Sunshine Care Training Sarah Yorwerth & Tara Hollinshead

1. Sunshine Care Training Sarah Yorwerth & Tara Hollinshead Infection Control

2. A human with an infection has another organism inside them which gets its sustenance (nourishment) from that person, it colonizes that person and reproduces inside them. We all develop a wide range of infections, but fight them off rapidly. Some people, however, develop persistent, long-term (chronic) infections. The majority of chronic infections are caused by viruses, such as hepatitis or herpes. Chronic bacterial infections are more likely to affected patients with diabetes, as well as those with weakened immune systems.

3. Viral Infections Inhaling the Virus Bitten by infected insects Sexual Contact. Respiratory infections of the upper airways, nose and throat are the most common. The virus invades and attaches to a cell, enters and releases its DNA. This helps multiply the virus and then it colonises the host! A single sneeze, on expulsion can travel at a speed of 95 miles per hour, however it can be up to 630 miles per hour, under the right conditions and can release at least 40,000 droplets. This can travel up to 40 metres.

4. Viral Infections Common Viral infections include: The Common Cold- This is normally caused by adenovirus, coronavirus and rhinovirus. Typically lasts 7-10 days and most adults have 2-4 colds a year. Influenza- This is caused by other viruses and is more serious than the common cold. Causes high temperature, chills and aches and pains. Can lead onto chest infections. Bronchitis- Can be caused by Bacteria, Virus or Chemicals that causes inflammation within the airways. Lasting about 3 weeks it can cause yellow/greyish mucus. Gastro enteritis- (Stomach Flu) Caused by Norovirus or Food poisoning which causes sickness and diarrhoea for 24-48 hours.

5. At Risk People who are most at risk are: • The Very Young • The Very Old • Chronic Conditions • Defected Immunity • Pregnant. Remember: Bacterial can live on your hands for about 3 hours. 1-4 hours on hard surfaces and materials.

6. Bacterial Infections Bacteria are tiny single celled organisms. A gram of soil holds around 40 million bacteria. The earth holds at least 5 nonillion bacteria. (5,000,000,000,000,000,000,000,000,000,000) Bacteria can live in virtually any kind of environment, from extremely hot to super cold, some even in radioactive waste. A number of bacteria live in our bodies, on our skin, airway, mouth, digestive and urinary tracts - most of the time without causing any harm to the host.

7. MRSA Methicillin Resistant Staphylococcus Aureus Golden staph is commonly carried on the skin or in the nose of healthy people. Around two to three out of every ten people carry the bacterium in their noses. This is known as ‘colonisation’ – the bacteria are present, but do not cause infection. The armpits (axilla), groin and under skin folds are other places golden staph likes to inhabit.Golden staph can be spread by skin-on-skin contact or by touching contaminated surfaces. Poor personal hygiene and not covering open wounds can lead to infection with golden staph. Thorough hand washing and good housekeeping, such as damp dusting, are important as golden staph is part of our environment.

8. PVL Panton- Valentine Leukocidin PVL is a toxic substances produced by some Staphylococcus Aureus, which is associated with increased diseases. Cytotoxins destroy white blood cells and cause extensive necrosis. There are currently 14 strains which affect humans. PVL can cause Necrotising infections, cellulitis, septic arthritis and recurrent abscesses.

9. Hepatitis Hepatitis is a medical term for ‘swelling’ and inflammation of the Liver. It can result from a Viral infection, drinking too much alcohol and being in contact with certain chemicals.

10. Norovirus Winter Vomiting Bug, Norwalk. Norovirus is a group of Viruses that can cause Gastroenteritis (infection of the gut). It is passed on from person to person contact with lack of hygiene, it can also be passed on from lack of environmental hygiene. Symptoms include sickness and Diarrhoea, and commonly, the risk of dehydration. If present, Norovirus is passed out through Diarrhoea so it can be passed on by lack of hand washing. It takes around 24-48 hours incubation period. The elderly are most at risk of dehydration, the person may feel dizziness, muscle cramps and sunken eyes. Symptoms normally last 3-4 days but if symptoms persist, it is important to see medical attention.

