infection transmission

 by hcsl

Mattresses – are your mattresses causing harm?

Mattresses aren’t just something to lie on but if not maintained and cared for appropriately, also have the potential for causing harm.

As I travel a lot for work, I have the opportunity to test many different mattresses, all with varying degrees of comfort.  This reminds me how difficult it must be for those who may be suffering painful joints to get a good night’s sleep.  Appropriate mattresses are not only required to reduce pain from positioning discomfort but also reducing risk to residents. This include ensuring the mattresses are of a suitable standard and fit for purpose.

I’ve seen a number of mattresses which had hardened and torn linings and were well past being able to provide much comfort or an appropriate degree of pressure support. Some had masking tape used in an attempt to cover splits in the mattress cover.  Others had holes in and were badly stained from exposure to body substances.  As the residents in care are becoming frailer, with increasing acuity, the need for ensuring appropriate pressure support is crucial to preventing pressure injuries, maintaining comfort and maximizing the opportunity for good sleep.

There is the potential for old and in poor condition mattresses to be a potential source for infection transmission.  For those of you operating newer facilities, this may not yet be an issue. For older facilities, part of stock and resource control should include mattress stock checks to verify they are in fact still fit for use.  When conducting checks, determine the mix of mattress types you have and speak with your supplier about a replacement programme should this be necessary.  As mattresses differ, so do beds and it’s important to make sure the mattress you use is appropriate for the particular bed type and size.

When reviewing your mattress stocks and purchasing new mattresses you might like to think about the following factors:

  • Only purchase from reputable suppliers. Review the manufacturer’s instructions for use to ensure they include verification of cleaning instructions and ask about preventative maintenance. This may include staffing training e.g. via the use of online training videos or instruction booklets.
  • Make sure you record the date of purchase and do your best to track each mattress and pillow to maximize warranties and make plans for replacement. Add the item to the facility cleaning schedules for regular cleaning and drying of exterior surfaces which should be durable, water-repellent and quick drying. They should also be seamless, if possible. When there are seams or edges, much sure these are situated away from resident skin contact to prevent absorption of liquid into interior and increased friction.
  • All seams must be tightly closed and sealed. Masking or packaging tape is not appropriate for sealing. When mattresses become worn and tear, you might like to have a supplier representative review to see what options are available for repair or replacement.
  • When reviewing the condition of mattresses, inspect all mattress surfaces, covers, seams and zippers for proper function and damage including wear, tears, splits, cracks, punctures, permanent odours and stains. If visible contamination from body substances are present, determine appropriate steps (eg. replacement or repair).
  • To support longevity of mattresses, remind staff not to place any furniture or sharp objects on mattresses. Protect the mattress with mattress protectors only if advised by the supplier this is appropriate. A number of pressure support functions in mattresses may be adversely impacted by the use of additional mattress coverings to do check.
  • Cleaning and disinfection must be considered in relation to mattresses, covers, wedges, cushions and pillows which are all classified as non-critical medical devices. Clean and low-level disinfect according to the manufacturer’s instructions between different resident use and when visibly soiled. Some mattress covers are removable for laundering so remember to verify which ones can be cleaned separately.
  • Remove damaged or stained items from service and report these in your maintenance book or to the Manager. Follow manufacturer’s instructions for use and disposal of damaged mattresses, covers, and pillows, and in accordance with infection prevention and control guidelines.
  • Ensure when using alternating therapy type mattresses that there is a process in place for a shift by shift verification that the pressure is maintained at the current level for the individual resident utilizing that mattress. If you plan to use an air alternating topper pad on a mattress, ensure it’s suitable for the mattress as depending on heights and size, it may not be appropriate.

Harm prevention can also be supported with advances in technology such as Pressure Monitoring sensing devices to ensure appropriate pressure distribution.  I’m not aware of anyone who can rent or lease out Pressure Mappers in NZ. However Cubro have one that they can bring onsite to facilities for training and education. Make contact with your supplier to see if they can assist if this could be useful for you.

Also remember that other devices used in beds should be checked  as well to ensure they are still safe and appropriate for use eg; wedges, rolls, pillows, seat cushions, mattress covers (where these are appropriate for use), bed sensor monitoring pads.  For reading on how to choose the best mattress option for your needs go here.

