Download Alert Organisms – Gastroenteritis also known as infective diarrhoea

Infection Prevention and Control Assurance Standard Operating
Procedure 26 (IPC SOP 26)
Alert Organisms – Gastroenteritis also known as infective
diarrhoea (e.g. Norovirus, Salmonella, and Campylobacter
etc.)
Why we have a procedure?
To ensure employees of the Black Country Partnership NHS Foundation Trust have a
standard procedure to follow when caring for patients symptomatic with gastroenteritis
(diarrhoea and/or vomiting) to minimise and manage the risks of transmission.
The Health and Social Care Act 2008: Code of Practice for the NHS for the Prevention and
Control of Healthcare Associated Infections (revised January 2015) stipulates that NHS bodies
must, in relation to preventing and controlling the risk of Health Care Associated Infections
(HCAI), have in place appropriate core policies/procedures. Implementation of this procedure
will contribute to the achievement and compliance with the Act.
What overarching policy the procedure links to?
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This procedure is supported by the Infection Prevention and Control Assurance Policy
Which services of the trust does this apply to? Where is it in operation?
Group
Mental Health Services
Learning Disabilities Services
Children and Young People Services
Inpatients
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Community
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Locations
all
all
all
Who does the procedure apply to?
This document applies to all staff employed by or working on behalf of the Trust caring for
patients as part of their role and job description.
When should the procedure be applied?
Effective prevention and control of healthcare associated infection (HCAI) must be embedded
into everyday practice and applied consistently. This procedure must be applied when caring
for patients symptomatic with gastroenteritis (diarrhoea/vomiting).
Additional Information/ Associated Documents
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Infection Prevention and Control Assurance Policy
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Hand Hygiene Policy
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Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP
1) - Standard Infection Control Precautions
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Infection Prevention and Control Assurance - Standard Operating Procedure 2 (IPC SOP
2) - Transmission Based Precautions
Infection Prevention and Control Assurance - Standard Operating Procedure 3 (IPC SOP
3) - Surveillance of Infection and Data Collection
Infection Prevention and Control Assurance - Standard Operating Procedure 4 (IPC SOP
4) - Reporting Incidents of Infection to Public Health England and/or the Local Authority
Infection Prevention and Control Assurance - Standard Operating Procedure 5 (IPC SOP
5) - Management and Recognition of Outbreaks of Communicable Infection/Disease
Infection Prevention and Control Assurance - Standard Operating Procedure 6 (IPC SOP
6) - Isolation – Care of Patients in Isolation due to Infection or Disease
Infection Prevention and Control Assurance - Standard Operating Procedure 7 (IPC SOP
7) - Decontamination - Cleaning, Disinfection and Sterilisation
Infection Prevention and Control Assurance - Standard Operating Procedure 9 (IPC SOP
9) - A-Z of Infections – A Quick Reference Guide
Infection Prevention and Control Assurance - Standard Operating Procedure 13 (IPC
SOP 13) - Closure of Wards due to an Infection Control Issue
Infection Prevention and Control Assurance - Standard Operating Procedure 14 (IPC
SOP 14) - Undertaking a Patient Infection Risk Assessment
Aims
To reduce the risk of transmission of gastrointestinal infections by ensuring that Trust staff:
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Are alert to the risks of individual patients symptomatic with diarrhoea and/or vomiting
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Ensure patients with diarrhoea and/or vomiting have appropriate infection prevention and
control related care and management, by isolating symptomatic patients promptly to
reduce the risks of transmission and promote adherence to standard and transmission
based precautions
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To aid diagnosis by sending appropriate specimens to the laboratory in a timely manner
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To administer appropriate treatment as/when indicated
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Inform other healthcare providers of the patients infectious status when any transfers of
care are planned either internally within the Trust or to external care providers
Definitions
Cohort
Refers to the grouping of patients with the same clinical diagnosis,
suspected symptoms or clinical risk category in relation to known or
suspected transmissible infection
Diarrhoea
Having at least three loose or liquid bowel movements each day (Bristol
stool chart type 6 and 7)
Faecal-oral route
Means spread of microbes (viruses, bacteria or parasites) from the
human or animal stool to your mouth
Gastroenteritis
Also known as infectious diarrhoea is inflammation of the
gastrointestinal tract that involves the stomach and small intestine.
