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Celebrating the COVID-19 vaccination

The following is contributed by Infection Prevention and Control Consultant (RN) Ruth Barrett –

I am 61 years old, a practicing nurse and recently I had a little celebration. I received my 2nd COVID-19 vaccination from a lovely team in Ashburton Hospital in Canterbury.

I feel like celebrating because I have played a small part towards helping New Zealand (and the world) fight this pandemic and get it under control. By having the vaccine, I am helping to keep my whanau and friends safe from catching the virus from me if I get infected, especially if I don’t have any symptoms. It also means I am happier to continue to look after vulnerable people, knowing I won’t be passing on the virus. It is reassuring to know that the vaccine will stop me getting really sick and ending up in hospital or worse. So, if we do have another large outbreak, my hospital bed can go to someone else.

We are lucky in New Zealand to have access to a vaccine that is very safe and very effective, and recent reports show that it is also works against the new variants that are out there.

I was a little nervous about getting the second dose and how I would feel afterwards. Although I have the influenza vaccine every year without any side effects, this time I needed two jabs. But in the end it was all good – I only needed two paracetamols about 6 hours later, had a good sleep, and then, apart from a sore arm for a day and a half, I felt fine.

Of course, I know that vaccinations are not the only thing that keeps us safe – all our public health measures and infection prevention and control activities are just as important. But if you are a healthcare worker, a parent, a partner, a friend, a child, a sibling, a grandchild or other, you can make a difference in your community by having the COVID-19 vaccine.

Ruth Barratt RN, BSc, MAdvPrac (Hons), CICP-E

Infection Prevention and Control Consultant

Christchurch, New Zealand

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When Norovirus hit, the staff hit back!

ONE EXPERIENCE OF NOROVIRUS MANAGEMENT  

Some may think the actions a little extreme but the objective was to minimise risk to others and in doing so, minimise the numbers of people (residents and staff) infected with Norovirus. The below is how one facility dealt with a norovirus outbreak recently.

Here’s how we dealt with what happened in our facility:

With the Clinical Nurse Manager on annual leave at 8.00 am on Friday 11 January the Senior RN advised the QA we had two suspected cases of vomiting and diarrhoea.  At 10.00 am the Senior RN advised the QA we could have four more cases of diarrhoea.

An immediate meeting was called with management and the situation discussed.  The following steps were instigated –

  • We immediately referred to our HCSL Safe and Appropriate Infection Control policy manual.
  • We decided to take the “worst case” scenario approach eg Norovirus.
  • We then set out an “action plan” and held a meeting at 11.00 am with all the staff present to advise the situation and actions to be taken –

Action Plan 

  • Infection Control at DHB were advised and samples were sent for analysis
  • The Rest Home was put into “lock down”. The families and next of kin of all the residents were advised.
  • The Village residents were advised and instructions given to them on procedures to follow.
  • The doors between the three sections of the Rest Home were closed and staff confined to these areas only – no exceptions.
  • The infection log from HCSL system was immediately put into use – an RN had to sight all vomit and diarrhoea together with noting the times and dates – this information was supplied on a daily basis to  DHB – this information was imperative to identify if virus was spreading, how quickly, or if it had been confined to certain areas etc.
  • The RNs appointed “dirty” nurses on each shift. A “clean” person was also appointed for delivering supplies around the whole rest home. Trollies were meticulously sanitised when “travelling” between these areas.
  • Kitchen staff were confined to the kitchen only
  • All residents were confined to their rooms with meals being delivered using “clean” and “dirty” trollies. This may seem extreme but the residents were agreeable to this.
  • Diagrams out of our policy manual were put in the Nurses Stations on how to put on PPE. Full PPE was mandatory in all “dirty” residents rooms and when serving food or drinks.   Face masks were mandatory for all staff at all times – no exceptions.  Full face shields were used in the laundry and any very soiled linen was disposed of as per instructions.
  • Hand washing and sanitising techniques were vigorously adhered to.
  • The cleaners were issued with “heavy duty” cleaning products and all vacuuming was banned.
  • Being an older Rest Home with only certain areas being air conditioned it was easy to turn off all conditioning and keep off.
  • Residents were encouraged to open their windows for fresh air and let in the sunlight.
  • Cleaning equipment was kept in the “dirty” rooms for their use.
  • All residents were advised to put toilet seats down prior to flushing and flush twice.
  • All residents and staff were reminded of hand hygiene practices and we ensured the appropriate supplies of hand washing and hand hygiene gels were available.
  • Communal areas in the Rest Home were closed, cleaned, sanitised and not used.
  • Management held a daily meeting at 9:00am to report on the up to date situation and a report was issued to the staff at 1:00pm and a daily report issued to the DHB.
  • The rest home was advised by DHB ON 16 January 2019 to let residents out of their rooms but stay confined to the areas of the Rest Home they lived in
  • On 21 January 2019 the rest home underwent a complete steam clean of carpets, drapes etc,
  • On 22 January 2019 we re-opened the Rest Home to visitors again.

