Download Appendix C: Information for Staff

Viral Diarrhoea and Vomiting
Prevention and Management Policy
Version
1
Name of responsible (ratifying) committee
Infection Prevention Management Committee
Date ratified
28 January 2015
Document Manager (job title)
Dr Caroline Mitchell - Head of Infection Prevention
Date issued
03 February 2015
Review date
01 February 2017
Electronic location
Infection Control Policies
Related Procedural Documents
Isolation Policy, Hand Hygiene Policy, Standard
Precautions Policy
Key Words (to aid with searching)
Norovirus, Rotavirus, Adenovirus, Viral Gastroenteritis,
Diarrhoea, Vomiting, Outbreak
Version Tracking
Version
Date Ratified
Brief Summary of Changes
Author
1
28/01/2015
Replaces Management of Outbreaks of Viral Diarrhoea
and Vomiting version 3
IPCT
Viral Diarrhoea and Vomiting Prevention and Management Policy
Version: 1
Issue Date: 03 February 2015
Review Date: 01 February 2017 (Unless requirements change)
Page 1 of 14
CONTENTS
1. INTRODUCTION ......................................................................................................................... 4
2. PURPOSE ................................................................................................................................... 4
3. SCOPE ........................................................................................................................................ 4
4. DEFINITIONS .............................................................................................................................. 4
5. DUTIES AND RESPONSIBILITIES.............................................................................................. 5
6. PROCESS ................................................................................................................................... 5
7. TRAINING REQUIREMENTS ...................................................................................................... 9
8. REFERENCES AND ASSOCIATED DOCUMENTATION ............................................................ 9
9. EQUALITY IMPACT STATEMENT ............................................................................................ 10
10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS ........................................ 11
Appendix B: Information for Staff ...................................................................................................... 13
Appendix C: Information for Staff ...................................................................................................... 14
Control measures for minimising transmission at ward level ............................................................. 14
Viral Diarrhoea and Vomiting Prevention and Management Policy
Version: 1
Issue Date: 03 February 2015
Review Date: 01 February 2017 (Unless requirements change)
Page 2 of 14
QUICK REFERENCE GUIDE
For quick reference the guide below is a summary of actions required. This does not negate the
need for the document author and others involved in the process to be aware of and follow the
detail of this policy.
1. Staff must critically assess all cases of diarrhoea and/or vomiting to determine the cause. This
may include underlying conditions, recent anaesthetic, antibiotics, laxatives, feeding regimen etc.
2. If the onset of diarrhoea and/or vomiting is sudden and the symptoms are not clearly attributable
to an underlying condition or therapy the patient must be isolated. Do not wait for further episodes
of diarrhoea and/or vomiting before isolating.
3. Patients with suspected viral diarrhoea and/or vomiting should be isolated within two hours of
onset of symptoms, preferably in a room with an en-suite toilet and washing facilities. If an en-suite
is not available a commode should be provided for their sole use. It is not acceptable to leave a
patient with suspected viral diarrhoea and/or vomiting in an open ward.
Where no suitable single room is available in the immediate clinical area, staff should escalate to:
i. Specialty flow coordinator (then)
ii. Duty hospital manager (then)
iii. (On-call) Infection Prevention Team
4. Any member of staff experiencing symptoms of diarrhoea and/or vomiting must stay away from
work until two days after symptoms fully resolve.
5. A potential outbreak is classified as two or more cases of unexplained diarrhoea (type 6/7) and/or
vomiting affecting patients or staff in a clinical area over a 48-hour period. Factors that may indicate
an outbreak is occurring:
 Generally both staff and patients are affected
 Symptom are of rapid onset (particularly nausea)
 Vomiting (often projectile) can occur in more than 50% of cases
 There is an incubation period of 15- 48 hours.
6. Effective communication is essential at all times during a suspected or confirmed outbreak. If you
require advice please contact:
In hours: The Infection Prevention and Control Team (IPCT) on the Clinical Lead Bleep (0064)
Out of Hours (inc. weekends): The IPCT via the main hospital switchboard.
