[Beckingham, Wendy]

Kristin this is often left out of documentation when sorting the drawing.

I have a very old book that recommends in:
a 40 sq.m 4 bed room that the distance between two beds from bedhead centre to bedhead centre is 2240mm. The space between the ends of two facing beds is 1700mm. This latter includes 400mm from foot of bed to bed screen and a central circulation space of 900mm when screens are drawn around the bed. This can be applied to a two bed room as well

At our facility we have run into problems where they have added form work around the oxygen and suction/medical panel therefore reducing this space without consideration to the circulation around the bed space. Important to measure before giving these measurements to ensure you are happy with the space.
Hope this is helpful

Wendy Beckingham
ADON Infection Prevention and Control
ph. (02) 512 43695 or mobile 0478408787
RN BHSc (Nursing) Grad Cert (Infection Control) MClinicalNurs CICP- E
Care Excellence Collaboration Integrity

Dear colleagues,
We are currently in the design phase of developing our new hospital. Health Infrastructure are pushing a design of a two bed toe to toe room with only 1388mm space between. This measurement does not take into account the curtains around both beds.
I have been searching through the literature for some evidence to support an IP&C argument reflecting the need for increasing the space between the two patient zones.
Health Infrastructure require concrete and not anecdotal evidence.

Does anyone know of any IP&C literature that states design schematics for room designs?
Kind regards
Kristin

Kristin Ryan-Agnew
Kristin Ryan-Agnew (MPH/Grad Cert IP&C)
Infection Prevention & Control Clinical Nurse Consultant
The Tweed Hospital

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[Beckingham, Wendy]

Cath
We have not as yet moved to disposable curtains but I like you believe that the changing of disposable bed screens could be less frequent in areas such as dialysis, outpatients, medical imaging, consult rooms and health centres just to name a few areas. I have looked at these areas leaving them for 12 months if we were using the disposable curtains. Changing between MRO patients in these settings I believe is also unnecessary. If they of course become visibly soiled of course changing is paramount.
I have looked into moving to disposable but our health care directorate is looking at the feasibility of changing over (this is in the future for me).

The second part of your question re accreditation I would think as the use of such items become more common place then the questions would not be raised. Evidence (which I know is mainly from the companies) supporting disposable curtains points to the longevity of such items and they visually seem to remain clean (maybe we all need to conduct research and publish). I like the idea of really knowing that the curtains have been changed as it is currently a problem that one assumes that changing has been done but don’t really know unless they hang a pink up where a blue one was hanging.

Cheers
Wendy Beckingham
CNC Infection Prevention and Control
ph. (02) 6244 3695 or mobile 0478408787 or pager 50390
e. wendy.beckingham@act.gov.au
Care Excellence Collaboration Integrity
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Whilst the Australian Guidelines For The Prevention And Control of Infection in Healthcare, recommend that curtains used in the care of patients known to be colonised or infected with an MRO are routinely changed on discharge this is obviously impractical and perhaps even unnecessary in settings where hand hygiene compliance is reasonable and turnover high. Specifically I am thinking day-only, and ambulatory care services like private oncology centres and dialysis units.

What do others think and what arguments would you offer to ill-experienced surveyors who are less flexible in their thinking and may potentially deem failure to change curtains or use disposable curtains in these types of settings as non-compliance?

Would be grateful for opinions, insights and debate. Thanks in advance.

Regards
Cath

Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
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[Beckingham, Wendy]

Hello Michael
here at TCH we have been supplying more a letter to the GP re clearance. Happy to send to you if you would like.
We receive a print also of the patients attending outpatients and this has been a good way to help with clearance swabs
Back to the GP way of seeking clearance, we are continuing even though we have had mixed results I do think it helps with education and information for the GP. We have also placed a posting in the GP liaison newsletter to help with the process.
Happy to talk off line if you wish.

Wendy Beckingham
CNC Infection Prevention and Control
ph. (02) 6244 3695 or mobile 0478408787 orpager 50390
e. wendy.beckingham@act.gov.au
Care Excellence Collaboration Integrity
GERMS CAN KILL…
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Hi all

I am seeking some information on current practices on ‘clearing’ patients from requiring transmission based precautions for MRO carriage on re-admission. I am aware of different guidelines about ‘clearance’ for MRO’s, but wondered if any facilities actively tries to clear a patient after discharge to the community (not via facility outpatient visits). We are looking at trialling a program for providing patients with information and pathology forms on discharge to have specimens collected with their GP or private pathology collection centre to assist to ‘clear’ them from the MRO prior to the next admission. Obviously this will need to done in conjunction with our current ‘clearance’ guidelines (eg no current wounds, no antibiotic treatment within a specified time frame, no indwelling devices, correct specimen types, etc).

Is anyone doing this currently? Has anyone tried this and stopped?

I hope you this question is clear. Thanks for any responses.

