Understanding and Preventing Infections

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1 Understanding and Preventing Infections Department of Infection Control Information for Patients and Visitors University Hospitals of Leicester NHS Trust Rated excellent for the quality of our services.

2 Introduction We understand that coming into hospital can be an anxious time for patients. The worry is sometimes made worse by media reports about so-called superbugs. This leaflet is designed to help take away that worry by answering the most common questions patients ask about two of the most talked about superbugs, Methicillin Resistant Staphylococcus Aureus or as it is better known, MRSA and Clostridium Difficile also known as C Diff. It is important to understand that the risk of getting an infection whilst in hospital is very low. We are one of the biggest hospital Trusts in the country treating over 1 million patients a year and the vast majority of our patients leave us with only good things to say about the quality of the care they have received. The Healthcare Commission rates our hospitals as excellent for the quality of our services and the Department of Health has asked us to share good practice on combating MRSA infection with other Trusts around the country. We hope that when you ve read this leaflet you will be reassured that tackling infections in our hospitals is our number one priority and we are committed to keeping you safe whilst you are in our care. Dr David Jenkins Director of Infection Prevention and Control What Causes Infections? Bacteria and viruses are present almost everywhere; in the air, on surfaces and all over our bodies, including our skin and in our gut. Many of them live inside our bodies without ever making us ill. Occasionally, an infection is caused by a bug that normally lives in our body or in the environment around us without causing us any problems. This usually happens when the immune system is weak, the patient is suffering from another illness or if they are receiving treatment like chemotherapy, radiotherapy or antibiotics. We take infections very seriously. Hand washing is the simplest and most effective way of controlling the spread of germs and we teach every new member of staff how to wash their hands properly. You should not worry about asking staff if they have washed their hands before they touch you. We train them to expect questions like this. It is also standard practice for our staff to wear gloves and plastic aprons when they come into contact with wounds, body fluids or contaminated items.

3 We Need a Helping Hand from You! We are doing everything we can to reduce the risk of patients catching an infection during their stay with us, but we can t achieve this on our own. Whether you re a patient, a visitor or a member of staff, it is everyone s responsibility to keep our hospitals clean and germ free. Germs don t care who they infect - protect yourself and others from getting an infection: Wash your hands regularly; especially before eating and after going to the toilet If you have visitors whilst you are in hospital, ask them to wash their hands or use the alcohol gel before they touch you, especially if you have had a surgical procedure or you have an open wound If you are a visitor, don t wait to be asked! Clean your hands before and after you have any contact with a patient. This will reduce the risk of infection for both of you Think twice about visiting someone in hospital if you are suffering from a cough, cold or diarrhoea. We treat over a million patients a year, making us one of the biggest hospital Trusts in the country, so it is important to understand that the risk of getting an infection is actually very low.

4 C Diff Clostridium Difficile Is it a new germ? No. But the latest strain - 027, which has arrived from Canada, is causing particular problems because it has become clever by creating spores that protect it and help it to lurk in the environment for a long time. What makes it different to other germs? The spores make it hard to kill, even after cleaning, and it isn t affected by alcohol gel, so thorough hand washing and cleaning are key in controlling it. How do you catch it? C Diff can cause illness if the balance of healthy bacteria in the gut is altered (often caused by antibiotics). It can then spread from person to person because patients with C Diff have spores of the germ in their faeces. The spores can survive for a very long time in the environment and can be spread by hands and contaminated environments such as floors, bedpans and toilets. To reduce the chance of spreading the infection, you should wash your hands with soap and water, especially after using the toilet and before eating. Are some people more at risk of catching it? Yes. The elderly are most at risk. Over 80% of cases are reported in people over the age of 65. Patients with low immunity and patients who have undergone or are undergoing repeated enemas or gut surgery are also at a higher risk. Can I only catch C Diff in hospital? No. Cases also occur in the community. What is C Diff? C Diff is a nasty diarrhoea-causing bug. It is present in the gut of up to 1 in every 33 healthy adults and is even more common in babies. Like many other germs it can live inside us without causing us any harm most of the time. What are the symptoms? These can range from nothing to diarrhoea of varying severity and severe inflammation of the bowel, fever, loss of appetite, abdominal pain or tenderness and nausea. How is it diagnosed if a patient isn t showing any signs of symptoms? It is difficult to diagnose C Diff on symptoms alone. The most reliable diagnosis is made by testing a sample of the patient s faeces (a stool sample).

