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ahh, my apologies – routine testing has been common practice in all of the
facilities I’ve worked in.Given the patients are having pre-operative bloods, then you should be able
to add the BBV screening to those bloods to reduce the lag time to results?I’m also bit dubious about getting “informed” consent while the patient is
in recovery and still groggy, but as I said in the original post, I don’t
agree with the need for exhaustive pre-test counselling prior to BBV
testing.We need to normalise screening – in this case, “there was an incident
during your procedure where a member of staff was exposed to your blood and
it is standard procedure for us to test you for viruses so we can assess
the risk to that staff member.”Not legal advice though!
Trent.
On Tue, 6 Sept 2022, 08:25 Jennifer Breen,
wrote:> Good Morning Trent,
> I may have not made myself clear.
> The testing would only occur in the event of a needlestick/sharps injury
> during theatre, there is no proposal to test every surgical patient . Each
> case would be risk -assessed and bloods taken if deemed appropriate. Most
> organisations have a 4+ hour window following anaesthetic that they would
> not consider gaining consent appropriate so this would occur in a case
> where the exposure was assessed as high risk.
> Many staff are highly anxious following an injury despite education about
> risk and reassurance and delays in testing can have an adverse effect on
> them.
> Post-op the patient would receive information about the incident, testing
> performed, results and post-test counselling as required.
>
> Many thanks
> Jenny
>
> ——————————
> *From:* ACIPC Infexion Connexion on behalf of
> Trent Yarwood
> *Sent:* Monday, 5 September 2022 5:59 PM
> *To:* ACIPCLIST@ACIPC.ORG.AU
> *Subject:* Re: [ACIPC_Infexion_Connexion] Consent for BBV Testing
>
> Hi all,
>
> I very strongly feel that it’s completely inappropriate to be routinely
> testing patients for BBVs prior to surgery. As noted in the initial
> question, it’s generally done without consent (although I’m not very fussed
> about full and documented informed consent for BBV testing, which I think
> reinforces stigma about BBVs and is a hangover from earlier times).
>
> In any event, the results of the tests shouldn’t change clinical
> management, because your surgeons / proceduralists should be using standard
> precautions for all patients regardless of the results and should all be
> vaccinated against HBV, and in the event they have a percutaneous injury,
> they need to a) report it to IPC; b) let the patient know, at which point
> testing can be done anyway. Results for BBV testing only take a few hours
> to get back in most labs, so they don’t affect the decision about starting
> PEP, and if the exposure is high-enough risk, then won’t actually change
> the decision about starting PEP at all.
>
> It’s an egregious waste of money on testing with absolutely zero impact on
> patient care or staff safety and should be firmly discouraged. (which I
> grant is very difficult to do in private hospitals).
>
> (personal opinions)
> Trent Yarwood
> Cairns Sexual Health / Cairns Hospital
> No conflicts.
>
> —
> Trent Yarwood
> trentyarwood@gmail.com
> PGP Key: 246AF263
>
>
> On Mon, 5 Sept 2022 at 15:08, Michael Wishart
> wrote:
>
> Hi Jenny
>
>
>
> We still have both on our surgical consent form currently, but we had
> previously received legal advice that suggested the consent for BBV testing
> was not valid unless it was appropriately explained (which we know its not
> as the surgeon will only focus on the procedural consent). So we do not
> utilise that consent in the case of a needlestick, which means we need to
> await the patient awakening post surgery and giving consent (or in the case
> of post op ventilated ICU patients, get the intensive care team to obtain
> or authorise consent).
>
>
>
> Thats within the private sector in Queensland.
>
>
>
> Cheers
>
> Michael
>
>
>
> *Michael Wishart *| Infection Control Coordinator, CICP-E
>
>
> St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD
> 4032
>
> *M *+61 448 954 282 | *T *+61 7 3326 3068 |* F* +61 7 3607 2226
>
> *E* michael.wishart@svha.org.au |
>
> *W *https://www.svphn.org.au
>
>
>
>
>
>
> St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT
> QLD 4169
> *M* +61 448 954 282 | *T *+61 7 3240 1208 |* F* +61 7 3240 1166
> *E* michael.wishart@svha.org.au |
>
> *W *https://www.svphb.org.au
>
>
>
>
>
>
>
>
>
>
>
> *From:* ACIPC Infexion Connexion *On Behalf Of *Jennifer
> Breen
> *Sent:* Monday, 5 September 2022 12:18 PM
> *To:* ACIPCLIST@ACIPC.ORG.AU
> *Subject:* [ACIPC_Infexion_Connexion] Consent for BBV Testing
>
>
>
> Good Morning,
>
> We would be interested to know how many healthcare organisations have both
> consent for blood transfusion and consent for blood borne virus testing
> included in their consent for surgery documentation and any obstacles they
> faced when doing this.
>
> I understand this is more common practice in the private health sector but
> currently am more concerned about the public sector.
