Episode Transcript
Infection Control Explained (ICE) Podcast 1 Introduction to Infection Control
This Podcast is brought to you by the GOSH Learning Academy.
[00:00:05] Kate: Welcome to the First ICE Podcast. In our series of podcasts. ICE stands for Infection Control Explained. We're going to take you through some general infection control, need to knows and some information about specific bugs and infections. Today's ICE podcast will introduce infection prevention and control in the hospital setting.
My name is Kate Harkus I'm the lead practice educator for Infection Prevention and Control at Great Ormond Street Hospital. And today I've got Helen Dunn with me, who's the Director of Infection prevention and Control, and consultant nurse at Great Ormond Street Hospital. She's here as our expert today.
So, Helen, welcome. Can you tell me a little bit about infection control and why it's important?
[00:00:52] Helen: Thanks, Kate. Yeah. Infection control's really important in hospitals and it's a key part of patient safety. Infection control in its broadest terms, refers to infections that patients might have, things like chicken pox or measles.
But it also covers things like antibiotic resistance, which we'll talk about a bit later, which is basically where bugs that live everywhere have become resistant to certain antibiotics. So when we think about infection control in the broadest sense, we're not only looking for patients that might have infections like we've talked about, like chicken pox, but we're looking for patients who may have bugs on them causing no harm, that have acquired some form of antibiotic resistance, and this is really important. The overall aim of infection prevention, control, or infection control, is to keep our patients and staff as safe as possible from these infections and these organisms that are resistant to certain antibiotics.
And that's for two reasons, really. A, we want to be able to keep patients free from infections so that they can live good, healthy lives. And the same with our staff, but also we want to try and stop the spread of antimicrobial or antibiotic resistance. So, in order to do this, infection control is really broad and we cover everything in the hospital from things that you might know about, like hand hygiene where we think about hand washing or cleaning our hands with sanitizers to linen, so the bedding that patients sleep on
and that we get in. And we also think about things like clinical guidelines that tell us how we want to do practices. Also review things like ventilation systems or water systems to make sure we're keeping our patients and staff as safe as possible.
[00:02:38] Kate: Got you. Okay. That sounds like a lot. So, let's talk a little bit more about what a patient and their family can expect when they come to Great Ormond Street Hospital.
So, maybe someone coming into an inpatient setting or an outpatient setting.
[00:02:55] Helen: Yeah, so I'll start with outpatients first. Perhaps that's a good place to start. So if we had a patient and their family or carers coming into our outpatient setting, obviously before they arrive, infection control begins right at the beginning.
So within the admission letter or the letter asking them to come for an appointment or a text message, asking them, there should be some information reminding them that it's really important that perhaps they don't attend if they're unwell. They obviously need to discuss that with their clinical team to see whether they actually need to come in, because obviously some children need to come in, even if they're unwell.
But then we can facilitate making sure that they put in a safe environment, not only for themselves if they've got a cold or a cough or a rash, but also for the benefit of other patients so that we don't expose other patients to what might be infectious diseases. So it's really important that they read that letter, that they understand if any of these things, the general things we're looking for
that we would want to know about for patients coming into outpatients are if they've had diarrhoea and vomiting in the last 48 hours, unless it was an urgent appointment, we would recommend that was deferred. If they've got a cough or cold or they're a bit snuffly, again, ideally they need to just have a chat with the clinical team and obviously themselves, see if they think that their child is well enough to come in or if actually it might not be a good idea.
If these children do need to come in, like I said, we can find what we call an isolation room for them, or a room where they can just go, come into the organisation and then just go straight into that room. And the final thing is just really around rashes and exposures to things like chicken pox or measles.
We know that after the pandemic that actually there was quite a large portion of the population that missed lots of their vaccinations, like mmr, etc. and lots of, altered children who would normally have got chicken pox perhaps missing getting chicken pox because we were in bubbles and things at the time.
So, it is really important to let us know if your child's got a new rash, or if they have, say for example, at their nursery or school you've had an email or messages to say that they've been exposed to chicken pox or measles so that we can make a decision about whether it's good to bring them in or not.
So that's like the things we need to know that help us make the appointment as good as possible for the patient and make sure that we do the correct things with regards to cleaning and protecting other patients. And the same questions would be asked if a patient was admitted to the ward.
So as part of the admission, you would expect the medical or the nursing team to ask those same type of questions. And ask about a vaccination history. There are some other general things that you can expect. When you come in. Obviously hand hygiene is a huge part of infection control and probably the thing that is associated most with people for infection control.
So you should see people washing their hands and all members of staff should, either wash or decontaminate their hands with the red sanitizer that you see on the walls and around various places before and after they have contact with your child or before and after they've contact with the child.
So that's really important.
The other thing that we also ask all admitted patients to provide or give us is a poo sample so that we can test the poo for any of the resistant organisms that I spoke about. And we also do MRSA screens on all patients. So that's two swabs generally for most patients. One in the nose and one at the back of the throat that the nursing staff will help with.
And we do that to look for MRSA, which is a resistant organism. So that will happen every time a patient is admitted and once they are admitted, we currently retest patients every 30 days.
[00:06:49] Kate: Got you. Thank you. During the COVID-19 pandemic, so, we at Great Ormond Street Hospital, we were asking patients and families about their symptoms of COVID on a daily basis and whether they felt unwell.
The advice at the time was to stay away from the hospital if you were unwell, what is the current advice from infection control?
[00:07:10] Helen: So, I alluded to this earlier. I think it really, there is some things like diarrhoea and vomiting and other things where actually if your patient's unwell, unless it's urgent, we would normally advise that either the appointment or the admission is postponed, perhaps.
