Figure 4.1 provides an example of a draft cluster, PII or outbreak meeting agenda.
56
ϭ͘tĞůĐŽŵĞ͕ŝŶƚƌŽĚƵĐƟŽŶƐĂŶĚĂƉŽůŽŐŝĞƐϮ͘ŽŶĮĚĞŶƟĂůŝƚLJ
ϯ͘WƵƌƉŽƐĞŽĨŵĞĞƟŶŐ͕ƌŽůĞƐĂŶĚƌĞƐƉŽŶƐŝďŝůŝƟĞƐ
ϰ͘,ŝƐƚŽƌLJĂŶĚďĂĐŬŐƌŽƵŶĚ͕ĨŽƌĞdžĂŵƉůĞůŽĐĂƟŽŶ͕ǁŚĞŶƚŚĞŝŶĐŝĚĞŶƚǁĂƐĮƌƐƚƌĞĐŽŐŶŝƐĞĚ ĂŶĚŚŽǁ͕ĐĂƵƐĂƟǀĞŽƌŐĂŶŝƐŵ͕ŶƵŵďĞƌƐŽĨƉĂƟĞŶƚƐĂŶĚƐƚĂīĂīĞĐƚĞĚ͕ĂŶĚŝŵŵĞĚŝĂƚĞ ĂĐƟŽŶƐ
ϱ͘ƵƌƌĞŶƚƐŝƚƵĂƟŽŶ͕ĨŽƌĞdžĂŵƉůĞŶƵŵďĞƌŽĨƉĂƟĞŶƚƐĂŶĚƐƚĂīĐƵƌƌĞŶƚůLJĂīĞĐƚĞĚ͖ĂŶĚ ǁĂƌĚŽƉĞŶŽƌĐůŽƐĞĚ͗ĞīĞĐƚŽŶĂĚŵŝƐƐŝŽŶƐ͕ƚƌĂŶƐĨĞƌƐĂŶĚĚŝƐĐŚĂƌŐĞƐ
ϲ͘/ŶĨĞĐƟŽŶƉƌĞǀĞŶƟŽŶĂŶĚĐŽŶƚƌŽůƌĞƉŽƌƚ͕ĨŽƌĞdžĂŵƉůĞ͗
• /ƐŽůĂƟŽŶ
• ^ĐƌĞĞŶŝŶŐĂŶĚƐĂŵƉůŝŶŐ • ĞĐŽůŽŶŝƐĂƟŽŶ
• ŶƟďŝŽƟĐƉƌĞƐĐƌŝďŝŶŐ • ,ĂŶĚŚLJŐŝĞŶĞ • WW
• ^ƚĂĸŶŐ • ƋƵŝƉŵĞŶƚ • ŶǀŝƌŽŶŵĞŶƚ
dŝƚůĞ͕ĚĂƚĞ͕ƟŵĞĂŶĚǀĞŶƵĞ 'E
Figure 4.1 Potential agenda items for a cluster, PII or outbreak meeting.
57
• DĂŶĚĂƚŽƌLJƚƌĂŝŶŝŶŐ • ĚƵĐĂƟŽŶ
• ĚŵŝƐƐŝŽŶƐ͕ƚƌĂŶƐĨĞƌƐĂŶĚĚŝƐĐŚĂƌŐĞƐ • sŝƐŝƚŽƌƐ
• ŽĐƵŵĞŶƚĂƟŽŶ • ƵĚŝƚĨĞĞĚďĂĐŬ
ϳ͘ƵƌƌĞŶƚĐŽŶƚƌŽůŵĞĂƐƵƌĞƐʹƚŚĞƐĞŵĂLJŝŶĐůƵĚĞĂƌĞĐĂƉŽĨƚŚĞĂďŽǀĞƉŽŝŶƚƐ͘
ϴ͘KĐĐƵƉĂƟŽŶĂů,ĞĂůƚŚĞƉĂƌƚŵĞŶƚʹŝĨƚŚĞƌĞĂƌĞĐŽŶĐĞƌŶƐƌĞŐĂƌĚŝŶŐƐƚĂīŚĞĂůƚŚ͖ĂŶĚ ŶĞĞĚĨŽƌƐĐƌĞĞŶŝŶŐĂŶĚĚĞĐŽůŽŶŝƐĂƟŽŶ͕ŽƌƉƌŽƉŚLJůĂdžŝƐ͘
ϵ͘,WhʹƚŚĞůŽĐĂů,WhŵĂLJŚĂǀĞƋƵĞƐƟŽŶƐƌĞŐĂƌĚŝŶŐŵĂŶĂŐĞŵĞŶƚĂŶĚĐŽŶƚƌŽůŵĞĂƐƵƌĞƐ ĂŶĚͬŽƌŵĂLJǁŝƐŚƚŽŵĂŬĞƌĞĐŽŵŵĞŶĚĂƟŽŶƐ͘
ϭϬ͘'ʹĂƐĂďŽǀĞ
ϭϭ͘ŽŵŵƵŶŝĐĂƟŽŶƐʹĚĞƉĞŶĚŝŶŐŽŶƚŚĞŶĂƚƵƌĞŽĨƚŚĞŝŶĐŝĚĞŶƚ͕ĂƌĞĂĐƟǀĞƉƌĞƐƐƐƚĂƚĞŵĞŶƚ ŵĂLJďĞƌĞƋƵŝƌĞĚ͖ƚŚŝƐŵĂLJŝŶǀŽůǀĞůŝĂŝƐŽŶďĞƚǁĞĞŶƚŚĞdƌƵƐƚ͕,WhĂŶĚWd
ĐŽŵŵƵŶŝĐĂƟŽŶƐƚĞĂŵƐ͘
ϭϮ͘^h/ƌĞƉŽƌƟŶŐ
ϭϯ͘ĐƟŽŶƐʹĂĐƟŽŶƐǁŝůůďĞĂŐƌĞĞĚĂŶĚĂůůŽĐĂƚĞĚƚŽŶĂŵĞĚŝŶĚŝǀŝĚƵĂůƐƚŽďĞĐŽŵƉůĞƚĞĚ ǁŝƚŚŝŶĂƐƉĞĐŝĮĞĚƟŵĞĨƌĂŵĞ͘
ϭϰ͘ŶLJŽƚŚĞƌďƵƐŝŶĞƐƐ͘
ϭϱ͘ĂƚĞ͕ƟŵĞĂŶĚǀĞŶƵĞŽĨŶĞdžƚŵĞĞƟŶŐ
Figure 4.1 Continued
58
At the meeting, following all of the necessary reporting, actions will be identified and allocated to individuals, who will be responsible for ensuring that they are implemented within a specified time frame. The actions may be displayed as an action plan, disseminated with the minutes, and if further meetings are required, the action plan will become a rolling agenda item for discussion and updating. The outcome of the meeting has to be fed back to staff, and the incident itself reported via the appropriate clinical governance and clinical risk channels, and to the Infection Control Committee. It may be reported as an SUI (Serious Untoward Incident). Whether further meetings are required or not depends on the scale of the incident, the type of incident (an outbreak may require meetings over a period of weeks to months), the effectiveness of control measures and whether there are any new cases. The IP&CT will declare the incident over when they are satisfied that control measures have been effective and sustained.
•
Clusters, periods of increased incidence and outbreaks have numerous and potentially far-reaching implications.•
Clusters and periods of increased incidence may lead to an outbreak unless control measures are implemented swiftly.•
Look-back exercises may be undertaken as part of outbreak control measures or may lead to an outbreak being declared.•
Although clusters, periods of increased incidence and outbreaks are generally managed locally by the IP&CT, outside agencies are often involved.•
The IP&CT have to undertake in-depth investigations or observations regarding compliance with infection control policy and clinical practice.•