>
> Many thanks
>
>
>
> *Jenny Breen *
>
> *Senior Infection Prevention Clinical Nurse Consultant *
>
> *Infection Prevention & Control Unit *
>
> PO Box 52, Frankston Vic 3199
>
> T Direct * 03 9784 8239 * * *Fax *9784 2347** *Switchboard *03* *9784
> 7777*
>
> *E **jbreen@phcn.vic.gov.au *
>
>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
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> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
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> 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
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>
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>
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> Replies to this message will be directed back to the list. To create a new
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>
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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
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> Replies to this message will be directed back to the list. To create a new
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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.
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Hi all,
I very strongly feel that it’s completely inappropriate to be routinely
testing patients for BBVs prior to surgery. As noted in the initial
question, it’s generally done without consent (although I’m not very fussed
about full and documented informed consent for BBV testing, which I think
reinforces stigma about BBVs and is a hangover from earlier times).In any event, the results of the tests shouldn’t change clinical
management, because your surgeons / proceduralists should be using standard
precautions for all patients regardless of the results and should all be
vaccinated against HBV, and in the event they have a percutaneous injury,
they need to a) report it to IPC; b) let the patient know, at which point
testing can be done anyway. Results for BBV testing only take a few hours
to get back in most labs, so they don’t affect the decision about starting
PEP, and if the exposure is high-enough risk, then won’t actually change
the decision about starting PEP at all.It’s an egregious waste of money on testing with absolutely zero impact on
patient care or staff safety and should be firmly discouraged. (which I
grant is very difficult to do in private hospitals).(personal opinions)
Trent Yarwood
Cairns Sexual Health / Cairns Hospital
No conflicts.—
Trent Yarwood
trentyarwood@gmail.com
PGP Key: 246AF263On Mon, 5 Sept 2022 at 15:08, Michael Wishart
wrote:> Hi Jenny
>
>
>
> We still have both on our surgical consent form currently, but we had
> previously received legal advice that suggested the consent for BBV testing
> was not valid unless it was appropriately explained (which we know its not
> as the surgeon will only focus on the procedural consent). So we do not
> utilise that consent in the case of a needlestick, which means we need to
> await the patient awakening post surgery and giving consent (or in the case
> of post op ventilated ICU patients, get the intensive care team to obtain
> or authorise consent).
>
>
>
> Thats within the private sector in Queensland.
>
>
>
> Cheers
>
> Michael
>
>
>
> *Michael Wishart *| Infection Control Coordinator, CICP-E
>
>
> St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD
> 4032
>
> *M *+61 448 954 282 | *T *+61 7 3326 3068 |* F* +61 7 3607 2226
>
> *E* michael.wishart@svha.org.au |
>
> *W *https://www.svphn.org.au
>
>
>
>
>
> St Vincents Private Hospital Brisbane | 411 Main Street KANGAROO POINT
> QLD 4169
> *M* +61 448 954 282 | *T *+61 7 3240 1208 |* F* +61 7 3240 1166
> *E* michael.wishart@svha.org.au |
>
> *W *https://www.svphb.org.au
>
>
>
>
>
>
>
>
>
> *From:* ACIPC Infexion Connexion *On Behalf Of *Jennifer
> Breen
> *Sent:* Monday, 5 September 2022 12:18 PM
> *To:* ACIPCLIST@ACIPC.ORG.AU
> *Subject:* [ACIPC_Infexion_Connexion] Consent for BBV Testing
>
>
>
> Good Morning,
>
> We would be interested to know how many healthcare organisations have both
> consent for blood transfusion and consent for blood borne virus testing
> included in their consent for surgery documentation and any obstacles they
> faced when doing this.
>
> I understand this is more common practice in the private health sector but
> currently am more concerned about the public sector.
>
> Many thanks
>
>
>
> *Jenny Breen *
>
> *Senior Infection Prevention Clinical Nurse Consultant *
>
> *Infection Prevention & Control Unit *
>
> PO Box 52, Frankston Vic 3199
>
> T Direct * 03 9784 8239 * * *Fax *9784 2347** *Switchboard *03* *9784
> 7777*
>
> *E **jbreen@phcn.vic.gov.au *
>
>
>
> 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 acipclist@acipc.org.au
>
> To send a message to the list administrator send an email to
> admin@acipc.org.au
>
> You can unsubscribe manually from this list by sending ‘signoff acipclist’
> (without the quotes) to listserv@aicalist.org.au
> This email and any attachments to it (the “Email”) is confidential and is
> for the use only of the intended recipient, and may not be duplicated or
> used by any other party without the express consent of the sender. If you
> are not the intended recipient of the Email, please notify the sender
> immediately by return email, delete the Email, and do not copy, print,
> retransmit, store or act in reliance on the Email. St Vincent’s Health
> Australia (“SVHA”) does not guarantee that the Email is free from errors,
> viruses or interference. Emails to and from SVHA or its related entities
> may be scanned and filtered in locations outside Australia
> 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
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>
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>
> You can unsubscribe manually from this list by sending ‘signoff acipclist’
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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.
