INFECTION PREVENTION CONTROL NURSES COLLEGE CONFERENCE 2019 Let’s go on a Pseudomonas hunt Iona Bichan RN, MN etc Nelson Marlborough DHB
TODAY’S TRIP • AN EXPEDITION INTO THE WILDS OF ENDOSCOPY TO SEARCH FOR THE ELUSIVE PSEUDOMONAS BEAST • HOW DID WE SET UP AND CARRY OUT THE HUNT? • TIPS FOR FUTURE EXPEDITIONS
THERE’S PSEUDOMONAS IN OUR WATER! • SCOPE SURVEILLANCE: POSITIVE GROWTHS • GENCA PROCESS FOLLOWED • TAP WATER TESTED
PSEUDOMONAS FACTS TOXIN-PRODUCING • PSEUDO/MONAS=FALSE/UNIT. AERUGINOSA=BLUE GREEN COLOUR EXOTOXIN A- PREVENTS • NORMALLY PRESENT IN WET ENVIRONMENTS CELL PROTEIN SYNTHESIS EXOENZYME EXOU- DAMAGES CELL MEMBRANE • LIKES 37 BUT CAN LIVE UP TO 42 DEGREES CELSIUS PYOVERDINE- ROBS IRON FROM MITOCHONDRIA (YELLOW PIGMENT) • BIOFILM SPECIALIST PYOCYANIN- A BLUE PIGMENT
CUTE & FLUFFY ....& DANGEROUS • OPPORTUNISTIC PATHOGEN • MAJOR SURVEILLANCE FINDING
THE PSEUDOMONAS HUNT • HUNTING PARTY (IP TEAM, LAB, ENDO TEAM, MANAGERS, GALLAY) • TRACKING EQUIPMENT (SURVEILLANCE, DATA ANALYSIS) • PATIENT SAFETY DURING THE HUNT
ENDOSCOPE PROCESSING • LONG NARROW TUBES • IMPOSSIBLE-TO-STERILISE MATERIALS • GOING IN TO UNPROTECTED PARTS OF THE BODY WHAT COULD GO WRONG?
THE TERRAIN Environment People Processes Plant
FOLLOWING THE FOOTPRINTS • PLANNING • COLLECTION OF FACTS/DATA • TRYING AND ELIMINATING VARIOUS TRAILS
I’LL TAKE THE HIGH ROAD….. • INDIVIDUAL VARIATIONS IN CLEANING PROCESS • EXTRAS AND OMISSIONS • A HOME FOR EVERY OCTOPUS
LOOKING UNDER EVERY STONE • PROCESS OF TESTING AND EXCLUDING EACH AREA • TEST SAMPLING • WORKFLOWS • MACHINERY
FALSE TRAILS NOT THE WATER SUPPLY NOT THE MANUAL CLEANING NOT THE SOLUSCOPES NOT THE DRYING CABINET NOT SAMPLING CONTAMINATION
THE HUNT INTERFERES WITH BAU • REGIONAL BOWEL SCREENING PROJECT JUST STARTING • PRIVATE HOSPITAL EXPECTATIONS • INCREASED SURVEILLANCE WORKLOAD • EXTRA TRAFFIC IN THE ENDOSCOPY SUITE • PATIENT SAFETY IS THE LINE
RETRACING OUR STEPS • HAVING ELIMINATED ALL OPTIONS, RETURN TO THE START TO RE-ASSESS • PSEUDOMONAS LIVES IN WATER. WHAT IS WET IN THIS ROOM?
Is it the source? ESR STRAIN TESTING
TIPS FOR FUTURE EXPEDITIONS • PATIENT SAFETY COMES FIRST- IP’S CORE FUNCTION • SURVEILLANCE WORKS • STAFF NEED SUPPORT AND EDUCATION TO DO THEIR JOB PROPERLY • GOOD COMMUNICATION IS VITAL • BEAR HUNTS SOMETIMES FIND MORE THAN JUST BEARS • NEVER TRUST THE PLUMBER WHEN THEY SAY “THE WATER’S OFF!”
Thanks to Wairau endoscopy nurses & sterile services technicians Drs Richard Everts & Erana Gray, IP service Gillian Clarke, endo CNS Kendall Stewart, Gallay DHB Facilities & Management
REFERENCES GASTROENTEROLOGICAL NURSES COLLEGE OF AUSTRALIA & GASTROENTEROLOGICAL SOCIETY OF AUSTRALIA (2011). INFECTION CONTROL IN ENDOSCOPY 3 RD ED • • GAVEAU, A., COETSIRE, C., ROQUES, C., BCCHIN, E ET AL(2017). BACTERIA TRANSFER BY DEFORMATION THROUGH MICROFILTRATION MEMBRANE, JOURNAL OF MEMBRANE SCIENCE 523. 446-555. DOI10.1016/JMEMSCI.016.10.023 • KISKO G, SZABO-SZABO O (2011). BIOFILM REMOVAL OF PSEUDOMONAS STRAINS USING HOT WATER SANITATION. ACTA UNIV. SAPIENTIAE ALIMENTARIA 4:69-79. • OFSTEAD C., WITZLER, H., HEYMAN, O., JOHNSON, B., EILAND, J. & SHAW (2017) LONGITUDINAL ASSESSMENT OF REPROCESSING EFFEICTIVENESS FOR COLONOSCOPES AND GASTROSCOPES; RESULTS OF VISUAL INSPECTIONS, CHEMICAL MARKERS AND MICROBIAL CULTURES. AMERICAN JOURNAL OF INFECTION CONTROL 45 DOI 10.1016/J.AJC • WICKHAM LABORATORIES (2019). FACT SHEET” PSEUDOMONAS AERUGINOSA WWW.WICKHAMLABS.CO.UK/TECHNICAL RESOURCE CENTRE • OFSTEAD, C.., HEYMANN, O., QUICK, M., EILAND, J., & WETZLER, H. (2018) RESIDUAL MOISTURE AND WATERBORNE PATHOGENS INSIDE FLEXIBLE ENDOSCOPES-EVIDENCE FROM A MULTISITE STUDY OF ENDOSCOPE DRYING EFFECTIVENESS. AMERICAN JOURNAL OF INFECTION CONTROL 46, 680-96 DOI 10.1016/J.AJC.10.2018.03.002 • XUE-YUE JI MM A, PEI-YONG NING, WEI ZHANG B, DONG-JING YANG, HE LIU A, JUN LIU, JIA SONG, CHUN-NAN FEI (2018). MICROBIOLOGIC ASSESSMENT OF flEXIBLE GASTROINTESTINAL ENDOSCOPE REPROCESSING USING A PUMP-ASSISTED SAMPLING TECHNIQUE: AN INVESTIGATION INVOLVING ALL ENDOSCOPY UNITS IN TIANJIN, CHINA. AMERICAN JOURNAL OF INFECTION CONTROL 46 E43-E48 DOI.ORG/10.1016/J.AJIC.2018.04.216 • IMAGES: MICROBEWIKI.KENYON.EDU; FARVER, C., & ZANDER, D.(2009). MOLECULAR BASIS OF PULMONARY DISEASE. WWW. SCIENCEDIRECT.COM/TOPIC/AGRICULTURAL- AND-BIOLOGICAL-SCIENCES/PSEUDOMONAS AERUGINOSA
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