Infection Prevention and Control Assurance - Standard Operating Procedure 6 (IPC SOP 6) Isolation Care of Patients in Isolation due to Infection or Disease Why we have a procedure? The spread of infection between patients in our in-patient services can be reduced by physical isolation of either those patients at risk (Protective Isolation) or those patients with infection (Source Isolation). Isolation precautions can be applied to a patient in a multi-bedded area, a cohort of patients suspected to have the same infection or to a patient in a single room. It will also ensure compliance with the Health and Social Care Act 2008: Code of Practice for the NHS for the Prevention and Control of Healthcare Associated Infections (revised January 2015). The purpose of this document is to provide clear infection control guidelines and when caring for a patient requiring isolation due to an infection or disease. What overarching policy the procedure links to? This procedure is supported by the Infection Prevention and Control Assurance Policy Which services of the trust does this apply to? Where is it in operation? Group Inpatients Community Locations Mental Health Services all Learning Disabilities Services all Children and Young People Services all Who does the procedure apply to? All staff involved in the care of patients should adhere to these standard procedures when dealing with a known or suspected outbreak of infection/communicable disease e.g. Matrons, Service Managers, Ward Managers & all clinicians involved in the delivery of care Facilities staff When should the procedure be applied? Whenever it is suspected or confirmed that a patient has in infectious illness or disease or condition affecting the immune system making them more vulnerable to infections and requiring single room isolation. Isolation Care of Patients in Isolation due to Infection or Disease Page 1 of 8 Version 1.0
How to carry out this procedure Additional Information/ Associated Documents Infection Prevention and Control Assurance Policy Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP 1) - Standard Infection Control Precautions Infection Prevention and Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) - Transmission Based Precautions Waste Management Policy and Procedures Hand Hygiene Policy The decision to isolate a patient or a clinical area should always be taken after assessing the risk to the individual, other patients and staff with the support & advice from the Infection Prevention & Control Team. When isolation precautions are required they should be tailored to meet the needs of each patient and reflected in their care plan. Once the decision has been made to isolate a patient or a clinical area, the necessary precautions must be commenced promptly so as not to put other patients, visitors or staff at risk. While it is acknowledged that strict implementation of isolation precautions in the mental health & learning disability environments may be difficult for reasons such as poor patient understanding and compliance and the need to maintain as normal a lifestyle as possible, it remains important that the principles of good infection control practice are not compromised and in all cases the care plan must include any specific precautions required. In order that patients who are isolated in a single room do not feel ostracised, the reason for isolation should be explained to the patient as best as possible and to their close family contacts and carers. Aims To prevent the transmission of infective organisms from an infected patient to others To give psychological support and reassurance to the patients whilst he/she is in isolation To ensure all staff (including housekeeping staff) are aware of the correct precautions to take To protect vulnerable patients and staff Definitions Source Isolation Protective Isolation Cohort nursing Used for patients who are sources of pathogenic microorganisms which may spread from them and infect other patients and/or staff, isolating the source patient to prevent transfer of infection Used for patients who are rendered highly susceptible to infection by disease or therapy, isolating vulnerable patients to prevent acquisition of infection Grouping of infectious patients and nursing them within an area of a hospital ward as a strategy for controlling infection Isolation Care of Patients in Isolation due to Infection or Disease Page 2 of 8 Version 1.0
Types of Isolation Strict Isolation Standard Isolation (Source Isolation) Respiratory Isolation Protective Isolation For highly transmissible or dangerous diseases. It is envisaged that strict isolation would only be provided as a short-term temporary measure while transfer to an appropriate isolation unit is arranged. (No suitable facilities in this Trust) For most communicable diseases, single room with hand wash sink For diseases where the main route of transmission is airborne, including pulmonary tuberculosis For individuals suffering from a weakened immune system and susceptible to microorganism invasion are isolated to avoid exposure High Priority for Isolation Patients with: Diarrhoea and vomiting Clostridium difficile Chickenpox Tuberculosis Meningitis (confirmed or suspected) Multi-drug resistant organisms Influenza/influenza like symptoms Pyrexia of unknown origin with recent history of foreign travel Patients requiring source isolation should be cared for in a single bedroom (ideally en-suite) and with a hand wash sink. Where several patients have the same infection they may be nursed together in one bay, this is called co-horting. The Infection Control Nurse will advise accordingly. Isolation facilities across the Trust do not have negative or positive pressure ventilation facilities and therefore patients requiring this type of accommodation may require transfer to another hospital. The Infection Control Team or Microbiologist will advise. If a suitable isolation room is not immediately available on a ward, liaison must take place between the Nurse-in-Charge, Service Manager/Matron and the Infection Control Team to enable the rationalisation of isolation needs. This may involve the transfer of other patients out of single rooms to accommodate those with higher needs. An incident form (DATIX) must be completed if a patient cannot be suitably isolated so that the reasons for this can be identified and appropriate action taken. *Caring for patients in Source Isolation - see Appendix 1 *Caring for patients in Protective Isolation - see Appendix 2 *General isolation precautions - see Appendix 3 Isolation Care of Patients in Isolation due to Infection or Disease Page 3 of 8 Version 1.0
