Infection Control Leaflets

The leaflet is detailed below, or you can download the 'Infection Prevention & Control Service General Patient' leaflet in PDF. 

Picking up an infection in hospital is a concern for many patients. Although most patients do not get an infection Liverpool Women's Hospital NHS Foundation Trust (LWH) is committed to reducing infection rates to an absolute minimum.

This leaflet aims to provide information about infection at LWH, what you should expect from the Infection Prevention & Control Service and what you can do to help protect yourself and your visitors from infection.

Infections are mainly caused by viruses and bacteria commonly known as ‘bugs’ or germs.

Most germs are in the environment and are harmless. Sometimes when we are in hospital there is an increased risk of the germs entering our bodies e.g., intravenous lines (drips), catheters, surgical wounds. The germs can be passed from one person to another by physical contact.

Health care workers, visitors and patients reduce this risk by regularly cleaning their hands.

Infection Prevention Service

The Director of Infection Prevention & Control and the Infection Prevention Team are health professionals trained in infection control and prevention. They advise the ward staff on all aspects of patient care when infection may be a risk.

The Trust has an Infection Prevention & Control policy which all staff must follow when providing care to patients.

The Infection Control Team produce an Annual Report for the Trust which demonstrates the numbers of hospital infections detected and what actions are being taken to prevent infections.

This report can be viewed on the Trust website

 https://www.liverpoolwomens.nhs.uk/

The Trust has very low levels of hospital acquired infections. Information on MRSA bacteraemia (blood stream infection) is monitored by the department of Health. This Trust is amongst the lowest in the Northwest and nationally for this serious infection. All patients admitted to the gynaecological ward are screened/swabbed for MRSA as are all pregnant women who are booked to have a caesarean section.

Diarrhoea acquired in hospital can be caused by a bug called Clostridium Difficile Toxin (also known as C. diff or CDT). LWH once again has very low levels of this infection.

Wound infections are more common than either MRSA or C diff. It is difficult to collect accurate information as patients may be discharged with a wound which is healing well but becomes infected in the community after discharge home. (Current information on all types of infection and prevention can be found on the notice board in the Trust’s main reception).

What You Can Do to Help

All health care staff are trained in hand hygiene and are expected to carry out this technique before each patient contact or procedure. If they forget to do this, they will be happy for you to remind them. If you wish, the staff will be happy to demonstrate the correct technique for hand washing.  It is important hands are cleansed when:

• Entering and leaving the ward area.
• Before eating.
• After toileting or using sanitary products.
• Whenever you can see your hands are dirty.
• After visiting a patient who is known to have an infection.
• If you have wounds, dressings or catheters try not to touch them more than necessary.
• If you have a cough, cough away from your wound.

Hands can be cleansed using soap and water when visibly dirty or after using the toilet. At all other times hands can be cleaned with hand gel. The gel is provided at your bedside for your use and the use of the staff and visitors.

Please tell the nursing or medical staff if you have had any of the following in the week before admission:

• Diarrhoea or vomiting
• Flu-like illness
• An unexplained rash (or contact with someone with a rash)

If you have any questions about the risk of infection associated with your surgery/procedure, please ask the nurse/midwife or doctor caring for you they will be pleased to discuss any concerns you have.

If you have concerns regarding infection or infection prevention, please speak to the nurse looking after you. You can also discuss your concerns with a Matron or a member of the Infection Prevention & Control Team on 0151 702 4014.

Trust Information Leaflets are Available on the Following Topics:

Hand Hygiene

Hand Hygiene - Neonatal, Guidance for Parents and Visitors

Helping care for your Wound.

Carbapenemase-producing Enterobacterales Screening

Carbapenemase-producing Enterobacterales Positive Result

Clostridium difficile

MRSA

Health Protection Agency Leaflets:

Noro virus

 

 

 

 

 

The leaflet is detailed below, or you can download the 'Hand Hygiene – Advice for patients and their visitors' leaflet in PDF. 

Hand washing is the most important method of preventing and controlling infection.

Organisms (germs) live on our skin and do not cause any problems. The skin acts as a barrier, it is only when the skin is broken that germs can enter the body and may cause an infection.

Patients, staff and visitors can reduce the spread of infection by good hand hygiene.

Our staff take hand hygiene seriously but sometimes they may forget to clean their hands as often as they should. So, if you are worried that they have forgotten it is OK to remind them.

We welcome your help in keeping you safe.

When should I wash my hands with soap and water?

• Before eating.
• Before preparing food for others or assisting them to eat. After using the toilet or bathroom.
• After assisting someone else to use the toilet or bathroom. After coughing or sneezing.
• When visibly dirty.

