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Good Afternoon,
I would always include the filtered water when putting together a testing programme for any healthcare building. The carbon filters do (in my experience) tend to have a build-up of bacteria in them, and they also get rid of residual chlorine in the water supply that passes through them. If they are present, then they should be maintained as per the manufacturer’s instructions, and filters changed in line with this. The source tap water should also be tested at some point, as only then do you know if the filter is the issue, or if it is an issue with supply water. If they are needed or not should be part of the Legionella/potable water risk assessment for the facility.
I’m going to be speaking at the national conference on Legionella, on the Tuesday just before lunch.
Hopefully I can cover this, but, if anyone else has any burning questions that they would like to know the answer to, please get in touch and I will see how much I can include to make my presentation as useful as possible for everyone.
Sarah Bailey MSc, PGDip Med Myc
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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
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Hi Glenys,
The webinars are free to access for 24 hours for non-members from the time of the presentation as long as you register in advance. Just click on the link, then the booking information tab, and then on the blue text at the top that says register your free place here ignore the members bit further down the page. Its just a bit odd how theyve laid out the page where you register.
Just to reiterate what John said, Susanne is an excellent speaker and well worth listening to.
Sarah Bailey
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This communication contains information which is confidential and the copyright of QED Environmental Services Pty Ltd (ACN 060 866 720) (QED) or a third party. If you are not the intended recipient of this communication please delete and destroy all copies and contact QED immediately. If you are the intended recipient of this communication you should not copy, disclose or distribute this communication without the authority of QED. Except as required at law, QED does not represent, warrant and/or guarantee that the integrity of this communication has been maintained nor that the communication is free of errors, virus, interception or interference. The information contained in this communication is intended solely for the use of the individual or entity to whom it is addressed and others authorised to receive it. It may contain confidential information. If you are not the intended recipient you are hereby notified that any disclosure, copying, distribution or taking any action in reliance on the contents of this information is strictly prohibited and may be unlawful. If you have received this communication in error, please notify us immediately by responding to this email and then delete it from your system. QED is neither liable for the proper and complete transmission of the information contained in this communication nor for any delay in its receipt.From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Glenys Harrington
Sent: Thursday, June 15, 2017 11:26 AM
To: AICALIST@AICALIST.ORG.AU
Subject: Re: FW: [Commercial] Water Webinar: Managing water safety in complex buildingsHi John,
Looks like you need to be a paying member of RSPH to access this webinar?
Regards
Glenys
Glenys Harrington
Infection Control Consultancy (ICC)
P.O. Box 6385
Melbourne
Australia, 3004
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E: infexion@ozemail.com.auFrom: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Matthew, John
Sent: Thursday, 15 June 2017 9:21 AM
To: AICALIST@AICALIST.ORG.AU
Subject: [ACIPC_Infexion_Connexion] FW: [Commercial] Water Webinar: Managing water safety in complex buildingsHello Infexion Connexion:
Below, please find an invitation from the RSPH to register for their webinar on water safety management, presented by Dr. Susanne Lee, Chair of the RSPH Water Special Interest Group, and chaired by Dr. Claressa Lucas from the CDC.
For those of you who were not able to make it to one of our Masterclasses in March this year, this is a great opportunity to hear Susanne speak.
Please note that the webinar will be made available for 24 hours after the live presentation, but you will need to register your interest prior to the event.