Transfer of Patients with a Known/Suspected Infection to Other Departments and Organisations If the patient requires transfer to another ward/department or other healthcare care facility, suitable and sufficient information on the patient s status must be given to the receiving department The Nurse-in-charge is responsible for advising the receiving department e.g. ECT, A&E, X-ray, Ambulance etc. and of any necessary precautions to be taken Only in exceptional circumstances would the patient s infectious status prevent infections or procedures being undertaken in other departments Any staff transporting patients must be advised of any precautions to be taken e.g. correct use of PPE Porters are not required to wear gloves or aprons unless they are physically moving the patient and contact with blood or bodily fluids is likely. Hands however must be decontaminated with soap/water Following transport of an isolated patient the trolley/wheelchair should be wiped down with detergent wipes, paying particular attention to contact points e.g. armrests Where do I go for further advice or information? Infection Prevention and Control Team Your Service Manager, Matron, General Manager, Head of Nursing, Group Director Your Group Governance Staff Training Staff may receive training in relation to this procedure, where it is identified in their appraisal as part of the specific development needs for their role and responsibilities. Please refer to the Trust s Mandatory & Risk Management Training Needs Analysis for further details on training requirements, target audiences and update frequencies. Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness. Equality Impact Assessment Please refer to overarching policy Data Protection Act and Freedom of Information Act Please refer to overarching policy Isolation Care of Patients in Isolation due to Infection or Disease Page 4 of 8 Version 1.0
Appendix 1 Source Isolation for Patients with a Known or Suspected Infection *The decision to isolate a patient or clinical area should be based on the infection risk posed and decided after discussion with the Infection Control Team. Preparing the Source Isolation Room Care in Isolation Visitors Discontinuation of Isolation Ideally the patient must be cared for in a single room with a hand wash basin and preferably an ensuite toilet The patient should be informed of the reason & need to comply with isolation requirements The care plan must reflect individual specific requirements to prevent transmission Ensure that all unnecessary equipment is removed from the room Ensure that all the equipment in the room is designated to the isolated patient if possible and safe to do so (i.e. commode, BP machine) All personal belongings and equipment should be washable or disposable if possible Keep charts and care plans outside the room Ensure all clinical waste bags. Paper towels, alcohol hand gels etc. are to hand and if necessary locked in a cupboard Place a source isolation sign on the door Standard infection control precautions must be adhered to at all times Hand hygiene must be performed before entering and prior to leaving the room Wear all appropriate personal protective equipment (PPE) as directed - disposable gloves and apron to be donned before entering the room and removed before leaving the room followed by hand washing All bodily fluid spillage, waste & soiled linen to be dealt with immediately and removed from the room Place all used sharps into an approved sharps bin immediately after use and store safely between uses If en-suite bath/shower not available the patient in source isolation should bath/ shower last and the bath/shower must be cleaned/ disinfected before & after use Visits to other departments should be avoided, however if unavoidable, this must be made by prior arrangements with the receiving department who must be informed of the patients status As far as possible keep the door closed at all times, ensuring the situation is regularly assessed and re-evaluated Ensure PPE is always available for use. Bed linen should be changed daily as a minimum * Remember alcohol gel can only be used on visibly clean hands and not at all if Clostridium difficile or Norovirus is diagnosed or suspected use soap & water Explain in appropriate language the reasons for isolation Advise on the importance of hand hygiene prior to entering and before leaving the room Advise on correct use of PPE as appropriate Discourage visitors from visiting or having contact with any other patients Visitors and staff from other departments must report to the Nurse-in-Charge before entering the room or co-hort area If unsure discuss requirements with the Infection Control Nurse Isolation may be discontinued when the patient is no longer a risk for spreading infection to others and following approval by the infection control team The room must be cleaned thoroughly (even if the patient is staying in the room). It should be cleaned again thoroughly when it is vacated and curtains laundered (disposable curtains must be discarded & replaced before the room can be re-occupied) The care plan must be reviewed and updated and the patient notes record when the isolation was discontinued Isolation Care of Patients in Isolation due to Infection or Disease Page 5 of 8 Version 1.0
