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Source Isolation Procedures Ratified by: Infection Control & Decontamination Assurance Group: 24
th January 2017
Review date: June 2019 Page 1 of 33
Source Isolation Policy and Procedures for Hospital Patients
Post holder responsible for Procedural Document
Judy Potter, Lead Nurse/Director of Infection Prevention and Control
Author of Procedure/ Guideline Judy Potter, Lead Nurse/Director of Infection Prevention and Control
Division/ Department responsible for Procedural Document
Specialist Services /Infection Prevention & Control
Contact details x2355
Date of original document 1997
Impact Assessment performed Yes/No
Ratifying body and date ratified Infection Control & Decontamination Assurance Group: 24th January 2017
Review date (and frequency of further reviews)
June 2021 (every 5 years)
Expiry date January 2022
Date document becomes live 21 February 2017
Please specify standard/criterion numbers and tick other boxes as appropriate
Monitoring Information Strategic Directions – Key Milestones
Patient Experience Maintain Operational Service
Delivery
Assurance Framework Integrated Community Pathways
Monitor/Finance/Performance Develop Acute services
CQC Fundamental Standards - Regulation: 8 Infection Control
Other (please specify):
Note: This document has been assessed for any equality, diversity or human rights implications
Controlled document This document has been created following the Royal Devon and Exeter NHS Foundation Trust Development, Ratification & Management of Procedural Documents Policy. It should not be altered in any way without the
express permission of the author or their representative.
Source Isolation Procedures Ratified by: Infection Control Operational Group: 23
rd January 2014
Review date: June 2016
Full History
Status: Final
Version Date Author (Title not name)
Reason
1.0 1997 Lead Nurse New procedure
2.0 2002 Lead Nurse Routine revision
3.0 0226 Lead Nurse Routine revision
4.0 Aug 2007 Lead Nurse Routine revision
5.0 Aug 2009 Lead Nurse Routine revision
6.0 Nov 2011 Lead Nurse Routine revision
7.0 Jan 2014 Lead Nurse Routine revision
8.0 Nov 2016 Lead Nurse Routine revision harmonised with community services requirements
Associated Trust Policies/ Procedural documents:
Avian Influenza - Guidance for the Management of Suspected Cases of Severe Imported Respiratory Virus Infections (Including Avian Influenza & MERS Cov. Care of the Deceased Patient Policy CJD & Other Transmissible Spongiform Encephalopathies Policy Clostridium Difficile Infection Policy Decontamination Policy & Procedures Group A Streptococcal Infections - Policy for the Prevention & Control of Guidelines on the Management of PVL and Other High Risk Staphylococcus Aureus Infections Herpes Simplex Information & Guidance Incident Reporting Analysing Investigating and Learning Policy Influenza - Guidance on the Management of Seasonal Measles Information & Guidance MRSA Policy Multi-Drug Resistant Organism Policy Respiratory Syncytial Virus (RSV) - Guidance on the Management of Scabies Guidance Standard Infection Control Policy & Precautions (Including Hand Hygiene) Surveillance and Reporting of Infectious Disease, Healthcare Associated Infection and Antibiotic Resistant Organisms Terminal Cleaning Co-Ordination - Guidelines for Tuberculosis Management in a Hospital Setting Vancomycin/Glycopeptide Resistant Enterococci (VRE/GRE) Guidelines Varicella Zoster (Vz) Virus, Chickenpox & Shingles Guidance Viral Gastroenteritis Guidance Viral Haemorrhagic Fever – Guideline for Risk Assessment and Management of Ward Closure due to a Suspected or Confirmed Outbreak of Infection
Source Isolation Procedures Ratified by: Infection Control & Decontamination Assurance Group: 24
th January 2017
Review date: June 2019 Page 3 of 33
Key Words Barrier nursing; isolation; infectious disease containment; transmission based precautions
In consultation with and date: Infection Control Operational Group: 14th November 2016 Community Professional Leads, Senior Nurses and Matrons: 19th December 2016 Infection Control & Decontamination Assurance Group: 24th January 2017 Policy Expert Panel (PEP): 1st February 2017
Contact for Review:
Lead Nurse/Director for Infection Prevention and Control
Executive Lead Signature: (Only applicable for Strategies & Policies)
Medical Director
Source Isolation Procedures Ratified by Infection Control & Decontamination Assurance Group: 24
th January 2017
Review date: June 2021 Page 4 of 33
CONTENTS
1. INTRODUCTION ................................................................................................ 5
2. PURPOSE .......................................................................................................... 5
3. DEFINITIONS ..................................................................................................... 5
4. DUTIES AND RESPONSIBILITIES ...................................................................... 6
5. RISK ASSESSMENT .......................................................................................... 8
6. COMMUNICATION ............................................................................................. 8
7. ACCOMODATION .............................................................................................. 9
8. HAND HYGIENE ................................................................................................ 9
9. PERSONAL PROTECTIVE EQUIPMENT (PPE) .................................................... 9
10. VULNERABLE STAFF & VISITORS .................................................................. 10
11. EQUIPMENT .................................................................................................... 10
12. LINEN .............................................................................................................. 10
13. WASTE DISPOSAL .......................................................................................... 10
14. EXCRETA ........................................................................................................ 11
15. SHARPS .......................................................................................................... 11
16. COLLECTION OF SPECIMENS ......................................................................... 11
17. CROCKERY AND CUTLERY............................................................................. 12
18. VISITS TO OTHER DEPARTMENTS .................................................................. 12
19 TRANSFER/DISCHARGE OF PATIENTS ........................................................... 12
20. VISITORS ........................................................................................................ 12
21. ROUTINE CLEANING ....................................................................................... 13
22. TERMINAL CLEANING ..................................................................................... 13
23. LAST OFFICES ................................................................................................ 13
24. ARCHIVING ARRANGEMENTS ........................................................................ 13
25. PROCESS FOR MONITORING COMPLIANCE WITH AND EFFECTIVENESS OF
THE PROCEDURES ......................................................................................... 13
26. REFERENCES ................................................................................................. 14
APPENDIX 1: TABLES OF COMMUNICABLE DISEASES AND APPROPRIATE
PRECAUTIONS ................................................................................................ 15
APPENDIX 2: TABLE OF SPECIFIC GASTROINTESTINAL INFECTIONS ..................... 27
APPENDIX 3: MANAGEMENT OF THE CONTACTS OF PATIENTS WITH PROBABLE
MENINGOCOCCAL DISEASE ........................................................................... 30
APPENDIX 4: COMMUNICATION PLAN ...................................................................... 31
APPENDIX 5: EQUALITY IMPACT ASSESSMENT TOOL ............................................ 32
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1. INTRODUCTION 1.1 Standard infection control precautions are the principal strategy for the prevention
and control of healthcare acquired infection. However, additional transmission based precautions are required for the care of patients who are known or suspected to be infected (or colonised) with highly transmissible or epidemiologically important pathogens. Such precautions are known as source isolation precautions and are applied, primarily, to patients in hospital but may be helpful to health professionals delivering care in the community particularly with regard to the use of personal protective equipment.