Signs and symptoms include some combination of diarrhoea, vomiting,
and abdominal pain. Fever, lack of energy, and dehydration may also
occur. This typically lasts less than two weeks
Healthcare
Acquired Infection
(HCAI)
Healthcare associated infection (HCAI) refers to infections that occur as
a result of contact with the healthcare system in its widest sense – from
care provided in the patient’s own home, to general practice, hospital
and nursing home care
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Infection
The presence of microorganisms on/in the body that is causing an
adverse effect or host- response – the person is unwell and has signs
and symptoms of an infection
Infection prevention Processes to prevent and reduce to an acceptable minimum the risk of
the acquisition of an infection amongst patients, healthcare workers and
and control
any others in the healthcare setting
IPCT
Infection Prevention and Control Team
Pathogenic
A medical term that describes micro-organisms that can cause some
kind of disease
Risk Assessment
A process used to identify any potential hazards and analyse what could
happen, and to identify steps to be taken to reduce or minimise the risk
Possible Causes of Gastroenteritis/Diarrhoea
Gastroenteritis can be due to infections by viruses, bacteria, parasites, and fungus but the
most common cause is viruses.
Norovirus – sometimes known as the winter vomiting bug and is the most common
cause of viral gastroenteritis in humans. It affects people of all ages. Norovirus can be
spread via several different routes; faecal-oral, vomiting and aerosolisation, and
through contaminated food and water. Viruses may be introduced into the hospital
environment via any of these routes and propagated by person-to-person spread,
whereby hands are contaminated from the environment and virus ingested by mouth.
Norovirus infection is characterized by sudden onset of nausea, vomiting, watery
diarrhoea, abdominal pain, and in some cases, loss of taste. A person usually develops
symptoms of gastroenteritis 12 to 48 hours after being exposed to norovirus. General
lethargy, weakness, muscle aches, headaches, and low-grade fevers may occur. The
disease is usually self-limiting, and severe illness is rare. Several cases may occur on a
ward within hours.
Clostridium difficile – is an anaerobic, gram positive spore forming Bacillus that can
cause an infection in the gut. Signs and symptoms of Clostridium difficile infection (CDI)
range from mild diarrhoea to severe life-threatening inflammation of the colon with
watery diarrhoea (with a characteristic odour) and is commonly associated with current
or recent antibiotic treatment [See Infection Prevention and Control Assurance Standard Operating Procedure 20 (IPC SOP 20) - Clostridium Difficile].
Rotavirus – is the most common cause of severe vomiting and diarrhoea among
infants and young children, a mild to severe disease characterised by nausea,
vomiting, watery diarrhoea, and low-grade fever. Once a child is infected by the virus,
there is an incubation period of about two days before symptoms appear. The period of
illness is acute. Symptoms often start with vomiting followed by four to eight days of
profuse diarrhoea. Dehydration is more common in rotavirus infection than in most of
those caused by bacterial pathogens, and is the most common cause of death related
to rotavirus infection. There are eight species of this virus, referred to as A, B, C, D, E,
F, G and H. Rotavirus A, the most common species, causes more than 90% of rotavirus
infections in humans.
Shigella – Shigellosis is an infectious disease caused by a group of bacteria
called Shigella. Most who are infected with Shigella develop diarrhoea, fever, and
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stomach cramps starting a day or two after they are exposed to the bacteria. Shigellosis
usually resolves in 5 to 7 days. Some people who are infected may have no symptoms
at all, but may still pass the Shigella bacteria to others. There are four different species
of Shigella: Shigella sonnei, Shigella flexneri, Shigella boydii and Shigella dysenteriae.
(Shigella dysenteriae type 1 can cause deadly epidemics).
Campylobacter – is characterized by inflammatory, sometimes bloody diarrhoea or
dysentery syndrome, mostly including cramps, fever, and pain. The most common
routes of transmission are faecal-oral, ingestion of contaminated food or water, and the
eating of raw meat. Foods implicated in campylobacteriosis include raw or undercooked poultry, raw dairy products, and contaminated produce. Symptoms typically last
five to seven days, most cases occurring 3 to 5 days after exposure.
Amoebic dysentery - Amoebic dysentery, also called amoebiasis, is caused by a
single-celled parasite called Entamoeba histolytica. This form of dysentery is more
common abroad in tropical countries. Symptoms can appear as many as 10 days after
exposure and infection by the parasite. The common symptoms of amoebic dysentery
may include violent diarrhoea, often accompanied with blood and/or mucus visible in
the foul-smelling stools, severe colitis, frequent flatulence in which the patient gives off
malodorous gas, abdominal bloating, dehydration, severe abdominal cramps and
tenderness, slight to severe weight loss, moderate to severe anaemia, moderate fever,
mild to severe fatigue and mild chills. The amoebae may be then carried in the blood to
the liver resulting in the formation of an abscess that presents the following symptoms:
fever, chills, mild to severe explosive diarrhoea, pain in the upper right portion of the
abdomen, jaundice, weight loss and hepatomegaly. Symptoms can last from a few days
to a few weeks. Untreated, even if symptoms go away, parasites can live in the bowel
for months or years.
