Care Home Conference November 2014
Infection Prevention and Control
Norovirus C-difficile
Senior Infection Control Nurse Jacqui Campbell
Infection Control Nurse Cheryl Maddocks
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What are the differences between Cdiff and Norovirus?
• C. difficile or C. diff is short for Clostridium difficile
• present in small numbers in the gut of healthy people.
• Spores can persist on surfaces for weeks or months.
• can be spread by people, animals, and in water or food.
• Other people can become colonised if they ingest these spores
• Norovirus (winter vomiting bug)
• Is a virus spread by direct contact and can be airbourne
• common cause of infectious gastroenteritis (diarrhoea and vomiting or
‘tummy bug’) in England and Wales.
• Can be mild
• Can be severe and dehydrating
• Often sudden, projectile (vomiting and /or diarrhoea) without warning
• people usually recover fully within 2-3 days.
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Groups most at risk of developing HCA diarrhoea
• The elderly
• Have spent a long time in hospital or other type of healthcare setting such as a nursing home
• People who have been exposed to patients with C diff /Noro
• People who have had C diff infection previously
• Are taking, or have recently finished taking, antibiotics or any other medication that may alter the normal bacteria in the gut
• Have a reduced resistance to infection generally;
• Have a serious underlying illness or have had bowel surgery
• Patients taking proton pump inhibitors (a type of anti-ulcer medication)
• Patients on nasogastric feeding
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How do we recognise norovirus or C-diff ?
The symptoms of norovirus are very distinctive :
• People often report a sudden onset of nausea
• Followed by projectile vomiting and watery diarrhoea
• Resolved in 2-3 days (longer in the elderly)
The symptoms of C-diff are :
• The main symptom is explosive watery diarrhoea
• unpleasant ‘sweet’ smell
• may contain mucous or blood.
• Other symptoms may include stomach cramps, fever, nausea, loss of appetite
• As disease progresses diarrhoea may cease – increase of other symptoms –
CALL THE DOCTOR!
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What do we do if we suspect C-diff/Norovirus?
If a resident develops loose stools follow the Department of Health’s ‘ SIGHT ’ advice:
S
uspect a case may be infectious where there is no clear alternative cause for diarrhoea.
I
solate the patient while finding out the cause of the diarrhoea. If infection cannot be ruled
---------out continue to isolate until clear of symptoms for 48 hours.
G
loves and aprons must be used for all contacts with the patient and their environment.
H
and washing with soap and water before and after every contact with the patient and the
…………patient’s environment. Alcohol gel does not work against C diff.
T
est the stool if not bowel care related. Inform GP, if stool test required send a liquid specimen
………..immediately see Bristol Stool Chart. Discuss with, or inform the residents GP according to local
………..policy.
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The Bristol Stool Form Scale (Bristol Stool Chart)
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Other causes or assessment tools:
• bowel care medicines (Lactulose, Senna).
• Are they constipated, is this faecal overflow.
• Is this the normal bowel habit for that person?
• Have they got any relevant history i.e. Crohns, IBS, Colitis.
• Have they been prescribed any antibiotics recently
• new medication – e.g. omeprazole can cause diarrhoea, or constipation!
• How often are they having a bowel action – IMPORTANT for assessment of seriousness of disease, or risk of dehydration.
• Has anyone else in the home or family/visitors had diarrhoea or vomiting
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Both organisms are highly contagious and is transmitted by contact with :
• Direct contact with vomit or diarrhoea without good hygiene measures, especially when projectile vomiting/explosive diarrhoea (airbourne)
• C.diff spores can survive for months in the environment and on surfaces/furnishings;
• From food that has been contaminated by those infected during food prep;
• From food that was contaminated at source, such as oysters, from sewage polluted sea (Salmonella, campylobacter, listeria, ecoli).
• By swallowing the virus in the air around someone who has just projectile vomited/coughed.
• Once a person has been exposed to norovirus virus, if they get infected it usually takes within 48 hours for them to become ill.
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Who do we need to inform if an outbreak occurs?
• It is considered an outbreak if two or more residents become symptomatic.
• Inform Public Health England on Tel (office hours 9am-5pm): 0845
055 2022
• Out of hours on call service: 0844 967 0082
• Wessex Public Health England (Wessex@phe.gov.uk) 0345 055 2022
• Out of hours number: 0844 967 0082 Email : Wessex@phe.gov.uk
• PHE need to know ASAP what infection control precautions you have already put in place, specimens obtained etc.
• They will then advise you of further actions that need to be taken.
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• Standard precautions for Infection prevention and control to be followed
• Encourage and assist patients with hand hygiene .
• Do not rely on alcohol gels as these do not kill the virus.
• Decontaminate all equipment immediately after use
• Ensure all staff are aware of the work exclusion policy and the need to go off duty at first symptoms, return when 48 hours clear of last symptoms (WHY?)
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Thank you.
A ny questions ?
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