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To send a message to the list administrator send an email to admin@acipc.org.au
You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au
Also some good links in this thread on twitter from this morning, including
some guidelines and a toolkithttps://twitter.com/cjcrnich1/status/1171892055062327298
T.
On Thu., 12 Sep. 2019, 18:34 , wrote:
> Hi Karen,
>
> Most GPs are well aware of the guidelines. It is a common topic in GP
> medical weekly magazines but they succumb to habit and pressure from
> families and RACFs where they routinely test asymptomatic patients and send
> off urines for MCS. I work in general practice and take calls from RACFs
> regularly. More work needs to be done to assist RACF in better
> understanding of AMR and prescribing antibiotics for asymptomatic patients
> and protocols re testing of same. Some female patients would benefit from
> topical oestrogen as a preventative but this is not commonly discussed for
> elderly women. I know ACIPC is running aged care IPC workshops.
>
>
>
> The commonwealth Chief Medical Officer writes to GPs and antibiotic
> prescribing is often a target of his messages.
>
>
>
> Kind regards
>
> Karen
>
>
>
> Karen Booth
>
> RN BHSCN GAICD
>
> President APNA
>
> Australian Primary Health Care Nurses Association
>
> M: 0411 898 884
>
> karenbooth1@bigpond.com
>
>
>
> Australian Primary Health Care Nurses Association (APNA)
> Level 17/350 Queen Street, Melbourne VIC 3000
> p: 1300 303 184 f: (03) 9322 9599
> president@apna.asn.au | http://www.apna.asn.au
>
>
>
>
>
>
>
> *From:* ACIPC Infexion Connexion *On Behalf Of *Team
> Leader RN Wynyard
> *Sent:* Tuesday, 10 September 2019 1:32 PM
> *To:* ACIPCLIST@ACIPC.ORG.AU
> *Subject:* Re: [ACIPC_Infexion_Connexion] RE Prophylactic Long term
> Antibiotic usage in RACF
>
>
>
> Hi Trent
>
> Thank you very much for the information
>
> It appears that the GPs in question generally do make reference to the
> Therapeutic Guidelines and generally prescribe only once and if
> *symptomatic* and /or when all other interventions have proved
> unsuccessful. ( recurrent infections occur 2 or more in 6 months). I
> struggle to get them to review and consider ceasing once this occurs as
> they of the opinion that the so called infection will reoccur to the
> detriment of the Resident involved. It is frustrating especially when they
> do in part understand the requirement of responsible prescribing and
> generally do prescribed as per the recommended criteria but to then turn
> around and refuse to consider ceasing especially after 6 months and
> sometimes 12 months plus .. I will just have to persist.
>
>
>
>
>
> Karen Panzich RN / IC Coordinator
>
> Wynyard Care Centre
>
> Tasmania
>
>
>
>
> *Karen Panzich*
> Teamleader RN
> Synovum Care Group
>
> Cnr Quiggin and Moore St, Wynyard TAS 7325
> *P* 03 6442 1760
> *F* 03 6442 1765
>
>
> http://www.synovumcare.com.au
>
>
>
>
>
>
> Any views or opinions presented in this email are solely those of the
> author and do not necessarily represent those of the company. Employees of
> Synovum Care Group are expressly required not to make defamatory statements
> and not to infringe or authorise any infringement of copyright or any other
> legal right by email communications. Any such communication is contrary to
> company policy and outside the scope of the employment of the individual
> concerned. The company will not accept any liability in respect of such
> communication, and the employee responsible will be personally liable for
> any damages or other liability arising.
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU
> ] *On Behalf Of *Trent Yarwood
> *Sent:* Tuesday, 10 September 2019 12:55 PM
> *To:* ACIPCLIST@ACIPC.ORG.AU
> *Subject:* Re: [ACIPC_Infexion_Connexion] RE Prophylactic Long term
> Antibiotic usage in RACF
>
>
>
> Hi Karen,
>
>
>
> There’s lots more information on the scale of this problem in the Aged
> Care National Antimicrobial Prescribing Survey (acNAPS) – report available
> here:
> https://www.safetyandquality.gov.au/publications-and-resources/resource-library/2017-aged-care-national-antimicrobial-prescribing-survey-report
>
>
>
> Therapeutic Guidelines: Antibiotic has a good and pretty clear section on
> indications for long-term prophylaxis for UTIs – including only if
> non-antibiotic measures fail, greater than two infections in six months,
> and for a defined period of time then ceasing (recommended at six months).
>
>
>
> This is a huge potential area for quality improvement, and needs more than
> just a screening urine to solve, but certainly the docs should be
> collecting urine to make sure the patients don’t have resistance and
> repeating them if the patient develops new clinical symptoms, but I don’t
> think routine urines while patients are on therapy are the way to go.
