1. Supporting people in Dorset to lead healthier lives C-difficile Care Home Conference November 2014 Infection Prevention and Control Norovirus How to spot it & How to stop it Senior Infection Control Nurse Jacqui Campbell Infection Control Nurse Cheryl Maddocks

2. Supporting people in Dorset to lead healthier lives C. difficile or C. diff is short for Clostridium difficile present in small numbers in the gut of healthy people. Spores can persist on surfaces for weeks or months. can be spread by people, animals, and in water or food. Other people can become colonised if they ingest these spores Norovirus (winter vomiting bug) Is a virus spread by direct contact and can be airbourne common cause of infectious gastroenteritis (diarrhoea and vomiting or ‘tummy bug’) in England and Wales. Can be mild Can be severe and dehydrating Often sudden, projectile (vomiting and /or diarrhoea) without warning people usually recover fully within 2-3 days. What are the differences between C- diff and Norovirus?

3. Supporting people in Dorset to lead healthier lives The elderly Have spent a long time in hospital or other type of healthcare setting such as a nursing home People who have been exposed to patients with C diff /Noro People who have had C diff infection previously Are taking, or have recently finished taking, antibiotics or any other medication that may alter the normal bacteria in the gut Have a reduced resistance to infection generally; Have a serious underlying illness or have had bowel surgery Patients taking proton pump inhibitors (a type of anti-ulcer medication) Patients on nasogastric feeding Groups most at risk of developing HCA diarrhoea

4. Supporting people in Dorset to lead healthier lives The symptoms of norovirus are very distinctive : People often report a sudden onset of nausea Followed by projectile vomiting and watery diarrhoea Resolved in 2-3 days (longer in the elderly) The symptoms of C-diff are : The main symptom is explosive watery diarrhoea unpleasant ‘sweet’ smell may contain mucous or blood. Other symptoms may include stomach cramps, fever, nausea, loss of appetite As disease progresses diarrhoea may cease – increase of other symptoms – CALL THE DOCTOR! How do we recognise norovirus or C-diff ?

5. Supporting people in Dorset to lead healthier lives What do we do if we suspect C-diff/Norovirus? If a resident develops loose stools follow the Department of Health’s ‘ SIGHT ’ advice: S uspect a case may be infectious where there is no clear alternative cause for diarrhoea. I solate the patient while finding out the cause of the diarrhoea. If infection cannot be ruled ---------out continue to isolate until clear of symptoms for 48 hours. G loves and aprons must be used for all contacts with the patient and their environment. H and washing with soap and water before and after every contact with the patient and the …………patient’s environment. Alcohol gel does not work against C diff. T est the stool if not bowel care related. Inform GP, if stool test required send a liquid specimen ………..immediately see Bristol Stool Chart. Discuss with, or inform the residents GP according to local ………..policy.

6. Supporting people in Dorset to lead healthier lives The Bristol Stool Form Scale (Bristol Stool Chart)

7. Supporting people in Dorset to lead healthier lives Is it really C-diff or Norovirus? Other causes or assessment tools: bowel care medicines (Lactulose, Senna). Are they constipated, is this faecal overflow. Is this the normal bowel habit for that person? Have they got any relevant history i.e. Crohns, IBS, Colitis. Have they been prescribed any antibiotics recently new medication – e.g. omeprazole can cause diarrhoea, or constipation! How often are they having a bowel action – IMPORTANT for assessment of seriousness of disease, or risk of dehydration. Has anyone else in the home or family/visitors had diarrhoea or vomiting

8. Supporting people in Dorset to lead healthier lives spread Both organisms are highly contagious and is transmitted by contact with : Direct contact with vomit or diarrhoea without good hygiene measures, especially when projectile vomiting/explosive diarrhoea (airbourne) C.diff spores can survive for months in the environment and on surfaces/furnishings; From food that has been contaminated by those infected during food prep; From food that was contaminated at source, such as oysters, from sewage polluted sea (Salmonella, campylobacter, listeria, ecoli). By swallowing the virus in the air around someone who has just projectile vomited/coughed. Once a person has been exposed to norovirus virus, if they get infected it usually takes within 48 hours for them to become ill.

9. Supporting people in Dorset to lead healthier lives Who do we need to inform if an outbreak occurs? It is considered an outbreak if two or more residents become symptomatic. Inform Public Health England on Tel (office hours 9am-5pm): 0845 055 2022 Out of hours on call service: 0844 967 0082 Wessex Public Health England (Wessex@phe.gov.uk) 0345 055 2022 Out of hours number: 0844 967 0082 Email :Wessex@phe.gov.uk PHE need to know ASAP what infection control precautions you have already put in place, specimens obtained etc. They will then advise you of further actions that need to be taken.

10. Supporting people in Dorset to lead healthier lives How do we stop it? Standard precautions for Infection prevention and control to be followed SIGHT Encourage and assist patients with hand hygiene. Do not rely on alcohol gels as these do not kill the virus. Decontaminate all equipment immediately after use Ensure all staff are aware of the work exclusion policy and the need to go off duty at first symptoms, return when 48 hours clear of last symptoms (WHY?)

11. Supporting people in Dorset to lead healthier lives Thank you. A ny questions ?

12. Supporting people in Dorset to lead healthier lives Standard Precautions Hand Hygiene after each and every contact/task Use of Personal Protective Equipment (PPE) Isolation / containment Waste management Decontamination Collection of specimens