Download isolation policy - RDaSH NHS Foundation Trust

ISOLATION POLICY
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4
Clinical Effectiveness Committee
8 March 2012
Practice Development Modern Matron and Senior
Infection Prevention and Control Nurse Specialist
Infection Prevention and Control Committee
19 March 2012
March 2015
The policy applies to all staff providing care to all
patients under the care of the Trust, whether in a direct
or indirect patient care role.
CONTENTS
SECTION
1.
INTRODUCTION
PAGE NO
2.
PURPOSE
3
3
3.
SCOPE
3
4.
RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES
4
4.1
Chief Executive, Nurse Director, Deputy Director of
Nursing
4
4.2
4.3
4.4
4.5
Infection Prevention and Control Nurse Specialists
Matrons and Ward/Department Managers
All staff
4
4
4
4
5.
PROCEDURE/IMPLEMENTATION
4
5.1
5.2
5.3
5.4
Principles Of Isolation
Guidelines For Single Room And Cohort Nursing
Management Of The Isolated Patient
Confidentiality
5
5
5
6
6.
TRAINING IMPLICATIONS
6
7
MONITORING ARRANGEMENTS
7
8.
EQUALITY IMPACT ASSESSMENT SCREENING
7
8.1
Privacy, Dignity and Respect
7
9.
LINKS TO OTHER TRUST PROCEDURAL DOCUMENTS
7
10
REFERENCES
7
11
APPENDICES
Appendix 1- Mode of Transmission
Appendix 2 - ISOLATION PRECAUTIONS - PLANNING GUIDE
Appendix 3- Signage for Isolation Nursing
Appendix 4 - ISOLATION – CLEANING CHECK LIST
Appendix 5 - Inter-healthcare transfer form
8
9
10
14
16
17
Ward/Department Managers
Page 2 of 18
1.
INTRODUCTION
Healthcare associated infections such as Meticillin Resistant Staphylococcus aureus; Clostridium
difficile infection, Extended Spectrum Beta-Lactamase, Norovirus and other multi resistant organisms
may be transmitted between patients and potentially between patients, staff and visitors. Transmission
of infection involves a source of infecting microorganism, a susceptible host and a mode of
transmission.
When a patient is suspected or known to be suffering from infection, an understanding of the source,
route and mode of the transmission (Appendix 1) of infection is essential in order to institute the
appropriate infection prevention and control principles, including isolation.
Standard precautions must be applied to all patients without exception, inclusive of environmental
cleaning, personal protective equipment and hand hygiene.
The isolation of patients must be based on the infection risk, symptoms and transmission in
accordance with the relevant infection prevention and control policy
The Medical Practitioner is responsible for ensuring notification of communicable diseases is
undertaken.
In the Community Setting, isolation of patients is not usually required. However, staff caring for the
susceptible or known infected patient must adhere to the principles of infection prevention and control.
Advice should be sought in the first instance from the Infection Prevention and Control Team (IPCT) on
the appropriateness of isolating patients. Out of hours, at weekends and bank holidays, through the
Assistant Director who would if needed consult the local Microbiology service.
2.
PURPOSE
This policy has been developed in order to ensure the correct employment of isolation procedures to
reduce and minimise the risk of cross infection to patients, visitors and healthcare workers. Minimising
the inappropriate movement of patients with infections for non-clinical reasons. Ensuring the
organisation complies with the requirements of the Health and Social Care Act (2008) Code of Practice
for health and adult social care on the prevention and control of infections and related guidance.