Giardia lamblia - Giardiasis is an infection of the digestive system caused by tiny
parasites called Giardia intestinalis (also known as Giardia lamblia, or Giardia
duodenalis). Symptoms of giardiasis are variable; some people have no symptoms but
still pass cysts in the stool and are considered carriers of the parasite while others may
develop acute or chronic diarrheal illnesses that begin to show symptoms in one to two
weeks after swallowing cysts. Symptoms of acute giardiasis are profuse watery
diarrhoea that later becomes greasy and foul-smelling with occasional bloating and
abdominal cramping. Other symptoms can include: foul-smelling flatulence and
belching, nausea, bloating, indigestion, fatigue, dehydration, loss of appetite, weight
loss caused by malnutrition. It can affect people of all ages but is most common in
young children and their parents. This is because things like nappy changing increase
the risk of infection. Treatment for Giardiasis is mainly done by medicines.
Verotoxin producing E.coli (VTEC) – Illness is characterised by severe abdominal
pain, and cramping and watery diarrhoea that becomes grossly bloody and lasts for 5–
10 days. Fever is usually mild or absent. Asymptomatic infection can occur. The
incubation period is 2–8 days, with an average of 3–4 days. Ingestion of contaminated
food and water, and person-to-person and animal-to-person transmission by the
faecal–oral route are responsible for VTEC infection. Undercooked meat, especially
ground meat or mince, is a source of infection. Other known food sources have
included lettuce, sprouts, salami, unpasteurised milk and fruit juices. The infectious
dose necessary to cause disease is thought to be as low as 10 organisms. VTEC is
communicable for as long as the organism is present in faeces, which is approximately
1 week in adults and as long as 3 weeks in children.
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Cryptosporidium - Cryptosporidiosis is a disease usually caused by the parasites
Cryptosporidium hominis and Cryptosporidium parvum. It is most commonly seen in
children aged between 1 and 5 years. People with weak immune systems are likely to
be more seriously affected. The most common symptoms are watery diarrhoea,
vomiting, stomach pains, and fever which may only last a couple of days, but which can
continue for up to three or four weeks. It can affect people with weak immune systems
for much longer. Most people with crypto get better with no treatment, but crypto can
cause serious problems in people with weak immune systems such as in people
with HIV/AIDS.
Salmonella - Different types of the Salmonella bacteria can cause the illness. The two
most common types are S. typhimurium and S. enteritidis. Salmonella infection occurs
from consumption of raw meats and eggs, contaminated dairy foods such as
unpasteurized (raw) milk, or fruits and vegetables contaminated by food handlers.
Reptiles, rodents, and birds may be infected with Salmonella. Contact with these
animals increases the likelihood of getting the infection. Symptoms include
diarrhoea, stomach cramps and sometimes vomiting and fever. On average, it takes
from 12 to 72 hours for the symptoms to develop after swallowing an infectious dose of
salmonella. Symptoms usually last for four to seven days and most people recover
without treatment.
Symptoms of Gastroenteritis
The main symptoms of gastroenteritis are:
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Sudden, watery diarrhoea
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Nausea (feeling sick)
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Vomiting, which can be projectile
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A mild fever
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Abdominal pain
Some people also have other symptoms, such as a loss of appetite, an upset stomach,
lethargy, aching limbs and headaches. The symptoms usually appear up to a day after
becoming infected. They typically last less than a week, but can sometimes last longer.
Routes of Transmission for Gastroenteritis
The bacteria/viruses are commonly transmitted by people with unwashed hands. People can
get the infection through close contact with infected individuals by sharing their food, drink, or
eating utensils or by eating food or drinking beverages that are contaminated with the
organism. Noroviruses, in particular, are typically spread through contact with the stool or
vomit of infected people and through contaminated water or food especially oysters from
contaminated waters.
Viral gastroenteritis in particular is highly contagious, people who no longer have symptoms
may still be contagious, since the virus can be found in their stool for up to two weeks after
they recover from their illness. Also, people can become infected without having symptoms
and can still spread the infection.
