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VIRAL HAEMORRHAGIC FEVER POLICY
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1
Name of responsible (ratifying) committee
Infection Prevention Management Committee
Date ratified
28 January 2015
Document Manager (job title)
Consultant Infection Prevention
Date issued
12 February 2015
Review date
31January 2017
Electronic location
Infection Control Policies
Related Procedural Documents
Hand Hygiene, Standard Precautions, Isolation, Linen
and Laundry, Waste.
Key Words (to aid with searching)
Viral Haemorrhagic Fever, VHF, Ebola, Lassa, CongoCrimean, Marburg
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Viral Haemorrhagic Fever Policy
Version: 1
Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
Page 1 of 15
CONTENTS
QUICK REFERENCE GUIDE ............................................................................................................. 3
1. INTRODUCTION ......................................................................................................................... 4
2. PURPOSE ................................................................................................................................... 4
3. SCOPE ........................................................................................................................................ 4
4. DEFINITIONS .............................................................................................................................. 4
5. DUTIES AND RESPONSIBILITIES .............................................................................................. 6
6. PROCESS ................................................................................................................................... 6
7. TRAINING REQUIREMENTS .................................................................................................... 12
8. REFERENCES AND ASSOCIATED DOCUMENTATION .......................................................... 12
9. EQUALITY IMPACT STATEMENT ............................................................................................ 13
10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS ........................................ 14
11. APPENDIX 1 .............................................................................................................................. 15
Viral Haemorrhagic Fever Policy
Version: 1
Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
Page 2 of 15
QUICK REFERENCE GUIDE
1. VHF must be considered for any patient presenting with undiagnosed fever ≥37.5°C or a
history of fever in the past 24 hours within 21 days of returning from an endemic area or
having an epidemiological exposure to VHF.
The VHF Risk Assessment and Advisory Committee on Dangerous Pathogens ‘Management of
Hazard Group 4 viral haemorrhagic fevers’ can be found here:
2. Patients categorised as ‘UNLIKELY to have a VHF infection’ Patients with a fever ≥37.5°C or a history of fever in the past 24 hours who are highly unlikely
to have a VHF infection if:
 They have not visited a VHF endemic area within 21 days of becoming ill;
 They have not become unwell within 21 days of caring for or coming into contact with
the bodily fluids of / handling clinical specimens from a live or dead individual or animal
known or strongly suspected to have a VHF;
 If their UK malaria screen is negative and they are subsequently afebrile for >24 hours;
 If their UK malaria screen is positive and they respond to malaria treatment;
 If they have a confirmed alternative diagnosis and are responding appropriately1
3. Patients categorised as ‘LOW POSSIBILITY of VHF infection’ Patients may be classified as Low Possibility of VHF infection if:
 They have a fever ≥37.5°C or a history of fever in the past 24 hours who and have
been in an endemic area during the 21 days before the onset of illness BUT
 have none of the additional risk factors that place them in the high risk category (see
appendix 1) AND HAVE NOT
 cared for/come into contact with body fluids of/handled clinical specimens (blood, urine,
faeces, tissues, laboratory cultures) from an individual or laboratory animal known or
strongly suspected to have VHF within the past 21 days1
4. Patients categorised as ‘HIGH POSSIBILITY of VHF infection’ Includes febrile patients with a fever ≥37.5°C or a history of fever in the past 24 hours who:
a) Have been in an endemic area during the 21 days before illness and
 have lived or worked in basic rural conditions in an area where Lassa Fever is
endemic? OR
 have visited caves / mines, or had contact with or eaten primates, antelopes or bats in a
Marburg / Ebola endemic area? OR
 have travelled in an area where Crimean-Congo Haemorrhagic Fever is endemic AND
sustained a tick bite or crushed a tick with their bare hands OR had close involvement
with animal slaughter OR
 were previously categorised as “low possibility” but who have developed organ failure
and/or haemorrhage.1
b) Have not been in an endemic area but during the 21 days before illness they
 cared for/came into contact with body fluids of/handled clinical specimens (blood, urine,
faeces, tissues, laboratory cultures) from an individual or laboratory animal known or
strongly suspected to have VHF1
5. Contact details:
Portsmouth Hospitals On-call Microbiology or Infection
Prevention Team
High Security Infectious Disease Unit, Royal Free, London
(24 hrs, ask for infectious disease physician on call)
Public Health England (Wessex Centre) CCDC
Imported Fever Service
Viral Haemorrhagic Fever Policy
Version: 1
Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
Via Portsmouth Hospitals
Switchboard
020 7794 0500 or 0844
8480700
In Hours 0345 055 2022
OOH 0844 9670082
0844 778 8990
Page 3 of 15
1. INTRODUCTION
The Viral Haemorrhagic Fevers (VHF’s) are severe and life-threatening viral diseases that have
been reported in parts of Africa, South America, the Middle East and Eastern Europe. VHFs;
 can spread within a hospital setting;
 have a high case-fatality rate;
 are difficult to recognise and detect rapidly;
 have no effective, definitive treatment1.
