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Infection Prevention & Control Manual Chapter 4 Isolation Policy Version 7 Document Summary This policy provides guidance for the appropriate actions and responsibilities for the management of patients in isolation. DOCUMENT NUMBER APPROVING COMMITTEE DATE APPROVED DATE IMPLEMENTED NEXT REVIEW DATE ACCOUNTABLE DIRECTOR POLICY AUTHOR TARGET AUDENCE KEY WORDS STHK0046 Patient Safety Council 10 September 2014 1 October 2014 1 October 2017 Sue Redfern, Director of Nursing, Midwifery & Governance Karen Allen, Director of Infection Prevention & Control All clinical staff Isolation, barrier nursing. Important Note: The Intranet version of this document is the only version that is maintained. Any printed copies should therefore be viewed as “uncontrolled” and, as such, may not necessarily contain the latest updates and amendments. Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 1 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Document Version History Date Version August 1992 1 1 February 2001 2 1 August 2003 3 1 December 2006 4 1 December 2008 5 1 November 2011 6 1 November 2014 7 1st November 2017 Summary of key changes Format Changed. Contact details updated. Appendix 1: Isolation audit tool added Format Changed. Chapters 4 (Guidelines for isolated patient) and 12 (Isolation Policy) amalgamated into a single policy. Review date Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Author Designation Service Manager Infection Prevention & Control Service Manager Infection Prevention & Control Service Manager Infection Prevention & Control Service Manager Infection Prevention & Control Service Manager Infection Prevention & Control Service Manager Infection Prevention & Control DIPC Lead Nurse, Infection Prevention & Control Page 2 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust CONTENTS Item No. Subject Page No. 1. Scope 4 2. Introduction 4 3. Statement of Intent 4 4. Definitions 4 5. Duties, Accountabilities and Responsibilities 4 Process Sources of infection Risk assessment Categories of isolation and recommended precautions General principles of isolation nursing Isolation procedures The side room Transporting patient outside isolation area Death of patient in isolation Staff injuries or illness Visitors to patients in isolation Outbreaks of infection/infectious disease For further advice and guidance Glossary 5 5 5 5 6 10 10 12 13 14 14 14 15 15 7. Training 15 8. Monitoring compliance 15 8.1. Key Performance Indicators of the Policy 15 8.2. Performance Management of the Policy 16 9. References and Bibliography 16 10. Related Policies and Procedures 16 11. 12. Equality analysis Appendices Appendix 1: Audit tool: isolation precautions Appendix 2: Summary of isolation nursing and isolation precautions Appendix 3 A-Z quick reference guide for isolation requirements 16 6. 6.1 6.2 6.3 6.4 6.5 6.5.1 6.5.2 6.5.3 6.6 6.7 6.8 6.9 6.10 Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 3 of 32 Policy Reference number: STHK0046 17 19 20 St Helens & Knowsley Teaching Hospitals NHS Trust 1. Scope This policy applies to all clinical and Medirest staff within St Helens and Knowsley Teaching Hospitals NHS Trust to ensure that appropriate actions are taken when isolation precautions are required. 2. Introduction The aim of isolation nursing or isolation precautions is to confine the pathogenic organism, prevent spread to other patients or staff, and eradicate it if possible. This does not always mean confining a patient to a single room but that relevant and effective precautions are taken. Isolation may be very disturbing for some patients and they will require additional moral support while isolated. Hospital-acquired infections can have considerable consequences. These may include: Increased pain, distress and anxiety Delayed or prevented recovery Extended hospitalisation Financial implications for patients and the health authority. Potential outbreaks Legal implications The correct and timely placement of infected patients (suspected or proven) into single rooms can be very effective in reducing the overall numbers of infective patients (DH 2007). It is also a requirement of the Health Act 2006 (DH) that an evidence based isolation policy exists incorporating local risk assessment findings and measures. This policy describes the general principles of isolation precautions, when they may be required and the rationale behind their use. 3. Statement of Intent The aim of the policy is to control the spread of transmissible infections within the Trust. 4. Definitions Isolation is the use of infection prevention and control precautions aimed at controlling and preventing the spread of infection. Source Isolation (barrier nursing) is where the patient is isolated because they pose an infection risk to others Protective Isolation (reverse barrier nursing) is where the patient is isolated because they at risk of acquiring infection from others i.e. they are immunocompromised. 5. Duties Accountabilities and Responsibilities For full details of infection control responsibilities see Infection Control Policy, Chapter 28B Infection Control Manual. 5.1. Staff It is the responsibility of all clinical staff to: be aware of the current guidelines. put these guidelines into practice. bring to the attention of the Unit Manager or Infection Prevention and Control Team any problems in applying these guidelines Breaches of this policy may lead to disciplinary action being taken against the individual. 5.2. Unit managers (person in charge of a ward or department) must ensure that Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 4 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust The policy is readily accessible to all staff. The required facilities and equipment are available to enable compliance with the policies. All staff within their area of responsibility have received training in the appropriate procedures with respect to infection control. The ADT/HEARTS/EDMS systems are checked for infection alert status when a patient is admitted. 5.3 Medirest It is the responsibility of Medirest management to ensure that all domestic, catering and portering staff adhere to the Trust Isolation Policy. 6. Process 6.1 SOURCE OF INFECTION 6.1.1 Self-infection (endogenous infection) Self-infection results when tissue becomes infected from another site in the patient’s body e.g. by own normal microbial flora of body. 6.1.2 Cross-infection (exogenous infection) Cross-infection may be caused by infection from patients, hospital staff or visitors who are suffering from the relevant disease or who are symptomless carriers. Other factors e.g. equipment, bedding, food, air, hands of staff etc. may also transfer pathogens. 6.2 RISK ASSESSMENT All patients identified with infectious diseases or alert organisms will be risk assessed for the need for isolation. This will take place between the Infection Prevention and Control Team and the clinical team. Risk assessment will take into account: The classification of the pathogen and the ability to protect against or treat individual infections. The probable route of transmission and evidence of transmission. Susceptibility of the other patients near to the infected patient in the same bay i.e. do the other patients have open wounds or an invasive device. Whether the organism is antibiotic resistant. 