EBOS Healthcare Carelines Newsletter - Vital Med · 4 EBOS Healthcare Aged Care Division. For more information please Phone: 1800 269 534 or Email: [email protected] Conference

PEOPLE CARING FOR PEOPLE

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Issue # 4

EBOS HealthcareAged Care DivisionFree call: 1800 269 534 Free fax: 1800 810 257Email: [email protected]

November 2012

Save the environment, sign up to receive this newsletter via email. Visit: www.eboshealthcare.com.au

EBOS NEWS + CONFERENCESPage 3

NEW!Flavour Creations, Page 7Whiteley Super Concentrates, Page 8

Malnutrition in the Older Adult by Abbot NutritionPage 4

The Importance of Hydration in the Enterally Fed Patient Page 10

2 EBOS Healthcare Aged Care Division. For more information please Phone: 1800 269 534 or Email: [email protected]

To the FIRST BIRTHDAY issue of Carelines!

Yes, the newsletter everyone looks to for industry news and product updates is one year old this month.

We are celebrating by sending you our biggest issue yet and as usual it is full of relevant information and features.

Our lead feature this issue takes a good look at malnutrition and its causes in an ageing population. Great reading also on the importance of hydration, as well as a very comprehensive coverage of skin and wound care and infection control.

Take a look at the new Instant Thick product from Flavour Creations and the Super Concentrate range of Whiteley Cleaning Systems as well as all the other great products featured in our bumper Birthday issue.

A couple of reminders on how to get in touch with us:

• The latest issue of Carelines is now available in the news section of our corporate website www.eboshealthcare.com.au

• Our new online ordering system www.ebosonline.com.au has grown to contain over 7,000 products across all the product categories you need every day for your facility. Make sure to visit the website, browse the product range and register to order online – it’s quick and easy!

• We value your feedback and love to hear from you: if you want to send any comment or suggestion on what you would like to see next in Carelines just email us at [email protected]

Cheers,

The Aged Care Team @ EBOS Healthcare

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National Account ManagerDebbie Greenaway0400 424 [email protected]

Key Account Manager NSWElizabeth Conridge 0419 612 [email protected]

Key Account Manager VICCarolyn Knight 0411 542 [email protected]

Key Account Manager SAJanet Pitts 0416 130 [email protected]

Key Account Manager QLDLarissa Mueller0417 524 [email protected]

Key Account Manager QLDFiona Carey0414 486 [email protected]

Key Account Manager TASPattie Reptik 0419 377 [email protected]

Key Account Manager WACherie Baxter 0405 502 [email protected]

Key Account Manager QLDFiona Carey0414 486 [email protected]

Key Account Manager SAJanet Pitts 0416 130 [email protected]



Key Account Manager QLDLarissa Mueller0417 524 [email protected]

Key Account Manager QLD

[email protected]

Our Aged Care Team

page 3What’s making news at EBOS,In the spotlight

page 4Conference Update,Malnutrition in the Older Adult - Abbot Nutrition

page 8 Introducing Whiteley’s NEW Super Concentrates

page 10The Importance of Hydration in the Enterally Fed Patient

page 12Skincare - Why is it so important to us all

page 14DuoDERM® Dressings

page 16 The ACIPC 7th Biennial Conference

page 19 Hand Sanitising - Why Foam is Better than Gel?

page 20A Brief Look at Infection in Aged Care Homes - Washcloth Extra

page 22Melbourne Royal Children’s Hospital - A comparison of the efficacy of cleaning products on multi resistant organisms

2 EBOS Healthcare Aged Care Division. For more information please Phone: 1800 269 534 or Email: [email protected] www.eboshealthcare.com.au 3



Carolyn Knight, VICTORIA

What is one of your favorite quotes? Live long and prosper (I am a bit of a sci fi fan).

What chore do you absolutely hate doing? Folding and putting away the washing.

If you won the lottery what is the first thing you would do? Buy a champion racehorse for all of my friends and family to share.

What do you miss most about being a kid? Playing barbies .

Have you ever broken any bones, if so how? Never, or even had a stitch.

Have you ever lived in another country? No

If you had to change your name what would you change it to? I am not sure, maybe Carolyn Clooney.

Name one thing not many people know about you? I hate chocolate and I love reality TV (although I pretend not to).

Whats your favorite song of all time? Rhiannon – Stevie Nicks.

What is your computer screen wallpaper at the moment? My son and my niece on a train.

Who inspires you? My mum and my sister – they have great senses of humour and always see the good in everything.

What is your favorite time of day/day of the week/month of the year? I love spring in Melbourne warm weather and the start of the racing carnival.

If you could invite anyone at your dinner party who would it be? The Real Housewives of Beverley Hills.

If you could choose anyone, who would you pick as your mentor? Madonna – I like the way she is tough and successful and ageless.

If you could witness any event past, present or future, what would it be? In the future I would love to see my champion racehorse that I bought when I won lotto win the Melbourne Cup.

What would you name the autobiography of your life? No Regrets.

Improved Efficiencies A big welcome goes out to Emma Blake who this month has transferred within EBOS to take on an important support role within the Aged Care Division. Emma has a successful track record in both co-ordination and customer assistance and will support our National Account Manager, Debbie Greenaway as the business expands.

AGED CARE DIVISONPEOPLE CARING FOR PEOPLE

EBOS is Australasia’s largest and most experienced provider of medical supplies.

With 5 divisions specialising in different sectors of the healthcare industry, our divisional teams can customize their service to meet the expectations of each market sector.

Our Aged Care Division has dedicated sales and customer service teams with many years of experience in the industry. The team is committed to providing their clients with the most professional and responsive service levels.

We meet all product and service requirements across all Aged Care product categories and offer complete supply chain solutions – and because we supply across many healthcare sectors we can deliver all this in a most cost efficient manner due to our significant economies of scale.

If you want to know more about us….

>> Visit our corporate website eboshealthcare.com.au to see our products and specials, and download the previous issues of Carelines.

>> Go to ebosonline.com.au to browse over 7,000 products that you can order online in a couple of simple clicks. It’s our fast and convenient online ordering system!

Emma Blake, Sales Support Aged Care Division.

The Aged Care Industry has lost two great advocates in the last month:

Mrs Susan Foote, Head of Purchasing, BUPA Care Services Mr William Kennedy, Founder of Kennedy Health Care,1969

Our sympathies to all.

CARELINES ISSUE #4


Conference UpdateIt was a hot quarter for Industry Conferences since our last update in July. The EBOS Aged Care team has been very busy extending their knowledge on the changing needs of our industry and networking with all our Clients at the NIMAC Conference (QLD, July) and LASA Congress (Perth, October).

Coming up in the new year:

Queensland Age Services Conference (LASA Queensland).

From 20 March 2013 8:00 am To 23 March 2013 4:00 am at the Jupiters Hotel – Broadbeach Island, Gold Coast QLD 4218

Melbourne Carex 2013, ‘Australia’s Premier Health, Aged & Disability Services Expo’ April 17 & 18, 2013 at Main Grandstand, Caulfield Racecourse. Attendance is free.

The older Australians are a rapidly growing and diverse segment of the population, with those aged 65 years or more accounting for approximately 13% of the Australian population in 20071.

A satisfactory nutritional status is of paramount importance in establishing quality of life and positive aging in older people. However, malnutrition is a major problem amongst this population group. While estimates of its prevalence vary, protein-energy malnutrition has been reported to be present in 20-50% of hospitalised patients2-4 and 32-72% of residents in aged care facilities3,5. These results are consistent with other recent studies conducted both within Australia and internationally. While protein-energy malnutrition is extremely common in older adults, it is often referred to as the “skeleton in the closet”, as it is

overlooked, undiagnosed and under-treated.

Causes and consequences of malnutritionThe causes of malnutrition in the older adult are multi-factorial and may be divided into medical, physiological, socioeconomic and psychological conditions (Table 1). Malnutrition occurs where dietary intake is insufficient to meet nutritional requirements (the latter of which will be increased during illness or metabolic stress), increased nutrient losses, poor nutrient absorption or a combination of these factors.

Food intake naturally declines with age, heralding the onset of what has been called a “physiological anorexia of aging”6. Such a decline in food intake, coupled with the characteristic loss of lean body mass (sarcopenia) associated with age leaves the older adult at nutritional risk when psychological or

physical disease processes come into play.

The consequences of malnutrition can be profound, and affect every organ system. Involuntary weight loss with sarcopenia and loss of subcutaneous fat leads to decreased muscle strength, mobility and impaired immune function. Increased susceptibility to infection, delayed wound healing and pressure sores ensue, leading to increased risk of clinical complications and mortality2,4,5. Studies have shown that older patients with malnutrition on average have 65% more GP visits, 80% more likely to be admitted to hospital, have between 20-70% longer hospital stays than a well nourished patient7. Such outcomes greatly compromise quality of life and increase dependency and the need for long-term care, as well as imposing a high economic burden. >>

Malnutrition in the Older AdultBy Sarah Donnelly, Dietitian, MINDI

Cherie Baxtor & Debbie Greenaway, National LASA 2012 Conference Perth.

