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Document reference code: IC/010/14 This document is only valid on the day of printing Title: Source and Protective Isolation Purpose: To provide guidance in regard to both source and protective isolation of patients. Applicable to: All Trust Staff, Contractors, Visitors, Volunteers Document Author: Leslie Lawson-Kinross, Infection Control/Medical Devices Lead Ratified by and Date: Sharon Linter – Director of Quality and Governance / Executive Nurse 6 August 2014 Review Date: February 2017 6 months prior to the expiry date Expiry Date: August 2017 3 years after ratification unless there are any changes in legislation or changes in clinical practice Document library location: Safety and Risk: Infection Control Related legislation national guidance: and Department of Health (2010) The Health and Social Care Act 2008: Code of practice on the prevention and control of infections and related guidance Loveday et al (2014) epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection 86, S1–S70 NICE (2011) Prevention and Control of Healthcare Associated Infections: Quality Improvement Guide. NICE Public Health Guidance 36 NICE (2012) Infection Prevention and control of healthcareassociated infections in primary and community care. NICE Clinical Guideline 139. NICE (2014) Infection Prevention and Control. Quality Standard 61 World Health Organisation (2009) WHO guidelines on hand hygiene in health care Norovirus Working Party (2012) Guidelines for the management of norovirus outbreaks in acute and community health and social care settings Department of Health and Health Protection Agency (2009) Clostridium difficile infection: How to deal with the problem Siegel et al (2007) Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings Document reference code: IC/010/14 Document reference code: IC/010/14 Associated Trust Policies Infection Prevention and Control Policies and Documents: Cleaning Strategy, Policy and Manual Mental Health Act Policies Equality Impact Assessment: The Equality Impact Assessment Form was completed on 18th July 2014 Training Requirements: All staff to complete Infection Control e-learning as part of annual mandatory training. Compliance monitored by Workforce and Development and reported to service lines. The organisation trains staff in line with the requirements set out in its training needs analysis and published in its Corporate Curriculum. Training which is categorised as statutory or essential must be completed in line with the training needs analysis and Corporate Curriculum. Compliance with statutory and essential training is monitored through the Learning and Development team with monthly manager’s reports and staff individual training records twice yearly. Training reports are also submitted quarterly through the Trust Quality and Governance Committee Meeting. Staff failing to complete this training will be accountable and could be subject to disciplinary action. Monitoring Arrangements: An annual programme of audit to monitor compliance utilising Infection Prevention Society Quality Improvement tools. Audit will be completed by the IPC Lead and ward/department links. Results will be fed back to the relevant service line clinical cabinet and IPC committee to ensure any necessary actions are implemented to improve performance. Implementation: The policy will be uploaded onto the Trust’s Document Library and will replace any previous versions. Staff will be made aware of the policy through local induction Version Control Version V3 Date Reviewed July 2014 Changes Full Review. New Trust format. Updated National Guidance This document Replaces: HS.IC/018/11 – Source and Protective Isolation By Whom Leslie LawsonKinross Document reference code: IC/010/14 This document can be released under the Freedom of Information Act. Document reference code: IC/010/14 Contents 1. Introduction ....................................................................................................................... 19 2. Routes of Transmission .................................................................................................... 19 3. Types of isolation .............................................................................................................. 19 4. Isolation Procedure Key points .......................................................................................... 21 5. Visitors / Staff .................................................................................................................... 22 6. Accommodation ................................................................................................................ 23 7. Room Cleaning ................................................................................................................. 23 8. Standard precautions – Please refer to separate policy for full guidance........................... 24 9. Visits to other Departments ............................................................................................... 25 10. Last Offices ....................................................................................................................... 26 11. Collection of Specimens .................................................................................................... 26 12. References and Bibliography ............................................................................................ 26 13. Tables of Communicable Diseases and Appropriate Precautions ..................................... 