Management of Patients in Isolation

Management of Patients in Isolation Reference : Version: 8 Ratified by: G_IPC_28 LCHS Trust Board Date Approved: 10 th October 2017 Name of originator/author: Name of responsible committee/individual: Infection Prevention Team Infection Prevention Committee Date issued: vember 2017 Review date: August 2019 Target audience: Distributed via: All staff employed by Lincolnshire Community Health Services and invited contractors. Website P a g e 1

Lincolnshire Community Health Services Management of Patients in Isolation Version Control Sheet Version Section/Para/ Appendix Version/Description of Amendments Date Author/Amended by V4 Add in para 12. Appendix H. Inter healthcare transfer form Appendix I. Handling cadavers Appendix J. Isolation audit tool 5 All Change Infection Control Forum to Infection Control Committee, Link Practitioners to Link champions May 2013 Sue Silvester, ICNS, LCHS All Change Link Practitioners to Link Champions 4.7 & 17 Addition of information regarding e-learning 11 & 12 Addition of Multi-resistant Gram Negative bacteria 14.1 Addition of an IR1 completed. 14.3 &14.4 Additional information re alcohol hand rub 14.16 Addition of chlorine releasing agent 6 Remove Guidance on Isolation Precautions for Communicable infections Quick reference guide. Included in new Management and tification of infectious disease and food poisoning guidelines Appendix J Remove Protocol for cleaning ward following closure due to an outbreak of infection and daily Isolation Audit Tool May 2013 May 2013 May 2013 May 2013 May 2013 May 2013 May 2013 May 2013 Appendix H Include Monitoring May 2013 Appendix I Appendix C Document Include Equality and Diversity analysis Remove poster and replace with new posters Remove header from pages other than front page. Changed HPA to PHE 7 Document Changed footers and headers, leaflet May 2013 May 2013 May 2013 June 15 8 Document Removed strap line July 17 Appendix B Updated July 17 Associated documents Updated July 17 P a g e 2

Management of patients in Isolation Contents Version Control Sheet... 2 Guidance Statement... 5 1. Introduction... 6 2. Background... 6 3. Scope of guidance... 6 4. Key Responsibilities... 6 4.1. The Chief Executive... 6 4.2. The Director of Infection Prevention & Control... 6 4.3. The Infection Prevention Team... 7 4.4. Managers... 7 4.5. Infection Prevention Link Champions:... 7 4.6. Employees... 7 4.7. Occupational Health... 7 4.8. Education and Workforce... 7 5. Source of Infection... 7 6. Transmission of Infection (see Appendix A)... 8 7. tification and management of of infectious diseasesand food poisioning... 8 8. Risk management... 8 9. Categories of isolation nursing... 8 9.1. Source Isolation... 8 9.2. Protective isolation... 8 10. Indications to Isolate... 8 11. Priority in the Isolation of patients... 9 12. Admission of Patients to Isolation... 9 13. Facilities for isolation... 9 13.1. Single room isolation... 9 13.2. Cohort Isolation nursing... 9 13.3. Isolation ward/ area... 9 13.4. Ventilation of Isolation rooms... 10 13.5. Inside the isolation room:... 10 13.6. Outside the isolation room:... 10 14. Management of patients in isolation... 10 14.1. Communications and Documentation... 10 14.2. Signage... 10 14.3. Procedure to be followed prior to entering the room... 11 14.4. Procedure to be followed prior to exiting the room... 11 14.5. Hand hygiene... 11 14.6. Personal Protective Equipment (PPE)... 11 14.7. Specimen collection and transportation... 11 14.8. Food... 12 14.9. Transfer / Movement of patients in isolation... 12 P a g e 3

