Transcript Infection Control

Infection ControlIssues in the Community
Dr Yimmy Chow
Interim Director and Consultant in Communicable Disease Control
NW 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&HPAwebAutoListNam
e/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/P
age/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
MRSA
MSSA
C.diff
MRSA
CCG Name
Hammersmith And
Westminster Fulham
Central London
Westminster (Westminster)
West London (K&C &
London
Qpp)
Central London
Westminster (Westminster)
Hammersmith And
Westminster Fulham
West London (K&C &
London
Qpp)
Central London
Westminster (Westminster)
Hammersmith And
Westminster Fulham
West London (K&C &
London
Qpp)
London
England
April
2013
May
2013
June
2013
July
2013
August
2013
September
2013 Total
0
0
0
0
0
0
0
1
0
0
0
0
0
1
0
1
1
0
1
0
3
1
0
4
2
3
2
12
3
5
2
1
4
2
17
1
6
3
3
4
5
22
3
2
2
6
6
4
23
7
4
4
1
1
3
20
6
2
3
10
9
5
35
April
2013
9
55
May
2013
10
40
June
2013
7
36
July
2013
6
30
August
2013
5
36
September
2013 Total
10
47
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.
35
All CRO by Year North West London Hospitals
30
25
20
Hillingdon
North West
15
Imperial
10
5
0
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
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/PublicationsPoli
cyAndGuidance/DH_110288
Infection control guidance for care homes*
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPoli
cyAndGuidance/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/InfectionCont
rolInCareHomes/
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 details
Dr Yimmy Chow
Consultant in Communicable Disease Control & Interim Local Director for Health Protection
[email protected]
North West London Health Protection Team
Public Health England
61 Colindale Avenue
London NW9 5EQ
[email protected]
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?