keeping the primary

healthcare team safe

18 | November 2014 | best tests
Providing a safe working environment involves both minimising the risk of transmission of infectious
pathogens and dealing with exposures after they have occurred. Exposure to body fluids is one of the
major occupational hazards faced by healthcare workers. Effective use of standard precautions, including
hand hygiene and personal protective equipment, is the best way to protect healthcare workers from
these infectious pathogens. However, even strict adherence to standard precautions will only minimise
the infection risk and dealing effectively with any potential exposures, e.g. needlestick injuries, if they
occur is vital in protecting healthcare workers.

Prevention is better than cure: keeping the

practice environment safe
Standard precautions – the backbone of
Healthcare workers are likely to be exposed to a number of
good infection control and prevention
potentially infectious body fluids on a daily basis. All body Standard precautions are a set of procedures which can
fluids should be assumed to contain transmissible infectious be followed to achieve a minimum level of infection
pathogens. Reducing transmission of these pathogens, and control and prevention. They help prevent the risk of
dealing with exposures if they occur, is vital in protecting transmission of infectious pathogens and protect both
healthcare workers and complying with the Health and Safety healthcare workers and patients.
in Employment Act 1992. A practice-wide staff health policy
should be in place to achieve the safest working environment Some of the basic standard precautions include:1
possible. This should include maintaining appropriate levels ■ Hand hygiene
of vaccination, training and education in infection control and
■ Use of personal protective equipment
prevention procedures for all clinical and non-clinical workers.
The most important principles for achieving a safe working ■ Promotion of respiratory hygiene and cough
environment are based on standard precautions, which are etiquette
regarded as the minimum requirements for infection control ■ Use of aseptic technique
and prevention. A number of easy-to-implement procedures
■ Appropriate sharps/waste management
can substantially reduce the rates of infectious disease
■ General cleaning of the practice environment
transmission in general practice; promotion of effective hand
hygiene is a good starting point. ■ Dealing with spills
■ Appropriate reprocessing of reusable medical
Good hand hygiene procedures are the first step in equipment
preventing transmission

Hand hygiene is regarded as the single most important

activity for preventing the spread of infection in the healthcare
setting.2 The Hand Hygiene New Zealand (HHNZ) programme,
which is run by the Health Quality and Safety Commission
of New Zealand, recommends following the World Health
Organisation’s “Five moments for hand hygiene”.2 These
recommendations, although intended for people working
in a hospital setting, provide a useful guide for when hand
hygiene should be considered in the general practice setting.

best tests | November 2014 | 19

The five moments for hand hygiene are:3 Soap and water should be used when hands are visibly
■ Before patient contact soiled
Hand washing with soap and water should be performed
■ Before performing a procedure
when hands are visibly soiled with blood or other body fluids,
■ After a performing a procedure or a potential exposure or after using the toilet.6 The duration of the entire hand
to body fluids washing procedure should be 40 – 60 seconds.7 For optimal
■ After patient contact effect it is important to ensure that hands are completely dry
after hand washing. Hand washing with soap and water is also
■ After contact with patient surroundings. In a primary
recommended following known or suspected exposure to C.
care setting this may be relevant when clinicians see
difficile infection (or as a standard precaution after contact
patients in rest homes or perform home visits.
with a patient with diarrhoea or vomiting), as it has been
shown to be more effective in removing C. difficile spores
Alcohol-based hand rubs are recommended when hands than alcohol-based hand rubs.8, 9 Plain or antimicrobial soaps,
are not visibly soiled e.g. containing chlorhexidine or triclosan, can be used for
Alcohol-based hand rubs should almost always be preferred routine hand washing; antimicrobial soaps are not necessary
over hand washing with soap and water for hand hygiene in for everyday use.10
general practice, except when the hands are visibly soiled.2
This is because alcohol-based hand rubs:2 A poster on hand washing for the clinic is available
■ Have been shown to be more effective than soap and from:
water against the majority of pathogens encountered www.handhygiene.org.nz/images/stories/
in a healthcare setting (with the exception of HHNZDOWNLOADS/promotionalMaterialsNEW/pdfs/
Clostridium difficile). In a randomised study it was How%20to%20handwash%20poster.pdf
found that reductions in bacterial contamination
were significantly higher after using an alcohol-based Personal protective equipment should be used according
hand rub (83%) than after washing hands with an to risk
antibacterial soap containing chlorhexidine gluconate
(58%).4 The decision to use personal protective equipment, such
as gloves, gowns, protective glasses and masks, should be
■ Cause less irritation to the skin as they contain
based on a risk assessment of the probability of transmission
moisturising agents, are less associated with contact of infectious pathogens. There are certain circumstances
dermatitis and are less drying on the hands than soap when additional precautions may be necessary (see: “What to
and water.3 do during a highly infectious pandemic”, Page 23).
■ Can be quickly and conveniently used at the point of
care, e.g. placed on the clinician’s desk, and carried on Gloves are not a substitute for hand hygiene
home visits. Pathogens can gain access to the hands via small defects in
gloves or by contamination when removing gloves.2 In general,
gloves should be used when there is a risk of exposure to the
It is recommended that hands are rubbed with the alcohol patient’s blood or body fluids or when there is contact with
solution for 20 – 30 seconds.5 HHNZ recommends using non-intact skin or mucous membranes. It is recommended
products that have ethanol concentrations of at least that hand hygiene is performed before and after using
70% or isopropyl alcohol concentrations of at least 60%.3 gloves.2 Gloves should ideally be put on last and removed first
Some alcohol-based hand rub preparations also include when used in combination with other protective equipment.
chlorhexidine to provide a more prolonged antibacterial Used gloves should be discarded in a yellow biohazard bag
effect after the alcohol dries; however, in primary care, the and not in a general purpose rubbish bin.
plain alcohol preparations are preferable as they result in
less skin irritation. Alcohol remains the essential component It is particularly important for clinical staff to wear gloves
of these formulations as it has the more potent antibacterial if they have broken skin on their hands and direct physical
activity.3 contact with a patient is likely.

20 | November 2014 | best tests

N.B. Latex allergy can pose a problem for both clinicians and
Safely dispose of medical waste and sharps
patients. An allergy to latex should be documented in the
patient’s notes and alternative latex-free gloves available for Collection and disposal of all medical waste should follow
use. the New Zealand Standards for Management of Healthcare
Waste (NZS 4304: 2002). All sharps including needles, scalpel
Masks may sometimes be required blades, glass ampoules or any other objects with sharp points
Although masks are not routinely used in general practice, capable of causing penetrating injuries should be placed in a
there are a number of circumstances when it is important to yellow sharps bin which is periodically collected and disposed
consider their use to protect both practice staff and patients of by an authorised medical waste service.1 The bin should
from airborne pathogens (see: “What to do during a highly not be overfilled, as this increases the risk of an injury when
infectious pandemic”, Page 23). An example is when a patient disposing of a sharp. Ensuring that sharps are handled in a
presents with respiratory symptoms, e.g. coughing and safe manner can also reduce the risk of injuries occurring, e.g.
sneezing, and there is an increased likelihood of airborne/ not recapping needles and not passing sharps from person
droplet transmission. This is particularly important during to person.
outbreaks of respiratory-transmitted infections, e.g. measles
and influenza. If this situation occurs, it may be appropriate Other hazardous clinical medical waste should be placed
to ask the patient to wear a mask and have them wait in a in yellow biohazard bags for disposal, including waste that
vacant area of the practice rather than in the waiting room. contains blood or pus present in a large enough volume to
Reception staff should be aware of these procedures as they be squeezed from absorbent material, and tissue not being
usually have first contact with the patient. Where possible, the sent for histology.10 Disposable equipment that has been
patient should be asked to maintain at least a one metre gap used to examine a patient, e.g. spatulas and ear covers for
between other patients and healthcare workers, although otoscopes, should also be disposed of in yellow biohazard
this is not always practical.10 bags. Hair and nail clippings that are not contaminated can
be placed in general purpose rubbish bags. Urine and faeces
Body fluid spills need to be dealt with quickly and can be tipped down the toilet.
effectively
When spills occur, all blood or body fluids (with the exception
Keep the practice environment as hygienic as possible
of sweat) need to be treated as potentially infectious and
promptly dealt with by staff members wearing personal All environmental surfaces in the practice need to be
protective equipment appropriate to the situation, e.g. included in a regular cleaning schedule – surfaces that are
gloves, disposable aprons and masks. The exact management used frequently and are likely to be contaminated need to
of the spill will depend on the type and volume of the body be cleaned more often, e.g. door handles, reception counters
fluid spilt, the possible pathogens present and the type of and consultation desks. Linen also needs to be changed
surface or area where the spill has occurred, e.g. all blood and washed on a regular basis, especially when it becomes
spills on hard/vinyl surfaces should be disinfected using visibly soiled or after contact with a patient with an infectious
a diluted sodium hypochlorite solution. Ideally, practices disease.
will have fully-equipped spill kits available, i.e. containing
protective equipment, waste bags and detergents, and have It is important to consider that some pathogens can remain
procedures in place to manage spills appropriately. In some viable on fomites (any inanimate object or substance capable
circumstances, e.g. large spills or spills on carpeted areas, it of carrying infectious organisms) for prolonged periods. For
may be necessary to use a commercial cleaning company. example, the hepatitis B virus is comparatively stable in the
Ensure that the area containing the spill is isolated. environment and can remain viable on surfaces for several
days.11 A 2014 study that investigated the duration of hepatitis
An example of specific procedures for dealing with C viability on fomites reported that the virus remains viable
body fluid spillages is available from: www.cdhb.health.nz/ for up to six weeks at room temperature, which is much
Hospitals-Services/Health-Professionals/CDHB-Policies/ longer than previously thought.12
Documents/4810-Volume-10-Decontamination-of-the-
Environment.pdf

