Prevention and Control of Infection in Care Homes Infection - - PowerPoint PPT Presentation

Prevention and Control of Infection in Care Homes

Infection Prevention and Control Team Public Health Norfolk County Council January 2015

Content for today

• Importance of IPAC -refresher
• IPAC audits in Care Homes
• Identified common themes and trends:
• Laundry
• Sluice
• Housekeeping facilities
• Use of chlorine
• Cleaning schedules
• Uniform policy
• Hand hygiene/PPE
• Management of Outbreak
• Clostridium difficile
• MRSA
• Isolation technique
• Catheters

‘It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm’ (Florence Nightingale 1859)

Clinical Context

• 300,000 patients a year in England

acquire a HCAI as a result of care in the NHS

• Cost to the NHS is estimated at £1 billion

a year and £56 million of this is estimated to be incurred after discharge

Chain of Infection

Susceptible People

• MRSA
• C. Diff
• Norovirus
• Animals
• Humans
• Surfaces
• Food
• Faeces
• Urine
• Vomit
• Blood
• Contact
• Droplet
• Airbourne
• Break in

skin

• Membranes
• Inhalation

We all have a responsibility to break the links in the chain of infection and reduce the likelihood

• f an organism causing harm

Standard Precautions

Hand Hygiene Use of Gloves PPE Safe handling of sharps Safe handling of waste Safe handling of soiled linen Environmental cleaning

My 5 Moments for Hand Hygiene

• 1. Before

touching a resident

• 2. Before

clean/asceptic procedure

• 3. After body

fluid exposure risk

• 4. After

touching a resident

• 5. After

touching a persons surroundings

Uniform policy

• Studies have found that the public make conclusions

about professionalism and trustworthiness

• Current perception of the general public is that uniforms

pose an infection risk to patients and, when worn outside the clinical setting, the wider public.

• Reinforced by media
• Damaging effect on the relationship of trust that exists

between professional carers and patients and the public image of healthcare professionals

• Loveday et al (2007)

Common themes in laundry

• No dirty to clean flow
• Concrete flooring
• Working from floor
• Clutter
• Damage
• No PPE
• No dedicated hand wash sink

Common themes in sluice

• Lack of sluice
• Dirty
• No designated hand wash sink
• Clutter
• Damage
• No PPE

Common housekeeping themes

• No disposal unit
• No dedicated hand wash sink
• Concrete flooring
• Clutter
• Damage
• No PPE

Cleaning schedules

• A robust schedule which includes who is

responsible for cleaning items/equipment, what they should be cleaned with and the frequency

• f cleaning needs to be developed, this requires

auditing

Area/ Item Frequency Responsibility Cleaning Materials H&S Precautions (Refer to product label) Method of Cleaning Checked By (initial)

Example of cleaning schedule

OUTBREAKS

Inform Manager PHE IP&C lead All staff Residents Relatives GP

Ensure relevant people have been informed Seek advice re microbiological specimens

Norovirus

• Residents with diarrhoea and/or vomiting should be

isolated for duration of symptoms

• Symptoms short lived, little warning, can be severe
• Environment at risk of heavy contamination causing

rapid spread of infection

• Residents/staff should be excluded until 48 hours after

symptoms have settled

• Enhanced cleaning regime required

• Use of chlorine releasing agent 10,000 ppm
• disposable cloths/mops should be used on

frequently touched surfaces at least twice daily

• Alcohol hand rub not effective in diarrhoea

Clostridium difficile (C.diff/CDI)

• C.diff is an anaerobic bacterium that is present

in the gut of up to 3% of healthy adults and 66% of infants

• However, C.diff rarely causes problems in

children or healthy adults, as it is kept in check by the normal bacterial flora

• When certain antibiotics disturb the balance
• f bacteria in the gut, Clostridium difficile can

multiply rapidly and produce toxins which cause illness

• CDI ranges from mild to severe diarrhoea to,

more unusually, pseudomembranous colitis

CDI Transmission

• Spores are produced when Clostridium difficile bacteria

encounter unfavourable conditions, such as being

• utside the body
• Clostridium difficile is usually spread on the hands of

healthcare staff and other people who come into contact with infected patients or with environmental surfaces (e.g. floors, bedpans, toilets) contaminated with the bacteria or its spores

• The spores are very hardy and can survive on clothes

and environmental surfaces for long periods

• Soap and water hand wash and hypochlorite cleaning

agents recommended

CDI risk factors

• People who have been treated with broad

spectrum antibiotics

• People with serious underlying illnesses
• The elderly– over 80% of Clostridium difficile

infections reported are in people aged over 65 years (PHE 2014)

Number of CDI cases 2008/09 to 2014/15 (NNUH laboratory data)

MRSA

• MRSA (meticillin-resistant Staphylococcus

aureus) is a bacterium from the Staphylococcus species that is resistant to meticillin and other antibiotics

• It commonly survives nose, groin, axilla without

causing infection – a state known as colonisation

• An MRSA bacteraemia (blood stream infection)

can occur if MRSA enters particular sites in the body, for example, a surgical wound, indwelling device or the respiratory system

De-colonisation treatment

• Dual treatment of Octenisan and

Mupirocin, unless Mupirocin resistant when naseptin is used as an alternative

• Re-screening – if necessary then this

should occur 2 days after decolonisation treatment has been completed. Include separate swabs of nose, groin and any breaks in skin, indwelling devices

MRSA Bacteraemia Norfolk

• Resident in care home
• Not previously known MRSA +ve prior to

BSI

• Root cause associated with urinary

catheter management

• Breakdown of communication between

primary care, hospital, care home

Isolation Technique

• Single room – remove any unnecessary

furniture/items

• Equipment and bins for patient should be kept

inside the room

• PPE required for patient care should be kept
• utside the room along with laundry skip
• Patient notes should be kept outside the room
• Bedpans/urinals should be disposed of directly

into the sluice or bed pan washer. If a bed pan washer is not available then these items need cleaning with chlorine 10,000ppm

• Hard surfaces/equipment to be cleaned

with chlorine

• Avoid vigorous bed making!
• Crockery and cutlery can be put in a

dishwasher which heats to 80 degrees

• Transporting of patients should be avoided

unless essential

• Information for patient/relatives

Process

• 1. Wash hands
• 2. Gloves, apron before entering the room
• 3. Deliver care/task/procedure in the room
• 4. Remove gloves, apron in the room and

dispose in clinical waste bin

• 5. Wash hands in the room
• 6. Leave room in clean state

Indications for catheterisation in care homes

• Urinary tract obstruction
• Acute or chronic retention of urine
• Management of urinary incontinence when

all other methods are not applicable

Infection routes in catheter- associated urinary tract infections

Reducing the risks of catheter- associated urinary tract infection

• Avoiding unnecessary catheterisation
• Aseptic technique
• Maintaining a closed drainage system
• Education of patients, nurses and care

staff of catheter care

References

• SIGN (2006)
• Prevention and control of infection in care

homes-an information resource. DH 2013

• The Health and Social Care Act 2008
• Prevention and control of healthcare-

associated infections in primary and community care. NICE (2012)

• World Health Organisation ‘Clean Care is

Safer Care’

• RCN

Questions?