7. The following immediate control measures must be implemented by clinical staff if an outbreak of
viral gastroenteritis is suspected (full list of actions see section 7.5):
 Isolate symptomatic individuals immediately and keep all bay and side room doors closed
 Wear gloves and apron for contact with an affected patient or environment
 Wash hands with soap and water after contact with an affected patient / environment / PPE
 Do not use alcohol hand rub to decontaminate hands
 Remove all exposed food e.g. fruit from lockers etc. and de-clutter all areas
 Provide fresh drinking water and encourage regular sips of fluid for affected patients
 Use a chlorine-based agent (Difficil-S or 1000ppm Actichlor plus) to disinfect all surfaces
and touch points e.g. door handles, bed rails, tables, chair handles at least twice daily
 Clean and disinfect vomit and faeces spillages promptly
 Use clear signage to alert staff and visitors that they are entering a restricted area (Appendix
B) and emphasise hand hygiene before and after visiting patients
 Avoid transfer of patients and staff to unaffected wards or departments (unless medically
urgent or for the specific purpose of isolation after consultation with IPCT)
Viral Diarrhoea and Vomiting Prevention and Management Policy
Version: 1
Issue Date: 03 February 2015
Review Date: 01 February 2017 (Unless requirements change)
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1. INTRODUCTION
The most common causes of infectious viral diarrhoea and/or vomiting are Noroviruses, followed
by Adenoviruses and Rotaviruses.
Norovirus accounts for at least 50% of all viral gastroenteritis outbreaks worldwide1,2 and can be
detected throughout the year. An estimated 600,000 to one million people contract Norovirus
annually in the UK, mainly in their own homes. Approximately 3000 people a year are admitted to
hospital with Norovirus in England. The Hospital Norovirus Outbreak Reporting System (HNORS)
in England estimate that, on average, reported outbreaks are associated with 13,000 patients and
3,400 staff becoming ill, 8,900 days of ward closure and the loss of over 15500 bed-days,
annually3 with a cost to the NHS in excess of £100 million per annum in years of high incidence.4,5
2. PURPOSE
This Policy defines the actions taken by the Trust to ensure prompt recognition of viral diarrhoea
and/or vomiting and to reduce the risk of transmission of infection by reducing the movement of
the patient and contacts and preventing cross infection within the healthcare environment.
3. SCOPE
This policy applies to all PHT Healthcare workers (HCW), including agency, bank and locum staff,
Carillion staff including porters and house-keepers and visiting Health and Social Care Workers
from other organisations.
‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that
it may not be possible to adhere to all aspects of this document. In such circumstances, staff
should take advice from their manager and all possible action must be taken to maintain
ongoing patient and staff safety’
4. DEFINITIONS
Adenovirus: Types 40 and 41 cause gastroenteritis especially in children under the age of two.
The virus is transmitted by the faecal-oral route with an incubation period of 3-10 days. The illness
lasts approximately one week. Diarrhoea is more prominent than vomiting or fever, and respiratory
symptoms are often present. Long-term immunity is acquired in childhood.
Diarrhoea and vomiting: Diarrhoea refers to type 6/7 stool on the Bristol Stool Chart. Any case of
diarrhoea or vomiting amongst patients or staff should be regarded as potentially infectious and
treated as such unless an infectious cause can be confidently excluded.
Norovirus: Norovirus has a small infective dose with an incubation period of 12 to 48 hours. Peak
viral shedding occurs between two to five days. The virus is transmitted by the faecal-oral route or
from contaminated surroundings. Occasionally food may be implicated in its transmission.
Symptoms are typically rapid onset nausea and vomiting (often projectile), followed by watery
diarrhoea. Symptoms persist for one to two days, and are generally mild but may be more serious
in the extremes of age or when other pre-existing disease is present. In the elderly population,
typical projectile vomiting frequently may not occur and the main symptoms are nausea and
diarrhoea. In the elderly or immuno-compromised, symptoms may continue for four to seven days.
Rotavirus: Is the most common cause of severe diarrhoea among infants and young children.
Immunity develops with each infection, so subsequent infections are less severe; adults are rarely
affected. The virus is transmitted by the faecal-oral route. Rotavirus gastroenteritis is
Viral Diarrhoea and Vomiting Prevention and Management Policy
Version: 1
Issue Date: 03 February 2015
Review Date: 01 February 2017 (Unless requirements change)
Page 4 of 14
characterised by vomiting, watery diarrhoea, and low-grade fever. The incubation period is around
two days. Symptoms often start with vomiting followed by four to eight days of profuse diarrhoea.