When should I use alcohol gel?

• When entering and leaving the ward
• Alcohol gel can be used in place of soap and water in most circumstances. If hands look dirty it is best to use soap and water

How to Perform Good Hand Hygiene

Remove hand and wrist jewellery and roll your sleeves up this gives better access to perform this task.

Using soap:

1. Wet your hands first.
2. Apply the soap – follow the technique in this leaflet or on the poster above all sinks.
3. Dry hands thoroughly with individual paper towels.
4. Dispose of paper towel in bin using foot pedal only.

Using alcohol gel:

Apply gel from dispenser - follow the same technique. Allow the gel to evaporate in order for it to be effective.

Handwashing is the single most important measure for preventing the transmission of infection.

If you have concerns regarding infection or infection prevention, please speak to the nurse looking after you. You can also discuss your concerns with a Matron or a member of the Infection Prevention & Control Team on 0151 702 4014.

Follow the below steps when washing hands with soap and water or applying alcohol gel

Trust Infection Control Information leaflets are available on the following topics:

General patient Information

Hand Hygiene- NICU, Guidance for Parents and Visitors

Helping care for your Wound

MRSA

Clostridium Difficile

Health Protection Agency Leaflets:

Noro virus

 

The leaflet is detailed below, or you can download the 'Carbapenemase-producing Enterobacteriaceae (CPE) screening' leaflet in PDF. 

What does ‘Carbapenemase-producing Enterobacterales’ mean?

Enterobacterales are bacteria that usually live harmlessly in the gut of humans. This is called ‘colonisation’ (a person is said to be a ‘carrier’). However, if the bacteria get into the wrong place, such as the bladder or bloodstream they can cause infection. Carbapenems are one of the most powerful types of antibiotics. Carbapenemases are enzymes (chemicals), made by some strains of these bacteria, which allow them to destroy carbapenem antibiotics and so the bacteria are said to be resistant to the antibiotics.

Why does carbapenem resistance matter?

Carbapenem antibiotics can only be given in hospital directly into the bloodstream. Until now, doctors have relied on them to successfully treat certain ‘difficult’ infections when other antibiotics have failed to do so. Therefore, in a hospital, where there are many vulnerable patients, spread of these resistant bacteria can cause problems.

Does carriage of Carbapenemase-producing Enterobacterales need to be treated?

If a person is a carrier of Carbapenemase-producing Enterobacterales (sometimes called CPE), they do not need to be treated. As mentioned, these bacteria can live harmlessly in the gut. However, if the bacteria have caused an infection, then antibiotics will be required.

How will I know if I am at risk of being a carrier or having an infection?

Your doctor or nurse may suspect that you are a carrier if you have been in a hospital abroad, or in a UK hospital that has had patients carrying these bacteria, or if you have been in contact with a carrier elsewhere. If any of these reasons apply to you, screening will be arranged for you, and you will be accommodated in a single room with your own toilet facilities at least until the results are known.

How will I be screened for Carbapenemase-producing Enterobacterales?

Screening usually entails taking a rectal swab by inserting it just inside your rectum (bottom). Alternatively, you may be asked to provide a sample of faeces. The swab / sample will be sent to the laboratory, and you will normally be informed of the result within two to three days. If the result is negative, the doctors or nurses may wish to check that a further two samples are negative before you can be accommodated on the main ward. These measures will not hinder your care in any way. If all results are negative no further actions are required.

 

 

 

 

 

 

 

The leaflet is detailed below, or you can download the 'Carbapenemase-producing Enterobacteriaceae (CPE) Positive' leaflet in PDF. 

What Happens if the Result is Positive?

If the result is positive, do ask your doctor or nurse to explain this to you in more detail. You will continue to be accommodated in a single room whilst in hospital. If you have an infection, you will need to have antibiotics. However, if there are no signs of infection and you are simply ‘carrying’ the bacteria, no treatment is required.

How can the Spread of Carbapenemase-Producing Enterobacterales be Prevented?

Accommodating you in a single room, if the result is positive, helps to prevent spread of the bacteria. Healthcare workers should wash their hands regularly. They will use gloves and aprons when caring for you. The most important measure for you to take is to wash your hands well with soap and water, especially after going to the toilet. You should avoid touching medical devices (if you have any) such as your urinary catheter tube and your intravenous drip, particularly at the point where it is inserted into the body or skin. Visitors will be asked to wash their hands on entering and leaving the room and may be asked to wear an apron.

What About When I go Home?

Whilst there is a chance that you may still be a carrier when you go home, quite often this will go away with time. No special measures or treatment are required; any infection will have been treated prior to your discharge. You should carry on as normal, maintaining good hand hygiene. If you have any concerns, you may wish to contact your GP for advice.

