Download Generic Outbreak Control Measure Trigger Tool

Generic Outbreak Control Measure Trigger Tool
For outbreaks where there has been or might be Person-to-Person Transmission via people,
equipment or the environment
The control measures in this tool are in addition to Standard Infection Control Precautions
(SICPs)
Organism
Hospital ward/Clinical Area
Date Trigger Tool Commenced
Date Trigger Tool Closed
Person closing the Trigger
Health Protection Scotland
October 2014 v2
Generic Outbreak Control Measure Trigger Tool
This Generic Outbreak Control Measure Trigger Tool is designed for use in any hospital outbreak where
there has been identified person-to-person transmission and/or where person-to-person transmission
presents an ongoing risk.
The Generic Outbreak Control Measure Trigger Tool comprises:

Roles and Responsibilities.

An assessment to determine if the trigger presents a risk.

A Key Information sheet to be adapted for each type of outbreak.

A checklist of everything that needs done at Day 0 (when the trigger is recognised).

A daily checklist for every day until the outbreak stops being a risk to people.
Roles and Responsibilities
Senior Charge

Ensure implementation and ongoing compliance with SICPs/TBPs.
Nurse

Recognise and report to the IPCT any incidences of clinical conditions where the
(Ward
signs/symptoms are suggestive of an outbreak, i.e. patients having similar
Manager)
Clinicians
signs/symptoms of infection (diarrhoea, or pneumonia, or surgical site infections).

Work with the IPCT in completing the daily assessments.

Report using Risk Management Reporting systems as locally required.

Ensure that sufficient staff are available to deal with patient care needs.

Recognise and report to the IPCT any incidences of clinical conditions where the
signs/symptoms are suggestive of an outbreak, i.e. patients having similar
signs/symptoms of infection (diarrhoea, or pneumonia, or surgical site infections).

Confirm that the clinical care of patients is compliant with local/national guidance,
including observations, specialist referrals and antibiotic therapy.

Report to IPCT directly if they have concerns regarding infection prevention and
control.
Infection

Have effective surveillance systems to detect and investigate outbreaks.
Prevention &

Determine whether this Outbreak Control Measure Trigger Tool is required.
Control Team

Apply this Outbreak Control Measure Trigger Tool when there is evidence of an
(IPCT)
Pharmacist
outbreak.

Consider the need for additional control measures if transmission continues.

Ensure that actions required after HIIAT assessment are in place.

If requested, review the antibiotic regimens of all patients in the ward ensuring this is
(If required)
General
consistent with local policy.

Provide recommendations for prescribing to reduce the risk to patients.

Report triggers to the Antimicrobial Management Team.

Ensure the ward team has the resources to provide a safe patient environment and
Manager
safe patient care.

Communicate to appropriate staff and management team.
HPS. Version 2.0: October 2014
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Generic Outbreak Control Measure Trigger Tool
Date: ……/……/….
Initial Assessment
(the date the trigger was identified)
Assessment to determine if the Control Measure Trigger Tool is required.
Section to be completed by the IPCT.
Location: Hospital and Clinical Area
What is the outbreak trigger for this ward? (e.g. 2 new cases of alert
organism in 30 days; for many organisms it could be 1 case).
What is the number of cases prompting this trigger?
(This could be higher than the set trigger if more than 1 case is
identified on the same day).
Assess the patients’ data to confirm if the Trigger is real:

Is there a possibility of laboratory error?

Is the number of cases correct (no double counting of cases)?

Is the organism being acquired in this clinical area?

Are there any recent changes in the patient population that could
account for this trigger?