For more related information view here.

Article compiled by Gillian Robinson (RN, BN, Lead Auditor) for Healthcare Compliance Solutions Ltd.

in News
 by Gillian Robinson

Influenza season

Prepared for winter coughs and colds?

Winter is fast approaching and now is the time to be preparing your facility for the season’s usual crop of influenza, coughs and colds.

Last year the elderly were hit hard with, not just influenza, but also other respiratory viral infections. Many were admitted to hospital with complications such as pneumonia.

The predominant circulating influenza strain in 2016 was Influenza A, H3N2, different from the previous year’s Influenza A, H1N1. Although covered by the vaccine, last year’s predominant strain changed slightly from what was covered in the vaccine and there were numerous reports of laboratory confirmed cases of young vaccinated adults who still acquired influenza. Despite this, vaccination still affords some protection and symptoms are less severe than without it. This is the same for the elderly whose uptake of the influenza vaccine is not so good – experts agree that there are still benefits from the elderly having an annual influenza vaccine.

Some of the other respiratory viruses last year that caused severe disease in our elderly included coronavirus, rhinovirus and parainfluenza.

 

Check list for winter virus planning

  • Encourage and offer seasonal influenza vaccination to both staff and residents
  • Ensure hand sanitiser is available for visitors at the entrance of the home
  • Consider displaying a poster discouraging visitors with symptoms – a poster is available from CDHB communications
  • Remind staff and residents about good cough etiquette / respiratory hygiene
  • Have a good stock of tissues and hand sanitiser for residents
  • Remind staff to stay off work if sick – no-one wants their germs!
  • Educate staff about S&S of influenza – not all residents will display fever or cough
  • Keep residents in their rooms if symptomatic and introduce droplet precautions, i.e. droplet masks for staff providing cares
  • If you suspect an outbreak then confirm the outbreak[1] and introduce control measures[2]

Ensure all infections are logged into you infection register (for HCSL QA online uses – this is part of your infection log process) – remember your outbreak notification requirements as per your policies and procedures.  If you would like more assistance with this please contact us.

 

This article kindly contributed by: Ruth Barratt RN, BSc, MAdvPrac (Hons) – Independent Infection Prevention & Control Advisor (Canterbury)

Infectprevent@gmail.com

[1]  Infection Prevention & Control Guidelines for the management of a respiratory outbreak in ARC / LTCF

[2] A Practical Guide to assist in the Prevention and Management of Influenza Outbreaks in Residential Care Facilities in Australia

in News
 by Gillian Robinson

Are your staff increasing risk of cross infection?

Cardigans – a potential vector of infection?

Each winter cardigans or long sleeved tops under uniform tunics appear as part of clothing worn by carers, nurses and other staff providing resident care.  Does this practice increase the risk of cross infection?

There are certainly studies that demonstrate that uniforms become contaminated with potential pathogenic organisms including Staphylococcus aureus, Clostridium difficile and Norovirus[1]. It is more difficult to find evidence that links contaminated uniforms with the transmission of pathogens to patients and residents.

Most contamination occurs in areas of greatest hand contact such as pockets and cuffs[2], which may the cause the wearer to re-contaminate their cleaned hands. Long sleeves may also become contaminated with bodily fluids, which then directly contaminate another resident through direct hands on care. This would be a great way to spread around those multi-drug resistant organisms that live in the bowel, such as ESBL, VRE and CRE!

The biggest risk of wearing long sleeves when delivering care involving patient contact is that hand hygiene cannot be carried out effectively. Anyone who has been taught hand washing using the Glitterbug gel and UV light will remember how the wrists were often left glowing, demonstrating that your wrists also get contaminated and need cleaning. In many healthcare facilities across the world, a ‘Bare Below the Elbows’ policy is used to ensure that effective hand hygiene is undertaken. This applies to the use of an alcohol based hand rub or gel, as well as washing with soap and water.

So the next time that you put your cardigan on or come to work with a long-sleeved top, remember that, prior to any patient contact remove the cardigan or roll up your sleeves and perform hand hygiene.

