What is Antimicrobial Stewardship?

This is alarming, but do nurses understand the positive impact we can have in reducing antimicrobial resistance?

In the last century, antibiotics have revolutionised medicine and reduced mortality and morbidity from almost all serious infections.

Antibiotics have dramatically reduced the risks associated with many medical and surgical procedures. Treatment for leukaemia, organ transplants, joint replacements, and more. Without antibiotics, many of these procedures would have unacceptably high failure or death rates.

Overuse of antibiotics contributes to the development of resistant bacteria, like MRSA, VRE, CRE, and Clostridium difficile.

Antimicrobial resistance occurs when some of the germs (bacteria, virus, or fungus) that cause infections become resistant to the effects of the medicines used to treat them.

This may lead to the inability to treat the cause of the infection.

There are a few reasons for the dramatic increase in AMR, including a shortage of new antimicrobials, widespread use of antimicrobials in agriculture and inappropriate or overuse.

Our Residential Aged Care Facilities have frail older residents who need help with daily living, antibiotics, and invasive devices like catheters. With group activities, shared living spaces, objects, and bathroom facilities, and a lack of infection prevention and control, residential aged care has a challenge managing infection.

Infections become increasingly difficult to diagnose and treat as antimicrobial resistance grows. In nursing homes, this is one of the biggest causes of mortality and morbidity. Lower respiratory tract infections (LRTIs), urinary tract infections (UTIs), skin and soft tissue infections, and gastroenteritis are our most common infections.

According to reports, 1 in 10 residents in Residential Aged Care are taking an antimicrobial.

 It is widely reported that half of the antibiotics used in residential care facilities are inappropriate or unnecessary. Inappropriate use can include the wrong choice of antibiotic, the wrong dose or prolonged use of antibiotics.

These reports are hardly surprising when you consider the decision on prescribing antibiotics is made off-site by telephone, with limited laboratory and clinical information. An overworked and under-resourced GP surgery can be adversely influenced by staff members concerned about their residents.

AMS programs reduce inappropriate antimicrobial use, improve resident outcomes, and reduce the consequences of antimicrobial use (like antimicrobial resistance, toxicity, and unnecessary costs).

In response to this widespread over and inappropriate use of antibiotics, countries are now implementing quality initiatives in how we detect and diagnose infection

Along with infection prevention, hand hygiene, and surveillance, AMS programs prevent antibiotic resistance and decrease preventable infections.

But what is Antimicrobial Stewardship? The term Antimicrobial Stewardship (AMS) first appeared in the scientific literature in 1996 (McGowan & Gerding, 1996) and refers to an approach to using antimicrobials responsibly to maintain their future effectiveness.

There’s a broad range of understanding of the term ‘AMS’. Nurses are often asked “what is AMS?” Or “what can we do when our doctor prescribes antibiotics?”

Despite the huge amount of research and promotion, the term remains unclear. Aged care nurses need to know that they play a pivotal and significant role in antimicrobial stewardship. In an environment where infection prevention education is often underfunded, it’s crucial to acknowledge and fully support this.

Aged Care Facilities can be largely managed by Healthcare Workers, we need to address that roles in AMS can often be limited by scope of practice. Additionally, nurses may feel limited in their ability to contribute to AMS due to their limited role in prescribing. This disparity is due to the distinction that exists between the GP’s role in prescribing and the nurse’s role in administering medication.

Doctors and pharmacists have traditionally been responsible for Antimicrobial Stewardship.

Despite studies showing that stewardship requires a multidisciplinary approach, the role of nurses is seldom acknowledged.

Nursing plays a unique role in resident care by being present at every stage of a resident’s journey. Nurses and Healthcare Workers are, therefore, ideally placed to contribute to AMS.

 

It is, therefore, vital to know how nurses perceive their own role in AMS, so that AMS programmes can be adapted to maximise nurses’ contributions.

The most effective AMS programs require a multidisciplinary approach that includes improving clinical practice, educating healthcare workers and residents, monitoring antimicrobial use, and implementing government policies. Antimicrobial resistance can be minimised with AMS, leading to fewer infections, reduced resident mortality and, in the long run, lower healthcare costs.

Nurses, when aware of their role, take part in Antimicrobial Stewardship and are eager to contribute. Nurses are also keen to work together in partnership to achieve this. To get such participation, nurses must feel confident about raising concerns. As a nurse, speaking up is an essential part of keeping residents safe.

It’s common for nurses and healthcare workers to be hesitant to speak out of fear they won’t be taken seriously. In addition, they may want to be part of the team and not be labelled a troublemaker. Nurses are hesitant to ask antibiotic prescribers questions because challenging prescribing practices will often not be well received, and challenging prescribing decisions is not a consideration.

Practices such as nurses not being included on GP rounds, or their opinions not being proactively sought, validate the perception of nurses’ contribution to antibiotic management practices having no value.

Nurses’ reluctance to raise concerns about AMS may be due to this culture, and research shows that some nurses are hesitant to cross what they view as a clear boundary between the nursing and medical roles.

How can we improve the role of nurses in aged care and decisions affecting residents, especially in AMS?

Nurses and Healthcare Workers who are empowered through education will be able to contribute to Antimicrobial Stewardship by educating both residents and the community. Nurses and healthcare workers need to be educated about the importance of safe and appropriate antibiotic use, including the risks and when antibiotics are not appropriate.

