INCREASED INCIDENT /OUTBREAK OF DIARRHOEA AND/OR VOMITING

Transcription

1 INCREASED INCIDENT /OUTBREAK OF DIARRHOEA AND/OR VOMITING Documentation to support the management of an increased incident or outbreak of Diarrhoea and/or Vomiting including Norovirus Developed by Amanda Hemsley on behalf of the Infection Prevention and Control Team Reviewed: September 2014

2 Contents Page 1. Introduction 3 2. Infection Prevention and Control Team 4 Contact details 3. Increased Incident/Outbreak/Norovirus checklist Notification details (form) 9 5. Summary Record of Patients Daily Record of Symptomatic patients Summary Record of Symptomatic staff Norovirus Outbreak Data Record 13-14

3 Increased Incidence / Outbreak of Infection Record Introduction This paperwork is to be used in conjunction with all other policies and guidelines which relate to an increased incidence or outbreak of infection which affects patients and/or staff An increased incident or outbreak of infection can be defined as significant increase in the occurrence of a specific organism or infection usually 2 or more cases linked in time or place. During the course of the increased incident some or all of the paperwork will be used and it should support documentation of care delivery, plans and actions in response to the management of the increased incident. Contact with the Infection Prevention and Control must take place once the incident is identified. If it occurs over the weekend or out of hours the on call manager should be contacted and the IPC team informed as soon as possible. The following Policies should be consulted in conjunction with this paperwork (although this is not an exhaustive list): Policy for the Management of Patients with suspected or confirmed Infectious Diarrhoea and/or vomiting for Inpatient areas, community services and primary care Policy for the Management of Increased incidents or outbreaks of Infection for Inpatient areas, community services and primary care If an outbreak of infection or increased evidence is suspected please contact the Infection Prevention and Control Team. Please ensure that this includes patients and staff.

4 Infection Prevention and Control Team contact details Amanda Hemsley Senior Nurse Advisor Antonia Garfoot Senior Infection Prevention and Control Nurse Una Willis Senior Infection Prevention and Control Nurse Mel Hutchings Infection Prevention and control Nurse Fiona Drew Infection Prevention and control Nurse Jennie Parkes Team Administrator - Infection Prevention Riverside House, Bridge Park Road, Thurmaston, Leicester. LE4 8BL Riverside House, Bridge Park Road, Thurmaston, Leicester. LE4 8BL Riverside House, Bridge Park Road, Thurmaston, Leicester. LE4 8BL Riverside House, Bridge Park Road, Thurmaston, Leicester. LE4 8BL Riverside House, Bridge Park Road, Thurmaston, Leicester. LE4 8BL Riverside House, Bridge Park Road, Thurmaston, Leicester. LE4 8BL Office: Mobile: Office: Mobile: Office: Mobile: Office: Mobile: Office: Mobile: Office: For Out of hours please contact the On Call Manager and/or local Public Health England contact Public Health England option 1

5 Increased Incident/Outbreak/Norovirus Checklist This checklist is intended for use by healthcare staff within a hospital environment when dealing with a suspected case(s) of gastrointestinal infection, it is not intended to replace standard infection prevention and control measures Ward Staff to Action Action For new admissions direct patient with existing/recent history of diarrhoea and/or vomiting to designated area (i.e. Single room) and commence source isolation precautions when complete Put up source isolation for at bedside/door to single room Ensure staff wear gloves and aprons for direct patient contact or contact with equipment and environment Identify single patient use toilet/commode where possible Provide dedicated patient equipment if available, clean according to LPT policy for cleaning and decontamination Obtain medical review to include review of medication i.e. aperients, PPI s, antibiotics Complete clinical assessment to confirm symptoms are of an infectious origin (i.e. sudden onset, projectile vomit, history of contact, diarrhoea of unknown origin) Assess risk of other infectious origins i.e. food history, travel Record fluid balance and commence Bristol Stool Chart Commence diarrhoea care plan to include date of onset of symptoms and origin of admission (home, acute hospital etc.) Check for previous history or diagnosis of CDT Obtain 2 specimens of stool 1 for MC&S and CDT and 1 for Virology

