Policy for Ward Closure due to an Infection Control Issue

Transcription

1 for Ward Closure due to an Infection Issue Sue Dailly Lead Nurse Infection Prevention and Paula Shobbrook Director of Infection Prevention and (DIPC) Reviewer(s): Approval body: Infection Prevention and Committee; Nursing & Midwifery Group Approval Group Trust Reference Number: Status: CP077 Final Effective Date: November 2010 Review Date: November 2013 Disposal Date: November 2035 Document Authorisation Prepared By: Sue Dailly Lead Nurse Infection Prevention and Authorised Officer: Chris Gordon Acting Chief Executive Signature: Signature: Paula Shobbrook Director of Infection Prevention And Page 1 of 14

2 DOCUMENT CONTROL for Ward Closure due to an Infection Issue Document Amendments No. Details By Whom Date 1 Original document S. Dailly Lead August 2007 Nurse Infection Prevention and 2 Reviewed and updated K Davis-Blues Infection Prevention and August 2010 Review Timetable Date Reason By Whom August 2010 October year review K Davis- Blues. Infection Prevention and Date Completed August 2010 Distribution List No Title 1 All Winchester and Eastleigh Health Care NHS Trust employees via intranet 2 Winchester and Eastleigh Health Care NHS Trust website for public consultation Paula Shobbook Director of Infection and Prevention and Page 2 of 14

3 for ward Closure due to an Infection Issue RELATED TRUST POLICIES OPO11 OP049 CPO55 CP062 CP071 CP074 CP076 CP101 CP104 Incident policy Learning and Development MRSA Pandemic Flu Plan Outbreak Plan Infection Assurance Framework and Roles and Responsibilities Standard precautions and PPE policy for the Management and of Diarrhoea and vomiting (Norovirus) Infections New Strain Respiratory Virus policy Page 3 of 14

4 for ward Closure due to an Infection Issue Contents Section Title Page No. 1. Purpose 5 2. Scope 5 3. Roles and Responsibilities 5 4. Definitions 6 5. Training Implications 6 6. Actions to be taken 7 7. Escalation 9 8. Actions during an escalation 9 9. Further Isolation Bay Closure Ward Closure Outbreak Group Monitoring Compliance and Effectiveness Reporting mechanism 13 Appendix 1 Equality Impact Assessment Tool 14 Page 4 of 14

5 1.0 PURPOSE for Ward Closure due to an Infection Issue 1.1 This policy has been developed to advise all employees of Winchester and Eastleigh Healthcare NHS Trust (WEHCT) on the correct procedure to follow when it is necessary to close a ward due to infection or for purposes of infection control 2.0 SCOPE 2.1 This policy should be followed by all staff employed by WEHCT and should also apply to all patients and visitors. 2.2 Ward closure for reasons of non-infection control issues are beyond the scope of this policy, see OPO11 Incident. 2.3 It is the duty of all staff to notify their appropriate line manager if they suspect an infection problem of one or more cases is not properly contained and is a risk to other patients, staff or visitors 2.4 Please see CP101 for the management and control of Diarrhoea and vomiting (Norovirus) Infections; CPO55 Methicillin Resistant Staphlococcus aureus (MRSA) for details about ward closures concerned with viral diarrhoea and vomiting and MRSA respectively. Please also see CP071 Outbreak Plan for more serious/widespread infection control related outbreaks. 3.0 ROLES AND RESPONSIBILITIES 3.1 Chief Executive Officer (CEO) The CEO has overall responsibility for ensuring the Trust has appropriate strategies, policies and procedures in place to ensure the Trust continues to work to best practice and complies with all relevant legislation. The CEO has responsibility to ensure there is a safe environment for staff and patients 3.2 Trust Board The Board is responsible for ensuring the strategic context of this policy is appropriate and meets the needs of the Trust. The Director of Infection Prevention and (DIPC) is the designated lead executive. 3.3 Infection Team The Infection Prevention and Team (IPCT) is responsible for updating this policy and ensuring it represents best practice and is based on current evidenced based information. Paula Shobbook Director of Infection and Prevention and Page 5 of 14