Environmental conditions in the UK do not support the natural reservoirs or vectors of any of
the haemorrhagic fever viruses, and all recorded cases of VHF in the UK have been acquired
abroad, with the exception of one laboratory worker who sustained a needle-stick injury.
VHF must be considered for any patient presenting with undiagnosed fever within 3 weeks of
returning from an endemic area (see appendix 1)2.
This guidance covers four VHFs which may (rarely) present either in the Emergency
Department (ED) or via a local General Practitioner (GP).
 Lassa fever
 Marburg fever
 Ebola fever
 Congo-Crimean haemorrhagic fever
All four are severe, highly infectious, life threatening diseases, although there are other VHF’s
of less severity e.g. Yellow fever virus and Dengue virus. Further information on the viruses
classified as Advisory Committee on Dangerous Pathogens (ACDP) hazard group 4 viruses
can be found here:
2. PURPOSE
The purpose of this policy is to provide guidelines on the assessment and management of
patients with suspected or confirmed viral haemorrhagic fevers (VHF).
3. SCOPE
This Policy applies to all staff employed by Portsmouth Hospitals NHS Trust (the Trust) or
Carillion, and also to all visiting staff including staff from external agencies (e.g. CCG or other
Trusts), tutors, students, agency/locum staff and contractors.
‘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
Category A waste - an infectious substance that is transported in a form that, when exposure
to it occurs, is capable of causing permanent disability, life-threatening or fatal disease to
humans or animals. Wherever possible, Category A waste should be treated on- site using an
autoclave or equivalent before being transported for disposal3.
Category B waste - an infectious substance that does not meet the criteria for inclusion in
Category A3.
Viral Haemorrhagic Fever Policy
Version: 1
Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
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Viral haemorrhagic fevers - a group of illnesses that are caused by several distinct families of
viruses e.g. Ebola, Lassa fever, Crimean Congo haemorrhagic fever, Dengue fever, Yellow
fever.
Crimean-Congo haemorrhagic fever (CCHF) - is transmitted through the bite of an infected
tick, contamination with tick body contents, or direct contact with the blood, tissues or body
fluids of infected humans or animals. The incubation period varies according to the mode of
acquisition of the virus; tick bite: usually 1-3 days, and up to 9 days; infection via contact with
infected blood or tissues: 5-6 days: maximum recorded incubation period is 13 days.
The illness begins abruptly, with fever, muscle aches, dizziness, neck pain and stiffness,
backache, headache, sore eyes and photophobi. Nausea, vomiting and sore throat may also
occur, with diarrhoea and abdominal pain. Over the next few days the patient may experience
mood swings, confusion and aggression, followed by sleepiness, depression and liver
enlargement. More severe symptoms may follow, including petechial rash, bruising and
generalised bleeding of the gums and orifices. In severe cases patients develop failure of the
liver, kidneys and lungs, and become drowsy and comatose after 5 days. Approximately 30% of
cases are fatal.4
Ebola virus disease - (formerly known as Ebola haemorrhagic fever) is believed to be a
zoonotic disease, however the natural reservoir is unknown. The first human case in an
outbreak of Ebola is acquired through contact with blood, secretions organs or other bodily
fluids of an infected animal. The virus is then transmitted to others through direct contact with
the blood, secretions, organs or other bodily fluids of infected persons. The incubation period of
Ebola virus disease ranges from 2 to 21 days. The onset of illness is sudden, with fever,
headache, joint and muscle pain, sore throat and intense weakness. This is then followed by
diarrhoea, vomiting, rash, impaired kidney and liver function and stomach pain. Some patients
may develop a rash, red eyes, hiccups, internal and external bleeding. Ebola haemorrhagic
fever is fatal in between 50-90% of all clinically ill cases.4
Lassa Fever - transmission of Lassa virus to humans normally occurs through contamination of
broken skin or mucous membranes via direct or indirect contact with infected rodent excreta.