Thanks, and regards
John Matthew
Marketing & Strategic Leader
Pall Medical, ANZ
M: +61 419 130 668
E: john_matthew@pall.com
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From: Royal Society for Public Health [mailto:rsph@rsph-email.org.uk]
Sent: Wednesday, 14 June 2017 22:07
To: Matthew, John <john_matthew@ap.pall.com>
Subject: [Commercial] Water Webinar: Managing water safety in complex buildingsJune 2017
View in browser | Forward to a friend
Latest Water Webinar: Register Now
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Managing water safety in complex buildings
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Wednesday 12th July 2017, 13.00pm – 14.00pm BST
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Speaker: Dr Susanne Lee, Leegionella Ltd
Chair: Dr Claressa Lucas, Centers for Disease Control and Prevention
It is now 40 years since the organism which caused the first recognised outbreak of Legionnaires disease was discovered by CDC and since then legislation and guidelines have been developed in most of the world to minimise the risks public buildings. Despite all the research that has occurred within the last 40 years across the world cases of Legionnaires disease are rising. Public building architects and building design engineers do not generally design out the potential for Legionella and other waterborne pathogens to colonise and grow within water systems.
Within complex buildings such as hospitals and hotels etc. where water is used for purposes other than for the drinking, cooking personal hygiene etc. there are additional risks from water borne infection from water used in treatment, diagnosis or recreational purposes where opportunistic pathogens, in addition to legionellae such as Pseudomonas aeruginosa are of concern. This webinar will look at how risks from water borne pathogens can be minimised by ensuring good quality point of entry water quality; good system design; installation practices; commissioning and management.
This webinar is available for viewing for 24 hours after the live broadcast.
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Register your free place now
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Good Morning Sally,
Air conditioning units need a monthly inspection, as per AS 3666 Air handling was water systems of buildings.
The in room units don’t usually have a filter as such, but usually contain a lint screen that captures larger particles. It’s hard to say how often they should be cleaned or changed, as it depends very much on the conditions in which they are working – some will become clogged more quickly than others.
When the air conditioning units are inspected, this should include an inspection of the condition of the heat exchange coil of the unit – as there isn’t a proper filter in these units, dust and debris can clog the coils leading to inefficiencies and sometimes mould growth within the unit.
Regards,
Sarah Bailey MSc PGDip Med Myc
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Dear all
I was wanting some feedback regarding the cleaning of air conditioner filters and what is an acceptable time frame between cleaning in a hospital setting.
In particular, single aircon units within patient rooms.Kind regards,
Sally Brew
Mon & Wed 6 am – 2.30pm
Tues & Thurs 8am – 4.30 pmInfection 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
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Hi Everyone,
We carry out OT testing using the guidelines in the WA Circular, which is pretty clear on the need to carry out testing and when to do it. The guidelines here state that it should be carried out at commissioning, and after significant building/maintenance works that generate dust. The WA Guidelines state that a microbial count (bacteria and fungi combined) of <10cfu/m3 are required for the unit to pass.
I've been reliably informed that many other states use the WA Guidelines as these are stricter than others available. The ASID Guidelines still use a cut off of 35cfu/m3 bacteria with specific testing for fungi if required (WA Guidelines used this level until June last year too).
ASID Guidelines can be found here:
http://hicsigwiki.asid.net.au/index.php?titleOperating_theatre_commissioning_-_MicrobiologicalWe recommend microbial testing to our clients as good microbial air quality, and ultimately not infecting the patient on the table is what you are trying to achieve by using your HEPA filters. Particle counting and all of the other methods are great, but if you pass the particle count, but all of the particles you do have coming through are viable bacteria and fungi, you still have a problem that needs fixing. We also do some annual testing for theatres, which could be argued to be a duty of care requirement.
We also recommend the same method for HEPA filtered rooms for BMT patients/positive pressure HEPA filtered isolation rooms (Class P), but does anyone have any thoughts on this?
As regards the NATA accreditation, any lab that is NATA accredited to do air sampling counts should be accredited to count your theatre plates. As far as I'm aware, it's not a separate special category for 'Theatre testing' – it is just a matter or counting colonies on plates after incubation and reporting a number. But with it being a more 'sensitive' area, the lab manager may not be happy signing off on it, which is a different matter.
Regards,
Sarah Bailey MSc PGDip Med Myc
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Dear brains trust
I have a Question around the validity of undertaking air sampling as part of infection control QA for commissioning of operating theatres.
