Infection prevention and control community of Practice
The interest group, set up to support IPC leaders in hospices, meets twice a year.
Meetings are held at Hospice House and run from 11am to 3pm.
These sessions are highly interactive and informative, dealing with topics of national interest like the EU sharps directive and assisting with more local issues, including microwave heat pads and patients access to pets in the inpatient unit.
Meeting dates for 2017
The date for the next 2017 meetings has changed.The meeting scheduled on 10 October has been cancelled. The date of the next meeting is now:
Summaries of previous meetings – click on the meeting date to access resources from the meeting.
MC welcomed everyone to the meeting.
The meeting started with a query from Julie Hughes, Alexander Devine Children’s Hospice relating to IPC policies and procedures for children’s hospices. At present the hospice delivers outreach care to children and families including respite care throughout the Childs’ care pathway and symptom care and support at end of life. They have a generic IPC policy with a number of relevant procedures for outreach care which can be transferable to inpatient care. However as their recently commissioned completed hospice build is now looking for CQC site inspection they need to produce further policies and procedures in line with the Health and Social Care Act 10 criteria and the HB note 00-09 Infection control in the built environment. She wondered if any of the CoP members would be happy to share IPC policies/procedures for children’s hospice care. They were particularly keen to determine criteria that hospices may have for transferring children in from other healthcare settings. During the meeting members of the group offered assistance.
Presentations from Rick
WHO 12 – ‘Most Wanted!’
The contents of Rick’s first presentation regarding the World Health Organisation’s priority pathogens that are now becoming more resistant to antibiotics and the need to develop new antibiotics were noted.
Reporting Changes in HCAI priorities in E-coli
This presentation gave an overview of which infections were reported to Public Health England, the results of this reporting, the introduction of reporting on E-coli infections and PHE’s new directive to reduce these infections by 50% by 2021. He suggested that the group might want to look at the PHE Fingertips website under Infection control where this information would be shown. The non trust figures will include hospices.
The group discussed the use and prescription of antibiotics and agreed that good infection prevention was key as this would reduce infection therefore reduce the need for treatment reducing the risk of CPE.
Ellen Tummelty recommended watching the Antibiotic Guardian Video – created by colleagues at East and North Herts NHS Trust promoting antibiotic guardians. The lyrics were written by Kirstin Paisley-Pearce, an Infection Prevention and Control Nurse at the Trust and the video was made in conjunction with Think Filming.
Hear from your colleagues
Gill Matthews – Peace Hospice Care
Gill is the Clinical Adviser on Infection Prevention and Health & Safety at Peace Hospice and she gave an overview of her role, the IPC team which includes the housekeeping manager and nurses, HCA’s and the Day Care Manager, how often they meet and how they feed into the hospice management.
The hospice use Infection Prevention Solutions for training and assistance with policies and procedures. They also do an audit once a year and the results give a plan of what needs to be done over the following year. If you are interested their website is infectionpreventionsolutions.co.uk.
Gill agreed to share their C.Diff toolkit which she adapted from Shropshire and Telford and Wrekin Clinical Commissioning Group Clostridium Difficle Tool Kit February 2014.
As part of Infection Control Awareness for the whole hospice she holds a ‘bug busting day’ where she leaves wipes to clean the telephones and keyboards on every desk. This has proved very successful with many people coming back to request more wipes.
Anne Nash – St Christopher’s
Anne gave a presentation on the Legionella outbreak that affected St Christopher’s in 2012 including how it occurred, what they did and the lessons learned. It highlighted the importance of proper and regular training, especially for those with specific responsibilities and questioning when you see that things aren’t right rather than just ‘make do and mend’.
Anne said she and the operations manager at St Christopher’s would be happy to talk to anyone who wanted to know more. To do so just email Amber who will forward the query on.
MC welcomed everyone to the meeting.
MC gave an overview of the Resilience Webinar programme that started on 6 October 2016. She encouraged everyone to take a look and to register for the remaining webinars. More information, including access to the video of the last webinar can be found on the workforce pages of our website.
