Infection Prevention and Control
We aim to promote the health and wellbeing of our
patients and staff by monitoring, preventing and controlling of
healthcare associated infection.
We are committed to reducing the risk of infection to our
patients and to tackling healthcare associated infections,
including MRSA and C. Difficile. This remains one of our highest
priorities.
In order to do this, we have specific policies and procedures in
place to ensure all of our employees maintain the highest
standards.
Cancer Patients and Infections
Many of the treatments given to cancer patients suppress their
immune system and make them more vulnerable to picking up
infections. We make every effort to reduce the risks to patients
and prevent them from developing infections while they are at The
Christie.
To prevent infections, we use two types of isolation:
We use this for some patients who have an infection. We nurse
these patients in a single room with en suite bathroom and toilet
facilities to help prevent the spread of those infections to other
patients.
Other patients are nursed in single rooms to protect them, as
some cancers and their treatments can destroy their immune systems,
stopping them from producing white blood cells that fight
infection.
Infection update
We aim to promote the health and wellbeing of our patients and
staff by monitoring, preventing and controlling of healthcare
associated infection.
MRSAOpen
MRSA stands for meticillin resistant
Staphylococcus aureus. Staphylococcus aureus is a bacterium or germ
found in about a third of the population, especially in the nose
and throat and on the skin. MRSA is a variety of this germ that is
resistant to a type of penicillin called meticillin and some other
antibiotics that are commonly used to treat infections.
Screening for MRSA
Healthcare associated infections are a national concern and
reporting to the Department of Health of all patients with an MRSA
bloodstream infection is mandatory.
Screening patients for MRSA helps us to identify those patients
who are colonised so we can manage their care more appropriately.
This is done by obtaining a swab from the nose, throat and
sometimes other skin sites. Patients found to be colonised are then
given a bodywash and nasal ointment to help to decolonise the
organism from the patients. All patients who are due elective
admission to the trust either overnight or for longer will be
screened on admission to identify whether they are colonised with
MRSA. Any patient undergoing an invasive intervention as a day case
e.g. insertion of a central line, will be screened in advance and
commenced on decolonisation treatment to help reduce the risk of
infection.
If you do have MRSA you will be cared for in a single room both
as an outpatient and as an inpatient. If you are an outpatient
please tell the clinic nurse about your MRSA.
From April 2007 - March 2008 there were 8 cases of MRSA
bloodstream infection, and since then there has been a 50%
reduction year on year. The last case of an MRSA bloodstream
infection was in October 2009.
Clostridium difficileOpen
C difficile infection is the most important cause
of healthcare associated diarrhoea. C difficile is a micro-organism
that is present in the gut of up to 3% of healthy adults and 66% of
infants. However, C difficile rarely causes problems in children or
healthy adults, as it is kept in check by the normal bacteria
population (flora) of the gut. Some drugs can alter the natural
flora of the gut and if C difficile is present the organism may
produce toxins causing mild to severe diarrhoea and occasionally
severe inflammation of the bowel.
The elderly are at greatest risk with over 80% of C difficile
infections reported in people over 65 years. However, people with
serious underlying illnesses such as cancer are also at risk.
C difficile infection is usually spread on the hands of
healthcare staff and other people who come into contact with
infected patients or with environmental surfaces (e.g. floors,
bedpans, toilets) contaminated with the bacteria or its spores.
Spores are very hardy and can survive in the environment on
surfaces for long periods. At The Christie we clean every day with
mild bleach that can remove the spores.
If you do have C difficile and you have diarrhoea you will be
cared for in a single room. If you are an outpatient and you are
having diarrhoea at home, please tell the clinic nurse.
Healthcare associated infectionOpen
HCAI are infections that are acquired as a result
of healthcare interventions and can occur in hospitals and in
health or social care settings in the community.
People routinely carry a variety of micro-organisms on their
skin and are said to be 'colonised'. These do not cause any harm
unless they enter the body via a break in the skin such as through
a wound or a surgical device eg a cannula and cause an
infection.
Some of these organisms can enter the blood stream and cause
what is called a 'bacteraemia' which can be a significant problem
for the patient.
The measures we take to prevent the spread of HCAI will also
reduce the spread of other infections.
Education
All staff receive education when they start working at The
Christie in the prevention and control of infections. This
education is repeated every year and focuses on the vital part
played by hand hygiene and stresses the need for a clean safe
environment.
The infection prevention and control team also provide extra
sessions to those staff where attendance is difficult and bespoke
sessions to staff when there are major changes in the current
available guidance.
Clean environment
The trust is committed to providing a clean and safe environment
to help prevent and control infections.
All staff are responsible for ensuring that the environment is
kept clean, tidy and safe and to support this we employ trained
staff to clean both within our ward areas and all other areas of
the hospital.
The trust complies with the national cleaning standards and
every ward displays the 'cleaning frequencies' that you can expect
to be in place. If you are unable to find them, please ask a member
of staff.
A team consisting of an infection prevention and control nurse,
domestic services manager, ward manager and member of our estates
team undertake an environmental inspection of every clinical
department within the trust on a quarterly basis. These inspections
are undertaken to monitor standards of cleanliness and maintenance
issues and identify any problems that need to be attended to.
