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
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
North West London Health Protection Team
Public Health England
61 Colindale Avenue
London NW9 5EQ
Tel: +44 (0)20 8327 7181
Fax: 020 8327 7206
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