Monday 9 November 2009

Effective Infection Control

With winter and swine flu, I thought I'd post a general blog about controlling infections which, aside from apnea, are one of the main causes of death in leukodystrophy patients. You don't need to follow all of these unless there is a very vigorous need to control infections (such as immune system compromise after a bone marrow transplant). I am not a doctor, nurse or transplant advisor or anything - these were just ideas I collected from multiple sources and brought together.

General
- Sterilise all feeding equipment daily
- Give an antibacterial-antiviral such as sambucol, olive leaf extract or eccinacea at the first hint of any infection.
- Wash hands regularly throughout the day, using hot water and an antibacterial soap.
- Wash hands before handling the feeding tube, doing breathing treatments or doing anything near the person's mouth
- Use surgical gloves when dealing with breathing treatments or feeding tube, and wipe the feeding tube site with an antiseptic when changing it.
- Wear a facemask when giving breathing treatments or when dealing with the feeding tube
- Vaccume the floor and disinfect surfaces daily
- Have the person wear a facemask when outside in a crowded area. Give the person a full body scrub and put their clothes for laundry after being in a crowded area. Do the same for yourself.
- Do not allow anyone into your house or near you or the person, who has had an infection in the last week, or who has been in contact with someone who has had an infection in the last week.
- Get the person and yourself seasonal, and any other, flu vaccines
- Clean gastrostomy feeding tube sites in the morning and evening with warm water and TCP.
- If someone who was infected within a week ago, or was associated with someone with an infection in the last week has been in the house, vaccume all carpets, wash all carpetless floors with hot water and soap, wash and dry all curtains and seat covers/throws, disinfect all surfaces and allow the room to air for a day before allowing the person with leukodystrophy back into it.

Urinary Tract Infections
- When changing the nappy, ensure that the entire area covered by the nappy is wiped with baby wipes, and allowed to thoroughly dry before the new nappy is put on.
- Try to induce a bowel movement in the morning by giving a rectal wash out with warm water and glycerine, so that bowel movements come into minimal contact with the front area. This will also help prevent constipation.
- Try to catheterise the bladder four times a day, as this will ensure all the urine drains from the bladder and does not stagnate. However an indwelling catheter may increase the chance of infection by making it easier for infections to enter into the body from outside.
- Give adequate water through the tube to ensure proper hydration and flushing of the kidneys. The person's doctor should be able to recommend a good total volume to aim for.

Eye Infections
- Wash hands thoroughly and wear a face mask and surgical gloves when doing anything with the eyes.
- Use artificial tears to keep eyes moist and prevent fluid stagnating in them.

Ear, nose and throat infections
- Have a look in the ears, nose and throat each day with a small torch. If there is any redness or swelling in the throat, or any waxy build-up in the ears, see a doctor for antibiotics and/or to get ears syringed. Suck out mucus from the nose and throat, if there is any.

Gastrointestinal Infections
- Clean and disinfect cooking surfaces thoroughly before use
- Feed a probiotic such as yakkult or actimel.
- Wear an apron when cooking to prevent germs from getting from your clothes onto your hands and thus into food. Wash and dry apron after every cooking session.
- Ensure everything you use is within its best before, display until and use-by dates, and also smell/view it to ensure it has not gone bad prematurely.
- Do not re-freeze food after defrosting it once. Do not freeze cooked meat at all. In the fridge ensure raw meats are placed on the lowest shelf, so they cannot drip onto raw foods like cheese, pudding and vegetables.
- Use a clean dish towel every time you dry dishes - put each dish towel for the laundry after . Preferably allow them to drip dry.
- When washing up use water that is the hottest it can be, and an antibacterial washing up liquid. Alternatively use a dishwasher but check the dishes are clean and dry upon coming out.
- Do not sneeze, touch your face, cough or yawn near food
- Wash hands in hot water with soap and dry thoroughly before handling food or dishes, or after putting things in the bin.
- Tie back long hair before cooking.
- Wipe up any spillages immediately. After washing up or wiping up, place the dish cloth or sponge in the laundry and use a new one for next time.

Intravenous Sites
- Change the tape/dressing on these every three days at least. Wash hands in hot water and soap, dry them thoroughly and use a face mask and surgical gloves when dealing with an open IV site. Do not touch face. Always wipe site with an antiseptic swab to disinfect before immediately replacing tape/dressing. Keep the IV away from water, or the tape will peel off and site may become contaminated.

Cuts, Grazes and Open Sores
- Wear a surgical mask and gloves when cleaning these sites
- Wash hands thoroughly first with hot water and soap and dry thoroughly. Do not touch face in the process.
- Wash the site with TCP diluted in warm water, using cotton wool.
- Put antiseptic cream on the site, such as savlon
- Cover site with a waterproof sticking plaster, or sterile non-fluffy dressing if needed/preferred.

Lung Infections
- Carry out normal breathing treatments at an increased frequency throughout the day.