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Managing Outbreaks of an Infection Essay

NICE and Department of Health Guidelines
NICEandDepartment of Health guidelines set the standards for high quality healthcare. It encourages a healthy lifestyle for people. The NICE and Department of Health guidelines are also used by the NHS, Local Authorities, employers, voluntary groups and anyone else involved in delivering care and promoting wellbeing. The recommendations that are given provide guidance on infection control and taking precautions. These should be applied by all healthcare personnel, and other carers, to the care of patients in all healthcare settings. For example, hands must be washed immediately before each and every episode of direct patient contact or care, and after any activity or contact that could potentially result in hands becoming contaminated. Another example is, when handling and disposing sharp objects.

Sharps must not be passed directly from hand to hand and handling should be kept to a minimum. Also needles must not be recapped, bent, broken or opened before use or disposal. This is to ensure that infections do not spread and no one gets hurt with the needles. When it comes to precautions then these guidelines say that precautions should be taken with care. Health care professionals should ensure that these precautions benefit the patients who have TB and also prevent anyone else from getting these ill. For example, isolation nursing. The guideline says that this should be done to prevent anyone else from catching the infection and to stop the infection from spreading.

What is Tuberculosis (TB)? Tuberculosis (TB) is a bacterial infection that is spread through inhaling tiny droplets from the coughs or sneezes of an infected person.It is a serious condition but can be cured with proper treatment. TB mainly affects the lungs but it can also affect any part of the body, including the bones and nervous system. In some cases the bacteria infect the body but do not cause any symptoms which are known as latent TB. It is called active TB if the bacteria causes symptoms. A TB infection of the lungs is known as pulmonary TB but TB can occur outside the lungs, which is known as Extrapulmonary TB. What are my Concerns? My concerns are that the TB infection can spread from four patients to more. TB is caused by a type of bacterium called mycobacterium tuberculosis. TB is spread when a person with the TB infection in their lungs coughs or sneezes. Someone else needs to inhale and take in the droplets containing the TB bacteria.

To catch it from someone else you would usually have to spend a long period of time in close contact with the infected person for you to catch the infection. For example, TB is more likely to spread between family members who live in the same house. This is because family members are living and are around the infection person mostly. This means they are at more risk of catching the infection. It would be very unlikely for someone to become infected by sitting next to an infected person on a bus. It is my concern that some of my other patients will be able to catch the infection from the four patients who already have TB. This is a concern because we do not want all the patients within our ward being infected with TB. TB is a serious infection. Why I need to prevent an outbreak?

I need to prevent this outbreak because TB is an infection which could harm the person who has it. If untreated the patients can become worse. Also we need to prevent it from spreading. This is done to ensure that other people do not catch the infection. Also when one person has the infection then it will keep spreading and everyone in the hospital will be sick. This will be done by isolation. This is when we isolate the patient away from the other patients. This ensures that this infection is not able to spread to anyone else. This means the infection will keep spreading. The bacteria enters our body and once it has entered our body it starts to multiply and because it is a bacterial infection it does not need to attach to another cell to multiply. It is able to multiply on its own. After multiplying it starts to cause mycobacterium infection. Our immune system cannot stop the TB bacteria from growing and spreading after the infection has started to spread into our body.

Medication and treatment is then needed for the body to then recover. Preventing an outbreak is important because it can spread and start to infect other people. If a person is around someone that has been infected then they need to make sure that you stay away from them. This is because the individual is able to catch the infection from affected items and affected people. The NICE guidelines:“It has long been recognised that people who are sputum microscopy positive from spontaneously expectorated sputum are those cases with the highest infectivity, and pose a risk to household and other close contacts such as workplace contacts. For these reasons, traditionally, patients with pulmonary disease in whom tuberculosis is suspected are isolated in a single room.” Isolation nursing is one way in which an outbreak of infection can be prevented. The Department of Health guidelines:“This section discusses the evidence and associated recommendations for the use of personal protective equipment by healthcare workers in general care settings, including aprons, gowns, gloves, eye protection and face masks.

Where appropriate, in addition to the grade of the evidence underpinning the recommendations, there is an indication of a Health and Safety requirement. The decision to use or wear personal protective equipment must be based upon an assessment of the level of risk associated with a specific patient care activity or intervention and take account of current health and safety legislation.” Using personal and professional equipment is another way in which an outbreak can be prevented. The doctors, nurses and other professionals working in a hospital should make sure that they do everything that prevents the infection from spreading to the workers, all the patients and visitors. Preventing an outbreak is important because we do not want other people getting ill. TB is a serious bacterial infection. Preventing other people from getting it is important.

