INFECTIOUS DISEASES

CONTENTS

1. SWAHS ANTIBIOTIC POLICY PROCEDURE

2. MANAGEMENT OF OCCUPATIONAL BLOOD/BODY FLUID EXPOSURES

3. PROCEDURE FOR HEPATITIS B (HBV) PROPHYLAXIS

4. PROCEDURE FOR HIV (Human Immuno-deficiency Virus) SCREENING

5. PROCEDURE FOR HEPATITIS C VIRUS (HCV) SCREENING

6. INFECTIOUS DISEASES REPORTING

7. WESTMEAD INFECTION CONTROL & HOSPITAL EPIDEMIOLOGY UNIT

SWAHS ANTIBIOTIC POLICY PROCEDURE

Purpose  This policy is intended to: 

support  the process of antimicrobial prescribing  in accordance with  therapeutic guidelines  (or 

WSLHD Drug Committee‐approved documents) for hospitals in WSLHD  

detail the governance and reporting processes of the WSLHD antimicrobial stewardship program 

provide a traffic light restriction list of antimicrobial agents in WSLHD 

detail education and policy review processes in regards to antimicrobials 

ensure adherence to National Safety and Quality Health Service Standards (Standard 3)   

Intended Audience  All health professionals involved in the prescription of antimicrobials throughout WSLHD   

Expected Outcomes  

Improve patient outcomes (e.g. reduced toxicity and length of stay) 

Reduce selection pressure of multi‐drug resistant organisms 

Improved appropriateness of antimicrobial prescribing 

Reduce antimicrobial utilisation   

Definitions  Antimicrobial AMS

Antibacterial, antifungal, antiviral, antiprotozoal and anthelmintic medications 

 

Antimicrobial Stewardship 

Formulary Drugs which have been approved by the WSLHD Drug Committee for use

within WSLHD sites

Non-Formulary Drugs which require two members of the WSLHD Drug Committee to

approve prior to use

Prescriber Any Medical Officer or Nurse Practitioner able to legally prescribe antimicrobials 

SAS Special Access Scheme (refers to arrangements which provide for the import

and/or supply of an unapproved therapeutic good for a single patient, on a case by case basis)

WSLHD Western Sydney Local Health District   

WSLHD Antimicrobial Stewardship Policy (WASP)

Policy Statement

Use of antimicrobials throughout WSLHD must comply with this policy, unless the WSLHD Drug Committee has approved alternative unit-based guidelines/protocols for the use of antimicrobials in particular clinical circumstances. For example, the WSLHD Drug Committee-approved Febrile Neutropenia Protocol. Approval to use antimicrobials restricted in these documents will be granted automatically, however use of these antimicrobials still needs to be logged on Guidance MS. If there are clinical situations commonly encountered within a service that require the use of restricted antimicrobials, the formulation of protocols for submission to the WSLHD Drug Committee for approval is recommended, as this will simplify patient management.  

For  specific  therapeutic  guidelines  (where  a  local  guideline  does  not  exist), 

antimicrobials  should  be  used  in  accordance  with  those  published  in  Australian 

Therapeutic Guidelines (Antibiotic version 15). 

NOTE: A multidisciplinary committee of experts in all Australian States and Territories prepares the Therapeutic Guidelines. Their recommendations are based on published best available evidence for use of antimicrobials. This evidence is based on such factors as spectrum of activity in relation to the known or suspected causative organism, safety including adverse reactions and drug interactions, cost, and the potential for selection of resistant organisms and the associated risk of superinfection, as well as patient factors. They are intended as a guide and cannot cover all clinical scenarios.

Empiric Antimicrobial Therapy

When the use of restricted antimicrobials is considered because infection with more resistant organisms is suspected, appropriate specimens should be collected for microbiological culture before therapy is commenced. The use of a specific agent for empiric therapy should always be reviewed after 72 hours when results of culture are available and the agent de-escalated or discontinued if possible.

Hospital Formulary

The WSLHD formulary lists all antimicrobials available for use in WSLHD hospitals. This formulary contains a traffic light system of restricted and unrestricted antimicrobials. Please direct all enquiries about WSLHD formulary to the local hospital Department of Pharmacy.

