The IPCT plays an important role in creating and maintaining a safe environment for patients, visitors and staff.  Members of the team are actively involved in

• Advising clinical staff on patient’s infectious status and optimum use of the Trust’s isolation capacity to assist with the patient flow and deliver safe care.
• Advising on the management of outbreaks and periods of increased incidence (PII) of healthcare associated infections (HAI) to minimise disruption to essential services and improve patient outcomes
• Formulating infection control policies/guidelines that are evidence based and in line with the most up to date national guidance and recommendations to prevent the spread of infection
• Education of Trust staff  both formally, on induction, via mandatory training sessions, and informally on individual cases and scenarios to ensure staff are up to date with safe working practice
• Monitoring infection rates, practices and standards of patient care and their environment via audit and clinical ward rounds to maintain consistently high standards
• Surveillance  to monitor trends including MRSA, C. difficile, bacteraemia, septicaemia, viruses and all other healthcare associated infections.
• Ensuring the Trust complies with health building regulations by being involved with capital projects and building refurbishment works
• Supporting Health4Work initiatives to ensure staff are protected whilst at work
• Supporting trials when new items of equipment or products are being considered for use in the Trust
• Providing information leaflets for patients, relatives and carers regarding infections that they may come into contact with
• Training of Trust staff in competencies for cannulation, venepuncture, line care and IV drug therapy
• Monitoring Trust-wide compliance with the Sepsis NICE guidelines and acting upon sub-optimal practice

Complete a Diarrhoea and\or Vomiting Risk Assessment Form   

Think about SIGHT and follow the algorithm which will help you make the decision as to whether you need to send a stool or vomit sample.

File a copy of the completed Diarrhoea and/or Vomiting Risk Assessment Form in the patient notes.

Stool samples can still be sent if:

• mixed with urine
• can be scraped from a sheet, pad, floor etc
• the sample does not fill the pot (minimum 5ml required for testing)
• melaena (dark tar coloured).
• Bowel mucus can be tested

Remember:

• send samples to the laboratory for testing promptly
• isolate the patient (within 2 hours) and whilst awaiting the results
• if result is negative, send a resample if diarrhoea is ongoing ≥72 hours
• do not overfill the sample pot.

Extended Spectrum Beta Lactamase (ESBL) producing coliforms and AmpC beta-lactamases

ESBLs and AmpCs are enzymes that can be produced by coliforms making them resistant to almost all β lactam antibiotics including co-amoxiclav, piperacillin/tazobactam (Tazocin) and cephalosporins e.g., cefuroxime, cefotaxime and ceftazidime - which are widely used antibiotics in many hospitals.

Read more Appendix G - Extended Spectrum Beta Lactamase (ESBL) producing coliforms and AmpC beta-lactamases

DEFINITIONS

Classical Scabies: caused by a low burden of mites (5–15), with the rash typically located in an acral distribution (peripheral body parts like hands and feet).

Crusted Scabies: caused by hyper infestation of millions of mites, which leads to hyperkeratosis characterised by plaques and extensive scale, and in severe cases, deep fissures may develop. In contrast to classical scabies, crusted scabies may not be itchy.

Read more about Scabies Information for Staff

MRSA is the abbreviation for Meticillin Resistant Staphylococcus aureus – an organism generally found in the nose or on the skin of a small percentage of the population which is resistant to a lot of commonly used antibiotics

Management of high-risk patients requiring screening on admission

Any patient identified that requires MRSA screening must be isolated into a single room upon admission if clinically safe to do so and a full screen for MRSA obtained. In the event that isolation facilities are not available, guidance must be obtained from the Infection Prevention and Control Team, Director of Infection Prevention and Control or Consultant Microbiologist.

High risk patients are defined below:

• all patients previously identified as colonised or infected by MRSA

• those who have recently (within the last 12 months) been an inpatient in hospitals either abroad or in the UK

• healthcare workers

• those who are residing in other healthcare facilities for example residential/ nursing homes.

Sites to sample are:

USE BLUE TRANS SWAB (ROUTINE)

• the anterior nares (nose)

• the groin (or perineum)

plus:

• any wounds/lesions/skin breaks

• a catheter specimen of urine (CSU) if a urinary catheter is present

• any device entry sites when the dressing change is due (it is not recommended to disturb a sterile dressing unnecessarily in order to swab)

• Sputum (depending on clinical presentation)

It is not necessary to swab the axilla. Wounds/lesions/skin breaks should be swabbed individually, and the site labelled, including all surgical wounds, leg ulcers, pressure sores, trauma wounds, supra-pubic catheter sites, peg sites, and any other skin break such as eczema, dermatitis and psoriasis.

MRSA Care Plan 2024

MRSA Decolonisation therapy 

Click here  HHFT MRSA Policy for more info.

Carbapenemase-producing Enterobacterales (CPE) - a group of bacteria capable of
producing carbapenemase.

Enterobacterales are a large family of bacteria that usually live harmlessly in the gut of all humans and animals but, in the wrong place, can cause serious infections.
Carbapenems are a valuable family of antibiotics normally reserved for serious infections. They include Meropenem, Ertapenem, Imipenem and Doripenem. Carbapenemases are enzymes that destroy carbapenem antibiotics, conferring resistance.

