[Tim Spencer]

Hi Belinda,
Have you checked the CDC site? Here is a document on the Public Health Emergency Response Guide

https://emergency.cdc.gov/planning/responseguide.asp

rom CDC website;
Purpose of the Public Health Emergency Response Guide

Health department staff need readily accessible information and guidance to:

Prepare and train public health professionals,
Establish priorities in disaster responses, and
Act quickly and efficiently in emergencies and disasters.
To meet these needs, the National Center for Environmental Health (NCEH), Division of Emergency and Environmental Health Services (EEHS) has developed the Public Health Emergency Response Guide for State, Local, and Tribal Public Health Directors, an all-hazards public health emergency response guide.

Public Health Roles and Responsibilities in Emergencies and Disasters

The Public Health Emergency Response Guide is a valuable resource for public health professionals who have the following roles and responsibilities:

Initiating the public health response during the first 24 hours (i.e., the acute phase) of an emergency or disaster.
Coordinating with the existing emergency response structures in specific types of incidents, such as floods, earthquakes, and acts of terrorism.
Information in the guide is consistent with the doctrine, concepts, principles, terminology, and organizational processes in the National Response Framework (NRF) and the National Incident Management System (NIMS).

This is from their site also;
Preparation & Planning
https://emergency.cdc.gov/planning/index.asp

Hope this is of some help..
Tim..

Timothy R. Spencer, DipAppSc, BHSc, ICCert, RN, APRN, VA-BC
Global Vascular Access, LLC
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 409 463 428 (AU)
http://www.vascularaccess.com.au
http://orcid.org/0000-0002-3128-2034

> On Jul 25, 2018, at 3:42 PM, Belinda Boston (South Eastern Sydney LHD) wrote:
>
> Hi all
> Happy Thursday
>
> Does anyone have a management plan for Cleaning in the event of an outbreak that you would be happy to share?
>
> Thanks so much
> Belinda
>
> Belinda Boston
> Infection Prevention and Control CNC | Nursing
> St George Public Hospital
> 1st Floor James Laws House
> Gray Street Kogarah NSW
> Tel (02) 9113 4608 | Fax (02) 9113 1575 | Mob 0429 890 544 | belinda.boston@health.nsw.gov.au
> http://www.seslhd.health.nsw.gov.au/
> Click HERE to access SESLHD and SGH Infection Prevention and Control Information and resources
> http://seslhnweb/SGSHHS/Business_Rules/Clinical/Infection_Control/default.asp
>
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[Tim Spencer]

Hi All,
I think the other thing to consider is the human factors that influence the staff.

Many staff are unaware of the current evidence pertaining to scrub the hub (in relation to the INS SOP), and while there has been somewhat limited high-level published evidence, there is sufficient to support for the correct solution and time to scrub.

Much of it comes down to the correct scrubbing technique. There was a video we made for ACI several years ago on scrub the hub demonstrating this. Kaye Rolls (?) is it still around?

Not only is this lack of understanding confusing to floor clinicians, but the confusion behind changing of needlefree connectors etc reigns just as high on the list.

The INS SOP states that either 70% IPA or >0.5% CHG + 70% IPA swabs. This is used for device access/de-accessing.

If you are talking about the cap covers that are attached to provide a passive protection, then IPA is all that is required (INS SOP) as this provides for intraluminal microbial contamination.

Scrubbing solution and time of scrub (5-15secs) has been studied previously and is included in INS SOP.
–
INS SOP – Section 6
Standard
34.1 Use a luer-locking mechanism to ensure a secure junction when attaching needleless connectors to a vas- cular access device (VAD) hub or access site.
34.2 Disinfect needleless connectors prior to each entry into the device.
34.3 Use aseptic no-touch technique to change the needleless connector.
34.4 Access needleless connectors only with a sterile device.

This should also be in conjunction with the needlefree device manufacturers IFU. see below for more details..

E. Follow manufacturers directions for the appropriate sequence of catheter clamping and final syringe disconnection to reduce the amount of blood reflux into the VAD lumen and, thus, the incidence of intraluminal thrombotic occlusion. The sequence for flushing, clamping, and disconnecting the syringe depends upon the internal mechanism for fluid dis- placement. Standardizing the type of needleless connector within the organization may reduce risk for confusion about these steps and improve out- comes.14,15 (V)

F. Perform a vigorous mechanical scrub for manual disinfection of the needleless connector prior to each VAD access and allow it to dry.
1. Acceptable disinfecting agents include 70% iso-propyl alcohol, iodophors (ie, povidone-iodine), or >0.5% chlorhexidine in alcohol solution.7,16 (II)
2. Length of contact time for scrubbing and drying depends on the design of the needleless connector and the properties of the disinfecting agent. For from 5 to 60 seconds with biocide activity occurring when the solution is wet and immediately after drying. More research is needed for other agents or combinations of agents due to conflicting reports regarding the optimal scrub time.3,17,18 (II)
3. Use vigorous mechanical scrubbing methods even when disinfecting needleless connectors with antimicrobial properties (eg, silver coatings).19-24 (IV)

G. Use of passive disinfection caps containing disinfect- ing agents (eg, isopropyl alcohol) has been shown to reduce intraluminal microbial contamination and reduce the rates of central line-associated blood- stream infection (CLABSI). Use of disinfection caps on peripheral catheters has limited evidence but should be considered.
1. The length of exposure time to be effective depends upon product design; consult manufac- turers directions for use.18 (V)
2. Once removed, these used caps are discarded and are never reattached to the needleless connector.3,18 (II)
3. After removal, multiple accesses of the VAD may be required to administer a medication (eg, flush syringes and administration sets) and require additional disinfection before each entry. Scrubbing time, technique, and agents for disin- fection of the needleless connector between sub- sequent connections are unknown due to a lack of research. Consider using a vigorous 5- to 15-second scrub time with each subsequent entry into the VAD, depending upon the needleless connector design.25-30 (Committee Consensus)
4. Use a stopcock or manifold with an integrated needleless connector rather than a solid cap due to contamination from personnel hands and the environment. Replace the stopcock with a needle- less connector as soon as clinically indicated.31-33 (III)
H. Change the needleless connector no more frequently than 96-hour intervals. Changing on a more fre- quent time interval adds no benefit and has been shown to increase the risk of CLABSI.
1. When used within a continuous infusion system, the needleless connector is changed when the primary administration set is changed (eg, 96 hours).
2. For peripheral catheters with dwell times longer than 96 hours, there are no studies on changing the attached needleless connector/extension set.
3. Additionally, the needleless connector should be changed in the following circumstances: if the needleless connector is removed for any reason; if there is residual blood or debris within the needleless connector; prior to drawing a sample
for blood culture from the VAD; upon contamination; per organizational policies, pro- cedures, and/or practice guidelines; or per the manufacturers directions for use (see Standard 49, Infection).7,34,35 (IV)
I. Ensure that disinfecting supplies are readily avail- able at the bedside to facilitate staff compliance with needleless connector disinfection.14,36 (V)

