Download Management of a Patient Requiring Source Isolation Procedures

Management of a Patient Requiring Source
Isolation Precautions
D
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Infection Prevention Control Policy
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s
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Description: The document describes the processes and
procedures to be taken by LPT staff for the management of a
patient requiring source isolation precautions within in-patient
facilities and the community
Key words:
Infection Prevention and Control
Source isolation
Version
6
Adopted by
Quality Assurance Group
Date adopted
Main author
January2015
Fiona Drew
Name of responsible
committee
Infection Control Committee
Quality Assurance Committee
Date issued
January 2015
Review date
August 2017
Expiry date
January 2018
Target audience
All LPT Staff
Type of policy
Clinical

Non clinical
Contribution List
Key individuals involved in developing the document
Name
Designation
Fiona Drew
Infection Prevention and Control Nurse
Amanda
Howell, Infection Prevention and Control team
Antonia Garfoot, Una
Willis, Mel Hutchings
Circulated to the following individuals for consultation for this document
Name
Infection Prevention
Control Team
Di Postle
Neil Hemstock
Katie Willetts
Paul Williams
Francisco Guerra
Michelle ChurchardSmith
Claire Armitage
Louise Carpenter
Samantha Pearson
Kathy Feltham
Emma Wallis
Janet McNally
Sarah Clements
Linda Bull
Sarah Latham
Bernadette Keavney
Jo Bale
Designation
Leicester Partnership NHS Trust
Trust lead for Professional Standards
Lead Nurse FYPC
Senior Nurse, Specialist Nursing FYPC
Team Manager, Langley Ward
Senior Matron, Oakham House
Lead Nurse, LD
Lead Nurse, AMH
Inpatient Lead, AMH
Service Manager Acute Inpatient Services, AMH
Lead Nurse MHSOP
Lead Nurse CHS
Integrated Team Manager
Matron Loughborough Hospital
Matron Coalville Hospital
Matron Evington Centre
Health Safety and Security Manager
Nursing Operational Lead
Management of a patient requiring source isolation precautions
2
Contents
Definitions that apply to this policy ……………………………………………………
5
1.0
Summary …………………………………………………………………………. 6
2.0
Introduction ………………………………………………………………………
3.0
Purpose ………………………………………………………………......……… 6
4.0
Justification for the document … …………………………………….……......
7
5.0
The management of a patient requiring source isolation precautions
in-patient facilities ……………………………………………………………….
7
6
5.2
Patients in their own homes.…………………………………………………..... 16
5.3
5.4
Disposal of infected cadavers ……………………………………………….. …16
.
Criteria for admitting patients to an acute hospital …………………………... 16
5.5
Conditions requiring source isolation precautions or no isolation .……….17-25
6.0
Training …………………………………………………………………………... 26
7.0
References and associated documents ……………………………………... 27
Appendix 1: Source isolation precautions …………………………………… 28
Appendix 2: Inter-healthcare transfer form …….………………………….29-31
Management of a patient requiring source isolation precautions
3
Version Control and Summary of Changes
Version
number
Date
Version 1,
May
2010
Version, 2
May
2010
June
2010
June
2010
August
2011
August
2014
Version, 3
Version, 4
Version 5
Version 6
Author Status
Draft 1
Comments
(description change and amendments)
Replaces NO 0186
“Infection Control Policy for the Management of
a Patient Requiring Source Isolation in
Community Hospitals”
Reviewed by U. Willis to incorporate
requirements of the Health and Social Care Act
2008, Care Quality Commission and NHSLA
Standards.
Circulated for comments
Comments inserted.
Forwarded to Clinical Governance for approval.
Policy approved by Clinical Governance
Committee
Harmonised in line with LCRCHS, LCCHS, LPT
(Historical organisations)
Reviewed to ensure continuing compliance with
the Health & Social Care Act (2008) and in line
with current guidelines.
Document forwarded to policy group for
approval.
For further information contact: The Infection Prevention and Control Team.
Management of a patient requiring source isolation precautions
4
Definitions that apply to this policy
Due Regard
Consultant in
Communicable
Disease (CCDC)
Cohort Nursing
Disease
DIPaC
Infection
Infectious
Having due regard for advancing equality involves:
 Removing or minimising disadvantages suffered by people
due to their protected characteristics.
 Taking steps to meet the needs of people from protected
groups where these are different from the needs of other
people.
 Encouraging people from protected groups to participate in
public life or in other activities where their participation is
disproportionately low.
A consultant is who is knowledgeable in Infectious Diseases
Grouping of infectious patients and nursing them within an
area of an inpatient facility. It is recommended as a strategy
for controlling transmission of healthcare associated infection
in the absence of single patient rooms.
A pathological condition of a part, organ, or system of an
organism resulting from various causes, such as infection,
genetic defect, or environmental stress, and characterized by
an identifiable group of signs or symptoms
Director of Infection Prevention and Control
This is an organism is present at a site and causes an
inflammatory response or where the organism is present in a
normally sterile site.
Caused by a pathogenic microorganism or agent that has the
capability of causing infection
LPT
Outbreak
Leicestershire Partnership Trust
The occurrence of two or more cases of the same infection
linked in time or place or, the situation when the observed
number of cases exceeds the number expected.
