Prevention of Healthcare- associated Gastrointestinal Infections.
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Transcript of Prevention of Healthcare- associated Gastrointestinal Infections.
Prevention ofHealthcare-associatedGastrointestinal Infections
Learning objectives
1 List the types of microorganisms that can cause gastrointestinal infections (GI) associated with health care facilities
2 Define diarrhoea3 Identify risk factors for GI infections4 Outline methods to prevent GI infections
Dec
emb
er 1
20
13
2
Time involved
bull 45 minutes
Dec
emb
er 1
20
13
3
Introductionbull Many microbes cause GI problems
bull Most outbreaks caused by viruses bull Norovirus
bull Bacterial gastroenteritis associated with food andor water bull Another cause - toxigenic strains of Clostridium difficile
bull Food-borne infections occurbull Especially in low resource countries during warmer months
Dec
emb
er 1
20
13
4
Key points bull Critical elements for prevention and control
bull Isolationbull Contact Precautionsbull Decontamination of spillages
bull Antibiotic stewardship essential to prevent Clostridium difficile infections
bull Hand hygiene with soap and water in outbreaksbull In food production - temperature controlbull Inspection and auditing often reveal deficiencies
in practices
Dec
emb
er 1
20
13
5
Definitions
bull Diarrhoeabull 2 or more episodes of watery stools (Bristol Stool
Type 7) orbull 3 or more episodes of loose stools (Bristol Stool
Type 6) bull Over a period of 24 hours
bull All cases of acute diarrhoea andor vomiting regarded as potentially infectious
Dec
emb
er 1
20
13
6
Non-infectious causes of diarrhoeabull Exclude when investigating infections
bull laxative usebull allergic reactionsbull chemical and physical agentsbull nasogastric feedingbull inflammatory bowel diseasebull surgery on the gastrointestinal tractbull constipation associated with faecal impaction
Dec
emb
er 1
20
13
7
Food-borne outbreakbull Considered when two or more
persons who have consumed the same food develop gastroenteritis within 24 hours
bull Cases occur in the same ward in short time
bull Causesbull Common vehicle bull Poor hygiene and non-compliance
of practices
Dec
emb
er 1
20
13
8
Viral gastroenteritis - 1
bull Norovirus Adenovirus Rotavirus bull Vomit major symptom
bull Sudden and projectile
bull Elderly most affected bull Often resolves spontaneouslybull Immunosuppressed shed viruses longer
Dec
emb
er 1
20
13
9
Viral gastroenteritis - 2
bull Noroviruses highly infectious
bull Transmissionbull Direct
bull Hand contact
bull Indirect bull Contamination of
environment and subsequent contamination of hands
Dec
emb
er 1
20
13
10
Viral gastroenteritis - 3
bull Characteristic of outbreaksbull Short incubation period
bull 15 to 48 hours
bull Limited duration of illness bull 12 to 60 hours
bull Vomiting the key symptombull Affect both patients and staff
Dec
emb
er 1
20
13
11
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Learning objectives
1 List the types of microorganisms that can cause gastrointestinal infections (GI) associated with health care facilities
2 Define diarrhoea3 Identify risk factors for GI infections4 Outline methods to prevent GI infections
Dec
emb
er 1
20
13
2
Time involved
bull 45 minutes
Dec
emb
er 1
20
13
3
Introductionbull Many microbes cause GI problems
bull Most outbreaks caused by viruses bull Norovirus
bull Bacterial gastroenteritis associated with food andor water bull Another cause - toxigenic strains of Clostridium difficile
bull Food-borne infections occurbull Especially in low resource countries during warmer months
Dec
emb
er 1
20
13
4
Key points bull Critical elements for prevention and control
bull Isolationbull Contact Precautionsbull Decontamination of spillages
bull Antibiotic stewardship essential to prevent Clostridium difficile infections
bull Hand hygiene with soap and water in outbreaksbull In food production - temperature controlbull Inspection and auditing often reveal deficiencies
in practices
Dec
emb
er 1
20
13
5
Definitions
bull Diarrhoeabull 2 or more episodes of watery stools (Bristol Stool
Type 7) orbull 3 or more episodes of loose stools (Bristol Stool
Type 6) bull Over a period of 24 hours
bull All cases of acute diarrhoea andor vomiting regarded as potentially infectious
Dec
emb
er 1
20
13
6
Non-infectious causes of diarrhoeabull Exclude when investigating infections
