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Doctors induction 2012. Infection Control and Antibiotic Prescribing Dr A. Keith Morris. Overview. Transmission Based Precautions Peripheral Vascular Catheter (PVC) C. Difficile Hand decontamination Death certification Communication OHSAS & needle stick injuries MRSA screening

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doctors induction 2012

Doctors induction 2012

Infection Control and Antibiotic Prescribing

Dr A. Keith Morris

overview
Overview

Transmission Based Precautions

Peripheral Vascular Catheter (PVC)

C. Difficile

Hand decontamination

Death certification

Communication

OHSAS & needle stick injuries

MRSA screening

Antibiotic prescribing

what is nhs fife doing to prevent hai
What is NHS Fife doing to prevent HAI?

NHS Fife is doing alot and you are expected to do your part

  • Process will be different in Fife
  • Infection Control Manual on intranet
  • Ward Boards
  • Antibiotic management
  • Protecting YOU from the patient and the patient from YOU
infection control terminology
Older terms that now should not be used

- “Universal precautions”

- “Enteric precautions”

Infection control terminology

Standard infection control precautions

Transmission based precautions

Standard precautions

transmission based precautions
Transmission based precautions
  • Supplement standard precautions.
    • specify precautions to individual patients documented/suspected of being infected or colonised with highly transmissible and/or epidemiologically important pathogens or clinical syndromes
  • Three types
      • Contact
      • Droplet
      • Airborne
transmission based precautions1
Transmission Based Precautions
  • Infection Control Manual found on the right hand side of the NHS Fife Intranet home page
  • Has all you need to know for every infectious organism you will come across but…….

If in doubt call the Infection Prevention & Control Team x28833

how good are we
How good are we?

NHS Fife has one of the lowest rates of CDI in Scotland

c difficile1
C. difficile
  • Microbiologist will contact the ward to speak to the FY1/FY2 about the case
  • You need to be able to assess the severity
  • Know which antibiotic to give depending on the severity
  • In Fife there is aCDI care pack. Consists of

-C. difficile Notification Form

-CDI Medical Management Form

-Stool chart – monitored daily

-Algorithm for the Management of CDI

what else you should be doing
What else you should be doing
  • Monitor – fluid balance and nutritional status with U&Es, albumin
  • Stop gastric acid suppressants
  • Contact precautions
  • Wash hands with soap and water
hand decontamination
Hand Decontamination
  • Hand hygiene is the most important action to prevent the spread of infection
  • Use alcohol rubs if hands socially clean
  • Hands MUST be washed after removing gloves
  • Use alcohol gel before EVERY patient contact

If patient has diarrhoea or vomiting must wash hands with soap and water

hand decontamination spsp expect
Hand decontamination –SPSP expect
  • Bear below the elbows plus removal of watches and rings with stones
  • Wet hands AND THEN apply soap to all surfaces
  • Rinse hands
  • Dry hands with paper towels
  • Dispose of paper towels with out contaminating hands
  • Switch off tap without re-contaminating your hands
cmo letter 2011 13
CMO letter (2011)13

This makes it mandatory in Scotland to inform the Infection Prevention Control Team if any of the following terms are written on either part of a death certificate

  • MRSA – inform Procurator fiscal
  • C. difficile – inform Procurator fiscal
  • Death during an outbreak – inform Procurator fiscal
  • Hospital acquired infection contributed to death
  • S, aureus bacteraemia – all SAB related deaths to be investigated and the report sent to the Procurator fiscal

If any of these criteria fulfilled discuss with the patient’s consultant before completing the MCCD

communication
Communication
  • Patients with an infectious disease or syndromes e.g. D&V, MUST NOT be transferred or sent for investigation without warning the receiving unit
  • This requires documentation on transfer letters, and investigation requests
  • Follow up results as soon as available if patient has moved elsewhere
peripheral vascular catheters pvcs
Peripheral Vascular Catheters (PVCs)
  • All PVCs to have the time & date of insertion clearly labelled on the dressing
  • Insertion sticker in the Medical notes (A&E- printed on front sheet of A&E record)
  • Maintenance sticker in the nursing notes (nurses perform this task)
  • PVC change after 72 hours
  • DO NOT take blood cultures through PVCs

Make your life easy switch to oral agents!

slide18

Ensure an Insertion Label is completed

for every venflon inserted

I feel assured!

Are you?

Date & time visible

Insertion site clearly visible

Every patient…

Every time!