>
>
>
> Trent
>
> Qld Statewide AMS Program
>
>
> —
> Trent Yarwood
> trentyarwood@gmail.com
>
> PGP Key: 246AF263
>
>
>
>
>
> On Tue, 10 Sep 2019 at 11:47, Team Leader RN Wynyard TeamLeaderRNWynyard@synovumcare.com.au> wrote:
>
> Hi all
>
>
>
> I just have a question regarding GP s who prescribe Antibiotics
> prophylactically to minimise recurrent infections. Some have had
> prophylactic antibiotics prescribed for recurrent UTIs for example ( more
> than 4-5 in previous 12 month period)
>
> Some of our Residents have been on Prophylactic Antibiotics for > 6 months.
>
> Predominantly for either recurrent UTI or Respiratory Tract infections
> (exacerbation of COPD)
>
> Around 50 % (sometimes higher depending on others prescribed) of our
> Monthly data statistic in regards to Antibiotics prescribed consists of
> those who are on ongoing prophylactic antibiotics
>
>
>
> Should these Residents have a specimen sent to pathology for M S & C at
> any time to confirm whether they have become Resistant during the 6
> months plus they have been prescribed them ?
>
> Should a GP at minimum be reviewing this in regards to ceasing at any
> specified time ?
>
>
>
> Kind Regards
>
> Karen Panzich TLRN / Infection Control Coordinator
>
> Wynyard Care Centre
>
> Tasmania
>
>
>
> *Karen Panzich*
> Teamleader RN
> Synovum Care Group
>
> Cnr Quiggin and Moore St, Wynyard TAS 7325
> *P* 03 6442 1760
> *F* 03 6442 1765
>
>
> http://www.synovumcare.com.au
>
> Any views or opinions presented in this email are solely those of the
> author and do not necessarily represent those of the company. Employees of
> Synovum Care Group are expressly required not to make defamatory statements
> and not to infringe or authorise any infringement of copyright or any other
> legal right by email communications. Any such communication is contrary to
> company policy and outside the scope of the employment of the individual
> concerned. The company will not accept any liability in respect of such
> communication, and the employee responsible will be personally liable for
> any damages or other liability arising.
>
>
>
>
>
>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
> or services by brand or commercial names, please do this outside the list.
>
>
> Archive of all messages are available at http://aicalist.org.au/archives
> – registration and login required.
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> Replies to this message will be directed back to the list. To create a new
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>
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>
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>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
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> The use of trade/product/commercial brand names through the list is
> discouraged by ACIPC. If you wish to discuss specific reference to products
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>
>
> Archive of all messages are available at http://aicalist.org.au/archives
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>
> The use of trade/product/commercial brand names through the list is
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> NOT REPRESENT THE OPINION OF ACIPC.
>
> The use of trade/product/commercial brand names through the list is
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Hi Karen,
There’s lots more information on the scale of this problem in the Aged Care
National Antimicrobial Prescribing Survey (acNAPS) – report available here:
https://www.safetyandquality.gov.au/publications-and-resources/resource-library/2017-aged-care-national-antimicrobial-prescribing-survey-reportTherapeutic Guidelines: Antibiotic has a good and pretty clear section on
indications for long-term prophylaxis for UTIs – including only if
non-antibiotic measures fail, greater than two infections in six months,
and for a defined period of time then ceasing (recommended at six months).This is a huge potential area for quality improvement, and needs more than
just a screening urine to solve, but certainly the docs should be
collecting urine to make sure the patients don’t have resistance and
repeating them if the patient develops new clinical symptoms, but I don’t
think routine urines while patients are on therapy are the way to go.Trent
Qld Statewide AMS Program—
Trent Yarwood
trentyarwood@gmail.com
PGP Key: 246AF263On Tue, 10 Sep 2019 at 11:47, Team Leader RN Wynyard wrote:
> Hi all
>
>
>
> I just have a question regarding GP s who prescribe Antibiotics
> prophylactically to minimise recurrent infections. Some have had
> prophylactic antibiotics prescribed for recurrent UTIs for example ( more
> than 4-5 in previous 12 month period)
>
> Some of our Residents have been on Prophylactic Antibiotics for > 6 months.
>
> Predominantly for either recurrent UTI or Respiratory Tract infections
> (exacerbation of COPD)
>
> Around 50 % (sometimes higher depending on others prescribed) of our
> Monthly data statistic in regards to Antibiotics prescribed consists of
> those who are on ongoing prophylactic antibiotics
>
>
>
> Should these Residents have a specimen sent to pathology for M S & C at
> any time to confirm whether they have become Resistant during the 6
> months plus they have been prescribed them ?
>
> Should a GP at minimum be reviewing this in regards to ceasing at any
> specified time ?
>
>
>
> Kind Regards
>
> Karen Panzich TLRN / Infection Control Coordinator
>
> Wynyard Care Centre
>
> Tasmania
>
>
>
>
> [image: http://mitchmorgandesign.com/wp-content/uploads/2017/06/Logo96.jpg%5D
>
>
> *Karen Panzich*
> Teamleader RN
> Synovum Care Group
>
> Cnr Quiggin and Moore St, Wynyard TAS 7325
> *P* 03 6442 1760
> *F* 03 6442 1765
>
>
> *www.synovumcare.com.au *
>
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Hi Cath (et al)
It’s an interesting and challenging question. You’re right – there is some
data about from overseas, examples including:http://www.rand.org/randeurope/research/projects/antimicrobial-resistance-costs.html
http://cid.oxfordjournals.org/content/49/8/1175.long
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)00270-4
http://www.bmj.com/content/346/bmj.f1493but a definite paucity of Australian data; hopefully now that AURA is up
and running we’ll be able to use the longitudinal data to estimate some of
these things (ie: resistance increased by this much and model based on
overseas data on length of stay etc).Equally frustrating, however, is the fact that talking about economic costs
completely turns the public off. There was great research published by
Wellcome Trust (blog post is here:
https://blog.wellcome.ac.uk/2015/07/29/antimicrobial-resistance-still-widely-misunderstood/
; unfortunately, they’ve redone their website, so the link to the full
report is broken) that pretty clearly shows that if we say “AMR will cost
eleventy trillion dollars” that the public don’t understand, don’t really
care and just think that HCWs are lobbying for more funding. The report
went on to suggest that we need to personalise the stories to patient /
family / relative. Following on your email:“Grandpa Jack went to hospital to have a knee replacement so he could
still go an play bowls on the group visit from the nursing home. Because
he’d been on antibiotics for more than six months, he got a resistant
infection and spent 4 months in hospital and never played bowls again”.(Obviously this is a bit too much of a scare campaign, but you get the idea)
We’re finally getting some government action; now we need to engage the
public.Cheers,
Trent Yarwood
Infectious Diseases Physician – Antimicrobial Stewardship
Cairns Hospital
(no conflicts)—
Trent Yarwood
trentyarwood@gmail.com
PGP Key: 246AF263On 17 June 2016 at 05:44, Dr Cathryn Murphy wrote:
> Dear Ramon
>
>
>
> Thank you for sharing this work and thanks also to whoever was the
> Colleges representative on this Committee. Their output in terms of the
> Report are impressive and at the same time very concerning.
>
>
>
> I have only had a chance to glean this Report at this stage but am struck
> by two issues. Firstly, the extent of antimicrobial misuse in residential
> long-term care settings with approximately 50% of the almost 10% of
> residents being treated having no confirmed or suspected infection. Having
> just lost my remaining parent in aged care and watching such antimicrobial
> misuse first hand I am especially passionate about learning how the
> Colleges response to the Report will address this issue.
>
>
>
> Secondly, Section 1.3 of the Report addresses the cost of antimicrobial
> resistance and is completely devoid of any local Australian costings or
> estimates. Instead it refers to a very few reports all of which are from
> the United Kingdom. Readers are given estimated extrapolations which
> suggest the cost of AMR per episode of care ranges from ($10 to $41, 200).
>
>
>
> Given the increasing need for IC&P staff to cost justify almost every
> aspect of their program and in particular capital costs for new
> technologies and equipment proven to reduce HAIs including cases of AMR is
> it not time we Australian IC&Ps started lobbying for timely access to
> reliable HAI costing data even at just a local level. It saddens me that
> after 50 years of formal infection control programs in this country we are
> still unable to truly demonstrate the return on our investment. Few other
> industries would survive such circumstances and I wonder if we will.
>
>
>
> Would love to hear the opinions of others on these issues and as always I
> am willing to assist the College or individual members in strategizing ways
> to address them.
>
>
>
> Warm regards
>
> Cath
>
>
>
>
>
> Cathryn Murphy MPH PhD CIC
>
> Chief Executive Officer
>
> Infection Control Plus Pty Ltd
>
> PO Box 3079
>
> Burleigh Town 4220
>
>
>
> E: Cath@infectioncontrolplus.com.au
>
> M: +61 428 154154
>
> W: infectioncontrolplus.com.au
>
>
>
>
>
>
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Professor Ramon Shaban, ACIPC President
> *Sent:* Thursday, 16 June 2016 11:24 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Fwd: Media Release: Australia’s most comprehensive report on
> antibiotic resistance released
>
>
>
> Colleagues
>
> Please note release of the *First Australian report on antimicrobial
> resistance in human health *by the Australian Commission on Safety and
> Quality in Health Care.
>
>
>
> More information is available at the following link.