14.10. Transport of Patients by Ambulance... 12 14.11. Management of Linen and Clothing... 12 14.12. Spillages of blood / bodily fluids.... 12 14.13. Management of Sharps/Waste... 12 14.14. Environmental cleaning... 12 14.15. Nursing / Medical Equipment... 13 14.16. Elimination... 13 14.17. Visitors... 13 14.18. Discharge of a patient undergoing isolation... 13 14.19. Deceased Patients... 13 14.20. Termination of Isolation nursing... 13 14.21. Terminal Cleaning... 13 15. Inability to isolate a patient... 14 16. Audit and Monitoring... 14 17. Evidence Base... 14 18.. Acknowledgements... Error! Bookmark not defined. 19. Appendices... 14 Appendix A - Transmission of Infection... 15 Appendix B - tification of infectious diseases... 16 Appendix C Door Signs... 17 Appendix D Inter-healthcare transfer form... 21 Appendix E: GUIDELINES FOR HANDLING CADAVERS... 23 Appendix F Patient Leaflet... 24 Appendix G: Monitoring... 25 Appendix H... 27 P a g e 4

Guidance Statement Guidance on the management of patients in isolation Background The purpose of this guidance is to advise on the precautions and control measures that are needed to contain specific infections, thus minimising the risk of healthcare associated infections to patients, visitors and staff in health care settings. Statement This guidance is comprehensive, formally approved, ratified and disseminated through appropriate channels. It will be implemented for all staff within the Trust. Responsibilities Compliance with this guidance will be the responsibility of all Trust staff and invited contractors. Training The Infection Prevention Team will support/ facilitate any training associated with this guidance Dissemination Via the Trust Website Resource implication This guidance has been developed in line with the NHS Litigation Authority guidelines to provide a framework for staff within the organisation to ensure appropriate production, management and review of organisation wide policies. P a g e 5

Guidance on the Management of Patients in Isolation 1. Introduction It is important to minimise the risk of healthcare associated infections to patients, visitors and staff in health care settings. This guidance outlines the precautions and control measures that are needed to contain specific infections. 2. Background Historical and current evidence indicates that the isolation of patients with suspected or proven infection is effective in reducing transmission of infections to others. Whilst the risk of transmission differs between types of infection, the need to separate infected patients from the general population applies in all cases. The purpose of isolation is to control, confine and minimize the spread of potential or known pathogenic or epidemiologically important micro-organisms. If isolation is to be considered the advantages and disadvantages should be fully considered and a risk assessment undertaken. This document should be considered in conjunction with the following guidance: G_IPC_06 Guidance on the Management of Linen G_IPC_17 Guideline on hand washing and the use of hand sanitizer G_IPC_18 Management of inoculation exposure injuries G_IPC_19 Management of Specimens G_IPC_20 MRSA: screening and management of patients with MRSA (including Panton-Valentine Lecocidin (PVL) MRSA G_IPC_25 Guideline for the management prevention and control of Multi resistant gram negative bacteria (including extended spectrum beta lactamase producing microorganisms ESBL s) G_IPC_26 Standard precautions G_IPC_29 Management and tification of infectious disease and food poisoning G_IPC_31 Management of blood and bodily fluid spillages G_IPC_33 Management of Viral gastro-enteritis G_IPC_36 Management of patents with Clostridium difficile associated disease in the community G_IPC_43 Carbapenemase producing Enterobacteriaceae Management of Waste Deprivation of Liberty 01 How to guide for the Decontamination of vacant Bed Spaces 02.How to guide for decontamination of a commode P_CS_09 Medical Devices Policy 04. MEDICAL DEVICES Decontamination 3. Scope of guidance The principles contained within the guideline reflects best practices and applies to those members of staff who are directly employed by the Trust and for whom the Trust has legal responsibility. 4. Key Responsibilities 4.1. The Chief Executive Has the overall responsibility for the effective implementation of this guideline. 4.2. The Director of Infection Prevention & Control Is responsible for ensuring that policies, guidelines and procedures in relation to infection prevention and control are developed and their implementation monitored. P a g e 6

4.3. The Infection Prevention Team The Infection Prevention Team will: Review the guidance in response to the publication of any urgent communications from the Department of Health. Liaise with staff and external agencies where appropriate 4.4. Managers Managers have the responsibility for the standards of clinical practice by their staff in the health care setting. They must: Ensure that they are familiar with this document and support its implementation Ensure all individuals are appropriately trained. Inform new employees of their responsibilities under this guidance. Ensure that all employees within their area of responsibility comply with this guidance. Ensure the recourse are available to maintain patient safety 4.5. Infection Prevention Link Champions: Trusts should ensure, through their Directors of Adult Services and Human Resources, that each clinical area is covered by an Infection Prevention Link Champion (DH 2008), whose role and job description should include, training, auditing and feeding back to staff on: isolation hand hygiene cleanyourhands campaign raise and action environmental and practice issues decontamination 4.6. Employees All employees have a responsibility to abide by this guidance and any decisions arising from the implementation of it. Any decision to vary from this guidance must be fully documented with the associated rationale stated. Employees have a responsibility to attend or complete the mandatory training/update training as identified within the Trust s Mandatory Training Matrix. 4.7. Occupational Health Are responsible for alerting the Infection Prevention Team of any infectious conditions amongst Trust employees, which could be transmitted during the course of their work. They are also responsible for: Participating in the contact tracing of staff members exposed to infectious conditions. Co-ordinating staff treatment of any infectious disease. Reporting of staff symptoms during an outbreak. 4.8. Education and Workforce The Trust s Workforce Team has a responsibility to ensure the coordination of the learning and development of staff, as identified within the Workforce Development Policy. In relation to this guidance they will: In conjunction with the Infection Prevention Team, facilitate education sessions to staff groups where necessary Identify and follow-up non attendance at mandatory training sessions and non compliance with e-learning with Line Managers 5. Source of Infection Infected or colonised patients, healthy carriers and patients who are incubating infections are all potential sources of infection to others. Skin, hands and body fluids can all act as a source of infection. The relative P a g e 7

importance of each of these is dependent on the infection (e.g. MRSA from skin, Shigella from faeces). Pets are also vectors of infections. 6. Transmission of Infection (see Appendix A) The common means of transmission of infections are; Airborne route Contact route: direct and indirect Faecal oral route. Blood / Bodily fluid route 7. tification and management of of infectious diseasesand food poisioning PLEASE REFER TO MANAGEMENT AND NOTIFICATION AND MANAGEMENT OF INFECTIOUS DISEASE AND FOOD POISIONING GUIDELINES FOR FURTHER INFORMATION AND relevant FORMS For over a hundred years, it has been a statutory requirement for doctors to notify to the Proper Officer of the local authority of cases of certain infectious diseases. These are also known as notifiable diseases (Appendix B) tification must be made to the Consultant in Communicable Disease Control (CCDC) at the Public Health England who acts as the Proper Officer. The notification form can be found in the Management and tification of infectious disease and food poisoning guidelines once completed is to be forwarded to the Local Public Health England (PHE) where food poisoning is suspected a copy needs to be forwarded to the local Environmental Health Offices. Also link on Infection Prevention Web page. The Infection Prevention Team (LCHS) should also be notified. 8. Risk management An assessment must be made of the physical and psychological safety of patients prior to placement in isolation. PLEASE REFER TO MANAGEMENT AND NOTIFICATION AND MANAGEMENT OF INFECTIOUS DISEASE AND FOOD POISIONING GUIDELINES FOR FURTHER INFORMATION FOR INFECTIONS REQUIRING ISOLATION and for information for patients may be at particular risk and where isolation is difficult to achieve, e.g. dementia, individual cases will need to be discussed with the Infection Prevention and Control Team. n compliance with isolation, whatever the reason, must be fully documented in the SystmOne and reported via Datix (IR1) 9. Categories of isolation nursing There are two main categories of isolation nursing: 9.1. Source Isolation Source isolation aims to prevent the transfer of micro-organisms from colonised or infected patients to other patients and staff. 9.2. Protective isolation Where deemed necessary, the aim of protective isolation is to prevent the occurrence of infection in those patients who are immune compromised e.g. underlying disease or treatments. These patients are very susceptible to infection from themselves, other persons and the environment. Protective isolation and general information sign (appendix C) 10. Indications to Isolate To find out whether isolation of a patient is necessary refer to Management and tification of Infectious Diseases and Food Poisoning guidelines. P a g e 8

If you require further advice contact the Infection Prevention Team. 11. Priority in the Isolation of patients. Priority in isolation of patient must be given to those patients with suspected or confirmed: Diarrhoea and vomiting (including suspected C.difficile) Chicken pox Suspected cases of bacterial meningitis Suspected and confirmed cases of TB, including Multi drug resistance and Extreme drug resistance cases. Patients with Carbapenemase producing Enterobacteriaceae Patients diagnosed with MRSA/Multi-resistant Gram Negative bacteria on admission 12. Admission of Patients to Isolation It is essential that emergency admissions (and potential patients for isolation) to be segregated from elective surgical admissions in order to minimise the possible spread of infection. Local written guidance must demonstrate this segregation and be available for all staff to view. On admission patients should be assessed for risk factors such as suspected / confirmed infection and presence of multi-resistant organism s e.g. MRSA/Multi resistant Gram Negative bacteria and follow relevant guidelines 13. Facilities for isolation 13.1. Single room isolation The isolation facilities around the Lincolnshire Community Health Services vary widely. The simplest form of isolation is a single room with a hand wash basin. Where the single room has only a hand wash basin provided, this must be used for the purposes for hand washing only and not for the patients general hygiene needs. A more satisfactory single room is one with an additional en suite toilet and bathroom facilities. The best form of isolation is a single room with positive/negative ventilation system, accessed via a ventilated lobby. The room having en Suite facilities and a dedicated hand wash basins inside and outside the room. 13.2. Cohort Isolation nursing Where a single room is not available, patient s colonised or infected, with the same micro-organisms may be nursed in an identified designated area, bay or ward (known as Cohort nursing). Other co-morbidities must be considered prior to adopting this form of isolation e.g. suitability of cohorting where a patients may be immune compromised This is provided that they are not infected with other potentially transmissible microorganisms and the possibility of re-infection with the same organism is minimal. The standard of facilities used in cohort nursing must be similar to those expected in single room isolation 13.3. Isolation ward/ area In extreme circumstances, the advice from the Infection Prevention Team/ Outbreak Committee may be to establish an isolation ward / area. The principles of isolation will still apply, in additional to any other advice from the Infection Prevention Team/ Outbreak Committee. P a g e 9

13.4. Ventilation of Isolation rooms. The purpose of the isolation room is to provide elements of control by preventing the spread of microorganisms, particularly those of the airborne nature. Appropriate ventilation in these circumstances are crucial. In simple single rooms, where ventilation systems are not present, the door to the room must be closed at all times. The windows in the room are permitted to be open providing environmental cleansing is of a high standard. Fans should not be used. In those single rooms with a ventilation system in place, guidance on appropriate use can be obtained from the Estates/ Maintenance Department. Any failure in the ventilation systems must be reported immediately, completing the necessary Datix reporting system (IR1). 13.5. Inside the isolation room: Soap and alcohol system Paper towels 13.6. Outside the isolation room: Trolley/dispenser with plastic aprons and gloves. Small supply of clinical waste and red outer bags (to double bag those used in isolation room). Items which need to be available outside the room Disposable gloves Plastic aprons Clinical waste bag and holder Water soluble bag-infected linen Patient s equipment disposable washbowl, sphygmomanometer with disposable cuff, disposable tourniquet, stethoscope, etc. Fans must not be used Display the door Source Isolation sign and general information sign at the entrance of the room. Appendix C Keep room door closed. Document all interventions NB It is advisable the supplies must be kept to the minimum and stored appropriately e.g. cupboard / enclosed trolley. 14. Management of patients in isolation 14.1. Communications and Documentation The nurse / nurse in charge must ensure that the patient is fully informed of the rationale for isolation (Refer to Management and tification of Infectious Disease and Food Positioning guidelines) and the reason be clearly recorded on the nursing care records. The psychological and physical well-being of the patient should be evaluated daily. The date the patient is removed from isolation must be clearly recorded in the nursing records. There may be occasions where isolation is not possible; in these instances the reasons must be clearly documented, advice gained from the Infection Prevention Team and an IR1 completed. 14.2. Signage A Source isolation sign and general information sign must be clearly displayed on the room door (Appendix C) Persons wishing to enter the room e.g. visitors and facilities staff must first consult with the nurse/nurse in charge. P a g e 10

During an outbreak situation, it may be necessary for visiting to be strictly controlled. The infection Prevention and Control Team will be able to support and advise. 14.3. Procedure to be followed prior to entering the room Obtain any equipment that may be required (e.g. dressing pack, waste bags, linen bags etc) to prevent unnecessary movement in and out of the room. Wash hands or use alcohol hand rub where appropriate (follow Hand hygiene and the use of alcohol hand rub guidance) Put on apron and gloves or other personal protective equipment as required. 14.4. Procedure to be followed prior to exiting the room Dispose of any aprons and gloves into the waste bin inside the room. Wash with soap and water at the sink, dry hands thoroughly. On exiting the room, use alcohol hand rub. If leaving the room with body fluids/excreta to dispose of in sluice, ensure protective clothing is worn until task is complete, dispose of immediately into waste. Wash hands thoroughly. 14.5. Hand hygiene Hand hygiene forms part of standard infection prevention and control precautions (refer to Hand hygiene and the use of alcohol hand rub guidance). Hand hygiene should be performed before entering an isolation room, after physical contact with the patient, their immediate environment or any other items in the isolation room and before leaving the room. The use of alcohol hand rub should be used immediately after exiting the room. For some conditions i.e. Clostridium difficile, rovirus alcohol hand rub is not effective and hand washing with soap and water should be undertaken. 14.6. Personal Protective Equipment (PPE) The use of PPE forms part of the standard infection prevention and control precautions (refer to Guidance on Standard Precautions). PPE should be readily available outside the isolation room for all health care workers to use. The level and type of PPE required is determined by suspected / confirmed condition e.g. Respiratory. PPE may not always be necessary every time the room is entered, as some activities are unlikely to result in contact with infective material, e.g. delivering post or a drink/ meal. Health Care Workers such as portering staff who are involved with the transport of the patient are unlikely to come into contact with colonised/infectious material and it is therefore not necessary to routinely wear PPE. However, appropriate hand hygiene must be undertaken. If maintenance personal are required to enter an isolation room to essential repairs, they must report to the nurse/nurse in charge and appropriate PPE must be provided and worn 14.7. Specimen collection and transportation Label specimen pots before entering the room (including biohazard label where necessary). Leave request cards outside the room. Ensure that there is no leakage of the specimen and the outside of the pot is free from contamination. Specimen placed into the appropriate compartment of specimen bag. Transport the specimen as per local policy. P a g e 11

14.8. Food Uncovered food, not for immediate consumption, should not be stored in an isolation area. 14.9. Transfer / Movement of patients in isolation If transport of an isolated patient to another department/area is necessary, infected lesions should be covered with a dressing and the patient infected with airways infection asked to cover the mouth if coughing or sneezing. Ideally they should be seen at the end of the list or at the end of the session, if possible. Support service may continue, unless advised by the Infection Prevention Team. Standard precautions still apply to this group of services. If transfer of the patient is to other healthcare facilities, staff must verbally inform the receiving facility and inter-healthcare transfer form must be completed and accompany the patient (Appendix D). 14.10. Transport of Patients by Ambulance Requiring ambulance transport should not prevent a patients discharge. The ambulance services should follow standard precautions and hand hygiene where appropriate. Ensure the inter-healthcare form is completed and follows the patient. The ambulance service has their own guidance on the management of infected patients. 14.11. Management of Linen and Clothing All linen generated from isolation rooms should be handled as infected linen (refer to Management of Linen Guidance). Used linen should not be stored in linen bags inside the room. 14.12. Spillages of blood / bodily fluids. All spillages of blood /bodily fluids must be dealt with in line with the trusts guidance (Management of Spillages). 14.13. Management of Sharps/Waste Waste generated during the care of a colonised/infected patient/s may be contaminated with infectious material and must be disposed of safely (refer to Waste Management Guidance). All waste generated from colonised/infectious patient/s should be treated as hazardous waste and placed into ORANGE hazardous waste bags. Sharps should be disposed of into a sharps container as per trust guidance. It is advisable that small sharps container be stored in each isolation area, however, this must be preceded by a risk assessment. 14.14. Environmental cleaning The extent of the daily cleaning of side rooms will be as laid out in local cleaning schedules Dedicated disposable equipment must be used for this purpose in line with NHS cleaning/colour coding requirements. Side rooms should be cleaned daily paying particular attention to horizontal surfaces, en suite facilities, the floor and any items potentially frequently handled by the patient such as doorknobs, bedrails and switches. The isolation room must be free of clutter to enable environmental cleansing to take place effectively. P a g e 12

Disposable crockery and cutlery is not necessary as these items can be reprocessed safely in a dishwashing machine. 14.15. Nursing / Medical Equipment Only necessary nursing / medical equipment should be taken into the isolation room. Where possible single use/ disposable/ dedicated equipment should be used. All reusable equipment, where used in isolation, must be decontaminated as per local guidance. This process should be recorded and audited together with regular checks of equipment. All opened items such as tissues/wipes/dressings should be for individual patient use only and should be discarded once isolation has been discontinued. 14.16. Elimination Where en-suite facilities are not available, commode chairs and bedpan supports may be dedicated for that patient to use. Commode chairs/ bedpan supports must be cleaned, on all surfaces, after each use with the recommended detergent wipes/chlorine releasing agent or automated facility as deemed appropriate. It may not be necessary to keep the commode in the isolation room, in which the commode must be fully cleaned on all surfaces after removal from the room. Bedpans must be covered with an appropriate covering before removing from the isolation room. PPE must be worn by the health care worker, the bedpan disposed of directly into the macerator and then the PPE can be removed and disposed of as per local guidance. Hands must then be washed with soap and water. 14.17. Visitors Visitors must be encouraged to wash their hands on entering and before leaving the room. Visitors are unlikely to have contact with infectious material so there is usually no reason for them to wear PPE. 14.18. Discharge of a patient undergoing isolation When the patient is discharged, or transferred to other health care facility/care home, the same level of precautions may not be necessary. The reasons for this may require careful explanation and good communication between healthcare workers, carers and/or home staff and community staff. Advice can be sought from the Infection Prevention Team. An inter-healthcare transfer form must be completed. 14.19. Deceased Patients Where necessary those handling the body should be made aware of any potential risk and the appropriate Infection Prevention measures taken as identified within this guidance (see appendix E) 14.20. Termination of Isolation nursing Isolation precautions will be terminated on when it is clear that the patient/s are no longer infectious to others or if he/she has been discharged or transferred to another hospital. Further advice may be sought from the Infection Prevention Team. 14.21. Terminal Cleaning Nursing staff are responsible for ensuring that a terminal clean has taken place prior to next use of the room. (See Decontamination of medical equipment and environment guidelines) P a g e 13

15. Inability to isolate a patient Occasionally it is not possible to isolate all patients who ought to be isolated for infection prevention and control reasons. When this happens consideration must be given to which patients should take priority for see Management and notification of infectious disease and food poisoning guidelines. A Datix IR1 (Incident Report Form) should be completed and the Infection Prevention Team informed. 16. Audit and Monitoring It is the responsibility of the manager to ensure that audit is conducted noting both facilities and practice on an annual basis using the Infection Prevention Environmental tool and Isolation tool 17. Evidence Base Health Building te 4 (2005) Supplement 1: Isolation facilities in acute settings. The Stationary Office, London. Lawrence J. May D. (2003) Infection control in the community. Churchill Livingstone, London. Wilson J. (2007) Infection control in clinical practice. Bailliere Tindall, London. Gloucestershire PCT (2008) Isolation policy. Lincs South West PCT (2005) Infection Control Manual. Review of Hospital Isolation and Infection Control related Precautions, Report of the Joint Working Group (Association of Medical Microbiologists, Infection Control Nurses Association, Hospital Infection Society, British Infection Society), July 2001. Control of Communicable Diseases Manual, James Chin, 17th Edition (2000), American Public Health Association. Coia JE, Duckworth GJ, Edwards DI et al. (2006) Guidelines for the control and prevention of Meticillin-resistant Staphylococcus aures (MRSA) in healthcare facilities. Journal of Hospital Infection, 635: S1-S44 Department of Health (2003) Winning Ways: Working together to reduce healthcare associated infection in England, London: DH. Department of Health (2008) The Health Act 2008: Code of practice for the prevention and control of healthcare associated infections. London: DH. Department of Health (2007) Guidance and Summary of Best Practice on Isolating Patients with Healthcare-associated Infection: DH. Gateway ref: 8772 Department of Health (2006).Essential Steps to Safe, Clean Care: Reducing health care associated infection. London: DH, 2006. UK Health Departments 1998 Guidance for Clinical Healthcare Workers: Protection against infection with Blood-borne Viruses. Recommendations of the Expert Advisory Group on AIDS and the Advisory Group on Hepatitis. Department of Health, London. NHS Executive 1995 Hospital Laundry Arrangements for Used and Infected Linen HSG(95)18 HMSO London. ULHT Guidance on the isolation of patients 2009 18. Appendices Appendix A. Transmission routes Appendix B. List of notifiable diseases Appendix C. Source, protective and general information signs Appendix D. Inter health care transfer form Appendix E. Guidelines for handling cadavers Appendix F. Patients leaflets Appendix G. Monitoring Appendix H. Equality analysis P a g e 14

Appendix A - Transmission of Infection Mode of Spread Example Pathogen Example Conditions Airborne route Viral Diarrhoea and Vomiting Vomiting and diarrhoea For example: Respiratory droplets, Aerosolised Aerosolised contaminated fluids Nebulisers Humidifiers Showers Cooling towers Direct and indirect contact route: For example: Hands of patients, visitors and staff. Direct contact with infected skin/mucous membrane Contact with infected blood/body fluid Indirect contact with contaminated equipment, environment, and food. Parenteral contact via needlestick /sharps injury. Contaminated infusion fluids (intravenous) Faecal oral route For example: Poor hand hygiene after toileting Contamintated equipment / environment Poorly cooked / stored foods. Contaminated water Poorly maintained hydrotherapy pools/ treatment baths Respiratory Syncytial virus Heamophilus Influenza virus Influenza viruses Paramyxovirus Rubella virus Clostridium difficile, Escherichia coli 0157 Viral Diarrhoea and Vomiting Staphylococcus Aureus including Meticillin resistant, and PVL strains. Streptococcus A Clostridium difficile, Escherichia coli 0157 Viral Diarrhoea and Vomiting Staphylococcus aureus Giardia Cryptosporidium Upper and lower respiratory tract infections. Communicable infections such as: Meningitis, measles, mumps and rubella. Diarrhoea Skin and soft tissue infections Urinary tract infections Bacteraemia Infectious rashes Gastrointestinal infections Vomiting and Diarrhoea Blood and bodily fluid route For example: Poor hand hygiene, Contaminated equipment/ Environment Poor management of spillages (blood /bodily fluids). Inoculation injures: percutaneous and Mucotaneous. Hepatitis B virus Hepatitis C virus Human immunodeficiency virus Hepatitis: acute and choric disease HIV AIDs Local infections P a g e 15

Appendix B - tification of infectious diseases Acute encephalitis Malaria Acute meningitis* Measles* Acute poliomyelitis* Meningococcal septicaemia * Acute infectious hepatitis* Mumps Anthrax* Plague Botulism* Rabies* Brucellosis Rubella Cholera * SARs* Diphtheria* Smallpox* Enteric fever (typhoid or paratyphoid fever)* Tetanus Food poisoning Tuberculosis Haemolytic uraemic syndrome (HUS) Typhus Infectious bloody diarrhoea Viral haemorrhagic fever (VHF) * includes Ebola Invasive group A streptococcal disease * and scarlet fever Whooping cough Legionnaires Disease* Yellow fever Leprosy See Management and tification of infectious disease and food poisoning guidelines P a g e 16

Appendix C Door Signs Source Isolation Protective Isolation General information P a g e 17

SOURCE ISOLATION Before entering this room, please consult a member of staff Thank you for your co-operation P a g e 18

PROTECTIVE ISOLATION Before entering this room, please consult a member of staff Thank you for your co-operation P a g e 19

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Appendix D Inter-healthcare transfer form Inter-healthcare Infection Control transfer form Patient/client details: (insert label if available) Name: Address: Consultant: GP: Current patient/client location: NHS number: Date of birth: Transferring facility hospital, ward, care home, other: Contact no: Receiving facility hospital, ward, care home, district nurse Contact no: Is the ICT/ambulance service of transfer? / aware Is the ICT aware of transfer? / Is this patient/client an infection risk? Please tick most appropriate box and give confirmed or suspected organism Confirmed risk Organism: Suspected risk Organism: known risk Patient/client exposed to others infection e.g. MRSA / with Relevant specimen results (including admission screens for MRSA) including antimicrobial therapy. Specimen: Date: Result: Other information: Is the patient/client aware of their diagnosis/risk of infection? / Does the patient/client require isolation? / Should the patient/client require isolation, please phone the receiving unit in advance. Name of staff member completing form: Print name: Contact number: For further advice, please contact your infection prevention team P a g e 21

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Appendix E: GUIDELINES FOR HANDLING CADAVERS Degree of Risk Infection Bagging Viewing Low Acute encephalitis. Clostridium difficile (would recommend a body bag if patient leaking faecal fluid). Measles. Meningitis (except meningococcal). MRSA. Mumps. Ophthalmia neonatorum. Rubella. Tetanus. Whooping cough. Medium High High (rare) Relapsing fever. Food poisoning. Hepatitis A. Acute poliomyelitis. Diphtheria. Dysentery. Leptospirosis (Weil s Disease). Malaria. Meningococcal septicaemia (with or without meningitis). Paratyphoid fever. Cholera. Scarlet Fever. Tuberculosis. Typhoid Fever. Typhus. HIV, Hepatitis B & C and other blood borne hepatitis viruses. Transmissible spongiform encephalopathies. Anthrax. Plague. Rabies. Smallpox. Viral haemorrhagic Fever. Yellow Fever. Adv / Adv Adv Adv Adv Adv Adv Adv Adv Adv Definitions:- Bagging: Placing a body in a plastic body bag (recommend the use of the body bag if excessive body fluids). Viewing: Allowing the bereaved to see, touch and spend time with the body before disposal. Adv : Advisable. P a g e 23

Appendix F Patient Leaflet P a g e 24

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Appendix G: Monitoring Minimum requirement to be monitored Process for monitoring e.g. audit Responsible individuals/ group/ committee Frequency of monitoring/audit Responsible individuals/ group/ committee (multidisciplinary) for review of results Responsible individuals/ group/ committee for development of action plan Responsible individuals/ group/ committee for monitoring of action plan Compliance Audit Managers/Link Champions/IP& C Team Annual Infection Prevention Control Committee and Infection Prevention Control Committee and Infection Prevention Control Committee and P a g e 26

Appendix H A. B. C. D. Briefly give an outline of the key objectives of the policy; what it s intended outcome is and who the intended beneficiaries are expected to be Does the policy have an impact on patients, carers or staff, or the wider community that we have links with? Please give details Is there is any evidence that the policy\service relates to an area with known inequalities? Please give details Will/Does the implementation of the policy\service result in different impacts for protected characteristics? This guideline provides all employees of LCHS and outside agencies with the principles and management of the isolation of patients. The aim is to reduce the risk of spread of infection with a clinical setting. This guideline provides the management of isolation of patients and the measures required by patients, staff and visitors to reduce the risk of spread of infections. ne Disability Sexual Orientation Sex Gender Reassignment Race Marriage/Civil Partnership Maternity/Pregnancy Age Religion or Belief Carers If you have answered to any of the questions then you are required to carry out a full Equality Analysis which should be approved by the Equality and Human Rights Lead please go to section 2 The above named policy has been considered and does not require a full equality analysis Equality Analysis Carried out by: Date: 10 th July 2017 x x x x x x x x x x P a g e 27