DN FORUM MEETINGS. September 2018 Community Infection Control Service

Transcription

1 DN FORUM MEETINGS September 2018 Community Infection Control Service

2 Aim of this Forum: To provide an update and refresh knowledge on preventative measures for infection control for Dental Infection Control Leads/ Dental Nurses. Objectives of the session: Understand the importance of wearing appropriate PPE in the dental setting and to identify/ change practice in areas within the workplace were necessary. Understand the impact of healthcare associated infections (HCAI s) on patients and the dental professional s duty of care to patients to help prevent the spread of these infections. Implement precautionary measures for infection control in the dental setting and update any policies and procedures were relevant.

3 Agenda Time: 6.00pm pm 1. Welcome and Apologies 2. Minutes of the last meetings / Matters arising from minutes Influenza and vaccination for Healthcare Staff CQC myth busters: Sepsis Public Health England: Infectious diseases update - Measles PPE- HSE guidance Literature and articles Network and sharing best practice Any other business - Oral Health Improvement services (St Helens borough) - Survey results

4 FLU FOR DENTAL STAFF By Sandra Holt Lead Infection control nurse for Halton, St Helens and Warrington

5 Flu overview Flu is an acute viral infection of the respiratory tract (nose, mouth, throat, bronchial tubes and lungs) it is a highly infectious illness which spreads rapidly in closed communities even people with mild or no symptoms can infect others most cases in the UK occur during an 8 to 10 week period during the winter easily transmitted by large droplets, small-particle aerosols and by hand to mouth/eye contamination from a contaminated surface or respiratory secretions of infected person people with mild or no symptoms can still infect others incubation period 1-5 days (average 2-3 days) though may be longer especially in people with immune deficiency Infectious for 5 days after symptoms start and 7 days in children. 5 Common symptoms include: sudden onset of fever, chills, headache, muscle and joint pain and extreme fatigue dry cough, sore throat and stuffy nose in young children gastrointestinal symptoms such as vomiting and diarrhoea may be seen

6 Influenza viruses A viruses cause outbreaks most years and are the usual cause of epidemics and pandemics live and multiply in many different animals and may spread between them birds, particularly wildfowl, are the main animal reservoir B viruses tend to cause less severe disease and smaller outbreaks predominantly found in humans burden of disease mostly in children 6

7 Flu A virus Genetic material (RNA) in the centre Two surface antigens: Haemagglutinin (H) (blue) Neuraminidase (N) (red) There are 18 different types of H and 11 different types of N The role of haemagglutinin is to bind to the cells of the infected person The role of neuraminidase is to release the virus from the cell surface 7 The national flu immunisation programme 2018/19

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9 Possible complications of flu Common: bronchitis otitis media (children), sinusitis secondary bacterial pneumonia Less common: meningitis, encephalitis, meningoencephalitis primary influenza pneumonia Risk of most serious illness is higher in children under six months older people those with underlying health conditions such as respiratory disease, cardiac disease, long-term neurological conditions or immunosuppression pregnant women (flu during pregnancy may be associated with perinatal mortality, prematurity, smaller neonatal size and lower birth weight) 9

10 Flu epidemiology Weekly all age GP influenza-like illness rates for 2017/18 and past seasons, England (RCGP) flu activity usually between September to March (weeks 37 and 15) impact of flu varies from year to year moderate to high levels of influenza activity seen in 2017/18 season co-circulation of influenza B and influenza A(H3) in 2017/18 biggest impact in older adults, consistent pattern of outbreaks in care homes and excess mortality seen particularly in the 65+ year olds high number admissions to hospital and ICU/HDU higher than seen in previous six seasons 10 The national flu immunisation programme 2018/19

11 Flu vaccine eligibility: 2018/19 flu season all those aged two and three (but not four years or older) on 31 August 2018 (ie date of birth on or after 1 September 2014 and on or before 31 August 2016) all children in reception class and school years 1, 2, 3, 4 and 5 people aged six months to under 65 years in clinical risk groups such as diabetic, chest problems e.g asthma, liver problems etc. all pregnant women (including those who become pregnant during flu season) people aged 65 years and over (including those becoming 65 years by 31 March 2019) people living in long-stay residential care homes or other long-stay care facilities carers and household contacts of immunocompromised individuals Morbidly obese BMI over 40. Frontline health and social care workers with direct patient/service user contact should be provided with flu vaccination by their employer. This includes staff in all NHS trusts, general practices, care homes, and domiciliary care The national flu immunisation programme 2018/19

12 Flu immunisation should also be offered to: those living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality (this does not include prisons, young offender institutions, university halls of residence etc.) those who are in receipt of a carer s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill household contacts of immunocompromised individuals, specifically those who expect to share living accommodation on most days over the winter and therefore for whom continuing close contact is unavoidable health and social care staff in direct contact with patients/service users should be vaccinated as part of an employer s occupational health obligation 12

13 Pregnant women All pregnant women are recommended to receive the inactivated flu vaccine irrespective of their stage of pregnancy pregnant women at increased risk from complications if they contract flu having flu during pregnancy may be associated with premature birth and smaller birth size and weight flu vaccination during pregnancy provides passive immunity against flu to infants in the first few months of life studies on safety of flu vaccine in pregnancy show that inactivated flu vaccine can be safely and effectively administered during any trimester of pregnancy no study to date has demonstrated an increased risk of either maternal complications or adverse fetal outcomes associated with inactivated flu vaccine women should be offered the vaccine every time they are pregnant 13 The national flu immunisation programme 2018/19