Is the patient previously identified/tagged as CPE positive OR in the past 12 months, has the patient been:

• admitted to any hospital in the UK or abroad?
• Regularly attending for hospital treatments (within any healthcare setting, including HHFT) e.g. cystic fibrosis, haemodialysis or receiving cancer chemotherapy?

If yes:

Isolate as High-Risk priority

Screen for CPE

• Rectal Swab (blue top trans swab) or stool specimen
• Sputum (if productive cough)
• Wound (if any on admission)
• Drainage fluid (if drain in-situ)
• CSU (if catheterised)
• Any device related site 

For more info about Admission risk assessment and screening for CPE, click here HHFT CPE Policy

Candidozyma auris (formerly Candida auris) is an emerging fungal pathogen – a yeast species first isolated from the external ear of a patient in Japan in 2009. Of significance, it is commonly resistant to the first-line antifungal, fluconazole and can develop resistance to other classes of anti-fungal agents

Patient must be isolated with strict contact standard precautions and screened as per screening regime, if YES to any of the following below:

1. Has the patient had an inpatient admission within the last 12 months to a hospital abroad? (If there are any UK hospitals of concern, the IPC team will contact wards to request patient screening for C. auris.)

2. Is the patient known to be colonised with C. auris (on this admission or from a previous admission)? – check for C. auris tag

3. Is the patient known to have had contact with patients colonised with C. auris? -  check for C. auris contact tag

Have a full screen taken on admission and then a further 2 more screens taken 48 hours apart until three sets of screens have been taken. 

A blue top Microbiology swab should be used to take samples from the necessary sites.

Mandatory sites for screening:

Groin swab

Axilla swab

Nose swab

Additional sites for screening  - if present or previously positive:

Wound swab including any dry wounds – if present/ visible

Sputum, if productive, OR Endotracheal Tube (ET) secretions if present

Catheter specimen of urine (CSU) – if patient is catheterised

Drain fluid – if any drains are present

Cannula entry sites – if present

Any other medical device

Refer to Guidance for the Management of Patients with and Patients at high risk of having Candida auris

Refer to Animals and Pets in Healthcare Settings

Print and fill-up Animals visiting healthcare settings form

Prohibited healthcare areas

Assistance animals, ‘Pets as Therapy’ animals and domestic animals will not be allowed to enter specific clinical areas, listed below. This is due to the high-risk nature of the patient groups of these areas or the procedures which the rooms are designated for.

Animals must not:

• be allowed into anaesthetic or theatre rooms or anywhere in the theatre suite.

• be allowed into the Intensive Care Unit.

• be allowed into the Neonatal Unit.

• be allowed within the Endoscopy Suite.

• be allowed into any clinical procedure rooms.

• be allowed into the Labour Suite except in very exceptional circumstances.

• be allowed on patient beds.

• enter areas where there is known infection or query infection.

Creating a safe space to care for our patients and ensuring safety for our colleagues, volunteers, contractors, visitors and members of the public is a priority for the Trust. When installing any decoration,  artwork, or fixtures the spread of fire and infections must be considered.

This guidance applies in all HHFT Buildings and Occupancies.

• Decorations are not permitted in patient bays or side rooms e.g. they can be in the ward corridors, receptions, waiting rooms etc. High risk areas should only have decorations around the nurse’s station.
• Only artificial Christmas trees and garlands are permitted indoors; natural trees dry out, drop their needles and become combustible and can harbour mould and spores as well as bugs and insects. Do not place a Christmas tree of any type in front of a direct heat source.
• No edible displays or products are permitted. No Trust products to be utilised e.g. gloves, plastic cups, bedpans.
• All decorations in patient areas must be able to be cleaned with Clinell wipes. Paper decorations, tinsel, hanging cobweb, cotton wool, crêpe paper, polystyrene, flammable sprays, or similar materials cannot be used in any setting.
• Consideration to be given for decorations presenting a choke hazard. All decorations must be disposed of if the ward has an outbreak of infection or are in a Period of Increased Incidence
• Do not block access to fire extinguishers, fire exits, escape ways, or cover direction exit signage for example with a Christmas tree, display or festive decorations.
• Never hang or tie decorations or cards to lighting fixtures, especially those from the ceiling.
• Do not drape any electrical items with decorations including paper decorations e.g., blocking air vents of computers or computer screens.
• The only plug-in Christmas tree and festive lighting permissible is the LED type, the plug must be one that is recommended and supplied with the lighting. Battery operated LED lights are preferrable.
• All electrical items used must have a British or European kite mark and be purchased from a reputable retailer. Electrical items must be checked prior to every switch-on by the user for obvious signs of damage. If any damage is found DO NOT USE, remove and correctly dispose. Unless brand new any electrical plug-in trees/lighting should be subject to a PAT electrical test
• All electrical items must be switched off at the end of every workday, and inpatient areas during the patient sleep hours.
• Never use real candles or tealights, these are not permitted in HHFT buildings or controlled areas.
• Artificial Christmas trees and all other decorations will need to be cleaned at the end of the season if they are being stored for another year. Decorations must not be stored in Linen rooms.
• All outdoor decorations must only be put up by the Estates team.