infection prevention & control practice nurse forum
TRANSCRIPT
INFECTION PREVENTION& CONTROL
Practice Nurse Forum
Julia Shields Infection Prevention & Control
Professional Lead NurseApril 2019
Ipswich & East Suffolk CCG
West Suffolk CCG
North East Essex CCG
Infection Prevention & Control –Introduction
Legislation Health & Safety at Work Act 1974
The Control of Substances Hazardous to Health Regulations 2002
Health & Social Care Act ,2008,2015)
Public Health (Control of Disease) Act 1984
The Health Protection (Notification) Regulations 2010.
Guidance Department of Health (2015): The
Health & Social Care Act 2008, Code of Practice on the Prevention and Control of Infections and related guidance.
Loveday HP et al (2014),epic3 :National Evidence-Based guidelines for preventing Healthcare Associated Infections in NHS hospitals in England , Journal of Hospital Infection 8651 (2014) S1-S70.
National Institute for Health &Care Excellence (2012), Infection Control : Prevention & Control of Healthcare Associated Infection in Primary and Community Care.
Infection Prevention & Control Primary Care
Care Quality Commission (CQC)
Infection prevention & Control key priority -DH
Health & Social Care Act 2008,2015) Set 10 standards.
CQC requires all GP Practices to adhere to these 10 standards
IPC –fits with all 5 key questions Is it Safe It is Effective? Is it Caring? Is it Responsive of people’s needs Is it Well-led?
Training
Level 2 : every year
All healthcare staff providing direct patient care and other relevant staff based on local risk assessment .
The Role of IP&C Link Champions
The role of the IPC –link champion in Primary Care
Support for IPC within the practice
Nominated IPC link person/lead person
Audit ( decontamination of equipment /hand hygiene)
Time to attend IP&C study days
Newsletter –practice forum CCG Website
Antibiotic guardian/champion for the practice
Assist with short RCA/ PIR for HCAI demonstrates collaborative partnership working
Access to IPC – CCG team via [email protected]
Join the GNBSI –task and finish group – demonstrates collaborative partnership working
MRGNB Superbugs- Make Headline News
• Elderly hit worst as deadly superbug infections soar
• Health officials are worried by a 33% rise in E coli cases among those over 65 as resistance to antibiotics increases
• Andrew Gregory, Health Editor• March 24 2019, 12:01am, The Sunday Times
E.coli Bacteraemia
Suffolk & North East Essex
GNBSI - project is part of an overall strategy to
reduce GNBSI infections
Part 1: Reducing E.coli Bacteraemia
Gram negative bloodstream infection (GNBSI) project team have set up a task & finish group for Suffolk and North East Essex. Part 1 : objective to reduce E.coli bacteraemia rates :
Review E.coli BSI /AMR / antibiotic prescribing data to inform the group
Support improvement projects undertaken by Prosper (Essex) and Care Home Team (Suffolk) for hydration in older residents/patients
Promote the use of PHE –UTI diagnosis algorithm across providers
Support a reduction in the use of urine dipstick tests in patients over the age of 65 years
Review continence services in domiciliary care
The project supports the antimicrobial resistance (AMR) strategy.
The Task and Finish Group supports the use of the following resources to diagnose, manage and prevent UTIs /CAUTIs:
Out of hospital management of UTIs in elderly patients :antibiotics is supported by Health Education England:
e-lfh.org.uk/programmes/ant… NHS Improvement : Catheter passport /catheter resource
tools: https://improvement.nhs.uk/resources/urinary-catheter-tools/.
PHE: Diagnosis of urinary tract infections: Quick reference guide tools for primary care diagnosis: https://www.gov.uk/government/publications/urinary-tract-infection-
If you would like to support the project or would like information about the project please contact : [email protected]
Diagnostic tool - UTI OVER 65s
HCAI Surveillance /Mandatory reporting to PHE-DCS & CDI-reporting processes
Dear Practice Manager, The Infection Prevention & Control Team working across Suffolk CCGs & North East Essex CCG has been notified that a patient registered with your surgery has tested positive for Clostridium difficile. The team are responsible for undertaking a clinical review of this case for which a history from the GP will be required. Therefore, we would be very grateful if you could complete the following form:
CCG Reference
NHS Number
Named GP
Date of Specimen
Specimen Location
Date of onset of diarrhoea (if known)
If specimen sent from the surgery please give medical history (If inflammatory markers, white cell count, CRP and temperature was known at time of specimen please include these) and state if this supported the decision to send a sample.
The following are risk factors for patients who acquire a Clostridium difficile infection. Please indicate whether this patient had:
Risk Factor Y N Comments/Type etc.
