Anywhere, Anytime, Anyone – Leading the aseptic technique AAA learning approach
The Grampians Region Victoria Australia covers 47,980 square kilometres and has 11 public hospitals with multiple campuses spread over large distances. In 2012-13 training of the workforce on aseptic technique was required under the National Safety and Quality Health Service Standards accreditation process. Online learning became the mode of training delivery due to distance, however it was not always effective as evidenced by clinician’s poor verbal recall of aseptic technique principles during clinical practice.
What could be used Anywhere, Anytime, and by Anyone to consolidate principles, practice the selection of aseptic technique, inspire clinician ongoing learning, maximise workforce coverage, and not rely on electronic systems? In 2013, a project commenced to investigate this potential.
In 2014, two resources were developed and implemented. A simple hands-on educational tool depicting a variety of complex and simple procedures to consolidate aseptic technique principles, and a flow chart to assist with the decision-making process on the selection of aseptic technique type during clinical practice.
In 2019 clinician verbal recall of aseptic technique principles has improved significantly and the principles embedded into practice. The online learning has provided the theoretical knowledge, while the additional hands-on educational tools were successful in guiding knowledge into practice. The tools have provided a platform for agreement between peers on aseptic technique selection in everyday practice, engaged clinicians in ongoing learning, and contributed to a clinician led culture of reflection to maintain appropriate and safe aseptic practice.
These AAA resources have empowered clinicians to remind each other on safe aseptic practice and maintain momentum for clinician driven aseptic technique training and consolidation. These simple resources could be utilized in the New Zealand health care environment, so let’s try the AAA approach with this presentation!
Sue is a NZ trained Registered Comprehensive Nurse and Infection Control Practitioner, and an Australian Credentialed Infection Control Professional – Expert. Sue has spent the last 16 years working in infection prevention and control in a variety of Australian settings and is currently one of two Regional Infection Control Advisors for the Department of Health and Human Services, Grampians Region, Victoria. This position assists in facilitating a coordinated approach to the implementation of a state-wide infection prevention and control strategic framework, and supports the practitioners working in the Grampians Region Healthcare Services. Sue has delivered aseptic technique symposiums across Australia on behalf of the Australasian College for Infection Prevention and Control, and has provided aseptic technique resources, implementation tips, train the trainer education days, and ongoing support to meet accreditation requirements for many metropolitan, regional and rural healthcare services in Victoria.
Let’s go on a Pseudomonas hunt
Colonoscopes are used in the dirtiest areas of the human body, have long dark narrow channels and are constructed of materials that don’t tolerate the most effective sterilisation processes. What better place for Pseudomonas to take up residence? This presentation tells the story of a novice infection prevention nurse on the trail of recurring Pseudomonas contamination in a family of colonoscopes in a small regional hospital. Enlisting the support of various experts, the investigation led down several blind alleys until the culprit, hiding in plain view, was finally identified.
Iona Bichan is an old dog learning new tricks, having left her previous career in emergency nursing to join the infection prevention team at Nelson Marlborough Health. She’s enjoying living in the sunny South Island and learning about the intricacies of her new career in infection prevention through the post graduate course at Toi Ohomai. Her current aim is to become proficient in both infection prevention and paddleboarding.
Healthcare workers’ perceptions of respiratory infection risk; a mixed methods research study into protective mask use in routine practice
The optimal use of personal protective equipment by healthcare workers (HCWs) is an important infection prevention measure in limiting transmission of infectious disease. Recent respiratory outbreaks, including Middle East respiratory syndrome (MERS), were notable for hospital transmission and HCW disease acquisition. Appropriate mask use during routine care is a forerunner to best practice in an outbreak and may limit the part HCWs play in infection transmission as vectors or victims of respiratory infectious disease. The purpose of this research was to explore the behaviour and decision making of HCWs in relation to their use of protective masks for infectious diseases during routine practice.
A cross-sectional, mixed methods study was undertaken, underpinned by participatory and behavioural change methodologies. A survey and video-reflexive ethnography were used to collect data in an emergency department and respiratory ward in a 950-bed tertiary hospital in Western Sydney. Qualitative findings were analysed using a thematic approach.
The HCW perception of risk for respiratory infectious diseases and associated behaviour towards protective masks differs between clinical areas. Factors that influence mask use include the working environment and unit culture around transmission-based precautions. In the emergency department, the emphasis is for patients to wear a mask to prevent transmission of their infection. With the exception of wearing masks when attending to immune-suppressed patients, HCWs primarily associate their own mask use with self-protection and do not see their significance for preventing healthcare associated infections.