3.
A summarised planning guide to isolation procedures is provided (Appendix 2). The Consultant in
Communicable Disease Control (CCDC) must be notified for infections marked with an asterisk (*).
This is the responsibility of the medical staff and notification forms are available for this purpose.
SCOPE
The policy applies to all staff providing care to all patients under the care of the Trust, whether in a
direct or indirect patient care role.
Adherence to this policy is the responsibility of all staff employed by the Trust, including agency, locum
and bank staff contracted by the Trust.
Page 3 of 18
4.
RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES
4.1
Chief Executive, Nurse Director, Deputy Director of Nursing
The Chief Executive has ultimate responsibility for Infection Prevention and Control (IPC) however; the
Nurse Director has designated responsibility as Director of Infection Prevention and Control (DIPC).
The DIPC will provide regular updates to the Board.
The Deputy Director of Nursing also has designated IPC duties in support of the DIPC, particularly with
regard to the implementation of the Essence of Care Standards.
4.2
4.3
Infection Prevention and Control Nurse Specialists

To provide specialist advice and support to Modern Matron, Lead nurses and staff within the
localities.

Give advice on complex issues relating to the control of infection and report findings to the DIPC.
Matrons and Ward/Department Managers
It is the responsibility of Matrons and Ward/Department Managers to ensure implementation and
compliance with this policy.
4.4
Ward/Department Managers
It is the responsibility of ward/department managers to ensure:



4.5
All clinical staff can demonstrate compliance with the policy
All relevant staff to attend mandatory annual infection prevention and control training.
Infection Prevention and Control responsibilities form part of the individuals annual Personal
Development Plan.
All staff
All staff must be aware of their personal responsibilities in preventing the spread of infection.
Adherence to this policy is the responsibility of all staff. This applies to staff employed by the Trust,
agency, locum, and bank staff and those contracted to the Trust.
5.
PROCEDURE/IMPLEMENTATION
Infection risks should be assessed (risk assessment) and managed accordingly (risk management).
Advice should always be sought from a member of the infection prevention and control team.
Isolation of patients is undertaken for two reasons:

Source Isolation
To prevent transmission of infection from the infected patient to
Others

Protective Isolation
To prevent transmission of infection to a susceptible patient
Page 4 of 18
In some cases strict source isolation is required to prevent the spread of highly transmissible
infections e.g. Diphtheria and viral haemorrhagic fevers using negative pressure facilities.
Current facilities for isolation within the Trust include limited single room access. These facilities are not
suitable for prolonged accommodation of patients with highly infectious diseases e.g. Diphtheria and
viral haemorrhagic fevers.
Strict guidance must be sort from the Consultant Microbiologist and Infection Prevention and Control
team. This will involve transfer of such patients to an identified infectious diseases hospital in specially
equipped ambulances.
Principally this policy will refer to source isolation.
5.1
PRINCIPLES OF ISOLATION








5.2
GUIDELINES FOR SINGLE ROOM AND COHORT NURSING





5.3
Ideally, the most effective form of isolation is a single room (Pratt et al 2007).
Single rooms should always be the first choice for placement of an infected patient.
Where this is not possible cohort nursing should be employed.
Cohort nursing involves nursing patients with the same organism (or displaying similar signs and
symptoms of infection) as an alternative form of isolation nursing when single room capacity is
exceeded.
Cohort patients should be nursed by designated staff
Advice on the decision to isolate a patient and guidance on isolation management should always
be sought from the Infection Control Team.
Individual risk assessment should take into account infection risk; severity of illness requiring close
observation, patient’s mental state being a contra-indication to single room accommodation and
the availability of single room accommodation.
Staff must follow standard infection prevention and control procedures at all times in line with Trust
policies.
Routine explanation of infection, isolation procedures and treatment must be given to affected
patients and visitors.
Rooms, bays and areas for isolated patients must have dedicated hand hygiene and toileting
facilities for example designated commodes.
Use clear signage on doors or walls to alert staff and visitors of isolation precautions (Appendix 3)
Doors must be kept closed at all times.
Potentially there may be a need to restrict the number of visitors / relatives visiting the affected
patient. This will be discussed with the Nurse in charge and infection prevention and control team.
MANAGEMENT OF THE ISOLATED PATIENT
Hand Hygiene




Refer to Hand Hygiene policy
High standards of hand hygiene minimise the risk of cross infection
Hand hygiene must be performed before and after each direct patient contact (regardless of
glove use)
Adequate hand hygiene facilities and hand gel must be available for use
Personal Protective Equipment