Aged Care Conference Queensland.


CARELINES ISSUE #4

Identification of malnutritionWithin any healthcare setting, malnutrition and risk of malnutrition can be identified by the use of nutritional screening or assessment tools. Screening is a rapid, simple and general procedure that involves the identification of patient characteristics known to be associated with malnutrition (e.g. unintentional weight loss over a defined timescale, lack of nutritional intake, current body mass index) and the initiation of a defined care plan outlining how to treat and monitor the patient thereafter. It precedes nutritional assessment which is a more in-depth and specific evaluation of individuals at risk, typically undertaken by a dietitian.

A number of nutritional screening tools exist, however there is no gold standard method for identifying malnutrition. The Malnutrition Screening Tool (MST)8 is a simple, quick and valid screening tool that uses a scoring system based on two criteria to identify residents at risk of malnutrition: recent weight loss over the previous 6 months and recent poor intake which could be the result of chewing and swallowing problems. If a resident has lost weight and/or are eating poorly they maybe at risk of malnutrition which is evident with a MST score of 2 or greater. The MST is a nutritional screening tool that can be easily implemented as part of routine clinical care within the hospital and aged care settings.

The British Association for Parenteral and Enteral Nutrition (BAPEN) and many other international bodies recommend that all older patients admitted to hospital, long-term care facilities, and those attending out-patient clinics should be routinely screened on admission, and at regular intervals thereafter, depending on clinical condition. In Australia, the Dietitian’s Association of Australia Best Practice Guidelines further strengthens the argument for the implementation of routine nutritional screening2,9. Screening alone is, only one part of the solution. A clear nutrition pathway should indicate the action required based on the screening result.

Management of malnutritionEarly detection is key to the successful management of malnutrition in the older adult. Once malnutrition is identified, prompt referral to a dietitian and commencement of nutrition support is a priority. The underlying cause(s)

of malnutrition should be ascertained and treated concurrently (e.g. disease-associated symptoms, depression, management of psycho-social problems).

In malnourished older adults, the use of oral nutritional supplements (ONS) is known to significantly improve energy, protein and nutrient intake, weight gain, functional capacity (muscle strength, ADL’s, mobility) and to cause significant reductions in mortality and complications (e.g. infections, pressure ulcers)10.

In Australia, malnutrition has been identified as a public health issue, but there remains a distinct lack of awareness regarding the impact of malnutrition on the older population. It is widespread in all healthcare settings, and the adverse consequences are well documented. Malnutrition is treatable in the vast majority of cases but success depends on early identification of those at risk through the use of a nutritional screening tool, and prompt initiation and management with nutrition support.

In summary, malnutrition is prevalent in Australia and around the world and is a burden on patients and health care facilities. However, malnutrition is easily identifiable, cost effective to treat and nutritional intervention can lead to improved clinical outcomes.

References

1. Australian Institute of Health and Welfare. Older Australia at a glance. Department of Health and Ageing. November 2007. www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442454209

2. Barker LA, Gout BS, Crowe TC. Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System. Int J Environ Res Public Health 2011; 8: 514-527

3. Banks M, Ash S, Bauer J et al. Prevalence of malnutrition in adults in Queensland public hospitals and residential aged care facilities. Nutr & Diet 2007; 64: 172-178

4. Ferguson M, Banks M, Bauer J et al. Nutrition screening practices in Australian healthcare facilities: A decade later. Nutr & Diet 2010; 67: 213-218

5. Gaskill D, Black LJ, Isenring EA et al. Malnutrition prevalence and nutrition issues in residential aged care facilities. Austr J Ageing 2008; 27(4): 189-194

6. Wilson MMG, Morley JE. Invited Review: Ageing and energy balance. J Appl Physiol 2003; 95: 1728-1736

7. Data on File. Abbott Nutrition 2012 (UCD Policy Document: Nutrition and Health in an Ageing Population)

8. Ferguson M, Capra S, Bauer J et al. Development of a Valid and Reliable Malnutrition Screening Tool for Adult Acute Hospital Patients. Nutr 1999; 15(6): 458-464

9. Watterson C, Fraser A, Banks M et al. Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care. Nutr & Diet 2009; 66 (Suppl. 3): S1-S34

10. Stratton, R.J, Elia M. A review of reviews: A new look at the evidence for oral nutritional supplements in clinical practice. Clin Nutr Supp 2007; 2: 5–23.

Causes of malnutrition in the older adultMedical • Malignant disease

• Gastrointestinal disease

• Dysphagia due to neurological diseases

• Endocrine disorders

• Malabsorption

• Polypharmacy

• Chronic infection

• Sore/dry mouth

• Reduced mobility

• Psychotrophic medications

Physiological

• Age-related changes: “physiological anorexia of aging”, reduced efficiency of chewing, delayed gastric emptying, reduced appetite

• Reduced taste & smell

• Dysphagia

• Arthritis

• Poor dentition/ill-fitting dentures

• Visual deficits

• Inability to self-feed

• Excessive pacing or wondering

Socio-economic• Poverty

• Social isolation

• Inability to procure or prepare food

Psychological

• Depression or other psychiatric disorders

• Dementia

• Cognitive impairment

• Loneliness

• Bereavement

Table 1: Causes of malnutrition in the older adult


Visit us at www.abbottnutrition.com.au

Is she malnourished?

Abbott Australasia Pty Ltd. 32-34 Lord St, Botany, NSW 2019. Customer Service 1800 225 311 GEN-119-1112-1AU

1. Jukkola K, MacLennan P. Innovations in Aged Care: Improving the efficacy of nutritional supplementation in the hospitalised elderly. Australasian J Ageing 2005;24(2):119-124

Is your patient malnourished or at risk of malnourishment?

Screen for malnutrition

Does your patient have specific needs?

NoYes

Compliance is key

95% compliance rate among

patients who are malnourished or at risk of malnutrition1

TwoCal HN ProSureGlucerna SR Nepro

Cancer

Enlive PlusEnsure Plus

Patient variety

Milkshake Powder Juice Pudding

Ensure Ensure Pudding

Pulmocare

Diabetes Renal Respiratory

No Yes

Disease specific

Please ask your Abbott Nutrition representative about MST Plus, the software (based on the MST) developed by Abbott Nutrition.


CARELINES ISSUE #4

Enjoy the food & drinks you love

NO MESS, NO LUMPS, NO FUSS

Flavour Creations’ ne’ ne’ west thickener product, instant THICK, is s, is s, pecifically designed for highly enhanfor highly enhanf ced dispersibility and clarity. It is the indispensable solution for bfor bf road-based dysphagia management providing excellent hydration for single and bulk for single and bulk f consumption. Available in a handy 100 g can or 2 kg pail.

Enjoy the fofof od and drinks you love – just add instant THICK to achieve the required consistency. Add to hot or cold foofoof ds or liquids including fruit juices, i, i, ce-cream, soup, soup, s, pu, pu, reed fruits and vegetables or nutritional supplements.

• Gluten Free• Lactose Free• Soy & Dairy Free• Fat Free• Cholesterol Free• GMO Free• No Added Sugar• Low Sodium

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Flavour Creations’ Dysphagia range also includes our fantastic Ready To Drink products which, come in an ideal 185mL (or 190g) serve. . . Choose from over 25 flavours in three standard viscosities.

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For our complete product range visit: ww: ww: w.flavourcreations.com.au


Whiteley’s Super Concentrate Dispensers ensure accurate dilution across a wide range of water pressure – this allows for optimal cleaning performance. The dispensing units allow for easy monitoring of 2.5L Super Concentrate bottles without opening the cabinet and includes select valve technology for dispensing multiple products.

The Super Concentrate range is designed to simplify the cleaning process, increase cleaning efficiency and maintain performance standards in institutions. Super Concentrates include a selection of neutral detergents, window & glass cleaner, air freshener and total bathroom cleaner. The Super Concentrates range offers cleaning professionals an integrated system that is versatile and user-friendly through quick color identification of products, labels and cleaning charts.

Introducing the NEW Super Concentrates By Whiteley Corporation

Whiteley’s Super Concentrates and Dispensers - a complete cleaning system for healthcare, commercial and institutional facilities.

OH & S Benefits � Spill prevention bottle caps

� Convenient 2.5L product pack size

� Reduced manual handling

� Lockable chemical cabinets

� Monitor product levels without opening cabinets

� Non hazardous products at end dilution (as defined by Safework Australia)

Benefits � Superior OH&S benefits over

traditional dispensing systems

� Integrated system for covering most cleaning applications in healthcare, commercial & institutional facilities

� Superior cleaning performance

� Versatile & user-friendly colour coded identification system

� Reduced labour costs through increased productivity

� Simplified cleaning process - decreased inventory and training costs

� On-site training & technical support.Whiteley’s Super Concentrate Dispensers offer a complete cleaning system for healthcare, commercial and institutional facilities.

