Download Isolation Policy - Gateshead Health NHS Foundation Trust

Policy No:
IC06
Version:
8.0
Name of Policy:
Isolation Policy
Effective From:
18/08/2015
Date Ratified
Ratified
Review Date
Sponsor
15/07/2015
Infection Prevention & Control Committee
01/07/2017
Director of Nursing, Midwifery & Quality / Joint
Director Infection Prevention & Control
14/07/2015
Expiry Date
Withdrawn Date
Unless this copy has been taken directly from the Trust intranet site (Pandora) there is no assurance that
this is the most up to date version.
This policy supersedes all previous issues.
Version Control
Version
Release
1.0
2.0
3.0
Feb 2002
Author/Reviewer
April 2006
4.0
5.0
Sept 10
IPCT
6.0
07/12/2010
A Cobb
7.0
11/10/2012
A Cobb/
V Atkinson
8.0
18/08/2015
A Cobb
IC06 Isolation Policy v8
Ratified
by/Authorised by
Date
Infection
Prevention and
Control
Committee
20/01/2006
Infection
Prevention and
Control
Committee
Infection
Prevention and
Control
Committee
Infection
Prevention and
Control
Committee
Infection
Prevention and
Control
Committee
26/09/2010
Changes
(Please
identify page
no.)
30/07/2010
27/07/2012
15/07/2015
2
Contents
Section
Page
1
Introduction .................................................................................................................................. 4
2.
Policy scope .................................................................................................................................. 4
3.
Aim of policy ................................................................................................................................. 4
4
Duties (Roles and responsibilities) ............................................................................................... 4-6
5
Definitions .................................................................................................................................... 6
6
Isolation ....................................................................................................................................... 7-13
6.1 Source of isolation ............................................................................................................. 7
6.2 Protective isolation ............................................................................................................ 7
6.3 Cohort isolation.................................................................................................................. 7
6.4 Risk assessment ................................................................................................................. 7
6.5 Accommodating the patient who requires isolation ......................................................... 7-8
6.6 The routes of transmission ................................................................................................ 8
6.7 Visitors ............................................................................................................................... 8
6.8 Indications for isolating patients........................................................................................ 9
6.9 Effective communication of infection control needs......................................................... 10
6.10 Managing patients in an isolation room ............................................................................ 10-11
6.11 Isolation precautions ......................................................................................................... 11-13
7.
Training ......................................................................................................................................... 13
8.
Equality and diversity ................................................................................................................... 13
9.
Monitoring compliance with the policy ....................................................................................... 13
10.
Consultation and review .............................................................................................................. 14
11
Implementation of policy (including raising awareness) ............................................................. 14
12
References .................................................................................................................................... 14
13
Associated documentation (policies) ........................................................................................... 14
Appendices
Appendix 1
Appendix 2
Appendix 3
Appendix 4
Appendix 5
Appendix 6
Meticillin Resistant Staphylococcus Aureus (MRSA)
Patient accommodation guide ........................................................................................... 15
Infection risk assessment and isolation guide .................................................................... 16-17
Universal MRSA screening cirteria...................................................................................... 18
For patients who do not meet Department of Health
Universal screening cirteria ................................................................................................ 19
Alphabetical list of infections ............................................................................................. 20-24
Using an isolation room ...................................................................................................... 25
IC06 Isolation Policy v8
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Isolation Policy
1
Introduction
This policy aims to fulfil the criteria set out within The Health & Social Care Act which includes the
Code of Practice for the Prevention and Control of Healthcare Associated Infections (updated
2008). This policy is underpinned with the guidance within the epic3: National Evidence-Based
Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England 2014 which
suggest a non-discriminatory approach to patient care with the Health & Safety Executive and
Public Health England guidance.
By isolating a patient in a single room or nursing patients with the same infection together the rest
of the ward population can be protected from unnecessary exposure to an infection. Occasionally,
patients may need to be protected from infection and in this case they are nursed in a side room to
ensure that they minimize the risk of picking up infection. The Trust has a mix of facilities to care for
inpatients and where there is limited availability to side rooms a risk assessment must be
undertaken. See Appendix 1 and 2.
2
Policy scope
This policy applies to all Trust health care workers who work in the clinical setting. All health care
workers have a responsibility to adhere to Trust policy and ensure that appropriate measures are
taken to reduce the risks associated with infection. This policy incorporates advice for side room
allocation for suspected or confirmed infection reasons.
3
Aim of policy
This policy outlines precautions within Gateshead Health NHS Foundation Trust to minimise the risk
of infection to patients, visitors and staff.
The policy explains the operational implementation of risk assessment and side room prioritisation
to ward teams and bed managers.
4
Duties (Roles and responsibilities)
Those listed all have a duty to assist the Trust in the achievement of national standards for infection
prevention and control by compliance with this and all other Infection Prevention and Control
policies. All staff have a responsibility to disseminate good practice. Specific responsibilities are
outlined as follows:
Chief Executive Officer
The Chief executive Officer has ultimate responsibility for ensuring that effective systems and
processes are in place to minimise the risk of infection to patients, staff and visitors.
Trust Board
The Trust Board has a responsibility to ensure that the risk of infection to patients, staff and visitors
is minimised to its lowest potential and therefore supports the full implementation of this policy.
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All Trust Staff
All Trust staff have a responsibility to adhere to Trust policy and ensure that appropriate measures
are taken to reduce risks associated with infection. All Trust Staff have a responsibility to ensure
they receive annual training in Infection Prevention and Control and where appropriate are using
the Infection Risk Assessment tool to screen patients and appropriately place them within their
current specialty.
