Download Source and Protective Isolation - Royal Cornwall Hospitals NHS Trust

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
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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.
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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.
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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.
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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.
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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
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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
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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.
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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
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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
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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
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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
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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