A Guide to

Infection Prevention and Control For

Agency and Temporary Staff working with Patients in Community Hospitals within Shropshire Community

Health NHS Trust

Infection Prevention and Control

The leaflet outlines the standards expected of all staff working within the Trust.

If you need additional information about infection prevention and control (IPC) please contact the IPC team on: 01743 277671

1

The most common mode of transmission of micro-organisms is via our hands. Health care related infections are both costly in financial terms but more importantly costly to our patients.

All clinical staff must be Bare Below the Elbows.

Nails MUST be short, clean and free of varnish or gel/shellac; false nails are not permitted. Jewellery including wrist watches and fitness trackers; stoned rings (including wedding rings) must not be worn within the clinical area, staff are allowed to wear one plain ring.

Hands MUST be thoroughly washed using soap and water then dried:

if they are visibly contaminated

if you have been wearing Personal Protective Equipment (PPE)

If you have had contact with bodily fluids

if you have been nursing a patient with diarrhoea or known Clostridium difficile infection (CDI)

If hands are visibly clean and the criteria above are met alcohol hand gel can be used. All wounds on hands and arms should be covered with a waterproof dressing.

moments of hand hygiene must be followed at all times.

10

Notes

9

IPC Team Contact

During working hours the Infection Prevention and Control Team are available on:

Tel. 01743 277671

E-mail:

shropcom.ipcteam@nhs.net Out of hours contact the SaTH Consultant Microbiologist on 01743 261000.

Staff must ensure that they are familiar with infection prevention and control policies which are available on the Trust website: Log on to www.shropscommunityhealth.nhs.uk (staff zone)

Information Produced by: Infection Prevention and Control Team Publication Date: April 2017 Review Date: April 2020 Document ID: 2031-36878 Shropshire Community Health NHS Trust, www.shropscommunityhealth.nhs.uk

2

The steps of hand hygiene decontamination are displayed at all clinical hand wash basins. Clinical hand wash basins must only be used for hand washing i.e. not used for the disposal of patients’ washing water, drinks. flower water etc. Hand decontamination is the most important and simplest way to break the chain of infection.

To view the Hand Hygiene Policy on SCHT website please visit: http://www.shropscommunityhealth.nhs.uk/content/doclib/10384.pdf

Decontamination of Equipment

Routine daily cleaning of the patient’s room/bed area MUST be undertaken using detergent and if they have an infection such as ESBL, MRSA, GRE/VRE, C. difficile or gastrointestinal infections then Tristel should be used. Particular attention should be paid to all horizontal surfaces, beds and bed bases.

SCHT Cleaning and Disinfection Policy is available on the SCHT website via the link on the desktop of all ward computers.

Commode Cleaning:

All commodes MUST be cleaned, after each and every patient use, using Clinell Detergent wipes or Tristel Jet if used by an infectious patient.

Staff MUST wear the correct PPE (gloves and apron) when cleaning. Face protection is available and the use is risk assessed

Care should be taken to ensure all surfaces especially the underside and those the patient will touch are thoroughly cleaned

A green Decontamination Status Label must be completed and placed on the commode after it has been cleaned.

3

Personal Protective Equipment: Risk Assessment

You should risk assess your need for PPE according to the above. To view the Standard Precautions Policy on SCHT website please visit: http://www.shropscommunityhealth.nhs.uk/content/doclib/11452.pdf

Order of PPE Application

Order of PPE Removal

Gloves

Apron

Hand Hygiene

Gloves

Apron

Hand Hygiene

Eye Protection,

Face Protection

Hand Hygiene

PPE must be put on immediately before a task and removed immediately afterwards.

Hand Hygiene

Apron

Gloves

·

Hand Hygiene

Apron

Face Protection

Eye Protection

Gloves

8

Diarrhoea and/or vomiting within the last 48 hours

Staff who develop symptoms of diarrhoea and/or vomiting whilst on duty should report to their Manager and go off duty immediately. They should report to their GP if necessary. Staff should then stay off work until they have been clear for 48 hours.

Conditions which impede hand hygiene e.g. wearing of non-removable hand/arm splints

Sharps/Splash Exposure with Blood and Body Fluids

Care must be taken during the use and disposal of sharps:

Dispose of syringes and needles as a single unit

User must place sharp in the sharps bin at point of use

Re-sheathing used needles must not be performed

Use ‘safer sharps’ devices. Where this is not possible a risk assessment must be undertaken and documented

In the event of a sharp, needlestick or splash inoculation injury:

1. Encourage bleeding under running water 2. Dry and cover with a waterproof dressing 3. Bleed it, Wash it, Cover it 4. Seek help and advice from Occupational Health, or out of hours,

A&E Department 5. Notify line manager and document the incident via DATIX 6. Staff MUST be familiar with local policy which will give in-depth

details—available on SCHT website

In the event of splashing to mucous membrane or conjunctiva with blood/blood-stained fluids irrigate with copious amounts of tap water and follow steps 3-4 above.