Whiteley’s Super Concentrate Dispensers ensure accurate dilution across a wide range of water pressure – this allows for optimal

cleaning performance. The dispensing units allow for easy monitoring of 2.5L Super Concentrate bottles without opening the

cabinet and includes select valve technology for dispensing multiple products.

The Super Concentrate range is designed to simplify the cleaning process, increase cleaning efficiency and maintain performance

standards in institutions. Super Concentrates include a selection of neutral detergents, window & glass cleaner, air freshener and

total bathroom cleaner. The Super

Concentrates range offers cleaning

professionals an integrated system that

is versatile and user-friendly through

quick colour identification of products,

labels and cleaning charts.

w Superior OH&S bene�ts over traditional dispensing systems

w Integrated system for covering most cleaning applications in healthcare, commercial & institutional facilities

w Superior cleaning performance

w Versatile & user-friendly colour coded identi�cation system

w Reduced labour costs through increased productivity

w Simpli�ed cleaning process – decreased inventory and training costs

w On-site training & technical support

OH&S Bene�ts:wSpill prevention bottle capswConvenient 2.5L product packsizewReduced manual handling wLockable chemical cabinetswMonitor product levels without opening cabinetswNon hazardous products at end dilution

(as de�ned by Safework Australia)

All Super Concentrate products are supported by Material Safety Data Sheets

(diluted and undiluted). For more information phone the Product Support Hotline on

1800 833 566 or visit www.whiteley.com.au

Super Concentrates by Whiteley Corporation


CARELINES ISSUE #4

All Super Concentrate products are supported by Material Safety Data Sheets

(diluted and undiluted). For more information phone the Product Support Hotline on

1800 833 566 OR visit www.whiteley.com.au

* Always test products in a small discrete area before application to large areas.

VANILLA BREEZE AIR FRESHENER

VANILLA BREEZE Air Freshener is used for deodorising toilets, washrooms and all common areas.*

Bottle Application: For long-lasting deodorisation, apply behind toilets, under sinks, behind desks and furniture, into waste bins after cleaning.

NON - HAZARDOUS AT DILUTIONIf safety information is required, refer to the Material Safety Data Sheet.

AVAILABLE IN 2.5L PACK SIZE

VANILLA BREEZE

VANILLA BREEZE Air Fresheneris used for deodorising toilets, washrooms and all common areas.*

CLEAR REFLECTIONS WINDOW AND GLASS CLEANERCLEAR REFLECTIONS

CLEAR REFLECTIONS Window and Glass Cleaner is streak-free and rapidly penetrates and dislodges dirt. Suitable for cleaning windows, mirrors, computer monitors, TV screens, whiteboards, plastic and enamel.*

Bottle Application: Apply directly onto the surface and wipe off soils and excess product using a clean cloth. For stubborn soils, apply directly onto the area, wait for the product to penetrate the soil, then wipe off using a cloth.



ZEST TOTAL BATHROOM CLEANERZEST

ZEST Total Bathroom Cleaner rapidly cleans, sanitises and deodorises soils on contact. Suitable for cleaning toilets, urinals, wash basins, showers, ceramic tiles, bathroom floors and walls.*

Bottle Application: Apply directly onto the surface and wipe off soils and excess product using a clean cloth. For stubborn soils, apply directly onto the area, wait for the product to penetrate the soil, then wipe off using a cloth.Bucket Application: Always use a clean mop when cleaning floors. Once the water becomes dirty, replace with a fresh solution.



CITRON NEUTRAL DETERGENT

CITRON Neutral Detergent is a multipurpose neutral detergent that rapidly emulsifies common soils. Suitable for cleaning all surfaces, including floors, walls, desks, bench tops and doors.*




CITRONCITRON Neutral Detergenta multipurpose neutral detergent that rapidly emulsifies common soils. Suitable for cleaning all surfaces, including floors, walls, desks, bench tops and doors.*

RESOLVE HEAVY DUTY DETERGENT

RESOLVE Heavy Duty Detergent is a general purpose cleaner that rapidly emulsifies, suspends and removes oils, grease and soils. Suitable for cleaning all surfaces, including floors, walls, desks, benchtops and doors.*

Bottle Application: Spray directly onto the surface and wipe off soils and excess product using a clean cloth. For stubborn soils, spray directly onto the area, wait for the product to penetrate the soil, then wipe off using a cloth.Bucket Application: Always use a clean mop when cleaning floors. Once the water becomes dirty, replace with a fresh solution.



RESOLVE Heavy Duty Detergentis a general purpose cleaner that rapidly emulsifies, suspends and removes oils, grease and soils. Suitable for cleaning all surfaces, including floors, walls, desks, benchtops and doors.*

TEMPO HD NEUTRAL DETERGENTTEMPO HD

Tempo HD Neutral Detergent is a multipurpose neutral detergent designed for use in commercial, institutional and industrial environments. TEMPO HD rapidly emulsifies common food oils, mineral and synthetic oils.*




Super Concentrates by Whiteley Corporation

Complete cleaning system for healthcare, commercial & institutional facilities

• Free Call 1800 269 534 • Free Fax 1800 810 257 • Email [email protected]

For more information on this range contact EBOS Customer service:


DehydrationDehydration is one of the most common fluid

and electrolyte imbalances in older adults.8

Adequate hydration is essential as it ensures

good physiological function and has a strong

correlation to maintaining good cognition and

alertness.9, 10, 11 Consuming adequate amounts of

water per day has an impact upon many

activities of living, such as satisfactory urinary

and faecal elimination. However, any reduction in

fluid consumption can result in constipation,

urinary tract infections, pressure ulcer

formation, as well as other skin conditions.10 Fluid

balance is principally determined by the volume

of fluid one consumes, against the normalof fluid one consumes, against the normal

excretion of fluid occurring via the kidneys, skin,

faeces and lungs. Much of the fluid held within

the body is contained within the body’s cells,

with just over 30 per cent sitting extracellularly.

Constant physiological osmotic processes ensure

that fluid balance does not shift greater than

one per cent. If this occurs in the absence of a

negative energy balance then dehydration can be

assumed, resulting in headaches, fatigue in the

short-term, and in prolonged periods the above

potential eliminatory problems.12 Mild

dehydration can usually be treated fairly easily

by replacing lost fluids. However, if left untreated

the cumulative effects of severe dehydration can

be serious, and possibly life threatening. It has

been noted that clinical outcomes for patients

who are dehydrated can be significantly different

compared to those who receive their full fluid

requirements. One particular study, conducted

by Warren et al.,13 demonstrated that older

patients admitted with dehydration had a higher

mortality rate within 30 days than those

dehydrated patients who were younger.

Furthermore, Warren e, Warren e, W et al. suggested that the

management of hydration requirements need to

remain an essential component of care of the

hospitalised patient.13

However, the identification of dehydration

does rely upon the clinical judgement of the

healthcare professional caring for the patient.

Dehydration can be identified with a thorough

visual assessment (see Figure 1). If looked at in

isolation, symptoms (see Figure 1) may not flag

up the issue of dehydration, but if the patient

exhibits twexhibits two or more of these symptoms theo or more of these symptoms the

possibility of dehydration should be raised so

that appropriate levels of additional fluid can be

considered. Many suggestions have been put

forward recommending adequate levels of fluid

intake ranging from 1.5 litres to three litres per

day.14, 2, 15 The appropriate amount for an

individual will depend upon their height, weight,

level of activity, as well as their surrounding

temperature and possible fluid losses.

AssessmentThe Care Quality Commission,16 in their recent

review of hospital care, found that in one hospital

some patients needed to be prescribed ‘water’ just

to ensure they received it. Their damning reports

indicated that vulnerable patients who are able to

drink orally are, in some cases, being denied access

to adequate hydration.

Contributory factors to the development of

dehydration may include:

• A deterioration in cognitive abilities, e.g.

ageing, confusion, dementia

• Changes in functional ability, e.g. the ability to

safely hold a glass or mug and raise it to the

mouth; deterioration in the ability to swallow

• Regular administration of medication, such as

laxatives, diuretics or hypnotics

• The inability to swallow their own saliva (as

this is fluid that would normally enter the

digestive system)

• An increase in fluid requirements due to

increased losses, e.g. burns, high output

stomas.

Fluid administration Where oral intake of fluid is suboptimal, one

method of ensuring the most vulnerable

patients receive hydration is that of enteral tube

feeding. This can be an effective method of

delivering nutrition, hydration and medication

into the gastrointestinal tract. This is achieved

by using a tube either via the nasal, gastric or

jejunal route.17 This type of intervention can be

supplementary (in addition to eating and

drinking) or provide full support (where the

individual takes nothing by mouth). When

patients commence enteral feeding, they often

commence slowly, usually either by pump

feeding (using a machine to infuse an amountfeeding (using a machine to infuse an amountf

over a period of time, such as 25mls per hour)

or using a bor using a bolus methoolus methodd (50-100mls using a0mls using a

Figure 1: Signs andSymptoms of DehydrationThe patient may complain of /display someor all of the following:• Thirst • Headache• Dry mouth and lips• Tiredness• Feeling dizzy or lightheaded• Passing small levels of dark coloured

concentrated urine infrequently • Dry sunken eyes• Fragile skin • Confusion

Disclaimer: This is a reprint of an article that featured in Complete Nutrition (2011); 11(3): 37-39. The authors were independently commissioned by Complete Media & Marketing Ltd., publishers of Complete Nutrition. The authors and Complete Media & Marketing Ltd., do not endorse any particular companies’ products or services. Thisarticle is © Complete Media & Marketing Ltd. 2010.