Tim Spencer, DipAppSc, BHSc, IC Cert, RN , APRN, VA-BC
Global Vascular Access, LLC

Sent from my iPhone

> On Jul 1, 2018, at 15:55, Michael Wishart wrote:
>
> Hi Cath
>
> I still have not seen definitive evidence that equates hub scrubbing with chlorhexidine containing swabs as being more effective than just 70% alcohol swabs for prevention of line infections.
>
> The 2016 INS guidelines state:
>
> F. Perform a vigorous mechanical scrub for manual disinfection of the needleless connector prior to each VAD access and allow it to dry.
> 1. Acceptable disinfecting agents include 70% isopropyl alcohol, iodophors (ie, povidone-iodine), or >0.5% chlorhexidine in alcohol solution. 7,16 (II)
> 2. Length of contact time for scrubbing and drying depends on the design of the needleless connector and the properties of the disinfecting agent. For 70% isopropyl alcohol, reported scrub times range from 5 to 60 seconds with biocide activity occurring when the solution is wet and immediately after drying. More research is needed for other agents or combinations of agents due to conflicting reports regarding the optimal scrub time. 3,17,18 (II)
> 3. Use vigorous mechanical scrubbing methods even when disinfecting needleless connectors with antimicrobial properties (eg, silver coatings). 19-24 (IV)
> G. Use of passive disinfection caps containing disinfecting agents (eg, isopropyl alcohol) has been shown to reduce intraluminal microbial contamination and reduce the rates of central line-associated bloodstream
> infection (CLABSI). Use of disinfection caps on peripheral catheters has limited evidence but should be considered.
>
> I do agree that staff confusion is an issue, so one product should be selected and made available. But until I see credible evidence to support use of chlorhexidine containing swabs on hubs, I will continue to promote 70% alcohol scrub the hub.
>
> My opinion, anyway.
>
> Cheers
> Michael
>
> Michael Wishart, CICP-E
> Infection Control Coordinator
>
> A 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
>
> P Please consider the environment before printing this email
>
>
>
>
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Catherine Wade
> Sent: Monday, 2 July 2018 8:36 AM
> To: AICALIST@AICALIST.ORG.AU
> Subject: Re: [ACIPC_Infexion_Connexion] Scrub the hub in routine clinical settings
>
> Hi All,
> Agree with Cath.
>
> Historically we stocked both 70% alcohol & the alcohol 2% CHG swabs / solution in clinical areas
> After reviewing & auditing accessing devices it became quite clear that staff were confused about what to scrub the hub with or for insertion of a PIVC etc.
> There was a lack of standardisation amongst staff about what product to use on which vascular access device when asked,
> More frighteningly, staff also often referred to swabs according to the colour of the packet not the antiseptic solution use the blue swabs / use the pink swabs / use the orange swabs.
> To further complicate things – the colours of the swab packets can change depending on the supplier of the product. & at one point the alcohol swabs were virtually the same colour as the CHG swabs.
> Chinese whispers were also a problem as some staff had heard about CHG sensitivity either in a journal, TV, Dr Google or at a conference & were taking it upon themselves & influencing others to use alcohol only which was not procedure.
>
> Using a risk management approach 1st rule of thumb Eliminate!
> The decision was made by the LHF to remove the alcohol swabs from all patient units & only stock alcohol CHG unless the clinical area identified a specific need for just alcohol swabs.
> The risk of infection due to staff not using the correct antisepsis solution to scrub the hub or insertion far out-weighs the sensitivity issue for CHG.
>
> Cheers
> Catherine Wade
>
> Clinical Nurse Consultant | Infection Prevention & Control (IPAC)
> Level 1 / 67 Holden Street, GOSFORD NSW 2250
> Tel: (02) 4320 2664 | Internal Ext: 92664 | Page: 18885
> Fax:(02) 4320 2874 | Internal Fax: 92874
> Catherine.Wade@health.nsw.gov.au or CCLHD-IPAC@health.nsw.gov.au
>
>
>
>
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Cathryn Murphy
> Sent: Friday, 29 June 2018 3:37 PM
> To: AICALIST@AICALIST.ORG.AU
> Subject: Re: Scrub the hub in routine clinical settings
>
> Dear Daniella
>
> I recently reviewed evidence and guidelines for best practice with vascular access devices. Below are the recommendations I made on based on the review and the supporting references.
>
> I have never understood Australias reluctance to adopt scrub the hub campaigns and lack of interest in routine use of protective IV caps. As a recently hospitalised and immunosuppressed patient I worried every time my line was accessed as there was nothing uniform in any of the accesses. There are now good Australian research papers showing risk with even simple peripheral vascular catheters. IVs are inserted very commonly making them one of the most frequent infection risks in acute care settings.
>
> With regard to CHG I also note a general reluctance to its use in Australia as evidenced by poor recommendations in the draft NHMRC IC Guidelines, questions raised previously on this discussion forum and at ACIPC meetings. Personally I disagree with Michaels earlier comment given that it is often a long time between accesses of IV lines and if oncovered they can easily become contaminated hence an agent containing alcohol and CHG is safe to use in non CHG-sensitive populations and it gives immediacy plus residual. As you would appreciate CHG has been used extensively in healthcare and domestic settings for decades. True CHG sensitivity is extremely rare. Anaphylaxis reports typically demonstrate multi-site simultaneous exposure to CHG ie surgical skin prep + use of CHG lubricant jelly + CHG impregnated CVC insertion. The NHMRCs recommendation that we keep risk registries of CHG containing products is salient as is the recommendation to take adequate histories from patients regarding sensitivities.
>
> In a recent report where he considered resistance Kampf argued that we should use CHG cautiously and perhaps even in a stewardship way. He was smart to recognise that there is no universal agreed definition of CHG-resistance and that the mechanisms are very different to antimicrobial resistance.
>
> I expect many will disagree with my views but I am very happy that CHG was used extensively to help prevent infection in my recent surgery and hospitalisation. I would have warmly welcomed the use of routine CHG & alcohol hub disinfection.
>
> Recommendations based on literature and guideline review.
>
> Care must be taken not to contaminate the lines when accessing lines and their administration sets.1,65,72
>
> A single patient use application of 70% alcohol alone1,73 or >0.5% chlorhexidine in 70% alcohol1,10,29,72 should be used70 for 529- 15 seconds1,10,73 and allowed to dry when decontaminating the catheter hub or injection ports prior to every access of the circuit. This includes every time an infusion set is added or removed, as well as administration of medication.10,65 Supplies for disinfecting should be kept at the bedside.1
>
> Use of disinfection caps on peripheral and central catheters should be considered.1,72
>
> 1. Gorski LA, Hadaway L, Hagle ME, McGoldrick M, Orr M, Doellman D. Infusion therapy standards of practice. J Infus Nurs. 2016;39(1S):1-256.
> 10. Loveday HP, Wilson JA, Pratt RJ, et al. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014;86 Suppl 1:S1-70.
> 29. Marschall J, Mermel LA, Fakih M, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(7):753-771.
> 65. Society. AaNZIC. Central Line Insertion and Maintenance Guideline. 2012; http://www.anzics.com.au/Downloads/ANZICS_Insertion%26maintenance_guideline2012_04.pdf, 2017.
> 70. Ling ML, Apisarnthanarak A, Jaggi N, et al. APSIC guide for prevention of Central Line Associated Bloodstream Infections (CLABSI). Antimicrob Resist Infect Control Antimicrobial Resistance & Infection Control. 2016;5(1).
> 72. Nursing. RCo. Standards for infusion therapy. London.: Royal College of Nursing.; 2016.
> 73. (INICC). INICC. International Nosocomial Infection Control Consortium (INICC) Bundle to Prevent Central Line Associated Bloodstream Infections (CLAB) in Intensive Care Units (ICU): An International Perspective. Argentina.2017.
>
>
> Cath
>
> Cathryn Murphy RN B. Photog MPH CIC FAPIC FSHEA CICP-E PhD
> Chief Executive Officer & Creative Director
> Infection Control Plus Pty Ltd
> Adjunct Associate Professor
> Faculty of Health Sciences and Medicine, Bond University
> QLD, Australia
>
> E: Cath@infectioncontrolplus.com.au
> M: +61 428 154154
> W:http://www.infectioncontrolplus.com.au
>
>
>
>
> From: ACIPC Infexion Connexion On Behalf Of Karanfilovska, Daniela
> Sent: Friday, 29 June 2018 10:25
> To: AICALIST@AICALIST.ORG.AU
> Subject: Scrub the hub in routine clinical settings
>
> Dear colleagues,
>
> I am interested to know if Australian hospitals are routinely using wipes containing chlorhexidine 2% with alcohol 70% to disinfect vascular access hubs (i.e. to scrub the hub). In particular, is this practised on general wards when accessing a PIVC?
>
> Many thanks,
> Daniela
>
> Daniela Karanfilovska
> Clinical Nurse Consultant
> Infection Prevention & Healthcare Epidemiology
>
> t 03 90762819 m 0427 703 769
> e D.Karanfilovska@alfred.org.au
>
> Alfred Health
> 55 Commercial Road
> Melbourne VIC 3004
> PO Box 315 Prahran
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[Tim Spencer]