6 for ward Closure due to an Infection Issue 3.4 Line managers Line managers are responsible for ensuring adequate dissemination and implementation of this policy. They are responsible for identifying any training needs on the implementation of new or updated policies. They are responsible for ensuring adequate facilities and resources are available to adhere to this policy and also ensuring that any changes in practice are implemented. Line managers are responsible for ensuring that all Infection Prevention and (IPC) policies and procedures are accessible for all their staff and that they have read them. 3.5 All Trust employees All staff are responsible for ensuring their compliance to this policy to ensure the safety of all patients, staff, visitors and contracted staff to this Trust. Information regarding the failure to comply with this policy, lack of training or inadequate equipment must be reported to the line manager and the incident reporting system used where appropriate. If patients or staff safety is compromised as a result of the revised policy, staff must inform their line manager and ensure that a risk assessment is completed and reported through divisional risk forums and the Trust incident reporting system. It is the responsibility of individual practitioners to ensure they receive the education they require to improve their knowledge, skills and competence. They are accountable to themselves, their line manager and the patient in acknowledging their limitations and to verbalize their concerns in caring for patients during a bay/ward closure. 4.0 DEFINITIONS Term Ward closure Bay closure Cohorting Definition Ward is closed to admissions, transfers and discharges other than to patient s own home. Bay is closed to admissions, transfers and discharges other than to own patient s home, but rest of ward is open. Placing two or more patients together who are known to have the same infection. 5.0 TRAINING IMPLICATIONS 5.1 All clinical staff are required to have annual infection control updates via mandatory training days, e learning or workbooks. Line managers have a duty of care to ensure that all staff annually receive infection prevention and control updates. The line manager keeps a record of staff attendance on the training matrix. Each member of clinical staff keep his/her own records of attendance at study sessions within their portfolio. It is the responsibility of individuals and their Page 6 of 14

7 for ward Closure due to an Infection Issue line managers to ensure attendance at training. The Training Department feeds back on non attendance to line managers and it is their responsibility to follow up non attendees and ensure their subsequent attendance. Refer to OP049 Learning and Development. 5.2 If staff do not attend, compliance with infection prevention and control training will be reviewed at their appraisal and prompt training arranged. 5.3 E-learning for infection control is an acceptable alternative on alternate years once face to face induction is completed. E learning is accompanied by certification which can be used as evidence at appraisal. 6.0 Actions to be taken On noticing a new or suspected infection, ward staff are responsible for immediately alerting the nurse in charge. 6.1 Nurse in charge Should ensure immediate safe management, notify medical staff as appropriate and inform the infection prevention and control team (IPCT), site co-ordinators and Clinical Matron for the division. Specimens should be sent promptly to the laboratory for microbiology culture and sensitivity (MC&S) and for Clostridium difficile if indicated. Records of infection symptoms should be recorded daily. 6.2 Clinical Matrons and Heads of Nursing Should support ward manager with adequate resources and liaise as appropriate with site co-ordinators, divisional management structure and IPCT. 6.3 Bed Manager Should support ward manager as appropriate and provide overview of current hospital isolation room usage using the Utilisation of side rooms spreadsheet (found on the essence of care drive on the WEHCT). Early liaison with the IPCT may be informal but if the situation escalates (see section 7) formal liaison will be required. The site co-ordinators may need to co-ordinate the movement of some or all of the patients. 6.4 Infection Prevention and Nurses (IPCN) Should provide initial assistance in the infection control aspects of management of the case including isolation (see CP022 Isolation ), use of protective clothing (PPE) (see CP076 Standard Precautions and Protective Clothing ), and advisability or otherwise of cohort nursing or any special requirements. If necessary the IPCN will inform and liaise with the Consultant Microbiologist and the laboratory manager in Microbiology. Daily, or more frequently, bulletins will be circulated by the IPCT to all parties involved with current advice and management plans. Page 7 of 14