11. E- Coli Escherichia Coli E-coli is naturally found in the gut of healthy people and animals, and is usually harmless. We need E-Coli as part of our normal flora, it produces Vitamin K2 and helps prevent harmful pathogenic bacteria. Although there are some strains which are a cause of Gastroenteritis. The type VTEC 0157 is serious, causing severe infection with bloody diarrhoea, which can be fatal. Incubation period can take up to 14 days. E-Coli can cause 90 % of UTI’s, Cystitis and Kidney Infections, usually due to faecal contamination of the back passage. It can cause other infections such as Gastroenteritis, Pneumonia and Meningitis. VTEC 0157 is found in the faeces of animals, and it has been known to be passed on through petting. It can also transmitted by eating contaminated beef, unpasteurised milk, yoghurt, cheese and raw vegetables. There is no cure for infection, the immune system will normally clear it, but its important to keep fluid intake up.

12. C.Diff Clostridium Difficile Clostridium Difficile infection mostly affects people who have had a course of antibiotics. C.Diff lives harmlessly in the gut of around 3/100 adults and 7/10 healthy babies. C.Diff is kept in check by other harmless bacteria. C.Diff produces spores that are hardy and resistant to high temperatures, and is passed out through faeces. Spores can live on bedding and surfaces for years. Spores can be spread through the air and land on our food our mouth. If the numbers of C.Diff increase, due to the Antibiotics killing off the protecting bacteria, C.Diff will then start to produce harmful toxins. C.Diff can damage the lining of the colon. Mild cases include watery diarrhoea, cramps, sickness, bouts of gastroenteritis, which can last a few days to week. Severe cases can cause Colitis and the Colon to rupture. 80% of cases affect the over 65’s Treatment includes stopping current antibiotics, and replace with other antibiotics. Keeping fluids up and not taking Anti-Diarrhoeal medication such as Loperimide.

13. Pseudomonas Pseudomonas are strains of bacteria found in the environment which can infect people with weakened immunities. It can infect the blood, cause pneumonia and can lead to serious illness or fatality. It is spread by poor hand hygiene of Health Care Workers and the cleanliness of equipment. It can be due to poor sanitation, drainage of sinks, catheters and feeding tubes. It can be found widely in soil and stagnant water. Mild infections can cause ear and eye infections. Which is generally treated by antibiotics. Depends on the route into the body. If it enters the lungs, it can cause pneumonia. If it enters the tissues, it can cause septic shock and necrosis. It affects around 3,700 to 4,000 people each year.

14. Haemophilus HiB. Haemaphillus is a bacterial infection which can cause pneumonia or meningitis. Infection is spread person-to-person by direct contact or through respiratory droplets like by coughing and sneezing. Usually the bacteria remain in the nose and throat — causing no harm Sometimes the bacteria can enter the blood and spread, causing serious infection in the individual. Heaemaphillus can cause life threatening conditions such as: • Meningitis- Infection of the brain/spinal cord. • Pneumonia- Infection of the lungs • Epiglottitis- Infection in the windpipe • Septic Arthritis- infection of the joints. • Cellulitis- Infection of skin and tissues. • Blood poising which can be fatal.

15. Streptococcus Pneumonaie Streptococcus is one of the most common infections seen in the community. Pneumonia accounts for 25% of Streptococcus infections and it is a frequent cause of death in the elderly. Statistics show there are 90 different strains. Streptococcus enters through the nose and mouth, through droplets. Symptoms include chills, sweats, headaches, temperature above 38 degrees, blood in mucus. The people most at risk are HIV, Diabetes, Over 65. There is a PPV vaccination available against this infection.

16. HIV Human Immunodeficiency Virus HIV attacks the immune systems ability to fight infection. HIV enters the immune system cells (CD4) and creates thousands of copies of itself which then gradually kills off the CD4 cells which protects the body. This process can take about 10 years. It was discovered in the 1980’s and it is believed its origin was from Primates. It is present in the blood and some bodily fluids, although when exposed outside, it doesn’t live very long. It is not present in sweat or urine. It is not passed on as easily as colds and flu. It is mostly passed on through unprotected sex 95% cases, contaminated needles and blood transfusions. It cannot be passed on through mouth-mouth resuscitation, kissing, holding hands or being sneezed on. There have been no cases of HIV spread through needle stick injuries since 1999. Incubation Period when exposed to the virus takes around 2-6 weeks. People develop a flu like illness in 80% of cases and lasts for about 4 weeks. HIV will then remain dormant, sometimes with no further symptoms for years.