14 14. Tables of Infestations and Appropriate Precautions .......................................................... 21 Equality Impact Assessment Proforma Initial Screening ............................................................... 23 Document reference code: IC/010/14 1. Introduction Standard precautions are the principle strategy for the prevention and control of healthcare associated infection. However, additional precautions are required for the care of patients who are known or suspected to have an infectious disease, are carrying a multi-resistant organism or are particularly vulnerable to infection. Such precautions are known respectively as source isolation precautions and protective isolation precautions. This policy is intended to provide the key principles of isolation precautions, when they are required and the rationale behind their use. 2. Routes of Transmission Knowledge of the possible route of transmission is necessary to apply isolation precautions appropriately and, in particular, to select appropriate protective clothing. 2.1 Contact transmission This is the most important and frequent mode of transmission of Health Care Associated Infection (HCAI). This may be direct contact such as touching, biting and kissing. It also includes indirect contact via a contaminated intermediate object (including sharp objects e.g. needles, blades), as well as the faecal oral route. 2.2 Droplet transmission. Large droplets are generated from the source person primarily during coughing, sneezing, and talking, and during the performance of cough inducing procedures such as suctioning. Transmission occurs when droplets containing micro-organisms generated from the infected person are propelled a short distance (approximately 1 metre) and deposited on the host's conjunctivae, nasal mucosa, or mouth. 2.3 Airborne transmission This route of transmission can be divided into two types, droplet nuclei and dust. 2.3.1 Droplet nuclei Small respiratory droplets rapidly evaporate into small-particle residues [5 μm or smaller in size] known as droplet nuclei, that may contain micro-organisms. Droplet nuclei remain suspended in the air for long periods of time and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient. 2.3.2 Dust Skin squames are shed from the skin surface at a rate of approximately 300 million a day and are the main component of dust. Some of the squames carry micro organisms. Small dust particles may remain airborne for several hours and can be inhaled or settle in wounds. 3. Types of isolation Document reference code: IC/010/14 3.1 Source Isolation is the physical separation of one patient from another, in order to prevent spread of infection. The infected/colonised patient, as the source of infection, is separated from unaffected patients, usually in a single room, on occasions, within a cohort of similarly affected patients. 3.2 Protective Isolation Precautions are used to provide a physical separation to prevent the transmission of infection for patients who are susceptible to infection, by isolating them from the risks of infection by exogenous (cross infection) sources. The clinical condition and physical interventions required for patients if their blood neutrophil blood count falls , or is expected to fall, below 0.5 x 109/L would probably determine that the majority of these patients would require due to their predominant clinical factor, acute hospitalisation. However there may be occasions where patients with varying degrees of neutropenia may be admitted to CFT wards i.e. patients undergoing treatment for cancers, the result of taking some anti psychotics such as clozapine, infection with HIV. In this instance further advice should be sought from Infection Control and an individualised plan of care developed. These patients may not only require segregation from other patients, but information regarding diet i.e. bottled water is not advised, as well as certain foods such as pate, liver, soft cheeses and live yoghurts. In all instances the patient should be carefully monitored for signs and symptoms of infection and treatment promptly. The overall risk factor from the other patients on the ward should also be monitored. Particular caution is required when working with immunocompromised patients and therefore staff with upper-respiratory tract infections or oral-facial herpes simplex should be excluded from direct contact with these patients. 3.3 Cohort Nursing – Cohort nursing patients with the same organism. 3.2.1 The decision to implement cohort nursing must be based on a risk assessment considering the clinical diagnosis, suspected symptoms or clinical risk category. This must be carried out in conjunction with the Infection Control team and documented. 3.2.2 Cohorting patients carries a significant risk of re-infection/re-colonisation, therefore cohorting should be considered only in situations for the shortest time possible. 3.2.3 The need to cohort the patients must be reviewed daily with a view to moving patients into single rooms as soon as possible and discontinuing the cohort area. 3.2.4 Cohort patients should be cared for by designated staff. 3.2.5 For effective isolation, cohort areas should have doors that can be closed to provide physical separation from other patients. 