Case Studies in Infection
Training in Infection Control
The Bug Blog
Page updated 30 September 2006
This manual is derived from several documents including the old Middlesex and University College Hospitals guidelines. Some policies have not been circulated previously. Staff should familiarise themselves with the list of contents and with the policies applicable to their areas.
The manual has now been reviewed by a team from Camden and Islington Acute NHS Trust, Columbia Health Care, Cromwell Hospital and King Edward VII's Hospital . We have taken into account recent documents and recommendations from national organisations such as: The Department of Health; Division of Hospital Infection, Central Public Health Laboratory Colindale; Expert Advisory Group on AIDS; Health and Safety Commission; London Waste Regulation Authority; and the Infection Control Nurses Association for the United Kingdom. There have been very few changes to any policy. More than ever before, the risks of transmission of resistant and virulent bacteria to patients in our hospitals are increasing. MRSA is now endemic in London hospitals and any patient who has been in another hospital may be assumed to have picked up this organism. There is now enormous heterogeneity of strains and perhaps MRSA will eventually replace methicillin-sensitive strains as the predominant hospital-acquired Staphylococcus aureus. Patients will begin to acquire MRSA in the community without ever having been in hospital. By observing the simple precautions suggested in this manual, each member of staff can reduce the risks of transmission. In particular, handwashing before touching a patient remains the mainstay of this policy and may well save significant numbers of lives.
If the policy says "MUST" or "WILL" - you must obey the instruction.
If it says "SHOULD/MAY" - this is what we recommend as the most appropriate action according to advice and research.
If it says "WHERE/WHEN/AS APPLICABLE" - you may exercise professional judgement according to the circumstances.
Minor changes have been made to the infection control manual. They include new policies or advice about legionnellosis, respiratory virus infections, variant CJD, hepatitis B infected health care workers, and development of the policy on viral haemorrhagic fever in line with new guidelines. Since the first edition, a radical change in view has taken place over MRSA some strains of which have predictably become very prevalent in our hospitals. There is a move away from handwashing to greater use of alcohol gel, so we now refer to hand hygiene. Many new guidelines have been published. A short bibliography is added to enable reference to source materials.
After an audit of the hard copy manual use, from next year the manual will only be available electronically. All old version hard copies will be removed. A short form consisting only action points will be available on the wards. The action points have been updated and made as comprehensive as possible. Apart from your lines of communication and the telephone numbers for reporting sharps incidents, most policies are not designed for any particular hospital, but may be applied generally. As always, we invite comment and constructive criticism.
The Infection Control Manual has been reviewed and revised. It has been produced in two forms; first as an web version for universal use. Some references to UCLH are left in where this is unavoidable (e.g. policies for viral haemorrhagic fever and prion diseases), but these diseases are rare and specialist advice can be obtained from experts at UCLH.
This web version includes forms which can be printed off or downloaded for local use. The advantage of having the manual in a web format is that it can be revised in one place. We welcome constructive comments.
We are also launching a desk-top list of Core Instructions for Infection Control, which can be printed in colour on A3 size paper. In general these are the action points in the manual with pointers to the forms and policies which are available on the website. The desk-top list of Core Instructions generally contains all that is needed for day-to-day infection control guidance.