bradford and airedale tpct infection prevention control mandatory training face to face session 2008

1. Bradford and Airedale tPCT Infection Prevention Control Mandatory Training face to face session 2008

2. Bradford and Airedale tPCT Infection Prevention Control Team Susan E Campbell Infection Prevention and Control Manager, Tel 07773390048 Yvonne Hanson Infection Prevention and Control Practitioner, Tel 07944770675 Samantha Thomas Infection Prevention and Control Practitioner, Tel 07976084771 Monday � Friday, 09.00 � 17.00 hrs.

3. Contents Infection prevention and control � overview Basic Microbiology How infections are spread Standard precautions MRSA Clostridium Difficile Norovirus Outbreaks You and infection control

4. Infection Control and Prevention is Everyone�s business Reception staff Administrators Doctors Nurses Care Assistants Physiotherapists Midwives Podiatrists

5. Infection and Prevention Control comprised of: - Director of Infection Prevention and Control (DIPC) - Consultant in Communicable Disease Control (CCDC) - Infection Control Committee - Microbiologist - Infection Prevention and Control Manager/Practitioners - Infection Control Doctors - Health Protection Unit - Link Workers

6. Current Climate ��.. Public Concern Media/Celebs Politics Staff Concern Quality Issues Published data Patient Choice ��������s

7. Types of micro organisms The Chain of Infection How infection is spread

8. Information about micro-organisms Micro-organisms are those that cannot be seen with the naked eye Not all cause disease in humans, some live on and in the body quite harmlessly, this is known as colonisation Organisms that cause harm are known as pathogenic micro-organisms There are approximately 1,870 known pathogenic organisms. 33% discovered in the last 30 years!

9. Types of Micro-organisms

10. Viruses Attack both plants and animals 27 nm in diameter Only visible using an electron microscope Can only multiply in other living cells (host cell) The host cell dies after the virus has replicated itself

11. Examples of viral infections Chicken pox Measles Rubella HIV Mumps Hep A,B and C Noro virus

12. Bacteria Commonly found in food and water 1000 nm Can be seen with a microscope Found in the gut, skin, throat and mouth Reproduce asexually, known as binary fission Replication usually takes approximately 20 minutes

13. Examples of Bacterial Infections Clostridium difficile MRSA Salmonella Streptococci Escherichia coli

16. Chain of Infection .

17. Breaking the Chain of Infection Infectious Agent :- Identify agent via assessment: clinical details and obtain a specimen e.g. culture swab. Reservoir:- Protective Wear, Employee Health, Environmental Hygiene, Cleaning/Disinfection/Sterilisation, Water Temperature. Portal of exit:- Protective Wear, Safe Management of Secretions /excretions, Safe Management of Clinical Waste & Used Linen. Mode of transport:- Sharps Disposal & management of sharps injury, Water Temperature, Food Hygiene and hand washing. Portal of Entry:- Management of Invasive Devices, Universal Precautions and Principles of Asepsis. Susceptible Host:- Appropriate patient placement and Informed care

18. How is Infection Spread? Droplets, aerosol e.g. respiratory droplets. Direct Contact e.g. kissing. Inoculation e.g. needle stick injury. Indirect Contact e.g. Healthcare workers hands. Vertical transmission from mother to baby.

19. Standard Precautions Hand Hygiene Protective clothing Accidental exposure to blood/body fluids Sharps safety Managing spillages Waste Specimens Laundry

20. Hand Hygiene There are two types of bacteria on our hands: - transient - resident Transient skin bacteria � Patient�s skin and immediate environment is colonized with transient (moveable) bacteria. Resident skin bacteria � deep seated, usually S. epidermidis or diptheroids. Not usually associated with infection.

