INFECTION PREVENTION & CONTROL UPDATE 2020
INFECTION PREVENTION & CONTROL UPDATE
2020
Infection Prevention & Control Team
• DIPC – Angela Helleur
• Deputy DIPC – Sheila Howard
• Consultant Microbiologists
• Antimicrobial Pharmacists
• Matrons
• Clinical Nurse Specialists
• Infection Control Nurses
• Administrators
Contact:
➢ QEH - ext: 5703/2/5841Bleep: 338/684
➢ UHL - ext: 6654/Bleep: 7020
➢ Out of hours: Consultant Microbiologist via switchboard
Objectives of session
To update knowledge on current infection prevention and control practices to ensure patient and staff safety.
Update on new Resistant Organisms: Carbapenem resistant organisms (CRO)
Candida Auris (C.auris)
Management of Inoculation injuries
What are Healthcare Associated Infections?• Any infection that arises as a result of healthcare, regardless of
the care setting
• Last National Point Prevalence Survey in 2016 - one in fifteen patients in acute hospitals or 6.6 % were classed as HCAI.
• In 2016, the commonest cause of Blood stream Infections(BSIs) was Escherichia coli; of these, 41% were resistant to the commonest antibiotic used to treat infections in hospitals.
Why prevent Healthcare Associated infections (HCAIs)?
•HCAIs cost the NHS approximately £2.3billion (NHS Improvement)
•Effects on patient – delayed recovery, increased interventions, extended hospitalisation, psychological issues, potential death!
•Implications for relatives/carers & community
•Patient-centred care – the basic philosophy of
“doing no harm”
Key Government Ambitions
Halving the numbers of healthcare-associated Gram-negative bloodstream infections (GNBSIs) by March 2021
LGT currently on Target
Catheter related urinary Tract Infections(CAUTIs) project in progress with in the Trust.
The Chain of Infection
Break any link
to interrupt the
transmission
of infection
Required national reporting and Trust thresholds
➢MRSA positive blood cultures – 0
➢C. difficile toxin positive samples – 27
VRE positive blood cultures
Orthopaedic Surgical Site Infection
MSSA positive blood cultures
E. Coli, Klebsiella Species + Pseudomonas aeruginosa positive blood cultures
Carbapenam Resistant Organism (CRO)
Standard
Precautions
Hand Hygiene
Personal Protective Equipment
Safe Handling
and Disposal of
LinenManagementof body fluid
spillages
Sharps Safety
Safe Disposal
of Clinical wasteStaff
Health
Cleaning of the
Environment and patient equipment
Heading
Your 5 moments for hand hygiene at the point of care*
*Adapted from the WHO
Alliance for Patient Safety
2006
Physical barriers to Hand Hygiene
Watches
Long sleeves
GlovesRings
Artificial nails/varnish
Hand Hygiene & Water Safety
Only use hand wash sinks for hand washing
Do not dispose of body fluids at the hand
wash sink
Do not decontaminate any patient
equipment at the hand wash sink
Never install alcohol gel dispensers at the
hand wash station.
Standard Precautions-Further guidance on PPE
Remove gloves & apron after use and each patient
Change gloves between clean/dirty activities on the
same patient
Never wash or use alcohol gel on gloves
Is a mask required? What type of mask?
Dispose of contaminated PPE in orange clinical waste bin
Standard precautions Equipment Decontamination
Follow Manufacturers guidelines
•Is it single use? single patient use? reusable?
•How is it cleaned?
•Does it need to go to CSSD?
•Do you know the symbol for single use?
•Decontamination certificate
Decontamination
• Know your roles and responsibilities
• Refer to decontamination guidelines and policy
• Refer to manufacturers’ instructions
• Ensure that equipment is cleaned between each patient
• Assurance stickers –
Standard Precautions Body Fluid Spills
Wear protective clothing
Use spill kit/ paper towels to dry up spills
Dispose of waste in clinical waste bin
If spill kit is not available -clean area with Chlorine
detergent ‘Actichlor Plus’
Heading
Community transport
box
HeadingHhh
Non-recyclable domestic waste, including polystyrene, food contaminated packaging etc.
Mixed recyclables, including all the items you would usually recycle at home, including paper towels, cardboard etc.
