.auMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Hi Cate
We have had to consider this with a new build project for our paeds wards. Our beds will be drop down beds.
IPC considerations included the fact that not only will the family be using the bed, but also the child or patient who is likely to use it as well as their own. Therefore the frame and mattress must meet the same IPC requirements for cleaning and potential disinfection as inpatient beds and mattresses. Obviously the mattresses do not need to meet the same therapeutic requirements but that is outside of IPC. Also from experience, these beds would need to be sturdy and strong as they get a lot of wear and tear.Cheers
Ruth[IPC logo for email signature]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
Community Liaison Infection Prevention
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!We are looking into the purchase of beds for boarders who sleep in rooms with patients. Does anyone have experience with this or any thoughts on suitable products taking into consideration Infection Control issues. The vast majority of our patients population are Indigenous people from remote areas who often bring family members to stay with them during their admission. The boarders currently sleep on a mattress on the floor which I would like to change.
Thanks everyone.Cate Coffey | Clinical Nurse Consultant
Infection Prevention and Control Unit | Central Australia Health Service
Northern Territory Government
Alice Springs Hopsital, Gap Rd, Alice Springs
GPO Box 2234, Suburb, NT Postcode
p … 08 89517737
e … cate.coffey@nt.gov.au http://www.nt.gov.au/healthOur Vision: Better health outcomes for all Central Australians
Our Values: Community at the Centre | Equity and Integrity | We are Accountable | We are Relevant Today and Ready for Tomorrow | We are Committed to High Quality Care | We Value our PartnershipsCentral Australia Health Service is a Smoke Free Workplace
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Hi Lincoln,
I checked our busy Christchurch ED which often has patients on trolleys in the corridor as well. Each trolley is cleaned by the orderly who returns it to ED after delivering the patient to the admitting ward. There are plenty of detergent wipes in canisters for this purpose in ED. After it is cleaned, the sheets go back on and everyone knows the trolley is clean.
If the patient goes home from ED, then the Hospital Aide or nursing staff will do the same. Of course if the trolley has been in an isolation room or needs disinfecting then a disinfection process (dilute sodium hypochlorite) is used instead of the routine detergent clean.Cheers
Ruth[IPC logo for email signature]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
Community Liaison Infection Prevention
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!Hi Lincoln
In our ED, the bays (trolleys equipment like BP cuffs and monitor touch screens )are cleaned between patients using a detergent/disinfectant combination wipe. This cleaning is done by the nurse allocated to that bay or if the Hospital aide if she is on duty.
We have discussed using the same Tasmanian Infection Prevention and Control Unit audit tool that we use in the general wards for assessing discharge cleans in the ED.
Regards
HeatherHeather Craigie
CNC Infection Prevention and Control,
Mersey Community Hospital,
Tasmanian Health Organisation – North West
Phone 6426 5443 or 0400 351 706Hi All
ED is a busy place and some things appear to get routinely missed.
Does anybody have a guideline/process that deals with the cleaning of patient trolleys in the ED between patients?
I am also interested in who performs the cleaning, and if there is any process for demonstrating it has been done.
RegardsLincoln Fowler
Infection Prevention ConsultantBairnsdale Regional Health Service
http://www.brhs.com.auBairnsdale Regional Health Service is located on the traditional land of the Gunaikurnai people.
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Hi Cath,
This is what I do here in our hospital in New Zealand.
We capture any blood stream infections associated with day patient oncology services if the blood culture comes through our hospital lab i.e. it was taken while attending the hospital or they were admitted because they were septic. If they have a CVC in situ then we assess them as to whether they meet the definition for a non-inpatient HABSI as below:They are subcategorised as either non-inpatient associated
OR
Inpatient associated (those that occur more than 48hrs after hospital admission or within 48hrs of discharge)Healthcare Associated event satisfies at least one of the following criteria:
– Acquired during hospitalisation and not present or incubating on admission
– Is a complication of the presence of an indwelling medical device (e.g. IV catheter, urinary catheter)
– Occurs within 30 days of a surgical procedure, where the bloodstream infection is related to the Surgical Site Infection
– An invasive instrumentation or incision related to the bloodstream infection was performed within 48hrs before onset of the infection. If the time interval was longer than 48hours, there must be compelling evidence that the infection was related to the invasive device or procedure; or
– Associated with neutropaenia (<1×109/l) contributed to by cytotoxic therapySo most of the cases that are attributed to the CVC and they have not been in wirthin the previous 48 hours we would class them as 'non-inpatient HABSI, source CVC' and they counted in our rates.
