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Infection Prevention and Control Primary Care Newsletter ISSUE 4 ~ September 2012 Welcome to the forth edition of NHS Kirklees Primary Care News Letter. This month’s issue contains information about the following topics -

1. Appropriate antibiotic prescribing- Key messages 2. Common themes from C- diff RCA’s 3. 4. 5. 6. 7.

The New- Catheter Rrcord Faecal sampling The news item from HPA: Waste Link to the Infection Prevention and Control web site

1. Appropriate antibiotic prescribing- Key messages

% C.difficile infections

Kirklees C.difficile infections (CDI) as a percentage of total CDI in the area (CHFT + PCTs) 50 40 30 20 10 0 2011-12





C.difficile infections (CDI) attributed to Kirklees PCT has been increasing over the past few years and accounted for 40% of total CDI (both Trust and PCT) in 2011-12. Antibiotics are a major risk factor for CDI and their use must be clinically justified. Those associated with the greatest risk are fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin), cephalosporins and clindamycin. These antibiotics should be avoided if possible in patients with a history of previous CDI, the elderly and those with repeated hospitalisations. Factors such as previous CDI or colonisation with MRSA or ESBLs should be taken into account when prescribing antibiotics. A majority of MRSA strains are resistant to

Erythromycin and Ciprofloxacin and these should be avoided in patients with a history of MRSA. The presence of adequate clinical details on microbiology specimens (e.g. antibiotics, symptoms, renal function) is likely to improve the reporting of results and antibiotic prescribing. Patients with long-term catheters should have cultures sent only if clinically indicated and not routinely or on the basis of ‘smell’ or ‘colour’. Dipsticks are not indicated on catheter urines and asymptomatic bacteriuria is not an indication for antibiotic treatment unless in pregnancy. The following graphs summarise local sensitivity in H.influenzae and S.pneumoniae isolates from sputum samples in 2011.

Sensitivity in S.pneumoniae from sputum, 2011

Sensitivity in H.influenzae from sputum, 2011


% Sensitive


100 90 85 80 75 Pen



120 100 80 60 40 20 0









A positive culture result from non-sterile sites (e.g. sputum, CSU, wound swabs) may represent colonisation only. Antibiotics should be prescribed only if clinically indicated.

2. Common themes/findings from C- diff RCA The last Issue (3) of the Primary Care Newsletter informed that the Infection Prevention Control team will now carry out RCA investigations for patients residing in care homes, who develop a C- diff positive infection. A member of the Infection Prevention and control team will visit the care home and contact their GP to obtain patient history and relevant information. The findings of the RCA will be shared with the GP and health care professionals involved with the patients care to share learning. From April to August 2012. Six care home patients developed a C-diff infection which resulted in RCA investigations. Findings from Two of the RCA’s conducted found that antibiotics where not prescribed according to Antimicrobial Guidelines for Primary Care (NHS Calderdale/Kirklees/Wakefield District August 2010). However, an early review of antiperistaltic agents/laxatives and PPI’s had been undertaken.

3. New- Catheter Record

The Infection Prevention and Control team (NHS CKW) have been working closely with the continence team and colleagues from the acute hospital trusts to improve urinary catheter management within the community. As a result of these meetings and in order to improve urinary catheter care, a Catheter Record has been devised for newly catheterised patients. This catheter record provides general information and advice about catheter management, and is targeted at patients and their carers either living within their own home or within a care home. The catheter record is intended to be completed by anyone who inserts a catheter, whether the patient is in hospital or within the community. If in hospital the discharging ward will complete the record indicating the type of catheter equipment and the reason for catheterisation. The catheterised patient will be issued with the record on hospital discharge and will share the information with carers or care staff. The patient will also present the record on hospital admission, to ensure essential information is shared.

As this is a completely new document, the Infection Prevention and Control team will be issuing posters to GP practices to promote the catheter record before fully launching it within NHS Kirklees and NHS Wakefield in October 2012.