best tests | November 2014 | 21

Give disinfectants time to work to be substantial following a single physical examination,
Disinfectants, e.g. hypochlorite and quaternary ammonium with rates comparable with those observed on the clinician’s
compounds, are antimicrobial agents that reduce the levels dominant non-gloved hand after patient contact.14 Products
of infective pathogens on surfaces, although they do not containing chlorhexidine, phenol, hypochlorite or quaternary
necessarily kill all pathogens and have been shown to fail ammonium compounds should not be used to clean medical
where prior cleaning has been non-existent or ineffective.10 devices as they can cause surface oxidation and denaturing
Disinfectants need to be accurately diluted and usually of rubber seals.15
require a contact time of five to 15 minutes to kill micro-
organisms.13 When surfaces are wiped with disinfectants and Ensure healthcare workers are up to date with
dried immediately, the disinfectant does not have time to act vaccinations
and is simply being used as a cleaning agent.13
Maintaining a high rate of immunity within general
It is recommended that frequently touched surfaces are practice staff helps to reduce personal disease risk for
disinfected at least daily as well as when visibly soiled or after healthcare workers and has the flow on effect of reducing
likely pathogen contamination.10 It is unrealistic to clean some transmission to patients, especially those at increased risk of
frequently touched items after each use, e.g. pens, phones, developing complications following infections. The National
computer keyboards and mouse. However, these items can Immunisation Advisory Centre has released a set of guidelines
be sources of indirect contact transmission and should be on vaccinations for clinical, non-clinical and cleaning staff in
cleaned with alcohol wipes (or discarded where applicable) primary care, including hepatitis A and B, influenza, measles
in situations where the risk of infection is increased, e.g. after mumps and rubella (MMR), tetanus/diphtheria/pertussis and
contact with a patient who may have a highly infectious or varicella, as well as advice on poliomyelitis and tuberculosis.19
significant infection such as influenza or methicillin-resistant These guidelines provide important recommendations about
Staphylococcus aureus (MRSA). the vaccinations required for primary healthcare workers
depending on their role and therefore risk of infection.
Alcohol-based wipes are recommended to clean
stethoscopes and should ideally be used after the For additional information see:
stethoscope has been in direct contact with a patient.14 www.immune.org.nz/sites/default/files/resources/
Bacterial contamination on stethoscopes has been shown NonprogrammeOccupationalPhc20121009V01Final.pdf