Sub-optimal mask use in the emergency department may be a risk for healthcare transmission in the early stages of an emerging respiratory infectious disease outbreak and has implications for pandemic planning. Infection prevention and control isolation policies should consider differences between clinical contexts.
Ruth is a registered nurse, quality advisor and researcher. She holds a Masters in Infection Prevention and Control and has over 22 years of experience in this field across the private and public sector. Ruth has authored several IPC journal publications and represented infection prevention and control professionals on a number of NZ national committees and working parties. Ruth is currently studying for her PhD through the University of Sydney, with her research focus on personal protective equipment practice among clinicians.
Promoting social wellbeing in patients with spinal injury during MDRO isolation: a quality improvement project
Patients with spinal cord injury often experience social disconnectedness and a sense of social isolation. Although research shows that that opportunities for social interactions can optimize well-being for these patients, this may be impaired during hospital stays when isolation precautions are required to prevent transmission of MDROs. Therefore, an IPC quality improvement project was initiated to promote social well-being of patients with spinal injury requiring MDRO isolation.
The Plan, Do, Check, Act (PDCA) quality improvement tool underpinned development, implementation and evaluation of this IPC project.
Learnings and results from stage one of this project i.e. PDCA-Cycle (Plan) will be presented, which included a literature review, expert consultation and development of new education resources and tools for staff on the spinal injury unit.
Infection Prevention nurses can contribute to social well-being of spinal cord injured persons requiring MDRO isolation by ensuring policy and procedures are based on latest evidence and providing education and resources for health care workers on current best practice.
Louise has been nursing since 2000, after spending 10 years living and working in the UK and Australia. After several years of surgical nursing, and parenting, the opportunity to pursue postgraduate qualifications came along. Over several years she has obtained a Master’s Degree in Health Sciences (endorsed in clinical nursing). She has also had the good fortune to spend time working in oncology in a chemotherapy day unit and then later in Sydney as a member of the EVIQ team. More recently she has spent time as a continence advisor and finally settled into the wonderful and challenging role as a CNS in the IPC team in Christchurch – where she has been in for 3 ½ years.
Reduction in surgical site infection in the Southern Cross Hospitals network, 2004-2015: successful outcome on a long-term surveillance and quality improvement project
Aim: To share with other Infection Prevention and Control Nurses the benefits that reporting infections rates can have on improving patient outcomes. To show the reduction in the surgical site infection (SSI) rate in the Southern Cross Hospitals network over a 12-year period, 2004-2015, that we achieved following active surveillance and quality improvement actions.
Methods: Ten hospitals in the network performed prospective SSI surveillance using standard definitions across a range of ten surgical procedure groups. Data was manually collected on a standardised form and entered into a bespoke database. Information collected included timing and dose of surgical antibiotic prophylaxis, type of surgical site skin preparation used, and patient information on smoking, diabetes and body mass index (BMI). Patients were contacted 30 days after their elective surgery to detect SSIs presenting after discharge from hospital. Surveillance results were widely reported to infection control and clinical review committees. Quality improvement activities to increase use of best practice interventions for surgical antibiotic prophylaxis and alcohol-based skin preparations were initiated.
Results: 42,792 procedures performed in ten hospitals were analysed. There were 932 (2.2%) SSIs. The SSI rate decreased from 3.5% in 2004 to 1.2% in 2015, r -0.865, p = <0.0001, a decrease of 59%, approximately 5% a year. Rates decreased in seven of the 10 hospitals, p ≤0.02 for each, and in five of the ten procedure groups, p ≤0.02 for each. Diabetic patients, odds ratio (OR) 1.4 (95% confidence interval (CI) 1.1-1.9), obese patients (BMI>30), OR 2.0
Conclusions: This long-term surveillance and quality improvement programme has made a significant contribution to the overall reduced rate of SSIs in Southern Cross Hospitals. This reduction occurred despite patient risk factors for SSI increasing.
Extract from article published NZ Medical Journal
Tanya has worked in Infection Prevention and Control for 20 years both in the public and now more recent years in the private sector. She was the lead infection control nurse at ADHB before moving south and am now an Infection Prevention and Control Consultant for Sothern Cross Hospitals. She has enjoyed the change in focus of the Infection Control nurse role moving from being about control to now a greater focus on prevention of infections and patient outcomes. She has published numerous articles on our surveillance results both at the DHB including the point prevalence results and the costs of infections and more recently the private sector on how we were able to reduce the number of surgical site infections. Tanya has a keen interest in Surveillance and how you can use this information and the process to improve our patient outcomes.