bull laxative usebull allergic reactionsbull chemical and physical agentsbull nasogastric feedingbull inflammatory bowel diseasebull surgery on the gastrointestinal tractbull constipation associated with faecal impaction
Dec
emb
er 1
20
13
7
Food-borne outbreakbull Considered when two or more
persons who have consumed the same food develop gastroenteritis within 24 hours
bull Cases occur in the same ward in short time
bull Causesbull Common vehicle bull Poor hygiene and non-compliance
of practices
Dec
emb
er 1
20
13
8
Viral gastroenteritis - 1
bull Norovirus Adenovirus Rotavirus bull Vomit major symptom
bull Sudden and projectile
bull Elderly most affected bull Often resolves spontaneouslybull Immunosuppressed shed viruses longer
Dec
emb
er 1
20
13
9
Viral gastroenteritis - 2
bull Noroviruses highly infectious
bull Transmissionbull Direct
bull Hand contact
bull Indirect bull Contamination of
environment and subsequent contamination of hands
Dec
emb
er 1
20
13
10
Viral gastroenteritis - 3
bull Characteristic of outbreaksbull Short incubation period
bull 15 to 48 hours
bull Limited duration of illness bull 12 to 60 hours
bull Vomiting the key symptombull Affect both patients and staff
Dec
emb
er 1
20
13
11
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Time involved
bull 45 minutes
Dec
emb
er 1
20
13
3
Introductionbull Many microbes cause GI problems
bull Most outbreaks caused by viruses bull Norovirus
bull Bacterial gastroenteritis associated with food andor water bull Another cause - toxigenic strains of Clostridium difficile
bull Food-borne infections occurbull Especially in low resource countries during warmer months
Dec
emb
er 1
20
13
4
Key points bull Critical elements for prevention and control
bull Isolationbull Contact Precautionsbull Decontamination of spillages
bull Antibiotic stewardship essential to prevent Clostridium difficile infections
bull Hand hygiene with soap and water in outbreaksbull In food production - temperature controlbull Inspection and auditing often reveal deficiencies
in practices
Dec
emb
er 1
20
13
5
Definitions
bull Diarrhoeabull 2 or more episodes of watery stools (Bristol Stool
Type 7) orbull 3 or more episodes of loose stools (Bristol Stool
Type 6) bull Over a period of 24 hours
bull All cases of acute diarrhoea andor vomiting regarded as potentially infectious
Dec
emb
er 1
20
13
6
Non-infectious causes of diarrhoeabull Exclude when investigating infections
bull laxative usebull allergic reactionsbull chemical and physical agentsbull nasogastric feedingbull inflammatory bowel diseasebull surgery on the gastrointestinal tractbull constipation associated with faecal impaction
Dec
emb
er 1
20
13
7
Food-borne outbreakbull Considered when two or more
persons who have consumed the same food develop gastroenteritis within 24 hours
bull Cases occur in the same ward in short time
bull Causesbull Common vehicle bull Poor hygiene and non-compliance
of practices
Dec
emb
er 1
20
13
8
Viral gastroenteritis - 1
bull Norovirus Adenovirus Rotavirus bull Vomit major symptom
bull Sudden and projectile
bull Elderly most affected bull Often resolves spontaneouslybull Immunosuppressed shed viruses longer
Dec
emb
er 1
20
13
9
Viral gastroenteritis - 2
bull Noroviruses highly infectious
bull Transmissionbull Direct
bull Hand contact
bull Indirect bull Contamination of
environment and subsequent contamination of hands
Dec
emb
er 1
20
13
10
Viral gastroenteritis - 3
bull Characteristic of outbreaksbull Short incubation period
bull 15 to 48 hours
bull Limited duration of illness bull 12 to 60 hours
bull Vomiting the key symptombull Affect both patients and staff
Dec
emb
er 1
20
13
11
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Introductionbull Many microbes cause GI problems
bull Most outbreaks caused by viruses bull Norovirus
bull Bacterial gastroenteritis associated with food andor water bull Another cause - toxigenic strains of Clostridium difficile
bull Food-borne infections occurbull Especially in low resource countries during warmer months
Dec
emb
er 1
20
13
4
Key points bull Critical elements for prevention and control
bull Isolationbull Contact Precautionsbull Decontamination of spillages
bull Antibiotic stewardship essential to prevent Clostridium difficile infections
bull Hand hygiene with soap and water in outbreaksbull In food production - temperature controlbull Inspection and auditing often reveal deficiencies
in practices
Dec
emb
er 1
