1. Infection Prevention & Control (IPAC) at RCHT Dr Tristan Clark Infectious Diseases physicin and joint DIPC

3. General Principals Standard precautions (including hand hygiene) Patient isolation Environmental decontamination Surveillance and outbreak investigation Antibiotic stewardship Education and training

4. Specific organisms MRSA Clostridium difficile ESBL producing gram negatives Norovirus Influenza (and other respiratory viruses) Others (Chickenpox, Pertussis, PVL producing Staphylococcus aureus)

5. MRSA rates RCHT 2011/12 (per 100,000 bed days) Acute trust apportioned MRSA bacteraemia rate = 0 South West = 1.0 Non-acute trust apportioned MRSA bacteraemia rate = 1.2 South West = 1.0

6. 923 days since last MRSA bacteraemia

7. Name of NHS Trust April 2007 - March 2008April 2008 - March 2009 MRSA bacteraemia reports MRSA bacteraemia rate per 100,000 bed days MRSA bacteraemia reports MRSA bacteraemia rate per 100,000 bed days Total4,45111.92,9357.8 Royal Cornwall Hospitals4318.94419.2 MRSA Bacteraemia rates 2007 / 8 (acute trust, per 100,000 bed days)

8. Clostridium Difficile RCHT Numbers per annum: 2004/5 = 189 2005/6 = 195 2006/7 = 372 2007/8 = 228 2008/9 = 127 2009/10 = 56 2010/11 = 47 2011/12 = 41 (rate = 17 per 100,000 bd; SW rate =17; national rate = 21.8) 2012-2013 = 24 (as of 15/02/2013) Target (tolerance) for 2012-2013 = 41 Target for 2013-2014 = 20 (!)

9. Standard Precautions – for all patient contact Hand hygiene – before and after touching patients Soap and water for all patients with diarrhoea (min 30s) Alcohol gel adequate for all others (easier and faster but doesn’t eradicate C.diff) Gloves indicated for contact with patient fluids but still need hand hygiene

10. Hand Moisturiser If you are unable to use the Trust hand cleansing or moisturising products due to a skin condition/allergy seek advice from Occupational Health Department If you develop eczema, dermatitis or any other skin condition you must seek advice from the Occupational Health Department as soon as possible.

11. Contact Dermatitis Work-related contact dermatitis is a skin disease which can be caused by substances used at work. It is often called eczema and develops when the skin is damaged. This leads to redness, itching, swelling, blistering, flaking and cracking. The most susceptible parts of the body are the hands, followed by the forearms and face.

12. Patient Isolation To prevent spread of infectious agents to other patients and staff Based on risk assessment of likely pathogen causing symptoms Prioritisation based on high risk agents (TB, Influenza, Chickenpox, Norovirus, C.difficile) MRSA and ESBL colonisation where possible (again based on risk assessment)

13. Environmental decontamination Cleaning – physical removal of all foreign material (usually water and detergents) Disinfection – elimination of all pathogenic organisms (except spores) from objects - usually chlorine based Sterilization – complete elimination of all microbial life (e.g. Hydrogen peroxide)

14. Surveillance Collection of accurate and relevant data on infections in real time Clusters of infection allow targeted investigations and interventions Detection and management of outbreaks Comparison with other institutions National performance targets (MRSA bacteraemia, C.difficile, MSSA, E.Coli)

15. Antibiotic stewardship Collection of accurate data of antibiotic use in the hospital Creation of antibiotic policy and guidelines List of restricted ‘high risk’ antibiotics Principal of ‘start smart then focus’ Monitoring and policing of adherence to the above Ongoing education and training

16. ‘Start Smart then focus’ Use local guidelines to chose agent(s) Cultures prior to starting abx Antibiotics within 1 hour with severe infections Indication, duration and review date – documented on drug chart Review at 48 hours and make clear plan Options include; Stop, Switch from IV to oral, Change to narrow spectrum, Continue unchanged, OPAT.

17. Consultants role in promoting Infection control Hand hygiene Active role in auditing of infections, antibiotic prescribing, prevalence of resistant organisms etc within dept Influenza vaccination Early risk assessment of suspected infections with appropriate early use of patient isolation Early liaison with IPAC and microbiology / infectious diseases