I have read around current literature and guidelines attached it being recommended (& I have undertaken air sampling and had the micro lab previously read and report on the results which have been reviewed with the Clinical microbiologist/ID) I have attached a coupe I have looked data and used previously at what I thought were great documents!!However recently I was asked to undertake this again as we will be undertaking work in OT re our air-conditioning system and was happy to progress as previous with sir sampling . however the health laboratory I am currently working with has declined to accept and undertake the analysis and reporting as they have indicated they are not NATA accredited to undertake this analysis and reporting .
So we have been looking around for an external private laboratory to undertake this analysis and reporting at great cost to us .
However in asking around my colleagues I have also been advised that there is no current NATA credentialing for air sampling (so even the private lab we will need to use won’t be accredited accredited?)Can I clarify with anyone else working elsewhere if this is true, and /or what their experience has been in undertaken air sampling and how they have had it analysed and reported on
I am seriously wondering if I have missed anything new or different in the literature that has changed the concept of air sampling as useful tool for commissioning given if there is no there is no standard (ie NATA) of accreditation around the sample data analysis & reporting methodology and its validity then why would an air sampling need test still be recommended to be done at all if the labs are telling us the info can’t be considered accurate or correct without NATA validation
Any thoughts responses or advice greatly appreciated as we look at our next step here around value for money and safety
Kind regards
Lindy
Lindy Ryan
Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs Harbour Health Campus
Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au
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Hi Cate,
The Australian Standard, AS1668.2 doesn’t specifically mention HEPA filters in relation to isolation rooms, just specifies that they should be of a lower air pressure than the general ward that they are on.
The Australian Health Facility Guidelines only mention HEPA filtration if external exhaust is not possible. I’ve attached a PDF of the relevant part of the guideline, or it can be found at https://healthfacilityguidelines.com.au/
As Donna mentioned, any HEPA filter on the exhaust of an isolation room would need pre-filters and lint filters otherwise it would become blocked very quickly.
Regards,
Sarah Bailey MSc PGDip Med Myc
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Hi Cate,
I would recommend you refer to the Victorian Guidelines for the classification and design of isolation rooms in health care facilities (https://www2.health.vic.gov.au/about/publications/policiesandguidelines/Guidelines%20for%20the%20classification%20and%20design%20of%20isolation%20rooms%20in%20health%20care%20facilities%20Victorian%20Advisory%20Committee%20on%20Infection%20Control%202007)https://www2.health.vic.gov.au/about/publications/policiesandguidelines/Guidelines%20for%20the%20classification%20and%20design%20of%20isolation%20rooms%20in%20health%20care%20facilities%20Victorian%20Advisory%20Committee%20on%20Infection%20Control%202007https://www2.health.vic.gov.au/about/publications/policiesandguidelines/Guidelines%20for%20the%20classification%20and%20design%20of%20isolation%20rooms%20in%20health%20care%20facilities%20Victorian%20Advisory%20Committee%20on%20Infection%20Control%202007
There is no requirement for HEPA filters on either the supply or exhaust air (see pages 9-10). If your negative pressure rooms will be used by very immunosuppressed patients (e.g. in a haematology unit) then you may want to consider having a HEPA on the supply air. The facility I worked in previously (Austin Health) did fit 2 neg pressure rooms with HEPA filter supply air in the Olivia Newton John Cancer and Wellness Centre because of the patient population.
The guideline does state “HEPA filters should be installed on exhausts only if the requirements of AS1668.2 cannot be met due to physical limitations of an exiting building. If HEPA filters are installed, high efficiency deep bed filters shall be installed to protect the HEPA.” In other words HEPA filters are only required if the exhaust air cannot be located far enough away for supply air intakes. Deep bed filters are essential if HEPA filters are installed on the exhaust air as the HEPA filters become clogged very quickly with all the lint and dust drawn through them (a neg pressure room is the dust and lint sink for a ward!).
