Infections and infection control in Lourdes

1. Infections (and infection control) in Lourdes Brendan McCarron Infectious Diseases Department South Tees NHS Trust

5. Protect the patient Protect the carer

10. Standard Principlesof Infection control Need to limit spread of infection Hand washing Led/taught by nursing/medical teams Equipment Gloves Aprons Goggles Sharps disposal

12. Hand hygiene HAI cost NHS-England £1B/year and 5000 deaths Bare below the elbow, including watches Before touching a patient’s skin Before doing a sterile procedure After handling body substances Wear an apron Alcohol hand rub vs hand washing Semmelweis vs Lister

14. Thank You

15. Infection prevention Catheter Care

16. Catheter care Keep the system closed Prevent backflow Keep the catheter off the floor Daily bathing Don’t treat asymptomatic bacteriuria Long-term antibiotics have no evidence of benefit

17. MRSA and eradication Mupirocin 2% nasal ointment applied to both anterior nares three times daily for five days. Daily washes with Aquasept body-wash for five days. Hair washed with antiseptic body-wash twice in five day treatment period. Daily change of bedding, flannel, towel and personal clothing.

18. Infection prevention in children Specifics to children and Usual infections of adults Venerable and vulnerable Get sick quickly (and recover the same) Less whingy than adults More rashes Notify? and let those back home know

20. Meningococcal disease Index of suspicions Rash, cerebral irritation, neck stiffness, calf pain, fever Early antibiotics-Benzyl penicillin/ceftriaxone Prophylaxis Rifampicin Ciprofloxacin Ceftriaxoxe

23. Chickenpox MP->vesicular->pustular->crust Pregnancy, smokers and immunocompromised Chickenpox&shingles&chickenpox 5-8% of adults non-immune-15mins contact IP 14-21 days Infectious 5 (usually 1-2) days prior to rash Who have had chickenpox? To nurse Pregnant should avoid if not sure

24. VZIG For the exposed who has a condition that increases the risk of varicella infection (e.g. pregnant women, neonates, immune-suppressed individuals including those receiving high-dose corticosteroids). The exposed person is classified as non-immune on the basis of not having a previous history of varicella infection and not possessing antibodies to varicella-zoster virus. There has been significant exposure to a person with chickenpox or shingles in the previous 10 days.

29. Pregnant Should avoid (unless good history of previous infection) Measles Mumps Chickenpox/shingles Rubella HPV B19 ie Rashes Diarrhoeal illness

32. Scabies Scabies is an allergic response to the excreta of the small mite Sarcoptes scabiei, which burrows under the skin Isolate depends on capabilities and mental state. If they can be relied upon not to have skin contact (i.e. touch, hold hands, etc. with anyone), then isolation is not needed If this cannot be guaranteed then isolation is indicated until completion of the treatment, in order to prevent further cases Carers need be reminded to wear gloves

33. Scabies Typical vs Norwegian Itching esp at night distribution Fingers webs Genitals Anterior folds of axilla Excoriations

34. Scabies Rx Cool skins-not after bath Cover all skin below head for 24 hours Reapply as required eg hand washing Changing bedding clothing Repeat Rx at 7 days Treat skin-contacts

39. Pediculosis-Lice Treat if seen eg malathion 0.5% repeat at 7/7 Apron and gloves Apply solution and air dry. Wash off at 12 hrs Kills mites but not eggs Comb and repeat at 4 days No need to isolate Tie back loose hair Tactfully check others

45. Case 1st day a nine year old autistic lad has sudden onset of profuse vomiting getting ready with his helper for the trip to Gavarnie. 30 mins later he has had 4 episodes of vomiting, then appears to settle. Plan for rest of day? Gavarnie with sick bags? Child stays back with the nurse? Rotate the helpers, to give the main helper a break? Let child comes to meal with others? Treat with co-amoxyclav?

46. Gastrointestinal infections Diarrhoea 3+ stools/day Take the shape of the container Infectious or not? Bloody or not? Food history Contacts Want to prevent outbreaks Usually no antibiotics

47. Vomiting and Diarrhoea Patients should be isolated for 48 hours after end of symptoms Restrict carers Hand washing (even more than normal) Outbreaks-3 or more cases Should have daily outbreak meetings All group leaders, nursing /medical staff sharing accommodation Report up

48. Bacterial Salmonella Campylobacter Food poisoning Clostridia difficle Notifiable

50. Blood borne viruses HIV Viral hepatitis

55. BBV Transmission risk-infected on a need to know basis

56. BBV protection Universal precautions Wear gloves+/-goggles when exposed to possible infected fluids Cover up cuts Own toothbrush/razors Don’t re-sheath needles/sharps Report accidents in timely fashion

58. Conclusions Keep sensible Keep organised GPs often know best, its closer to their practice You may not always be popular, but you’ll still be right May be we can expect miracles Keep praying and have a good time AND!