Recent laxatives/enema
PPI
Enteral nutrition
Inflammatory bowel disease
Recent gastrointestinal surgery
Other gastrointestinal infection (e.g. Norovirus) including C.difficile (with dates)
Previous history of diarrhoeal illness
Chemotherapy/immunosuppressed
Please list all antimicrobials prescribed by your practice, or that you are aware of over the last 3 months (please include out of hours if known):
Antibiotic Indication Prescribed by: Start date Duration
Antimicrobial Resistance (AMR)
Modes of Transmission
The Chain of Infection
Hand Hygiene
Hand Washing
Hand Rub
Putting on & Removing PPE
Waste -Management
Sharps Bin Management
Do not discharge syringes into bins Don’t overfill-don’t fill above the fill-line (black line) Don’t leave anything sticking out of the top Use the temporary closure Close after 3 months use (NICE guidance) Complete the label
Confirms correct assembly (safety) Confirms correct final closure (safety) Tracks time in use Audit trail
Sharps Bins
Hazardous
Infectious (known or likely)
Pharmaceutical contamination (non-cyto)
Incineration only
•Examples: Syringes & needles•Blades• Scissors, forceps etc.• Used vials
Sharps Bins
Hazardous
Infectious (known or likely)
Pharmaceutical contamination
(cytotoxic / cytostatic)
Incineration only
Sharps Bins
NO pharmaceutical contamination
Incineration or treatment
Sharps/Injuries
Decontamination of Equipment
Cleaning : a process which physically removes dirt
Disinfection : a process to remove or kill pathogenic micro-organisms
Sterilisation : a process for the complete destruction or removal of micro-organisms
Audit : Quality Improvement Tool
• Use IPS Audit tool designed for GP practice 1) Infection Prevention & Control is Integral to Safety in this Clinical Area
No. Standard statement Guidance Yes No N/A Comments
1 Does this GP setting, have a designated person
responsible leading on IPC, e.g. a link nurse or the
GP setting manager?
Ask staff members who leads for IPC in this
general practice. This may be a link nurse.
2 Does the IPC lead role include: audit, feedback to
individuals on IPC practices, promoting optimal IPC
and close liaison with the IPC team?
Discuss the role with the IPC lead /link
nurse and staff members.
3 Is there evidence that IPC risks / topics are
frequently included in safety briefs and
ward/clinical area meetings?
Ask staff about the process and look for
triangulation, i.e. more than one person
stating the same answer. Ask for any
relevant documentation.
4 Is there clear information about when and how
to contact the IPCT – including out of hours?
Ask staff to show you where this
information is kept?
5 Is there evidence of a process of reporting
untoward incidents to the IPCT?
Ask staff what infection related untoward
incidents they know about and would
report, e.g. cross-transmission incident,
decontamination failure.
6 Is there data from local environmental / IPC
practice audits, (to include analysis, feedback
and improvement plan)?
Ask to see data from audits and
action plans. [Provide positive
feedback on good and
improved practices].
7 Are staff in this GP setting aware of national
surveillance data on antimicrobial
prescribing and HAI such as C. difficile?
Ask staff where the data feedback from
national surveillance programmes is kept
and how it is interpreted and used to
improve practice.
8 Is there a local risk assessment detailing
any challenges to effective IPC in this GP
setting?
Ask to see local risk assessment, e.g.
register incident book.
Confirm that identified risks are being
identified.
Suffolk & North East Essex IP&C teams
ESNEFTColchester hospital & Ipswich hospital and Ipswich & East Suffolk community services
Heather Dakin : Head of Infection & Prevention and Control
Contact :01206 742706
WSFTWest Suffolk hospital & west Suffolk community services
Anne How : Head of Infection Prevention & Control
Contact : 01284 712786 /713688
Suffolk & North East Essex CCGsJulia Shields: Infection Prevention & Control Professional Lead Nurse
Contact : 07939123458
Available IP&C Resources
Health Education England has just launched a short film supporting healthcare workers looking after older adults with suspected urinary tract infections: e-lfh.org.uk/programmes/ant…
UTI management; out of hospital management of UTIs in elderly patients. https://www.rcgp.org.uk/TARGETantibiotics
NHSI national hand hygiene policyThe NHSI Infection Prevention and Control Team (IPCT) has launched a national hand hygiene policy; a practice guide for NHS healthcare staff of all disciplines in all care settings. It covers responsibilities for organisations, staff and IPCTs; and it sets out how, then when and with what to decontaminate hands. Infection prevention is recognised as a key component of the new 5 year action plan on antimicrobial resistance. https://improvement.nhs.uk
CCG website :IP&C policy (2017)
Public Health England : http://www.gov.uk
https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/target-antibiotic-toolkit.aspx
External private provider of IPC : www.infectionpreventioncontrol.co.uk
External private provider of IPC : https://infectionpreventionsolutions.co.uk/
References
Department of Health (2015): The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance
Department of Health (2013): Health Technical Memorandum 07-01:Safe management of healthcare waste.
Department of Health(2009): Clostridium difficile infection: How to deal with the problem.
Loveday, HP, et al,(2014) EPIC3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England :Journal of Hospital Infection 86S1 :S1-S70
National Institute for Health and Care Excellence (2015): Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use.
National Institute for Health and Care Excellence (2017): Infection :prevention and control of healthcare –associated infections in primary and community care . Clinical Guideline 139