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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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Individuals in mental health trusts should be screened only if they fall into specific ‘higher risk’ groups. Guidance from the department of health has suggested several categories which should be considered for screening. These are as follows ♦ Those admitted following recent* surgery (nasal and wound screen) ♦ Those admitted following recent* admission to an acute trust. (nasal screen) ♦ Recent* Intravenous drug users (nasal and wound/abscess screens) ♦ Those who self harm (nasal and wound screens) ♦ Those with chronic wounds e.g. leg ulcers or indwelling devices such as catheters (nasal and wound or catheter site screens) * Where recent activity is indicated in the above criteria this is considered to be within the last 2 weeks, if clinical presentation suggests that a client may be at risk after a longer period please contact the Infection Prevention and Control Team for advice.

All of the above should be identified and screened following a risk assessment process upon admission, readmission from an acute trust or if they come into one of the categories following deterioration in their health which would place them into one of the above groups.

These risk factors should be considered upon admission, and at any other relevant time in the service user’s journey within our trust.

Those who self harm should only be screened if the self harm is of an invasive nature which would create a route for bacteria to get into the body thus placing them at risk of acquiring an infection, e.g. cutting.

Where following risk assessment the service user is identified as belonging to a higher risk group, screening should be carried out and where possible the service user should be accommodated in a single room.

Data Collection Healthcare Associated Infection HCAI Monthly Surveillance data collection form (Appendix 3) must be completed and sent each month even if you have no cases (nil returns) these should be e-mailed to Divison Leads, who are to collate and forward these data to the Infection Prevention and Control team.

Page 45 of 94 Infection Prevention and Control Policy

Isolation – Risk Assessment Service users identified as being at higher risk of colonisation or infection with MRSA should where possible be accommodated in a single room. Before imposing isolation on clients consideration should be made of the impact that isolation may have to their mental wellbeing.

Where isolation is not implemented or is terminated due to it having a significant negative impact on the mental wellbeing of a client, the client should be managed locally to reduce the risk of transmission this is particularly important if other clients in the areas are vulnerable to infection.

Screening Swabs Should clearly identify the site swabbed e.g.

Nose, groin, Wound as appropriate.(follow the Royal Marsden’s Clinical Procedure or check with IPCT). http://www.royalmarsdenmanual.com/online/toc.asp Occlusive dressings should not be removed just to obtain a swab, staff should wait until the dressing is due to be removed or replaced as clinically indicated.

Suppression Therapy A suppression therapy reduction regime consists of a course of treatment with antimicrobial agents, this aims to reduce the amount of bacteria that are living on the individual (bacterial load) to a level that significantly reduces the risk of cross infection from that individual to others. It also reduces the risk of invasive infection occurring in the carrier (autoinfection).

Any suppression therapy should be carried out under the advice of the IPCT as repeated use of these antimicrobial agents can lead to resistance.

• Nasal Carriers Mupirocin ointment 3 times a day for 5 days. Effective treatment of nasal MRSA is dependent on strict adherence to the administration regime.

• Skin Carriers Daily baths/showers with a skin cleanser (as indicated in the antimicrobial guide). For 5 days, the skin should be moistened and the skin cleanser must be applied thoroughly to all areas, paying particular attention to the known carriage sites of axillae, groin and perineal areas. The hair should also be washed with the skin cleanser. Change bedding, clothing and night attire following each day’s decontamination.

All used laundry must be washed as infected. For service users with eczema, dermatitis or other skin conditions, emollient bath additives may be used.

Nasal and skin carriers must have treatment concurrently.

• Colonised Wounds See wound formulary

• Colonised Catheterised Service users See IPC procedure for the management of urinary catheters

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Medical Devices Any instruments or equipment (e.g. stethoscopes, sphygmomanometers, lifting slings, commodes, wheelchairs, and physiotherapy exercise machines) should be single patient use and identified with the patient’s name for the duration of infectivity. All items to be decontaminated after use as per Medical Device Policy.

Environmental Hygiene Whilst MRSA infection is difficult to treat, bacterium is not difficult to destroy in the environment with routine cleaning Maintaining high standards of environmental hygiene is essential to reducing the risk of cross infection. Rooms should be kept clutter free and dust should not be allowed to collect.

Terminal clean of the room must be carried out, where the patient has been cared for suppression therapy is completed or the service user is discharged or moved.

Movement of Service users with MRSA If a patient known to be colonised or infected with MRSA who requires to attend for treatment or investigation in another part of the trust or in another trust, the ambulance or transport service must be informed and liaison with the receiving area, to ensure that the risk of transmission of infection to others is minimised.

When service users are discharged/transferred with MRSA, please complete an inter-healthcare Infection Prevention and Control transfer form (Appendix

1) and notify: The Health Centre (Ashworth only).

• The Infection Prevention and Control Team.

• The Patient’s GP

• The Ambulance or Transport Service

• Receiving Hospital/Nursing Home If re-admission to Mersey Care NHS Trust occurs, please advise: The Infection Prevention and Control Team

• The Nurse in Charge of the Ward

• The Escorting Staff Discharge letters Where appropriate, letters must include information regarding screening and what suppression therapy has been carried out. It is not necessary to report negative results.

6.13 Surveillance Surveillance does not just refer to the reporting of organisms or disease, it is the continuing process of data collection, analysis, interpretation and the dissemination of information to enable appropriate action to be taken.

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• There is alert organism and alert condition surveillance to detect outbreaks of infection.

