ALERT ORGANISM Dr Suhazeli Abdullah

ALERT ORGANISMS

are organisms that pose a significant risk of

transmission to non-infected patients or

healthcare workers (HCW) by either colonization

and /or subsequently a patient or HCW

developing healthcare associated infections

(HAIs) as a result of infection by the organisms

OR

They pose a significant risk of transmission to

non-infected people in the population or

community

FACTS AND FIGURES

More than 300,000 people each year are affected by a healthcare associated infection

At any one time 8.2% of patients have a healthcare associated infection.

On average a person with a healthcare associated infection will spend over 2.5 times longer in hospital, cost over £3,000 more to treat and often requires treatment after discharge.

The cost to a typical Trust like ours of treating healthcare associated infection is £3.6m a year.

5000 patients die a year because of healthcare associated infection and it contributes to the deaths of a further 15,000 others1.

The cost of healthcare acquired infections to the NHS is approximately £1 billion a year

CURRENT INFECTION RATES

Between February and May 2006, infection control staff across the UK and Ireland surveyed 75,763 beds and found that 7.6% of adult patients in acute hospitals had healthcare-associated infections. This rate had not changed appreciably since the previous survey conducted over ten years before.The Trust contributed data based on observations made on the WRH site (255 patients) and the Alexandra site (100 patients). The combined Trust prevalence was 10% (WRH 8%, Alexandra 12%).

Currently, the Trust has made very great progress in reducing the prevalence of the two main healthcare associated infections, meticillin resistant Staphylococcus aureus

(MRSA) bloodstream infection and

Clostridium difficile infection (CDI).

CLASSIFICATION OF MICROORGANISMS ON

THE BASIS OF HAZARD (WHO “RISK

GROUPS”)

Risk Group I

• Low risk in laboratory worker and community

• UNLIKELY to cause disease

• eg: Rhizopus, Mucor (moulds)

CLASSIFICATION OF MICROORGANISMS ON

THE BASIS OF HAZARD (WHO “RISK

GROUPS”)

Risk Group II

• Moderate risk to laboratory worker and

community

• Preventive measure (vaccination) or drugs are

available

for treatment

• Risk of spread in community low

• e.g: Staphylococci, Streptococci, Coxsackie

CLASSIFICATION OF MICROORGANISMS ON

THE BASIS OF HAZARD (WHO “RISK

GROUPS”)

Risk Group III

• High risk to the laboratory worker

• Low risk to community

• Do not spread rapidly from one person to

another

• Preventive measure (vaccination) or drugs are

available

for treatment

• eg: Mycobacterium tuberculosis, Salmonella

typhi

CLASSIFICATION OF MICROORGANISMS ON

THE BASIS OF HAZARD (WHO “RISK

GROUPS”)

Risk Group IV

• HIGH risk to laboratory worker and

community

• Easily transmitted from one person to another

• Preventive measure (vaccination) or drugs NOT

available for treatment

• Mainly viruses- e.g: Marburg, Ebola

INFECTIOUS ROUTE:

AIRBORNE ROUTE

Some infections are transmitted by the

inhalation of micro-organisms in droplet nuclei.

These minute particles are expelled from the

respiratory tract by coughing or sneezing, and

may remain suspended in the air for a long time.

Infections transmitted in this way include

Tuberculosis,

Influenza,

Chickenpox and

Severe Acute Respiratory Syndrome (SARS).

INFECTIOUS ROUTE:

CONTACT ROUTE

Contact transmission is the most common mode

of transmission within the healthcare setting.

Infections commonly spread in this way include

Staphylococcus aureus including MRSA strains,

Clostridium difficile and gram negative

organisms including EBSL producers.

Contact transmission may be sub-divided into

direct contact, and indirect contact.

Feco-oral Route

RESPIRATORY DROPLET ROUTE

Infections such as meningococcal meningitis,

pertussis, and some respiratory viruses are

transmitted by contact with respiratory

secretions, including particles produced during

coughing and sneezing. These particles do not

travel far or remain airborne for long, unlike

those infections which generate airborne

particles easily

Meninggococal Meninggitis

Pertusis

BLOOD ROUTE

Some infections such as Hepatitis B, Hepatitis C

and HIV are spread via blood and high risk body

fluids. Health care workers may be at risk via

inoculation injuries or splashes into mucous

membranes such as eyes or mouth.

PRECAUTION

COMPLIANCE

In 34 major studies of handwashing, workers washed their hands only 40% of the time. Another reason why personnel don't wash their hands often is that frequent handwashing with soap and water may cause skin irritation and dryness. In the winter months, some personnel may even develop cracks in their skin that cause bleeding. Healthcare workers can get 100's or 1000's of bacteria on their hands by doing simple tasks like:

Moving and handling patients in bed

Measuring blood pressure or pulse

Touching a patient's hand

Rolling patients over in bed

Touching the patient's gown or bed sheets

Touching equipment like bedside rails, over-bed tables, IV pumps

ALCOHOL RUB

If hands are not visibly soiled or contaminated with

blood or body fluids, use an alcohol-based hand rub

for routinely cleaning your hands. Hands should be

decontaminated at the following times;

Before having direct contact with patients

After having direct contact with patient's skin

After touching equipment or furniture near the

patient, within the patient's bedspace

Before and after any clinical procedure

After removing gloves

Before eating

After using the toilet

PROTECTIVE CLOTHING

Wear gloves for contact with all blood and body

fluids and remove after use.

Wear eye protection/masks if splashing into the

face is likely e.g. intubation.

