INFECTION PREVENTION AND CONTROL

10th Jun 2021 

Speakers 

Jintana Loss ‐ IPC Lead BW CCG  Restarting spirometry HCAIs COVID updateMelanie Spencer ‐ IPC nurse BHFT Every action counts‐ Courageous Conversation in IPC  Liz Halley ‐ Wound care Nurse BW CCG Wound care – PseudomonasNigel Olsen  PN – South Reading & Shinfield  GP Dashboard – IPC audit 

Valerie Benham – BW CCG ‐ minutes

ACTION TRACKER

Electronic audit tool‐ Dashboard Completed  IPC audits (quarterly)‐ ongoing IPC policy‐ to be approved at QC next week IPC education‐ ongoing/ BOB IPC Survey – no feedback received 

Restoration of Spirometry 

Purpose Confirmation of diagnosis  e.g. suspected COPD as part of QOFManaging the backlog patients How to tackle the waiting list, prioritise groups (impact on treatment, confirm Dx, routine spirometry‐not QOF)

Who should perform the spirometry  Trained Practice Nurse who is certified/registered and competent with ARTP 

Practice or PCNs delivery ?

Spirometry is NOT an AGP but spirometry associated cough has potential to generate aerosol droplets

Airborne particle transmission from Spirometry

Coughing 

Data (2021)51% of patients with various chronic respiratory illnesses33% of patients with no history of coughing

Royal Brompton Hospital – 50% of patients coughing post spirometry  

Research – see page 14  on the guideline https://www.brit‐thoracic.org.uk/document‐library/quality‐improvement/covid‐19/restarting‐spirometry/

Contraindications

People should not undergo a spirometry test if they: Have chest pain or have recently had a heart attack

or stroke Have a collapsed lung (pneumothorax) Had recent eye surgery (deep breathing increases eye

pressure) Had recent abdominal or chest surgery Have an aneurysm in the chest, abdomen, or brain Have tuberculosis (TB) Have a respiratory infection, such as a cold or the flu

Restoration of Spirometry  (Cont.)

Risks/Mitigations ( of airborne particle transmission) Risk reduction: LFT, vaccination, Triage, Covid measures Use a single use antibacterial /antiviral filter Spirometer must be cleaned between patient  (outer casing of the transducer/outer part  of the spirometer itself)

PPE – Gloves, apron , visor/goggles, type IIR surgical mask (FFP2/3 is not required)

Cleaning : room/ equipment Ventilation : 6 ACH  (or good ventilation‐windows/doors/, extraction fan, HEPA fan, car park/drive through)

Perspex screen between patient/staff (or no face‐ face position) Gap between each patient ?

How to reduce Cough ?

To undertake a relaxed or slow vital capacity manoeuvre followed by a 1‐2 second expiratory manoeuvre to obtain the forced expiratory volume in one second (FEV1).

Patients are pre‐counselled about what actions to take if they need to cough‐stay on the mouthpiece / testing device if possible and cough in to the bacterial/viral filter

If need to come off the device to cough‐ wear a surgical mask them lower it to the chin to allow capture of any airborne particles on coughing. Alternatively, use of a face shield that is lifted during the manoeuvre or to use adapted screens to undertake these procedures

HCAIs UPDATE April‐June 2021

C.Diff Concerns: Antibiotic use, long term PPIs use, Laxative meds, Anti motility meds.GNBSI ConcernsCAUTI, antibiotic use, cannula site, wound infection, sepsis, LRTI

Data 2019-2020 2020-2021 2021-2022

C.diff 102 100 (58 target) 16 (57 target)

E.coli 372 341 58

MRSA 5 5 (0 target) 0 (0 target)

MSSA 106 122 16

Klebsiella spp 75 94 20

Example: CDI‐ RCA

ID 1072572 10/03/21  COCA, ID 1081635 12/04/21  COHA, ID 1089584 12/05/21  COCA PMH : Diverticular disease never had a flare ‐ no antibiotic treatment 

required.  UTI in December and was treated with Fosfomycin Diarrhoea on 09/03/21 (x 5 per day) – Imodium PO, stool sample sent on 

10/03/21 11/03/21 admitted to RBH : watery diarrhoea ‐CDI confirmed on 12/03/21 Rx 

Fidaxomicin 200mg BD x 10days (started?)  D/C 21/03/21 Hydroxycarbamide taken once the diarrhoea has stopped – (chemotherapy 

medication given by RBH for Thrombocythaemia) 12/04/21 mucus in stool, no blood no other symptoms – stool sample sent  

and CDI detected, Rx Fidaxomicin  16/04/21 ? UTI ‐ frequency/urgency  (urine MC&S showed E.coli) Rx 

Fosfomycin 12/05/21  many BO over the night, stool sample sent ‐ recurrent CDI, no 

treatment required

Summary: CDI

Is the advice given to the patient to take Imodium on the first CDI appropriate?