8 for ward Closure due to an Infection Issue 6.5 Medical team Should access and manage all the medical aspects of the individual patient(s) and follow all Trust guidance in the Infection Prevention and manual to minimise spread to other patients. Specimens should be sent promptly for laboratory investigation and medical records kept daily and up to date. 6.6 Consultant Microbiologist Should support and liaise with the IPCNs and Microbiology Laboratory staff and assist IC management decisions when required. They will also provide specialist advice to medical teams with 24 hour availability for patient management. They will also liaise with the DIPC as required and with other executives as indicated. 6.7 Microbiology laboratory manager Should liaise with Consultant and IPCNs to ensure timely results and adequate resources to investigate situation. 6.8 Executive Team/CEO Should clearly state Trust intention to tolerate no avoidable infection and assist by resourcing divisions, wards and the infection control team to make this a reality. Should have overall authority in decision making, taking specialist advice at each stage as necessary. Will liaise externally as appropriate. 6.9 Divisional Executives/managers Should make infection control a priority within their division and resource its implementation adequately. Should liaise within and across divisions with IPCT and Executives as appropriate DIPC Should support the IPC team and decision making process as necessary and liaise with CEO, other executives and the Trust Board. If the situation escalates (see section 12) on the ward an Outbreak Group will be convened Hotel services/ housekeeping Should allocate resources and clean all clinical areas and escalate the cleaning schedule when so advised. Managers should keep abreast of developments in the field of hospital cleanliness and liaise with the IPCNs to evaluate products Occupational Health and Safety Department (OHSD) The implications for staff health will vary with the nature of the infection concerned. The IPCNs will inform and liaise with OHSD at an early stage by e- Page 8 of 14

9 for ward Closure due to an Infection Issue mail or telephone, to provide information and specialist IPC advice as required. OH advisors should make all necessary arrangements to see and/or advise affected or concerned staff about the implications (if any) for staff health and fitness to work. Please refer to the CP101 for the management and control of Diarrhoea and vomiting (Norovirus) Infections, CP055 MRSA, and CP104 New Strain Respiratory virus and CP062 the Pandemic Flu Plan for more advice. 7.0 Escalation 7.1 In the event of two or more cases of similar symptoms or infection linked in time or place and without other plausible explanation, a possible outbreak may be underway. 8.0 Actions during an escalation 8.1 As in 6.1 but if cases cannot be contained in single room isolation, the possibility of a double room may be considered, provided the diagnosis is established as the same. 8.2 When the number of cases exceeds the number of side rooms on the ward, cohort nursing may be advised by a member of the infection control team. This is permissible in the case of some infections, depending on the type of ward, case mix and resources available. Advice from IPCT must therefore always be taken by ward staff and bed management before cohorting is undertaken, particularly in less common infections 9.0 Further Isolation 9.1 When patients and non-infected patients cannot be managed safely on the same ward because of the risk of spread of infection or relapse, partial or complete closure of the ward must be considered. 9.2 Liaison between ward staff, site co-ordinators and the Infection Prevention and team is essential and must be documented. 9.3 Each individual situation is different and must be managed on its merits and reviewed on a daily or more frequent basis. 9.4 Some wards are more difficult to close than others e.g. ITU or CCU. Early advice from the Consultant Microbiologist must always be taken. The decision to convene an Outbreak Group (see section 12) may be made earlier in high risk situations. Page 9 of 14

10 for ward Closure due to an Infection Issue 10.0 Bay Closure 10.1 Bay closure to new admissions may need to be considered on the basis or risk assessment. Factors influencing consideration of bay closure are: 1 Risk status of patients to be admitted e.g. elective orthopaedics in the case of MRSA and stroke patients in the case of viral vomiting. 2 Number of cases 3 MRSA strain/type 4 Availability of alternative facilities CCU or ITU 5 Staffing issues The decision to close individual bays on a ward but to allow the rest to remain open may be made by the IPCNs or site co-ordinators after advice from the Microbiologist. Review is daily or more frequently and liaison with Housekeeping on regular or additional cleaning requirements is critical Ward Closure 11.1 The decision to close a ward should be made by or after consultation with the Consultant Microbiologist. It may be the only acceptable way to bring the situation rapidly under control A closed ward means no admissions (from anywhere), transfers or discharges to another ward or institution. The exception is when patients are fit for discharge to their own home. When a ward is closed, a member of the IPCT, by agreement, should inform the Medical Director, Chief Nurse and DIPC Liaison between ward, infection prevention and control, medical staff, management and Housekeeping is necessary to bring the outbreak swiftly under control Outbreak control group (OCG) 12.1 Ward closure may or may not necessitate the formation of a short term Outbreak Group but most usually will. This may be called by any Executive or the Consultant Microbiologist, but will usually be convened by the DIPC It will be organised by the PA to the Director of Infection Prevention and or another designated PA and will meet once a day or more frequently until the situation is clearly under control. Page 10 of 14