3.2.6 In some areas it may be necessary to cohort patients into specific areas of the unit/ward, ensuring that these areas can be physically separated from the rest of the ward. 3.2.7 On ceasing the cohort isolation the area must be thoroughly cleaned before opening to patients. Document reference code: IC/010/14 4. Isolation Procedure Key points 4.1 Risk assessment On admission the physical health monitoring of the patient must be undertaken, which includes the assessment of infection risk. This will ascertain the infection risk both to the patient and to others. Subsequent assessment must take place on the presentation of signs of infection. The decision to isolate a patient should be based on a risk assessment carried out in conjunction with Infection Control. A risk assessment should be carried out that takes into account the following The infecting organism, the probable route of transmission, the factors that influence the transmission of the pathogen and its impact. . The classification of the pathogen and the ability to protect against or treat individual infections. The psychological effect of the isolation and the impact of other forms of treatment and hinder rehabilitation. Possible detrimental effects of isolation to the patient i.e risk of falls, confusion or depression. Capacity to understand the explanation of the nature of disease or organism, symptoms and treatment. The susceptibility of other patients. Regular assessment and evaluation of the situation, in conjunction with Infection Control is necessary to decide if isolation of the patient remains the most appropriate form of care. 4.2 Refusal / lack of capacity Studies have shown the detrimental effect of isolation on patients’ psychological well-being (Gammon 1998). In situations where the isolation is required for that individual, both for source or protective isolation, and consent or capacity can not be obtained, or it is assessed that this would be detrimental to that persons mental health the Mental Health Act advisor should be contacted alongside the IPC team, to determine the correct course of action. Alternative measures to reduce the risk to themselves and others may be considered i.e. restrictive use of the patient laundry, allocation a member of staff, dining room access, agreement, to access areas at quieter periods. 4.3 Communication 4.3.1 Information Explain the rationale for isolation to the patient/family and, where possible, the duration of isolation anticipated. Information leaflets are available on the intranet to support information provided by staff. Document reference code: IC/010/14 4.3.2 Notifiable Disease Check whether the patient has a “Notifiable Disease”. This should be reported either through the laboratory or will be the responsibility of the medical practitioner (depending on the disease) in accordance with national guidance. 4.4 Documentation Record on RIO; 5. That isolation has been commenced and the reason why. The appropriate care plan according to the known infection or infectious symptoms of patient / or risk of infection to that individual. Including required minimum observations; temp, blood pressure fluid balance, Bristol stool chart. Include within the care plan strategies to reduce the impact of isolation. Include where the patient has refused to be isolated and the alternative methods to reduce the risk to that person and others. Visitors / Staff Some staff or visitors may be more vulnerable than others to infection and must seek advice prior to caring for patients in isolation. These may include: Pregnant women Immunosuppressed staff/visitors Staff with eczematous/psoriatic or similar skin lesions ( particularly relevant with MRSA) Staff and visitors receiving antibiotics ( relevant to C.difficile infection) Discuss with Infection Control in relation to the specific disease to ascertain if visitors should be excluded from visiting due to particular susceptibility. If isolation is for Varicella-zoster virus (chickenpox or shingles) measles, mumps or rubella, only staff with immunity to the disease (e.g. by vaccination or previous history of the disease) should attend to the patient. 5.2 Visitor restrictions In some circumstances visiting may be restricted; this may include staff from other areas and contractors. It may be necessary to ask about immunisation status prior to visiting. Visitors with active infections must be restricted from visiting. Prior to visiting the patient the nurse in charge should explain to the visitor the reason for isolation maintaining confidentiality and the associated risks. Advice should be provided on hand hygiene, the use of personal protective equipment and/or other precautions. Visitors need only wear protective clothing if they are going to have close contact with the patient, e.g. helping with the patient’s physical care, or if otherwise advised. Document reference code: IC/010/14 They should be advised not to eat or drink whilst in the isolation room. Visiting by young children should be discouraged. If visitors insist on bringing young children they must be informed of any risks. For patients within source isolation - Visitors should be advised not to visit other patients on the same day as visiting a patient in isolation. However, where this cannot be avoided, visitors should visit other patients before visiting the patient in isolation. They should also be advised not to have contact with other patients on the ward following the visit. For patients within protective isolation - Visitors should be advised not to visit the patient if they are unwell with any kind of infectious bacteria or virus e.g. wound infections, sore throats D&V or other patients before they visit the patient in protective isolation. 