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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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_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_35 Investigation Management of Tuberculosis in Children and Young People

Countywide guidance on the investigations and management of Tuberculosis in children and young people.

Tuberculosis (TB) is an ancient disease that, despite a falling incidence in the 20th century, remains the leading infectious cause of death worldwide. TB is inhaled by droplet spread from an infected person. In most cases the immune system kills and removes the bacteria. However if this does not happen two possible outcomes remain - either the bacteria are "contained" and lie dormant as "Latent" or the bacteria grow and either spread within the lungs or onward to the lymphatics or extra pulmonary organs leading to "Active TB". Active TB causes symptoms with significant morbidity and mortality

A child usually needs to be in close, regular contact with an infectious person in order to acquire TB. It can only be passed on if a person has TB in their lungs or throat and are coughing up TB bacterium. Not everyone with TB is infectious.

Children who live with adults who were born in, or have recently arrived from, a country with a high incidence of TB, who might unknowingly harbour the infection, are most at risk. Also children living below the poverty line who may live in crowded homes, with inadequate nutrition are at risk (Appendix A).

This guidance is for all staff working within Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and Lincolnshire Partnership Foundation Trust.

This guidance may also be adopted for use in health organisations where children and young people with TB may be identified at risk e.g. General Practitioners, Children's services.

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G_IPC_34 Maintaining the Cold Chain

 

Medicinal products should be stored and transported under conditions which ensure that their quality is maintained. Maintenance of the cold-chain is required for both the storage and transportation of some medicinal products.

There is an increasing number of medicinal products requiring controlled storage and transit conditions. Among the cold-chain items are high risk products such as vaccines, insulins, blood products and other proteinaceous materials, which normally require storage between 2°C and 8°C. These products must be protected from freezing; even a brief period at sub-zero temperatures may irreversibly denature the protein, leading to a loss of efficacy. There are also products such as emulsion systems and solutions of sparingly soluble components which may become physically unstable at sub-zero temperatures.

At every point in the chain precautions should be taken to minimise the effect of adverse external conditions on the quality and stability of that product. Where relevant, records should be maintained to provide evidence of compliance with the labelled storage recommendations for those in whose care the product is at the time and to other interested parties who may seek this assurance, such as the recipient and/or marketing authorisation holder.

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G_IPC_33 Management of Viral Gastroenteritis

Gastroenteritis caused by viruses (usually small round structured viruses - SRSVs (Norovirus) (Norovirus), most common is Norovirus) is common in the community, particularly in the winter months. It is difficult to prevent it from being introduced into hospitals and care facilities and it can have a significant impact on patient care as both patients and staff may be affected. However, simple control measures as detailed below can greatly reduce its impact.

Aim of this guideline

The aim of the guideline is to ensure that a co-ordinated approach to the managing of a potential / actual outbreak of viral D&V is undertaken by:

  • Promptly identifying and managing the infection outbreak
  • Quickly identifying the source, method of spread and causative organisms responsible for the outbreak.
  • Reducing the spread of the organism.
  • Ensuring all individuals, departments and any outside agencies likely to be involved in an outbreak have a clear understanding of their roles and are fully briefed.
  • Reduce the risk for further recurrence of the infection.

The principles contained within the guideline reflects best practices and applies to those members of staff who are directly employed by Lincolnshire Community Health Services NHS Trust and for whom the Trust has legal responsibility. It provides advice on the working practices which may be required when managing an enhanced activity/ outbreak relating to diarrhoeal and vomiting infection. It may be adopted locally by other care providers.

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