Episode Transcript
Infection Control Explained (ICE) Podcast 2 Resistant bugs
This Podcast is brought to you by the GOSH Learning Academy.
[00:00:04] Kate: Welcome back to the ICE Podcast. ICE stands for Infection Control Explained Today's ICE podcast will explain a bit more about resistant bugs. My name is Kate Harkus. I'm the lead practice educator for infection prevention and control. And today I have got Helen Dunn with me once again, who's the Director of Infection Prevention and Control and consultant nurse at Great Ormond Street Hospital as our expert.
So Helen, welcome back. Can you tell us a little bit about resistant bugs and why we are concerned about them?
[00:00:39] Helen: Thank you. So, yeah, I can, but I think in order to start with, there are just a couple of things we need to talk about before we talk about resistance, what they are and why we're concerned about them.
The first thing that I would say is that, bugs are everywhere.
There are more bugs on the human body than there are people in the world, so kind of don't be afraid of them. When we are thinking about them in this context, they're not all bad.
In order to talk about why resistant bugs are a problem and why we're worried about them, we need to understand two terms that I'm gonna try and explain first, that we use a lot in infection control.
The first one is infection. So what's an infection? And the second one is colonisation, which people may or may not have heard of. So if we think about infection first , we sort of know what that means. The clues in the title, there's something going on, a bug is causing an infection. So it's causing, in simple terms, an inflammatory response in the body.
So if you think about the cut that you get in your hands,
it'll often become red, sore. It can sometimes have a bit of pus and things. If it's infected, those types of things. Whatever bug has got in and is causing an infection is there, and, and doing all those things. Does that make sense?
[00:02:03] Kate: Just like causing harm.
[00:02:04] Helen: Yeah. Basically. Causing harm. Colonisation is slightly different. So colonisation means that a bug is there, but it's not causing any harm. So a good example for that I always think, is to think about yakult yogurts.
And we don't particularly promote any brand of the yogurt, but if we think about yakult yogurts, we have this thing called our normal flora that we hear about in the news and in adverts and things.
When we have a yakult yoghurt or those types of probiotic drinks, we are sort of drinking the healthy microorganisms, if that's the right word, and trying to get them to colonise our gut so that we have a better microorganism system down there, or a better environment down there.
So colonisation in the simplest terms means that bugs are present, but they're not causing an infection.
[00:02:55] Kate: Okay.
[00:02:56] Helen: So all of us are colonised with bugs. Does that make sense?
[00:03:00] Kate: Yeah. Yep.
[00:03:02] Helen: The difficulty is, and the things that why resistant bugs are important is, bugs are everywhere, we are colonised with bugs all over our body, inside and out. If some of those bugs are resistant to antibiotics or certain groups of antibiotics, that can make it really difficult for us in healthcare to treat patients.
[00:03:23] Kate: Okay
[00:03:23] Helen: And it's not just patients with infections that we are concerned about because you might be thinking about a patient who comes in, and is unwell after they've cut their leg or things like that who have come in with something we call sepsis, when the body reacts essentially to the infection and, and starts sort of cascading an an immune response and things.
So we would be concerned about, those bugs that are kind of getting into the body, being resistant to the antibiotics we were going to use to treat the infection.
[00:03:56] Kate: Okay.
[00:03:57] Helen: An easy way to think about it is, if you think of a, perhaps a tube of, or a jar of jelly beans, and we've got, all green jelly beans in there and we've got one red jelly bean.
[00:04:11] Kate: Mm-hmm.
[00:04:12] Helen: If we were to give a drug that killed all the green jelly beans, the red one would still be left. The red one then has the opportunity to grow. That's how sort of resistant organisms spread. So if we've got one bug that's resistant in there. Then when we give antibiotics, patients can seemingly get better and then they can almost relapse.
Sometimes that can be due to resistant organisms being there, or bugs that aren't killed by all the antibiotics. So this causes a problem for us for a number of reasons. The first is we don't have lots of new antibiotics that are coming out. Antibiotics are not as popular as some other drugs. Things that you would need to take every day for the rest of your life, such as metformin if you're diabetic or those types, or a heart drug, for example.
They're obviously from a pharmaceutical point of view, much better to manufacture. 'cause you've gonna be able to supply them to somebody for the rest of their life.