6.3 CATEGORIES OF ISOLATION AND RECOMMENDED PRECAUTIONS There are 4 categories of isolation and precautions are recommended, each with a specific purpose. Information posters detail the relevant precautions to be taken. These should be affixed to the outer side of the cubicle door. Isolation posters can be downloaded from the Infection Prevention & Control website. 6.3.1 Blood and body fluid isolation universal/standard precautions (no poster required) Used to prevent infection with blood borne disease. Health care workers who come into contact with blood, secretion and excreta may be exposed to pathogens including blood borne viruses such as HIV, Hepatitis B and C. As it is impossible to identify all those with infection it is recommended that all body fluids are regarded as potentially infectious and universal precautions are used. See appendix A for further details. 6.3.2 Contact isolation Used to prevent the dissemination of infections normally spread by direct contact/or contact with any body fluids or secretions and articles which have been in close contact with the infected patient. Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 5 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust 6.3.3 Airborne isolation Used to prevent infection with airborne pathogens, those that are transmitted by large/small droplet nuclei and generated in the course of talking, coughing, sneezing and during procedures involving the respiratory tract i.e. suction. 6.3.4 Protective isolation (reverse isolation nursing) This is used to prevent both airborne infections and those spread by direct contact to susceptible patients (e.g. those immunosuppressed by disease or drug therapy). Precautions are therefore to prevent contamination by direct contact and by self-infection (endogenous) from the patient’s natural flora. N.B. These patients should not be nursed in the vicinity of infected patients. 6.3.5 Isolation charts Copies of isolation charts are available to download from the Infection Prevention & Control Intranet Website. Refer to Chapter 4B, Isolation Instruction Charts, Infection Control Manual. Do not photocopy charts. Only computer-generated charts are acceptable. All charts must be laminated. 6.3.6 Quick reference table For a list of infections requiring isolation and precautions/posters required see Appendix 3. 6.4 GENERAL PRINCIPLES OF ISOLATION NURSING 6.4.1. Hand decontamination This is the most important measure in preventing the spread of infection. Washing the skin thoroughly with liquid soap, quickly removes harmful bacteria. Hands must be wet first, be rinsed well and dried thoroughly using paper towels. Hands must be washed before handling patient. after handling patient and prior to leaving the isolation room, after removal of gloves. when soiled. 6.4.2 Hand sanitiser gel Use on physically clean hands immediately after leaving isolation room. Rub vigorously covering fingers, hands and wrists thoroughly. Continue rubbing until dry. (Use Ayliffe technique, see Chapter 12). Hand sanitiser gel is ineffective with some infections, viral diarrhoea, Clostridium difficile infection. Soap and water must always be used when dealing with these infections. (Refer to Chapter 5, Personal Protective Equipment). 6.4.3 Protective clothing When specifically advised in Isolation Policy. Plastic aprons and gloves to be worn for patient contact when handling contaminated or infected articles, excreta, secretions. N.B. always when handling blood/body fluids or articles soiled with blood/body fluids Surgical masks, Visimasks only when specifically advised in Isolation Policy. Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 6 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust FFP3 filter masks only when specifically advised in Isolation Policy e.g. for smallpox, SARS/MERS, multi-drug resistant TB (Refer to Chapter 5, Personal Protective Equipment). 6.4.4 Single Room Use as directed in Isolation Policy. Single room essential for respiratory and protective isolation. Always keep door closed as bacteria and viruses are often spread by the airborne route. 6.4.5 Crockery and cutlery Conventional crockery and cutlery is to be used and washed in central dishwasher. If the dishwasher is out of action, use disposable crockery/cutlery. Wash hands after handling used crockery and cutlery. N.B. No disinfection is normally required nor is the use of disposable items unless specifically advised by the Infection Prevention & Control Team e.g. VHF 6.4.6 Sharps Discard carefully into ’sharps box’ (within the cubicle if patient is isolated). Keep it out of patients reach especially if they are elderly, confused of children. Do not store on floor, use bracket to affix to wall. Do not re-sheath needles as there is a great danger of needlestick injuries. (Refer to Infection Control Manual, Chapter 22 Sharps Policy) 6.4.7 Laundry Place contaminated laundry into red-alginate bag then into a white plastic (Sunlight) bag (available from laundry). Secure top and affix ward indicator labels. N.B. There is rarely an indication for incineration of laundry. 6.4.8 Clinical waste Place into orange/yellow plastic bag, no more than 3/4 full. Tie securely, attach bag identity tag. Avoid external contamination of the bag. Orange bags for clinical waste should be held on the appropriate stand in the isolation room. Send for immediate incineration. (Refer to Chapter 15, Hospital Waste Disposal Policy), 6.4.9 Equipment Use as little as possible in infected area. Disinfect after precautions are discontinued (see Chapter 9, Disinfection Policy). Disposable bed pans, urinals, vomit bowls, blood pressure cuffs, tourniquets and sputum containers to be used. Keep individual items e.g. bed pans shells for patient’s sole use. If the ward mobile telephone is used: thoroughly wipe over with disinfectant wipes e.g. Sanicloth, before returning it to the main ward. If the telephone has been handled by a patient with active Clostridium difficile infection (CDI), wipe it over with Chlorclean first. 6.4.10 Bathing of patients Where possible shower patients. Patients washing bowl must be disposal. If patient is bathed, thoroughly clean using chlorclean and dry bath after use. Leave room to dry before use by any other patient. Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 7 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust 6.4.11 Spillage of blood or body fluid Blood/Blood Stained Body Fluids Sprinkle 10,000ppm chlorine releasing granules (Haz tab granules) over spill until all moisture is completely absorbed. Leave for at least 2 minutes. Use paper towels to collect granules and discard into yellow clinical waste bag. Then wipe over area with 10,000 ppm Haz tab solution. Body Fluids – Faeces/Vomit/Urine Make a 10,000ppm chlorine solution. Add four Haz tab tablets to the small 1 litre dilute and fill to the line with tepid water. When the tablets have dissolved, screw down the diluter cap and mix by inversion. Use with disposable paper towels to wipe area and remove drips or splashes on vertical surfaces. Rinse disinfected area thoroughly and wipe dry. 6.4.12 Diagnostic specimens Accurately label container and request form. Place into sealable plastic specimen bag. Transport immediately to laboratory. Danger of infection labels are to be affixed if patient is known or suspected to be suffering from a dangerous infection e.g.: HIV/AIDS SARS/MERS Anthrax Hepatitis B/C Paratyphoid Tuberculosis Typhoid Viral haemorrhagic fever Rabies Plague It is the responsibility of the doctor requesting the test to ensure that any specimen from such patients and the appropriate request forms are so labelled and contain the relevant clinical information. Specimens which are a ‘danger of infection’ should be transported to the laboratory as soon as possible in a sealed plastic bag. Do not use staples or pins to seal the bag. 6.4.13 Cleaning Domestic staff The domestic manager must be informed by the nurse in charge of the ward as soon as isolation nursing is commenced. He or she will then provide the ward domestic with appropriate instructions. The nursing staff must check that the ward domestics understand and are following their instructions correctly. Domestic management (See Chapter 12A, Infection Control Manual for details). Use disposable yellow cloths and yellow labelled disposable mop and bucket (available from Domestic Manager). Report to nurse in charge before starting work in the isolation room. Wash hands outside the room. Put on plastic apron and gloves. A mask may also be occasionally necessary if the patient is in respiratory or protective isolation. For patients in containment isolation, clean these rooms last; for those in protective isolation, clean these rooms first. Terminal clean When the patient has been discharged the Response Cleaning Team is available for terminal cleaning 24 hours a day. Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 8 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Daily management Wipe over all surfaces with Chlorclean. Wipe instruments (stethoscope, sphygmomanometer etc.) with disinfectant wipes e.g. Sanicloth. Spillages of body fluids (urine, faeces, vomit etc.) should be first cleaned up using a disinfectant as directed in Chapter 9. Wall washing Washing of isolation room walls is seldom necessary. It is only required on the request of the Infection Prevention and Control Team or where there is obvious contamination with blood, excreta or body fluids. 6.4.14 Recommended disinfectant/antiseptic agents See Decontamination Policy, Chapter 9, Infection Control Manual for further details. General purpose detergent Keeping surfaces clean and dry will prevent infection. Chlor-clean To be used for general purpose cleaning on all acute wards/units. Hypochlorite Especially for use for blood borne viral infection 1% - general use (Chlor-clean) 1,000ppm 10% - for all blood/body fluid spillages (HazTabs) 10,000ppm Hand sanitiser Hand sanitiser to be used when hands are physically clean but require disinfection. (Not effective against CDI or norovirus). Liquid soap To be used when hands are physically dirty Hard surface wipes Disinfectant wipes for use in disinfecting surfaces and some instruments. 6.4.15 Staff allocation A minimum number of staff should be involved with an infected patient. The nurse concerned with the infected patient should not also attend to other susceptible patients. If isolation nursing is for an infectious disease e.g. chickenpox, shingles or measles, it is preferable that only personnel who are immune (disease/vaccination) should attend this patient. For individual advice contact the Infection Prevention and Control Nurse or Health, Work and Wellbeing Department. 6.4.16 Notification of infection/infectious diseases 6.4.16.1 Notification to IPCT Notification by telephone must be made to the Infection Prevention & Control Nurse of any patient with or suspected of having an infectious disease. wound infections (especially post-operative infections) blood borne infections (Hepatitis B/C, HIV, AIDS) infestations e.g. scabies, fleas Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 9 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust herpes zoster (shingles or chickenpox) any outbreaks of diarrhoea/vomiting, respiratory or other infections amongst patients or staff ie. more than two people. the commencement of isolation precautions for any patient any infection according to the discretion of the nurse in charge of the ward N.B. Patient’s diagnosis of personal details must not be divulged to staff not directly concerned with the patient’s nursing or medical care. 6.4.16.2 Notification to CCDC Many infectious diseases are legally required to be notified to the Consultant in Communicable Disease (CCDC). A comprehensive list of these and means of notification may be found in Chapter 3, Infection Control Manual. 6.4.17 Communication with the isolated patient and visitors Careful explanation to the patient is essential so that he/she can co-operate fully with the restrictions. The nurse should be sensitive to the psychological implications of being labelled infectious and being confined in isolation. The patient’s visitors must also be informed why the isolation restrictions are necessary. They must be taught to observe the correct procedures for entering and leaving the room. As children are more susceptible to infection than adults and have higher carriage rates of pathogenic organisms, any visit by a child should be discussed with the appropriate personnel. Give each patient the isolation explanation booklet for patients. Ward should keep a stock, spare copies are available from the Infection Prevention & Control Nurse Specialists or on the Infection Prevention & Control Website. 6.5 ISOLATION NURSING PROCEDURE See Appendix 2 for summary. See Appendix 3 for A-Z quick reference guide for isolation requirements for individual infections. 6.5.1 THE ISOLATION ROOM ACTION RATIONALE Place appropriate isolation chart outside the To inform anyone intending to enter the door. room of the situation and give appropriate instructions. Dani Centre/trolley or shelf outside the room Protective clothing available prior to to contain: entering room. Yellow plastic apron Gloves Masks (If directed by Infection Prevention & Control). Hand sanitiser gel available. Patient’s charts to be kept outside of the room. Remove all non-essential furniture. To minimise the risk of furniture harbouring The remaining furniture should be easy to microbial spores or bacterial growth and clean and should not conceal or retain dirt makes terminal cleaning easier. or moisture either within or around it. Stock the wash hand basin, liquid soap, Facilities for handwashing within the hand sanitiser gel and paper towels for staff infected area are essential for effective use. isolation nursing. For use by patient, visitors and staff. Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 10 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Place a hand sanitiser gel dispenser at patient’s bedside. Place an orange clinical waste bag in the For containing contaminated waste within room on a foot operated stand. The bag the room. must be sealed before it is removed from the room by knotting when ¾ full. Place a container for sharps in the room. To contain contaminated sharps within infected area. N.B.: When the sharps container is full it must be kept in the room until collected for incineration. Keep the patient’s personal property to a minimum. Advise him/her to wear hospital clothing. All belongings taken into the room should be washable, cleanable or disposable. Provide the patient with his/her own sphygmomanometer and disposable, singlepatient-use blood pressure cuff and all items necessary for attending to personal hygiene. Keep dressing solutions, creams and lotions etc. to a minimum and store them within the room. Safety of sharps. The patient’s belongings may become contaminated and should not be taken home unless they are washable or cleanable. Do not wash on the ward: send to laundry as infected linen. Equipment used regularly by the patient should be kept within the infected area to prevent the spread of infection. All partially used materials must be discarded when isolation nursing ends (resterilisation is not possible) therefore unnecessary waste should be avoided. Ensure patient has a working call button. So that patient can summon assistance. Give patient an information booklet. To give him/her special information about isolation and so reduce anxiety. Inform the Infection Prevention & Control To ensure that precautions are appropriate Nurse for individual patients needs. ENTERING THE ROOM Collect all equipment needed. To avoid entering and leaving the infected area unnecessarily. Adhere to ‘Bare Below the Elbow’ policy. To protect clothing from contamination. Put on a disposable plastic apron (and To protect clothing from contamination. mask if directed) Put on disposable gloves. To reduce the risk of contaminating your hands. Enter the room, shutting the door behind you. LEAVING THE ROOM Remove and discard gloves and then plastic Correct disposal of clinical waste. apron into orange bag. Thoroughly wash hands using liquid soap. To remove bacterial contamination. Rinse and dry well. Leave the room, closing the door behind you. Remove any eye protection. Discard mask directly into clinical waste e.g. sluice. Wash hands immediately. Use hand sanitiser gel. To remove pathogenic organisms acquired Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 11 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust form the door handle etc. 6.5.2 TRANSPORTING PATIENTS OUTSIDE THE ISOLATION NURSING AREA ACTION TO OTHER WARDS/DEPARTMENTS Before transferring the patient, inform the head of department or nurse in charge of the ward/department of any information regarding the type of infection and precautions to be taken. If possible arrange for the patient to have the last appointment of the day. Complete the risk of infection section on all request forms. Any porters involved must be given necessary instructions. RATIONALE In order that special arrangements may be made and infection risks to other patients or staff are minimised. So that porters transporting patient and staff in the receiving department are conversant with any special precautions required. Fears are allayed and infection risks are minimised. The patient should preferably be transferred To minimise the risk of infection. using a wheelchair or trolley. Use fresh linen and discard after the transfer is complete. Decontaminate trolley/wheelchair. If the patient is to be transferred by bed, all linen must be changed and the frame wiped over with Chlor-clean or disinfectant wipes prior to transfer. TO THE OPERATING THEATRE The operating theatre must be informed in In order that appropriate precautions may advance. be taken to minimise the possibility of cross infection and to avoid potential hazards and delays. If possible, the patient should be transferred To minimise the risk of infection. to and from theatre on a trolley. All linen should be changed before using the trolley for another patient. The trolley must be decontaminated with Chlorclean. Should the patient require transfer in his own bed, all linen must be changed immediately before transfer and the bed frame wiped over with Chlorclean. TRANSFER BY AMBULANCE The ambulance officer must be given prior So that ambulance personnel are information regarding the type of infection. conversant with any special precautions, Details of special precautions required must fears are allayed and infection risks are be entered on the transfer form. minimised. DICHARGE FROM HOSPITAL OF AN INFECTED PATIENT Inform the Infection Prevention & Control To advise on any special precautions and Nurse/Doctor when the patient is due for give advice regarding the home or to inform Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 12 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust discharge. the Department of Environmental Health of patient’s discharge. The nurse in charge of the ward must inform To minimise any infection risks and allay the community care staff if any special fears. precautions need to be taken in the home or nursing home or residential home. Details must be documented on discharge summary. Tagging of notes/computer records is To indicate special precautions required normally done at the time of diagnosis of should re-admission be necessary or clinic MRSA/CDI/VRE/CPE. appointments. To minimise infection risks. The case sheet, if necessary, will have been marked by colour-coded sticker on the inside flap. A white alert sticker will have been affixed to the front of the case notes. Stickers are available from IPCN. The WebPAS, ADT and EDMS patient records will also have been tagged by the IPCN if required. The room should be stripped and aired. All To remove contaminated articles and linen should be placed in a red alginate bag, associated infection risks. which is placed inside a white plastic laundry bag. Curtains should be changed and sent to the laundry. All equipment, surfaces and floors should Cleaning of surfaces is effective in removing be thoroughly cleaned as per Chapter 12A, bacterial containments. Infection Control Manual and dried well. Use Chlorclean. N.B.: Pillows should be contained within To minimise cross-infection. plastic covers. Wall or ceiling disinfection is not required Not generally an infection risk. unless there is obvious soiling by blood, excreta or body fluids or unless specifically advised by Infection Prevention & Control Team, see Wall washing policy, Chapter 26 Infection Control Manual. Leave window open to air. Room may be occupied one hour after cleaning is completed. 