Infection Prevention and Control

G_IPC_45 Management of Patients with Diarrhoea

In the UK, incidences of diarrhoea have a huge impact on the community, through absence from work or the effect on bed capacity in acute and community hospitals and nursing/residential/care homes.  The emergence of Clostridium difficile as a clinically and politically significant healthcare associated infection and the impact of Norovirus infections, affecting the functioning of healthcare organisations, require a high degree of suspicion when diarrhoea has developed.  Health care staff across the health economy must be aware of what is required to detect the cause, minimise the effect on the patient and prevent the risk of cross infection.

 

The purpose of this guidance is to advise on the best practice required around the management of patients with diarrhoea and the standard infection prevention and control precautions required to identify the cause and minimise the risk of healthcare associated infections to patients, visitors and staff in health care settings.

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G_IPC_43 Guidance on Management of Carbapenemase Producing Enterobacteriaceae (CPE)

Bacteria from the family Enterobacteriaceae live harmlessly in the gut, but can cause significant infections when they get into the wrong place. It is a very large family of Gram negative bacteria, including Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae. They can cause a broad range of infections from uncomplicated urinary tract infections, through to overwhelming sepsis.

These guidelines are to be used by all staff and applied to all patients treated by LCHS, in particular those at risk or known to be carrying CPE.

Although designed for CPE, these guidelines are also applicable for the control of other carbapenemase producing organisms, for example carbapenemase-producing Pseudomonas aeruginosa.

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G_IPC_37 - Decontamination Guidelines

The purpose of this guideline is to implement a co-ordinated approach to decontamination in line with current Department of Health requirements.

Lincolnshire Community Health Services NHS Trust (LCHS NHS Trust) is committed to the wellbeing of its patients, carers and staff by ensuring that all decontamination processes undertaken within the Trust are performed in line with national guidance.

The purpose of this guideline is to confirm the LCHS NHS Trust requirements for decontamination which are put in place to reduce avoidable risks of exposure from infection to patients and staff.

The policy will address the inherent risks, both clinical risks and health and safety issues, which relate to decontamination.

The guidelines aim:

  • To establish required standards for decontamination process in line with national standards.
  • To ensure that staff receive appropriate decontamination training and updates.
  • To have effective systems in place to prevent and control infection where this is associated with decontamination.
  • To establish review processes to audit, improve and accredit decontamination processes.

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P_IPC_01 Infection Prevention Policy

Healthcare associated infections (HCAI's) are infections that are neither present nor incubating when a patient is admitted to hospital. They are well recognised to cause morbidity and mortality. Not all infections are preventable as in many cases the outcome of an infection is dependent upon patient susceptibility. Infection Prevention and Control serves to reduce the risk of an infection spreading to a new host to an "irreducible minimum".

Clinical care is now delivered within the governance framework that is itself firmly embedded in an environment of managed risk. The fundamental principle of "Infection Prevention and Control" is the creation and maintenance of a safe environment through the development and implementation of robust guidelines and policies. Annual work programmes form the basis of arrangements for preventing and controlling healthcare acquired infections that will effectively minimise, manage or eliminate cross infection risks within the working environment and reduce the risk of the spread of infection to both patients and staff.

We have an open approach to infection prevention and control with all of our infection control documents being made publically available to staff and the public via the internet and other supporting written material such as patient leaflets. Reducing this risk has led to many initiatives which have been taken into account during the development of this policy and the associated guidelines.

Lincolnshire Community Health Services NHS Trust has a legal obligation to ensure that arrangements are in place to protect patients and staff from the risks of acquiring an HCAI during the provision of healthcare. The Trust is committed to the development of safe working practices relating to the control of infection and the spread of disease.

Staff will be provided with appropriate training to protect their health and safety when meeting the needs of the patients/clients they serve.

This overarching policy should be read in conjunction with the relevant Infection Prevention and Control clinical guidelines, policies and leaflets which may be found on the website.

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P_IPC_02 Community Hospitals Cleaning Strategy and Operational Cleaning Plan

 Providing a clean and safe environment for healthcare is a key priority for the Trust. It also recognises the role cleaning has in ensuring that the risk to patients from healthcare associated infections is reduced to a minimum.

The Code of Practice for the prevention and control of healthcare associated infections (the hygiene code) outlines the Trust's duty to provide and maintain a clean and appropriate environment. The National Patient Safety Agency (NPSA) document places further responsibility on NHS trusts to ensure that local provision of cleaning services is adequately resourced, clearly defined through a strategic cleaning plan, with clear cleaning schedules and frequencies.

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G_IPC_42 Transmissible Spongiform Encephalopathy Agents

The purpose of this guidance is to provide healthcare workers who provide clinical care and/or practice in primary care and community settings with a practical working document to underpin safe working practices in relation to Transmissible Spongiform Encephalopathy (TSE).

Transmissible spongiform encephalopathies (TSEs), sometimes known as prion diseases are fatal degenerative brain diseases which occur in humans and certain animal species.  A common feature of all TSEs is the appearance of microscopic vacuoles (holes) in the grey matter of the brain, resulting in a sponge-like appearance.