The National Patient Safety Agency,1

supported by the Royal College of Nursing,2 have attempted in recent years to raise awareness of the importance of hydration for all patients. The ‘water the forgotten ingredient’ campaign and subsequent toolkit ‘Hospital Hydration Best Practice Toolkit’ were launched to attempt to push hydration to the forefront of clinical practice. Most recently, the issue of hydration has been raised again by the NACC, who have launched ‘Dehydration in Older People Awareness Week’ and have produced their own ‘Tool Box Talk’ kit.3

Few articles are published discussing the issues surrounding hydration and clinical outcomes, indicating that hydration is often not seen as important an issue as nutrition.Although one accepts that some of our fluid requirements will be met via our nutrition intake, and vice versa, it is important that both elements are treated with equal importance.The emphasis over recent years in ensuring patients receive adequate nutrition4,5,6,7 may have had the impact of inadvertently contributing to the most basic essential component for life being forgotten or sidelined.

The Importance of Hydration in the Enterally Fed PatientCarolyn Best, Nutrition Nurse Specialist, Winchester and Eastleigh Healthcare Trust and Communications Officer for the National Nurse Nutrition Group (NNNG), and Neil Wilson, Senior Lecturer, Manchester Metropolitan University and Secretary of the National Nurse Nutrition Group (NNNG)


CARELINES ISSUE #4

syringe, gravity and increasing volume). The

individual may often be given supplementary

fluids either intravenously (IV) or

subcutaneously (SC) whilst their regime of

enteral feeding gradually increases. This may

then reduce their need for supplementary fluid

support, phasing the IV or SC fluids outsupport, phasing the IV or SC fluids out

completely. What is important is that the

patient is allowed to build up their nutrition

requirements at a sensible rate enterally before

supplementary fluid support is removed. The

enteral feed itself will contribute towards the

patient’s daily fluid requirements. If additional

fluid is required in relatively large amounts, 200-

300mls of fluid can be administered fairly easily

via the enteral feeding tube. It is more

convenient, less restrictive and carries fewer

risks, while negating the need for the reinsertion

of a subcutaneous or peripheral cannula.

The method chosen (pump/bolus) will depend

upon the patient’s medical condition, their fluid

requirements, level of activity and ability to safely

administer fluid requirements into the

gastrointestinal tract.

The type of water used will depend upon the

location of the feeding tube and local policy. The

general rule is that for patients who are not

immuno-compromised and who have an enteral

feeding tube that sits in the stomach, e.g. a

nasogastric tube or gastrostomy tube, cooled

boiled water or freshly drawn tap water should

be used.18

For those patients who are immuno-

compromised, sterile water should be used. Sterile

water should also be used for patients with a

feeding tube that sits in the small bowel, e.g.

nasojejunal tube, PEGJ or surgical jejunostomy.

A dietitian will calculate a patient’s

nutritional and fluid requirements on an

individual basis. However, it is worth

remembering that the patient’s requirements

may change. If the patient’s general condition

changes, e.g. they develop a pyrexia, their fluid

losses increase, or their level of activity changes,

then their fluid requirements are likely to rise. As

we would increase the level of fluid we drink in

such situations it is important for nursing staff

to recognise the need to increase the level of

fluid administered to the patient with an enteral

feeding tube, even in the absence of a formal

dietetic review.

In the stable patient, one indicator of their

hydration level will be the concentration of their

urine. In a patient who is adequately hydrated,

urine should be straw coloured. If the patient

complains of thirst, or their urine is dark

yellow/brown in colour, they probably require

additional fluid. It is essential that nurses act

upon this as they would for patients who are

consuming fluid orally.

The patient’s regimen should be monitored to

ensure all feed and water flushes are being given

as sometimes individuals or their carers may be

concerned regarding urinary incontinence, and

periodically reduce water flushes as a means of

managing this. This is where accurately

completed fluid balance charts become very

important in the monitoring process.

It is not sufficient for nursing staff to

administer the regimen blindly. If they identify

that a patient in their care is becoming

dehydrated through the delivery of insufficient

fluid or an increase in fluid losses they have a

responsibility to act.

Mouth careOral hygiene is important and should be

performed even if a patient is taking nil orally.

Their mouth may still feel dry, particularly if they

are mouth breathing or receiving oxygen.

Regular tooth brushing with toothpaste should

be encouraged. This is effective in removing

plaque and preventing tooth decay. The use of

mouth swabs will not clean teeth or remove

plaque effeplaque effeplaque ef ctively, they will merely moisten the

mouth. If a dry mouth is a problem rinse

regularly with water, if safe to do so. Artificial

saliva, an ice-cube, pineapple juice, or frozen

fruit juice may also be helpful.

ConclusionAlthough hydration has not always been given

the same level of recognition as nutrition, it is

probably more important physiologically inprobably more important physiologically inpr

the short-term because of the rapid onset of

symptoms the patient may experience. Nurses

havhavha e a respe a respe a r onsibility to ensure that enterally

fed patients’ fluid and nutritional requirements

are met. This should be in accordance with not

only their documented regime, but also in

relation to their ever changing clinical

condition and nursing assessment.

References: 1. NPSA (2008). Water the Forgotten Ingredient from Pipe toPatient. National Patient Safety London. Reference 0547. 2. RCN (2007).Water for health hydration best practice toolkit for hospitals andhealthcare, part of the nutrition now campaign. RCN NPSA. London. 3.NACC (2011). Dehydration in Older People Awareness Week, NationalAssociation of Care Catering. Accessed online: http://www.thenacc.co.uk/events/calendar/event/41/Dehydration+in+Older+People+Awareness+Week?PHPSESSID=5a27c34aaa0ee2753bf952c3eca63a61 (June 2011).4. Department of Health (2010). The Essence of Care: Patient-focusedbenchmarking for health care practitioners. DH London. 5. NICE (2006).Nutrition Support for Adults: oral nutrition support, enteral tube feedingand parenteral nutrition. NICE London. 6. Department of Health (2007).Improving Nutritional Care A Joint Action Plan from the Department ofHealth and Nutrition Summit stakeholders. DH London. 7. AGE UK (2010).Still hungry to be heard; the scandal of people in later life becomingmalnourished in hospital. AGE UK London. 8. Hodgkinson B, Evans D,Wood J (2003). Maintaining oral hydration in older adults: A systematicreview. International Journal of Nursing Practice; 9: S19–S28. 9. Ritz P,Burrut G (2008). The importance of good hydration for day to day health.Nutrition Reviews; 63: S6-S13. 10. Benelem B (2010). Recognising thesigns of dehydration. Practice Nursing; 10(5): 230 -235. 11. Jequier E(2010). Water as an essential nutrient: the physiological basis ofhydration. European Journal of Clinical Nutrition; 64: 115–123. 12.Shirreffs SM, et al (2004). The effects of fluid restriction on hydrationstatus and subjective feelings in man. British Journal of Nutrition; 91(6):951–8. 13. Warren J, et al (1994). The Burden and Outcomes Associatedwith Dehydration among US Elderly American Journal of Public Health;84(8): 1265-1269 14. Ellins N (2006). Water for health – hydration bestpractice for older people. Nursing and Residential Care; 8(10): 470-472.15. Scales K, Pilsworth (2008). The importance of fluid balance in clinicalpractice Nursing Standard; 22(47): 50-7. 16. Care Quality Commission(2011). Press Release: CQC publish first of detailed reports into dignityand nutrition for older people. Accessed online: http://www.cqc.org.uk/newsandevents/newsstories.cfm?FaArea1=customwidgets.content_view_1&cit_id=37384 (June 2011). 17. Bowling T (2004). Nutritional supportfor adults and children: A handbook for hospital practice. Oxon: RadcliffPublishing Group. 18. ICNA (2003). Enteral Feeding Infection controlguidelines. Infection Control Nurses Association. Nutricia.

The reproduction of this article has been sponsored by an educational grant from Covidien. Website: www.covidien.com

Disclaimer: This is a reprint of an article that featured in Complete Nutrition (2011); 11(3): 37-39. The authors were independently commissioned by Complete Media & Marketing Ltd., publishers of Complete Nutrition. The authors and Complete Media & Marketing Ltd., do not endorse any particular companies’ products or services. Thisarticle is © Complete Media & Marketing Ltd. 2010.

Covidien Pty Ltd 166 Epping Road, Lane Cove NSW 2066 Australia (T) 1800 252 467 COVIDIEN, COVIDIEN with logo, Covidien logo and positive results for life are U.S. and internationally registered trademarks of Covidien AG. © 2012 Covidien AG or its affiliate. All rights reserved. PDB 553-10-12

Covidien Kangaroo™ ePump and Kangaroo™ Joey enteral feeding pumps can be programmed to deliver the optimal amount of nutrition and pre-programmed hydration, helping to ensure that patients stay well-nourished, perfectly hydrated and safe.