Refer to Standard Infection Prevention and Control Precautions policy
Page 5 of 18





Disposable aprons must be worn by all staff and visitors assisting in the care of the patient or
having contact with their immediate environment
Disposable gloves must be worn where there is contact with bodily fluids and when handling
contaminated items
Fans must not be used to control patient’s temperature
Medical notes and charts must be kept outside the room/bay/area
Personal protective clothing worn in the isolation room should be disposed of in the room unless
dealing with body fluids that require disposal in the sluice
Cleaning and Decontamination











Refer to the Decontamination policy
Isolation room/bay/area should be clean and uncluttered with only necessary equipment used
Where possible single patient use equipment should be used e.g. commodes and medical
equipment
Multiple patient use equipment must be decontaminated in accordance with the Decontamination
Policy
Protective covers should be used on both disposable and non-disposable bedpans/urinals.
When used bedpan holders, bedpans and urinals must be emptied and placed immediately into
washer disinfector at a temperature of 80 degrees Celsius
Treat all linen as infected (Refer to Laundry policy)
Waste must be categorised as hazardous waste (Refer to Waste policy)
Cleaning procedures must be rigorously applied (Refer to Decontamination policy)
Enhanced cleaning must be performed twice daily and documented accordingly (Appendix 4)
All staff must be aware of individual responsibilities for undertaking regular cleaning (Refer to
Decontamination policy) All staff including domestic staff must be aware of which rooms require
terminal cleaning and when these have been completed.
Movement


Transfer and movement of patients must be kept to a minimum to reduce the risk of cross
infection
Transfer and movement of patients must only be undertaken for clinical reasons
If transfer is necessary




5.4
Inform the Infection Prevention and Control team
Receiving area must be informed of infection status to ensure implementation of infection control
measures. Ensure the inter health care transfer form is fully completed (appendix 5)
Hand hygiene and personal protective equipment procedures must be strictly maintained
Equipment used for transfer of patient must be decontaminated after use
CONFIDENTIALITY
All patients have a right to dignity, privacy and respect. It is essential to maintain confidentiality,
regarding the patient's illness.
Certain infections or outbreaks of infection arouse interest and
speculation by the media and staff must not divulge such information within or outside the hospital.
6.
TRAINING IMPLICATIONS
There are no specific training needs in relation to this policy, but all staff will need to be aware of its
contents. Staff will be made aware through:

Line manager
Page 6 of 18




7.
Team Brief
Team meetings
One to one meetings/supervision
Trust Policy web site
MONITORING ARRANGEMENTS
Area
for How
monitoring
Breaches
policy
When
Isolate
8.
Who by
of IR1
Modern
Matrons and
IP&CT
Incorporated in IP&CT
to
IP&C audit tool
Reported to
Frequency
IP&C
Committee
As there
occur
Audit results to Annually
Modern Matron
and
Ward
Managers
EQUALITY IMPACT ASSESSMENT SCREENING
The completed Equality Impact Assessment for this Policy has been published on the Equality
and Diversity webpage of the RDaSH website click here
8.1
Privacy, Dignity and Respect
The NHS Constitution states that all patients should feel that their
privacy and dignity are respected while they are in hospital. High
Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies
the need to organise care around the individual, ‘not just clinically
but in terms of dignity and respect’.
Indicate how this will be met
No issues have been identified
in relation to this policy.
As a consequence the Trust is required to articulate its intent to
deliver care with privacy and dignity that treats all service users with
respect. Therefore, all procedural documents will be considered, if
relevant, to reflect the requirement to treat everyone with privacy,
dignity and respect, (when appropriate this should also include how
same sex accommodation is provided).
9.
LINKS TO OTHER PROCEDURAL DOCUMENTS
This policy should be read in conjunction with other Trust Infection Prevention and Control Policies,
particularly:





