infection prevention and control 10th jun 2021
TRANSCRIPT
Speakers
Jintana Loss ‐ IPC Lead BW CCG Restarting spirometry HCAIs COVID updateMelanie Spencer ‐ IPC nurse BHFT Every action counts‐ Courageous Conversation in IPC Liz Halley ‐ Wound care Nurse BW CCG Wound care – PseudomonasNigel Olsen PN – South Reading & Shinfield GP Dashboard – IPC audit
Valerie Benham – BW CCG ‐ minutes
ACTION TRACKER
Electronic audit tool‐ Dashboard Completed IPC audits (quarterly)‐ ongoing IPC policy‐ to be approved at QC next week IPC education‐ ongoing/ BOB IPC Survey – no feedback received
Restoration of Spirometry
Purpose Confirmation of diagnosis e.g. suspected COPD as part of QOFManaging the backlog patients How to tackle the waiting list, prioritise groups (impact on treatment, confirm Dx, routine spirometry‐not QOF)
Who should perform the spirometry Trained Practice Nurse who is certified/registered and competent with ARTP
Practice or PCNs delivery ?
Spirometry is NOT an AGP but spirometry associated cough has potential to generate aerosol droplets
Airborne particle transmission from Spirometry
Coughing
Data (2021)51% of patients with various chronic respiratory illnesses33% of patients with no history of coughing
Royal Brompton Hospital – 50% of patients coughing post spirometry
Research – see page 14 on the guideline https://www.brit‐thoracic.org.uk/document‐library/quality‐improvement/covid‐19/restarting‐spirometry/
Contraindications
People should not undergo a spirometry test if they: Have chest pain or have recently had a heart attack
or stroke Have a collapsed lung (pneumothorax) Had recent eye surgery (deep breathing increases eye
pressure) Had recent abdominal or chest surgery Have an aneurysm in the chest, abdomen, or brain Have tuberculosis (TB) Have a respiratory infection, such as a cold or the flu
Restoration of Spirometry (Cont.)
Risks/Mitigations ( of airborne particle transmission) Risk reduction: LFT, vaccination, Triage, Covid measures Use a single use antibacterial /antiviral filter Spirometer must be cleaned between patient (outer casing of the transducer/outer part of the spirometer itself)
PPE – Gloves, apron , visor/goggles, type IIR surgical mask (FFP2/3 is not required)
Cleaning : room/ equipment Ventilation : 6 ACH (or good ventilation‐windows/doors/, extraction fan, HEPA fan, car park/drive through)
Perspex screen between patient/staff (or no face‐ face position) Gap between each patient ?
How to reduce Cough ?
To undertake a relaxed or slow vital capacity manoeuvre followed by a 1‐2 second expiratory manoeuvre to obtain the forced expiratory volume in one second (FEV1).
Patients are pre‐counselled about what actions to take if they need to cough‐stay on the mouthpiece / testing device if possible and cough in to the bacterial/viral filter
If need to come off the device to cough‐ wear a surgical mask them lower it to the chin to allow capture of any airborne particles on coughing. Alternatively, use of a face shield that is lifted during the manoeuvre or to use adapted screens to undertake these procedures
HCAIs UPDATE April‐June 2021
C.Diff Concerns: Antibiotic use, long term PPIs use, Laxative meds, Anti motility meds.GNBSI ConcernsCAUTI, antibiotic use, cannula site, wound infection, sepsis, LRTI
Data 2019-2020 2020-2021 2021-2022
C.diff 102 100 (58 target) 16 (57 target)
E.coli 372 341 58
MRSA 5 5 (0 target) 0 (0 target)
MSSA 106 122 16
Klebsiella spp 75 94 20
Example: CDI‐ RCA
ID 1072572 10/03/21 COCA, ID 1081635 12/04/21 COHA, ID 1089584 12/05/21 COCA PMH : Diverticular disease never had a flare ‐ no antibiotic treatment
required. UTI in December and was treated with Fosfomycin Diarrhoea on 09/03/21 (x 5 per day) – Imodium PO, stool sample sent on
10/03/21 11/03/21 admitted to RBH : watery diarrhoea ‐CDI confirmed on 12/03/21 Rx
Fidaxomicin 200mg BD x 10days (started?) D/C 21/03/21 Hydroxycarbamide taken once the diarrhoea has stopped – (chemotherapy
medication given by RBH for Thrombocythaemia) 12/04/21 mucus in stool, no blood no other symptoms – stool sample sent
and CDI detected, Rx Fidaxomicin 16/04/21 ? UTI ‐ frequency/urgency (urine MC&S showed E.coli) Rx
Fosfomycin 12/05/21 many BO over the night, stool sample sent ‐ recurrent CDI, no
treatment required
Summary: CDI
Is the advice given to the patient to take Imodium on the first CDI appropriate?