Appendix 2 Protective Isolation for Patients Vulnerable to Infection e.g. Immunocompromised/ Neutropenic *The decision to isolate a patient or clinical area should be based on the infection risk posed and decided after discussion with the Infection Control Team. Preparing the Protective Isolation Room Care in Isolation Visitors Discontinuation of Isolation Ideally the patient must be cared for in a single room with a hand wash basin and preferably an ensuite toilet The patient should be informed of the reason & need to comply with isolation requirements The care plan must reflect individual specific requirements to prevent transmission Ensure that all unnecessary equipment is removed from the room Ensure that all the equipment in the room is cleaned thoroughly & designated to the isolated patient if possible and safe to do so (i.e. commode, BP machine) All personal belongings and equipment should be washable or disposable if possible Keep charts and care plans outside the room Ensure all clinical waste bags. Paper towels, alcohol hand gels etc. are to hand and if necessary locked in a cupboard Place a protective isolation sign on the door Standard infection control precautions must be adhered to at all times Protective isolation rooms should be cleaned first using disposable equipment Hand hygiene must be performed before entering and prior to leaving the room Wear all appropriate personal protective equipment (PPE) as directed - disposable gloves and apron to be donned before entering the room and removed before leaving the room followed by hand washing All bodily fluid spillage, waste & soiled linen to be dealt with immediately and removed from the room Place all used sharps into an approved sharps bin immediately after use and store safely between uses If en-suite bath/shower not available the patient in protective isolation should bath/ shower first and the bath/shower must be cleaned/ disinfected before & after use Visits to other departments should be avoided, however if unavoidable, this must be made by prior arrangements with the receiving department who must be informed of the patients status As far as possible keep the door closed at all times, ensuring the situation is regularly assessed and re-evaluated Ensure PPE is always available for use. Bed linen should be changed daily as a minimum * Remember alcohol gel should be used to clean hands between tasks with the same patient Explain in appropriate language the reasons for isolation Advise on the importance of hand hygiene prior to entering and before leaving the room Advise on correct use of PPE as appropriate Discourage visitors from visiting if they have any signs of illness e.g. cold, sore throat, D/V etc. Visitors and staff from other departments must report to the Nurse-in-Charge before entering the room If unsure discuss requirements with the Infection Control Nurse Isolation may be discontinued when the patient is no longer a risk for acquiring infection to and following approval by the medical team The room must be cleaned thoroughly (even if the patient is staying in the room). It should be cleaned again thoroughly when it is vacated and curtains laundered (disposable curtains must be discarded & replaced before the room can be re-occupied) The care plan must be reviewed and updated and the patient notes record when the isolation was discontinued Isolation Care of Patients in Isolation due to Infection or Disease Page 6 of 8 Version 1.0
Appendix 3 Hands PPE Room Door Activities/Therapies Visitors Equipment Crockery & Cutlery Linen Waste Decontamination Blood/Body Fluid Cleaning of Rooms General Isolation Precautions Hand washing before and after contact with the patient and their immediate environment is the single most important measure in preventing the spread of infection Bare below the elbows & the Hand Hygiene Policy guidelines must be adhered to at all times Alcohol gel must NOT be relied upon as an alternative to hand washing particularly where Clostridium difficile infection or Norovirus exist Gloves & aprons must be donned prior to direct patient contact Gloves & apron must be discarded as clinical waste prior to leaving the room & hand washed Face/eye protection to be worn as/when required (dependant on route of transmission & risk) Provided the patient s safety is not compromised, the isolation room door should remain closed A sign indicating type of isolation precautions required should be placed on the door All group/communal activities must be suspended for duration of isolation specific advice can be sought from the Infection Control Nurse Everyone entering the isolation room must comply with the Infection Control Teams recommended procedures The ultimate responsibility for deciding who may visit a patient rests with the patients Consultant & Ward Manager, but specific advice can be obtained from the Infection Control Team Limit the number of items taken into or stored in the isolation room to essential equipment only All equipment must be cleaned after use & when removed from the room prior to re-use No special precautions, cleaning crockery (including medicine tots if not disposable) should be carried out in a dishwasher (avoid quick cycle) Soiled linen should be placed immediately into a linen bag, secured & removed from the room immediately and placed ready for collection Infected/heavily soiled linen must be placed into an Alginate water soluble bag & secured then into a red linen bag. Bags must be secured & removed immediately and placed ready for collection All waste classed as clinical waste. Bins to be emptied at least daily. Further information available in the Waste Management policy & procedures Any spillage of blood or body fluid should be made safe prior to cleaning using a chlorine releasing agent [see Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP 1) - Standard Infection Control Precautions] Separate cleaning equipment must be reserved for each isolation room Rooms must be cleaned daily as a minimum Nursing staff are responsible for the standard of hygiene in isolation rooms and for decontaminating spillages of blood & body fluids Nursing staff must identify hazards and undertake a risk assessment before allowing domestic staff to clean the room Domestic staff should be advised on specific precautions by the Nurse-in-charge/Infection Control prior to entering/cleaning the room Isolation Care of Patients in Isolation due to Infection or Disease Page 7 of 8 Version 1.0
Standard Operating Procedure Details Unique Identifier for this SOP is State if SOP is New or Revised BCPFT-COI-POL-05-06 New Policy Category Executive Director whose portfolio this SOP comes under Policy Lead/Author Job titles only Committee/Group Responsible for Approval of this SOP Month/year consultation process completed Control of Infection Executive Director of Nursing, AHPs and Governance Infection Prevention and Control Team Infection Prevention and Control Committee November 2015 Month/year SOP was approved Next review due December 2018 Disclosure Status B can be disclosed to patients and the public Review and Amendment History Version Date Description of Change 1.0 Dec 2015 New Procedure established to supplement Infection Control Assurance Policy Isolation Care of Patients in Isolation due to Infection or Disease Page 8 of 8 Version 1.0