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For well-balanced nutrition,simply add water





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Skin Care - Why is it so important to us all?Smith & Nephew

Skin is our natural first line of defence against bacteria. Keeping skin intact is essential to reduce the human and economic cost of wounds. Broken skin causes discomfort and is often painful, reduces mobility and can affect how that individual feels about life– a significant human cost. Additionally, the associated economic costs for the individual and the medical facility treating them can be significant, especially if it develops into something more complex, such as an infection. By keeping skin intact through good skin care management, we can all assist to reduce the human and economic cost of further complications.

Healthy intact skin maintains a naturally acidic pH (4.5-5.5) providing an unfavorable environment for bacterial growth. Appropriate skin care helps avoid skin breakdown and infection and may reduce the incidence of skin tears, the development of pressure injuries from the effects of friction, and protect from the damaging effects of incontinence and wound exudate.

Age and altered mobility as well as nutritional status and altered consciousness also contribute to skin breakdown.

The Effects of Moisture on the Skin

Excess moisture comes from sweat, perspiration (e.g. under breasts skin folds and tummy aprons), urine, wound exudate and saliva. Prolonged exposure on intact skin can alter the natural pH of the skin and the protective barrier effect, making it vulnerable to breakdown and infection and weakening its ability to withstand friction and shear.

Prolonged exposure to urine and faeces raises the pH making it more vulnerable to bacterial growth and exacerbating the detrimental effects of faecal enzymes, which destroy the structure of the skin. Combined with frequent washing the skin can be stripped of its natural oils that keep it soft and hydrated, and denuded

of its outer layer, the stratum corneum. This can result in incontinence associated dermatitis and infection. Areas most at risk are the perineum, the thighs and between the buttocks.

Skin Hygiene

The main approach to protecting the skin and avoiding skin breakdown is appropriate washing and drying and the use of barrier treatments. This can be a three step approach of cleanse, protect and moisturise.

Why Cleanse?

Washing with conventional soap and water may damage the skin by interfering with several of its protective mechanisms. Whilst this approach may be suitable for protecting the skin from occasional incontinence or faecal soiling, it exposes the skin to several potentially damaging factors. Soap is highly alkaline and continued use can disrupt the skin’s natural protective acidic conditions, and alter the delicate balance of the skin’s normal flora. Soap residue on the skin is common, even after rinsing. Scrubbing the skin is abrasive and can remove the stratum corneum. More effective alternatives to soaps are pH neutral cleansers because surfactants in the formula lift body waste away from the skin without harsh scrubbing.

Why Protect and Moisturise?

Intact skin that is supple and moisturised is stronger and better able to resist skin breakdown and infection. Moisture barriers (e.g. creams and lotions) and films may help shield the skin from exposure to irritants such as urine, faeces and excess moisture, as they are designed to seal out wetness from unwanted moisture and may help prevent water loss and improve skin hydration. They can provide relief to irritated and sensitive skin. Zinc and dimethicone based barrier creams are thicker in texture and leave a protective barrier from

incontinence episodes.

Moisturising creams are thicker whereas moisturising lotions are less dense and generally have higher water content. Regular application protects and reduces the effects of dry skin, a known risk factor for skin tears.

Broken skin can be uncomfortable and painful. Keeping skin intact through good skin care management, can assist to reduce the human and economic cost of skin complications.

Fig.2. Skin breaks from incontinence


CARELINES ISSUE #4

SECURA™ is formulated with high-quality ingredients that make the

difference between basic care and proactive prevention. The user-

friendly, colour-coded packaging reflects the 3-step, preventive skin

care system. SECURA™ products are formulated with high quality

ingredients that define the standard of care for prevention.

SECURA™ provides a simple 3 step process for good skin care management:

1. Cleanse 2. Protect 3. Moisturise

The SECURA™ difference.

SECURA™Preventive Skin CareSimple skin care management

with SECURA™Easy. Effective. Economical.

New ZealandT 64 9 828 4059 F 64 9 820 2867www.smith-nephew.com/nzCustomer ServiceT 0800 807 663 F 0800 263 222

Smith & Nephew Pty Ltd Healthcare DivisionAustraliaT 61 3 8540 6777 F 61 3 9544 5086www.smith-nephew.com.au/healthcareCustomer ServiceT 13 13 60 F 1800 671 000 ™ Trademark of Smith & Nephew SN10332 (08/12)

1. Cleanse

2. Protect

3. Moisturise


DuoDERM® Dressings

What is a Hydrocolloid dressing?

Hydrocolloid dressings are made from a layer of gel-forming material attached to a semi-permeable film or foam backing. The gel layer comprises an adhesive matrix that contains a combination of absorbent materials such as sodium carboxymethylcellulose, pectin and gelatin. The resulting dressing is absorbent and self adhesive, even in moist conditions1.

Even though different hydrocolloid dressings may look similar, their fluid handling abilities can differ markedly2. Many hydrocolloid dressings are available in a variety of shapes, sizes and thicknesses. These may include products designed for specific anatomical areas (eg the sacrum or heel). Some products are very thin or have tapered edges that make them less likely to wrinkle, ruck or roll at the edges. These thinner products may also be semi-transparent allowing visualisation of the wound without the need to remove the dressing.

Variations in the backing materials may

alter the ‘slipperiness’ of the dressing. Dressings that have a more ‘slippery’ outer surface reduce the coefficient of friction between the support surface and the patient, and so reduce the amount of shear and friction transmitted to the underlying skin. In this way, they may help to reduce the risk of further damage.

Many of the more recently available hydrocolloid dressings, including some thicker products, combine tapered edges and a smooth backing surface.

DuoDERM® Dressings:

The right dressing at the right point in time™

The DuoDERM® dressings range is trusted by healthcare professionals and patients worldwide to help manage wounds.

DuoDERM® Signal® and Extra Thin dressings have been designed to help healthcare professionals find a solution for wounds such as pressure ulcers; whilst facilitating comfort and positive outcomes for their patients.

� Suitable for the different stages of wound healing and multiple wound types.

� Cost-effective,3 and may result in savings compared with other dressings.

� May increase the likelihood of pressure ulcer healing compared with other hydrocolloids.4

� Promote faster rates of healing compared to traditional gauze dressings.5–7

� Can protect against the spread of viruses such as HBV and HIV-1,*8

and the spread of bacteria including MRSA.9

� Easy to use.10

* Whilst the dressing is intact and without leakage. Use of DuoDERM™ dressings neither guarantees nor warrants against the transmission of HBV or HIV. In vitro testing.

References: 1. Heenan A. Frequenly asked questions: hydrocolloid dressings. World Wide Wounds, 1998. Available at: http://www.worldwidewounds.com/1998/april/Hydrocolloid-FAQ/hydrocolloidquestions.html (accessed 27 September2011).

2. Thomas S, Loveless P. A comparative study of the properties of twelve hydrocolloid dressings. World Wide Wounds 1997. Available at: http://www.worldwidewounds.com/1997/july/Thomas-Hydronet/hydronet.

3. Kerstein MD, et al. Cost and cost effectiveness of Venous and Pressure Ulcer Protocols of Care. Dis Manage Health Outcome 2001; 9(11): 651–63.

4. Day A, et al. Managing sacral pressure ulcers with hydrocolloid dressings: Results of a controlled clinical study. Ostomy Wound Manage 1995; 41: 52–65.

5. Hickerson WL, et al. A Prospective Comparison of a New, Synthetic Donor Site Dressing Versus an Impregnated Gauze Dressing. J Burn Care Rehab 1994; 15(4): 359–63.

6. Smith DJ, et al. Microbiology and Healing of the Occluded Skin-Graft Donor Site. Plastic Reconstructive Surg 1993; 91(6): 1094–7.

7. Demetriades D and Psaras G. Occlusive versus semi-open dressings in the management of skin graft donor sites. S Afr J Surg 1992; 30(2): 40–1.

8. Bowler PG, et al. The Viral Barrier Properties of Some Occlusive Dressings and Their Role in Infection Control. Wounds 1993; 5(1): 1–8.

9. Wilson P, et al. Methicillin-resistant Staphylococcus aureus and hydrocolloid dressings. Pharm J 1988; 241(1): 787–8.

10. Forshaw A. Hydrocolloid dressings in paediatric wound care. J Wound Care 1993; 2(4):209–12.

DuoDERM® CGF dressings DuoDERM® Signal™ dressings

DuoDERM® Extra Thin dressings DuoDERM® GEL™


CARELINES ISSUE #4

The right dressing

at the right point in time™

Wound management is a daily dilemma. DuoDERM® dressings help tip the balance towards recovery, by protecting the wound and creating a moist healing environment.