Hi Jane,
CDC, SHEA and INS have expanded their administration set change to 96hr, but no longer.
S84 if he INS SOP covers all aspects of administration set changes.

Im not near my computer at the moment but feel free to email offline and I can help you.
Tim..

Sent from my iPhone

> On Apr 5, 2018, at 20:21, Jayne OConnor wrote:
>
> Dear Brains Trust,
>
> I was asked a question today regarding the frequency of line changes, for patients receiving ‘slow chemo infusions’ i.e. over 4 days, (our policy is 72 hours) in the case of a slow chemo treatment where do we stand as this means changing line partway through treatment. Doing this delays treatment for a period of time and may reduce therapeutic dose , prolongs the process, requires disconnect of a closed system which could be detrimental to the patient from an IPC perspective and expose the staff unnecessarily to cytotoxic drugs. The chemo is being administered via a PICC line. Logically, I would think it OK to prolong length of time for the line changes but would be interested in your views, or indeed if you know of any evidence to support this.
>
> Many thanks in advance.
>
> Jayne O’Connor RN ,BSc.,Inf.Cont
> IPC Co-Ordinator
> Sydney Adventist Hospital | 185 Fox Valley Road, Wahroonga, NSW 2076
>
> p: +61 2 9487 9732 | f: +61 2 9473 8052 | m: +61 0406 752685 | e: jayne.oconnor@sah.org.au
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[Tim Spencer]

Hi Helen and all,

I would also have a look at the 2016 INS Standards of Practice, which is the go-too document for infusion therapy and vascular access professionals.
Here is the excerpt on Add-On devices.

36. ADD-ON DEVICES Standard

36.1 Add-on devices are used only when clinically indicated for a specific purpose and in accordance with manufacturers directions for use.
36.2 Add-on devices are of luer-lock or integrated design to ensure a secure junction, reduce manipulation, and minimize the risk of disconnection.

Practice Criteria

Consider the use of add-on devices (eg, single- and multilumen extension sets, manifold sets, extension loops, solid cannula caps, needleless connectors, in-line filters, manual flow-control devices and stop- cocks) only for clinical indications. When indicated, preferentially use systems that minimize manipulation and reduce multiple components, such as inte- grated extension sets (see Standard 34, Needleless Connectors).1-4 (IV)

Clinical indications may include adding length, enabling filtration capabilities, or enhancing function of the infusion system (ie, adding an extension to decrease movement/manipulation at the short peripheral catheter hub).1,2 (V)

Consider that the potential for contamination exists with all add-on devices. Limit the use of add-on devices whenever possible to decrease the number of manipulation episodes, acciden- tal disconnections or misconnections, and costs.1-9 (IV)

Ensure that all add-on devices are compatible with the administration system to prevent the risk of leaks, disconnections, or misconnections.5-6 (V)

Change the add-on device with new vascular access device (VAD) insertion, with each administration set replacement, or as defined by the organization, and whenever the integrity of the product is compromised or suspected of being compromised.1,2 (V)

Avoid the use of stopcocks due to the increased risk of infection.