6. Accommodation Mental Health Wards - Single rooms with en-suite toilet and washing facilities are available. Children’s Short breaks – single rooms with hand washing facilities are available with the use of the communal bathroom, which must be cleaned thoroughly with the appropriate cleaning solution following use. Note - Following the onset of symptoms the child should be sent home as early as possible. Source isolation - It is particularly important to keep the door closed when the side room is used for isolating a patient with an airborne infection and for ALL C difficile and norovirus cases. Protective isolation - Keep the door closed to reduce risk of any potential airborne transmission entering the room. Remove all non essential furniture and equipment from the room. Negative and positive pressure ventilation rooms are not available within CFT facilities. Therefore, CFT properties are not suitable when caring for patients with clinical or microbiological evidence of highly communicable diseases such as drug-resistant pulmonary TB, or any untreated open TB. Highly communicable diseases require negative pressure isolation rooms, and such patients must be transferred to an area within appropriate facilities. Place the appropriate isolation notice on the door of the room and indicate the appropriate precaution. Limit the number of staff entering the isolation room. Reducing the number of staff who come into contact with the patient will further reduce the risk of spreading the infection EQUIPMENT - Within CFT Inpatient wards it would not be safe to leave equipment, sharps bins and waste bins within or outside of the room. Therefore the appropriate equipment must be taken to the room, used, decontaminated and returned to the designated area. Children’s Short breaks a risk assessment must be carried out when leaving equipment in the room. 7. Room Cleaning Method statements and colour coding can be found in the Cleaning Strategy, Policy and Manual. Document reference code: IC/010/14 The method for room cleaning remains the same for all organisms, but the frequency and cleaning product will differ. 7.1 For protective isolation patients ensure that the room is cleaned meticulously before and during admission. Routine Cleaning As a general rule rooms must be cleaned daily. Use detergent & water or sanitising wipe to clean mattress and all items and surfaces in patient’s room. Rooms occupied by ANY diarrhoea case require twice daily enhanced cleaning. Use Chlorine based solution 1000ppm (e.g. Actichlor+) to clean mattress and all other items and surfaces in the room 7.2 Terminal Cleaning Terminal cleaning of the environment and furniture should be carried out by the domestic staff on the ward/department. However, when housekeeping services are not available it is the responsibility of the nursing staff to ensure the room is cleaned before reuse. Use detergent & water or detergent wipe (i.e. Clinell) to clean mattress and all items & surfaces in patient’s room. For rooms that have been occupied by ANY diarrhoea cases, use Chlorine based solution 1000ppm e.g. Actichlor+) to clean mattress and all other items and surfaces Remove & replace curtains 8. Standard precautions – Please refer to separate policy for full guidance Hand Hygiene - the single most important means of reducing the spread of infection Protective Clothing Selection and use of should follow a risk assessment of the procedure to be performed Strict adherence of bare below the elbows is required. Within the room hands must be cleansed: Prior to patient care. Between different patient care activities to prevent cross contamination of different body sites. After contact with the environment Prior to leaving the isolation room and following leaving the isolation room. If the patient has diarrhoea soap and water should be used for hand hygiene rather than alcohol rub. It is often unnecessary and inappropriate to require every person entering an isolation room to wear protective clothing. Protective clothing should be worn according to the routes of transmission (i.e. Contact, Droplet or Airborne transmission) and the risk of contamination If worn, protective clothing must be removed immediately prior to leaving the room and must be disposed of inside the room into a clinical waste bag and taken to the dirty utility/sluice. Always wash hands with soap and water after removal of protective clothing The following factors should be considered: The risk of contamination by blood or body fluid of Health Care Document reference code: IC/010/14 Safe handling and disposal of sharps Equipment Crockery and Cutlery Linen Waste Disposal Treating blood and body fluid spillages. Excreta Workers clothing and skin/ mucus membranes The risk of transmission to the patient In addition, in relation to gloves, patient/user latex allergy must be considered. Sharps should be disposed of at the point of use, therefore the sharps bin must be taken to the isolation room, the sharps disposed of into the box, and the sharps bin decontaminated and returned to the clinical room. Where it is not advisable to take a sharps bin that is already in use onto the open ward, then a new empty bin must be taken. Disposable equipment should be used whenever possible. Non disposable equipment must be decontaminated using a sanitising wipe and returned to the designated area. For patients within protective isolation it is essential that the equipment is cleaned and disinfected prior to use for that patient. Re usable (not disposable) crockery and cutlery can be used and is adequately decontaminated in the dishwasher. Return items