Canberra Hospital and Health Services Standard Operating Procedure

To minimise discomfort, promote wellbeing and provide a safe environment for patients with Multiple Chemical Sensitivities (MCS). The Health Directorate recognises the significant distress and impairment that is caused by MCS and is committed to providing an environment that reduces exposure to incitants (common triggers that produce clinical symptoms) and improving the health outcomes of people who require hospital based or non hospital based treatment.

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  All Canberra Hospital and Health Services (CHHS) staff; and
  
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  CHHS students (medical, nursing and allied-health) under direct supervision.
  

Required for admission of all patients with MCS

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  a red identification band (Refer to “Patient Identification Band” SOP – CED11-29)
  
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  100% cotton gowns
  
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  caps
  
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  clean, sterile or disposable linen
  
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  fragrance-free hand wash
  
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  bottled drinking water
  
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  stop/caution signs
  
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  fragrance-free cleaning products
  
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  low irritant cleaning products (i.e. Sodium Bicarbonate)
  
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  fragrance free wipe down cloths, and
  
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  latex-free products including clinical consumables such as oxygen tubing and face-masks (Refer to “Latex Allergy – Patients” SOP – TCH11:37).
  

A.

Elective Presentation

(Appendix 2)

B.

Emergency Presentation

Admission

Care on the Ward

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  doorways exposed to vehicle (ambulance) activity and exhaust fumes
  
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  areas being remodelled or renovated
  
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  high traffic areas
  
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  chemical storage and supply areas
  
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  chemotherapy treatment areas, or
  
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  computers, photocopy, fax machines.
  

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  attend to hand hygiene (ACT Health Directorate “Hand Hygiene” SOP CED11-50) with fragrance-free hand wash, and
  
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  don gown, surgical cap and latex free gloves.
  

DMU will facilitate appropriate bed allocation to a single room with ensuite where possible.

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  ask the patient to identify any reactions they have experienced and identify
  

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  ask the patient to detail what can be done to reduce the severity and list the information in the patients clinical record and medication chart, and
  
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  check the patient’s previous clinical record/s (if applicable) for documentation in relation to MCS.
  

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  The MCS patient should not be accommodated near an area that:
  
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    Is a high traffic area;
    
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    Is used for used for chemical storage or supply, or for chemotherapy treatment;
    
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    Contains computers, photocopiers or fax machines;
    
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    Is being remodelled, renovated or repaired; or
    
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    Has had a pesticide application in the previous twelve months.
    
    
    
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  The MCS patient should not be allocated a room that is:
  
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    Carpeted
    
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    Does not have an ensuite or access to a private bathroom
    
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    Has been remodelled, renovated or repaired (i.e. repainting, new floor coverings etc.) in the previous six months.
    
    
    
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  The room/area allocated to the MCS patient should be prepared so that:
  

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  non-fixed perfumed or fragranced items and/or other items that may emit volatile odours and potentially cause symptoms (i.e. plastic or vinyl furnishings, soft-furnishings, curtains, fluorescent lights etc) that are not essential for the care of the patient are removed; and
  

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  fixed items containing components which may be possible triggers and not required for care of the patient should be covered with materials that are tolerated as much as possible by the patient with MCS. Wherever possible confirm these details with patient prior to arrival in the room/area.
  

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  the cleaning supervisor of the patient’s admission to facilitate room cleaning with the relevant cleaning staff to ensure that exposure to incitants is minimised. The care environment is cleaned in accordance with relevant Standards/requirements (Refer to Cleaning Standards – Cleaning Standards for Victorian Hospitals, and, Linen Standards - AS 204146:2000 Laundry Practices); and
  
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  members of the health care team, including the Medical Officer, Pharmacist, Dietician, Nurse Manager and food, cleaning and laundry and social services (if supported by the patient) of the patient’s admission and requirements.
  

Where possible, prior to the nursing staff member arriving at the hospital for their allocated ‘shift,’ the CNC or Team Leader will discuss with the attending staff member allocated to care for the MCS patient the need to not wear, have used, or have been exposed to:

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  perfume or scented hygiene products prior to shift;
  
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  aerosol products such as hairspray;
  
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  laundry soaps, fabric softeners, deodorants, shampoo, hair lotions, make-up, hair mousse, gels and bath soaps (which can all contain perfume or masking fragrances and deodorisers, and should be avoided by staff whilst caring for a patient with MCS);
  
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  new clothing which has not been laundered to remove chemical residue;
  
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  clothing which has been freshly dry-cleaned, or
  
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  cigarette smoke.
  

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  be familiar with the patient’s condition and what incitants or allergens the patient is affected by (Attachment 1). Different patients may react to different ranges of incitants
  
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  when the MCS patient is allocated a single room ensure that the door of the room is kept closed at all times
  
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  not permit any flowers, plants, newspapers, or chemically treated or perfumed paper in the patient’s room unless the patient advises that this is acceptable
  
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  ensure room cleaning requirements are adhered to (Refer to D7 Ongoing Care Requirements - Cleaning).
  
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  ensure Bed Linen requirements are adhered to (Refer to D8 Ongoing Care Requirements – Bed Linen
  
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  remove all wet laundry and towels immediately after the patient has finished personal hygiene;
  
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  remove patient’s meal tray/s from the room immediately after meals (Refer D9 Ongoing Care Requirements – Dietary Requirements).
  
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  consider any possible environmental triggers for the patient with MCS and eliminate or manage the risk of exposure.
  