Faeces can be transported to your mouth by:
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Hands, by shaking someone’s hands contaminated by faeces, touching surfaces in
public toilets, changing nappies or incontinence pads, working in the garden, dealing with
cattle or pets
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Toys, mostly in small children
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Fomites – various objects, including utensils, capable to carry microbes
Food, usually raw fruits or vegetables, contaminated by stool-contaminated
hands or house flies
Drinking water, usually from lakes, contaminated by animal stool, swimming pools,
contaminated by human faeces, or even tap water in certain countries with low-hygiene
habits
Eating faeces, in children, or in a mental disorder called coprophagia
Definition of Acute v Chronic Diarrhoea
It can be difficult to determine what actually constitutes a “normal” bowel action as this can
vary greatly between individuals, but true diarrhoea consists entirely of liquid/water (type 6/7
Bristol Stool Chart.
Acute diarrhoea has a sudden onset and typically lasts between 1 – 4 days. Chronic diarrhoea
persists longer than 4 weeks and is usually due to an underlying cause. Diarrhoea is
considered significant when a patient has more than 3 episodes in 24 hours. However, any
case of diarrhoea, which may or may not be accompanied by vomiting, amongst
patients or staff should be regarded as potentially infectious and treated as such
unless an infectious cause can be confidently excluded.
Key Recommendations
Recognising a Suspected/Confirmed Case
Patients with any of the following symptoms:
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Vomiting - Two or more episodes of vomiting of a suspected infectious case* occurring
within a 24 hour period
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Diarrhoea - Two or more loose stools in a 24 hour period*
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Diarrhoea and Vomiting - One or more episodes of both symptoms occurring within a
24 hour period*
* Not associated with prescribed drugs or treatments and not associated with reaction to
anaesthetic or underlying medical condition or existing illness. In addition to the symptoms
above patients may also exhibit nausea, pyrexia, headache and abdominal cramps.
A confirmed case:
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Patient with symptoms as per suspected case above and with microbiological
confirmation
Specimen Collection
It is imperative that faecal samples are obtained from all symptomatic cases. This is to enable
the IPandC Team to identify the cause of the problem and to rapidly implement the correct
control measures to prevent further spread to the rest of the hospital setting.
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The date and time the sample was obtained must be recorded in the patient’s records.
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The reason for sending the sample must be indicated on the request form
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Any recent antibiotic history should also be recorded on the form
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Hands must be washed thoroughly with soap and water after specimen collection
Usually there is no requirement to provide clearance samples.
Actions to be Taken on Identification of Two or More Cases of Unexplained Diarrhoea
and / or Vomiting
Careful clinical assessment of the causes of vomiting and diarrhoea is important. Even in the
midst of an outbreak there will be patients who have underlying pathologies. Senior nursing
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staff in conjunction with medical staff and the Infection Prevention and Control Team (using
the case definition) should make a decision as to the likely cause. When an outbreak is
suspected please refer to Infection Prevention and Control Assurance - Standard
Operating Procedure 5 (IPC SOP 5) - Management and Recognition of Outbreaks.
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In areas where it can be demonstrated that symptomatic persons can be physically and
safely separated from non-symptomatic individuals through cohorting it may not be
necessary for the full “closure” or instigation of restrictions on an entire ward
Where cohort nursing is in operation within a bay area personal protective equipment (PPE)
should be worn and changed in between caring for each patient and hands must be
decontaminated thoroughly with soap and water. PPE should be removed and hands
washed prior to leaving the cohort area or single room
Where there is more than a single case a list should be compiled, including symptomatic
members of staff and visitors, stating the symptoms and the date/time that these started.
This information is vital in assisting the IPandC team to undertake accurate risk
assessment when they visit the ward (This form can be found in Infection Prevention
and Control Assurance - Standard Operating Procedure 5 (IPC SOP 5) Management and Recognition of Outbreaks - Appendix 2).
Further cases should be added to the list as/when they occur and these will be monitored
and documented during the IPandC team daily review
In situations where additional cases occur in locations other than the initial cohort bay or
side rooms in wards that are not fully “closed” the IPandC team needs to be informed
immediately (or on call manager out of hours), as risk assessment may indicate the need
to progress to a full ward closure restrictions
Symptomatic patients are required to be clear of all symptoms for 48 hours prior to being
deemed fully recovered and isolation restrictions lifted – seek advice from the IPandC
Team
Visitors
Visitors may contribute to the on-going spread of gastrointestinal infections. Visitors where
possible should be discouraged but not prevented from attending the wards that are closed or
have restrictions in place due to gastrointestinal infections. This applies especially to the
elderly, immunocompromised or the very young, in whom infections may be more severe.
