Infection Prevention & Control

Infection Prevention & Control (IPC) at the Mater Private Hospital Cork is fundamental to our delivery of safe patient care.

Infection Prevention & Control can have a profound impact on the patient and their ability to recover; be assured it is something that is always top of our focus in the delivery of care.

We follow a ‘Search & Destroy' approach to infection – we seek to find it and deal with it, before it finds us.

Hand hygiene is recognised as the single most important factor in preventing the spread of infection and plays a key role in delivering safe patient care. All staff are regularly trained, reviewed and updated in hand hygiene techniques and IPC measures.

At the Mater Private Hospital Cork our Infection Prevention & Control (IPC) Programme is delivered by a dedicated specialist team. The programme is designed to prevent, detect and control the spread of infection through surveillance, education and research. Continuous audit and surveillance plays a significant role in our IPC Programme with regular targeted audits and compliance checks in any identified risk areas.

Adoption and regular audit of the 2009 Health Information and Quality Authority (HIQA) standards for all healthcare facilities ensures that the Mater Private Hospital Cork guarantees compliance to national and international guidelines related to the prevention and control of infection.

We monitor for a range of infections and identified risk points so that we can stay ahead of any infection risk. Our programme spans all elements of hygiene and infection control, for example:

  • Infection Surveillance and Management – multi-resistant organisms such as MRSA and organisms of specific interest such as Clostridium Difficile
  • Surgical Site Infections
  • Device associated Blood Stream Infections (BSI)
  • Catheter associated Urinary Tract Infections (UTI)
  • Environmental and Equipment Cleanliness
  • Hand Hygiene
  • At the Mater Private Hospital Cork we use an active ‘search & destroy’ policy for MRSA. We have a detailed surveillance programme which, along with pre-screening, helps us identify patients who potentially may have MRSA, who may have been in contact with it or who have MRSA.

    We pre-check all patients admitted to us for major surgical procedures and those who have been in another hospital in the past month for MRSA by swabbing nose, groin and other areas. This ensures that we can treat and remove the MRSA, if present, before it can cause a problem such as a wound infection after your surgery.

     

    About MRSA

    MRSA is a term used to describe a bacterium (germ), called Staphylococcus Aureus which no longer responds to many commonly used antibiotics such as penicillin. These germs are found on the skin of most humans. They cause common infections like boils and are also found in the nose and throat of some individuals. About 30% of people carry some of these germs.

    Some patients treated with antibiotics may acquire MRSA, as the staphylococci (germs) become resistant to penicillin and other commonly used antibiotics.

     

    What will happen to me if I have MRSA?

    In most cases, this is no cause for concern. However, for some it can cause problems such as wound infection for people who are undergoing surgery or those who are very ill in hospital.

     

    Can I spread MRSA to others?

    MRSA can spread from person to person on unwashed hands and equipment. This is among the many reasons why hand hygiene is so important. However, contact with friends and family who are healthy is not a risk.

     

    Precautions required if MRSA positive

    • Hand washing is the easiest way to prevent the spread of MRSA.
    • You will be nursed in a single room to reduce the risk of MRSA spreading to other patients.
    • All those entering your room will be asked to wash their hands when leaving to remove any bacteria from hands.

     

    How can I get rid of MRSA?

    There are creams and powders as well as antibiotics that can be used to treat MRSA effectively. Your doctor will decide on the most suitable form of treatment for you. Most people lose MRSA once they leave hospital or complete a course of treatment. Occasionally the treatment may need to be repeated to remove the MRSA completely.

    If you are re-admitted to hospital in the future, you should inform the nurse / doctor that you have had MRSA in the past. They will then arrange for an MRSA screen to ensure you are still free from MRSA. This is especially important if you are being admitted for surgery. It is important to remember MRSA can be killed by specific antibiotics, powders and creams.

     

    Some things you can do to help get rid of MRSA….

    • Change your pyjamas / nightwear daily and send them home for a 60° Celsius wash. This temperature will kill any MRSA that may be on your clothes.
    • Use a fresh disposable face cloth daily.
    • Remember to pay special attention to hand washing, especially after applying your nasal cream.

    Please Note: Family and friends can visit as normal and do not need to wear gowns, gloves etc. These precautions are only necessary to prevent staff from carrying the bugs from one patient to another. However, you should ask them to wash their hands when they are leaving your room.

     

    What are your infection rates for MRSA in the hospital?

    Since opening, our track record is very good. No patient has acquired an infection with MRSA.

     

    What does it mean if you are colonised with MRSA?

    The presence of MRSA without any signs of infection is known as colonisation. Some patients carry MRSA on the skin or in their nose or throat with no symptoms. Some patients can carry MRSA for years and never develop an infection.