Organisms
This is defined as any living thing, in medical terms we refer to
bacteria and viruses as organisms
Personal Protective Specialized clothing or equipment worn by employees for
Equipment (PPE)
protection against health and safety hazards.
Source Isolation
Isolation for the control of infection is used to prevent infected
patients from infecting others.
Symptomatic
Physical or mental sign of disease
Management of a patient requiring source isolation precautions
5
Summary
This policy provides organisation wide guidance on the management of patients
requiring source isolation in inpatient facilities and patients who are cared for in their
own homes. The guidance is designed for patients who are known or suspected to
be infected with transmissible micro-organisms in order to reduce the risk of
transmission of infection. An A to Z table of conditions is given which lists any
additional precautions that are required. This is not an exhaustive list and further
advice can be sought from the Infection Prevention and Control Team. In many
instances, the risk of transmission of infection may be highest before a definitive
diagnosis can be made. The routine use of Standard Precautions that are taken for
all patients at all times should greatly reduce the risk of spread of infection.
2.0
Introduction
The management of a patient requiring source isolation policy applies to all staff
employed by Leicestershire NHS Partnership Trust (LPT)
LPT has a wide range of teams and services operating from a large number of
properties making up our overall estate. LPT also delivers healthcare in peoples own
homes, including care homes.
The provision of healthcare carries with it inherent risks to the health care worker.
The purpose of this document is to ensure that all staff are aware of their
responsibilities for safe practice and take the appropriate precautionary measures to
protect themselves, their co-workers and their patients. The policy identifies staff’s
responsibilities and provides them with the information they require to enable them to
minimise the risk of transmission of infection.
3.0
Purpose
The purpose of this policy is to provide staff employed by Leicestershire Partnership
Trust with clear and robust infection prevention and control guidelines for the
Management of a Patient requiring source isolation within LPT.
This policy applies to all permanent employees including medical staff who work for
LPT including those on bank, agency or honorary contracts either at the community
hospitals or within the community services. All health professionals should ensure
they work within the scope of their professional code of conduct, providing evidence
based care which is in accordance with the Health & Social Care Act (2008) and the
latest guidance provided by Public Health England (PHE).
Management of a patient requiring source isolation precautions
6
4.0
Justification for Document
As a duty of care LPT must ensure that staff are given guidance as to the
appropriate steps they need to undertake to ensure that they can protect the patients
within their care. Infection prevention and control safety is a legal requirement under
the Health and Safety at Work Act 1974.
Isolation for the control of infection is used to prevent infected patients from infecting
others and or prevent susceptible patients from being infected. Isolation refers to the
precautions that are taken in the hospital to prevent the spread of an infectious agent
from an infected or colonized patient to susceptible persons.
5.0
The Management of a Patient requiring Source Isolation Precautions
5.1
In-Patient facility.
Standard precautions which are taken for all patients at all times will greatly reduce
the spread of infection from person to person. However there are some organisms
for which additional precautions are considered necessary. The term source
isolation precaution (SIPs) is used to indicate that the patient is the source of
infection. Conversely, patients at risk of infection from others or the environment due
to their immune status are placed in protective isolation.
Source Isolation Procedure
Patients requiring source isolation precautions should be admitted or transferred to a
single room (preferably with en-suite facilities) and the precautions outlined in this
policy enforced. In the event of a single room being unavailable for one of the
following reasons, it will be necessary to carry out source isolation precautions in the
bay:
o Single rooms already contain patients with infections that pose a higher
risk than the patient requiring a single room
o Patient requiring source isolation have had a risk assessment and are
deemed to be unsuitable/unsafe to be nursed in a single room
o Cohort nursing is required, when several patients with the same signs and
symptoms require source isolation. Usually due to an outbreak or an
increased incident. – see Increased incident/outbreak policy (need to
make sure we have the correct name of the policy).
If a single room is not available or not suitable, a risk assessment must be carried
out by the clinician or nurse caring for the patient. The outcome of the risk
assessment must be documented in the patient’s clinical records. The Infection
Control team must be informed of the outcome of the risk assessment as soon as
possible.
Management of a patient requiring source isolation precautions
7
The risk assessment will ensure, wherever possible, that only patients presenting the
least cross infection risk to others will be cared for in the main ward area using
source isolation precautions and procedures.
Where source isolation precautions are carried out within the bay the procedure
must be followed in the same way as for a patient in a single room.
The infection control team must be informed of patients requiring source isolation as
soon as practical by telephone. The source isolation form (see Appendix 1), must
also be completed and displayed.
Upon commencement of source isolation precautions, the nurse responsible for the
patient should explain to the patient and relatives the reason for source isolation
precautions, what special measures and procedures will be taken, and any
patient/visitor restrictions.
Environment and Equipment
Unnecessary furniture and equipment should be removed from the single room or
the bed space before admitting the patient.
If a patient is nursed in a single room, the room should contain:o
o
o
o
o
Hand wash basin
Wall mounted liquid soap.
Paper hand towels in wall mounted dispenser.
A foot operated pedal bin for clinical waste
'Sharps' bin for disposal of sharps if required and if safe to do so (if unsafe
to leave in the room the sharps bin should be decontaminated after each
use on removal from the room).
o Thermometer, sphygmomanometer and stethoscope if required.
o Allocated manual handling equipment if required
o Allocated commode if en-suite facilities not available. The commode
should not be used/left by the patient’s bedside unless absolutely
necessary and a risk assessment should then be done.