Experience with negative pressure rooms that have exhaust air HEPA filters has taught me to try to avoid this at all cost!
Regards,
Donna………………………………………………………………………..
Donna Cameron | Infection Control Consultant
Microbiological Diagnostic Unit
Public Health Laboratory | Department of Microbiology & Immunology
The University of Melbourne, Building 248, Level 1, 792 Elizabeth Street, Melbourne, 3010, VIC
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Hi everyone,
Can anyone clarify whether HEPA filters go on the supply line or exhaust line in Negative pressure rooms? Or both?The International Health Facility Guidelines says both – esp if there are immunosuppressed and infectious pts, however has a table which states not required for supply air.
ThanksCate Coffey | Clinical Nurse Consultant
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Hi Sharyn,
With regard to using the ventilation system of the procedure room as part of the infection control measures, this is probably not possible, depending on the set up of the system.
For a patient under airborne precautions, they would be cared for in a room with negative pressure, to prevent infectious microorganisms entering the rest of the ward. For Operating theatres and procedure rooms, these have to be under positive pressure. This would mean that although the air changes would be sufficient to clear any infectious organisms from the room, they would be distributed to the rest of the hospital by air leaving the procedure room. If the room only has an ordinary air-conditioning system, this isn’t HEPA filtered and air is recycled, so this would also not be a control method that could be used.
Regards,
Sarah Bailey MSc PGDip Med Myc
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Hi Sharyn,
Many moons ago I use to work as an RN in Interventional Radiology department of a Tertiary Hospital.
When working in the MRI unit, if a patient required Airborne precautions the patient would wear a surgical mask when leaving their room on the ward until they returned back to their room. This is in line with MoH policy.
The staff would wear the P2/N95 duckbilled mask inside the scanning room with no trouble without altering the mask. The small aluminium strip didn’t pose a problem.
The surgical mask didn’t pose a problem with artefact during brain scans.
Kind Regards
Louisa Sasko
Clinical Nurse Consultant | Infection Control & Physical Health Care
Mental Health Drug & Alcohol NSLHD
Macquarie Hospital
Tel (02) 9887 5479 | Fax (02) 9887 5678 | Mob 0422 005 640Masters Candidate | Western Sydney University | School of Nursing
Conjoint Associate Lecturer | Western Sydney University | School of Medicine
Louisa.sasko@health.nsw.gov.au
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Hi Sharyn,
I’m assuming the MRI procedure room itself had dedicated ventilation that is not shared with other areas?
If so the patient can be managed in airborne precautions during the MRI procedure and the patient does not need to wear a P2/N95 mask (which contains metal).
After entering the room the patient can remove the mask and this can be taken out of the room by staff who would be wearing a P2/N95 mask.
Once the procedure is completed the patient can be given another P2/N95 mask for transfer back to their ward/unit. This is assuming that the patient can tolerate P2/N95 mask.
If not then the same would apply if the patient was only able to wear a surgical mask (which also has metal).
Depending on the ventilation air exchange per hour in the MRI room you would also want to allow time for the ventilation to clear possible airborne contaminates from the room (i.e. TB).
See Appendix B, Table B1 – Air change/hour and time required for airborne contaminant removal efficiencies of 99% and 99.9%.
This table is in the from the USA Centers for Disease Control and Prevention – Guidelines for Environmental Infection Control in Health-Care Facilities – extract attached
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 47533508426Dear All,
I am seeking responses (actual or hypothetical) in relation the possibility of needing to MRI scan a patient on Airborne Precautions
* What processes are in place within your MRI departments for patients on Airborne Precautions that require scanning?
* Do you know of any manufacturers that have P2/N95 mask that MRI compatible
Looking forward to your responses
Sharyn
Sharyn Hughes
Acting Clinical Nurse Consultant |Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264490Click here Infection Prevention and Control to visit the IPAC webpage
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