20
13
5
Definitions
bull Diarrhoeabull 2 or more episodes of watery stools (Bristol Stool
Type 7) orbull 3 or more episodes of loose stools (Bristol Stool
Type 6) bull Over a period of 24 hours
bull All cases of acute diarrhoea andor vomiting regarded as potentially infectious
Dec
emb
er 1
20
13
6
Non-infectious causes of diarrhoeabull Exclude when investigating infections
bull laxative usebull allergic reactionsbull chemical and physical agentsbull nasogastric feedingbull inflammatory bowel diseasebull surgery on the gastrointestinal tractbull constipation associated with faecal impaction
Dec
emb
er 1
20
13
7
Food-borne outbreakbull Considered when two or more
persons who have consumed the same food develop gastroenteritis within 24 hours
bull Cases occur in the same ward in short time
bull Causesbull Common vehicle bull Poor hygiene and non-compliance
of practices
Dec
emb
er 1
20
13
8
Viral gastroenteritis - 1
bull Norovirus Adenovirus Rotavirus bull Vomit major symptom
bull Sudden and projectile
bull Elderly most affected bull Often resolves spontaneouslybull Immunosuppressed shed viruses longer
Dec
emb
er 1
20
13
9
Viral gastroenteritis - 2
bull Noroviruses highly infectious
bull Transmissionbull Direct
bull Hand contact
bull Indirect bull Contamination of
environment and subsequent contamination of hands
Dec
emb
er 1
20
13
10
Viral gastroenteritis - 3
bull Characteristic of outbreaksbull Short incubation period
bull 15 to 48 hours
bull Limited duration of illness bull 12 to 60 hours
bull Vomiting the key symptombull Affect both patients and staff
Dec
emb
er 1
20
13
11
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Key points bull Critical elements for prevention and control
bull Isolationbull Contact Precautionsbull Decontamination of spillages
bull Antibiotic stewardship essential to prevent Clostridium difficile infections
bull Hand hygiene with soap and water in outbreaksbull In food production - temperature controlbull Inspection and auditing often reveal deficiencies
in practices
Dec
emb
er 1
20
13
5
Definitions
bull Diarrhoeabull 2 or more episodes of watery stools (Bristol Stool
Type 7) orbull 3 or more episodes of loose stools (Bristol Stool
Type 6) bull Over a period of 24 hours
bull All cases of acute diarrhoea andor vomiting regarded as potentially infectious
Dec
emb
er 1
20
13
6
Non-infectious causes of diarrhoeabull Exclude when investigating infections
bull laxative usebull allergic reactionsbull chemical and physical agentsbull nasogastric feedingbull inflammatory bowel diseasebull surgery on the gastrointestinal tractbull constipation associated with faecal impaction
Dec
emb
er 1
20
13
7
Food-borne outbreakbull Considered when two or more
persons who have consumed the same food develop gastroenteritis within 24 hours
bull Cases occur in the same ward in short time
bull Causesbull Common vehicle bull Poor hygiene and non-compliance
of practices
Dec
emb
er 1
20
13
8
Viral gastroenteritis - 1
bull Norovirus Adenovirus Rotavirus bull Vomit major symptom
bull Sudden and projectile
bull Elderly most affected bull Often resolves spontaneouslybull Immunosuppressed shed viruses longer
Dec
emb
er 1
20
13
9
Viral gastroenteritis - 2
bull Noroviruses highly infectious
bull Transmissionbull Direct
bull Hand contact
bull Indirect bull Contamination of
environment and subsequent contamination of hands
Dec
emb
er 1
20
13
10
Viral gastroenteritis - 3
bull Characteristic of outbreaksbull Short incubation period
bull 15 to 48 hours
bull Limited duration of illness bull 12 to 60 hours
bull Vomiting the key symptombull Affect both patients and staff
Dec
emb
er 1
20
13
11
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Definitions
bull Diarrhoeabull 2 or more episodes of watery stools (Bristol Stool
Type 7) orbull 3 or more episodes of loose stools (Bristol Stool
Type 6) bull Over a period of 24 hours
bull All cases of acute diarrhoea andor vomiting regarded as potentially infectious
Dec
emb
er 1
20
13
6
Non-infectious causes of diarrhoeabull Exclude when investigating infections
bull laxative usebull allergic reactionsbull chemical and physical agentsbull nasogastric feedingbull inflammatory bowel diseasebull surgery on the gastrointestinal tractbull constipation associated with faecal impaction
Dec
emb
er 1
20
13
7
Food-borne outbreakbull Considered when two or more
persons who have consumed the same food develop gastroenteritis within 24 hours
