QAH HospitalPortsmouth Hospitals NHS Trust04/09/2015Page 1 Infection Prevention and Control Quality and Safety Infection Prevention Team 2012

QAH HospitalPortsmouth Hospitals NHS Trust Preventing Infection 2,940 people died on Britain’s roads ,780 people were injured 9,000 people died from MRSA/C.diff alone 300,000 had an HCAI Estimated that paediatrics accounts for 1-2% of HCAI

QAH HospitalPortsmouth Hospitals NHS Trust Meticillin-resistant Staphylococcus aureus (MRSA) Bacteraemia Infection Prevention & Control Department 48 hours after admission 12 month rolling total

QAH HospitalPortsmouth Hospitals NHS TrustPage 404/09/2015 Screening for MRSA  Admission within the last 12 months  Transfer in from another hospital/abroad  Indwelling IV device/urinary catheter  Chronic wounds/leg ulcers  Chronic skin condition  History of MRSA  IV drug user  Military staff / students / healthcare worker  Admitted for high risk surgery (e.g. ortho) Page 404/09/2015

QAH HospitalPortsmouth Hospitals NHS TrustPage 504/09/2015 Managing MRSA Reservoirs  High risk – start suppression therapy  Low risk – wait for swab results  Suppression Therapy – Why, How, When?  “Once positive, always high risk”

QAH HospitalPortsmouth Hospitals NHS Trust

QAH HospitalPortsmouth Hospitals NHS TrustPage 704/09/2015 Isolation

QAH HospitalPortsmouth Hospitals NHS Trust Clostridium difficile Infection 72 hours after admission 12 month rolling total

QAH HospitalPortsmouth Hospitals NHS Trust S Suspect that a case may be infective where there is no clear alternative cause for diarrhoea I Isolate the patient immediately and consult with the infection prevention team (IPT) while determining the cause of the diarrhoea G Gloves and aprons must be used for all contacts with the patient and their environment, with chlorine cleaning of all equipment and touch points H Hand washing with soap and water should be carried out before and after each contact with the patient and the patient’s environment T Test the stool for toxin, by sending a liquid specimen immediately

QAH HospitalPortsmouth Hospitals NHS Trust

QAH HospitalPortsmouth Hospitals NHS Trust

QAH HospitalPortsmouth Hospitals NHS TrustPage 1204/09/2015 Removing the Means of Transmission

QAH HospitalPortsmouth Hospitals NHS Trust Cleaning

QAH HospitalPortsmouth Hospitals NHS TrustPage 1404/09/2015Page 1404/09/2015 Identify the good & poor practice with this device No insertion time or date No extension set or swanlock Insertion site is exposed for inspection Blood in the hub Dressing completely covers device

QAH HospitalPortsmouth Hospitals NHS Trust Influenza (A/H1N1 & B) 3 days post influenza 7 days post influenza

QAH HospitalPortsmouth Hospitals NHS TrustPage 1604/09/2015 Infectious Agent Susceptible Host Portal of EntryPortal of Exit Reservoirs Means of Transmission

QAH HospitalPortsmouth Hospitals NHS TrustPage 1704/09/2015 Infectious Agent Susceptible Host Portal of EntryPortal of Exit Reservoirs Means of Transmission Bacteria Fungi Viruses Prions Respiratory Genitourinary Vascular Gastrointestinal Skin Mucous membranes People Water & solutions Instruments & equipment Soil & air Direct contact Inhalation (airborne, droplet) Ingestion Innoculation Broken skin Puncture wound (IV lines etc) Surgical Site Mucous membranes Devices eg urinary catheters Patients Service providers Ancillary staff Community members

QAH HospitalPortsmouth Hospitals NHS TrustPage 1804/09/2015 Cleaning & Decontamination  Actichlor plus – infected cleaning 1.7G tablet disssolved in 1 litre cold water  Neutralising spillages (blood) - 10 tablets dissolved as above (2 minute contact time)  Sani-cloths - general cleaning

QAH HospitalPortsmouth Hospitals NHS TrustPage 1904/09/2015 Suspected Outbreak Management  2 or more patients with unexplained D or V  Rapid identification, isolation and cleaning prevents infection  Take immediate action