The Director of Nursing, Midwifery & Quality, and of Director of Infection Prevention and Control
The Director of Nursing, Midwifery and Quality, Director of Infection Prevention and Control has
delegated responsibility for ensuring that effective systems and processes are in place to minimise
the risk of infection to patients, staff and visitors.
The Medical Director/Director of Infection Prevention and Control
The Medical Director has a shared responsibility with the Director of Nursing, Midwifery and
Quality and Infection Prevention and Control for ensuring that effective systems and processes are
in place to minimise the risk of infection to patients, staff and visitors.
The Director of Estates and Facilities
Has the responsibility to ensure that isolation facilities are retained and where possible expanded
upon to ensure availability in refurbished and new builds.
Technical Ventilation Engineer
Ensure scheduled testing and maintenance of ventilation systems within the Trust. Advice on the
installation of isolation ventilation systems and alarm features to promote staff and patient safety.
Keep records of all scheduled maintenance of ventilation systems.
The Consultant Microbiologists
Provide expert advice in line with Trust infection control needs and national policy to the Infection
Control Team, Director of Infection Prevention and Control and service users. Assess the clinical
significance of MRSA Bacteraemia with the relevant clinician and report all mandatory surveillance
and other significant infections to Public Health England. Assist clinicians in the prioritisation of side
room availability for Trust builds. Advise on specific infections and their epidemiology during actual
or suspected outbreaks.
Provide input into Trust builds from pre planning to post commissioning phases and specifically the
Estates architects to provide the required complement of side rooms.
The Head of Infection Prevention and Control
Has a duty to provide expert infection control advice and support to the Directors of Infection
Prevention and Control, the Infection Control Team and other service users. Produce an annual
Forward programme for infection prevention and control which reflects the requirements of the
Health and Social Welfare Act 2008 and specifically protection of staff, patients and visitors from
avoidable infection. Provide input into trust builds from pre planning to post commissioning phases.
Ensure that Education and Training programmes are appropriate to meet national guidelines and
the local needs of service users.
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Infection Prevention and Control Nurses
Has a duty to provide expert advice, education and training to service users. Assist in the
achievement of the Forward programme. Deliver Mandatory Education and Training to service
users. Participate in daily surveillance and patient management for actual and potential infection.
Support staff in prioritising side room use when a new or suspected infection occurs.
Modern Matrons
Matrons are responsible for the reduction of Healthcare associated infection. They monitor
adherence to Infection control policy via clinical presence/expertise and the Ward Quality Measure
audit tools.. Ensure that Infection Prevention and Control Link staff are released to attend study
sessions and perform audits for their areas which will provide the Trust with evidence of
compliance in infection control.
Domestic Staff
Comply with requests to enhance clean side rooms and sections of wards where infection is present.
Occupational Health and Safety Staff
Provide support and direction to Trust staff for individual and outbreak infection control issues.
Ensure implementation of the Trust Immunisation policy.
Bed Managers
Ensure compliance with patient placement tools for individual infections and outbreak situations
within the Trust.
Infection Prevention and Control Link Persons
Perform Infection Prevention and Control audits as directed by the IPCT/Modern Matron. Attend
Link group meetings and cascade information to the ward manager and ward teams.
5
Definitions
5.1
There are 2 main types of isolation:
i
ii
5.2
The Trust has 3 types of single rooms to accommodate patients for isolation:
i
ii
ii
5.3
Source isolation for the isolation of patients to prevent the transfer of their infection
to others and;
Protective isolation for the patients who are highly susceptible to infection by disease
or therapy.
Isolation cubicles able to be switched to positive pressure for protective isolation or
negative pressure for source isolation. This type of facility has an antechamber or
gowning lobby.
Single on suite rooms with no antechamber
Single rooms with no en suite or antechamber facilities.
Multi Drug Resistant Tuberculosis
This can occur when a patient has a co infection with a virus such as HIV or has not completed a full
course of treatment and develops resistance to several antibiotics.
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6
Isolation
6.1
Source Isolation
Source isolation can be further divided into the following categories:
i)
Standard Isolation for most communicable diseases and also for patients who have
infections caused by multi-resistant organisms.
ii)
Strict Isolation for highly transmissible disease e.g. Multi drug resistant tuberculosis
(MDRTB), viral haemorrhagic fever (VHF) or pulmonary anthrax. These patients
would need to be transferred to the Infectious Diseases Unit at Royal Victoria
Infirmary, Newcastle. When suspected, urgently contact in person the Microbiologist
and if necessary the Infection Prevention and Control Nurse.
If inpatient treatment is being considered for suspected or known multi drug
resistant tuberculosis (MDRTB) suitable accommodation is not currently available in
this Trust and transfer to the Infectious Diseases unit at RVI Newcastle should be
considered. In the interim the patient should be nursed in a negative pressure cubicle
with the doors closed.
iii)
6.2
Respiratory for diseases where the main pathway of transmission is airborne i.e.
pulmonary tuberculosis or pandemic flu. Most childhood illnesses would also be in
this category.
Protective Isolation
For patients who are highly susceptible to infection by disease or therapy. Where positive pressure
isolation facilities are available they should be used for nursing this patient group.
6.3
Cohort Isolation
In the event of respiratory epidemics, clusters of MRSA or other multi-resistant organism (MRO)
infections or diarrhoeal outbreaks it may be preferable to temporarily designate a ward area to
accommodate similar infected/colonised patients. Cohort nursing will require one team of nurses
to look after these patients where possible.