Before you leave hospital, ask the doctor or nurse to give you a letter or card advising that you have had an infection or been colonised with Carbapenemase-Producing Enterobacterales. This will be useful for the future, and it is important that you make health care staff aware of it. Should you or a member of your household be admitted to hospital, you should let the hospital staff know that you are, or have been, a carrier and show them the letter / card.

Where can I find more Information?

If you would like any further information please speak to a member of your care staff, who may also contact the Infection Prevention and Control Team for you. The Public Health England website is another source of information:

Actions to contain carbapenemase-producing Enterobacterales (publishing.service.gov.uk)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The leaflet is detailed below, or you can download the 'MRSA' leaflet in PDF.

What is MRSA?

Staphylococcus aureus is a common bacterium (germ) that is found on the skin or in the nose of many people without causing harm. Occasionally in some patients it can cause common skin infections such as boils or sometimes infections after surgery. These infections can usually be treated with antibiotics.

Meticillin resistant Staphylococcus aureus (MRSA) is a type of Staphylococcus aureus that has become resistant to many antibiotics including Meticillin. Meticillin is a type of penicillin, an antibiotic that is used to treat infections.

Most of the time MRSA just sits on the skin without causing a problem. Some people carry MRSA for just a few days, but other people carry MRSA for weeks or months. They do not know that they carry MRSA because they have no symptoms, and it does not harm them. This is called ‘colonisation.’

Why is it a problem?

MRSA is not a problem to healthy people, children or pregnant women. However, patients in hospital are more vulnerable to acquiring MRSA infection if they have open wounds e.g., after surgery or have urinary catheters, intravenous lines or are receiving frequent courses of antibiotics. If MRSA enters the body and into the blood stream it may cause an infection.

If a patient gets an infection caused by MRSA it may be more difficult to treat as the bacteria is resistant to many, but not all, antibiotics.

How do you know if someone has MRSA?

People who are colonised with MRSA do not look or feel different from anyone else. The MRSA does not harm them, and they have no symptoms of infection. The only way hospital staff can find out if someone has MRSA is to send a swab or sample to our hospital laboratory for examination.

Patients who have an infection may develop signs and symptoms, such as a high temperature or a fever. An infected wound may become red and sore and discharge pus. Many other different bacteria can cause these signs and symptoms, but laboratory tests can show whether MRSA is the cause.

How does MRSA spread?

MRSA is spread mostly by direct physical contact between people. Hospital staff have a lot of contact with patients and MRSA can be carried on their hands from patient to patient. This is why healthcare workers may wear gloves and aprons when caring for patients in hospital.

MRSA is spread mostly by direct physical contact between people.

How Do Hospital Staff Care for Patients With MRSA?

Patients in hospital can be susceptible to infection because of their illness and/or treatment.

Hospital staff take special precautions with patients who have MRSA in order to stop it spreading to other people

Simple hygiene measures reduce the risk of spreading MRSA:

• Everyone should clean their hands before and after touching patients.
• Hands can be cleaned with soap and water, or alcohol hand rubs.
• Hospital staff may wear aprons and gloves when delivering care to patients with MRSA however these are worn by staff routinely for many other reasons as well.
• It may be necessary for patients with MRSA to be nurse in a single room.

Hospital staff may wear aprons and gloves when delivering care to patients with MRSA however there are by staff routinely for many other reasons as well.

Can MRSA be treated?

Once MRSA has been found in one place on the body, staff will usually take more swabs to see if it is present elsewhere on the body.

If treatment is necessary, it will vary depending on whether or not the patient is colonised or has an infection. If needed, treatment prescribed for colonisation may consist of ointment applied inside the nose and an antiseptic skin cleanser/hair wash. In addition, the doctor may prescribe antibiotics if MRSA is causing an infection.

The need for treatment will be assessed by the doctors caring for you in hospital and is based on each person’s individual circumstances.

Do patients have to stay longer in hospital because they have MRSA?

Patients who are colonised with MRSA do not usually have to stay longer in hospital. Patients who have an MRSA infection or any other infection may have to stay in hospital until it shows signs of improvement.

Leaving hospital with MRSA

Patients leaving hospital with MRSA who are colonised with MRSA or have an MRSA infection, do not need to take the same special precautions at home as in hospital. Normal hygiene precautions such as hand washing, good hygiene and cleaning procedures in your household are sufficient.

Can MRSA harm friends and family visiting patients in hospital?

Patients with MRSA can have visitors as usual. Patients or visitors who have any concerns should feel free to discuss them with the nursing or medical staff, or a member of the infection control team.

