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Isolation Policy V4 25.07.2016 Isolation Policy Flow Chart Refer to Appendix 3 If „Notifiable Disease‟ Notification of diseases certificate to be completed If Source Isolation Required Explain to patient rationale for isolation Transfer patient to side room with en-suite facilities where possible Keep door closed Display isolation precautions in use Inside Room Inside Room Infectious waste bag/bin Linen bag Thermometer BP cuff Stethoscope Outside Room PPE in appropriate dispenser Nursing notes Remove PPE prior to leaving room Carry out hand hygiene prior to leaving room and immediately after leaving the room On discharge arrange a terminal clean of the room Isolation Policy Page 2 of 26 Table of Contents Summary. ............................................................................ Error! Bookmark not defined. 1. Introduction ................................................................................................................... 4 2. Purpose of this Policy/Procedure .................................................................................. 4 3. Scope ........................................................................................................................... 4 4. Definitions / Glossary .................................................................................................... 4 5. Ownership and Responsibilities .................................................................................... 4 5.1. Role of the Chief Executive ................................................................................... 4 5.2. Role of the Director of Infection Prevention and Control (DIPC) ............................ 4 5.3. Role of the Managers ............................................................................................ 4 5.4. Role of the Infection Prevention and Control (IPAC) Steering Group .................... 5 5.5. Role of the Hospital Infection Prevention and Control Committee ......................... 5 5.6. Role of individual staff members............................................................................ 5 5.7. Consultant Medical Staff ........................................................................................ 5 5.8. The Infection Prevention and Control Team .......................................................... 5 5.9. Chief Operating Officer/Senior Manager on Call ................................................... 5 6. Standards and Practice ................................................................................................ 5 6.1. Source Isolation ..................................................................................................... 5 6.2. Source Isolation Precautions ................................................................................. 6 6.3. Protective Isolation .............................................................................................. 10 6.4 Psychological Effect of isolation .......................................................................... 13 6.5 Ward Rounds....................................................................................................... 13 7. Dissemination and Implementation ............................................................................. 14 8. Monitoring compliance and effectiveness ................................................................... 14 9. Updating and Review.................................................................................................. 14 10. Equality and Diversity .............................................................................................. 14 Appendix 1. Governance Information ................................................................................ 15 Appendix 2. Initial Equality Impact Assessment Form ....................................................... 19 Appendix 3. Table of Communicable Diseases and Appropriate Precautions .................. 21 Isolation Policy Page 3 of 26 1. Introduction 1.1. Standard precautions are the principle strategy for the prevention and control of healthcare associated infection. However, additional precautions are required for the care of patients who are known or suspected to be infected (or colonised) with highly transmissible or epidemiologically important pathogens and those who have an increased susceptibility to infection because they have a compromised immune system or extensive skin loss due to burns or other trauma. Such precautions are known respectively as source isolation precautions and protective isolation precautions. 2. Purpose of this Policy/Procedure 2.1. This policy has been designed to aid health care professionals when looking after patients with compromised immunity to try and reduce the risk of infection to these patients whilst in our care (Protective Isolation). This policy also provides information on the management of patients who are known or suspected to be infected or colonised with highly transmissible or epidemiologically important pathogens thereby protecting others from infection (Source Isolation) 3. Scope 3.1. This policy applies to all staff working in the Royal Cornwall Hospitals NHS Trust. 4. Definitions / Glossary 4.1. Definitions are included in the text. 5. Ownership and Responsibilities 5.1. Role of the Chief Executive The Chief Executive Officer (CEO) is responsible for ensuring that there are effective arrangements for infection control within the Trust. This includes determining the mechanisms by which the Trust Board ensures that there are adequate resources available to secure effective prevention and control of healthcare associated infections. 5.2. Role of the Director of Infection Prevention and Control (DIPC) The DIPC is responsible for overseeing the implementation of the policy, for reporting any concerns and performance in infection prevention and control to the Trust Board and CEO, and for challenging inappropriate clinical practice and antibiotic prescribing. 