6.4
Risk Assessment
Whenever a situation arises where there are not enough single rooms available for the isolation of
patients then a risk assessment of each patient requiring a side room needs to be undertaken. Staff
responsible for care of the patients will assess who may be at an increased risk of cross infection.
The Infection Prevention & Control Team will assist in this process. Refer to Patient
Accommodation Guide – appendix 1 and Risk Assessment Tool appendix 2. Whenever a patient
cannot be isolated appropriately a Datix report should be completed by the healthcare worker
looking after them at that time.
6.5
Accommodating the Patient who requires isolation
All patients admitted to this trust should have an infection risk assessment completed on
admission. Please refer to trust risk assessment tool appendix 2. This will assist in deciding if the
patient requires accommodation in an isolation room.
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All adult patients admitted to this Trust should be screened for MRSA if they fulfil the universal
screening criteria (appendix 3), otherwise screen if the patient has identified infection risk factors
on completion of the risk assessment tool. This should be done either on admission to the ward if
an emergency admission or in Pre-assessment Clinic if they are a waiting list admission. Please refer
to appendix 2 for details of the Risk Assessment tool.
Bed Managers in conjunction with the senior nurse with site responsibility and the ward staff have
responsibility for finding suitable accommodation for patients. When suitable accommodation is
NOT available for a patient who is either infected or potentially infected the Infection Prevention
and Control Team are available for advice. A Consultant Microbiologist is available on a 24-hour
basis via QE switchboard.
Where necessary refer to other policies in the Infection Prevention and Control Trust Intranet.
Further information and advice is available on the Infection Prevention and Control Team Trust
Intranet page.
Specific information relating to infectious diseases and their management can be obtained by
contacting:
6.6
6.7
•
Consultant Microbiologists (QEH Tel: 0191 4820000 or via the
Duty Bleep 2092)
•
Infection Prevention & Control Nurse (QEH Tel: 0191 4820000
Ext 3161, Bleep 2057)
•
Consultant in Communicable Disease Control, Public Health England:
Tel: 03003038596 (contact via QEH switch board out of hours)
The Routes of Transmission
i.
Airborne – droplets from a cough or sneeze, skin/dust floating in the air from bed
making etc.
ii.
Enteric excretions - faecal oral route.
iii.
Direct contact – hands, clothing, and equipment.
iv.
Blood borne disease e.g. Hepatitis B, & C and Human Immunodeficiency Virus (HIV)
infection – any contact with body fluids or secretions which may contain blood.
Visitors
All visitors should routinely report to ward staff before visiting patients who are in a side room.
Visitors should be made aware that they should NOT visit if they have an infection, an infected
wound or symptoms of flu or diarrhoea and/or vomiting. Any visitors or staff with infections or a
potentially infective lesion or skin condition should be excluded from the clinical areas. For staff, a
referral to Occupational Health will need to be made in this instance.
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6.8
Indications for isolating patients
The following categories of patient should be admitted to isolation beds in the first instance:
1.
Patients symptomatic of Clostridium difficile infective diarrhoea or GDH positive (see IC
Policy 26 Clostridium difficile and Infective Diarrhoeal Illness Policy). The time interval to
isolate the patient into an isolation bed will be investigated by the Modern Matron and
Infection Prevention and Control Team during the roost cause analysis process as prompt
isolation is essential to prevent cross infection.
2.
Patients with diarrhoea of suspected infectious or unknown cause. In addition the Infection
Prevention and Control Team should be informed in the event of two or more patients
and/or staff members on a ward having diarrhoea or vomiting (See IC Policy 24 Outbreak
Management Policy).
3.
Patients with wounds that are known to be colonised/infected with resistant organisms e.g.
Meticillin Resistant Staphylococcus Aureus (MRSA) or multi-resistant organisms (MRO).
4.
Suspected meningitis.
5.
Neutropenic patients and those undergoing chemotherapy.
6.
Patients in whom pulmonary TB is known or suspected always inform Infection Prevention
& Control Team and place into a negative pressure isolation room whenever possible.
7.
Patients with severe infected dermatitis or large open wounds, should always be
accommodated in a single room. Patients admitted with abscesses or other open wounds,
including pressure sores, should also be in a single room until the results of microbiological
culture are known.
8.
Pyrexia of unknown origin (PUO) where there is a clinical indication or the patient has made
recent travel abroad.
9.
Patients in whom clinical AIDS is known or suspected to protect the very vulnerable
individual (inform pathology dept. when submitting specimens).
10.
Respiratory infection during respiratory disease epidemics (especially children). Occasions
may arise when cohorting of patients is more appropriate. See also Major Incident Plan,
appendix 5 – Pandemic Plan.
11.
Neonatal transfers are routinely isolated until results of screening available.
12.
It is best practice to isolate patients transferred from other hospitals whenever there are
problems with hospital-acquired infections e.g. MRSA or when an infectious illness such as
TB has been diagnosed elsewhere.
See Appendix 4 for alphabetical list of infections and the level of isolation required.
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6.9
Effective Communication of infection control needs
Good written and verbal communication is essential between the various disciplines of staff
involved in the patient’s care and treatment. Cubicle signage notices asking visitors and visiting
members of staff to seek advice from a member of staff before entering the cubicle are essential.
See below:
It is the responsibility of each visiting member of staff to ask the ward nursing staff for information
and advice about any infection risks or specific precautions required before they enter a side room.
Always document in the patient’s plan of care, the reasons for isolation and the rationale for not
isolating patients when isolation is recommended. Note the position of the patient within the ward
prior to isolation.
STOP!