It is generally not necessary for visitors to wear plastic aprons or gloves. Hospital staff wear these items in addition to washing their hands as part of infection control measures to prevent spread of MRSA. However, if visitors are assisting with personal care staff on the ward may advise them to wear aprons and gloves.

It is important that visitors wash their hands with soap and water or alcohol gel when arriving on the ward and before leaving.

It is important that visitors wash their hands with soap and water or alcohol gel when arriving on the ward and before leaving.

Who needs to know that I have MRSA?

Only staff involved in your health care need to know you have MRSA. Patients with MRSA who are admitted to hospital again should tell the nursing and medical staff that they have had MRSA previously.

Where can I find more information?

If you would like any further information, please speak to the member of staff looking after you. You can also discuss your concerns with a Matron or a member of the Infection Prevention & Control Team 0151 702 4014.

The Public Health England and The NHS website are other sources of information:

 http://www.hpa.org.uk

MRSA - NHS (www.nhs.uk)

The leaflet is detailed below, or you can download the 'Clostridium Difficile' leaflet in PDF.

What Is Clostridium difficile?

Clostridium difficile (commonly called C. difficile or C. diff) is a bacterium (germ) that lives in the bowel. It rarely causes problems as it is kept under control by the normal ‘good’ bacteria in the bowel. Unfortunately, some antibiotics can reduce the amount of good bacteria and C. difficile can multiply and produce toxins which can cause diarrhoea. C. difficile is infectious and can be spread from patient to patient unless strict hygiene measures are followed.

What are the symptoms of C. difficile?

The main symptom is diarrhoea and can vary in severity, the diarrhoea can have a particularly unpleasant smell and may contain mucous or blood. Other symptoms may include stomach cramps, fever, nausea and loss of appetite. Severe inflammation of the bowel is possible, but this is rare. For most people symptoms will begin to settle within a few days, for others it may be longer.

Who is most at risk of getting C. difficile?

People are more at risk of developing C. difficile infection are:

• The elderly (over 65 age group)
• Those who are, or have recently finished taking antibiotics or any other medication that may alter the normal bacteria in the gut
• Those who have had gastrointestinal surgery
• Those with reduced immunity

How is C. difficile diagnosed?

It is difficult to diagnose C. difficile infection by symptoms only. Therefore, a sample of diarrhoea is taken and sent to a laboratory for testing. You can normally expect the result to be available within 48 hours.

How is C. difficile Treated?

Once the diagnosis is made your doctor will review your medication and make any necessary changes. Fortunately, most people only develop mild illness and stopping antibiotics (if possible) can result in improvement. Sometimes it is necessary to give specific antibiotics to treat the C. difficile infection.

How is C. difficile Spread?

1. difficile produces spores that can be spread in the environment when a person has diarrhoea. These spores can be spread to patients in many ways, such as from the hands of healthcare workers, or by patients and visitors who have touched a contaminated surface such as medical equipment or toilets. C. difficile infection occurs when spores enter the body through the mouth and are swallowed.

What can be done to reduce the risk of Clostridium difficile spreading?

It is very important to maintain good personal hygiene. Alcohol hand gels are not effective against C. difficile spores. It is important that spores are removed from the hands by thoroughly washing with soap and water. You must wash your hands after using the toilet and before eating or handling food; this will help reduce germs spreading. Don’t forget to ask for help with this if you need it.

How will C. difficile affect my stay in hospital?

If C. difficile infection is confirmed, then you may be moved to a single room. You will also be given your own toilet or commode to use. Staff will wear gloves and an apron when providing care for you as well as washing their hands with soap and water before and after delivering care. This will help stop the spread of C. difficile to other patients.

Once you have stopped having diarrhoea and have had formed stools for 48 -72 hours, you are not considered infectious although you will be expected to finish your treatment for the

1. difficile infection. It is important to inform staff immediately if you have any further episodes of diarrhoea.

What precautions do visitors have to take?

Visitors do not usually need to wear gloves and aprons unless they are helping with personal care, the staff on the ward will be able to advise. All staff, patients and visitors should be thorough in their hand washing with soap and water every time they deliver treatment or visit.

Can people with C. difficile still send their washing home?

Used clothing should be transported from hospital to home in a sealed plastic bag and the contents of the bag should be emptied directly into the washing machine. Clothing should be washed separately at the highest temperature that the care label recommends whilst diarrhoea persists. Hand must be washed thoroughly with soap and water after handling the clothing.

Can I go home with C. difficile?

You will be allowed to go home when you are medically fit. Your medical team will let you know if you need to continue treatment at home. If your diarrhoea continues, will you need to wash hands with soap and water especially after using the toilet and before and after eating food.