bull Cases occur in the same ward in short time
bull Causesbull Common vehicle bull Poor hygiene and non-compliance
of practices
Dec
emb
er 1
20
13
8
Viral gastroenteritis - 1
bull Norovirus Adenovirus Rotavirus bull Vomit major symptom
bull Sudden and projectile
bull Elderly most affected bull Often resolves spontaneouslybull Immunosuppressed shed viruses longer
Dec
emb
er 1
20
13
9
Viral gastroenteritis - 2
bull Noroviruses highly infectious
bull Transmissionbull Direct
bull Hand contact
bull Indirect bull Contamination of
environment and subsequent contamination of hands
Dec
emb
er 1
20
13
10
Viral gastroenteritis - 3
bull Characteristic of outbreaksbull Short incubation period
bull 15 to 48 hours
bull Limited duration of illness bull 12 to 60 hours
bull Vomiting the key symptombull Affect both patients and staff
Dec
emb
er 1
20
13
11
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Non-infectious causes of diarrhoeabull Exclude when investigating infections
bull laxative usebull allergic reactionsbull chemical and physical agentsbull nasogastric feedingbull inflammatory bowel diseasebull surgery on the gastrointestinal tractbull constipation associated with faecal impaction
Dec
emb
er 1
20
13
7
Food-borne outbreakbull Considered when two or more
persons who have consumed the same food develop gastroenteritis within 24 hours
bull Cases occur in the same ward in short time
bull Causesbull Common vehicle bull Poor hygiene and non-compliance
of practices
Dec
emb
er 1
20
13
8
Viral gastroenteritis - 1
bull Norovirus Adenovirus Rotavirus bull Vomit major symptom
bull Sudden and projectile
bull Elderly most affected bull Often resolves spontaneouslybull Immunosuppressed shed viruses longer
Dec
emb
er 1
20
13
9
Viral gastroenteritis - 2
bull Noroviruses highly infectious
bull Transmissionbull Direct
bull Hand contact
bull Indirect bull Contamination of
environment and subsequent contamination of hands
Dec
emb
er 1
20
13
10
Viral gastroenteritis - 3
bull Characteristic of outbreaksbull Short incubation period
bull 15 to 48 hours
bull Limited duration of illness bull 12 to 60 hours
bull Vomiting the key symptombull Affect both patients and staff
Dec
emb
er 1
20
13
11
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Food-borne outbreakbull Considered when two or more
persons who have consumed the same food develop gastroenteritis within 24 hours
bull Cases occur in the same ward in short time
bull Causesbull Common vehicle bull Poor hygiene and non-compliance
of practices
Dec
emb
er 1
20
13
8
Viral gastroenteritis - 1
bull Norovirus Adenovirus Rotavirus bull Vomit major symptom
bull Sudden and projectile
bull Elderly most affected bull Often resolves spontaneouslybull Immunosuppressed shed viruses longer
Dec
emb
er 1
20
13
9
Viral gastroenteritis - 2
bull Noroviruses highly infectious
bull Transmissionbull Direct
bull Hand contact
bull Indirect bull Contamination of
environment and subsequent contamination of hands
Dec
emb
er 1
20
13
10
Viral gastroenteritis - 3
bull Characteristic of outbreaksbull Short incubation period
bull 15 to 48 hours
bull Limited duration of illness bull 12 to 60 hours
bull Vomiting the key symptombull Affect both patients and staff
Dec
emb
er 1
20
13
11
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Viral gastroenteritis - 1
bull Norovirus Adenovirus Rotavirus bull Vomit major symptom
bull Sudden and projectile
bull Elderly most affected bull Often resolves spontaneouslybull Immunosuppressed shed viruses longer
Dec
emb
er 1
20
13
9
Viral gastroenteritis - 2
bull Noroviruses highly infectious
bull Transmissionbull Direct
bull Hand contact
bull Indirect bull Contamination of
environment and subsequent contamination of hands
Dec
emb
er 1
20
13
10
Viral gastroenteritis - 3
bull Characteristic of outbreaksbull Short incubation period
bull 15 to 48 hours
bull Limited duration of illness bull 12 to 60 hours
bull Vomiting the key symptombull Affect both patients and staff
Dec
emb
er 1
20
13
11
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Viral gastroenteritis - 2
bull Noroviruses highly infectious
bull Transmissionbull Direct
bull Hand contact
bull Indirect bull Contamination of
environment and subsequent contamination of hands
Dec
emb
er 1
20
13
10
Viral gastroenteritis - 3
bull Characteristic of outbreaksbull Short incubation period
bull 15 to 48 hours
bull Limited duration of illness bull 12 to 60 hours
