Infection Prevention & Control
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The ACORN Standards: S11 Standard Statement 2 states that 'perioperative attire shall be supplied and laundered by the health care facility or its contractor'.
Rationale
Supply and laundering of perioperative attire ensure personnel wear the appropriate standard of attire. In addition laundering by the health care facility or a contractor ensures the cleanliness of the attire meets a consistent standard.
Criteria
Health care facilities shall: provide perioperative attire which meets the relevant Australian standards in design and manufacture and, provide perioperative attire and ensure the attire is laundered by the HCF in an approved laundry and by monitored practices Water temperature and timing for appropriate laundering is stated in AS/NZS 4146:2000 Laundry Practice. Other references include AS 3789.3-1994 textiles for health care facilities and institutions-Apparel for operating theatre staff.
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Hospital curtains that surround patient beds to give privacy provide a source of transmission of healthcare associated pathogens for several reasons:
- They are commonly touched by patients and healthcare workers
- In the majority of hospitals they are changed infrequently
- Healthcare workers are less likely to disinfect their hands after contact with inanimate objects than after direct contact with patients
- Curtain tracks are 'dust traps'
- Curtain fabrics are not designed for frequent laundering at high temperatures
Recent reserach conducted in the USA identified that 42% of hospital privacy curtains were contaminated with vancomycin-resistant enterococci (VRE), 22% with methicillin-resistant Staphylococcus aureus, and 4% with Clostridium difficile.
Alternative Design Options
- Single rooms designed with doors with Vistamatic glass panels thatare striped with alternate bands of opaque and clear glass which, with the turn of a lever become completely opaque. This design element for privacy and discrete surveillance has been in operation now for a number of years in the Infectious Diseases Unit of the Gold Coast Hospital. This initiative has demonstrated cost-efficiencies in cleaning, laundering and porterage.
- The Gold Coast University Hospital has addressed the infection prevention & control / privacy issues in their design brief by specifying integrated ventians in the glass panels of all single room doors. There are no curtains or bed screens in any single rooms. The one exception to this specification is the maternity unit due to the sensitive nature of the patient care.
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Hand hygiene occurs for different durations depending on the situation. For example, a social or routine handwash only takes 15-30 seconds while a clinical handwash takes a minute. The hands don't have to be under water for the duration in either scenario; it is about contact time between the hands and the antimicrobial agent which involves rubbing the hands together to ensure coverage of all surfaces as well as the mechanical action required to loosen and remove soil etc then the rinsing action of the water. There is also an additional responsibility to be water-wise. As sensor taps have been limited to procedure rooms and clinical areas where significant invasive procedures are performed the hand washing requirements are more likely to be those associated with the clinical handwash and possibly even some scrubbing for really invasive procedures. Therefore a 30 second automatic run time has been endorsed.
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How should I manage mould within a hospital setting?
In the first instance always consult your facility's engineering department for expert advice.
Supporting Documents
Risk Assessment
- Patient population e.g immunosuppressed, neonates
- Location of mould in relation to patients
- If the risk to patients is considered high then local decisions regarding temporary closure of patient care areas will need to be considered by the facility executive
Identify the Source
- Has the airconditioning maintenance schedule been adhered to?
- Is the airconditioning being turned off after hours in the affected areas?
- Investigate other potential sources of humidity and moisture
Cleaning
- Until the source of the mould or the contributing factors have been corrected there is limited value in undertaking extensive cleaning as spores will continue to be generated in the environment
- Once the source of the mould has been identified and corrected, cleaning must be undertaken
- Cleaning should be performed using a 1% sodium hypochlorite solution [100 mls sodium hypochlorite added to 900 mls of water = 1000ppm]
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Is it safe to leave alcohol based hand rub (ABHR) in a car?
The main active ingredient of alcohol based hand rub (ABHR) is ethanol. Ethanol has a low ignition point; however it will generally only ignite if there is an external ignition source (e.g a flame or spark).
Auto-ignition temperature is the lowest temperature at which a substance will spontaneously ignite in a normal atmosphere, without an external source of ignition. The auto-ignition point of ethanol is 363 degrees celsius. Given this, it is safe to leave ABHR in a car.
Exposure to direct sunlight, however may lead, over time, to evaporation of ethanol and an increase in product viscosity. This may reduce the efficacy of the product and it is recommended to not leave the ABHR in direct sunlight.
For further information on the safe use of ABHR see factsheet.
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