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«Policy Number IC01 Policy Title INFECTION PREVENTION AND CONTROL POLICY Accountable Director Director of Infection Prevention and Control Author Lead ...»

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• Treat all linen and clothing as infectious, place in a red plastic/alginate bag, and then into red cloth bag whilst in the room, tie this off and remove to designated area promptly.

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• Decontaminate en-suite toilet or commode after every use. Using a 1000ppm Chlorine based cleaning agent or a sporicidal disinfectant

• Isolation of service user must continue until 48 hours symptom free.

Treatment of symptomatic Clostridium difficile Oral Metronidazole 400mgs TDS for 10 days, if treatment is unsuccessful or symptoms recur, the Consultant Microbiologist and IPCT must be contacted.

Antimotility agents e.g. Loperamide must not be administered or prescribed without consulting the consultant microbiologist.

Stop all unnecessary antimicrobials and proton pump inhibitors (PPIs) Clearance of infection is determined by absence of symptoms and retesting of stools is not recommended as it can give a misleading result.

Other treatment options may be considered in severely ill patents as per antimicrobial guidelines. Please contact the Consultant Microbiologist for advice before prescribing.

Discharge or transfer of infectious service users C. difficile infection can often relapse therefore the service user’s GP should be informed of all occurrences of C. difficile on discharge.

If service user is transferred to another hospital or nursing/residential home the nurse in charge of the service user must inform the receiving area prior to transfer and complete the Inter-healthcare Infection Prevention and Control transfer form Appendix 1 (also available on the trust website)

• Mersey Care NHS Trust IPCT must also be informed (0151 471 2635).

• Out of hours ask for Silver on Call.

Communication and Reporting Monthly reporting from all inpatient areas across the trust utilising the Healthcare Associated Infection (HCAI) – Monthly Surveillance data collection form (Appendix 3) must be returned to Infection Prevention and Control, this may be via the Service Manager or Modern Matron dependant on local arrangements. These data must be returned even if it is a NIL return.

The return of this form is an essential indicator on the clinical area assurance checklist The trust submits the Health Care Associated Infections Assurance Framework compliance on a quarterly basis to the Clinical Commissioning Group as per contact management process.

It is essential that all cases of unexplained diarrhoea or suspected C.difficile cases are reported on this form not only positives

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It is essential that everyone is aware of the Infection Prevention and Control precautions that need to be in place.

Explain to the service user and relatives why isolation is required and what Infection Prevention and Control precautions are in place. It is also important to maintain the service user’s dignity and confidentiality.

The Mersey Care NHS Trust ‘Clostridium difficile information for service users, relatives, carers and visitors what you need to know’ leaflet is available on the trust website and should be offered to service users visitors and relatives in the event of a suspected case, confirmed case or outbreak of C. difficile infection on the ward.

All staff, both regular and visiting must be made aware of the importance of adhering to Infection Prevention and Control precautions.

Systems are in place whereby the Pharmacy will to contact the IPCT in the event that a case of C.difficile infection is suspected. Wards however must not rely on this mechanism as a means of communicating with the IPCT.

Cleaning, Daily and Terminal Decontamination All surfaces should be kept free from clutter to aid enhanced cleaning.

The environment around the service user can become heavily contaminated with C. difficile spores which are difficult to remove. Frequent and meticulous cleaning of all areas touched by the service user or contaminated by infectious diarrhoea must be cleaned with a Chlorine based cleaning agent as recommended specifically for this purpose by the trust’s Infection Prevention and Control Team.

Decontamination must be carried out at the end of the infectious episode. When the episode or outbreak of C.difficile infection is over (at least 48hours after last symptoms) contact the Infection Prevention and Control Team (out of hours contact Silver on call) before commencing terminal cleaning.

For details of how to carry out the terminal clean please see – Cleaning Standards policy 6.12.2 Diarrhoea and Vomiting Diarrhoea is the condition of having three or more loose or liquid bowel movements per day. See Bristol stool chart type 5 to 7 - Appendix 2.The most common cause is gastroenteritis.

Vomiting is the forceful expulsion of the contents of the stomach through the mouth. Vomiting can be caused by a wide variety of conditions.

Although not all Diarrhoea and or Vomiting is of an infectious nature, all episodes should be treated seriously and suspected to be infectious in the first instance.

–  –  –

Guidelines for diarrhoea and vomiting Outbreaks

• Report cases in service users and staff to the nurse in charge and the Infection Prevention and Control Nurse.

• Closure of ward to new admissions may be recommended by the ICT.





• Inter-ward transfer and discharge is not usually advised.

• Restrict staff entering the ward to only those who genuinely need to be there.

• Service users should be encouraged to recover in their own rooms.

• Service users should bathe or shower daily.

• Bed linen, towels and night attire should be changed as soon as soiled and at least every day to prevent re-infection.

• Linen should be put into red linen bags.

• Bedrooms and en-suite area to be cleaned daily.

• Hand hygiene is paramount, all staff must wash their hands thoroughly after contact with patient and linen.

• All crockery, cutlery must be washed in the dishwasher.

• Ensure that sick service users have their TPR recorded twice daily.

• Service users with diarrhoea should have samples obtained and sent for Norovirus and C&S.

• Incident log number will be issued by the Infection Prevention and Control Nurse and this is to be written on all lab forms.

• Do not give Imodium until a specimen has been obtained, and immodium is contraindicated if Clostridium difficile is suspected.

• Staff attending to service users confined to bed, when handling samples, or when cleaning up body fluid spillages will wear disposable gloves and aprons.

• Ensure that extra fluids are available to prevent dehydration, but do not give fruit juice as this may cause further diarrhoea.

• Encourage thorough patient hand washing after using the toilet.