Cheers
Michael

Michael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3607 2226
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[Beckingham, Wendy]

The recommendation from CDC that replacement of IV cannuales at 72-96
hours is based on studies of phlebitis however in our experience at TCH
we have found that the majority of our peripheral cannulae related BSI
occurred with dwell times of greater than 72 hours.
Therefore we have kept our policy to 48 -72 hours with good success. We
have a 24 hour rule for those inserted in an emergency or prior to
ambulance transfer. On another note we don’t routinely change children
peripheral IV unless it has ceased to work.

Wendy Beckingham
CNC Infection Control
The Canberra Hospital
pager 50390 or phone 43695

________________________________

Behalf Of Glenys.Harrington@HEALTH.VIC.GOV.AU

Michael,

The CDC Guideline for the Prevention of Intravascular Catheter-Related
Infections recommends the following:

“In adults, replace short, peripheral venous catheters at least 72–96
hours to reduce the risk for phlebitis. If sites for venous access are
limited and no evidence of phlebitis or infection is present, peripheral
venous catheters can be left in place for longer periods, although the
patient and the insertion sites should be closely monitored”

This is a Category IB recommendation – Strongly recommended for
implementation and supported by some experimental, clinical, or
epidemiologic studies, and a strong theoretical rationale.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

However having noted the above recommendation it should be read in
context with other statements in the guideline including the following:

“Recommendations should be considered in the context of the
institution’s experience with catheter-related infections, experience
with other adverse catheter-related complications and availability of
personnel skilled in the placement of intravascular devices”.

While the reviews conclusions are of interest consideration of local
factors before a change in clinical practice (as per the CDC guideline)
would be judicious.

Glenys

Glenys Harrington, Infection Control Consultant |Communicable Disease
Prevention and Control | Public Health
Department of Health | Level 14 50 Lonsdale Street Melbourne Victoria
3000 Australia
t. 1300 651 160 (03 909 65123) | f. 03 909 69174 | e.
glenys.harrington@dhs.vic.gov.au | http://www.health.vic.gov.au/ideas

Sent by: AICA Infexion Connexion

________________________________

There has been a recent Australian published review of routine
replacement of peripheral IV catheters as recommended in the current
HIPAC guidelines. The review concludes:

The review found no conclusive evidence of benefit in changing catheters
every 72 to 96 hours. Consequently, health care organisations
may consider changing to a policy whereby catheters are changed only if
clinically indicated. This would provide significant cost savings
and would also be welcomed by patients, who would be spared the
unnecessary pain of routine re-sites in the absence of clinical
indications.
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD00779

8/pdf_fs.html

[NB Here is a short link in case the longer link gets broken –
http://tinyurl.com/22m4xlf ]

Have any facilities considered this recommendation and made changes to
current routine replacement of peripheral IV catheters?

Personally, I am concerned that such a recommendation does not take into
account the variety of settings in which peripheral IV catheters are
inserted and managed. It appears possible that all of the six included
studies were in settings where additional resources were available to
manage peripheral IV’s (eg dedicated IV teams), which could in part
account for the improved outcomes of catheter management.

Whilst we should review and challenge current standards, I feel we
should be cautious in making changes which have the potential for harm
to patients. Bacteraemias associated with peripheral IV catheters are
reasonably rare events, and a rise in incidence may not be readily noted
in an individual facility.

Thanks
Michael

Michael Wishart | GPH – Infection Control Coordinator

GPH – Quality & Safety Unit (Infection Control) | Greenslopes Private
Hospital
Newdegate Street, Greenslopes QLD 4120
t: 07 3394 7919 | f: 07 3394 7985
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[Beckingham, Wendy]

Hi Beth
At TCH we do the following
We require that staff stay off work until 48hours after the last
symptom
They take sick leave. At one time during an outbreak we in infection
control wrote sick certificates for the staff but we don’t do that
anymore. It became a problem as it was difficult in some cases to
detemine if the staff member really had gastro or not.
The rules apply to all staff in the healthcare facility regardless of
work place
Jan Roberts
Infection Prevention and Control
The Canberra Hospital
Ph 62443694
Email janL.roberts@act.gov.au

________________________________

Behalf Of Beth Bint

Good afternoon

I am interested in knowing how various health services or facilities
managed staff who become ill during a gastroenteritis (norovirus)
outbreak.

How long are symptomatic staff recommended to stay off duty?

What type of leave do they take whilst symptomatic and recovering?

If it is deemed a work related illness, what are the
parameters/definitions used for this?

Is there a variation in recommendations according to the type and place
of employment in the health service?

Thank you

Beth

Beth Bint

CNC Infection Control

The Wollongong Hospital

M: 0458 230 562

e beth.bint@sesiahs.health.nsw.gov.au

Infection Management and Control Service (IMACS)

Level 1, Lawson House

The Wollongong Hospital

LMB 8808

SCMC NSW 2521

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