Propofol anesthesia may increase risk for postoperative infection because of microorganism growth in stopcock dead spaces. Bacterial con- tamination of the patients skin, the providers hands, and the environment contribute to infection risk associated with stopcocks.10,11 (IV)

Use a stopcock or manifold with an integrated needleless connection rather than a solid cap or replace the stopcock with a needleless connector to reduce stopcock contamination.12,13 (IV)

42. ADMINISTRATION SET CHANGE

Standard

42.1 Administration set changes are performed routinely, based on factors such as type of solution administered, frequency of the infusion (continuous versus intermittent), immediately upon suspected contamination, or when the integrity of the product or system has been compromised.

42.2 In addition to routine changes, the administration set is changed whenever the peripheral catheter site is changed or when a new central vascular access device (CVAD) is placed.

42.3 A vented administration set is used for solutions supplied in glass or semirigid containers, and a non-vented administration set is used for plastic solution containers.

42.4 Administration sets are attached to a vascular access device (VAD) hub or access site with a luer- locking mechanism to ensure a secure junction.

Practice Criteria

I. General

A. Minimize the use of add-on devices for administration sets as each device is a potential source of contamination, misuse, and disconnection; when feasible use an administration set with devices as an integral part of the set (refer to Standard 36, Add-on Devices).

B. Check the packaging of administration sets for latex and avoid use of a latex-containing set for patients with a latex allergy (refer to Standard 14, Latex Sensitivity or Allergy).

C. Attach the administration set and prime just prior to administration.1,2 (V, Regulatory)

D. Label administration sets for infusion via VADs with the date of initiation or date of change based on organizational policies and procedures. Label administration sets used for medications that are administered via specialized access devices (ie, intraspinal, intraosseous, subcutaneous) to indicate the correct administration route and device, and place the label near the connection to the device.3,4 (V)

E. Trace all catheters/administration sets/add-on devic- es between the patient and the solution container before connecting or reconnecting any infusion/device, at each care transition to a new setting or service, and as part of the handoff process.5-7 (IV)

II. Primary and Secondary Continuous Infusions

Replace primary and secondary continuous adminis- tration sets used to administer solutions other than lipid, blood, or blood products no more frequently than every 96 hours. There is strong evidence that changing the administration sets more frequently does not decrease the risk of infection.8-11 (I)

Change a secondary administration set that is detached from the primary administration set every 24 hours as it is now a primary intermittent administration set (see Practice Criteria III, Primary Intermittent Infusions).3 (V)

Avoid disconnecting primary continuous administration sets from the VAD hub or access site. (V, Committee Consensus)

III. Primary Intermittent Infusions

Change intermittent administration sets every 24 hours. When an intermittent infusion is repeatedly disconnected and reconnected for the infusion, there is increased risk of contamination at the spike end, catheter hub, needleless connector, and the male luer end of the administration set, potentially increasing risk for catheter-related bloodstream infection (CR-BSI). There is an absence of studies addressing administration set changes for intermittent infusions.10 (V, Committee Consensus)

Aseptically attach a new, sterile, compatible cover- ing device to the male luer end of the administration set after each intermittent use. Do not attach the exposed male luer end of the administration set to a port on the same set (looping).3,12 (V)

Now this is not exhaustive but my provide some clarity.

You may also find some of these references have something potentially useful;
Simmons D, Symes L, Guenter P, Graves K. Tubing misconnections: normalization of deviance. Nutr Clin Pract. 2011;26(3):286-293.

Mermel LA. What is the predominant source of intravascular catheter infections? Clin Infect Dis. 2011;52(2):211-212.

Ayer P, Adams S, Boullata J, et al. A.S.P.E.N. parenteral nutrition safety consensus recommendations. J Parenter Enteral Nutr. 2014;38(3):291-333.

DeVries M, Mancos PS, Valentine MJ. Reducing bloodstream infection risk in central and peripheral intravenous lines: initial data on passive intravenous connector disinfection. J Assoc Vasc Access. 2014;19(2):87-93.

Marschall J, Mermel LA, Fakih M, et al; Society for Healthcare Epidemiology of America. Strategies to prevent central line-asso- ciated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(7): 753-771.

Flynn, J. M., Keogh, S. J., & Gavin, N. C. (2015). Sterile v aseptic non-touch technique for needle-less connector care on central venous access devices in a bone marrow transplant population: A comparative study. European Journal of Oncology Nursing, 19(6), 694-700.

Nancy L. Moureau and Julie Flynn, Disinfection of Needleless Connector Hubs: Clinical Evidence Systematic Review, Nursing Research and Practice, vol. 2015, Article ID 796762, 20 pages, 2015

Hope this is helpful.
Regards,
Tim..

Timothy R. Spencer, DipAppSc, BHSc, ICCert, RN, APRN, VA-BC
Global Vascular Access, LLC
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 409 463 428 (AU)
http://www.vascularaccess.com.au
http://orcid.org/0000-0002-3128-2034

> On Feb 21, 2018, at 4:37 PM, Lindy Ryan wrote:
>
> Hello Helen
>
> Like Michael NSW have some guidelines that may help as well as they indicate similar to what QLDs documents
>
> NSW PIVC GL2013_013 document (which I believe are under review but these do remain current at this time)may hopefully also provide you with some direction in section 9.3 Care of admin sets pg 7
>
> 9.3 Care of administration sets
> 9.3.1 Label all administration sets attached to the PIVC with an intravenous line label in accordance with NSW Policy User applied labelling of Injectable Medicines, Fluids and Lines 13
>
> 9.3.2 IV tubing sets should not be disconnected for routine care, but may be disconnected for transient, controlled disconnections such as changing IV infusions, removing a sling or sleeve, or access in Operating Theatres, Medical Imaging or Radiology Departments
>
>
> 9.3.3 Except for transient controlled disconnections as above, if the IV giving set is disconnected, replace the entire IV tubing
>
>
>
> Kind regards
>
>
> Lindy Ryan
>
> District Infection Prevention & Control CNC | Clinical Governance Unit MNCLHD
> Level 1 Coffs Specialist Centre, Pacific Hwy, Coffs Harbour
> Mob 0419 990 693 | lindy.ryan@ncahs.health.nsw.gov.au
> http://www.health.nsw.gov.au
>
>
>
> Wise and humane management of the patient is the best safeguard against infection
> (Florence Nightingale Circa 1860)
>
>
>
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Michael Wishart
> Sent: Wednesday, 21 February 2018 12:41 PM
> To: AICALIST@AICALIST.ORG.AU
> Subject: Re: Discouraging disconnection of IV fluids for showering patients ad going to X-ray etc.
>
> Hi Helen
>
> We have this statement in our IV infusion care policy:
>
> Intermittent disconnection of administration sets used for continuous infusions, is not recommended due to the increased risk of infection through manipulation of the hub and occlusion due to reflux of blood into the cannula tip when the line is disconnected; Intermittent administration sets should be discarded after each use if disconnected
>
> This is based on the QLD iCARE guidelines (https://www.health.qld.gov.au/__data/assets/pdf_file/0025/444490/icare-pivc-guideline.pdf ).
>
> Hope this helps.
>
> Cheers
> Michael
>
>
> Michael Wishart, CICP-E
> Infection Control Coordinator
>
> A 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
>
> P Please consider the environment before printing this email
>
>
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU ] On Behalf Of Helen Scott
> Sent: Wednesday, 21 February 2018 11:31 AM
> To: AICALIST@AICALIST.ORG.AU
> Subject: [ACIPC_Infexion_Connexion] Discouraging disconnection of IV fluids for showering patients ad going to X-ray etc.
>
> Hi all,
>
> Does anyone have any evidence or best practice guidelines for the above please?
> Where I am currently working, this happens all the time, both with PIVCs and CVADs (rather worrisome).
> Sometimes these giving sets are hanging around, disconnected for several hours. And theres the risk of them being forgotten.
> But the biggest problem is the staff capping the end and thinking this is ok. Im not seeing good hand hygiene for a start but surely theres a risk of contamination once the giving set is disconnected from the the cannula? And does anyone have anything around how long IV fluids can sit in the giving set for once disconnected?
> I have found a guideline from 2009 from the Royal Hospital for Women, but its not quite specific enough.
>
> Thanks in advance,
> Helen Scott, ICP.
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[Tim Spencer]