In nursing, we are aware of the need to tailor information to our audience’s knowledge, literacy, and language. The focus of infection prevention education has too long been on the immediate setting, but there are many advantages to including all service members, including residents and visitors. Collaboration is essential for infection prevention and AMS.

As a service, we need to improve knowledge of AMS and infection prevention by prioritising training, protecting teaching time, and ensuring members are supported.

Get your Bug control AMS Compendiums here.

Surge workforce planning resources for Covid outbreaks

Covid hits harder and faster than you think

Pandemic plans can’t articulate the resiliencies and requirements needed when you lose over 50% of the workforce. And it was actually much worse than that. I had only 8 members of the original team and not one RN. I asked more of these remaining staff than was reasonable and they all exceeded expectations in work and kindness.

I’d like to say that this experience made me stronger but in truth, it almost broke me.

Before this event hit, I had the idealistic view that the DHB would be my knight on a white horse. I thought that they would be there to save the day in this kind of situation, but I was about to be disappointed.

A Covid outbreak is unlike any other the stakes are higher, the tension is greater, and to add to this I had no staff.

My story does get better. We had a homecare company that sent a variety of healthcare workers and professionals to cover the roster. To them, I will be eternally grateful.

I started this blog by talking about my experience, but my experience was nothing compared to the challenges the homecare staff encountered as they entered an aged care facility for the first time to find us at our worst moment. We were mostly unprepared to support them for the physical and emotional work we asked of them.

Doggy-paddling in the deep end

Initially, when given our staffing package for the day, we were not given names, “6 coming this morning Cara, 4 this afternoon, 3 tonight.” The relief that there would be staff on the floor…phew. When you’re underwater and someone throws you a rope you don’t ask questions: you just grab it and hang on.

This was in no way enough staff to run a facility. Even though we had the numbers, imagine all your staff being new and no-one, no way and no time to orientate them. I needed extra staff to fill PPE trolleys, move the pallets of PPE delivered to the door daily, empty the bins, clean nightingale tables and put linen away, provide clinical governance, but there weren’t those people. I would find myself spread so thin that hours of the day would be lost in a blur of cold coffee and adrenaline rushes.

My experience lasted just over three weeks and in that time I developed a range of handwritten, reactive resources for these staff that I have converted to downloadable documents. Primarily they were created to manage the risks to staff, the facility and the resident, but I did take the opportunity to say thank you on nearly all of the documents to compensate in a small way for my inability to do this in person.

Finding our feet and meeting the team

As the days went by, I wanted to identify who the workers were and know their profession. There were a few reasons for this. As a new staff member helping that day, I believed their minimum expectation would be that we could identify them by name and be aware of their qualifications and skill level in relation to the job we were expecting them to do.

With my manager’s hat on, skill mix was a safety concern. We became that aware speech-language therapists and medical administration staff were being asked to deliver care with no experience in providing hands-on personal care to the elderly.

Secondly, I attempted (as reminded at daily meetings) to cohort staff as much as possible, even isolate dementia residents. This a huge untenable gap between gold standard and reality. But the simple logistics of no-one being there to meet the staff when they arrived was an issue. If they were lucky they might meet a Big Bird look-a-like (that’s me) as they entered the building, otherwise they were left to fend for themselves.

Outbreak resources

Welcome, are you here to help?

My first resource was the ‘Welcome, are you here to help?’ sheet. This resource was further developed to add answers to the question they all asked as they arrived: “where am I working?” and the second question was always “what is the Wi-Fi password?”.

I went on to further develop this resource to add where they could eat and that a meal was provided. In time I added the codes to cupboards with key codes and the storage etc., and most importantly who they reported to.

You can download ‘Welcome are you here to help?’ here.

Who should I talk to about this?

There was a day when I arrived and as I walked around the facility I saw PPE trolleys empty and the staff going from resident to resident wearing the same gown. AHHHH!!!

In the interest of staying calm and the old adage of seeking to understand, the staff explained that the trolleys had not been filled as all the staff were all new and they didn’t know who to ask. I realised that we needed a resource for improved communication to help new staff out and improve compliance.

This resource is a list of staff, identifying their role, cell number and two reasons why you would want to contact them. These were positioned throughout the facility with excellent results. Not only did this improve compliance, but now the workload appeared to be more evenly distributed. Staff knew who they needed to contact and for what reason, instead of just saying “I’ll ask the manager.”

You can download ‘Who can I call if I have a problem’ here.

Easy fixes for big problems

Shift planners were developed in A3 with simple instructions of what was expected on an hourly basis, guiding overwhelmed and disorientated staff. One-page care plans for resident doors were developed and joined later by a one-page “10 drinks a day chart” which the staff ticked when a resident had a drink. This sheet of paper reduced the incidence of dehydration and successfully reduced UTI symptoms.

I learned that the essential focus in a crisis is to recognise the impact uncertainty has on the people you rely on to provide day-to-day care. In these times, empathy and compassion for the staff and residents was my focus. As a manager, my job was to help them do their jobs. The resources I made and tested are now available for all who would like to download from our website.

I also recommend that you download the Australian Government’s first 24-hour checklist.

Don’t get me wrong, there was a lot I would do differently given the chance. I admit I didn’t get it right in many areas, but these resources really worked, and as the days and weeks went by it got easier. The best advice is to be ready. Prepare all outbreak resources ahead of time. And as a thank you for reaching the end, if I can offer any last pockets of wisdom: label all doors that are not identified as a resident’s room. This is instant orientation for all who enter the building.