Wherever possible patients should have dedicated equipment when source isolation
precautions are being carried out. If this is not possible the equipment must be
cleaned and decontaminated appropriately in between use.
The patient’s charts and notes must not be taken into the room.
A trolley must be placed outside the room if appropriate (for that area) containing:
o
o
o
o
o
Clinical waste bag (for double bagging all waste)
Gloves and aprons (masks and goggles if applicable)
Alcohol hand sanitiser
Linen bags (Refer to Linen Policy)
Waste tie tags
Management of a patient requiring source isolation precautions
8
Other additional items should not be stored on the trolley
If the patient is being isolated in a bay area the following equipment must
be available at the bedside on a trolley:
o Clinical waste bag (for bagging all waste and then must be taken to clinical
waste bin for double bagging)
o Sharps bin if required and safe to do so (if unsafe to leave on the trolley
the sharps bin must be decontaminated after each use on removal from
bed space
o Gloves and aprons (masks and goggles if applicable)
o Alcohol hand gel
o Linen bags (red hot water-soluble inner, white plastic outer)
o Waste tie tags
The bay must also contain:
o Hand wash basin
o Wall mounted liquid soap
o Paper hand towels in wall mounted dispenser
The patient should be allocated a toilet specific for their use whilst they are receiving
source isolation precautions. If a toilet cannot be allocated for the patient then a
commode must be allocated for the patient but this is not to be used at the patient’s
bedside but the commode must be taken to a toilet area. The commode must be
cleaned and decontaminated after use.
Following all care with a patient and after removal of PPE which is to be disposed of
at the bedside or within the room of a patient receiving source isolation precautions
hands must be immediately washed with soap and water within the single room or at
the hand wash basin within the bay and then hands immediately disinfected with
hand sanitiser.
If it is deemed unsafe to have paper towels in the bay or single rooms, and therefore
immediate hand washing is prohibited, a risk assessment must be undertaken to
indicate this and documented in the patients notes. In this instance alcohol sanitiser
should be used to decontaminate hands in the first instance by staff at the bedside,
then washed with liquid soap and water at the nearest hand-wash basin, dried then
followed by disinfection with hand sanitiser.
All hand wash basins should have elbow operated taps. In the event that taps are
not elbow operated, taps should be turned off using a clean paper hand towel.
Hand hygiene
Hand hygiene, is imperative before and after clinical contact with the patient, contact
with body fluids, and after cleaning contaminated equipment or the environment.
Cuts or abrasions on the hands of staff should be covered with waterproof dressings.
Please refer to LPT Infection Prevention and Control Policy for Hand Hygiene in
Community Health Services, Inpatient Facilities and Primary Care Infection
Prevention and Control
Management of a patient requiring source isolation precautions
9
Personal Protective Equipment (PPE)
PPE is used to protect both the patient and the healthcare worker from the potential
risks of cross infection. Uniforms are not classed as PPE. The table below identifies
what items of PPE should be used and when it is appropriate to be used.
The appropriate colour coding for the use of PPE should be used and followed at all
times.
Apron
Disposable plastic
Gloves
Disposable, non-sterile nitrile
Eye protection and surgical mask
or Full face visor
Disposable or re-processable
Aprons should be worn by all staff having any
direct contact with the patient and or the
environment
Gloves must be worn by all staff having any
direct contact with the patient and/or the
environment
Any procedure which may generate aerosols
e.g. suction or any procedure that may
produce splashing of blood and other body
fluids e.g. urinary catheters, sampling of
urine
Disposable PPE is used once only and is removed immediately before leaving the
room or bed space and placed directly into the clinical waste bag. Hands should then
be decontaminated thoroughly. Please refer to LPT Infection Prevention and Control
Policy for Personal Protective Equipment.
Waste Disposal
All categories of waste from the isolated areas must be treated as clinical waste and
when disposed of, be double bagged using clinical waste bags. Bags must not be
more than two-thirds full and they must be tied securely. Double bagging is carried
out as follows using two clinical waste bags.
The first or 'inner' bag is kept in the isolation room in a bin. When this is two-thirds
full the bag is tied securely. The nurse in the area where source isolation is being
undertaken should place the bag in the second or ‘outer’ bag held by a second nurse
outside the room or bed space area who must be wearing a disposable plastic apron
and nitrile gloves. The second nurse then seals the bag securely, and immediately
places it for collection in the designated waste holding area.
If there is no second nurse available, place the waste bag at the door, take off and
dispose of the PPE as per policy. Wash hands and decontaminate using alcohol
sanitiser as per policy. Put on new PPE and dispose of waste as above.
Please refer to the LPT Infection Prevention and Control policy for the Management
of Waste.
Management of a patient requiring source isolation precautions
10
Sharps
Sharps bins if kept in the room where source isolation is being undertaken, or kept
on the trolley if the patient is nursed in a bay area need to be terminally locked and
wiped, if it is full to the designated fill line as marked on the outside of the sharps bin
(or when it is no longer required by the patient, whichever is the sooner), with Chlorclean before removal from the area.
Please refer to the LPT Infection Prevention and Control Policy for the Management
of Sharps and Exposure to Blood Borne Viruses in Community Health Services,
Inpatient Facilities and Primary Care.
Linen
Excessive wafting of bed sheets during bed making must be avoided. All used
hospital linen should be placed into a red soluble inner bag and then placed into a
red outer plastic bag.