21. When should we wash our hands? Entering/leaving a clinical environment Preparing, handling or eating food Contact with patient or patient�s environment Before/after barrier nursing Before applying/removing gloves Before and after wound care Before/after handling invasive devices or systems eg IV Catheters, uninary catheters Before/after bed making After personal contamination eg nose blowing, after visiting the toilet After handling specimens After leaving the dirty utility room

22. How should we cleanse our hands Wet hands first Apply liquid soap Rub all surfaces of the hands for 15-20 seconds Rinse thoroughly Dry thoroughly (using paper towels) Do not contaminate hands when disposing of towels

23. Correct Hand Wash Technique

24. How should we cleanse our hands with alcohol gel? Alcohol Correct amount of product Rub in thoroughly Cover all surfaces of the hands Allow to dry naturally Do not use paper towels DO NOT USE IF HANDS ARE VISIBLY DIRTY DO NOT USE IF THE PATIENT HAS CLOSTRIDIUM DIFFICILE

25. Frequently Missed Areas

26. Engagement Ring False Nails

27. Britain's No.1 quality newspaper website | Make us your homepage Tuesday 13 February 2007 By Richard Gray, Science Correspondent, Sunday Telegraph Last Updated: 11:55pm GMT�25/11/2006 Thousands of hospital staff fail to wash hands correctly Telegraph.co.uk

28. Hand Hygiene Compliance

29. Protective Clothing

30. Gloves: Must be changed and disposed of after each procedure and hands rewashed. Use when: Cleaning equipment Cleaning spillages Venepuncture Any task where contamination may be likely to occur Face Protection: Must be worn for any procedure in which there is a high risk of splashing.

31. Aprons Aprons should be worn to protect clothing/uniform and the wearer if the wearer if direct contact with body fluids is anticipated and they should also be worn for: Equipment cleaning Serving food (blue) Bed bathing/assisting patients with personal hygiene Bed making They are microbiologically impervious and water repellent!

32. Safe Disposal of Sharps Dispose at point of use Do not over fill sharps bin Ensure lid is on correctly Once � full close, seal and dispose Never place fingers into bin Keep bin out of reach of children

33. Sharps injury and exposure to blood and body fluids First aid treatment - gently bleed sharp injury under warm running water. Rinse eye/mouth splash with copious amounts of cold water. Report injury to line manager Report it immediately to Occupational Health or A+E (out of hours) Complete documentation

34. Spillages of Blood and body Fluids Should be dealt with as soon as possible Wear PPE Must be disinfected with 10,000ppm sodium hypochlorite or NaDCC Follow manufacturers instructions Caution required for vomit or urine. Do not use on soft furnishings

35. Transport of specimens Specimens should be tightly secured to prevent spillage Specimens should spend the shortest possible time in transit Laboratories can refuse to accept badly packaged specimens! Laboratories can refuse inadequately labelled specimens!

36. What should be on a request form? Patient�s name and NHS number Origin of Specimen (GP name/surgery) Patient�s date of birth Date and time of specimen Relevant clinical information Site of the specimen Danger of infection sticker e.g. BBV/TB

37. Waste Classification DoH Hazardous Waste Regulations �Safe Management of Healthcare Waste 07-01: November 2006 Category A - an infectious substance which is transported in a form that, when exposure to it occurs, is capable of causing permanent disability, life threatening or fatal disease in humans or animals. Category B � an infectious substance which does not meet the criteria for inclusion in Category A

38. Segregation Process Hazardous waste EWC code 18 01 02 (Cat A consigned) - Yellow lidded Hazardous/infectious waste EWC code 18 01 03* (Cat B consigned) - Orange lidded Cytotoxic/cytostatic waste (consigned) EWC code 18 01 03* (Cat A)18 01 08* - Purple lidded Offensive Waste (Tiger bag) (Sanpro) Domestic/general waste ( Black bag)

39. Sharps Bins Dental � All yellow lidded sharps bins District Nurses/ Health Visitor/ School Nurses/Family planning � Purple lidded sharps bins (in the community) Patients on cytotoxic therapy, purple bin, if swab gloves etc contaminated during treatment place in bin label as mixed waste. In premises, all yellow bins for sharps, purple for cytotoxic/cytostastic, orange lid bin for phlebotomy if required.