If your symptoms increase or you become unwell inform your GP or hospital immediately.

Can C. difficile come back?

There is a possibility that the infection and symptoms may re-occur. You should contact your GP or hospital if you develop symptoms after discharge from hospital.

Where can I find more information?

If you would like any further information, please speak to the member of staff looking after you. You can also discuss your concerns with a Matron or a member of the Infection Prevention & Control Team 0151 702 4014.

The Public Health England website and The NHS Website are other sources of information: http://www.hpa.org.uk

Clostridium difficile (C. diff) - NHS (www.nhs.uk)

The leaflet is detailed below, or you can download the 'Helping care for your wound – Information for Patients' leaflet in PDF. 

The Liverpool Women’s Foundation Trust is committed to giving the best care for all patients. We hope you have a trouble-free journey after your surgery. 

Your wound will have a dressing on; this will have been put on in Theatre.  Any professional healthcare worker wishing to see your wound or remove stitches/clips will wash their hands before and after changing your dressing. They will also wear sterile gloves during the procedure to help prevent wound infection.

Whilst the procedure is taking place you should not be tempted to touch the area exposed. This could introduce ‘germs’ to the wound which may lead to an infection.

There are lots of germs on our skin and in the environment around us. Most of them are harmless, some are beneficial, and a very small proportion can cause harm. Our skin protects us from germs that cause harm.

If you feel the need to cough or sneeze when the dressing is being removed or changed then please turn your head away from the exposed wound, use a tissue and wash your hands as soon as you can.

You should not remove the dressing unless instructed by a health care worker, should the dressing start coming off please inform a member of the health care team.

Steps you can take prior to surgery to help prevent infection

Showering

You are advised to have a shower or bath using soap, either the day before or on the day of surgery. Showering or bathing helps reduce the number of germs on the skin.

Hair removal

Hair at the site of the operation should not be removed with a razor, or by waxing in the week before surgery as this can increase the risk of infection by damaging the skin surface. If it is necessary to remove hair this will be done safely at the time of surgery.

Keeping warm

Staying warm before surgery will lower the risk of complications including infection. Bring additional clothing, such as a vest, dressing gown and slippers, to help keep comfortably warm before and after surgery. Tell staff if you feel cold at any time during your hospital stay.

When do surgical wound infections develop?

A surgical wound infection occurs when germs from the skin or the environment enter the incision (cut) that the surgeon makes through your skin to carry out the operation.

A surgical wound infection can develop at any time from two or three days after surgery until the wound has healed (usually two to three weeks after the operation).

How will I know if I have a surgical wound infection?

You may develop one or more of the symptoms listed below:

• The skin around the wound gets red or sore, or it feels hot and swollen.
• Your wound has a green or yellow coloured discharge (pus)
• You feel genuinely unwell or feverish, or you have a temperature.

If you have questions about the risk of infection associated with your surgery/procedure, please ask the nurse/midwife or doctor caring for you. They will be pleased to discuss any concerns you have.

What happens if I develop symptoms?

If the nurse/midwife or doctor suspects that you have a surgical wound infection, they make take a wound swab which is sent to the laboratory for tests. Your nurse or doctor may prescribe treatment with antibiotics.

Following discharge

If you think you may have an infection after you have been discharged. You should tell your visiting professional health care worker. If your health care worker is not due to visit in less than 24 hours or has stopped visiting, ring your GP.

Where can I get further information about infections in hospital?

The HPA website www.hpa.org.uk has a section on surgical wound infections which includes the latest report.

More information about surgical wound infections can be found in the Guideline on the Prevention and Treatment of Surgical Site Infection published by the National Institute for health and Clinical Excellence in 2008 can be found online at www.nice.org.uk 

If you have concerns regarding infection or infection prevention, please speak to the nurse looking after you. You can also discuss your concerns with a Matron or a member of the Infection Prevention & Control Team on 0151 702 4014.

If you have concerns regarding your wound, please speak to the nurse looking after you, or contact the Tissue viability Nurse on 702 1005, You can also discuss your concerns with a Matron or a member of the Infection Prevention & Control Team on 0151 702 4014.

Trust Information leaflets are available on the following topics:

General patient Information (IPC01)

Hand Hygiene (IPC02)

Hand Hygiene- NICU, Guidance for Parents and Visitors (IPC03)

leaflet-caring-for-my-c-section-wound.pdf (liverpoolwomens.nhs.uk)

caring-for-your-surgical-wound-leaflet.pdf (liverpoolwomens.nhs.uk)

MRSA

Clostridium Difficile

Health Protection Agency Leaflets

Noro virus