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

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Specific Questions
1. Introduction: 

The document should be able to be accessed as a whole so that the search function (control F) can be used

2. Basics of infection prevention and control: 

2.1 Statement However, droplets can also be transmitted indirectly to mucosal surfaces (e.g. via hands or contact with fomites). So should this be reflected in content of table 6.4 i.e that all organisms spread by droplet transmission be treated with droplet and contact precautions

3. Standard and transmission-based precautions: 

Section 6.4. 

The header should be a frozen pane to make easier to read.  Also I am sure that people will not realise there is additional columns to the right and will not scroll across- this needs to be addressed.

The section on special requirement soft healthcare workers is confusing.  What does infected means?  Does this mean if they have an infection there is special requirements.  What are special requirements?  Can they work?  Would it not be best to group pregnant and immunocompromised together?.

The reference Source: Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings [365] is very old.  There are public health songs that include more current research that could be used as references

Abscess- why is this contact for all patients?

Enterococcus VRE - is this saying it is only contact precautions for faecally incontinent?  The under Vanco resistant enterococcus VRE is states contact for all patients which contradicts entercoccus VRE section.  This is a concern.  One says duration of illness, the other states duration of incontinence

Transmission route (3rd column) and the type and target (4th Column) information contradicted- Human metapnuemovirus and rhinovirus states transmission route contact and droplet then just D for precautions required.  RSV and bronchiolitis states contact and droplet and then just C.

Chickpox and shingles are combined.  Shingles is not always airborne as indicated in the table, it may be standard or contact or airborne.

Gastroenteritis states contact precautions for faecally incontinent for duration of illness.  Campylobacter states contact precautions for all patients which contradicts the gastroenteritis statement.  There is no mention of salmonella which we see frequently.  I am concerned about ceasing precautions for gastroenteritis/ norovirus after duration of illness- most practice is precautions for 48 hours after cessation of symptoms.

Ebola- this states contact however this is not what the most recent CDC recommendation was i.e. shoe covers, hoods etc.

Conjunctivitis acute bacterial- it does not state transmission of precautions required

SARS- is unclear if to do S, D or C

Streptococcal A- no precautions indicated

 There are many organisms not listed in the table that we see on a regular basis or that are of concern that should be added- see below- adenovirus, enterovirus, CRP, CPE, CRAB, ESBL, coxsackievirus, Hendra, zika

wording is not highly preferential for negative pressure rooms – saying it may show to reduce transmission.  I think this should say- “does show to reduce”.

3.2.4 Airborne precautions

wording is not highly preferential for negative pressure rooms – saying it may show to reduce transmission.  I think this should say- “does show to reduce”.

3.3.1 Multi-Resistant Organisms

What are the references for this section?

There should be some guidance on what groups decolonisation of MRSA is considered for

Aust commission guidelines for CPE say is not recommended to clear which is contracdicted in the CPE section (reference 199)

VRE- there should be some more guidance for this organism

4.2.2 Exclusion periods for healthcare workers with acute infections

Reference is Staying Healthy in Child Care: Preventing infectious diseases in early childhood education and care services (Fifth Edition) [307].  There should be other references such as CDC.

Gastro can return after 24 hours, norovirus is 48 hours – they should both be 48 hours

Influenza is not clear- I would suggest it be 24 hours symptom AND 5 days since onset OR 72 hours post Tamiflu.

There are many many diseases we get calls about, particularly form exposure to staff’s own children that should be listed i.e hand, foot and mouth

6.3 Application of standard and transmission-based precautions

This table is unnecessary as is all in table 6.4

Visitors for MROs should just do hand hygiene- no PPE required unless visiting other people in the hospital- PPE is not practical for visitors that may be in the room for hours

Organisms for droplet precautions should be droplet and contact precautions

6. Appendix 2: 

Appendix 2: there is no appendix 2 – is this 6.4 table

Page reviewed: 24 September, 2019