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Draft revised Australian Guidelines for the Prevention and Control of Infection in Healthcare submission

ID: 
9
Personal Details
First Name: 
Pauline
Last Name: 
Bass
Specific Questions
1. Introduction: 

nil

2. Basics of infection prevention and control: 

2.0 Summary line 1: "Healthcare-associated infections (HAIs) are an infection acquired as a direct or indirect result of health care." Re word to "Healthcare-associated infections (HAIs) are infections acquired as a direct or indirect result of health care"

Transmission Based precautions 

Transmission-based precautions are recommended as extra work practices in situations where standard precautions alone may be insufficient to prevent transmission. Change to "Transmission-based precautions are recommended as additional work practices in situations where standard precautions alone may be insufficient to prevent transmission".

2.3.1 under Use of PPE table ?add in a statement regarding possible HCW allergy/ sensitivity to Latex and the HCF providing alternate products where necesary. 

3. Standard and transmission-based precautions: 

3.1.1 Practical information : Table 2 Add in sections for before and after a procedure: list examples

Add in to the 'after' box - smoking.

Under 3.1.1 Figure 5

Another had print obtained after the worker's hand had been cleaned with alcohol-based hand rub was negative for MRSA (image on right). Should read - "Another hand print...."

3.1.1 Point 2: Patients should be educated regarding hand hygiene. Under practical information (2nd to last statement):

  • Healthcare workers should have short, clean fingernails and not wear artificial fingernails or jewellery - add in nail polish

3.1.3 Safe handing of sharps: add in a statement re: safety devices should be considered where appropriate to minimise risk of injury to staff. This should apply to all HCFs not only dentistry.  

3.1.5 Use of sodium hypochlorite - under practical information - novel cleaning disinfectants are talked about first. This is not relevant in this section.

3.1.8 Aseptic Technique- Risk Assessment. For example, if it were necessary to touch a key part directly, sterile gloves would be the gloves of choice. Otherwise non-sterile gloves would be used. Change to "For example, if it were necessary to touch a key part or key site directly, sterile gloves would be the gloves of choice. Otherwise non-sterile gloves would be used.

3.1.8 Surgical or standard aseptic technique?

Standard aseptic technique—Clinical procedures managed with Standard aseptic technique will characteristically be technically simple, short in duration (approximately less than 20 minutes), and involve relatively few and small key sites and key parts. Standard aseptic technique requires a main general aseptic field and non-sterile gloves. Change this last sentance to: Standard aseptic technique requires a main general aseptic field and typically non-sterile gloves.

23. It is suggested that contact precautions, in addition to standard precautions, are implemented in the presence of known or suspected infectious agents that are spread by direct or indirect contact with the patient or the patient's environment. under practical info:

Patient Placement

Other points relevant to patient placement include the following:

  • keep patient notes outside the room
  • keep patient bedside charts outside the room
  • disinfect hands upon leaving room and after writing in the chart
  • keep doors closed ADD - where safe to do so - patient requiring high visualisation may not be able to have the door closed. 
  • make sure rooms are clearly signed.
Transfer of patients: 
Clean PPE should be put on before the patient is handled at the destination. Change toClean PPE should be put on before assisting the patient at the destination.


24.It is suggested that appropriate hand hygiene be undertaken and personal protective equipment worn to prevent contact transmission. Under practical info:

A surgical mask and protective eyewear must be worn if there is the potential for generation of splashes or sprays of blood and body substances into the face and eyes. Change to :A surgical mask and protective eyewear or face shield must be worn if there is the potential for generation of splashes or sprays of blood and body substances into the face and eyes.

 

27.It is suggested that a surgical mask should be worn when entering a patient-care environment  to prevent droplet transmission. under practical info:

Droplet transmission is, technically, a form of contact transmission and some infectious agents transmitted by the droplet route may also be transmitted by contact. Change to "Some infectious agents transmitted by the droplet route may also be transmitted by contact"

28. It is good practice to place patients who require droplet precautions in a single-patient room. under practical info:

 Placement of patients on droplet precautions
Placing patients on droplet precautions in a single-patient room reduces the risk of patient-to-patient transmission. When single-patient rooms are in short supply, the following principles apply in decision-making on patient placement:

  • prioritise patients who have excessive cough and sputum production for single-patient room placement
  • place together in the same room (cohort) patients who are infected with the same pathogen and are suitable roommates.
  • Add in "Consideration should also be given to the patients ability to perform hand hygiene and follow appropriate cough etiquette. 
30. It is good practice to wear a correctly fitted P2 respirator when entering the patient-care area when an airborne-transmissible infectious agent is known or suspected to be present

P2 respirators – fit testing and checking
In order for a P2 respirator to offer the maximum desired protection it is essential that the wearer is properly fitted and trained in its safe use. A risk-management approach should be applied to ensure that staff working in high-risk areas are fit tested and are aware of how to perform a fit check. Change last sentence too: A risk-management approach should be applied to ensure that staff working in high-risk areas are trained in appropriate fit of the P2 respirator and how to perform a fit check at the point of use. This may also include fit testing of the mask as outlined below.

Wearing a P2 respirator
Considerations when using a P2 respirator include 
Add in " Removal of the P2 respirator should be by the straps from the back of the head.