>
>
>
> http://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/
>
>
> Kind regards,
>
> Ramon
>
>
>
> [image: ACIPC_Logo_Colour_RGB_Hi_Res.jpg]
>
>
> *Professor Ramon Z Shaban PRESIDENT*
>
> Australasian College for Infection Prevention and Control
>
> GPO Box 3254, Brisbane Qld 4001
> Tel: +61 7 3735 6463 Mobile: 0478 312 668
>
> Email: president@acipc.org.au
>
> Web: https://www.acipc.org.au
>
>
>
> ———- Forwarded message ———-
> From: *ACSQHC Communications*
> Date: 16 June 2016 at 10:09
> Subject: Media Release: Australia’s most comprehensive report on
> antibiotic resistance released
> To:
>
> Having trouble reading this? *View it in your browser*
> . Not
> interested? *Unsubscribe*
> instantly.
>
> [image: Australian Commission on Safety and Quality in Health Care]
>
>
> [image: space]
>
>
> Thursday 16 June
> Media Release: Australias most comprehensive report on antibiotic
> resistance released
>
>
>
> *THURSDAY 16 JUNE 2016*
>
>
>
> *The Australian Commission on Safety and Quality in Health Care (the
> Commission) has released a landmark report outlining the most comprehensive
> picture of antimicrobial resistance, antimicrobial use and appropriateness
> of prescribing in Australia to date.*
>
>
>
> *Antimicrobial Use and Resistance in Australia (AURA) 2016: First
> Australian report on antimicrobial use and resistance in human health*
> highlights antimicrobial use and resistance as a critical and immediate
> challenge to health systems in Australia and around the world.
>
>
>
> *AURA 2016* contains valuable data on antimicrobial use in the community,
> hospitals and residential aged care facilities; key emerging issues for
> antimicrobial resistance; and a comparison of Australias situation with
> other countries.
>
>
>
> Commission Senior Medical Advisor Professor John Turnidge said that *AURA
> 2016 *sets a baseline that will allow trends to be monitored over time
> and highlights areas where future work will inform action to prevent the
> spread of antimicrobial resistance.
>
>
>
> Antimicrobial resistance is one of the most significant challenges for
> the delivery of safe, high-quality health services, and has a direct impact
> on patient care and patient outcomes.
>
>
>
> Antibiotic resistance has developed because of the overuse and misuse of
> antibiotics, and now, bacterial infections that were once easily cured with
> antibiotics are becoming harder to treat. In 2014, nearly half the people
> in Australia were prescribed antimicrobials so the threat of
> antimicrobial resistance has the potential to affect every individual.
>
>
>
> Read the media release in full.
>
>
> *Back to top *
>
>
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Hi Ruth,
Dollars per life-year saved is a pretty standard measure of
cost-effectiveness in health economics.If you think about what we do in healthcare in terms of economics and
patient outcomes, it can either save money or cost money and can either
save lives/reduce disease or kill people / increase disease.Things that save money and save lives are no-brainers.
Things that cost money and reduce health are obviously stupid ideas.The tricky issue is assessing interventions that cost money but improve
health, or (to a lesser extent) save money but are less-good in terms of
health outcomes.If you have an intervention that prevents 1000 deaths but costs a billion
dollars, you need to consider all of the other things you could do with
that billion dollars and if together, you could prevent more than 1000
deaths by doing them instead, and dollars-per-life-year-saved is one of the
ways of measuring that.You can read more:
https://en.wikipedia.org/wiki/Cost-effectiveness_analysis
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497852/
http://www.who.int/choice/publications/p_2003_generalised_cea.pdf(and around $20,000 per life-year saved is a common threshold for
cost-effective care, depending on the circumstances)Regards,
Trent.
—
Trent Yarwood
trentyarwood@gmail.comOn 24 March 2016 at 09:35, Ruth Ryburn wrote:
> Good morning,
>
>
>
> I have read the discussion around this issue and publication with
> interest but limited understanding.
>
> Would someone please be able to explain in simple terms the phrase:
>
>
>
> *.changed from $29,700 per life year gained to $25,094 per life year
> gained.*
>
>
>
> Thank you,
>
>
>
> *Ruth Ryburn*
>
> *Infection Control Coordinator*
>
>
>
> *[image: DPH_logo]*
>
> *58 Quirk Street*
>
> *Dee Why, NSW 2099*
>
> *T: (02) 8978 5276 *
>
> *F: (02) 9971 7299 *
>
> *M: 0414 801 660 *
>
>
>
> The content of this e-mail is the view of the sender or stated author and
> does not necessarily reflect the view of Delmar Private Hospital. The
> content, including attachments, is a confidential communication between of
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>
> P *Please consider the environment before printing this email*
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Michael Wishart
> *Sent:* Monday, 21 March 2016 3:04 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Hand Hygiene Aistralia – Cost effectiveness publication
>
>
>
> [Posted on behalf of the original authors Moderator}
>
>
>
> As the University based authors of this paper, we also welcome this
> discussion. It was a challenging and difficult study but that made it
> interesting. With almost $1M of funding from the NHMRC and ACSQHC we felt a
> large responsibility to do the best possible study. We have no prior
> position or biases about the value of the NHHI.