17. HIV Human Immunodeficiency Virus Later stage HIV is when the person becomes very ill, and your body looses its ability to respond to some treatments. The person may then be diagnose with AIDS. AIDS (Acquired Immunodeficiency Syndrome) is a syndrome caused by the HIV virus, you cannot catch AIDS. Symptoms of AIDS are Persistent tiredness, night sweats, weight loss, blurred vision. Statistics show 91,500 people are diagnosed with HIV in the UK. There is currently no cure, but there is treatment to enable a healthy lifestyle. Prognosis based on a Man at 30 years old, expected to live up to 75 years old with early treatment. Since 1990’s health care workers who were positive were barred from working and carrying out invasive procedures. The law has now lifted restrictions in Aug 2013 and this will be in effect from April 2014. People with HIV are now protected under the Equality Act 2010, so it is now illegal to discriminate against HIV in the workplace.

18. Prions Disease A prion is an infectious agent consisting mainly of protein - it contains no genetic material. It is neither bacterial nor fungal. It occurs normally in a harmless form, but when it folds into an abnormal shape it turns into a rogue agent and affects the structure of the brain or other parts of the nervous system. All forms of prion infections are currently untreatable and fatal.Prions cause degenerative brain diseases, such as mad cow disease, CJD (Creutzfeldt-Jacob disease), kuru, fatal familial insomnia, and scrapie. Experts also link some cases of Alzheimer's disease to prion infection. Prion diseases, also called transmissible spongiform encephalopathies, are brain wasting diseases that affect humans and animals. Made primarily of protein, prions are small active agents that act a bit like viruses: they don't replicate themselves but hijack material in the host and cause it to behave abnormally, for instance they force host proteins to fold into shapes that clump together into plaques that clog up the brain, causing it gradually to waste away.

19. CJD Creutzfeldt-Jakob Disease CJD is a rare and fatal condition that affects and degenerates the brain. Classic CJD is caused by abnormal infectious proteins that misfold in the brain, and that cannot be killed by radiation or antibiotics. Sporadic CJD, the cause is unknown, but a normal protein changes and turns into prion. It affects 1 in 1million people between the ages of 45-75 years old. 83 recorded deaths in 2012. Variant CJD is caused by the consumption of affected meat by Mad Cow Disease (Bovine Spongiform Encephalopathy). It was discovered in 1996 and strict controls are in place. Incubation period from exposure can be up to 10 years. There has been 177 recorded deaths to date. People with CJD carry a mutation of proteins and the likelihood of inheritance is 1 in every 9 million. There have been 10 recorded deaths in 2012.

20. CJD Creutzfeldt-Jakob Disease • Symptoms of CJD are: • Loss of intellect and memory • Change in personality • Loss of balance and co-ordination • Slurred Speech • Vision disturbance and Blindness. • Fatigue • Bizarre Behaviour • There is no cure of CJD. But treatment is available to alleviate symptoms of conditions developed from the disease.

21. Botulism Botulism is a rare but potentially fatal infection caused by Clostridium Botulinium. It attacks the Nervous System, Brain and Spinal Cord and can cause paralysis. In some cases, it can spread to the lungs and cause breathing failure. Incubation period is 12-36 hours. Symptoms include Double Vision, Sickness and Diarrhoea, Breathlessness and Nausea. The bacteria can be found in soil, dust, honey, beans and corn. It can also be passed on through the processing of canned foods. Symptoms can last 10 days to several months and immediate admission to hospital is needed. Treatment will include intravenous antitoxins to prevent transmission to the brain but this cannot cure the paralysis.

22. Campylobacter Most common cause of Food borne poisoning. It is found in the gut of turkeys, chicken, cattle and pets. It is spread through eating or drinking contaminated water. It can include parasites which lives on organisms which live on for some time. Symptoms include Sickness and Diarrhoea, bloody diarrhoea and stomach cramps. Incubation period is normally 2-5 days. It is important maintain good fluid intake to reduce the risk of dehydration.

23. Leptospirosis Leptospirosis is found in wild and domestic animals such as cattle, pigs and dogs. It lives for many years within the kidneys and urine. It can be passed through infected soil. Humans can transmit this infection through minor skin wounds and burns. This is can also be passed into the blood stream. There are 50-60 reported cases a year. Incubation period is anything between 2-30 days. Symptoms include high temperature, chills, headaches, conjunctivitis, tiredness and muscle pains in the calves. Second Stage Leptospirosis is known as ‘Weils disease’ Symptoms include Jaundice, abdominal pain and diarrhoea. Antibiotics such as Penicillin and doxycycline are used to treat but recovery is anything between 2-6 weeks.