Restriction List

The restriction list is subject to a two-tier approval system. Antimicrobials are either restricted or unrestricted according to the following lists (Please note: non-formulary items are NOT included as they require Drug Committee approval prior to use): GREEN Antimicrobials (unrestricted): In general, these include antimicrobials that are used to treat community-acquired infections. They are mostly available on reserve stock/imprest for individual ward use and do not require entry on to Guidance MS or any form of Infectious Diseases input unless desired by the Prescriber. RED Antimicrobials (restricted): Use of these agents must be entered on to Guidance MS prior to use. An approval number will be issued with a specified duration depending on the indication for which the antimicrobial is being used and this needs to be written next to the order on the National Inpatient Medication Chart. If using an antimicrobial from this list following a WSLHD Drug Committee-approved document, OR if regular AMS rounds exist on the ward (e.g. E3A, E3B, C3C, Blacktown ICU), automatic approval will be provided, however use of such medications still needs to be entered into Guidance MS.

Guidance MS Approval Number

When approval is granted by Guidance MS, an approval number which includes the date the approval is given, as well as duration of the approval, is provided. This number must be written next to the drug name on the medication chart by the Prescriber. This approval number is recorded and can be accessed by Pharmacy, Infectious Diseases and Microbiology staff for future reference. If an approval number has not been obtained and endorsed on the medication chart for a restricted antimicrobial by the Prescriber, the Department of Pharmacy will liaise with the Prescriber and/or Infectious Diseases/Microbiology regarding review of the antimicrobial therapy. See Appendix ONE for standard operating procedure for approvals

SAS Antimicrobial Agents

The use of  Special Access  Scheme  (SAS)  and  Investigational Antimicrobial Agents 

must be approved by Infectious Diseases/Microbiology (and have individual patient 

approval  by  two members  of  the WSLHD  Drug  Committee  prior  to  use  if  non‐

formulary).  Seek  Pharmacist  advice.  Please  note,  a  SAS  drug  is  an  unapproved 

therapeutic good and  the responsibility  for prescribing  these agents appropriately 

rests with the patient's medical practitioner. Patient consent is required prior to use 

of these agents.  

 

   

Aciclovir, IV  Ciprofloxacin  Piperacillin/Tazobactam

(e.g. Tazocin®) 

Amikacin  Clarithromycin  Posaconazole 

Amphotericin IV  Clofazimine (SAS)  Praziquantel 

Anidulafungin  Colistin  Primaquine 

Artemether with 

Lumefantrine 

Cycloserine (SAS)  Pristinamycin (SAS)

Artesunate (SAS)  Dapsone 

(except dermatology) 

Pyrimethamine 

Atovaquone  Daptomycin  Quinine 

Atovaquone with 

proguanil 

Ertapenem   Rifabutin 

Azithromycin  Fidaxomicin (SAS) 

Flucytosine 

Rifampicin 

Aztreonam  

 

Capreomycin (SAS) 

Foscarnet 

Fosfomycin (SAS) 

Sodium fusidate

Caspofungin  Ganciclovir  Streptomycin (SAS)

Cefepime  Gentamicin   Sulfadiazine (SAS)

Cefotaxime  Imipenem/Cilastatin Teicoplanin 

Ceftaroline  Ivermectin  Terbinafine  

(except Dermatology) 

Ceftazidime  Linezolid   Tetracycline (SAS)

Ceftriaxone  Mefloquine  Ticarcillin/Clavulanate

(e.g. Timentin®) 

  Meropenem 

Micafungin 

Tigecycline 

Chloramphenicol IV  

(SAS) 

Moxifloxacin  Tobramycin 

Chloramphenicol, top  

(except ophthalmic 

use) 

Neomycin  Valganciclovir 

Chloroquine (SAS)  Oseltamivir  Vancomycin 

Cidofovir  Pentamidine  

(except immunology) 

Voriconazole 

    Zanamivir 

 

UNRESTRICTED ANTIMICROBIALS Infectious Diseases/Microbiology consideration is not essential for these agents because they may either:

- Be narrow spectrum agents which are suitable for directed therapy and are less likely to promote antimicrobial resistance 

- Do not require therapeutic drug monitoring - Less likely to have life threatening drug 

interactions/adverse effects. 