Hi Kaylene,
You can find guidelines from ASUM in their website here;
http://onlinelibrary.wiley.com/doi/10.1002/ajum.12042/full

Might find home useful info there..
Tim..

Timothy R. Spencer, DipAppSc, BHSc, ICCert, RN, APRN, VA-BC
Global Vascular Access, LLC
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 409 463 428 (AU)
http://www.vascularaccess.com.au
http://orcid.org/0000-0002-3128-2034

Sent from my iPhone

> On Feb 11, 2018, at 13:00, KAYLENE STYLES wrote:
>
> Good morning all
> I am looking for some assistance with managing the high level disinfection of ultrasound probes. We currently use Trophon (hydrogen peroxide) but have found a few new small ultrasound transducers for the renal patients that have been brought into the system without an consultation with infection prevention. These have not been tested with the Trophon system and we do not have any other method to disinfect appropriately at this point.
> Our biomedical team have distributed information to the teams that use ultrasounds suggesting they implement UV Antigermix system. Is there anyone using this?
> Our team would appreciate any information that might help our choices.
> Regards
>
>
>
> Kaylene Styles
> Clinical Nurse Consultant | Infection Prevention Service | Barwon Health
> Direct. (03) 4215 2323 |kaylenes@barwonhealth.org.au
> Post. PO Box 281 Geelong 3220
>
>
>
>
>
>
>
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[Tim Spencer]

Hi Michael,
This is the recommendation from the INS (Infusion Nurses Society) Standards of Practice 2016 – points F & G are your answers.

56. CONTINUOUS SUBCUTANEOUS INFUSION AND ACCESS DEVICES

Standard

56.1 The clinician assesses the patient for appropriate- ness of the subcutaneous route in relation to the pre- scribed medication or solution, the patients clinical condition, and the presence of adequate subcutaneous tissue.

Practice Criteria

Consider administration of isotonic solutions (5% dextrose in water or 0.9% sodium chloride) via a subcutaneous access device (hypodermoclysis) for treatment of mild to moderate dehydration.1-8 (V)

Consider the subcutaneous route for continuous opioid (eg, morphine, hydromorphone, fentanyl) and other infusion therapies/medications (eg, immu- noglobulin therapy, terbutaline). In addition, admin- ister other medication on an intermittent basis via a subcutaneous access device.2,5,9-11 (V)

Use hyaluronidase to facilitate the dispersion and absorption of 1,000 mL or more of subcutaneously administered hydration solutions in adults and pedi- atric patients. The dosage of subcutaneous solutions administered is dependent upon the patients age, weight, clinical condition, and laboratory values. The rate and volume of subcutaneous fluid administration should not exceed those employed for intravenous infusion.2,3,5-7,12-20 (V)

Consider the use of hyaluronidase to increase the dis- persion and absorption of other injected drugs.19,20 (V)

In patients taking salicylates (eg, aspirin), steroids (eg, cortisone or estrogens), or antihistamines, a larger dose of hyaluronidase for equivalent dispersing effect may be required.19 (V)

Do not use hyaluronidase to enhance the disper- sion and absorption of dopamine and/or alpha- agonist drugs, as the drugs are incompatible. Consult the drug manufacturers references prior to administering any drug with hyaluronidase.19 (V)

When hyaluronidase is added to a local anes- thetic agent, it hastens the onset of analgesia and tends to reduce the swelling caused by local infil- tration, but the wider spread of the local anes- thetic solution increases its absorption; this shortens its duration of action and tends to increase the incidence of systemic reaction.19 (V)

Use with caution in a nursing mother as it is not known if hyaluronidase is excreted in breast milk.19 (V)

Assess for adverse reactions of hyaluronidase of mild local access site reactions such as redness, pain, anaphylactic-like reactions, and allergic reactions.19 (V)

Select a site for subcutaneous access to include areas with intact skin that are not near a joint and have adequate subcutaneous tissue, such as the upper arm, subclavicular chest wall, abdomen (at least 2 inches away from the umbilicus), upper back, and thighs and/or as recommended by the drug manufacturer 1. A stainless steel winged needle is not recommended.5 (IV)

Rotate the subcutaneous access site used for medica- tion administration every 7 days and as clinically indicated based on the access site assessment findings.5,6 (V)

Rotate the subcutaneous access site used for hydration solutions every 24 to 48 hours or after 1.5 to 2 liters of solution has infused and as clinically indicat- ed based on the access site assessment findings.2,7 (V)

Assess the subcutaneous access site and rotate the site when there is erythema, swelling, leaking, local bleeding, bruising, burning, abscess, or pain.1,5-7 (V)

1. For patients receiving subcutaneous immunoglobulin infusions, some swelling and site erythema, pain, and pruritis are common and tend to decrease over time. Persistent reactions may require a slower infusion rate or decreased volume per site, longer needle, or site change.10,22 (V)