To find out more about DuoDERM® dressings or to arrange a visit from y please

www.convatec.com

®/™ indicates a trademark of ConvaTec Inc. ConvaTec Limited is an authorised user.© 2012 ConvaTec Inc. W387


vt

AUSTRALASIAN COLLEGE FOR INFECTION PREVENTION AND CONTROL

NATIONAL CONFERENCE 20128-11 OCTOBER 2012 • SYDNEY, AUSTRALIA

AUSTRALASIAN COLLEGE FOR INFECTION PREVENTION AND CONTROL

The ACIPC 7th Biennial Conference took place on 8th October to 11th October 2012 at the Sydney Exhibition and Convention Centre, Darling Harbour, Sydney, Australia. EBOS Healthcare was proud to support this premier industry event. This conference is Australia’s one of the region’s most important events related to Infection Prevention and Control. It attracted over 500 delegates and 55 trade exhibitors, and is the major educational and networking forum for professionals working in and related to the IP area .

The key theme for this event was ‘building, balancing, believing and beyond’, with a program containing pre-conference workshops and presentations by experts in the infection prevention and control field including well known and highly respected international and national invited keynote speakers.

The 2012 was able to highlight and build on accomplishments of the recent, past and present research and innovative strategies that will define infection surveillance, prevention and control beyond and into the challenging future for Infection Prevention and Control. The event was an excellent opportunity for the EBOS Infection Prevention Team (as well as all other participants) to share skills and experience as well as to attend the scientific program will contain many internationally respected speakers in the area of infection prevention.

Among the key speakers this year:

• Hugo Sax; head of infection control program at the University Hospital of Zurich, Switzerland; certified in internal medicine and infectious diseases.

• Andreas Voss; Professor of Infection Control Radboud University Nijmegen Medical Centre; Clinical microbiologist of Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands, and Head of Regional Infection Control Group (i-Prevent).

• Emma Burnett; Lecturer and Researcher in Infection Prevention at the University of Dundee, School of Nursing & Midwifery following 13 years as an Infection Prevention and Control Nurse; member of the Infection Prevention Society Research and Development Committee.

• Dale Fisher; Chair of Infection Control and Head of Infectious Diseases at the National University Hospital, Singapore.

• Peter Hoffman; Consultant Clinical Scientist with the Health Protection Agency’s (HPA) Laboratory of Healthcare associated Infection in London.

• Martin Kiernan; Nurse Consultant in Infection Prevention at Southport and Ormskirk NHS Trust in England. He has worked in the field of infection prevention and control for 22 years. He has a Masters in Public Health (University of Birmingham), currently undertaking a Masters in Clinical Research at the University of Manchester.

Martin Kiernan is also a member of the UK Department of Health Expert Advisory Committee on Antimicrobial

Resistance and Healthcare-associated Infection and is the immediate past President of the UK Infection Prevention Society (formerly the Infection Control Nurses Association). His research interests currently centre on surveillance and urinary catheter-associated infections and his other professional interests include wound management, environmental hygiene and human waste disposal methods.

Martin Kiernan currently acts asan independent clinical advisorto Vernacare Ltd in the UK.

EBOS stand at ACIPC Darling Harbour


CARELINES ISSUE #4

vt

Martin Kiernan Southport and Ormskirk NHS Trust, UK

PAPER ABSTRACT“Human Waste Disposal in Clinical Settings: A Review of the Evidence” ACIPC Conference, Tuesday 9th October 3:30pm

Human waste disposal is carried out in every healthcare setting the world over, yet there are considerable differences in the methods and techniques for this common procedure. Human faeces carries a demonstrable risk of environmental contamination with a large variety of potential pathogens including Meticillin-resistant Staphylococcus aureus (MRSA), Vancomicin-resistant enterococci (VRE), emerging highly-resistant gram-negative organisms such as those producing New Delhi Metallobetalactamase (NDM), C. difficile, and Norovirus. Many of these organisms contaminating the environment survive well and are highly transmissible in healthcare settings. Despite these demonstrable risks, human waste disposal methods are an under-researched area and have a limited evidence base. Only in recent times risks posed by human faeces are being recognized, as pathogens like a multi resistant gram negative and Colostridium Difficile have

become more prevalent and there are numerous studies demonstrating the potential for cross infection of these pathogens.

Internationally, a number of different systems are used to handle human waste. In the USA the use of local cleaning in a patient’s room followed by terminal cleaning is common, local decontamination by the use of a washer-disinfector is found all worldwide, in the UK local disposal by the use of single-use pulp products is the most common method of removal and recently in Canada a plastic bag containment system has been proposed as a potential solution.

Martin’s paper and presentation at the ACIPC conference discussed the available evidence and highlighted the positive and negative aspects of each method of disposal, particularly with respect to decontamination facilities and the use of single-use, disposable systems. The discussion also considered the financial and environmental aspects of each system.

Martin Kiernan is a Nurse Consultant in Infection Prevention at Southport and Ormskirk NHS Trust in the UK. He has 22 years experience in infection prevention and control and has a Masters in Public Health.

Martin currently acts as an independent clinical advisor to Vernacare Ltd in the UK. Vernacare provides a total solution to human waste management in healthcare and is the global leader in this sector.

Healthcare Acquired Infections (HAIs) continue to pose a risk to both patients and Healthcare facilities worldwide. The emphasis is now on Healthcare providers to ensure they do all they can to protect patients from HAIs.

Financially HAIs are one of the biggest burdens on any healthcare facility; in Australia they are costing the healthcare system more than $1 Billion a year in lost bed days¹.

The cost to patients, although not financial, is far greater. UK-based research shows that patients with HAIs take an average of 17 days longer to return to their normal daily activities than those without infections and are seven times more likely to die².

An area regularly overlooked but of paramount importance is reducing the risk of cross infection when toileting patients and handling human waste.

One common patient toileting practice is the use of reusable utensils which are reprocessed

in a bedpan washer disinfector. However, Alfa et al³ concluded that ward washer disinfectors may not provide adequate conditions for killing C difficile spores, because they cannot achieve the necessary thermal killing conditions. As such it is important to address issues of decontamination failures.

An alternative single use system is now available, used in over 50 countries, in 94% of UK hospitals and in many Australian healthcare facilities such as the Royal Children’s Hospital in Melbourne, the Vernacare system is an environmentally friendly, time saving and cost effective alternative that can help reduce the risk of cross infection.

In a study at Salford Royal NHS Foundation Trust in 2007, in which the Vernacare disposable washbowl was introduced alongside several other interventions, Power et al4 concluded: “at baseline the non-collaborative wards had 1.15 (95% CI 1.03 to 1.29) cases per 1000 occupied bed days. In August 2007, cases reduced 56% from baseline (0.51, 0.44, 0.60) which has been maintained since that time.”

Healthcare providers are continually looking for ways to reduce and remove the risk of HAIs.

The Vernacare system, when used as part of a proactive, infection prevention program, can help to reduce the risk of cross infection and not only save healthcare facilities money but also improve patient care and safety.

References:

1. Economic rationale for infection control in Australian hospitals..Nicholas Graves A E, Kate Halton C, David Paterson D, Michael Whitby B Healthcare Infection 14(3) 81–88. 26 August 2009. Queensland University of Technology (2009, September 2). Hospital Infections In Australia Cost $1 Billion In Lost Bed Days. ScienceDaily

2. Plowman R, Graves N, Griffin M et al. The socio-economic burden of hospital acquired infection. London: Public Health Laboratory Service, 2000.

3. Alfa M, Olson N, Buelow-Smith L. Simulated-use testing of bedpan and urinal washer disinfectors. Evaluation of Clostridium difficile spore survival and cleaning efficacy. Winnipeg, Canada. Am J Infect Control 2008:36:5-11.

4. Power, M et al. Reducing Clostridium difficile infection in acute care by using an improvement collaborative. Salford, UK. British Medical Journal 2010;341c3359

PROTECTING PATIENTS FROM HAIs


• Free Call 1800 269 534 • Free Fax 1800 810 257

For more information:

The Vernacare Disposable System. Advancing infection prevention in healthcare facilities around the world.

The Vernacare pulp range is designed to help protect the nurse and patient from the risk of infection, the comprehensive range of

pulp receptacles are manufactured in the UK and carry the B.S.I Kitemark to guarantee effective liquid retention and maceration. The

Vortex macerator disposes of four single-use bedpans or urine bottles every 2 minutes, with no waiting around to unload processed

bedpans, no unhygienic stacking of soiled receptacles, and no cross contamination from inadequately cleaned bedpans. The Vortex

saves approx 60% water and 97% electricity compared to traditional pan washers.

TA K E I T F O R A S P I N P U L P R A N G E

Vernacare has led the way in modern, hygienic and cost effective human waste management for more than four decades.