bull Vomiting the key symptombull Affect both patients and staff
Dec
emb
er 1
20
13
11
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Viral gastroenteritis - 3
bull Characteristic of outbreaksbull Short incubation period
bull 15 to 48 hours
bull Limited duration of illness bull 12 to 60 hours
bull Vomiting the key symptombull Affect both patients and staff
Dec
emb
er 1
20
13
11
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Prevention of outbreaks - 1bull Admissions with GI symptoms isolated or
cohorted immediatelybull Gloves and apron for all contacts
bull patients and environment
bull Hand washing with soap and water after every contact
bull Alcohol-based hand rub should not be usedbull No masksbull Bed linen and clothing changed daily
Dec
emb
er 1
20
13
12
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Prevention of outbreaks - 2bull Environmental cleaning
bull Perform at least once a day bull Disinfect (eg 1000 ppm chlorine)
bull Special attention to toilets bathroom and bedpans bull Attention to horizontal and frequently touched
surfacesbull Decontamination of all spillages of vomit and faeces
bull Cohorting of staff and patients
Dec
emb
er 1
20
13
13
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Decontamination of all spillages of vomit and faecesbull Wear personal protective equipment
bull Disposable gloves apron visor or mask discard
bull Absorb by paper towels discardbull Wash area
bull Hot water and detergent then disinfect with fresh chlorine solution at 10000 ppm
bull Hand washing
Dec
emb
er 1
20
13
14
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Cohorting of staff and patients
bull Staff from wards with cases must not work in unaffected areas until 48 hours have elapsed from the last case
bull Affected staff should be excluded until they have been symptom-free for 48 hours
Dec
emb
er 1
20
13
15
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Prevention of outbreaks - 3
bull Monitor compliance with IPampC practices bull If cases continue despite intervention consider
closing ward and stopping new admissions bull Do not transfer patients to unaffected wards
unless urgent bull If so consult IPampC staff
bull Visitorsbull Restrict bull Gown or apron bull Hand hygiene while visiting and hand washing on
leaving
Dec
emb
er 1
20
13
16
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
End of outbreaks
bull IPampC team determines when overbull Expert opinion two complete incubation periods
without a new casebull Terminal disinfection and changing of bed
curtains bull Special attention to bathrooms and toilets
Dec
emb
er 1
20
13
17
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Antibiotic-associated Gastroenteritisbull Diarrhoea common complication in patients
bull Disruption of the flora in intestine
bull Can colonise with Clostridium difficile bull Can produce exotoxins resulting in mucosal
injury and inflammation
Dec
emb
er 1
20
13
18
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
C difficile infections bull Symptoms from mild diarrhoea to
pseudomembranous colitis and perforation bull Risk increases with health care staybull Antibiotic use major pre-disposing factor
bull All antibiotics especially wider spectrum can predispose
bull Antibiotic stewardship initiatives crucial for prevention
Dec
emb
er 1
20
13
19
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Prevention of Antibiotic-associated Gastroenteritis - 1bull IPampC measures promptly enforcedbull Hygienic interventions bull Hand hygiene with soap
bull Lack of activity of alcohol on spores
bull Gloves and disposable gowns or aprons
Dec
emb
er 1
20
13
20
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Prevention of Antibiotic-associated Gastroenteritis - 2bullProgramme of Cleaning
bull Critical to reduce environmental contamination with spores
bull Chlorine-based compounds main productbull Recently hydrogen peroxide mist has been used for
terminal decontamination
Dec
emb
er 1
20
13
21
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Prevention of Antibiotic-associated Gastroenteritis - 3bull Isolation of patients as soon as possible in a
single room with toiletbull If not achievable cohort
bull Screening or decolonisation not recommendedbull Single use items preferred or thorough
cleaningdisinfection between patients bull Disposable rectal thermometersbull Antibiotic Stewardship
Dec
emb
er 1
20
13
22
