Download - Alert Organism
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