Please report to a
member of the nursing
staff before entering
6.10
Managing Patients in an Isolation room
Please refer to appendix 5 – Using an Isolation Room guide. The door should normally be kept
closed unless patient’s safety and wellbeing would be compromised. Following the assessment of
the patients safety, if the door is required to be open the rational for this should be clearly
documented in the nursing evaluation. All unnecessary furniture or equipment must be removed
and the room equipped to suit the patient’s needs/requirements. Pillows and mattress must
always have intact waterproof covers. Dedicated equipment to monitor the patient is preferable A
patient being isolated should be nursed in a single room preferably with an ante chamber and
extract ventilation. Extract ventilation may operate under either:
Positive pressure when the aim is to protect the patient being nursed in isolation e.g. neutropenic
patients.
Negative pressure when the aim is to protect other patients as well as the patient being isolated
e.g. open pulmonary tuberculosis (TB), MRSA.
Patient compliance to remaining in a side room with the doors closed may be variable and
additional advice may be obtained from the Infection Prevention and Control Team. Leaflets to
support cooperation are available for common infective conditions.
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The domestic response team should be contacted when a patient vacates their room and a
terminal enhance clean is required - stating which organism/infection it is for, i.e. TB, MRSA
(infection not colonisation) or C. difficile etc. See Cleaning and Disinfection Policy
Negative Pressure
Positive Pressure
The negative pressure setting should be used
when:
The positive pressure setting should be used
when:
The patient has an infection or is suspected of
an infection
The patient is particularly vulnerable to infection
i.e. neutropenic
Negative pressure air flow ensures that air
from the patient’s room does not enter the
main corridor.
Positive pressure air flow ensures that air from
corridor does not enter the patient’s room.
6.11
Isolation Precautions
This applies to Standard, Strict, Respiratory and Protective isolation unless otherwise stated.
Hand Hygiene:
Hand hygiene before and after any patient contact is the single most
effective way to prevent the spread of infection. Hands and forearms
should be thoroughly washed using the correct technique with soap and
water or an alcohol foam should be applied, on entering and leaving the
patient’s room and before/after removing personal protective
equipment (PPE) e.g. aprons, masks and gloves.
NB. DO NOT USE ALCOHOL HAND FOAM FOR DIARRHOEAL PATIENTS
Please refer to Infection Control Policy No. 4 Hand Hygiene
Personal Protective Equipment:
Aprons/Gowns:
All staff with direct patient contact, their secretions or dirty linen must
wear disposable plastic aprons. They are single use only and should be
discarded after use as per policy - See IC No 9 - Waste Disposal and
Recycling Policy
(Paediatrics/maternity only - disposable plastic apron with a non-slip
absorbent front)
Strict isolation precautions:
Staff are required to wear long sleeved disposable gown rather than a
disposable apron on entering room. Please refer to IC No 2 Personal
Protective Clothing in Clinical Practice Policy.
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Masks & eye:
Necessary for all procedures likely to cause splashing or aerosol spray
Protection to the face or mucous membranes e.g. suctioning patients,
chest physiotherapy or a procedure that induces coughing. Masks are
single use only; remove by the strap rather than touching the mask
itself; dispose of as clinical waste and wash hands after disposal.
Eye protection is required when there is a risk of spray into the eyes.
Protective isolation precautions: Masks should be worn when staff
member has a cough or cold or a lesion such as a cold sore. (Please refer
to Personal Protective Clothing in Clinical Practice Policy No. 2).
Gloves:
Disposable gloves should be worn when contact with any body fluid is
anticipated, for handling infected sites or wounds and contaminated
materials such as bed linen, incontinence pads. Single use only and
dispose of after use as per policy IC No 9 Waste Disposal and Recycling
Policy.
Linen:
Return to laundry in red alginate bag. Dispose into red bag immediately
at the bedside.
Clinical Waste:
All waste from isolation rooms must be classed as clinical waste and
disposed of into orange clinical waste bags and immediately removed to
sluice facility. Please refer to Waste Disposal Policy – Infection Control
Policy Number 9. See also Infection Control Policy No.22 for suspected
or known cases of CJD.
Respiratory precautions:
Infective Secretions
Sputum, sputum cartons, used paper tissues are disposed as clinical
waste. Always wear personal protective clothing - aprons and gloves
Advise patients and visitors to wash their hands after a cough or sneeze
or after using a tissue.
Excreta
Dispose of immediately wearing personal protective clothing, either in
the en-suite facility or in the sluice room.
Equipment
Autoclavable equipment must be returned to CSSD in the bags provided.
Where possible allocate equipment to single patient use or disposable
items otherwise ensure the correct decontamination of equipment
before re-use. Refer to Cleaning and Disinfection Policy No.15 for
information on the cleaning of all other equipment.
The Medical Device library holds a stock of BP monitoring machines and
tympanic thermometers.
Respiratory precautions: Disposable items such as oxygen masks,
humidifiers, nebulisers, suction canisters and tubing should be used and
disposed of as clinical waste. Always wipe clean after each use.
Crockery & cutlery
IC06 Isolation Policy v8
Return to central dishwashing area main kitchen or dishwashers
available in most ward kitchens. Hot water and detergent wash in
ward kitchen areas.
12
Waste water
Water used to wash the patient must not be disposed of into the clinical
washbasin. This would present a risk of potential contamination to the
tap, basin and splash back.
Sharps
Always dispose of sharps IMMEDIATELY in sharps box at the point of
care. Always wear PPE - apron and gloves, facial protection if risk of
splash into the face when using a sharp. It may be reasonable and
practicable in some instances to leave the sharps boxes in the patient’s
room or in the air lock room but only after an individual risk assessment.