Yeah. Antibiotics are much more difficult because anyone who's been to the GP lately should know how difficult it is to get an antibiotic prescription if you go in with a cough or cold.
. Because we want to try and preserve the antibiotics we've got left. As a result of that, it's not really in pharmaceutical company's best interest to produce lots of new antibiotics because we will safeguard them for the infections that are hardest to treat.
[00:05:37] Kate: Mm-hmm.
[00:05:38] Helen: So, that's one of the reasons why we are so concerned about them.
There are also drugs, bugs out there that we call pan resistant. And pan resistant means resistant to every antibiotic that is available.
[00:05:51] Kate: Okay.
[00:05:52] Helen: They're becoming more common and we do see them in this country. So for those patients if they get an infection, that can obviously be really bad. And just to finish up on this there, if we think about, the example that I gave was someone who came in with a cut who was septic, for example.
[00:06:11] Kate: Yeah.
[00:06:11] Helen: That's all well and good, but if we think about most of our patients that we see, about half of them come in for elective surgery. And as part of coming in for surgical procedures, we give prophylactic antibiotics or antibiotics is covered to stop people getting infection. If resistant bugs continue to grow and continue to sort of like spread like they are, then those antibiotics that we're giving to prevent infection for complex operations might not work.
So we might see more infections after surgeries and things like that. So it is really important.
[00:06:46] Kate: Well, it's really well explained, I think. So here then, or from an infection control team point of view, what do we do? What do we, how do we test, how do we monitor our patients?
[00:06:57] Helen: So the things that we've talked about in the first podcast, so
the most simple thing we do is we collect an MRSA sample, which is a nose and throat swab.
[00:07:08] Kate: Mm-hmm.
[00:07:09] Helen: It's important to say that that swab in some groups of patients, whilst we call it an MRSA swab in some sort of critically ill patients that may test for more microorganisms as well. So, in broad principles, we test and we see if somebody's colonised with MRSA.
We also take a poo sample, which we spoke about before, because a lot of the organisms that can cause infections in patients live in the gut. So actually what we want to do is get a sample of poo rather than a rectal swab, which is where you take a swab and just swab inside someone's rectum, which isn't very nice.
We, we would rather have a stool sample.
[00:07:47] Kate: Mm-hmm.
[00:07:48] Helen: A, because it's nicer for our children, although might not even think a poo sample's very nice, but it's nicer than a rectal swab.
[00:07:55] Kate: Mm-hmm.
[00:07:55] Helen: And B, it actually gives us a bit, it's a better test because we've actually got a bit of poo to test rather than just a swab
of someone's poo off their skin from the inside of their rectum, if that makes sense. Yeah. So that's the, and obviously any clinical samples we get are also tested to grow any bugs. And then once we've grown the bugs, we then put in the laboratory, we put antibiotic discs on top of where we've grown the bug to see which ones they're sensitive to and which ones they're not.
[00:08:27] Kate: Yeah. Get you. Thank you. So in terms of management then of the patients with resistant bugs, how do we try and do that here?
[00:08:35] Helen: Yeah. So for staff, the most common way that our staff will see that patients have got a resistant bug is that they'll have a epic alert on, as we call it. So on the storyboard side of Epic where the picture is and their name, there'll be sort of a yellow highlighted area that will say something like MRSA colonisation, Gram negative colonisation, , CPE colonisation, it will give, VRE or given, it will tell you which resistant bug that child is. Has been isolated from that child's sample.
[00:09:12] Kate: Mm-hmm.
[00:09:12] Helen: For staff who are working, it's really important that they don't just see that and think that's the end of it. If they actually click into that alert or hover over it, there's a whole heap of information that we update based on all the child's most recent sample.
So it'll say something like, last positive result on X date. It will give you information about what kind of isolation they need, what kind of tests they need when they come in, and any specific cleaning that needs done after they go home.
[00:09:42] Kate: Mm-hmm.
[00:09:42] Helen: So that's a really quick, easy place you can find all that information.
So they're kind of the main things that from a staff point of view is as a quick, easy guide. We've also got lots of information on the intranet that is available for staff. Once you know which bug it is, which I know some of the other ICE podcasts are gonna talk about. So I won't go into specific details, but once you know which organism it is you're talking about, it will give you direction around the cleaning or any specific care things we need to think about with those patients.