Patients’ Own Clothing and Bed Linen
Patients’ own clothing and bed linen if used should be sent home with relatives
wherever possible. It should be kept in the patient’s room until it is collected, in a
non-permeable bag/container. This should take place as soon as possible and
relatives need to inform the ward staff if there is a delay. Staff need to ensure that
relatives are aware that there is patients own clothing and linen awaiting collection.
If the dirty linen cannot be collected then the patient will need to use the hospital
linen.
In the event that there are no relatives or carers who are able or willing to launder a
patient’s own clothing it should be laundered on site if possible. Such items must be
bagged in a red soluble bag and then placed into a blue plastic outer patient’s bag
before being transported to the laundry area. If there are no on site laundry facilities
available, patient’s clothing may be sent to the main laundry with consent from the
patient or their family if appropriate and be clearly marked with the patients name
and location. If any garments have a detachable belt this should also be clearly
labelled. Ensure that the marking will withstand numerous washes.
Manual sluicing, soaking or hand washing of soiled items must never be carried out.
A sluice cycle or cold pre-wash via the washing machine must be used for all soiled
items. Any solid matter, i.e. faeces must be removed prior to this in the appropriate
toilet receptacle sluice hopper. PPE must be worn at all times when carrying out this
task.
Permission must be sought from the patient or their family when appropriate
prior to defacing their personal belongings by labelling it.
Crockery and Cutlery
Disposable crockery and cutlery is not required providing an automatic dishwasher is
used to clean the crockery and cutlery, (manual washing of the crockery must not
Management of a patient requiring source isolation precautions
11
take place). Crockery and cutlery can be adequately decontaminated in a
dishwasher with a final rinse temperature of 80C. The crockery and cutlery does not
need to be washed separately to other crockery and cutlery.
Food may be delivered to patients in isolation using a tray. After the meal, the
crockery, cutlery, leftovers and tray are placed directly into the trolley. PPE must be
worn and hands decontaminated following removal of PPE as per LPT policy.
Jugs, glasses, cups and saucers should be returned to the unit`s main kitchen and
be washed immediately in the automatic dishwasher.
Equipment
Patient dedicated equipment must be used when available.
All equipment brought into the room or bed space must be cleaned and disinfected
between uses and upon removal from the room or bed space.
Please refer to LPT Infection Prevention and Control Policy for Cleaning and
Decontamination in Community Health Services, Inpatient Facilities and Primary
Care.
Management of Body Fluids
Toilets/Commodes
Patients should use the toilets in the room where they are receiving source isolation
precautions wherever available. A toilet/commode specifically designated for the
patient should be used if there are no en-suite facilities or the patient is unable to use
them
If a patient who is receiving source isolation precautions within a bay area a toilet
should be designated for the sole use of the patient whilst they are receiving source
isolation precautions. If this is not able to be facilitated a risk assessment must be
completed and held within the patients notes. The toilet must be cleaned and
decontaminated between each use.
A commode should not be used or left at the bedside of a patient who is receiving
source isolation precautions within bay areas. The maintenance of the patient’s
privacy and dignity is imperative where it is safe and reasonable to do so.
This will also support the prevention of spores being displaced throughout the bay
environment. If a commode has to be used at the patient’s bedside for safety
reasons then a risk assessment must be completed and held within the patient’s
notes. Consideration must be given to the other patients within a bay who are at
risk of spores that may be dispersed whilst a patient is using a commode at the
bedside.
Management of a patient requiring source isolation precautions
12
Disposable Bedpans and Urinals
A bedpan carrier should be designated for the sole use of the patient undergoing
source isolation precautions and not used for other patients. After use, the covered
bedpan and carrier or urinal is to be disposed of; the nurse must remove and
dispose of PPE as per policy, wash hands and decontaminate using alcohol sanitiser
as per policy. Put on new PPE and dispose of bedpan. Disposable items are placed
into the macerator, care being taken not to contaminate the outside of the machine.
The bedpan carrier should be cleaned and disinfected with Chlor-clean. Remove
PPE, clean and decontaminate hands. If the macerator is not available for use, the
contents of the bedpan/urinal within the disposable liner should be solidified using a
solidifying gel, the liner and contents should then be double bagged and disposed of
as clinical waste.
Non disposable Bedpans and Urinals
Where there is no access to an automatic washer, the contents of the bedpan/urinal
should be solidified using a solidifying gel. The solidified contents can then be double
bagged and disposed of as clinical waste. The bedpan or urinal should be cleaned
and disinfected with Chlor-clean. Staff must wear PPE including face/eye protection
carrying out this task
Disposal of Urinary Catheter bags
Following disconnection of the catheter bag, empty the contents of the bag directly
into the toilet if en-suite facilities are available.
Where these facilities are not available, the contents of the catheter bag must be
emptied into a urinal and disposed of as above. The empty catheter bag can then be
disposed of directly into the clinical waste bag.
PPE must be worn during the procedure, including face protection if deemed
appropriate.
Disposable Vomit bowls
Disposable items are placed into the macerator, care being taken not to contaminate
the outside of the macerator and surrounding area. Chlor-clean is to be used to
clean and decontaminate the macerator. PPE must be worn as per LPT policy, face
protection to be worn id deemed appropriate.