1.2 The infected/patient, as the source of infection in hospital, is segregated from
unaffected patients, usually in a single room but, on occasions, within a cohort of similarly affected patients. Physical segregation, combined with other precautions such as the use of protective clothing, is aimed at reducing the likelihood of infections spreading via the airborne, droplet or contact routes.
1.3 The extent of isolation depends on: i The infecting organism and the route of transmission ii The physical and mental abilities of the patient. 1.4 Failure to comply with these procedures could result in disciplinary action.
2. PURPOSE 2.1 This policy and associated procedures provides the information required to determine
appropriate hospital isolation precautions based on the route of transmission. However, consideration must also be given to an individual patient’s mental or physical needs which often need to be balanced against the risk of transmission of infection. Care should be planned on an individual basis taking into account the needs of the patient and susceptibility of other patients.
3. DEFINITIONS 3.1 Route of Transmission - the method by which infection or organism is transmitted
from one person to another. Understanding of the possible route of transmission is necessary to apply isolation precautions appropriately and, in particular, to select appropriate personal protective equipment.
3.2 Contact transmission
This is the often the most important and frequent mode of transmission. This may be direct contact between an infected person and a susceptible individual and includes such as touching, biting, kissing, sexual transmission and the faecal oral route. It also includes indirect contact via employees hands, inanimate objects such as furniture and toys, contaminated sharp objects e.g. needles, blades and the contaminated environment and foodborne infection. .
3.3 Droplet transmission
Large droplets are generated from the source person primarily during coughing, sneezing, and talking, and during the performance of cough inducing procedures such as suctioning.. Transmission occurs when droplets containing micro-organisms
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generated from the infected person are propelled a short distance (approximately 1 metre) and deposited on the host's conjunctivae, nasal mucosa, or mouth.
3.4 Airborne transmission This route of transmission can be divided into two types, droplet nucleii and dust.
i Droplet nucleii Small respiratory droplets rapidly evaporate into small-particle residues [5 µm or smaller in size] known as droplet nuclei, that may contain micro-organisms. Droplet nuclei remain suspended in the air for long periods of time and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient.
ii Dust
Skin squames are shed from the skin surface at a rate of approximately 300 million a day and are the main component of dust. Some of the squames carry micro-organisms. Small dust particles may remain airborne for several hours and can be inhaled or settle in wounds.
3.5 Single room A single occupancy room with a door that can be closed. 3.5 Negative pressure isolation room
A single room that includes a ventilation system that generates negative pressure to allow air to flow into the isolation room but not escape from the room, as air will naturally flow from areas with higher pressure to areas with lower pressure, thereby preventing contaminated air from escaping the room.
3.6 Aerosol generating procedures
Aerosol-generating procedures (AGP) are those that stimulate coughing and promote the generation of aerosols e.g.
Intubation
Manual ventilation
Non-invasive ventilation (e.g., BiPAP, CPAP)
Tracheostomy insertion
Bronchoscopy
4. DUTIES AND RESPONSIBILITIES 4.1 The Board of Directors have a responsibility to promote a high level of compliance
with this policy. This responsibility is delegated to the Joint Directors for Infection Prevention and Control.
4.2 Each Divisional Management Team has a responsibility to actively encourage compliance with the policy by:
giving due consideration to the recommendations of the Infection Prevention and Control Team with regard to the provision and use of single room and cohort isolation facilities.
consulting at an early stage in planning of any service developments or building works to enable the Infection Prevention and Control Team to assess impact and advise on infection prevention and control.
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Considering lapses to this policy at Divisional Governance Group meetings and identifying corrective measures
4.4 Infection Prevention and Control Team (ICT) including the Directors for Infection Prevention and Control are responsible for
Advising the Trust on current best practice/policy for isolation or segregation of infectious patients.
Advising the Trust on current best practice in planning isolation facilities for new construction and refurbishment work.
Providing advice to clinical teams regarding individual patient infection risks, risk assessment and minimisation, and isolation. The ICT cannot provide advice in response to every new alert organism identified in the laboratory but they provide policies, guidelines and training to ensure that clinical teams have the knowledge and resources to implement appropriate control measures in most circumstances. However, they will provide advice on request of the clinical team or when extraordinary measures are required that ward staff cannot be expected to determine for themselves.
4.5 Site Management Team is responsible for ensuring that:
Isolation facilities are provided promptly when the need is identified.
Allocation of single rooms is based on a clinical risk assessment with infection prevention and control requirements given priority over bed management/capacity issues (Healthcare Commission, 2006).
When isolation facilities are not available that the Infection Prevention and Control Team are informed and their advice taken on risk minimisation
Patients with infection prevention and control alerts are not transferred to other wards unless their clinical need dictates (refer section 9).
4.6 Clinical staff providing patient care are responsible for:
Assessing patients on admission for risk of infection including ensuring that there are systems in place to check for infection prevention and control alerts on PAS on admission and, following admission on the e-whiteboard on a daily basis.
Ensuring that suspected and confirmed infectious conditions/infection risks are clearly documented in the care record.
Ensuring that infection prevention and control alerts for patients with short term infectious conditions are added to and deleted from the e-white board when appropriate so that infectious status is apparent.
Ensuring that patients with infection prevention and control alerts are not
transferred to other wards unless clinically indicated. (refer section 8 and 9)
Ensuring that information about the infectious condition is communicated to receiving wards and departments in advance to ensure that appropriate facilities are available and any special arrangements are in place.
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Completing an incident report if it is identified that patients with an infection prevention and control alert have been transferred unnecessarily and/or without communication in line with the Incident Reporting Analysing Investigating and Learning Policy.
5. RISK ASSESSMENT
5.1 All patients identified with suspected or confirmed infectious diseases or alert organisms will be risk assessed for the need for isolation by their admitting doctor or nurse.
5.2 Risk assessment is the assessment of the factors that influence the transmission
of a pathogen and its impact. It enables staff to prioritise the use of isolation facilities.
5.3 The following factors will be considered:
The classification of the pathogen and the ability to protect against or treat individual infections
The probable route of transmission and evidence of transmission
Susceptibility of the other patients near to the infected patient in the same bay i.e. do the other patients have open wounds or an invasive device
Whether the organism is antibiotic resistant.
Possible detrimental effects of isolation to the patient i.e. risk of falls, confusion or depression weighed against severity of the risk of transmission to other patients.
6. COMMUNICATION 6.1 Explain the rationale for isolation to the patient and, where possible, the duration of
isolation anticipated. Where available, provide a patient information leaflet about the relevant infectious condition/disease.
