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

Personal Details
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Specific Questions
3. Standard and transmission-based precautions: 



Page 153: 

  • Other vascular access devices: suggest add umbilical catheters; suggest change "shunt" to fistula. 
Page 154: Risk factors for IVD-related BSI
  • Given a "systematic review with a rigorous approach" was used to inform the document, could you add supporting references for Risk factors for IVD-related BSI?
Skin preparation:
  • What is the supporting reference for clipping versus shaving?
Page 155: Device selection: re: PIVC insertion
  • if the vein is not visible or palpable suggest a trained clinician use advanced techniques to locate the vein 
Page 155: Site selection: re: PIVC insertion
  • why the non-dominant hand?
  • the suggestion of clot in the metacarpal veins is likely true of all upper limb veins. Clot is not specific to back of hand veins it is found in wrist and forearm and ACF veins too especially vein with many valves. 
  • Additional comment; Approx 50% of PIVCs are inserted in the ACF region you prob need to suggest a better strategy to reduce this figure ( ultrasound with a specialist team is one)
Page 155: Site selection: re: PICC insertion
  • why the non-dominant hand?
  • PICCs ae generally inserted in the Basilic and Brachial veins. 
Page 155:Site selection: re: CVC insertion
  • Suggest remove an IJ CVC for a subclavian is dangerous considering many clinicians still use landmark for Subclavian CVC's are performed ( and the risk associated with blind/landmark insertion). Why not suggest do it correctly in the first place. 
Page 156: Insertion: in particular Ultrasound (US); while the use of US-guided access is growing; instruction for cleaning the probe would be welcomed here. 
Page 156: Maintenance: I think you should change "sponge" to sponge/gel or CHG technology/product and can you add the reference for PIVC with regard to CHG reducing iVD related BSI and colonization rates. 
the sentence on "Replace catheter site dressing.......could be added to the sentence with "Examine the dressing" 
Page 157: Maintenance:
  • re: needless connectors (NC): can you add the minimum duration for a "scrub" and duration for dry time. Note the hub is on the catheter the NC has to my knowledge no hub, but it rhymes. 
Page 157: Device placement: 
  • Quality measures for monitoring Pre-hospital PIVCs would be good in this section; e.g how do you know which one is a pre-hospital versus an Emergency Department PIVC versus a ward PIVC. 
  • What is the duration for CVC if they are not to be routinely replaced. 
Replacement of PIVC
the three bullet points under "Replace a PIVC based on clinical indication" need to be inserted under Option 1 also. 
Page 158: 
  • Can you please define appropriately trained? 
Suggest: A great quality initiative is to expand the team approach to insertion from one device to many. For example, PICC teams to include PIVCs and CVCs. This will improve insertion related complications and reduce the fragmentation of clinical practice. Suggest a national data collection tool so many many many hospital attempts to collect the same information? 

Page reviewed: 24 September, 2019