Rotavirus vaccine is now routinely offered to infants.
5. DUTIES AND RESPONSIBILITIES
All Trust employees, including agency, bank and locum staff, are responsible for performing
appropriate infection control practice. Any member of staff experiencing symptoms of diarrhoea
and/or vomiting must stay away from work until two days after symptoms fully resolve.
Effective communication is essential at all times during a suspected or confirmed outbreak. If you
require advice please contact:
In hours: The Infection Prevention and Control Team (IPCT) on the Clinical Lead Bleep (0064)
Out of Hours (inc. weekends): The IPCT via the main hospital switchboard.
Clinicians: diarrhoea and/or vomiting can be feature of many serious illnesses. It is essential that
clinicians assess each symptomatic patient for possible infectious causes and escalate suspected
infectious cases to the nurse in charge for isolation. Clinicians are also responsible for managing
patient’s hydration and underlying health conditions which may be affected by viral gastroenteritis
A&E / MAU / Direct Admissions: patients referred to hospital with symptoms of diarrhoea and /
or vomiting, particularly if there is a household history of other cases, should be admitted into an
isolation room
Patient Flow Managers: are responsible for facilitating rapid isolation of suspected or confirmed
cases of viral gastroenteritis and for following the advice of the IPCT
Wards: are responsible for assessing each case of diarrhoea and/or vomiting and making a risk
assessment over possible infectious causes. Suspected cases should be isolated immediately and
the IPCT informed if there are two or more cases amongst patients or staff. Ward staff are
responsible for the prompt cleaning and disinfection of patient equipment and areas contaminated
by vomit and faeces and the maintenance of hydration of affected patients.
IPCT: are responsible for ensuring staff are appropriately educated and supported to prevent
outbreaks, for managing suspected and confirmed outbreaks of viral gastroenteritis and for liaising
with the trust management during an outbreak
6. PROCESS
6.1 ACTION TO BE TAKEN IN RESPONSE TO AN INDIVIDUAL CASE OF DIARRHOEA AND/OR VOMITING
It is critical that staff assess all cases of diarrhoea and/or vomiting to determine the cause.
 Assess cause of diarrhoea and/or vomiting (including underlying conditions, recent
anaesthetic, antibiotics, laxatives, feeding regimen etc)
 If onset is sudden and the diarrhoea and/or vomiting is not clearly attributable to an
underlying condition or therapy the patient must be isolated
 Do not wait for further episodes of diarrhoea and/or vomiting before isolating
Patients with suspected viral diarrhoea and/or vomiting should be isolated within two hours of
onset of symptoms, preferably in a room with an en-suite toilet and washing facilities. If an ensuite is not available a commode should be provided for their sole use.
It is not acceptable to leave a patient with suspected viral diarrhoea and/or vomiting in an
open ward
Viral Diarrhoea and Vomiting Prevention and Management Policy
Version: 1
Issue Date: 03 February 2015
Review Date: 01 February 2017 (Unless requirements change)
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Where no suitable single room is available in the immediate clinical area, staff should escalate to:
i. Specialty flow coordinator (then)
ii. Duty hospital manager (then)
iii. (On-call) Infection Prevention Team
 Observe contacts for symptoms of viral gastroenteritis and isolate further cases as required
 Obtain an infectious clean of the vacated bed-space and implement touch point cleaning
(door handles, bed rails, chair arms, taps etc. in the vacated area
 Accurately record all episodes of diarrhoea and/or vomiting on VitalPAC.
6.2 ACTION TO BE TAKEN BY THE NURSE-IN-CHARGE IN A SUSPECTED OUTBREAK
A potential outbreak is classified as two or more cases of unexplained diarrhoea (type 6/7)
and/or vomiting affecting patients or staff in a clinical area over a 48-hour period
Factors that may indicate an outbreak is occurring
 Generally both staff and patients are affected
 Symptom are of rapid onset (particularly nausea)
 Vomiting (often projectile) can occur in more than 50% of cases
 There is an incubation period of 15- 48 hours.