What are the risks and damage of an outbreak on staff, patients, visitors and their families? The risks of this are that staff, patients, visitors and their families are able to catch the TB illness. This is a risk because we will have more patients in the hospital with TB. Once a person is infected with TB bacteria, the chance of developing TB disease is higher if the person; has HIV infection, has been recently infected with TB bacteria (in the last 2 years), has other health problems, like diabetes, that make it hard for the body to fight bacteria, abuses alcohol or uses illegal drugs; or was not treated correctly for TB infection in the past. The damage of this is that it then damages the individual’s body. This is because they go into getting further illnesses in the future. The department of Health Guidelines: “The incidence of TB is influenced by risk factors such as exposure to, and susceptibility to, TB and levels of deprivation (poverty, housing, nutrition and access to healthcare), and differs in different parts of England and Wales. Where scientific evidence supports it, this guideline makes recommendations on service organisation, as well as for individual teams of healthcare professionals.

The guideline aims to focus NHS resources where they will combat the spread of TB, and some sections deal with high- and low-incidence areas separately. The NICE guidelines: “Anyone exposed to TB bacteria can become infected but people at particular risk are those that are less able to fight infection. Those at risk include: Household and frequent contacts of infectious cases, those who have lived in, travel to or receive visitors from places where TB is still very common, those who live in ethnic minority communities originating from places where TB is very common, those with immune systems weakened by HIV infection, the very young and the elderly, as their immune systems are less robust, those with chronic poor health and nutrition because of lifestyle problems such as homelessness, drug abuse or alcoholism, those living in poor or crowded housing conditions, including those living in hostels. Other conditions that suppress immunity such as renal failure and chemotherapy and diabetes increase the likelihood of reactivation of TB.”

What precautions do we need to take? Personal and Professional Equipment is a regulation which protects the person at work from any risk/harm to their health and safety. We need to make sure that we use the right equipment. This will ensure that we are safe. It will also ensure that everything is done well while at work. Wearing/using personal and professional equipment prevents contact with a infectious agent of a bodily fluid that may contact an infectious agent by creating a barrier between the potential infection and then the worker. For example, if we wear a duck mask then it blocks our nose and mouth. These are two portals in which infections can come into a person. That I why blocking these two portals of entry is important so the infection is not able to get into people. If a nurse or doctor does go into the room to then they need to make sure they use personal and professional
equipment. This will ensure that they are protected from the infection.

The NICE guidelines: “Healthcare workers caring for people with TB should not use masks, gowns or barrier nursing techniques unless: MDR TB (multidrug-resistant Tuberculosis) is suspected or aerosol-generating procedures are being performed. When such equipment is used, the reason should be explained to the person with TB. The equipment should meet the standards of the Health and Safety Executive which is mentioned in section 9.3.”The Department of Health Guidelines: “This section discusses the evidence and associated recommendations for the use of personal protective equipment by healthcare workers in general care settings, including aprons, gowns, gloves, eye protection and face masks. Where appropriate, in addition to the grade of the evidence underpinning the recommendations, there is an indication of a Health and Safety requirement. The decision to use or wear personal protective equipment must be based upon an assessment of the level of risk associated with a specific patient care activity or intervention and take account of current health and safety legislation.” Isolation is one more thing which health and social care professionals need to take care of. By isolated patients who have TB is another precaution which needs to be taken. TB is able to spread to other people who do not have TB.

That’s why it is important to make sure that we keep the patients who have TB away and isolate them. This needs to be done to ensure that the patient is isolated to prevent illness from spreading. We need to isolate the micro-organism and make sure that the person stays isolated until the TB infection is not treated. The NICE guidelines:“This isolation has been recommended until three separate sputum tests have been analysed on the patient. If these tests are negative, the patient is usually considered to cause a significantly lower infection risk. They may then be moved from the single room to a shared ward, provided there are no HIV-positive or other patients with major issues on the same ward. If patients are tested positive for tuberculosis, and need to be admitted to hospital, isolation is required until treatment makes the person non-infectious.”The Department of Health Guidelines:“It is recommended that patients with suspected or confirmed pulmonary TB who are admitted to hospital should remain isolated in a negative pressure room with airborne precautions applied, until discharge criteria are met. In principle these criteria include: a reduction in or absence of cough, reduced smear burden or smear negativity, assured treatment and an appropriate discharge plan.”