The matrons review their clinical areas on a daily basis. If you
experience any problems with cleaning or maintenance while you are
here, please do not hesitate to speak to a member of staff.
Other infectionsOpen
The measures we take to reduce infections such as
MRSA and C difficile will also reduce the risk of other organisms
causing infection in our patients. There are many different
organisms that we may encounter, and here are some examples:
Bacteria
Bacteria are the most common cause of infections in people with
cancer. Types of bacteria that cause infection include:
- Staphylococcus - mainly affect the skin. Infections are usually
treated with standard antibiotics but MRSA is a form of
Staphylococcus that is more difficult to treat as it is resistant
to standard treatments.
- Streptococcus - commonly cause tonsillitis and skin infections
such as cellulitis
- Escherichia coli - commonly live in the gut and can cause
fever, bladder and blood stream infections
Viruses
Viruses are very small organisms that need to infect a living
cell within a human body to cause infections
Here are some common types of viruses that cause infections in
people with cancer:
- Influenza - A and B
- Common cold viruses
- Herpes simplex - causes cold sores and genital herpes
- Varicella zoster - causes Chicken pox in early life and later
in life, this may recur as shingles
Fungal infections
Fungi can live in our bodies without causing any problems,
however, for cancer patients with a weakened immune system, a
fungal infection can be more serious. The most common fungal
infection in people with cancer is Candida, often called
'thrush'.
Patients who are severely immune suppressed such as those
undergoing bone marrow transplant are at risk of infection with
less common fungi such as aspergillosis. Aspergillus can cause a
serious chest infection that needs treatment with anti-fungal drugs
through a drip.
What you can do to prevent and control infections
- Hand hygiene - Washing your hands is the most
important thing you can do to prevent the spread of germs. Most of
the germs you pick up will be picked up on your hands. If you then
touch your face or other part of your body, or another person then
the germs will be passed on.
- Staff hand hygiene - it's ok to ask - Staff
who are caring for you must always clean their hands before and
after they have any contact with you. All staff are educated about
the importance of hand hygiene and if you do not see a member of
staff cleaning their hands and they are about to make contact with
you, please ask them to do so.
- Personal hygiene - Daily washing or showering
is important to help reduce the number of bacteria on your skin
especially if you have a central line or other medical device
permanently in place.
- Keep your bed area clutter free -To enable our
domestic staff to clean properly it is important that the wards and
other areas are kept tidy. Please try to keep your personal
belongings to a minimum and the area around your bed free of
clutter. If you are unable to do this for yourself the nurses will
help.
- Signs of infection - Tell us if you have any
signs of infection such as a high temperature, redness or swelling
around a wound site or if you are having any diarrhoea.
- Flowers - The Christie NHS Foundation Trust
does not ban flowers but we would like to remind our patients and
visitors that having flowers within the clinical environment is not
conducive to effective cleaning as they can add to/create clutter.
Many of our patients have electronic medical devices at the bedside
and there is a small risk of water being splashed or spilled onto
these devices. It is much nicer, and safer, to be surrounded
by beautiful flowers in the comfort of your own home when
discharged.
Visitors
Visitors are very welcome, but there are some things we would
ask you to consider. Please do not visit if you think you have an
infection as all our patients are vulnerable. Some units, such as
the HTU, have particular restrictions for visitors because of the
risk of infection. The staff on the individual wards or units will
discuss these with you.
Infection prevention and control team
The Christie has a specialist infection prevention and control
team (IPCT) that consists of:
- A director of infection prevention and control (DIPC)
- An infection control doctor
- A lead nurse for infection prevention and control
- Two infection prevention and control nurses
- Administrative support
The team provides advice to all staff regarding the management
of patients with communicable infections. They give advice about
the isolation of patients and other protective measures that may be
necessary.
The team also:
- Develops policies and procedures based on national guidance and
supporting evidence designed to prevent and control infections
- Provides training and education for all staff across the trust
about infection prevention and control measures
- Is a point of reference for expert advice on all aspects
related to the prevention and control of infections
- Along with domestic service colleagues and matrons, monitor
standards of cleanliness across the trust
- Provides advice in relation to new buildings and refurbishments
to ensure facilities promote infection prevention and control
- Monitors and uses an early warning system to identify, prevent
and control outbreaks of infection
Nursing Awards 2010
The infection prevention and control nurses were finalists in
the infection control category of the Nursing Times awards and
attended a lavish event at the Hilton hotel in London in November
2010.
The infection control nurses led the seasonal and swine flu
vaccination programme at the trust during the influenza pandemic in
the Winter of 2009/10. This involved much planning and coordination
of all members of staff across the trust, maintaining a high
profile campaign and ensuring that all staff knew about the
benefits of vaccination.
The programme had to be flexible enough to adapt to the swiftly
changing situation as more information became available from the
Department of Health.
The programme far exceeded the national target of 50% staff
uptake of vaccine and the Trust was ranked in the top 10% for
vaccine uptake nationally. This provided considerable benefits to
patients, staff and the Trust.
