ALERT ORGANISM

Dr Suhazeli Abdullah

ALERT ORGANISMS
are organisms that pose a significant risk of transmission to non-infected patients or healthcare workers (HCW) by either colonization and /or subsequently a patient or HCW developing healthcare associated infections (HAIs) as a result of infection by the organisms OR They pose a significant risk of transmission to non-infected people in the population or community

FACTS AND FIGURES

More than 300,000 people each year are affected by a healthcare associated infection At any one time 8.2% of patients have a healthcare associated infection. On average a person with a healthcare associated infection will spend over 2.5 times longer in hospital, cost over 3,000 more to treat and often requires treatment after discharge. The cost to a typical Trust like ours of treating healthcare associated infection is 3.6m a year. 5000 patients die a year because of healthcare associated infection and it contributes to the deaths of a further 15,000 others1. The cost of healthcare acquired infections to the NHS is approximately 1 billion a year

CURRENT INFECTION RATES

Between February and May 2006, infection control staff across the UK and Ireland surveyed 75,763 beds and found that 7.6% of adult patients in acute hospitals had healthcare-associated infections. This rate had not changed appreciably since the previous survey conducted over ten years before.The Trust contributed data based on observations made on the WRH site (255 patients) and the Alexandra site (100 patients). The combined Trust prevalence was 10% (WRH 8%, Alexandra 12%). Currently, the Trust has made very great progress in reducing the prevalence of the two main healthcare associated infections,
meticillin resistant Staphylococcus aureus (MRSA) bloodstream infection and Clostridium difficile infection (CDI).

CLASSIFICATION OF MICROORGANISMS ON THE BASIS OF HAZARD (WHO RISK GROUPS)

Risk Group I Low risk in laboratory worker and community UNLIKELY to cause disease eg: Rhizopus, Mucor (moulds)

CLASSIFICATION OF MICROORGANISMS ON THE BASIS OF HAZARD (WHO RISK GROUPS)

Risk Group II Moderate risk to laboratory worker and community Preventive measure (vaccination) or drugs are available for treatment Risk of spread in community low e.g: Staphylococci, Streptococci, Coxsackie

CLASSIFICATION OF MICROORGANISMS ON THE BASIS OF HAZARD (WHO RISK GROUPS)

Risk Group III High risk to the laboratory worker Low risk to community Do not spread rapidly from one person to another Preventive measure (vaccination) or drugs are available for treatment eg: Mycobacterium tuberculosis, Salmonella typhi

CLASSIFICATION OF MICROORGANISMS ON THE BASIS OF HAZARD (WHO RISK GROUPS)

Risk Group IV HIGH risk to laboratory worker and community Easily transmitted from one person to another Preventive measure (vaccination) or drugs NOT available for treatment Mainly viruses- e.g: Marburg, Ebola

INFECTIOUS ROUTE: AIRBORNE ROUTE

Some infections are transmitted by the inhalation of micro-organisms in droplet nuclei. These minute particles are expelled from the respiratory tract by coughing or sneezing, and may remain suspended in the air for a long time. Infections transmitted in this way include

Tuberculosis, Influenza, Chickenpox and Severe Acute Respiratory Syndrome (SARS).

INFECTIOUS ROUTE: CONTACT ROUTE

Contact transmission is the most common mode of transmission within the healthcare setting. Infections commonly spread in this way include Staphylococcus aureus including MRSA strains, Clostridium difficile and gram negative organisms including EBSL producers. Contact transmission may be sub-divided into direct contact, and indirect contact. Feco-oral Route

RESPIRATORY DROPLET ROUTE

Infections such as meningococcal meningitis, pertussis, and some respiratory viruses are transmitted by contact with respiratory secretions, including particles produced during coughing and sneezing. These particles do not travel far or remain airborne for long, unlike those infections which generate airborne particles easily Meninggococal Meninggitis Pertusis

BLOOD ROUTE

Some infections such as Hepatitis B, Hepatitis C and HIV are spread via blood and high risk body fluids. Health care workers may be at risk via inoculation injuries or splashes into mucous membranes such as eyes or mouth.

PRECAUTION

COMPLIANCE

In 34 major studies of handwashing, workers washed their hands only 40% of the time. Another reason why personnel don't wash their hands often is that frequent handwashing with soap and water may cause skin irritation and dryness. In the winter months, some personnel may even develop cracks in their skin that cause bleeding. Healthcare workers can get 100's or 1000's of bacteria on their hands by doing simple tasks like: Moving and handling patients in bed Measuring blood pressure or pulse Touching a patient's hand Rolling patients over in bed Touching the patient's gown or bed sheets Touching equipment like bedside rails, over-bed tables, IV pumps

ALCOHOL RUB

If hands are not visibly soiled or contaminated with blood or body fluids, use an alcohol-based hand rub for routinely cleaning your hands. Hands should be decontaminated at the following times; Before having direct contact with patients After having direct contact with patient's skin After touching equipment or furniture near the patient, within the patient's bedspace Before and after any clinical procedure After removing gloves Before eating After using the toilet

PROTECTIVE CLOTHING
Wear gloves for contact with all blood and body fluids and remove after use. Wear eye protection/masks if splashing into the face is likely e.g. intubation. Wear duckbill masks as required e.g. patients with TB, meningitis. Check you know how to apply and remove duckbill masks correctly. Mask..