6.5.3 DEATH OF A PATIENT IN ISOLATION If a patient is likely to die or dies in isolation, To reduce any infection risk to staff as body inform the Infection Prevention & Control may remain infectious after death. Team. It is the responsibility of the Consultant in charge of the patient to forewarn the Pathologist and Mortuary Staff of the confirmed or suspected infection. Protective clothing should be worn whilst Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 13 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust performing Last Offices. See Infection Control Manual, Chapter 16. It may be necessary to place the patient in a To comply with legal regulations. cadaver bag if the body is thought to be contaminated with dangerous pathogens. These include: Hepatitis B/C, HIV, AIDS, untreated tuberculosis, typhoid/paratyphoid fever. Attach a completed ‘Danger of Infection’ label. For further details see the Infection Control Manual, Chapter 16. N.B.: See Chapter 16 Infection Control Manual for details of where body bags are available for each division. 6.6 STAFF INJURIES OR ILLNESS 6.6.1 STAFF ILLNESS These must be reported to the Health Work & Well-being Department for appropriate action and treatment. Staff suffering an active infection e.g. cold sores, boils or weeping eczema or any similar condition should not care for any patient. 6.6.2 STAFF INJURIES In the event of needlestick injury or splashes of blood/body fluids into the eye or mouth or a fresh cut refer to– Infection Control Manual- Chapter 13A –Blood Borne Viruses Policy 6.7 VISITORS TO PATIENTS IN ISOLATION All visitors should report to the nurse in charge of the ward before entering any isolation room. Top coats and jackets should be removed prior to entering the room. Protective clothing, if recommended by Infection Prevention & Control personnel, should be put on before entering the room. If the patient has an infectious disease, non-immune staff and visitors should be excluded. Relatives and friends must not visit other patients on the ward. Social visiting may be restricted on an individual basis by the Consultant in charge of the patient and the nurse in charge of the ward. It is recommended that no more than two adult visitors at any one time are allowed to see the patient. If may also be necessary to discourage children from visiting. 6.8 OUTBREAKS OF INFECTION/INFECTIOUS DISEASE An outbreak of infection may be defined as two or more epidemiologically related infections caused by an organism of the same type. Immediate action is required to prevent further spread to staff and patients. Therefore, the Consultant Microbiologist or Infection Prevention & Control Nurse must be informed should an outbreak be suspected. Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 14 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust It is the responsibility of the Consultant Microbiologist to declare an outbreak and to institute control procedures. Out of hours, contact the on-call Microbiologist (Consultant/Specialist Registrar) via Whiston Hospital switchboard. 6.9 FURTHER ADVICE For further advice and guidance please contact: Lead Nurse, Infection Prevention & Control Ext. 1193 Clinical Nurse Specialists, Infection Prevention & Control Ext. 2452/1384 Consultant Microbiologists Ext. 1836/1622/1834 or duty Microbiologist via switchboard out of hours. The following are available from the Infection Prevention & Control Nurses: - Isolation information posters (also available to print on Infection Prevention & Control website) - Case note stickers if required - Isolation information booklets (available from the Infection Prevention & Control website) - Disease specific information booklets - Quick reference posters detailing infections/infectious diseases requiring special precautions. 6.10 GLOSSARY AIDS: Acquired immune deficiency syndrome CDI: Clostridium difficile infection HIPG: Hospital Infection Prevention Group HIV: Human immmunodeficiency virus IPCT: Infection Prevention & Control Team SARS: Severe acute respiratory syndrome TB: Tuberculosis 7. Training Training required to fulfil this policy will be provided in accordance with the Trust’s Induction Mandatory and Risk Management Training Policy - Training Needs Analysis. 8. Monitoring compliance with this document 8.1 Key performance Indicators of the Policy Describe Key Performance Frequency Indicators (KPIs) Review Infection Prevention Society Audit Annual Tool for isolation precautions (Appendix 1) Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 of Lead Lead Nurse, Infection Prevention & Control Page 15 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust 8.2 Performance Management of the Policy Aspect of Monitoring Individual Frequency Group / compliance method responsible of the committee or for the monitoring which will effectiveness monitoring activity receive the being findings / monitored monitoring report Compliance Ward audit with audit tool Appendix 1 IPCT Annual HIPG Group / committee / individual responsible for ensuring that the actions are completed HIPG 9. References/ bibliography 9.1. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings Healthcare Infection Control Practices Advisory Committee (HICPAC). http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf 10. Related trust policy/procedures Chapter 4B: Isolation instruction charts policy Chapter 5: Personal protective equipment policy Chapter 9: Disinfection policy Chapter 15: Hospital waste disposal policy Chapter 12: Isolation Policy Chapter 12A: Cleaning for isolation cubicles policy Chapter 21: Hand decontamination policy Chapter 22: Sharps policy Chapter 24: Clostridium difficile policy Chapter 33: Viral gastro-enteritis policy 11. Equality analysis Please refer to the overarching document which covers all chapters of the Infection Control Manual. http://nww.sthk.nhs.uk/MANAGE/library/documents/EqualityAnalysisforICM.pdf Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 16 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust APPENDIX 1 INFECTION PREVENTION AND CONTROL AUDIT TOOL CLINICAL PRACTICES ISOLATION PRECAUTIONS Standard: Clinical practices will be based on best practice and reflect infection control guidance to reduce the risk of cross infection to patients’ whilst providing appropriate protection to staff NB. This section should be undertaken over a period of time to allow for the observation of as many practice elements as possible Date ………………………. Ward ………………………………….. Auditor …………………………………………. Yes No N/A Comments 1 Isolation facilities are available in inpatient areas 2 Patients requiring isolation facilities due to infection have access to them 3 Where a patient is being isolated for infection control reasons, the precautions are appropriate and according to local policy 4 Protective clothing is readily available upon entering the isolation room 5 Hand hygiene facilities are available, accessible and clean within the room 6 No inappropriate or unnecessary items are stored in the isolation room (no clutter) 7 Where a patient is being isolated for infection control reasons, the patient is aware of the need or rationale for this 8 Clear instructions for staff and visitors are in place when a patient is in isolation (e.g. confidential notice on the door) 9 Appropriate information leaflets are available to patients for common infections e.g. MRSA, Clostridium difficile infection (CDI). 