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Contact Precautions
Dec
emb
er 1
20
13
23
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Prevention of Food-borne Gastroenteritisbull Prevalence of healthcare-associated Salmonella
and Shigella infections 3 and 25 respectivelybull Hepatitis A Campylobacter Yersinia also cause
food-related illnessbull The role of IPampC Teams depends on facility
bull Simple supervision to a more significant contribution
bull IPampC personnel need to have a clear understanding of effective food hygiene
Dec
emb
er 1
20
13
24
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Food Hygienebull Food pathogens survive and multiply within the
temperature danger zone bull 6degC to 63degC
bull Cold food must be served as soon as possible after removal from refrigeration
bull Heating food to 75degC for 1-2 minutes guarantees destruction of any biological hazardbull Cooling of cooked food must be rapid
bull Maintain temperature control until food is servedbull Maintain hot holding temperatures above 63degC
Dec
emb
er 1
20
13
25
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Common causes of food-borne infections bull Preparing food more than a half day in advancebull Storage at room temperaturebull Inadequate coolingbull Inadequate reheatingbull Undercookingbull Cross contamination from raw to cooked foodbull Contamination from food handlers
Dec
emb
er 1
20
13
26
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Food Hygiene
bull Training should include bull Conditions for temperature and timebull Effective personal hygienebull Environmental hygiene bull Potential sources of contamination
Dec
emb
er 1
20
13
27
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Hazard Analysis Critical Control Points (HACCP) bull Pioneered in the 1960s by USArsquos National
Aeronautics and Space Administration program bull Incorporated into legislation of food safety both
in USA and the EU bull Evaluates food production to determine hazards
that may contaminate foodbull Identifies critical control points after which any
contamination cannot be reversedbull Preventive measures monitored and corrected
Dec
emb
er 1
20
13
28
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Elements of HACCP
bull Regular equipment cleaning and maintenance bull Provision of effective hygiene facilitiesbull Systems to control insects and other pests bull Temperature controlbull Regular training for staff on food hygiene
Dec
emb
er 1
20
13
29
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Adapting HACCP to health care food production
Dec
emb
er 1
20
13Process Concern Prevention Methods
Reception Growth of pathogens Toxin production Contamination
Temperature control
Storage Stored covered and dated Rotate stockEnsure a pest free environment
Preparation
Limit exposure to ambient temperatures Prepare with clean equipment Separate cooked and raw foods Wash hands before handling food
Cooking Cook food to 111308875degC in thickest part two minutes
Cooling Cool foods as quickly as possible Refrigerate within 90 minutes Do not leave at room temperature
Chilled storage
Temperature controlCheck expiration dates Consume within three days Store 6 inches above the floor and away from the wall Use in rotation
Hot holding Distribution
Keep food hot at gt63degC
Reheating Avoid if possible Reheat to gt75degC Serving Serve as soon as possible
Ensure hands and equipment clean
30
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Testing of food environment and individualsbull Not required to monitor food safety bull May be occasions when is useful
bull Confirmation of microbiological quality and safety bull Educational tool for behaviour changes among food
handlers
bull Semi-quantitative testing of production area simple and low cost
bull E coli a good indicator to identify poor hygienic food production practices
bull Routine testing of food handlers not indicated (eg faeces)
Dec
emb
er 1
20
13
31
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Whatrsquos on YOUR hands
Bobulsky G et al CID 2007 Farr et al LID 2001
Dec
emb
er 1
20
13
32
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Ward kitchens precautions
bull Kept clean bull Refrigerators away from direct heat or sunlight
bull Temperature monitoring
bull Items should be labelled dated and used within 72 hours
bull Separation between raw and cooked itemsbull Place cooked above if in the same refrigerator