Toys in waiting rooms: teddy may have to go eliminate coliforms in the soft toys, they required a 30-minute
Children toys, particularly “soft” toys, pose an infection risk soak in a hypochlorite solution followed by machine washing
for staff and patients as they can carry high levels of bacterial and drying.16 Frequent washing of toys is recommended as
contamination. A New Zealand study that investigated bacterial counts have been shown to return to pre-wash
bacterial contamination of children’s toys in the waiting room levels within a week for both soft and hard toys – with soft
of six general practices found that “hard” toys had lower levels toys undergoing more rapid re-colonisation.16 Consideration
of bacterial contamination, did not re-contaminate as quickly should be given to removing all toys during an infectious
and were easier to clean than soft toys.16 The study reported disease outbreak.10
that hard toys had lower rates of coliform contamination
than soft toys (14% vs. 90%), and there were less instances There appears to be no evidence that freezing soft toys
of moderate-to-high bacterial contamination in hard toys reduces bacterial contamination, although this practice has
compared to soft toys (27% vs. 90%).16 been shown to reduce house dust mite concentrations.17

In the study it was found that hard toys were effectively N.B. The covers of magazines from general practice waiting
cleaned after soaking in a hypochlorite solution (2.5 g/L) rooms have been shown to have low rates of bacterial
for one hour.16 To effectively reduce bacterial counts and contamination.18

22 | November 2014 | best tests

What to do during a highly infectious pandemic

Pandemics occur when an infectious disease outbreak ■ Wearing gloves at all times when dealing with
spreads throughout populations across a large region, patients
e.g. multiple continents or worldwide. There have been ■ Ensuring the practice has adequate ventilation
a number of notable examples over the past few years
as some pathogens, e.g. influenza, spread more
including the H1N1 influenza (swine flu) pandemic in
rapidly in confined environments
2009 and the severe acute respiratory distress (SARS)
■ Having a separate triage area set up for patients
pandemic in 2002 – 2003. Although the current outbreak
with symptoms of the pandemic illness
of Ebola virus has not reached New Zealand, the Ministry
of Health is releasing frequent updates with advice on ■ Treating all waste that has been in contact with a
infection control and prevention measures. patient as potentially infectious
■ Using additional protective equipment if
For further information on Ebola virus see: necessary, e.g. it may be necessary to use full
w w w. h e a l t h . g ov t. n z / o u r-wo r k / d i s e a s e s - a n d - protective equipment, i.e. goggles, gowns, face
conditions/ebola-update/ebola-information-health- shields, N95 respirators, if dealing with patients
professionals with suspected highly infectious, deadly diseases,
e.g. SARS
During pandemics, it is important that primary
■ Nominating a staff member to keep up to date
healthcare workers are aware of strategies that can
with what is happening with the pandemic both
prevent the pandemic spreading. These strategies will
globally and nationally
depend on the nature of the pandemic illness, and can
include:20
■ Using and promoting hand hygiene, cough and
sneeze etiquette (e.g. covering nose and mouth
when sneezing and using tissues) and distancing
(one metre gaps where possible)
■ Asking patients if they have any infectious
symptoms when they phone the practice for an
appointment and discouraging all non-urgent
visits. If patients do have symptoms, they can be
asked to wear a mask when entering the practice
(a box of masks can be placed at the practice
entrance). Masks should be replaced when they
become damp.
■ Having educational material about the pandemic
on the entrance doorway of the practice and on
the walls of the waiting room
■ Having alcohol-based hand rubs available in the
waiting room and on the reception counter
■ Encouraging all practice staff to wear masks.
Whether masks need to be worn at all times,
or just when treating patients, will depend on
the pandemic illness and the discretion of the
healthcare worker.

