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Emergency infection control patrol

Fionna Cassie travels to post-quake Christchurch and finds there are invaluable infection control lessons to be learnt by those working in aged care following large scale disasters.

Infection control nurse Alison Carter is in a unique and authoritative position to talk about crisis-related infection control in aged care.

It was a sad situation she found herself in when she first visited Christchurch’s rocked aged care facilities. She said that despite the portaloos at entrances and residents on mattresses, it was the spirit of the staff and residents she took home with her.

As an infection control community consultant for laboratory services provider Medlab South for more than 15 years, residential facilities have been one of Carter’s major clients. When, 10 days after the quake, she headed out to follow up her phone calls to the facilities in person, she found a sector tested like never before.

“When I got out to the facilities… I think probably ‘sad’ is the best way of putting it,” Carter says. “But the spirit of staff and the residents was inspiring.”

Facilities in areas without water had water tankers at the curb and those lucky enough to have a relatively safe sewerage system had buckets of water tucked beside the toilet cistern ready for flushing. Those that didn’t had water tankers and portaloos parked at the front entrance. Tougher still were those areas which had lost their facility altogether – not only had the residents lost their homes but the staff their jobs. “It’s going to be hard for them.”

For facilities that were structurally sound, there were people sleeping on mattresses on the floor and three people in two-bed rooms. “One facility was trying to get residents to go to another facility that had kindly offered showers, but residents didn’t want to go. They felt wanted and loved and safe in their own community – even though it was a mess.”

With the power off, barbecues came into their own so staff could provide residents with a hot sausage or hot meat pattie. To keep mobile residents occupied, a number of facilities put them into teams with tasks like damp-dusting the lounge and corridors or standing vigil at the entrance to the dining room to ensure everybody used alcohol-based hand rub before they sat down to their meal.

Carter says a lot of the elderly residents didn’t even remember the quake because of their dementia. “They all felt safe and secure in their own environment – which I found quite strange as some of their environments… well I thought, ‘goodness me’.”

With infection control, Carter says alcohol-based hand rub and adult-sized ‘baby wipes’ were invaluable in quake-hit facilities. While many facilities had running water back on, those that hadn’t had been using bed bath packs – colloquially known as ‘baby wipes’ – to wash residents. Carter laughs and says she had been happy to use them when she’d been without water herself for a few days. “But I was still glad when I got that shower.”

Many facilities already had residents reliant on incontinence pads, so they were using these and disposing of them in the ordinary way. But others were using plastic bags to dispose of faeces.

Carter says all facilities had good supplies of plastic aprons, alcohol-based hand gel and gloves.

“And the facilities used the usual standard precautions – the facilities use these all the time and it was just second nature.”

As facilities own emergency supplies of water and products were depleted, the district health board stepped in with bottled drinking water and other supplies.

Staff at some homes were taking home laundry and residents’ clothes to wash because of the lack of water, but a number already outsourced their laundry and had enough in stock to get through until laundry services resumed. “They weren’t changing the beds as often as they did and were feeling quite bad about that, but the beds were clean and dry.”

When it came to portaloos, clinical microbiologist Dr Rosemary Ikram, Carter’s infection control partner at Medlab South, says the toilets themselves were not the problem but the fact that there were multiple people using them and this emphasised the need to ensure good hand hygiene on leaving the loo.

The pair says their answers to questions from facilities and others hit by the loss of water and sewerage was usually just to follow the usual simple infection control procedures. “But people just wanted reassurance,” Carter says. “If people are compliant, then the simple things actually work,” adds Ikram. “And people always find that surprising.”

Evacuated along with hundreds of facility residents have been the bugs unique to their institution.
Ikram says the result was likely to be a bit of “cross-fertilisation”. But when Medlab was aware that homes had transferred residents with bugs like MRSA, it had contacted the new facility to inform them and advise them of the precautions to follow.

General practices have also been seeking advice from the Medlab pair about working when the water from the tap is at risk of being contaminated by sewerage.

The best practice was for health professionals to wash their hands with boiled water, but with most practices unlikely to have enough boiled water on hand, Medlab was advising health professionals to first wash their hands under the tap and then use alcohol-based rub. Also for cleaning wounds, it was okay to boil water for three minutes and use it once it had cooled down.

They also corrected an incorrectly-advised practice that if a bowl of water was treated with chlorine bleach then all the staff could safely wash their hands in it.

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