Also some other precautions that need to be taking are making sure that everything is clean and looked after. Cleanliness is very important because it prevents infections from spreading. Another precaution which needs to be taken it to make sure that all of the things which the patient with TB has used are disposed and cleaned properly. Also the patients clothes and linen should be washed separately from the other patients linen and clothing. This will ensure that infections do not spread. Taking all of these precautions is important because it ensures that patients, staff and visitors are safe and do not get any infections. The NICE guidelines: “Linen, Waste and Cleaning for bed linen, books, crockery or washing up facilities should be washed separately. Disposal of infected material should be as clinical waste per hospital policy. Rooms should be cleaned as normal/regularly and a normal full clean after discharge. Extra cleaning is unnecessary.”

The department of Health Guidelines: “There are three levels of TB infection control: Administrative (managerial) control measures/ work place policy, environmental control measures, and personal protective equipment (respiratory protection). Administrative control measures are the most important since environmental control measures and personal protective equipment (respiratory protection) will not work in the absence of solid administrative control measures. Each level operates at a different point in the transmission process: administrative control measures reduce HCW and patient exposure; environmental control measures reduce the concentration of infectious droplet nuclei, personal protective devices (respiratory protection) protect HCWs in areas where the concentration of droplet nuclei cannot be adequately reduced by Administrative and environmental control measures.”

How would we educate staff, visitors and patients? Education is vital for people. If we educate staff, visitors and patients about TB then they would be more aware of what TB is, how it affects the body and how to prevent yourself from getting TB. We could do this through putting up posters around the ward and hospital. We could also make leaflets and hand them out to patients and visitors around the hospital. Also doctors and nurses could speak to family members and friends and tell them about TB. Doing all of this will make people more aware of TB and the risks of it.The Department of Health Guidelines: “It is recommended that service providers aim to improve awareness of TB among the public, the professions and local authority agencies. Experience suggests that targeted campaigns tailored to the local population work better than national campaigns.

Examples include: keeping local GPs informed about local TB services and reminding them of the importance of screening new entrants on arrival and on an ongoing basis. Keeping GPs aware of prompt referral systems. Resourcing TB services adequately so that they are not only involved in teaching clinical colleagues, but also in raising awareness of TB, particularly among high-risk groups; and informing clinicians of peer group networks and encouraging them to seek advice on treatment where appropriate. The NICE guidelines:“During the development of the guideline, patient and carer representatives on the GDG highlighted these suggestions: a single national source of high-quality TB information in relevant languages, and formats for vision- or hearing-impaired people. TB services to assess local language and other communication needs, and accordingly make information from the national source available locally.

Clear discussion between healthcare professionals, people with (or at risk from) TB and their carers about tests, treatment, contact tracing and infection control measures, to enable understanding. People with both HIV and TB to be provided with information about the different specialties who may provide care during and after their treatment for TB. Contact tracing explained and handled sensitively to avoid misunderstanding and stigma. Information set out so as not to medicalise the patient. TB services providing each patient completing anti-tuberculosis treatment with clear ‘inform and advise’ information.” D1: ASSESS HOW THE SUGGESTED MEASURES TO MANAGE AN OUTBREAK OF INFECTION MEET LEGAL REQUIREMENTS AND GUIDELINES OF THE PREVENTION AND CONTROL OF INFECTION IN A HEALTH AND SOCIAL CARE SETTING One of the measures that we will use to prevent the outbreak of TB is by using personal and professional equipment. By usingpersonalandprofessionalequipmentit ensures that we are safe. It makes sure that we are trying our best to prevent ourselves from getting any infections. Doing this is important because we need to make sure that the bacterial infection does not get into us.Personal and Professional Equipment protects a person in hospital from any risk/harm to their health and safety.

We need to make sure that we use the right equipment to ensure that we are safe. Wearing/using personal and professional equipment prevents contact with an infectious agent of a bodily fluid that may contact an infectious agent by creating a barrier between the potential infection and then the worker. The NICE guidelines say about Personal and Professional Equipment: “Healthcare workers caring for people with TB should not use masks, gowns or barrier nursing techniques unless: MDR TB (multidrug-resistant Tuberculosis) is suspected or aerosol-generating procedures are being performed. When such equipment is used, the reason should be explained to the person with TB.”The Department of Health Guidelines say about Personal and Professional Equipment: “This section discusses the evidence and associated recommendations for the use of personal protective equipment by healthcare workers in general care settings, including aprons, gowns, gloves, eye protection and face masks. The decision to use or wear personal protective equipment must be based upon an assessment of the level of risk associated with a specific patient care activity or intervention and take account of current health and safety legislation.” The strengths of this measure are that by using personal and professional equipment it protects the person at work or visitors from any risk/harm to their health and safety. We need to make sure we use the right equipment.