     

    What precautions does the hospital take to prevent patients contracting MRSA while in hospital?

    In order to reduce the risks of infection with MRSA, our hospital proactively searches for MRSA. This involves:

    • Screening patients attending for high risk surgery such as joint implant and any major surgical procedure before or at time of admission.
    • Screening patients known to have increased risks for MRSA colonisation such as those in hospital recently and those with history of MRSA.
    • Staff education programme on infection prevention and control as well as strict hygiene monitoring help us reduce risks of spread of MRSA and indeed other infections to our patients.
  • What is Clostridium Difficile?

    Clostridium Difficile, also know as ‘C.Difficile’ and ‘C.Diff’ is a bacteria (germ) that normally lives in your large intestine or gut.

    A small proportion (less than 1 in 20) of the healthy adult population carry a small amount of C.Diff and don’t experience any problem with it. It is kept in check by the normal, ‘good’ bacteria of the intestine. However, when you take an antibiotic, some of the ‘good‘ bacteria die causing the C.Diff bacteria to multiply and so lead to infection.

     

    C.Diff Symptoms

    If you become infected with Clostridium Difficile you may get:

    • diarrhoea – very unpleasant smelling
    • stomach cramps, fever, nausea, loss of appetite

    Most people only get mildly ill and recover fully from it. However, in certain circumstances you may get seriously ill and develop colitis (inflammation of the bowel). If the colitis is severe it can be life threatening.

     

    How is Clostridium Difficile diagnosed?

    A sample of diarrhoea is sent to the laboratory for testing.

     

    Is Clostridium Difficile contagious?

    Yes, it is. If you have Clostridium Difficile diarrhoea, the bacteria can survive on your hands and surfaces for a long time unless they are washed.

    It can then pass from your hands and surfaces to others through unwashed hands and soiled equipment. To prevent Clostridium Difficile from spreading, you, your family members and hospital staff need to regularly wash your hands and clean and disinfect equipment.

    If you don’t have diarrhoea, Clostridium Difficile cannot be spread to other people.

     

    Who is most likely to get Clostridium Difficile?

    Those most at risk of developing infection include:

    • taking or have recently finished taking antibiotics
    • spent a long time in hospital or other healthcare settings (e.g nursing home)
    • elderly
    • serious illness
    • weakened immunity (e.g. receiving cancer treatment)
    • had bowel surgery

     

    Treatment

    In some cases, certain antibiotics may have caused the diarrhoea so you may have to stop taking them. You may be given other antibiotics which are effective against the Clostridium Diff bug. It is important to drink enough fluids so that you don’t become dehydrated.

     

    What happens if I have Clostridium Difficile while I’m in hospital?

    • You will be moved to a single room with a toilet for your own use
    • You must make sure to wash your hands with soap and water after using the toilet and before meals
    • Staff looking after you will wear aprons and gloves and wash their hands after caring for you

     

    Can I have visitors if I am infected with Clostridium Difficile?

    • Yes, you can have visitors as healthy people are at very little risk. If you have any concerns about someone visiting, please seek advice from your nurse.
    • Your visitors will be asked to report to the nurse in charge before visiting you.
    • Ask your visitors to wash their hands with soap and water after visiting you.
    • Your visitors may need to wear gloves and aprons if they are helping with your care.
    • Your visitors should sit on the chairs provided, not on your bed and should not use your toilet.

     

    Will any of my treatment be delayed because I have Clostridium Difficile?

    Your tests or treatment should continue as planned, with staff taking the correct precautions to prevent it spreading. Some non-urgent tests may be delayed if you have severe diarrhoea.

     

    How will I know when the itis no longer infectious?

    Once the diarrhoea has stopped for at least 48 hours and your bowel motion is back to normal you are on the mend. However, the bacteria may remain in your bowel for some time afterwards and the diarrhoea may return requiring further treatment.

     

    Can I go home with Clostridium Difficile?

    You should normally wait until the diarrhoea has settled and your doctor is satisfied that you are fit to go home. Your doctor will let you know if you need to continue treatment at home.

     

    Can it come back?

    Yes, some patients may suffer a relapse of diarrhoea. Please contact your GP / family doctor if you develop diarrhoea after you are discharged from hospital and let him / her know that you had Clostridium Difficile recently.

    If you need antibiotics for another illness please tell your GP / family doctor that you recently had Clostridium Difficile.

     

    If I have Clostridium difficile diarrhea at home how do I stop my family from catching it?

