Infection Prevention and Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) Why we have a procedure? Transmission Based Precautions Adherence to this procedure will ensure that Trust staff are protected as far as is reasonably practicable when providing care to patients with a known or suspected infection. 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). This document has been developed to provide a framework to provide staff with clear guidelines on transition based infection control precautions and to protect patients, staff and the public by effective prevention and control of infection and communicable disease. NB these transition based precautions must be used in addition to the standard precautions procedures 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 or anticipate contact with blood or other bodily fluids e.g. Matrons, Service Managers, Ward Managers and all clinicians involved in the delivery of care Facilities staff All staff have a responsibility for ensuring that the principles outlined within this document are universally applied. Transmission Based Precautions Page 1 of 6 Version 1.0 December 2015
When should the procedure be applied? Transmission based precautions are additional measures used where patients are known or suspected to be colonised or infected with highly transmissible or epidemiologically important microorganism or are at increased risk of infection. There are three types of transmission-based precautions which must be used in addition to the standard infection prevention and control precautions for specific disease management: Each type of precautions has some unique prevention steps that should be taken. Definitions Transmission Based Precautions (TBPs) Airborne Precautions Contact Precautions Droplet Precautions Transmission based precautions are additional measures used in addition to Standard Infection Control Precautions (SICPs) where patients are known or suspected to be colonised or infected with highly transmissible or epidemiologically important microorganism or are at increased risk of infection. The Infection Prevention and Control Team will provide additional advice and support when these precautions are required For use in managing diseases spread by small particles suspended in the air For use in managing diseases spread by direct or indirect contact For use in managing diseases spread by large particles and droplets in the air Modes of Transmission how germs are spread from person-to-person Direct Contact Indirect Contact Droplet Airborne Direct spread of infection occurs when one person infects the next by direct person-to-person contact Indirect spread of infection occurs when an intermediate carrier is involved in the spread of organisms e.g. on healthcare workers unwashed hands or fomite (equipment used for more than one patient) Droplets are generated from the source person primarily during coughing, sneezing and talking and propelled a short distance only, therefore special ventilation is not required Occurs by dissemination of droplet nuclei or dust particles containing the infectious agent, microorganisms are therefore dispersed widely and over long distances. Sometimes special air handling and ventilation is required to prevent airborne transmission Transmission Based Precautions Page 2 of 6 Version 1.0 December 2015
Inoculation Ingestion Vectors Sexual Vertical Infection can occur following a sharps or needle stick injury when contaminated blood is directly inoculated into the blood stream of the victim. Bites from humans can also spread infection by this mode Infection can occur when organism s cable of infecting the gastro-intestinal tract is ingested via contaminated food/water. When an infected person excretes these organisms in their faeces or contaminate objects such as door handles, the infection can be picked up on hands and faecal-oral spread can occur Crawling or flying insects and vermin are examples of vectors, which can carry and transmit infections e.g. malaria, salmonella, Weil s disease. From person to person through sexual contact From mother to child either in utero during childbirth or via breast milk How to carry out this procedure It must be noted that in addition to the specific precautions detailed below, standard infection control precautions must always be used once the mode of transmission is suspected/determined. (See Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP 1) - Standard Infection Control Precautions) Airborne Precautions Airborne precautions are used for patients that have an infection that can be spread over long distances when suspended in the air. These disease particles are very small and require special respiratory protection and for some conditions specialist room ventilation. Examples of infections/conditions that require airborne precautions: Chickenpox Measles Tuberculosis In addition to standard precautions: Wear a mask or respirator prior to room entry, depending on the diseasespecific recommendations Most diseases will require surgical mask or respirator mask Place patient in a single isolation with the door closed If a special respiratory isolation room is required transfer to an appropriate acute hospital facility will be required. The Infection Prevention and Control Team will advise When possible, non-immune healthcare workers should not care for patients/residents with vaccine preventable airborne diseases (like measles and chickenpox) Transmission Based Precautions Page 3 of 6 Version 1.0 December 2015
Contact Precautions Transmission by direct contact occurs when a micro-organism is transferred by direct physical contact between an infected/colonised person and another person. Indirect contact occurs when a micro-organism is transferred to another person via an object e.g. un-washed hands or contaminated equipment. Contact precautions are used for patients that have an infection that can be spread by contact with the person s skin, mucous membranes, faeces, vomit, urine, wound drainage, or other body fluids, or by contact with equipment or environmental surfaces that may be contaminated by the patient/resident or by his/her secretions and excretions. Examples of infections/conditions that require contact precautions: Salmonella, scabies, Shigella, and pressure ulcers (not an exclusive list). In addition to standard precautions: Wear an apron/gown and gloves upon room entry of a patient on contact precautions Use disposable single-use or patient-dedicated noncritical care equipment (such as blood pressure cuffs and stethoscopes) or designate for this patient only. N.B. must be decontaminated prior to use with any other patient For certain organisms likely to have spores (like Clostridium difficile) and some disease with on-going transmission (like Norovirus), special contact precautions are needed. In addition to the measures above, perform hand hygiene using soap and water and consider use of a hypochlorite solution (e.g., bleach) for environmental cleaning. Droplet Precautions Droplet precautions are used for patients that have an infection that can be spread through close respiratory or mucous membrane contact with respiratory secretions. Examples of infections/conditions that require droplet precautions: Influenza N. meningitidis (one of the causes of meningitis) Pertussis (also known as whooping cough ) Rhinovirus (also known as the common cold ) In addition to standard precautions: Wear a mask upon room entry of a patient on droplet precautions A single patient room is preferred. If not available, spatial separation of more than 3 feet and drawing the curtain between beds is especially important Patients on droplet precautions, who must be transported outside of the room, should wear a mask if tolerated and follow respiratory hygiene/cough etiquette Transmission Based Precautions Page 4 of 6 Version 1.0 December 2015
References The Health and Social Care Act (2008). Code of Practice for the NHS for the Prevention and Control of Healthcare Associated Infections 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 and 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 Transmission Based Precautions Page 5 of 6 Version 1.0 December 2015
Standard Operating Procedure Details Unique Identifier for this SOP is State if SOP is New or Revised BCPFT-COI-POL-05-02 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 December 2015 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 Transmission Based Precautions Page 6 of 6 Version 1.0 December 2015