best tests | November 2014 | 23

How to minimise risk after exposure – keeping or mucosal exposures to blood have occurred. Other
healthcare workers safe exposures can usually be handled with a common sense
approach, including thorough washing of the exposed area
Despite following recommended precautions and prevention and removal of any soiled clothing.
strategies, personal exposures to body fluids do sometimes
occur. A number of different body fluids can be involved, e.g. Needlestick injuries: Immediately rinse the affected area
blood, respiratory secretions and faecal matter. Blood-borne of skin with warm running water and soap for at least three
pathogens are present in larger quantities in blood than in minutes.22 There is no evidence that encouraging the wound
other fluids and therefore exposure to blood is associated to bleed or applying an antiseptic to the wound reduces the
with the most significant risk of transmission.21 Needlestick rate of infection, but these actions are not contraindicated.23
injuries are generally regarded as posing the greatest risk of Caustic agents, such as hypochlorite, should not be used
transmission of blood-borne pathogens, particularly after as they can compromise skin integrity.10 Injuries should be
a skin penetration injury with a sharp hollow-bore needle covered with an appropriate dressing. The tetanus status of
that has recently been removed from an infected patient. the exposed individual should also be checked and a tetanus
Needlestick injuries are, however, relatively rare in general booster administered if required.
practice and a number of other exposures to body fluids, e.g.
via mucosal surfaces or respiratory droplets, are more likely Mucous membrane exposures: Any mucous membranes,
to be encountered on a day-to-day basis. e.g. the eyes, that are exposed to body fluids should be rinsed
out with a large amount of water or saline for at least three
Different body fluids are associated with different minutes.22
pathogens
The risk of infection for the healthcare worker exposed to
Testing for HIV, hepatitis B and hepatitis C is
body fluids depends on the type of exposure, the body
recommended after needlestick injuries or mucosal
fluid involved and the infectious pathogen. In addition to
exposure to blood
blood, body fluids such as respiratory secretions, faecal
matter and contact with a patient’s contaminated skin or Although there are many infections which can be transmitted
mucous membranes, potentially pose an infection risk. For through body fluids the most consequential are generally
example, influenza, conjunctivitis and Campylobacter can considered to be HIV, hepatitis B and hepatitis C. The
be transmitted via these methods. Although all body fluids likelihood of transmission of these viruses after exposure
should be considered potentially infectious, certain fluids to different body fluids varies and an understanding of the
are generally associated with lower risks of transmission, e.g. risks is pivotal when performing a risk assessment (Table 1).
urine and vomitus. In general, testing for HIV, hepatitis B and hepatitis C should
only be considered after needlestick injuries, or after mucosal
An example of management strategies for workers after or broken skin exposure. If it is decided that testing should
potential body fluid exposure is available from: be undertaken, blood tests for HIV, hepatitis B, hepatitis C
www.cdhb.health.nz/Hospitals-Services/Health- for both the source individual and the exposed healthcare
Professionals/CDHB-Policies/Infection-Prevention-Control- worker need to be conducted within 24 hours and marked
Manual/Documents/4816%20Volume%2010%20-%20 as urgent. If consent is refused by either the exposed person
Staff%20Health%20and%20management%20of%20 or the source, document this, and the reasons for refusal.
work-related%20infection%20risks.pdf
Source individual: When known, the source individual should
be asked for consent to test their blood for:24
Appropriate first aid can reduce the risk of transmission
1. HIV antibody
First aid should be given immediately after the exposure
2. Hepatitis B surface antigen
occurs and the spill cleaned up appropriately (Page 21). In
general, more extensive first aid is required when needlestick 3. Hepatitis C antibody

24 | November 2014 | best tests

Exposed individual: Blood from the exposed person should markers mean clinically to help when analysing test results
be tested for:24 (Table 2):29
1. HIV antibody ■ HBsAg – persistent or acute infection

2. Hepatitis B surface antigen ■ Anti-HBs – immunity due to vaccination or past

infection
3. Hepatitis B surface antibody
■ HBeAg – highly infectious disease
4. Hepatitis C antibody
■ HBV DNA – circulating virus