6.2 Place the appropriate isolation card on the door of the room/bay and indicate the appropriate precautions.
6.3 Record in the patient's notes that isolation has been commenced and the reason why.
6.4 Revise the nursing care plan accounting for infection control precautions to be
maintained by staff, patient and visitors. 6.5 Inform the Infection Control Team that there is a patient in isolation.
6.6 Check whether the patient has a ‘Notifiable Disease’ and, if so, complete a
downloadable ‘Notification Form’ available on Hub.
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7. ACCOMMODATION 7.1. Identify appropriate isolation facilities e.g. single room or cohort bay.
A single room with negative pressure ventilation may be required for airborne infections - refer Appendix 1 for details.
It is particularly important to keep the door closed when the room is used for isolating a patient with an airborne infection.
If a single room is indicated it is preferable that it has en-suite toilet and washing facilities.
7.2 Remove any unnecessary furniture and equipment prior to admission of the patient. 7.3 Ensure that appropriate equipment is available:
Inside the room Hand cleansing facilities Gloves & Aprons Clinical waste bag holder/bin. Linen receptacle with water soluble bag. Sharps Bin (if safe to leave within room) Thermometer Sphygmomanometer, Stethoscope (if required) Toileting and wash facilities (if no en suite bathroom).
Outside the room Appropriate protective clothing Alcohol hand rub
N.B. The mental health of the patient may dictate that it is unsafe to leave some of this equipment within the room. Always undertake a dynamic risk assessment.
8. HAND HYGIENE 8.1 Hands must be cleansed prior to leaving the isolation room. Hand hygiene must also
be performed prior to donning gloves and between different patient care activities to prevent cross contamination of different body sites ( gloves must also be changed). If the patient has diarrhoea, soap and water should be used for hand hygiene rather than alcohol rub.
8.2 Immediately after leaving the room, cleanse hands.
9. PERSONAL PROTECTIVE EQUIPMENT (PPE) 9.1 It is often unnecessary and inappropriate to require every person entering an isolation
room to wear PPE. 9.2 If worn, PPE must be removed immediately prior to leaving the room and must be
disposed of inside the room into a clinical waste bag (except when leaving the room to dispose of used bedpans etc. when it is removed in the sluice after placing bedpan in macerator/bedpan washer).
9.3 The type of PPE required is dependent on the mode of transmission and the type of
contact.
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9.4 Guidance regarding the need for gloves and aprons is provided in the Index of
Infections at Appendix 1 and has been divided into the following three categories:
Limited to Standard Precautions (LSP)
If the infectious agent is transmitted in blood or other body fluids then protective clothing is only required when contact with such material is anticipated
Direct contact and cleaning (DCC)
For many conditions PPE is only required for direct patient contact and activities such as bed making and room cleaning. In this situation PPE is not required for social contact by staff or visitors.
All staff and visitors (ALL) For a small number of conditions it is appropriate for all persons entering the room to wear protective clothing.
9.5 Occasionally, additional PPE, such as masks or gowns, is required. Where this is
appropriate it has been identified in the Index of Infection ( Appendix 1).
10. VULNERABLE STAFF & VISITORS
10.1 Some may be more vulnerable than others to infection and may need to avoid entering the room In particular:
Pregnant women
Immunocompromised people (for any reason)
Staff with eczematous/psoriatic or similar skin lesions (particularly relevant with MRSA)
Staff and visitors receiving antibiotics (relevant to C.difficile infection)
10.2 Staff with such risk factors must seek advice from occupational health prior to caring for patients in isolation.
11. EQUIPMENT
11.1 Disposable equipment should be used whenever possible. Non disposable equipment must be decontaminated in accordance with the Decontamination Policy & Procedure when removed from the room. Wherever possible equipment should be allocated for sole use of the patient and decontaminated when no longer required.
12. LINEN
12.1 All laundry from isolation rooms must be managed as fouled/infectious laundry and therefore be placed in water soluble bags within the room and then into an outer linen sack.
13. WASTE DISPOSAL
13.1 All waste must be disposed of into clinical waste bags inside the room. Double bagging is not necessary. The bag should be placed immediately at the designated
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collection point. (Additional measures are required for suspected viral haemorrhagic fevers and waste should be kept within the room until arrangements are made for special containers to be brought to the ward).
14. EXCRETA
14.1 Excreta can be disposed of directly into the toilet adjoining the room. If no en-suite facilities, cover commode/bed pan and take directly to the sluice - avoid touching anything other than the pan/urinal whilst en route. Pans and urinals must be placed directly into the macerator ensuring that any wipes have been removed and disposed of as clinical waste. Gloves and aprons should then be removed and discarded in clinical waste bin and hands washed.
15. SHARPS
15.1 A sharps bin should be kept inside the room for sharps disposal, unless this will be a hazard to the patient.
16. COLLECTION OF SPECIMENS
16.1 Specimens should be obtained within the room. Care must be taken to avoid contaminating the outside of the specimen container. All clinical specimens should be regarded as potentially infectious and handled as such. Specimens from patients likely to have the following organisms have to be treated as ‘high risk ‘and identified on the accompanying form, with a label to indicate this or if using electronic test requesting (i.e. order-comms/Medway) include information under the clinical details.
INFECTION SUSPECTED ORGANISM SPECIMEN
HEPATITIS Blood Borne Viruses Hepatitis B&C
Blood and body fluids
HIV / AIDS HIV I+II HTLV I+II
Blood and body fluids
TB Mycobacterium tuberculosis (MTB)
Specimens from site of infection Eg: sputum, urine
TYPHOID Salmonella typhi Salmonella paratyphi
Faeces & Blood Cultures
BRUCELLOSIS ("UNDULANT FEVER")
Brucella abortus/melitensis Blood Cultures Bone Marrow
PLAGUE Yersinia pestis Specimens from discharging lesions Sputum
ANTHRAX Bacillus anthracis YELLOW FEVER Arboviruses Blood
ON NO ACCOUNT SHOULD ANY SPECIMENS BE TAKEN FROM PATIENTS WITH SUSPECTED VIRAL HAEMORRHAGIC FEVER (eg: LASSA/EBOLA, etc., A POTENTIALLY LETHAL CROSS-INFECTION HAZARD) WITHOUT CONTACTING A MEDICAL MICROBIOLOGIST FIRST.
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17. CROCKERY AND CUTLERY
17.1 Crockery and cutlery is adequately decontaminated by dishwasher. Return items to kitchen promptly.
18. VISITS TO OTHER DEPARTMENTS
18.1 The department should be notified in advance so that arrangements may be made to prevent possible spread of infection i.e. patients with infections spread by the airborne route should be seen at the end of a list/session. Ward staff should advise of any necessary precautions. The Infection Control Nurse can also be contacted for advice. After the investigation/treatment is completed, surfaces with which the patient has had contact should be cleaned with hot water and detergent or detergent wipes.
18..2 Portering staff and other staff accompanying the patient do not need to wear PPE but
must clean their hands thoroughly after having direct contact with the patient.
