Infection Prevention & Control (IPAC) at RCHT

Dr Tristan ClarkInfectious Diseases physicin and joint DIPC

General Principals

Standard precautions (including hand hygiene)Patient isolation

Environmental decontaminationSurveillance and outbreak investigation

Antibiotic stewardshipEducation and training

Specific organisms

MRSAClostridium difficile

ESBL producing gram negativesNorovirus

Influenza (and other respiratory viruses)Others (Chickenpox, Pertussis, PVL producing

Staphylococcus aureus)

MRSA rates RCHT 2011/12 (per 100,000 bed days)

Acute trust apportioned MRSA bacteraemia rate = 0 South West = 1.0

Non-acute trust apportioned MRSA bacteraemia rate = 1.2 South West = 1.0

923 days since last MRSA bacteraemia

Name of NHS Trust

April 2007 - March 2008 April 2008 - March 2009

MRSA bacteraemia reports

MRSA bacteraemia rate per 100,000 bed

daysMRSA bacteraemia

reports

MRSA bacteraemia rate per 100,000 bed

days

Total 4,451 11.9 2,935 7.8

     

     

Royal Cornwall Hospitals 43 18.9 44 19.2

MRSA Bacteraemia rates 2007 / 8 (acute trust, per 100,000 bed days)

Clostridium Difficile RCHTNumbers per annum: 2004/5 = 189

2005/6 = 1952006/7 = 3722007/8 = 2282008/9 = 1272009/10 = 562010/11 = 47

2011/12 = 41 (rate = 17 per 100,000 bd; SW rate =17; national rate = 21.8)2012-2013 = 24 (as of 15/02/2013)

Target (tolerance) for 2012-2013 = 41Target for 2013-2014 = 20 (!)

Standard Precautions – for all patient contact

Hand hygiene – before and after touching patients

Soap and water for all patients with diarrhoea (min 30s)

Alcohol gel adequate for all others (easier and faster but doesn’t eradicate C.diff)

Gloves indicated for contact with patient fluids but still need hand hygiene

Hand Moisturiser

If you are unable to use the Trust hand cleansing or moisturising products due to a skin condition/allergy seek advice from Occupational Health Department

If you develop eczema, dermatitis or any other skin condition you must seek advice from the Occupational Health Department as soon as possible.

Contact Dermatitis

Work-related contact dermatitis is a skin disease which can be caused by substances used at work. It is often called eczema and develops when the skin is damaged. This leads to redness, itching, swelling, blistering, flaking and cracking. The most susceptible parts of the body are the hands, followed by the forearms and face.

Patient Isolation

• To prevent spread of infectious agents to other patients and staff• Based on risk assessment of likely pathogen causing symptoms

• Prioritisation based on high risk agents (TB, Influenza, Chickenpox, Norovirus, C.difficile)

• MRSA and ESBL colonisation where possible (again based on risk assessment)

Environmental decontamination

Cleaning – physical removal of all foreign material (usually water and detergents)

Disinfection – elimination of all pathogenic organisms (except spores) from objects - usually chlorine based

Sterilization – complete elimination of all microbial life (e.g. Hydrogen peroxide)

Surveillance

Collection of accurate and relevant data on infections in real timeClusters of infection allow targeted investigations and interventions

Detection and management of outbreaksComparison with other institutions

National performance targets (MRSA bacteraemia, C.difficile, MSSA, E.Coli)

Antibiotic stewardship

Collection of accurate data of antibiotic use in the hospitalCreation of antibiotic policy and guidelines

List of restricted ‘high risk’ antibioticsPrincipal of ‘start smart then focus’

Monitoring and policing of adherence to the aboveOngoing education and training

‘Start Smart then focus’

Use local guidelines to chose agent(s)Cultures prior to starting abx

Antibiotics within 1 hour with severe infectionsIndication, duration and review date – documented on drug chart

Review at 48 hours and make clear planOptions include; Stop, Switch from IV to oral, Change to narrow

spectrum, Continue unchanged, OPAT.

Consultants role in promoting Infection control

Hand hygieneActive role in auditing of infections, antibiotic prescribing, prevalence

of resistant organisms etc within deptInfluenza vaccination

Early risk assessment of suspected infections with appropriate early use of patient isolation

Early liaison with IPAC and microbiology / infectious diseases