We also use the CDC 'Mucosal barrier injury laboratory-confirmed bloodstream infection' definiton for this patient population and have seen a reduction in attributing BSI in neutropaenic patients to their CVC as a result..Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
e: ruth.barratt@cdhb.health.nz
t: + 64 3 3640 083 or ext.80083
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!—–Original Message—–
Dear ACIPC Colleagues
I am looking for help regarding current practices of monitoring bloodstream infections in day patient oncology services. The service I am working with has no inpatient capacity. The majority of patients have long-term implantable devices and are most often neutropenic, suffering episodes of "febrile neutropenia". The amount of time between their therapies varies making it impossible to apply the usual 48hrs since healthcare equals HA BSI logic. One could argue that without an implantable device the patient would have no risk of developing a BSI. Or you could equally argue that the majority of pts w/ neutropenia inevitably develop an episode of febrile neutropenia and discount the case arguing that if asepsis on line/port access and site care are perfect in the facility sepsis may be related to something happening while the pt is not receiving therapy. Although my counter argument is that our responsibility includes teaching the patient and family how to manage and care for the site/ port whilst in the domestic setting. This is very difficult for me epidemiologically, logistically and clinically to determine the importance and or need for BSI monitoring among this day-only population.
Would others please be willing to share:
1. how they approach BSI monitoring in non-inpatients; 2. their opinions on whether this should be done at all; 3. whether just monitoring S. aureus BSI would suffice for purposes of Accreditation; and 4. how they classify BSI in populations w/ febrile neutropenic patients 5. any other gems ie. protocols.The model I have used up to now has been based on CHRISP, QLD recommendations. I would be really grateful for other suggestions.
Regards and advanced thanks.
CathDr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
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Hi Rachel,
When this advisory came out from the Anaesthetists we challenged the amount of evidence to change our practice of using CHG and alcohol swabs for disinfecting both skin and IV bungs. We did not want to introduce a 2nd swab to confuse staff. We felt that the evidence for harm in the instances described did not outweigh the potential confusion of having 2 different products and the potential of a staff member routinely using alcohol only for skin disinfection relating to IV access etc.
So to answer your question we continue to use CHG and alcohol for all.[IPC logo for email signature]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
Community Laiason Infection Prevention
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives![Posted on behalf of Rachel Thompson – Moderator]
Hi again,
I also attach for the interest of members some information from the ANZCA in relation to CHG sensitivity – can I ask if others use plain alcohol wipes for IV drug administration or alcohol + CHG wipes?
Thanks!
Rachel……………………………………………………………………………..
Rachel Thomson
Nurse Unit ManagerInfection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658Level 4, H Block
48 Liverpool Street
Hobart, 7000Hi all,
I am very interested in input from list subscribers to the issue surrounding use of wipes containing 70% alcohol and 2% CHG to clean the tops of vials prior to injecting or drawing up. Most subscribers would be aware of the adverse events reported in relation to injection of alcoholic CHG into an epidural that has altered practices in relation to insertion and management of epidurals. This concern has resulted; it appears, in a real concern in relation to the use of wipes on any equipment used in the management of epidurals. Please refer to the attached editorial. As the bottles of solution used are presented in a sterile form (sealed sterile packaging) we have recommended that the tops of these vials do not need swabbing prior to use. There do appear, however, to other real concerns relating to the potential for adverse events relating to both epidural and nerve infusions and possible contamination with chlorhexidine residues.
Can I ask if anyone would like to make comment on your approach to this concern?
I flag for those who may not be aware the information provided from the TGA in July 2014 when the TGA investigated a number of reported cases of an unusual infection that were associated with propofol (Ralstonia spp.). As a result of this specific investigation the TGA issued a statement which included the following general information;
“The exterior surfaces of injection vials are not intended to be sterile. Most protective lids do not guarantee sterility of the outer surface of a vial rubber stopper/aluminium crimp seal. This lid is intended to act as a shield for the rubber stopper and to keep dust and other physical contaminants away from it.