She also advised that the ECLiHP forum had been merged with the Care and Clinical forum on Hospice IQ. She encouraged the group to take a look and upload resources.
She also reminded everyone about the Patient First event on 22 November 2016.
Water hygiene including Legionella, pseudomonas, in both wards and community care
The contents of the presentation on Pseudomonas Aeruginosa and Legionalla were noted.
Following the presentation there was a discussion and the following points were raised:
- If you suspect a patient of being infected with Pseudomonas should you isolate – Look at the chain of transmission, if it cannot be controlled then yes.
- Use of hot tubs and Jacuzzis.
- This is ok as long as you have a good cleaning routine. You can get Jacuzzis that self clean after every use.
- To avoid legionella you should have a good flushing routine.
Hear from your colleagues
Shirley Balmer – Queenscourt Hospice
Forensic Attention To Detail: Lessons learned from a Clostridium Difficile outbreak in a hospice setting
The contents of Shirley’s presentation on the CDiff outbreak they had at their hospices and the lessons learnt were noted.
Denise Condick – St Margaret’s Hospice
South West – Infection Control Forum
The contents of Denise’s presentation on the South West IPC forum where SW hospices meet to share issues, resources and benchmark audits were noted.
MC thanked Shirley and Denise for their presentations and asked if anyone else would like to present at the next meeting.
The contents of the presentation on vaccines for staff were noted. He confirmed the employer is responsible for ensuring that staff are working in a safe fashion under CoSHH (2002). The presentation concentrated on ‘selected’ vaccines BCG, Hepatitis B, Influenza, Varicella rather than the routine vaccines which most people will have. These vaccines should be given to staff with direct patient care.
RC confirmed that the employer is not responsible for routine vaccinations. It was asked if volunteers would qualify, RC advised that the hospice should look at the expectation of risk and whether the volunteer was involved in direct patient care, dealing with blood or body fluids.
If you were employing staff from abroad you may want to check that they have had all the routine vaccination before they start work, however agencies may already do this.
MC asked the group to email herself and Amber with suggestions for the next meeting or to volunteer to give a presentation on a piece of work at their hospice. Sepsis was suggested.
Date of next meeting
To be confirmed.
MC welcomed everyone to the meeting. Minutes of the previous meeting and matters arising
The contents of the presentation showing the results of the IPC survey were noted. MC thanked everyone who took part. The group then discussed the findings and agreed that the group and meetings were valued. It was suggested that we could offer a certificate of attendance, possibly using the NMC template for the participatory part of the meeting as this allows a reflective account on the back. MC suggested that we had some presentations from members of the group to help share good practice and asked for volunteers.
Dan Ward, Head of Publishing, gave an overview of Hospice IQ a web based service which would allow members to upload policies, job descriptions and training documents that they would like to share with other hospices and a forum facility which would take over from the email Q&A.
MC reviewed information on Communities of Practice (CoP) as this group would become the IPC CoP instead of an interest group.
She also advised that we have been offered 50 free places at the Patient First event on 22 and 23 November. We will be holding a networking meeting on 22 November and IPC members are welcome to attend. More information will be sent out in due course. This meeting will be held in addition to the October meeting.
MC asked the group to break into smaller groups and discuss one of the following activities:
- One which challenged you.
- One which evidenced your robust IPC processes.
- Something new you have learnt (for example, a good resource).
- A new development you would like to introduce at work.
- How more could the IPC group be doing to support you in your role?
The group then feedback one of the points discussed. There was also a discussion on FIT testing and whether it was necessary in hospices. It was suggested that it would be better to carry out a risk assessment and make a decision should a high risk patient be referred.
Disinfectants verses detergents
The contents of the presentation on disinfectants verses detergents was noted giving an overview on cleaning including what is best to clean what, how to clean and when items should be cleaned.
RC emphasised that all items should be cleaned, before they are disinfected. He went on to give examples of different cleaning products giving the pros and cons of each. He also emphasised the importance of the cleaning staff and that they should be trained in cleaning methods used by the NHS in hospitals.
This presentation will be made at the next meeting in October, however you can view the prepared presentation. Should this raise any comments or queries please email Amber Morgan who can pass them to Rick who can include them when he discusses this topic in the October meeting.