>
>
>
> In response to the specific points raised by Lindsay and Andrew:
>
>
>
> o When we halved the costs of running Hand Hygiene Australia (HHA) the
> main result changed from $29,700 per life year gained to $25,094 per life
> year gained
>
> o When we additionally reduced the estimated time spent on audits by
> hand hygiene auditors by 50% the main result changed from $25,094 per life
> year gained to $18,960 per life year gained.
>
> o *S. aureus* bloodstream infections were chosen as the outcome measure
> by the steering committee for the project, and the reasoning was sound. The
> data are reliable for the states and territories, SAB is very expensive to
> treat and has large mortality risk. It is likely the best outcome measure
> to demonstrate the cost-effectiveness of the NHHI.
>
> o We did an analysis of other infection outcomes that showed a
> statistically significant reduction in 11/23 infection rates, no change for
> 9/23 and increases for 3/23. Here is the paper
> http://www.publish.csiro.au/?paperHI14033
>
> o Including quality of life changes had a negligible impact on the
> results.
>
> o We responded to Lindsays letter in JHI here
> http://www.ncbi.nlm.nih.gov/pubmed/25555834
>
>
>
> Estimating the value for money of infection prevention programmes is
> important, particularly in todays climate where funding is tight. This
> situation of scarce resources is likely to be the new normal for health
> services.
>
>
>
> Our study, and the interest in it, highlights the need for evaluations to
> inform policy decisions. As a community we should take every opportunity to
> build a culture of evidence-based policy. We are obliged to prefer health
> programmes that deliver good value for money.
>
>
>
> Prof Nick Graves, on behalf of the authors
>
>
>
> [This post added for continuity Moderator}
>
>
>
> [Posted on behalf of HHA – Moderator]
>
> We welcome discussion regarding this paper, and more broadly of the
> National Hand Hygiene Initiative. The QUT study was a large and complex
> project with many issues that warrant discussion and comment. Some of our
> comments have been previously published (see Grayson ML. J Hosp Infect
> 89: 137 ). Wed like to
> contribute the following points to todays discussion on this list:
>
>
>
> – The annual cost of the NHHI as assessed by this study reflects
> start-up rather than maintenance costs. The cost information used in
> this study is taken from the 2011-2012 financial year (Page *et al*. J
> Hosp Infect, 2014;88:141). HHAs budget, which represented 20% of the NHHI
> costs, was halved in the subsequent financial year of 2012-13 (on schedule)
> and has since remained at this lower level.
>
>
>
> – Other changes have been made as this program matured. For example,
> the costing study pre-dates introduction of the HHCApp mobile tool. This
> was developed to reduce total auditing time requirements (by elimination of
> data entry), while also facilitating immediate feedback and minimising data
> entry errors. Surveyed hand hygiene auditors that have moved to mobile
> devices have estimated that this can reduce time spent on audits by up to
> 50% (we aim to publish). So the cost-effectiveness study no longer reflects
> current practice.
>
>
>
> – The benefits of the NHHI are almost certainly under-estimated. This
> study only considered health and cost benefits of preventing one type of
> HAI: *S. aureus* bloodstream infections. This is because no national
> measures were available for other infection types or pathogens. But
> appropriate hand hygiene should have broader benefits, not only for other
> healthcare-associated infections but also to reduce the transmission of
> antimicrobial resistance. No assessment of patient suffering was included.
>
>
>
> Despite these points, the summary finding of this QUT study was that the
> NHHI is cost-effective according to Australian standards: This is the
> first cost-effectiveness evaluation of a National Hand Hygiene Initiative
> and shows that overall the programme was cost effective with a cost per
> life year gained of $29,700.
>
>
>
> The NHHI is unique both in Australia and globally. We believe that its
> successes have been the result of combining evidence-based interventions
> and strong collaboration between infection control professionals,
> jurisdictional authorities, HHA, the Australian Commission on Safety and
> Quality in Health Care, and other groups. But just as the program has
> evolved since the 2012 snapshot provided by this study, it should also
> continue to do so into the future. This discussion is one part of that
> process.
>
>
>
> Andrew Stewardson, National Project Manager, Hand Hygiene Australia
>
> Lindsay Grayson, Director, Hand Hygiene Australia
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU
> ] *On Behalf Of *Michelle Bibby
> *Sent:* Friday, 26 February 2016 12:26 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Hand Hygiene Aistralia – Cost effectiveness publication
>
>
>
> Thank you Mary-Louise for your response re Graves et al study and the
> variances.
>
>
>
> The concerns of biased data reported for hand hygiene compliance is worth
> noting and I too agree with your comments here.
>
>
>
> Costs associated with the efforts to report HH data as required which
> detracts from some of the critical day to day requirements of the IC nurse
> need further review.