Some TSE's have a protracted pre-clinical phase.  This is followed by rapidly progressive dementia, loss of memory and intellect, personality changes or progressive unsteadiness and clumsiness.

TSE in humans is relatively rare. Known human TSE's include:

  • Creutzfeldt-Jakob disease (CJD) including classical, sporadic, familial, iatrogenic and new variant
  • Gerstmann-Straussler-Sheinker syndrome (GSS)
  • Fatal familial insomnia (FFI)
  • Kuru

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G_IPC_36 - Management of Patients with Clostridium Difficle (C.difficile) infection in the community

Clostridium difficile (C.difficile) is the major cause of antibiotic associated diarrhoea and colitis, a healthcare associated intestinal infection that mostly effects elderly patients with underlying diseases (DH 2006).

C.difficile is a spore forming, anaerobic bacterium. It is estimated that between 2-3% of healthy adults and up to 36% of hospital patients are asymptomatic carriers of C.difficile in their faecal flora. C.difficile associated disease (CDAD) is frequently associated with antibiotic treatment (Hawker et al 2001).

The diarrhoea associated with this disease can range in severity from mild to severe and can rapidly result in deterioration in the patient’s condition. The complications arising from this disease include; pseudomembranous colitis, toxic megacolon, colonic perforation and death.

C.difficile has the greatest potential for spread within in-patient units, thus prevention and appropriate management of infection is of paramount importance to quality and safety.

Preventing exposure to the organism. This may be done through routine infection control procedures. The most important aspects of this are:

  • hand washing by both staff and clients
  • appropriate disinfection and sterilisation of equipment
  • environmental cleaning
  • isolation of all clients with diarrhoea pending diagnosis

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G_IPC_38 Decontamination of Patient Equipment

Decontamination is the combination of processes used to make a re-usable item safe for further use with patients and handling by staff. As a combination of processes, it is important that they are undertaken correctly, both individually and collectively, to reduce the likelihood of infectious agents being passed to individuals or to the environment.

The CQC assurance marker, Outcome 8°c, specifically refers to decontamination as one of the standards against which organisations will be monitored. The requirements as set out in this standard, give a clear indication as to what is expected of the organisation and will be used to confirm that appropriate management arrangements are in place.

It is a mandatory requirement that all organisations who undertake local decontamination must "keep  patients,  staff  and  visitors  safe  by  having  systems  to  ensure  that  all  reusable medical devices are properly decontaminated prior to use and that the risks associated with decontamination facilities and processes are well managed."

These can be categorised as:

  • sterilisation of instruments
  • decontamination of medical devices and patient equipment 

The overall decontamination process can include purchasing and acquisition of instruments/equipment, cleaning, sterilising and disinfection, packaging, transport, storage and disposal. It requires effective management of systems often spanning a range of disciplines and locations within the organisation.

There are a number of health and safety issues associated with decontamination (including uncontrolled use of chemicals and inappropriate use of processes) that potentially can expose patients and staff to risk or injury.

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G_IPC_40 Endoscope Guidelines

The purpose of this guideline is to provide best practice guidance in relation to infection prevention and control pertaining to decontamination of endoscopes within the community and primary care settings.

Principles for processing heat sensitive endoscopes

  • initial manual clean
  • disinfection on automated washer/disinfector
  • rinsing with bocienc free water 

Decontamination should begin as soon as possible after endoscopes and their accessories have been used. Thorough manual cleaning with a suitable detergent and in accordance with the endoscope manufacturer's instructions is an essential first stage.

The level of decontamination depends upon the invasiveness of the procedure. Endoscopes used in sterile body areas eg, laparoscopes / arthroscopes, should be sterilised before and after use.

Those in contact with non sterile centres can be decontaminated by chemical disinfection. Failure to remove deposits of blood, faeces, tissue, mucus, infectious agents or biofilm may result in cross infection, misdiagnosis or instrument malfunction.

After manual cleaning the instrument should be either disinfected or sterilized. This should be performed by using an automated endoscope reprocessor (AER). The final stage of the process is drying and ensuring safe storage.

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G_IPC_39 Guidelines for Decontamintion of Vacated Bed Spaces

The purpose of this guideline is to provide best practice guidance in relation to infection prevention and control pertaining to decontamination of vacated bed spaces in community and primary care settings.

Key points

  • Before commencing cleaning, all lockers and bedside, tables must be completely empty.
  • All surfaces of the equipment, inside and out, topside and underside must be thoroughly cleaned and dried.
  • Any disposable equipment used on the previous patient/client must be disposed of and renewed at the time of the bed space clean.
  • Any re-usable equipment must be decontaminated in accordance to the manufacturer's instruction and the local Decontamination of Equipment guidance
  • Privacy curtains surrounding the bed space must be checked and, if soiled, replaced/renewed.
  • The 25 point bed space checklist form must be completed and left on display for the next patient to be admitted to that space to see and comment upon if they wish.
  • All blood/body fluid spillages should be dealt with in accordance with the Spillage Policy
  • All waste must be disposed of in accordance of the Waste Policy

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