Download Practice No - Hampshire County Council

Practice No.
404
Reference: 10/06
Version 2
Page 1 of 3
Last up-dated
December 2008
HCC AS 31/00
MANAGING AN OUTBREAK OF INFECTION WITHIN A RESIDENTIAL,
NURSING OR DAY CARE UNIT
This summarises the arrangements to be followed in a care home or day care unit where there
is an outbreak of infection, to ensure that the health risks to service users, staff and visitors are
minimised:
Staff will refer to the Hampshire County Council Infection Control Guidelines. A
copy of which will be available in every home. (31/00 S. VIII)
1.
2.
CONTROL OF AN OUTBREAK OF INFECTION:
1.1
An outbreak of infection is defined as ‘more cases of an infection than would
normally be expected of the same infection in the unit’. This applies to cases
related to both service users and staff.
Essentially, this applies if more than two cases, which are suspected or known to
be infectious, occur within a few days. If an outbreak is suspected the manager/
duty manager as appropriate will contact the Health Protection Agency or the
Environmental Health or Health & Safety Executive who will verify whether or not
the outbreak is valid. If so, an appropriate action plan will be agreed and
implemented. The Service Manager must also be informed without delay.
1.2
If the outbreak status is confirmed a CSCI Regulation 37 report and an incident
report must be made.
IF THE OUTBREAK IS CONFIRMED, THE FOLLOWING ACTION WILL BE TAKEN:
2.1
Infected residents should be isolated wherever possible as directed. Admissions
to, and transfers from, the home will be restricted for an agreed period of time, to
help in containing the infection. Visitors to infected residents will need to be
restricted unless the individual is very unwell. It will also be necessary to explain
the need for prevention of cross infection and methods of infection control will
need to be explained verbally and by signage.
Carers of infected day service users will be informed that the service user
cannot be accepted into the service until they are confirmed clear of infection.
2.2
Records of all infections will be kept in the affected individual’s personal files.
2.3
An infection incident log will be kept and a brief summary will be recorded. The
log will also contain a record of all specimens sent to the local laboratory for
analysis.
2.4
The manager or duty manager, will carry out a surveillance of hitherto unaffected
residents or service users and monitor for signs of the infection spreading.
2.5
Food-borne infection:
The local Environmental Health Officer (EHO) will be informed immediately. The
EHO will need to check on the following and appropriate records and procedures
should be available for inspection:
3.

Hygiene / cleaning procedures within the kitchen / food handling
areas.

Interview catering / food handling staff regarding their health, if
necessary

refer to the appropriate Staff Questionnaires, and conformance to
the home's Food Hygiene Practice No. 437.

Menus, records of food taken by residents or service users, and
any retained samples of food.
SPECIFIC INSTANCES OF INFECTION:
Infection can manifest in many ways e.g.
3.1
3.2
Diarrhoea / Vomiting:
3.1.1
This is not always infectious in elderly people, but must be
presumed to be so until confirmed otherwise. The resident’s
GP will be informed and it may be necessary for samples of
faeces or vomit to be sent for analysis. Samples should be
kept in appropriate containers (obtainable from the GP’s
surgery) as soon as a referral is considered necessary. This
issue will be co-ordinated with the CCDC until an outbreak is
confirmed either positively or negatively.
3.1.2
Residents who are vomiting should be kept isolated for as long
as symptoms persist, to reduce the risk of airborne viral
infection and contact contamination infection. See section 4 of
these guidelines.
3.1.3
Residents should, if possible, have sole use of a dedicated
toilet for as long as symptoms persist.
3.1.4
A full review, of each case, should be undertaken with the
CCDC and a contingency plan devised. This will consider,
continence, overall health, personal hygiene, vulnerability of
other residents, staff and visitors and the facilities available.
Respiratory infections:
These may be bacterial or viral, and may present a greater danger to
elderly people. The GP may require sputum specimens to be sent for
analysis. Samples should be collected as for 3.1.1. The resident
should be cared for in a single room, particularly if coughing persists
and particularly during the acute stage of the illness. See section 4 of
these guidelines.
3.3
Skin infections / Infestations:
Residents with visible skin lesions will need to be treated with greater
tact and sensitivity. Care and nursing in a single room is preferable,
particularly when skin infections are open or weeping. Appropriate
protective clothing must be worn by care staff working with the
residents, and visitors should be made aware of hygiene procedures
necessary to protect the infected person and prevent cross infection.
See section 4 of these guidelines.
3.4
Blood-borne infections:
Refer to Practice No. 405 for working with residents and other service
users who are HIV+ (Human Immunodeficiency Virus positive) or who
have progressed to AIDS. (Acquired immunodeficiency syndrome)
3.5
Notifiable Diseases:
If a GP suspects that a resident or service user is suffering from a
notifiable infectious disease s/he has a statutory duty to notify the
CCDC IMMEDIATELY. The following constitute Notifiable Infectious
Diseases under Public Health legislation:
Under the Public Health (Infectious Diseases) Regulations, 1988:
Acute Encephalitis
Acute Poliomyelitis
Anthrax
Diphtheria
Dysentery (amoebic or
bacillary)
Leprosy
Leptospirosis
Malaria
Measles
Meningitis
Meningococcal Septicaemia
(without Meningitis)
Mumps
Ophthalmia Neonatorum
Paratyphoid Fever
Rabies
Rubella
Scarlet Fever
Tetanus
Tuberculosis
Typhoid Fever
Viral Haemorrhagic
Fevers
Viral Hepatitis
Whooping Cough
Under the Public Health (Control of Disease) Act, 1984:
Cholera
Food Poisoning
4.
Plague
Relapsing Fever
Smallpox
Typhus
ISOLATION OF SERVICE USER:
Refer to Practice guidelines No. 406 for the use of isolation facilities.