10 Visitors are advised that they do not routinely need to wear protective clothing 11 Reusable equipment which may become readily contaminated is dedicated for the patients use only (e.g. commode, hoist, sling) are they clean? 12 Used linen, waste and crockery have Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 17 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust 13 14 15 16 17 18 19 20 been removed from the room in a timely manner Continued Yes No Housekeeping staff are aware of the local policy and procedures for cleaning isolation rooms Separate colour coded cleaning equipment is in use for isolation facilities Isolation precautions are discontinued when no longer necessary Nursing documentation is outside the room Are staff following infection control policy/: i.e. wearing PPE, decontaminating hands Are MRSA/CDI Care plans evident in nursing documentation? Have CDI patients’ had referral to dietetics? Are fluid balance/stool charts evident in CDI patients’ documentation? N/A Comments Comments: Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 18 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Appendix 2: Summary of isolation nursing and isolation precautions Contact Instruction Charts Single room Plastic apron Masks Routine hand washing Additionally Gloves Contact isolation chart Category of Isolation Blood and MRSA/CDI body fluid Airborne isolation MRSA/CDI isolation chart Not necessary Airborne Isolation Chart Protective Available if required – clinical decision Not necessary Not usually Necessary. unless Necessary. Necessary. necessary but Door closed advised by Door Door closed. desirable. Infection closed. Control personnel For patient For patient For contact contact, contact For with handling blood handling blood handling blood/body Patient body fluids or body fluids or blood or fluids contact contaminated contaminated body fluids respiratory articles articles secretions No No No No No Unless specifically recommended by Infection Control Personnel 1. Always before and after patient contact. 2. Before any contact with a susceptible site e.g. wound, IV site etc. 3. After any contact with blood/body fluids or contaminated articles/equipment. 4. After any activity where hands may have become contaminated. Handling Only Contact with blood or required Handling infected area, For patient bloodfor contaminated e.g. dressing contact. soiled handling items. or urine items, or blood and body fluids. body fluids Own toilet, disposable bed pans, liners macerated immediately after use Excreta Disinfectant: routine and Chlor-clean unless otherwise recommended by Infection Prevention & terminal Control Team cleaning 10,000ppm chlorine releasing granules for blood and body stained fluids Spillages 10,000ppm chlorine releasing solution for faeces/vomit/urine (see section 6.4.11 for details) Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 19 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Appendix 3: A-Z quick reference guide for isolation requirements See separate chapter of Infection Control manual, as indicated for further details. Anthrax Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Chapter 31 Contact Secretions Gowns, mask and gloves Until lesion has healed. There is no evidence of airborne person-to-person transmission of anthrax. Therefore isolation in side room is not necessary. However direct contact with the skin lesions in cutaneous anthrax may result in cutaneous infection. Gowns, mask and gloves must be worn. Hands must be washed on removal of gloves. Specimens for culture must be marked as possible anthrax and High risk so that appropriate containment facilities will be used in the laboratory. Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Campylobacter (see Diarrhoea) Carbapenemase-producing Enterobacteriaceae (CPE) Separate chapter of Chapter 46 Infection Control Manual Category of isolation Contact, single room Infective material Secretions Protective clothing Plastic apron and gloves Period of isolation Until instructed by IPCT Comment Chickenpox Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Chapter 37 Airborne, single room Vesicles, nasopharyngeal secretions Plastic apron and gloves 7 days after onset of rash Staff who have not had this disease or been vaccinated must avoid nursing these patients. If staff think they are susceptible, blood should be sent (via Health, Work & Well-Being) for HVZ IgG. Visitors who have not had the disease must be warned of the risks. Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 20 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Chlamydia Separate chapter of Infection Control Manual Category of isolation Standard precautions. Open ward. Infective material Secretions and infected lesions. Protective clothing Plastic apron and gloves for handling infected sites and contaminated articles. Period of isolation After 24 hours of correct antibiotics. Comment Cholera (see Diarrhoea) Clostridium difficile Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Chapter 24 Contact, single room Faeces Plastic apron and gloves Until diarrhoea has stopped for 48 hours but continue to nurse in side room in case of recurrence. Treat according to C difficile algorithm on Infection Control intranet website (CDI toolkit) Cryptosporidium (see Diarrhoea) Diarrhoea/Gastroenteritis e.g. Salmonella, Shigella, Campylobacter, Cryptosporidium, cholera, dysentery, rotavirus, E. coli 0:157/HUS (Haemolytic Uraemic Syndrome), Separate chapter of Chapter 33 (Viral gastroenteritis) Infection Control Chapter 24 (C difficile infection) Manual Category of isolation Contact, single room Infective material Faeces Protective clothing Plastic apron and gloves Period of isolation Until diarrhoea has ceased for 48 hours or as directed by IPCT. Comment If two or more patients or staff on the same ward develop diarrhoea at about the same time, the Infection Prevention & Control Nurse or Consultant Microbiologist must be informed and stool specimens for culture obtained. Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 21 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Diphtheria Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Airborne, single room Respiratory secretions Plastic apron and gloves From onset until two consecutive nose and throat swabs (and skin lesions in cutaneous diphtheria) are negative (not less than 1 day apart and at least 1 day after stopping antibiotics). Consider transfer to Regional Infectious Diseases Unit. Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Dysentery (see Diarrhoea) E. coli 0:157, HUS (Haemolytic Uraemic Syndrome) (see Diarrhoea) Gas gangrene ( Clostridium perfringens) Separate chapter of Infection Control Manual Category of isolation Isolation not required Infective material Protective clothing Period of isolation Comment Glandular fever/ Infectious mononucleosis Separate chapter of Infection Control Manual Category of isolation Airborne, single room Infective material Oral secretions Protective clothing Plastic apron and gloves when handling oral secretions Period of isolation While in hospital Comment Gonorrhoea Separate chapter of Infection Control Manual Category of isolation Standard precautions Infective material Secretions and infected lesions. Protective clothing Plastic apron and gloves for handling infected sites and contaminated articles. Period of isolation After 24 hours of correct antibiotics. Comment Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 22 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Hepatitis A Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Hepatitis B Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Hepatitis C Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Contact, single room Faeces Plastic apron and gloves For first week of jaundice Blood precautions should also be taken if Hepatitis B or C is suspected, until the laboratory results are available. Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Chapter 13A (standard precautions) Standard precautions Blood and body fluids Plastic apron and gloves when handling blood or blood soiled articles. Visimasks to be used if blood splashes are likely during procedures. Not necessary, unless bleeding. Use ‘Danger of Infection’ sticker on specimens. Avoid needlestick injuries. Should accidental inoculation injuries occur immediately contact the Health, Work & Well-Being Department. Hepatitis B immunoglobulin may be offered to vaccine nonresponders. Acute cases: Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Chapter 35 Standard precautions Blood and body fluids Plastic apron and gloves when handling blood or blood soiled articles. Visimasks to be used if blood splashes are likely during procedures. Not necessary, unless bleeding. Use ‘Danger of Infection’ sticker on specimens. Avoid needlestick injuries. Should accidental inoculation injuries occur immediately contact the Health, Work & Well-Being Department. Acute cases: Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 23 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust HIV/AIDS Separate chapter of Chapter 11 HIV/AIDS Infection Control Chapter 11A HIV infected HCWs Manual Chapter 11B HIV/AIDS in pregnancy Chapter 11C HIV/AIDS in Paediatric patients Category of isolation Standard precautions Infective material Blood and body fluids Protective clothing Plastic apron and gloves when handling blood or blood soiled articles. Visimasks to be used if blood splashes are likely during procedures. Period of isolation Not necessary, unless bleeding or has secondary infections e.g. tuberculosis (TB) Comment Additional isolation may be required if patient has secondary infections (e.g. TB, Cryptosporidium etc.) Herpes simplex Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Herpes zoster Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Contact, single room Lesion secretions Plastic apron and gloves Until lesions dry, no fresh vesicles Cuts or abrasions on fingers should be covered if in contact with infected patient. Staff with active lesions should be excluded from neonatal and maternity wards, and not attend immunosuppressed or eczematous patients. Chapter 35 Airborne, single room Lesions secretions Plastic apron and gloves Until lesions dry, no fresh vesicles (usually 7 days after onset) Non-immune staff who have not had chickenpox (infection or immunisation) or pregnant staff or visitors must avoid attending these patients (check HVZ IgG levels). Worried contacts who are not certain if they have had chickenpox should have blood sent (via Health, Work & Well-Being Department) for HZV IgG. Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 24 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Influenza/acute viral respiratory infections Separate chapter of Chapter 23 (influenza) Infection Control Manual Category of isolation Airborne, single room Infective material Respiratory secretions Protective clothing Depends on whether seasonal/pandemic/avian/swine flu. See chapter 23 for full details. Period of isolation 5 days (adult), 7 days (child), longer if immunocompromised Comment Malaria Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Measles Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Inform Infection Prevention & Control Nurse if two or more patients are affected. Vaccination is offered via Health, Work & Well-being Department to susceptible staff. Standard precautions Blood & body fluids Plastic apron and gloves for contact with blood/body fluids Not necessary Not transmitted from person-to-person except through transfusion rarely and through a failure to follow Standard Precautions during patient care. Doctor must notify CCDC (see Chapter 3, Infection Control Manual) (by telephone if UK acquired). Airborne, single room Respiratory secretions Plastic apron and gloves Until 5 days from onset of rash If outbreak on paediatric ward do not admit non-immune children until 14 days after last contact has been discharged or isolated. Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 25 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Meningitis/encephalitis Separate chapter of Chapter 34 Infection Control Manual Category of isolation Airborne, single room. Contact precautions for viral meningitis. Infective material Respiratory secretions, faeces (viral meningitis) Protective clothing Plastic apron and gloves Period of isolation Until 48 hours after start of antibiotics for bacterial meningitis or while symptoms persist for viral infections Comment Doctor must notify CCDC of all cases of meningitis/encephalitis (see Chapter 3, Infection Control Manual). Mumps Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Airborne, single room Respiratory secretions Plastic apron and gloves For 9 days after onset of parotid swelling or onset of illness. Exclude non-immune staff if possible. Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Multiple Antibiotic Resistant Gram-Negative Organisms (MARO) (Infection or colonisation) Separate chapter of Chapter 42 Infection Control Manual Category of isolation Standard precautions (single room if requested by IPCT) Infective material Secretions, urine, faeces or exudate from infected or colonised sites, or articles contaminated with these. Protective clothing Plastic apron and gloves Period of isolation While in hospital Comment Isolation precautions to continue until directed by IPCT. Meticillin-resistant Staphylococcus aureus (MRSA) Separate chapter of Chapter 14 Infection Control Manual Category of isolation Airborne, single room Infective material Skin Protective clothing Plastic apron and gloves Period of isolation Until instructed by IPCT Comment Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 26 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Ophthalmia neonatorum (gonococcal or Chlamydia) Separate chapter of Infection Control Manual Category of isolation Contact, single room or incubator Infective material Secretions Protective clothing Plastic apron and gloves Period of isolation 24 hours after starting effective treatment Comment Screening and treatment of the parents is essential. They should be referred to the Genitourinary Medicine/Sexual Health Department. Poliomyelitis Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Rabies Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Contact, single room Faeces, respiratory Plastic apron and gloves. Surgical mask for first week. Droplet & enteric precautions for 1 week, then stop droplet precautions. Virus may be detected in faeces for up to 6 weeks. Doctor must notify CCDC. (see Chapter 3, Infection Control Manual). Airborne, single room while awaiting transfer to ID Unit Oral and respiratory secretions Plastic apron and gloves. Mask Duration of illness Inform IPCT. Transfer to ID Unit if possible. Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Rotavirus (see Diarrhoea) RSV Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Airborne, single room Respiratory secretions Plastic apron and gloves Duration of illness Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 27 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Ringworm Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Standard precautions Infected skin, hair or nails Plastic apron and gloves when handling patient While lesions are present. Nurse child in single room. Rubella (German measles) Separate chapter of Infection Control Manual Category of isolation Airborne, single room Infective material Respiratory secretions Protective clothing Plastic apron and gloves Period of isolation 5 days from onset of rash Comment Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Exclude staff and visitors who may be pregnant unless known to be immune. Salmonella (see Diarrhoea) Shigella (see Diarrhoea) SARS/MERS Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Chapter 38 Airborne, single room Respiratory secretions A filter mask (FFP3 respirator) Gloves. Eye protection Disposable gown (long sleeved fluid-repellent) Plastic apron Until informed by IPCT Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 28 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Scabies Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Comment Chapter 6 Contact Skin lesions Plastic apron and gloves when handling patient Until successfully treated. Smallpox Separate chapter of Chapter 36 Infection Control Manual Category of isolation Airborne. Lobbied side room while awaiting transfer to High Level Isolation Unit (HLIU) Infective material Respiratory secretions and contact with contaminated bed linen/clothing. Protective clothing Impermeable, disposable gown Respirator FFP3 mask Eye protection Head cover Gloves Period of isolation Comment Until last scabs falls off. Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Streptococcal infection (Group A) Separate chapter of Infection Control Manual Category of isolation Contact, single room Infective material Oral secretions, infected site Protective clothing Plastic apron and gloves Period of isolation Until infected site clear and not less than 48 hours after starting effective antibiotic therapy. Comment Streptococcal infection (Group B, Maternity Unit only) Separate chapter of Infection Control Manual Category of isolation Airborne, single room (mother & baby together) Infective material Infected or colonised secretions Protective clothing Plastic apron and gloves Period of isolation Duration of stay in hospital Comment Precautions taken to prevent cross infection (and potentially serious infection) of other babies. Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 29 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Syphilis (Primary or secondary) Separate chapter of Infection Control Manual Category of isolation Standard precautions Infective material Secretions and infected lesions. Protective clothing Plastic apron and gloves for handling infected sites and contaminated articles. Period of isolation After 48 hours of correct antibiotics. Comment Tetanus Separate chapter of Infection Control Manual Category of isolation Isolation not necessary Infective material Protective clothing Period of isolation Comment Tuberculosis Separate chapter of Chapter 19 Infection Control Manual Category of isolation Airborne, single room. Lobbied side room if possibility of MDR (multi-drug resistant) TB. Infective material Respiratory or other infected secretions Protective clothing Plastic apron and gloves i.e. use standard precautions for contact with blood, body fluids, secretions and excretions. FFP3 masks for staff & visitors during contact with a patient with suspected or known MDR TB. FFP3 masks should also be worn for aerosol-generating procedures Period of isolation For the first 2 weeks of antituberculous treatment. Longer if known/risk factors for MDR TB. Seek advice from IPCT. Comment Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Typhoid/paratyphoid (enteric fever) Separate chapter of Infection Control Manual Category of isolation Contact, single room Infective material Faeces, urine Protective clothing Plastic apron and gloves Period of isolation Whilst in hospital Comment Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 30 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Viral Haemorrhagic fever Separate chapter of Chapter 17 Infection Control Manual Category of isolation Lobbied side room while awaiting transfer to High Level Isolation Unit (HLIU) Infective material Blood, body fluids Protective clothing Hand hygiene; Double gloves; Fluid repellent disposable gown or suit; Plastic apron (over the disposable gown or suit) Disposable visor; FFP3 respirator Overshoes or boots should be considered if there are large blood/body fluid spills from patients with a high possibility of VHF (or a confirmed VHF case). Period of isolation Until advised by Infectious Diseases physician Comment Doctor must notify CCDC (see Chapter 3, Infection Control Manual). VRE Separate chapter of Infection Control Manual Category of isolation Infective material Protective clothing Period of isolation Chapter 29 Contact, single room Colonised/infected sites. Environment. Plastic apron and gloves Once patients have acquired VRE, prolonged carriage is inevitable and may persist for many years. Comment Whooping cough (pertussis) Separate chapter of Infection Control Manual Category of isolation Airborne, single room Infective material Respiratory secretions Protective clothing Plastic apron and gloves. Surgical mask. Period of isolation After 3 days erythromycin. Infectious for 3 weeks after onset if no antibiotics. Comment Post-exposure chemoprophylaxis for household contacts and HCWs with prolonged exposure to respiratory secretions. http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/131713671 3302 Doctor must notify CCDC (see Chapter 3, Infection Control Manual). Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 31 of 32 Policy Reference number: STHK0046 St Helens & Knowsley Teaching Hospitals NHS Trust Worms e.g. tapeworm, threadworm Separate chapter of Infection Control Manual Category of isolation Isolation not required Infective material Protective clothing Period of isolation Comment Infection Control Manual - Chapter 4-Isolation Policy-Version 7 (clinical) Issue Date: 1st October 2014 Page 32 of 32 Policy Reference number: STHK0046