But anything you sort of must know is within that alert on the first page. So just open it up and have a look, would be my first thing.
[00:10:24] Kate: Mm-hmm.
[00:10:25] Helen: If you're a parent and your child has a resistant bug or an alert on for a resistant bug, you should have received that information in one of two ways.
If we got the result. Remember I said it takes a while for these samples to come back? Mm-hmm. So unfortunately, if your child's just in for a short period of time, it might be that by the time we've got the result, you've already gone. That doesn't mean we're not gonna tell you about it. We review all of these as the infection control team, add the alerts. If the child's already gone home,
then we send a letter either via my gosh, or postal if needed. Mm-hmm. We also let the GP know, 'cause we have a, an obligation under the Health and Social Care Act to tell other healthcare providers mm-hmm. Of any resistant organisms. So we make sure we tell them. And that's important because if your child has
infection. It's important to understand if they're colonised with any resistant bugs, so we can give you the right antibiotic, which we spoke about back at the beginning. So you can see how it all starts to link in together, but you'll receive a letter explaining that, and you'll also receive a leaflet, which we call the resistant bugs leaflet, which explains what that means.
And what that means when your child's gonna be admitted, etc. If you are a inpatient, when that happens, then we will phone the ward staff and they should come and tell you and they should give you that leaflet. Mm-hmm. The leaflets are also available on the, gosh, internet for parents.
We update that page as the infection control team.
[00:11:56] Kate: So is there anything that you know, staff, patients, parents, and carers can do to help manage resistant bugs?
[00:12:05] Helen: Yeah, I think the most important thing is stool samples. And MRSA screens nobody really likes the poo samples. We've got a big project going on in our team at the moment to try and increase compliance you know, try and get more people giving us poo samples so that we can test for resistant bugs'cause it's really difficult for us to, to control the problem if we haven't got all the information around it. So, I'd say testing is the first thing. So provide your poo sample.
Second thing, the really things we've talked about before, so keeping areas clean and tidy so that we can clean. We've talked about the importance of cleaning with infection prevention control, so just keeping your bed spaces clean and being able to enable the cleaners to, to come in and do their cleaning and the nursing staff to clean the medical equipment as well is really important. And hand hygiene really, we know that's one of the most important things that we can do to prevent the spread of infection.
It is difficult. As I've said before, you know, our staff are busy. Looking after more than one patient. So, you know, don't be afraid to remind people about hand hygiene. They'll be grateful you have asked them. We are all here for the same purpose, which is to care for our patients and our children.
So it's part of all of our responsibilities. Staff, parents, carers, children, if they're able to, to remind us all about hand hygiene.
[00:13:33] Kate: Perfect. Alright. I do think you've just answered this, but we're gonna try and wrap up each podcast in the same way. So, top three things to remember from this podcast about resistant bugs.
[00:13:44] Helen: Yeah. If you get given a course of antibiotics, finish it.
Because that's one of the most important things that you can do to prevent antibiotic resistant organisms actually happening in yourself. So if you do need antibiotics, take the full course. Don't just take it till you feel better and then stop and keep them for an emergency.
Finish the course because as I spoke about with those jelly beans, you want to get rid of all of the bugs that are there, not just the proportion of them. Otherwise, those that grow back can be a bit more resistant.
Really give samples. So poo samples, again, love a poo sample. You know, make sure we take a poo sample.
It's really important for staff to always ask patients, you know, have you been told you've got any organisms that are resistant to antibiotics as part of our admission process, but also, you know, if you're a parent, just if your child was treated somewhere else, then you know this.
Tell us so that we can we can manage them appropriately here because not every sample that you send always grows the bug that you're looking for, if that makes sense because of the poo sample you get, you only take a small piece of it out the pot and put it on the plate. So it might be another bit of the poo that's got the resistant bug in it, which is why we keep testing over and over again.
And, and why we ask for repeat sample so that we can see over time.
[00:15:08] Kate: Yeah. Okay. That makes sense. Well thank you very much for your time and I hope that that has been able to explain a few things to our listeners.
[00:15:17] Helen: Yeah, thank you.
[00:15:18] Kate: Alright, thanks.
[00:15:20] SA: .
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