It is strongly advised that anyone with symptoms should not be allowed to visit. (Information
for patients and carers can be seen in Appendix 2 and 3).
Personal Protective Equipment (PPE) for Care of Patients with Gastrointestinal Illness
PPE
Entry to isolation room or close
patient contact
Hand Hygiene
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Gloves
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Plastic apron
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Long-sleeved gown
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Surgical face mask
X
Risk assessment
Eye protection
(risk of aerosol/splash)
N.B. Hand hygiene MUST always take place after removal of personal protective equipment.
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Key Observations
Each patient should be reviewed daily by the medical team to review the observations made
by the nursing team. Clinical vital signs e.g. temperature, pulse, respirations and blood
pressure should be observed and recorded regularly (at least twice daily), for all patients
symptomatic with gastrointestinal illness, to monitor for clinical signs of
infection/sepsis/deterioration until the patient has been symptom free for at least 48 hours. In
addition frequency of diarrhoea and vomiting must be recorded on stool charts (the Trust
standard stool chart can be found in Infection Prevention and Control Assurance Standard Operating Procedure 20 (IPC SOP 20) - Clostridium Difficile - Appendix 1). Any
concerns must be brought to the attention of the Nurse-in-Charge and the medical team.
Clinical Treatment
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Dehydration - The mainstay of clinical treatment is the avoidance or correction of
dehydration which may be achieved through any standard oral rehydration regimen if
tolerated. For those who are unable to take oral fluids then intravenous or sub-cut
administration of appropriate fluids may be indicated. These measures are particularly
important in the elderly and those with underlying conditions or illnesses
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Anti-emetic - These are not recommended routinely there is no current evidence for the
efficacy of these drugs in adults and conflicting evidence for their use with paediatric patients
for whom side effects may be an issue. There is also the risk of compromising IPandC
measures through masking the infectivity of patients
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Anti-diarrheal drugs - These are not recommended routinely as there is the risk of
compromising IPandC measures through masking the infectivity of patients
Cleaning
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Ensure the rooms of patients with gastrointestinal infections are prioritised for frequent
cleaning (at least daily) with a focus on frequently touched surfaces and equipment in the
immediate vicinity of the patient
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Keep the environment clean and clutter free
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Use disposable cloths for cleaning and discard immediately after use
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Clinical equipment should as far as possible be allocated to the individual patient
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Re-usable equipment MUST be decontaminated after patient use and between each
patient
See Infection Prevention and Control Assurance - Standard Operating Procedure 7 (IPC
SOP 7) - Decontamination, for more information. Environmental cleaning is vitally important
in preventing the spread of infection. The cleaning regime incudes the standard daily clean
followed by disinfection with 1,000ppm chlorine solution to all surfaces and frequent touch
points.
N.B When a patient with a gastrointestinal infection is transferred/discharged the room/bed
space must have a terminal deep clean undertaken before its re-use – this includes replacing
curtains. Contact the Estates and Facilities Helpdesk to arrange on 0121 612 8010 or ext.: 8010
Discontinuation of Precautions
Providing symptoms are no longer present, isolation can usually be discontinued 48hrs after
the last episode of diarrhoea and/or vomiting, however this may vary dependant on the
causative organism. The Infection Prevention Team should be contacted for advice in these
situations.
On discontinuation of precautions a thorough isolation clean should be carried out using
detergent and hot water followed by a 1,000PPM chlorine solution.
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Staff
The main focus is based on the principle of minimising the disruption to important and
essential services and maximising the ability of the Trust to deliver appropriate care to patients
safely and effectively.
