Course Handout: Infection Prevention and Control Handout

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1 Course Handout: Infection Prevention and Control Handout

2 Infection Control THE LAW IN NURSING AND RESIDENTIAL CARE HOMES The employer has legal responsibilities under the Health and Safety at Work Act 1974 to ensure, so far as is reasonably practicable, the health, safety and welfare of all its employees, whilst at work. They also have an obligation to ensure that the environment is safe for staff and visitors. The Employee must take reasonable care for the health and safety of themselves and others that may be affected by their acts and omissions at work. CODES OF PRACTICE New codes of practice have been developed on Health Care Associated Infections (HCAI s): Became mandatory for NHS April 2009 October Extended to become: Code of Practice for Health + Adult Social Care on Prevention and Control of Infection LEAD AND CHAMPION Under the new care standards effective 1st October 2010 all care homes have to have: Lead (usually the manager) responsible for: Policy and procedures Equipment that is suitable and maintained Using an audit and monitoring tool Developing an annual infection plan Champion responsible for: Check staff follow procedures Develop and use a clear cleaning programme Train all staff in their responsibility in controlling infection Develop evidencing of all procedures UNIVERSAL PROCEDURES It is usually not possible to identify those people who may spread infection to others, therefore, precautions to prevent the spread of infection must be followed at all times. Remember some people are carriers but suffer no symptoms themselves. All body fluids are potentially infectious and should be disposed of appropriately. All safety measures must be followed with equipment, both in storage, use and disposal. Special precaution should be taken with sharps. The most important areas to control the spread of infection have been proved to be:

3 Thorough hand washing with hot water, liquid soap and paper towels Proper handling of contaminated waste, Effective environmental surface cleaning Limited use of antibiotics (Libman 2007) Hand washing This is one of the most important ways of reducing the spread of infection. It should be done: Before and after each work shift or break. Before and after physical contact with each client. After handling contaminated items such as dressings, bedpans, urinals and drainage bags Before and after wearing protective clothing. After using the toilet, blowing the nose, covering a sneeze. When your hands become visibly soiled. Before and after eating, drinking, smoking. Wear minimal jewellery, keep nails short and do not wear nail polish or acrylic nails as all these attract and trap microbes which are difficult to wash off. Always cover cuts with waterproof dressings. Put on clean gloves every time you change tasks, and that means washing your hands first as you will contaminate the outside of the gloves with the germs already on your hands if you do not wash them! What makes us wash our hands? Hand washing behaviour depends on our perception of: Importance Workplace Support Risk posed to others

4 How much stress we are under at work (Hanna D. et al 2009 Belfast City Hospital COSHH Regulations - Disposal of Clinical Waste COSHH states that Employers have a duty of care in relation to hazardous substances, such as clinical waste at work. Biological or clinical waste is divided into categories: A Human tissue, blood and animal carcasses B Sharps such as discarded syringes, needles, broken glass. (These should be in a special puncture resistant container). C + D relate to pathological and pharmaceutical waste. E Soiled dressings, continence pads,urine and faeces. (particularly found in residential and nursing homes). Disposal A and B must be disposed of by incineration. E may be disposed of via a sewer, macerator unit or toilet. CLINICAL WASTE MUST NOT BE PLACED IN ORDINARY BIN BAGS OR DUST BINS Proper handling of contaminated waste Clean up all spills immediately to prevent cross contamination if the spill is walked in and possible slip injury. Apply effective cleaning methods which includes both the type of cleaning products, equipment and time of carrying out the task. Use colour coded equipment to avoid cross contamination, for example red for toilet and bathroom floor areas. Colour Coding System RED -high risk areas- showers, bathrooms, toilets urinals and bathroom floors YELLOW - sinks, counters,wash room surfaces; special areas eg service counters, mirrors, metal works. BLUE - lower risk areas,such as desktops, ledges, walls / tiles, window cleaning and high and low dusting GREEN - food processing and food serving areas, such as kitchens & canteens, as well as bar areas. Handling Employers have a duty of care to train care and domestic staff to dispose of waste safely. Staff should: Check that bags/containers are sealed before handling Understand the need to separate clinical from ordinary household waste. Wear protective clothing/gloves Handle sacks by the neck Be aware of special risks associated with sharps Know how to deal with spillages.