Dec
emb
er 1
20
13
33
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Kitchen auditing
bull Checklists for every day documentation of critical points
bull Auditing of kitchen practices bull Including points related to causes of foodborne illness
bull Critical pointsbull Temperature control bull Compliance with hygiene practices
bull Itemised audit sheet
Dec
emb
er 1
20
13
34
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Summary
bull There are many risks of GI infections in health care
bull Can be produced by bacteria and virusesbull Can be associated with incorrect IPampC practices
excessive antibiotic use and poor foodor water hygiene
bull Most outbreaks caused by viruses and spread by contact
Dec
emb
er 1
20
13
35
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
References
Dec
emb
er 1
20
13
1 Lewis SJ Heaton KW Stool form scale as a useful guide to intestinal transit time Scand J Gastroenterol 1997 32 (9) 920ndash4 httpinformahealthcarecomdoiabs10310900365529709011203 And Bristol Stool Scale httpenwikipediaorgwikiBristol_Stool_Scale
2 Koopmans M Noroviruses in healthcare settings a challenging problem J Hosp Infect 2009 73331-7
36
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
References
Dec
emb
er 1
20
13
1 Chadwick PR Beards G Brown D et al Management of hospital outbreaks of gastro-enteritis due to small round structured viruses J Hosp Infect 2000 451-10 httpwwwhpaorgukinfectionstopics_aznorovirushospital_noroviruspdf
2 World Health Organisation Five keys to Safer Food Manual [online] 2006 httpwwwwhointfoodsafetypublicationsconsumermanual_keyspdf
3 Food and Agriculture Organization of the United Nations Food Quality and Safety Systems - A Training Manual on Food Hygiene and the Hazard Analysis and Critical Control Point (HACCP) System 1998 httpwwwfaoorgdocrepW8088EW8088E00htm
37
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
Quiz1 Which of the following is effective to prevent food borne
infections a) Adopting a HACCP system in food productionb) Ensuring stringent temperature control when storing foodc) Avoiding preparing food too far in advanced) All of the above
2 Which of the following is NOT a strategy to prevent transmission of diarrhoea by Clostridium difficile
a) Antimicrobial prophylaxis for all surgical operationsb) Using narrow spectrum antibiotics where possiblec) Contact precautions for all cases of diarrhoead) Education of staff in infection prevention and antibiotic stewardship
3 Laboratory testing of food handlers is indicated whena) Neverb) To create awareness in workersc) To know epidemiology and causes of infectionsd) To identify potential risks
Dec
emb
er 1
20
13
38
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
-
International Federation of Infection Controlbull IFICrsquos mission is to facilitate international networking in
order to improve the prevention and control of healthcare associated infections worldwide It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe
bull The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication consensus building education and sharing expertise
bull For more information go to httptheificorg
Dec
emb
er 1
20
13
39
- Prevention of Healthcare-associated Gastrointestinal Infections
- Learning objectives
- Time involved
- Introduction
- Key points
- Definitions
- Non-infectious causes of diarrhoea
- Food-borne outbreak
- Viral gastroenteritis - 1
- Viral gastroenteritis - 2
- Viral gastroenteritis - 3
- Prevention of outbreaks - 1
- Prevention of outbreaks - 2
- Decontamination of all spillages of vomit and faeces
- Cohorting of staff and patients
- Prevention of outbreaks - 3
- End of outbreaks
- Antibiotic-associated Gastroenteritis
- C difficile infections
- Prevention of Antibiotic-associated Gastroenteritis - 1
- Prevention of Antibiotic-associated Gastroenteritis - 2
- Prevention of Antibiotic-associated Gastroenteritis - 3
- Contact Precautions
- Prevention of Food-borne Gastroenteritis
- Food Hygiene
- Common causes of food-borne infections
- Food Hygiene (2)
- Hazard Analysis Critical Control Points (HACCP)
- Elements of HACCP
- Adapting HACCP to health care food production
- Testing of food environment and individuals
- Slide 32
- Ward kitchens precautions
- Kitchen auditing
- Summary
- References
- References (2)
- Quiz
- International Federation of Infection Control
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