CARELINES ISSUE #4

Bed End BracketFor use with 400ml Pump Pack

400ml Pump Pack

50ml Personal Issue Pack

1 Litre Sanitiser Cartridge For more informationand your free site audit contactDeb Australia on 1800 090 330

www.debgroup.com

Sanitise your hands with to help preventthe spread of infection

For use with 1 LitreSanitiser Cartridge

ARTGListed

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Hand sanitising is an effective way to reduce bacterial counts on visibly clean hands, when access to soap and running water is inconvenient. In healthcare environments, alcohol is the preferred active biocide for skin sanitising without the need for rinsing with water

Deb’s hand sanitiser formula is a liquid that is dispensed as a foam. This ensures there

alcohol hand sanitisers that are dispensed

Up to 10 times more effective — Independent laboratory tests prove that Deb’s foam hand sanitiser is efficacious to 99.999% against most germs and bacteria. Many alcohol gels claim efficacy at 99.99%. This means that Deb’s foam hand sanitiser is 10 X more efficacious than many alcohol gels.

No sticky after feel — Traditional gel style alcohol hand sanitisers feature polymer thickening agents and other ingredients that can result in a “sticky” feeling after application. Deb’s foam hand sanitiser does not require polymer thickeners and therefore leaves no sticky feel.

Quicker application — Complete coverage and rub-in is achieved using Deb’s foam hand sanitiser in less time than that required to spread and rub-in a traditional gel.

No mess — Deb’s hand sanitiser is dispensed as a foam and remains this way on the hands during the application. Alcohol gel products liquefy almost on contact with the hands, making it very difficult to manage the application without spilling or splashing.

Spreads easily — Each application of Deb’s foam hand sanitiser contains 1000’s of marble shaped bubbles that roll over the skin for an easy application. Gel style products simply smear over the hand, requiring a more concerted effort to

complete total coverage.

Non-clogging — Deb’s foam hand sanitiser contains no thickening agents therefore the risk of clogging is eliminated.

Effervescence — The refreshing bursting action of the 1000’s of bubbles in Deb’s foam hand sanitiser help loosen dirt and dead skin cells that can harbour germs and bacteria. The static state of alcohol gel merely covers over the skin, trapping dirt and dead skin cells.

For more information, visit www.debgroup.com

Hand Sanitising - Why Foam is Better than Gel?


Outbreaks of infectious diseases such as influenza (‘flu) & gastroenteritis (gastro) occur often in the general community. Where people live together, such as boarding schools, cruise ships and aged care homes, such outbreaks can be quite common and difficult to control. Older people can be particularly vulnerable to illness and complications from these diseases. ‘Flu and gastro can be life threatening for people living in aged care homes’.

What is an ‘outbreak’?

As few as two or three residents becoming ill in an aged care home can be considered the start of an outbreak of flu or gastro. This is because these diseases are contagious and can spread quickly. For some infectious diseases, even one case is viewed as an outbreak. Homes must act immediately to control the spread of infectious disease and protect other residents, staff and visitors from becoming ill.

What is Gastroenteritis?

A highly infectious disease that causes nausea, diarrhoea and vomiting. Gastroenteritis is common in aged care homes and spreads through faeces and vomit as well as person to person quickly, often through unwashed hands.

Contaminated surfaces, bedding, clothing and food can also spread the disease.

Urinary Tract Infections

Urinary tract infections (UTIs) are very common in women, babies and the elderly. The most common cause is a bacteria called Escherichia coli (E. coli), which usually lives in the digestive system and bowel. Infection can target the urethra, bladder or kidneys.

Each episode of pneumonia or UTI can last 14 days and may cost thousands of dollars in unanticipated costs.

� Lost reimbursement to 5-10 day hospitalization

� Increased staff time

� Increased pharma expenses

� The average course of hospital treatment is $11,000-18,000.t

In 2007, there were 1,825 gastroenteritis outbreaks reported in Australia. Of those, 989 (54 per cent) were in nursing homes. Since 1 January 2008, there have been 671 gastro reported outbreaks nationally, with 383 (57 per cent) reported in nursing homes.

State and territory governments have legislation in place regarding infectious disease and are responsible for investigating them. Nursing homes must meet the state and territory requirements.

In a University of Arizona study of 10 hospitals, more than 90% of reusable cloth were contaminated with heterotropic bacteria after washing.

If you are using re-usable flannels as washcloths to clean the hands and face of your residents, how do you know whether they were used on the perineum or on the face previously?

Can you be sure that the laundering method being used is killing all the harmful bacteria?

Your patients deserve to be clean and comfortable without the risk of cross-contamination while in your care. Our solution is to use a disposable washcloth such as KIMBERLY-CLARK* Washcloth Extra. As it is single-use, you can be confident that each cloth is hygienic.

It’s soft on the skin and with its high absorbency, makes cleaning patients’ hands and face quick, easy and gentle. KIMBERLY-CLARK* Washcloth Extra is disposable making it not only the economical choice in assisting with the reduction of laundering costs, but the hygienic choice for patient protection.

The resealable packs help prevent dust and particles from contaminating the wipes.

Source: http://www.haaa.com.au/102-health-aged-care-news-National-guidelines-for-nursing-homes.aspx

Source: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-publicat-gastro-kit-brochure.htm

Source: Australian Government Department of Health and Ageing “Flu and Gastro Managing infectious diseases in aged care homes and Gastro-Info”

Source: Agency for Health Care Policy and Research http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Urinary_tract_infections

A Brief Look At Infectious Disease in Aged Care Homes - Washcloth Extra


CARELINES ISSUE #4

INFECTION?NOT ON MY WATCH*.

EBOS fp Ad v3.indd 1 1/11/12 5:11 PM

As a healthcare professional, the last thing you want to think about is infection, for either your patients or your staff.


The IP team at RCH in Melbourne recently conducted a trial to determine the efficacy of cleaning products on Multi Resistant Organisms (MROs) on frequently touched patient surfaces in the hospital environment.

Commonly touched surfaces — vinyl, laminate (over bed tables) and stainless steel (dressing trolleys) were inoculated with MROs prevalent in paediatric patient populations in a tertiary referral centre by a senior scientist.

The following organisms were used:

� Vancomycin resistant Enterococcus faecalis (VRE; ATCC 51299)

� Methicillin Resistant Staphylococcus aureus (MRSA; ATCC 43300)

� Extended Spectrum Beta Lactamase (ESBL) producing Klebsiella pneumoniae (ATCC 700603)

Each inoculated surface was swabbed in a standardised fashion to confirm the recovery of the MRO. Surfaces were then cleaned as per the manufacturers’ instructions by an Infection Control Nurse Consultant with:

� AGAR™ CH detergent

� Tuffie 5 wipes

� DetSol® 500ppm (3 step process: CH detergent-

� DetSol-water rinse)

� AGAR™ Chloradet (2 step cleaning process:

� Chloradet-water rinse)

� Nocospray®

Surfaces were allowed to dry and then re-swabbed to quantitate the presence

of any residual MRO.

Inoculation of surfaces and cleaning with Nocospray® occurred in a vacant patient room to meet manufacturer’s guidelines. Inoculation and cleaning with Tuffie 5 Wipes, DetSol® and Chloradet occurred in the Bacteriology Laboratory. To ensure cross contamination of surfaces did not occur, two over bed tables, two dressing trolleys and several pieces of vinyl were used. The vinyl (Mozart M2 by Griffine, France) was a sample of material chosen for new furniture with a proprietary antimicrobial surface coating.

ResultsK. pneumoniae was only isolated from two inoculated surfaces, suggesting that it did not survive well on the surfaces trialed. Where K. pneumoniae was isolated it was removed by all cleaning products.

VRE was isolated from every surface inoculated. AGAR™ CH detergent and water significantly reduced the amount of VRE detected, and removed it completely from the over bed table.

Chloradet eliminated VRE from all surfaces except the over bed table, where a scanty amount remained. DetSol® decreased the number of VRE although there was still scanty to moderate colonies detected on all surfaces after cleaning.

Tuffie 5 wipes and Nocospray® completely removed VRE from all inoculated surfaces.

Table 1. VRE cleaned with CH detergent and Nocospray®

+(scanty) = 1–10 colonies

++ (moderate) = 10–100 colonies +++

(profuse) = >100 colonies

Table 2. VRE cleaned with Tuffie 5 Wipes, DetSol® and Chloradet+ (scanty) = 1–10 colonies

++ (moderate) = 10–100 colonies +++

(profuse) = >100 colonies

# 2 step cleaning process: Chloradet-water

rinse

Melbourne Royal Children’s HospitalA comparison of the efficacy of cleaning products on multi resistant organisms

Terri Butcher 1, Gena Gonis 2, Andrew Daley 3, Karl Wood 4

1. Infection Control Nurse Consultant, The Royal Children’s Hospital, Victoria, Australia (RCH)2. Senior Scientist, Bacteriology, RCH3. Infection Control Medical Officer, RCH4. Operations Manager, Support Services, RCH

BAM! and the bugs are gone — A comparison of the efficacy of cleaning products on multi resistant organismsTerri Butcher1, Gena Gonis2, Andrew Daley3, Karl Wood4


ObjectiveTo determine the efficacy of cleaning products on Multi Resistant Organisms (MROs) on frequently-touched patient surfaces in the hospital environment.

MethodCcommonly touched surfaces — vinyl, laminate (over bed tables) and stainless steel (dressing trolleys) were inoculated with MROs prevalent in paediatric patient populations in a tertiary referral centre by a senior scientist.