I. Use a small-gauge (ie, 24- to 27-gauge) infusion device to establish subcutaneous access, and insert the subcutaneous infusion device according to the manufacturers guidelines. Use a subcutaneous needle labeled for high flow rates when indicated by the drug manufacturer.5-7,21 (V)

J. Perform skin antisepsis prior to inserting the subcutaneous access device using 70% isopropyl alcohol, povidone-iodine, or >0.5% chlorhexidine in alcohol solution.6,23 (V)

K. Aspirate the subcutaneous infusion access device to confirm the absence of a blood return prior to medication and fluid administration.5,6,10 (V)

L. Apply a transparent semipermeable membrane (TSM) dressing over the subcutaneous access site to allow for continuous observation and assessment. Change the TSM dressing with each subcutaneous site rotation but immediately if the integrity of the dressing is compromised.2,5,7 (V)

M. The optimal subcutaneous infusion rate is unknown. Medication infusion rates of 3 to 5 mL per hour are reported, and hydration infusion rates of up to 1500 mL over 24 hours are reported. More than 1 subcutaneous infusion site may be used to accomplish a larger infusion volume. Follow the manufacturers recommended subcutaneous administration rate/infu- sion method for immunoglobulin infusions.2,6,7,9 (V)

N. Regulate the infusion of medications administered as a continuous infusion via a subcutaneous access device using an electronic infusion device that has the ability to titrate the rate up or down if required to improve tolerability.5,21 (V)

O. Infuse isotonic fluids for hydration via a subcutaneous access device using a manual flow regulator.4,6,7 (V)

Hope this helps.

Timothy R. Spencer, DipAppSci, BHealth, ICU Cert, RN, APN, VA-BC
Global Vascular Access, LLC
E: tim.spencer68@icloud.com
W: http://www.vascularaccess.com.au
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
http://orcid.org/0000-0002-3128-2034

> On Sep 28, 2017, at 10:17 PM, Michael Wishart wrote:
>
> Hi everyone
>
> How long do you recommend subcutaneous infusion devices remain insitu for before they are resited? Do you recommended a fixed interval resite, as well as as required?
>
> There appears to be some difference between subcutaneous devices used for opiate infusions, and devices uses for hydration. Can anyone comment on this? There are some recommendations about devices used for opiate infusion in this document: https://www.health.qld.gov.au/__data/assets/pdf_file/0029/155495/guidelines.pdf
>
> Does the latest version of INS make any recommendations for these devices?
>
> Thanks for any help on this.
>
> Cheers
> Michael
>
>
> Michael Wishart
> Infection Control Coordinator
>
> A 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
>
> P Please consider the environment before printing this email
>
>
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[Tim Spencer]

Hi Jayne,
There was a recent discussion some time back on decontamination of US probes on the list (which I would classify a TOE probe generally.
I did go back and found a link to the new updated Australasian Society for Ultrasound in Medicine (ASUM) Guidelines..
http://onlinelibrary.wiley.com/doi/10.1002/ajum.12042/full

I also found a few links to interesting articles;
https://www.researchgate.net/profile/Robert_OConnell4/publication/231585892_Chemical_Burn_Injury_Secondary_to_Intraoperative_Transesophageal_Echocardiography/links/0f31752d6877e035e6000000/Chemical-Burn-Injury-Secondary-to-Intraoperative-Transesophageal-Echocardiography.pdf

http://www.ncahcsp.org/Newsletter/Newsletter%201609.pdf

https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/nosocomial-outbreak-of-a-novel-extendedspectrum-lactamase-salmonella-enterica-serotype-isangi-among-surgical-patients/A3A296DB3F00E44B37498FBA218B5925

http://www.ajicjournal.org/article/S0196-6553(16)00007-9/fulltext?ccy

http://journals.sagepub.com/doi/abs/10.1177/1742271X16665873

Hope this helps.
Tim..

Timothy R. Spencer, RN, APN, DipAppSci, BH, ICU Cert, VA-BC
Vascular Access Consultant
E: tim.spencer68@icloud.com
W: http://www.vascularaccess.com.au
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
http://orcid.org/0000-0002-3128-2034

> On May 8, 2017, at 6:31 AM, Jayne OConnor wrote:
>
> Thanks Jennifer,
>
> Our cleaning/disinfection process is OK, but we had an issue recently whereby the responsibility of who does the process after hours is in question.
> Thank you for your response.
>
> Jayne O’Connor RN,BSc.Inf.Cont.
> IPC Co-Ordinator
> Sydney Adventist Hospital
> 185 Fox Valley Rd.,
> Wahroonga 2076
>
> Tel DD: (02) 9487 9732
> Mobile: 0406752685
>
>
> Email: jayne.oconnor@sah.org.au
>
>
> —–Original Message—–
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Jenny Lukeis
> Sent: Monday, 8 May 2017 8:13 AM
> To: AICALIST@AICALIST.ORG.AU
> Subject: Re: Toe probes
>
> Hi Jayne,
> We have just implemented a 3 step-high level disinfection wipe system for this process. Nurses have been trained in ICU by the company to undertake this process.
>
> Jen
>
> Jennifer Lukeis | Infection Prevention Coordinator
> South West Healthcare | Ryot Street | Warrnambool Victoria 3280 Phone 03 5563 1592 jlukeis@swh.net.au | http://www.southwesthealthcare.com.au
>
>
>
>
>
> —–Original Message—–
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Jayne OConnor
> Sent: Friday, 5 May 2017 3:55 PM
> To: AICALIST@AICALIST.ORG.AU
> Subject: Toe probes
>
> Dear brains trust
> Would anyone be willing to share policy on decontamination/disinfection of TOE probes for out of hours procedures. Also who is responsible for taking the probe for reprocessing or indeed who takes the responsibility for reprocessing?
> Many thanks in advance.
>
> Jayne OConnor
> IPC Coordinator
> Sydney Adventist Hospital
>
> Sent from my iPhone
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[Tim Spencer]

Hi Rita,
At my old institution (Liverpool) we added documentation to our EMR with reminder flags when the device was due for removal/resite. rom memory, we were doing 96hr changes – this was before clinically indicated changes became popular. The reminder flag would reset for 24hrs if needed, but would continue to alert until device removed.
It was fairly concise and included the usual demographics – date, time, site removed, condition of site – allowed several comments. Did not state if device was intact however..
I may have some screen captures from our working group I can look up for you.
Just contact me directly if you would like me to follow up.
Regards,
Tim..