Cara Kelly is Bug Control New Zealand’s Senior Consultant. Having managed a COVID outbreak, she is keen to help facilities in New Zealand reduce infections and better manage outbreaks. Bug Control have been working tirelessly to support IP Leads in Australia and New Zealand with their new roles. If you want to see what we’re up to, sign up for a free one-month trial of our IPC Lead Program.

You can also sign up for our newsletter for free fortnightly infection prevention and control news and information.

Delivering effective infection control training for aged care volunteers

In early 2022, the Australian Government announced their Re-Engaging Volunteers into Residential Aged Care Facilities Program. Created in response to Covid and the Royal Commission, the program offers support to facilities that want to engage volunteers to help.

However, we can’t just let our volunteers wander in and start ‘helping out’ – no, they need to have basic skills in workplace health and safety, especially infection control training. So how do we do this?

Government infection control training for volunteers

The Australian Government Department of Health have made free online training modules available. They encourage all staff, including volunteers, to maintain their IPC skills by completing these training modules. This is great for staff and volunteers who are computer literate, but for those who find computers daunting, we need another way of training them in IPC.

Delivering face-to-face education for volunteers

IPC training really needs to be face-to-face, especially for those staff and volunteers with English as a second language, or whose computer skills are very limited. So how do we provide this face-to-face IPC training, and what are the IPC essentials that are a must-know?

I have some ideas! Your volunteers could join your facility’s IPC training days and learn about the chain of infection, what standard precautions are and how these are implemented in the workplace. But this doesn’t need to be a comprehensive education session, it would just need to emphasise the relevant activities, such as when and how to perform hand hygiene (including practicing this), as well as when to wear PPE and how to don and doff!

You could also discuss good respiratory hygiene and cough etiquette, and explain what a blood or body fluid exposure is, and how volunteers can protect themselves from bloodborne pathogen exposure. You could also touch on the safe handling and disposal of waste, and probably the basics of cleaning and disinfecting.

Infection control education for families

Your education program could extend to educate families as well as volunteers about transmission-based precautions. This will include another explanation about the chain of infection and how transmission of infection occurs, that is via contact, droplet and airborne routes. We need to teach them what precautions are in place at the time, and why they have been implemented, and how to protect themselves. A greater understanding of how these precautions keep them safe will hopefully lead to better compliance and a safer facility!

Tips for effective volunteer education

  • Keep material simple. Focus on volunteer safety and what they need to do to stay safe. Don’t get bogged down in theory.
  • Test their understanding in the education session. Ask them to demonstrate what you’ve just told them (so for hand hygiene, ask them to show you how they wash their hands).
  • Develop resources that they can take home or look at later, like a printed handout. It should make sense to someone who is seeing it for the first time, and not rely on information from the education session.

Keep knowledge fresh by refreshing

We all know that training once is not enough. Ideally refresher training should be offered every three months. However, everyone is time-poor, so developing information sheets on the basics of infection control and how to protect yourself with standard and transmission-based precautions would be helpful resources to leave around the place.

You may find that the government training resources are more than enough for your volunteer workforce. You may struggle to find training that explains enough and sticks. However the training is developed and delivered, what’s important is that we actually do it. Our volunteers and families are an important extension of our workforce, and they need to be trained, prepared and kept safe.

Bug Control know how hard it is to keep on top of infection control in aged care at the moment. If you want training material for your staff developed especially for aged care, sign up for Bug Control Membership today. Our online IPC education platform keeps track of staff training completion so that you don’t have to.

Managing the first 24 hours of a COVID outbreak: the next 23 hours

The Bug Control team thought that we’d expand a little on the major steps to help you anticipate the difficulties you might face while trying to manage a COVID outbreak.

Disclaimer: The order of tasks over the next 23 hours needs to be in line with your facility’s procedures.

1. Contact trace affected staff and residents and check vaccination status

You need to know who was potentially exposed to the affected resident and/or staff members, so contract tracing is crucial.

2. Arrange for staff and resident testing

The PHU will advise you so don’t jump ahead if you are unsure. They will also advise whether testing will be via RAT or PCR.

3. Have your first Outbreak Management Team (OMT) meeting

Your staff meetings and the Outbreak Management Meeting are separate although the information will be shared from both meetings. You will potentially feel overwhelmed with the tasks needed to be completed but this is an essential meeting to guide you through this outbreak, and especially the first 24 hours.

Take the relevant documents and information you have gathered and the checklist to help you organise your thoughts and ask the questions you need answers to.

4. Plan your staff roster

Once you have an idea of the potential impact of Covid in your facility, you can start planning staff rostering. Review your workforce management plan and make sure you are using your workforce as efficiently as possible. Consider options such as using furloughed staff and volunteers to relieve duties from the onsite staff or to run errands. If you can’t safely cover the roster, you will need to escalate.

5. Activate your communication plan

Your OMP should have a communication plan. You will need to notify the local PHU and Commonwealth Department of Health to meet your obligations and access government support. You may also need to report positive cases to WorkSafe. A strong communication plan and timely execution will have a direct effect on the high volume of calls and media contact – if people feel informed, they are less likely to call for reassurance.