• Clinical Area reporting of infections including MRSA and C.difficile to the IPCT.

• Monitoring of staff sickness rates in conjunction with Managers and the Occupational Health departments occurs at times of risk, e.g. Influenza.

• There is a procedure for monitoring and reporting adverse incidents associated with infection. Involving safety of service users and staff or others, via Datix. For Steiss and Riddor.

Reportable incidents (by the Infection Prevention and Control Team) are those


• Result in significant morbidity or mortality.

• Involve highly virulent organisms.

• Are readily transmissible.

• Require control measures that have an impact on the care of other service users including limitation of access to health services.

These are: Outbreaks, two or more linked cases of infection in a health care setting.

• Infected health care worker or patient or incidents necessitating look back investigations, (e.g. TB, vCJD and BBV infections).

• There is regular reporting of adverse events to the ICC.

• The Microbiology laboratories used by the Trust are CPA approved, and support the Infection Prevention and Control Team by processing data, surveillance, specialist testing and providing results.

Alert Condition Surveillance Alert conditions are conditions and organisms that may give rise to hospital outbreaks. The Infection Prevention and Control Team must be advised of any occurrence of the following conditions at the earliest possible opportunity.

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Alert Organism Surveillance Alert organisms are usually isolated in the laboratory; the laboratory staff are responsible for informing the Infection Prevention and Control Team.

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Transfer into the trust of service users with known infective organisms Should a patient be transferred in to Mersey Care NHS Trust with a positive diagnosis for any of the following organisms, then the Infection Prevention and Control Team should be notified: Urine

• Gentamicin resistant gram negative bacilli

• Staphylococcus aureus

• MRSA Faeces

• Salmonella

• Campylobacter

• E-coli (0157)

• Cryptosporidium

• Clostridium difficile toxin Swabs


• Staphylococcus aureus

• Group A streptococcus

• Pseudomonas aeruginosa

• Gentamicin / multi resistant gram negative Viral Isolates / Positive Antigen Tests

• Herpes zoster

• Parvovirus

• Respiratory viruses

• Rotavirus

• Norovirus Notifiable Diseases “Notifiable Diseases” is a legal term denoting diseases that must, by law, be reported to the “proper officer,” who is the Consultant in Health Protection.

The Notification of Disease Report book is kept in the Infection Prevention and Control Department and the Infection Prevention and Control Nurse ensures that the relevant Consultant signs the documentation.

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6.14 Isolation Isolation is a precaution of physical separation utilised to prevent the transmission of organisms responsible for infection. It aims to minimise the risk of transmission and limit the spread of infection to protect other service users, staff and visitors. The Health and Social Care act 2008 requires all trusts to have isolation provision identified within policy Isolation precautions can be applied to an individual case, a patient in a single room, cohorting a number of service users with the same infection in a bay, wing or ward. The system implemented will be dependant on the infection, the number of people infected and the isolation facilities available.

The need for isolation must be regularly reviewed and will only be implemented for the duration of infectivity.

Levels of Isolation, and Facilities Required There are different levels of precautions and isolation required to prevent the

spread of infection and these include:

• Contact precautions/ isolation.

• Respiratory isolation.

• Strict isolation.

Contact Precautions/ Isolation These are used in situations where the mode of transmission of the infecting organism is via Bodily fluids – Blood to blood (e.g. Hepatitis), the faecal oral route (e.g. viral gastroenteritis and other enteric organisms), or by contact via hands, skin, mucous membranes or wounds (e.g. MRSA).

Isolation Facilities:

• a single room with en suite facilities.

• a single room with named single person commode.

• a single room next to an identified toilet for sole use of infected patient.

If no single room is available every effort must be made to provide a room on the ward including consideration of moving a non infectious patient to another ward.

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An en suite single room is the preferred choice, but it may not always available.

Respiratory Isolation (e.g. T.B, Chickenpox) Respiratory isolation is to prevent the transmission of infectious diseases over short distances through the air and a single room is essential. Serious infections spread by the respiratory route will normally be transferred to Acute NHS Trusts.

Strict Isolation (e.g. suspected diphtheria, or viral haemorrhagic fever).

The Infection Prevention and Control Nurse must be notified immediately out of hours contact Silver on Call.

The trust is not equipped to treat some infectious diseases, arrangements will be made by the IPCT with the On Call Consultant in Communicable Diseases and the Infectious Disease Unit for transfer of service users with high risk infections.

The IPCN will also inform the receiving hospitals IPCT of the admission.

Single Room Isolation Single room isolation is necessary when a patient presents an infection risk to others or the patient is at risk from infection from others (immunocompromised), Ayliffe 2001.

Single room isolation will not, by itself, prevent the transmission of infection, it is part of the isolation procedure and must be used in conjunction with Infection Prevention and Control precautions.

The objective of single room isolation is to minimise infection, when there is a risk of airborne infection, the door must be kept closed and only essential staff should enter.

The psychological implications of isolation must be considered before it is implemented.

Individual patient care needs will be taken into account in the risk assessment process by the IPCT and the Clinical Team, which may increase the risk of spread of infection. Where the team decide not to implement isolation due to the mental state of the patient the rationale for this should be recorded in the clinical notes.

Such service users may need careful management with consideration of their potential to contaminate the environment. This may require increased cleaning and decontamination of areas affected.


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This occurs when a number of service users with the same infection are nursed in a bay or area.

Communication It is important that staff, service users and visitors are aware of the infection

prevention and control precautions that have been put in place:

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