Was UTI treatment appropriate? knowing patient just had CDI?
Is the stool sample collection for the 2nd episode appropriate ( mucus in stool 3-4 time per day, no blood or other symptoms – Patient had Diverticular Disease)
Lesson learned ?
COVID update
Quarantine Hotels
Arrival – negative COVID 72 hrs, testing day 2, 8 – isolation 10 days
Serge Testing
https://www.getreading.co.uk/news/reading‐berkshire‐news/live‐reading‐wokingham‐surge‐testing‐20755571
West Berkshire Council has confirmed it will not be carrying out surge testing in the area
COVID outbreak – RBH – Paeds/Security team
COVID outbreak ‐ Schools
COVID vaccinations – Pop up buses, PCNs, mass vaccination centres
Vaccination Data (Berkshire West)
https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-vaccinations/
Variants: distribution of cases data (2)
The VOC‐21JAN‐02 variant was first detected in Japan in travellers from Brazil in January 2021 and was first detected in the UK in February 2021.
The VUI‐21FEB‐01 variant was first detected in the UK in December 2020.
The VOC‐21FEB‐02 variant was first detected in the UK in December 2020.
The VUI‐21FEB‐03 variant was first detected in the UK in December 2020.
The VUI‐21FEB‐04 variant was first detected in the UK (England).
The VUI‐21MAR‐02 variant was first detected in the Philippines.
The VUI‐21APR‐01 variant was first detected in India.
The VOC‐21APR‐02 variant was first detected in India.
The VUI‐21APR‐03 variant was first detected in India.
The VUI‐21MAY‐01 variant’s location of first detection is to be confirmed.
Nepal variant – Under investigation ‐ ? Portugal has been removed from the Green list
IPC/COVID guideline
Covid Testing https://www.england.nhs.uk/coronavirus/wp-
content/uploads/sites/52/2020/12/C0957-primary-care-lateral-flow-test-sop-v2.pdf
https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/12/C0964-lft-in-primary-care-faqs-v2-jan-2021.pdf
IPC/COVID guideline dated 1st of June 2021
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/990923/20210602_Infection_Prevention_and_Control_Guidance_for_maintaining_services_with_H_and_C_settings__1_.pdf
Roadmap out of lockdown
Step 4 ‐ not before 21 June‐ to remove all legal limits on social contact
The Government plans to delay the June 21 unlocking, Matt Hancock indicated (06/06/21) that the date for the next step in the roadmap could be put back
https://www.gov.uk/government/publications/covid‐19‐response‐spring‐2021/covid‐19‐response‐spring‐2021‐summary
PPE and heat: risk of heat stress
CMO Messaging ‐ Personal protective equipment and heat: risk of heat stress Wearing personal protective equipment (PPE) in warm/hot environments
increases the risk of heat stress. This occurs when the body is unable to cool itself enough to maintain a healthy temperature. Heat stress can cause heat exhaustion and lead to heat stroke if the person is unable to cool down.
Measures to control the temperature of clinical environments and enable staff to make behavioural adaptations to stay cool and well hydrated should be made. Staff may require more frequent breaks and the frequency of PPE changes may increase, with a resulting increase in demand.
Further information and actions are available on the CAS website
https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103156
IPC CAMPAIGN /TRAINING
Global IPC campaign 5‐21/03/21 Nutrition and hydration week (moved to 14‐20 June 2021 due to the pandemic)
05/05/201 World hand hygiene day 13/09/21 Sepsis day 14‐20/10/21 IPC week 15/10/2021 Global handwashing day 11/ 21 Antimicrobial Awareness Week 01/12/21 World HIV day