5 Know the cleaning and disinfection procedures Know how to deal with accidents and incidents Know basic first aid. Be given advice on appropriate immunisation Spillages The employer should have appropriate policies and procedures. Protective clothing should be available (e.g gloves and aprons) and suitable disinfectant and cleaning equipment should be readily available. Even if the quantities of waste are small, employers still have to use safe disposal. Accidents and Incidents Procedures should be identified by the employer for dealing with accidents/incidents involving biological or clinical waste including: Immediate first aid Reporting to Senior/DRP Retention of the item for identification Medical attention Reporting under RIDDOR Support in preventing Infection All Care Home Managers should have access to the Health Protection Team for infection control; this comprises the Consultant in Communicable Disease, the Nurse Consultant or Health Protection Nurse, the Community Nurse, the G.P and Environmental Health Officers. Their role is to offer: Advice Guidance Policy Development Management of any outbreak Control of the situation Reasons for increased spread of infection in 21 st Century Increased world travel Increasing elderly population Resistance to antibiotics Healthcare acquired infections Increased invasive procedures eg plastic surgery enhancement. Terrorism (Bio-terrorism) Who is most susceptible? Apart from the young whose immune system is not yet developed and the elderly where it is beginning to reduce and those who are already sick or are recovering, those who suffer from mental health problems may be susceptible as they have reduced self esteem and often do not self care. Other susceptible groups will be those with chronic medical problems such as diabetes, heart conditions and respiratory problems, also those who have indwelling catheters or are on therapies such as chemotherapy.

6 Methods of Spread Microbes will choose the easiest route to spread and multiply, in the fastest time. Airborne ( droplet or dust) Person to person (direct contact) Food/water/objects, environment (indirect contact) Faecal-Oral Sexually transmitted Blood and body fluid Insect, parasites and animal bites Chain of Infection Susceptible person A way in Microbe The Chain Method of spread Reservoir A way out There are many communicable diseases which range from childhood illness such as whooping cough, mumps, chicken pox and rubella and measles, (which may carry serious complications if immunisation is not carried out). However, there are many illnesses where microbes are spread, which cause severe illness and possible death. Those most commonly seen in the Care Home /Nursing Home setting will be those such as Clostridium Difficile and MRSA, in the Super-bug Hospital Acquired Infections group. Questions are often asked about these groups and about the Hepatitis spectrum, HIV, and Shingles, Chicken Pox and Herpes which share a common virus (Varicella Zoster). Clostridium Difficile - C. Diff. A Spore forming bacteria - The major cause of pseudo-membranous colitis and antibiotic associated diarrhoea. Mild cases may result in frequent foul smelling watery stools. Severe cases may cause cramps, contain blood + mucous and development of abnormal heart rhythms. The level of infection rose by 28% in 2007 when it became law that it appeared on the Death Certificate as a contributory cause of death. Research shows that prevalence is higher in men. Diagnosis is through a stool specimen. Spread spores are shed in the stools of C. Diff. Patients and can spread person to person, usually on the hands of healthcare workers and those giving personal care, or by contact with environmental surfaces which have not been cleaned effectively e.g bedpans, toilets, baths, showers, moving and handling equipment. Spores can survive between 70 days and 9 months. Treatment - If positive, current antibiotic treatment is stopped and re-assessed as usually there is resistance to all antibiotics other than Vancomycin. However, a vaccine may be available in three years using Formaldehyde, which attacks the toxins produced by the C.