Person to person transmission occurs through exchange of infected bodily fluids, such as
blood, saliva, urine or semen. Infection is mild or asymptomatic in 80% of cases, but can cause
severe illness and is fatal in approximately 1-3% of patients. The incubation period for disease
is usually between 7 and 10 days, although a range of 3-21 days has been reported in some
cases. The onset of illness is insidious, with fever and shivering accompanied by malaise,
headache, generalised aching and a sore throat. This may be accompanied by nausea,
vomiting, diarrhoea or cough. There may be patches of white or yellowish exudate and
occasionally small vesicles or shallow ulcers on the tonsils and pharynx and this is an important
diagnostic feature. Fever is very variable, occurring constantly or in peaks, and lasting on
average for 16 days; extremes of 6-30 days have been reported. Severe attacks are
characterised by extreme lethargy and exhaustion, disproportionate to the level of fever. During
the second week of illness there may be oedema of the head and neck, encephalopathy,
pleural effusion, and ascites. Renal and circulatory failure may occur, aggravated by vomiting
and diarrhoea. In the severest cases bleeding into the skin, mucosae and deeper tissues
occurs, usually leading to death. Infection is fatal in around 15% of hospitalised patients. Lassa
fever is particularly severe in pregnant women in the third trimester; the foetus dies in about
95% of cases.4
Marburg virus - clinically almost indistinguishable from Ebola virus disease. Fruit bats are
considered the natural host of the virus. The incubation period is 3-10 days. The onset of illness
is sudden, with severe headache, malaise and high fever, with progressive and rapid
debilitation. This is followed by watery diarrhoea, abdominal pain, cramping, nausea and
vomiting by about the third day. Symptoms become increasingly severe, and many patients
develop severe haemorrhagic fever after 5-7 days. Fatal cases usually have bleeding, which is
often from multiple sites. The initial infection is acquired through exposure in mines or caves
Viral Haemorrhagic Fever Policy
Version: 1
Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
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inhabited by Rousettus bat colonies. Subsequent transmission of virus from person to person
requires close contact with an infected patient with transmission through contact with blood or
other bodily fluids (faeces, vomit, urine, saliva and respiratory secretions) containing a high
concentration of virus, particularly when these fluids contain blood.4
5. DUTIES AND RESPONSIBILITIES
Chief Executive is responsible for ensuring the Trust has an appropriate policy in place to
appropriately care for patients with VHF;
Infection Prevention and Control Team are responsible for providing support and advice;
Medical Microbiology are responsible for co-ordinating laboratory samples and conducting a
risk assessment for patients suspected of VHF;
All Clinical Staff are responsible for complying with all aspects of this policy;
Laboratory staff are responsible for recording and processing specimens and for the
appropriate reporting of results to the relevant areas and staff.
6. PROCESS
6.1 Diagnosis - In the early stages of the illness there may be no specific clinical features so
VHF must be considered for any patient presenting with undiagnosed fever within 21 days of
returning from an endemic area or having an epidemiological exposure to VHF.
Other clinical features may include:
 Chills
 Vomiting,
 Malaise
 Rash
 Headaches
 Bleeding
 Myalgia
 Shock
 Pharyngitis
 Lymphopaenia
 Diarrhoea
 Thrombocytopaenia
 Bloody diarrhoea
 Raised AST.