10.
Standard Precautions
Hand Hygiene
Laundry
Waste Management
Decontamination
REFERENCES
1. Hospital Infection Society (2001) - Review of Hospital Isolation and Infection Control Related
Precautions - Report of the Joint Working Group.
Page 7 of 18
2. Wilson, J. (2001) - Infection Control in Clinical Practice. London: Bailliere Tindall.
3. Department of Health (2008). The Health and Social Act: Code of Practice for health and adult
social care on the prevention and control of infections and related guidance. London. Crown
Copyright.
4. Department of Health (2009) Clostridium difficile infection : How to deal with the problem
5. Department of Health (2007a) Saving Lives: Reducing Infection, Delivering Clean and Safe Care.
www.dh.gov.uk
6. Department of Health (2007b) High Impact Intervention No 7. Care Bundle to Reduce the Risk
from Clostridium Difficile. www.dh.gov.uk
7. Department of Health (2007c). A Simple Guide to Clostridium Difficile. www.dh.gov.uk
8. Department of Health (2006). Essential Steps to Safe, Clean Care. London. Crown Copyright.
9. Department of Health (2006). A Health Technical Memorandum: Safe Management of Healthcare
Waste. London. Crown Copyright.
10. Department of Health (2006). Saving Lives Programme. Isolating patients with healthcare
associated infection. A summary of best practice. London. Crown Copyright.
11. Healthcare Commission and the Health Protection Agency (2005). Management, prevention and
surveillance of Clostridium Difficile: Interim findings from a national survey of NHS acute trusts in
England. December 2005.
12. Healthcare Commission (2007) Investigation in to outbreaks of Clostridium difficile at Maidstone
and Tunbridge Wells NHS Trust. London. October (2007).
13. Hospital Infection Society (2001) - Review of Hospital Isolation and Infection Control Related
Precautions - Report of the Joint Working Group.
14. Wilson, J. (2001) - Infection Control in Clinical Practice. London: Bailliere Tindall.
15. Department of Health (2008). The Health and Social Act: Code of Practice for health and adult
social care on the prevention and control of infections and related guidance. London. Crown
Copyright.
16. Department of Health (2009) Clostridium difficile infection : How to deal with the problem
17. Department of Health (2007a) Saving Lives: Reducing Infection, Delivering Clean and Safe Care.
www.dh.gov.uk
18. Department of Health (2007b) High Impact Intervention No 7. Care Bundle to Reduce the Risk
from Clostridium Difficile. www.dh.gov.uk
19. Department of Health (2007c). A Simple Guide to Clostridium Difficile. www.dh.gov.uk
20. Department of Health (2006). Essential Steps to Safe, Clean Care. London. Crown Copyright.
21. Department of Health (2006). A Health Technical Memorandum: Safe Management of Healthcare
Waste. London. Crown Copyright.
22. Department of Health (2006). Saving Lives Programme. Isolating patients with healthcare
associated infection. A summary of best practice. London. Crown Copyright.
23. Healthcare Commission and the Health Protection Agency (2005). Management, prevention and
surveillance of Clostridium Difficile: Interim findings from a national survey of NHS acute trusts in
England. December 2005.
24. Healthcare Commission (2007) Investigation in to outbreaks of Clostridium difficile at Maidstone
and Tunbridge Wells NHS Trust. London. October (2007).
25. National Institute of Clinical Excellence. (2003) Infection Control: Preventing Healthcare
Associated Infection in primary and community care. NICE Publications.
26. National Institute of Clinical Excellence. (2003) Infection Control: Preventing Healthcare
Associated Infection in primary and community care. NICE Publications.
11.
APPENDICES
Page 8 of 18
APPENDIX 1
Mode of Transmission
Airborne


Microorganisms transmitted directly, to susceptible patients, in dust
and skin cells carried by the air during procedures.
The microorganism is dispersed widely and over long distances

Human
Skin scales,
droplets

wound
dressings,
bedding
and
respiratory
Aerosolised fluid
Nebulisers, humidifiers, showers and cooling towers

Dust
Building work, sweeping and bed making
Droplet
Contact


Microorganisms transmitted in respiratory droplet nuclei sneezing,
coughing and talking.
The microorganism is dispersed over short distances only

