Beaumont Hospital Kidney Centre

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Infection & Vaccination

Infections & VaccinationsCauses Of Infection

The common causes of Infections in Ireland are:

  • Bacteria (e.g., salmonella, TB, E.Coli)
  • Viruses (e.g., common cold, flu, winter vomiting bug)
  • Fungi (e.g., thrush, athletes foot)


Infections are spread by:

Air (e.g. TB, chicken pox).

  • Droplet, sneezing and coughing (e.g., mumps, rubella, common cold).
  • Direct contact (e.g., salmonella from eating uncooked chicken, and sexually transmitted diseases such as syphilis).
  • Indirect contact (e.g., salmonella from a sandwich made by the unwashed hands of a person infected with salmonella).
  • Vectors - e.g., mosquitoes spreading malaria.


Preventing Infection

The human body has developed general and specific defences against infection. General defences protect the body against all infections and examples include skin, secretions such as tears, cilia (tiny hairs), which filter air entering the lungs, and body washings, such as flow of urine from the bladder, which washes away bacteria with the urine.

Specific defences develop when the body's immune system produces antibodies against certain diseases. These antibodies develop after an infection (e.g., chicken pox) or after vaccination (e.g., whooping cough, rubella) and ensure that infection or re-infection very rarely occur.

People with kidney disease have an immune system that does not work as efficiently as normal. In addition, some complications of common illness such as pneumonia after flu can be dangerous for people with kidney disease. However, everyone can assist his or her natural immune system preventing infection by:

  • Eating a well balanced diet and taking regular exercise.
  • Good general hygiene will help keep the skin in good condition.
  • Regular hand washing, especially before eating, and after using the toilet.
  • Attending for regular check-ups with your kidney specialist and GP will ensure that your kidney function and general health are maintained.
  • Attending your GP or the kidney unit promptly if you are not feeling well.


Infections & Kidney Disease

People with kidney disease are vulnerable to the same infections as the general population, such as flu, measles and mumps. However, they are more vulnerable to certain infections due to the treatments used (haemodialysis, peritoneal dialysis and transplantation) and due to regular hospital admissions (MRSA, VRE, and C.Difficle).


Infection Complications Associated With Haemodialysis Treatment

Haemodialysis treatment is known to be a risk for:

1. Bacterial infections associated with access, i.e., catheters, fistulas and grafts.

2. Blood borne viral infections (hepatitis B, C and very rarely HIV).


Access Infections

See chapter 4 for detailed information on infection associated with access.


Blood Borne Infections Associated With Haemodialysis (HD)

Outbreaks of viral blood infections (Hepatitis B and C) have happened in haemodialysis units. As a result, our unit takes infection control very seriously indeed and make every effort to reduce the risk to an absolute minimum. The measures include the following:

  • All patients are screened on admission and routinely for hepatitis B & C & HIV.
  • All staff are vaccinated against hepatitis B.
  • All patients are strongly recommended to bevaccinated against hepatitis B.
  • Patients with known infections are treated insingle rooms, on special machines.

All equipment used, on each patient, is either disposed of after each use or cleaned and disinfected after every use.


Infection Complications Associated With Peritoneal Dialysis

See chapter 5 for detailed information on infection associated with Peritoneal Dialysis.


Infection Complications Associated With Transplantation

See chapter 8 (Book 3) for information on infection, associated with transplantation.



What is MRSA?

MRSA is the shortened term used when referring to Methicillin Resistant Staphylococcus Aureus. Staphylococcus aureus (S. aureus) is the name of the bacteria. The sensitive strain is found in the nose and skin of 20-30% of healthy people. The resistant strain (MRSA) means that it cannot be treated with antibiotics normally used to treat the sensitive strain.


Where is MRSA found?

MRSA is most often found in hospitals or nursing homes where antibiotics are used frequently therefore encouraging the development of resistant strains of bacteria.


How does a person acquire it?

MRSA is transferred from one person to another by human contact. The main method is on hands, during patient care. Patients, who are carriers, may pass it on to other patients if they are in close contact.


Does MRSA make a patient more ill?

Some patients are colonised with MRSA and others have infections caused by MRSA. A patient is colonised with MRSA when he/she has no signs or symptoms of infection. It does not alter their treatment and is not a reason to stay in hospital. MRSA infection, like other infections, varies from mild to severe and depends on other factors, such as where the infection is, and the patient age and underlying conditions. A person found to be colonised or infected with MRSA will be nursed separately from other patients, in a single room (isolation), or in a room with others who also have MRSA (cohorted).


What is the treatment for MRSA?

A patient, colonised with MRSA, is treated with special washes and ointments. A patient, infected with MRSA, is treated with antibiotics, in tablet or by a drip into a vein.



What is VRE?

VRE is the short-term used when referring to Vancomycin Resistant Enterococci. Enterococci are bacteria found in the faeces of humans. Most of the time enterococci are part of the normal bacteria of the bowel and do not cause disease. A strain of enterococci has developed resistance to vancomycin, which is an antibiotic used to treat serious infections including MRSA infections.