■ Anti-HBc IgM – recent infection

The exposed person should be reassured that the risk of
infection after accidental exposures is low and advice and ■ Anti-HBc IgG – past/current infection
education should be provided that highlights the importance
of:24
■ Having blood tests as soon as possible after exposure Hepatitis C testing
Management of potential hepatitis C exposures (Table 3) can
with follow-up testing at the appropriate times (Tables
be problematic as there is no known effective prophylaxis
2, 3 and 4)
and a high proportion of people (approximately 75%) are
■ Not donating blood, avoiding pregnancy and practising
unaware they have the disease.27
safe sex until all final follow-up tests have been
completed and results are available Most cases of hepatitis C in New Zealand are in people with a
■ Reporting any glandular fever-like illness for the six history of illicit IV substance use or a history of sexual contact
months after exposure with people with confirmed hepatitis C.29 The prevalence
rates of hepatitis C in illicit IV substance users in New Zealand
Hepatitis B testing and prophylaxis have been reported to be as high as 70%.29 There is also an
There are a number of serological markers used to test and increased risk of infection in people who underwent a blood
monitor patients for hepatitis B. The following definitions transfusion prior to 1992, as this was when blood was first
are intended to assist clinicians in understanding what these screened for hepatitis C.30

Table 1: Transmission risks and incidences of HIV, hepatitis B and hepatitis C in New Zealand.21, 24 – 27

HIV Hepatitis B Hepatitis C

The number of people living with the disease in New Zealand 2000 90 000 50 000

The risk of transmission following exposure to a single needlestick or 0.3% 6 – 30% 1.8%
cut injury

Fluids and tissues capable of transmitting blood borne infections

Blood and fluids visibly contaminated with blood Yes Yes Yes

Faeces, nasal secretions, sputum, sweat, tears, urine or vomit No No No

N.B. Breast milk, inflammatory exudates, semen and vaginal fluids, pleural, amniotic, pericardial, peritoneal, synovial, and
cerebrospinal fluids are all potentially capable of transmitting HIV, hepatitis B and hepatitis C but are less likely to be encountered
in a primary care setting.

best tests | November 2014 | 25

Table 2: Testing and prophylaxis for hepatitis B24

Exposed individual Source individual Action for exposed individual

HBsAg Anti-HBs HBsAg Anti-HBs

– – – – Consider hepatitis B vaccination for future protection

(vaccination not needed for this exposure)
– – – +

– + – – No action required as exposed person is immune

– + – +

– + + –

– + unknown unknown

– past + now – – +/- Booster dose of hepatitis B vaccine recommended

– past + now – + –

Recommend HBIG* 400 IU IM and hepatitis B vaccination

– – + –
schedule. Known non-responders to hepatitis B vaccination
should have two doses of HBIG. Request HBsAg and HBsAb
testing at 3, 6, and 12 months

Consider HBIG 400 IU IM and hepatitis B vaccination

– – unknown unknown
schedule. Request HBsAg and HBsAb testing at 3, 6, and 12
months

* HBIG = hepatitis B immune globulin; obtain from the New Zealand Blood Transfusion Service.

Table 3: Testing for hepatitis C antibody24

Exposed individual Source individual Action for exposed individual

Negative or unknown Negative or unknown No action is usually required, but testing can be performed at 3, 6
and 12 months if there is concern the source may be incubating
hepatitis C

Positive 1. Consider hepatitis C polymerase chain reaction (PCR) testing of

the source, which will also determine how infectious they are
2. If the source individual’s PCR test is positive, test the exposed
individual (PCR) at 1 month
3. Test all exposed individuals (PCR) at 3, 6 and 12 months.
4. Test the exposed individual if they are exhibiting signs and/or
symptoms of hepatitis C
5. No prophylaxis is available. If acute infection occurs the patient
should be referred for initiation of antiviral treatment

26 | November 2014 | best tests

HIV testing and prophylaxis
The risk of contracting HIV after exposure to HIV-infected
blood is relatively low even for needlestick injuries (Table
1). Mucous membrane exposure, e.g. eye, nose or mouth, to
HIV-infected blood carries an even lower risk of infection –
reported to be approximately 0.1%.21 The transmission risk
after skin exposure is lower again. A small amount of blood
on intact skin is not likely to pose a risk, as no documented
cases of HIV transmission have been reported after exposure
to a small amount of blood on intact skin for a short period
of time.21

Post-exposure prophylaxis is recommended if the source

individual is known to be HIV positive (Table 4).

