This section explains about the role of the Infection control team at Great Ormond Street Hospital and how it is working with other members of staff to reduce the risk of your child acquiring an infection while in hospital.
What do infection and colonisation mean?
An infection, in general terms, is the illness caused by the growth of a germ on or in a person.
Sometimes the infection does not give any symptoms - this is called an ‘asymptomatic’ infection.
When the germ is commonly found on our body without causing an illness, we call it carriage or colonisation.
Carriage may be very short term (transient). For example, acquired by touching someone but quickly removed by washing your hands, or persistent with the germ multiplying on your body (usually called colonisation).
In certain circumstances the germs that colonise our bodies may go on to give an infection.
What sort of infections are there and how do they spread?
Infections can range from the fairly minor, like coughs and colds, to more serious ones like septicaemia (blood poisoning) and wound infections. Infections tend to be more common for people in hospital because they are in close contact with other patients and staff who themselves may be colonised or suffering infection.
Infections can spread quickly unless certain measures are taken. Any patient who has an operation or other procedure where the skin is broken, like intravenous infusions, is at risk of infection.
Patients with certain conditions are also more at risk from infection. For instance, those with heart, kidney or skin diseases or those with low immune systems. Other patients at risk include very young babies or children who are not feeding well.
The germs that cause infection spread in various ways, the main methods being:
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Airborne – the germs are carried by the air, such as the chicken pox virus.
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Droplet spread – infectious droplets of moisture are coughed or breathed out during infection. They settle on surfaces and may be transferred to another person’s eyes or mouth, usually by their hands.
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Direct contact – by touching someone that has the infection, such as scabies.
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Indirect contact – by contact with dirty equipment or other materials.
There are various ways we can all prevent infections, some of which are outlined below.
Monitoring
What we can do
When a new member of staff joins the hospital, they are checked for immunity against certain diseases and immunised if needed. They are also screened using a questionnaire, or by testing, to see if they are carrying certain infections. If necessary, we can then treat them.
When a child is admitted to hospital, we always ask for a swab of their nose and throat and a sample of faeces (poo). This is then sent to the laboratory and checked for germs that are resistant to antibiotics such as MRSA (methicillin resistant Staphylococcus aureus).
When the results are available, this helps the doctors and nurses decide if any special precautions are needed to prevent cross infection. If the child is carrying a germ that is resistant to the common antibiotics, then we will nurse them in a single cubicle and alert this on the computer that contains your child’s information.
What you can do
You can help by telephoning outpatients or the ward before you come in if your child has been in contact with any infectious disease, like chicken pox or a tummy bug, so we can prevent it spreading to other children and their families.
Hand washing
What we can do
Everyone coming into contact with your child, like doctors, nurses, members of staff and yourself, should wash their hands thoroughly before and after they touch your child. This is a good way of reducing healthcare acquired infection.
We provide liquid soap and water on every ward. Alcohol gel can be used to wash hands quickly if they are not physically dirty.
What you can do
You can help by asking members of staff coming into contact with your child whether they have washed their hands. You should also ask your visitors to wash their hands, and make sure your hands are clean too. Remember that alcohol gel is available as well as soap and water.
Environment
What we can do
We try to make sure that all areas of the hospital are clean. Each ward has a housekeeper who monitors how clean the ward is and takes action to get an area cleaned if necessary. We work closely with our domestics who work very hard to maintain our high standards of cleanliness.
We realise that sometimes we do not manage to reach our high standards. However, the senior nurses, managers and Infection Control team all try to resolve any problems quickly.
We also have special ‘clean’ cubicles for children who are severely immuno-suppressed. For instance patients who have recently had a bone marrow transplant.
On very rare occasions, a ward may need to be closed because of an outbreak of infection such as diarrhoea and vomiting. If this happens, we will inform you as quickly as possible as we may need to restrict access to the ward.
What you can do
You can help by telling us if you think an area is not clean enough. You can also keep the area by your child’s bed clear of waste, like dirty cups, used tissues and leftover food, and toys tidied away when they are not being used. There is limited storage space by each bed, please use it to keep belongings out of the way.
Each bed area is cleaned once a day between 10.30am and 4.30pm. As space is limited, please go to the parents’ room while it is being cleaned. Cleaning should take about 20 minutes. If the bed area is kept tidy then it is easier for our domestics to clean.
If you have any questions please talk to the ward housekeeper.
If a ward is closed due to infection, please keep your movements within the hospital to a minimum and avoid visiting other wards if possible. If possible, you should also restrict the number of people visiting your child and let us know if a visitor develops any signs of infection once they have returned home.