11 for ward Closure due to an Infection Issue 12.3 Minutes should be taken and circulated by the PA or representative to the other attendees Constitution of the group Ward Manager of the closed ward Clinical Matron of the closed ward Head of Nursing for relevant division Chief Nurse or deputy Medical Director or deputy Consultant or Divisional Director (or deputy) involved Senior manager on call Infection Prevention & Nurse Consultant Microbiologist Microbiology Biomedical Scientist Trust Communications Manager Clinical site team member Hotel Services Representative Occupational Health Representative Estates Representative if appropriate Health Protection Unit representative PA (minutes) Other co-opted member from eg pharmacy, microbiology lab, Physiotherapy, social services as appropriate Direct advice to the CEO should be provided by the Chair of the OCG, usually the DIPC or a nominated representative. Direct specialist advice will always be available from the Consultant Microbiologist Daily s /bulletins on management of the situation will be prepared by The OCG The IPCN for operational management The Communications Manager Liaison with out of hours managers/executives and cross over professionals is the responsibility of the individual handing over duties from day to night cover As the outbreak comes under control or is less severe it may be possible to plan ahead and meet less frequently for example a weekend plan may be adopted on a Friday A planned reopening, following thorough terminal cleaning, will be made on the advice of the Consultant Microbiologist to the OCG. This will include deep clean, high clean and change of all items such as curtains. All non disposable items Page 11 of 14

12 for ward Closure due to an Infection Issue must be cleaned in line with manufacturer s instructions e.g. chairs, stethoscopes, dinomaps Following closure of the incident a lessons learnt exercise should be undertaken by all staff concerned but led by the OCG members. Shared learning should be cascaded across divisional structures by the staff and managers involved e.g. discussion at Divisional Governance, Infection Committees and divisional clinical meetings Incorporation of new learning points into policies and procedures should follow in a timely manner Audit of policy where lack of compliance may have contributed should be undertaken a reasonable period after new learning has embedded. This will vary with the severity of the incident, its uniqueness or otherwise and the likelihood of it occurring again MONITORING COMPLIANCE AND EFFECTIVENESS 13.1 Look back exercises following a ward closure will examine the compliance or otherwise with this policy. Should a ward closure not occur during a 2 year period a simulated exercise will be conducted to evaluate compliance. This will be facilitated by the IC team but support from other relevant members of the Trust will be required, including managers There is a regular programme of audits, led by the Director of Infection Prevention and and co-ordinated by the Infection Prevention and Team, which are reported to the Infection Prevention and Committee e.g. Hand Hygiene, infection prevention and control policy compliance, High Impact Interventions. Divisional audits are reported via the divisions to the Infection Prevention and Committee and Patient Safety and Quality Committee. Serious Incidents Resulting in Investigation (Infection) are discussed at IPCC and reported to the Risk Management and Governance Committee, Health Protection Agency, Commissioning Primary Care Trust and Strategic Health Authority. Training and education attendance is monitored by the Education Centre and reported to individual managers and collectively to the Executive Management Team. Monthly reports on infection control and surveillance are taken by the DIPC to the Trust Board as part of the performance report. Training Attendance reports are presented to the Executive Management Team meeting and the Infection Prevention Committee. Attendance Page 12 of 14

13 for ward Closure due to an Infection Issue numbers are also reported via the Divisional score card and discussed at divisional meetings. At annual appraisals managers must ensure staff have completed their mandatory education, and if not ensure attendance Reporting mechanism The IPC team will inform the Clinical governance Unit of the ward closure details. A Serious Incident Requiring Investigation report will be generated and submitted to the PCT/SHA Page 13 of 14

14 for Ward Closure due to an Infection Issue Appendix 1 - Equality Impact Assessment Form To be completed and attached to any controlled document when submitted to the appropriate committee for consideration and approval. Yes/No Comments 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race N Ethnic origins (including gypsies and travellers) N Nationality N Gender N Culture N Religion or belief N Sexual orientation including lesbian, gay and bisexual people N Age N Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? 5. If so can the impact be avoided? 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? N N N N If you have identified a potential discriminatory impact of this procedural document, please refer it to the Board Secretary, together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact the Board Secretary (Tel No: ). Paula Shobbook Director of Infection and Prevention and Page 14 of 14