Refer to the Viral Haemorrhagic Risk Assessment (appendix 1) for clinical history and
additional questions.2
Refer to
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/ViralHaemorrhagicFever/VHFMa
ps/ for current endemic areas.5
6.2 Communication - If the possibility of VHF is raised, the clinician must consult a consultant
microbiologist to discuss whether the patient can be admitted and investigated locally or
whether transfer to the High Security Infectious Disease Unit (HSIDU) at The Royal Free
Hospital is required.
The Consultant in Infection Prevention (in hours) or the on-call Infection Prevention Team must
also be immediately notified of any suspected VHF infection.
The Consultant for Communicable Disease Control (CCDC) must be notified urgently by
telephone of any patient categorised as HIGH POSSIBILITY of VHF’.
Viral Haemorrhagic Fever Policy
Version: 1
Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
Page 6 of 15
Portsmouth Hospitals On-call Microbiology or Infection
Prevention Team
High Security Infectious Disease Unit, Royal Free, London
(24 hrs, ask for infectious disease physician on call)
Public Health England (Wessex Centre) CCDC
Imported Fever Service
Via Portsmouth Hospitals
Switchboard
020 7794 0500 or 0844
8480700
In Hours 0345 055 2022
OOH 0844 9670082
0844 778 8990
6.3 Infectivity - Dependant on the virus, modes of transmission can include blood, urine,
semen, vomit, faeces and tick body contents. There has been no evidence of aerosol
transmission from VHF patients. Patients can be managed more effectively if they are
categorised according to level of infectivity and risk:
6.3.1 Patients categorised as ‘UNLIKELY to have a VHF infection’ Patients with a fever ≥37.5°C or a history of fever in the past 24 hours who are highly unlikely
to have a VHF infection if:
 They have not visited a VHF endemic area within 21 days of becoming ill;
 They have not become unwell within 21 days of caring for or coming into contact with
the bodily fluids of / handling clinical specimens from a live or dead individual or animal
known or strongly suspected to have a VHF;
 If their UK malaria screen is negative and they are subsequently afebrile for >24 hours;
 If their UK malaria screen is positive and they respond appropriately to malaria
treatment;
 If they have a confirmed alternative diagnosis and are responding appropriately1
The risk of VHF in the patient should be reassessed if a patient with a relevant exposure history
fails to improve or develops one of the following:
 Nosebleed;
 Bloody diarrhoea;
 Sudden rise in aspartate transaminase (AST);
 Sudden fall in platelets;
 Clinical shock;
 Rapidly increasing O2 requirements in the absence of other diagnosis.1
6.3.2 Patients categorised as ‘LOW POSSIBILITY of VHF infection’ Patients may be classified as Low Possibility of VHF infection if:

They have a fever ≥37.5°C or a history of fever in the past 24 hours who and have
been in an endemic area during the 21 days before the onset of illness
BUT

have none of the additional risk factors that place them in the high risk category (see
appendix 1)
AND HAVE NOT
 cared for/come into contact with body fluids of/handled clinical specimens (blood, urine,
faeces, tissues, laboratory cultures) from an individual or laboratory animal known or
strongly suspected to have VHF within the past 21 days1
6.3.3 Patients categorised as ‘HIGH POSSIBILITY of VHF infection’ Includes febrile patients with a fever ≥37.5°C or a history of fever in the past 24 hours who:
a) Have been in an endemic area during the 21 days before illness and
Viral Haemorrhagic Fever Policy
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Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
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
have lived or worked in basic rural conditions in an area where Lassa Fever is
endemic? (https://www.gov.uk/lassa-fever-origins-reservoirs-transmission-andguidelines)

have visited caves / mines, or had contact with or eaten primates, antelopes or bats in a
Marburg / Ebola endemic area? (https://www.gov.uk/ebola-and-marburg- haemorrhagicfevers-outbreaks-and-case-locations

have travelled in an area where Crimean-Congo Haemorrhagic Fever is endemic
(http://www.who.int/csr/disease/crimean_congoHF/Global_CCHFRisk_20080918.png?u
a=1) AND sustained a tick bite or crushed a tick with their bare hands OR had close
involvement with animal slaughter

were previously categorised as “low possibility” but who have developed organ failure
and/or haemorrhage.1
OR
OR
OR
b) Have not been in an endemic area but during the 21 days before illness they
 cared for/came into contact with body fluids of/handled clinical specimens (blood, urine,
faeces, tissues, laboratory cultures) from an individual or laboratory animal known or
strongly suspected to have VHF1
Infection Prevention and Control Measures
6.4 A patient categorised as ‘UNLIKELY to have a VHF infection’ should be admitted if ill
and requiring hospital treatment, under STANDARD ISOLATION procedures to Portsmouth
Hospitals. Also see Trust policies: Hand Hygiene; Standard Precautions; Isolation.1
6.5 A patient categorised as ‘LOW POSSIBILITY of VHF’ should be isolated in a single side
room immediately to limit contact until the possibility of VHF has been ruled out. The room
should also have dedicated en-suite facilities or at least a dedicated commode.
