Infection control in Aged Residential Care Facilities. Dr Sally Roberts Clinical Advisor for IP&C Service, ADHB

Transcription

1 Infection control in Aged Residential Care Facilities Dr Sally Roberts Clinical Advisor for IP&C Service, ADHB

2 Background Endemic infections Epidemic infections Managing outbreaks Administrative measures Staff Residents

3 Endemic Infections Patients in RCF are at increased risk of infection Aging-associated changes Comorbidities Functional impairment Institutional residence

4 Endemic Infections Urinary tract infections High prevalence of asymptomatic bacteriuria. Treat only those with localising symptoms Urinary infections in residents with long term IDC may present with fever without localising signs and symptoms

5 Endemic Infections Respiratory tract infections Minimise aspiration Discourage smoking Yearly Influenza vaccine Skin and soft tissue infections Optimal management of comorbid conditions Prevent trauma and injury

6 Influenza

7 Influenza Seasonal epidemic High rates in the young and the elderly 1% of >65yr get admitted annually with influenza Associated with significant mortality

8 Influenza Surveillance 30 April September Characteristics Admissions Assessed Non-SARI Cases (%) Non-SARI tested % of the tested cases Influenza positive cases % of flu +ve among tested Overall Age group (years) < to to to to to to and over Unknown Sex Female Male Unknown

9 Demographics SARI Cases (%) Cases per 1000 hospitalisations Influenza SARI cases positive (%*) SARI & influenza cases among ADHB & CMDHB residents SARI incidence Influenza Influenza incidence (per ) Cases (per Overall (45.8) (22.7) (30.5, 38.6) Age group (years) < (13.9) (198.7, 388.6) 1 to (18.6) (42.8, 89.5) 5 to (29.1) (6.0, 15.6) 20 to (31.4) (12.1, 24.3) 35 to (27.8) (11.5, 23.6) 50 to (29) (32.6, 56.9) 65 to (23.8) (70.0, 122.2) 80 and over (24.4) (96.1, 206.0) Unknown (16.2) 3 0 Ethnicity Maori (18.7) (33.8, 62.0) Pacific Peoples (27.6) (76.7, 110.8) Asians (27.5) (13.1, 27.3) European and others (19.6) (16.6, 25.7) Unknown (20.4) (8.9, 36.8) Hospitals ADHB (54.5) (20.9) (25.7, 36.8) CMDHB (38.2) (24.2) (32.1, 43.9) Sex Characteristics Admissions Assessed SARI & influenza cases among all hospital patients Female (24.3) (29.3, 40.7) Male (21.7) (28.2, 39.7) Unknown (17.1) 13 2

10 Outbreak Management Administrative measures Policies and procedures Clinical and epidemiologic definitions Prevention Vaccinate all residents and staff Visitors policy Consider chemoprophylaxis

11 Outbreak Management Recognizing it Consider an outbreak if during the influenza season 2 residents manifest signs and symptoms of IL-I within 72 hours of each other Sore throat, breathing difficulties, myalgia and headache Seek advice from primary care/ip&c

12 Norovirus

13 Norovirus Transmitted by the faecal-oral route Consumption of contaminated food or water or personto-person spread. Tiny infecting dose 10 particles 5 billion particles per gram of faeces Incubation period hours Acute onset vomting, non-bloody diarrhoea with abdominal cramps and nausea Low grade fever occasionally occurs Symptoms last 24 to 60 hours Asymptomatic infection may occur

14 Norovirus Probably contributes to about 50% of foodborne outbreaks Most outbreaks due to contamination of food by food handler immediately before consumption Diagnosis Molecular assays Expensive Not readily available in the community Immunity Strain-specific and lasts only a few months Elderly can shed virus for up to 28 days Elderly tend to remain symptomatic for longer

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16 NZ Guidelines

17 Preventing transmission What favours spread in RCF? Shared bathroom facilities Prolonged shedding of virus Limited hand washing facilites Incontinent residents Recognizing Norovirus outbreak Sudden onset of vomiting and diarrhoea in 2 residents +/- staff

18 Prevention of transmission Hand hygiene Soap and water or ABHR (ethanol) Environment Remove soiling wearing PPE Bleach 0.1% for cleaning surfaces Mediwipes for shared equipment 70% alcohol, 0.5% CHG and a QAT Increased cleaning of patient and staff bathrooms Managing patients Contact Precautions Single room, PPE If transferring to hospital inform receiving hospital of potential outbreak in facility Reinforce hand hygiene before eating Oral rehydration

19 Signage

20 Managing staff Clinical staff Educate Reinforce hand hygiene Stop shared or communal food/meals Send home if become unwell at work Absent from symptoms for 48 hours before returning to work Food handlers Educate Reinforce hand hygiene Exclude from duty if develop symptoms of acute gastroenteritis. Exclude for a min of 48hrs after resolution of symptoms

21 Multiple antibiotic resistant pathogens MRSA ESBL MDR-Gram negative bacilli VRE Clostridium difficile

22 Revolving door Discharged to RCF Admitted to hospital Admitted to hospital Discharged to RCF

23 MRSA Colonisation leads to infection Infection of skin and soft tissue Can cause pneumonia or urinary tract infections Hand hygiene

24 ESBL Community-onset vs healthcare-associated Mainly associated with urinary tract infections Hand hygiene Environmental cleaning Shared bathroom facilities

25 Management Maintain surveillance Guidelines for management Policy around transfer to other HCF Review antimicrobial policy Standard Precautions

26 Clostridium difficile infection Commonest cause of hospital-acquired diarrhoea Self limiting severe colitis All antimicrobial agents are associated with disease 3G Cephs, amoxycillin, clindamycin, FQ, macrolides, tetracyclines, TMP-SMZ Contributing factors include: advanced age, severity of underlying illness, use of agents that alter normal GI motility

27 Management Diagnosis Stool specimen for testing Hand washing with soap and water (spores) Environmental cleaning Reduce antibiotic use

28 WHO 5 Moments for Hand Hygiene

29 Questions?