           RESTRICTED ANTIMICROBIALS Infectious Diseases/Microbiology consideration is required for these agents PRIOR to use because they may either: - Be very broad spectrum agents which should only be 

used when difficult‐to‐treat multi‐resistant organisms are suspected/present; and/or 

- Be suitable for empirical therapy however require de‐escalation when cultures are returned and/or the patient improves;  and/or 

- Lead to increased rates of antimicrobial resistance if overused; and/or 

- Require therapeutic drug monitoring to ensure efficacy and avoid toxicity; and/or 

- Be expensive; and/or - Possibly have life threatening drug 

interactions/adverse effects. 

MUST be logged on GUIDANCE MS PRIOR to use

Aciclovir, oral   Griseofulvin 

Albendazole  Hexamine hippurate 

Amoxycillin  Itraconazole   

Amphotericin Lozenges  Ketoconazole  

Amoxycillin/clavulanate 

(e.g. Augmentin Duo Forte ®) 

Lincomycin 

Ampicillin  Mebendazole 

Benzylpenicillin  Metronidazole 

Benzathine penicillin  Minocycline 

Cefaclor  

 

Cefuroxime  

Nitrofurantoin 

Cephalexin  Norfloxacin 

Cephalothin (Cefalotin)  Nystatin 

Cephazolin  Phenoxymethylpenicillin 

Chloramphenicol, top  

(Ophthalmic use only) 

Procaine Penicillin 

Clindamycin  Pyrantel 

Dicloxacillin  Roxithromycin  

Doxycycline  Sulfamethoxazole/ 

Trimethoprim (e.g. Bactrim®)  

Erythromycin  Tinidazole 

Famciclovir   Trimethoprim 

Flucloxacillin  Valaciclovir  

Fluconazole   

Do NOT need to be logged on GUIDANCE MS prior to use

  Approval Process

All requests for restricted antimicrobials (agents in the RED box above) must be entered into the electronic antimicrobial stewardship system (Guidance MS). Automatic approval may be given in some circumstances (see ‘Automatic Approval’ below). In all other circumstances however, Infectious Diseases or the AMS team will review the request and either:

1. APPROVE: If request is approved, the Prescriber will be provided with an approval number for a specified duration. The Prescriber is required to write the approval number and clearly mark the cease/review date on the order for the antimicrobial agent on the patient’s medication chart so that pharmacy can supply, or

2. DENY: If request is denied, Infectious Diseases may suggest an alternative agent or phone the Prescriber for further information and possible formal consult.

 

An APPROVAL NUMBER (including the DURATION of approval) will be issued by Guidance MS.

This number is to be written on the patient’s medication chart by the Prescriber in order for pharmacy to supply the medication.

 

If advice is required regarding Guidance MS or antimicrobial choice, Prescribers may contact the AMS Pharmacist during business hours (pager: 27812 and 8926) or a member of the Infectious Diseases/Microbiology team (Contact Details below). Supply of restricted antimicrobials from Pharmacy: If the prescriber has not sought approval via Guidance MS then pharmacy will provide a temporary supply of the restricted antimicrobial pending the prescriber gaining an electronic approval. It is the prescriber’s responsibility to obtain a Guidance MS approval number prior to charting the restricted antimicrobial. Contacting Infectious Diseases: If a prescriber contacts Infectious Diseases for advice, it is still their responsibility to obtain the electronic Guidance MS approval. Extensions: Once the duration of approval expires, the Medical Officer must review therapy and optimise the patient’s regimen. If the Medical Officer wishes to continue the same antibiotic which approval was previously granted for, they must CONTACT Infectious Diseases for an extension.

See Appendix 2 – 4

Contact Numbers for ID/Microbiology WSLHD Microbiology Registrars Phone: 9845 6065, 9845 7525, 9845 8965 ID Registrar Pager (Westmead/Auburn) (Team A): 9461 ID Registrar Pager (Westmead/Auburn) (Team B): 22906 ID Registrar (BMDH All wards): 7808 After Hours

Westmead and Auburn: Contact on-call Registrar/Staff Specialist via switch

Blacktown and Mount Druitt: Contact on-call Registrar/Staff Specialist via switch

Further information may also be available on the Antibiotic Stewardship intranet page.   

 

 

 

 

 

 

 

Automatic Approval on Guidance MS

The circumstances in which automatic approval may be granted by Guidance MS include: 1. Restricted antimicrobial usage via a WSLHD Drug Committee-approved

document - The correct indication will need to be specified when seeking approval via Guidance MS in order for this to occur. Examples include Febrile Neutropenia and Community-Acquired Pneumonia.