6. Maintain and organise leadership structure for continuity of care (IPC lead)

Your OMP should specify the command-based governance structure to be implemented during an outbreak. Senior leadership should be onsite at all times, and there should be comprehensive handover information that is suitable for shift changes and relief staff.

7. Maintain prior care routines and social contact

Feelings of disconnection and uncertainty can have a direct impact on resident health. It’s crucial that as much normality is maintained as possible, where staffing levels allow. Social contact should continue where possible, and use technology facetime, zoom to make contact more accessible.

8. Cohort and zone

Saying this is easy, but doing it presents a variety of struggles. Cohorting with reduced staffing is difficult. It’s hard enough to move the resident and all their belongings when you don’t have the manpower, but you also need to reduce anguish and confusion for an already compromised resident. This is a situation you need to address at the time with the support of the Outbreak Management Team and PHU.

9. Improve PPE and environmental cleaning

The environment is an important part of infection control management. Cleaning needs to be increased in line with your OMP. Cleaning staff also need to cohort, so remember there may be further training required for staff who are covering for others or who are new to the facility. Make sure the staff and the cleaning staff are aware of their roles and responsibilities when it comes to cleaning isolation rooms, zones etc.

10. The rest of the facility

When managing the first 24 hours it is easy to forget that there is still a facility full of residents needing clinical governance and routine cares, meals, showers, wound care etc. Consider who can provide this and give clear instruction regarding the identification and reporting of symptoms from all residents.

Essential documents

These can be ready in advance and ready to go. A clear and simple outline of the floor plan of your facility is essential. You can also include resources to support the potential of a surge workforce, associated policies and procedures with the OMP. Having them in one place as printed copies will be an advantage.

Fatigue management

If you have a fatigue management plan refer to this and start putting actions into place. Ask the questions how much sleep they had. Was it good sleep? Managing the roster and ensuring the staff you do have are not compromised is key.

Don’t underestimate the impact on the wellbeing of the staff. We are all fighting our own war, as they say, and this event will have an effect on staff members’ resilience.

Stay up to date

As we said in the beginning, it seems information changes hour to hour so assign a staff member download the app and stay up-to-date with the changes as they happen.

Remember all good emergency advice starts with putting the oxygen mask on yourself first. Managers need a support person assigned to them for the Covid event and their hours and their wellbeing must be an equal priority.

Managing outbreaks is stressful. Having the right tools and processes in place makes a big difference. If your facility needs better processes or more infection prevention support, call Bug Control. From staff education to facility audits to comprehensive policy manuals and guides, we have a range of resources to help you stop infections.

Further reading

Don’t take our word for it. Here are some more resources so that you can be ready when COVID comes to your facility:

Managing the first 24 hours of a COVID outbreak: the first 60 minutes

Aged care has been living with tension for so long, bracing themselves for the worst and hoping for the best. Covid has brought unprecedented challenges and disproportionate threats to older people’s lives and to the relationships and wellbeing of staff and residents. The hero in this story is good infection control practices, but for those of us working in aged care, there are challenges between theory and practice as Covid outbreaks increase our acuity and decrease staffing.

We spoke to our clinical team to ask how Bug Control could help prepare facilities for COVID outbreaks. We knew there were a lot of resources out there, but they were often too particular about time frames. “Things are happening too quickly, and no one’s looking at their watch to see how long it’s been.” Being prepared is our best defence knowing and feeling confident in managing the first 24 hours to have the greatest impact on the spread and impact of the virus. Let’s talk through the steps. 

Note: This is the first in a two-part series on managing the first 24 hours of a COVID outbreak. It covers the first hour after the outbreak has been discovered. We will share the second post shortly.

With that in mind, we wanted to give you an overview of the first 24 hours of a COVID outbreak. We’ve split this into two parts: the first one is the first hour of the outbreak, and the second is for the other 23 hours.

So what should you do if there’s a COVID outbreak in your facility?

The first 30–60 minutes of a Covid outbreak

1.      Take control of the situation

You won’t necessarily be at the facility when you get the call confirming the news we all dread. To manage a potential outbreak, you may need turn your attention in seconds from children’s homework and dinner to being a blackbelt in Covid management. As there may not be a registered nurse on duty, you need to give the simplest and the clearest of instructions to whoever is at the end of the phone.

2.      Isolate, Communicate, Assess

Memorise ‘Isolate, communicate and assess’ and keep using it during the outbreak. It is the easiest way to remember what should be done, especially during those crucial first few hours.

Isolate the resident or send the staff member home. Set up the PPE trolleys and consider how to separate shared facilities e.g. use a commode for the resident if they are sharing a bathroom.

Communicate the news to the staff and start enforcing proper PPE use and staff cohorting. Communicate the news to the resident in a sensitive way that considers their cognition and attempts to allay their anxiety. Don’t forget the families! In smaller communities news spreads fast, so provide clear direction to families about contact. Inform them of what the next 24 hours will look like and tell them what direct communication they can expect. This is particularly important because getting through to the facility once the announcement is made becomes an almost impossibility.

Assess the COVID-positive resident and report this outcome to the resident’s GP for guidance. You will need to continue assessments for positive residents and also maintain regular symptom checks of other non–COVID positive residents as per your procedures.

3.      Take a deep breath – you did it!

Look at you go!

The situation has been stabilised. Contact your line manager or as your OMP directs then get yourself to the facility. This is where a telephone box and a cape would come in handy.