Staff should implement standard precautions as appropriate. The level of any additional staff
protection is dependent on the patient’s symptoms as follows:1
Infection control measures for ‘Low possibility of VHF’
Standard Precautions:
 hand hygiene
 gloves
 plastic apron
Additional protection for splash inducing procedures
 fluid repellent surgical facemask
 eye protection
It is recommended that, if a patient is bruised or bleeding, the lead clinician should have an
urgent discussion with the nearest High Security Infectious Disease Unit at the Royal Free
Hampstead NHS Trust, London (see communication 6.2).1
Single use (disposable) equipment and supplies should be used. The use of a needle-free
intravenous system to eliminate the risk of needlestick injuries should also be considered.
6.5.1 Waste - should be handled as infectious and placed in the orange waste bags for normal
disposal by incineration.
6.5.2 Laundry - should be treated as infectious, and packaged using a red water soluble bag
inside a red linen bag.
Viral Haemorrhagic Fever Policy
Version: 1
Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
Page 8 of 15
6.5.3 Cleaning and Decontamination - should be performed as normal with hypochlorite
containing 1,000ppm available chlorine or chloride dioxide solution.
6.5.4 Staff Information - Staff must be informed about and understand the risks associated
with a VHF patient, for example:
 The severity of a VHF if infection is confirmed;
 That virus may be present: in blood; body fluids including urine; waste; on contaminated
instruments and equipment; on contaminated clothing; on contaminated surfaces.
 That exposure to virus may occur:
- directly, through exposure (broken skin or mucous membranes) to blood and/or body
fluids during invasive, aerosolising or splash procedures;
- indirectly, through exposure (broken skin or mucous membranes) to environments,
surfaces, equipment or clothing contaminated with splashes or droplets of blood or body
fluids.1
6.6 Diagnostic specimens / investigations in patients categorised as ‘LOW POSSIBILITY
of VHF’ As the risk of VHF infection from patients categorised as ‘low possibility of VHF’ is low, there
are no additional precautions to be taken when collecting specimens, above those already in
place under standard precautions (section 6.5). It is not necessary to inform the laboratory, as
the risk to laboratory staff is extremely low.1
Investigations required will include URGENT Malaria investigations as Malaria remains the
most likely diagnosis even if the patient has already had a malaria screen performed abroad
with a negative result.1
Testing of specimens taken for patient management may be conducted locally at standard
containment level 2 conditions.
Liaison with the Microbiologist/Virologist is advised, particularly if the patient has bruising or
bleeding.
6.7 A patient categorised as ‘HIGH POSSIBILITY of VHF’ should be isolated in a single side
room immediately to limit contact. The side room should have dedicated en-suite facilities or at
least a dedicated commode.
The number of staff in contact with the patient should be restricted.
The level of staff protection required is dependent on the patient’s symptoms and is as follows:1
Infection control measures for ‘high possibility of VHF’
Enhanced precautions required (standard plus droplet plus respiratory protection):
 hand hygiene
 double gloves
 fluid repellent disposable coverall or gown
 head cover e.g. surgical cap
 fluid repellent footwear e.g. surgical boots/shoe covers
 Full face shield or goggles
 FFP3 respirator or EN certified equivalent
It is recommended that, if a patient is bruised or bleeding or has uncontrolled diarrhoea or
uncontrolled vomiting, the lead clinician should have an urgent discussion with the nearest
HSIDU at the Royal Free Hampstead NHS Trust, London (see communication 6.2).
