Infection Control- Issues in the Community Dr Yimmy Chow Interim Director and Consultant in Communicable Disease Control NW London Health Protection Team, London PHE Centre Nov 2013 – London Care and Support Forum

What’s our role? We help protect the health of local people against infectious disease & non-infectious environmental hazards

1.Provide specialist advice & support - reactively & proactively - on comm dis’s, infection control & environmental hazards - to LAs, CCGs, acute hospitals, community settings, public…. - through evidenced based guidelines, protocols… 2. Undertake surveillance and analysis of trends in comm dis’s (epidemiology) 3. Manage incidents and outbreaks – infectious and chemical, biological and radiological 4.Support the development and implementation of prevention and health promotion programs 5.Act as ‘Proper Officer’ for Public Health law (receive statutory notifications) 6.Teach and Train 7.Conduct research & undertake audit

Current issues Norovirus Influenza MRSA New emerging antibiotic resistant organisms- CRO

Figure 1: All reports of IID outbreaks (suspected or confirmed) by setting, London, week to week Source: PHE HNORS & HPZone

Table 2: Reported impact of IID outbreaks in health and social care settings by Area team/PHE Centre, week 44

Links and resources 1. Links to the PHE Hospital Norovirus Outbreak Reporting Tool: and the latest national norovirus update e/Page/ ?p= Guidelines for the management of norovirus outbreaks in acute and community health and social care settings: age/ ?p=

Risk factors for MRSA Being hospitalized. MRSA remains a concern in hospitals, where it can attack those most vulnerable — older adults and people with weakened immune systems. Having an invasive medical device. Medical tubing — such as intravenous lines or urinary catheters — can provide a pathway for MRSA to travel into your body. Residing in a long term care facility. MRSA is prevalent in nursing homes. Carriers of MRSA have the ability to spread it, even if they're not sick themselves.

Monthly Counts of MRSA,MSSA, and C.diff Infections Local AuthorityCCG Name April 2013 May 2013 June 2013 July 2013 August 2013 September 2013Total MRSAWestminster Hammersmith And Fulham Westminster Central London (Westminster) London West London (K&C & Qpp) MSSAWestminster Central London (Westminster) Westminster Hammersmith And Fulham London West London (K&C & Qpp) C.diffWestminster Central London (Westminster) Westminster Hammersmith And Fulham London West London (K&C & Qpp) April 2013 May 2013 June 2013 July 2013 August 2013 September 2013Total MRSALondon England

A MRSA policy should address: Colonisation with MRSA for a healthy person is asymptomatic and does not present a risk – no need for exclusion. Patients/clients with open wounds or invasive devices are at greater risk of cross-infection. When a patient/client has been identified as colonised or infected with MRSA, infection control advice should be followed as per the “essential steps” guidance where there are shared amenities with other vulnerable patients/clients. Good hygiene practice and standard infection control precautions employed within the home will protect other patients/clients. The inter-healthcare infection control transfer forms should be used to alert other organisations about a patient’s/client’s status.

Care Plan for person with infection The following care activities should be in such a care plan: Patient treatment (e.g. administration of drugs or creams etc) Isolation (where appropriate) Hand hygiene (staff and visitors) Use of personal protective equipment (PPE) Taking of specimens Decontamination of the resident, equipment and the environment Handling of laundry Handling of waste Information for and management of visitors Safe transfer to another care facility

Available Infection Control guidance The Health and Social Care Act 2008: Code of Practice for health and adult social care on the prevention and control of infections and related guidance cyAndGuidance/DH_ Infection control guidance for care homes* cyAndGuidance/DH_ A DVD entitled ‘Introduction to Infection Control in Care homes’ was sent to all care homes by the Health protection Agency rolInCareHomes/

Outbreak and Incident Management Early reporting Accurate record keeping Use of checklists Clarity of advice and action (isolation, IC arrangements) Close monitoring Review Sharing good practice and lessons learnt

Contact details Dr Yimmy Chow Consultant in Communicable Disease Control & Interim Local Director for Health Protection North West London Health Protection Team Public Health England 61 Colindale Avenue London NW9 5EQ Tel: +44 (0) Fax:

Questions for Round table discussion Do your organisation have an Infection Control Policy? Do you know who provides infection control service in your organisation? ICT? DIPC? Who do you report to if you have a breach of infection control? How would you manage an outbreak? What is your role?