The presentation on 'Water hygiene including Legionella, pseudomonas, in both wards and community care' was postponed until the October meeting.
Feedback from forum questions
A summary of the queries from October 2015 to April 2016 has been disseminated to the group. There was no further discussion on this topic. If you haven't received a copy please contact us.
MC asked the group if people have a separate freezer for icepacks. The consensus was yes and it was kept in the clinical room.
It was agreed that the topics covered in the next meeting would be on water hygiene including Legionella, pseudomonas, and Vaccines. We also hope that there will be short presentations from members of the group on work they are currently doing. If you would be interested in presenting at a meeting please contact us.
Date of next meeting
- Tuesday 11 October 2016 at Hospice UK
There is also a networking meeting on Wednesday 22 November 2016 at the Patient First conference, London Excel.
Marie Cooper (MC) discussed looking at the current format of the meetings and advised that we would send a survey to the group to address this. A suggestion would be to have case studies from members which would be presented at the meetings to help share learning on top of the presentations from Rick.
Matters arising from the notes from the last meeting
Infection Prevention Society (IPS) had been approached regarding Hospice UK holding a group membership. However the fee was very high and not practical as it would not have given each hospice access. She went onto say that the organisation fee of £500 or the individual fee of £70 were very reasonable. IPS has lots of good content, opportunities to attend regional meetings, information from their conference and ability to view old articles.
MC also reported that there was no new information regarding remote access. However we are continuing to look for a solution.
Urinary catheter care – revisiting saving lives and essential steps
The contents of the presentation on urinary catheter care were noted. It concentrated on the saving lives and essential steps care bundles, the differences and when to use them:
- Saving lives – IPC/HCAI care bundles for acute care from 2004 to 2007, Still available online.
- Essential steps – IPC/HCAI care bundles for community based care. Still available online.
One of the key points was to consider whether a catheter was really needed and, if so, why?
It was suggested that the HOUDINI acronym could be helpful, it stands for:
- Hematuria, gross.
- Obstruction, urinary.
- Urologic surgery.
- Decubitus ulcer – open sacral or perineal wound in incontinent patient.
- Input and output critical for patient management or hemodynamic instability.
- No code/comfort care/hospice care.
- Immobility due to physical constraints.
With regards to training on this subject Sarah Warnes advised that their organisation had invested in the Nursing Times Learning Group Access to help them with revalidation and "Catheter care: managing indwelling urinary catheters in adults" is one of the learning units. It was also suggested that e-learning for Health (Elfh) or e-ELCA could be helpful. Also it would be worth asking your local authority or CCG as training could be provided as part of the contract.
The content of the presentation on CPE were noted. Rick Catlin (RC) advised that it would be good to view the original presentation made in March 2014.
Feedback from forum questions
Contents of the presentation relating to questions and answers that were received between April 2015 and October 2015 were noted.
Any other business (AOB)
It was agreed that the next meeting would be on water hygiene, including Legionella, Pseudomonas, in both wards and community care and disinfectants versus detergents.
MC welcomed everyone to the meeting. She advised that as the venue we used previously no longer offered remote facilities the meeting had been moved back to Hospice UK and we were videoing Rick’s morning sessions that would be available on our website for members only.
MC introduced Emma Burrows and Simon Hawes from PSUK which is the largest pharmaceutical supplier to prescribing only practices in the UK who have kindly sponsored this meeting. Emma gave a presentation on what PSUK did and how they could help hospices.
PPE and Ebola overview (video)
The contents of Rick’s presentation giving an overview of Ebola, this outbreak and the need for training on how to put and more importantly remove PPE was noted. As the Public Health England video on this is not available RC shared information of a video which featured in the New England Journal of Medicine’s ‘Videos in clinical medicine’ about putting on and removing personal protective equipment, focussing on protection from the Ebola virus.
