Hands-On Newsletter Winter Issue

Message from our Director

Welcome to our Winter Newsletter which we hope you will finda useful resource to support your infection prevention and management program.

Where has half the year gone! The team has been busy these past two months with the influenza vaccination season. Fortunately to date, WA has not experienced the increased influenza cases and outbreaks that our colleagues on the East Coast are living through, particularly in the residential aged care sector. However, it reminds us all of the importance of influenza vaccination in our HCWs and the consistent application of effective infection prevention and management systems and processes.

Apart from influenza vaccination, our team has also been busy updating infection prevention and control manuals, performing facility-wide risk assessments, undertaking AS/NZS 4187:2014 and hand hygiene compliance audits, delivering on-site education and training activities, and providing advice on infection control issues for our clients. To support this we have also been keeping up-to-date with our professional development activities so that we can ensure we are providing our clients with the latest evidence-based knowledge and practices to keep everyone safe and healthy.

The infection prevention and control world has been particularly focused on antimicrobial resistance and stewardship, environmental cleaning, aseptic technique, reprocessing of reusable medical devices and of course, hand hygiene. These are the issues we have been providing increasing support and advice to our clients on in order to adequately address the NSQHS Standards for preventing and controlling healthcare associated infections.

I will be busy co-coordinating the Graduate Certificate in Infection Prevention and Control Course which commences in August this year. With 19 students from a variety of healthcare settings across Western Australia, I look forward to imparting my knowledge and skills, and sharing experiences as we prepare the next group of Infection Prevention and Control Professionals.

Infection PreventionIt’s in Your Hands

Megan Reilly, Director of Hands-On Infection Control

June 2017

Suite 1/ 120- 122 Lake StreetPerth WA 6000www.handsoninfectioncontrol.com.au

E: info@handsoninfectioncontrol.com.au T: 61-8-9227 1132F: 61-8-9227 1134

It’s flu season, have you been vaccinated yet?

HAND HYGIENE PRODUCT COMPATIBILITY

Intact skin is a first line defence mechanism against infection. Damaged skin can not only lead to infection in the host, but can also harbour higher numbers of micro-organisms than intact skin and hence increase the risk of transmission to others. Damaged skin on HCWs is an important issue and needs to be seriously addressed.

There are two major types of skin reactions associated with hand hygiene: Irritant contact dermatitis; which includes symptoms that can

vary from mild to debilitating, including dryness, irritation, itching, and even cracking and bleeding. 

Allergic contact dermatitis, which is rare and represents an allergy to some ingredient in a hand hygiene product. In its most serious form allergic contact dermatitis may be associated with symptoms of anaphylaxis.

The vast majority of skin problems among HCWs that are related to HH are due to “irritant contact dermatitis”. Irritant contact dermatitis is primarily due to frequent and repeated use of HH products, especially soaps, other detergents, and paper towel use, which result in skin drying. The initial use of ABHR among such HCWs often results in a stinging sensation. However, recent studies have suggested that the ongoing use of emollient-containing ABHR leads to improvement in irritant contact dermatitis in approximately 70% of affected HCWs.  Also, the use of an oil-containing lotion or a barrier cream three times a shift can substantially protect the hands of vulnerable healthcare workers against drying and chemical irritation, preventing skin breakdown.

It is important to ensure that the selected ABHR, soaps and moisturising lotions are chemically compatible to minimise skin reactions among staff.

If staff are having skin reactions, Hand Hygiene Australia has a skin care questionnaire for healthcare workers (click here for the questionnaire).

Reference:http://www.hha.org.au/About/ABHRS/abhr-limitations/hand-care-issues.aspx

June 2017 Winter IssueWhat’s New?

Gloving for Surgical Procedures

ACORN Standard: Surgical hand asepsis, gowning and gloving

Standard Statement 2: A risk management approach shall be taken when deciding on the product range of surgical hand asepsis agents, gowns and gloves.

Health service organisations have a duty to establish clear policies and procedures for the evaluation and application of surgical hand asepsis products, surgical gowns and surgical gloves.

Standard Statement 4: The surgical gown and gloves shall be donned and used in a manner that minimizes contamination of the aseptic field and reduces the risk of exposure to blood-borne pathogens.

Although wearing gloves acts as a barrier to pathogen transmission and reduces the risk of occupational exposure to blood and body fluids, wearing double gloves, preferably with a puncture indicator system, may provide more protection that single gloving.

For surgical gloves to act as a barrier they must be intact.

The frequency of apparent glove perforation has been estimated to be 8 – 50 %. Reported unintended glove microperforation rates range from 9 – 18% with 80% of perforations going unnoticed by surgeons. The potential for glove microperforation is influenced by the type and duration of surgery.

Surgical scrub teams have a duty to:

Double glove, donning the second pair of gloves prior to approaching the surgical field;

Be vigilant to maintain glove integrity and avoid bacterial loading during surgical procedures;

Use an indicator glove system, when available; Use the closed gloving method, which allows gloves to be

donned in a manner consistent with the principles of aseptic technique;

Change gloves if they become contaminated or if the integrity is breached during surgery; and

Change gloves after a maximum of 1 ½ to 2 hours of wear.

Standard Statement 5: Education, training, competency and performance evaluation programs shall be developed to establish and maintain standardized practice and the required level of expertise in surgical hand asepsis, gowning and gloving.

In line with Australian guidelines and National Standards, initial and ongoing training in surgical hand asepsis, gowning and gloving is mandatory to ensure perioperative staff practices are standardized, current, and inline with evidence-based principles of asepsis, infection prevention and control.

Reference: ACORN Standards for Perioperative Nursing (2016). Standard: Surgical hand asepsis, gowning and gloving.

