5. Infection Control

The session schedule is as follows:

The learning outcomes are examination of infection control and any issues that are specifically relevant to health care workers:

The goals and outcomes of the session are:

The participants will be able to state they have an increased/renewed awareness of infection control

The participants will be able to state they are aware of their role and the roles of others in relation to infection control

The participants will be able to state that due to their increased/renewed awareness of infection control their nursing and caring practice will take account of the principles of infection control included in this training session.

The content of the session includes:

Introduction to the Infection Control Training Session
Infection - principles and practice
Infection control in the hospital setting
Hospital-acquired infection
The cost of hospital-acquired infection
Epidemiology
Types of hospital-acquired infection
Legislation and expert guidance
Framework for infection control management
Basic microbiology
Micro-organisms
Bacteria
Bacterial toxins
Bacterial multiplication
Growth requirements of bacteria
Destruction of bacteria in the environment
Chlamydiae, Rickettsiae and Mycoplasmas
Viruses
Prions
Fungi
Protozoa
Helminths
Ectoparasites
Resident and transient micro-organisms
Infection and disease
Pathogenicity
The chain of infection
Patient susceptibility
Sources of infection
Contact transmission
Droplet and air-borne transmission
Blood and blood contaminated body fluid transmission
Faecal-oral transmission
Vectors
Risk assessment
Risk management in infection control
Assessing risks
Planning management
Principles of infection control
Standard precautions
Hand hygiene (including naked below elbow)
Protective clothing - gloves
Management of sharps
Decontamination and re-processing of equipment
Environmental cleaning
Spillages
Waste management
Linen
Specimens
Staff health
Isolation
Contact precautions
Respiratory precautions
Enteric precautions
Food hygiene in the ward kitchen
Aseptic technique
Care of intravenous devices
Indwelling urinary catheters
Surveillance and audit
Case studies

MRSA:

Osmosis Training has updated the infection control session with the following content. We contain the information here as previous inspectors have asked for specific information concerning MRSA and C.diff.

Methicillin resistant Staphylococcus aureus is the full name for MRSA (sometimes referred to as the 'superbug').

It belongs to the Staphylococcus aureus family, which is a very common cause of bacterial infections, such as boils, carbuncles, infected wounds, deep abscesses and bloodstream infection.

Staphylococcus aureus is however generally harmless and can normally be found on human skin.

MRSA is no more infectious than other types of Staphylococcus aureus bacteria.

However, MRSA infections are more difficult to treat due to the antibiotic-resistance of the bacteria.

The number of antibiotic-resistant bacteria has increased in recent years due to:

  1. people not finishing the full course of antibiotics they have been prescribed - this allows some bacteria to survive, develop a resistance to the antibiotic, and then multiply, and
  2. 2. antibiotics being overused - this has allowed bacteria to develop resistance to a wide range of antibiotics.
MRSA was relatively uncommon through the 1960s and 1970s but the problem exploded in the mid-1990s when particular 'epidemic' strains of MRSA became established in hospitals throughout the UK.

These strains are easily transmissible (passing between and colonising both patients and hospital staff easily) and have the capacity to cause serious disease.

Those who are most at risk of MRSA include those who:

  1. have a weakened immune system, such as the elderly, newborn babies, or those with a long-term health condition such as diabetes, cancer or HIV/AIDS,
  2. have an open wound,
  3. have a catheter (a plastic tube inserted into the body to drain fluid) or an intravenous drip,
  4. have a burn or cut on their skin,
  5. have a severe skin condition such as leg ulcer or psoriasis,
  6. have recently had surgery, or
  7. have to take frequent courses of antibiotics.
About 30% of the general population are colonised by Staphylococcus aureus.

In hospitals the percentage is higher because of the increased risk of contact with infected cases.

Carriage sites are most commonly the nose and the skin, especially folds such as axilla (armpit) or groin. A carrier can be a source of infection for themselves (e.g. they can infect themselves if they have a wound).

There is no specific 'MRSA disease'. Staphylococcus aureus infects a range of tissues and body systems giving general often ambiguous symptoms.