[1] Mitchell et al. Role of healthcare apparel and other healthcare textiles in the transmission of pathogens: a review of the literature. Journal of Hospital Infection, 2015 Aug;90(4):285-92

[2]Loh et al. Bacterial flora on the white coats of medical students. Journal of Hospital Infection,  2000 May;45(1):65-8.

 

Contributed by:

Ruth Barratt

Infection Prevention & Control Advisor

infectprevent@gmail.com

in News
 by Gillian Robinson

MRSA or ESBL positive staff or residents – what to do, changing times

MRSA was first isolated in NZ in 1975, remained at extremely low levels over the next 10 years (0.05% of 2077 surveyed Staphylococcus aureus isolates nationally in 1982). But from the 1990’s onwards the incidence of various strains of MRSA has steadily increased in both hospitals, rest homes and the community.

Most of us carry Staph aureus as part of our normal skin flora.  When we have a cut, wound  or other compromised skin integrity (e.g. infected dermatitis/eczema) some of our normal flora can increase in numbers to cause what we recognise as a clinical infection.

i.e. we catch this Staph aureus infection from our own normal flora

Community laboratory data now shows that 5 out of every 100  Staph aureus  infections in the South Island,  12 out of every 100 in the Auckland region,  are now MRSA

i.e. MRSA is now endemic in the population,  so trying to isolate those with MRSA or remove it from those who are carriers by ‘decolonisation’ (e.g. chlorhexidine body washes and mupiricin) is a wasted effort, and can in fact be counterproductive – toxicity, promotes antibiotic resistance, stigmatisation, isolating residents is generally shown to produce worse clinical outcomes.  Isolation is required for some infectious diseases which MRSA is not.

Resident/patient with MRSA – use good Standard Precautions (hand hygiene).  Cover any infected cuts or wounds as per normal.  Plus Contact Precautions (glove/gown) as you normally would if providing wound care and splashing or direct skin or uniform contact possible.

Staff member with MRSA – again no special precautions are generally required and ‘decolonisation’ is not indicated.  Good Standard Precautions (hand hygiene – alcohol hand rubs or liquid soap and water both work well).

We should always aim to prevent any cross infections of any organisms, susceptible or resistant.

Good ongoing environmental and equipment cleaning and hygiene should be maintained routinely in the facility, regardless of any known MRSA or other resistant organisms  (e.g. ESBL).

Additional Facts

  • Our total combined use of antibiotics has bred or created these resistant bacteria – are we doing all we can to reduce any over use of antibiotics? g. UTI’s are commonly ‘over treated’ on a positive dipstick result rather than clear clinical symptoms
  • Any known positive MRSA (or ESBL) only represents the tip of the iceberg – a known positive person is an indicator only of a much larger issue, there will be many more unknowns. So, like blood and body fluids, it is best to think any one of us – staff residents and patients – could be positive at any time because we not uncommonly will be but seldom be aware of it
  • MRSA, ESBL, VRE carriers – the good news is 9 times out of 10 we spontaneously lose our carriage or colonisation of these resistant bacteria in 1-12 months when we happen to be carriers and do not use antimicrobials, and usually we will not know when we are carriers, but temporary carriage is likely on staff several times over in a 5-10 year period
  • ESBL (extended spectrum beta lactamase) is increasing similarly to MRSA, but started a few years later. Its primary reservoir source is the bowel not the skin
  • Staph aureus itself (the susceptible form MSSA and the more resistant form MRSA) generally have equal pathogenic potential but are generally normal flora also
  • Each one of us is made up of 10 trillion tissue cells and 90 trillion bacteria  e. ‘your bugs are my bugs’ – we cannot but help share our microbes by touch, shedding skin, etc but we must actively reduce this sharing by good Standard Precautions on all by all

Our combined total use of antibiotics continues to create ever more microbial resistance.

Good hand hygiene and cough containment Standard Precaution practice coupled with thorough cleaning of equipment and the environment will ensure there is a lower risk of transmission and environmental contamination of our shared microbes – the resistant and susceptible forms.

Article shared with the kind permission of:

Author: Ben Harris – Microbiologist – Southern Community Laboratories (2015) 

 

 

 

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