18.3 Wheelchairs/trolleys used to transport patients to other departments must be cleaned with hot water and detergent or detergent wipes.
19 TRANSFER/DISCHARGE OF PATIENTS
19.1 Patients can be transferred from one ward to another ward or unit, if clinical need dictates. The receiving area must be informed in advance of the nature of the infection to ensure that the appropriate facilities are available and the required precautions are applied. Movement for non clinical reasons, e.g. outlying medical patients who are in isolation rooms to surgical wards to increase bed availability in medicine, should be avoided.
19.2 On discharge ensure that receiving hospital/nursing home or community services are
informed of any necessary precautions. If transport by ambulance is required, the ambulance service must be informed of any necessary precautions.
20. VISITORS
20.1 Visitors must report to the nurses’ station prior to entering the isolation room/bay. It may be necessary to ask about immunisation status prior to visiting. In some circumstances visiting may be restricted.
20.2 If visiting is allowed it is usually unnecessary for visitors to wear PPE but they should
be advised to wash/clean their hands when leaving the room. Visitors may need to be shown how to do this effectively.
20.3 Visitors should be advised not to visit other patients but if this is necessary they
should do so before visiting the patient in isolation. They should be advised not to eat or drink whilst in the isolation room.
20.4 Visiting by young children should be discouraged. If visitors insist on bringing young
children they must be informed of any risks.
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21. ROUTINE CLEANING
21.1 Isolation rooms must be cleaned at least as frequently as other patient areas using standard cleaning procedures. Cloths must be disposable. Mop heads must be removed and should be laundered after use or disposable mop heads discarded.
22. TERMINAL CLEANING
22.1 Terminal cleaning of the environment and furniture can be arranged via the housekeeping/domestic supervisor. However, when housekeeping services are not available it is the responsibility of the nursing staff to ensure the room is cleaned before reuse.
22.2 For terminal cleaning of siderooms following C.difficile infection and some
antimicrobial resistant infections, hydrogen peroxide vapour will be used – this must be undertaken by a member of the housekeeping dept.
23. LAST OFFICES
23.1 Following death, the body may remain an infection risk to personnel and therefore isolation precautions must be maintained whilst Last Offices are performed.
23.2 Last Offices are performed in accordance with the Care of the Deceased Patient
Policy.
23.3 All bodies should be sealed in a leak proof cadaver bag.
24. ARCHIVING ARRANGEMENTS The original of this policy will remain with the author, Lead Nurse/Director for Infection Prevention and Control. An electronic copy will be maintained on the Trust Intranet, P – Policies (Trust-wide) – S – Source Isolation. Archived electronic copies will be stored on the Trust's “archived policies” shared drive, and will be held indefinitely. A paper copy (where one exists) will be retained for 10 years.
25. PROCESS FOR MONITORING COMPLIANCE WITH AND EFFECTIVENESS OF THE PROCEDURES
25.1 In order to monitor compliance with this policy, the auditable standards will be
monitored as follows:
No Minimum Requirements Evidenced by
1.
Patients with suspected or confirmed infectious conditions will be placed appropriately in single rooms in high risk areas or in a bay in lower risk areas with evidence of risk assessment
Annual audit of Patient Placement, isolation facilities and infection risk assessment.
Datix reports of cross infection
25.2 Frequency
In each financial year, the Lead Nurse/Director of Infection Prevention and Control will ensure that results of the auditable standards are included in the annual report of the Joint Directors of Infection Control which is presented to the Board of Directors.
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25.3 Undertaken by Lead Nurse/Director of Infection Prevention and Control 25.4 Dissemination of Results
Results from reporting will be discussed through Divisional Governance Group meetings and at Infection Control and Decontamination Assurance Group meetings, if compliance with the minimum standards not achieved.
25.5 Recommendations/ Action Plans Implementation of the recommendations and action plan if required will be monitored by the Infection Control and Decontamination Assurance Group, which meets quarterly.
25.6 Any barriers to implementation will be risk-assessed and added to the risk register. 25.7 Any changes in practice needed will be highlighted to Trust staff via the Governance
Managers’ cascade system.
26. REFERENCES
Not applicable
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APPENDIX 1: TABLES OF COMMUNICABLE DISEASES AND APPROPRIATE PRECAUTIONS Disease or Organism Mode of transmission
from person to person In the health care setting
Single room
Gloves Apron Other PPE Visitor Restrictions
Duration of
isolation
Comments
Anthrax
Cutaneous Pulmonary
Contact with lesions
Person to person spread unknown. * See comments
Yes
Yes
ALL
ALL
ALL
ALL
See comments
-
Duration of disease
NOTIFIABLE DISEASE Infection Control Team must be informed if anthrax is suspected.
*In the event of a deliberate release of anthrax spores the patient, his/her belongings and the environment may be contaminated. Refer to PHE guidelines
Bronchiolitis Droplet
Yes DCC DCC - Exclude pre-
school children
Clinical Recovery
Brucellosis No person to person spread
No
LSP LSP
Chickenpox
(Varicella zoster) Airborne via respiratory
secretions and vesicle fluid Contact with vesicle
exudate
Yes
DCC DCC - Exclude non immune
1 week after onset or until lesions are dry
Non immune staff must be excluded. Negative pressure isolation room preferred Also refer Varicella Zoster Guidance
Creutzfeldt Jakob Disease (CJD) and
related disorders
Contact via instruments
used for invasive procedures
No LSP LSP - - Duration of hospital stay
Special precautions required for invasive procedures Also refer CJD & other transmissible spongiform encephalopathies policy
Key to table Modes of transmission
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only N/A = Not applicable Airborne - via droplet nucleii or skin scales – remain suspended in the air for long periods PPE = Personal Protective Equipment AGP = aerosol generating procedure
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Disease or Organism Mode of transmission
from person to person In the health care setting
Single room
Gloves Apron Other PPE
Visitor Restrictions
Duration of
isolation
Comments
Croup
Droplet Contact via contaminated hands.
Yes DCC DCC - Exclude pre-school children
Clinical recovery
Cryptococcus neoformans
No person to person spread
No LSP LSP
Cytomegalovirus Contact with saliva, blood,
urine No LSP LSP -
Dengue Fever Contact via contaminated
sharps No LSP LSP Clinical
recovery Always consider other communicable diseases when travelling from abroad. Isolate in s/r until diagnosis is confirmed.
Diarrhoea and/or vomiting (suspected
infective) See Section 5 for individual causes
Contact via faecal oral
route Yes DCC DCC Variable Variable
see Appendix 2
Refer Appendix 2 Also refer C.difficile Policy and Norovirus Guidance if either are suspected
Diphtheria
Respiratory Cutaneous
Droplet
Direct contact with skin
lesions
Yes
Yes
ALL DCC
ALL
DCC
Surgical mask ALL
Exclude non immune
Until swabs are repeatedly negative
NOTIFIABLE DISEASE.
