The Infection Control Toolbox is a set of themed links accessible from a single site which aims to help the Healthcare Worker access relevant infection control information quickly.

The information is compartmentalised for easy access.

To search for a topic press the 'Ctrl-F' (find) function.
Please contact VICNISS if any links are broken.

 


AGED CARE

Aged Care Quality Standards: Standard 3 requirement (3) (g)

Minimisation of infection-related risks through implementing: standard and transmission-based precautions to prevent and control infection; and practices to promote appropriate antibiotic prescribing and use to support optimal care and reduce the risk of increasing resistance to antibiotics.

Guidance material to assist aged care services to comply with the Aged Care Quality Standards (Quality Standards) are available.

Prevention and control of infection and control in aged care (currently under review)

 

Management of outbreaks and epidemiologically significant organisms in aged care

Gastroenteritis

The Victorian Government has produced a guide to assist in the management and control of outbreaks of gastroenteritis (gastro) in aged care homes and other facilities.

The Gastro-Info Kit, developed by the Australian Government Department of Health and Ageing as a resource kit to assist aged care homes in the event of a gastroenteritis outbreak. It is not a set of guidelines to manage an outbreak of gastroenteritis.

Clostridioides difficile (previously ‘Clostridium difficile’)

Residents of aged care homes are at increased risk of Clostridioides difficile infection. These guidelines assist in preventing and controlling the spread of infection.

Scabies

Scabies is found worldwide, and may affect people of all races and social classes.  Facilities such as aged care homes are often sites of scabies outbreaks

Carbapenamase Producing Enterobacteriaceae

The Victorian Department of Health has provided information for Carbapenamase Producing Enterobacteriaceae (CPE) specifically for Long Term Health Care Facilities

Influenza            

Managing a respiratory outbreak (suspected or confirmed) effectively requires a number of required actions. Influenza is not the only virus that may cause an outbreak in aged care homes.  Other viruses include parainfluenza, respiratory syncytial virus (RSV), adenoviruses, and rhinoviruses The Victorian Department of Health Respiratory illness in management in residential and aged care facilities has a variety of tools and checklists to support the facility in the event of a single case or an outbreak.

The National guidelines offers further information in managing influenza outbreaks: Guidelines for the Prevention, Control and Public Health Management of Influenza Outbreaks in Residential Care Facilities.

VICNISS Fact Sheets for aged care homes

Fact Sheet on Prevention and control of Herpes Zoster in Aged Care Homes
Fact Sheet on Prevention and control of Influenza in Aged Care Homes
Fact Sheet on Prevention and control of Pneumococcal Disease in Aged Care Homes

 

Antimicrobial stewardship

The purpose of Antimicrobial Stewardship is to promote optimal management of antimicrobials in order to maximise the effectiveness of treatment and minimise potential for harm (including drug resistance and toxicity).

The National Centre for Antimicrobial Stewardship (NCAS) has provided resources to assist aged care homes.

Available to purchase is a book from National Quality Partners Antibiotic Stewardship Post-Acute and Long-Term Care Playbook. This book offers practical strategies and useful resources for implementing high-quality antibiotic stewardship programs in post-acute and long-term care facilities.  Internationally the Centers for Disease Control and Prevention (CDC) has tools to assist aged care homes with the Core Elements of Antibiotic Stewardship

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ANTIMICROBIAL STEWARDSHIP

NSQHS Standards: Action 3.15 & 3.16
The Health Service organisation implements systems for the safe and appropriate prescribing and use of antimicrobials as part of an antimicrobial stewardship program

AURA — Antimicrobial Use and Resistance in Australia is a surveillance system to support strategies to prevent and contain antimicrobial resistance

National Centre for Antimicrobial Stewardship (NCAS) is using a ‘One Health’ approach in tackling antimicrobial resistance.  Antimicrobial resistance is seen as an ecologic problem that includes strategies that cover food production, veterinary prescribing, community general practice and hospital prescribing.

National Antimicrobial Prescribing Survey (NAPS) is a national survey which has been in use since 2011.  It helps health services to assess their antimicrobial prescribing practises and provides valuable information on the utilisation of antimicrobials within Australia.