to kitchen promptly. All laundry from source isolation rooms must be managed as fouled/infected laundry and therefore be placed in red water soluble bags within the room and then into an outer linen bag. Linen is then removed from the room and dealt with as per linen policy. All laundry from protective source isolation rooms to be placed into white bag and disposed of as per policy. If the patient has a known infection, linen to be placed into a red water soluble bag within the room and then into an outer linen sack, as per policy Waste must be disposed of into a bag inside the room and waste segregated as clinical, infected or household waste, and taken to the designated collection point. Spillages of blood or body fluids should be dealt with promptly, by staff who have received appropriate training and who are fully protected against Hepatitis B. Excreta can be disposed of directly into the toilet adjoining the room. Should a commode be required, a dedicated commode should be in the room following a risk assessment and a solidifying gel used to solidify the urine and or faeces. Wearing clean gloves and apron cover the used bed pan liner/urinal and take straight to the sluice for maceration. Avoid touching door handles when moving from the isolation room to the sluice. Once the bed pan liner has been disposed, remove gloves and aprons and wash hands with soap and water 9. Visits to other Departments 9.1 Source isolation precautions – Patients who are being isolated should not routinely be taken out of their isolation room for non essential out patient visits. However, if the patients visit is urgent/ essential, the department should be notified in advance so that arrangements may be made to prevent possible spread of infection i.e. patients with infections should be seen at the end of a list/session. Ward staff should advise of any necessary precautions and the Infection Control Nurse on call can also be contacted for Document reference code: IC/010/14 advice. After the investigation/treatment is completed, surfaces with which the patient has had contact should be cleaned according to the infection. Staff accompanying the patient do not need to routinely wear protective clothing but must decontaminate their hands thoroughly after having direct contact with the patient, appropriately. Wheelchairs/trolleys used to transport patients to other departments must be cleaned according to the infection. 9.2 Protective isolation precautions – Visits to other departments should not be avoided when patient is in protective isolation. However, the department should be informed prior to the appointment and strict Standard Precautions should be in place to reduce the risk of cross infection. Visits to other departments that have outbreaks of D&V should be avoided at all costs 9.3 Transfer / Discharge of Patients Patients can be transferred from one ward to another ward or unit, if clinical need dictates. The receiving area must be informed in advance of the nature of the infection/protective isolation to ensure that the appropriate facilities are available and the required precautions are applied. Movement for non-clinical reasons, i.e. to increase bed availability, must be avoided. On discharge ensure that receiving hospital/nursing home or community services are informed of any necessary precautions and relevant documentation is complete. If transport by ambulance is required, the ambulance service must be informed of any necessary precautions. 10. Last Offices Following death, the body may remain an infection risk to personnel and therefore isolation precautions must be maintained whilst Last Offices are performed (see “In the Event of Death” Policy). 11. Collection of Specimens Specimens should be obtained within the room. Care must be taken to avoid contaminating the outside of the specimen container. All clinical specimens should be regarded as potentially infectious and handled as such. 12. References and Bibliography Gammon, J (1998) Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs. International Journal of Nursing Practice 4: 2, 84-96. Hawker, J. Begg, N. Blair, I. Reintjes, R. Weinberg, J. (2012) Communicable Disease Control and Health Protection Handbook 3rd Edition. Blackwell Publishing. Oxford. The Royal Marsden NHS Trust (2011) Manual of Clinical Nursing Procedures Eighth Edition. Blackwell Publishing. Oxford Wilson, J. (2006) Infection control in Clinical Practice. 3rd Edition. Bailliere Tindall. London. Document reference code: IC/010/14 13. Tables of Communicable Diseases and Appropriate Precautions NB - It is the responsibility of the clinical team to complete a Notification of Diseases Certificate Disease or Organism Mode of transmission from person to person In the health care setting Visitor Restrictions Duration of isolation NOTIFIABLE DISEASE Anthrax Cutaneous Pulmonary CPE (Carbapenemase-producing Enterobacteriaceae) Chickenpox (Varicella zoster) Clostridium C. difficile Comments Contact with lesions None. Person to person spread unknown. Advise not to touch any lesions. Exclude those who are immunosuppressed. Exclude those who are nonimmune Contact – via contaminated hands, surfaces and faecal/oral route Airborne via respiratory secretions and vesicle fluid Contact with vesicle exudate Contact – via contaminated surfaces and faecal/oral route None Person to person transmission rare Contact via instruments used for invasive procedures None Not required Infection Prevention and Control Team must be informed if anthrax is suspected. All laboratory samples must