Inform infection control on suspicion.
Encephalitis
(suspected infective)
Contact via faecal oral
route Yes LSP LSP NOTIFIABLE DISEASE
Enterovirus
(Echo and Coxsackie)
Contact via faecal oral
route Yes for
infants only DCC DCC
Epiglottitis
Droplet Yes DCC DCC Exclude pre-school
48hours of appropriate antibiotic therapy
Immunisation and prophylaxis of close contacts may be necessary
Gas Gangrene No person to person spread
No LSP LSP Infection is usually endogenous
Key to table Modes of transmission
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only approximately 1 metre N/A = Not applicable Airborne - via droplet nucleii or skin scales – remain suspended in the air for long periods PPE = Personal Protective Equipment AGP = aerosol generating procedure
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Disease or Organism Mode of transmission from person to person
In the health care setting
Single room
Gloves Apron Other PPE
Visitor Restrictions
Duration of
isolation
Comments
Glandular fever
Contact via saliva (kissing) No LSP LSP
Gastroenteritis
Refer Diarrhoea and/or vomiting
Contact via faecal oral route
Yes DCC DCC Variable Variable see Appendix 2
Refer Appendix 2
Also refer C.difficile Policy and Norovirus Guidance if either are suspected
Gonococcal Infection
Genito-urinary tract Ophthalmia neonatorum
Contact with exudate from
mucous membranes of the genital tract Contact via unwashed
hands
Yes, children
only
Yes
LSP
DCC
LSP
DCC
24 hours of antibiotic therapy
NOTIFIABLE DISEASE
Hepatitis
Undiagnosed
Contact with blood, faeces
and other body fluids (percutaneous expsure)
Yes
LSP
LSP
NOTIFIABLE DISEASE
Hepatitis A Contact (faecal-oral) Yes LSP LSP 7 days after onset of jaundice
NOTIFIABLE DISEASE
Hepatitis B, C & δ Contact with blood and
body fluids (usually percutaneous exposure via used sharps)
Not usually*
LSP LSP LSP NOTIFIABLE DISEASE (if acute)
*Single room required only if bleeding uncontrollably or has large open wounds or receiving haemodialysis.
Herpes simplex Type
I and II
Contact with lesions and
via shared towels etc. Droplet
Not usually*
LSP
LSP All lesions scabbed
* Single room may be required if patient has extensive lesions Also refer Herpes Simplex information on Hub
Herpes zoster
Refer Shingles
Key to table Modes of transmission
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only approximately 1 metre N/A = Not applicable Airborne - via droplet nucleii or skin scales – remain suspended in the air for long periods AGP = aerosol generating procedure PPE = Personal Protective Equipment
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Disease or Organism Mode of transmission from person to person In health care setting
Single room
Gloves Apron Other PPE
Visitor Restrictions
Duration of
isolation
Comments
Human Immunodeficiency Virus
Direct or indirect contact
with blood and body fluids (usually percutaneous exposure via used sharps)
No LSP LSP LSP
Patients with AIDS may have infectious conditions that require isolation
Impetigo Refer streptococcal infection
Infestations
Human Fleas Cat/dog fleas
Contact with patient and
bedding and clothing N/A
Yes
No
ALL ALL Gowns DCC
Recommend limiting visitors to those who have already had contact until treated
Until patient, bedding and clothing are treated.
Human fleas are extremely uncommon. Treat animals and environment
Lice (Body) Contact with patients,
clothing, bedding, towels etc
Yes ALL ALL Gowns DCC
Recommend limiting visitors to those who have already had contact until treated
Until patient, bedding and clothing are treated
Body lice live in the seams of clothing.
Lice (Head) Contact (head to head)
and via shared combs, head wear, pillows
Yes DCC DCC Advise visitors to avoid head to head contact
Until treated
Lice (Pubic) Contact (usually sexual) No LSP LSP Until treated
As this is usually STD consider referral to GUM clinic for screening
Key to table Modes of transmission
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only approximately 1 metre N/A = Not applicable Airborne - via droplet nucleii or skin scales – remain suspended in the air for long periods PPE = Personal Protective Equipment AGP = aerosol generating procedure
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Disease or Organism Mode of transmission
from person to person In the health care setting
Single room
Gloves Apron Other PPE
Visitor Restrictions
Duration of
isolation
Comments
Infestations continued
Scabies Crusted/atypical scabies
Contact with skin
(prolonged skin contact usually required) Contact with skin, bedding, clothing etc
Yes
Yes
DCC
DCC
DCC
Gown DCC
None until treated
Until treated As advised by the ICT
Itching may continue for several days/weeks Close contacts will need treatment Refer to dermatologist Contacts will need treatment. Also refer Scabies guidance
Worms
Contact via faecal oral
route
No
LSP
LSP
Until treated
Family contacts or equivalent may need treatment
Influenza, Seasonal Droplets Yes LSP LSP Surgical mask DCC FFP3 respirator for AGPs
Advise against visiting particularly if not immunised.
7 days after onset of symptoms
Alert ICT if more than one case on same ward. Also refer Influenza - Guidance on the Management of Seasonal
Legionnaires’ Disease
No person to person spread
No LSP LSP N/A Microbiologist MUST be contacted to arrange for rapid diagnostic methods to be set up. NOTIFIABLE DISEASE
Leptospirosis
(Weil’s Disease)
Contact with blood and
urine No LSP LSP N/A NOTIFIABLE DISEASE
Lice
Refer Infestations
Listeriosis
Mother to baby in utero and during delivery Contact (faecal oral)
although very rare.
Yes in neonatal
unit only
LSP LSP Clinical recovery
Microbiologists should be informed as potentially food borne
Key to table Modes of transmission
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only approximately 1 metre N/A = Not applicable Airborne - via droplet nucleii or skin scales – remain suspended in the air for long periods PPE = Personal Protective Equipment AGP = aerosol generating procedure
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Disease or Organism Mode of transmission
from person to person In the health care setting
Single room
Gloves Apron Other PPE
Visitor Restrictions
Duration of
isolation
Comments
Malaria Contact via contaminated
sharps No LSP LSP NOTIFIABLE DISEASE
Always consider the possibility of other tropical infections which may be infectious. Therefore until diagnosis confirmed a single room is advisable.
Measles Airborne Yes ALL ALL FFP3 respirator ALL
Exclude non -immune
4 days after rash appears
NOTIFIABLE DISEASE. Also refer Measles information &
guidance
Meningitis
Undiagnosed
? Droplet transmission ? Indirect contact (faecal
oral)
Yes
DCC
DCC
Surgical masks
Variable depending on cause
NOTIFIABLE DISEASE
Masks for airway management and close prolonged contact
Bacterial
Meningococcal (Neisseria meningitidis)
Droplet Yes DCC DCC As above 48 hours of appropriate antibiotics
NOTIFIABLE DISEASE Antibiotic prophylaxis may be required for household and mouth kissing contacts. CCDC or Health Protection Nurse will advise. Refer Appendix 1.
