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«Policy Number IC01 Policy Title INFECTION PREVENTION AND CONTROL POLICY Accountable Director Director of Infection Prevention and Control Author Lead ...»

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• Explain to the patient and relatives why isolation is required and what Infection Prevention and Control precautions are required, whilst maintaining the patient’s dignity and confidentiality.

• Ensure all staff, both visiting and regular, are made aware of the importance of adhering to infection prevention and control precautions.

• Certain outbreaks or infections attract media interest if the clinical area is contacted refer them to the Communication Department.

• Isolation notice to go on bay or single room door. See Appendix 10

6.15 Infection Prevention and Control Standard Precautions Hand Washing This is the single most effective way to prevent cross infection, and staff must adhere to the trusts Hand Hygiene Guidelines.

Personal Protective Equipment (PPE) See Personal Protective Equipment Section 3.5 on Page 27 Linen and Clothing All contaminated clothing and used linen must be folded carefully to prevent airborne contamination, and placed into red alginate bags, secured whilst in the infected area and taken on leaving the area straight to the dirty utility area or collection point.

Decontamination of Equipment Follow guidance from: Policy and Procedure for the Management and Decontamination of Medical Devices (SA19) Decontamination of the Environment Follow Daily and Terminal Cleaning sections in the Infection Prevention and Control Policy.

Crockery and Cutlery

–  –  –

No specific precautions are required. Always use a dishwasher.

Movement of Infectious Service users This should be avoided, wherever possible investigations are to be undertaken in the isolation room.

If unavoidable and clinical need determines it is necessary then prior arrangements must be made and the level of contact with other people minimised.

Porters and ambulance staff must be given prior notice and decontamination of chairs/ trolleys to occur following transportation.

6.16 Major Outbreak Guidelines A major outbreak can be defined as involving more than 20 people in total (service users or staff or both) or a smaller number when control measures are appearing to be ineffective. The main difference in management is the formal committee structure which is automatically set in place when a major outbreak is declared. In practice the same principles of good hygiene and cohorting of infected service users apply. The likely types of infections which may cause outbreaks within the trust are respiratory tract infections and gastroenteritis.

Major Outbreak is assessed by : The number of people involved.

• Type of organism.

• Potential and mode of spread.

Requirements to recognise a major outbreak.

It is important to rapidly recognise an outbreak and this is achieved by : Surveillance.

• Prompt notification of infectious disease.

• Vigilance of medical and nursing staff.

When a member of staff notes two or more service users or staff with the same symptoms then that staff member should inform the Infection Prevention and Control Nurse as soon as possible.

Types of Outbreak Two main types of outbreaks: Acute outbreaks i.e. which lead to sudden increase of number of people with symptoms.

• Non acute outbreak i.e. which develop over a number of days or weeks.

Action

–  –  –

Close collaboration and co-operation of multidisciplinary Staff is necessary during an outbreak, guidance issued by the Infection Prevention and Control Team must be followed to effectively control and manage the outbreak.

• Admissions, Transfers, and discharge may well be affected.

• Intervention must take place to halt spread.

Infections – Further Information The likely cause of outbreaks of infections are respiratory tract infections or gastroenteritis.

The following symptoms should alert staff to the possibility of such a diagnosis:

Respiratory Tract Infection Upper Respiratory Tract Infection :Sore throat / pain on swallowing/pyrexia/headaches/listlessness.

Upper Respiratory tract Infection :Headache/pyrexia/breathlessness/rapid breathing/patient may be very ill.

Gastroenteritis Vomiting (may be blood stained) and/or abdominal pain/ or diarrhoea and pyrexia.

Please note:

All cases in service users or staff on one ward or area must be reported to the Infection Prevention Control Nurse.

Further details of those affected will be requested i.e. date of onset of symptoms, Date of birth etc.

6.17 Procedure to Be Followed On Specific Outbreaks

• To be adhered to by Managers/Heads of Departments/Nurse in Charge.

A.Outbreak of diarrhoea and vomiting

• Report all cases in service users and staff to the nurse in charge and the Infection Prevention and Control Nurse.

• Cohorting or Closure of ward to new admissions may be recommended by the IPCT.

• Inter-ward transfer and discharge is not usually advised.

• Limit staff on the ward to minimise risk of cross infection.

• Service users should be encouraged to recover in their own rooms.

• Service users should bathe or shower daily.

• Bed linen, towels and night attire should be changed as soon as soiled to prevent re-infection.





• Linen should be treated as infectious and managed as per local protocol.

Page 54 of 94 Infection Prevention and Control Policy

• Bedrooms and en-suite area to be cleaned daily. Inform Facilities manager to advise of situation.

• Hand hygiene is essential follow ‘5 Moments of Hand Hygiene’.

• Symptomatic service users to have their vital signs monitored for signs of infection.

• Service users with diarrhoea (liquid stools) obtain a single sample and send to lab.

• Incident log number if issued by the lab should be written on all lab forms.

• Do not give anti motility medication until a specimen has been obtained.

• When handling samples, or when cleaning up body fluid spillages staff must wear disposable gloves and aprons.

• Ensure that fluids are available to prevent dehydration.

• Encourage patient hand hygiene after using the toilet.

• Ensure that there is an adequate supply of sample pots, bedpans, orange clinical waste bags, disinfectant, wipes, disposable gloves and aprons, toilet paper, bed linen, towels, soap and red linen bags.

• Body fluid spillages must be covered immediately with a body fluid spillage wipe, carefully follow instructions contained in the kit.

• Staff symptomatic with diarrhoea and or vomiting MUST GO HOME, and remain off duty for 48 hours after the last episode of vomiting or diarrhoea.

