Episode Transcript
Infection Control Explained (ICE) Podcast 3 Viruses
This Podcast is brought to you by the GOSH Learning Academy.
[00:00:04] Speaker: Welcome back to the ICE Podcast. ICE stands for Infection Control Explained, and today we will be explaining a little bit about viruses. So my name is Kate Harkus. I'm the lead practice educator for Infection Prevention and Control. And today I've got with me Professor Elaine Cloutman-Green, and she's the infection control doctor.
She's the deputy Director of infection control at GOSH. She's also also a healthcare scientist, and Elaine, that sounds like a lot of jobs. Can you tell us sort of how you work with infection control there?
[00:00:40] Elaine: Yeah. I'm not good if I'm bored, so they like to keep me busy. I am a healthcare scientist, which means that actually my background is in science in terms of my undergrad versus a medical doctor, where their degree is obviously in terms of medicine.
But all my postgraduate certificates, so all of my MSCs, my PhDs, my consultants exams are the same as my medical colleagues, so I bring a slightly different lens to infection control. I work really closely with the infection control team, and my job is to give that slightly more medical scientific input. So we all have really good clinical discussions and we all bring slightly different lenses to problems in order to get the best outcome for our patients.
So it's how we all work together.
[00:01:27] Kate: That's really good to know. So let's kick off about viruses and are you able, this is a big subject obviously, to explain a little bit about what they are.
[00:01:39] Elaine: I am so excited to get viruses 'cause I think they're amazing. And they are often the forgotten bit of infection control.
Whereas we work in paediatrics, we work with children. Children are out there getting viruses as part of their normal development. A lot of viruses you’ll get by the age of five and viruses come all kinds of forms. So we have the respiratory viruses, which most people know a lot about because of the recent pandemic.
So I think respiratory viruses are very much in people's minds. But we have a lot of gastro viruses. So those are viruses of our gastrointestinal tracts that give us kind of dicky tummies, give us diarrhoea, vomiting very common again in children. It's the kind of thing that kids go and pick up at nursery.
Then we've got all of those viruses that cause rashes. So things like chicken pox, measles is really important to know about right now, but there's quite a lot of viruses that cause rashes. And that's because as the virus replicates in bloodstream, it also seeds into the skin and you get those skin changes, which are the visible things that we see.
And then we've got lots of things like blood viruses, other things that are a bit more specialised that we're probably not gonna talk about so much today but are still important part of how we think about viruses and how we think about viruses being spread around.
[00:03:01] Kate: Yeah, I got you. It's really useful to sort of set the scene and so are we concerned about them?
Why are we concerned about them?
[00:03:10] Elaine: They're really interesting because of the fact that they actually don't really fulfill a lot of the standard rules that we have in terms of what a living organism is because they can't do things like reproduce on their own. They need to have a host or like us as things that they'll steal some of how our cells work in order to reproduce.
So they very much need us, but in needing us, they can then cause us problems because of the fact that they are using all of our mechanisms in our bodies for stuff that isn't normally how it should be used. And that's where the problems come about really. So they are ubiquitous. That means they're everywhere, like everyone gets exposed to them.
And for a lot of people, if you get exposed to a virus, then it might make you feel a bit unwell. You know, for a couple of days, sometimes a week, they're usually quite short-lived because these things grow really, really rapidly and they kind of burn themselves out. They'll transmit or the body will get control of them or, and within a quite a short period of time compared to bacteria.
But can cause quite a lot of problems while they're there. And if you are somebody who has never seen that virus before and so you don't have any immune response to it, it can get quite out control before you manage to amount an immune response if you are, more unwell, when you get that virus, so you've already got other things going on, then that can cause you to be more severely sick.
[00:04:50] Kate: Mm-hmm.
[00:04:50] Elaine: And if you've got a condition where you actually don't have an immune function, so your body just doesn't respond as well, generally, then it's gonna be harder for your body to deal with them. And so, although for most people, viruses are not so much of an issue, there are always going to be people within our group, our population, and within our schools, within our hospitals, where it is more of an issue.
And even those viruses that like we have talked about a lot, like I've just mentioned, measles. So measles can be a pretty nasty virus. And the reason we think about of it as if it's not going to be such a problem is because, we've had vaccines against it for a long time. So a lot of people don't remember those people that died.
Those people that became very unwell from measles, because that's not what we have seen in our lifetime. But before we had things like immunisations, that was actually a fairly regular event. And so I think that, we need to keep on top of all of our options for controlling them because otherwise there are people out there who will get more unwell and could get quite ill, either because of the fact that they've already got things going on, or there's always a percentage of people that sadly,
there's always one person has to be the one in 10,000or the one in a hundred thousand, and if you're that one, then it's significant.
[00:06:27] Kate: Mm-hmm.
[00:06:28] Elaine: I think one of the other reasons that we really need to think about viruses is that, when you go to a doctor to get an antibiotic, for instance, so something that will treat a bacterial infection.
[00:06:41] Kate: Mm-hmm.
[00:06:42] Elaine: And that targets their bacteria. Now bacteria are a different type of organism to us, so they have very different ways of dealing with reproducing and eating and all of those things. So you can design a medicine that will target them specifically. That shouldn't do us as humans very much harm. The problem with something like an antiviral,so a medicine that targets a virus, is because those viruses are using our own cells in order to reproduce.
[00:07:15] Kate: Mm-hmm.
[00:07:15] Elaine: When you target the virus, you are also targeting bits of us as human beings and so antivirals themselves are quite hard to make.
[00:07:26] Kate: Yeah.
[00:07:26] Elaine: And also can be quite hard to use without causing us problems as humans.
So they tend to have a lot of what we call side effects that can make it pretty unpleasant to take. So we don't want to be targeting and using antivirals all the time. And there are certain viruses where there is just nothing available for us to use because they use our cellular mechanisms so closely that it's just not possible to target the virus very well without doing us a lot of harm.
So once we get them, they can be quite difficult to treat, which is why vaccines are so important as a way of our own bodies dealing with them, without us having to take an additional step in order to try to manage the virus on its own. Because once we get to that point, it can be quite hard.
[00:08:20] Kate: Yeah, that's really explained for me really well.
So obviously, we are wanting to prevent this from happening. And in terms of infection control, would you say that there are different infection control measures for viruses then versus sort of bacterial infection or colonisation?
[00:08:42] Elaine: Yeah, I think it's really useful to think about them quite differently because of the fact that when you are getting a virus for the first time, unlike when you are getting a bacteria for the first time, you tend to have huge amounts of it present, right?
So I always talk about if someone throws up because they've got Norovirus, which happens. Norovirus is what we call cyclical, it comes in two to three year cycles. And so actually we don't maintain immunity to it. So we're all kind of at risk every now and again. And when you throw up with something like Norovirus, which I did earlier this year, and it was not so much fun, I can tell you.
Then you're throwing up like a million copies of virus into the air.
[00:09:26] Kate: That
sounds
like a lot
[00:09:28] Elaine: and you only need,, yeah, it's a lot. 'cause you only need 10 to a hundred to get the infection. Okay. So you only need a tiny amount of that. Whereas if I was a bacteria, then actually most of the time you're looking at loads of kind of few hundred
to a few thousand. It's a very different type of risk.
[00:09:47] Kate: Mm-hmm.
[00:09:47] Elaine: And so we have to think about viruses in a different way. And you have to think about them in a different way, both within your patient, if you are looking after a patient because of the fact that they've got lots and lots of stuff on board.
But also when those viruses then land on a surface.
[00:10:06] Kate: Mm-hmm.
[00:10:07] Elaine: After you've had that moment then you've got a lot of it in the environment. Although we say viruses don't really replicate so they don't grow and reproduce in the same way as bacteria in that setting 'cause they need us to be able to do so.
They are still often able to survive for at least days, if not longer, on those surfaces. So we have to be able to make sure that we are doing things like hand hygiene really well. Mm-hmm. That we're cleaning surfaces really well in order to keep all of those loads down. One of the other things that's really interesting in terms of viruses is
because we have an incubation period, and a lot of people will remember during the pandemic that we have this whole, it could take three to five days before you develop symptoms.
[00:10:52] Kate: Mm-hmm.
[00:10:52] Elaine: And that's because you get the virus on board and then the symptoms are part of it, having reached a point where it's grown enough
and it's causing you symptoms as your cells break open or other things.
[00:11:03] Kate: Mm-hmm.
[00:11:03] Elaine: And so it takes a few days to get to that point. So you can have what we call an asymptomatic phase, which is a bit where you've got the virus and you may be breathing it out, you may be kind of having it in your poo and you go to the loo, but you don't know mm-hmm.
That you've got it on board. And so, for viruses we have to be really aware of that. And in children, sometimes children never develop any symptoms, but they're still there and a risk to other people. And so we do a lot of work to screen people to look at what people have got going on, but it also means that there are some things that we can't control so well in terms of infection control for exposures.
And a really great one of that is chicken pox. So chicken pox, you breathe it out for 48 hours before you get the rash.
[00:11:57] Kate: Mm-hmm.
[00:11:58] Elaine: But there aren't any symptoms or anything associated with that, so we can't possibly know that that's happening.
[00:12:07] Kate: Yeah.
[00:12:08] Elaine: Until someone gets the rash, which is why so important if you are a family member at home, or if you're a member of staff, to report that rash as soon as you've seen it.
Yeah. So we can then go back and work out who's being exposed.
[00:12:22] Kate: Mm-hmm.