Other bacterial causes
No person to person transmission
No LSP LSP
e.g. pneumococcal, haemophilus influenzae
Viral Contact (faecal oral) +/- Droplet
Yes DCC DCC Clinical recovery
NOTIFIABLE DISEASE
Commonly caused by enterovirus
Key to table Modes of transmission
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only approximately 1 metre N/A = Not applicable Airborne - via droplet nucleii or skin scales – remain suspended in the air for long periods PPE – Personal Protective Equipment AGP = aerosol generating procedure
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Disease or Organism Mode of transmission
from person to person In the health care setting
Single room
Gloves Apron Other PPE
Visitor Restrictions
Duration of
isolation
Comments
Meningococcal Septicaemia – See Meningococcal Meningitis
MRSA Contact via unwashed hands most significant route unless patient has an exfoliating skin condition when the airborne route becomes important
Refer MRSA Policy
DCC DCC On the advice of the Infection Control Team
Always start topical suppression treatment to reduce risk of transmission to other patients - refer MRSA policy
Multi-Resistant Gram Negative Organisms
Depends on site of colonisation and organism. Contact via unwashed
hands and contaminated equipment most significant route of transmission.
Depends on
organism and
setting. Seek
advice.
DCC DCC Gown may be required - depends on organism
On the advice of the Infection Control Team
For ESBL and AMP C producing bacteria and Carbapenamase producing organisms refer to Multi-Drug Resistant Organism Policy
Mumps Droplet Contact with urine/saliva
Yes DCC DCC Surgical mask for close contact /airway management
Exclude non immune
9 days after onset
NOTIFIABLE DISEASE
Mycoplasma pneumonia
Droplet Yes
LSP LSP Surgical mask for close contact /airway management
10 days after onset
Patients are usually no longer infectious by the time the diagnosis is confirmed.
Key to table Modes of transmission
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only approximately 1 metre N/A = Not applicable Airborne – via droplet uclei or skin scales – remain suspended in the air for long periods PPE = Personal Protective Equipment AGP = aerosol generating procedure
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Disease or Organism Mode of transmission
from person to person In the health care setting
Single room
Gloves Apron Other PPE Visitor Restrictions
Duration of
isolation
Comments
Norovirus Contact and droplets Yes ALL ALL Exclude unless already exposed
48 hours symptom free
Norovius is highly transmissible and causes outbreaks in hospital. Strict adherence to use of PPE and hand hygiene is essential
Parvo virus (human)
(Slapped Cheek)
Droplet Yes
LSP LSP Exclude pregnant women
Usually once rash appears but see comments.
Patients in aplastic crisis may be infectious for 1 week after onset. Exclude pregnant members of staff.
Plague
Bubonic Pneumonic
Contact with pus from
buboes Droplet
Yes
Yes
ALL
ALL
ALL
ALL
Surgical Mask, Gown ALL
Exclude unless already exposed
Duration of disease
NOTIFIABLE DISEASE Contact Infection Control Team immediately on suspicion. Person to person transmission is rare but the patient should be transferred to high security infectious disease unit.
Polio
Contact via faecal oral
route Droplet
Yes LSP LSP
Exclude non immune
7 days from onset of symptoms
NOTIFIABLE DISEASE
Psittacosis
Person to person spread very rare
No LSP LSP N/A
Pyrexia of Unknown Origin with recent
travel abroad
As cause is unknown all modes of transmission must be considered
Yes
ALL
ALL
Limited to previous contacts and close family
Variable – clinical recovery if cause not confirmed
Malaria, typhoid and Hepatitis A are the commonest causes of PUO in returned travellers BUT always consider possibility of Viral Haemmorhagic Fever.
Also refer VHF guidance.
Q-fever
No person to person spread
No LSP LSP
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only N/A = Not applicable Airborne – via droplet nuclei or skin scales – remain suspended in the air for long periods PPE = Personal Protective Equipment AGP = aerosol generating procedure
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PPE = Personal Protective Equipment Disease or Organism
Mode of transmission from person to person
In the health care setting
Single room
Gloves Apron Other PPE
Visitor Restrictions
Duration of
isolation
Comments
Rabies
Person to person transmission rare; transmission via corneal, tissue and organ transplants has been reported
Yes LSP LSP Masks and eye protection if coughing
Limited Clinical recovery
NOTIFIABLE DISEASE Contact Microbiologist and Infection Control Team if suspected.
Person to person transmission is only a theoretical risk but because of the implications of acquisition single room accommodation is required
Ringworm (extensive)
Contact with skin scales,
nail and hair and via associated equipment e.g.hair clippers, shavers
No DCC DCC Variable Own bath shower facilities desirable.
Rubella
Droplet Yes DCC DCC Surgical mask for close contact
Exclude non immune
4 days after onset of rash.
NOTIFIABLE DISEASE
Scarlet Fever Refer Streptococcal infection
Smallpox Contact with vesicles Airborne via respiratory droplet nucleii
Yes ALL ALL FFP3 respirators gowns and eye protection ALL
Exclude unless already exposed
Until informed
by the Infection Control Team
NOTIFIABLE DISEASE CONTACT MICROBIOLOGIST AND INFECTION CONTROL IMMEDIATELY ON SUSPICION Implement Emergency Preparedness Plan
Key to table Modes of transmission
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only N/A = Not applicable Airborne - via droplet nucleii or skin scales – remain suspended in the air for long periods PPE = Personal Protective Equipment AGP = aerosol generating procedure
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Disease or Organism Mode of transmission
from person to person In the health care setting
Single room
Gloves Apron Other PPE
Visitor Restrictions
Duration of
isolation
Comments
Shingles Contact with exudate Airborne via vesicle fluid
(in disseminated shingles only)
Yes
DCC
DCC
Exclude if non immune to chickenpox
1 week after onset or until lesions are dry
Exclude staff non-immune to chicken pox
Also refer Varicella zoster virus
(VZ),chickenpox and shingles information
Streptococcal (Group A) Infection
Including sore throat scarlet fever, impetigo, erysipelas, wound Infection, toxic shock syndrome, puerperal fever.
Contact with lesions Droplets
Yes
DCC
DCC
Surgical face mask for close contact
Recommend excluding children and any visitor with a wound.