4. Faecal sampling It has been identified that some GPs practices have refused to accept faecal samples from care home patients/staff during a suspected outbreak of viral gastroenteritis. In the event of a suspected outbreak, care homes are asked by the IPC team, to obtain specimens from symptomatic patient/staff, in order to identify the causative micro organism. The HPA issue a specific ILOG number to the care home in the event of an outbreak. The care home(s) are told to document the ILOG number on individual faecal specimen form(s). GP practices are not charged for this service if an ILOG number is written on the request form. The care homes are responsible for completing the form correctly as shown in the example below. GP reception staff may want to check that the ILOG number is present on receiving the specimen.

5.Information from the HPA Migrant health in the primary care setting, with a focus on infectious diseases The HPA's migrant health guide ( aims to assist primary health care practitioners to look after people who have come to live in the UK from abroad. It is organised on a country specific basis and outlines a range of health issues that might affect someone coming from each country. It also provides practical guidance and resources to assess and manage a wide range of health needs. The resource has been developed in consultation with users and is endorsed by both the Royal College of General Practitioners and the Royal College of Nursing. A free training event for primary care practitioners, organised by the Health Protection Agency, is taking place on Monday 12 November 2012 in central London. The day will include talks from experts in the diagnosis and management of TB, HIV, hepatitis and parasitic infections as well as information about entitlements to NHS care, catching up immunisations for migrants and new entrant health checks. This one day event is an opportunity for GPs and practice nurses to develop their knowledge of migrant health issues and put questions to the experts. The event is primarily for GPs and practice nurses. The event is free to attend for those working in primary care, but places are limited to one representative per practice. Those who do attend are encouraged to share the knowledge they gain with their practice colleagues. Full details including how to register are available at The West Yorkshire Health Protection unit has moved from Seacroft Hospital to Quarry House in Leeds city centre. The contact details for the West Yorkshire HPU Duty Desk will be 0113 386 0300. The secure fax number will be 0113 243 8463. Email addresses remain unchanged, the email for the West Yorkshire Duty Desk will remain 5a Measles Measles remains a serious infection that can cause considerable morbidity and some mortality. Since the beginning of 2012 a total of 145 cases have been brought to the attention of the West Yorkshire Health Protection Unit. The majority of recent cases have been seen in the travelling community. Control of measles depends on having a good understanding of the local epidemiology. The West Yorkshire Health Protection Unit is asking you to do three things to assist the control of measles. 1) Please ensure that all cases are notified promptly. This both complies with the legal obligation on all registered medical practitioners and greatly supports public health measures to be undertaken in a timely manner.

2) Please ensure that every effort is made to confirm the diagnosis. Misdiagnosis is common and it is not possible to confirm the diagnosis without laboratory evidence of recent infection. For hospitalised patients serology is available. For patients in the community it is possible to test saliva samples but that takes longer for results to be available. 3) Please ensure the prompt provision of infection control advice, both to protect hospital staff and patients and to limit subsequent community spread. The Health Protection Unit will always be willing to discuss public health aspects of management. Contact can be made on 0113 3860300. Guidance is also available on the HPA website at:

6.Waste The latest DH information about the safe management of healthcare waste can be found on the following link. 26348.pdf

7.Link to web site All IPC resources and information can be found and downloaded from our web site. The link to Infection Prevention and Control Home Page is below.

The NHS Kirklees and NHS Wakefield ‘ cluster’ Infection Prevention & Control Team • • • • • • • • • •

Dr Judith Hooper -Director of Public health/Director of Infection Control (DIPC), Jane O’Donnell -Deputy Director of Infection Prevention & Control; Sue Ross - Lead Infection Prevention and Control Nurse Alison Harvey - Senior Infection Prevention & Control Nurse Donna Roberts - Senior Infection Prevention & Control Nurse Tracey Singleton – Senior Infection Prevention & Control Nurse Yvonne Hanson -Senior Infection Prevention & Control Nurse Angela Billings- - Senior Infection Prevention & Control Nurse Jacqui Elliot - Infection Prevention & Control Nurse Phil Hargreaves (IPC practioner for care homes in the Dewsbury locality)


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