Equipment
What we can do
All our equipment, like infusion pumps and ventilators, is cleaned regularly, decontaminated in between patients and maintained to make sure it is working well. Every member of staff who is trained to use the equipment is also trained to report if the equipment fails or needs cleaning.
What you can do
You can help by telling us if you think a piece of equipment is not working properly. All external parts of equipment should be cleaned regularly, so if you think it needs cleaning, please tell the ward housekeeper.
Protective clothing
What we can do
Our staff will wear an apron and gloves if there is a risk of contact with:
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bodily fluids, like saliva, blood, vomit, urine (wee) or faeces (poo)
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patients colonised or infected with germs such as MRSA
Latex-free gloves are available if your child is allergic to latex.
We advise our staff to wear masks if there is a risk of breathing in an infection. In certain circumstances, where there is a risk of bodily fluids being splashed into the eyes and mouth, we recommend our staff wear a visor or goggles.
What you can do
You can help by telling us when your child is admitted if they have had any infections with germs like MRSA, hepatitis B or C, or HIV. It will not make any difference to the quality of your child’s care if they have any of these germs, but knowing about them helps us to protect our staff and other children.
Injuries to staff
What we can do
If a member of staff has an accident involving your child’s blood, for instance, a needle prick, current guidance says that we should test your child’s blood for any blood-borne virus like hepatitis or HIV. This is to protect our staff.
If an accident happens, we will ask you to give permission for us to take a sample of your child’s blood to check. All accidents are monitored closely to reduce any risks to our staff and our patients.
What you can do
You can help by telling us when your child is admitted if they have any illness like hepatitis B or C, or HIV. If an accident happens, you can help by allowing us to test your child’s blood. We will let you know the results.
The Infection Control team
All hospitals in the UK have an Infection Control team of doctors, nurses and scientists who are all specially trained in microbiology, virology and infection control.
The Infection Control team at GOSH is available 24 hours a day, seven days a week to offer advice and guidance to hospital staff. It monitors all infections in the hospital and is responsible for the prevention and control of outbreaks.
The team works closely with staff within the hospital through a ‘link’ system. This means that each ward and department has a member of staff who is responsible for making sure everyone in their area is up-to-date on infection control standards. The Infection Control team also works closely with all our ward teams to ensure they are kept up-to-date with infection prevention and control.
It also works with different departments around the hospital to spot problems before they occur and advises on the best methods of preventing them in future.
The Infection Control team works with:
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ward housekeepers to make sure that standards of cleanliness and food safety are achieved
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catering to make sure that all food is prepared in a safe and clean way
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laundry to make sure that all linen is cleaned correctly to minimise infection
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estate and building services to make sure that any building work is carried out with the minimum of dust and dirt. The team also ensures that the maintenance of water and air systems are monitored regularly and are satisfactory.
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domestic services to make sure that all areas are kept clean
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the Hospital Decontamination Unit (HDU) to make sure high standards are maintained and ensure there is a ‘tracking’ system for theatre trays and equipment, so that if an incident happens, we can trace all the equipment and people involved.
The Infection Control team carries out regular checks on every ward and other relevant departments in the hospital, to check that infection control standards are being met.
It also works closely with the Health Protection Agency and Public Health Laboratories throughout the local area and beyond.
The team is in touch with organisations worldwide to monitor and reduce the risk of healthcare acquired infection through travel. It has access to immediate alerts about potential outbreaks of infectious disease, such as influenza, so that it is aware of any outbreak that could have an impact on patients.
What happens if my child develops an infection in hospital?
If your child shows any signs of infection while in hospital, like a high temperature, diarrhoea and vomiting, a rash or wound infection, we will take samples of urine, faeces, wound swabs and blood.
These samples will be sent to the laboratory to see if they can identify whether your child has an infection or not.
While the samples are being checked, and afterwards if your child has an infection, they will be nursed in a cubicle on their own, or along with other children with the same infection. The staff will wear protective clothing, like aprons and gloves while caring for your child.
We will continue to take samples regularly, to check whether your child still has the infection.
What happens if my child is or becomes infected or colonised with MRSA or other antibiotic resistant organisms in hospital?
If the child is carrying a germ that is resistant to common antibiotics then we will nurse them in a single cubicle and alert this on the computer that contains your child’s information.
We will inform you if we think this has been acquired while in hospital and we will investigate every situation to detect the possible risk factors so they can be reduced.