Refer to WSLHD Drug Committee website (WSLHD Policies and Procedures) for approved alternative local unit-based antimicrobial procedures.

2. Restricted antimicrobial usage where AMS rounds exists. The correct unit

will need to be selected in order for this to occur, for example: - Intensive Care Unit (E3A, E3B) - Cardiothoracic Intensive Care Unit (C3C) - Blacktown Intensive Care Unit (BIC)

NOTE: An exemption from the use of Guidance MS exists for the following drugs if used by the specified specialities (i.e. these drugs do NOT need to be logged on Guidance MS): 1.

nti-tuberculosis drugs Respiratory Medicine Infectious Diseases

2. Antitretroviral (HIV) drugs

Immunology Sexual Health Medicine Infectious Diseases

3. Anti‐hepatitis  C/Hepatitis  B drugs 

Gastroenterology/Hepatology Sexual Health Medicine Infectious Diseases

4. Antimicrobials prescribed in paediatrics and neonates.

Topical Antimicrobial Agents

In general, topical antimicrobials should only be prescribed where there is good evidence to support their use (Refer to Therapeutic Guidelines: Antibiotics Version 15) and consultation should occur with the relevant specialty. In general, antimicrobials recommended for topical use should not be from the same antimicrobial classes used for systemic therapy.

Routes of Administration

It is recommended that routes of administration (other than oral or intravenous) be assessed on an individual patient basis among the relevant specialties, for example intravitreal or intrathecal injections.  

Continuing Therapy

Duration of therapy for restricted (Red) antimicrobials will be recorded in Guidance MS. If the treating team wishes to increase the duration of therapy, the approval will need be extending by the Infectious Diseases team.

Surgical Prophylaxis

Systemic prophylaxis should be considered where there is a significant risk of infection or where postoperative infection, even if uncommon, would have severe consequences (e.g. infection associated with a prosthetic implant). When an antimicrobial is used for prophylaxis in surgical procedures, a single dose should be given within 30 minutes before incision. Please see Surgical Prophylaxis Guideline. In summary of the Surgical Prophylaxis Guideline, a single preoperative dose of a parenteral drug is sufficient. A second dose may be necessary under the following circumstances:

o a delay in starting the operation o If a short-acting antimicrobial is used (e.g. cephazolin) and the

operation is prolonged beyond 3 hours. o Excessive blood loss (>1500 mL)

Postoperative doses are not advised except where specifically recommended:

Cardiac Surgery: prophylaxis should be continued for 24 hours only Vascular Surgery: prophylaxis should be continued for 24 hours only Amputation (ischaemic limb): prophylaxis should be continued for 24

hours only Open fractures (clean): If debridement occurs within 8 hours of injury,

continue prophylaxis for up to 72 hours. If debridement occurs after 8 hours of the injury. Continue prophylaxis for 7 days.

Open fractures (wound soiling; severe tissue damage; devitalising tissue present): Continue prophylaxis for 7 days.

Established infection should be treated. Vancomycin as prophylaxis Routine use of vancomycin prophylaxis should be discouraged to prevent selection pressure for vancomycin-resistant enterococci (VRE) and vancomycin-intermediate Staphylococcus aureus (VISA). However, vancomycin should replace the cephalosporin component of the regimen in the following circumstances:

patients hypersensitive to penicillins and/or cephalosporins Vancomycin should be used in addition to the cephalosporin in the following circumstances:

preoperative patients infected or colonised with a methicillin-resistant S. aureus (MRSA) strain (health care–associated or community-associated) currently or in the past

patients having major surgery who are at high risk for MRSA colonisation (e.g. those who have resided for longer than 5 days in a health care facility where MRSA is endemic)

patients undergoing prosthetic cardiac valve, joint or vascular surgery where the procedure is a re-operation (return to theatre or revision)

If vancomycin is used, postoperative doses are not required except in cardiac surgery and vascular surgery (see above for recommendations)

Risks of Non-Compliance with WASP

Emergence of resistant bacteria and other pathogens compromise patient care due to inadequate therapy available and possible increased adverse effects.

Economic unsustainability of service delivery Failure to meet National Accreditation Standards

Education Notes

The WSLHD antimicrobial policy has been developed in response to several important issues including:

The increasing emergence of new strains of antimicrobial-resistant Gram-positive micro-organisms including: multi-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), multi-resistant pneumococci and most recently vancomycin-resistant S. aureus

The increasing emergence of new strains of antimicrobial-resistant Gram-negative micro-organisms including: multi-resistant Acinetobacter spp., and cephalosporin and/or carbapenem–resistant species

Rational and appropriate prescribing is central to limiting the progression to antimicrobial resistance

The slow development of novel antimicrobials to combat resistant organisms despite the introduction of many new antimicrobial agents into clinical practice

Antimicrobial agents are a major contribution to total hospital drug costs

 

              

Risk Rating Risk category(s): Clinical Care & Patient Safety Risk rating: Low - Review in 3 Years Implementation Plan All guidelines are to include an implementation plan suitable to support the appropriate embedding of the guideline into practice. The plans are to include: timeframe; communication strategy; education strategy; resources required; and system for monitoring compliance.

Implementation Timeframe Ongoing

Position Responsible WSLHD AMS Committee

Brief description of implementation strategy:

Implementation facilitated by the WSLHD AMS Committee described below

Process for monitoring and review:

• Medical staff to receive in-service regarding the policy and best antimicrobial prescribing practice by the Infectious Diseases Service

• Policy to be included in Prescriber Orientation programs • Broadcast message to be sent out by the Executive Unit • Wide dissemination of policy via electronic media • Access to policy and Therapeutic Guidelines: Antibiotic Version

15 via WSLHD Intranet • Reminder system incorporated into routine practice • Regular Audits/Drug Utilization Evaluations via Antimicrobial

Stewardship Pharmacist to collect data for relevant clinical indicators

• Feedback regarding adherence to policy to relevant Department Heads and Committees

• Education and adherence to Policy to be overseen by Infectious Diseases Service, Department of Pharmacy and all relevant networks

• Provision of decision support, electronic approval number allocation at the ward level and audit tools

• Formulate a Risk Register to monitor and record improvement activities

 References and Related Documents

1. Cruickshank M, Duguid M. Antimicrobial stewardship in Australian hospitals. Sydney:

Australian Commission on Safety & Quality in Health Care,; 2011.

2. Therapeutic Guidelines; Antibiotic, Version 15, 2014; North Melbourne, Vic. Therapeutic

Guidelines Limited

 

2. MANAGEMENT OF OCCUPATIONAL BLOOD/BODY FLUID EXPOSURES

1. These procedures only apply following injuries with needles or other sharp implements which have, or may have come into contact with patient's tissues, body fluids or blood, or following splashing of blood or serum into the eyes or on mucous membranes or non-intact skin.

2. The incident must be documented using a STAFF INCIDENT/ACCIDENT REPORT FORM and reported to the person designated on the form.

3. If the accident occurs out of hours, the staff member should attend the Emergency Department as soon as possible. Follow-up is the responsibility of the Staff Health Clinic.

4. The wound should be cleaned and dressed and the staff member should be offered a tetanus toxoid booster or vaccination course AS APPROPRIATE.

5. Where a sharp item causing an injury is found in linen, rubbish, etc and the source is not known, the Infection Control Team is to be notified. They must take responsibility for trying to trace the source and recommending corrective action if applicable.

3. PROCEDURE FOR HEPATITIS B (HBV) PROPHYLAXIS

3.1 INJURED INDIVIDUAL NOT VACCINATED

Take blood for:

HBsAg, anti-HBs, anti-HBc

If source is known to be HBsAg positive

Give a dose of hepatitis B immunoglobulin (HBIG) as soon as possible and preferably within 48 hours

HBIG must be given within 7 days of exposure; its value beyond 7 days is unclear

Serological screening of the staff member for immunity should not delay use of HBIG beyond 2 days.

At the same time

give hepatitis B vaccine, with

second and third doses 1 month and 6 months later

The same protocol can be followed in pregnancy, but if the staff member refuses this she may be given a second dose of HBIG thirty days after the first injection.

If source is known, but HBsAg status unknown

Test patient and staff

If patient HBsAg +ve and staff -ve

- give HBIG

- Commence vaccination

If the source is unknown

Test staff serology

if -ve,

commence vaccination within 7 days

3.2 INJURED INDIVIDUAL HAS PRIOR VACCINATION WITH HEPATITIS B VACCINE

If source is known to be HBsAg positive

Test exposed person for HBsAb:

If HBsAb >10 mIU/mL, no further treatment or follow up needed.