All healthcare workers have a responsibility to know their immunisation status:

what vaccinations they have had; if their vaccinations are up-to-date; and what they are not immune to.

Do you know your vaccination status?

West Australian Immunisation Schedule

This is a state coordinated immunization schedule designed to provide maximum protection to the population of WA. AGE DISEASE VACCINATED FORBirth (within 7 days) Hepatitis B6-8 weeks Diphtheria, Tetanus, Pertussis, Hepatitis B,

Poliomyelitis, Hib*, Pneumococcal, Rotavirus4 months Diphtheria, Tetanus, Pertussis, Hepatitis B,

Poliomyelitis, Hib, Pneumococcal, Rotavirus.Allow for minimum interval of 4 weeks between doses.

6 months Diphtheria, Tetanus, Pertussis, Hepatitis B, Poliomyelitis, Hib, Pneumococcal, Rotavirus.Allow for minimum interval of 4 weeks between doses.

6 months to <3 years Influenza annually12 months Measles, Mumps, Rubella,Hib, and

Meningococcal C12 months (Aboriginal children only)

Hepatitis A

12 months all medically at risk children

Pneumococcal

12 months pre-term or low birth weight babies

Hepatitis B

18 months Measles, Mumps, Rubella, Varicella, Diptheria, Tetanus, Pertussis

18 months Aboriginal children only

Pneumococcal (if not given at 12 months)Hepatitis A

4 years Diphtheria, Tetanus, Pertussis, Poliomyelitis4 years all medically at risk children

Pneumococcal

School year 8Term 1:HPV & VaricellaTerm 2:HPV & dTpaTerm 3/4:HPV & catch up

Human Papilloma virus (HPV)Varicella (Ends 2018)Diphtheria, Tetanus, Pertussis

Adults:Aboriginal >15yrs OR non-Aboriginal > 65 years.

Non-Aboriginal >65 yrs, Aboriginal > 50 yrs, OR Aboriginal > 15 yrs medically at risk.

Pregnant women

70-79 yrs

Influenza annually

Pneumococcal

Influenza annually and Pertussis (every pregnancy)

Herpes zoster (shingles)Healthcare workers Influenza annually* Haemophilus influenza type B.

June 2017 Winter Issue

Operational Directive / National Guideline Updates

The following public health and infection control related operational directives/guidelines have been published. This is an opportunity to review your policies, procedures and protocols on these issues where indicated.

MP 0038/16 Insertion and Management of Peripheral Intravenous Cannulae in Western Australian Healthcare Facilities

Australian Commission on Safety and Quality in Health Careupdated National Infection Control Guidance for Non-tuberculous Mycobacterium associated with heater-cooler devices: https://www.safetyandquality.gov.au/publications/national-infection-control-guidance-for-non-tuberculous-mycobacterium-associated-with-heater-cooler-devices/

Australian Commission on Safety and Quality in Health Care(2017) Advisory notice A16/03: Reprocessing of reusable medicaldevices in health service organisations:

https://www.safetyandquality.gov.au/publications/advisory-a1603-

WHAT AM I?I am a single stranded RNA orthomyxovirus classified antigenically as types A, B or C. Only types A and B are clinically important in human disease. I am transmitted from person to person by the droplet route, or by direct contact with secretions from someone infected with me. I cause a widespread spectrum of disease, from no or minimal symptoms, to multi-system complications and death from primary viral or secondary bacterial pneumonia. As I am often an asymptomatic or mild illness, I am often not reported. I can be minimized with annual vaccinations, which are highly recommended for all health care workers.

Salmonella:

There has been an increase in the number cases of Salmonella infection in WA since December 2016 related to eggs. Many different brands have been implicated.

Symptoms may include: fever, diarrhoea, loss of appetite, headache, stomach cramps, nausea and vomiting. Sometimes there may be blood or mucus in the faeces. Dehydration is a serious complication. Person-to-person spread may occur when hands, objects or food become contaminated with faeces from people who are infected and the bacteria are then taken in by mouth by another person.

People were advised to prepare egg dishes as close as possible to the time of eating them and refrigerate them at or below 5C. It was important to wash and dry hands thoroughly after handling eggs.

Safe handling and preparation of eggs reduces the risk of food poisoning. Cooking eggs until both the white and yolk are solid will kill any Salmonella bacteria. Foods made with raw or lightly cooked eggs are not recommended for young children, elderly people, pregnant women and people who are already unwell.

Recovery from me usually occurs within a week, and antibiotics are not usually required.

Information is available from: http://healthywa.wa.gov.au/Articles/A_E/Eggs

Update 2017

June 2017 Winter Issue

Hand-On Infection Control Professional Development Events for 2017

Hands-On Infection Control offers a broad range of education and training programs in infection prevention, management and related areas. Programs can be tailored to suit the specific needs of individual organisations, specialities, environments and staff/volunteer groups. These programs can be incorporated into existing induction/orientation, inservice, professional development and targeted programs for all categories of clinical, support and ancillary staff.

ACIPC 2017 Conference

19-22 November in

Canberra

Quiz Answers:

What am I? Influenza virus

Education & Training

Newsletters

The purpose of bringing our seasonal newsletters to you is to provide you with information and updates on contemporary infection prevention and control issues that may be relevant to your workplace. We hope you find the information informative and useful.

If there are any particular topics you would like covering, or any comments you would like to make, please let us know by contacting us at:

info@handsoninfectioncontrol.com.au

EventsKey Dates for Your 2017 Calendar

World Hand Hygiene Day5th May

World Sepsis Day13th September

International Infection Prevention Week15th – 21st October

Antibiotic Awareness Week13th – 19th November 2017