Timothy R. Spencer, RN, APN, DipAppSci, BH, ICU Cert, VA-BC
Vascular Access Consultant
E: tim.spencer68@icloud.com
W: http://www.vascularaccess.com.au
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
http://orcid.org/0000-0002-3128-2034

> On Apr 18, 2017, at 6:17 PM, Rita Roy wrote:
>
> Dear All,
> I am emailing to find out what procedures other institutions follow in terms of documentation for the removal of PIVCs. Our LHD policy requires the following:
>
> The removal of the PIVC must be documented in the medical record by the clinician removing the PIVC
> Date and time.
> If the PIVC was intact, whole and included tip.
> Condition of the site on removal.
>
> Do you do anything different and if so, would you be happy to share that information? Especially, how do you monitor that such documentation is occurring.
> Many thanks in advance,
> Rita
>
> Rita Roy
>
> Clinical Nurse Consultant | Infection Control
> Hornsby Ku ring gai Health Service, Palmerston Road, Hornsby NSW 2076
> Tel (02) 9477 9232 | Fax (02) 9477 9013 Rita.Roy@health.nsw.gov.au
> http://www.health.nsw.gov.au
>
> Click here to visit the Infection Prevention and Control page on the Intranet
>
>
>
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[Tim Spencer]

Hi Mathias,
INS is the Infusion Nurses Society, (www.ins1.org) a professional organization for infusion therapy – their standards are what many vascular access clinicians work and policy develop too.

The Infection (section 49) from the Standards of Practice is what I quoted and the references were for that section.

And yes, in sub-section L it says ‘do not to routinely culture CVAD tip’ UNLESS required/indicated in diagnosis of CLABSI/CRBSI, also consistent with the Mermel paper from Claire (quoted in References)

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)
http://orcid.org/0000-0002-3128-2034

Sent from my iPhone

> On Mar 16, 2017, at 21:11, Matthias Maiwald (SHHQ – KKH) wrote:
>
> Dear 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 1387
>
>
>
>
>
> From: 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 culture
>
> Hi 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 Infections
> 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/0000-0002-3128-2034
>
> On Mar 15, 2017, at 10:42 PM, Cate Coffey 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/health
>
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[Tim Spencer]

Hi 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
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 Infections
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)
http://orcid.org/0000-0002-3128-2034

> On Mar 15, 2017, at 10:42 PM, Cate Coffey 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/health
>
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[Tim Spencer]

Hi Cate,
There is moderate risk of syringe tip contamination when connecting directly to the plastic ampules – especially if using the luer-lock style syringes (but also the plain lure-slip) – although this is a widespread clinical practice, it also poses significant contamination risk on behalf of the user, especially during emergent situations.
At the moment, I think it comes down to the overall clinician preference, however, the blunt cannula technique to draw up the fluid does pose potentially less contamination risk in my opinion.
It has been a mixed issue on both techniques for many years which probably has not been looked at closely before.

I also reviewed the INS Standards of Practice (2016) and the recommendations are to use a blunt drawing device, filtered needle or straw for removing contents from an ampule (doesnt specify plastic or glass ampules, however plastic ampules are not used in the USA) – those are only used for inhalation drugs or ophthalmology drops as single dose containers. Glass ampules or rubber stoppered vials are what we have in USA, plus absence of published evidence on their (plastic ampule) use.

So, to draw any fluid out of the ampule, you would need to use a needle, filter needle or straw carefully inserted into the open ampule and withdraw the fluid. Filter not needed unless that are very small plastic particles that can fall into the solution (or for a glass ampule) being careful to prevent contamination of the needle as it is placed into the ampule.

INS Standards of Practice 2016

Practice Criteria

A. Use sterile medications that were compounded in a pharmacy environment that meets USP , state pharmacy rules and regulations, and ASHP guidelines. The compounding environment is defined by risk category.1-4 (V, Regulatory)

1. Use pharmacy-prepared or commercially avail- able prefilled syringes of appropriate intravenous (IV) solution to flush and lock vascular access devices (refer to Standard 40, Flushing and Locking).

B. Begin the administration of an immediate-use compounded sterile product (CSP), as defined by USP , within 1 hour after the start of the preparation, or discard.1-3 (V, Regulatory)

C. Administer IV push medication in a safe manner:
1. When it is necessary to prepare more than 1 medication in a single syringe for IV push administration, limit preparation to the pharmacy.5 (V)

2. In adults, use IV push medications in a ready-to- administer form (to minimize the need for manipulation outside the pharmacy sterile compounding area).5 (V)

3. If dilution or reconstitution of an IV push medication becomes necessary outside the pharmacy sterile compounding area, perform these tasks immediately prior to administration in a clean, uncluttered, and functionally separate location using organization-approved, readily available drug information resources and sterile equipment and supplies.5,6 (V)

4. If more than 1 syringe of medication or solution to a single patient needs to be prepared at the bedside, prepare each medication or solution separately, and immediately administer it before preparing the next syringe. If preparing several IV push medications at a time for sequential IV push administration, label each syringe as it is being prepared and prior to the preparation of any subsequent syringes. If 1 or more medications or solutions needs to be prepared away from the patients bedside, immediately label each syringe, 1 at a time, before preparing the next medication or solution.5 (V)

5. Do not dilute or reconstitute IV push medications by drawing up the contents into a commercially available, prefilled flush syringe of 0.9% sodium chloride (USP).5,6 (V)

6. Do not withdraw IV push medications from commercially available, cartridge-type syringes into another syringe for administration.5 (V)

D. Do not use IV solutions in containers intended for infusion, including minibags, as common-source containers (multiple-dose product) to dilute or reconstitute medications for 1 or more patients in clinical care areas (see Standard 40, Flushing and Locking). (V)5-7

E. Use safe injection practices:
1. Use a new needle and syringe for every injection.6-8 (III)

2. Discard a single-dose vial after a single entry.5-8(V)

3. Dedicate a multidose vial for a single patient.5-8(V)

a. Use a multidose vial up to a maximum of 28 days of opening or puncture (except for vaccines or when original manufacturers expiration date is shorter) or when the manufacturers expiration date is reached if it is not opened in a direct patient care area or a shorter period.1-3,6-8 (V, Regulatory)

b. Label a multidose vial with the beyond-use date (BUD) and store the vial according to the manufacturers recommendations. Discard if the vial lacks a BUD, the sterility is compromised or questionable, and after the BUD has been met.1-3,6 (V, Regulatory)

F. Use a filter needle or filter straw to withdraw medication from an ampoule, and discard any leftover medication.1-3,5,6 (V, Regulatory)

G. Disinfect the vial septum before each entry and the neck of a glass ampoule prior to breaking the ampoule, and allow the disinfectant to dry prior to entry.5,6 (V)

H. Do not add medications to infusing containers of IV solutions (refer to Standard 57, Parenteral Medication and Solution Administration).