6 Ensure trust policy for environmental cleaning is implemented Ensure trust policy for management of infected linen is implemented Ensure trust policy for the management of clinical waste is implemented Report suspected case(s) to the Infection Prevention and Control Team Before Every Patient contact with all Staff Action Hand Hygiene (wash hands or use alcohol sanitiser) when complete Identify and use appropriate PPE Between/After Every Patient contact all Staff Action Clean and disinfect patient equipment when complete Dispose of infected linen and waste in designated bags Dispose of PPE as clinical waste Wash hands with liquid soap and water and dry with single use disposable paper towels Disinfect hand with alcohol sanitiser Advise visitors to wash hand with liquid soap and water and disinfect with alcohol sanitiser on entrance and exit to the wards and after visiting patients

7 Control of Designated Area (Single room or Bay/Ward) Action Instigate trust policy for the management of a known or a suspected outbreak of infection when complete Post restricted entry and infection control signs at designated area Inform identified partner agencies i.e. Emas as appropriate Trolley outside room/bay to include: Alcohol hand rub Aprons Gloves Orange bags for clinical waste Red plastic bags (inner and out) for linen Clear bags for meal trays Change apron and gloves between each patient, wash hands with liquid soap and running water, dry thoroughly, dispose of paper towels and PPE as clinical waste, use alcohol hand sanitiser as a secondary process Isolate toilet facilities (commode/bedpan or toilet) for affected patients use only Check that the bedpan washer/macerator is functioning correctly o Are the bedpans clean following washing? o Does the washer go through a cold clean cycle followed by a hot wash? o Hot wash = 65 C for 10 minutes or 71 C for 3 minutes If no macerator/bedpan washer available use Verna gel to solidify any liquid, double bag in orange clinical waste bags and dispose of as clinical waste Affected areas should be cleaned thoroughly and disinfected once a day with chlor clean. A check later in the day by cleaning services must take place, paying attention to toilets, waste bins, door handles and horizontal surfaces

8 Entrances Ward staff/ Hotel services Action Provide patient/visitor/carer/staff information (i.e. Norovirus information) when complete Restrict visiting according to local policy Ensure trust protocol for enhanced environmental cleaning and decontamination is implemented Patient and Staff Movement Action Advice on placement of further suspected cases should be sought from the IP&C team. Patients should not be routinely moved in order to cohort them on the ward when complete Restrict movement of ward/bank staff/ medical staff Allied Health Professionals (AHP) to allocate nominated individual to designated area or to visit last on round Allocate nursing staff to designated area if limited to Bay/Rooms and avoid cross working between affected and unaffected patients Movement of patients from ward to ward for cohort management is NOT recommended Agree patient transfers with receiving areas following individual assessment and for urgent clinical need only Symptomatic staff should remain absent until symptom free for 2 working days (>48hrs) and inform Occupational Health

9 Notification details: This form is to be filled in when patients within a care/in-patient facility are affected, including staff Facility: No of beds: No. of patients: Date ICN informed: No. of beds open: No. of beds closed: Date ward closed: Date ward open: Date outbreak commenced: Date outbreak completed: Type of outbreak: Persons to be notified immediately (as applicable) Infection Prevention and Control Team Date and person notified (Start of outbreak) Date and person notified (Outbreak ended) Signature *Bleep holder/on call manager Bed Bureau at UHL Physiotherapy Occupational Therapy Catering Domestic Services Manager Occupational Health if staff affected

10 Summary Record of Patients - Increased Incidence/Outbreak Total number of patients affected: No. of cohort bays: No. of beds single rooms: No. of beds closed: No. of patients in single rooms: Date Patient s name Date of Birth NHS No Symptoms Room Number Bed location Date/time symptoms commenced (BSC type) Specimen sent/date Date symptoms finished

11 Daily Record of Symptomatic Patients At the start of the increased incident/outbreak fill in the start date and continue until the incident is closed, this will give you a daily total of symptomatic patients Patient Names Date and time - if symptomatic, X if symptom free Total number of patients symptomatic