48 hrs from commen-cing appropriate antibiotics
Scarlet Fever – NOTIFIABLE DISEASE
Staff with sore throats should seek advice from Occupational Health
Also refer Group A Streptococcal Infections –Prevention & Control Policy
Streptococcal Group B (Neonatal)
Contact via faeces, skin sites
No
LSP
LSP
N/A
Syphyllis
Early congenital Primary Secondary
Contact with lesions, secretions, blood
No LSP LSP 24 hrs of effective therapy
Latent & Late No person to person spread
No LSP LSP N/A
Tetanus No person to person spread
No LSP LSP N/A NOTIFIABLE DISEASE
Key to table Modes of transmission
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only N/A = Not applicable Airborne - via droplet nucleii or skin scales – remain suspended in the air for long periods PPE = Personal Protective Equipment AGP = aerosol generating procedure
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Disease or Organism Mode of transmission
from person to person In the health care setting
Single room
Gloves Apron Other PPE
Visitor Restrictions
Duration of
isolation
Comments
Toxoplasmosis No person to person spread
No LSP LSP N/A
Tuberculosis
NOTIFIABLE DISEASE Also Refer TB guidance
Pulmonary (open) ie sputum smear positive
Airborne via resp droplet
nuclei
Yes
LSP
LSP
FFP3 respirator for AEP
Limit to household/ family contacts
Usually 2 weeks treatment
Negative pressure ventilation preferable. MDRTB must be nursed in negative pressure isolation and FFP respirators worn at all times.
Pulmonary (closed)
No spread
No
LSP
LSP
N/A
Extrapulmonary No spread
No
LSP LSP N/A
Typhoid & Paratyphoid
Indirect contact - faecal/urine/oral spread
Yes, with en-suite facilities
DCC
DCC
Advise
visitors not to eat or drink in the isolation
room
Variable
NOTIFIABLE DISEASE
Ensure blood cultures and stools are labelled with risk of infection stickers
Typhus
Indirect contact via inoculation injury
No
Yes
LSP
LSP
Until any
infestation is treated
NOTIFIABLE DISEASE
Ensure patient is free of infestation.
Key to table Modes of transmission
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only N/A = Not applicable Airborne - via droplet nucleii or skin scales – remain suspended in the air for long periods PPE = Personal Protective Equipment AGP = aerosol generating procedure
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Disease or Organism Mode of transmission from person to person In the health care setting
Single room
Gloves Apron Other PPE
Visitor Restrictions
Duration of isolation
Comments
Vancomycin Resistant Enterococcus (VRE)
Contact with colonised/infected sites
Yes
DCC
DCC
-
-
Until informed by Infection Control
Also Refer VRE/GRE Guidance
Varicella Zoster Refer
Chicken pox or Shingles
Viral Haemorrhagic Fever (eg Lassa, Ebola, Marburg)
Contact - percutaneous
exposure to blood and body fluids ?Droplet - pharyngeal
secretions
Yes ALL FFP3 respirator Visors Gown Boots ALL
Immediate family/partner Exclude children.
As advised by
Infection Control Team
NOTIFIABLE DISEASE CONTACT INFECTION CONTROL IMMEDIATELY ON SUSPICION
Also refer VHF guidance
Whooping Cough Droplet - respiratory
secretions Yes DCC DCC Surgical
face masks for close contact
Exclude non immune
5 days after antibiotics started
NOTIFIABLE DISEASE
Yellow Fever Contact - percutaneous
exposure Yes LSP LSP 5 days
after onset
NOTIFIABLE DISEASE
Key to table Modes of transmission
ALL = Applies to all persons entering the room Contact – direct (touching, kissing, biting) or indirect via equipment/fomites (includes percutaneous DCC = Required for direct contact or cleaning exposure via used sharps) LSP = Limited to standard precautions Droplet - large respiratory droplets propelled a short distance only N/A = Not applicable Airborne - via droplet nucleii or skin scales – remain suspended in the air for long periods PPE = Personal Protective Equipment AGP = aerosol generating procedure
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APPENDIX 2: TABLE OF SPECIFIC GASTROINTESTINAL INFECTIONS
Organism Risk Group Source Person to Person Spread
Incubation Period
Period of Excretion
Specific Therapy Single Room Duration of Isolation
Notes
Adenovirus Mainly pre school children
Human ++ ? 2-5 days No Yes Duration of disease
Amoebic Dysentery Foreign Travellers
Human + ? May be prolonged
Variable Metronidazole Yes Duration of disease
NOTIFIABLE DISEASE
Astrovirus Pre school children
Human ++ ? 2-7 days No Yes Duration of disease
Bacillus cereus All ages Food esp. Chinese takeaway
- 1-6 hours N/A No No N/A NOTIFIABLE DISEASE as food poisoning
Calicivirus All ages Human ++ 24-48 hours 2-3 days No Yes Duration of disease
Campylobacter All ages Food Raw milk Water
+ 2-7 days Variable Possibly Erythromycin or Ciprofloxacin
If possible Duration of disease
NOTIFIABLE DISEASE as food poisoning
Clostridium botulinum
All ages Food - 12-36 hours N/A Specific Anti-toxin No N/A NOTIFIABLE DISEASE as food poisoning
Clostridium difficile
Refer C.difficile Policy
Human. Contaminated environment
++ Variable Variable Refer C.difficile Policy
Yes 48 hours after symptoms resolved with return to normal bowel action
Inform Infection Control Nurses
Also refer C.difficile Policy
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th January 2017
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Organisms Risk Group Source Person to Person Spread