Hope this helps somewhat.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Vascular Access Consultant
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
http://orcid.org/0000-0002-3128-2034

> On Jan 24, 2017, at 10:43 PM, Cate Coffey wrote:
>
> Hi everyone,
> Just wanting your thoughts, advice and experience regarding:
> Water for Injection ampules which attach directly to syringe V Water for Injection ampules that do not attach and require drawing up needle?
> Is one better than the other in terms of best practice or is it personal preference?
> thanks
> 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/health
>
> Our 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 Partnerships
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[Tim Spencer]

Hi Cath,
As you know, there is one at Liverpool Hospital that I established in 1996 and ran until 2014. Provided full Vascular Access services – PIVC (limited service due to staffing) to all midline, PICC, CVC & HD catheters.
For many years, we were staffed with 1.0 FTE CNC (Grade 2) and 0.2 FTE CNS – the CNS position was shared between 2 clinicians and they worked 1day/week.
Currently, the position is now job shared.
We had a huge improvements in reducing catheter and infectious related complications – see our publication from CCM (attached) and also the Yacopetti article from 2010 (attached).
If you need anything further, feel free to reach out Im just an email away.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Vascular Access Consultant
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
http://orcid.org/0000-0002-3128-2034

> On Jan 18, 2017, at 4:33 PM, Catherine Wade wrote:
>
> We are currently undertaking a Vascular Access Device Quality Project at CCLHD
> We are interested to know if any LHDs / Private Hospitals have dedicated a Vascular Access Device service.
> We would also be interest to know the structure of the service i.e. scope plus types & numbers of positions e.g. NUM, CNC, CNE, CNS, RN.
> If you do have a dedicated Vascular Access Device service have you observed a decrease in PIVC / CVAD related infections / injury?
> Any feedback would be greatly appreciated
> Many Thanks
> Cath Wade
>
> Clinical Nurse Consultant | Infection Prevention and Control
> Level 1, 67 Holden Street Gosford Hospital
> Tel: (02) 4320 2664 | Internal Ext: 92664| Fax: (02) 4320 2874 | Internal Fax: 92874| Page: 18885
> Catherine.Wade@health.nsw.gov.au or CCLHD-IPAC@health.nsw.gov.au
>
>
>
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[Tim Spencer]

Hi Lindy,
Sterile saline is just that – sterile saline!
It has no antiseptic properties at all and so I would not recommend cleaning the site with saline prior to cannulation. There is still potential to drag skin colonies into the fistula during the cannulation process.

If anything, I would suggest the use of plain isopropyl alcohol (70%) as at least that will kill bacteria on the skins surface.
CHG & PI merely provide a longer acting antiseptic phase once on the skin.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Vascular Access Consultant

Sent from my iPhone

> On Dec 8, 2016, at 17:20, Lindy Ryan wrote:
>
> Hello
>
> We have a pt with sensitivity to povidine /iodine and CHG who has a fistula & is having regular haemodialysis .
>
> Other than cleaning her skin with sterile normal saline prior to cannulating them for their dialysis is there any other skin antisepsis that could be used.
>
> I have looked at referenced from CDC and APIC but there is nothing useful re any other skin antisepsis just wondering if anyone out there was using anything else in these pts with success or is sterile normal saline the only best option to stick with ?
>
> Many thanks
>
> 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
> http://www.health.nsw.gov.au
>
>
>
>
> Wise and humane management of the patient is the best safeguard against infection
> (Florence Nightingale Circa 1860)
>
>
>
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[Tim Spencer]

Hi Erica,I hear your pain! Singling out clinicians may be regarded as potential ‘bullying’ in the workplace, however results of non-compliance audits can be addressed and discussed by clinical specialty, highlighting issues and addressing the potential responsibilities of everyone to conform to higher levels of compliance.
Clinicians need to take responsibility for their actions, and while this is essentially a generalised statement, we need to remind clinicians continuously, and offer quality education to address these issues.
We do not want create an unhealthy divide between our other healthcare colleagues by starting an individual witch hunt over HH compliance 😉
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.Vascular Access Consultant
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_____________________________

Good Afternoon All,

I am chasing some guidance/advice on how you best address noncompliance with the 5 moments for hand hygiene.

How do you tack staff that are repeatedly non-compliant?

What is your process for identifying repeat offenders?

What is your process for addressing noncompliance? ie, training, management notification, executive escalation etc.

What is your definition of non-compliance?

Thankyou in advance for your assistance.

Kind Regards

Erica Short| Infection Prevention and Management

Clinical Nurse, GradCert IPC

South Metropolitan Health Service Fiona Stanley Hospital

Level Ground, Block, 11 Robin Warren Drive, MURDOCH WA 6150

Postal address: Locked Bag 100, PALMYRA DC WA 6961

T: 6152 6635 | P: 28915

E:Erica.Short@health.wa.gov.au

http://www.southmetropolitan.health.wa.gov.au

http://www.fsh.health.wa.gov.au

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[Tim Spencer]

Hi Cath,
In the words of Dr Robert Helm (article attached) – “Consequently, any potential source of infection or other injuryespecially one leading directly to the bloodstream, such as peripheral IV cathetersmust be definitively addressed.
Sterile insertion should be a minimum.
A basic dressing pack/PIV insertion kit is essential to help create the sterile field – this cannot be achieved by placing PIV at the bedside with a kidney dish and an alcohol swab and dressing. Totally inappropriate.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Vascular Access Consultant
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)
http://orcid.org/0000-0002-3128-2034

> On Oct 13, 2016, at 11:20 PM, Dr Cathryn Murphy wrote:
>
> Ive been asked my opinion on whether or not PIVC insertion should be managed according to surgical aseptic technique rather than a general aseptic technique and I wondered what the general consensus is amongst members.
>
> I am aware of recent research and research interest around peripheral IVs just not sure on whether there have been significant policy changes or if practice is changing without policy change.
>
> Warm regards
> Cath
>
> Cathryn Murphy MPH PhD CIC
> Chief Executive Officer & Creative Director
> Infection Control Plus Pty Ltd
> PO Box 3079
> Burleigh Town 4220
> OLD, Australia
>
> E: Cath@infectioncontrolplus.com.au
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> W: infectioncontrolplus.com.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.

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.

You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au

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