Overview of PVL (Panton-Valentine Leukocidin) - producing strains of Staphylococcus aureus (video)
The content of a presentation on Panton-Valentine Leukocidin (PVL), producing strains of Staphylococcus aureus was noted. He showed how the infections can affect skin and soft tissues as well as being invasive and showed examples. He advised that the infections are more common in community care rather than acute care and are spread where people are close together. He advised people should be aware of recurring infections such as cellulitis which are cleared by antibiotics but come back. Tests for PVL have to be requested specifically and are done in a separate lab. PVL’s are easily treated with antibiotics.
CPE was discussed briefly concentrating on whether hospices screened or not.
Following the last meeting members of the group had sent in items included in their mandatory training. It was agreed the average session lasted an hour. The group agreed on the topics which were highest priority being hand hygiene, PPE and chain of infection.
The group also agreed it was hard to get protected time for training. RC said he would find the minimum requirements for training that appear in the Code of Practice on prevention and control of infections to share with the group.
It was agreed that training that was quick and interesting was more successful and the group discussed games that they had played such as a card game based on the five moments, isolation cluedo and the weakest link.
RC agreed to share the PDF of his card game and isolation cluedo.
He asked the group to send their games and training presentations to AM who would share them with the group.
There was also a brief discussion on whether the group wore uniform and if so were they washed on 60 degrees as most modern clothes cannot be washed on that high a temperature. It was thought that with modern methods, improved detergents this probably wasn’t an issue however it was highlighted that research carried out by De Montfort University Leicester has highlighted that washing uniforms at 60 degrees and separately from normal clothes was still important.
It was requested that Catheter care was discussed at the next meeting.
MC confirmed that following feedback she would look into corporate membership to IPS
Group advised that Help the Hospices is now Hospice UK and confirmed the links to website are as follows:
To enable everyone to benefit from the answers provided to questions asked the new process is as follows:
- Email AM your query
- AM will send this to the group
- Send any replies directly to the person making the enquiry, copying AM in
- A summary of the replies provided by the questioners will be prepared sent to AM to share with the group.
Rick gave an update on Ebola and the transmission of the disease to three people from cross contamination in the USA which emphasises the importance of following the correct IPC and PPE procedures. PPE guidance.
He reviewed CPE and confirmed that the guidance given is not consistent. If hospices have all single rooms the need to screen is not necessary as it is very invasive although hospitals are likely to screen more regularly. During this discussion Kim Gunning agreed to share her screening tool. RC then gave a presentation on ANTT Aseptic Techniques
The group then reviewed some of the questions raised in the last 6 months
concentrating on discussing those questions that had not received many or any
replies. These included:
- CVC’s - RC suggested that the Royal Marsden Guidelines would be good to follow.
- Decontamination of blinds - RC suggested roller blinds were a good option.
- Trialling of equipment – RC advised hospices that if the regional groups approached organisations they may be able to get free trials of equipment.
- Are mortuaries seen as a clinical area – RC not necessarily but they need to be safe for staff so regular cleaning required.
- General cleaning - RC promised to share his poster presentation, shared with IPS, on using ultraviolet tagging to ensure equipment has been cleaned.
- Carpets vs wooden floors - Jenny Wratton agreed to share her risk assessment on carpets in clinical areas.
The fact sheets, developed at the last meeting are now ready for publication. They were approved by the group. Copies have been emailed and are also attached below. They can be adapted by individual hospices referring to specific policies and practice and adding their own logo.
The group were encouraged to use the Forum to share question as this allows everyone to view the replies. It was noted that there is now a good number of experts in the group and maybe we needed to develop this, possibly replicating the peer mentoring scheme used by ECLiHP.
Positive feedback was received from members of the group who had attended the HCAI events.
Rick Catlin gave an overview of the DH CPE (Carbapenemase Producing Enterobactericae) Toolkit and how it may affect hospices, although currently only applicable to acute hospitals. Among the resources available following this meeting, is a personal overview of the toolkit, by Rick, including a list of the acronyms together with a template email for the group to advise their SMT.
Work on pet guidelines is on-going and should be completed in the new year.
A review of the website, including the use of the Forum to take over from the question and answer service, currently in use. Information on the new share board which will allow members to share policies and examples of good practice. Amber will ask permission from any members who have supplied policies in the past.