MRSA infections can include:

  1. Asymptomatic colonisation
  2. Wound infections
  3. Superficial ulcers
  4. Intravenous line infections
  5. Deep abscesses
  6. Lung infections
  7. Bacteraemia / septicaemia
MRSA infections are diagnosed by testing blood, urine or a sample of tissue from the infected area for the presence of MRSA bacteria.

Antibiotics can still be used to treat MRSA - the infection may simply require a much higher dose over a much longer period, or the use of an antibiotic to which the bacteria is not resistant.

Most MRSA infections will require treatment in hospital and antibiotic treatment may need to continue for several weeks.

Patients colonised with MRSA bacteria do not need any treatment for illness, but as they can infect themselves or others it is important to remove the bacteria.

A special antibiotic cream can be applied to the skin or inside of the nose to remove the bacteria.

To prevent MRSA the full course of prescribed antibiotics should always be completed.

Hospital staff who come into contact with patients should maintain very high standards of hygiene and take extra care when treating patients with MRSA.

Before and after caring for any patient, hospital staff should make sure they have thoroughly washed and dried their hands.

Many hospitals now use fast-acting, special antiseptic solutions, like alcohol rubs or gels - you may find dispensers placed by patients' beds and at the entrance to clinical areas for use by staff and visitors.

Staff should wear disposable gloves when they have physical contact with open wounds, for example when changing dressings, handling needles or inserting an intravenous drip.

Clostridium difficile:

Clostridium difficile is the major cause of antibiotic - associated diarrhoea and colitis, a healthcare associated intestinal infection that mostly affects elderly patients with other underlying diseases.

The number of reports increased from less than 1,000 in the early 1990s to 44,488 in 2004.

Since January 2004, Clostridium difficile has been part of the mandatory surveillance programme for healthcare associated infections.

Clostridium difficile is a bacterium of the family Clostridium. Its usual habitat is the large intestine and is present naturally in around 3% of adults and 66% of children.

It does not cause disease in babies and infants because its toxins do not damage their immature intestinal cells.

Clostridium difficile can cause diarrhoea, ranging from a mild disturbance to a very severe illness with ulceration and bleeding from the colon (colitis) and, at worst, perforation of the intestine leading to peritonitis. It can be fatal.

Generally, it is only able to do this when the normal, healthy intestinal bacteria have been killed off by antibiotics.

When not held back by the normal bacteria, it multiplies in the intestine and produces toxins that damage the cells lining the intestine. The result is diarrhoea.

The symptoms of Clostridium difficile (C. diff) infection can include:

  1. mild to severe diarrhoea,
  2. blood stained stools,
  3. fever, and
  4. abdominal cramps.
People most vulnerable to a C. diff infection are those who:

  1. have been treated with broad spectrum antibiotics (antibiotics that can treat different types of bacteria),
  2. have had to stay for a long time in a healthcare setting, such as a hospital,
  3. are over 65 years old,
  4. have a serious underlying illness or condition,
  5. have a weakened immune system, or
  6. have had numerous enemas or gut surgery.
Most people who get a C. diff infection will get symptoms while they are taking antibiotics.

However, symptoms can appear up to 10 weeks after they have finished taking antibiotics.

C. difficile spreads by cross infection from another patient, either through direct patient to patient contact, via healthcare staff, or via a contaminated environment.

A patient who has C. difficile diarrhoea excretes large numbers of the spores in their liquid faeces.

These can contaminate the general environment around the patient and can survive for a long time.

C. difficile is diagnosed with a sample of diarrhoeal faeces which is tested for the presence of the C. difficile toxins.

C. difficile can be treated with certain antibiotics, and in some cases probiotic (good bacteria) treatments may be prescribed.

There are three important components to the prevention and control of C. difficile disease:

  1. Prudent antibiotic prescribing to reduce the use of broad spectrum antibiotics
  2. Isolation of patients with C. difficile diarrhoea and good infection control nursing:
      3. - handwashing (not relying solely on alcohol gel as this does not kill the spores)
      - wearing gloves and aprons, especially when dealing with bed pans etc
  3. Enhanced environmental cleaning and use of a chlorine containing disinfectant where there are cases of C. difficile disease to reduce environmental contamination with the spores.
The assessment of candidates takes place via an online exam.