7

Specimen Collection and Labelling

Correct container: red, blue, white top

Label container: date, time, patient details

Complete form: date and time specimen obtained not date/time when filling out the form

Single specimen per container and form

Correct transport mechanism: hospital transport/taxi/’Blood Bikes’ – red transport boxes are available in community hospitals.

Example of SCHT Microbiology Specimen Form Infections in Staff

If you are suffering from any of the following you should not work within Shropshire Community Health NHS Trust:

Chicken Pox/Shingles

Scabies (until treatment has commenced)

Flu like symptoms

4

Meticillin-Resistant Staphylococcus aureus (MRSA) If a patient has a history of MRSA and has devices in-situ and/or has a skin condition, they should be isolated until a negative screen is available. Patients who have a positive result should not be removed from isolation until they have had three negative screens which should be a week apart, the first screen must be taken on admission or 48 hours post treatment (whichever is applicable). MRSA Screening

SCHT screens all patients within 24hours of admission to the Community Hospitals. Screening should include nose, all lesions and any invasive devices including PEG sites and a CSU should be taken if the patient has a urinary catheter in-situ. Dry sites e.g. the nose: moisten the swab with sterile water not saline or tap water. A separate microbiology form must be completed for each swab/specimen to be sent.

MRSA Treatment

MRSA treatment regimens for Mupirocin Sensitive (Mup S) and Mupirocin Resistant (Mup R) MRSA can be found in the SCHT Management and Screening of MRSA Policy on the SCHT website Diarrhoea If a patient is admitted with diarrhoea or develops diarrhoea a stool sample should be sent unless there is a valid reason not to e.g. laxatives. or previous CDI positive - see overleaf. Diarrhoea is defined as 2 or more episodes within a 24 hour period and the stool conforms to the shape of the receptacle i.e. is watery or liquefied. Please refer to Patient Stool Record for Bristol Stool Chart. Document types 5 to 7 in the patient’s individual charts and notes.

PPE must be put on immediately before a task and removed immediately afterwards.

5

Diarrhoea (and vomiting) have many different causes. It is important to distinguish between infectious and non-infectious causes of diarrhoea and whether it could be associated with food or water. Some patients may regularly suffer from diarrhoea but any variation in their ‘normal’ stool pattern e.g. increased frequency is indicative of a problem. The following mnemonic protocol (SIGHT) should be used when managing suspected potentially infectious diarrhoea: If the patient is known to be C.diff. positive or is colonised/is a carrier always discuss with the IPC team, or out of hours, with Consultant Microbiologist at Shrewsbury and Telford NHS Trust on (01743) 261000 prior to sending a specimen.

Influenza

Any patient who has had a flu swab taken MUST be isolated until the result is known

If positive they will be treated and any of their high risk contacts given prophylaxis

S Suspect that a case may be infective where there is no

clear alternative cause of diarrhoea

I Isolate the patient (within 2 hours), clean vacated bed

space and consult with the IPC team while determining the

G Gloves and aprons must be used for all contacts with the

patient and the patient’s environment

H Hand washing with soap and water before and after each

contact with the patient, their environment and following

T Test faeces, by sending a specimen immediately

E Educate the patient, family and visitors

D Document actions – including when isolation is not

available

6

Staff should wear a surgical mask and apron while in contact with the patient

FFP3 Masks and gowns are to be worn for aerosol generating procedures. You must be fit tested to wear an FFP3 mask.

Gentamycin Resistant Enterococcus (GRE)/ Vancomycin Resistant Enterococcus (VRE)

Patients who are positive in clinical specimens and who are colonised with VRE, and who are experiencing diarrhoea must be source isolated.

Extended Spectrum Beta-Lactamase (ESBL)

If the patient is positive in a wound, sputum or urine they must be source isolated. Isolation Notices

For all isolation precautions an isolation notice must be placed on the door of the isolation room or bay. The door must be kept shut to prevent and minimise the risk of environmental contamination. If for any reason the door cannot be kept shut e.g. the patient is at risk of falls, then a risk assessment must be completed and this must be documented in the patient’s notes. However when there is any activity in the room e.g. bed making or cleaning the door MUST be closed. All staff including domestic staff must be aware that isolation is in progress, and be aware of the specific precautions that will need to be taken.

Red

Source Isolation

Please see nurse before entering

Blue

Protective Isolation

Please see nurse before entering