be labelled “high risk” Until 3 clear screens Refer to “Antibiotic Resistant Micro-Organisms (other than MRSA) Guidelines” 7 days after onset or until lesions are dry Non immune staff must be excluded. Negative pressure isolation room preferred Infectious up to 5 days before appearance of rash Until 48 hours of normal bowel movements Not required Gas gangrene Creutzfeldt Jakob Disease (CJD) and related TSE disorders None Use contact precautions if wound drainage is extensive Not required Special precautions required for invasive procedures. Also refer to CJD policy Document reference code: IC/010/14 Croup Diarrhoea (suspected infective) Disease or Organism Droplet Contact via contaminated hands and equipment. Contact via faecal oral route Mode of transmission from person to person In the health care setting Children and the elderly Whilst symptoms persist Exclude those who are immunosuppressed. Variable. Usually 72 hours after cessation of symptoms Visitor Restrictions Duration of isolation Refer to “Management of Diarrhoea/Vomiting with a possible infectious cause” Some diarrhoeas e.g. food poisoning are NOTIFIABLE DISEASES Comments Document reference code: IC/010/14 Diphtheria Respiratory Cutaneous Gastroenteritis Campylobacter NOTIFIABLE DISEASE. Droplet Direct contact with skin lesions Restrict to those who have already had contact. 3 days of antibiotic therapy or 4 weeks untreated None Not required C. difficile None Norovirus Visitors to be restricted Salmonella Contact – via contaminated surfaces and faecal/oral route Inform infection prevention on suspicion. Until 48hrs of normal stool Not required None Not required None Shigella Viral (if not covered elsewhere) Glandular fever Contact via saliva (kissing) GRE Contact via hands and body fluid exposure (Glycopeptide resistant enterococci) Visitors to be restricted None None Until 48hrs of normal stool Not required Not required unless diarrhoea symptoms present Refer to “Antibiotic Resistant Micro-Organisms (other than MRSA) Guidelines” Gonococcal Infection Genito-urinary tract (GT) Contact with exudate from mucous membranes of the GT None Ophthalmia neonatorum Hepatitis Hepatitis A Disease or Organism 24 hours of antibiotic therapy Contact via unwashed hands Contact (faecal-oral) Mode of transmission from person to person In the health care setting None Visitor Restrictions 7 days after onset of jaundice Duration of isolation NOTIFIABLE DISEASE Comments Document reference code: IC/010/14 Hepatitis B, C, E Contact with blood and body fluids (usually percutaneous exposure via used sharps) None Herpes simplex Type I and II Contact with lesions and via shared towels etc. Droplet None Not required * Single room may be required if patient has extensive lesions Direct or indirect contact with blood and body fluids (usually percutaneous exposure via used sharps) None Not required Patients with AIDS may have additional infectious conditions that require isolation Contact with lesions and via shared towels etc. None Until 24hrs of antibiotics Influenza, Seasonal & Pandemic Contact – via contaminated surfaces and equipment Droplets Advise elderly visitors to be immunised 5 days after onset Alert Infection Control if more than one case on same ward. Legionnaires’ Disease No person to person spread None Not required NOTIFIABLE DISEASE Microbiologist MUST be contacted to arrange for rapid diagnostic methods to be set up. Not required NOTIFIABLE DISEASE (if acute) *Single room required if bleeding uncontrollably or has large open wounds or receiving haemodialysis. Herpes zoster see Shingles Human Immunodeficiency Virus Impetigo Document reference code: IC/010/14 Disease or Organism Leptospirosis Mode of transmission from person to person In the health care setting Visitor Restrictions Duration of isolation No person to person spread None Not required Mother to baby in utero and during delivery None Clinical recovery None Not required Comments (Weil’s Disease) Listeriosis Malaria Measles Meningitis Bacterial Meningococcal (Neisseria meningitidis) Other bacterial causes e.g. pneumococcal, haemophilus influenzae Viral Multi-Resistant Gram Negative Organisms Contact (faecal oral) although very rare Transmitted by mosquito bite or via percutaneous exposure Microbiologists should be informed as potentially food borne NOTIFIABLE DISEASE Always consider the possibility of other tropical infections which may be infectious. NOTIFIABLE DISEASE. Exclude non immune staff Airborne Exclude non immune 4 days after rash appears or duration of illness if immune compromised Droplet Recommend limiting visitors to those who have already had contact. 48 hours of appropriate antibiotics Droplet None Not required Contact (faecal oral) +/- Droplet Depends on site of colonisation. Contact via unwashed hands most significant route of transmission. None Not required NOTIFIABLE DISEASE None On the advice of the IPAC Team Refer to “Antibiotic Resistant Micro-Organisms (other than MRSA) Guidelines” NOTIFIABLE DISEASE Masks for airway management and close prolonged contact. Antibiotic prophylaxis may be required for household and mouth kissing contacts, those involved with airway management. CCDC or Health Protection Nurse will advise NOTIFIABLE DISEASE Document reference code: IC/010/14 Mumps Droplet Contact with urine/saliva Exclude non immune 9 days after onset Mycoplasma pneumonia Droplet None Duration of illness NOTIFIABLE DISEASE Norovirus see gastroenteritis Disease or Organism Parvovirus (human) Mode of transmission from person to person In the health