Viral Haemorrhagic Fever Policy
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Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
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Single use (disposable) equipment and supplies should be used. The use of a needle-free
intravenous system to eliminate the risk of needlestick injuries should also be considered.
6.7.1 Waste - should be handled as infectious and placed in the orange waste bags for
treatment as Category A waste (see definition).1,3
6.7.2 Laundry - Disposable linen should always be used if possible. This linen must be treated
and disposed of as category A waste. All re-useable linen from patients with a ‘high possibility’
or ‘confirmed’ for VHF infection should not be returned to a laundry and must therefore be
treated and disposed of a category A infectious waste.1
6.7.3 Cleaning and Decontamination - General cleaning and decontamination must be
carried out with single use disposable items with hypochlorite containing 1,000ppm available
chlorine. Persons carrying out decontamination and cleaning procedures must wear
appropriate PPE.1
Spillages of body fluid should be managed as normal, using full PPE (including face and eye
protection) and the area decontaminated with hypochlorite containing 10,000ppm available
chlorine.1
6.7.4 Crockery and cutlery - disposable crockery and cutlery should be used where possible
for those patients categorised as high possibility or confirmed VHF. These items should be
disposed of as category A waste.1
6.7.5 Toilets or commodes - may be used by patients categorised as ‘high possibility’ or
‘confirmed’ for VHF infection. Where commodes are employed, a dedicated commode should
be used with a disposable bowl. After use, the contents are to be solidified with highabsorbency gel and then autoclaved or incinerated. Toilets and commodes should be
disinfected with hypochlorite containing 10,000ppm available chlorine at least daily, preferably
after each use, and upon patient discharge. For non-ambulant patients, disposable bedpans
should be used and the contents to be solidified with high-absorbency gel and then autoclaved
or incinerated.1
6.7.6 Staff Information - Communication with staff about the potential VHF risks and infection
control measures is paramount. The important risks to make staff aware of are listed in section
6.5.4.
6.8 Diagnostic specimens / investigations in patients categorised as ‘HIGH POSSIBILITY
of VHF’ An urgent VHF screen (on EDTA and clotted blood) and urgent MALARIA screen should be
requested through the Portsmouth Hospital microbiologist, who will liaise with the PHE
reference laboratory regarding patient specimens.
There are potential risks of infection associated with collecting and handling specimens from
patients categorised as high possibility of having a VHF infection, or those with a positive VHF
screen. The main risk of infection when collecting and handling specimens is direct contact with
blood or body fluids from the patient, for example by accidental inoculation (needlestick) or
contact with broken skin or mucous membranes.
Laboratory analysis should be kept to the minimum necessary for patient management and
diagnostic evaluation. During specimen collection, standard infection control principles and
practices should always be adopted. Staff must select PPE in accordance with the risk category
of the patient (section 6.7).
The following principles should be followed to ensure safe transfer of these specimens to the
laboratory:
Viral Haemorrhagic Fever Policy
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Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
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 Laboratory staff should be notified prior to receipt of all specimens from patients with a
‘high possibility of VHF’ or with a positive VHF screen in order for them to be segregated
and processed separately using dedicated equipment;
 Specimens should be transported in person i.e. not be sent on automatic transport
systems (e.g. pneumatic transport systems) nor in standard mail;
 Specimens should be transported to the laboratory using appropriate precautions i.e.
specimens should be carried in suitably sealed containers;
 Policies for the transportation of specimens to a HSIDU laboratory should be agreed
between sender and recipient e.g. hospital to HSIDU laboratory, or HSIDU laboratory to
a Containment Level 4 laboratory.1
6.9 Notification - In the event of any patient categorised as ‘HIGH POSSIBILITY of VHF’ or
‘CONFIRMED VHF’, the Consultant for Communicable Disease Control (CCDC) must be
notified urgently by telephone in order that contacts can be identified and if necessary placed
under surveillance (see communication 6.2).
The Infection Prevention and Control Team should identify all staff and laboratory contacts,
using the following risk categorisation:1
Categorisation
of contacts Risk
category
Unclear
Description
Action and Advice
Not sure of contact
No risk
(Category 1)
No contact with the patient or
body fluids.