Claire Underwood and Sarah Thomas
Superman where are you now?
In July of 2018, an OXA-48 strain of carbapenemase producing enterobacterales (CPE) was detected in a routine stool sample in a patient in the Hutt Valley. Although presentations of CPE have been recorded in New Zealand, this particular detection was unusual because it was not associated with overseas hospitalisation.
Over the last eleven months detection of 17 CPE cases to date, has resulted in an outbreak investigation in the community. CPE was detected in routine urine and stool cultures. Six patients had uncomplicated urinary tract infections, one had urosepsis, ten patients were colonised. Of the total detections so far, six patients had had recent contact with the hospital which resulted in contact tracing events. To date, over 180 patients have been offered contact tracing. One transmission event was detected as a result of this screening.
The infection prevention and control team have worked closely with public health (PH), and ministry of primary industries (MPI), to investigate the outbreak. Questionnaires were used for all cases to assess foreign travel or hospitalisation, and food history.
The IPC team worked closely with wards and patients affected to conduct contact tracing and uphold standard precautions. This outbreak highlighted the implications for nursing staff, hospital cleaning and infection prevention and control teams.
Claire Underwood is a Clinical Nurse Specialist and team leader in Infection Prevention & Control at Hutt Valley DHB. She has worked in infection control for the last nine years in both public and private sectors. Claire is the editor of the Infection Controlla and a current member of the IPCNC Committee. She is passionate about Infection Prevention, with special interests in Hospital Cleaning, hand hygiene and quality improvement projects. Claire emigrated to New Zealand with her husband and three children thirteen years ago, and in her spare time loves creative writing and is a published author.
Sarah Thomas is a Clinical Nurse Specialist in Infection Prevention & control at Hutt Valley DHB. Her background is in Medical Nursing, working in a variety of roles in Scotland and New Zealand. Sarah has special interests in improving processes for prevention of Central Line Infections and Aseptic Technique. Sarah is originally from Dunedin and lives in the Lower Hutt with her husband and two children and is a fabulous dressmaker in her spare time.
Reprocessing in endoscopy
This session will be looking at ‘a day in the life of an endoscope’, the places it has to go and what we need to do to get it ready to go there!
We will look at the reprocessing of endoscopes and the guidelines available to set standards in Australasia.
Holly is the charge nurse manager of the gastrointestinal investigative unit (endoscopy) in Christchurch Hospital. She trained and qualified as a nurse in the UK and only discovered a passion for gastroenterology nursing on my arrival to NZ in 2003. She has recently gained a Masters in Health Science from the University of Otago and have completed and presented audits looking at the psychological services available for people living with inflammatory bowel disease.
How do our hospitals ‘scrub up’
This presentation will qualitative the research on ‘How well do our hospitals scrub up? Discussing how ‘clean’ is measured and prioritised with Infection Prevention Nurses in New Zealand’ as it can extend our understanding about the ways in which New Zealand hospitals measure the effectiveness of their cleaning that is required by their environmental decontamination policies and what actually happens in practice. This study generates knowledge on the cleaning standards in our hospitals, sourced from the nurses directly involved in promoting cleanliness. I have collated and analysed information gained through interviews with Infection Prevention Nurses from 11 New Zealand hospitals. The interview questions focused on the cleaning practices in relation to how it is conducted, audited and prioritised. Data from the interviews illuminated the standard, reactionary and/or progressive approaches to cleaning and cleaning technologies and how cleaning decisions are made. I would like to share this knowledge to increase our understanding about how cleaning is measured and prioritised in many New Zealand hospitals as told by the IPC nurse specialists. These findings will be beneficial as a platform for further research into cleaning and developing standards and policies in New Zealand. The research participants will benefit from the research by having their expert knowledge and experience acknowledged and valued in the research.
Justine has been an IPC Nurse specialist for the last seven years and facilitate the IPC programme at two surgical hospitals. She is currently on the IPCNC national committee with the role of membership coordinator. She is presently completing my Masters in IPC with a dissertation in hospital cleaning. Her interests are in educating both patients and healthcare staff in antibiotic resistant bacteria, standardising and measuring cleanliness in hospitals and relationship building in IPC to create a culture of patient safety.