If the antibody ratio level <10 mIU/mL

If uncompleted HB vaccination (or not confirmed to have had an adequate antibody level in the past):

- give one dose of HBIG immediately

- At a different site, give a booster dose of hepatitis B vaccine.

If known to have had an adequate antibody level in the past:

- give booster dose of hepatitis B vaccine.

If source is known but HBsAg status unknown

Test source for HBsAg

If positive, test exposed person for HBsAg and proceed as above for HBsAg positive source

3.3 IF THE EXPOSED STAFF MEMBER IS POSITIVE FOR HBsAg, ANTI-HBc OR ANTI-HBs (antibody level >10 mIU/mL)

No further action is indicated.

3.4 THE NEEDLESTICK INJURY OR MUCOSAL EXPOSURE TO BLOOD OCCURRED MORE THAN 10 DAYS AGO

Test the exposed person for HBsAg and anti-HBc. If negative, offer hepatitis B vaccination.

3.5 REFER EXPOSED PERSON TO STAFF HEALTH FOR FOLLOW-UP SEROLOGY TESTING

Repeat HBV serology (HBsAg, anti-HBs, anti-HBc) at 6 weeks, 3 months and 6 months.

This will determine whether or not the person has become infected with HBV (i.e. positive HBsAg and anti-HBc), or has responded to HBV vaccine (i.e. positive anti-HBs, negative anti-HBc)

4. PROCEDURE FOR HIV (Human Immuno-deficiency Virus) SCREENING

Test patient and staff member for HIV antibodies, with prior informed consent (particularly if the patient has known risk behaviour for HIV infection).

If the patient is positive:

the staff member should be retested for HIV antibodies at three and six months after interview. However, if the source is unknown, HIV antibody testing of the staff member should be done only if requested after counselling.

If the staff member negative

- refer to the Infectious Diseases registrar/consultant on call for consideration of anti-retroviral post exposure prophylaxis (PEP).

- Significant exposure should be a pre-requisite for PEP use. If used PEP should be commenced as soon as possible, preferably within 24 hours. Starter packs for PEP are kept in the ED Drug Cupboard. The PEP treatment will be monitored through the Tuesday afternoon Clinic B outpatients.

Person presenting to ED for consideration of non-occupational PEP should also be discussed with the Infectious Diseases consultant on call.

Human Immunodeficiency Virus (HIV): Antiretroviral post-exposure prophylaxis Policy

5 PROCEDURE FOR HEPATITIS C VIRUS (HCV) SCREENING

HCV is the cause of the majority of non-A/non-B hepatitis.

The virus is parenterally acquired and is carried by:

Approximately 1% of the population

Especially common in:

- intravenous drug users (86%)

- haemophiliacs

Patients who have had many previous transfusions.

Risk of HCV infection through needlestick injury involving HCV-infected blood is 2-3%. In such cases the source individual usually has abnormal LFT's.

5.1 Procedure

Test source for anti-HCV and perform LFTs.

If source anti-HCV is positive,

-Test exposed staff member for

o anti-HCV and

o perform LFTs.

Test source for HCV RNA by PCR, to determine whether they are chronically infected with HCV. Obtain a history of previous HCV treatment.

Approximately 30-40% of people who are infected with HCV clear the virus spontaneously within 3-6 months, so become HCV RNA negative. People who are treated for HCV and have a sustained virological response (SVR) become HCV RNA negative, unless reinfected. People who clear HCV RNA (either spontaneously or following treatment) usually remain anti-HCV positive, as antibodies persist for years, probably for life.

5.2 REFER EXPOSED PERSON TO STAFF HEALTH FOR FOLLOW-UP SEROLOGY

If source is HCV RNA positive and exposed person is anti-HCV negative

- Repeat LFTs in exposed person every 2 weeks for 3 months

- Test exposed person for HCV RNA after 6 weeks, or earlier if LFTs flare

- Test exposed person for anti-HCV after 6 weeks and 3 months

-

Any health care worker who seroconverts to HCV or develops persistently abnormal LFTs should be referred to the Liver Clinic for consideration of antiviral treatment.