Further details from ward staff

slide19

What else have I to do once I have inserted a venflon?

Venflon to be checked daily. Complete a daily check label

example

Date & time of insertion to be written on venflon dressing

Peripheral Vascular Catheter Care Bundle HPS

Cannula site:

Cannula gauge / colour:

Still in use / required Y N

Absence of inflammation / extravasation Y N

Dressing intact and dated & timed Y N

Inserted for less than 72 hours Y N

Hand hygiene before & after all PVC bundle

checks Y N

Please circle PVC removed PVC left in situ

Reason for removal:

Date: / / Time:

Complete an

Insertion Label

example

Place label in medical notes / episode of care sheet

insertion stickers
Insertion stickers
  • Collect them when you collect other items for the PVC insertion
  • Where do you find them on blood trolleys and nursing stations
  • Insert them into the medical notes after you have inserted the venflon and complete
sabs and you
SABs and you
  • All hospital acquired SAB will be investigated.
  • MRSA SAB will be investigated with a member of the senior management team present
  • SAB acquired in hospital are predominantly due to medical devices or pressure sores
  • If a SAB occurred on your patient you will have to explain any failings in the management of the PVC, pressure sores, etc.
  • Make your life easy remove PVCs, catheters and ask the nursing staff about pressure sores and broken skin.
  • All SAB related deaths to be reported to the Infection Prevention & Control office
mandatory mrsa screening in scotland
Mandatory MRSA screening in Scotland
  • All elective admissions (except obstetrics & paediatrics)
  • All emergency and elective admissions to ICU, vascular, orthopaedics and renal unit
  • Clinical Risk Assessment on all other patients
  • If answer positive to ≥1 of three questions then patient screened
ohsas
OHSAS

Know you immune status too:

  • HBV
  • Chicken pox
  • Mumps
  • Measles
  • Rubella
needle stick injuries
Needle Stick Injuries
  • What to do
  • Who to inform (line manager, OHSAS)
  • Who performs risk assessment
  • Who takes blood (patient and HCW)
  • Where to get PEP
why has antibiotic control become so important
Why has antibiotic control become so important?
  • Increasing antibiotic resistance in Fife
  • Lack of new antibiotics in the pipe line
  • C. difficile

“The age of liberal antibiotic policies is over. The time for antibiotic restriction has arrived”

Dr Keith Morris

2008

what are we trying to do in fife
What are we trying to do in Fife?

Restrict the use of certain antibiotics/antifungals with out Microbiology or ID approval

Abbreviated antibiotic guidance for common infections applicable to all in-patient areas

Making antibiotic guidance accessible

-Pocket guidance

-Ward posters

Full guidance available in the intranet

Collect data on antibiotic consumption

Provide surveillance information to wards

AMT controls antibiotic use in Fife

examples of restriction
Examples of restriction
  • The only use of ceftriaxone is meningitis
  • Ceftriaxone to be removed form drug cupboards on adult general medical & surgical wards
  • Meropenem and tigecycline
  • Temocillin
  • Linezolid
  • Voriconazole

Is it having any effect?

always think
Always think..

Does this patient really need an antibiotic?

If the patient is clinically stable with a raised WCC or temperature they do not need antibiotics?

Have a plan for what antibiotics to prescribe if patient deteriorates

If a patient has had 5 days of an empirical antibiotic and not improved they are on the incorrect antibiotic or source control has not been established

know the nhs fife
Know the NHS Fife….
  • Dress code

-For everyone in NHS Fife

  • Boards for wards

-Operational division only

healthcare environment inspectorate scotland heis
Healthcare Environment Inspectorate Scotland (HEIS)
  • A branch of SGHD
  • Inspect ALL acute hospitals in Scotland
  • Expect FY and STS doctors to know about and follow

-Dress code

-Where to find the Infection Control Manual

- National surveillance for infection prevention

-SSI surveillance for hip arthroplasty & C sections

-SABs & C. difficile

-Hand hygiene audits

-Cleaning audits

-Where to find ward results for the above

summary
Summary
  • NHS Fife will have different practice to where you have come from and where you trained e.g. C. difficile & PVCs
  • Follow NHS Fife practice not what you think is best practice
  • ALL medical devices and areas of broken skin will give rise to infection if you do not manage them. THINK ABOUT THEM
  • If in doubt ask

-I/C ext 28833

-The switchboard for “duty microbiologist”

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