Infection prevention & control

1. Infection prevention & control
A trust wide approach to reducing
Healthcare Associated Infections
Infection Prevention & Control Team

2. Is Infection Control old news?
• Maidstone and Tunbridge Wells NHS Trust
– 2006//7. More than 1,170 patients infected with Clostridium difficile; 90 patients died over 30
month period. 264 had infection at time of death
• Stoke Mandeville NHS Trust
– 2004/5. Over 30 patients died as consequence of 2 outbreaks of infection caused by
Clostridium difficile
• Altnagelvin Hospital, Londonderry/Royal Jubilee Maternity Hospital,
Belfast
– 2011. Four babies died from outbreak of Pseudomonas aeruginosa. Infected taps and mixer
values responsible

3. Is Infection Control old news?
• James Cook University Hospital
– 2009. Guidelines put into place to protect patient from Clostridium difficile not adhered to an
inquest heard in 2012 relating to patient death from Clostridium difficile and aspergillosis

4. This is the front page of the Times and
was quoted by the House of Lords and
Commons and by the National Audit Office
This is the front page of the Times and
was quoted by the House of Lords and
Commons and by the National Audit Office
AVERAGE COST OF a UK MRSA/Clostridium difficile CASE - £5000.00
AVERAGE HOSPITAL STAY:
MRSA – 18 DAYS (K.V. Menon et al – J.Rcoll. Surg. Edinburgh 1999)
Clostridium difficile – 20 days (M H Jen et al, Alimentary Pharmacology & Therapeutics, 2011)

5. Although the financial cost is important, more so is the
cost to the patient through acquiring an infection
through no fault of their own.

6. The Health and Social Care Act 2008
• Legislation
• Annual inspection by the CQC
• Applies to all staff within the
organisation

7. The Health and Social Care Act 2008
• You need to be aware of this legally
binding document.
• All healthcare providers must be
registered with the CQC and must abide
by the 10 duties set out in this
document.
• The CQC will visit unannounced yearly
to check we are complying with this
document.
• They will look at things such as isolation
facilities, cleanliness of
equipment/environment.

8. The Health and Social Care Act 2008
• They will speak to any member of staff
randomly available there it’s important
that everyone is aware of this document.
• Document also ensures staff safety
precautions are in place such as up to
date policies and OHD services.

9. What is expected of you?
• All staff should be aware of the IPC policies and must practice and
promote compliance.
• All staff should be able to challenge poor practice/non compliance
and know who to escalate concerns to
• All staff are responsible for updating their own knowledge and
disseminating any education and training to colleagues
• All staff should be aware of and be involved in the corporate agenda

10. What is expected of you?
All Trust staff
•Policy compliance
•Challenge/support colleagues
•Education
•Corporate agenda
•Patient management
•Surveillance
•Audit
•Competency
ICPT
•Patient review
•Training
•Surveillance
•Outbreak management
•Audit
•Specialist advice and support
•Lead on DOH initiatives
•IPC policies

11. Infections – some you may know, some
you may not…

12. Carbapenemase-producing
Enterobacteriaceae
Global spread of Carbapenemase-producing Enterobacteriaceae
Carbapenemase-producing Enterobacteriaceae (sometimes called CPE) is the name
given to a group of bacteria that have become very resistant to antibiotics including those
called carbapenems. Many of these bacteria live harmlessly in the gut and help you
digest food. However, if they get into the wrong place such as the bladder or bloodstream
they can cause infection.
These types of multi-resistant organisms are of great concern going forward.

13. Extended-Spectrum
Beta-Lactamases (ESBLs)
• Multi resistant gram negative
bacteria
• Isolation / IPC precautions
• Medical assessment /
treatment
• IPC review / advice

14. Extended-Spectrum
Beta-Lactamases (ESBLs)
• E.coli, pseudomonas and klebsiella
• All require isolation – usually carried in the
bowel – so could have prolonged carriage,
screening not feasible.
• Colonisation or infection – treatment usually IV
meropenum
• Sputum/wounds reculture 48hours following
treatment if negative stop isolation
• B/C & urine don’t reculture can discontinue
isolation when treatment completed and there is
no faecal incontinence

15. HCAI Targets: MRSA
• Mandatory target
• Screening
• Decolonisation
• Pathway
• Isolation
• Hand hygiene
• Cleaning
• Equipment
• Communication

16. HCAI Targets: MRSA
• Screening – discuss elective and emergency admission screens,
PPP’s – new swabs. Pre op theatre cases eradication and teicoplanin.
• Pathways reinforce the importance of documentation.
• Discuss isolation within 2 hours of knowing and isolation in bays with
stop sign trolley and datix risk assessment depending on where the
MRSA is.
• Cleaning discuss daily cleaning with actichlor plus, and all equipment
that leaves the room to be decontaminated.
• Communication discuss completed discharge letters and advise any
other services that the patient will require…

17. HCAI Targets: MRSA
• Correct decolonization therapy for a newly diagnosed MRSA patient is
Mupiricin TDS & Octenisan OD for 5 days including hair washed with
Octenisan twice within the 5 days.