Direct
Microorganisms transmitted from person to person and by the hands of
healthcare workers
Skin, mucous membrane, blood and body fluid

Indirect
Microorganisms transmitted to susceptible people via contaminated
objects (faecal oral route)
Blood borne

Equipment, environment and food
Blood borne
Exposure to blood/body fluid infected with microorganisms
Including exposure to needle stick and sharps injuries
contaminated intravenous infusion fluids
Page 9 of 18
and
APPENDIX 2
ISOLATION PRECAUTIONS - PLANNING GUIDE This guide outlines measures to prevent cross-infection within the hospital environment.
Notifiable to CCDC
Disease
Acquired
Immune Disease
Route of Spread
What is
infected
Blood and
body fluids





Campylobacter*
Faeces
Chicken Pox
Respiratory
secretions
Discharge
from vesicle
fluid
CJD and CJDv
Brain, eye,
nerves and
lymphoid
tissue




Personal Protective
Equipment
Linen
Period of
precaution
Comments
No
unless
bleeding
profusely
Yes
For contact with blood or
body fluids
Infected
If contaminated
with blood or
body fluids
On going
throughout
admission
Yes
Yes contact with diarrhoea
If soiled treat as
infected
Until symptom
free for 48 hrs
Direct contact with
vesicle
Droplet/airborne
Indirect contact
with freshly soiled
clothing/linen
Yes
With
door
closed
Yes
For direct patient contact
Infected
Until lesions
are crusted
and dry
Non immune and
pregnant staff to
avoid contact with
affected patient
Direct and Indirect
contact
Not
usually
Yes
For contact with blood or
body fluids
Gloves For direct patient
contact
If soiled treat as
infected
On going
throughout
admission
Special care with
surgical instruments
Blood or infected
tissue
Sexual exposure
Vertical
transmission
Breast milk
Occupational
exposure e.g.
sharps injury
Faecal oral
Ingestion of organism

Single
room
Page 10 of 18
Full face visor if risk
of splashes or sprays
* -
Disease
What is
infected
Route of Spread
Single
room
Personal Protective
Equipment
Linen
Period of
precaution
Comments
Clostridium
Difficile
Faeces
Faecal oral
Ingestion of organism
Yes
Yes contact with diarrhoea
If soiled treat
as infected
Until symptom
free for 48 hrs
Diarrhoea +/Vomiting, known
or suspected
food poisoning *
E Coli 0157
Faeces and
vomit
Faecal oral
Ingestion of organism from
faeces or vomit
Yes
Yes contact with diarrhoea
If soiled treat
as infected
Until symptom
free for 48 hrs
Review antibiotic use
Stringent
environmental
cleaning
Refer to outbreak
policy if more patients
affected
Faeces
Faecal oral
Ingestion of organism
Yes
Yes contact with diarrhoea
If soiled treat
as infected
Until symptom
free for 48 hrs
Group A
Streptococcus
Saliva
Wound
exudates
Respiratory secretions
Fluid from lesions
Yes
Yes For direct patient contact
Infected
Hepatitis A *
Faeces
Yes
Yes contact with diarrhoea
Hepatitis B *
Blood and
body fluids
No
unless
bleeding
profusely
Yes
For contact with blood or
body fluids
If soiled treat
as infected
Infected
If
contaminated
with blood or
body fluids
Hepatitis C *
Blood
and
body fluids
Faecal oral
Ingestion of organism
 Blood or infected
tissue
 Sexual exposure
 Vertical
transmission
 Breast milk
 Occupational
exposure e.g.
sharps injury
 Blood or infected
tissue
 Sexual exposure
 Vertical
transmission
 Breast milk
 Occupational
exposure e.g.
sharps injury
Until 48 hrs of
appropriate
antibiotics or
advised by IPCT
Until symptom
free for 48 hrs
On going
throughout
admission
No
unless
bleeding
profusely
Yes
For contact with blood or
body fluids
Page 11 of 18
Infected
If
contaminated
with blood or
body fluids
On going
throughout
admission
Can cause
haemolytic uraemic
syndrome
Staff developing a
sore throat refer to
Occupational health
Disease
Route of Spread
What is
infected
Influenza
Respiratory
secretions