PPE prevents contact with a infectious agent or a bodily fluid that may contact an infectious agent by creating a barrier between the potential infection and the worker. This is important because it prevent the infection from getting into other people. We need to make sure that we prevent the infection from getting to anyone else. It ensures people are safe. Also teaching this to people who do not know e.g. visitors and family members of the patient is also important. This gives them an understanding of how serious the illness is and what should be done to prevent it. It makes them more aware and next time if someone else they know catches TB then they will know what personal and professional equipment to use and the important of them.

A weakness of this is that sometimes people might forget to use them. They might go into the patient’s isolated room and not realise that they have forgot to put on equipment. This is a weakness because if people forget to put on protective equipment then they are more likely of catching the TB infection. Also when visitors come into the hospital then they might not know that they have to use personal and protective equipment, especially children. The nurses or doctors need to make sure that they are there at the ward and are telling visitors about the importance of personal protective equipment. This is another weakness. This is because nurses and doctors might be busy with many other patients within the hospital. They might not always be there to tell the visitors. Meanwhile the visitors might go into the isolation room without realising. Isolation is one more thing which health and social care professionals need to take care of. By isolated patients who have TB is another precaution which needs to be taken. TB is able to spread to other people who do not have TB.

That’s why it is important to make sure that we keep the patients who have TB away and isolate them. This needs to be done to ensure that the patient is isolated to prevent illness from spreading. We need to isolate the micro-organism and make sure that the person stays isolated until the TB infection is not treated. The NICE guidelines say about Isolation:“This isolation has been recommended until three separate sputum tests have been analysed on the patient. If these tests are negative, the patient is usually considered to cause a significantly lower infection risk. They may then be moved from the single room to a shared ward, provided there are no patients with major issues on the same ward. If patients are tested positive for tuberculosis, and need to be admitted to hospital, isolation is required until treatment makes the person non-infectious.”The Department of Health Guidelines say:“It is recommended that patients with suspected or confirmed TB who are admitted to hospital should remain isolated in a negative pressure room with airborne precautions applied, until discharge criteria are met. In principle these criteria include: a reduction in or absence of cough, reduced smear burden or smear negativity, assured treatment and an appropriate discharge plan.”

Strengths of isolation are that it protects the patient from getting any other infection from other people. Isolation nursing also protects staff, visitors and families/friends that have come into the hospital. This is very important because the patients are protected from getting any other illnesses which will make their TB. Also another benefit of isolation is that it gives time for the patient to recover. The patient is alone and isolated which lets them rest and recovery time. This is important for the patient. On the other hand if they were on a shared ward with other patients then they might not get time to rest and also with visitors as well. Weaknesses of isolation are that the patients might feel socially and emotionally isolated. This is not good for them.

They might not like the fact that they are isolated and could feel restricted. This could then lead to them refusing to go into isolation. It is important that they go into isolation because if they don’t then it leads to their infection getting worse as their body is vulnerable and could catch other illnesses. Also they could infect other people with their illnesses which then make them ill. It might make the people isolated moody and depressed. This is not good for them. The aim of isolation nursing is to isolate the micro-organism and not the patient even though the patient is still being isolated.

Also some other precautions that need to be taking are making sure that everything is clean and looked after. Cleanliness is very important because it prevents infections from spreading. Another precaution which needs to be taken it to make sure that all of the things which the patient with TB has used are disposed and cleaned properly. Also the patients clothes and linen should be washed separately from the other patients linen and clothing. This will ensure that infections do not spread. Taking all of these precautions is important because it ensures that patients, staff and visitors are safe and do not get any infections. The NICE guidelines say: “Linen, Waste and Cleaning for bed linen, books, crockery or washing up facilities should be washed separately. Disposal of infected material should be as clinical waste per hospital policy. Rooms should be cleaned as normal/regularly and a normal full clean after discharge. Extra cleaning is unnecessary.”

The department of Health Guidelines say: “There are three levels of TB infection control: Administrative (managerial) control measures/ work place policy, environmental control measures, and personal protective equipment (respiratory protection). Administrative control measures are the most important since environmental control measures and personal protective equipment (respiratory protection) will not work in the absence of solid administrative control measures. Each level operates at a different point in the transmission process: administrative control measures reduce HCW and patient exposure; environmental control measures reduce the concentration of infectious droplet nuclei, personal protective devices (respiratory protection) protect HCWs in areas where the concentration of droplet nuclei cannot be adequately reduced by Administrative and environmental control measures.”


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