The first hour of an outbreak is your first real opportunity to take charge of the situation. The steps you take when you first discover Covid in your facility can greatly minimise the difficulties you experience in the future. Establishing cool and collected leadership in the most panicky moments will help set a calmer, more orderly mood.

Tune in next week for our blog on managing the next 23 hours of a COVID outbreak.

If you can’t wait, here are some resources for you right now:

Influenza vaccinations: What you need to know in 2022

Firstly, a bit about ‘the flu’. Flu (influenza) is a highly contagious disease, caused by the influenza virus. Each year The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) closely monitor flu patterns within the general population. There are many different strains, and they can change every year, which is why the flu vaccine is ‘tweaked’ annually to combat the dominant strain.  

Flu vaccine myths debunked:

Flu is not the same as a common cold

The flu and the common cold are not the same thing. There are a number of infections that can present as a common cold, but influenza is only caused by the influenza virus. The flu is serious as it can lead to other, often life-threatening, conditions such as pneumonia, bronchitis, heart and other organ damage, croup and even death. While flu deaths were at a record low for 2021, this was largely because of social distancing measures and increased infection control in the community. In 2019 there were nearly 1000 deaths in Australia due to the flu, and 1100 in 2017. These are very good reasons why we need to have the flu vaccine.

The flu vaccine will not give you the flu

Getting the flu vaccine will not give you the flu. The flu vaccines contain dead or inactive strains of influenza A and influenza B viruses. Because these flu strains are dead, it’s impossible for the flu shot to give you the flu.

Influenza vaccines are prepared from purified inactivated influenza virus that has been cultivated in embryonated hens’ eggs (standard influenza vaccines and adjuvated influenza vaccine) and propagated in Madi-Darby canine kidney (MDCK) cells (cell-based influenza vaccine) 
https://www.ncirs.org.au/sites/default/files/2022-03/Influenza%20vaccines-FAQs_update_March%202022_Final.pdf

Influenza vaccination in 2022

The Australian Technical Advisory Group on Immunisation (ATAGI) advised through The Australian Immunisation Handbook: “All people aged 6 months and over are recommended to receive influenza vaccine every year. Under the NIP schedule flu vaccines are free for certain vulnerable groups.” But that shouldn’t deter those who are not included under the NIP from getting the flu vaccine.

Co-administration with COVID-19 vaccinations

ATAGI stated in a 2022 influenza update that, “During the COVID-19 pandemic, there has been a reduced circulation of influenza virus and lower levels of influenza vaccine coverage compared with previous years. With borders reopening, a resurgence of influenza is expected in 2022.” In the same statement they also stated, “All COVID-19 vaccines can be co-administered (given on the same day) with an influenza vaccine.”

Flu vaccine contraindications and precautions

According to the Australian Immunisation Handbook, “The only absolute contraindications to influenza vaccines are anaphylaxis after a previous dose of any influenza vaccine, and anaphylaxis after any component of an influenza vaccine.” As for the egg-based influenza vaccines used in the National Immunisation Program (NIP), they only contain minute traces of egg protein. As such, people with an egg allergy can be safely vaccinated against influenza, but this should be discussed first with their immunisation provider.

So, when the new season influenza vaccines are available, which is expected to be from April, don’t dilly-dally around, book in and get your flu jab! Help keep us all safe from getting influenza!

But wait, there’s more! While everything above is important, so is how the flu vaccine is stored. 

Vaccine storage for the 2022 flu season

Many facilities will soon be ordering influenza vaccines and organising vaccine programs for staff and residents. When you’re planning your storage and distribution, remember to Strive for 5.

Strive for 5

Correct vaccine storage and handling has been an important factor in preventing and eradicating many common vaccine-preventable diseases. Yet, each year, storage and handling errors result in revaccination of many clients and significant financial loss because of wasted vaccines. Failure to store and handle vaccines properly can reduce vaccine potency, resulting in inadequate immune responses in clients and poor protection against disease. Clients can lose confidence in vaccines and immunisation service providers if they have to be revaccinated after receiving vaccines that may have been compromised.Excerpt Strive for 5 Guidelines

From the DOH vaccination information website:

The Vaccine Storage Guidelines ‘Strive for 5’ provide information and advice for vaccine storage management for Australian immunisation service providers, from medical practices to large hospitals, clinics and outreach providers.

‘Strive for 5’ refers to 5°C – that is, the point midway between +2°C and +8°C – the temperature range recommended for vaccine storage. Many vaccines are damaged or destroyed at temperatures outside this range.

These guidelines:

  • describe the best approach to ensure that clients receive effective and potent vaccines
  • describe the ‘cold chain’ and provide advice on what should be done in the event of a cold chain breach
  • include resources such as checklists, charts, posters and stickers.

Not sure of where to find information to ready yourself for the upcoming vaccination season? This resource is all you will need.

It’s important to ensure that vaccines are stored properly to ensure their effectiveness. By doing your part and checking your current arrangements, you’ll be making everything much easier for yourself in the future.

The flu is a seasonal illness that we’re not ready for this year. With borders reopening and people beginning to mix more in the community, it’s inevitable that aged care will be impacted by flu. The last thing anyone wants is a flu outbreak in 2022. Is your IPC Lead ready for the flu season? Is your facility? Support your IPC Lead with our IPC Lead Coaching Program – there’s a one-month free trial waiting for them.