Needlestick or sharps injuries must be reported to Occupational Health
Department immediately or go to A+E if out of hours and Datix report
submitted. See IC - Blood Borne Virus Policy no. 7 – Sharps Policy.
7
Training
All staff with clinical input or potential contact with body fluid will receive advice at local induction and via
mandatory training Local induction to the staff area must include use of any isolation facilities available.
8
Equality and diversity
The Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to
the public and the way we treat our staff reflects their individual needs and does not discriminate against
individuals or groups on the grounds of any protected characteristic (Equality Act 2010). This policy has
been appropriately assessed.
Care should be planned on an individual basis taking into account the needs of the patient, including their
mental health and well-being. Where isolation would endanger the mental health and safety of an
individual, their situation must be urgently discussed with a microbiologist or the IPCT.
9
Monitoring compliance with the policy
Standard/process/issue
Monitoring of isolation for
suspected infective diarrhoea
patients.
Monthly ward DAMP compliance
report sent to individual ward
managers/Matrons for actioning
aspects of non-compliance
sharing good practice. Trust
monthly
DAMP compliance report sent to
the DIPC, associate directors,
service line managers, Matrons
and ward managers for action.
Ongoing surveillance follow up
with new results across the Trust
Suspected Cross infection
investigation
IC06 Isolation Policy v8
Monitoring and audit
Method
By
IPCN for surveillance
reviews all inTrust staff
patient diarrhoea
IPCN
patients when a
stool sample has
been submitted.
IPCN for surveillance
advises to DATIX
exception/delay
As above with
serious investigation
(SI) where indicated
Trust staff
SI panel and/or
Hospital
coordinating
Group and IPCT
Committee
Frequency
Ongoing
Monthly
reports
Local IPCC to Trust
IPCC by clinical
membership
Trust IPCC Part 2
paper for Trust
Board if indicated
from investigation
Ongoing
Exceptions
Ongoing
Exceptions
13
10
Consultation and review
Infection Prevention & Control Team – Head of Infection Prevention & Control, Consultant Microbiologists
and Infection Prevention & Control Nurses.
The policy has been circulated electronically to members of the Infection Prevention and Control
Committee (IPCC) prior and agreed by the committee
11
Implementation of policy (including raising awareness)
On ratification of this policy at the Infection Prevention & Control committee, a trust e mail will be sent via
OD & Training to alert Trust personnel of the updated policy.
12
References
Epic 3 (2014) http://www.epic.tvu.ac.uk/
DoH Health & Social Care Act 2008 http://www.dh.gov.uk
http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/Publications
PolicyAndGuidanceArticle/fs/en?CONTENT_ID=4139336&chk=6oAPfi
13
Associated documentation
The following policies have been highlighted within this policy and will provide additional support towards
the implementation of this policy.
IC 2
IC 3
IC 4
IC 7
IC 9
IC 15
IC 24
Personal Protective Clothing in Clinical Practice Policy
Standard Precautions Policy
Hand Hygiene Policy
Sharps Policy
Waste Disposal and Recycling Policy
Cleaning and Disinfection Policy
Outbreak Management Policy
Influenza Pandemic Plan – appendix within the Major Incident Plan (available via the Trust intranet
homepage)
IC06 Isolation Policy v8
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Appendix 1
Meticillin Resistant Staphylococcus Aureus (MRSA)
Patient Accommodation Guide
(Range 1 = Preferred accommodation – 4 = Only accommodation available)
*Always risk assess the patients physical and mental suitability for
sideroom accommodation
Colonised with
MRSA*
(Colonised patients have
MRSA but are not at present
symptomatic of clinical
signs/symptoms of infection)
Infected with MRSA*
•
1.
Sideroom with gowning lobby
2.
Sideroom
3.
Bay with like patients
4.
Bay with patients with no
wounds, devices, skin
conditions, planned surgery or
immunocompromising
condition.
1.
2.
3.
Sideroom with gowning lobby
Sideroom
Bay with like patients
If unable to accommodate patient using flow chart, contact the infection control team on bleep
2057 or out of hours a Microbiologist via QEH switchboard.
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Appendix 2
Infection Risk Assessment and Isolation Guide
•
•
•
•
•
Risk factors for infection should be identified at initial admission assessment and managed
appropriately within the patient’s plan of care. Repeated thereafter weekly or as condition changes
or on transfer to another ward.
All patients should be offered daily Octenisan body wash & shampoo to minimise cross infection.
The KIC (Known Infection Colonisation) Record placed at the front of the medical notes is completed
for any previously known MRSA, Clostridium difficile/ GDH, TB, Blood borne viruses, e coli & MSSA
bloodstream or any significant infection or multi-resistant organism cases and will assist with your
patient management and bed allocation.
All adult patients, Critical Care Department patients including SCBU, require MRSA screening of nose
and throat plus any other wounds, sputum if expectorating and indwelling devices on admission to
hospital, transfer to another ward or if condition changes.
Any elective surgical or medical admissions should be checked for their pre-assessment screening
results and if they have had no pre-operative screen completed it should be taken on admission to
hospital.
Infection Risk factors:
(please tick and date all that apply)
Current or previous MRSA infection/
colonisation
Dry Skin condition
Wounds/ leg ulcers/pressure damage
*Take a swab as part of admission or transfer
MRSA screen
Devices in situ, including urinary catheter,
central venous access device, peg tube, drain,
tracheostomy
*Take a
specimen as appropriate as part of admission
or transfer MRSA screen
Immunosuppression
Frequent hospital or healthcare
admissions/interventions
Nursing/Residential /Institution resident eg.
prison or armed forces
Transfer from another hospital
Healthcare worker
Recent foreign travel
Unexplained diarrhoea – ensure that a Stool
chart is completed, laxatives are discontinued
and a stool specimen is obtained
No risks identified
IC06 Isolation Policy v8
Date
Date
Date
Date
Date
Date
Date
16
All healthcare workers should follow infection prevention & control practices in adherence with Trust
policies and procedures at all times. Infection Prevention & Control Policies and Care Standards are
available for reference on Trust Intranet.