>
>
>
> Thank you
>
> Michelle
>
>
>
> Michelle Bibby
>
> Infection Prevention Australia
>
> Michelle@infectionprevention.com.au
>
> +429071165
>
>
>
>
>
> *From: *MaryLouise McLaws
> *Reply-To: *ACIPC Infexion Connexion
> *Date: *Thu, 25 Feb 2016 23:24:28 +0000
> *To: *
> *Subject: *Re: FW: Hand Hygiene Aistralia – Cost effectiveness publication
>
>
>
> Dear Ramon and Glenys
>
>
>
> Graves et al study relies on the accuracy of the 2 pivotal variables: SAB
> and hand hygiene compliance. The accuracy of the latter is serious
> limited. Our report in the Medical Journal of Australia (*Med J Aust* 2014;
> 200 (9):534-537. http://dx.doi.org/10.5694/mja13.11203) concluded the HHA
> program reports rates that have been biased upwards by *very few high
> performers*.
>
>
>
> The conclusion from our findings and Graves et al is:
>
>
>
> (1) SAB respond to multiple interventions and hand hygiene is only one of
> these.
>
> (2) hygiene compliance rates have not reached a tipping point to reduce
> SAB and this tipping point is a long way off because
>
> (3) the hand hygiene compliance rates are inaccurate.
>
>
>
>
>
> *It is important to have a national HH program*. But the expense of the
> current program is too high when the cost of audits provides flawed data
> that reinforces a misguided belief that our hospitals are performing HH
> well.
>
>
>
>
>
> Mary-Louise
>
> *Professor Mary-Louise McLaws*
>
> *Professor of Epidemiology in Healthcare Infection and Infectious Diseases
> Control *
>
> http://research.unsw.edu.au/people/professor-marylouise-mclaws
>
> SPHCM SAMUELS BUILDING
>
> UNSW AUSTRALIA, SYDNEY NSW 2052 AUSTRALIA
>
> Telephone: (+612) 9385 2586 FaX: (+612) 93136185
>
> CRICOS Provider Code 00098G
>
>
>
>
> ——————————
>
> *From:* ACIPC Infexion Connexion [AICALIST@AICALIST.ORG.AU] on behalf of
> Professor Ramon Shaban, ACIPC President [president@ACIPC.ORG.AU]
> *Sent:* Friday, 26 February 2016 09:10
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: FW: Hand Hygiene Aistralia – Cost effectiveness publication
>
> Colleagues
>
>
>
> The study by Graves et al. reports a range of interesting findings, and
> raises many issues regarding hand hygiene for broader consideration. The
> College is examining the paper and is preparing a media release for release
> in the coming days.
>
>
>
> Kind regards,
>
> Ramon
>
>
>
>
> *Professor Ramon Z Shaban PRESIDENT*
>
> Australasian College for Infection Prevention and Control
>
> GPO Box 3254, Brisbane Qld 4001
> Tel: +61 7 3735 6463 Mobile: 0478 312 668
>
> Email: president@acipc.org.au
>
> Web: https://www.acipc.org.au
>
>
>
> On 25 February 2016 at 21:16, Glenys Harrington
> wrote:
>
> Dear All,
>
>
>
> Find attached the following publication (February 9, 2016).
>
>
>
> *Graves et al. Cost-Effectiveness of a National Initiative to
> Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated
> Staphylococcus aureus Bacteraemia. PLoS ONE 11(2): e0148190.
> doi:10.1371/journal.*
>
>
>
> The analysis was undertaken on data from 6 Australian states:
>
>
>
> In 2/6 states there was a 1% chance it was cost effective
>
> In 1/6 states there was a 26% chance it was cost effective
>
> In 1/6 states there was a 80% chance it was cost effective and
>
> In 2/6 a 100% chance it was cost effective.
>
>
>
> Interesting figure showing cost increases and cost savings by state (fig
> 2).
>
>
>
> Also some interesting points in the discussion.
>
>
>
> Shame there was No useable pre-implementation data available for
> Victoria and hence was not able to be analysed.
>
>
>
> *Given the findings of the analysis it raises the following questions for
> governments:*
>
>
>
> *Shouldnt the program be scaled back and some of the money be
> spent on other initiatives to reduce hospitals associated infections(HAIs)?*
>
>
>
> * Shouldnt the program be scaled back to reduce the infection
> control workload associated with the program which is currently
> overwhelming and taking ICPs away from other core infection control
> activities?*
>
>
>
> *A press release by the College about the findings of this study and the
> views of the college in terms of the allocation of limited resources would
> be timely.*
>
>
>
>
>
> regards
>
>
>
> Glenys
>
>
>
> *Glenys Harrington*
>
> *Consultant*
>
> *Infection Control Consultancy (ICC)*
>
> *PO Box 5202*
>
> *Middle Park*
>
> *Victoria, 3206*
>
> *Australia*
>
> *M: +61 404 816 434 *
>
> *infexion@ozemail.com.au*
>
> *ABN 47533508426*
>
>
>
>
>
>
>
>
>
>
>
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