18. HCAI Targets: Clostridium difficile
• Mandatory target
• Isolation
• Hand hygiene
• Antibiotic review
• Pathway
• Stool chart
• Daily review
• RCA
• Surveillance
• Communication
• Positive/unconfirmed
positive

19. HCAI Targets: Clostridium difficile
• Huge importance of prompt isolation/appropriate STOP sign/door closed
• Use of soap and water not alcohol gel
• Importance of avoiding antibiotics known to select for C-diff (previous
treatment).
• Review of start/stop date.
• Appropriate antibiotic treatment for severity of CDI
• Unconfirmed cdiff is GDH and PCR present but toxin A&B neg – still needs
treating as cdiff pos but won’t be seen unless requested on the cdiff ward
rounds.
• Complete documentation – importance of documenting stool score and
frequency
• IPC daily review to ensure pt safety
• RCA for trust attributed CDI
• Importance of communication

20. HCAI Targets: Clostridium difficile
• Clostridium difficile toxin detected patients room you need to request for
a Terminal clean with HP fog
• A patient with Clostridium difficile be transferred out of isolation 48
Hours after symptoms have stopped

21. Previously positive patients – MRSA
and Clostridium difficile

22. Not only South Tees…

23. Outbreak management
• Gastroenteritis outbreak assessment tool
• Patient assessment
• Isolation
• Specimen collection
• Outbreak pack
• Hand hygiene
• Cleaning
• Documentation
• Communication
• Outbreak instructions

24. Outbreak management
• If a patient develops sudden onset of diarrhoea – your initial actions
should be;
– Medical review
– antibiotic review
– isolate (terminal clean bed space)
– complete stool chart
– obtain stool sample on request from medical team

25. Diarrhoea Assessment Tool
The Diarrhoea Assessment Tool
(DAT) is to be complete for all
patients who develop diarrhoea. A
member of the medical team must
be involved in any decision
making regarding stool sampling.

26. Gastroenteritis Outbreak Assessment Tool

27. Communicable diseases in staff:
• Discuss chicken pox measles – know
your status check with OHD
• D&V 48hours symptom free inform
OHD send a specimen

28. Communicable diseases in staff:

30. Hand Hygiene
Chlorine
handwash

31. Hand Hygiene
Semmelweis identified in the 1800’s that
there was a direct link between hand
hygiene and cross infection. These are
still discussions we find ourselves
having in the 21st century.

32. Hand Hygiene
•Every effort goes into encouraging
hand washing and still not everyone
does it.
•Hand-washing promotion is out of step
with the realities of hand hygiene. So,
what else can we do?

33. Hand Hygiene
• Alcohol gel can be used to implement
the ‘my 5 moments for hand hygiene’
concept for the majority of hand
hygiene opportunities.
• Soap and water must be used when:
– hands are visibly soiled
– the patient has infectious vomiting
and/or diarrhoea
– for direct contact with bodily fluid
– outbreaks of diarrhoea & vomiting
(unless otherwise stipulated by the
IPCT)

34. Hand Hygiene
• Hand wipe / hand hygiene should
always be asked/provided to patients
prior to meal times

35. Isolation principles
• Applying IPC principles
can reduce transmission
dramatically.

36. Isolation principles
• Gloves and aprons –
single use, no wandering
around.

37. Isolation principles
• Isolation green for
clostridium difficile and
diarrhoea
• Yellow for MRSA / ESBL
• Blue for TB is in the
making

38. IPC principles
• Dispose of sharps at point
of care
• Never re-sheath a needle
• Don’t overfill
• Sharps injury
• Bleed it, wash it, cover it,
report it

39. IPC principles
£1.20 25p
Clinical waste Domestic waste

40. Decontamination - 3 stage process
• Cleaning
– soap and water
– wipes
• Cleaning is the most important stage and must be done first
• Clinell wipes for general cleaning, all equipment to be used on more
that 1 patient must be cleaned after each use.

41. Decontamination - 3 stage process
• Disinfection
– chlorine releasing agent
• Patient in isolation should have designated equipment.
• Decontamination certificates to be utilised if equipment is being sent to
other departments, medical engineering etc..

42. Decontamination - 3 stage process
• Sterilisation
– CSSD
• No local decontamination should be occurring.
• Single use sign and application - can’t decontaminate locally and reuse.

43. Actichlor® Plus 1.7g tablets
• Actichlor Plus contains a chlorine compatible detergent that enables
cleaning and disinfection in a one-step procedure. Active ingredient is
sodium dichloroisocyanurate (NaDCC)
• Would be used for daily decontamination of an isolated patient’s room
• Releases the active compound hypochlorous acid when added to water
• Should be mixed in a ventilated room
• Do not screw lid tightly while mixing to allow escape of the gases
• Rinse of equipment that touches patient skin and stainless steel

44. Actichlor® Plus 1.7g tablets
• General Environment
– 1 tablet / 1 litre of water (1,000ppm of available
chlorine)
– Cold water 20 mins to dissolve
– Dispose of after 24hours
– Minimum 5 min contact time prior to rinsing and drying
• Blood spills
– 10 tablet / 1 litre of water or 1 tablet / 100mls of water
– (10,000ppm of available chlorine)
– Cold water 20 mins to dissolve
– Dispose of after 24hours
– Minimum 2 min contact time prior to rinsing and drying
• Can not be used directly on urine, vomit or
faecal matter
• Must be rinsed if the equipment comes into
contact with the patient skin

45. Environment
• IPC principles all staff responsible for keeping the ward/department
environments clean and tidy.
• Domestics can’t get into clean if the environment is cluttered, resulting
in dust collections etc…
• Use the friends and family test – would you be happy for you or your
rels to receive care here?
• IPC conduct a yearly environmental audit, CM’s do regular walk round
checks.
• PII wards are audited more regularly as well as wards who score less
that compliant 85%.

46. Environment
• IPCT - yearly environmental audit
• Action plan
• HCAI repository
• Re-audit
• Responsibility
• Friends and family test

47. Infection Prevention and Control Team
Telephone:
• JCUH - ext 54800
• FHN - ext 63901
• Middlesbrough, Redcar & Cleveland, Hambleton & Richmond
Locality
ext - 54800
Email: InfectionControl.Team@stees.nhs.uk