Condition / key
High Risk – priority isolation
Must be in a cubicle
TEC = terminal enhance
clean including curtain
change
MRSA or MSSA
(for further info refer to
MRSA policy)
If infected or colonised (a
carrier of MRSA/MSSA
bacteria but no active
infection) with open
wounds, pressure damage
and/or devices (cannula,
catheter etc).
To start decolonisation
treatment.
TEC required
Patient with confirmed or
suspected infectious
diarrhoea. (Clostridium
Difficle, GDH +ve,
salmonella, campylobacter
or norovirus)
(for further info refer to
C.diff and Outbreak
polices)
Scabies (classical or
Norwegian)
(for further info refer to
Scabies policy)
Head Lice Once treatment
given patient is not
infectious. A cubicle may
be preferred for privacy &
dignity.
Meningitis
(for further info refer to
Meningitis policy)
Clostridium difficile toxin
positive or GDH positive,
with type 5-7 stools.
Patient with diarrhoea
and/or vomiting . Stools 5-7
on Bristol stool chart.
TEC required when 72 hours
clear of type 5-7 stools
Moderate Risk – isolation necessary,
consider at earliest opportunity
Could be moved in to main ward, only if
essential but maintain standard
precautions
Once decolonisation treatment has
commenced. If patient does not have open
wounds or skin conditions and is not
coughing or having aerosol generated
treatment.
Must not be placed next to/adjacent to
patients with open wounds, SRC or skin
conditions.
Nursing Home, Residential Home or other
institution resident or transfer from
another hospital. Routine clean with
Chlorclean
Minimal Risk – may remain
in main ward area
May be moved out of
cubicle on to main ward
area
Negative swabs post
decolonisation obtained,
from all potential sites
including pressure damage
and CSU.
When room vacated, TEC
required if patient had
expectorating cough or
active wound infection.
Otherwise routine clean
with Chlorclean.
Clostridium difficile - 72
hours clear of symptoms
and patient well.
Norovirus - if 48 hours clear
of symptoms.
TEC required if patients once
48 hours clear of symptoms.
Routine clean with
Chlorclean
For both classical and
Norwegian, post treatment
and with clear skin.
Routine clean with
Chlorclean
If patient suspected of
having scabies, whilst
undergoing treatment.
Consider MRSA status
TEC required for Norwegian
scabies.
After 2 treatments, 1 week apart.
Norwegian scabies may need longer as 2
treatments may not be enough.
Establish MRSA status.
Routine clean with Chlorclean
Patient with suspected
meningitis.
Routine clean with
Chlorclean
If meningitis confirmed as bacterial to stay
in cubicle. If viral may move out of cubicle
if patient well.
Routine clean with Chlorclean
May come out of cubicle
when asymptomatic and
course of antibiotics
complete.
Routine clean with
Chlorclean
Suspected or known
respiratory tuberculosis
(for further info refer to TB
policy)
Any patient who has
suspected or known
tuberculosis.
TEC with 5,000ppm HAZ tabs
May move out of cubicle, after 2 weeks of
antibiotic treatment and with the
clinician’s agreement.
Cubicle must be TEC with 5,000ppm HAZ
tabs
Routine clean with Chlorclean
Non respiratory TB cases do
not require isolation
Suspected or known
shingles
(for further info pleases
refer to antimicrobial
guidelines for shingles)
Any patient who has
suspected or known
shingles.
Consider MRSA status.
Routine clean with
Chlorclean
Pandemic flu
Measles, mumps Routine
clean with Chlorclean
Other infective conditions
May move out of cubicle
after 5 days of treatment
and rash has dried up.
Routine clean with
Chlorclean.
Recent foreign travel with signs of
May move out of cubicle
infection.
when free of symptoms or
Pyrexia of unknown origin. Unknown cause established cause. When
of jaundice with other infection markers.
room vacated routine clean
Routine clean with Chlorclean
with Chlorclean
References: Epic3 (2014) National evidence based guidelines for preventing healthcare associated infection; Health Act (DoH 2008)
IC06 Isolation Policy v8
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Appendix 3
Universal MRSA Screening Criteria
Following the introduction of MRSA screening for all elective patients by the end of March 2009,
there is a commitment in the 2010/2011 Operating Framework to introduce screening of relevant
emergency admissions for MRSA by December 2010.
All elective admissions should be routinely MRSA screened on admission or pre-admission with
the following exceptions:
Day case Ophthalmology
Day case Dental
Day case Endoscopy
Minor dermatology procedures e.g. warts or other liquid nitrogen applications
Minor procedures such as arthroscopies, joint injections, minor hand surgery such as carpel
tunnel decompression
Lumbar puncture procedures and attendances for clinical immunology
Radiological patients
Children/paediatrics unless in a high risk group (identify using infection risk assessment tool)
Maternity/obstetrics except for elective caesareans and any high risk cases, ie. high risk of
complications in the mother and/or potential complications in the baby (likely to need SCBU,
NICU because of size or known complications or risk factors) or infection risks identified on
infection risk assessment tool.