• Please note that in the event of an outbreak of diarrhoea and vomiting the IPCT advise that staff should not be working in a non infected area for 48 hours following completion of a shift in an infected ward/dept.

B.Outbreak of Respiratory Infection

Procedure to be followed for respiratory infections.

• Report all cases in service users and staff to the nurse in charge and the Infection Prevention and Control Nurse.

• Cohorting or Closure of ward to new admissions may be recommended by the IPCT.

• Inter-ward transfer and discharge is not usually advised.

• Limit staff on the ward to minimise risk of cross infection.

• Service users should be encouraged to recover in their own rooms.

• Service users should bathe or shower daily.

• Bed linen, towels and night attire should be changed as soon as soiled to prevent re-infection.

• Linen should be treated as infectious and managed as per local protocol.

• Bedrooms and en-suite area to be cleaned daily. Inform Facilities manager to advise of situation.

• Hand hygiene is essential follow ‘5 Moments of Hand Hygiene’.

• Symptomatic service users to have their vital signs monitored for signs of infection

• Sputum containers must be provided for service users who are expectorating.

• Sputum samples must be sent to the lab for culture and sensitivity.

Page 55 of 94 Infection Prevention and Control Policy

• Chest x-ray may be advised to diagnose pneumonia/tuberculosis.

• Incident log number will be issued if required by the Infection Prevention and Control Team, and this is to be written on all laboratory forms.

• Staff attending to service users confined to bed, when handling specimens, cleaning up body fluid spillages or changing bed linen, will wear disposable gloves and aprons.

• Ensure that fluids are available to prevent dehydration

• Ensure that there is an adequate supply of sample pots, disposable gloves, aprons, bed linen, towels, soap, red linen bags, disinfectant wipes and disinfectant.

• Staff who arrive on duty ill or become unwell at work MUST GO HOME and remain off duty for the duration of the illness.

NB In the event of a Pandemic Influenza Outbreak staff will be informed to follow the Mersey Care NHS Trust Pandemic Contingency Plan.

Preventing outbreaks depends on prompt recognition of cases and taking action to prevent further spread to staff and service users.

6.18 Declaration of a Medical Emergency An Outbreak Control Team (OCT) will be convened by the Infection Prevention and Control Doctor and the DIPC.

The team will consist of:Infection Prevention and Control Doctor Medical Director DIPC Infection Prevention and Control Nurses Consultant in Health Protection (CPHE) Executive Director of Nursing Nurse Manager of the Unit concerned Occupational Health Manager Director of Estates & Facilities Consultant Psychiatrist of Ward/Unit Pharmacist Communications Manager Secretarial Support Other People are co-opted by the chairman as required.

Role of the Outbreak Team Infection Prevention and Control Doctor

• Declare an outbreak and inform CPHE, and Chief Executive

• Chair the OCT meetings.

• Head the Epidemiology Investigation.

–  –  –

Infection Prevention and Control Nurse Specialist

• Provide professional advice to ICT

• Collate information and assist with epidemiological investigations.

• Provide infection Prevention and control advice to health professionals and others.

• Ensure that infection prevention and control measures are effective.

Director of Infection Prevention and Control

• Ensure secretarial assistance is available to OCT

• Advise/update Chief Executive as required.

• Make available an outbreak meeting room.

• Liaise with the Infection Prevention and Control Team.

• Ensure adequate additional resources are available, including staff.

Occupational Health Manager

• Provide professional Occupational Health advice to IPCT.

• Collate information and assist with epidemiological investigations.

Director of Facilities

• Provide 7 day a week cleaning service.

• Provide extra cleaning supplies as required.

• Provide extra portering services as required.

• Ensure extra provision of linen and towels etc are delivered.

Pharmacist

• Provide advice on pharmaceutical products (antimicrobial, vaccines etc.)

• Liaise with manufacturers or local pharmacies to obtain supplies speedily and as appropriate.

• Prepare information on indications, contra-indications and interactions.

• Ensure the administration of pharmaceutical preparations is undertaken in accordance with patient’s group directives.

• Ensure proper documentation of administration of pharmaceutical preparations and reporting of adverse reactions.

Communications Manager

• Provide advice on media issues to OCT.

• Be point contact for press enquiries for the outbreak investigation.

• Be responsible for media strategy.

• Produce press statement based on advice of OCT.

Secretarial Support

• Arrange meetings of the OCT and notify OCT members of date, time and venue.

• Produce minutes of the OCT meetings, verify with chair and circulate minutes.

• Provide secretarial support to OCT

6.19 Outbreak Control Team Agenda

–  –  –

Checklist:

• Case definition.

• Confirmation and extent of the outbreak.

• Coordinate all arrangements for the investigation of source and cause of outbreak.

• Reports from Infection Prevention and Control Nurse and Occupational Health Manager.

• Clinical control - assessment of outbreak.

• Co-option to team. E.g. Additional staffing

• Take all necessary steps for the continuing care of service users during the outbreak.

• Further assistance requirements - assess need for additional resources.

• Information to relatives and media.

• Provide clear instruction for staff.

• Information for the Chief Executive.

• Specimens to be collected and sent to the Microbiology department.

• The IPCD will inform the Microbiology Laboratory of any potential major outbreak and keep them updated.

• Any decision to seek the advice of the Communicable Disease Surveillance Centre would be made within the Outbreak Control Team.

• Certificate of Notification of Infectious Disease will be completed if applicable.

• Meet as frequently as is necessary in the circumstances of the particular infection outbreak and keep minutes of the meetings.

• Define the end of the outbreak.

Report At the end of the outbreak a report will be written by the DIPC for the Chief Executive.

6.20 PANDEMIC INFLUENZA GUIDANCE.



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