N.B. The rates of HIV infection in people who use illicit

substances intravenously in New Zealand are very low and
post-exposure prophylaxis is not routinely recommended
after exposure to body fluids from these people, unless they
are known to be HIV positive.11, 25

ACKNOWLEDGEMENT: Thank you to Dr Rosemary

Ikram, Clinical Microbiologist, Christchurch for
expert review of this article.

Table 4: Testing for HIV antibodies and prophylaxis24

Exposed individual Source individual Action for exposed individual

Negative or unknown Negative or unknown No action is usually required, but testing can be performed at 3, 6 and
12 months if there is concern the source individual may be incubating
HIV, e.g. if the source patient has undergone recent testing but it is too
early to tell whether they have contracted the disease

Positive 1. It is recommended that, when appropriate, post-exposure

prophylaxis is initiated within one to two hours of exposure. A
clinical microbiologist or infectious diseases specialist should
be contacted immediately to determine whether prophylaxis is
required.

2. Repeat serology testing at 3, 6 and 12 months

best tests | November 2014 | 27

References
1. The Royal New Zealand College of General Practitioners. 13. MacCulloch D, Mead P, Morris A. Disinfection and sterilization of
Cornerstone infection control checklist 2011. Available from: reusable medical devices in General Practice 2002. Available from:
www.rnzcgp.org.nz/assets/documents/CORNERSTONE/ www.dml.co.nz/media/77159/bulletin-disinfection&sterilization.
InfectionControlCheckList11.pdf (Accessed Oct, 2014). pdf (Accessed Oct, 2014).