5.3. Role of the Managers Divisional Management Teams and Directorates must ensure that resources are available for health care workers to undertake effective standard and isolation precautions. Isolation Policy Page 4 of 26 Clinical Matrons, Ward Sisters/Charge Nurses and departmental managers are responsible for ensuring that staff are aware of this guidance and that the guidance is implemented. 5.4. Role of the Infection Prevention and Control (IPAC) Steering Group The IPAC Steering Group is responsible for the implementation and monitoring of this policy. 5.5. Role of Committee the Hospital Infection Prevention and Control The Hospital Infection Prevention and Control Committee is responsible for approving this document. 5.6. Role of individual staff members Each individual has a clinical and ethical responsibility to carry out effective Infection prevention and control procedures and to act in a way, which minimises risk to the patient. All staff members working on Trust premises, including Trust employed staff, contractor staff, agency and locum staff are responsible for: adhering to this policy, and for reporting breaches of this policy to the person in charge and to their line manager 5.7. Consultant Medical Staff Are responsible for ensuring their junior staff read and understand this policy, and adhere to the principles contained in it at all times. 5.8. The Infection Prevention and Control Team Is responsible for providing expert advice in accordance with this policy, for supporting staff in its implementation, and assisting with risk assessment where complex decisions are required. The team is also responsible for ensuring this policy remains consistent with the evidence-base for safe practice, and for reviewing the policy on a regular basis. 5.9. Chief Operating Officer/Senior Manager on Call Is responsible for providing senior and executive leadership to ensure implementation of this policy, and for ensuring infection risks are fully considered and documented when complex decisions need to be made regarding capacity and patient flow. 6. Standards and Practice 6.1. Source Isolation The infected/colonised patient, as the source of infection, is segregated from unaffected patients, usually in a single room but, on occasions, within a cohort of similarly affected patients. Physical segregation, combined with other precautions such as the use of protective clothing, is aimed at reducing the likelihood of infections Isolation Policy Page 5 of 26 spreading via the airborne, droplet or contact routes. The extent of isolation depends on: The infecting organism and the route of transmission The physical and mental abilities of the patient Risk assessment of susceptibility of other patients Facilities available for isolation Wherever possible patients who require source isolation should be transferred to the isolation ward in line with the Standard Operating Policy for the Isolation Ward. 6.2. Source Isolation Precautions 6.2.1. Communication Explain the rationale for isolation to the patient and, where possible, the duration of isolation anticipated. Where available provide a patient information leaflet. Ensure the Isolation Precautions sign on the door of the room/bay is clearly displayed. Record in the patient's notes that isolation has been commenced and the reason why. Revise the nursing care plan accounting for infection control precautions to be maintained by staff, patient and visitors. Inform the Infection Prevention and Control Team that there is a patient in isolation. Check whether the patient has a „Notifiable Disease‟ and if so a Notification of Diseases Certificate must be completed by the medical team. Notification Certificate Books are kept in each clinical area. 6.2.2. Accommodation Identify appropriate isolation facilities e.g. single room or cohort bay. A side room with negative pressure ventilation may be required for airborne infections. Negative pressure ventilation is available in the ITU side room; otherwise patients would need to be transferred to another hospital. It is particularly important to keep the door closed when the side room is used for isolating a patient with an airborne infection. If a single room is indicated it is preferable that it has en-suite toilet and washing facilities. Remove all non-essential furniture and equipment. Ensure that appropriate equipment is available: Inside the room Hand washing facilities Clinical waste bag holder/bin. Linen receptacle with water soluble bag. Sharps Bin (if safe to leave within room) Thermometer, BP cuff & tourniquet (preferably disposable) Stethoscope (if required) Toileting and wash facilities (if no en suite bathroom). Isolation Policy Page 6 of 26 Outside the room Appropriate protective clothing in dedicated dispensers where possible. Alcohol hand rub (except in cases of diarrhoea). Nursing notes to be outside room. NB The mental health of the patient may dictate that it is unsafe to leave some of this equipment within the room. Always undertake a risk assessment. 