Respiratory
airborne
Legionnaire
Lung tissue


Airborne
Water
Measles
Respiratory
secretions


Droplet spread
Indirect contact
Meningococcal
Meningitis
(bacterial)
Respiratory
secretions


Droplet spread
Direct contact –
mucous
membrane
Pneumococcal
Meningitis
Respiratory
secretions


MRSA
Dependent
on site of
colonisation /
infection
Respiratory
secretions

Mumps
Rotavirus
Faeces,
vomit and
Respiratory
secretions




Single room
Personal Protective
Equipment
Linen
Yes for direct contact
Treat as non
infected
No
Treat as non
infected
Yes
With door
closed
Yes
Yes
For contact with respiratory
secretions
Yes
For contact with respiratory
secretions
Treat as non
infected
Droplet spread
Direct contact –
mucous
membrane
Yes
Yes
For contact with respiratory
secretions
Treat as non
infected
Direct contact
Yes
Yes for direct contact
Treat as
infected
Yes
Yes
For contact with respiratory
secretions
Treat as non
infected
Yes
Yes
For contact with diarrhoea
and respiratory secretions
Infected
Droplet spread
Direct contact –
mucous
membrane
Droplet spread
Faecal oral
Yes
With door
closed
No
Page 12 of 18
Treat as non
infected
Period of
precaution
Comments
Duration of
illness
Masks must be worn
Refer to HPA
pandemic flu guidance
Not thought to be
transmissible person
to person
For 4 days after
the rash has
appeared
Until patient
has received 24
hrs of
appropriate
antibiotic
therapy
Until patient
has received 24
hrs of
appropriate
antibiotic
therapy
Until advised by
Infection
prevention and
control
For 9 days after
onset
of
swollen glands
Non immune staff to
avoid contact with
affected patient
Prophylaxis indicated
for close family
contacts - discuss
with Microbiologist
Until symptom
free for 48 hrs
Refer to outbreak
policy if many babies
affected
Refer MRSA
screening Policy
MRSA policy
Non immune staff to
avoid contact with
affected patient
Respiratory
Syncytial virus
Respiratory
secretions