• Ensure that there is an adequate supply of sample pots, bedpans, Orange clinical waste bags/bins, disinfectant, disposable gloves and aprons, toilet paper, bed linen, towels, soap and red linen bags.

6.12.3 Hepatitis B Virus (HBV) Hepatitis means inflammation of the liver. Viruses are the commonest cause but drugs and alcohol can also disturb the body’s immune system.

Hepatitis B virus is present in virtually all body fluids – blood, saliva, vaginal secretions and blood have been found to be infectious to other people. HBV is transmitted in the same way as HIV, but it is far more infectious.

Transmission Puncture wounds, i.e. sharps Mother to baby Unprotected sexual intercourse Injecting drug users

–  –  –

Incubation 90 days.

Symptoms Vary from no noticeable symptoms, to mild like flu like symptoms, nausea, vomiting, fever, jaundice, hepatic failure coma and death within 8 weeks.

90 to 95% of adults who are infected with the Hepatitis B Virus will fully recover.

5 to 10% will become long term carriers. If the infection is acquired at birth, the majority of these children will become long term carriers. A small number of chronic carriers may go on to develop chronic active Hepatitis, cirrhosis or liver cancer.

Hepatitis B is a major concern for nationally for those who are exposed to blood and body fluids.

The most important measure that health care workers can take is to be vaccinated against HBV.

Please also see Blood Borne Virus section 3.17.

6.12.4 Hepatitis C Virus (HCV) Hepatitis C is a blood borne virus that causes liver disease. The effects of HCV differ from person to person. Many people will remain symptom free, some will develop cirrhosis and a few will develop liver cancer. Symptoms that some people may experience are: Muscle aches and a high temperature.

• Mild to severe fatigue.

• Nausea.

• Loss of appetite.

• Weight loss.

• Depression or anxiety.

• Pain or discomfort in the liver.

• Jaundice.

• Poor memory or concentration.

• Alcohol intolerance.

It should be noted that the severity of symptoms does not necessarily equate to the extent of liver damage.

Transmission Blood to blood contact.

Blood transfusion prior to 1991 Mother to baby transmission (rare) Sexual contact (rare) Incubation Period Three to six months. Many people will be unaware that they have the virus for years.

–  –  –

Tests An initial antibody blood test will indicate infectivity.

Please also see Blood Borne Virus section 3.17.

6.12.5 Human Immunodeficiency Virus (HIV) HIV which causes acquired immunodeficiency syndrome (AIDS) is transmitted when body fluid from an infected person enters the body of an uninfected person.

HIV reduces immunity in people which can lead to the development of a number of opportunistic infections, various types of cancer and mental illness.

The time period between becoming HIV positive and AIDS can vary from less than 1 year up to 20 years. With effective treatment the onset of AIDS can often be delayed indefinitely.

Transmission Through unprotected sexual intercourse with an infected person.

Sharing of contaminated needles.

Transfusion of contaminated blood/blood products.

From mother to baby.

Incubation 3 to 4 months.

Testing Blood tests Infectivity From onset of HIV and for life.

Precautions Follow Standard Principles.

Protective equipment.

Please also see Blood Borne Virus section 3.17.

6.12.6 Meticillin Resistant Staphylococcus aureus (MRSA) MRSA stands for meticillin-resistant Staphylococcus aureus. It is a variety of Staphylococcus aureus that is resistant to meticillin (a type of penicillin) and some of the other antibiotics that are usually used to treat Staphylococcus aureus.

Staphylococcus aureus is an organism that up to one third of the population carry on their skin or in their noses without any associated problems. MRSA can live on the body of healthy people without causing infection. It becomes a problem only when it enters the body. MRSA can infect wounds, ulcers,

–  –  –

abscesses, catheter entry points and cause inflammation, prevent wounds from healing and can lead to blood poisoning (bacteraemia).

MRSA is no more virulent than other varieties of Staphylococcus aureus, but it is much more difficult to treat because the range of antibiotics which are effective against it is reduced.

MRSA is one of the most prevalent micro-organisms involved with healthcareassociated infections. It is usually confined to hospitals and in particular to vulnerable or debilitated service users.

MRSA does not pose a risk to hospital staff, family members of affected service users, their close social or work contacts. (unless they are suffering from a debilitating disease) Targeted screening, colonisation reduction regimes and effective management through Infection Prevention and Control precautions and isolation (where appropriate) have been introduced to meet these standards.

MRSA must be managed to ensure that transmission is minimised, by screening higher risk service users and where appropriate isolating service users who may be colonised or infected with MRSA.

The Trust is committed to minimising the impact of MRSA and will work to national guidelines to ensure that staff follow and implement the Infection Prevention and Control measures that are identified as necessary at audit.

Transmission Direct spread.

One of the commonest modes of spread is by direct contact, e.g. When the hands of health care workers have been in contact with a patient colonised or infected with MRSA, they can potentially pass the MRSA bacteria on to others.

The movement of service users with MRSA should be minimised.(contact the IPCT for advise).

Indirect spread Occurs when the environment becomes contaminated with MRSA bacteria, which is subsequently picked up from the environment by touch. Indirect spread can be minimised by ensuring frequent and adequate cleaning of the equipment between service users e.g. baths, bedpans, commodes.

Some service users shed the organism into the immediate environment This is not a significant mode of transmission unless the patient is shedding excessive amounts of skin.

Screening Screening for MRSA falls into two distinct categories

–  –  –

1. Screening prior to admission to acute trusts for elective procedures.

Service Users attending Acute Trusts for elective surgery will require preoperative screening. This would ordinarily be performed at a pre-operative assessment clinic.

2. Screening following admission, transfer or those whose clinical presentation means that they fall into one of the higher risk groups, e.g. if an individual develops leg ulcers or self harms, causing an open wound whilst within our care.



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