14 Flu vaccine composition 2018/19 Quadrivalent vaccines will contain the following four viruses: an A/Michigan/45/2015 (H1N1)pdm09-like virus an A/Singapore/INFIMH /2016 (H3N2)-like virus a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage) a B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage). Trivalent vaccines will not contain: B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage). More detailed information on the characteristics of the available vaccines, including age indications can be found in the Influenza chapter of the Green Book (Immunisation against infectious disease) and the product SPCs 14

15 Adjuvanted influenza vaccine (ativ) during 2018/19, an adjuvanted trivalent influenza vaccine (ativ) is recommended for use in those aged 65 years and over, and particularly for those aged 75 years and over this recommendation was made following a PHE analysis which showed that the non-adjuvanted inactivated vaccine showed no significant effectiveness in this age group over recent seasons a sub optimal response to influenza vaccine in those aged 65 years and over is due to their aging immune system adjuvants are added to vaccines to enhance the immune response using an adjuvanted vaccine should improve protection against flu in elderly people ativ (Fluad ) was licenced in the UK in 2017 but has been used for 20 years, is now used in over 20 countries and over 93 million doses have been distributed. Fluad has been proven to be safe and effective 15 The national flu immunisation programme 2018/19

16 Encourage good respiratory etiquette Ensure flu vaccination is made accessible for staff. Protecting clients and staff against influenza. Promote positive flu messages. Hand hygiene reduces the spread of infections Staff who are unwell should be sent home. Ensure clients that are being treated do not have flu unless in an emergency. 16

17 Myth Busters Influenza vaccine can give you the flu. True or false. The flu vaccine has bad side effects True or false I had the flu vaccine last year so I don t need it again True or false Flu is only a mild illness True or False 17

18 CQC Myth Busters- Sepsis

19 What to expect on CQC inspection We will ask staff what systems and processes are in place to manage, follow up and refer patients for specialist care when presenting with bacterial infections. This includes: treating patients who: are not responding to conventional oral antibiotic treatment cannot have their infection drained at an initial appointment what advice is given to patients, including when they should seek emergency advice or treatment if symptoms worsen or when the dental surgery is closed. For example: CQC may ask staff to describe a typical patient journey if a patient has an acute infection associated with a partially erupted lower wisdom tooth and possible limited opening of the jaw. In addition, they may ask to see dental care records to assess how a practice has dealt with previous cases in which a patient has presented with bacterial infection.

20 Regulation Regulation 12 (safety of care and treatment). Key line of enquiry S2.6 (managing risks): How do staff identify and respond appropriately to changing risks to people, including deteriorating health and wellbeing, medical emergencies or behaviour that challenges? Are staff able to seek support from senior staff in these situations?

21 DENTAL SEPSIS DECISION TOOLKITS GDP Paediatric Sepsis Decision Support Tool For Primary Dental Care- applied to all children under 5 years GDP Paediatric Sepsis Decision Support Tool For Primary Dental Care- applied to all children aged 5-11 years GDP Sepsis Decision Support Tool For Primary Dental Careapplied to all adults & young people 12 years and over More information & resources :

22 PHE - Infectious diseases update

23 PPE- HSE GUIDANCE

24 Legislation for PPE The Personal Protective Equipment Regulations 2002 and the Personal Protective Equipment at Work Regulations 1992 (as amended) give the main requirements. Other special regulations cover hazardous substances (including lead and asbestos), and also noise and radiation.

25 Employers duty Employers have duties concerning the provision and use of personal protective equipment (PPE) at work. PPE is equipment that will protect the user against health or safety risks at work. It can include items such as safety helmets, gloves, eye protection, high-visibility clothing, safety footwear and safety harnesses.

26 Making the workplace safe includes providing instructions, procedures, training and supervision to encourage people to work safely and responsibly. Even when controls and safe systems of work have been applied, some hazards might remain. These include injuries to: the lungs, e.g. from breathing in contaminated air the head and feet, e.g. from falling materials the eyes, e.g. from flying particles or splashes of corrosive liquids the skin, e.g. from contact with corrosive materials the body, e.g. from extremes of heat or cold

27 What hazards do you think are in the dental setting that require the use of PPE?

28 Selection & Use You should ask yourself the following questions: Who is exposed and to what? How long are they exposed for? How much are they exposed to?

29 When selecting PPE Choose products which are CE marked in accordance with the Personal Protective Equipment Regulations 2002 suppliers can advise you Choose equipment that suits the user consider the size, fit and weight of the PPE. If more than one item of PPE is worn at the same time, make sure they can be used together, e.g. wearing safety glasses may disturb the seal of a respirator, causing air leaks Instruct and train people how to use it, e.g. train people to remove gloves without contaminating their skin. Tell them why it is needed, when to use it and what its limitations are

30 Monitor & Review Check regularly that PPE is being used correctly. If not find out why and address accordingly. All staff aware PPE to be worn in line with local policy? Take note of any changes in equipment, materials and methods ( e.g. religious requirements) you may need to update what you provide

31 PPE Guide/Leaflet

32 Agenda Time: 6.00pm pm 1. Welcome and Apologies 2. Minutes of the last meetings / Matters arising from minutes Influenza and vaccination for Healthcare Staff CQC myth busters: Sepsis Public Health England: Infectious diseases update - Measles PPE- HSE guidance Literature and articles Network and sharing best practice Any other business - Oral Health Improvement services (St Helens borough) - Survey results

33 Next meetings Date & Time of next meeting at Newton Community Hospital : Thursday 6th December pm-7.30pm *CHANGED* Date & Time of next meeting Room F27,Warrington Wolves, Warrington: Tuesday 11th December pm pm ****Dates/ venues for 2019 to be arranged****