Specific modules include:

  • Hospital NAPS
  • Aged Care NAPS
  • Surgical NAPS
  • QI NAPS (complementary to Hospital NAPS)

Therapeutic Guidelines: Antibiotics is an evidence based guide to appropriate antimicrobial prescribing.  This is available to Victorian health service clinicians via the Clinicians Health Channel

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ASEPTIC TECHNIQUE

NSQHS Standards: Action 3.9
The health service organisation has processes for aseptic technique that:
a) Identify the procedures where aseptic technique applies
b) Assess the competence of the workforce in performing aseptic technique
c) Provide training to address gaps in competency
d) Monitor compliance with the organisation’s policies on aseptic technique

Victoria

The Victorian Department of Health is making this aseptic technique learning module freely available for health services to use and adapt to meet the National Safety and Quality Health Service Standards of the Australian Commission on Safety and Quality in Health Care.

National

Aseptic technique risk matrix provides a score for the following factors

  • Clinical context
  • The treatment type
  • Assessment of skills of clinical workforce

Australasian College for Infection Prevention & Control (ACIPC)

Has a large number of resources to assist ICPs in developing an aseptic technique program such as an action plan, assessment, workbooks and education. 

International

ANTT® (Aseptic Non Touch Technique) program was developed in the UK.  It uses a standardised approach to aseptic practice.  It has become the de facto national standard aseptic technique in both the UK and Australia and continues to expand internationally.   

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BUILDING & RENOVATION

NSQHS Standards: Action 3.12
The health service organisation has processes to evaluate and respond to infection risks for maintaining, repairing and upgrading buildings, equipment, furnishings and fittings 

 The role of Infection Control teams in any construction work within the health care facility is as follows:

1. Involved in planning phases as part of a multidiscipline team
2. Risk assessment
2.1 Patient profile
2.2 Construction activity type
2.3 Recommended interventions
3. Environmental monitoring and compliance auditing
4. End of work—fit for use assessment

Construction practices may impact on patient wellbeing by disseminating bacteria and filamentous fungi causing hospital acquired infections.

Victorian DHHS document Infection Control Principles for the Management of Construction, Renovation, Repairs and Maintenance within HealthCare Facilities is a practical manual for reducing the risk of health care associated infection by dust and water borne micro-organisms. 

Employing risk management principles

  • identify the at risk population,
  • identify the location of the at risk population in relation to the construction,
  • know the transmission route of a likely pathogen, and then
  • mitigate the risk in the planning stages.

South Australian Department of Health has provided a similar toolkit: - Infection prevention and control during construction and renovation (2018)

The Australasian Health Facility Guidelines (AusHFG) have been made freely available. The 6 chapters are:

    • Building elements such as approaches to hand basins and isolation rooms
    • The physical environment describing elements such as air handling etc.
    • Surfaces and finishes
    • Considerations relating to construction and renovation of healthcare facilities to minimise risk of infection.
  • Part E: Building Services & Environmental Design
  • Part F: Project Implementation

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 CLEANING

NSQHS Standards: Action 3.6
Clinicians asses infection risks and use transmission based precautions on the risks of transmission of infectious agents, and consider the need for additional environmental cleaning or disinfection
NSQHS Standards: Action 3.11
The health service has processes to maintain a clean and hygienic environment in accordance with Australian Guidelines for the prevention and Control of Infection in Healthcare and jurisdictional requirements

 Cleaning standards for Victorian health facilities aim to improve the quality of healthcare provision by ensuring risks are identified and managed.

Auditing cleanliness

  1. Environmental cleanliness will be measured through accreditation to the National Safety and Quality Health Service (NSQHS) Standards and patient-reported cleanliness through the Victorian healthcare experience survey.
  2. Health facilities may adopt alternative auditing methods, in addition to, or in the place of visual inspections
    1. ATP bioluminescence testing (adenosine triphosphate) are commercial systems designed to test for residual organic matter on the surface after cleaning
    2. Fluorescent markers to high touch surfaces. Ultraviolet light is used after cleaning to assess the quality of the clean
    3. Microbiological testing of environmental areas may be valuable in outbreak settings
  3. Health facilities will be able to utilise internal or external auditors, for auditing of environmental cleanliness.
  4. Areas are weighted according to risk