6.2.3. Hand Hygiene Hands must be cleansed prior to leaving the isolation room. Hand hygiene must also be performed between different patient care activities to prevent cross contamination of different body sites. If the patient has diarrhoea soap and water must be used for hand hygiene rather than alcohol rub. Hands must be immediately cleansed after leaving the room 6.2.4. Protective Clothing Protective clothing should be worn whenever there is any physical contact with the patient. Protective clothing must be removed immediately prior to leaving the room and must be disposed of inside the room into a clinical waste bag (except when leaving the room to dispose of used bedpans etc. when it is removed in the sluice after placing bedpan in macerator/bedpan washer). The type of protective clothing required is dependent on the mode of transmission and the type of contact. All that is usually required is disposable gloves and aprons. If it is anticipated that more than one apron or pair of gloves are required during an episode of care, the additional gloves and aprons should be taken into the room at that time. Boxes/rolls or aprons must not be kept inside the room. Occasionally additional protective clothing, such as masks and gowns, is required. Where this is appropriate it has been identified in Section 4. It is important to note that masks are rarely necessary and are of limited value in protecting against infection spread by the airborne respiratory route. It is more important that staff caring for patients with airborne infections are immune. Where acute rooms are available PPE should be removed here. 6.2.5. Vulnerable Staff and Visitors Some people may be more vulnerable than others to infection. In particular: Pregnant women Immunocompromised people (for any reason) Staff with eczematous/psoriatic or similar skin lesions (particularly relevant with MRSA) Staff and visitors receiving antibiotics (relevant to C.difficile infection) and must seek advice prior to caring for patients in isolation. 6.2.6. Equipment Disposable equipment should be used whenever possible. Non disposable equipment must be decontaminated in accordance with the Decontamination Policy when removed from the room. Wherever possible equipment should be Isolation Policy Page 7 of 26 allocated for sole use of the patient and decontaminated or disposed of when no longer required. 6.2.7. Linen All laundry from isolation rooms must be managed as fouled/infected laundry and therefore be placed in water soluble bags within the room and then into an outer linen sack. 6.2.8. Waste Disposal All waste must be disposed of into clinical waste bags inside the room. Double bagging is not necessary. The bag should be placed immediately at the designated collection point. 6.2.9. Excreta Excreta can be disposed of directly into the toilet adjoining the room. If ensuite facilities are not available, cover commode/bed pan and take directly to the sluice. Pans and urinals must be placed directly into the macerator. Gloves and aprons should then be removed and discarded in clinical waste bin and hands washed. 6.2.10. Sharps A sharps bin should be kept inside the room for sharps disposal, unless this will be a hazard to the patient each case must be risk assessed. 6.2.11. Collection of Specimens Specimens should be obtained within the room. Care must be taken to avoid contaminating the outside of the specimen container. All clinical specimens should be regarded as potentially infectious and handled as such. However, since it is National Health and Safety Policy, specimens from patients likely to or suspected of having the following infections must be treated as „high risk „and identified on the accompanying form. Hepatitis B&C HIV Pulmonary TB Brucellosis Plague Anthrax Yellow Fever 6.2.12. Crockery and Cutlery Crockery and cutlery is adequately decontaminated by dishwasher. Return items to kitchen promptly. 6.2.13. Visits to Other Departments Movement of infectious or potentially infectious patients should be kept to a minimum. If it is possible to delay an investigation without adversely affecting the patients management this should be considered. However the presence of an infectious disease should not delay urgent clinical investigations. The receiving department must be notified in advance so that arrangements can be made to prevent possible spread of infection i.e. patients with infections spread by the airborne route should be seen at the end of a Isolation Policy Page 8 of 26 list/session. Ward staff should advise of any necessary precautions. The Infection Prevention and Control Nurse can also be contacted for advice. After the investigation/treatment is completed, surfaces with which the patient has had contact should be cleaned with hot water and detergent or detergent wipes followed by actichlor (actichlor plus can also be used). Portering staff and other staff accompanying the patient do not need to wear protective clothing but must clean their hands thoroughly after having direct contact with the patient. Wheelchairs/trolleys used to transport patients to other departments must be cleaned with hot water and detergent or detergent wipes. 6.2.14. Transfer/Discharge of Patients All transfers must be restricted unless clinical need dictates. The receiving area must be informed in advance of the nature of the infection to ensure that the appropriate facilities are available and the required precautions are applied. Movement for non-clinical reasons, is not advocated. On discharge ensure that receiving hospital/nursing home or community services are informed of any necessary precautions. If transport by ambulance is required, the Ambulance Service must be informed of any necessary precautions. 6.2.15. Visitors Visitors must report to the nurses‟ station prior to entering the room. It may be necessary to ask about immunisation status prior to visiting. In some circumstances visiting may be restricted. If visiting is allowed it is usually unnecessary for visitors to wear protective clothing but they should be advised to wash/clean their hands when leaving the room. Visitors may need to be shown how to do this. Visitors should be advised not to visit other patients but if this is necessary they should do so before visiting the patient in isolation. They should be advised not to eat or drink whilst in the isolation room or bring in food for the patient unless previously agreed. Visiting by young children should be discouraged. If visitors chose to bring children to the hospital for visits they must be informed of any risks. 6.2.16. Routine Cleaning Isolation rooms must be cleaned at least as frequently as other patient areas using standard cleaning procedures and Actichlor plus. Cloths must be disposable. Mop heads must be removed and should be laundered after use or disposable mop heads discarded. Isolation rooms used for source isolation must be cleaned after all other areas. 