40. MRSA

41. What is MRSA?Meticillin Resistant Staphylococcus Aureus. Staphylococcus aureus is a gram positive organism which lives harmlessly on the skin and in the anterior nares and is present in 30% of the population It can be an effective pathogen causing particular problems in hospital MRSA is a strain of Staphylococcus aureus which is resistant to meticillin (flucloxacillin) and some other antibiotics MRSA can still be treated with antibiotics but these can be expensive and have side �effects.

42. MRSA in the past 1959-Methicillin first used in UK 1961-Methicillin resistance reported 1970�s-outbreaks in UK and Europe Late 70�s-outbreaks declined 1979-Melbourne- major MRSA outbreak 1980- Dublin- Start of MRSA epidemic 1981-UK 1st epidemic strain EMRSA1

43. Britain in Europe

44. Who is at Risk? The elderly The very young Immune compromised people Presence of invasive devices Diabetics Chronic wounds Residents in care homes Surgical patients Patients undergoing increased nursing/medical intervention Antibiotic users The elderly especially in nursing homes. People have ulcers or bed sores which can be colonised or infected and this increases the risk for other residents especially if control measures are not taken. The very young in the community are not equipped to fight off bacteria their immune system is not as developed as an adult to fight off invading bacterias. Therefore they are vulnerable especially if they have any skin breaks for example umbilical cord is warm and moist until it drops off. That�s why the antibiotic powder is used to keep it dry to avoid infection. The immunocompomised people are cancer sufferers who may be on immuno suppressants to help keep their illness at bay. Those who have catheters in place feeding tubes or tubes into their skin for medication or anti cancer therapy treatments such as chemotherapy. Those people who are immunocompromised are also H.I.V. sufferers or the I.V. drug abusers.The elderly especially in nursing homes. People have ulcers or bed sores which can be colonised or infected and this increases the risk for other residents especially if control measures are not taken. The very young in the community are not equipped to fight off bacteria their immune system is not as developed as an adult to fight off invading bacterias. Therefore they are vulnerable especially if they have any skin breaks for example umbilical cord is warm and moist until it drops off. That�s why the antibiotic powder is used to keep it dry to avoid infection. The immunocompomised people are cancer sufferers who may be on immuno suppressants to help keep their illness at bay. Those who have catheters in place feeding tubes or tubes into their skin for medication or anti cancer therapy treatments such as chemotherapy. Those people who are immunocompromised are also H.I.V. sufferers or the I.V. drug abusers.

45. Transmission Contact transmission- the most important route of cross infection is direct contact (poor hand washing) Exfoliating skin conditions e.g. eczema, psoriasis. Skin scales Ease of transmission is due to its viability for long periods in dust and on hard surfaces. Equipment Sputum, wounds

46. Management of MRSA Inform infection control Check your policy MRSA care plan Patient and carer education Universal Precautions Wound management Isolation? Communication Laundry Don�t stop discharges or transfers.

47. Screening for MRSA In acute settings targeted screening and colonisation suppression is being trailed to look at the best and most practical approach Colonisation suppression involves treatment for nasal carriage and antibacterial wash. Questions to group: Discuss the pros and cons of screening and eradication Notes Staff/patients High risk areas Financial Lab capacity Isolation availability of side rooms Bed occupancy Under-staffing Netherlands Antibacterials: Aquasept/bactriban/flamazine chlorhexidine, Triclosan and povidone iodine are all active against MRSA Emergence of resistant strains is a major limiting factor lQuestions to group: Discuss the pros and cons of screening and eradication Notes Staff/patients High risk areas Financial Lab capacity Isolation availability of side rooms Bed occupancy Under-staffing Netherlands Antibacterials: Aquasept/bactriban/flamazine chlorhexidine, Triclosan and povidone iodine are all active against MRSA Emergence of resistant strains is a major limiting factor l

48. Clostridium difficile

49. Clostridium difficile It is an Health Care Associated Infection (HCAI) A major cause of diarrhoea affecting patients in Health Care Establishments. The infection is associated with antibiotic use and environment contamination.