care setting Droplet (Slapped Cheek) Visitor Restrictions Exclude pregnant women Duration of isolation Usually once rash appears but see comments. Comments Patients in aplastic crisis may be infectious for 1 week after onset. Exclude pregnant members of staff. Pertussis see Whooping Cough Psittacosis Person to person spread rare None Not required Pyrexia of Unknown Origin with recent travel abroad As cause is unknown all modes of transmission must be considered Limited to previous contacts and close family Variable – clinical recovery if cause not confirmed Malaria, typhoid and Hepatitis A are the commonest causes of PUO in returned travellers BUT always consider possibility of Viral Haemorrhagic Fever. Rabies Contact via percutaneous exposure to saliva Limited to previous contacts and close family For duration of illness NOTIFIABLE DISEASE Contact Microbiologist and IPAC team if suspected. None Variable Own bath shower facilities desirable. Single patient use items i.e. nail clippers, shavers Exclude non immune 7 days after onset of rash. NOTIFIABLE DISEASE Exclude non-immune staff Droplets of saliva to conjunctiva/mucosa. Ringworm (extensive) Rubella Contact with skin scales, nail and hair and via associated equipment e.g. hair clippers, shavers Droplet Person to person transmission is only a theoretical risk but because of the implications of acquisition strict adherence to isolation precautions must be observed. Document reference code: IC/010/14 SARS Or MERS-COV Disease or Organism Shingles (Herpes Zoster) Streptococcal (Group A) Infection Including sore throat scarlet fever, impetigo, erysipelas, wound Infection, toxic shock syndrome, puerperal fever. Toxoplasmosis Contact Airborne Droplet Mode of transmission from person to person In the health care setting Duration of Illness plus 10 days after resolution of fever (if respiratory symptoms absent/ improving) NOTIFIABLE DISEASE Visitor Restrictions Duration of isolation Exclude if nonimmune to chickenpox Recommend excluding children and any visitor with a wound. Until lesions are dry and crusted Exclude staff non-immune to chicken pox 48 hrs from commencing appropriate antibiotics Scarlet Fever – NOTIFIABLE DISEASE None Not required Restrict to those who have already been exposed only. Two weeks following commencing treatment and symptoms improving NOTIFIABLE DISEASE Refer to TB policy No spread None None NOTIFIABLE DISEASE No spread None None NOTIFIABLE DISEASE Contact with exudate Airborne via vesicle fluid (in disseminated shingles) Contact with lesions Droplets Person to person transmission rare Tuberculosis Pulmonary (open) ie sputum smear positive Limited to previous contacts Airborne via respiratory droplet Comments Staff with sore throats should seek advice from Occupational Health Pulmonary (closed) Extrapulmonary (excluding open abscess and other Document reference code: IC/010/14 drainage lesions) Typhoid & Paratyphoid Indirect contact – faecal/urine/oral spread Viral Haemorrhagic Fever (Lassa, Ebola, Marburg) Contact –percutaneous exposure to blood and body fluids Droplet – pharyngeal secretions Airborne – respiratory secretions Whooping Cough 14. Advise visitors not to eat or drink in isolation room Immediate family/partner. Exclude children Variable NOTIFIABLE DISEASE Ensure blood cultures and stool specimens are labelled as risk of infection As advised by Infection Control NOTIFIABLE DISEASE Exclude non immune 5 days after antibiotics commenced CONTACT INFECTION CONTROL IMMEDIATELY IF SUSPECTED NOTIFIABLE DISEASE Tables of Infestations and Appropriate Precautions Disease or Organism Mode of transmission from person to person In the health care setting Visitor Restrictions Duration of isolation Comments Human Fleas Contact with patient and bedding and clothing None Not required Human fleas are extremely uncommon. Cat/dog fleas N/A None Not required Treat animals and environment Lice (Body) Contact with patients, clothing, bedding, towels etc Contact (head to head) and via shared combs, head wear, pillows Contact (usually sexual) None Not required None Not required Body lice live in the seams of clothing. Wear gown and gloves when removing clothing Repeat treatment one week None Not required Contact with skin (prolonged skin contact usually required) None Not required Lice (Head) Lice (pubic) Scabies As this is usually STD consider referral to GUM clinic for screening Patient not considered infectious following first application of treatment. Apply second application after one week. Itching may continue for several days/weeks. Close contacts will need treatment. Document reference code: IC/010/14 Crusted/atypical scabies Contact with skin, bedding, clothing etc Worms Contact via faecal oral route Recommend limiting visitors to those who have already had contact until treated None As advised by the IPAC team Until treated Refer to dermatologist Contacts will need treatment. Family contacts or equivalent may need treatment Equality Impact Assessment Proforma Initial Screening Section Safety and Risk: Infection Control Name of Procedural Source and Isolation document to be Precautions assessed Officer responsible for the assessment Leslie Lawson-Kinross Date of Assessment 18.07.14 Is this a new or existing procedural document? E 1. Briefly describe the aims, objectives and purpose of the procedural document. 2. Are there any associated objectives of the procedural document? Please explain. 3. Who is intended to benefit from this procedural document, and in what way? 4. What outcomes are wanted from this procedural document? 