INFECTION PREVENTION AND CONTROL - 10th March 2021

INFECTION PREVENTION AND CONTROL
         10th March 2021

ACTION TRACKER

 Attendance certificate – completed

 Electronic audit tool- ongoing
 IPC audits (quarterly)- ongoing
 IPC policy- ongoing
 IPC education- ongoing
 Primary care weekly bulletin – sent to PMs to cascade
 to the team

TERMS OF REFERENCES (ToRs)

IPC/COVID-19 guidelines

Current IPC Guideline for Primary Care
Infection Control in Primary Care - updated 10th January 2021
https://www.england.nhs.uk/coronavirus/primary-care/infection-control/
Covid-19 guideline in Primary Care V.4 - updated 22nd December 2020
https://www.england.nhs.uk/coronavirus/wp-
content/uploads/sites/52/2020/03/CO800-guidance-and-standard-operating-
procedures-general-practice-v4.pdf
Covid-19 waste management in Primary care V.4 – updated 5th January 2021
https://www.england.nhs.uk/coronavirus/wp-
content/uploads/sites/52/2020/04/C0611-COVID-19-Waste-Management-Guidance-
SOP-doc-v4-Final-rev.pdf
Guidance on care home visiting- updated 4th March 2021
https://www.gov.uk/government/publications/visiting-care-homes-during-
coronavirus/update-on-policies-for-visiting-arrangements-in-care-homes

LFT suspected patient ?
72 hours waste for COVID cases

Variants: distribution of cases data (1)

 VOC-202012/01        England, UK/UK Sept 2020 – most positive cases identified
 VOC-202012/02        South Africa /UK Dec. 2020
 VUI-202101/01        Brazil/UK Nov. 2020
 VOC-202101/02        Japan ex Manaus, Brazil/ UK Feb.2021
 VUI-202102/01        England, UK/UK Dec.2020
 VOC-202102/02        England, UK/UK Dec.2020
   VUI-202102/03      England, UK/UK Dec.2020
 VUI-202102/04        TBC

https://www.gov.uk/government/publications/covid-19-variants-
genomically-confirmed-case-numbers/variants-distribution-of-cases-data

Variants: distribution of cases data (2)

 6 people in the UK (Croydon) – variant linked to Brazil. Croydon
  undergoing Surge Testing- positive tested to have “genomic
  sequencing.
 R number 0.86 (what is the K number ?- super spreaders)
 Cases rising in parts of London, South East, and Midlands
 Overall the infection rate has been decreased significantly

https://assets.publishing.service.gov.uk/government/uploads/syste
m/uploads/attachment_data/file/967283/Weekly_Flu_and_COVID
-19_report_w9_v2.pdf
Updated 4th March 2021

COVID-19 data

 7th March 2021

COVID-19 Vaccinations

Vaccination: (PCN/Mass Vaccination Centre)
 Pfizer BioNTech COVID-19 vaccine
 Guideline & Site assurance checklist
Prioritisation (Currently)
 Cohort 5 (65 and over) - Madejski Mass vaccination Centre
 Cohort 6 (16-65 with additional health conditions) – PCN
https://www.gov.uk/government/publications/covid-19-vaccination-care-home-
and-healthcare-settings-posters/covid-19-vaccination-first-phase-priority-
groups?fbclid=IwAR3_MB8Rhme36X4W3cf_AQ-
vQGCSt2XSl1p78tjqfI96HGnRv1ToOmFosV8
Uptake
National uptake – 22.2 M: 1st vaccine, 1.1M: 2nd vaccine
BWCCG – Cohort 1-4 - 92-94% received 1st vaccine, 2nd vaccine starts
with Cohort 6

Vaccine inequalities
Three factors are identified (WHO)
 Confidence- vaccine hesitancy (understand why, and solution esp. BAME)
 Convenience- barriers to access (understand barriers and remove barriers)
 Complacency –understand complacency in certain groups e.g. younger
   populations and develop local solution to support them
Initial data (based on cohort 1-4) suggests that:
• Black African communities have the highest hesitancy compared to other
ethnic groups
• Pakistani and Bangladeshi communities have higher hesitancy than White
British/Irish and Indian communities
• Gypsy, Roma and Traveller communities, people experiencing homelessness
and Asylum seeker, Refugee and migrant populations may need additional
routes to access the vaccine
• Income and socio-economic circumstances correlate with lower levels of
uptake

Roadmap out of lockdown

Step 1 - 8 and 29 March
• 8th March- school return – LFT twice weekly, 1 visitor to care home, meet
  with 1 person outside household
• 29th March- 6 people or 2 household outdoor, outdoor sport, stay at home
  rules ended, but work from home if possible and avoid travelling

Step 2 – not before 12th of April; opening of non-essential retail, indoor gym,
serve outdoor food, funerals up to 30
Step 3 - not before 17th May; gatherings of over 30 people will remain illegal,
Indoors, the rule of 6 or 2 households, update the advice on social distancing
between friends and family, including hugging, Sport: 1000 indoor venue, 4000
outdoor (or half-full)/ 10,000 where the seats can be spread, wedding – 30
people. Review on 1 metre social distancing ?
Step 4 - not before 21 June- to remove all legal limits on social contact

https://www.gov.uk/government/publications/covid-19-response-spring-
2021/covid-19-response-spring-2021-summary

Because I care

 https://youtu.be/0nZG_oOHp7M

Please share this VDO with your team

        (NHS improvement)

Wound Assessment

By Stacey Evans-Charles

FLU

BW: The Flu Programme 2020-21 has delivered vaccination to;
80.9% of over 65s
56.8% of those aged under 65 and at clinical risk
46.7% of pregnant women
64% of two and three year old children.
The CCG Flu Team is evaluating the programme with a view to better
shape preparations for 2021-22.