Notify the IPCT (section 5) as soon as an outbreak is suspected
Isolate in single cubicles with transmission precautions the first cases
Accurately record all episodes of diarrhoea and/or vomiting on VitalPAC
Collect specimens for microbiological testing
Inform the Senior Nurse or bleep holder for unit/department
Inform the Duty Hospital Manager on bleep 118
Information required by the IPCT will include the following that should be recorded on the Ward
Symptom Monitoring Form (Appendix A):
 The number of patients and/or staff members affected.
 For each patient/member of staff, the date and time of onset and the symptoms.
 For each patient, any treatment e.g. antibiotics, laxatives, NG feeds etc. they are receiving,
and any confirmed microbiology results e.g. Clostridium difficile.
 The dates any stool specimens have been taken and the results if known.
 A stool specimen should be obtained from affected patients and sent for both M C & S and
virology.
Members of staff who become symptomatic while on duty should inform their manager and
contact the Occupational Health Service. They must leave the clinical area and Must Not return to
work until they have been symptom free for 48 hours. Catering staff must seek advice regarding
return to duty from the Occupational Health Service.
6.3 ACTION TO BE TAKEN BY THE IPCT IN A SUSPECTED OUTBREAK
The IPCT will conduct an immediate clinical assessment of the patients affected and the ward
area. Early, aggressive intervention is critical in breaking the chain of transmission and preventing
uncontrolled onwards spread.
Following assessment, the IPCT will determine the most appropriate course of action to protect
patients and the operational functioning of the hospital.
Viral Diarrhoea and Vomiting Prevention and Management Policy
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Review Date: 01 February 2017 (Unless requirements change)
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 NOT AN OUTBREAK: Symptoms are clearly attributable to non-infectious causes – no further
action and ward staff to monitor
 LOW POSSIBILITY OF AN OUTBREAK: Most symptoms clearly attributable to non-infectious
causes. Immediate isolation of patient(s) with suspicious symptoms and implementation of
enhanced cleaning and precautions, ward open to admissions, discharges and transfers
 HIGH POSSIBILITY OF AN OUTBREAK: Most symptoms are suspicious of, or attributable
infectious causes. Immediate isolation of patient(s) with suspicious symptoms and
implementation of enhanced cleaning and precautions, transfers from the ward may be
restricted.
6.4 ENHANCED OUTBREAK PRECAUTIONS AND WARD RESTRICTIONS
It may become necessary to place a ward under enhanced outbreak precautions and restrict the
movement of patients (transfers to other wards or care facilities) if the transmission rate (attack
ratio) is such that the safety of patients and staff is affected.
The decision to restrict the movement of patients must be made under the guidance of the IPCT.
Restricted movement will generally involve:
 No general transfer of patients to other wards in the hospital (unless for the purpose of
isolation or specific specialty treatment). This should not compromise the safety, efficacy or
quality of the patient’s care
 No discharge of patients receiving a package of care or to other institutions/healthcare
facilities (unless the patient has been in an unaffected area of the ward or the receiving
facility can implement isolation and barrier precautions
 The IPCT will determine if it is appropriate to admit patients to a restricted area.
Where patients can be safely discharged, this should be encouraged to reduce the potential
reservoir of patients and create space on the ward. Patients may be discharged to their own
homes, provided they are medically fit for discharge and have support.
The IPCT will request enhanced cleaning measures from the Carillion Help Desk when
appropriate.
