The HOCUS in PoCUS! Healthcare-associated infection and other challenges arising with Point of Care Ultrasound (PoCUS) Percutaneous Cannulation in emergency and critical care

Background

Point of Care Ultrasound (PoCUS) Percutaneous Cannulation is increasingly used globally in emergency and critical care settings as routine practice and a core skill of practitioners. There is an ever-increasing body of evidence demonstrating its efficacy and safety as the prefer method for percutaneous cannulation for particular patient groups and presenting conditions. The practice is, however associated with significant risks to patients, in particular for healthcare-associated infections such as bloodstream infection and associated sepsis.

Aims

This paper presents a critical review of the literature that examines the risk of healthcare-associated infection and other hospital associated complications associated with PoCUS Percutaneous Cannulation. It reports a recent outbreak of Burkholderia cenocepacia bacteraemia and infection in 11 intensive and emergency departments patients caused by contaminated sterile ultrasound gel used for central line insertion and sterile procedures within four hospitals across Australia. It examines these events and the genesis and publishing of recent ASUM/ACIPC Ultrasound Probe Reprocessing Guidelines.

Results

While the popularity Point of Care Ultrasound (PoCUS) Percutaneous Cannulation is ever-increasing, measures to protect patients from procedure-associated bacteraemia have not been as forthcoming. There are significant issues with a lack of systematic cleaning and decontamination of the equipment of this semi-critical device poor that is associated with both the high demand for its use in emergency care settings and a lack of recognition of the risks of healthcare-associated infection. A lack of formal accreditation of practitioners in the use of PoCUS poses significant risks to patients.

Conclusion

Point of Care Ultrasound (PoCUS) Percutaneous Cannulation has become a core skill in emergency medicine and nursing practice. Formal training and certification of practitioners together with formal decontamination procedures is required to ensure not only the efficacy of the procedure but also to its safety with respect to the significant risks of healthcare-associated infection.


Biography:

Professor Ramon Shaban is Editor-in-Chief of the Australasian Emergency Nursing Journal. As an emergency nurse and credentialled expert infection control practitioner with an extensive background in clinical sciences and practice, his inter-professional expertise in infectious diseases, infection control and emergency care are the basis of a highly successful and integrated program of teaching, practice, and research. Professor Shaban is the Inaugural Clinical Chair and Professor of Infection Prevention and Control at the University of Sydney and Western Sydney Local Health District, within the Sydney Nursing School and Marie Bashir Institute for Infectious Diseases and Biosecurity. He is a member of the Australian Government Strategic and Technical Advisory Group on Antimicrobial Resistance, a member of the Australian Commission on Safety and Quality in Healthcare Healthcare-associated Infection Advisory Committee, and was 2016-2017 President of the Australasian College for Infection Prevention. He is a member of the World Health Organization Global Outbreak and Response Network, and in 2016 Ramon served as Technical Advisor (Antimicrobial Resistance) to the World Health Organization. Ramon is particularly interested in the role of emergency clinicians in the management, prevention and control of infectious diseases and healthcare-associated infection.

Early access to defibrillation program

Garry White, Ambulance Tasmania

The Early Access to Defibrillation Program (EADP) was developed by Ambulance Tasmania to coordinated the use of AED recourses available within the Tasmanian community. Since its inception in July 2014, the registry has grown to hold over 660 AEDs, by far the largest per capita AED database in the country. Registered AED owners have now been notified of cardiac arrests on many occasions, delivery lifesaving care prior to the arrival of Ambulance resources, saving many Tasmanian lives. This presentation describes the development, implementation and subsequent use of the database and notification system.

Big old jet airliner – in flight medical emergencies and you!

 

Michael Browne

This will be a fun session focusing on the nuts & bolts information you need to provide care during an in-flight medical emergency. What is in your medical kit? What drugs do you have? How do you go about providing care? Indemnity? Can you divert the plane to Fiji? All very good “need to know” practical information for your next flight. This session will have a twist… so pack your parachute.

“Ask an interventional cardiologist”

Ever wanted to tell an experienced interventional cardiologist from New York what you really think? Well, here’s your chance. This will be an interview style session with questions from the the chair & audience. There will be no script, powerpoint or common sense involved. This will hopefully be interesting and informative. Come ready with your questions… even better if done in a New York accent. But please, no Donald Trump.

Interactive Best Papers of 2016

Dr Brian Doyle & Dr Mark Reeves 

Ok… these may not be the “best” papers of 2016, but they are important, relevant and fantastic for group discussion. This will very much be an interactive session and we will be seeking the expertise of the audience. In addition, we will have our own biostatistical guru on hand to lend us his wisdom and unique perspective on matters. These sessions have always been well received and we hope you enjoy.

 

AnnEM Isopropyl Alcohol Nasal Inhalation for Nausea an RCT

AnnEM Propofol or Ketofol for Procedural Sedation- The POKER study a RCT

NEJM Amio lido vs placebo for out of hospital cardiac arrest

NEJM Trial of Continuous or Interrupted Chest Compressions during CPR 2015

The I.T factor in emergency healthcare: boon or blight?

Wayne Varndell

Increasingly, information technology (IT) is being integrated into the healthcare environment to enhance access to clinical information, communication, safe medication use, training and education of clinicians and performance monitoring.   However, the benefits of IT in emergency healthcare have been notoriously difficult to measure, and are largely focused on timeliness and precision. Rarely is productivity, applicability or feasibility explored.  In time-sensitive environments such as ED, workflows are rarely linear or identical.  IT is a general purpose technology; the benefits and impact on patient care vary enormously, and are dependent upon the application and the characteristics of the adopting organisation and the clinician.  Is IT improving patient care, or is it becoming a wedge between the clinician and the patient?

Sedation and pain management in the critically ill

Wayne Varndell

Critically ill patients have complex needs; chief among these is adequate sedation and pain relief.  While the incorporation and effectiveness of procedural sedation in ED has been well documented, the safety and effectiveness of sedation and pain management of critically ill intubated patients in ED is not. Over half of intubated and mechanically ventilated patients experience moderate to severe pain; a situation potential worse for all patients unable to verbally communicate.  Patient pain and distress may be multifactorial in terms of presentation (e.g. trauma, delirium), but also iatrogenic.  Multiple barriers are present within the ED setting.

In this presentation, an overview of the current literature and strategies with a particular focus on the ED will be discussed.

Political humanitarian disaster-training expedition event medicine” AusMAT at the Tour de Timor

After you’ve diverted your inflight emergency to West Africa and fought off Ebola with your heavily gloved hands, peel off your sweaty PPE and relax – Humanitarian medicine may at times be hard, but hopefully it isn’t all pain, frustration, sadness and PTSD.

Come with Domhnall on a trip to our nearest and poorest neighbour – Timor L’Este – to watch a bike race, meet some local kids, get up with the dawn and sleep under the stars while planning for the worst without it ever happening, doing a little medicine, and maybe learning a thing or two about the training that sits in the background of Australia’s humanitarian disaster response.

Peri-mortem c-section and the aftermath

Keith and Nick will describe a case of peri-mortem c-section. The history, indications and potential outcomes will be discussed with a view to considering where this procedure might sit in the skill sets of emergency physicians and primary responders.

Should you be able to undertake one?

Conference Committee

Dr Brian Doyle
Australasian College for Emergency Medicine (ACEM)

Bess Swinton & Ryan Posselt
Paramedics Australasia (PA)

Michael Browne
College of Emergency Nursing Australasia (CENA)

Important Dates

Early Bird - June 2018
Conference - 10 - 12 August 2018

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