What are you experiences/lessons learned from the Flu programme this
year? ---- send your feedback to Victoria Farley by 19 th of March
Any IPC concerns ? PPE, Waste management, IPC measures, Needlestick
injury

Flu Report

PHE data (4th March 2021)
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/a
ttachment_data/file/967283/Weekly_Flu_and_COVID-19_report_w9_v2.pdf
 There was no influenza positive samples between 28 December
   2020 and 14 February 2021.
 Just 1 positive flu case was detected out of 1,075 samples tested
   between 21 December and 29 December 2020.
 No report of Flu outbreak
Influenza vaccine uptake in GP patients
• 52.5% in under 65 years in a clinical risk group
• 43.7% in pregnant women
• 80.8% in 65+ year olds
• 34.1% in those aged 50-64 who are not in a clinical risk group
 75% among healthcare workers

What did we do well?

             LOW FLU CASES
Good hand hygiene
Social distancing
Shielding
Face mask covering

Outbreak Management

COVID-19 Outbreak
 II MARCH form
 Inform CCG and PHE
 IPC support
Scabies Outbreak – George Hotel (Asylum seekers)
 Up to 4-8 weeks to show symptoms
 Isolation – 3 days , if crusted scabies – 7days
 Laundering
 Deep clean
 Treatment – positive cases and close contact persons

HCAIs UPDATE Oct-Nov.2020

      Data                2019-2020          2020-2021
      C.diff              102                84 (58 target)
      E.coli              372                309
      MRSA                5                  4 (0 target)
      MSSA                106                107
      Klebsiella spp      75                 82

C.Diff Concerns:
Antibiotic use, long term PPIs use, Laxative meds, Anti motility meds.
GNBSI Concerns
CAUTI, antibiotic use, cannula site, wound infection, sepsis, LRTI

HCAIs reduction Group work

 Lessons learned - feedback to GP doctors – What is the
  best way?
 Antibiotic use campaign – for UTI, LRTI, wound
  infection/SSI
 UTI education- Patients
 Stool collection – Bristol stool chart
 Laxative treatment
 ANTT – wound care

MRSA Bacteraemia

Case PIR – likely line associated
 Normally fit and well until accident.
 Repatriated from St Andrews burns hospital on 04/12/20
  following 56% flame injury to
  chest/abdomen/back/arms/legs/feet/inhalational injury.
 Previous positive MRSA result from a wound swab in St Andrews
  on 16/11/20.
 04/12/20-Admission swabs, MRSA +ve
 07/12/20- MRSA +ve swabs and bronchial wash
 13/12/20- Patient becomes tachycardia and spikes
  temperatures. Blood cultures sent from femoral vascath line
  which come back as MRSA +ve

VRE Bacteraemia

Case PIR - likely line associated
 5/11/20 , sudden abdominal pain, showing evidence of
  diverticulitis and perforation on CT.
 12/11/20, underwent Hartmann's procedure (ICU)
 14/11/20, moved to Surgical ward
 02/12/20, rectal swab -VRE +ve
 03/12/20, rectal swab- VRE +ve
 07/21/20, bronchial wash-Serratia marcescens, Candida kefyr
  +ve
 13/12/20, blood culture CVC line: VRE, Serratia marcescens +ve

IPC education/resources

International resources for IPC/Newsletter
 https://mailchi.mp/1ee0487dbb12/inric-newsletter-march-
  7508025?e=7b46cf1f46

Webber training – Teleclass education
 https://webbertraining.com/recordingslibraryc4.php

IPC education for primary care staff - BWCCG
 Primary Survey – April
 Evaluation/Education plan

IPC AUDITS

Annual IPC audit
 Annual IPC audit
Quarterly IPC audit

IPC CAMPAIGN /TRAINING

Global IPC campaign
 5-21/03/21    Nutrition and hydration week (moved to 14-20
  June 2021 due to the pandemic)
 05/05/201     World hand hygiene day
 13/09/21      Sepsis day
 14-20/10/21 IPC week
 15/10/2021    Global handwashing day
 11/ 21        Antimicrobial Awareness Week
 01/12/21       World HIV day

Any Other Business?

Staff uniform
https://www.rcn.org.uk/-/media/royal-college-of-
nursing/documents/publications/2020/april/009-245.pdf?la=en

https://www.england.nhs.uk/wp-content/uploads/2020/04/Uniforms-and-Workwear-
Guidance-2-April-2020.pdf

Health and safety alert- FFP3 mask fit testing
https://www.hse.gov.uk/coronavirus/ppe-face-masks/face-mask-ppe-rpe.htm

Notifiable Diseases
https://www.gov.uk/guidance/notifiable-diseases-and-causative-organisms-how-to-report

https://www.gov.uk/health-protection-team

                     NEXT Meeting 10th June 2021 (Thursday)