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Laundry staff infection control: are you doing enough?

But even after the facility and room designing is complete, there is still plenty of work to be done. Not least of all, your laundry staff need to be equipped to do their job properly.

This is important because there are standards that dictate laundry requirements. Your facility’s laundry policies and procedures must meet the requirements outlined in the standards. If you use an external laundry service, they must meet these standards as well. Laundry staff infection control starts with the Standard, but it doesn’t stop there.

Laundry Standards in Australia and New Zealand

Healthcare facilities must have documented policies on the collection, transport, and storage of linen. Healthcare facilities that process or launder linen must have documented operating policies consistent with Standard AS/NZS 4146:2000.HMRC Australian Guidelines for the Prevention and Control of Infection in Healthcare, 2019

This means, among other things, that there must be a documented environmental cleaning procedure for the laundry staff, and they must be provided with education on infection prevention and control. Another standard that you could consult when developing and reviewing your policies is AS/NZS 4146:2000 ‘Codes of Practice for Public Healthcare Operated Laundries and Linen Services 2012’.

Bug Control has a Laundry Guide to help your facility establish proper, compliant laundry services. It’s available as a physical resource for an online resource accessible 24/7. Compliance has never been easier!

What do my laundry staff need to manage infection control?

1.      Laundry staff education

All laundry staff need infection control education. This should include performing effective hand hygiene, education on the correct use of PPE and how to don and doff in the correct order to avoid contamination. They also need education on breaking the chain of infection and how to prevent the spread of micro-organisms in the environment to cleaned linen and to themselves.

Laundry staff must also be educated on the safe and effective use of the machines being used for laundry (i.e. washers and dryers) as well as the appropriate chemicals and handling processes. They should also have education on the safe use of the relevant chemicals, as well as first aid related to those chemicals.

Bug Control’s Laundry Flip Chart has been specially developed to make laundry policies easy to find and follow.

2.      A written laundry policy

The Standard mentioned above specifies that there must be a documented environmental cleaning procedure for the laundry staff, and they must be provided with education on infection prevention and control. The policy should cover effective and safe collection/sorting, washing, drying and finishing. This includes allocating zones and specifying how laundry is to be moved through those zones as it is processed. These policies and processes will need to be unique to your facility and take into consideration the particular needs and limitations of your set-up.

3.      Appropriate equipment

Laundry involves some specialised equipment. First and foremost is the equipment used for washing and drying. Washing machines either thermally disinfect or chemically disinfect linen. The washing machines must be industrial grade in order to effectively remove dirt, contaminants and destroy harmful micro-organisms.

To be effective, thermal disinfection requires that linen be washed at a minimum of 65°C for not less than 10 minutes, or a minimum of 71°C for not less than three minutes. Thermal washing machines must be compliant with AS/NSZ 4146. Facilities using chemical disinfection washers should ensure that the correct chemicals are being used for their machine. Regardless of the machine type, the right kind and the right amount of detergent need to be used, as well as the right cycle for the washing to be effective in destroying harmful micro-organisms.

The laundry should also contain infection control and safety equipment, such as appropriate PPE and a sharps container to dispose of items left in laundry. Often needles and razor blades can be dropped into gathered linen, so ensuring laundry staff can safely dispose of them is important.

4.      Appropriate PPE

Laundry staff must wear appropriate PPE, including disposable gloves or heavy-duty gloves that are washed every day, as well as disposable oversleeve protectors. They must also wear plastic aprons when handling soiled linen and clothing. If possible, staff could also bring in a change of clothes so they don’t wear their work clothes home. This adds another layer of protection for your laundry staff and their households.

5.      Appropriate chemicals

The laundry must contain the necessary chemicals for processing laundry, as well as safety data sheets for those chemicals. These should be kept in an accessible location and staff should be told where they are so that they can be accessed.

Correct laundry procedures are vital to infection control in aged care facilities. Ensuring that your facility meets and upholds laundry hygiene standards is crucial for the health of the residents, staff and visitors. Proper handling of linen shows that residents are being well looked after.

Laundry was February’s topic for our IPC Lead Coaching Program. If you are interested in supporting your IPC lead or improving infection control in your facility, sign up for a free one-month trial of our IPC Lead Coaching Program today.

Cloth masks vs. surgical masks

How we got here

When COVID-19 first struck in early 2020, mask advice came strong and early. There were public health campaigns that explained the importance of wearing masks, and wearing them properly. Instructions and patterns were circulated online so that creative folk could make their own.

PPE availability played a large part in the use of homemade or cloth masks for the general public. Shortages across the world meant that any clinical standard PPE had to be stockpiled for use in a clinical setting. Because of this, surgical masks, which have since become ubiquitous, were not generally available to the public.

Unfortunately, a less stringent standard generally results in lower quality across the board. Remember testing cloth masks by trying to blow a candle out while having the mask on? If not, you’re not alone. In an article by the OzSAGE Community Mask Working Group, “… the basic cloth and surgical masks which most Australians use, whilst somewhat effective at protecting others from an infected wearer (‘source control’), are varied in quality and are not effective at adequately protecting the wearer. The filtration effectiveness of cloth masks is generally lower than that of surgical masks, and surgical masks have poor fit.”

So while cloth masks are less effective than surgical masks, at a time where any mouth and nose covering was beneficial, it made sense to compromise.