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All staff must understand the significance and potential consequences of gastrointestinal
illness within the Trust and ensure they are aware of and apply the appropriate infection
prevention and precautions interventions when caring for patients with suspected /
confirmed gastroenteritis
Staff must be able to identify the symptoms early in order to prevent transmission and
outbreaks occurring and must be able to appropriately manage outbreaks of
gastrointestinal infections as/when they do occur
All staff caring for patients with a known or suspected gastrointestinal infection must use
standard and transmission based precautions to reduce the risk of further acquisition and
transmission of infection [See Infection Prevention and Control Assurance Standard Operating Procedure 1 (IPC SOP 1) - Standard Precautions and Infection
Prevention and Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) Transmission Based Precautions]
Staff Exclusion Rule
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All staff who are taken ill at work with either diarrhoea and / or vomiting should be sent
home immediately without completing their shift. It is the individual’s responsibility to
communicate to colleagues that the bathroom / toilet area requires immediate
decontamination before use by other staff members. This is to prevent spread to other
members of staff on the ward
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Staff should be excluded from the workplace for 48 hours after all symptoms of diarrhoea
and/or vomiting have ceased. The period of exclusion is to prevent further transmission to
the workplace environment due to potential continued viral shedding which can occur up to
48 hours after symptoms have ceased. Staff and students working within the Trust are to
be advised that this exclusion is mandatory. For further advice on an individual basis
please contact the IPCT or Occupational Health
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The submission of a stool sample by staff is also a requirement if the reason for staff
sickness is diarrhoea and vomiting. Samples should be submitted via the Occupational
Health Department or G/P
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Advice and guidance can be sought from the IPCT or Occupational Health team should
this situation arise
Discharge/Transfer of Patients with Gastrointestinal Infections
Good communication is essential to ensure a safe transfer of patients with gastrointestinal
infections.
Transfers out - If a symptomatic patient is to be transferred to another hospital or other care
provider, the receiving ward/department/care-home should be notified prior to the transfer
taking place – this is the responsibility of the Nurse-in-Charge. When transferring to another
hospital the IPCT will liaise with the receiving Trusts infection prevention and control team
[See Infection Prevention and Control Assurance - Standard Operating Procedure 16
(IPC SOP 16) - Sharing Information with other Health and Social Care Providers].
Transfers between wards – Patients with gastrointestinal infections must only be transferred
to another area due to clinical necessity. If these patients are transferred within the Trust, the
receiving area must be fully aware of the precautions necessary prior to transfer. The patient
must not be transferred until the receiving area is prepared. In addition the IPCT must also be
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informed of the planned transfer PRIOR to the transfer taking place so that appropriate
information and advice can be given.
Where do I go for further advice or information?
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Infection Prevention and Control Team
Physical Health Matron
Your Service Manager, Matron, General Manager, Head of Nursing, Group Director
Your Group Governance Staff
Training
Staff may receive training in relation to this procedure, where it is identified in their appraisal
as part of the specific development needs for their role and responsibilities. Please refer to the
Trust’s Mandatory and Risk Management Training Needs Analysis for further details on
training requirements, target audiences and update frequencies.
Monitoring / Review of this Procedure
In the event of planned change in the process(es) described within this document or an
incident involving the described process(es) within the review cycle, this SOP will be reviewed
and revised as necessary to maintain its accuracy and effectiveness.
Equality Impact Assessment
Please refer to overarching policy
Data Protection Act and Freedom of Information Act
Please refer to overarching policy
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Appendix 1
Infection Prevention and Control Precautions Overview
Patient Placement
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Isolate symptomatic patients in a single room with en-suite facilities
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Restrict patient movement and exclude from all communal therapies
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Keep isolation room door closed as far as possible ensuring patient safety at all times
Patients
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All affected patients should be commenced on a Bristol Stool Chart [chart can be found
in Infection Prevention and Control Assurance - Standard Operating Procedure 20
(IPC SOP 20) - Clostridium difficile- Appendix 1]
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Send specimens to the lab for diagnostic investigations e.g. culture, norovirus and C.
difficile testing as required. Only stool recognised as Bristol Stool Chart type 6 and 7 will
be tested. The date and time the sample was obtained must be recorded
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Provide adequate opportunity to allow patients to decontaminate their hands at regular
intervals particularly after visiting the toilet and prior to consuming food and drinks
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Provide patients with relevant information and the control measures they should follow to
minimise cross-infection (see Appendix 3)
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Advise on restricted visiting and visitors visiting at their own personal risk
Hand Hygiene
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Adequate facilities for hand hygiene must be provided for patients, staff and visitors
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Hand wash basins should be accessible and regularly restocked with liquid soap and
paper towels
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N.B. hand sanitising gels may not be effective therefore use of soap and water is advised
when caring for patients symptomatic with diarrhoea and/or vomiting
Personal Protective Equipment (PPE)
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Use gloves and apron as indicated to prevent transmission between patients [see
Infection Prevention and Control Assurance - Standard Operating Procedure 1
(IPC SOP 1) - Standard precautions]
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PPE must be used when handling excreta or vomit and when in close patient contact
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PPE must be removed and hands washed before leaving the isolation room/cohort area
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PPE must be changed and hands washed before moving from one patient to another
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Consider use of facial protection if there is a risk of body substances contaminating the
face of the healthcare worker
Environment
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It is essential that environmental cleaning is carried out to a high standard and
cleanliness maintained paying particular attention to frequent touch points
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Intensify cleaning ensuring affected areas are cleaned with the appropriate chemicals
e.g. chlorine 1,000 PPM solution [See Infection Prevention and Control Assurance Standard Operating Procedure 7 (IPC SOP 7) - Decontamination]
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Decontaminate equipment after each use
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Do not leave exposed foods out on the open ward, kitchen or staff areas e.g. communal
fruit bowl, open biscuits etc.