LESSONS LEARNT

We had a total of  only 4 confirmed cases of Norovirus – one in the hospital and three in the rest home.  At the time the Rest Home was fully occupied (60 residents).

Follow your Policies and Procedures “to the letter”.  Without the excellent information contained in our policy manual we would not have achieved the result we did as everyone had varying views on what to do.  We had only one “view”.

We received congratulations from our DHB on handling this situation and receiving the outcome we did.

And of course we knew we always had the back-up of Gillian at HCSL either via email or telephone if required.

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Influenza season

Prepared for winter coughs and colds?

Winter is fast approaching and now is the time to be preparing your facility for the season’s usual crop of influenza, coughs and colds.

Last year the elderly were hit hard with, not just influenza, but also other respiratory viral infections. Many were admitted to hospital with complications such as pneumonia.

The predominant circulating influenza strain in 2016 was Influenza A, H3N2, different from the previous year’s Influenza A, H1N1. Although covered by the vaccine, last year’s predominant strain changed slightly from what was covered in the vaccine and there were numerous reports of laboratory confirmed cases of young vaccinated adults who still acquired influenza. Despite this, vaccination still affords some protection and symptoms are less severe than without it. This is the same for the elderly whose uptake of the influenza vaccine is not so good – experts agree that there are still benefits from the elderly having an annual influenza vaccine.

Some of the other respiratory viruses last year that caused severe disease in our elderly included coronavirus, rhinovirus and parainfluenza.

Check list for winter virus planning

  • Encourage and offer seasonal influenza vaccination to both staff and residents
  • Ensure hand sanitiser is available for visitors at the entrance of the home
  • Consider displaying a poster discouraging visitors with symptoms – a poster is available from CDHB communications
  • Remind staff and residents about good cough etiquette / respiratory hygiene
  • Have a good stock of tissues and hand sanitiser for residents
  • Remind staff to stay off work if sick – no-one wants their germs!
  • Educate staff about S&S of influenza – not all residents will display fever or cough
  • Keep residents in their rooms if symptomatic and introduce droplet precautions, i.e. droplet masks for staff providing cares
  • If you suspect an outbreak then confirm the outbreak[1] and introduce control measures[2]

Ensure all infections are logged into you infection register (for HCSL QA online uses – this is part of your infection log process) – remember your outbreak notification requirements as per your policies and procedures.  If you would like more assistance with this please contact us.

This article kindly contributed by: Ruth Barratt RN, BSc, MAdvPrac (Hons) – Independent Infection Prevention & Control Advisor (Canterbury)

Infectprevent@gmail.com

[1]  Infection Prevention & Control Guidelines for the management of a respiratory outbreak in ARC / LTCF

[2] A Practical Guide to assist in the Prevention and Management of Influenza Outbreaks in Residential Care Facilities in Australia

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Infection Prevention and Control – 2017 review

Antimicrobial stewardship for aged residential care  

The below article was contributed by Ruth Barrett – RN, BSc, MAdvPrac (Hons); Independent Infection Prevention & Control Advisor

What is your New Year resolution for 2017 in the world of infection prevention and control (IPC)? If you haven’t thought of it I would suggest looking at antimicrobial stewardship in your facility.

