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INFECTION CONTROL MATTERSPresented by: Linda Newsham

Aim of presentation

• Principles of Infection Control

• Spread of infection

• Hand hygiene

• Childhood illnesses

• Cleaning and disinfection

• Outbreak management

Principles of Infection Prevention and Control

“The general principles of Infection Prevention and Control are based on the use of

practices and procedures that prevent or reduce the likelihood of infection being

transmitted from a source to a susceptible individual.”

Methods of spread

• Airborne

• Contact: Direct

Indirect

• Ingestion

• Vectors

Airborne transmission

Droplet infection

• Inhaling droplets of moisture containing viruses, bacteria, etc, from an infected person who has coughed or sneezed.

• Touching surfaces covered by droplets (as above) or from the person’s hands and then touching our own face or eyes:– surfaces include door knobs, telephones, toys, flush

handles.

Dust and skin scales – small particles may remain airborne for some time. Larger ones can settle on horizontal surfaces.

Faecal-oral transmission

Directly from person to person

• Eating contaminated food or drinking contaminated water:– sucking fingers, thumbs, biting finger nails, smoking a

cigarette with dirty hands;– hands can become contaminated from touching pets,

farm animals, raw meat and poultry, soiled clothing, toilets etc.

Contact transmission

Direct – person to person

• By SKIN to SKIN contact:– giving care to children;– holding hands.

• By HEAD to HEAD contact:– children playing;– adults having head contact with children,

Indirect:

– via food and water;– via fomites (inanimate objects);– via the environment (contaminated secretions;

excretions, soil and dust).

Blood and body fluid transmission

• By blood or certain body fluids from an infected person, getting into the body of another person:– through cuts or damaged skin;– through mucous membranes (eyes, mouth);– by injection through the skin e.g. body piercing, tattoos,

IV drug use, blood transfusion.• Vertical transmission – mother to baby

Handwashing

Regularly throughout the day and especially at these times:-

Before:

• Preparing food

• Eating

• Providing physical care

Between

• Handling raw foods (meat, fish, poultry and eggs) and touching any other food or kitchen utensils

When should hands be washed

• Touching rubbish/waste bins

• Going to the toilet

• Changing nappies/clothing

• Caring for the sick, especially those with upset stomachs

• Coughing or sneezing

• Handling and stroking pets or farm animals

• Gardening – even if you wear gloves

• Cleaning cat litter boxes etc.

When should hands be washed

• Wet hands before applying soap as this prevents irritation.

• Rub hands together for about 15 seconds, making sure both sides of the hands are washed thoroughly: especially around the thumbs, between fingers and fingertips

• Rinse with clean water.

• Dry hands thoroughly preferably using a paper towel.

How to wash your hands

5.3

Handwashing

Palm to palm. Right palm over left dorsumand left palm over right dorsum.

Palm to palm fingers interlaced.

Backs of fingers to opposing palms with fingers interlocked.

Rotational rubbing of right thumb clasped in left palm and vice versa.

Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm

and vice versa.

1 2 3

4 5 6

Conditions

Chickenpox • Caused by a highly infectious virus -

characterised by blisters.• Droplet spread e.g. via coughing

and sneezing or by direct contact with blister fluid.

• Incubation period 13-17 days. • Infectious 4 days before onset of

rash until 5 days after appearance of first spots. May return to school after 5 days of spots appearing and when well.

• Pregnant women should seek antenatal advice – first 20 weeks and last 3 weeks.

Threadworm

• Tiny white worms that live in the bowel.• Common symptom, itching round the back passage at night (most active time) where they leave bowel and lay eggs on surrounding skin.• Spread by inadequate hand washing after using toilet. Eggs also get into carpets, bed linen, etc. • Incubation may be between 2-6 weeks.• Return to school as soon as they have received treatment.

Ringworm

• Not a worm but a fungus, characterised by circular patch of red itchy skin that increases in size.• Can occur on scalp, body, groin, hand, foot or nail.• Spread by direct or indirect contact with an infected person. May also be acquired by contact with infected animals (cats, dogs, horses).• Use separate face cloths, towels, combs, etc. Keep area well ventilated and dry.• No exclusion once treatment begun; usually antifungal tablets or cream (depending on area)

Hand, foot and mouth disease

• Caused by a virus (coxsackie virus). Usually affects children under 10yrs.• Sore throat, fever and blisters inside the mouth and throat. May have blisters on palm, fingers and soles.• Spread by close contact with discharges of nose or blisters of someone in acute phase. Can also be passed by contact with faeces.• Incubation usually 3-5 days. No treatment required.• Exclusion whilst unwell or obvious blisters.

Conjunctivitis

• Inflammation of the clear membrane that covers the white of the eye. Can be bacterial or viral cause.• Spread person to person by direct contact with infected discharge by sneezing, on hands, towels and wash cloths.• Ointments/drops required for bacterial infection (never share!).• Exclude until treated or appears normal again.

Impetigo

• A skin infection caused by certain bacteria.• Commonly affects the face, starting with redness that develops into weeping spots and then crusts. Lesions should be left open to air.• Infectious whilst spots discharging pus. Spread by direct contact with the skin and by sharing towels etc. Also carried in nose of 20-30% population and passed on by hand contact.• Exclude until spots healed or crusted over or after 24hrs antibiotic treatment.

Viral gastro-enteritis

• Caused by 2 main virus types:- norovirus;- rotavirus (mainly under fives).