Can the clinical conditions be explained by other diagnosis?
Situation Assessment – To be completed by IPCT
Today, how many patients on this ward are known to have this alert
organism and/or symptoms?
Today, how many other patients are asymptomatic but are known to
have the alert organism?
Today, how many staff are symptomatic and/or known to be
colonised/infected with the alert organism?
In the last 30 days, has the alert organism/infection been recorded on
any patients’ death certificates?
What is the Hospital Infection Incident Assessment Tool (HIIAT) for this
Red
incident?
Amber
(NB inform SGHD and HPS if HIIAT Red or Amber).
Green
Who is the lead IPCT member for this trigger?
Who is the Senior Charge Nurse/Ward Manager for the ward?
Is the Trigger confirmed as real?
Yes
or
If the Trigger is considered to be natural variation STOP here and
Signature:
No
sign to say this the Trigger is not real
If the Trigger is real complete: The Key Information Sheet, Day 0 Actions Checklist. Complete a Daily
Actions Checklist every day thereafter until the Trigger is considered resolved.
If the Trigger is not real: keep this sheet as a record of decision making.
HPS. Version 2.0: October 2014
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Generic Outbreak Control Measure Trigger Tool
Day 0 Actions
KEY INFORMATION SHEET
(The IPCT: will adapt this sheet to provide key information on the outbreak to the clinical team)
Case Definitions:
A case
Any person (patient or HCW) with (include symptoms of communicable disease/place/time
period)
A suspect
case
Any patient or HCW with
investigations are yet to be completed.
symptoms from who microbiological
Relevant symptoms/signs that cases and suspect cases could present with in this outbreak are (IPCT to
remove those not relevant and add any that are specific to this type of outbreak:
Diarrhoea (without or without blood)
Sore throat
Vomiting
Any purulent or change in wound discharge
Cloudy urine +/- other symptoms of (CA)UTI))
Inflamed wound or surgical site
Exfoliative or inflamed skin areas
Invasive device insertion site inflammation
Pyrexia
Chest symptoms (productive cough)
Bacteraemia
Other, please specify
To confirm if a person with relevant symptoms is a case, list the following specimens required:
Take specimens from any patient who develops any of the symptoms/signs indicated above
Complete with recommended decolonisation regimen if relevant for cases in this outbreak:
Product/Drug
Mode of application
Frequency / duration
Modes of transmission/Survivability in the Environment
Modes of Transmission:
Droplets
Contact (direct/indirect)
How long does this organism survive in the environment on horizontal surfaces
or fabrics?
Airborne
Days/ Weeks/Months
High-Contamination Procedures: List any procedures that could increase environmental or personal
contamination, during this outbreak, e.g. wound dressings, bed-making, Aerosol Generating Procedures
High-Contamination Procedures
State any procedure modifications needed to reduce risk
Admission Restrictions (Patient):
Do not admit to ward:
Do not admit to bay number(s):
No restrictions
Visitor restrictions Recommended:
Criteria to discontinue isolation of a case:
HPS. Version 2.0: October 2014
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Generic Outbreak Control Measure Trigger Tool
Day 0 Actions Checklist
Date: …………/………./………. (the date the trigger was identified)
Initial Control Measures (This is a do, then confirm done, checklist)
Patients Placement:

Isolate/cohort case patient(s)

Close doors to isolation cohort areas (undertake safety risk assessment for door closure).

Place signage on entry to isolation/cohort areas indicating admission restrictions.

Check readmitted patients for being previously exposed/symptomatic pre placement.
Admission Restrictions

Close the ward or bay if instructed by the IPCT.

Reduce patients’ visitors if considered beneficial to gaining control/or to reduce visitor risks.
Transfer and Discharge Restrictions

Avoid unnecessary intra-hospital transfer of patients from closed and open areas. If
clinically necessary confirm with receiving area they are infection control ready before patient
transfer.

Avoid inter-hospital transfer to other healthcare facilities unless advised/agreed by IPCT.

Discharge patients to their home if safe to do so. (Ensure patients/relatives/GPs are aware
of signs/symptoms to report and any ongoing control measures they should take).
Healthcare worker (HCW) Practices and Restrictions

Ensure that all staff on duty are asymptomatic (See: Relevant Symptoms).

Refer all symptomatic staff to Occupational Health/GP.

Allocate staff to care for cases or, non-cases for the duration of the incident.

If they are considered to present an infection control risk, modify ways of working for staff
scheduled to work in multiple clinical areas - including closed ward areas, e.g. phlebotomists,
physiotherapists, occupational therapists.(Reiterate SICPs and TBPs are required).
Patient Care Checks (Cases and non-cases)

Ensure patients have had their clinical condition reviewed today and if clinically indicated,
been referred to a specialist for their infection condition, e.g. microbiologist, infectious disease
physician, respiratory physician.

Ensure patients are not at increased risk due to inappropriate medications e.g. aperients or
antibiotics.

If the alert organism is drug resistant or cases have CDI, the overall prescribing and
compliance with local antimicrobial policy for all patients on the ward should be reviewed (e.g.
by an antimicrobial pharmacist working with the ICD/microbiologist, clinicians).

For patients with diarrhoea – ensure there is an up to date stool chart, with all stools passed
recorded and described, e.g. using the Bristol Stool Chart.

Ensure patients are not at increased risk due inappropriate use of invasive devices (i.e.
invasive devices that are no longer clinically required or that have signs of inflammation/
infection)

From the High-Contamination Procedures, identify the patient specific modifications in
routine practice that could reduce personal, equipment and environment contamination.

If MRSA, start decolonisation regimens.
HPS. Version 2.0: October 2014
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Generic Outbreak Control Measure Trigger Tool
Day 0 Actions Checklist cont.
Hand Hygiene and Personal Protective Equipment

Use ABHR if hands clean and not a diarrhoeal outbreak.
o
For diarrhoeal outbreak or visibly dirty hands use either: soap and water wash followed
by AHBR or Antimicrobial soap wash.

HH before PPE (apron [gown] and/or gloves); PPE before entering area; PPE off before
leaving area, HH after PPE removed.

If advocated by the IPCT, wear a surgical mask if within <1 metre of a suspect case/entry to a
case’s room.
Safe Patient Environment

Assess the risk of possible airborne dissemination of organisms. To reduce contamination,
remove fans or other equipment that could exacerbate any environmental contamination.

De-clutter the ward and the clinical environment.

Decontaminate all frequently touched surfaces and any area possibly contaminated
following a High-Contamination Procedure, e.g. toilets, over-bed tables with 1000 ppm av cl.
Patient Care Equipment

Decontaminate all communal patient equipment with 1000 ppm av cl (or the manufacturers
recommended solution). Then commence a daily cleaning regiment which includes
decontamination with 1000 ppm av cl should be carried out and protocols put in place for this
to be maintained.

Provide patient-dedicated care equipment for isolation/cohort areas (thermometers/
commodes/washbowls/blood pressure equipment/lifting-equipment, stethoscopes etc).

If the allocation of certain equipment cannot be achieved, ensure all patient care
equipment is adequately cleaned and disinfected in use, post use and prior to next patient use.
Communications and Knowledge Management by the IPCT and or Clinical team

Inform all members of staff on the ward (including domestic staff) of the situation, the
organism, how it spreads in the ward environment and what they need to do to further reduce
risk to patients, to themselves and to co-workers. Advise them of their part in monitoring for
deterioration in the situation e.g. changes in cleaning frequencies and the need to add
disinfectants to routine cleaning regimens.

Ensure all members of the clinical team are aware of any modifications to HighContamination Procedures to prevent contamination of people/environment/equipment

Ask all members of the clinical team to consider their practice and identify any actions or
inactions that could have contributed to the increased number of patients with this alert
organism, and discuss this with the clinical leads or the IPCT.

All members of the clinical team know what to do should they develop any relevant
symptoms over the next 30 days, i.e. seek medical help – report to Occ Health not for duty.

Inform patients/parents/relatives of situation, precautions/restrictions and risks (document in
the case notes)

Inform the wider management of the Trigger and the HIIAT assessment:
o
o
All Consultants with patients on the ward; Antibiotic pharmacist; HAI Executive Lead;
Entire IPCT; Local Management as specified in Local Governance Reporting Procedure
e.g. Risk Manager, Bed Manager, General Manager, Communication Representative and
Health Protection Team
HPS (Scottish Government if HIIAT is Amber or Red).
Microbiological screening of people

Following confirmation by the IPCT, take samples from any patients who are, or have
been, in the same room as a case (non-diarrhoeal conditions).

Take samples from any patient with relevant symptoms (See Relevant Symptoms).
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Generic Outbreak Control Measure Trigger Tool
Daily Actions Checklist: Day__ Date: …/…./…. (the date the trigger was identified)
Daily Outbreak Trigger Checklist for IPCT & Nurse in Charge complete daily until Trigger is resolved
Date (dd/mm/yy)
Completed by (initials)
New symptomatic pts today
New positive (micro)
Total symptomatic pts today
Total positive today (include sym)
Increase or Decrease from yesterday
Are any patients giving cause for concern due to outbreak organism/infection?
Y/N
Y/N
Y/N
Y/N
Y/N
Y/N
New symptomatic staff today
Patients Placement: Isolation/cohort procedures are effectively established.
Patients Placement: Doors to isolation/cohort areas closed and signage is clear.
Admission Restrictions: Are complied with, includes previously positive checks pre-placement.
Discharge/Transfer Restrictions: Inter-care facility transfers are pre-agreed with IPCT. Intra-hospital
transfers are only if clinically necessary and the receiving area is infection prepared.
Patient care checks: Clinical assessments are completed for today.
Patient care checks: Antibiotic prescribing for all patients has been reviewed today.
Patient care checks: A daily invasive device check has been completed today.
Patient care checks: Decolonisation, if recommended, is established.
Patient care checks: High-contamination procedures are modified to reduce contamination.
Microbiological screening of people: Has been completed as per Key Information Sheet
HCW practices and restrictions: Staff on duty are asymptomatic.
HCW practices and restrictions: Sufficient staff are on duty for all areas.
HCW practices and restrictions: Staff are allocated to isolation area or non-isolation area.
HH and PPE: Soap and water if diarrhoeal illness. HH before PPE; PPE before entry to area; PPE
removed before exit; HH after PPE removed (+ surgical mask if advocated by the IPCT).
Safe Patient Environment (SPE): All areas are clutter free.
SPE: Cleaning of isolation areas is established with includes 1000 ppm av cl.
SPE: X2 daily decontamination of frequently touched sites with 1000 ppm av cl and following any HighContamination Procedure is established. See High-Contamination Procedures.
SPE: There are sufficient supplies of PPE and other sundries for safe practice./? add FFP3 if indicated
SPE: Following patient discharge, terminal cleaning is done pre-resuming normal services.
Equipment: All ward equipment is visibly clean and in a ready for next-patient use condition.
COMPLETE OTHER SIDE
HPS. Version 2.0: October 2014
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Y/N
Generic Outbreak Control Measure Trigger Tool
Date (dd/mm/yy)
Equipment: There is sufficient dedicated equipment available in isolation/cohort areas.
Knowledge Management: HCWs know how the organism spreads, and how to practice safely.
Knowledge Management: Patients/relatives/GPs know the situation and what precautions to take
(includes patients being discharged).
Knowledge Management: For discharged patients, GPs are being informed of any additional ongoing
monitoring needed and, any actions should symptoms develop post discharge.
IPCT to advise on ward status (open/closed) and patients placement
HIIAT assessment today: Red/Amber/Green
IPCT to advise if daily actions checklist still required
If daily actions checklist no longer required - book terminal clean
IPCT to confirm if re-opening criteria have been met
Communicate all changes to email group
HPS. Version 2.0: October 2014
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