If the macerator is not available for use, the contents of the vomit bowl within the
disposable liner should be solidified using a solidifying gel, the liner and contents
should then be double bagged and disposed of as clinical waste.
Management of a patient requiring source isolation precautions
13
Cleaning of single rooms and bed spaces where source isolation precautions
are taking place.
All staff are responsible for seeing that the room or bed space is kept clean and tidy
at all times. The domestic staff must be informed that source isolation precautions
are required. All isolation rooms or bed spaces must have one full clean in the
morning and one check-clean in the afternoon to check general cleanliness and
waste bins and action accordingly. Chlor-clean must be used to clean and
decontaminate the room or bed space and environment.
A designated mop and bucket must be allocated to each patient requiring source
isolation. Cleaning cloths must be disposable. (Cleaning materials must be in line
with the national colour coding requirements)
Only necessary equipment should be kept inside the room or around the bedside.
This will facilitate effective cleaning and decontamination procedures.
Communal bath and shower rooms must be thoroughly cleaned and disinfected
using Chlor-clean immediately after use by a patient with a known or suspected
infection.
Discharge/Terminal/Post Infection Cleaning of Room or bed space and
Furniture
All staff must wear PPE when undertaking cleaning activities. Hands must be
decontaminated following the removal of PPE.
After discontinuing source isolation the area and equipment must be cleaned and
decontaminated. If the patient is to remain in the room following the discontinuation
of source isolation precautions the room or bed space must still undergo a
discharge/terminal/post infection clean.
Curtains should be removed and double bagged as infected linen, prior to cleaning
and disinfecting the room or bed space. Once cleaning and disinfection of the room
or bed space is completed clean curtains should be hung.
Clean and disinfect all surfaces with Chlor-clean. Mop-heads should be machinewashable or disposable. The mop handle and bucket should be cleaned, disinfected
and dried using Chlor-clean. Cloths used for cleaning must be disposable, and be
disposed of as clinical waste.
Cleaning or disinfection of walls or ceiling is only required if visibly contaminated or
at the discretion of the Infection Control Team.
Any dressings, bandages etc., information, such as menus, ward welcome packs
and paperwork etc. that is left in a patients room following discharge that cannot be
cleaned and decontaminated must be disposed of.(Note this list is not exhaustive).
Management of a patient requiring source isolation precautions
14
Unused Pharmaceutical Products
Unused medications from isolation rooms should be placed into a clear disposable
plastic bag, labelled “Source isolation” and then returned to Pharmacy in the usual
way.
Visits to other departments
When patients who are receiving source isolation precautions need to visit other
departments within a community hospital, the ward where the patient is located must
contact the department to ensure appropriate precautions are can be taken.
Arrangements should be made to minimise any delay and possible contact with other
patients en route as well as in the visiting department.
Any unnecessary equipment must be moved out of the room wherever possible prior
to the patient visiting. If not possible it should be covered with a disposable or
washable cover. Areas where patients with known infections are likely to need to
visit should not be used as routine storage areas for equipment.
All equipment within the department, whether used or not by the patient should be
cleaned and decontaminated after the patient has visited the area unless it is
covered beforehand.
Porters, nursing and other staff should wear protective equipment only when in direct
contact with the patient. This is not necessary when escorting the patient through the
hospital. After use the trolley or wheelchair must be cleaned and disinfected with
Chlor-clean.
The ambulance liaison officer should be told when patients requiring source isolation
precautions are transferred to another hospital for investigations or as potential
inpatients and should be informed of the transit precautions required. The receiving
hospital department must also be told of the need for source isolation precautions.
The transferring ward will need to complete the Essential Steps Inter-healthcare
infection control transfer form (Appendix 2).
Cleaning and decontamination of the environment is essential to prevent
transmission of potentially pathogenic organisms. The environment and any
equipment within the area, unless covered must be cleaned and decontaminated
appropriately.
Visiting arrangements
Patients in source isolation may be visited by family and friends.
Hands should be thoroughly washed by all visitors inside the room/bay and alcohol
hand sanitiser used outside the room/bay.
Visitors do not routinely need to wear PPE. However advice must be provided by
staff caring for the patient. For example, if relatives are involved with direct patient
care, they should then wear disposable gloves and aprons, removing them after use
Management of a patient requiring source isolation precautions
15
and placing them in to clinical waste, then washing their hands with soap and water
before decontaminating them with alcohol sanitiser.
If there is an increased incident of diarrhoea and/or vomiting then single use
disposable aprons must be worn by visitors when they visit, whether they are giving
direct care or not. It is the responsibility of the nursing staff to advise patients and
relatives of this if it is appropriate.
5.2
Patients in their own Homes
Patients who are being cared for in their own home do not pose as great a risk to
others as within the healthcare environment. This is due to the fact that they are not
usually nursed in an environment with other susceptible individuals. However
standard precautions must still be used for patients with a known infection.
When visiting patients who are suspected of infection in their own home then a good
standard of infection prevention and control precautions must be maintained to
prevent carriage of transient organisms between patients. All practices identified for
caring for a patient in an inpatient area including; hand hygiene, use of personal
protective equipment and cleaning of equipment (belonging to LPT) must be adhered
to for patients in their own homes. Carers and / or relatives caring for someone with
an infection should be encouraged / advised:
5.3
Disposal of Infected Cadavers
Please refer to LPT Infection Prevention and Control Policy for the Patient who has
died (Cadaver) in Community Inpatient Facilities.