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 EDUCATION

NSQHS Standards: Action 1.20
The health service uses its training systems to assess the needs and competency of its workforce and to monitor the workforce's involvement in training
NSQHS Standards: Action 1.27
The health service organisation has processes that support clinicians to use the best available evidence, including relevant clinical care standards developed by the ACSQHC

 Australian Commission on Safety and Quality in Health Care: Infection Control Training Portal

  • To assist healthcare workers who undertake Infection prevention and control as part of a clinical role
  • 10 online modules each equal to 1 CPD point. Each module may be completed in order of preference by the registered user. Certificate of completion is available at the end of each module

VICNISS offers a range of educational webinars annually. To registered users, modules are available on each surveillance module.

The Australasian College for Infection Prevention and Control (ACIPC) is the peak body for Infection Prevention and Control in the Australasian region.  It offers a wide range of professional development opportunities for members and non-members:

  • Annual Conference
  • Foundations of Infection Prevention and Control Course
  • Educational Workshops
  • Member only—webinars
  • Peer support

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HAND HYGIENE

NSQHS Standards: Action 3.8
The health service organisation has a hand hygiene program that:
a) Is consistent with the current National Hand Hygiene Initiative and Jurisdictional requirements
b) Addresses noncompliance or inconsistency with the current National Hand Hygiene Initiative

 Hand Hygiene Australia

  • Hand Hygiene Australia eLearning Modules
    • Infection Control
      • Direct patient contact
      • Indirect patient contact
      • Minimal patient contact
    • Hand Hygiene modules for a wide range of healthcare workers
      • Standard Theory
      • Nursing/Midwifery
      • Medical
      • Royal College of Surgeons
      • Allied Health
      • Renal dialysis
      • Dental
      • Non-clinical
      • Student
    • Hand Hygiene Auditor Modules
      • Pre-workshop
      • Annual Auditor Validation
    • Other—Hand dermatitis

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IMMUNISATION 

NSQHS Standards: Action 3.13
The health service organisation has a risk based workforce immunisation program that:
a) Is consistent with the current edition of the Australian Immunisation Handbook
b) Is consistent with jurisdictional requirements for vaccine-preventable diseases
c) Addresses specific risks to the workforce and patients

Resources

  • The Australian Immunisation Handbook provides clinical advice for health professionals on the safest and most effective use of vaccines in their practice.
  • The Melbourne Vaccination Education Centre (MVEC) is an online initiative which provides up-to-date immunisation information for healthcare professionals and the public. It is based at the Murdoch Children’s Research Institute and is affiliated with SAEFVIC.

Focusing on Healthcare Workers

Healthcare workers may be exposed to, and transmit, vaccine-preventable diseases such as influenza, measles, rubella and pertussis. Maintaining immunity in the healthcare worker population helps prevent transmission of vaccine-preventable diseases to and from healthcare workers and patients.

NSQHS Standards Workforce immunisation risk matrix may be used to calculate the risk response for the organisation’s workforce. This information can be used to prioritise action.

Adverse events related to vaccinations are rare but may be life threatening

Adverse Events Following Immunisation-Clinical Assessment Network (AEFI-CAN) formerly known as SAEFVIC provides a central national reporting hub for adverse events.

The adverse event following immunisation (AEFI) reporting portal used by immunisers to report individuals who may have had a serious or unexpected adverse event following immunisation. The service is twofold.

1.  Reported individuals are expertly reviewed and follow up by a specialist doctor maybe arranged

2.  By getting as much information about AEFI, problems with vaccines or systems are detected as early as possible if they do occur.

Therapeutic Goods Administration (TGA) is another portal for reporting vaccine related adverse events.

Cold chain

Cold chain; breaches can affect the potency of the vaccine.  There are clear processes to be followed for vaccine safety including delivery, storage and back up plans in the event of power outages. All immunisation providers should ensure effective cold chain management of vaccines in line with the National vaccine storage guidelines: Strive for 5

What to know

Webinar: Vaccine and Cold Chain Management

Becoming a nurse immuniser

The Victorian Chief Health Officer recognises a number of study programs for the Nurse Immuniser

Immunisation Nurses Special Interest Group (INSIG)

INSIG is a professional body of the Australian Nursing Midwifery Federation (ANMF Vic Branch) to support Nurses working in Immunisation Practice.