6.2.17. Last Offices Following death, the body may remain an infection risk to personnel and therefore isolation precautions must be maintained whilst Last Offices are performed. Last Offices are performed in accordance with local Trust procedures. All bodies should be sealed in a leak proof cadaver bag. Isolation Policy Page 9 of 26 6.2.18. Terminal Cleaning Terminal cleaning of the environment and furniture can be arranged via the Mitie Helpdesk: ext: 2468. The room must not be used for other patients until a terminal clean has been completed. All disposable items are to be discarded. 6.3. Protective Isolation The purpose of protective isolation is to provide a safe environment for patients who have an increased susceptibility to infection because they have a compromised immune system or extensive skin loss due to burns or other trauma. Generally these patients are most at risk from their own resident flora (endogenous infection) but must also be protected from the risk of cross infection (exogenous infection). As most infections are endogenous, there should be an emphasis on patient education regarding hand washing and basic hygiene. The most common reason for placing a patient in protective isolation is if the blood neutrophil count falls, or is expected to fall, below 0.5 x 109/L. Although immunosuppression may occur for many reasons (including organ transplants, some genetic disorders and infection with HIV), it is commonly encountered in cancer services. This is due to high-dose chemotherapy and occurs particularly in patients with haematological malignancies who are given bone marrow or stem cell transplants. These patients may also receive prophylactic antifungals and/or antibiotics to reduce the risk of endogenous infection. The decision to institute protective isolation is made by the clinician caring for the patient or on the advice of the infection prevention and control team, Haematologist or Oncologist. 6.3.1. Accommodation A single room helps to reinforce the need for rigorous attention to standard infection prevention and control precautions. Immunocompromised individuals should never be placed in the same room or adjacent to people with a known infection. Therefore ideally patients should be nursed in a single room, preferably with en-suite facilities and the door should be kept closed. Patients with prolonged neutropenia should be nursed in isolation rooms with HEPA filtered air at positive pressure as this may help to reduce exposure to airborne infections, particularly Aspergillus. This is especially relevant when refurbishment, building or demolition works are in progress nearby. In order for the system to work effectively windows and doors must be kept closed at all times. Single rooms with positive pressure ventilation will usually have an anteroom. For maximum effect, only one of the doors in the ante-room should be open at any time when entering or leaving the cubicle. Flowers and plants should not be allowed in the room. All persons entering the room should practice strict hand washing procedures and visitors with active infections should be discouraged from entering the room. Strict adherence to bare below the elbows is required. Isolation Policy Page 10 of 26 Occasionally, an immunocompromised patient may acquire an infection and is therefore potentially a hazard to other patients on the ward which means that source isolation is also required. In this situation the positive pressure ventilation should be switched off. At RCHT Lowen Ward is the only facility in the hospital to have positive pressure facilities. 6.3.2. Communication The rationale for isolation must be explained to the patient and, where possible the duration of isolation anticipated. The appropriate isolation notice must be placed on the door to the room. A record must be made in the patient‟s notes that isolation has been commenced and the reason why. The nursing care plan must be revised accordingly. The patient‟s family and friends must be provided with education and communication as to why their relative has been isolated and what precautions they need to adhere to. 6.3.3. Infection Control Precautions Standard infection control precautions must be applied when providing care to Neutropenic or other severely immunosuppressed patients, in particular: Hand Hygiene Strict attention must be paid to hand decontamination prior to entering the room. Hands must be cleansed before and after each episode of patient contact. In order to reduce the risk of cross contamination of different body sites hands must also be decontaminated between different tasks and procedures undertaken on the same patient, e.g. between assisting a patient with toileting and mouth care. Relatives and visitors must be educated and advised with regard to good hand hygiene when entering and leaving the isolation area. Protective Clothing Disposable, single use plastic aprons should be worn for all clinical procedures to provide a protective barrier that will minimise the risk of transmission of micro-organisms to the patient. Non-sterile gloves must be worn for contact with body fluids as per standard infection control precautions. Staff should to avoid the contamination of uniforms by not sitting on patients beds/chairs unnecessarily. Gloves and aprons should be removed outside the isolation room (unless further care/procedures are to be carried out) and placed inside clinical waste bins. Decontamination of Equipment All unnecessary equipment should be removed from the room. Disposable equipment should be used whenever possible. Non-disposable equipment must be cleaned before and after use in accordance with the decontamination policy. Wherever possible equipment should be allocated for the sole use of the patient during their admission. Isolation Policy Page 11 of 26 Decontamination of the Environment It is important that the room is kept as clean as possible. The room must