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Deal with spillages immediately – clean and disinfect all faecal and vomit spillages [See
Infection Prevention and Control Assurance - Standard Operating Procedure 7
(IPC SOP 7) - Decontamination])
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Linen
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Used and soiled linen from affected patients should be bagged into Alginate (red water
soluble bags) before placing into the linen bag and treated as infected linen. If laundry is
to be taken home by relatives place contaminated laundry into the orange and white
patient laundry bag (see information in the Gastroenteritis – information for patients and
carers in Appendix 2 and 3)

Bed linen should be changed daily as a minimum for all affected patients
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Beds not in use should not be remade until the ward is ‘re-opened’ and mattresses and
bed frames have been thoroughly cleaned to minimise the risk of contamination of
bedding
Healthcare Workers

Ensure all staff are aware of the necessary control measures

Allocate staff where possible to care for affected OR non-affected patients to reduce the
risks of transmission
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Prevent non-essential staff visiting the ward
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Ensure affected staff refrain from work until they are 48 hours clear of all symptoms
Equipment

All shared equipment MUST be thoroughly decontaminated after every use to prevent
person-to-person spread

Use single patient use equipment whenever possible [See Infection Prevention and
Control Assurance - Standard Operating Procedure 7 (IPC SOP 7) Decontamination]
Continuous Monitoring and Communication

Maintain an up-to-date record of all patients with symptoms and the number of staff
affected

Monitor all affected patients for signs of dehydration and correct as necessary

Communicate with the multidisciplinary team/managers and infection prevention and
control on a daily basis
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Appendix 2
Special Instructions for Visitors and Relatives
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Visitors should be advised not to visit if they have symptoms of gastroenteritis or have
had recent contact with a person with diarrhoea and / or vomiting. This includes recent
visits to other wards or departments affected for example with norovirus
Visitors where possible should be discouraged but not prevented from attending the
wards that are “closed” / have restrictions in place due to outbreak of gastrointestinal
illness. This applies especially to the elderly, immunocompromised or the very young, in
which infections may be more severe
Visitors should be encouraged to decontaminate their hands on entering and leaving the
ward by either hand washing (using liquid soap and water)
If clothing from symptomatic patients is returned to relatives or carers for laundering, they
should be given verbal instruction on how to safely launder the items in the home setting
(see below)
Soiled and contaminated clothing should be presented to relatives in an orange and
white water soluble bag (these are specific laundry bags compatible with domestic
washing machines). Instructions for use:
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Put the sealed white and orange patient laundry bag directly into the washing
machine. Do not take the clothes out of the white and orange bag, soak the
clothes or wash them by hand
After placing the laundry bag into the washing machine, wash your hands
thoroughly with soap and warm water
Wash the white and orange bag separately from all other laundry you may have,
don’t overload the machine
Use biological washing powder/liquid and wash the clothes using a 60°C wash
The bag has a soluble tape and central seam, which will dissolve during the
wash cycle. Remove the bag after washing and place into your household waste
Dry laundry as soon as possible. Tumble drying at high temperatures (if fabrics
permit) will have a further hygienic effect or alternately air dry on a clothes line
and iron
The Patient and Visitor Information Leaflet “Gastroenteritis – information for patients and
carers” (appendix 3) should be given and made available to all patients and visitors to
the ward
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Appendix 3
Infection prevention and control is everyone’s responsibility.
Patients and visitors all have an important role to play in
preventing the spread of healthcare associated infections.
Visitors with symptoms of gastroenteritis are advised not to visit the
hospital.
Issue Date: XXX
Ref.No: XXX
Antibiotics are not usually advised if you are normally in good health. Your
immune system can usually clear the infection. Antibiotics do not kill germs
which are viruses. Sometimes antibiotics may be prescribed if you become more
unwell, your symptoms are due to a bacterial infection or if you already have an
underlying chronic illness.
Information for patients and
carers
Department: XXX
What about antibiotics?