Noting this, health professionals are reminded that proper aseptic technique must be strictly followed when administering intravenous injections to a patient. This includes wiping the outer surface of the rubber stopper and its injection site with a suitable disinfectant wipe/swab and allowing it to dry before inserting any device into the vial.http://www.tga.gov.au/safety/alerts-medicine-provive-mct-lct-140707.htm#.U8h3DZSSxQE
As ANTT frameworks recommend the use of alcohol + CHG, any comments or advice pertaining to ANTT and epidural/ nerve infusion management and your organisations/ health service risk management approach would be most appreciated .
Many thanks in advance
Kind regards
Rachel……………………………………………………………………………..
Rachel Thomson
Nurse Unit ManagerInfection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South
*: 03 62227882/8658Level 4, H Block
48 Liverpool Street
Hobart, 7000________________________________
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Hi Cath,
The final draft for public review has now closed end of June. My understanding is that the final version will be ready December 2014 or January 2015[IPC logo for email signature]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!Could someone please give me a brief overview of where Standards Australia are up to with the review of AS 4187? I have accessed materials available to members on the College website but am keen to know how close we may be to a final version and if it is publically available information, how much of the College’s recommendations were considered in the final version?
Hope someone can help as preparing for implementation is critically important.
Regards
CathDr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty LtdAdjunct Professor
Griffith University, School of Nursing and Midwifery
http://www.infectioncontrolplus.com.au
[Description: twitter logo][Description: FB logo][Description: icp icon]MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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Hi Sandra,
I have attached our IPC risk assessment guidelines for use of nebulisers which may be useful.Cheers
Ruth
[IPC logo for email signature]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!Hi everyone
Just wondering what guidelines facilities use when it comes to using Nebulisers Vs Spacers and if someone has a document they are happy to share on how they manage the risk when nebulisers are used in a shared room?
Many thanks
SandraSandra Wharton
Infection Prevention and Control CNC
Western NSW LHD
Orange NSW 2800
sandra.wharton@health.nsw.gov.au
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Hi all,
I am interested in this discussion as I really think that environmental impact is an important consideration for us as IPC professionals. I concur that some single use patient items are useful – especially for patients in isolation, but I am concerned about the environmental (disposal) implications of going to all single use items. An example is disposable curtains. Contrary to distributer claims these are not always able to be recycled and I see that we have a responsibility to consider the wider impact of our choices in products.
To answer your specific questions Cath –* We have not put in a business case to go to all single use
* I cannot think of any particular item that does not already have a single use alternative available e.g. BP cuffs, tourniquets etc. Perhaps a finger probe cover for the Dynamap
* The environmental issue will always be a big one here in this facility.
CheersRuth
[IPC logo for email signature]
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
*: ruth.barratt@cdhb.health.nz
*: + 64 3 3640 083 or ext.80083
[1098272744j4O36h]: 0275 263175
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!Happy new year all
As you may know there’s a subtle movement in Australia towards more widespread adoption of single-use items such as venepuncture tourniquets, lower limb surgical tourniquets, BP cuffs and ECG leads. Tom Gottlieb recently did some elegant research on venepuncture tourniquets and AT ACIPC 2013 Karen Vickery presented new perspectives on biofilm on reusable equipment. Single-use items have been adopted widely in the US for some years and recommendations to that effect are included in many Standards published by relevant professional associations eg AORN.
Whilst appreciating that demonstrating causality between reusable equipment and transmission of colonising organisms or infection is difficult either is biologically plausible. There are also issues of non-cleaning, lack of clarity about who’s role it actually is to clean reusable equipment, how frequently they need to be cleaned or reprocessed etc. These issues have plagued us for at least 3 decades that I know of and likely longer. I’m wondering what others in Australia and beyond think about single-use pt care items
So my questions are:
1. Has any ACIPC colleague successfully built a business case to convert their facility to single-use pt equipment? If so who was involved in that process?;
2. Which pieces of pt equipment do folks think are most in need of single-use alternative options?;
3. Other than price, storage, supply and environmental/waste issues and lack of detailed science what other factors would need to be addressed to help convince you or your organisation’s decision makers to invest in specific single-use equipment?.