31. It is good practice to place patients on airborne precautions in a negative pressure room with bathroom facilities or in a room from which air does not circulate to other areas. Under practical information
Patient placement
When patients with suspected of confirmed airborne infection require treatment using nebulisers,...... change to
When patients with suspected or confirmed airborne infection require treatment using nebulisers,.....

This statement "Where possible only staff or visitors who are immune to the specific infectious agent should enter the room. Non-immune staff should be provided with appropriate PPE." insinuates that all immune staff do not need to wear PPE - this is contradictory to the PPE posters and relies on staff knowing their vaccination history. It also insinuates that visitors do not need to wear PPE. 

3.3.1
Multi-Resistant Organisms
For the purpose of these guidelines, MROs are taken to include:
a range of Gram-negative bacteria (MRGNs).......In particular, an increasing number of Capbapenemase Producing Enterobacteriaceae (CPE) (Spelling)

3.3.2
Outbreak investigation and management
Table 12. Steps in an outbreak investigation
step 5 - determine who is at risk. - include denominator figure. Number possibly/ who could be exposed (ie: total number on ward) 


3.4 and 3.4.1 need to mention and reference aseptic technique in these sections.

3.4.2
Therapeutic devices
35. Key concepts in minimising the risk of infection related to the use of invasive devices:
add: Daily review and documentation of device necessity. Remove when no longer required. 

3.4.2.2 IDCs
Key concepts in minimising the risk of infection related to the use of invasive devices:
INSERTION - add document insertion of the device in the patient medical record. Detailing device date/ time/ product and indication
Maintenance: 
  • Change drainage bags only when necessary (i.e. according to either manufacturers’ recommendations or the patient’s clinical needs)
3.4.2.3 Table 16 - Minimising the risk from intravascular access devices by device type
PIVC site selection- avoid the arm on the side of the body where lymph node clearance/ fistulas may be located. 
Dressings - - Gauze dressings should be replaced at least every 24 hours, and for CVADS/ PICCS transparent dressing every 7 days, for PIVCs, a short term device, change may not be required until the device is removed.
Device replacement/ maintenance - need discussion of replacing device if hot, red, phlebitic, pus etc. PIVC - should be some discussion around phlebitis scoring on examination. 

VAP: Physical strategies: 
  • Use new circuits for each patient and change these if they become visibly soiled or are malfunctioning and as per manufacturers instructions
3.4.3.1
Preventing Surgical Site Infections (SSIs)
  • Operating team members should remove hand jewellery, nail polish and artificial nails and nail polish
4. Organisational support: 

4.1.1

Clinical governance in infection prevention and control
36. It is good practice for healthcare facilities to have effective clinical handover processes in place that includes infection risks.
This should include transfers between wards and departments, transfers between different healthcare facilities and communication/ alerts on re-admission for long term infection risks such as MRO colonisation.
6. Appendix 2: 

 

6.1 Minimum cleaning frequency -   Alcohol hand rub dispenser, bedside Clean daily & between patient use. This is unrealistic to clean in between patient use. Daily clean only.

Beds in low risk areas such as rehab/ long term care - are not down to be cleaned at all even on d/c

Bedside tables are to be cleaned daily and after use - ? I'm not sure you could determine 'after use' of a bed side table - should just be clean daily.  

Computor & keyboard - clean weekly. Can there be some deliniation between static (at the nurses station) and mobile computors on wheels which travel from room to room , where the frequency of cleaning would be greater than 1 week. 

I cant undertsand the logic of cleaning  bed side tables daily but a locker twice daily? There appear to be some inconsistencies.

Cleaning items  within a patient  room twice daily - unless in the event of an outbreak I feel is an unrealistic expectation.

Would be useful to have some guidance on cleaning dressing trolleys with draws or line insertion trolleys with draws (which holds stock). The trolley would get wiped over before and after use but recommendations for frequency of drawer  cleaning ? weekly. 

6.2 under wound examination - sterile glove use - direct is spelt incorrectly.

6.4 Table - chickenpox and shingles - can this be changed to chickenpox and disseminated shingles. Need another recommendation for localised shingles - contact precautions only.

This table is difficult to undertand. Are the precautions meant for the target popultion only. ie: Herpes simplex (neonatal) is listed as contact precautions, target - all patients -  so everyone is isolated.  Hep A however is listed as contact precautions - but the taregt  is incontinent get their own room/ ensuite - it appears that you are saying that only those incontinent go into contact  precautions??? Influenza is a further example - placing patients in to droplet and contact precauions but it appears this only applies during an outbreak. 

I think target is the wrong heading for this column and will cause confusion. it should be listed as additional information. Where 'All patients' is listed in the target column it should be removed. Comments in this box should be the exception and not the general rule or additional guiding information. 

 Norovirus - I dont think droplet precautions are relevant if the patient has diarrhoea or is self caring. This should be by risk assessment. 

 6.8  - This should list relevant standards as well ie: reprocessing - AS4187/ Laundry - etc 

 

 

8. Glossary / Abbreviations and Acronyms: 

In the glossary : spelling


CPE

carbapenemaseproducing Enterobacteriaceae

Page reviewed: 24 September, 2019