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 INFECTION CONTROL GUIDELINES AND NATIONAL STANDARDS 

NSQHS Standards: Action 1.27
The health service organisation has processes that provide clinicians with ready access to best-practice guidelines and decision support tools

Victoria

Victorian Infection Control Guidelines

National

Australian Guidelines for the Prevention and Control of Infection in Healthcare 2019

National STANDARDS

NSQHS Standards

These eight standards have been developed to drive the implementation of safety and quality systems and improve the quality of health care in Australia.

Standard 3 focuses on Preventing and Controlling Healthcare-associated infection and is aligned with Standard 1 (Clinical Governance) & Standard 2 (Partnering with consumers).

Tools to assist:

Resources for NSQHS Standard – second edition. Includes a vast array of support material including workbooks, risk matrices and monitoring tools plus more.

ACSQHC email updates

On the Radar: A summary of some of the recent publications in the area of safety and quality in health care.

Commission eNews

Subscription to regular emails is the easiest way to access this information

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 INFECTIOUS DISEASES RESOURCES 

NSQHS Standards: Action 3.6
Clinicians assess infection risks and use transmission-based precautions based on the risk of transmission of infectious agents, and consider whether a patient has a communicable disease, or an existing or pre-existing colonisation or infection with organisms of local or national significance.
Clinicians are able to accommodate needs to manage infection risks, control the environment and establish processes for transferring the patient within the health service or to an external service.

A-Z of infectious Diseases, once known as the ‘Blue Book' provides detailed information about common and rare diseases that pose public health concerns. Information included are notification requirements, school and childcare exclusion, identification of symptoms, incubation periods, and modes of transmission and control measures. The aim is to assist public health practitioners in the prevention and control of infectious diseases.

For public health safety, prescribed conditions must be notified to the Department of Health and Human Services.  Notifiable conditions were once grouped into 4 groups (A, B, C & D).  The groupings have now been simplified as “Urgent” or “Routine”.  Notification procedures for infectious diseases clearly outline who is required to notify, what is to be notified and the timeline notification must occur.

Infectious disease surveillance in Victoria provides daily reports for notifiable diseases, and seasonal influenza reports

Brochures for culturally and linguistically diverse (CALD) in the Health Translations Directory has been produced by the Centre for Culture, Ethnicity and Health.  This group is regularly reviewing the collection

Therapeutic Guidelines: Antibiotics is an evidence base guide to appropriate antimicrobial prescribing.  Available to Victorian Health Services via the Clinicians Health Channel

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LEGIONELLA & MYCOBACTERIUM CHIMAERA 

NSQHS Standards: Action 3.4
Surveillance activities that include:
a) collection and reporting of data
b) monitoring and management of risks
c) Improvement strategies
NSQHS Standards: Action 3.6
Risk of transmission of infectious agents:
Maintenance or service history to identify appropriate monitoring of air-handling systems and water supply systems

Pneumonia is the most commonly described manifestation of Legionella infection and is termed Legionnaires’ disease.  Legionella can also cause a self-limiting acute febrile illness termed Pontiac fever. Infection by Legionella occurs following inhalation or aspiration of aerosol droplets containing Legionella bacteria or host organisms infected with Legionella bacteria.

Guidelines for Legionella Control, published by the Australian Government, are designed to assist a health service’s Legionella risk management team to assess and manage the risk from Legionella in health and aged care facilities. These guidelines are also accessible from the Victorian Department of Health and Human Services  - Legionella and water delivery systems.

Cooling tower systems are designed to remove heat, temporarily store water that is then recirculated.  The water is sprayed or dripped into a large chamber which is then cooled by a thermostatically controlled fan. Potentially Legionella-contaminated droplets may be generated by the cooling tower systems and inhaled by susceptible people.

Managing the risk in cooling tower systems and water delivery systems includes registration and auditing of the systems

Legionnaires’ disease is an urgent notifiable disease.

Infection control risks with medical devices that have built in reservoirs

There is a specific risk that heater-cooler devices used in Cardiac Surgery may be contaminated with Mycobacterium chimaera (M. chimaera), and that exposure of patients to the aerosolised exhaust from these devices may cause infection.