be cleaned prior to the admission of a patient and daily thereafter using standard daily cleaning procedures. Protective isolation rooms should be cleaned before other patient areas. Cloths must be disposable, and a freshly laundered or disposable mop head used. 6.3.4. Patient Hygiene Most infections are endogenous therefore measures to contain the body‟s normal flora are important. These include good personal hygiene, regular mouth care, and supportive care to maintain the integrity of skin and mucous membranes. Patients should preferably have en suite toilet and showering facilities. If this is not possible a commode or toilet should be allocated for their sole use. Patients can shower or bath in shared facilities as long as these areas are thoroughly cleaned immediately prior to use. Patients personal hygiene needs must be assessed on a daily basis and assistance given where required to maintain an acceptable level of cleanliness. Particular care needs to be given to the perineal area which is heavily colonised with bacteria. Immunocompromised patients frequently suffer irritation or infection of this area. It is felt that this can be exacerbated by the use of soap which may irritate the mucous membranes. Therefore the use of warm water alone is recommended (Lindell & Olsson 1989) Disposable cloths rather than flannels must be used and towels must be changed daily. 6.3.5. Diet The immunocompromised patient is at increased risk of food-borne illness and the acquisition of harmful micro-organisms from some food. Therefore immunocompromised individuals are advised to avoid certain high risk foods for example soft cheeses and foods made with raw eggs. For further information please refer to local dietary guidelines for Neutropenic patients as recommended by the Department of Nutrition & Dietetics for example Bloodwise booklet titled „Dietary advice for haematology patients with neutropenia‟ or Neutropenic Diet policy as compiled by the Nutrition and Dietetics Department. In general, good food hygiene principles should be followed foods should be well-cooked and reheated to an appropriate temperature. Fruit and vegetables should be packaged or peeled and dairy products should be individually packaged and pasteurised. Pate, liver, soft/blue cheeses, live yoghurts and probiotics are not advised. Drinking water should be from a tap with a tap filter. Taps without an identified filter should not be used. Where filtered water is not available sterile water should be used. This is available from pharmacy. Bottled water is not permissible. Water should not be taken from any water fountains. Isolation Policy Page 12 of 26 Commercially available non-carbonated bottle water may contain large numbers of gram-negative bacteria and therefore should be avoided. Carbonated bottled water is considerably safer than non-carbonated because of the low pH of these products; the low pH can however result in poor patient acceptability in patients with chemotherapy associated mucositis. Ward staff must inform the Mitie ward host of a patient‟s neutropenic status verbally and by updating the „ward host handover sheet‟. 6.3.6. Flowers Flowers and plants have not been directly linked to infection in immunocompromised patients; however they could potentially be a reservoir for gram negative bacteria or fungal spores. Therefore pot plants and flowers are not recommended. 6.3.7. Staff Illness Particular caution is required when working with immunocompromised patients and therefore staff with upper-respiratory tract infections or oral-facial herpes simplex should be excluded from direct contact with these patients. 6.3.8. Visitors The patient may receive visitors, however visitors should report to a member of staff before entering the room so that precautions can be explained and any infections in the visitor which might be dangerous to the patient can be identified. Visitors must be excluded if they have any form of transmissible infection. The efficiency of the ventilation system will be severely compromised by large numbers of visitors. Numbers should be restricted to no more than two at a time. Coats and jackets should be removed before entering the room. It is not necessary for visitors to wear protective clothing, unless they are performing assistance with personal care, when a disposable plastic apron should be worn. Visitors must be advised of the importance of hand hygiene before entering the room. 6.4 Psychological Effect of isolation Many studies have shown the detrimental effect of isolation on patients‟ psychological well-being (Gammon 1998, Knowles 1993). Some patients may find it beneficial to leave their isolation room for short periods of time or for mobilisation purposes. Patients can leave their isolation rooms for short periods as long as they avoid contact with crowds, other patients or people with infections. This may be easier to achieve during quieter periods on the ward, such as rest periods. This must be carefully explained to patients who may find it confusing. 6.5 Ward Rounds All staff must be bare below the elbows and hands decontaminated before entering the room using soap and water or alcohol gel. The number of people entering the isolation room should be kept to an absolute minimum. Isolation Policy Page 13 of 26 Wherever possible, equipment such as stethoscopes should be allocated to each patient for sole use throughout their stay. Where this is not possible equipment, such as palette hammers must be cleaned with a detergent impregnated wipe before and after use. Disposable single use ear-pieces should be used with auroscopes. The external surfaces of the auroscope must be cleaned before and after use with a detergent impregnated wipe. 7. Dissemination and Implementation This policy will be implemented via the following routes: The policy will be included in the Trust‟s Document Library Details of the policy will be circulated to all Link Practitioners, Ward Sisters/Charge Nurses and Matrons 8. Monitoring compliance and effectiveness This part must provide information on the processes and methodology for monitoring compliance with, and effectiveness of, the policy/procedure using the table below. Element to be monitored Lead Isolation of patients with known infections. Tool Guidance in appendix 3 Frequency During ward visits Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared The need for isolation will be reported to the nurse/medical team caring for the patient. Isolation to be carried out immediately unless risk assessment deems otherwise. Infection Prevention and Control Team Required changes to practice will be identified and actioned immediately where necessary. The ward Sister/Charge Nurse will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders. 9. Updating and Review 9.1. This policy will be reviewed within three years. 