50. The problem Cause of outbreaks Financial cost estimated at �4000 per case. Longer stay in hospital for the patient. Can cause pseudo membranous colitis and death.

51. Clostridium difficile � Key facts Is associated with antibiotics or a cocktail of antibiotics. Laxatives, enemas, antacids and bowel surgery are risk factors It is an anaerobic bacterium It produces spores. Spores are resistant to many disinfectants and can survive in the environment for a long time. The bacteria may also produce toxins which cause the symptoms. Spore are resistant to alcohol gel.

52. How does Clostridium difficile affect patients. Watery, green foul smelling diarrhoea. Patient dignity. Mainly affects the over 65�s Illness can range from mild to severe to fatal pseudo membranous colitis. Can become dehydrated, electrolyte imbalance colon perforation.

53. How does it spread? by the faecal-oral route spores in the faeces can contaminate Patients/Health carer�s skin and hands The environment

54. Treatment Review antibiotics Commence on Metronidazole 400mgTDS 7-10 days or Vancomycin 125mg 6 hourly 7-10 days. Isolation of patient. Observe fluids balance Stool chart Increased cleaning of all surfaces Communication. Staff not to eat in the affected area. Don�t use alcohol gel. Inform Infection Control.

55. How to manage Clostridium Difficile Isolation Dedicated toilet facilities Hand Hygiene Cleaning Record symptoms Inform Infection Control Communication, staff, patients and relatives

56. When is infectious period over? When the patient is clear of symptoms for 48 hours. Terminal clean of the area Recurrence of symptoms can occur, of around 20%. Regard the patient as infected. Reinstate precautions If the patient has had a positive specimen wait 14 days before sending a repeat. If the patient has had a negative result wait 7 days before sending a repeat sample.

57. What is Norovirus (Norwalk) ? A group of viruses that are a major cause of non-bacterial gastroenteritis Small, rounded in structure, sometimes called �winter vomiting virus�.

58. Why is it a problem? Spreads rapidly Affects all age groups (young and elderly being the most vulnerable) Immunity following infection is not life long Can have a major effect on staffing levels.

59. How does Norovirus spread? Faecal oral route Person to person hands of carers, patients contaminated objects/surfaces Aerosol spread Vomiting Food/water borne transmission via food chain

60. Why does it spread so rapidly? High levels of virus excreted Low infectious dose making this highly contagious May have non-specific clinical features Possibility of infectivity before acute onset and after symptoms cease High levels of environmental contamination from faeces and vomit

61. Clinical Features of Norovirus Incubation period 12 � 48 hrs Symptomatic 24 � 60 hrs Signs & Symptoms Vomiting * Nausea * Myalgia Diarrhoea * Headache * Dehydration Pyrexia * Abdo pain

62. Treatment Fluid replacement is essential Sufferers should be isolated Sufferers should not eat with or prepare food for others. Do not return to work until symptom free for 48 hours

63. Outbreak definition

64. What precautions might be necessary to prevent spread Report it and record symptoms Isolation of infected / exposed persons Closure of establishment Universal precautions Adapting working practices Enhanced environmental cleaning Communication Adequate resources

65. Who to isolate? Isolate the bug not the patient Individual risk assessment How is the infection spread, airborne, droplets, contact? Is the environment contaminated, e.g. Clostridium difficile? Are other patients highly susceptible? Does the patient present specific problems e.g. mental state?

66. Equipment needed for Outbreaks Disposable aprons Disposable non sterile and sterile gloves Masks? Goggles / visors Clinical waste bag and foot operated pedal bin Laundry bag for infected linen Alcohol gel / liquid soap and paper towels Wash basin, dedicated commodes if ensuite facilities are not available Sharp bin Notes for the door? Crockery?

67. You and Infection Control Do not come to work if you have any vomiting and diarrhoea. Do not come back to work until you are free of symptoms for 48 hours. Do not work on any other ward during an outbreak.

68. Infection Prevention and Control Policies Are Available on the Intranet Click on policies, procedures and guidelines Click on clinical quality Infection control Please do not hesitate to contact the Infection Control Team for advice

69. Any questions?