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!!!!