But it's really difficult with children with coughs and colds because we've both had children and we both know how much they snuffle and they have a cough and a cold. So that can be a really difficult decision to make as a parent, whether that's normal or whether this is a new respiratory tract infection or that type of thing, or a new cold.
So I think the most sensible thing to is, if they're well enough or if they're unwell enough that you would've kept them off school or off nursery, then you probably really do want to think about whether coming to the hospital is the right thing. There should always be a number that you can call or a member of the clinical team who's looking after your patient, who can give you that specific advice.
Because it may well be that your child or the child has a really complex, condition that actually they do need to come and be seen. So I'd always recommend that, infection control don't make that decision, but actually the clinical team make the decision about whether the child's well enough to come in or well enough to be deferred for a couple of weeks or something.
[00:08:29] Kate: I'm part of a clinical team and I'm not too sure about that, for example what could I do from a part of clinical team?
[00:08:37] Helen: So I think
if a parent had rung you, you mean, and said, I'm not really sure. So I think you need to escalate that within your team. So you either need to find the registrar or the consultant who's gonna be looking after that child or running the clinic.
Ask them what they think. Have a discussion with them. If they do need to come in and it's an outpatient's appointment, you can have a chat with perhaps, the matron for outpatients or one of the sisters with an outpatient and see if you can arrange an isolation room for that child to come in. And then obviously, the most important thing is the feedback to the families about what's been decided so that they're aware.
[00:09:14] Kate: Yeah, understand. Thank you. And you just mentioned this word, so this is a good question. So can you tell us what isolation means in infection control?
[00:09:23] Helen: Yeah. Isolation, I'm afraid means what it says on the tin, so it means children, being in a room by themself. And it means for example, if you were in isolation in outpatients, you would go to the desk or the kiosk and you would book in.
You would then not wait in the general waiting area and you would be escorted to an isolation room where you would wait and the staff would, the doctor or the nurse would come and see you within that isolation room. It's not very nice as a parent with a child to have to, have a child in isolation, but it is
necessary for a number of reasons. The most obvious reason we think about is when some of our children or our patients are immune suppressed. So when they've got a reduced immune system and we want to protect them from other patients. So there are times when children might need to be isolated for that reason.
But when we think about it from an infection control point of view, it's because the child could have an infectious disease like we spoke about, like diarrhoea and vomiting, norovirus, influenza, cough and cold, or things like chicken pox and measles, which are highly infectious. So we need to keep them away from other children to stop the spread and stop any complications.
Unfortunately, we also have to isolate children who have got antibiotic resistant infections or colonisation. And we do that to prevent the spread of those organisms to other children, we know that if we don't do this, children are allowed to interact and play, that these organisms can spread really easily.
If you think about how a child interacts in a waiting room, if there's toys if they're young and they're a toddler, they'll have them in their mouth. They'll put them down, and another child comes up, they pick them up, they put them in their mouth. It's even with the best will in the world,
unless we isolate these children, there is a risk that we can pass this on to other children, which is why we have to unfortunately isolate.
[00:11:29] Kate: Yeah, I understand. So to finish this one off, what would you say are the top three things that patients and their families need to know when they come to Great Ormond Street Hospital?
[00:11:43] Helen: So top three tips, I would say, number one, it's always okay to ask people if they've cleaned their hands, if they've, washed their hands, used the gel, I would say. We obviously from an infection control point of view in my team, we do lots of education. It's part of mandatory training, but actually our staff are all human and people we know will forget at times and will be caught up in, in other things and be keen to get on and look after your child.
So, as humans we do make errors. So if you notice someone come in and you haven't seen them do that, do just feel free to politely ask them. Do you mind using the gel? That would be really great. Thank you. That people will be grateful for that reminder. 'cause it's difficult for us to remember to do everything all the time.
So I think that would be my first thing. Number one we advocate for our children as parents and carers all the time in everything we do. So just continue to do that. And don't be afraid to remind people. Number two, I think, is just understanding the importance of things like the tests that we ask for.
So the MRSA screens and the poo samples they're not particularly nice, but they are a really important way within infection control that we stop the spread of infections. And the sooner we get these tests done, the sooner we can hopefully get your child into the playroom and those things, as soon as we get the test done we can get them back.
They do take some time to grow. So they're not an immediate answer. That's the other thing. These bugs, we actually grow them in the lab, so it can take up to five days. It won't be an immediate answer. And number three is just really helping us keep the place clean and tidy. We know that cleanliness and cleaning is a huge part of infection control.
So actually, if you are in an inpatient ward, keeping the bed space clean and tidy, making sure the cleaners can get in and clean every day, that the nurses can clean down the clinical equipment. If you're bored and you want to help with any of those things, pulling out your bits, cleaning the chair, those types of things, if you're there for a long time, all those things are helpful 'cause I, the cleanliness of the environment is a huge factor in preventing infection and resistant organisms spreading around.
[00:14:00] Kate: Lovely. There's lots more we can talk about, but this is only podcast number one of a series, so we will leave this one there as an introduction to infection control and what can be expected. So thank you very much for your time. And we'll see you all podcast two.
[00:14:20] SA: Thank you for listening to this episode. If you want to find out more about the work of the GOSH Learning Academy, you can find us on social media on Twitter, Instagram, and LinkedIn.
You can also visit our website at www. gosh. nhs. uk and search Learning Academy. We have lots of exciting new podcasts coming soon, so make sure you're subscribed wherever you get your podcasts. We hope you enjoy this episode and we'll see you next time. Goodbye.
