Infection Prevention & Control Core Skills Level 2

Transcription

1 Infection Prevention & Control Core Skills Level 2

2 Learning outcomes Risk assessment of patients Critical examination of the situation MRSA, CDT & CPE Ongoing challenges future-proofing infection control

3 Getting it right first time Alert checking admission & transfer Prompt screening/sampling IPC documentation MRSA & CPE pathways, CPE risk assessments Bristol Stool Chart for all patients Device management - VIIADs complete 3 X daily for all IV devices Catheter insertion record + daily monitoring sheet + HOUDINI

4 Alert checking on ICE Check every patient on admission & transfer

5 What is MRSA? Staphylococcus Aureus (S.Aureus) - bacteria commonly found on skin, hair, nose & throat Can cause skin, nose, eye & throat infections Meticillin Resistant Staphylococcus Aureus - S.Aureus bacteria that has developed resistance to some penicillin based antibiotics MRSA blood stream infections (bacteraemias) can therefore be difficult to treat

6 MRSA bacteraemia risk factors All MRSA bacteraemias reportable to CCG & subject to post infection review (PIR) process. Common themes from PIRs: Poor device management (cannulas, PICCs, CVCs) Delays in commencing decolonisation treatment Delays in screening on admission and post decolonisation Confusion over length of decolonisation courses

7 MRSA Screening Aim to identify any patients colonised with MRSA, commence treatment & reduce risk of developing a bacteraemia & risk of transmission to others Criteria All admissions within 48 hours Elective surgery screened in pre-op Bay contacts of known MRSA patients Known MRSA positive patients weekly screens throughout admission

8 Collecting MRSA screens

9 Wound screens

10 MRSA Readmissions Does patient have 3 consecutive negative screens including at least 1 throat screen? Yes- admit as normal, screen on admission No admit to side room, screen nose, throat, groin, wounds & send CSU if catheterised. Commence prontoderm foam

11 MRSA Decolonsiation Prontoderm foam All patients without 3 negative screens All positive patients Daily application after washing/bathing Prontoderm nasal gel 5 day course Rescreen 2 days after completing course do not screen whilst on nasal treatment Continue with weekly screens throughout admission

12 Clostridium Difficile Gram +ve, anaerobic spore Present in intestine of 2-5% of population Antibiotic exposure increases risk of developing C. Difficile infection (CDI) interrupts normal gut flora Long term hospitalisation also risk factor Vulnerable patient groups such as elderly or immunosuppressed high risk of CDI

13 C.Difficile tolerances Since 2007, year on year reduction in hospital acquired C.Difficile cases. Every healthcare Trust has an annual tolerance If cases considered unavoidable, can be presented to CCG for consideration Trusts can incur financial penalties for breaching tolerance

14 C.Difficile reporting CDI Patient has C.Diff in the bowel & is producing the toxin which causes diarrhoea GDH, Toxin B +ve Improves diagnosis for patient by identifying toxin carriers, but does not necessarily have C.Diff infection GDH +ve (glutamate dehydrogenase) Toxin B -ve Patient has C.Diff in the bowel but is not producing the toxin. Patient are often less symptomatic All cases reported to CCG Transfer to ID unit Commence Fidaxomycin & Optifibre HP mist vacated room/bay Reported locally only Reported locally only Treat as CDT Isolate Stool chart Terminal clean of room/bedspace

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16 C.Difficile risk factors for HAI Each CDT case is reportable to the CCG. Hospital acquired cases are subject to a PIR Common themes from PIRs: Antibiotic use Delayed sampling Laxative treatments not reviewed Bristol stool charts not commenced

17 Assessment of diarrhoea 1. Has patient received any laxatives, antibiotics, new feeding regimens? 2. Does the patient have any underlying pathology eg Crohns disease that may cause loose stools? 3. Are WCC & CRP raised if on antibiotics, are they responding? 4. Does the patient have any vomiting? 5. Has the patient been in contact with norovirus? Always sample unexplained diarrhoea

18 Carbapenemase Producing Enterobacteriacea (CPE) E.coli Klebsiella pneumoniae Enterobacter This group of bacteria may be referred to as gram negative bacteria and belong to the group of bacteria referred to as Enterobacteriaceae. (gut organisms)

19 Carbapenemase producing Enterobacteriaceae (CPE). There are strains of E.coli, Klebsiella and Enterobacter which can produce an enzyme called carbapenemase. These bacteria belong to a group referred to as CPE. This enzyme makes antibiotics such as meropenem and ertapenem (carbapenems) ineffective. These antibiotics are the last line of defence available against infections caused by gram negative bacteria.

20 Colonisation Usually in gut No signs or symptoms Not treated medically Environmental contamination Contamination of equipment Transmission opportunities Clinical Infection Raised WCC & CRP Pyrexial Likely sources wounds, urinary tract Limited treatment options 50% mortality rate

21 CPE Screening Gut organism rectal screen or faeces sample Screening swabs should have faeces visible on tip Screen all direct transfers from other hospitals and any patient who has been in hospital in the UK or abroad within the last 12 months. This includes RLUH!

22 Identification of a new case Isolate with en suite/dedicated toilet facilities Long sleeved gowns & gloves Dedicated equipment Clean environment with 3 in 1 wipes Screen bay contacts (if in a bay for > 24 hours) Keep bay closed until results are known Decant & HP mist if in bay for > 24 hours

23 Influenza Acute respiratory infection caused by Influenza A, B or C virus Flu A usually associated with more severe illness Characteristics Rapid onset of fever and cough Headache, sore throat, a runny or stuffy nose, aching muscles and joints, and extreme tiredness Infectious at onset of symptoms Usually infectious for 3-7 days Incubation period is 1-4 days (usually 2-3)

24 Management of a flu +ve patient Isolate preferably in a negative pressure room Use correct PPE long sleeved gowns/apron, surgical mask, gloves & face visor FFP3 respirator only if performing aerosol generating procedures Provide patient with tissues, bin & hand gel (if appropriate)

25 Face masks Surgical mask & face visor Required when entering the room of a flu/suspected flu patient A supply should be available outside the room Droplet precautions FFP3 respirator & face visor Required when performing aerosol generating procedures Staff should undergo a face fit test before using Airborne precautions

26 Norovirus Seasonal diarrhoea & vomiting bug Sudden onset projectile vomiting and/or explosive diarrhoea Extremely low infective dose

27 Management of Suspected Norovirus Contact precautions for all symptomatic patients Collect stool samples for Norovirus PCR & POD to Virology Inform Infection Prevention & Control Team Dedicate equipment, clean after each use Wash hands with soap & water after all patient contact

28 Rising to the challenge Getting the basics right every patient, every time Hand hygiene Equipment cleanliness Environmental cleanliness Timely & appropriate screening & specimen collection Emphasis on standard precautions

29 Conclusion IPC remains challenging Ward to board engagement Focus on back to basics Challenge poor practices

30 Contacts Infection Prevention & Control Team ext 4416 Medical microbiology/virology ext 4410 (or on-call via switchboard)