I was fortunate to attend a recent international IPC conference in Melbourne (ACIPC Conference 2016) and was pleased that aged residential care was a popular theme for both oral presentations and posters. One of the topical subjects was feedback from the first survey of antimicrobial use in residential care facilities in Australia. The results of this research are freely available and make interesting reading[1][2]. A good deal of the findings could equally apply to ARC in New Zealand.

Antimicrobial resistance and antimicrobial stewardship are two topics that go hand in hand.

As rates of antibiotic resistant bacteria continue to rise in New Zealand, then the responsibility for and management of the use of antibiotics becomes more important. Aged residential care (ARC) facilities are an important reservoir for MDRO transmission within the community. In the ARC setting, there are frequent transfers between the acute hospital setting and back to the rest home. This along with an over-use of antibiotics in the community can lead to a higher prevalence of multi-drug resistant organisms (MDRO) in ARC.

Even if a resident does not usually receive antibiotics, the resident is still at risk of picking up an MDRO if a lot of antibiotics are used. Managers, nurses and carers who work in a residential care facility all have apart to play in reducing the amount of antibiotics used and minimising the increase and spread of MDRO.

Some of the ways you can do this include-

  • Ensuring hand hygiene compliance is high for all staff and providing hand sanitiser close at hand for carers.
  • Using other specific contact precautions to control the spread of MDRO in your facility according to local policy.
  • Not using topical antimicrobial creams unless prescribed e.g. don’t routinely use Mupiricin (Bactroban) on wounds.
  • Only sending wound swabs, urines etc if there are obvious signs and symptoms of infection.
  • Recognising influenza or other respiratory outbreaks earlier to avoid secondary chest infections in the elderly, which would require antibiotics. Remember that in the winter season, many respiratory infections are caused by viruses and do not need antibiotic treatment.
  • Ensuring the residents finish their course of antibiotics.
  • Monitoring infections using a surveillance programme.
  • Monitoring the incidence of MDRO in the facility.
  • Accessing specialist IPC advice if infection or MDRO rates are of a concern.

So why don’t you make antimicorbial stwardship your IPC focus for 2017?

Contributed by:

Ruth Barratt RN, BSc, MAdvPrac (Hons)

Independent Infection Prevention & Control Advisor

Infectprevent@gmail.com

[1] Antibiotic use in residential aged care facilities, Australian Family Physician, Volume 44, No.4, April 2015

[2] Antimicrobial Stewardship in Residential Aged Care Facilities. Result of survey.

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Are your staff increasing risk of cross infection?

Cardigans – a potential vector of infection?

Each winter cardigans or long sleeved tops under uniform tunics appear as part of clothing worn by carers, nurses and other staff providing resident care.  Does this practice increase the risk of cross infection?

There are certainly studies that demonstrate that uniforms become contaminated with potential pathogenic organisms including Staphylococcus aureus, Clostridium difficile and Norovirus[1]. It is more difficult to find evidence that links contaminated uniforms with the transmission of pathogens to patients and residents.

Most contamination occurs in areas of greatest hand contact such as pockets and cuffs[2], which may the cause the wearer to re-contaminate their cleaned hands. Long sleeves may also become contaminated with bodily fluids, which then directly contaminate another resident through direct hands on care. This would be a great way to spread around those multi-drug resistant organisms that live in the bowel, such as ESBL, VRE and CRE!

The biggest risk of wearing long sleeves when delivering care involving patient contact is that hand hygiene cannot be carried out effectively. Anyone who has been taught hand washing using the Glitterbug gel and UV light will remember how the wrists were often left glowing, demonstrating that your wrists also get contaminated and need cleaning. In many healthcare facilities across the world, a ‘Bare Below the Elbows’ policy is used to ensure that effective hand hygiene is undertaken. This applies to the use of an alcohol based hand rub or gel, as well as washing with soap and water.

So the next time that you put your cardigan on or come to work with a long-sleeved top, remember that, prior to any patient contact remove the cardigan or roll up your sleeves and perform hand hygiene.

[1] Mitchell et al. Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of the literature. Journal of Hospital Infection, 2015 Aug;90(4):285-92

[2]Loh et al. Bacterial flora on the white coats of medical students. Journal of Hospital Infection,  2000 May;45(1):65-8.

Contributed by:

Ruth Barratt

Infection Prevention & Control Advisor

infectprevent@gmail.com

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