QEH Waste Stream
HeadingHhhQEH Waste Stream
Waste from infectious patients(excluding sharps), and without medicine contamination
Waste from non-infectious patients (excluding sharps)
Standard Precautions –Sharps Management
Ensure lid is secure before using container
Ensure lid is secure before using container
Standard Precautions –Sharps ManagementAVOID USE OF SHARP if possible e.g. Needle less systems
When using sharps:-• Wear gloves• Dispose of at ‘Point of care’ ( Sharps trays)• Dispose of sharps into a yellow lidded container.• Do not bend or break needles• When transporting to blood gas machine, replace needle with red hub• Only use removal devices to remove needles ( Blood gas syringes)
• Discard in sharps container immediately after use• Do not overfill sharps containers
Dispose of sharps that contain cytotoxic/cytostatic drugs into purple lidded container.
Inoculation Injury
Standard Precautions: Linen Management
Standard precautions -Staff Health
Cover all cuts and breaks in skin with a waterproof dressing
Ensure that your immunisation status is up to date particularly Chickenpox and Measles.
Vomiting and/or diarrhoea you must stay away from work until you are symptom free for 48 hours
Persistent sore throat, rash of unknown origin or any concerns about your health -Contact your GP.
OH Assist telephone number = 0845- 130-9174
Isolation Room Signs
Common resistant Organisms - MRSA
Staphylococcus aureus found in 1 in 3 people
Methicillin resistant strand first discovered in 1960`s
Colonises warm, moist areas, e.g. nose, groin, underarm
Adheres to IV lines, urinary catheters (biofilm).
Can survive on some surfaces e.g. keyboards
PVL Strains ( Panton - Valentine Leukocidin) very aggressive strain
Management of MRSA
Isolate with contact precautions
Admission screening and then monthly
Policy available on Trust intranet
Consider decolonisation
Re-screening advised by the IPCT on an individual basis.
Management of Clostridium difficile
• Source isolation ‘Enteric precautions’
• Hand washing with soap & water
• Clean rooms and equipment with chlorine detergent ‘Actichlor plus/ChlorClean’
• Report cases of diarrhoea in patients or staff to the Infection Prevention team
• Restrict antibiotic usage
Diarrhoea Protocol
S Suspect that a case is infective where there is no clear cause
I ISOLATE the patient
G Gloves and aprons must be used for all contact with the
patient and their environment
H Hand washing with soap and water
T Test stool for toxin, by sending a specimen immediately
( Always send a sample on admission if patient admitted with diarrhoea.
If on laxatives whilst an in-patient , stop laxatives and wait for 48 hours
before sending a sample unless discussed with microbiologist )
Bristol Stool Chart
Please remember to document on icare:
Carbapenem Resistant Organism (CRO)
Multi-drug resistant organism (MDRO)
Bacteria commonly found in the gut
Patients can be colonised/infected
Almost totally resistant to group of ABXs called ‘Carbapenems’
Mortality 30% - 50% associated with invasive infections and
Outbreaks
Transmitted from person to person, often via hands or contaminated medical equipment
Immuno-compromised patients/those with invasive devices/wounds are more vulnerable.
Candida Auris
Initially identified in 2009 from Japanese patient with ear discharge
Associated with infections and outbreaks in the healthcare setting
It appears to be highly transmissible between patients and contaminates environments and equipment.
Candida Auris has reduced susceptibility to first line antifungal therapy
Patients may be colonised with this is fungus or
develop invasive infections.
Management of highly Infectious Pathogens
Pathogens such as Ebola & VHF
MERS, Corona Virus - direct GOV.UK link via LGT intranet
https://www.gov.uk/government/collections/wuhan-novel-coronavirus
Identification and Risk assessment
Inform site managers & Infection Prevention
Isolation
PPE & Isolation boxes (standard & enhanced)
Transfer or Step-Down
All adult patients must be screened on admission for MRSA and monthly there after.
Pre-admission MRSA screens prior to procedures
Antenatal: High risk including all C-sections and elective C-sections
Neonates-weekly MRSA and resistant organism screens
ITU admission screens are MRSA, CRO and candida Auris, then weekly CRO & MRSA
Patient transfers from other hospitals and admissions from healthcare facilities abroad CRO screens+ urine x3 48 hrs apart.
Routine Screening
How else can you help?
Adhere to isolation signage
Hand hygiene opportunities
Immune status
Report, escalate & feedback/share
Please remember basic
Infection Prevention
practice
CHECK ALERTS ON
ICARE
Use correct ward exits
Adhere to uniform policy
?
Finally!!!!