Admissions for respite care or pain management therapy
Mental Health patients unless known infection risks eg. IV drug users, self harm, chronic
wounds, indwelling devices
All emergency admissions should be MRSA screened on admission regardless of the route of
admission with the following exceptions:
Attendances at A&E departments
Children/paediatric emergency admissions should be risk assessed and MRSA screened if
fulfil risk factor criteria
Mental Health emergency admissions unless known infection risks eg. IV drug users, self
harm, chronic wounds, indwelling devices
Maternity/obstetrics unless high risk of complications in the mother and/or potential
complications in the baby (likely to need SCBU, NICU because of size or known complications
or risk factors) or infection risks identified on infection risk assessment tool.
References:
MRSA screening – Operational Guidance 3 DH gateway ref no. 13482 March 2010
MRSA screening – Operational Guidance DH gateway ref no. 10324 July 2008
IC06 Isolation Policy v8
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Appendix 4
FOR PATIENTS WHO DO NOT MEET DEPARTMENT OF HEALTH UNIVERSAL
SCREENING CRITERIA
Admission and Pre-assessment Infection Risk Assessment
Patient name
Date of Birth
Unit number
Clinician
Ward/Dept
Date
Please file the top section of this form in the patient’s notes. The information below helps to:
• Identify patients who are, or who may be, colonised with MRSA (i.e. unknowingly carrying MRSA)
• Place the patient in the most appropriate accommodation
• Reduce the risk of infection for vulnerable patient groups
Has the patient:
Yes
No Unsure
1. Had MRSA in the past?
_
_
_
2. In contact with a known or suspected case of MRSA?
_
_
_
_
_
_
_
_
_
5. A regular visitor to this or other hospital or healthcare setting?
_
_
_
6. Has the patient recently developed a productive cough?
_
_
_
_
_
_
_
_
_
3. Transferred from another department/ward/ hospital
or healthcare settings?
4. Recent (within previous 6 months) patient in this or another hospital/
Healthcare setting?
7. Does the patient have an open wound; recurrent/non-healing skin
condition or medical device in situ?
(Excluding an intravenous cannula inserted within 72hrs and a
Visual Infusion Phlebitis Score of 0 - 1)
8. Is the patient a health care worker?
If YES to any of the above questions, take swabs* from the following sites and send to pathology using ICE
request system to request each swan separately.
1)
2)
3)
4)
5)
Nose (Anterior nares; Use one swab for both nostrils)
Throat
Only include Perineum for procedures affecting groin, hip or perineum eg. Obs & Gynae/Gynae
oncology, vascular, colorectal, femoral/inguinal hernia repair, varicose veins*
Swab from wound/skin lesion or medical device - State wound site and give clinical details
Sputum if coughing and expectorating
Date, Designation, Print and Sign Name on completion of form and file in patient notes:
IC06 Isolation Policy v8
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Appendix 5
DISEASE
CATEGORY OF
ISOLATION
PERIOD OF
ISOLATION
TRANSMISSION
ROUTE
COMMENTS
• ANTHRAX
(Respiratory)
Strict
Length of illness
Airborne
Standard
Length of illness
Direct contact
)
)
)
)
)
)
AUTOIMMUNE DEFICIENCY
DISEASE (HIV)
Standard
Duration of illness
Blood borne
BRONCHIOLITIS
(infants)
Standard
Clinical recovery
Airborne
BURNS/SCALDS
Protective
Clinical recovery
Direct contact
Airborne
See Personal
Protective Clothing
in Clinical Practice
Policy IC No 2
CHICKEN POX or
Standard
7 days from start
of eruption
Airborne
Direct contact
Staff who have not
had disease should
be excluded.
CLOSTRIDIUM DIFFICILE OR
ACTIVE GDH
POSITIVE
Standard
For a minimum of
72 hour post
symptoms
Direct contact
Faecal oral route
(Enteric)
See policy IC 26
Blue gown and
gloves with soap
and water hand
hygiene for
environmental and
patient contact
CJD
Standard
For length of stay
Unknown
See also IC Policy
No 22
Transmissible
Spongiform
Encephalopathies
agents: Safe
working and the
prevention of
infection.
DIARRHOEAL DISEASE OF
UNKOWN ORIGIN
Standard
Duration of
illness/ 72 hours
from last episode
Enteric
With toilet
facilities. Inform
ICN if two or more
cases of
unexplained
diarrhoea.
(Cutaneous)
HERPES ZOSTER
IC06 Isolation Policy v8
Laboratory to
be notified
when sending
specimens.
ICN to be
informed
) See also
) Sharps Policy
) IC No 7
20
DISEASE
CATEGORY OF
ISOLATION
PERIOD OF
ISOLATION
TRANSMISSION
ROUTE
• DIPHTHERIA
Strict
Negative cultures
Airborne
• BACILLARY
DYSENTRY
(Shigella)
Standard
Until 3 negative
specimens after
acute phase
Enteric
• CAMPYLOBACTER
E COLI 0157
Standard
Clinical recovery/
72 hours from
last episode
Enteric
• CHOLERA
Standard
Length of illness
Enteric
• CLOSTRIDIUM
DIFFICILE
Standard
72 hours
symptom free
Enteric
• SALMONELLA
(Food poisoning
and Enteric fever)
Standard
Discuss with ICN/
Microbiologist
Enteric
• ROTAVIRUS
Standard
72 hours
symptom free
Enteric
• NOROVIRUS (SRSV)
Standard
72 hours
symptom free
Enteric
HERPES SIMPLEX
Standard
Length of illness
Direct contact
• HEPATITIS A
Standard
Length of illness
Enteric
• HEPATITIS B/C
Standard
Length of illness
Blood borne
• VIRAL
HAEMORRHAGIC
FEVERS
e.g. LASSA FEVER,
EBOLA, MARBURG
Strict
COMMENTS
GASTROINTESTINAL
INFECTIONS
IC06 Isolation Policy v8
)
)
)
)
)
)
)
)
)
) With toilet
) facilities. IPCNs
) to be informed.