10. Equality and Diversity 10.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Isolation Policy Page 14 of 26 Diversity & Human Rights Policy' or the Equality and Diversity website. 10.2. The Initial Equality Impact Assessment Screening Form is at Appendix 2. Appendix 1. Governance Information Document Title Isolation Policy Date Issued/Approved: Corporate: Clinical Date Valid From: 1st November 2016 Date Valid To: 31st October 2019 Directorate / Department responsible (author/owner): Louise Dickinson Contact details: 01872254969 Brief summary of contents These guidelines provide the information required to determine appropriate isolation precautions based on the route of transmission. Suggested Keywords: Target Audience Executive Director responsible for Policy: Use this section to suggest keywords to be added by the Uploader to aid document retrieval. RCHT CFT KCCG Director of Nursing Date revised: This document replaces (exact title of previous version): Isolation Policy V3 Approval route (names of Hospital Infection Prevention and Control Committee committees)/consultation: Divisional Manager confirming approval processes Louise Dickinson Name and Post Title of additional signatories Not Required Name and Signature of Divisional/Directorate Governance Lead confirming approval by specialty and divisional management meetings {Original Copy Signed} Name: Isolation Policy Page 15 of 26 Signature of Executive Director giving approval Publication Location (refer to Policy on Policies – Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards {Original Copy Signed} Internet & Intranet Intranet Only Clinical / Infection Prevention & Control Regulation 12. The British Committee for Standards in Haematology (1995) Guidelines on the provision of facilities for the care of adult patients with haematological malignancies. (including leukaemia, lymphoma and severe bone marrow failure.), Clinical and Laboratory Haematology 1995; 17, 3-10 https://www.nice.org.uk/guidance/csg3/resources/impr oving-outcomes-in-haematooncology-cancer-update773373709 The drinking water inspectorate (2009) Drinking Water Safety: Guidance to health and water professionals. Hawker, J. Begg, N. Blair, I. Reintjes, R. Weinberg, J. (2012) Communicable Disease Control Handbook 3rd Edition. Wiley-Blackwell Publishing. Oxford. Related Documents: Heymann, D. (2014) Control of Communicable Diseases Manual 20th Edition. American Public Health Association. Washington. The Royal Marsden NHS Trust (2015) Manual of Clinical Nursing Procedures Ninth Edition. WileyBlackwell Publishing. Oxford Wilson, J. (2006) Infection control in Clinical Practice 3rd Edition. Bailliere Tindall. London. Department of Health (2015). The Health and Social Care Act; Code of Practice for the Prevention and Control of Health Care Associated Infections. Department of Health. London Cole, M. & Lai, L. (2009) Reviewing the efficacy of infection control isolation. British Journal of Nursing. Vol.18, No.7. pg 403-407. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Isolation Policy Page 16 of 26 Preventing Transmission of Infectious Agents in Healthcare Settings http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf. Accessed 29.10.13 Jones D, (2010) How to deal with the negative psychological impact of MRSA isolation on patients. Nursing Times, 106:36. Abad C, Fearday A, Safdar N (2010) Adverse effects of Isolation in hospitalised patients; a systematic review. Journal of Hospital Infection 76: 97-102. Department of Health (2010) Isolating patients with healthcare associated infection. A summary of best practice. DOH, London. Health Promotion Scotland (2014) Transmission Based Precautions Literature Review: Patient Placement (Isolation/Coherting). HPS http://www.nipcm.scot.nhs.uk/documents/tbp-patientplacement-isolation-and-cohorting/ Training Need Identified? No Version Control Table Version No November 1 2007 Date Summary of Changes Final amendments approved. Document published. Changes Made by (Name and Job Title) Infection Prevention and Control Team January 2011 2 Incorporated protective isolation policy. Full review and format update Louise Dickinson December 2013 3 Full review and format update Louise Dickinson June 2016 4 Full review. Changes made to: 6.2.13; 6.3.1; 6.3.5; References Louise Dickinson, Consultant Nurse, Joint DIPC [Please complete all boxes and delete help notes in blue italics including this note] All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Isolation Policy Page 17 of 26 Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Isolation Policy Page 18 of 26 Appendix 2. Initial Equality Impact Assessment Form Name of Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description): Isolation Policy Directorate and service area: Corporate Is this a new or existing Policy? Existing Infection Prevention and Control Name of individual completing Telephone: 01872 254969 assessment: Louise Dickinson 1. Policy Aim* To ensure staff have access to appropriate information to enable them Who is the strategy / to make decisions about the isolation of infected patients. policy / proposal / service function aimed at? 2. Policy Objectives* Appropriate isolation of infected and immunocompromised patients in order to protect other patient‟s staff and visitors. 