Public health advice vs. clinical standards

As clinicians, you are no doubt aware that cloth and surgical masks and N95 masks are tools in different strategies. While cloth masks aim to reduce the amount of infectious material that the wearer is putting out into the air, N95 masks filter the air the wearer is breathing, which helps to protect them from breathing infectious material from other people. N95 masks are also more expensive and require a proper fitting process to ensure that they are effective.

Knowing then that N95s are the best masks for personal safety, but that most people won’t wear them, what should the community be wearing in 2022?

In a The Guardian article in January 2022, Dr Katrina Powers, an occupational health physician in Western Australia, said, “It’s very important that with Omicron – it’s just so transmissible – that people wear the best quality mask they can. Cloth masks are not enough: there are either not enough layers to filter out the viral particles or the weave is too loose.”

Hassan Vally, an associate professor in epidemiology at Deakin University, said studies on previous Covid variants show that an N95 mask is better than a surgical mask, which is better than a cloth mask: “If you’re in a higher risk situation, you want to be wearing the best mask you possibly can,” he said.

Prof Malcom Sim believes P2 class respirators are less useful for the general public than in specific workplace settings such as hospitals. “They’re not designed for general use out in the community,” he said. “You need to be trained in how to use them, they need to be fit tested for them to perform at their proper level of protection, and they’re not really designed for taking on…and off.”

Where do we go from here?

A 2021 technical report by the European Centre for Disease Prevention and Control stated, “The evidence regarding the effectiveness of medical face masks for the prevention of COVID-19 is limited, face masks should be considered as a non-pharmaceutical intervention in combination with other measures as part of efforts to control COVID-19 pandemic.” The conclusion from this study is that masks should be used in public settings but are an intervention that should be used in combination with other measures. It goes on to start that “when non-medical face masks are use, it is advisable that masks that comply with available guidelines for filtration efficacy and breathability are preferred.”

It is clear that P2/N95 respirators are not recommended for use in the community, but surprisingly the preference between cloth mask and surgical masks really boils down to personal choice. While surgical masks are more likely to be effective than cloth masks, what’s more important is appropriate construction of the mask, and proper usage. A surgical mask isn’t helping anyone if it’s under their nose! And, it needs to be said, that the use of face masks, whichever you choose to wear, should complement other preventive measures such as physical distancing, staying home when ill, working from home if possible, good respiratory etiquette, meticulous hand hygiene and no touching the face, eyes, nose or mouth.

Are you struggling to stay on top of infection control news for Australia? Sign up for Bug Control’s free infection control newsletter, bringing interesting stories about infection control in aged care to your inbox fortnightly.

Omicron in aged care: what you need to know

Working through crises is nothing new for most people in healthcare, but Omicron’s impact is hard to ignore. For aged care facilities, it feels like ‘when’ not ‘if’ there will be an outbreak. This means we must ensure we’re prepared for when it happens.

A brief history of SARS-CoV-2

Since the COVID-19 outbreak began in 2020, there have been five major variants declared by the WHO: Alpha, Beta, Gamma, Delta and the most recent, Omicron. Omicron was first reported in South Africa on 24 November 2021 and has quickly spread across the world. It spreads far more readily than previous variants, but typically presents with less severe symptoms. While this might sound like a positive, unfortunately it’s not that simple.

Isn’t Omicron milder than previous variants?

If Omicron is so much milder, you might be wondering why everything is in such a state of disarray. Just because a disease is less severe, it doesn’t mean that it’s nothing to worry about. While Omicron is milder than the Delta variant, it is still a dangerous virus that can significantly impact people.

Omicron still has the full spectrum of Covid presentation, from asymptomatic infection all the way through to severe disease and death. While more people are likely to have a milder infection with Omicron, the fact that so many more people have been infected increases the number of severe cases in the community. We have learned that people with underlying conditions, people with advanced age and people who are unvaccinated can have a severe form of COVID-19 from Omicron infection. While Omicron is typically milder, people are more likely to catch it and less likely to know when they have it. This means that they are mingling in the community and spreading it to others, who then spread it to others. Eventually these infections make their way into vulnerable populations, where there is a higher chance of serious consequences.

What does Omicron look like?

While most of you will be tested regularly with RATs to determine whether you have Covid, there are still some symptoms to look out for.

The initial symptoms linked with Covid, such as the loss of taste and fever, are less common in the Delta and Omicron variants. The Delta variant caused cold-like symptoms: runny nose, sore throat and persistent sneezing, along with headache and cough, particularly in people who had been vaccinated. Unvaccinated people generally had more severe symptoms. Omicron appears to be continuing the trend set by Delta. Its symptoms are much more like a regular cold, particularly in people who’ve been vaccinated, and  it’s causing fewer general systemic symptoms, such as nausea, muscle pains, diarrhoea and skin rashes.

Most of the general public will still be looking for the original Covid symptoms (like loss of taste) and may be ignoring Omicron symptoms as ‘just a cold’. Because of this, it’s important that staff in your facility know the symptoms for the current variants and act accordingly.

Managing an Omicron outbreak

When managing an Omicron coronavirus outbreak, the principles are the same as an influenza outbreak or any other outbreak situation. The key focus areas here should be preparedness and completeness.

Make sure that your COVID outbreak plan is up-to-date and appropriate for your facility. Every facility’s outbreak plan (COVID or otherwise) will be different, but it should reflect the needs of your facility. It should be reviewed frequently to ensure it incorporates the latest COVID management information from your state or national health departments.