6. INFECTIOUS DISEASES REPORTING

The Public Health act outlines what conditions need to be reported.

The next pages contain the most recent lists of conditions that need to be reported by

1. The Hospital or medical practitioner

2. Laboratory staff

Notification mechanisms:

Please notify Western Sydney LHDSydney West Area Public Health Unit by telephone (9840 3603 / extension in WSLHD 43603).

After hours there is a Public Health Unit duty officer on page, contactable through Westmead Hospital switch (9845 5555)

Notification forms need to be completed and faxed to Western Sydney LHD Public Health Unit on secure fax 9840 3591.

For Hospital notification the form can be accessed here:

http://www.health.nsw.gov.au/Infectious/Documents/doctor-hospital-notification-form.pdf

For Laboratory notification the form can be accessed here:

http://www.health.nsw.gov.au/Infectious/Documents/lab-notification-form.pdf

HIV is notifiable only by laboratories carrying out confirmatory testing, to Communicable Diseases Branch, NSW Ministry of Health.

Please initiate notification within 24 hours of diagnosis.

Ensure conditions marked URGENT are notified to Public Health by telephone as soon as possible

Cancer

Cancer notifications should be directed to the NSW Cancer Registry.

Please see contact details for WSLHD 

PHU on the page preceding lists from 

Public Health Act 

Please see contact details for WSLHD 

PHU on the page preceding lists from 

Public Health Act 

7. WESTMEAD INFECTION CONTROL & HOSPITAL EPIDEMIOLOGY UNIT

Aims

To provide, within the hospital and the community, an environment that will guarantee minimal risk of acquisition and transfer of any infectious process

To provide information on the management, prevention and control of infections.

Principles

Employing NSW legislation in the management of Infection Control issues including the Medical Practice Act and the Infection Control Policy

- Incorporating Standard Precautions as the baseline of all Infection Control practices, and Additional Precautions for the prevention of the transmission of infectious diseases and healthcare associated infections.

- Involves avoidance of blood and body fluids through use of personal protective equipment, correct management of sharps and waste and handwashing

The Infection Control and Hospital Epidemiology Unit is part of the Centre for Infectious Diseases and Microbiology (CIDM) under the administration of the Institute of Clinical Pathology and Medical Research (ICPMR).

The Team

Prof Jon Iredell, Head of Infectious Diseases and Microbiology

Dr Patricia Ferguson, Clinical Lead, Infection Prevention and Control

Dr Nicole Gilroy, Staff Specialist in Infectious Diseases

Kathy Dempsey, Clinical Nurse Consultant/Co-ordinator

Jo Tallon, Clinical Nurse Consultant/Co-ordinator

Kathy O’Donnell, Clinical Nurse Consultant

Rachel Paton and Nicole Tolhurst, Clinical Nurse Specialists

Jen Sealy, Registered Nurses

WSLHD Isolation Policy

Isolation of hospitalised patients becomes necessary for two basic reasons:

1. To protect other patients, hospital staff and visitors from the possible transfer of micro-organisms from an infected or colonised patient i.e. contact isolation and respiratory isolation.

2. To protect an immunocompromised patient from the possible transfer of micro-organisms from other infected or colonised patients, hospital staff and visitors i.e. Protective Precautions.

NB: Infection Control have overriding authority on the isolation or clearing of a patient

The Infection Control Manual is available in all departments via the Intranet at

http://virtapp-mas109.nswhealth.net/WSLHD_DOCV3/SearchFiles/WSYD-MAN202206.pdf

Patients that are infected or colonised with an organism that requires nursing in an isolation room:

These patients are managed to minimise the risk of spread of infection from a patient to other patients, hospital staff and visitors. The follow procedures are required:

1. Personal protective equipment clothing must be worn by staff and visitors entering the room.

2. The number of people entering the room should be kept to a minimum.

3. Articles/equipment taken into room must be kept to a minimum and medical equipment must be cleaned appropriately (detergent/disinfectant) prior to removal from the room. This includes stethoscopes. Impregnated wipes can be found on the wards for this purpose (eg Clinell)

Hand hygiene

Good hand hygiene is the cornerstone of preventing colonisation with multi-resistant organisms (MROs) and reducing infection in hospitalised patients. It is required to be performed by all healthcare workers.