6.5 CONTROL MEASURES TO BE PUT IN PLACE IF THE WARD IS UNDER ENHANCED OUTBREAK
PRECAUTIONS AND WARD RESTRICTIONS
 Isolate symptomatic individuals immediately - only cohort under the guidance of the IPCT
 Keep all bay and side room doors closed (when safe to do so)
 Wear gloves and apron for contact with an affected patient or environment
 Wash hands with soap and water after contact with an affected patient or environment (after
removing gloves and apron)
 Do not use alcohol hand rub to decontaminate hands
 Remove all exposed food e.g. fruit from lockers etc. and de-clutter all areas
 Provide fresh drinking water for all patients, dish washer jugs and cups and implement
intentional rounding for affected patients to encourage regular sips of fluid
 Use a freshly prepared chlorine-based agent (e.g. Difficil-S or 1000ppm Actichlor plus) to
disinfect all surfaces and touch points e.g. door handles, bed rails, tables, chair handles at
least twice daily
 Clean and disinfect vomit and faeces spillages promptly
 Consider use of antiemetics for patients with vomiting
 Use clear signage to alert staff and visitors that they are entering a restricted area (Appendix
B) and emphasise hand hygiene before and after visiting patients
 Take time to inform patients and their visitors/ relatives of the nature and extent of the
outbreak and the consequences for the patient
Viral Diarrhoea and Vomiting Prevention and Management Policy
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Issue Date: 03 February 2015
Review Date: 01 February 2017 (Unless requirements change)
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 Provide written information to staff, patients and relatives (Appendix C). Leaflets for patients
and visitors can be obtained from medical photography (MPI 10/471)
 Exclude affected staff from the ward immediately and until 48 hours symptom-free
 Avoid transfer of patients and staff to unaffected wards or departments (unless medically
urgent or for the specific purpose of isolation after consultation with IPCT)
 Exclude non-essential staff from affected clinical areas
 Admissions to wards should be risk assessed by the IPCT to prevent the unnecessary
introduction of further susceptible individuals
 Staff working on affected wards must not work in unaffected areas for 48 hours after the end
of shift
 Vacuum cleaning carpets and buffing floors during an outbreak have the potential to recirculate Norovirus and are not recommended. Toys in paediatric wards should be capable
of withstanding disinfection and this should be carried out on a daily basis
 Thoroughly clean the ward and change the bed curtains before lifting restrictions
 Restrictions should not be lifted until 72 hours after the last new case and 72 hours after
uncontained vomiting and diarrhoea (as guided by the IPCT).
6.6 TESTING FOR NOROVIRUS
It is important that initial management is based on symptoms in order to facilitate rapid isolation
and control measures. Wards should not wait for the results of specimens to initiate control
measures.
Testing will be guided by the IPCT. Only unformed faecal specimens from symptomatic
individuals within three days of onset of symptoms should be referred for Norovirus PCR testing.
6.7 COMMUNICATIONS
Communications are always important in the control of suspected or confirmed outbreaks.
 Wards should inform the IPCT immediately whenever there are two or more cases of
unexplained vomiting or diarrhoea among patients or staff
 Other areas in the hospital should be alerted early so that all staff are vigilant and can give
notice of spread of infection to new areas. This alert should extend to services such as
radiology, physiotherapy, phlebotomy and portering where staff and patient movements can
potentially allow rapid spread of infection to all areas of the hospital.
 Managers and Patient Flow must be updated at least daily during an outbreak to allow
appropriate operational and manpower planning.
 The Consultant in Communicable Disease Control (CCDC) should be informed where there
is uncontrolled onwards tranmission despite adequate control measures
 The lead Clinical Commissioning Group (CCG) should be informed where the staffing of the
hospital is compromised or the operational capacity of the hospital is affected
 All outbreaks should be reported to Public Health England (PHE) via the Hospital Norovirus
Outbreak Reporting Tool
6.8 LIFTING OF WARD RESTRICTIONS
The decision to lift enhanced outbreak precautions and ward restrictions can only be made in
collaboration with a member of the IPCT.
 The attack rate and the recovery rate
 The decontamination of the clinical area to render it fit for safe patient care
 The overall need to admit new patients to the ward
 The staff/patient ratio in outbreaks that have debilitated the staff numbers
 Other organisational factors.
6.9 TERMINAL CLEANING AND DISINFECTION
 The timing of the terminal clean process should ideally be at least 72-hours post the last
uncontrolled episode of vomiting or diarrhoea. The presence on the ward of isolated patients
Viral Diarrhoea and Vomiting Prevention and Management Policy
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Issue Date: 03 February 2015
Review Date: 01 February 2017 (Unless requirements change)
Page 8 of 14
with unformed but contained faeces (i.e. delivered directly into a toilet or bedpan) should not
delay the start of terminal cleaning
7. TRAINING REQUIREMENTS
The IPCT will work with the Modern Matrons, Clinical Directors, clinical leads and infection control
link advisors to improve adherence to infection control policies and guidelines. The IPCT will
provide induction and ongoing education through the Setting Direction and Patient Safety study
days.
All staff have a duty of care to their patients to ensure they deliver a high standard of care in line
with current research and recommendations.
Modern Matrons / Service Leads have a duty to report any deficiencies in knowledge and ensure
appropriate training is undertaken.
Modern Matrons / Service Leads must ensure that all staff attend annual mandatory infection
prevention updates according to hospital policy.
8. REFERENCES AND ASSOCIATED DOCUMENTATION
1. Polage CR, Solnick JV, Cohen SH. Nosocomial diarrhea: evaluation and treatment of causes
other than Clostridium difficile. Clin Infect Dis 2012; 55: 982–989.
2. Ahmed SM, Hall AJ, Robinson AE, et al. Global prevalence of Norovirus in cases of
gastroenteritis: a systematic review and meta-analysis. Lancet Infect Dis 2014; 14: 725–730.
3. Harris JP, Adams NL, Lopman BA, Allen DJ, Adak GK. The development of web-based
surveillance provides new insights into the burden of Norovirus outbreaks in hospitals in
England. Epidemiol Infect. 2014; 142: 1590–1598.
4. Lopman BA, Reacher MH, Vipond IB, et al. Epidemiology and cost of nosocomial
gastroenteritis, Avon, England, 2002-2003. Emerg Infect Dis 2004; 10: 1827–1834.
5. Danial J, Cepeda JA, Cameron F, Cloy K, Wishart D, Templeton KE. Epidemiology and costs
associated with Norovirus outbreaks in NHS Lothian, Scotland 2007-2009. J Hosp Infect 2011;
79: 354–358.
Viral Diarrhoea and Vomiting Prevention and Management Policy
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Issue Date: 03 February 2015
Review Date: 01 February 2017 (Unless requirements change)
Page 9 of 14
9. EQUALITY IMPACT STATEMENT
Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably practicable,
the way we provide services to the public and the way we treat our staff reflects their individual
needs and does not discriminate against individuals or groups on any grounds.
This policy has been assessed accordingly
All policies must include this standard equality impact statement. However, when sending for
ratification and publication, this must be accompanied by the full equality screening
assessment tool. The assessment tool can be found on the Trust Intranet -> Policies -> Policy
Documentation
Our values are the core of what Portsmouth Hospitals NHS Trust is and what we cherish.
They are beliefs that manifest in the behaviours our employees display in the workplace.
Our Values were developed after listening to our staff. They bring the Trust closer to its vision
to be the best hospital, providing the best care by the best people and ensure that our
patients are at the centre of all we do.
We are committed to promoting a culture founded on these values which form the ‘heart’ of
our Trust:
Respect and dignity
Quality of care
Working together
No waste
This policy should be read and implemented with the Trust Values in mind at all times.
Viral Diarrhoea and Vomiting Prevention and Management Policy
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Review Date: 01 February 2017 (Unless requirements change)
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10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS
This document will be monitored to ensure it is effective and to provide assurance of compliance.
Minimum requirement to be
monitored
Lead
Tool
All diarrhoea and vomiting
patients routinely monitored
via the infection prevention
team
IPCT
VitalPAC and IPC
Manager
Monthly
Policy audit report to:
 Matrons
 NMAC
 IPMC
Dr Caroline Mitchell
Time to isolate monitored by
the infection prevention team
IPCT
VitalPAC and IPC
Manager
Monthly
Policy audit report to:
 Matrons
 NMAC
 IPMC
Dr Caroline Mitchell
Number of outbreaks reported
as KPI monthly to Trust Board
and CSC’s via dashboard
IPCT
Data Manager
Monthly
Policy audit report to:
 Trust Board
Dr Caroline Mitchell
Annual outbreak report to be
compiled by infection
prevention team
IPCT
Data logs
Annual
Policy audit report to:
Trust Board
Dr Caroline Mitchell
Viral Diarrhoea and Vomiting Prevention and Management Policy
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Issue Date: 03 February 2015
Review Date: 01 February 2017 (Unless requirements change)
Frequency of Report
of Compliance
Reporting arrangements
Lead(s) for acting on
Recommendations
Page 11 of 14
APPENDIX A: WARD SYMPTOM MONITORING FORM
No.
Hospital No.
Forename
Surname
Bed
No.
1.
Symptoms
Commencing
Specimen
Date
Specimen
Result
D D&V V
2.
D D&V V
3.
D D&V V
4.
D D&V V
5.
D D&V V
6.
D D&V V
7.
D D&V V
8.
D D&V V
1.
Underlying Diagnosis, Antibiotics / Laxatives / Feeds, relevant information
2.
Underlying Diagnosis, Antibiotics / Laxatives / Feeds, relevant information
3.
Underlying Diagnosis, Antibiotics / Laxatives / Feeds, relevant information
4.
Underlying Diagnosis, Antibiotics / Laxatives / Feeds, relevant information
5.
Underlying Diagnosis, Antibiotics / Laxatives / Feeds, relevant information
6.
Underlying Diagnosis, Antibiotics / Laxatives / Feeds, relevant information
7.
Underlying Diagnosis, Antibiotics / Laxatives / Feeds, relevant information
8.
Underlying Diagnosis, Antibiotics / Laxatives / Feeds, relevant information
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Review Date: 01 February 2017 (Unless requirements change)
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Appendix B: Information for Staff
IMPORTANT NOTICE
This area currently has a
high number of cases of
diarrhoea and vomiting
If your visit is essential, please
use the hand washing facilities
before entering and when
leaving the ward or department
Please follow all instructions
from members of staff
If your visit is not essential, we
would suggest that you do not
visit until the number of cases of
diarrhoea and vomiting has
reduced
CONTACT
Infection Prevention & Control
Bleep 0064 or via switchboard
Viral Diarrhoea and Vomiting Prevention and Management Policy
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Review Date: 01 February 2017 (Unless requirements change)
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Appendix C: Information for Staff
Norovirus (also known as Small Round Structured Viruses (SRSVs),
Norwalk like Viruses, winter vomiting disease)
The symptoms are predominately vomiting, diarrhoea, and occasionally fever. Nausea and
abdominal pain may also occur. Symptoms last between one to three days and recovery is usually
rapid thereafter. It is a virus that is spread from person to person by the faecal-oral route. The
vomitus will also be infectious.
Criteria for suspecting an outbreak;
1.
Vomiting often projectile occurs in more than 50% of cases
2.
Unexplained diarrhoea with, or without nausea, fever, and abdominal pain
3.
Incubation period of 15-48 hours
4.
Staff and patients affected.
Control measures for minimising transmission at ward level


















Isolate symptomatic individuals immediately - only cohort under the guidance of the IPCT
Keep all bay and side room doors closed (when safe to do so)
Wear gloves and apron for contact with an affected patient or environment
Wash hands with soap and water after contact with an affected patient or environment (after
removing gloves and apron)
Do not use alcohol hand rub to decontaminate hands
Remove all exposed food e.g. fruit from lockers etc. and de-clutter all areas
Provide fresh drinking water for all patients, dish washer jugs and cups and implement
intentional rounding for affected patients to encourage regular sips of fluid
Use a freshly prepared chlorine-based agent (e.g. Difficil-S or 1000ppm Actichlor plus) to
disinfect all surfaces and touch points e.g. door handles, bed rails, tables, chair handles at
least twice daily
Clean and disinfect vomit and faeces spillages promptly
Consider use of antiemetics for patients with vomiting
Use clear signage to alert staff and visitors that they are entering a restricted area (Appendix
B) and emphasise hand hygiene before and after visiting patients
Take time to inform patients and their visitors/ relatives of the nature and extent of the
outbreak and the consequences for the patient
Provide written information to staff, patients and relatives (Appendix C). Leaflets for patients
and visitors can be obtained from medical photography (MPI 10/471)
Exclude affected staff from the ward immediately and until 48 hours symptom-free
Avoid transfer of patients and staff to unaffected wards or departments (unless medically
urgent or for the specific purpose of isolation after consultation with IPCT)
Exclude non-essential staff from affected clinical areas
Admissions to wards should be risk assessed by the IPCT to prevent the unnecessary
introduction of further susceptible individuals
Staff working on affected wards must not work in unaffected areas for 48 hours after the end
of shift
Contact numbers for Infection Prevention and Control:
In hours: The Infection Prevention and Control Team (IPCT) on the Clinical Lead Bleep (0064)
Out of Hours (inc. weekends): The IPCT via the main hospital switchboard.
Viral Diarrhoea and Vomiting Prevention and Management Policy
Version: 1
Issue Date: 03 February 2015
Review Date: 01 February 2017 (Unless requirements change)
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