Once you are sure that your plan is current and comprehensive, it’s crucial that staff know what it is and where they can find the information they need. Do your staff know where to access your plan? Can they access the materials the plan references (such as PPE and contact information for reporting purposes)? If you have the capacity, a mock outbreak drill will let you see where the gaps are. An outbreak should not be the first time you test your outbreak plan!

Above all, it’s crucial not to panic. While an Omicron outbreak is not ideal, aged care facilities are no strangers to outbreaks. The key to controlling and overcoming them is ensuring the proper steps are taken by everyone involved. Calm management is the only way.

As the Omicron variant is so transmissible, as soon as a person is thought to have COVID of any description, the person must be isolated and outbreak management strategies immediately put into place. It is better to be safe rather than sorry!

If you’re looking for help with Covid outbreak management, you can download our free Covid outbreak checklist here. If you stay ready, you don’t need to get ready.

If you’re looking for help with infection control or omicron in aged care, you can sign up for our free IPC newsletter or contact us with your IPC queries. With clinical staff with Covid outbreak experience, we’re here to help.

Cleaning in community health services: the most common mistake

Before we give you the simplest tip. we have to improve your cleaning and disinfection, we need to give a quick refresher on cleaning and disinfection.

Why is it important to clean and disinfect?

Viruses, like coronavirus and influenza viruses, can land on any surface, and it is possible for people to become infected if they touch those surfaces then touch their nose, mouth or eyes.

The most reliable and effective way to prevent infections is to frequently perform hand hygiene with ABHR or soap and water. But forgetting hand hygiene is less problematic if environmental surfaces are free of pathogens that can spread infection. This makes environmental cleaning and disinfecting the next big-ticket item for preventing the spread of disease.

Now that we know that cleaning is vital to stop infections, the next question is when to clean and when to disinfect!

Why do we clean?

We can reduce the germs on a surface by cleaning it with products that contain soap or detergent. This removes the contaminants that host the germs, which decreases the risk of pathogen transmission. If there are no known or suspected infections in the service, then routine cleaning once a day with detergent and water is all that is required for most surfaces.

When drawing up a cleaning schedule, you should determine what needs to be cleaned, the type of surface it is, and how often it needs to be cleaned. Frequently touched surfaces will need to be cleaned more often than once a day. This includes things like door handles/knobs, phones, light switches, computer keyboards, tablets, TV remote controls, hand railings, sinks and faucets etc.

Cleaning and disinfecting frequency in the community health or disability service will depend on whether there is an active infection risk. If there is a known infection in the facility (i.e. someone is known to be unwell), then cleaning frequency for all surfaces should be increased. If you have a query about cleaning frequencies in a community health or disability service setting, please contact Bug Control for advice.

Any staff undertaking cleaning in community health settings must be trained in the proper use of both cleaning and disinfecting products and the difference between them.

When should we disinfect?

Okay, so we have the cleaning sorted, what about disinfecting?

Disinfection is undertaken when there is a known or suspected infection. Disinfection is easy to do, but we often get it wrong. This is mostly because people are in a hurry and want to get the job done so they can move on to the next task.

The disinfection process is:

  1. Clean the surfaces with detergent and water to remove actual contaminants
  2. Allow them to dry
  3. Apply a disinfectant following the directions for use
  4. Allow the disinfectant to dry fully.

Note that cleaning is part of disinfection. Disinfection is ineffective if the surface is not cleaned first. Following these steps ensures that the disinfectant has the proper time and contact with the surface to kill the germs it is there to kill.

The most common mistake and how you can stop making it

Now that you know how to clean and how to disinfect properly, you might think you’re ready to go. But wait! There’s one more thing.

You might think that the products you have are right for the job. Unfortunately, that’s often more about clever product advertising rather than anything scientific. Lots of products state they will kill 99.9 % of germs, but what type of germs? And are those the germs that you’re trying to get rid of? Just because a product gets rid of one type of germ, it doesn’t mean it gets rid of all germs. An antibacterial is not the same as a disinfectant!

I’m going to give an example, because I have seen this product being used in many houses as part of their COVID cleaning protocol. I have seen antibacterial disinfectant wipes used to do touch point COVID disinfecting! What is wrong with this? Simple, COVID is a virus and these wipes are antibacterial, so they are totally ineffective against any virus. Another one is antibacterial surface sprays. Some claim they can kill COVID-19, but again they’re antibacterial. While they might kill 99.99% of germs, they can’t touch Covid (or influenza), as it is a virus. You would be better off cleaning these surfaces with a detergent or soap to physically remove the virus particles than using these sprays.

Hopefully this has dispelled the myth of disinfectants being able to clean and the importance of physically cleaning with detergent and water. Antibacterial cleaning products are no better at eliminating bacteria and viruses than plain old detergents and warm water, which is applied using a good bit of elbow grease to physically remove the grime, rinsed, then left to air dry.

With this one tip, you’ll improve cleaning in your community health service and reduce the risk of spreading infections.

If you’re looking for help with improving cleaning and infection control in your community health or disability service, contact Bug Control today. With over twenty-five years of experience in infection control, we know how to get you back on track.

Correction: A previous version of this article mistakenly referred to a ‘disinfectant spray’ when it should have read ‘antibacterial spray’. This has now been fixed.