M.Chimaera infections may not be clinically apparent for several years after exposure.

Non-tuberculous Mycobacterium infections associated with heater cooler devices

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MULTI RESISTANT ORGANISMS 

NSQHS Standards: Action 3.4
Surveillance activities that include:
a) collection and reporting of data
b) monitoring and management of risks
c) improvement strategies
NSQHS Standards: Action 3.15
Antimicrobial Stewardship program:
a) provides access to evidence based information
b) monitors antimicrobial prescribing relevant to the clinical setting

Staphylococcus aureus bacteraemia in Australian hospitals 2016-17 (SABs) reports on hospital associated infection (sensitive and resistant strains).  SAB is an indicator of the safety and quality of hospital care. 

AURA — Antimicrobial Use and Resistance in Australia is a surveillance system to support strategies to prevent and contain antimicrobial resistance

AGAR  - is a unique collaboration of clinicians and scientists from major microbiology laboratories around Australia, who have tested and gathered information on the level of antibiotic resistance in bacteria causing important and life threatening infections since 1985.  It is funded by the Australian Commission on Safety and Quality in Health Care (ACSQHC)

AGAR is now a working group of the Australian Society for Antimicrobials (ASA), and three Program Committees have been formed

Staphylococcus aureus (ASSOP – Australian Staphylococcal Sepsis Outcome Program)

Enterococcus spp. (AESOP – Australian Enterococcal Sepsis Outcome Program)

Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter spp. (GNSOP – Gram negative Sepsis Outcome Program)

State Government

MRO

Patient-centred risk management strategy for multi-resistant organisms provides a framework to assist clinicians in determining how to care for an individual with an MRO within their clinical setting.

MRSA

Staphylococcal infections

Staphylococcus aureus – golden staph

What is MRSA brochure has been translated into 13 languages

CPE

The Victorian guideline on Carbapenamase-producing Enterobacteriaceae (CPE) for health services supersedes this risk management strategy and must be followed for all CPE cases.

Candida auris

C.auris is an emerging treatment resistant fungal infection of serious public health implications.

Confirmed or probable cases (invasive infection or colonisation) are to be notified by the treating clinician, by telephone, to the Department of Health and Human Services via 1300 651 160.

Additionally it is requested that all isolates of confirmed C. auris are forwarded to the Victorian Infectious Diseases Reference Laboratory for further confirmatory and susceptibility testing.

Guidelines for the management of Candida auris will soon be available following wide consultation within the health sector

VICNISS provides a wide range of resources for members.  It includes the following

CPE, VRE & MRSA

Reporting of New and Emerging Pathogens of Significance

National Guidelines for MROs & other significant organisms

ACSQHC CPE resources

Non-tuberculous Mycobacterium infections associated with heater cooler devices

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 OCCUPATIONAL EXPOSURES 

NSQHS Standards: Action 3.1
The workforce uses the safety and quality systems from the Clinical Governance Standard when implementing policies….for safe work practices

Health Services should have their own procedures for managing exposures to blood or body fluids.  Resources to aid development of procedure may be found at the Department of Health & Human Services: Managing exposures to blood and body fluids or substances

Consenting for Blood borne virus testing

Under the Public Health and Wellbeing Regulations, only a ‘person of prescribed class’ may gain consent for blood borne virus testing. This person may be either a medical practitioner or a person whose competencies and training qualifications have been determined by the Secretary of the DHHS.

Nurses, may consent if they have completed a pre and post testing course to become a ‘prescribed person’.

State requirements

Pre and Post-test counselling courses in Victoria

Family Planning Victoria

La Trobe university– Australian Research Centre in Sex, Health & Society (ARCSHS)

National references

Conveying blood borne virus results guidelines

Pre and post-test discussions (Hepatitis C) (Australian Government; as part of the National Hepatitis C Testing Policy 2007)

Australian guidelines for HCW with BBV/EPP

http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdna-bloodborne.htm

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OUTBREAK 

NSQHS Standards: Action 3.1
Policies governing outbreaks or unusual clusters of infection or communicable diseases
NSQHS Standards: Action 3.4
Surveillance strategy to identify possible cases
NSQHS Standards: Action 3.5
Transmission Based Precautions to reduce the risk of infection to patients, the workforce and visitors
NSQHS Standards: Action 3.6
Implementation of transmission based precaution, including accommodation requirements, environmental cleaning
NSQHS Standards: Action 3.7
Communication processes of infectious status, as required, to other health services and/or government bodies

Gastrointestinal diseases

Victorian: Guidelines for the investigation of gastrointestinal illness, reviewed annually. 