Where is VRE found?

VRE is found in hospitals where patients are very unwell, such as intensive care, kidney and transplantation wards. Enterococci can survive on surfaces, ledges and floors.


How does a person acquire VRE?

VRE may be transferred from one person to another by direct contact, particularly from hands, during patient care.


Does VRE make a person more ill?

This varies from patient to patient. The majority of patients are colonised, whilst some are infected. Colonised means that the VRE is not causing infection. The presence of VRE colonisation does not alter their treatment and is not a reason to stay in hospital. VRE infections can vary from mild to severe and depends on factors such as the site of the infection and the patient’s overall condition. Patients with VRE, in a wound or in a urine specimen or those having diarrhoea, need to be nursed in a single room (isolation) or nursed in a room with other patients with VRE (cohorted).


What is the treatment for VRE?

Infection, with VRE, is treated with antibiotics usually given in a drip in a vein. Colonisation with VRE does not require any special treatment.



What is Clostridium Difficle (C. Diff)?

C. Diff. is a bacteria that causes diarrhoea and may cause intestinal conditions such as colitis. It is a common injection in hospitals and long-term facilities. The use of antibiotics alters the normal bacterial content of the bowel and, thereby, increases the risk of developing C. Diff. diarrhoea.


Where is C. Diff found?

C. Diff is found in the bowel of some people and can also survive for a long time on surfaces.


How do people get C. Diff?

Healthy people are not at risk from getting C. Diff. People who have other illnesses or conditions requiring prolonged use of antibiotics and the elderly are at risk of infection. They can become infected if they touch items that are contaminated and then touch their mouth.


Does C. Diff make a person more ill?

In most patients, the symptoms are mild and discontinuing treatment with antibiotics and fluid replacement results in rapid improvement. Sometimes, it is necessary to give a specific antibiotic, by mouth, for the condition. Unfortunately, 20-30% of patients relapse and need further courses of antibiotics. Patients need to be nursed in a single room (isolation) or, in a room with other patients with C. Diff (cohorted), until bowel movement has returned to normal.


Vaccinations Recommended For People With Chronic Kidney Disease

As prevention is always better than cure, the Department of Heath and Children advise that certain vaccinations be given to people with kidney disease. Your kidney doctor or GP will advise you when you need to start getting vaccinated, but, in general, once a diagnosis of chronic kidney disease is confirmed, the vaccinations listed below should be given:

  • Pneumococcus - This bacterium can cause serious infection in the lungs (pneumonia), the blood (bacteraemia) and covering of the brain (meningitis). Vaccination consists of a single injection, followed by a once-off booster dose 5 years later.
  • Influenza (flu) - An annual flu vaccine is advised, as infection can be complicated by pneumonia, which is dangerous for people with chronic illness.
  • Hepatitis B - Hepatitis B is a serious illness and as haemodialysis is a recognised risk for acquiring Hepatitis B vaccination is advised. The vaccination course varies, depending on the product used, but it is usually 3 or more injections, over a 6-month period, with a follow-up blood test to check if immunity has developed. Some people need an additional injection (boost) or a repeat course to develop immunity. In addition, people on haemodialysis or peritoneal dialysis have a blood test, yearly, and, depending on the result, may need a boost.
  • Varicella (chicken pox) - Vaccine for patients not immune and planning to receive a transplant.

People should not get the vaccines if they ever had a life-threatening allergic reaction to yeast (Hepatitis B), eggs (flu) and/or to a previous dose (all vaccines). Pregnant women should discuss vaccination, with their doctor, and people who are ill should defer vaccination until feeling better.

While a vaccine, like all medicines, is capable of causing a serious problem, such as severe allergic reaction, the risk of vaccinations causing serious harm, or death is extremely small. Getting vaccinations is much safer than getting the disease.


Good Hand HygieneWhat Can Patients Do To Prevent The Spread Of Infections In Hospitals?

  • Patients can help reduce the risk of all infections spreading by:
  • Washing hands or using alcohol gel after using the toilet and before meals.
  • Reminding staff to wash their hands, or use alcohol gel before they care for you.
  • Advising visitors who are feeling unwell not to visit.
  • Advising visitors to wash their hands before and after visiting and to avoid going from one ward to another during visiting time.
  • Seeking advice from ward staff if young children wish to visit.
  • Complaining to the ward sister/consultant or any staff member if the general ward hygiene is not satisfactory or if staff are not washing their hands.


Preventing The Spread Of All Infections In Hospitals

This hospital, along with all hospitals in the country, is working hard to reduce the spread of all infections in hospitals by;

  • Improving hygiene throughout the hospital;
  • Improving hand hygiene of staff and patients;
  • Implementing antibiotic policies;
  • Education of staff, patients and visitors;
  • Increasing space between beds and number of single rooms especially as new wards are built.