3. Policy – intended Outcomes* All patients are risk assessed for the need for isolation & appropriate action taken. 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? Via auditing, practice review and carrying out work place inspections. b) If yes, have these *groups been consulted? Yes C). Please list any groups who have been consulted about this procedure. Infection Prevention and Control Steering Group Hospital Infection Prevention and Control Committee All staff and patients. Yes Isolation Policy Page 19 of 26 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Age Yes No Rationale for Assessment / Existing Evidence Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - Learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked “Yes” in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development No 8. Please indicate if a full equality analysis is recommended. Yes 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Names and signatures of members carrying out the Screening Assessment Date of completion and submission 1. 2. Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust‟s web site. Signed _______________ Date ________________ Isolation Policy Page 20 of 26 Appendix 3. Table of Communicable Diseases and Appropriate Precautions It is the responsibility of the clinical team to complete a Notification of Diseases Certificate. Disease or Organism Anthrax Cutaneous Pulmonary Mode of transmission from person to person In the health care setting Visitor Restrictions Duration of isolation Contact with lesions None. Duration of disease Person to person spread unknown. Advise not to touch any lesions. Comments NOTIFIABLE DISEASE Infection Prevention and Control Team must be informed if anthrax is suspected. All laboratory samples must be labelled „high risk‟ In the event of a deliberate release of anthrax spores the patient, his/her belongings and the environment may be contaminated. Refer to HPA guidelines www.hpa.org.uk Candida Auris Contact Limit visitors Chickenpox Airborne via respiratory secretions and vesicle fluid Contact with vesicle exudate Exclude those who are nonimmune 7 days after onset or until lesions are dry CPE Contact Exclude those who are nonimmune Duration of stay Creutzfeldt Jakob Disease (CJD) and related disorders Contact via instruments used for invasive procedures None Not required Croup Droplet Contact via contaminated hands and equipment. Contact via faecal oral route Children and the elderly Whilst symptoms persist Exclude those who are immunosuppressed. Variable. Usually 72 hours after cessation of symptoms (Varicella zoster) Diarrhoea (suspected infective) Non immune staff must be excluded. Negative pressure isolation room preferred Infectious up to 5 days before appearance of rash Special precautions required for invasive procedures. Also refer to CJD policy Refer to Management of Patients with Diarrhoea policy and Norovirus policy. Some diarrhoeas eg food poisoning are NOTIFIABLE DISEASES Isolation Policy Page 21 of 26 Disease or Organism Diphtheria Respiratory Mode of transmission from person to person In the health care setting Droplet Visitor Restrictions Duration of isolation Comments Restrict to those who have already had contact. NOTIFIABLE DISEASE. Gas Gangrene No person to person spread None 3 days of antibiotic therapy or 4 weeks untreated N/A Glandular fever Contact via saliva (kissing) None N/A Cutaneous Direct contact with skin lesions Gonococcal Infection Genito-urinary tract (GT) Ophthalmia neonatorum Hepatitis Undiagnosed Hepatitis A Hepatitis B, C, E Herpes simplex Type I and II Inform infection prevention on suspicion. Infection is usually endogenous NOTIFIABLE DISEASE Contact with exudate from mucous membranes of the GT Contact via unwashed hands Contact with blood, faeces and other body fluids (percutaneous expsure) Contact (faecal-oral) None 24 hours of antibiotic therapy None NOTIFIABLE DISEASE None 7 days after onset of jaundice NOTIFIABLE DISEASE Contact with blood and body fluids (usually percutaneous exposure via used sharps) Contact with lesions and via shared towels etc. Droplet None Not required NOTIFIABLE DISEASE (if None N/A Direct or indirect contact with blood and body fluids (usually percutaneous exposure via used sharps) None N/A acute) *Single room required if bleeding uncontrollably or has large open wounds or receiving haemodialysis. * Single room may be required if patient has extensive lesions Herpes zoster Refer Shingles Human Immunodeficiency Virus Impetigo Refer streptococcal infection Isolation Policy Page 22 of 26 Patients with AIDS may have additional infectious conditions that require isolation Disease or Organism Mode of transmission from person to person In the health care setting Visitor Restrictions Duration of isolation Comments Infestations Human Fleas Contact with patient and bedding and clothing None N/A Human fleas are extremely uncommon. Cat/dog fleas N/A None N/A Treat animals and environment Contact with patients, clothing, bedding, towels etc None N/A Repeat treatment one week Contact (head to head) and via shared combs, head wear, pillows Contact (usually sexual) None N/A Repeat treatment one week None N/A As this is usually STD consider referral to GUM clinic for screening Scabies Contact with skin (prolonged skin contact usually required) None Not required Patient not considered infectious following first application of treatment. Apply second application after one week. Itching may continue for several days/weeks. Close contacts will need treatment. Crusted/atypical scabies Contact with skin, bedding, clothing etc Recommend limiting visitors to those who have already had contact until treated None As advised by the IPAC team Refer to Dermatologist. Contacts will need treatment. Until treated Family contacts or equivalent may need