Gastroenteritis
Author: XXX
Why have I been isolated in my room?
In order to reduce the risk of spreading the infection to other vulnerable
patients you will be asked to stay in your room for a few days and the
staff looking after you will need to wear protective clothing (gloves and
apron) to reduce the risk of them spreading the infection to themselves
and others.
Review Date: XXX
What about my laundry?
Patient’s clothes will be given to your relatives to take home inside a
white and orange patient laundry bag. Where this is not possible it may
be possible to use the hospital laundry. The Infection Prevention and
Control Nurse will be able to advise. The risk of infection when washing
patient clothes at home is low.
If you require further advice or information, please contact the Trust’s Infection
Prevention and Control Team or a member of the ward/department staff.
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If you are at home then it’s best to stay in until you are feeling better. There is
not always specific treatment, so you have to let the illness run its course. You
do not normally need to see your GP as it should get better on its own and
visiting the surgery can put others at risk.
Get medical advice if you have:
 symptoms of severe dehydration such as persistent dizziness, only
passing small amounts of urine or no urine at all
 you have bloody diarrhoea,
 you are vomiting constantly and are unable to keep any fluids down
 you have a fever over 38°C
 your symptoms haven’t started to improve after a few days
 in the last few weeks you have returned from a part of the world with
poor sanitation or you have a serious underlying medical condition.
Your Doctor/GP may suggest sending off a sample of your poo to a laboratory to
check what’s causing your symptoms.
What can I do to help ease the symptoms?
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Drink plenty of fluids to avoid dehydration – you need to drink more than
usual to replace the fluids lost from vomiting and diarrhoea. Water is
best but you can also try fruit juice and soup.
Take paracetamol for any fever or aches and pains
Get plenty of rest
If you feel like eating, try small amounts of plain foods such as soup,
rice, pasta and bread.
Use special rehydration drinks made from sachets bought from your
local pharmacy if you have any of the signs of dehydration (dry mouth,
dark urine)
Can I spread the infection to others?
Gastroenteritis can spread vary easily, so you should wash your hands regularly
while you are ill and always after visiting the toilet or preparing your food/drinks.
Stay off work/school/college or university until at least 48 hours after your
symptoms have cleared to reduce the risk of passing it on to others. Also avoid
preparing/handling food for others for the same time period.
Good hand hygiene is the most important way to
prevent the spread of gastrointestinal infections
Posters showing the best way to wash your
hands are available at the hand wash sinks.
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What is gastroenteritis?
When you have gastroenteritis your stomach and intestines are irritated
and inflamed. It affects people of all ages but is particularly common in
young children. This is typically caused by a viral or bacterial infection.
What are the symptoms of gastroenteritis?
The symptoms are:
 Sudden watery diarrhoea
 Nausea (feeling sick)
 Vomiting which can be projectile
 Abdominal cramps
 A mild fever
Some people may have other symptoms such as loss of appetite, aching limbs
and headache.
How did I get gastroenteritis?
The bugs that cause gastroenteritis can spread very easily from personto-person. You can catch the infection if small particles of vomit or poo
from an infected person get into your mouth, such as through:
 Close contact with someone who has gastroenteritis
 Touching contaminated surfaces or objects
 Consuming contaminated food or water
 Unwashed hands after going to the toilet or changing nappies
The commonest cause of gastroenteritis is a virus – the main types are
Norovirus and Rotavirus. Rotavirus is the world’s most common cause of
diarrhoea in infants and young children, cases in adults are usually
caused by Norovirus or bacterial food poisoning.
The symptoms usually appear up to a day after becoming infected and
typically last less than a week, but can sometimes last longer.
What to do if you have gastroenteritis
The best thing to do is stay in your room if you are in hospital – the nurses will
advise you what to do
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Standard Operating Procedure Details
Unique Identifier for this SOP is
BCPFT-COI-POL-05-26
State if SOP is New or Revised
New
Policy Category
Control of Infection
Executive Director
whose portfolio this SOP comes under
Policy Lead/Author
Job titles only
Committee/Group Responsible for
Approval of this SOP
Executive Director of Nursing, AHPs and
Governance
Infection Prevention and Control Team
Infection Prevention and Control Committee
Month/year consultation process
completed
June 2016
Month/year SOP was approved
July 2016
Next review due
July 2019
Disclosure Status
‘B’ can be disclosed to patients and the public
Review and Amendment History
Version
1.0
Date
July 2016
Description of Change
New Procedure established to supplement Infection Control
Assurance Policy
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