All NSW Hospitals are required to perform hand hygiene as outlined by the 5 Moments for Hand Hygiene. All wards are required to audit compliance of staff every month. The moments are:

Moment 1 Before touching a patient Moment 2 Before a procedure Moment 3 After a procedure or body fluid exposure risk Moment 4 After touching a patient Moment 5 After touching a patient’s surroundings

The NSW Health benchmark for hand hygiene compliance has been 70%, and is increasing to 80%. However, the WSLHD benchmark for hand hygiene compliance is set at 95%.

Aseptic PIVC cannulation policy

Peripheral intravenous cannulation is an aseptic technique as outlined by NSW Health. In WSLHD the following need to occur:

1. Aseptic technique to be followed when inserting PIVC: a. Hand hygiene using antimicrobial soap (I min) or alcohol based hand rub b. Sterile gloves c. Aseptic field d. Skin prep: alcohol chlorhexidine ≥0.5% e. Single use tourniquet f. Asepsis maintained throughout and Insertion should stop if asepsis is

breached

2. Documentation of the cannula dressing with the date inserted, and this information entered into the medical notes

3. Daily review of cannulae to assess for ongoing requirement, signs of infection, and date since insertion with documentation in the medical records

4. Removal of PIVC required at 72 hours – consider alternate options (eg PICC) if prolonged IV access required or if cannulation very difficult.

Staphylococcus aureus blood stream infections (SABSIs)

Hospital-acquired Staphylococcus aureus blood stream infections (HA-SABSIs) are one of the key markers of hospital performance. They are reported monthly to NSW Health, and can be seen on MyHospital website.

SABSIs place patients at risk of endocarditis, osteomyelitis, and prolong admissions. They need treatment with at least 14 days of intravenous antibiotics. The main causes for developing hospital acquired SABSI include PIVC infections and wound infections. All HA SABSIs within WSLHD are investigated by a microbiology registrar and infection control for preventable factors. A letter is sent to the admitting consultant outlining the potential risks for the patient to have acquired infection.

At Westmead Hospital, the rates of HA-SABSI have reduced over the last 10 years from 4 / 10,000 OBDs (occupied bed days, double the benchmark set by NSW Health of 2/10,000 OBDs) to <1 / 10,000 OBDs in 2016. During this time, hand hygiene compliance has increased from 75% to 85% and the aseptic cannulation policy was implemented.

To prevent HA-SABSIs: Ensure PIVCs are inserted aseptically, are removed before 72 hours, wounds and PIVC sites are inspected for infections and appropriate antibiotics are given if this develops, alternate access is organised if a patient requires prolonged intravenous therapy.

SHARPS INJURIES - HEPATITIS B PROTOCOL

SOURCE PATIENT : HB sAg POSITIVE

STAFF NOT IMMUNISED STAFF IMMUNIZED NOT IMMUNE and/or IMMUNE TAKE 10mls TAKE 10mls CLOTTED BLOOD CLOTTED BLOOD HBsAg and ANTI HBc FOR ANTI-HBs GIVE HBIg IMMEDIATELY IF IMMUNITY AFTER EXPOSURE OR DOUBTFUL GIVE WITHIN 48 HOURS * HBIg (Must be given within 7 days) * BOOSTER HEP B VACCINE REFER TO STAFF HEALTH HBIg is available from Emergency Dept COMMENCE HEPATITIS (kept in Fridge in Treatment Rm) VACCINATION (2nd & 3rd DOSE Occupational exposure to Hep C 1 & 6 MONTHS LATER) Refer to Staff Health

SOURCE PATIENT: HB sAg NEGATIVE

NO URGENT ACTION REQUIRED

STAFF NOT IMMUNISED STAFF IMMUNIZED NOT IMMUNE and/or IMMUNE RECOMMEND COURSE NO FURTHER ACTION HEPATITIS B REQUIRED VACCINATION IN STAFF HEALTH

SOURCE PATIENT : HB sAg UNKNOWN

TEST HBsAg WITH CONSENT AND FOLLOW APPROPRIATE PROTOCOL

IF SOURCE PATIENT UNAVAILABLE

STAFF NOT IMMUNISED STAFF IMMUNIZED NOT IMMUNE and/or IMMUNE RECOMMEND COURSE NO FURTHER ACTION HEPATITIS B REQUIRED

VACCINATION IN STAFF HEALTH