• VancomycinresistantEnterococcus faecalis (VRE; ATCC 51299)

• MethicillinResistantStaphylococcus aureus (MRSA; ATCC 43300)

• ExtendedSpectrumBetaLactamase(ESBL)producing Klebsiella pneumoniae (ATCC 700603)


• AGAR™CHdetergent

• Tuffie5wipes

• DetSol®500ppm(3stepprocess:CHdetergent- DetSol-waterrinse)

• AGAR™Chloradet(2stepcleaningprocess: Chloradet-water rinse)

• Nocospray®

Surfaces were allowed to dry and then re-swabbed to quantitate the presence of any residual MRO.

InoculationofsurfacesandcleaningwithNocospray®occurred in a vacant patient room to meet manufacturer’s guidelines. Inoculation and cleaning with Tuffie 5 Wipes, DetSol®andChloradetoccurredintheBacteriologyLaboratory.Toensurecrosscontaminationofsurfacesdidnotoccur, two over bed tables, two dressing trolleys and several piecesofvinylwereused.Thevinyl(MozartM2byGriffine,France) was a sample of material chosen for new furniture with a proprietary antimicrobial surface coating.

ResultsK. pneumoniae was only isolated from two inoculated surfaces, suggesting that it did not survive well on the surfaces trialled. Where K. pneumoniae was isolated it was removed by all cleaning products.

VREwasisolatedfromeverysurfaceinoculated.AGAR™CHdetergent and water significantly reduced the amount of VRE detected, and removed it completely from the over bed table. ChloradeteliminatedVREfromallsurfacesexcepttheoverbedtable,whereascantyamountremained.DetSol®decreasedthe number of VRE although there was still scanty to moderate colonies detected on all surfaces after cleaning. Tuffie 5 wipes andNocospray®completelyremovedVREfromallinoculatedsurfaces.

Table 1.VREcleanedwithCHdetergentandNocospray®

VRE Pre cleaning Post cleaning

CH Detergent Nocospray®

Vinyl ++ + 0

Laminate ++ 0 0

Stainless steel

+++ +

0

+ (scanty) = 1–10 colonies ++ (moderate) = 10–100 colonies +++ (profuse) = >100 colonies

Table 2.VREcleanedwithTuffie5Wipes,DetSol®andChloradet


Tuffie 5 wipes DetSol® ## Chloradet #

Vinyl

++ 0 + 0

Laminate

+++ 0 ++ +

Stainless steel

+++ 0 + 0


# 2 step cleaning process: Chloradet-water rinse

## 3 step process: CH detergent-DetSol-water rinse

MRSA was isolated from all inoculated surfaces but two — one of the vinyl surfaces and one of the laminate surfaces.

Table 3.MRSAcleanedwithTuffie5Wipes,DetSol®andChloradet

MRSA Pre cleaning Post cleaning


Vinyl 0 N/A N/A N/A

Laminate +++ 0 0 0

Stainless steel +++ 0 0 0




Table 4.MRSAcleanedwithCHdetergentandNocospray®



Vinyl + 0 0

Laminate 0 N/A N/A

Stainless steel +++ 0 0


All cleaning methods removed MRSA from the inoculated surfaces.

DiscussionThis study was prompted by a hospital review of the efficacy of available cleaning products. Constraints of this study include the variability in surfaces of the over bed tables due to their age.

Additionally, verification of these results through replication was not undertaken.

This study does not take into consideration ease of product use or OH&S concerns.

ConclusionsIn this trial, AGAR™ CH detergent and water was effective in reducing the bioburden on all surfaces. However, further disinfection by Tuffie 5 wipes, Chloradet or Nocospray® was required to remove VRE. DetSol® reduced the bioburden on all surfaces, although it did not entirely remove all of the VRE. MRSA was removed by all cleaning methods.

These results have contributed to the revision of our current environmental cleaning practices. ER

C 1

11818

MRSA pre cleaning stainless steel

MRSA post cleaning with Chloradet

MRSA post cleaning with

DetSol


Tuffie 5

This poster is not to be reproduced without the permission of the authors

BAM! and the bugs are gone — A comparison of the efficacy of cleaning products on multi resistant organismsTerri Butcher1, Gena Gonis2, Andrew Daley3, Karl Wood4


ObjectiveTo determine the efficacy of cleaning products on Multi Resistant Organisms (MROs) on frequently-touched patient surfaces in the hospital environment.

MethodCcommonly touched surfaces — vinyl, laminate (over bed tables) and stainless steel (dressing trolleys) were inoculated with MROs prevalent in paediatric patient populations in a tertiary referral centre by a senior scientist.


• VancomycinresistantEnterococcus faecalis (VRE; ATCC 51299)

• MethicillinResistantStaphylococcus aureus (MRSA; ATCC 43300)

• ExtendedSpectrumBetaLactamase(ESBL)producing Klebsiella pneumoniae (ATCC 700603)


• AGAR™CHdetergent

• Tuffie5wipes

• DetSol®500ppm(3stepprocess:CHdetergent- DetSol-waterrinse)

• AGAR™Chloradet(2stepcleaningprocess: Chloradet-water rinse)

• Nocospray®

Surfaces were allowed to dry and then re-swabbed to quantitate the presence of any residual MRO.

InoculationofsurfacesandcleaningwithNocospray®occurred in a vacant patient room to meet manufacturer’s guidelines. Inoculation and cleaning with Tuffie 5 Wipes, DetSol®andChloradetoccurredintheBacteriologyLaboratory.Toensurecrosscontaminationofsurfacesdidnotoccur, two over bed tables, two dressing trolleys and several piecesofvinylwereused.Thevinyl(MozartM2byGriffine,France) was a sample of material chosen for new furniture with a proprietary antimicrobial surface coating.

ResultsK. pneumoniae was only isolated from two inoculated surfaces, suggesting that it did not survive well on the surfaces trialled. Where K. pneumoniae was isolated it was removed by all cleaning products.

VREwasisolatedfromeverysurfaceinoculated.AGAR™CHdetergent and water significantly reduced the amount of VRE detected, and removed it completely from the over bed table. ChloradeteliminatedVREfromallsurfacesexcepttheoverbedtable,whereascantyamountremained.DetSol®decreasedthe number of VRE although there was still scanty to moderate colonies detected on all surfaces after cleaning. Tuffie 5 wipes andNocospray®completelyremovedVREfromallinoculatedsurfaces.

Table 1.VREcleanedwithCHdetergentandNocospray®



Vinyl ++ + 0

Laminate ++ 0 0

Stainless steel

+++ +

0


Table 2.VREcleanedwithTuffie5Wipes,DetSol®andChloradet



Vinyl

++ 0 + 0

Laminate

+++ 0 ++ +

Stainless steel

+++ 0 + 0




MRSA was isolated from all inoculated surfaces but two — one of the vinyl surfaces and one of the laminate surfaces.

Table 3.MRSAcleanedwithTuffie5Wipes,DetSol®andChloradet



Vinyl 0 N/A N/A N/A

Laminate +++ 0 0 0

Stainless steel +++ 0 0 0




Table 4.MRSAcleanedwithCHdetergentandNocospray®



Vinyl + 0 0

Laminate 0 N/A N/A

Stainless steel +++ 0 0


All cleaning methods removed MRSA from the inoculated surfaces.

DiscussionThis study was prompted by a hospital review of the efficacy of available cleaning products. Constraints of this study include the variability in surfaces of the over bed tables due to their age.



ConclusionsIn this trial, AGAR™ CH detergent and water was effective in reducing the bioburden on all surfaces. However, further disinfection by Tuffie 5 wipes, Chloradet or Nocospray® was required to remove VRE. DetSol® reduced the bioburden on all surfaces, although it did not entirely remove all of the VRE. MRSA was removed by all cleaning methods.

These results have contributed to the revision of our current environmental cleaning practices. ER

C 1

11818

MRSA pre cleaning stainless steel

MRSA post cleaning with Chloradet


DetSol


Tuffie 5

This poster is not to be reproduced without the permission of the authors


CARELINES ISSUE #4

## 3 step process: CH detergent-DetSol-water

rinse

MRSA was isolated from all inoculated surfaces but two — one of the vinyl surfaces and one of the laminate surfaces. All cleaning methods (Tuffie 5 Wipes, DetSol® Chloradet, CH detergent and Nocospray®) removed MRSA from the inoculated surfaces.

ConclusionsIn this trial, AGAR™ CH detergent and water was effective in reducing the bioburden on all surfaces.

However, further disinfection by Tuffie 5 wipes, Chloradet or Nocospray® was required to remove VRE.

DetSol®, reduced the bioburden on all surfaces, although it did not entirely remove all of the VRE.

MRSA was removed by all cleaning methods.

These results have contributed to the revision of RCH’s current environmental cleaning practices.

NoteThis study was prompted by a hospital review of the efficacy of available cleaning products. Constraints of this study include the variability in surfaces of the over bed tables due to their age.



Thank you to the Melbourne RCH for allowing reproduction. December, 2011.

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