  
  

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  consider scheduling procedures to minimise chemical exposures (usually first in the day)
  
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  consider the patient’s sensitivities when choosing anaesthetics and medications
  
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  ensure only essential staff enter the patient’s room/area
  
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  ensure all hospital staff perform hand hygiene using fragrance-free hand wash, and don gown, cap and latex-free gloves prior to entering the room. Staff should confirm whether hand-wash chemicals are an incitant for the patient and if so, avoid using hand-wash products within the room, and
  
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  coordinate the plan of care with all other hospital departments the patient may be transferred to for treatment and, whenever possible, arrange to have the patient to be treated in his/her room. Where transport is required outside of the patient’s room, ensure that all efforts are made to shield the MCS patient from identified incitants.
  

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  contact cleaning of the patient’s environment is to be conducted prior to admission
  
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  it is essential that all cleaning products are to be fragrance free
  
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  consideration needs to be given to patient-specific requests around matters of cleaning and the need to create and maintain an incitant-free environment
  
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  after cleaning, the room should be wiped down with plain water and clean cloth
  
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  time is to be allowed for the room to air
  
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  aerosol cleaners, disinfectants, insecticides and/or room deodorisers, wherever possible, should not be used, and
  
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  the room is to be free of dampness and mould.
  
  
  

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  dust with a clean cotton cloth moistened with only water
  
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  use Sodium Bicarbonate for tubs, sinks and toilet
  
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  remove rubbish at least twice daily. Avoid use of toxic chemicals and highly fragrant cleaning products in the general area during the MCS patients stay, and
  
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  unscented vacuum cleaner bags are to be used.
  

Use of sterile or disposable linen may be required in cases where laundry chemicals are reported to be incitant agents. Sterile or disposable linen can be sourced from the Peri-Operative Unit after hours if required.

The patient may request to use their own linen (sheets and pillow cases). If this is requested ensure the linen is clear of dirt and foreign bodies before using on bed.

All Bed linen is to be changed as per: standard Unit protocols; patient/family request; and/or as required.

Wet laundry should be removed from the room immediately after use.


D9 Dietary Requirements
Patients with MCS may have different food sensitivities and allergies. If the patient is aware of specific food sensitivities and/or allergies and requires a special diet in hospital, the ward dietician should be contacted and appropriate arrangements made. This should occur as soon as admission is arranged and may require the provision of:

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  special foods
  
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  bottled or filtered water, or
  
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  special food preparation techniques or serving implements.
  

Patients with MCS may have significant reactions to medications. Referral should be made to the pharmacist as soon as admission is arranged ensuring that pre-admission care arrangements are implemented. Standard ingredients of medications should be known as MCS patients react to both naturally occurring and artificial substances including but not limited to: colouring agents, preservatives, sweeteners, flavourings etc.

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  muscle spasm
  
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  local swelling, hives
  
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  syncope
  
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  hyperventilation
  
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  seizures
  
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  asthma, and
  
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  severe anaphylaxis.
  

Where possible avoid use of medication vials that have a rubberised seal as some vials may contain latex. Check with the patient and Pharmacy Department before the administration of medications that are dispensed from vials with these seals.

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  if there is a need to don gown; surgical cap; face-mask; and/or latex free gloves prior to entering the room.
  
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  to wash their hands with the non fragrance soap provided prior to entering room,
  
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  to not wear perfumes or fragranced products; and
  
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  to keep the door of the room closed at all times
  
  
  

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  All incidents related to care of patients with MCS are reported via the Clinical Incident Reporting System (Riskman).
  
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  There is evidenced compliance against the ‘CHHS MCS - Care of Patients’ SOP.
  
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  There is reported positive satisfaction from consumers with the care provided by the CHHS as reflected in the ‘CHHS MCS - Care of Patients’ SOP.
  

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  All incidents related to patients with MCS are reported via the Clinical Incident Reporting System (Riskman). Incidents are reviewed and corrective actions are reported and managed via relevant departments in line with continuous quality improvement processes.
  
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  Teams overseeing the care will, in consultation with the patient (family/carers) review and evaluate the care provided against the ‘CHHS MCS - Care of Patients’ SOP.
  
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  All MCS patients will be provided with a consumer feedback form to facilitate further improvements. Patients will be encouraged to identify themselves as an ‘MCS’ patient on the form (they will have the option of not doing so). This feedback will be managed by the Quality and Safety Unit - Consumer Feedback & Engagement Team and clinical care team members and management.
  

Standards Australia/Standards New Zealand. 2000. AS/NZS 4146:2000 Laundry Practice. Standards Australia, Sydney, N.S.W.

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  anaesthesia
  
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  colours, flavours and preservatives (natural and artificial) in food, drinks, and medications
  
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  perfumes and fragrances
  
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  detergents and other cleaners
  
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  prescribed medications
  
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  smoke from tobacco products
  

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  solvents from felt pens etc.
  
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  pesticides
  
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  vehicle exhausts
  
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  new building and renovation materials including fresh paint and new carpet, and
  
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  other volatile agent such as chlorine, formaldehyde, adhesives, glues and newsprint.
  

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  respiratory symptoms
  
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  dizziness and faintness
  
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  nausea
  
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  rashes
  
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  headache
  
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  fatigue
  
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  flu-like symptoms
  
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  mental confusion
  
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  short term memory loss
  
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  gastro-intestinal tract symptoms
  
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  cardiovascular irregularities
  
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  genito-urinary symptoms
  
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  muscle and joint pain
  
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  irritability and depression, and
  
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  ear, nose and throat complaints.
  

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  going into fresh air (if clinically appropriate)
  
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  washing exposed skin and hair to remove incitants, and
  
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  removing identified incitant/s