2. Hand Hygiene New Zealand. Resource kit for medical professionals 14. Longtin Y, Schneider A, Tschopp C, et al. Contamination of
- Clean hands save lives. Available from: www.handhygiene.org.nz/ stethoscopes and physicians’ hands after a physical examination.
images/stories/HHNZDOWNLOADS/Hand%20Hygiene%20New%20 Mayo Clin Proc 2014;89:291–9.
Zealand%20Resource%20Kit%20for%20Medical%20Professionals.
15. 3M. A Clean Stethoscope is a healthy stethoscope. Available from:
pdf (Accessed Oct, 2014).
www.multimedia.3m.com/mws/mediawebserver?mwsId=SSSSSu
3. Hand Hygiene New Zealand. Hand Hygiene New Zealand fSevTsZxtUm82GN8_ZevUqevTSevTSevTSeSSSSSS--&fn=A_Clean_
implementation guidelines. 2013. Available from: www. Stethoscope.pdf (Accessed Oct, 2014).
handhygiene.org.nz/images/Hand%20Hygiene%20New%20
16. Merriman E, Corwin P, Ikram R. Toys are a potential source of cross-
Zealand%20Implementation%20Guidelines%20Revised%20
infection in general practitioners’ waiting rooms. Br J Gen Pract
June%202013.pdf (Accessed Oct, 2014).
2002;52:138–40.
4. Girou E, Loyeau S, Legrand P, et al. Efficacy of handrubbing
17. Chang C-F, Wu FF-S, Chen C-Y, et al. Effect of freezing, hot tumble
with alcohol based solution versus standard handwashing with
drying and washing with eucalyptus oil on house dust mites in soft
antiseptic soap: randomised clinical trial. BMJ 2002;325:362.
toys. Pediatr Allergy Immunol 2011;22:638–41.
5. Hand Hygiene New Zealand. Hand Rubs. Available from: www.
18. Charnock C. Swabbing of waiting room magazines reveals only low
handhygiene.org.nz/index.php?option=com_content&view=article
levels of bacterial contamination. Br J Gen Pract 2005;55:37–9.
&id=8&Itemid=111 (Accessed Oct, 2014).
19. Immunisation Advisory Centre. Vaccination for staff
6. Hand Hygiene New Zealand. Frequently asked questions. Available
working in primary health care. Available from:
from: www.handhygiene.org.nz/index.php?option=com_content&
www.immune.org.nz/sites/default/files/resources/
view=article&id=2&Itemid=104 (Accessed Oct, 2014).
NonprogrammeOccupationalPhc20121009V01Final.pdf (Accessed
7. Hand Hygiene New Zealand. How to hand wash. Available from: Oct, 2014).
www.handhygiene.org.nz/images/stories/HHNZDOWNLOADS/
20. Ministry of Health. Guidance for infection prevention and control
promotionalMaterialsNEW/pdfs/How%20to%20handwash%20
during an Influenza pandemic. 2006. Available from: www.moh.
poster.pdf (Accessed Oct, 2014).
govt.nz/notebook/nbbooks.nsf/0/42C7CA1478556705CC257AFC00
8. Jabbar U, Leischner J, Kasper D, et al. Effectiveness of alcohol-based 06CECD/$file/infection-control.pdf (Accessed Oct, 2014).
hand rubs for removal of Clostridium difficile spores from hands.
21. Centers for Disease Control and Prevention. Bloodborne pathogens
Infect Control Hosp Epidemiol 2010;31:565–70.
- occupational exposure - frequently asked questions. Available
9. Kundrapu S, Sunkesula V, Jury I, et al. A randomized trial of soap from: www.cdc.gov/oralhealth/infectioncontrol/faq/bloodborne_
and water hand wash versus alcohol hand rub for removal of exposures.htm (Accessed Oct, 2014).
Clostridium difficile spores from hands of patients. Infect Control
22. Aotea Pathology. Needlestick injuries, blood or body fluid exposure
Hosp Epidemiol 2014;35:204–6.
information and test forms. Available from: www.apath.co.nz/
10. The Royal Australian College of General Practitioners. Infection needlestick-injury-information (Accessed Oct, 2014).
prevention and control standards for general practices and
23. Ministry of Health (MOH). Immunisation Handbook 2014.
other office-based and community-based practices - 5th edition.
MOH, 2014. Available from: www.health.govt.nz/publication/
Available from: www.racgp.org.au/your-practice/standards/
immunisation-handbook-2014 (Accessed Oct, 2014).
infectioncontrol/ (Accessed Oct, 2014).
24. Diagnostic Medlab. Management of occupational exposure to
11. Starship Children’s Health. Needlestick injuries. Available from:
blood or body fluid. Available from: www.dml.co.nz/media/70547/
www.adhb.govt.nz/starshipclinicalguidelines/_Documents/
bulletin-blood&bodyfluidexposure.pdf (Accessed Oct, 2014).
Needlestick%20Injuries.pdf (Accessed Oct, 2014).
25. New Zealand AIDS Foundation. HIV in New Zealand. Available from:
12. Paintsil E, Binka M, Patel A, et al. Hepatitis C virus maintains
www.health.govt.nz/our-work/diseases-and-conditions/hiv-and-
infectivity for weeks after drying on inanimate surfaces at room
aids/aids-new-zealand-newsletter (Accessed Oct, 2014).
temperature: implications for risks of transmission. J Infect Dis
2014;209:1205–11.

28 | November 2014 | best tests

26. New Zealand Society of Gastroenterology. Hepatitis B. Available
from: www.nzsg.org.nz/cms2/research/hepatitis/hepatitis-b/
(Accessed Oct, 2014). COMING SOON
27. Hepatitis Foundation. Hepatitis C: Important information and
statistics. Available from: www.hepatitisfoundation.org.nz/
files/8513/5059/9674/HCV_Information.pdf (Accessed Oct, 2014).

28. Murtagh J, Rosenblatt J. Jaundice. In: Murtagh’s General Practice.

NSW, Australia: McGraw-Hill Australia Pty Ltd 2011. pp. 617–32.

29. Ministry of Health (MOH). Hepatitis C. MOH, 2012. Available from:

www.health.govt.nz/system/files/documents/publications/cd-
manual-hepatitis-c-may2012.pdf (Accessed Oct, 2014).

30. Hepatitis Foundation. What is hepatitis C? Available from: www.

hepatitisfoundation.org.nz/index.php/hepc/what-is-hepatitis-c/
(Accessed Oct, 2014).

Investigating
infectious
diarrhoea
C L I N I C A L AU D I T

View and download clinical audits from our website:

www.bpac.org.nz/audits
best tests | November 2014 | 29