)
)
)
)
)
)
)
)
)
)
)
)
)
Staff should wear
gloves when in
contact with
infected lesions.
Assess each
individual isolate if
risk of
haemorrhage or
patient jaundiced.
These patients
should be admitted
to the Regional
Centre –
NEWCASTLE
GENERAL HOSPITAL
21
DISEASE
CATEGORY OF
ISOLATION
PERIOD OF
ISOLATION
TRANSMISSION
ROUTE
COMMENTS
INFLUENZA
Standard
Clinical recovery
Airborne
Direct contact
Isolate only if
admitted with
influenza
IMMUNOSUPRRESSION/NE
UTROPENIA
Protective
Clinician in
charge will
decide
Airborne
Direct contact
Positive pressure
isolation room
• LEGIONNAIRES
DISEASE
None necessary
LEPROSY
(Smear positive)
Standard
Clinical recovery
Airborne
Not infectious
following adequate
treatment
• MEASLES
Respiratory
7 days from onset
of rash
Airborne
MENINGITIS
Respiratory
Clinical recovery
Airborne/
Enteric
• Meningococcal/H
. Influenza is
notifiable.
Includes acute
encephalitis
• MRSA
Standard
Negative culture
Direct contact
Airborne
See IC Policy No 18
MRSA Policy
• MUMPS
Standard
9 days after onset
of parotid
swelling
Airborne
NECROTISING FASCITIS
Standard
Clinical recovery
Direct contact
• OPHTHALMIA
NEONATORUM
Standard
24 hour
antibiotics
Direct contact
• PLAGUE
Strict
Negative culture
Airborne
• POLIOMYELITIS
Standard
Until discharged
Enteric
• PSITTACOSIS
(Parrot disease)
Standard
Clinical recovery
Airborne
PUERPERAL SEPSIS
Standard
Until
bacteriologically
negative (72
hours or longer)
During/
following childbirth
IC06 Isolation Policy v8
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DISEASE
CATEGORY OF
ISOLATION
PERIOD OF
ISOLATION
PYREXIA OF UNKNOWN
ORIGIN
Standard
? Until diagnosis
is confirmed.
Where likely to
be infectious
when in doubt
isolate.
• RABIES
Standard
Length of illness
Airborne
• RUBELLA
Standard
7 days from onset
of rash
Airborne
• SCABIES
Standard
72 hours
treatment
Direct contact
• SARS
Strict
Respiratory
Until symptom
free
Airborne
Direct contact
• SCARLET FEVER
Standard
24 hours
antibiotics
Airborne
STAPHYLOCOCCAL
INFECTION
Standard
Until lesion is
negative
following
treatment
Airborne
Direct contact
• TETANUS
No special source
isolation
precaution.
Patient should be
in side room for
medical reasons
not for isolation
reasons.
TONSILITIS
(Group A streptococcus)
Standard
24 hours
treatment
Airborne
• TUBERCULOSIS
(open/pulmonary)
Standard
2 weeks following
commencement
of treatment
Airborne
• TYPHOID
(Paratyphoid and
carriers)
Standard
For duration of
stay
Enteric
IC06 Isolation Policy v8
TRANSMISSION
ROUTE
COMMENTS
Exclude young
pregnant women
unless immune.
Requires specialist
isolation facilities
at Ward 25
Newcastle General
Hospital
See also IC 18
MRSA Policy
TB masks/PFR P2 to
be worn in
procedures
involving close
contact, e.g. chest
physiotherapy.
23
DISEASE
CATEGORY OF
ISOLATION
PERIOD OF
ISOLATION
TRANSMISSION
ROUTE
GENERALISED VACCINIA
(smallpox vaccine)
Strict
Length of stay
Airborne/Direct
contact
• WHOOPING COUGH
Standard
Clinical recovery
Airborne
PATIENTS ADMITTED WITH
WOUNDS/ INFECTED OPEN
LESIONS UNTIL RESULTS OF
CULTURE ARE KNOWN
Standard
Variable
Airborne/Direct
contact
COMMENTS
• INDICATES ILLNESSES THAT SHOULD BE NOTIFIED EITHER OFFICIALLY OR LOCALLY TO HPA.
• Death Certification – please inform Consultant Microbiologist and Dr Beaumont Medical Director if
considering completing death certificate part 1
IC06 Isolation Policy v8
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Appendix 6
USING AN ISOLATION ROOM
1.
Keep doors closed.
2.
Only open immediate door to corridor when absolutely necessary.
3.
When possible, allocate equipment to single patient use otherwise ensure correct
decontamination of equipment before re-use.
4.
Enter gowning lobby door via corridor and close door immediately.
5.
Wash your hands.
6.
Put on relevant personal protective equipment i.e. apron and gloves. Wear a mask if splash/spray
is anticipated.
7.
Open door from gowning lobby into patient room and close door immediately.
8.
Following patient care, open door from patient room into gowning lobby and close door
immediately.
9.
Discard personal protective equipment into an orange bin within the room or if available into the
antechamber/gowning lobby.
10. Wash your hands.
11. Exit gowning lobby into corridor and close door immediately.
NB:
The door from the main corridor into the gowning lobby and the door from the gowning lobby
into the patient room should never be opened at the same time or remain open.
IC06 Isolation Policy v8
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