5.4
Patients for whom admission to an acute hospital is required:
a) Isolation facilities within the Community inpatient units are inadequate for
the patient’s condition (i.e. the patient requires negative pressure
ventilation)
b) Where STRICT isolation is required see table below.
Where it has been deemed necessary to transfer a patient to the acute sector the
medic involved with the patient needs to discuss in the first instance transfer details
with the appropriate consultant within the acute hospital. In most cases, although
not all this is likely to be a consultant within the infection diseases unit at UHL, LRI
hospital. Please contact the infection control team if you require any advice
regarding this.
Arranging admission to the Infectious Diseases Unit
Admission to the Infectious Diseases Unit is arranged by telephoning the Senior
House Officer or Consultant via Leicester Royal Infirmary, University Hospitals of
Leicester inpatient facilities.
Management of a patient requiring source isolation precautions
16
5.5
Conditions requiring source isolation precautions or no isolation precautions, and period of isolation
DISEASE OR
INFECTING AGENT
PRECAUTIONS
REQUIRED
Abscess
Aetiology unknown &
draining
Auto Immune
Deficiency Syndrome
(AIDS)
See Human
Immunodeficiency
Virus (HIV)
Amoebiasis
Dysentery
Liver abscess
Anthrax
Cutaneous
Ascariasis
Aspergillosis
Botulism
Bronchiolitis
None (unless
microbiological
isolate indicates)
Bronchitis
Adults
Infants & young
children
None
Source
ROUTE OF
INFECTION
PERIOD OF ISOLATION
See advice for relevant organism
Faecal - oral
Source
None
Source
Contact
None
None
None
Source
Airborne
Management of patients with Source Isolation
RISK FACTORS
Airborne
Diarrhoea
Clinical recovery – 48 hours free from
diarrhoea and passed a formed stool or
discharge home
Until completion of successful treatment
Cough/
Clinical recovery or discharge home
Productive sputum
Cough/
Clinical recovery or discharge home
Productive sputum
17
Brucellosis
Campylobacter
Gastroenteritis
None
Source
Faecal - oral
Diarrhoea
Clinical recovery – 48 hours free from
diarrhoea and passed a formed stool or
discharged
Candidiasis
Clostridium Difficile
(CDT)
None
Source
Faecal - oral
Diarrhoea
Clinical recovery - Until free from
diarrhoea for 48 hours and has passed a
formed stool
Leaking vesicles
All lesions scabbed
Diarrhoea
Clinical recovery – 48 hours free from
diarrhoea and passed a formed stool or
discharge home
Gastroenteritis
Cellulitis
Intact skin
Exudating
Chickenpox
(Varicella Zoster)
Cholera
Gastroenteritis
Creutzfeld Jacob
Disease (CJD)
Common cold
Adults
Infants & young
children
None
None (unless
microbiological
isolate indicates)
Source
Source
None
None
Source
See advice for
relevant organism
Contact/
respiratory
Faecal - oral
Care for specific
invasive
procedures. See
Guidelines for the
Management of
CJD
Respiratory
Cough/
Productive
sputum
Clinical recovery or discharge home
Management of a patient requiring source isolation precautions
18
Conjunctivitis
Neonatal
(not a sticky eye)
Croup
Source
Contact
24 hours of appropriate antibiotic therapy
Source
Respiratory
Clinical recovery or discharge home
Cryptococcosis
Cryptosporidiosis
Gastroenteritis
None
Source
Faecal - oral
Diarrhoea
Clinical recovery –48 hours free from
diarrhoea and has passed a formed stool,
or discharged
Cytomegalovirus
None
Dengue
Source
Mosquito Bite
Dependent on clinical assessment
Diarrhoea and/or
vomiting
Source
Faecal - oral
Contact with body
fluids
Diarrhoea/
Vomiting
Dysentery
Shigella
Source
Faecal - oral
Diarrhoea
E-coli
Source
Faecal - oral
Diarrhoea
Encephalitis
None
Enterobiasis
Source
Faecal - oral
Until completion of treatment
Epiglottitis
Source
Respiratory
Epstein Barr virus
Source
Respiratory
24 hours of appropriate antibiotic
treatment
2 weeks after onset of symptoms
Erysipelas
Source
Contact
24 hours of antibiotic treatment
Clinical recovery –48 hours free from
diarrhoea and/or vomiting and the
patients has passed a stool that is normal
for them or a formed stool or until a noninfectious cause has been established or
patient discharged
Clinical recovery – 48 hours free from
diarrhoea and passed a formed stool
Clinical recovery – 48 hours free from
diarrhoea and passed a formed stool
Management of a patient requiring source isolation precautions
19
Gas Gangrene
German measles
(Rubella)
Glandular Fever
(Infectious
Mononecleosis)
Gonorrhoea
None
Source
Respiratory
5 days from onset of rash
Source
Respiratory
2 weeks after onset of symptoms
Haemophyllis
Influenza
Source
Respiratory
Hand, foot and
mouth disease
Source
Contact
Human
Immunodeficiency
Virus (HIV)
Risk factors present
No risk factors
present
Hepatitis A (HAV)
Risk factors present
No risk factors
present
None
Cough/
Productive
sputum
Lesions