The guideline includes best practice infection control recommendations and detailed information for the investigation of sporadic cases of gastroenteritis and food or water borne outbreak investigations tailored for different clinical settings such as hospitals, aged care and children’s service centres. Each module contains documents to support cleaning practices, hand hygiene, signage, outbreak case lists and the notification process.

National: The Gastro-Info Gastroenteritis Kit, published by the Australian Government, is a resource to assist residential aged care facilities in the event of a gastroenteritis outbreak.

Pandemics

Health services are required to have a plan in place to address the possible impacts and consequences of pandemic influenza on their organisations, and their responsibilities to communities.

The Victorian action plan for pandemic influenza provides guidance to help organisations to complete or review their pandemic influenza plans.

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REPROCESSING REUSABLE MEDICAL DEVICES 

NSQHS Standards: Action 3.14
Reprocessing of reusable equipment, instruments and devices is consistent with relevant current national standards, and meets current best practice.
Processes include traceability of critical and semi-critical equipment

Cleaning, disinfecting and sterilising re-usable medical devices and equipment is essential foundation for delivering safe and good-quality care.

The Australian Standard and New Zealand Standard (AS/NZS) 4187:2014, Reprocessing of reusable medical devices in health service organisations is available by subscription 

ASUM/ACIPC (Australian Society for Ultrasound Medicine/Australasian College for Infection Prevention and Control) joint guidelines for the cleaning, Disinfection, and Reprocessing of Ultrasound Transducers

Ultrasound Infection Prevention Toolkit is a resource regarding infection prevention during the use and reprocessing of ultrasound probes in Australia

SRACA (Sterilising Research and Advisory Council of Australia (Victoria) Inc.) is the professional body of sterilising technology practitioners.

Flexible Endoscopes

GENCA (Gastroenterological Nurses College of Australia) is the peak professional body that sets the gold standard for gastroenterological nursing.  The mission of GENCA is to develop and promote excellence in gastroenterology nursing practice

GESA (Gastroenterological Society of Australia) is the peak membership organisation for health care professionals and researchers working in the fields of gastroenterology and hepatology. GESA’s Infection Control position statements is available here

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RURAL

NSQHS Standards: Standard 1
Governance, leadership and culture

 Victoria public health has many rural & regional health services

  • 5 rural health regions with 70 rural and regional public health services and hospitals
  • 6 bush nursing hospitals and 15 bush nursing centres

Private health sector is represented by 15 services of which 7 are independent or community based and 8 are from a network.

Rural Infection Control Practice Group (RICPRAC) is an informal and voluntary group of regional Infection Control Practitioners (ICP) offering peer support to public health services within clearly defined regions.  Each region operates under a different model.

Useful websites for rural members:

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WASTE & THE ENVIRONMENT 

NSQHS Standards: Action 3.1
Uses safety and quality systems
Manages risk associated with healthcare associated infections
NSQHS Standards: Action 3.5
Application of standard and transmission-based precautions consistent with the current edition of the Australian Guidelines for the Prevention and Control of Infection in Healthcare and jurisdictional requirements

Waste streams

The Environment Protection Authority (EPA Victoria) regulates the storage, transport, treatment and disposal of clinical and related wastes in Victoria under the Environment Protection (Industrial Waste Resource) Regulations 2009.

EPA Victoria Publication: Clinical and Related Waste – Operational Guidance

Waste streams are regulated: Clinical (for incineration and non-incineration), Cytotoxic, Radioactive, Confidential, Recyclable, and General.

Victorian Department of Health links:

Environment

The Victorian Department of Health & Human services is committed to improving sustainability within the health system infrastructure. 

This is documented in the department’s strategic plan—Environmental sustainability strategy 2018-19 to 2022-23

Supporting tools include an action plan and progress report. These tools are in ‘word’ format for the internal use of the individual health service to map actions and progress.

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