Rubella *
Respiratory
secretions



Salmonella *
Faeces

Scabies
Skin


SARS *
Respiratory
secretions



Shingles
Vesicle fluid



Pulmonary TB
Whopping
cough
(pertussis)
Sputum
Respiratory
secretions





Droplet spread
Direct contact with
respiratory
secretions
Droplet spread
Direct contact with
respiratory
secretions
Faecal oral
Yes
Yes
For contact with respiratory
secretions
Infected
Until
free
Yes
Yes
For contact with respiratory
secretions
Treat as non
infected
For 7 days after
onset of rash
Yes
Yes
For contact with diarrhoea
Infected
soiled
if
Until 48 hrs
symptom free
Scabies mite
Direct skin to skin
contact
Droplet spread
Direct contact with
respiratory
secretions
Airborne
Direct contact with
vesicle fluid
Indirect contact
with soiled linen
Airborne
Direct contact with
respiratory
secretions
No
Yes For direct patient contact
Treat as non
infected
Yes
Infected
Until
successfully
treated
Duration
of
illness
Dermatology referral is
recommended for in
patient areas.
Masks must be worn.
Seek urgent advise
from infection control
If soiled treat
as infected
Until
lesions
are crusted and
dry
Non immune staff to
avoid contact with
affected patient
Yes
With
closed
Yes
For contact with respiratory
secretions
Infected
door
Until 2 weeks
after effective
compliant
treatment
Airborne
Direct contact with
nasal and throat
secretions
Yes
With
closed
door
Yes
For contact with respiratory
secretions
Treat as non
infected
Until 5 days
appropriate
antibiotic
therapy
Staff should wear
special filter masks
when
exposed
to
respiratory droplets
Only immune staff to
attend patient
Restrict contact with
infants and young
children until pt has
received at least 5
days treatment
Yes
With
closed
door
Yes
Yes
For direct
vesicle fluid
Page 13 of 18
contact
with
symptom
APPENDIX 3
Signage for Isolation Nursing
STOP AND THINK!
Isolation Nursing
All Visitors:
All Staff
 Please wash and dry your hands before
entering and on exiting the room
 Please ask the nurse before entering so
that she/he can explain any precautions
you need to take
 Please close the door behind you
 Please ask the nurse/matron or member
of the infection control team to explain
anything you are unsure of
Page 14 of 18
 Please adhere to standard
infection control precautions at
all times
 Please check care plan/ward
guidance if you are unsure
about any infection control
procedure
All Visitors:
All Staff
 Please wash and dry your hands before
Entering and on exiting the room
 Please ask the nurse before entering so
that she/he can explain any precautions
you need to take
 Please close the door behind you
 Please ask the nurse/matron or member
of the infection control team to explain
anything you are unsure of
Page 15 of 18
 Please adhere to standard
infection control precautions at
all times
 Please check care plan/ward
guidance if you are unsure
about any infection control
procedure
APPENDIX 4
ISOLATION – CLEANING CHECK LIST
Domestic Services provided by_____________________________________
Room/Bay:
Ward:
Date Isolation Cleaning Commenced:
Domestic/Service/Ward Assistants should wear a yellow plastic apron and yellow gloves to carry out the
cleaning
Chlor-Clean (Chlor- clean or alternative antimicrobial detergent) must be used as per manufacture
instructions
Patient Environment - 2 x Daily Clean
On discharge full terminal clean performed
Responsibility –Domestic services
Date
Time
Signature
Day 1
Frequency 1
Frequency 2
Day 2
Frequency 1
Frequency 2
Day 3
Frequency 1
Frequency 2
Day 4
Frequency 1
Frequency 2
Day 5
Frequency 1
Frequency 2
Day 6
Frequency 1
Frequency 2
Day 7
Frequency 1
Frequency 2
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Print Name
Appendix 5
Inter-healthcare transfer form
Patient/client details: (insert label if available) Name: Address: NHS number:
Date of birth:
Consultant: GP: Current patient/client location:
Transferring facility – hospital, ward, care home, other: Contact no: Is the Infection Prevention and
Control team aware of transfer? Yes/No
Receiving facility – hospital, ward, Care Home, Community
Contact no:
Who is aware of the transfer
Is this patient/client an infection risk? Please tick most appropriate box and give confirmed or
suspected organism
Confirmed risk Organism:
Discussed with: ………………………………………………………
Confirmed risk Organism:
Date / Time ……………………………………………………………
Suspected risk Organism:
Completed by …………………………………………………………
No known risk Patient/client exposed to others with infection e.g. D&V Yes/No
Designation ……………………………………………………………
Is the patient/client aware of their diagnosis/risk of infection? Yes/No
Date completed ……………………………………………………….
If patient/client has diarrhoeal illness, please indicate bowel history for last week: (based on Bristol stool form scale, see previous page)
1. Separate hard lumps, like nuts (hard to pass)
4. Like a sausage or snake, smooth and soft
5.
2 Sausage-shaped but lumpy
Soft blobs with clear-cut edges (passed easily)
3. Like a sausage but with cracks on its surface
6. Fluffy pieces with ragged edges, a mushy stool
7. Watery, not solid pieces ENTIRELY LIQUID
Day
Number
episodes
of Is the diarrhoea thought to be of an Does the patient/client require isolation? Yes/No
Should the patient/client require isolation, please phone the receiving unit in advance
infectious nature? Yes/No
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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Relevant specimen results (including admission screens – MRSA, C. Difficile, other multi-resistant organisms) and treatnt information, including antimicrobial therapy:
Other information
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