Clinical recovery or discharge home
Contact
Open wounds,
lesions risk of
bleeding
Dependant on clinical assessment
Contact
Ingestion of
food,water or
other objects
contaminated with
faecal matter from
an infected
person (even in
microscopic
amounts)
Sex with an
infected person
Dependant on clinical assessment
Clinical recovery or discharge home
Source
None
Source
None
Management of a patient requiring source isolation precautions
20
Hepatitis B (HBV)
Risk factors present
No risk factors
present
Hepatitis C (HCV)
Risk factors present
No risk factors
present
Influenza (Pandemic)
Contact
Open wounds,
lesions, risk of
bleeding
Dependant on clinical assessment
Contact
Open wounds,
lesions, risk of
bleeding
Dependant on clinical assessment
Respiratory/
contact
Sputum
generating
procedures
7 days from clinical onset or clinical
recovery
Source
None
Source
None
Source
Legionnaires
None
Leprosy
Smear positive
Smear negative
Source
None
Respiratory/
Contact
Leishmaniasis
Leptospirosis
None
None
Source
Contact
Listeriosis
Lyme disease
Malaria
Measles
None
None
None
Source
Respiratory
5 days from onset of rash
Meningitis
Confirmed or
suspected
Viral
Source
Source
Respiratory
Respiratory
24 hours of appropriate antibiotic
treatment
Length of acute illness
Head Lice
Negative smears
Prolonged contact
Prior to treatment and following 24
following anti-louse treatment
Management of a patient requiring source isolation precautions
21
Molluscum
contagiosum
Source
Contact
Until after appropriate treatment
Mumps
MeticillinResistant
Staphylococcus
Aureus (MRSA)
High risk areas
Low risk areas
Risk factors present
No risk factors present
Mycobacteria
(atypical)
Necrotising
Fasciitis
Strep. pyogenes
Nocardia
Source
Respiratory
10 days from onset
Source
Source
Source
None
None
Contact
Contact
Contact
Source
Contact
None
(source for
oncology &
transplants)
Source
Clinical Recovery
Faecal - oral
Diarrhoea
Source
Respiratory
Cough
None
Source
Respiratory
Paratyphoid fever &
carriers
Pertussis
(Whooping cough)
Pharyngitis
Adults
Infants & young
Children
Productive cough,
Heavily exudating
wounds, heavily
exfoliating skin
Three consecutive negative screens
Control of Infection Guide
If risk factors are present or 3 consecutive
negative screens
24 hours of antibiotic treatment
Clinical recovery – 48 hours free from
diarrhoea and passed a formed stool
Clinical recovery
Clinical recovery
Management of a patient requiring source isolation precautions
22
Pneumonia
Children
Adults
Poliomyelitis
Source
None
Respiratory
Cough
Source
Faecal - oral
Diarrhoea
Psittacosis
Puerperal sepsis
Source
Source
Respiratory
Contact
Rabies
Strict
Immediate
transfer to
Infectious
Diseases Unit
Source
Contact with
secretions/body
fluids
7 days from onset
24 hours of appropriate antibiotic
treatment
Until decision by Infection Control
Doctor/Infectious Diseases
Consultant/CCDC
Respiratory
Until Discharge home
Respiratory
5 days from onset of rash
For at least one month after delivery
Respiratory
Contact
Until clinical recovery
Respiratory
syncytial virus
Ringworm
Rubella
Acquired
Congenital
Sudden Acute
Respiratory
Syndrome (SARS)
Salmonella
None
Source
Source
Strict
Immediate
transfer to
Infectious
Diseases Unit
Source
Faecal - oral
Diarrhoea
Until Discharge home
Unless advised by microbiology/Infection
Control Team
7 days from onset of diarrhoea
Clinical recovery – 48 hours free from
diarrhoea and passed a formed stool
Management of a patient requiring source isolation precautions
23
Scabies Classical
(Atypical)
Norwegian (Crusted)
Source
Source
Contact
Contact
Scarlet fever
Source
Shingles
(Herpes Zoster)
Source
Respiratory
Contact
Contact
Shigella
Source
Faecal - oral
Strep. pyogenes
(Group A
Streptococcal
Infection includes
Necrotising fasciitis)
Syphilis
Source
Contact
Source (if risk
factors are
present)
None
None
Contact
Tapeworm
Tetanus
Threadworm
Tonsillitis
Children
Toxoplasmosis
None
Source
Respiratory
Until completion of 2 courses of treatment
2 weeks apart
Repeat treatment may be necessary
Discuss with Dermatologist/
24 hours of antibiotic treatment
Leaking vesicles
Care by staff if
have no immunity
(See Guidelines
on Staff Health
Diarrhoea
All lesions scabbed over
Clinical recovery - 48 hours free from
diarrhoea and passed a formed stool
24 hours of appropriate of antibiotics
Weeping lesions
Until lesions are dry
Until Clinical Recovery
None
Management of a patient requiring source isolation precautions
24
Tuberculosis
Pulmonary/Milliary
Smear Negative,
Smear Positive,
Multidrug Resistant TB
Admit to Single
room
Respiratory
Productive cough
Until Agreement between clinician and
Control of Infection Officer
Please refer to LPT Infection Prevention and Control Policy for the Management of Tuberculosis in Community
Facilities, Inpatient Facilities and Primary Care.
