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Bon Secours Hospital Cork Infection Prevention and Control and it’s challenges in the Primary Care Setting! • Brenda O Sullivan Connolly. 2016 Presentation Presentation Outline • Topics covered in the presentation are based on requests for information identified on the closed Practice Nurse Face Book Page INFLUENZA SEASON What is influenza (also called flu)? • Influenza is an acute contagious respiratory illness caused by infection with an influenza virus. Influenza can occur throughout the year but activity usually peaks in winter. • Influenza viruses infect the nose, throat and lungs. They can cause mild to severe illness and at times can lead to death. The best way to prevent flu is by getting the flu vaccine each year. • Influenza is a serious public health problem that causes severe illnesses and deaths for higher risk populations. • Three types; A, B and C ( A and B-human illness occur more frequently) • Acute self limiting illness, upper or lower RTI lasts 2-7 days. • Sudden/ Acute onset of symptoms. • Pyrexia >38◦c, cough, headache, severe malaise, sore throat, sore muscles/joints, SOB. • Can be severe in >65yrs, those with underlying medical conditions Symptoms Flu cold Fever >38◦C Lasts 3-4 days Rare Headache Prominent Rare General aches and pains Usual, often severe Slight Fatigue and weakness Can last 2-3 weeks Quite mild Extreme exhaustion Early and prominent Never Stuffy nose Sometimes Common Sneezing Sometimes Usual Sore throat Sometimes Common Chest discomfort, cough Common, can become severe Mild to moderate, hacking cough How is it spread? • Coughing, sneezing, contaminated hands or surfaces. • Anyone with flu can be infectious from 1 day before to 3-5 days after onset of symptoms. • Highly infectious and can survive on worktops/ objects. • Virus can live on hard surfaces for up to 24hrs and soft surfaces for 20mins In the Practice What can you do ??? • Standards precautions- Every patient, Every time • Hand hygiene. WHO 5 moments. • Clean equipment between patients. • Assess on arrival, Act fast for suspected patients • Contact & Droplet. • ? Diagnostic sample viral swab. • Review, assess, plan, evaluate Vaccination • Encourage vaccination for high risk groups. • Flu Vaccination- Encourage your colleagues – including the GP. • Flu Vaccination is highly recommended for all Health Care Workers. • Mandatory in some countries/states.! Influenza Vaccine Staff Uptake in Hospitals, 2015-2016 (n=50 Hospitals) (HPSC 2016) • Participation • 50 hospitals provided sufficient data for complete analysis • Uptake (average) • Among all HCWs was 22.5% • highest among ‘medical and dental’ professionals • lowest among ‘nursing’ staff • Acute Paediatric Services Hospital group highest uptake: 37.6% • In general uptake higher in larger (staff numbers) hospitals • 7 (14.0%) hospitals reported uptake > 40% among all HCWs (HSE Target) Influenza Vaccine Staff Uptake in LTCFs, 2015-2016 (n=98 LTCFs • Participation • 101 out of 229 (44.1%) of known LTCFs participated • Uptake (average) • LTCF HCWs was 26.6% • highest among ‘medical and dental’ professionals • lowest among ‘nursing’ staff • 18 (18.4%) LTCFs exceeded 40% national uptake target • Range across Community Health Organisations: 15.2-48.1% • highest in CHO 9 (Dublin North, Dublin North Central, Dublin North West) at 48.1% Uptake by Health Care Workers (HCWs) in Hospitals* by Season Total Total No. Avg. Seaso No. Vaccinat Upta n HCW ed ke % s HCWs 201146329 8275 17.7 2012 201241995 7325 14.6 2013 201350202 12234 21.5 2014 201451324 12006 21.3 2015 201559204 14833 22.5 2016 Avg. Uptake % 95% CIs 14.6820.75 11.5917.52 18.4824.49 17.5725.01 19.3825.62 Median Uptake % 15.7 11.0 19.4 20.1 19.8 Range Uptake % 4.0039.98 3.4838.79 2.5645.87 1.1247.53 6.8947.04 No. Hospital s 42 35 46 45 50 Uptake by Hospital HCW Staff Category by Season* Uptake in Hospitals by Hospital Group & Season* Waste Management in healthcare settings • Department of Health and HSE (2014) Healthcare Risk Waste Management, Segregation, packaging and storage guidelines for Health Care Risk Waste, 5th edition (November 2014) Definitions • Healthcare Risk Waste • Infectious Waste • Healthcare Non-Risk Waste. Healthcare Risk Waste This is categorised as risk waste which is potentially hazardous to those who come in contact with it by nature of its infectious, biological, chemical, radioactive nature or because it contains used sharp material which could cause injury. Infectious Waste Infectious substances are defined as substances containing viable microorganisms or their toxins which are known to cause disease. Healthcare Non-Risk Waste. Non risk waste which is not hazardous to those who come in contact with it. Its contents are non-infectious, nonradioactive or residual chemical waste Non Risk Waste Bag - Domestic Waste Not contaminated with blood or hazardous body fluids- Plastic, gloves, aprons, gowns, masks – INCLUDING from isolation cases Nappies/incontinence wear, stoma bags – from non-infectious patients. Non Risk Waste Bag - Domestic Waste Oxygen Face Mask and Tubing Empty Urine Drainage bags and Urinary Catheters Enteric feeding Bags Giving Sets with Tips Removed. Clear Tubing e.g.- NG etc Non Risk Waste Bag - Domestic Waste Normal commercial and catering waste Non infectious, non-toxic, nonradioactive Shredded waste documents of a confidential nature. Health Care Risk Waste: Yellow Bag Health Care Risk Waste: Yellow Bag Yellow Bags • All soiled bandages, Swabs, gown, gloves, tissues and soft disposables. • Gloves, gowns, Aprons, Mask contaminated with blood or infectious body fluid. • Incontinence pads and nappies from known or suspected enteric infections (e.g. Rotavirus etc) • Suction Catheters, tubing and wound drains. Health Care Risk Waste: Yellow Bag • No free fluids. • No sharp items. • No chemical or pharmaceutical waste Sharps Bin • Used for sharps with the exception of cytotoxic waste • Syringes • Scalpels • Contaminated slides • Stitch cutters • Razors. Sharps Bin with Purple lid • All needles, syringes, sharp instruments, cartridges + broken glass that have been used in the administration or production of cytotoxic/cytostatic medicines or other toxic pharmaceutical waste. Yellow Rigid Box with Black Lid • Recognisable large anatomical body parts, placentas. • Waste containing blood or tissue that may have originated from a patient with known or suspected TSE/CJD. • Contaminated large metal objects. Yellow Rigid Box with Purple Lid • NON sharp healthcare waste contaminated with cytotoxic/cytostatic medicines or other toxic pharmaceutical waste, discarded chemicals and medicines. • Small quantities of medication left over after administration to patient – e.g. glass antibiotic vials. Storage and other considerations • Healthcare risk waste must be treated with the respect it deserves. • It contains potentially dangerous material so therefore Must be handled carefully. Never dragged along the floor. Never thrown!! Must be stored separate to non risk waste How clean is your surgery? Cleaning of Equipment ↑ • Equipment used in health care may be designated as single use, single patient use or reusable multi-patient use – always read the label if you are not sure if an item can be reused • Any equipment not designated as a single use item must be made safe following use to prevent micro-organisms being transferred from equipment to patients and potentially resulting in infection. • Cleaning is the critical element of the process and should always be undertaken thoroughly regardless of the level of decontamination required. Decontamination of Equipment. • All items that are used between patients must be cleaned between patients. • Devise a cleaning list to ensure that all equipment is also cleaned weekly. Decontamination of Equipment. • Most equipment requires cleaning only with detergent and water. • Disinfection with a hypo chloride is required in the following circumstances • Contaminated with blood or body fluid – e.g. ACTICHLOR PLUS 1.7g in 100mls of water is the disinfectant of choice in this circumstance as per blood /body fluid spillage policy • After contact with a patient who has a condition known or suspected of being transmitted by contact. ACTICHLOR PLUS 1.7g in 1000mls of water Decontamination of Equipment. • Decontamination is a process (or combination of processes), which removes or destroys contamination and thereby prevents microorganisms or other contaminants reaching a susceptible site in sufficient quantities to cause infection or other harmful response. • It is important to establish the differences between cleaning, disinfection and sterilisation, which are used in the process of decontamination. Decontamination of Equipment • Cleaning The physical removal of contaminants including dust, soil and organic matter, along with a large proportion of micro organisms. Thorough drying following cleaning will cause a further reduction. This is the first and most important step in any decontamination process. • Disinfection Utilising heat or chemicals to reduce the number of viable micro- organisms to a level which is not harmful to health (but not all viruses and/or bacterial spores) • • Sterilisation Renders the object free from viable microorganisms, including bacterial spores and viruses Process is categorised as one of 3 levels • Low Risk: Items in contact with healthy skin or mucous membranes or not in contact with patient • Medium Risk: Items in contact with intact skin, particularly after use on infected patients or prior to use on Immunocompromised patients, or items in contact with mucous membranes or body fluids • High Risk: Items in close contact with a break in the skin or mucous membrane or introduced into a sterile body area. . • Cleaning • Disinfection • Disinfection or sterilisation Sterilisation • For Sterilisation using bench top steam sterilisers • Wear appropriate PPE • Items must be physically clean before being exposed to any sterilisation process Additional general good practice points • The decontamination process chosen must be effective for the device being reprocessed • Cleaning can be undertaken by either manual or automated methods • Ensure decontamination agents used are compatible with the devices and the reprocessing equipment • Decontaminate devices in accordance with the manufacturer’s instructions • Ensure appropriate decontamination facilities are available for the process to be undertaken Additional general good practice points • Ensure any decontamination equipment used is fit for purpose, regularly maintained, validated and tested • Staff undertaking decontamination activities should be trained for the tasks they undertake • Standard infection control precautions should be adhered to at all times • Workflow should proceed from dirty to clean • Sterile and sterilised devices must be segregated and stored in clean dry conditions, out of the decontamination area. MRSA • MRSA- identify high risk patients and encourage screening if scheduled for surgical procedure- may need to be decolonised pre-op. Patients deemed high risk for MRSA should be considered for preadmission screening & decolonisation particularly if for planned surgery • BSH offers a preadmission screening clinic for all patients undergoing orthopaedic implants & other surgeries • It is available to all high risk patients • Cost of €120: covers initial screening, decolonisation treatment and follow up screening • Please contact the IPCN's at 021 4801619 if your patients would like to avail of this service • Patients from Kerry can be facilitated in BSH Tralee by contacting the IPCN's in Cork MRSA Screening • Both nostrils (1 swab) • Perineum • Wounds, sites of damaged or abnormal skin (leg ulcers) and sputum if expectorating • Medical device sites e.g. insertion sites of intravenous catheters, drains, peg tubes, catheter urine samples. • Throat, both axilla and groins in KNOWN MRSA colonised patients and those who give a history of MRSA • All previously positive sites if still existent. WHO 5 Moments of Hand Hygiene Hand Decontamination Technique Use of Personal Protective Equipment (PPE) PPE: Gloves • Gloves for invasive procedures, contact with sterile sites and non-intact skin or mucous membranes, and all activities that have been assessed as carrying a risk of exposure to blood, body fluids, secretions or excretions, or to sharp or contaminated instruments. • Gloves must be worn as single-use items. • Gloves must be changed between caring for different patients, and between different care or treatment activities for the same patient. PPE: Plastic Aprons & Gowns • Wear a disposable plastic apron if there is a risk that clothing may be exposed to blood, body fluids, secretions or excretions or • Wear a long-sleeved fluid-repellent gown if there is a risk of extensive splashing of blood, body fluids, secretions or excretions onto skin or clothing. (NICE 2012) • Use them as single-use items, for one procedure or one episode of direct patient care • Ensure they are disposed of correctly (NICE 2012) PPE: Face Masks & Eye Protection • Face masks and eye protection must be worn where there is a risk of blood, body fluids, secretions or excretions splashing into the face and eyes. • Respiratory protective equipment, for example a particulate filter mask, must be used when clinically indicated PPE: Face Masks & Eye Protection Standard Surgical Mask (Flu, Neisseria Meningitis) FFP3 or High Filtration Mask (Pul TB: Measles & Chicken Pox (non immune staff) Stay Informed www.hpsc.ie Health Protection Surveillance Centre. Produce weekly reports on notifications of infectious diseases in Ireland. Is helpful to know what is circulating in the community. Week 1-35 2016 Example of Notifications Mumps – 387 ( ↓1186) Norovirus – 1,254 (↑ 213) MTB –248 (↑55) CDI- -1286 (↓ 16) Zika Virus Infection 9 Summary • Vaccination- encourage patients and HCWs Standard Precautions- all patients at all times. • Hand Hygiene- WHO 5 Moments. • MRSA- identify high risk patients and encourage pre-op screening • Equipment and environmental cleaning- consider a sign of sheet for weekly cleaning. Questions??? References • • • • CDC (2002) Guideline for Hand Hygiene in Health-Care Settings European Antibiotic Awareness Day (EAAD)-(2014) Key Messages- Public Health England National Institute for Health and Clinical Excellence (2012)Infection Prevention and control of healthcare –associated infections in primary and community care: NICE clinical guideline 139 (March 2012) guidance.nice.org.uk/cg139 Royal College of Nursing (2012) Essential practice for infection prevention and control Guidance for nursing staff • WHO (2005) Guidelines on Hand Hygiene in Health Care (Advanced draft) • WHO (2006) www.who.int/gpsc/tools/Five_moments/en/ • SARI (2005) Guidelines for Hand hygiene in Irish Health Care Settings • HPSC- (2014)Guidelines for the Prevention and Control of Multi-drug resistant organisms (MDRO) xcluding MRSA in the healthcare setting