24. Salmonella Salmonella is a group of bacteria which can be found in food and water which is contaminated with germs, poisons or chemicals. There are over 2,500 strains of Salmonella. One strain can cause fatal Typhoid fever. Salmonella can also be found in the gut of animals, eggs and other dairy products. Some cold blooded reptiles carry this infection but are asymptomatic. It can be transmissible through stools of an infected human or animal. Incubation period is 12-72 hours. Symptoms such as: Sickness and Diarrhoea, Stomach Cramps, Nausea, Fatigue and it can cause dehydration. Mild cases can last 4-7 days where severe cases last weeks.

25. Infection Prevention Health-Care associated infections accounts for 300,000 cases being cared for by the NHS. In 2007, MRSA and C.Diff were the leading cause of 9000 recorded deaths. All in all, it costs the NHS approximately £1billion a year. Health Care Workers are at increasing risk of acquiring acute infections due to lack of hand hygiene and the use of PPE. Half of all men and one-third of all women fail to wash their hands. Recent studies showed through observation within a hospital setting, hand washing compliance was at a low of 40%! Nurses and HCA’s were most compliant and lowest was among Intensive Care staff and Physicians. One hospital in the U.S showed 23.7% of staff washed their hands after patient contact and 6.7% before patient contact.

26. Break the Chain!

27. Clean Hands Save Lives Many nasty bacterium’s or virus can remain on your hands for up to 3 hours and still potentially cause infection. It is important to wash hands regularly when in direct contact with patients. The whole process of washing your hands should take around 15-30 seconds. Acrylic nails can harbour more germs and fungal bacteria between the false and natural nail.

28. PPE Gloves Disposable gloves are worn if you’re performing or assisting in a procedure that involves a risk of contact with body fluids, broken skin, dirty instruments and harmful substances such as chemicals and disinfectants. This includes procedures that involve: • A risk of being splashed by body fluids (blood, saliva, sputum, vomit, urine or faeces, for instance). • Contact with the patient’s/client’s eyes, nose, ears, lips, mouth or genital area, or any instruments that have been in contact with these. • Contact with an open wound or cut. • Handling used items of medical equipment, like scissors used in wound dressings. • Handling potentially harmful substances, such as disinfectants. You must then perform hand hygiene. Gloves are not a substitute for hand washing.

29. PPE Aprons These aren’t needed to carry out many normal aspects of day-to-day care with patients/clients, such as helping them to go for short walks, but you will need one when: • You’re performing or assisting in a procedure that might involve splashing of body fluids. • You’re performing or helping the patient/client with personal hygiene tasks. • You’re carrying out cleaning and tidying tasks in the patient’s/client’s living space, such as bed-making. • You must always perform hand hygiene before putting a disposable gown on and after taking it off and placing it in the correct clinical waste bin. • Note that different organisations have different-coloured aprons for different tasks – you should always check your workplace’s local policy.

30. Clinical Waste If patients are treated in their home by a community nurse or a member of the NHS profession, any waste produced as a result is considered to be the healthcare professional’s waste. If the waste is non-hazardous, and as long as it is appropriately bagged and sealed, it is acceptable for the waste to be disposed of with household waste. This is usually the case with sanitary towels, nappies and incontinence pads (known collectively as sanpro waste) which are not considered to be hazardous when they originate from a healthy population. Best practice guidelines suggest to use yellow biohazard waste bags, this is imperative within a Care home environment Red for soiled linen.

31. Disposal of Sharps Needle stick injury: Encourage wound to bleed Wash running cold water and soap Do not scrub or suck wound Dry and cover with a dressing Go to A&E with in 4 hours. HCP will assess whether you need a Post-Exposure Prophylaxis jab (PEP) Report to office immediately. Splash incidents: If in the mouth: do not swallow, rinse mouth out several times with cold water 2. If into eyes: remove contact lenses 3. Irrigate eyes well with cold, running water Seek medical attention Do not overfill. Always have 2 container boxes. Never bend or re-sheath needles.