7 Diff. Bacteria. The extreme diarrhoea causes patients to lose vital electrolytes and mineral salts from their bodies and these need to be replenished to ensure organ failure does not occur. Alcohol handwashes used in 94% of hospitals, encourage growth of C.Diff (Wren et al London School of Hygiene and Tropical Medicine) April 2008 The only effective method for healthcare workers is to wash their hands effectively and use effective cleaning methods to reduce cross contamination. Methicillin Resistant Staphylococcus Aureus MRSA A common bacteria carried by approximately 30% of the population. It is found in moist areas particularly of the nose and throat, arm pits, groin and perineum. It can cause a range of infections in wounds or appear as boils or abscesses. It has grown into a superbug following overuse of antibiotics when they became widely available in the 1960's and were seen as the panacea for all ills. In past two years the level has begun to fall with the increased use of alcohol gels in hospitals. Diagnosis swab or blood test. Spread direct and indirect contact; mainly by hands and on heavily contaminated uniforms, clothes, equipment, or any surfaces which could potentially transmit infection. The bacteria can survive on surfaces and in dust for long periods. Treatment spectrum of antibiotics. New research at Kingston University, London (December 2009) has shown that the rind of the pomegranate made into an ointment is very effective in treating MRSA Hospitals the bacteria can get into susceptible people who may be sick, immunosuppressed, may have already been on many antibiotics, have invasive procedures and deep wounds, and where patients are in close proximity and there is lots of staff contact. Care Environment residents are often frail rather than ill. Basic good hygiene should ensure residents with MRSA pose no threat to others. MRSA should never be used as a reason to refuse entry to a home or isolate the individual from communal life or joining in activities. Difference between Colonisation and Infection Colonisation Bacteria which are present on the skin, in the nose or other part of the body do not cause a reaction in the host and therefore they show no symptoms of the infection, but they can pass it on to others through direct or indirect contact. Therefore, just because a resident appears healthy, it does not mean less care should be given to hand hygiene and infection control. Infection Bacteria multiply in the body tissues; the host reacts with the development of pain, fever, redness swelling and pus. Hepatitis A virus -'Inflammation of the liver' affecting the way in which toxins are filtered; damage and side affects may occur if these build up. A associated with seafood C +B associated with blood borne infection E- One off viral illness poor hygiene

8 Hepatitis A Caught through contaminated food and water. Uncooked food- fruit, vegetables, seafood Spread through faecal/oral route,via poor hand hygiene. Usually contracted abroad. Africa, Asia, South America Vaccine available. Hepatitis C Associated with blood borne infection Contracted through direct contact with blood. No vaccine Only Interferon drugs 6-12mths treatment to boost immune system. Side affects from treatment can be unpleasant Sufferer cannot drink alcohol, needs to follow strict diet. May result in chronic liver damage and death. Hepatitis E Rare in UK Faecal-oral route, (poor hand hygiene) Often spread via food and water. Seafood Prevalent in Asia Africa and Central America. Known as Hepevirus Usually mild, non-recurring Rarely causes death except in pregnant women Treatment none diet and rest. Prevention is best course of action Hepatitis B (most commonly present and which care workers should be careful of) Dirty needles Non-sterilised equipment used for e.g. tattooing Blood transfusions abroad Blood transfusions in UK before 1990 Unprotected sex Sharing personal items e.g. razor, toothbrush Bites from an infected person Any situation where infected blood could enter your bloodstream 100 times more likely to catch than HIV Symptoms nausea, vomiting, diarrhoea, appetite and weight loss, jaundice. Some but not all of these symptoms may be experienced. Diagnosis blood test Treatment immune system, vaccine Vericella Zoster Virus Same infection for : -Chicken Pox -Shingles -Herpes When a person has Chicken Pox, the virus stays in the body by laying dormant at nerve endings. When the person becomes susceptible perhaps many years later, it awakens when they are in close contact with another person who has either Chicken Pox (often a child), or Shingles, and the infection will then present as Shingles. This is commonly found on trunk, back, face, or in eyes or mouth, and can last from two weeks to several months depending on how low the persons' immune system is. Excellent infection control should be practised.

9 Herpes Cold Sores, present in the same way as Chicken Pox spots large raised watery blisters, usually found on the mouth. Extra care should be taken not to kiss unless the sore is sealed with a special preparation, and to take special care with washing cups and utensils as the sore is highly contagious. HIV - Human Immunodeficiency Virus which goes on to cause AIDS (Acquired Human Immunodeficiency Syndrome) where the virus attacks the body's defence system until it has sufficiently lowered the immune system to make it open to one of 21 opportunistic infections. Diagnosis and Treatment the 'Elisa' test is 99% accurate and the earlier the diagnosis the soon the halt on the virus's ability to kill off further cells (CD4 Cells) from the immune system by drug therapy. There is no cure, only a control of the disease. Spread Through blood and body fluid semen, vaginal fluid, blood, breast milk. It is often passed through unprotected sex, use of dirty needles, unscreened blood through transfusion, and from mother to baby in the womb, through childbirth and breast feeding. It cannot be caught in any other way such as kissing, sharing food, using public swimming baths or gyms or through insect bites. REMEMBER TO WASH YOUR HANDS THOROUGHLY

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