- this is an infection control emergency
- notify ICU staff and ID team
- assess whether coloniser or producing active infection
- determine whether patients required antibiotic changes
- remove colonised material (e.g. resite lines)
- terminal cleaning once patients discharged
PREVENT CROSS CONTAMINATION
- full cleaning of contaminated areas
- notify visitors about importance of barrier contact
ROOT CAUSE ANALYSIS
– assessment of possible vector transmission
- prescribing practices
- screen environmental reservoirs (work surfaces, ventilation ducts, ventilator tubing)
- review antibiotic practices (many multi-resistant organisms are produced because antibiotic practice)
- review biograms
- review dosing
- discuss with ID regarding cycling of antibiotics
- review infection control procedures (hand-washing, barrier nursing, universal precautions)
- review CVL procedures (insertion, accessing, daily procedures)
- review ventilator care – scheduled tubing changes (weekly)
- vigilance on line accessing behaviour, insertion techniques, when removed (Provonost)
- review issue once behaviours changed
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of LITFL.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.