Typhoid fever and
Source
Faecal - oral
Diarrhoea
Clinical recovery
Carriers
Vancomycin
Source
Contact
Diarrhoea
After consultation with the Infection
Resistant
None
Urinary Catheter
Control Team
Enterococci (VRE)
Wounds
With risk factors
Central lines
No risk factors
Varicella zoster
(Chicken pox)
Vomiting
Source
Viral
gastroenteritis
Faecal - oral
Diarrhoea/
vomiting
Until free from diarrhoea for 48 hours and
has passed a formed stool
Viral
Haemorrhagic Fever
(Lassa fever, Marburg
fever, Ebola fever,
Crimean)
Strict
High security and
transfer to
Infectious
Diseases Unit
Source
Respiratory
contact
Until decision by Infection Control
Doctor/Infectious Diseases Consultant/
Respiratory
Clinical recovery
Yellow fever
Source
Contact/Respirat
ory
Contact
Faecal - oral
Leaking vesicles
All lesions scabbed
Clinical recovery or non-infectious cause
established
None
Management of a patient requiring source isolation precautions
25
6.0 Training
There is a need for training identified within this policy. In accordance with the
classification of training outlined in the Trust Human Resources & Organisational
Development Strategy this training has been identified as mandatory and role
development training.
The course directory e source link below will identify: who the training applies to,
delivery method, the update frequency, learning outcomes and a list of available
dates to access the
training.http://www.leicspart.nhs.uk/Library/AcademyCourseDirectory.pdf
A record of the event will be recorded on Ulearn as appropriate. The governance
group responsible for monitoring the training is the Infection Prevention and
Control Committee and Quality Assurance Committee.
Management of Patients requiring source isolation
26
7.0
References and Associated Documents
Department of Health: The Health and Social Care Act Code of Practice for
Health and Adult Social Care on the Prevention and Control of Infections and
related guidance (2008)
Department of Health (2010) Health Protection Legislation (England) Guidance 2010.
Health Protection Regulations. London.
Department of Health: Essential Steps to Safe Clean Care (2007)
Health and Safety at Work Act 1974
Health and Social Care Act 2012
National Resource for Infection Control – www.nric.org.uk
LPT policies via intranet. The website can be accessed at
http://www.leicspart.nhs.uk/
Management of a patient requiring source isolation precautions
27
Appendix 1
SOURCE ISOLATION PRECAUTIONS
FOR IN-PATIENT FACILITIES
Visitors: Before entering the room please speak to the nurse
looking after the patient
All staff: Before entering the room and having contact with
the patient or any items in the room you MUST
Wear disposable gloves
Wear a disposable plastic apron
All visitors and staff please wash your hands before leaving the room.
-----------------------------------------------------------
Management of a patient requiring source isolation precautions
28
Appendix 2
Transfer Letter/Inter-Healthcare Transfer Form
From:
To:
Date:
Transferring facility e.g. ward, care home etc.:
Receiving facility e.g. hospital, ward, care home, district nurse etc.:
PATIENT DETAILS
Name:
Address:
G.P.
Date of Birth:-……………………………………………
NHS Number:-………………………………………….
NEXT OF KIN:Aware of admission: Yes 
REASON FOR ADMISSION:-
No 
PAST MEDICAL HISTORY/ ALLERGIES
CURRENT MEDICATIONS
GP/DOCTOR/CONSULTANT- CLINICAL SUMMARY OF TREATMENT
Print Name on completion:
Contact No:
Date:
NURSING SUMMARY:(Activities of daily living)
Print name on completion:
Contact No:
Date:
Management of a patient requiring source isolation precautions
29
MULTIDISCIPLINARY TEAM ONGOING ACTIONS AND PLANS
(Aids/ equipment used)
DETAILS OF CURRENT CARE PACKAGE
Who
Medication Aid: Yes
Approximate Weight:-
When

DNAR order in place within LPT
Form sent with patient:
Frequency
No

Contact
Type:………………………………
Yes  No 
Yes  No 
100% Continuing Health Care Funding Yes  No 
Waterlow Score:INTER-HEALTH INFECTION CONTROL INFORMATION:Is this patient an infection control risk?
(please tick the most appropriate box and give confirmed or suspected organism)
Confirmed
risk

Organism………………………………………………………………………………………
…
Suspected
risk

Organism:………………………………………………………………………………………
…
No known
risk

Organism:………………………………………………………………………………………
…
Patient exposed to others with infection (e.g.: D&V)
Yes 
No 
If patient has diarrhoeal illness, please indicate bowel history for last week:(Assessed with Bristol Stool Chart)
Is the diarrhoea thought to be of an infective nature?
Yes 
Management of a patient requiring source isolation precautions
No 
30
Relevant specimen results (including admission screens – MRSA, glycopeptideresistant enterococcus SPP, C. Difficile, multi-resistant Acinetobacter SPP) and
treatment information, including antimicrobial therapy:
Specimen:
Date:
Result:
Treatment information:
Other information:
Is the patient aware of their diagnosis / risk of infection? Yes 
No 
Yes 
No 
Does the patient require isolation?
(please inform the receiving area in advance)
Is the Infection Control Nurse aware of the transfer?
If no why not?
Is EMAS aware of the transfer?
Print Name on completion:
Contact No:
Yes 
Yes 
No 
No 
:
Date:
Management of a patient requiring source isolation precautions
31