5 How can it be treated? It can be treated with special antibiotics, but in 20-30% of cases patients suffer a relapse and other treatments are tried including good bacteria to re-balance the gut. Do patients make a full recovery? Yes. In most cases, but in patients suffering from other very serious conditions, the infection can sometimes be fatal. How do hospitals fight the bug? Our priority is to make sure that, when you visit one of our hospitals, you receive the best care possible and that includes making sure that there s a minimal risk of you catching an infection during your stay with us. We have introduced new antibiotic prescribing guidelines because the bug generally occurs in patients who have been on long courses of antibiotics. Guidelines have been produced for different groups of staff which they must follow when caring for a patient with diarrhoea. When a patient is found to have C Diff, our infection control team will introduce special measures for staff, patients and visitors to follow. The patient may be moved into a room on their own or with other affected patients to reduce the likelihood of the infection spreading to other patients. Staff also: Wear disposable gloves and aprons when caring for patients with diarrhoea Routinely wash their hands with soap and water before and after touching every patient Use alcohol gel between treating patients who are not showing signs of diarrhoea, unless their hands are soiled, in which case soap and water is used Keeping our wards and medical equipment clean is also key to fighting the bug. Thorough cleaning with warm water and detergent is the most effective way of removing spores from the environment, but we combine this with steam cleaning. Steam cleaning removes spores of the bug from surfaces and gets rid of the dirt in cracks and crevices that everyday cleaning cannot get rid of (see picture). Since introducing it, we have seen a dramatic fall in cases of C Diff on wards which have been steam cleaned.

6 MRSA Methicillin Resistant Staphylococcus Aureus What is MRSA? MRSA is a mutation of the common bacteria Staphylococcus Aureus (SA), which has become resistant to some antibiotics. What makes MRSA different to other germs? Like other germs, it can live on the skin and inside the nose of healthy people without causing any harm. It only causes a problem when it gets into an open wound and causes an infection because it is resistant to common antibiotics. If MRSA is resistant to common antibiotics does that mean you can t treat it? No. But there are fewer antibiotics that can be used. Can I only catch MRSA in hospital? No. MRSA exists in the community and many patients come into hospital with the bacteria without them knowing. How can I tell if I have got MRSA? You can t. People who are carriers of the MRSA germ do not look or feel any different. The only way the germ can be detected is by taking samples for testing. How is MRSA spread? It is passed on easily from person to person by skin contact or direct contact with things that have been contaminated by it. It only causes an infection if it gets into the body through a wound, broken skin (such as a rash), cut or sore, or through a drip or drain. Are some people more at risk than others? Patients having a surgical procedure, or who are admitted to an intensive care unit, are at a greater risk of catching MRSA and developing an infection. If hospitals were cleaner would MRSA disappear? No. Cleanliness does play a vital part in the control of infection, but is not the entire answer. Hand hygiene and the use of gloves and aprons are also important, but, even with all these measures in place, there is still a small risk of catching MRSA.

7 What is the hospital doing to reduce the spread of MRSA? Pre-operative screening is carried out by taking a swab from the patient s skin to see if they have it before they come into hospital Patients who have MRSA may be treated in separate areas to prevent the germ spreading to other patients; this will depend on the type of ward they are in Patients may be asked to wash and shower using an antibacterial shower gel to reduce the number of germs on the skin and/or use an antibiotic nasal cream Alcohol gel can be found at most bedsides and entrances to all wards to supplement hand washing. Patient being swabbed for MRSA at a pre-operative screening Alcohol gel can be found at most bedsides and entrances to all wards M R S A

8 If you would like this information in another language or format, please contact the Service Equality Manager on If you have any more questions or concerns we have an infection control team at each of our hospitals who you can contact for information or advice call: Glenfield Hospital: Leicester General Hospital: Leicester Royal Infirmary: If you have any hygiene concerns about a ward please report them to the modern matron or ward manager. Printed November 2006.