• Sudden onset of vomiting and or diarrhoea.• Very infectious from spray created when ill.• Usually short-lasting = 24/48hrs.• Exclude from school until 48hours after last symptoms.• Thorough cleaning of wide area after illness episodes and isolation can reduce spread.

TB

• An infection affecting the lungs as well as other body systems and lymph glands.• Infectious only in the lung form from coughed up sputum (phlegm).• Close, prolonged contact needed to get infected.• Easily treated with cocktail of antibiotics.• Some immunity from BCG vaccination.

Scabies

• A skin infection with the scabies mite.• An allergic reaction to the mite gives a very itchy rash.• Rash can take up to 6 weeks to appear, but the person is infectious throughout this time.• All contacts need to be treated at the same time.• Itching can continue for 2-3 weeks after successful treatment.

Viral hepatitis A

• Hepatitis is an inflammation of the liver.• Hepatitis A is caught by swallowing the virus (contaminated food, water and from hands soiled with faeces).• After 6 weeks, lethargy, jaundice, nausea, pain in abdomen.• No treatment, usually full recovery.• Vaccination can protect contacts and travellers.

Viral hepatitis B

• Hepatitis B is caught by contact with infected blood or sexual fluids which get into the bloodstream.• 12 weeks later, flu-like illness, jaundice, pain and sometimes organ failure.• Some people become infectious carriers.• Can lead to chronic liver problems and cancer.• Vaccination can protect contacts and those with life-style risks.

Viral hepatitis C

• Hepatitis C is caught by contact with infected blood which gets into the blood stream.• Mild flu-like illness may develop 6-10 weeks later. Often no symptoms.• Can cause slow liver damage over many years.• Can lead to cirrhosis and liver cancer.• No vaccination available.

Measles

• Caused by a virus, rare in this country since introduction of MMR vaccine.• Fever, conjunctivitis, cough and/or spots on cheeks or inside mouth. 3-7 days later red, blotchy rash appears which lasts 4-7 days. Complications of pneumonia can occur. Incubation 7-14 days.• Spread by contact with coughing and sneezing, sometimes by dirty handkerchiefs etc.• Exclude until 5 days after onset of rash.• GP to notify to CCDC.

Mumps

• Caused by a virus.• Fever, swelling of one or more salivary glands in the neck. Adult males can develop orchitis.• Mumps virus can cause meningitis and deafness.• Passed from one person to another via droplets (sneezing, coughing) or direct contact with saliva.• Incubation normally 18 days but can be 12-25 days.• Exclude for 5 days from the onset of the swelling.• GP to notify CCDC

Rubella (german measles)

• Caused by virus which causes mild fever and a rash.• Virus can be passed to an unborn child that can cause serious birth defects.• Fever, swollen neck glands, possible conjunctivitis and fine rash.• Spread by direct contact with sneezing or coughing and contact with dirty handkerchiefs, etc.• Incubation period 16-18 days.• Exclude for 5 days from the onset of the rash.• GP to notify CCDC.

Fifth disease (slapped cheek disease)

• Caused by a virus. Usually mild.• More than half of all adults have been affected in the past and are now immune.• Red rash on cheeks, followed by lace-like rash on the body and limbs for up to 3 weeks.• Infectious before onset of rash. Mostly spread by droplets.• Return to nursery when feeling well.• Pregnant women should seek advice ASAP especially if in first 20 weeks.

Meningitis

• Meningitis is an inflammation of the brain membranes.• Caused by different bacteria, viruses and TB.• Meningococcal bacteria make toxins (poisons) which cause serious illness and sometimes death.• Spread into the bloodstream causes septicaemia and damage to blood vessels and organs.

Colds

• Although feeling unwell they can carry on with normal activities.• Useful things to do:

Keep warm

Rest

Fluids

Take things easy until symptoms subside

Influenza

• Commonly called flu, this is an infection of the airways – nose, throat, windpipe and lungs, caused by the flu virus.• 3 types: A, B, C. most outbreaks A.• Worldwide.• Incubation 1-3 days.• Infectious – 1 day before and up to 5 days after onset of symptoms.

• New vaccine every year – vulnerable individuals and age groups.• Exclusion – no recommendations but advised to stay away until well.• Complications – secondary bacterial infections such as bronchitis and pneumonia

Reduce droplets!

• Remind staff and children to cover noses and mouths with a tissue when sneezing or coughing.• Discourage nose picking!!• Provide adequate waste bins.• Encourage prompt disposal of tissues.• Hand washing after coughing or sneezing.

Raising Children’s Awareness

• Teach the importance of regular hand washing and supervise, especially after going to the toilet and before eating.• Cleaning teeth.• Wiping noses and disposing of tissues.• Covering mouths when coughing or sneezing.

Cleaning and Disinfection

• Cleaning schedules.• Storage areas.• Equipment – colour coded NPSA.• Detergent wipes.• Provide suitable hand washing facilities and ensure regular use!• Ensure disposable gloves and aprons are available for carrying out first aid.• Toys daily wipe stored in cupboard wash weekly.• Regular change of sand, water and clay etc.

Outbreaks

• Monitor normal sickness and absence and report if rates are abnormal.• Inform EHO,HPA, Community IPC Team.• Make a list of all affected individuals inc. staff with dates of onset and symptoms and send copy to EHO and IPC.• Contact EHO/IPC daily to update.• Activate enhanced cleaning procedures.• See guidance in updated policy.

For further details please contact

Linda NewshamLead Nurse Infection ControlLinda.Newsham@5bp.nhs.uk