Was UTI treatment appropriate? knowing patient just had CDI?

Is the stool sample collection for the 2nd episode appropriate ( mucus in stool 3-4 time per day, no blood or other symptoms – Patient had Diverticular Disease)

Lesson learned ?

COVID update

Quarantine Hotels 

Arrival – negative COVID 72 hrs, testing day 2, 8 – isolation 10 days

Serge Testing 

https://www.getreading.co.uk/news/reading‐berkshire‐news/live‐reading‐wokingham‐surge‐testing‐20755571

West Berkshire Council has confirmed it will not be carrying out surge testing in the area

COVID outbreak – RBH – Paeds/Security team 

COVID outbreak ‐ Schools

COVID vaccinations – Pop up buses, PCNs, mass vaccination centres

Vaccination Data (Berkshire West)

https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-vaccinations/

Vaccination Data (By Region of Residence)

Variants: distribution of cases data (2)

The VOC‐21JAN‐02 variant was first detected in Japan in travellers from Brazil in January 2021 and was first detected in the UK in February 2021.

The VUI‐21FEB‐01 variant was first detected in the UK in December 2020.

The VOC‐21FEB‐02 variant was first detected in the UK in December 2020.

The VUI‐21FEB‐03 variant was first detected in the UK in December 2020.

The VUI‐21FEB‐04 variant was first detected in the UK (England).

The VUI‐21MAR‐02 variant was first detected in the Philippines.

The VUI‐21APR‐01 variant was first detected in India.

The VOC‐21APR‐02 variant was first detected in India.

The VUI‐21APR‐03 variant was first detected in India.

The VUI‐21MAY‐01 variant’s location of first detection is to be confirmed.

Nepal variant – Under investigation ‐ ? Portugal has been removed from the Green list

IPC/COVID guideline

Covid Testing https://www.england.nhs.uk/coronavirus/wp-

content/uploads/sites/52/2020/12/C0957-primary-care-lateral-flow-test-sop-v2.pdf

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/12/C0964-lft-in-primary-care-faqs-v2-jan-2021.pdf

IPC/COVID guideline dated 1st of June 2021

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/990923/20210602_Infection_Prevention_and_Control_Guidance_for_maintaining_services_with_H_and_C_settings__1_.pdf

Roadmap out of lockdown

Step 4 ‐ not before 21 June‐ to remove all legal limits on social contact 

The Government plans to delay  the June 21 unlocking, Matt Hancock indicated (06/06/21) that the date for the next step in the roadmap could be put back

https://www.gov.uk/government/publications/covid‐19‐response‐spring‐2021/covid‐19‐response‐spring‐2021‐summary

PPE and heat: risk of heat stress

CMO Messaging ‐ Personal protective equipment and heat: risk of heat stress Wearing personal protective equipment (PPE) in warm/hot environments 

increases the risk of heat stress. This occurs when the body is unable to cool itself enough to maintain a healthy temperature. Heat stress can cause heat exhaustion and lead to heat stroke if the person is unable to cool down.

Measures to control the temperature of clinical environments and enable staff to make behavioural adaptations to stay cool and well hydrated should be made. Staff may require more frequent breaks and the frequency of PPE changes may increase, with a resulting increase in demand.

Further information and actions are available on the CAS website

https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103156

Risk of heat stress : Staff & Patient

IPC CAMPAIGN /TRAINING

Global IPC campaign 5‐21/03/21       Nutrition and hydration week (moved to 14‐20 June 2021 due to the pandemic)

05/05/201        World hand hygiene day  13/09/21           Sepsis day 14‐20/10/21     IPC week 15/10/2021      Global handwashing day 11/ 21                Antimicrobial Awareness Week 01/12/21           World HIV day

Wound Care

By Liz Halley

IPC Audit Tool

By Nigel Olsen

Every Action Counts

Courageous Conversation in IPC

By Melanie Spencer

AOBs

Questions ? Next meeting 09/09/21 Thursday