The management of outbreaks in particular is resource intensive.•
Clusters, periods of increased incidence and outbreaks are largely avoidable.Chapter summary: key points
Further resources are available for this book, including interactive multiple choice questions. Visit the companion website at:
www.wiley.com/go/fundamentalsofinfectionprevention
In the event of non-compliance with isolation, PPE and/or cleaning of patient equipment being identified at an Outbreak meeting, what do you think the actions will be? Who will be respon- sible for implementing them, and how will compliance be monitored?
Reflection point
59
References
Calvert N., Astbury J. (2002). Legionnaires disease outbreak in England. Eurosurveillance. 6 (32):
ii–1904. http://www.eurosurveillance.org/ViewArticle.aspx?Articleld=1904 (accessed 2 March 2013)
Department of Health (DH) (2002). Getting Ahead of the Curve: A Strategy for Combating Infec- tious Diseases (including Other Aspects of Health Protection). Report by the Chief Medical Officer. DH, London.
Department of Health and Health Protection Agency (DH and HPA) (2008). Clostridium difficile Infection: How to Deal with the Problem. DH and HPA, London.
Health and Safety Executive (2002). Report of the public meetings into the Legionella outbreak in Barrow-in-Furness. http://www.hse.gov.uk/legionnaires/assets/docs/barrowreport.pdf (accessed 2 March 2013)
Health Protection Agency (HPA) (2012). The Communicable Disease Outbreak Plan. HPA, London.
Public Health Laboratory Service (1996). Invasive fungal infections and contaminated tongue depressors. Communicable Disease Report Weekly. 6 (17). 26 April: 145.
Smith A.F., Wild C., Law J. (2005). The Barrow-in-Furness legionnaires’ outbreak: qualitative study of the hospital response and the role of the major incident plan. Emerg Med J. 22:
251–255.
World Health Organization (WHO) (2013). Disease outbreaks. http://www.who.int/topics/disease_
outbreaks/en/ (accessed 2 March 2013)
Contents
Fundamentals of Infection Prevention and Control: Theory and Practice, Second Edition. Debbie Weston.
© 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd. Companion Website: www.wiley.com/go/fundamentalsofinfectionprevention
Microbial classification and structure
5
Bacteria 61
Viruses 70
Prions 76
Chapter summary: key points 76
References 78
61
Introduction
Microorganisms exist everywhere – in and on the bodies of both humans and animals, and in plants, soil and water. The medically important groups include bacteria, viruses, prions, fungi, helminths and protozoa (although only bacteria, viruses and prions are covered in this chapter and within the book). In order to understand how bacteria and viruses replicate, invade and establish themselves in the human host, resulting in colonisation or infection, a basic knowledge of their classification and structure is necessary. This chapter aims to provide the reader with a basic understanding of their properties and characteristics, particularly those which act as virulence factors and increase the organism’s pathogenic potential, and relate these to the disease process.
Learning outcomes
After reading this chapter, the reader will be able to: