Page Page 1 of 9 Policy Objective To provide Healthcare Workers with details of the precautions necessary to minimise the risk of RSV cross-infection. This policy applies to all staff employed by NHS Greater Glasgow & Clyde and locum staff on fixed term contracts. KEY CHANGES FROM THE PREVIOUS VERSION OF THIS POLICY Reference to SOP re: cleaning of isolation rooms Document Control Summary Approved by and Board Infection Control Committee 12 th January 2009 Date of Publication 12 th January 2009 Developed by Infection Control Policy Sub-Group - 0141 201 4931 Related Documents NHSGGC Standard Precautions Policy NHSGGC CJD Policy NHSGGC Hand Hygiene Policy NHSGGC SOP Cleaning of Near Patient Healthcare Equipment Distribution/Availability NHSGGC Infection Prevention and Control Policy Manual and the Internet Implications of Race This policy must be implemented fairly and without Equality and other diversity prejudice whether on the grounds of race, gender, sexual duties for this document orientation or religion. Equality & Diversity 12 th January 2009 Impact Assessment Completed Lead Lead Nurse Infection Control - South Sector Responsible Director/Manager Board Infection Control Manager
Page Page 2 of 9 1. Responsibilities Healthcare Workers (HCW) must: Follow this policy. Inform their line manager if this policy cannot be followed. Managers must: - Support HCWs and ICTs in following this policy. Infection Control Teams must: Keep this policy up to. Audit compliance with this policy. Provide education opportunities on this guideline. Liase with laboratory staff when appropriate. Laboratory staff must: Provide diagnostic service appropriate with prevailing epidemic conditions. Monitor quality of point of care testing on a daily basis (local policy/procedure may apply) and alert staff in the Short Stay Unit of false positive or negative results.
Page Page 3 of 9 2. General Information on RSV Communicable Disease / Respiratory syncytial virus (RSV). Alert Organism / Clinical Condition Infections of the upper and lower respiratory tract (Bronchiolitis / pneumonia) in infants and young children. RSV may also cause upper respiratory tract infections or pneumonia in immunocompromised adults. RSV is a common cause of viral pneumonia in the elderly, particularly in nursing home outbreaks. RSV is also a major cause of asthmatic exacerbations and acute respiratory infections in the immunocompromised. Mode of Spread Incubation period Notifiable disease Period of communicability Respiratory route: Large particle aerosols (respiratory secretions) shed from the infected person enter the host via mucous membranes of the eyes and nose. Contact route: Contaminated hands may also transmit the virus from patient-to-patient or equipment to patient. (RSV can survive for up to 30 minutes on hands, two hours on clothing and several hours on inanimate surfaces). 5-8 days (May be shorter in immunocompromised patients). No. One or two days before, and for the duration of symptoms, this is usually 7-10 days after the onset of illness. Some older patients may have mild symptoms but continue to pose a risk to more vulnerable patients. Persons most at risk Children under 2 years. Children who are immunocompromised or who have underlying cardio-respiratory disease, for example, patients with leukaemia, congenital heart disease and those who were born prematurely. Adults who are immunocompromised. Elderly patients In what areas does this policy apply All acute paediatric wards and areas caring for high-risk patients (see above). Adult wards with severely immunocompromised patients and areas caring for high-risk patients.
Page Page 4 of 9 3. Transmission Based Precautions for RSV in High Risk Areas Accommodation Single room is preferred but cohort areas can be used when the (Patient Placement) patients RSV status is known. Care plan available Yes. Clinical Waste Contacts Crockery / Cutlery Decolonisation Domestic Advice Equipment Exposures Furniture Hand hygiene Discard all waste into clinical waste bags within the room. To operate the bin lid, use foot pedal not hands. No special precautions. Children less than two years of age should not be allowed to visit during the epidemic period. Not applicable. Not applicable. Domestic Assistant to clean single isolation rooms and equipment twice daily using chlorine based detergent and dedicated cleaning materials, ensuring that all surfaces are cleaned with disposable cloths. General Service Assistants must wear plastic apron and gloves for duties in single rooms. Gloves and apron to be discarded as clinical waste on completion and hands to be washed on leaving the single rooms. Please refer to the SOP for the Twice Daily Clean of an Isolation Room http://library.nhsggc.org.uk/mediaassets/infection%20control/ Microsoft%20Word%20- %20SOP%20Daily%20Clean%20of%20Isolation%20Rooms.do c.pdf Where practicable, the patient must be designated their own equipment. See Decontamination of Equipment and Environment Policy. Prevent exposures by using gloves to prevent direct contact with respiratory secretions and effective and frequent hand hygiene. Change gloves and perform hand hygiene between patients. A plastic apron is required when holding or feeding infected infants and small children. Plastic aprons are also required when entering the room of an adult patient. Keep clean by use of detergent and water and drying thoroughly. Hand hygiene is the single, most important means of preventing cross-infection. Hands must be decontaminated before and after each direct patient contact, and after contact with the environment regardless of whether personal protective equipment is worn. Alcohol hand rub/gel is acceptable if hands are visibly clean however, if hands are soiled, soap and water must be used.
Page Page 5 of 9 Last Offices Linen Marking Notes Moving between wards, hospitals and departments (including theatres) Notice for Door Outbreak Patient Clothing Patient Information Personal Protective Equipment Precautions Required Until Procedure Restrictions Risk assessment required Screening on Admission / Readmission No special requirements. Discard linen as fouled/infected, i.e. in alginate bag then clear bag then into a laundry bag. Not applicable. Patients can be transferred between units and departments. Staff transferring the patient do not need to wear protective clothing during the transfer, but should wash their hands once transfer is complete. Inform the receiving ward before transfer of the need for special precautions. Yes. Very likely in wards if infection control precautions are not followed. Follow Outbreak Control Plan in consultation with the Infection Control Team. Patient clothing should be placed in a plastic bag and taken home. Those washing the patient s clothes should be advised to wash their hands after the laundry has been placed in the washing machine. Inform the patient/parent/guardian/next-of-kin (as appropriate) of the patient s condition and the necessary precautions. Answer any questions and concerns they may have. Aprons should be worn for direct contact with the patient and his/her immediate surroundings. Gloves should be worn to prevent direct contact with respiratory secretions. Perform hand hygiene before donning and after removing personal protective equipment (PPE). Until discharge or when patient has 2 negative naso-pharyngeal aspirates (NPAs) 24 hours apart. None. See moving between wards. Yes. In conjunction with the ICT. Patients being admitted to acute paediatric wards/units and wards with high-risk patients should be screened if they have symptoms suggestive of respiratory tract infection during the RSV epidemic period. Paediatrics: Note: During the peak winter epidemic weeks, all patients admitted through the Short Stay Unit who are less than two years of age should be screened for RSV prior to admission. Adults: All immunocompromised adults with infectious respiratory symptoms should be isolated.
Page Page 6 of 9 Screening staff Specimens required Specimens Mark as Danger of Infection Terminal Cleaning of Room Visitors HCWs with respiratory symptoms should not be working with immunocompromised patients. NPA on admission or at start of symptoms. Throat swabs in older children and adults. If positive, then repeat at Consultant s request (only time it is done at RAH) every 4 days until two negative NPAs. If less than two years old and negative on admission, during the winter epidemic, screen every 7 days during child s stay. Throat swabs can be tested by the Regional Virus Laboratory, but results will not be available for several days unless marked urgent. In immunocompromised adults NPA on admission if symptomatic or at start of symptoms. Not applicable. Clean all surfaces and underneath surfaces with chlorine based detergent, warm water and a disposable cloth. See SOP Cleaning of Isolation Room and SOP for the Terminal Clean of Isolation Rooms http://library.nhsggc.org.uk/mediaassets/infection%20control/ Microsoft%20Word%20-%20SOPTerminal%20Clean.doc.pdf Paediatrics - Only parents (or two designated guardians) will be allowed to visit the patient in isolation. Do not admit visitors to immunocompromised wards who have colds or other infectious respiratory conditions.
Page Page 7 of 9 4. Audit Criteria Guide Score 1. Patients < 2 years old or immunocompromised adults with respiratory symptoms are screened for respiratory viruses during winter epidemics. Check condition and specimens taken. 2. Patients with a positive NPA / throat swab for RSV have been isolated / cohort nursed. Visit patient or phone unit to check location of patient. 3. In the isolation room / area, hand hygiene facilities are available. 4. Cohort areas are clearly identified. Visit patient to review accommodation. 5. Medical equipment is either disposable, single patient use or cleaned appropriately between patients. on the patient. 7. Paediatrics only: Stocks of essential consumables are available prior to the onset of epidemic, e.g. Binax diagnostic kits, disposable gloves, suction sets / mucus traps etc. Visit patient / cohort or phone to check facilities. Ask a member of staff how they are cleaning the equipment used There is usually a 4-week period after the diagnosis of the first RSV case and the full impact of the winter epidemic. All essential equipment should be ordered at this point no later. At RAH, diagnostic kits are ordered as required over the winter period. Audit undertaken by: Action plan: Results fed back to: Date: This audit may be undertaken by ward staff, or by the ICN as part of their annual audit programme.
5. Evidence Base NHS GREATER GLASGOW & CLYDE CONTROL OF Page Page 8 of 9 Madge P., Paton JY., McColl JH & Mackie PL. Prospective controlled study of four infection-control procedures to prevent nosocomial infection with respiratory synctial virus. Lancet 1992;31 340:1079-83 Abels S. Nadal D., Stroehle A & Bossart W. Reliable detection of respiratory synctial virus infection in children for adequate hospital infection control management. J. Clin Microbiology 2001 39;9:3135-9 http://jcm.asm.org/cgi/content/full/39/9/3135 Goldmann DA. Epidemiology and prevention of pediatric virus respiratory infections in healthcare institutions. 2001;7:2 http:www.cdc.gov.ncidod/id/vol7no2/goldmann.tom
Page Page 9 of 9 6. Glossary Contact / Mode of Spread Direct: HCW contaminated hands touching patient s respiratory mucosa. Indirect: Patients or HCWs hand touching contaminated equipment/environment then touching respiratory mucosa. Droplet Transmission Spread via droplets expelled during coughing or talking. Infectious droplets land on a person s conjunctivae, nasal mucosa or mouth to cause cross-infection. Healthcare worker A healthcare worker (HCW) is any employee of the NHS Great Glasgow & Clyde, whether permanent, locum, agency or contracted, full or part-time. This includes students, voluntary workers, those on work experience and all carers. ICN/T/O Managers SOP Service Assistant Single room Infection Control Nurse / Team / Officer. Included in the definition of Managers in the responsibilities section of this policy are clinical managers and those who manage more than one clinical area and who are responsible for either human or other resources. Standard Operating Procedure General service assistant (domestic). Also known as support service assistant. A single room should ideally contain the following; a wash hand basin, a dedicated hand hygiene sink, a shower and private toilet. Floors should not be carpeted but covered with a washable impervious material, e.g. non-slip lino or vinyl.