Wear duckbill masks as required e.g. patients

with TB, meningitis. Check you know how to

apply and remove duckbill masks correctly.

Mask..

CARE OF EQUIPMENT

Keep the environment clean and dust free

Detergent wipes can be used to clean most

surfaces effectively

Cleaning medical equipment is guided by a risk

rating in the Trust decontamination policy

CARE OF EQUIPMENT

Minimal Risk Equipment

- Items some distance away from the patient such as environmental surfaces and fittings, e.g. walls, floors, ceilings, sinks and drains. - Items in close proximity to the patient but unlikely to be contaminated with a significant number of pathogens, e.g. bed frames, lockers, flower vases.

Level of decontamination: domestic standard cleaning and drying adequate

CARE OF EQUIPMENT

Low Risk Equipment

- Items in contact with normal intact skin, e.g.

stethoscopes, wash bowls, crockery, cutlery,

mobile telephones.

Level of decontamination: domestic standard

cleaning and drying usually adequate

Intermediate Risk Equipment

- Items in contact with intact non-sterile mucous membranes, e.g. respiratory equipment, clinical thermometers, gastroscopes.

- Items in contact with particularly virulent or readily transmissible organisms.

-Items to be used on highly susceptible patients. Level of decontamination: disinfection

High Risk Equipment

- Items in close contact with a break in the skin

or mucous membranes, e.g. dressings.

- Items introduced into a normally sterile body

cavity, e.g. surgical instruments, needles,

implants, urinary catheters.

Level of decontamination: Sterilization

Always follow the method listed for decontamination and never improvise

Avoid communal items in the bathroom e.g. bar soap, shower gel.

Do not reuse any single use items

Complete Decontamination Forms (available in the Decontamination Policy on the intranet and from ward clerks) when returning clinically used equipment for repair..

WASTE

is colour coded to ensure safe disposal

Yellow bags - hazardous waste from known infected patients

Orange bags - all other clinical waste

Black bags - domestic waste

Brown (Worcester) Blue (Alexandra) Grey (Kidderminster) - confidential waste

Cardboard box - broken glass

Linen is also colour coded to aid appropriate laundry procedures.

Use white plastic for soiled linen. Double bag if very wet.

Use alginate and red plastic bags for infected linen e.g. ESBL producers. Note that infected linen bags are not required for patients with MRSA, but their linen should be sealed at the bedside into white plastic bag.

Systems are in place for laundering patient clothing or manual handling equipment - check your local site guidelines

SPILLAGES

Wear an apron and gloves for safe removal of any spillage.

Spills of high risk fluid, e.g. Blood, should be cleaned with a chlorine releasing agent (bleach) such as precept granules/sanichlor tablets. Bleach cannot be used on fabrics or carpets.

Low risk fluids such as urine should be cleaned with detergent and warm water.

ALERT ORGANISMS

Bacteria

Virus

Fungus

Parasite

NOTIFIABLE DISEASES

1. Cholera

2. Diphtheria

3. Encephalitis

4. Gonococcal

infection/Gonorrhea

5. Leprosy

6. Paratyphoid fever

7. Pertussis

8. Plague

9. Relapsing fever

10.Rickettsiosis

11.Syphilis

12.Tetanus

13.Tuberculosis

14.Typhoid fever

15. Typhus

16. Whooping cough

17. Acquired immunodeficiency syndrome

18. Dengue fever

19. Ebola

20. Hepatitis

21. Human immunodeficiency virus (HIV) infection

22. Measles

23. Poliomyelitis

24. Rabies

25. Yellow fever

26. Dysentery

27. Malaria

BACTERIA

Examples: :

• Vibrio cholerae

• Mycobacterium tuberculosis

• Salmonella typhi

• Neisseria gonorrhoeae

Alert Organisms- Bacteria

• Neisseria meningitidis

• Based on antibiograms

* MRSA

* Vancomycin-resistant enterococci (VRE)

* Extended spectrum beta-lactamase (ESBL) Klebsiella

MRO e.g Acinetobacter spp., Pseudomonas aeruginosa

MULTIDRUG RESISTANT ORGANISMS (MRO)

Definition:

Microorganisms,predominantly bacteria, that are

resistant

to one or more CLASSES of antimicrobial agents

(CDC Definition)

VIRUS

For viruses, they are usually NOT being cultured in routine diagnostic

laboratory, and the laboratory diagnosis most of the time is usually made

via serological tests.

They are usually mentioned as ALERT based on the conditions that they

caused

Alert Organisms- Virus

Examples: Dengue /DHF Dengue virus

Influenza Influenza A (H1N1)

SARS coronavirus

ALERT ORGANISMS- PARASITE

Malaria

Plasmodium spp.

CONVEYING THE MESSAGE OF ALERT

ORGANISMS

This can be done via:

• Telephone conversation

• Flagging system on LIS/THIS

• Tagging of patient’s bed ticket

• Ward visit by IC personnel

IMPLICATIONS OF ALERT ORGANISMS

Positive microbiology results that falls under ALERT

organisms may result in:

• Case review

• Search for other carriers or infected patients

• Isolation

• Early discharge (if possible)

• Report to Public Health authorities

• Public health measures in the community

IMPORTANT CONCEPTS IN TRANSMISSION OF

INFECTIOUS AGENT

Transmission is determined by:

• Availability of vulnerable patients

• Selective pressure exerted by antimicrobial use

• Increased potential for transmission from larger numbers

of colonized or infected patients : “colonization pressure”

• The impact of implementation and adherence to

prevention efforts.

TERIMA KASIH