Reassure about absence of risk;
Advise to contact the Monitoring
Officer should they recall any contact;
Provide general factsheet.
Reassure about likely absence of risk;
Provide category 1 factsheet*.
Low risk
(Category 2)
Casual contact, e.g. sharing a
room with the patient, without
direct contact with body fluids or
other potentially infectious
material.
Direct contact with the patient,
e.g. routine medical/nursing
care, handling of
clinical/laboratory specimens,
but did not handle body fluids,
and wore personal protective
equipment appropriately.
High risk
(Category 3)
Reassure about low risk;
Passive monitoring
Self-monitor for fever and other
disease compatible symptoms for 21
days from last possible exposure;
Report to the Monitoring Officer if
temperature >38.0oC, with further
evaluation as necessary;
Provide category 2 factsheet*.
Inform about risks;
Active monitoring
Record own temperature daily for 21
days following last contact with the
patient and report this temperature to
the Monitoring Officer by 12 noon each
day, with further evaluation as
necessary; Inform Monitoring Officer
urgently if symptoms develop; Provide
category 3 factsheet*.
Unprotected exposure of skin or
mucous membranes to
potentially infectious blood or
body fluids, including on clothing
and bedding.
This includes:
unprotected handling of
clinical/laboratory specimens;
mucosal exposure to splashes;
needlestick injury;
kissing and/or sexual contact.
* available from the CCDC Public Health England, Wessex.
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Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
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6.10 Transfer of Patients categorized as ‘HIGH POSSIBILITY or CONFIRMED VHF’
All transfers must be carried out as Ambulance Category 4 transfers using a specialist
ambulance crew and vehicle. There are two Ambulance Trusts in the UK who will carry out
transfer of a VHF patient – the North East Ambulance Service and the London Ambulance
Service. Further details are available
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947382005
6.11 After Death Care – In the unlikely event that a patient dies of VHF in Portsmouth
Hospitals, a post mortum should not be performed. Further details on after death care can be
found at http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947382005
7. TRAINING REQUIREMENTS
All staff most likely to come into contact with VHF (Emergency Department, Department of
Critical Care) must familiarise themselves with this policy and know where to find it on the
Intranet. The Infection Prevention Team may do specific education on the VHF policy as
applicable.
All staff in the Emergency Department will have had training in hand hygiene and basic
infection control precautions as should every person likely to come into contact with the
patient(s).
8. REFERENCES AND ASSOCIATED DOCUMENTATION
1. Management of Hazard Group 4 viral haemorrhagic fevers and similar human infectious
diseases of high consequence Department of Health and the Health and Safety Executive,
November 2014. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947382005
2. Viral Haemorrhagic Risk Assessment v5 (updated). Health Protection Agency, November
2014. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317135155050
3. Health Technical Memorandum 07-01: Safe management of healthcare waste. Department
of Health, March 2013.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/167976/HTM_07
-01_Final.pdf
4. Viral Haemorrhagic Fever. Public Health England July 2014.
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/ViralHaemorrhagicFever/
5. Viral Haemorrhagic Fever. Public Health England July 2014.
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/ViralHaemorrhagicFever/VHFMa
ps/
Viral Haemorrhagic Fever Policy
Version: 1
Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
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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 Haemorrhagic Fever Policy
Version: 1
Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
Page 13 of 15
10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS
Minimum requirement to
be monitored
Lead
Compliance with risk
assessment procedure
IPCT
Compliance with isolation
and PPE
IPCT
Tool
Frequency of Report
of Compliance
PHE Risk Assessment
Tool – VHF
Post Case review
Compliance audit against
ACDP Guidance
Post Case review
Reporting arrangements
Policy audit report to:

IPMC
This document will be monitored to ensure it is effective and to assurance compliance.
Viral Haemorrhagic Fever Policy
Version: 1
Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
Infection Prevention and Control
IPMC
Policy audit report to:

Lead(s) for acting on
Recommendations
Page 14 of 15
Infection Prevention and Control
11.
APPENDIX 1
Viral Haemorrhagic Fever Policy
Version: 1
Issue Date: 12 February 2015
Review Date: 31 January 2017 (unless requirements change)
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