treatment Lice (Body) Lice (Head) Lice (pubic) Contact via faecal oral route Worms Isolation Policy Page 23 of 26 Disease or Organism Mode of transmission from person to person In health care setting Visitor Restrictions Duration of isolation Comments Influenza, Seasonal Droplets 4 days after onset Alert IPAC if more than one case on same ward. FFP3 masks may be required to be worn by staff during aerosol generating procedures. Legionnaires’ Disease No person to person spread Advise at risk visitors to be immunised. Those in contact should not visit. None N/A Microbiologist MUST be contacted to arrange for rapid diagnostic methods to be set up. Leptospirosis (Weil‟s Disease) Listeriosis Contact with blood and urine None N/A Mother to baby in utero and during delivery None Clinical recovery Microbiologists should be informed as potentially food borne None Not required NOTIFIABLE DISEASE Always consider the possibility of other tropical infections which may be infectious. Exclude non immune 4 days after rash appears NOTIFIABLE DISEASE. Recommend limiting visitors to those who have already had contact. 48 hours of appropriate antibiotics No person to person transmission None Not necessary NOTIFIABLE DISEASE Contact (faecal oral) +/- Droplet None Not necessary NOTIFIABLE DISEASE Depends on site of colonisation. Contact via unwashed hands most significant route of transmission. Droplet Contact with urine/saliva None On the advice of the IPAC Team Exclude non immune 9 days after onset NOTIFIABLE DISEASE Mycoplasma pneumonia Droplet None 10 days after onset Parvo virus (human) (Slapped Cheek) Droplet Exclude pregnant women Usually once rash appears but see comments. Patients are usually no longer infectious by the time the diagnosis is confirmed. Patients in aplastic crisis may be infectious for 1 week after onset. Malaria Measles Meningitis Bacterial Meningococcal (Neisseria meningitidis) Other bacterial causes e.g. pneumococcal, haemophilus influenzae Viral Multi-Resistant Gram Negative Organisms Mumps Psittacosis Contact (faecal oral) although very rare Transmitted by mosquito bite or via percutaneous exposure Airborne Droplet Person to person spread very rare None Isolation Policy Page 24 of 26 NOTIFIABLE DISEASE NOTIFIABLE DISEASE Exclude non immune staff NOTIFIABLE DISEASE Masks for airway management and close prolonged contact. Antibiotic prophylaxis may be required for household and mouth kissing contacts, those involved with airway management. CCDC or Health Protection Nurse will advise N/A Commonly caused by enterovirus For ESBL refer to ESBL policy Exclude pregnant members of staff. Disease or Organism Mode of transmission from person to person In the health care setting Visitor Restrictions Duration of isolation Comments Pyrexia of Unknown Origin with recent travel abroad As cause is unknown all modes of transmission must be considered Limited to previous contacts and close family Variable – clinical recovery if cause not confirmed Malaria, typhoid and Hepatitis A are the commonest causes of PUO in returned travellers BUT always consider possibility of Viral Haemmorhagic Fever. Quinsy Droplet 48hrs from commencing antibiotics Rabies Contact via percutaneous exposure to saliva Exclude children and any visitor with a wound Limited to previous contacts and close family Droplets of saliva to conjunctiva/mucosa. For duration of illness. NOTIFIABLE DISEASE Contact Microbiologist and IPAC team if suspected. Person to person transmission is only a theoretical risk but because of the implications of acquisition strict adherence to isolation precautions must be observed. Own bath shower facilities desirable. Ringworm (extensive) Contact with skin scales, nail and hair and via associated equipment e.g.hair clippers, shavers None Variable Rubella (German Measles) Droplet Exclude non immune 4 days after onset of rash. NOTIFIABLE DISEASE Shingles Contact with exudate Airborne via vesicle fluid (in disseminated shingles) Exclude if non immune to chickenpox Exclude staff non-immune to chicken pox Streptococcal (Group A) Infection Including sore throat scarlet fever, impetigo, erysipelas, wound Infection, toxic shock syndrome, puerperal fever. Streptococcal Group B (Neonatal) Contact with lesions Droplets Recommend excluding children and any visitor with a wound. 1 week after onset or until lesions are dry 48 hrs from commencing appropriate antibiotics Toxoplasmosis Contact via faeces, skin sites None N/A Restrict to those who have already been exposed only. Two weeks following commencing treatment None None Scarlet Fever – NOTIFIABLE DISEASE Staff with sore throats should seek advice from Occupational Health No person to person spread Tuberculosis Pulmonary (open) ie sputum smear positive Airborne via respiratory droplet nuclei Pulmonary (closed) No spread NOTIFIABLE DISEASE Refer to TB policy NOTIFIABLE DISEASE Extrapulmonary (excluding open abscess and other drainage lesions) Typhoid & Paratyphoid NOTIFIABLE DISEASE No spread None None Indirect contact faecal/urine/oral spread Advise visitors not to eat or drink in the isolation room Variable Isolation Policy Page 25 of 26 NOTIFIABLE DISEASE Ensure blood cultures and stools are labelled with risk of infection stickers Vancomycin Resistant Enterococcus (VRE) Viral Haemorrhagic Fever (eg Lassa, Ebola, Marburg) Whooping Cough Contact with colonised/infected sites None Until informed by IPAC Team Contact - percutaneous exposure to blood and body fluids ?Droplet - pharyngeal secretions Airborne - respiratory secretions Immediate family/ partner Exclude children. As advised by IPAC Team NOTIFIABLE DISEASE Exclude non immune 5 days after antibiotics started NOTIFIABLE DISEASE Modes of transmission Contact - direct (touching, kissing, biting) or indirect via exposure with used sharps) Droplet - large respiratory droplets propelled a short distance only Airborne - via droplet nuclei or skin Isolation Policy Page 26 of 26 CONTACT IPAC TEAM IMMEDIATELY ON SUSPICION