INFECTION PREVENTION AND CONTROL - 10th Jun 2021 - Berkshire ...

INFECTION PREVENTION AND CONTROL
          10th Jun 2021

Speakers

Jintana Loss ‐ IPC Lead BW CCG
 Restarting spirometry
 HCAIs
 COVID update
Melanie Spencer ‐ IPC nurse BHFT
 Every action counts‐ Courageous Conversation in IPC
Liz Halley ‐ Wound care Nurse BW CCG
 Wound care – Pseudomonas
Nigel 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 QOF
Managing 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 illnesses
33% 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

      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

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

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/990923/2021
0602_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?Ale
rtID=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