Infection Control-Issues in the Community

Dr Yimmy ChowInterim Director and Consultant in Communicable Disease ControlNW London Health Protection Team, London PHE Centre

Nov 2013 – London Care and Support Forum

What’s our role?

We help protect the health of local people against infectious disease

& non-infectious environmental

hazards

1. Provide specialist advice & support

- reactively & proactively

- on comm dis’s, infection control & environmental hazards

- to LAs, CCGs, acute hospitals, community settings, public….

- through evidenced based guidelines, protocols…

2. Undertake surveillance and analysis of trends in comm dis’s (epidemiology)

3. Manage incidents and outbreaks – infectious and chemical, biological and radiological

4. Support the development and implementation of prevention and health promotion programs

5. Act as ‘Proper Officer’ for Public Health law (receive statutory notifications)

6. Teach and Train

7. Conduct research & undertake audit

Current issues• Norovirus

• Influenza

• MRSA

• New emerging antibiotic resistant organisms- CRO

Figure 1: All reports of IID outbreaks (suspected or confirmed) by setting, London, week 1 2012 to week 44 2013. Source: PHE HNORS & HPZone

Table 2: Reported impact of IID outbreaks in health and social care settings by Area team/PHE Centre, week 44

Links and resources

1. Links to the PHE Hospital Norovirus Outbreak Reporting Tool:

www.hpa-bioinformatics.org.uk/noroOBK/home.php

and the latest national norovirus update http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1191942172966?p=1191942172966

2. Guidelines for the management of norovirus outbreaks in acute and community health and social care settings:

http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1191942172966?p=1191942172966

Risk factors for MRSA

• Being hospitalized. MRSA remains a concern in hospitals, where it can attack those most vulnerable — older adults and people with weakened immune systems.

• Having an invasive medical device. Medical tubing — such as intravenous lines or urinary catheters — can provide a pathway for MRSA to travel into your body.

• Residing in a long term care facility. MRSA is prevalent in nursing homes. Carriers of MRSA have the ability to spread it, even if they're not sick themselves.

Monthly Counts of MRSA,MSSA, and C.diff Infections                  

Local Authority CCG Name

April 2013

May 2013

June 2013

July 2013

August 2013

September 2013Total

MRSA WestminsterHammersmith And Fulham 0 0 0 0 0 0 0

  WestminsterCentral London (Westminster) 1 0 0 0 0 0 1

  LondonWest London (K&C & Qpp) 0 1 1 0 1 0 3

   

MSSA WestminsterCentral London (Westminster) 1 0 4 2 3 2 12

  WestminsterHammersmith And Fulham 3 5 2 1 4 2 17

  LondonWest London (K&C & Qpp) 1 6 3 3 4 5 22

   

C.diff WestminsterCentral London (Westminster) 3 2 2 6 6 4 23

  WestminsterHammersmith And Fulham 7 4 4 1 1 3 20

  LondonWest London (K&C & Qpp) 6 2 3 10 9 5 35

                   

   April 2013

May 2013

June 2013

July 2013

August 2013

September 2013Total

MRSA London   9 10 7 6 5 10 47  England   55 40 36 30 36 41 238

A MRSA policy should address:

• Colonisation with MRSA for a healthy person is asymptomatic and does not present a risk – no need for exclusion.

• Patients/clients with open wounds or invasive devices are at greater risk of cross-infection.

• When a patient/client has been identified as colonised or infected with MRSA, infection control advice should be followed as per the “essential steps” guidance where there are shared amenities with other vulnerable patients/clients.

• Good hygiene practice and standard infection control precautions employed within the home will protect other patients/clients.

• The inter-healthcare infection control transfer forms should be used to alert other organisations about a patient’s/client’s status.

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

5

10

15

20

25

30

35

All CRO by Year North West London Hospitals

Hillingdon

North West

Imperial

Care Plan for person with infection

The following care activities should be in such a care plan:

Patient treatment (e.g. administration of drugs or creams etc)

Isolation (where appropriate)

Hand hygiene (staff and visitors)

Use of personal protective equipment (PPE)

Taking of specimens

Decontamination of the resident, equipment and the environment

Handling of laundry

Handling of waste

Information for and management of visitors

Safe transfer to another care facility

Available Infection Control guidance

The Health and Social Care Act 2008:  Code of Practice for health and adult social care on the prevention and control of infections and related guidance

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_110288

Infection control guidance for care homes*

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4136381

A DVD entitled ‘Introduction to Infection Control in Care homes’ was sent to all care homes by the Health protection Agency

www.hpa.org.uk/Publications/InfectiousDiseases/InfectionControl/InfectionControlInCareHomes/

Outbreak and Incident Management

Early reporting

Accurate record keeping

Use of checklists

Clarity of advice and action (isolation, IC arrangements)

Close monitoring

Review

Sharing good practice and lessons learnt

Contact detailsDr Yimmy Chow

Consultant in Communicable Disease Control & Interim Local Director for Health Protection

yimmy.chow@phe.gov.uk

North West London Health Protection Team

Public Health England

61 Colindale Avenue

London NW9 5EQ

Nwlhpt.oncall@phe.gov.uk

Tel: +44 (0)20 8327 7181

Fax: 020 8327 7206

Questions for Round table discussion• Do your organisation have an Infection Control Policy?

• Do you know who provides infection control service in your organisation? ICT? DIPC?

• Who do you report to if you have a breach of infection control?

• How would you manage an outbreak? What is your role?