    To reduce the risk of spreading Clostridium difficile to others, take the following steps:

    • Wash your hands thoroughly with soap and warm water and dry them after using the bathroom and before eating.
    • Be strict with your personal hygiene – do not share personal items such as towels and face cloths.
    • Machine wash soiled laundry separately from other washing on the hottest wash cycle suitable for linen and clothing.
    • Tell your family or carers to wash their hands thoroughly with soap and water and dry them after caring for you.
    • Try to avoid using the same toilet that your family members use. If this is not possible, ensure that the toilet is cleaned and disinfected after your use.
    • Clean surfaces in bathrooms on a regular basis with household detergents. If you have had diarrhoea, then disinfect with a mixture of bleach and water as instructed on the container.
    • Pay special attention to sink taps, flush handle, toilet seats and lastly the toilet bowl.
  • Vancomycin Resistant Enterococci – a multi-resistant organism. Enterococci are recognised as the cause of 13% of Blood Stream Infections (BSI). They are also the second most common cause of Hospital acquired UTI and the third most common cause of Endocarditis.

     

    What are Enterococci?

    Enterococci rank as one of the most common causes of Health Care Associated Infections (HCAI). Vancomycin Resistant Enterococci were first seen in 1986 in US. Most are Linizaloid sensitive.

     

    Where are Enterococci most often found?

    Enterococci normally inhabit the bowel and GI tract. The are also found to colonise the vagina, groin and chronic ulcers.

     

    Does colonisation occur prior to infection?

    VRE colonisation and infection is commonly associated with recent use of multiple antibiotics, enteric feeding, diarrhoea and in long term hospitalised patients.

    It is important to note that rectal colonisation has been found in 100% of patients with VRE bacteremia. Thus as with MRSA, VRE colonisation is normally a pre-cursor to VRE infection.

     

    How does it spread?

    Enterococci are hardy and survive well on environmental surfaces. Most often spread on hands of healthcare workers who pick it up on their hands from the environment around a colonised patient.

    Heavy environmental colonisation occurs when a colonised patient has diarrhoea or is incontinent.

    VRE has been found on thermometers, BP cuffs, patient gowns, pyjamas, beds, bed rails, bedside tables and commodes during outbreak investigations.

     

    How can we prevent the spread of VRE?

    • Similar to MRSA, prompt isolation and contact precautions for any patient who is known to be colonised is essential
    • Restricted use of Vancomycin can prevent emergence of VRE
    • Measures such as Urinary catheterisation only when essential and removing Catheters ASAP is helpful

     

    What measures should we take when a patient is admitted with VRE or a history of VRE?

    As with MRSA, we admit the patient to a single room with contact precautions and take swabs from groin and rectum for VRE. The Infection Control Team are notified. This is all done as a matter of routine and the patient is placed in a single room (we sometime refer to this as isolation because you are in a room on your own but you do have contact with people).

     

    Can others pick up VRE?

    It can occur occasionally. The best protection from VRE is PROMPT HAND WASHING and the use of alcohol hand gels between contacts.

     

    VRE in the Mater Private

    The Mater Private Hospital Cork does not have a problem with VRE. However, we continue to be vigilant and to ensure patients are promptly identified if admitted with it. We can also reduce risk of patients acquiring VRE by prudent use of antibiotics. A full disinfection clean is carried out as with all rooms used for infected patients.

  • Norovirus – commonly referred to as the WINTER VOMITING BUG is a nasty bug causing sudden onset vomiting and diarrhoea.

    The bug is characterised by sudden onset, unexplained vomiting which lasts from 3-10 hours. This then settles and is sometimes followed by a period of diarrhoea. The person continues to pass the bug in their faeces (stool) for at least 2 days after symptoms stop.

    This bug is easily spread. When you experience the symptoms you must take particular care to disinfect the area where you were sick, any surfaces close by and to thoroughly wash your hands with soap and warm water.

    In a hospital, it is often difficult to differentiate between patients who vomit due to anaesthetic or medication and those who may have a bug. Until we are sure, we may take precautions such as wearing gloves and aprons for contact with a patient who is vomiting to prevent possible spread .

    When we suspect the person has winter vomiting, we immediately introduce extra cleaning and disinfection of all surfaces on the ward.

    We move the patient to a single room as soon as possible.

    We ask other patients who shared the room to pay special attention to hand washing when they enter and leave the room and before they eat.

     

    Protecting Yourself

    • Hand washing is the most important action in preventing spread of winter vomiting bugs and other infections. Therefore, every time you enter and leave your room wash your hands with the hand gels available at all entry and exit points.
    • Advise your visitors to do the same.
    • Any food open to the air can become contaminated, do not keep open food in your room.
    • Wash fruit immediately before you eat it.
    • Wash your hands with soap and water for at least 30 seconds before you eat and after you use the toilet.