CARE OF EQUIPMENT
Keep the environment clean and dust free Detergent wipes can be used to clean most surfaces effectively Cleaning medical equipment is guided by a risk rating in the Trust decontamination policy

CARE OF EQUIPMENT

Minimal Risk Equipment - Items some distance away from the patient such as environmental surfaces and fittings, e.g. walls, floors, ceilings, sinks and drains. - Items in close proximity to the patient but unlikely to be contaminated with a significant number of pathogens, e.g. bed frames, lockers, flower vases. Level of decontamination: domestic standard cleaning and drying adequate

CARE OF EQUIPMENT
Low Risk Equipment - Items in contact with normal intact skin, e.g. stethoscopes, wash bowls, crockery, cutlery, mobile telephones.

Level of decontamination: domestic standard cleaning and drying usually adequate

Intermediate Risk Equipment - Items in contact with intact non-sterile mucous membranes, e.g. respiratory equipment, clinical thermometers, gastroscopes.

- Items in contact with particularly virulent or readily transmissible organisms. -Items to be used on highly susceptible patients. Level of decontamination: disinfection

High Risk Equipment - Items in close contact with a break in the skin or mucous membranes, e.g. dressings. - Items introduced into a normally sterile body cavity, e.g. surgical instruments, needles, implants, urinary catheters.

Level of decontamination: Sterilization

Always follow the method listed for decontamination and never improvise Avoid communal items in the bathroom e.g. bar soap, shower gel. Do not reuse any single use items Complete Decontamination Forms (available in the Decontamination Policy on the intranet and from ward clerks) when returning clinically used equipment for repair..

WASTE

is colour coded to ensure safe disposal Yellow bags - hazardous waste from known infected patients Orange bags - all other clinical waste Black bags - domestic waste Brown (Worcester) Blue (Alexandra) Grey (Kidderminster) - confidential waste Cardboard box - broken glass

Linen is also colour coded to aid appropriate laundry procedures. Use white plastic for soiled linen. Double bag if very wet. Use alginate and red plastic bags for infected linen e.g. ESBL producers. Note that infected linen bags are not required for patients with MRSA, but their linen should be sealed at the bedside into white plastic bag. Systems are in place for laundering patient clothing or manual handling equipment - check your local site guidelines

SPILLAGES
Wear an apron and gloves for safe removal of any spillage. Spills of high risk fluid, e.g. Blood, should be cleaned with a chlorine releasing agent (bleach) such as precept granules/sanichlor tablets. Bleach cannot be used on fabrics or carpets. Low risk fluids such as urine should be cleaned with detergent and warm water.

ALERT ORGANISMS
Bacteria Virus Fungus Parasite

NOTIFIABLE DISEASES
1. 2. 3. 4.

Cholera

15. 16. 17. 18. 19. 20. 21. 22. 23. 24.

Diphtheria
Encephalitis Gonococcal infection/Gonorrhea Leprosy Paratyphoid fever Pertussis Plague Relapsing fever

5. 6. 7. 8. 9.

10. Rickettsiosis 11. Syphilis 12. Tetanus 13. Tuberculosis 14. Typhoid

25.
26. 27.

Typhus Whooping cough Acquired immunodeficiency syndrome Dengue fever Ebola Hepatitis Human immunodeficiency virus (HIV) infection Measles Poliomyelitis Rabies Yellow fever Dysentery Malaria

fever

BACTERIA

Examples: : Vibrio cholerae Mycobacterium tuberculosis Salmonella typhi Neisseria gonorrhoeae Alert Organisms- Bacteria Neisseria meningitidis Based on antibiograms * MRSA * Vancomycin-resistant enterococci (VRE) * Extended spectrum beta-lactamase (ESBL) Klebsiella MRO e.g Acinetobacter spp., Pseudomonas aeruginosa

MULTIDRUG RESISTANT ORGANISMS (MRO)

Definition: Microorganisms,predominantly bacteria, that are resistant to one or more CLASSES of antimicrobial agents (CDC Definition)

VIRUS

For viruses, they are usually NOT being cultured in routine diagnostic laboratory, and the laboratory diagnosis most of the time is usually made via serological tests. They are usually mentioned as ALERT based on the conditions that they caused Alert Organisms- Virus Examples:

Dengue /DHF Dengue virus Influenza Influenza A (H1N1) SARS coronavirus

ALERT ORGANISMS- PARASITE

Malaria Plasmodium spp.

CONVEYING THE MESSAGE OF ALERT ORGANISMS

This can be done via: Telephone conversation Flagging system on LIS/THIS Tagging of patients bed ticket Ward visit by IC personnel

IMPLICATIONS OF ALERT ORGANISMS

Positive microbiology results that falls under ALERT organisms may result in: Case review Search for other carriers or infected patients Isolation Early discharge (if possible) Report to Public Health authorities Public health measures in the community

IMPORTANT CONCEPTS IN TRANSMISSION OF INFECTIOUS AGENT

Transmission is determined by: Availability of vulnerable patients Selective pressure exerted by antimicrobial use Increased potential for transmission from larger numbers of colonized or infected patients : colonization pressure The impact of implementation and adherence to prevention efforts.

TERIMA KASIH