[00:12:22] Elaine: So that we can make sure that they have either been vaccinated or they've had it before, or that all the right things are happening to stop going on in terms of an onward chain. And so we do a lot of things like, we add things like exposure alerts so that we then alert that person so you know, they've been exposed to chicken pox and therefore they could be in that phase where there are no symptoms, but we don't want them to pass it on to the next person.
So we manage it in a slightly different way to a bacteria because it's much more acute. And then once people have had a virus, we then have to do what we call a step down.
[00:13:02] Kate: Mm-hmm.
[00:13:02] Elaine: So we then take samples to make sure that even if they are asymptomatic, then also not shedding that virus to anyone else because once you stop having the symptoms, it can still take a little while mm-hmm.
For you to clear the virus from your system because it takes your immune system a little bit of time. And so we manage it in a slightly different way in that we will put something on when you've been exposed and we will also do a process to make sure your virus free mm-hmm. Before we take that alert off in order to protect everybody better.
[00:13:37] Kate: I get you. So obviously if you are bringing a patient in or you are a staff member, admitting a patient asking about that, you know, does your child attend nursery? Has there been any exposures of any diseases that you know of? Like chicken pox? That prompt for the parent?
[00:13:50] Elaine: Yeah. And say,
[00:13:51] Kate: oh yeah, just to be more, or their sibling’s got chicken pox or something like that.
[00:13:55] Elaine: Yeah, and I also think it's just, it's one of those things, isn't it? It's so common for children to have viruses that sometimes we just forget. To say, because it's one of those things that mm-hmm. Happens outside in schools and nurseries all the time, and you don't necessarily think of it as being a risk, but in a hospital where you've got people who are already more unwell.
[00:14:16] Kate: Yeah.
[00:14:17] Elaine: Then actually it means a slightly different thing here. And so, just phoning up going, actually my child's got a rash, can I still come in? Mm-hmm. And the answer is probably gonna be, yes, it's fine. But actually we'll put them in a room and get them checked out for the sake of their health as well as everybody else's first.
Yeah. But we just need to know that it's there.
[00:14:38] Kate: Yeah. And if you're a staff member, that's thing of like acting upon if they do report or something like that.
[00:14:43] Elaine: Yeah.
[00:14:43] Speaker: Preempting that and having a room ready so that then we can figure out if they have maybe got something on board or actually it's okay.
[00:14:52] Elaine: Yeah.
Then, and making sure you're doing things like taking the right type of sample. Yeah. So we often send things to bacteriology and microbiology. Thinking that they'll get viruses and bacteria, but that's not how it works. You have to know that actually, if you think that there's a virus there, you have to send it to virology as well as for bacteria so that we get all of the information we need.
'cause they use slightly different sample types and they run them through different types of tests in the lab. And so we have to have access to both. So it's really thinking about if there's something going on, making sure we find out. What virus it is because they all behave in different ways. They've all got slightly different, I call them personalities in terms of how they function and behave and what they do, and so we need to know which one it is in order to best take the most appropriate actions.
[00:15:42] Kate: So if you're a staff member and say you've managed to get enough for one stool sample, but you think that they might have a virus on board, but you also know that you need to screen their poo as well, would it be possible, do you think, to test from one stool sample to like split that sample or is that not a possible thing?
[00:15:59] Elaine: Yeah, if there is a decent amount, so we often talk about like a pea size amount of stool. If you can send a malteaser, if you've got a malteaser, you can split it into two. That would be the best way to make sure that they both get the right kind of test.
[00:16:14] Kate: Mm-hmm.
[00:16:15] Elaine: If not, then actually it's worth phoning the lab and just saying, I'm sending this down, but actually I've only got enough for one pot.
Can you, is there something can be done in order to make sure that this gets tested for both? There isn't quite enough for me to split it. Is that gonna be okay?
[00:16:32] Kate: Sure. I get you. That makes complete sense to me. And just thinking about then, the main things then that people should know about managing viruses.
What do you think that they might be?
[00:16:45] Elaine: I think one of the really important things is that we really like the use of alcohol gel and infection control. Actually, it does a, it does a better job in quite a lot of circumstances than using traditional hand hygiene with soap and water.
[00:17:00] Kate: Mm-hmm.
[00:17:00] Elaine: But if you've got a patient with diarrhoea because they could have something like c. diff or norovirus.
So viruses often have. Either a coating or they can be called naked, which is not the same as we often think it is. Naked viruses are not necessarily that much fun but they, they behave differently based on whether they have their coat on or their coat off. And so. Some of those don't respond so well to using alcohol gel and things like Norovirus is one example of that.
In which case, we wanna make sure that we're using soap and water. So if you've got,
[00:17:37] Kate: mm-hmm.
[00:17:37] Elaine: A patient who's come in and they're symptomatic and they have diarrhoea, then actually you always wanna be using soap and water because it can fall into this group of organisms that. Are not going to work so well with alcohol gel.