12 Total number of staff affected: Summary Record of Staff - Increased Incidence/Outbreak Date Staff member s name Symptoms Date/time symptoms commenced Date last at work Date symptoms finished Date returned to work

13 Norovirus Outbreak Data Record (to be used in conjunction with ward closure) Date Facility Ward/Area : ICT informed date: The ward is closed to admissions and transfers until 48 hours after last new case and 48 hours after last diarrhoea/vomit. The ICD may be based on specific epidemiological data extend the closure time. The doors to single rooms are closed and there is an approved notice on the ward door advising visitors of necessary actions. All Staff on the ward / area: o Aware of the status of the ward / area and how Norovirus is transmitted - Leaflets. o Norovirus symptom free. o Allocated if possible - to care for either affected or non-affected areas of the ward including agency and bank staff. All patients (and relatives) on the ward are aware of the norovirus situation and have been given information leaflets on norovirus and the need for hand hygiene, and safe handling of personal laundry. All patients with symptoms of norovirus have been assessed today for symptom severity and assessed for signs of possible dehydration (Stool and Fluid Balance charts). Norovirus Outbreak Data Record (overleaf) The outbreak data collection record has been updated including any new cases, the symptoms patients are experiencing today and laboratory data. (Stool samples have been requested from all symptomatic patients). Personal Protective Equipment (PPE) -gloves, apron, face (mask/visor - if risk of facial contamination with aerosols). There are sufficient supplies of PPE in the ward o Is used for single tasks and once removed hand washing is performed using liquid soap and warm water. o Is used before contact with the patient or the patient s immediate environment or before any dirty task. Hand hygiene is being carried out with liquid soap and warm water this can be followed by alcohol based hand rub. Hand hygiene: Patients are encouraged and given assistance to perform hand hygiene before meals and after attending the toilet. Environment: The environment is visibly clean including curtains - there is increased cleaning which includes decontamination of frequently touched surfaces with detergent and Chlor clean. [Cleaning records are up to date.] Environment: There are no exposed foods in the ward area even if unexposed all fruit should be washed before eating. Equipment: Where possible single patient use equipment is used and communal patient equipment avoided. All reusable equipment is decontaminated after use. There are sufficient other sundries on the ward to enable the control measures to be implemented.

14 Linen: Whilst the ward remains closed, categorise all discarded linen as infected. Spillages: All faecal and vomit spillages are decontaminated by staff wearing PPE. The spillage is dealt with using chlor clean wipes as per trust policy. All waste arising is discarded as healthcare waste. PPE is then removed and hands washed with liquid soap and warm water as per policy. Advice and Guidance: HCWs have access to, and follow NHS Board guidance on: o The decontamination of body fluid spills, equipment, soft-furnishings o What to do if uniforms become contaminated. Today the ICT has made an assessment of the outbreak and the continuing need for ward closure. The earliest possible date for reopening has been communicated to the clinical team, to bed management staff and to those listed in the Outbreak Policy. 1. In preparation for reopening - empty beds have been cleaned but left unmade. 2. In preparation for reopening - the curtains in empty rooms have been taken down. 3. In preparation for reopening consider if pre-booking a terminal clean and pre-booking clean curtains being hung is possible. 4. Before reopening: a terminal clean has been performed following ICT recommendation and following the hospital procedure. n/a n/a Patient and Staff Numbers Date (agree a time of day to be done) Comment No. of patients symptomatic No. of patients <48 hrs. symptom free No. of empty beds No. of new HCWs off duty with symptoms

15 Infection Prevention and Control Team Diarrhoea and/or Vomiting Information for Visitors VISITORS If you have diarrhoea and/or vomiting you could pass this on to your relative/friend, other patients and staff in the hospital Please go home until you are better If your visit is absolutely necessary, please keep your visit to a minimum and wash your hands before contact with your relative/ friend. STOP THE SPREAD If you DO NOT HAVE diarrhoea and are well: Use the alcohol gel on entering and leaving the ward Wash your hands with soap and water if you have contact with anyone with diarrhoea Version 1 - September 2014