A stimulating presentation on ‘Drug resistant gram negative organisms’ which is an issue posing serious global health issues, and some considerations the on the implications for hospice care and treatment options.
A training approach for quick one to one or small group sessions was shared with the group. This method has been found to be very effective in engaging staff in the clinical area rather than a class room setting. The group selected key areas of IPC which would benefit from ‘a quick fact sheet‘. Fact sheets on the following topics will be finalised and added to the website in due course:
- hand hygiene
- dress code
- waste management.
Rick gave a presentation titled 'Brave new world'. It gave an overview of the new restructuring facing the NHS and the implications for IPC in the NHS and what this may mean for hospices. He also included a brief review of winter IPC outbreaks being flu, Coronavirus and Norovirus.
Rick then gave a presentation on 'Cleaning and Disinfectants' explaining the difference between cleaning and disinfecting, emphasising the importance that everything should be cleaned/washed prior to any disinfectants being used. He then gave the pros and cons of using the different sanitisers and disinfectants providing examples for their use.
The group then participated in creating the outline for the 'Visiting and resident animal guidelines for hospices' which Rick will use to create a draft to share with the group for comment shortly. The final draft will be agreed at the next meeting.
Guidelines for 'Catheter care' and 'Use and cleaning of jacuzzi's and whirlpool baths' will be sent to the group prior to the next meeting for comment and possible finalisation at the next meeting.
Rick then reviewed some of the question that were received between July and November 2012.
Amber showed the group the newly published web pages for the IPC and advised them of the future plans to replace the questions and answers, that currently go through Amber, with an IPC Forum and the opportunity to share good practice, policy templates and training material through their own Share Board.
Becton Dickinson gave a presentation on the new Sharps Directive and answered questions on this topic. They also brought in products to show members what the needleless versions of various equipment looked like.
It was suggested that the group also visited the Health and Safety Executive website for further information on the Sharps Directive which contains further guidance and links to other sites such as the Safer Needles Network and European Bio-safety Network.
Andrew Thomson from the National Audit Tools Group came in to show the group the new format for the Infection Control Modules and asked for feedback which was very positive.
Rick reviewed questions that had been sent to the group since the last meeting and a version of this document will be shared with the group. Three topics were identified as needing generic guidelines:
- Use and Cleaning of Jacuzzi’s and whirlpool baths
- Pets in hospices including Pets as Therapy (PAT) and patient's pets
- Catheter Care.
Rick will prepare these and bring them to the next meeting for review.
Following a number of questions on what cleaning products to use it was decided that the next meeting should contain a presentation on "disinfectants vs detergents."
Rick Catlin fed back on a survey looking at people’s understanding about key infection that was sent out prior to the meeting and then gave a presentation on Notification of Infectious Diseases (NOIDS). Rick provided a copy of a NOIDs policy which contains an appendix on what to collect and a policy on the isolation of patients that contains list of Alert and Notifiable infections.
A presentation on Mandatory Surveillance was given and this covered four of the most common infections: MRSA Bacteraemias, Clostridium difficile infections, Staphylococcus aureus Bacteraemias andE. coli Bacteraemias.
The group then broke into smaller groups to discuss current issues they were facing and shared experiences of how they dealt with them.
Rick advised the group to visit the World Health Organisation website for WHO guidelines on hand hygiene in health care.
This was the first meeting of the Infection, Prevention and Control Interest Group (formerly the Infection Control Group).A discussion identified the priorities for future meetings. They are to:
- provide training and updates on topical and relevant IPC issues
- provide support and advice to IPC leads
- develop e-learning resources via web page
- build hospice IPC community offering peer learning.
Rick Catlin gave a presentation covering the IPC issues from a hospice perspective, including measles, C. difficile testing, water Safety and new EU legislation to reduce needle stick injuries in healthcare.
In future meetings topics for discussion will be identified either by a survey issued prior to the meeting or from issues raised in the previous meeting.
Andrew Thomson from the National Audit Tools Group gave a presentation giving an overview of the infection control modules and took questions and comments on the use of, content and format of the tools.