And obviously if your hands are visibly contaminated, you are always gonna want to use soap and water anyway.
[00:17:56] Kate: Hmm.
[00:17:56] Elaine: So understanding that you might have to behave a bit differently. It's really important to understand if you're a staff member and someone's come in and they're known to have a virus, to think about how we step down from that virus alert that we've talked about.
[00:18:11] Kate: Mm-hmm.
[00:18:11] Elaine: So sometimes people send samples like every two days, even when they still have symptoms. Well, if they still have symptoms, you're not gonna be able to step them down. 'cause the likelihood is if they've still got symptoms, they've still got ongoing growth of the virus.
[00:18:25] Kate: Yeah.
[00:18:26] Elaine: And so it's about waiting for 48 hours after the symptoms are stopped because that's the earliest point at which you're probably gonna have cleared the virus.
[00:18:35] Kate: Mm-hmm.
[00:18:36] Elaine: And then knowing how many to send based on whether a patient is immunosuppressed. So whether they don't have a good immune system or whether they're immunocompetent and all that information is available to help you in order to in flow charts and things to tell you what to send when. But it's often an important thing 'cause to explain to families because
GOSH has a really high risk group in terms of the fact that we've got lots and lots of kids that are pretty unwell who are spending a lot of time in hospital who may not have normal immune function.
[00:19:08] Kate: Mm-hmm.
[00:19:09] Elaine: So we work a bit differently than if somebody was admitted to a standardhospital where someone might only be turning up for two days or when most of the patients actually have immune systems in terms of how we manage viruses.
Mm-hmm. And so having really good conversations with people to explain why we do the things the way we do and what it means and why we want samples, and to make sure that we send samples at the right time. I think it's really important 'cause it helps everybody understand what's going on.
[00:19:39] Kate: Yeah, I get you.
It's all becoming clear. So to wrap up, 'cause we have been talking for a little bit now what are your three top key messages, the take home messages for viruses from today?
[00:19:54] Elaine: So. My first one is always act on symptoms and not on names.
[00:20:01] Kate: Mm-hmm.
[00:20:01] Elaine: So if the patient in front of you has a rash, has diarrhoea, has vomiting mm-hmm.
Has a cold, a cough, don't wait for me to name the virus. I mean, I love naming viruses. I'm a scientist, you know, it's what gets me outta the bed in the morning, but we need to act before we have a name. Mm-hmm. So if a patient is there and they have symptoms, use that as a moment to put them in the right kind of precautions so that we're limiting all of that environmental spread.
[00:20:31] Kate: Mm-hmm.
[00:20:31] Elaine: Make sure that we're using it as a moment to take the right sample, but don't wait until you get a name for what they've got to put all of those things in place.
[00:20:39] Kate: Mm.
[00:20:39] Elaine: Because then we're protecting everyone and we're doing the best possible thing for our families in order to put them in the best possible scenario so that they're not spreading to others, but also so we're supporting their patient care.
I would like everyone to think soap.
So if you have a patient where you think that there's a virus going on, especially a gastric virus, think do I need to be using soap and water rather than my normal alcohol gel? Mm-hmm. So if I've got a patient with diarrhoea or vomiting, then actually for them, and you,
make sure that you are using the right kind of hand hygiene in order to reduce your risk.
[00:21:17] Kate: And doing it properly.
[00:21:19] Elaine: Yeah, please do. Yeah. 'cause nobody wants to take noro home with them as an extra surprise from work. It is. It's not fun. And then finally, I think the really important thing is. Tell people.
Mm. So if you are bringing in your child and they have a rash or they've got a chicken pox running round at at nursery or school, just let people know and then everyone can be prepared. And if you are a member of staff and you notice a few spots and you're like, oh, this could be chicken pox, it could not.
It's always better to say,
[00:21:54] Kate: mm.
[00:21:54] Elaine: And then we can work it out rather than waiting until they're entirely covered the next day. If we act, when we see things or act when we have suspicion, act, when we think, oh, actually was that a bit of a vomit or was that just a bit of regurg? Right? If you act on the moment where you think something might have happened, then at least we can all put the right measures in place and then you can step them down if it's not a thing.
Mm-hmm. There is nothing wrong with stepping something up and then going actually, I've looked at them for the next 24 hours, they're all looking good. It's not a thing. Let’s step it down. All the samples are negative. That's absolutely fine. But I think it's about that communication and actually understanding that it's really important to get this stuff tackled early.
[00:22:40] Kate: Mm-hmm.
[00:22:41] Elaine: Because what you don't want is for it to spread around.
[00:22:45] Kate: Well, Elaine, thank you so much for taking the time today to just explain all of that stuff really well. I hope that's been a useful one and we will hopefully catch you all next time for the next ICE podcast.
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