5. What factors/forces could contribute/detract from the outcomes? 6. Who are the main stakeholders in relation to the procedural document? 7. Who implements the procedural document, and who is responsible for the procedural document? 8. Are there concerns that the procedural document could have a differential impact on RACIAL groups? To provide guidance in the isolation of patients for infection control purposes What existing evidence (either presumed or otherwise) do you have for this? 9. Are there concerns that the procedural document could have a differential impact due to GENDER What existing evidence (either presumed or otherwise) do you have for this? Written in accordance with National Guidance. Infection Prevention Guidance does not impact on Human Rights To minimise the spread of infections and protect those at risk from cross infection Staff, Patients, Visitors, Volunteers, Contractors To minimise the spread of infections and protect those at risk from cross infection Non-compliance with recommendations Staff, Patients, Visitors, Volunteers, Contractors Director of Quality and Governance/Executive Nurse N Please explain N Written in accordance with National Guidance. Infection Prevention Guidance does not impact on Human Rights Page 23 of 27 10. Are there concerns that the policy could have a differential impact due to DISABILITY? What existing evidence (either presumed or otherwise) do you have for this? 11. Are there concerns that the policy could have a differential impact due to SEXUAL ORIENTATION? What existing evidence (either presumed or otherwise) do you have for this? 12. Are there concerns that the procedural document could have a differential impact due to their AGE? What existing evidence (either presumed or otherwise) do you have for this? 13. Are there concerns that the procedural document could have a differential impact due to their RELIGIOUS BELIEF? What existing evidence (either presumed or otherwise) do you have for this? 14. Are there concerns that the procedural document could have a differential impact due to their MARRIAGE OR CIVIL PARTNERSHIP STATUS? (This MUST be considered for employment policies). What existing evidence (either presumed or otherwise) do you have for this? 15. Are there concerns that the procedural document could have a differential impact due to GENDER REASSIGNMENT OR TRANSGENDER ISSUES? What existing evidence (either presumed or otherwise) do you have for this? N Written in accordance with National Guidance. Infection Prevention Guidance does not impact on Human Rights N Written in accordance with National Guidance. Infection Prevention Guidance does not impact on Human Rights N Written in accordance with National Guidance. Infection Prevention Guidance does not impact on Human Rights N Written in accordance with National Guidance. Infection Prevention Guidance does not impact on Human Rights N Written in accordance with National Guidance. Infection Prevention Guidance does not impact on Human Rights N Written in accordance with National Guidance. Infection Prevention Guidance does not impact on Human Rights Page 24 of 27 N 16. Are there concerns that the procedural document could have a differential impact due to PREGNANCY OR MATERNITY? What existing evidence (either presumed or Written in accordance with National Guidance. Infection Prevention Guidance does not impact on Human Rights otherwise) do you have for this? 17. How have the Core Human Rights Values of: Fairness; Respect; Equality; Dignity; Autonomy Been considered in the formulation of this procedural document/strategy If they haven’t please reconsider the document and amend to incorporate these values. Page 25 of 27 N 18. Which of the Human Rights Articles does The right: this document impact? To life; Not to be tortured or treated in an inhuman or degrading way; To be free from slavery or forced labour; To liberty and security; To a fair trial; To no punishment without law; To respect for home and family life, home and correspondence; To freedom of thought, conscience and religion; To freedom of expression; To freedom of assembly and association; To marry and found a family; Not to be discriminated against in relation to the enjoyment of any of the rights contained in the European Convention; To peaceful enjoyment of possessions and education; To free elections What existing evidence (either presumed or Current National Guidance Written in accordance with Trust guidelines otherwise) do you have for this? How will you ensure that those responsible for All staff to work within Trust guidelines implementing the Procedural document are aware of the Human Rights implications and equipped to deal with them? N Please explain 19. Could the differential impact identified in 8 – Y 13 amounts to there being the potential for n/a adverse impact in this procedural document? N Please explain for each equality heading (questions 8 –13) on a separate 20. Can this adverse impact be justified on the Y grounds of promoting equality of opportunity piece of paper. for one group? Or any other reason? n/a If Yes, describe why, and then proceed to a full EIA. N 21. Should the procedural document proceed to a full equality impact assessment? If No, are there any minor further amendments None identified that should take place? Page 26 of 27 22. If a need for minor amendments is identified, what date were these completed and what actions were undertaken Signed (completing officer) Signed (Service Lead) Y Leslie Lawson-Kinross N n/a Date 18.7.14 Date Page 27 of 27