Incubation Period
Period of Excretion
Specific Therapy
Single Room
Duration of Isolation
Notes
Clostridium perfringens
All ages Food esp. cooked meats
- 10-18 hours N/A No No N/A NOTIFIABLE DISEASE as food poisoning
Cryptosporidium Mainly children Human Water Animal contact
+ 2-14 days 1-3 weeks No Yes Duration of disease
NOTIFIABLE DISEASE as food poisoning
E. Coli 0157 All ages Contact with cattle Contaminated food.
++ Variable If severe Yes 48 hours after resolution of symptoms
NOTIFIABLE DISEASE as food poisoning
Enteropathogenic E.coli
Children under 3 years
Human ++ 12-72 hours Variable Not usually Yes Duration of disease
NOTIFIABLE DISEASE as food poisoning
Giardia lamblia All ages Human Water
++ 1-4 weeks Variable Metronidazole
If possible
Duration of disease
NOTIFIABLE DISEASE as food poisoning
Norovirus
All ages Human ++++++ 24-48 hours Variable No Yes Min 48 hours resolution of symptoms
NOTIFIABLE DISEASE as food poisoning
Also refer viral gastroenteritis guidance
Rotavirus Mainly pre school children
Human ++ 1-4 days 2-5 days No Yes Min 48 hours resolution of symptoms
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Organisms Risk Group Source Person to Person Spread
Incubation Period
Period of Excretion
Specific Therapy
Single Room
Duration of Isolation
Notes
Salmonella sp.(non typhi)
All ages Food Human cases + 12-72 hours Variable Severe cases only
Yes Duration of disease
NOTIFIABLE DISEASE as food poisoning
Salmonella typhi & paratyphi
All ages esp. after foreign travel
Human Food ++ 1-3 weeks Variable Yes Yes Period of hospitalisation
NOTIFIABLE DISEASE
Shigella sp Young children Following foreign travel
Human ++ 1-7 days Variable If severe Yes Period of hospitalisation
NOTIFIABLE DISEASE as food poisoning
Staph aureus All ages Food esp. cooked meats
- 2-6 hours N/A No No N/A NOTIFIABLE DISEASE as food poisoning
Vibrio cholerae Travel abroad Human Water Food
+ 1-5 days Variable Yes Tetracycline
Yes Period of hospitalisation
NOTIFIABLE DISEASE
Yersinia sp Mainly children Food + 3-7 days Variable If severe Yes Duration of disease
NOTIFIABLE DISEASE as food poisoning
Source Isolation Procedures Page 30 of 33 Ratified by: Infection Control & Decontamination Assurance Group: 24
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APPENDIX 3: MANAGEMENT OF THE CONTACTS OF PATIENTS WITH PROBABLE MENINGOCOCCAL DISEASE
Action by ward doctor On which ever ward the patient is admitted, the ward doctor will prescribe and dispense from stock ciprofloxacin or rifampicin or ceftriaxone as appropriate to contacts. Drug stock and patient leaflets held in ED pharmacy cupboard. The name of each contact, their date of birth, GP, the drug and dose must be recorded in medical notes of the index case. Action by EXOHS
Keep records of 1) all staff contacts 2) all staff antibiotic prescriptions
Staff contacts needing prophylaxis, as agreed with duty HPU doctor
Action by HPU doctor Make a record of
1) all contacts 2) all antibiotic prescriptions
All other contacts needing prophylaxis
- not present in hospital
Close/ family contacts needing prophylaxis, as agreed with duty HPU doctor, who are - present in hospital
Action by GP/DDOC Duty GP/DDOC phoned and faxed to prescribe appropriate antibiotic
MANAGEMENT OF THE CONTACTS OF PATIENTS WITH PROBABLE MENINGOCOCCAL DISEASE
The object of this flowchart is to identify contacts at risk of meningococcal infection, and to prescribe them appropriate antimicrobial prophylaxis within 12 hours
Action by medical/nursing member of team, at the earliest opportunity Telephone the Health Protection Unit (HPU) 0844 225 3557 and ask for the Doctor/Nurse on duty for Public Health. Out of normal working hours ask RD+E switchboard for the Devon, Cornwall and Somerset Health Protection Unit Contact Rota 1st on.
1) Have the patient’s details to hand 2) If possible have a relative / partner / friend accompanying the patient available
Action by duty HPU Doctor HPU doctor will draw up lists of contacts, either by visiting or talking on ‘phone to hospital staff or persons who have accompanied the patient to hospital. An assessment is made of which contacts need prophylaxis, this includes hospital and ambulance staff as well as family / community contacts Copy list of staff contacts to Exeter Occupational Health Service (EXOHS)
Patient with probable meningococcal disease in the Royal Devon and Exeter Hospital
Action ED doctor as appropriate depending on where staff contacts work. Doctor will prescribe and dispense from stock ciprofloxacin or rifampicin or ceftriaxone as appropriate to staff contacts. Copy of prescription to go to EXOHS and HPU.
For hospital staff contacts
ED/and SWAST contacts
Source Isolation Procedures Page 31 of 33 Ratified by: Infection Control & Decontamination Assurance Group: 24
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APPENDIX 4: COMMUNICATION PLAN
COMMUNICATION PLAN
The following action plan will be enacted once the document has gone live.
Staff groups that need to have knowledge of the strategy/policy
All clinical staff
The key changes if a revised policy/strategy
Adapted to take updated guidance on PPE into consideration and greater clarity within the section on definitions
The key objectives The purpose of this policy is to: provide the information required to determine appropriate isolation precautions based on the route of transmission.
How new staff will be made aware of the policy and manager action
Induction
Specific Issues to be raised with staff Draw attention to the Index of infections which is the most useful tool for determining the required precautions
Training available to staff Induction and infection control updates
Any other requirements N/A
Issues following Equality Impact Assessment (if any)
No negative impacts
Location of hard / electronic copy of the document etc.
Infection Control Team Office and Site Management Office
Source Isolation Procedures Page 32 of 33 Ratified by: Infection Control & Decontamination Assurance Group: 24
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APPENDIX 5: EQUALITY IMPACT ASSESSMENT TOOL
Name of document Source Isolation Policy
Division/Directorate and service area Specialist Services, Infection Control
Name, job title and contact details of
person completing the assessment
Judy Potter
Lead Nurse/Joint Director for Infection
Prevention and Control
Date completed: 20/10/2016
The purpose of this tool is to: identify the equality issues related to a policy, procedure or strategy summarise the work done during the development of the document to reduce
negative impacts or to maximise benefit highlight unresolved issues with the policy/procedure/strategy which cannot be
removed but which will be monitored, and set out how this will be done.
1. What is the main purpose of this document?
The purpose of this policy is to: Provide the information required to determine appropriate isolation precautions based on the route of transmission.
2. Who does it mainly affect? (Please insert an “x” as appropriate:)
Carers ☐ Staff X Patients X Other (please specify)
3. Who might the policy have a ‘differential’ effect on, considering the “protected
characteristics” below? (By differential we mean, for example that a policy may have a noticeably more positive or negative impact on a particular group e.g. it may be more beneficial for women than for men)
Please insert an “x” in the appropriate box (x)
Protected characteristic Relevant Not relevant
Age ☐ X
Disability ☐ X
Sex - including: Transgender,
and Pregnancy / Maternity X X
Race ☐ X
Religion / belief ☐ X
Sexual orientation – including:
Marriage / Civil Partnership ☐ X
Source Isolation Procedures Page 33 of 33 Ratified by: Infection Control & Decontamination Assurance Group: 24
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4. Apart from those with protected characteristics, which other groups in society might this document be particularly relevant to… (e.g. those affected by homelessness, bariatric patients, end of life patients, those with carers etc.)?
N/A
5. Do you think the document meets our human rights obligations? X
Yes
6. Looking back at questions 3, 4 and 5, can you summarise what has been done during the production of this document and your consultation process to support our equality / human rights / inclusion commitments?
The content of this policy is not new but has had some anomalies regarding use of PPE corrected. Previous discussions with the Equality and Diversity Manager did not identified any issues relating to equality, diversity and inclusion commitments The policy has been circulated to all members of the Infection Control which includes Specialist Nurses and Medical Microbiologists for consultation, including those working in the community setting, and has been considered by the Infection Control Operational Group which includes widespread representation from clinical, managerial and support staff.
7. If you have noted any ‘missed opportunities’, or perhaps noted that there remains some concern about a potentially negative impact please note this below and how this will be monitored/addressed.
“Protected
characteristic”: N/A
Issue:
How is this going to be
monitored/ addressed
in the future:
Group that will be
responsible for
ensuring this carried
out: