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Management of a Patient Requiring Source Isolation Precautions D D Infection Prevention Control Policy e s c Description: The document describes the processes and procedures to be taken by LPT staff for the management of a patient requiring source isolation precautions within in-patient facilities and the community Key words: Infection Prevention and Control Source isolation Version 6 Adopted by Quality Assurance Group Date adopted Main author January2015 Fiona Drew Name of responsible committee Infection Control Committee Quality Assurance Committee Date issued January 2015 Review date August 2017 Expiry date January 2018 Target audience All LPT Staff Type of policy Clinical Non clinical Contribution List Key individuals involved in developing the document Name Designation Fiona Drew Infection Prevention and Control Nurse Amanda Howell, Infection Prevention and Control team Antonia Garfoot, Una Willis, Mel Hutchings Circulated to the following individuals for consultation for this document Name Infection Prevention Control Team Di Postle Neil Hemstock Katie Willetts Paul Williams Francisco Guerra Michelle ChurchardSmith Claire Armitage Louise Carpenter Samantha Pearson Kathy Feltham Emma Wallis Janet McNally Sarah Clements Linda Bull Sarah Latham Bernadette Keavney Jo Bale Designation Leicester Partnership NHS Trust Trust lead for Professional Standards Lead Nurse FYPC Senior Nurse, Specialist Nursing FYPC Team Manager, Langley Ward Senior Matron, Oakham House Lead Nurse, LD Lead Nurse, AMH Inpatient Lead, AMH Service Manager Acute Inpatient Services, AMH Lead Nurse MHSOP Lead Nurse CHS Integrated Team Manager Matron Loughborough Hospital Matron Coalville Hospital Matron Evington Centre Health Safety and Security Manager Nursing Operational Lead Management of a patient requiring source isolation precautions 2 Contents Definitions that apply to this policy …………………………………………………… 5 1.0 Summary …………………………………………………………………………. 6 2.0 Introduction ……………………………………………………………………… 3.0 Purpose ………………………………………………………………......……… 6 4.0 Justification for the document … …………………………………….……...... 7 5.0 The management of a patient requiring source isolation precautions in-patient facilities ………………………………………………………………. 7 6 5.2 Patients in their own homes.…………………………………………………..... 16 5.3 5.4 Disposal of infected cadavers ……………………………………………….. …16 . Criteria for admitting patients to an acute hospital …………………………... 16 5.5 Conditions requiring source isolation precautions or no isolation .……….17-25 6.0 Training …………………………………………………………………………... 26 7.0 References and associated documents ……………………………………... 27 Appendix 1: Source isolation precautions …………………………………… 28 Appendix 2: Inter-healthcare transfer form …….………………………….29-31 Management of a patient requiring source isolation precautions 3 Version Control and Summary of Changes Version number Date Version 1, May 2010 Version, 2 May 2010 June 2010 June 2010 August 2011 August 2014 Version, 3 Version, 4 Version 5 Version 6 Author Status Draft 1 Comments (description change and amendments) Replaces NO 0186 “Infection Control Policy for the Management of a Patient Requiring Source Isolation in Community Hospitals” Reviewed by U. Willis to incorporate requirements of the Health and Social Care Act 2008, Care Quality Commission and NHSLA Standards. Circulated for comments Comments inserted. Forwarded to Clinical Governance for approval. Policy approved by Clinical Governance Committee Harmonised in line with LCRCHS, LCCHS, LPT (Historical organisations) Reviewed to ensure continuing compliance with the Health & Social Care Act (2008) and in line with current guidelines. Document forwarded to policy group for approval. For further information contact: The Infection Prevention and Control Team. Management of a patient requiring source isolation precautions 4 Definitions that apply to this policy Due Regard Consultant in Communicable Disease (CCDC) Cohort Nursing Disease DIPaC Infection Infectious Having due regard for advancing equality involves: Removing or minimising disadvantages suffered by people due to their protected characteristics. Taking steps to meet the needs of people from protected groups where these are different from the needs of other people. Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low. A consultant is who is knowledgeable in Infectious Diseases Grouping of infectious patients and nursing them within an area of an inpatient facility. It is recommended as a strategy for controlling transmission of healthcare associated infection in the absence of single patient rooms. A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms Director of Infection Prevention and Control This is an organism is present at a site and causes an inflammatory response or where the organism is present in a normally sterile site. Caused by a pathogenic microorganism or agent that has the capability of causing infection LPT Outbreak Leicestershire Partnership Trust The occurrence of two or more cases of the same infection linked in time or place or, the situation when the observed number of cases exceeds the number expected. Organisms This is defined as any living thing, in medical terms we refer to bacteria and viruses as organisms Personal Protective Specialized clothing or equipment worn by employees for Equipment (PPE) protection against health and safety hazards. Source Isolation Isolation for the control of infection is used to prevent infected patients from infecting others. Symptomatic Physical or mental sign of disease Management of a patient requiring source isolation precautions 5 Summary This policy provides organisation wide guidance on the management of patients requiring source isolation in inpatient facilities and patients who are cared for in their own homes. The guidance is designed for patients who are known or suspected to be infected with transmissible micro-organisms in order to reduce the risk of transmission of infection. An A to Z table of conditions is given which lists any additional precautions that are required. This is not an exhaustive list and further advice can be sought from the Infection Prevention and Control Team. In many instances, the risk of transmission of infection may be highest before a definitive diagnosis can be made. The routine use of Standard Precautions that are taken for all patients at all times should greatly reduce the risk of spread of infection. 2.0 Introduction The management of a patient requiring source isolation policy applies to all staff employed by Leicestershire NHS Partnership Trust (LPT) LPT has a wide range of teams and services operating from a large number of properties making up our overall estate. LPT also delivers healthcare in peoples own homes, including care homes. The provision of healthcare carries with it inherent risks to the health care worker. The purpose of this document is to ensure that all staff are aware of their responsibilities for safe practice and take the appropriate precautionary measures to protect themselves, their co-workers and their patients. The policy identifies staff’s responsibilities and provides them with the information they require to enable them to minimise the risk of transmission of infection. 3.0 Purpose The purpose of this policy is to provide staff employed by Leicestershire Partnership Trust with clear and robust infection prevention and control guidelines for the Management of a Patient requiring source isolation within LPT. This policy applies to all permanent employees including medical staff who work for LPT including those on bank, agency or honorary contracts either at the community hospitals or within the community services. All health professionals should ensure they work within the scope of their professional code of conduct, providing evidence based care which is in accordance with the Health & Social Care Act (2008) and the latest guidance provided by Public Health England (PHE). Management of a patient requiring source isolation precautions 6 4.0 Justification for Document As a duty of care LPT must ensure that staff are given guidance as to the appropriate steps they need to undertake to ensure that they can protect the patients within their care. Infection prevention and control safety is a legal requirement under the Health and Safety at Work Act 1974. Isolation for the control of infection is used to prevent infected patients from infecting others and or prevent susceptible patients from being infected. Isolation refers to the precautions that are taken in the hospital to prevent the spread of an infectious agent from an infected or colonized patient to susceptible persons. 5.0 The Management of a Patient requiring Source Isolation Precautions 5.1 In-Patient facility. Standard precautions which are taken for all patients at all times will greatly reduce the spread of infection from person to person. However there are some organisms for which additional precautions are considered necessary. The term source isolation precaution (SIPs) is used to indicate that the patient is the source of infection. Conversely, patients at risk of infection from others or the environment due to their immune status are placed in protective isolation. Source Isolation Procedure Patients requiring source isolation precautions should be admitted or transferred to a single room (preferably with en-suite facilities) and the precautions outlined in this policy enforced. In the event of a single room being unavailable for one of the following reasons, it will be necessary to carry out source isolation precautions in the bay: o Single rooms already contain patients with infections that pose a higher risk than the patient requiring a single room o Patient requiring source isolation have had a risk assessment and are deemed to be unsuitable/unsafe to be nursed in a single room o Cohort nursing is required, when several patients with the same signs and symptoms require source isolation. Usually due to an outbreak or an increased incident. – see Increased incident/outbreak policy (need to make sure we have the correct name of the policy). If a single room is not available or not suitable, a risk assessment must be carried out by the clinician or nurse caring for the patient. The outcome of the risk assessment must be documented in the patient’s clinical records. The Infection Control team must be informed of the outcome of the risk assessment as soon as possible. Management of a patient requiring source isolation precautions 7 The risk assessment will ensure, wherever possible, that only patients presenting the least cross infection risk to others will be cared for in the main ward area using source isolation precautions and procedures. Where source isolation precautions are carried out within the bay the procedure must be followed in the same way as for a patient in a single room. The infection control team must be informed of patients requiring source isolation as soon as practical by telephone. The source isolation form (see Appendix 1), must also be completed and displayed. Upon commencement of source isolation precautions, the nurse responsible for the patient should explain to the patient and relatives the reason for source isolation precautions, what special measures and procedures will be taken, and any patient/visitor restrictions. Environment and Equipment Unnecessary furniture and equipment should be removed from the single room or the bed space before admitting the patient. If a patient is nursed in a single room, the room should contain:o o o o o Hand wash basin Wall mounted liquid soap. Paper hand towels in wall mounted dispenser. A foot operated pedal bin for clinical waste 'Sharps' bin for disposal of sharps if required and if safe to do so (if unsafe to leave in the room the sharps bin should be decontaminated after each use on removal from the room). o Thermometer, sphygmomanometer and stethoscope if required. o Allocated manual handling equipment if required o Allocated commode if en-suite facilities not available. The commode should not be used/left by the patient’s bedside unless absolutely necessary and a risk assessment should then be done. Wherever possible patients should have dedicated equipment when source isolation precautions are being carried out. If this is not possible the equipment must be cleaned and decontaminated appropriately in between use. The patient’s charts and notes must not be taken into the room. A trolley must be placed outside the room if appropriate (for that area) containing: o o o o o Clinical waste bag (for double bagging all waste) Gloves and aprons (masks and goggles if applicable) Alcohol hand sanitiser Linen bags (Refer to Linen Policy) Waste tie tags Management of a patient requiring source isolation precautions 8 Other additional items should not be stored on the trolley If the patient is being isolated in a bay area the following equipment must be available at the bedside on a trolley: o Clinical waste bag (for bagging all waste and then must be taken to clinical waste bin for double bagging) o Sharps bin if required and safe to do so (if unsafe to leave on the trolley the sharps bin must be decontaminated after each use on removal from bed space o Gloves and aprons (masks and goggles if applicable) o Alcohol hand gel o Linen bags (red hot water-soluble inner, white plastic outer) o Waste tie tags The bay must also contain: o Hand wash basin o Wall mounted liquid soap o Paper hand towels in wall mounted dispenser The patient should be allocated a toilet specific for their use whilst they are receiving source isolation precautions. If a toilet cannot be allocated for the patient then a commode must be allocated for the patient but this is not to be used at the patient’s bedside but the commode must be taken to a toilet area. The commode must be cleaned and decontaminated after use. Following all care with a patient and after removal of PPE which is to be disposed of at the bedside or within the room of a patient receiving source isolation precautions hands must be immediately washed with soap and water within the single room or at the hand wash basin within the bay and then hands immediately disinfected with hand sanitiser. If it is deemed unsafe to have paper towels in the bay or single rooms, and therefore immediate hand washing is prohibited, a risk assessment must be undertaken to indicate this and documented in the patients notes. In this instance alcohol sanitiser should be used to decontaminate hands in the first instance by staff at the bedside, then washed with liquid soap and water at the nearest hand-wash basin, dried then followed by disinfection with hand sanitiser. All hand wash basins should have elbow operated taps. In the event that taps are not elbow operated, taps should be turned off using a clean paper hand towel. Hand hygiene Hand hygiene, is imperative before and after clinical contact with the patient, contact with body fluids, and after cleaning contaminated equipment or the environment. Cuts or abrasions on the hands of staff should be covered with waterproof dressings. Please refer to LPT Infection Prevention and Control Policy for Hand Hygiene in Community Health Services, Inpatient Facilities and Primary Care Infection Prevention and Control Management of a patient requiring source isolation precautions 9 Personal Protective Equipment (PPE) PPE is used to protect both the patient and the healthcare worker from the potential risks of cross infection. Uniforms are not classed as PPE. The table below identifies what items of PPE should be used and when it is appropriate to be used. The appropriate colour coding for the use of PPE should be used and followed at all times. Apron Disposable plastic Gloves Disposable, non-sterile nitrile Eye protection and surgical mask or Full face visor Disposable or re-processable Aprons should be worn by all staff having any direct contact with the patient and or the environment Gloves must be worn by all staff having any direct contact with the patient and/or the environment Any procedure which may generate aerosols e.g. suction or any procedure that may produce splashing of blood and other body fluids e.g. urinary catheters, sampling of urine Disposable PPE is used once only and is removed immediately before leaving the room or bed space and placed directly into the clinical waste bag. Hands should then be decontaminated thoroughly. Please refer to LPT Infection Prevention and Control Policy for Personal Protective Equipment. Waste Disposal All categories of waste from the isolated areas must be treated as clinical waste and when disposed of, be double bagged using clinical waste bags. Bags must not be more than two-thirds full and they must be tied securely. Double bagging is carried out as follows using two clinical waste bags. The first or 'inner' bag is kept in the isolation room in a bin. When this is two-thirds full the bag is tied securely. The nurse in the area where source isolation is being undertaken should place the bag in the second or ‘outer’ bag held by a second nurse outside the room or bed space area who must be wearing a disposable plastic apron and nitrile gloves. The second nurse then seals the bag securely, and immediately places it for collection in the designated waste holding area. If there is no second nurse available, place the waste bag at the door, take off and dispose of the PPE as per policy. Wash hands and decontaminate using alcohol sanitiser as per policy. Put on new PPE and dispose of waste as above. Please refer to the LPT Infection Prevention and Control policy for the Management of Waste. Management of a patient requiring source isolation precautions 10 Sharps Sharps bins if kept in the room where source isolation is being undertaken, or kept on the trolley if the patient is nursed in a bay area need to be terminally locked and wiped, if it is full to the designated fill line as marked on the outside of the sharps bin (or when it is no longer required by the patient, whichever is the sooner), with Chlorclean before removal from the area. Please refer to the LPT Infection Prevention and Control Policy for the Management of Sharps and Exposure to Blood Borne Viruses in Community Health Services, Inpatient Facilities and Primary Care. Linen Excessive wafting of bed sheets during bed making must be avoided. All used hospital linen should be placed into a red soluble inner bag and then placed into a red outer plastic bag. Patients’ Own Clothing and Bed Linen Patients’ own clothing and bed linen if used should be sent home with relatives wherever possible. It should be kept in the patient’s room until it is collected, in a non-permeable bag/container. This should take place as soon as possible and relatives need to inform the ward staff if there is a delay. Staff need to ensure that relatives are aware that there is patients own clothing and linen awaiting collection. If the dirty linen cannot be collected then the patient will need to use the hospital linen. In the event that there are no relatives or carers who are able or willing to launder a patient’s own clothing it should be laundered on site if possible. Such items must be bagged in a red soluble bag and then placed into a blue plastic outer patient’s bag before being transported to the laundry area. If there are no on site laundry facilities available, patient’s clothing may be sent to the main laundry with consent from the patient or their family if appropriate and be clearly marked with the patients name and location. If any garments have a detachable belt this should also be clearly labelled. Ensure that the marking will withstand numerous washes. Manual sluicing, soaking or hand washing of soiled items must never be carried out. A sluice cycle or cold pre-wash via the washing machine must be used for all soiled items. Any solid matter, i.e. faeces must be removed prior to this in the appropriate toilet receptacle sluice hopper. PPE must be worn at all times when carrying out this task. Permission must be sought from the patient or their family when appropriate prior to defacing their personal belongings by labelling it. Crockery and Cutlery Disposable crockery and cutlery is not required providing an automatic dishwasher is used to clean the crockery and cutlery, (manual washing of the crockery must not Management of a patient requiring source isolation precautions 11 take place). Crockery and cutlery can be adequately decontaminated in a dishwasher with a final rinse temperature of 80C. The crockery and cutlery does not need to be washed separately to other crockery and cutlery. Food may be delivered to patients in isolation using a tray. After the meal, the crockery, cutlery, leftovers and tray are placed directly into the trolley. PPE must be worn and hands decontaminated following removal of PPE as per LPT policy. Jugs, glasses, cups and saucers should be returned to the unit`s main kitchen and be washed immediately in the automatic dishwasher. Equipment Patient dedicated equipment must be used when available. All equipment brought into the room or bed space must be cleaned and disinfected between uses and upon removal from the room or bed space. Please refer to LPT Infection Prevention and Control Policy for Cleaning and Decontamination in Community Health Services, Inpatient Facilities and Primary Care. Management of Body Fluids Toilets/Commodes Patients should use the toilets in the room where they are receiving source isolation precautions wherever available. A toilet/commode specifically designated for the patient should be used if there are no en-suite facilities or the patient is unable to use them If a patient who is receiving source isolation precautions within a bay area a toilet should be designated for the sole use of the patient whilst they are receiving source isolation precautions. If this is not able to be facilitated a risk assessment must be completed and held within the patients notes. The toilet must be cleaned and decontaminated between each use. A commode should not be used or left at the bedside of a patient who is receiving source isolation precautions within bay areas. The maintenance of the patient’s privacy and dignity is imperative where it is safe and reasonable to do so. This will also support the prevention of spores being displaced throughout the bay environment. If a commode has to be used at the patient’s bedside for safety reasons then a risk assessment must be completed and held within the patient’s notes. Consideration must be given to the other patients within a bay who are at risk of spores that may be dispersed whilst a patient is using a commode at the bedside. Management of a patient requiring source isolation precautions 12 Disposable Bedpans and Urinals A bedpan carrier should be designated for the sole use of the patient undergoing source isolation precautions and not used for other patients. After use, the covered bedpan and carrier or urinal is to be disposed of; the nurse must remove and dispose of PPE as per policy, wash hands and decontaminate using alcohol sanitiser as per policy. Put on new PPE and dispose of bedpan. Disposable items are placed into the macerator, care being taken not to contaminate the outside of the machine. The bedpan carrier should be cleaned and disinfected with Chlor-clean. Remove PPE, clean and decontaminate hands. If the macerator is not available for use, the contents of the bedpan/urinal within the disposable liner should be solidified using a solidifying gel, the liner and contents should then be double bagged and disposed of as clinical waste. Non disposable Bedpans and Urinals Where there is no access to an automatic washer, the contents of the bedpan/urinal should be solidified using a solidifying gel. The solidified contents can then be double bagged and disposed of as clinical waste. The bedpan or urinal should be cleaned and disinfected with Chlor-clean. Staff must wear PPE including face/eye protection carrying out this task Disposal of Urinary Catheter bags Following disconnection of the catheter bag, empty the contents of the bag directly into the toilet if en-suite facilities are available. Where these facilities are not available, the contents of the catheter bag must be emptied into a urinal and disposed of as above. The empty catheter bag can then be disposed of directly into the clinical waste bag. PPE must be worn during the procedure, including face protection if deemed appropriate. Disposable Vomit bowls Disposable items are placed into the macerator, care being taken not to contaminate the outside of the macerator and surrounding area. Chlor-clean is to be used to clean and decontaminate the macerator. PPE must be worn as per LPT policy, face protection to be worn id deemed appropriate. If the macerator is not available for use, the contents of the vomit bowl within the disposable liner should be solidified using a solidifying gel, the liner and contents should then be double bagged and disposed of as clinical waste. Management of a patient requiring source isolation precautions 13 Cleaning of single rooms and bed spaces where source isolation precautions are taking place. All staff are responsible for seeing that the room or bed space is kept clean and tidy at all times. The domestic staff must be informed that source isolation precautions are required. All isolation rooms or bed spaces must have one full clean in the morning and one check-clean in the afternoon to check general cleanliness and waste bins and action accordingly. Chlor-clean must be used to clean and decontaminate the room or bed space and environment. A designated mop and bucket must be allocated to each patient requiring source isolation. Cleaning cloths must be disposable. (Cleaning materials must be in line with the national colour coding requirements) Only necessary equipment should be kept inside the room or around the bedside. This will facilitate effective cleaning and decontamination procedures. Communal bath and shower rooms must be thoroughly cleaned and disinfected using Chlor-clean immediately after use by a patient with a known or suspected infection. Discharge/Terminal/Post Infection Cleaning of Room or bed space and Furniture All staff must wear PPE when undertaking cleaning activities. Hands must be decontaminated following the removal of PPE. After discontinuing source isolation the area and equipment must be cleaned and decontaminated. If the patient is to remain in the room following the discontinuation of source isolation precautions the room or bed space must still undergo a discharge/terminal/post infection clean. Curtains should be removed and double bagged as infected linen, prior to cleaning and disinfecting the room or bed space. Once cleaning and disinfection of the room or bed space is completed clean curtains should be hung. Clean and disinfect all surfaces with Chlor-clean. Mop-heads should be machinewashable or disposable. The mop handle and bucket should be cleaned, disinfected and dried using Chlor-clean. Cloths used for cleaning must be disposable, and be disposed of as clinical waste. Cleaning or disinfection of walls or ceiling is only required if visibly contaminated or at the discretion of the Infection Control Team. Any dressings, bandages etc., information, such as menus, ward welcome packs and paperwork etc. that is left in a patients room following discharge that cannot be cleaned and decontaminated must be disposed of.(Note this list is not exhaustive). Management of a patient requiring source isolation precautions 14 Unused Pharmaceutical Products Unused medications from isolation rooms should be placed into a clear disposable plastic bag, labelled “Source isolation” and then returned to Pharmacy in the usual way. Visits to other departments When patients who are receiving source isolation precautions need to visit other departments within a community hospital, the ward where the patient is located must contact the department to ensure appropriate precautions are can be taken. Arrangements should be made to minimise any delay and possible contact with other patients en route as well as in the visiting department. Any unnecessary equipment must be moved out of the room wherever possible prior to the patient visiting. If not possible it should be covered with a disposable or washable cover. Areas where patients with known infections are likely to need to visit should not be used as routine storage areas for equipment. All equipment within the department, whether used or not by the patient should be cleaned and decontaminated after the patient has visited the area unless it is covered beforehand. Porters, nursing and other staff should wear protective equipment only when in direct contact with the patient. This is not necessary when escorting the patient through the hospital. After use the trolley or wheelchair must be cleaned and disinfected with Chlor-clean. The ambulance liaison officer should be told when patients requiring source isolation precautions are transferred to another hospital for investigations or as potential inpatients and should be informed of the transit precautions required. The receiving hospital department must also be told of the need for source isolation precautions. The transferring ward will need to complete the Essential Steps Inter-healthcare infection control transfer form (Appendix 2). Cleaning and decontamination of the environment is essential to prevent transmission of potentially pathogenic organisms. The environment and any equipment within the area, unless covered must be cleaned and decontaminated appropriately. Visiting arrangements Patients in source isolation may be visited by family and friends. Hands should be thoroughly washed by all visitors inside the room/bay and alcohol hand sanitiser used outside the room/bay. Visitors do not routinely need to wear PPE. However advice must be provided by staff caring for the patient. For example, if relatives are involved with direct patient care, they should then wear disposable gloves and aprons, removing them after use Management of a patient requiring source isolation precautions 15 and placing them in to clinical waste, then washing their hands with soap and water before decontaminating them with alcohol sanitiser. If there is an increased incident of diarrhoea and/or vomiting then single use disposable aprons must be worn by visitors when they visit, whether they are giving direct care or not. It is the responsibility of the nursing staff to advise patients and relatives of this if it is appropriate. 5.2 Patients in their own Homes Patients who are being cared for in their own home do not pose as great a risk to others as within the healthcare environment. This is due to the fact that they are not usually nursed in an environment with other susceptible individuals. However standard precautions must still be used for patients with a known infection. When visiting patients who are suspected of infection in their own home then a good standard of infection prevention and control precautions must be maintained to prevent carriage of transient organisms between patients. All practices identified for caring for a patient in an inpatient area including; hand hygiene, use of personal protective equipment and cleaning of equipment (belonging to LPT) must be adhered to for patients in their own homes. Carers and / or relatives caring for someone with an infection should be encouraged / advised: 5.3 Disposal of Infected Cadavers Please refer to LPT Infection Prevention and Control Policy for the Patient who has died (Cadaver) in Community Inpatient Facilities. 5.4 Patients for whom admission to an acute hospital is required: a) Isolation facilities within the Community inpatient units are inadequate for the patient’s condition (i.e. the patient requires negative pressure ventilation) b) Where STRICT isolation is required see table below. Where it has been deemed necessary to transfer a patient to the acute sector the medic involved with the patient needs to discuss in the first instance transfer details with the appropriate consultant within the acute hospital. In most cases, although not all this is likely to be a consultant within the infection diseases unit at UHL, LRI hospital. Please contact the infection control team if you require any advice regarding this. Arranging admission to the Infectious Diseases Unit Admission to the Infectious Diseases Unit is arranged by telephoning the Senior House Officer or Consultant via Leicester Royal Infirmary, University Hospitals of Leicester inpatient facilities. Management of a patient requiring source isolation precautions 16 5.5 Conditions requiring source isolation precautions or no isolation precautions, and period of isolation DISEASE OR INFECTING AGENT PRECAUTIONS REQUIRED Abscess Aetiology unknown & draining Auto Immune Deficiency Syndrome (AIDS) See Human Immunodeficiency Virus (HIV) Amoebiasis Dysentery Liver abscess Anthrax Cutaneous Ascariasis Aspergillosis Botulism Bronchiolitis None (unless microbiological isolate indicates) Bronchitis Adults Infants & young children None Source ROUTE OF INFECTION PERIOD OF ISOLATION See advice for relevant organism Faecal - oral Source None Source Contact None None None Source Airborne Management of patients with Source Isolation RISK FACTORS Airborne Diarrhoea Clinical recovery – 48 hours free from diarrhoea and passed a formed stool or discharge home Until completion of successful treatment Cough/ Clinical recovery or discharge home Productive sputum Cough/ Clinical recovery or discharge home Productive sputum 17 Brucellosis Campylobacter Gastroenteritis None Source Faecal - oral Diarrhoea Clinical recovery – 48 hours free from diarrhoea and passed a formed stool or discharged Candidiasis Clostridium Difficile (CDT) None Source Faecal - oral Diarrhoea Clinical recovery - Until free from diarrhoea for 48 hours and has passed a formed stool Leaking vesicles All lesions scabbed Diarrhoea Clinical recovery – 48 hours free from diarrhoea and passed a formed stool or discharge home Gastroenteritis Cellulitis Intact skin Exudating Chickenpox (Varicella Zoster) Cholera Gastroenteritis Creutzfeld Jacob Disease (CJD) Common cold Adults Infants & young children None None (unless microbiological isolate indicates) Source Source None None Source See advice for relevant organism Contact/ respiratory Faecal - oral Care for specific invasive procedures. See Guidelines for the Management of CJD Respiratory Cough/ Productive sputum Clinical recovery or discharge home Management of a patient requiring source isolation precautions 18 Conjunctivitis Neonatal (not a sticky eye) Croup Source Contact 24 hours of appropriate antibiotic therapy Source Respiratory Clinical recovery or discharge home Cryptococcosis Cryptosporidiosis Gastroenteritis None Source Faecal - oral Diarrhoea Clinical recovery –48 hours free from diarrhoea and has passed a formed stool, or discharged Cytomegalovirus None Dengue Source Mosquito Bite Dependent on clinical assessment Diarrhoea and/or vomiting Source Faecal - oral Contact with body fluids Diarrhoea/ Vomiting Dysentery Shigella Source Faecal - oral Diarrhoea E-coli Source Faecal - oral Diarrhoea Encephalitis None Enterobiasis Source Faecal - oral Until completion of treatment Epiglottitis Source Respiratory Epstein Barr virus Source Respiratory 24 hours of appropriate antibiotic treatment 2 weeks after onset of symptoms Erysipelas Source Contact 24 hours of antibiotic treatment Clinical recovery –48 hours free from diarrhoea and/or vomiting and the patients has passed a stool that is normal for them or a formed stool or until a noninfectious cause has been established or patient discharged Clinical recovery – 48 hours free from diarrhoea and passed a formed stool Clinical recovery – 48 hours free from diarrhoea and passed a formed stool Management of a patient requiring source isolation precautions 19 Gas Gangrene German measles (Rubella) Glandular Fever (Infectious Mononecleosis) Gonorrhoea None Source Respiratory 5 days from onset of rash Source Respiratory 2 weeks after onset of symptoms Haemophyllis Influenza Source Respiratory Hand, foot and mouth disease Source Contact Human Immunodeficiency Virus (HIV) Risk factors present No risk factors present Hepatitis A (HAV) Risk factors present No risk factors present None Cough/ Productive sputum Lesions Clinical recovery or discharge home Contact Open wounds, lesions risk of bleeding Dependant on clinical assessment Contact Ingestion of food,water or other objects contaminated with faecal matter from an infected person (even in microscopic amounts) Sex with an infected person Dependant on clinical assessment Clinical recovery or discharge home Source None Source None Management of a patient requiring source isolation precautions 20 Hepatitis B (HBV) Risk factors present No risk factors present Hepatitis C (HCV) Risk factors present No risk factors present Influenza (Pandemic) Contact Open wounds, lesions, risk of bleeding Dependant on clinical assessment Contact Open wounds, lesions, risk of bleeding Dependant on clinical assessment Respiratory/ contact Sputum generating procedures 7 days from clinical onset or clinical recovery Source None Source None Source Legionnaires None Leprosy Smear positive Smear negative Source None Respiratory/ Contact Leishmaniasis Leptospirosis None None Source Contact Listeriosis Lyme disease Malaria Measles None None None Source Respiratory 5 days from onset of rash Meningitis Confirmed or suspected Viral Source Source Respiratory Respiratory 24 hours of appropriate antibiotic treatment Length of acute illness Head Lice Negative smears Prolonged contact Prior to treatment and following 24 following anti-louse treatment Management of a patient requiring source isolation precautions 21 Molluscum contagiosum Source Contact Until after appropriate treatment Mumps MeticillinResistant Staphylococcus Aureus (MRSA) High risk areas Low risk areas Risk factors present No risk factors present Mycobacteria (atypical) Necrotising Fasciitis Strep. pyogenes Nocardia Source Respiratory 10 days from onset Source Source Source None None Contact Contact Contact Source Contact None (source for oncology & transplants) Source Clinical Recovery Faecal - oral Diarrhoea Source Respiratory Cough None Source Respiratory Paratyphoid fever & carriers Pertussis (Whooping cough) Pharyngitis Adults Infants & young Children Productive cough, Heavily exudating wounds, heavily exfoliating skin Three consecutive negative screens Control of Infection Guide If risk factors are present or 3 consecutive negative screens 24 hours of antibiotic treatment Clinical recovery – 48 hours free from diarrhoea and passed a formed stool Clinical recovery Clinical recovery Management of a patient requiring source isolation precautions 22 Pneumonia Children Adults Poliomyelitis Source None Respiratory Cough Source Faecal - oral Diarrhoea Psittacosis Puerperal sepsis Source Source Respiratory Contact Rabies Strict Immediate transfer to Infectious Diseases Unit Source Contact with secretions/body fluids 7 days from onset 24 hours of appropriate antibiotic treatment Until decision by Infection Control Doctor/Infectious Diseases Consultant/CCDC Respiratory Until Discharge home Respiratory 5 days from onset of rash For at least one month after delivery Respiratory Contact Until clinical recovery Respiratory syncytial virus Ringworm Rubella Acquired Congenital Sudden Acute Respiratory Syndrome (SARS) Salmonella None Source Source Strict Immediate transfer to Infectious Diseases Unit Source Faecal - oral Diarrhoea Until Discharge home Unless advised by microbiology/Infection Control Team 7 days from onset of diarrhoea Clinical recovery – 48 hours free from diarrhoea and passed a formed stool Management of a patient requiring source isolation precautions 23 Scabies Classical (Atypical) Norwegian (Crusted) Source Source Contact Contact Scarlet fever Source Shingles (Herpes Zoster) Source Respiratory Contact Contact Shigella Source Faecal - oral Strep. pyogenes (Group A Streptococcal Infection includes Necrotising fasciitis) Syphilis Source Contact Source (if risk factors are present) None None Contact Tapeworm Tetanus Threadworm Tonsillitis Children Toxoplasmosis None Source Respiratory Until completion of 2 courses of treatment 2 weeks apart Repeat treatment may be necessary Discuss with Dermatologist/ 24 hours of antibiotic treatment Leaking vesicles Care by staff if have no immunity (See Guidelines on Staff Health Diarrhoea All lesions scabbed over Clinical recovery - 48 hours free from diarrhoea and passed a formed stool 24 hours of appropriate of antibiotics Weeping lesions Until lesions are dry Until Clinical Recovery None Management of a patient requiring source isolation precautions 24 Tuberculosis Pulmonary/Milliary Smear Negative, Smear Positive, Multidrug Resistant TB Admit to Single room Respiratory Productive cough Until Agreement between clinician and Control of Infection Officer Please refer to LPT Infection Prevention and Control Policy for the Management of Tuberculosis in Community Facilities, Inpatient Facilities and Primary Care. Typhoid fever and Source Faecal - oral Diarrhoea Clinical recovery Carriers Vancomycin Source Contact Diarrhoea After consultation with the Infection Resistant None Urinary Catheter Control Team Enterococci (VRE) Wounds With risk factors Central lines No risk factors Varicella zoster (Chicken pox) Vomiting Source Viral gastroenteritis Faecal - oral Diarrhoea/ vomiting Until free from diarrhoea for 48 hours and has passed a formed stool Viral Haemorrhagic Fever (Lassa fever, Marburg fever, Ebola fever, Crimean) Strict High security and transfer to Infectious Diseases Unit Source Respiratory contact Until decision by Infection Control Doctor/Infectious Diseases Consultant/ Respiratory Clinical recovery Yellow fever Source Contact/Respirat ory Contact Faecal - oral Leaking vesicles All lesions scabbed Clinical recovery or non-infectious cause established None Management of a patient requiring source isolation precautions 25 6.0 Training There is a need for training identified within this policy. In accordance with the classification of training outlined in the Trust Human Resources & Organisational Development Strategy this training has been identified as mandatory and role development training. The course directory e source link below will identify: who the training applies to, delivery method, the update frequency, learning outcomes and a list of available dates to access the training.http://www.leicspart.nhs.uk/Library/AcademyCourseDirectory.pdf A record of the event will be recorded on Ulearn as appropriate. The governance group responsible for monitoring the training is the Infection Prevention and Control Committee and Quality Assurance Committee. Management of Patients requiring source isolation 26 7.0 References and Associated Documents Department of Health: The Health and Social Care Act Code of Practice for Health and Adult Social Care on the Prevention and Control of Infections and related guidance (2008) Department of Health (2010) Health Protection Legislation (England) Guidance 2010. Health Protection Regulations. London. Department of Health: Essential Steps to Safe Clean Care (2007) Health and Safety at Work Act 1974 Health and Social Care Act 2012 National Resource for Infection Control – www.nric.org.uk LPT policies via intranet. The website can be accessed at http://www.leicspart.nhs.uk/ Management of a patient requiring source isolation precautions 27 Appendix 1 SOURCE ISOLATION PRECAUTIONS FOR IN-PATIENT FACILITIES Visitors: Before entering the room please speak to the nurse looking after the patient All staff: Before entering the room and having contact with the patient or any items in the room you MUST Wear disposable gloves Wear a disposable plastic apron All visitors and staff please wash your hands before leaving the room. ----------------------------------------------------------- Management of a patient requiring source isolation precautions 28 Appendix 2 Transfer Letter/Inter-Healthcare Transfer Form From: To: Date: Transferring facility e.g. ward, care home etc.: Receiving facility e.g. hospital, ward, care home, district nurse etc.: PATIENT DETAILS Name: Address: G.P. Date of Birth:-…………………………………………… NHS Number:-…………………………………………. NEXT OF KIN:Aware of admission: Yes REASON FOR ADMISSION:- No PAST MEDICAL HISTORY/ ALLERGIES CURRENT MEDICATIONS GP/DOCTOR/CONSULTANT- CLINICAL SUMMARY OF TREATMENT Print Name on completion: Contact No: Date: NURSING SUMMARY:(Activities of daily living) Print name on completion: Contact No: Date: Management of a patient requiring source isolation precautions 29 MULTIDISCIPLINARY TEAM ONGOING ACTIONS AND PLANS (Aids/ equipment used) DETAILS OF CURRENT CARE PACKAGE Who Medication Aid: Yes Approximate Weight:- When DNAR order in place within LPT Form sent with patient: Frequency No Contact Type:……………………………… Yes No Yes No 100% Continuing Health Care Funding Yes No Waterlow Score:INTER-HEALTH INFECTION CONTROL INFORMATION:Is this patient an infection control risk? (please tick the most appropriate box and give confirmed or suspected organism) Confirmed risk Organism……………………………………………………………………………………… … Suspected risk Organism:……………………………………………………………………………………… … No known risk Organism:……………………………………………………………………………………… … Patient exposed to others with infection (e.g.: D&V) Yes No If patient has diarrhoeal illness, please indicate bowel history for last week:(Assessed with Bristol Stool Chart) Is the diarrhoea thought to be of an infective nature? Yes Management of a patient requiring source isolation precautions No 30 Relevant specimen results (including admission screens – MRSA, glycopeptideresistant enterococcus SPP, C. Difficile, multi-resistant Acinetobacter SPP) and treatment information, including antimicrobial therapy: Specimen: Date: Result: Treatment information: Other information: Is the patient aware of their diagnosis / risk of infection? Yes No Yes No Does the patient require isolation? (please inform the receiving area in advance) Is the Infection Control Nurse aware of the transfer? If no why not? Is EMAS aware of the transfer? Print Name on completion: Contact No: Yes Yes No No : Date: Management of a patient requiring source isolation precautions 31