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Care Home Conference November 2014
Infection Prevention and Control
C-difficile
Norovirus
How to spot it & How to stop it
Senior Infection Control Nurse Jacqui Campbell
Infection Control Nurse Cheryl Maddocks
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What are the differences between Cdiff and Norovirus?
• C. difficile or C. diff is short for Clostridium difficile
• present in small numbers in the gut of healthy people.
• Spores can persist on surfaces for weeks or months.
• can be spread by people, animals, and in water or food.
• Other people can become colonised if they ingest these spores
• Norovirus (winter vomiting bug)
• Is a virus spread by direct contact and can be airbourne
• common cause of infectious gastroenteritis (diarrhoea and vomiting or
‘tummy bug’) in England and Wales.
• Can be mild
• Can be severe and dehydrating
• Often sudden, projectile (vomiting and /or diarrhoea) without warning
• people usually recover fully within 2-3 days.
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Groups most at risk of developing HCA diarrhoea
• The elderly
• Have spent a long time in hospital or other type of healthcare setting such
as a nursing home
• People who have been exposed to patients with C diff /Noro
• People who have had C diff infection previously
• Are taking, or have recently finished taking, antibiotics or any other
medication that may alter the normal bacteria in the gut
• Have a reduced resistance to infection generally;
• Have a serious underlying illness or have had bowel surgery
• Patients taking proton pump inhibitors (a type of anti-ulcer medication)
• Patients on nasogastric feeding
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How do we recognise norovirus or C-diff ?
The symptoms of norovirus are very distinctive :
• People often report a sudden onset of nausea
• Followed by projectile vomiting and watery diarrhoea
• Resolved in 2-3 days (longer in the elderly)
The symptoms of C-diff are :
• The main symptom is explosive watery diarrhoea
• unpleasant ‘sweet’ smell
• may contain mucous or blood.
• Other symptoms may include stomach cramps, fever, nausea, loss of
appetite
• As disease progresses diarrhoea may cease – increase of other symptoms –
CALL THE DOCTOR!
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What do we do if we suspect C-diff/Norovirus?
If a resident develops loose stools follow the Department of Health’s ‘SIGHT’ advice:
Suspect a case may be infectious where there is no clear alternative cause for diarrhoea.
Isolate the patient while finding out the cause of the diarrhoea. If infection cannot be ruled
---------out continue to isolate until clear of symptoms for 48 hours.
Gloves and aprons must be used for all contacts with the patient and their environment.
Hand washing with soap and water before and after every contact with the patient and the
…………patient’s environment. Alcohol gel does not work against C diff.
Test the stool if not bowel care related. Inform GP, if stool test required send a liquid specimen
………..immediately see Bristol Stool Chart. Discuss with, or inform the residents GP according to local
………..policy.
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The Bristol Stool Form Scale (Bristol Stool Chart)
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Is it really C-diff or Norovirus?
Other causes or assessment tools:
• bowel care medicines (Lactulose, Senna).
• Are they constipated, is this faecal overflow.
• Is this the normal bowel habit for that person?
• Have they got any relevant history i.e. Crohns, IBS, Colitis.
• Have they been prescribed any antibiotics recently
• new medication – e.g. omeprazole can cause diarrhoea, or constipation!
• How often are they having a bowel action – IMPORTANT for assessment of
seriousness of disease, or risk of dehydration.
• Has anyone else in the home or family/visitors had diarrhoea or vomiting
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spread
Both organisms are highly contagious and is transmitted by contact with :
• Direct contact with vomit or diarrhoea without good hygiene measures,
especially when projectile vomiting/explosive diarrhoea (airbourne)
• C.diff spores can survive for months in the environment and on
surfaces/furnishings;
• From food that has been contaminated by those infected during food prep;
• From food that was contaminated at source, such as oysters, from sewage
polluted sea (Salmonella, campylobacter, listeria, ecoli).
• By swallowing the virus in the air around someone who has just projectile
vomited/coughed.
• Once a person has been exposed to norovirus virus, if they get infected it usually
takes within 48 hours for them to become ill.
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Who do we need to inform if an outbreak occurs?
• It is considered an outbreak if two or more residents become
symptomatic.
• Inform Public Health England on Tel (office hours 9am-5pm): 0845
055 2022
• Out of hours on call service: 0844 967 0082
• Wessex Public Health England ([email protected]) 0345 055 2022
• Out of hours number: 0844 967 0082 Email :[email protected]
• PHE need to know ASAP what infection control precautions you have
already put in place, specimens obtained etc.
• They will then advise you of further actions that need to be taken.
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How do we stop it?
• Standard precautions for Infection prevention and control
to be followed
• SIGHT
•
•
•
•
Encourage and assist patients with hand hygiene .
Do not rely on alcohol gels as these do not kill the virus.
Decontaminate all equipment immediately after use
Ensure all staff are aware of the work exclusion policy and
the need to go off duty at first symptoms, return when 48
hours clear of last symptoms (WHY?)
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Thank you.
Any questions ?
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Standard Precautions
• Hand Hygiene after each and every
contact/task
• Use of Personal Protective Equipment
(PPE)
• Isolation / containment
• Waste management
• Decontamination
• Collection of specimens
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