I’d be grateful for any discussion here or as PMs on the email address below. If anyone is interested in my further work around this issue please email me.
Regards
CathDr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
Cath@infectioncontrolplus.com.auAdjunct Professor
Griffith University, School of Nursing and Midwifery
http://www.infectioncontrolplus.com.au
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Hi all,
Our approach in our tertiary facilities here in Christchurch, New Zealand may be of interest. A couple of years ago we introduced a risk assessment for ESBLs based on the Swedish work as we have limited single rooms and on average about 10-15 ESBL positive inpatients each day.The patient is assessed as low, medium and high risk. Low risk patients are nursed with Standard Precautions, no isolation and have dedicated toilet facilities. They effectively have gut colonisation only with no risk factors for spread. E.g. urinary catheter, stoma loose bowels etc.
At that time we rarely saw any Klebsiella pneumoniae isolates as they were primarily E.coli. Now we are seeing more KPN and we would strive to always isolate these patients irrespective of risk factors as there is evidence that Kleb species of ESBL are more transmissible.
I am happy to share our flow chart which was developed for the wards to use.
Cheers
Ruth
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Clinical NurseSpecialist Infection Prevention and Control
e: ruth.barratt@cdhb.health.nz
t: + 64 3 3640 083 or ext.80083
Pager: 8331
Level 5, Riverside Building
Christchurch Hospital | Private Bag 4710, Christchurch
Clean Hands Save Lives!—–Original Message—–
From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
Sent: Monday, September 09, 2013 12:09 p.m.
To: AICALIST@AICALIST.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] ESBL’s – which ones?That didn’t quote the original message like I thought it would, so was a little obscure… try again…
Hi all
Just thought I’d bump this question again, as I didn’t get any responses. Surely someone has an opinion on which gram-negatives need to be managed as MROs?
Thanks
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this emailOn Wed, 28 Aug 2013 02:58:33 +0000, Michael Wishart wrote:
>Hi all
>
>This is a partly microbiology, partly infection control question (like many we are faced with). We are an acute private hospital with a 16 bed ICU and oncology, major orthopaedic and cardiac surgical services. We have changed our main microbiology lab provider in the last few years, so some of the decisions we have made about infection control based on micro reporting now need to be revisited.
>
>The main issue is about what we determine as ‘multi-resistant gram negatives’, and how we then manage those. The lab we used to use only reported certain resistance patterns in certain organisms; the current lab seems to report much more broadly, especially in regard to ESBL-producing organisms. Our ID physician is of the opinion that most ESBL producing organism probably pose very little risk, and we should focus of Klebsiella EBSL producers only from an infection control perspective (ie alerting, additional precautions, etc), but the lab (which also services another major hospital group) reports any gram-negative that is positive for ESBL enzymes they test for (we had our first Aeromonas ESBL-producers reported recently, which kind of kick-started this discussion).
>
>I am of two minds. I appreciate the opportunity to reduce the number of patients we need to place in additional precautions and alert, but I am also concerned we open ourselves up to the potential for spreading ESBL enzymes within our facility. We currently have no evidence that ESBL producing organisms are endemic or established within our facility, and it would be nice to keep it that way. My concern is not so much which gram negatives are more likely to cause actual infection (which is I believe our ID physician’s view), but more the potential for gram negative organisms to share their ESBL enzymes with different gram negative species that ARE more likely to result in actual infection/disease. What I am not clear on is what the risk of this occurring is, and whether alerting and using additional precautions is a useful way to reduce this risk.
>
>I am aware there is a group working on some recommendations for standardisation of reporting gram negative resistance for labs, but I am not sure this will actually address my concerns.
>
>Any thoughts, or processes that your facilities have determined for this issue, would be of value in helping me work through this, and would be gratefully received.
>
>Cheers
>Michael
>
>Michael Wishart
>CNC Infection Control
>Holy Spirit Northside Private Hospital
>627 Rode Road, Chermside, Qld 4032
>t: (07) 3326 3068 | f: (07) 3607 2226
>e: Michael.Wishart@hsn.org.au
>w:www.holyspiritnorthside.org.au
>Please consider the environment before printing this email
>
>
>–
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