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The Newcastle upon Tyne Hospitals NHS Foundation Trust

Isolation Policy

Version No.: 4.7

Effective From: 17 April 2018

Expiry Date: 21 January 2019

Date Ratified: 17 April 2018

Ratified By: IPCC

1 Introduction

Micro-organisms (e.g. bacteria, viruses, fungi) can cause a range of infections, most of which can be prevented through the implementation of effective hand hygiene and standard IPC precautions; as described in the corresponding policies. However some diseases which can be transmitted between patients or between patients and members of staff require additional precautions in the form of source isolation. Patients who are at greater risk of infection due to reduced immunity such as transplant patients or patients on treatment for cancer may also require additional precautions to protect them from infection in the form of protective isolation. This policy describes how and when to implement both source and protective isolation.

2 Scope

This policy applies to all healthcare professionals working within the organisation including medical staff, nurses, allied health professionals and students. The policy includes details of:

Routes of transmission

Categories of isolation

Risk Assessment

Communication

General Principles of Isolation

Source Isolation Practices

Personal Protective Equipment (PPE) Requirements for Respiratory Illnesses

Protective Isolation

3 Aims of Policy

The aim of this policy is to prevent the transmission of infectious diseases between patients and staff through the correct implementation of isolation precautions.

4 Duties (Roles and Responsibilities)

4.1 The Executive Team is accountable to the Trust Board for ensuring Trust-

wide compliance with policy.

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4.2 The Chief Executive has overall responsibility for implementation, monitoring

and review of this policy. This responsibility is delegated to the Director of Infection Prevention and Control (DIPC).

4.3 The Infection Prevention and Control Committee (IPCC) will review and ratify the policy and any new evidence base within the time frame set out in the policy.

4.4 The Director of Estates and Facilities is responsible for ensuring that isolation facilities are maintained, including correct ventilation parameters.

4.5 The Infection Prevention and Control Team (IPCT) is responsible for giving IPC advice as necessary and for assisting with the review of this policy to ensure the policy contains current evidence based guidance.

4.6 The Occupational Health and Well Being Department is responsible for assisting with staff surveillance as necessary.

4.7 Matrons, Line Managers and Heads of Department are responsible for ensuring that policies, procedures and access to education and training are made available to all appropriate staff to ensure staff competence, minimise the risk of infection and ensure clinical practice is in line with Trust policy

4.8 All staff are responsible for ensuring they understand and implement this policy.

5 Definitions

Definitions are given throughout the policy.

6 Isolation

6.1 Routes of transmission

The common means of transmission of infection are by:

o Airborne route o Faecal-oral transmission o Direct contact

Isolation precautions reduce the risk of transmission of micro- organisms and would include the following:

1. Patients with a known transmissible infection 2. Patients who are known or may be colonised with multi-drug resistant

organisms e.g. MRSA, glycopeptide resistant enterococci (GRE), carbapenemase-resistant Enterobacteriaceae (coliforms and Acinetobacter species)

3. Patients who are particularly vulnerable to infection.

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6.2 Categories of Isolation

There are two classes of isolation:

Source isolation: for patients who are sources of potentially pathogenic micro-organisms which may spread from them and infect/colonise other patients and/or members of staff; (see points 1 and 2 above)

Protective isolation: for patients who are rendered highly susceptible to infection by disease or therapy (see point 3 above)

Source isolation can be divided into three categories:

o Strict - for highly transmissible or dangerous diseases which require isolation on ward 19, RVI in the high level isolation unit. Management of these patients is not covered in the policy but can be found in the Trust policies: Viral Haemorrhagic Fever (VHF) Patient Management Policy (with focus on Ebola Virus Disease (EVD)) and the Trexler Isolation Unit (TIU) Policy

o Standard - for most other communicable diseases o Respiratory - for diseases where the main route of transmission is

airborne, including pulmonary tuberculosis, influenza The conditions to which these types of isolation apply are listed in appendix 1.

6.3 Risk Assessment

Any patient who is infected / colonised with a communicable disease should be placed in source isolation.

In order to ensure that the correct IPC policies and procedures are being followed, the IPCT must be informed of any patient known/suspected of having a communicable disease on the ward (whether isolated or otherwise)

The requirement for protective isolation will be made by the patient’s clinician on an individual basis. A member of the IPCT is always available to give advice and help in the isolation of patients. Where necessary staff must refer to the following Trust policies and guidelines for additional guidance:

Cleaning and Disinfection Procedure

Clostridium difficile Policy

Control of MRSA in Newcastle Hospitals

CPE (Carbapenemase-Producing Enterobacteriaceae) Policy

Decontamination of Healthcare Equipment following Patient Use Prior to Service and//or Repair

Decontamination of the Patient Environment (including Terminal and Deep Cleaning)

6.4 Hand Hygiene Policy

Major Outbreaks, Investigation and Control

http://policies.app/launchit.asp?launchit=2533













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Patients with Blood borne Viral Infections

Standard Precautions

Tuberculosis: Prevention and Control in Newcastle Hospitals

Used Laundry Management Policy

Waste Management Policy Whilst every effort must be made to ensure that patients are isolated as described in this policy, it is recognised that in certain circumstances this may not be possible due to lack of single room accommodation. In such cases, ward staff must seek advice from the IPCT. If a patient cannot be isolated when necessary (e.g. due to falls risk) this MUST be documented in the nursing notes and reviewed on a daily basis.

6.5 Communication

A patient may find isolation a traumatic experience. To remain in isolation for prolonged periods of time can be distressing, and every effort should be made to explain the reason for isolation and where possible when it will be discontinued. Appropriate provision must be made available for disabled patients and patients with dementia to ensure effective communication. Patients must also be given information leaflets about the appropriate organism if they are available. Information leaflets must be printed double sided and in colour. Leaflets can be translated as necessary by contacting the Involvement and Equalities Officer. Leaflets available via the intranet, under Patient Information, are as follows: o Chickenpox o Clostridium difficile (supplied by the Infection Prevention and Control

Nurse (IPCN)) o CPE o Influenza o Measles o MRSA o MRSA Eradication Treatment o Mumps o Norovirus o Scabies o Shingles






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6.6 General Principles of Isolation

Hands Good hand hygiene before and after contact with the patient is the single most important measure in preventing spread of infection. Staff must refer to the Hand Hygiene Policy for more detail. Room A blue ‘Isolation in Progress’ sign must be clearly displayed on the outside of isolation cubicle door. The door to the isolation cubicle/bay must be kept closed.

In source isolation where this causes specific difficulty with patient management, a discussion between the nurse in charge and the IPCT must take place to agree a plan of action. A record of the discussion and agreed plan must be documented in the patient’s care pathway and nursing notes.

Where two cubicles share a toilet the adjoining door should be locked and the isolated patient provided with their own commode or vice versa Visitors Visitors do not need to don gloves and apron unless they are actively involved in direct care of the patient e.g. washing, in which case they should adhere to the appropriate precautions for the type of isolation being undertaken.

The ultimate responsibility for deciding who may visit a patient rests with the nurse-in-charge, but additional advice can be obtained from the IPCT Cleaning of rooms (source isolation only) Separate cleaning equipment must be reserved for each isolation room. Hotel Services staff must clean the room with 1,000ppm available chlorine solution twice daily. High touch areas are routinely cleaned three times daily in Medicine and Older People’s Medicine. Nursing staff must identify hazards and undertake a risk assessment before allowing domestic staff to clean the room, and must advise the domestic staff of the PPE required and any additional precautions which may have been implemented.

Clinical equipment Patients in isolation should have dedicated equipment, where possible. Unnecessary items of furniture should be removed prior to use of the room for isolation. If equipment used on the patient needs to leave the isolation area it must be disinfected with 1,000ppm chlorine solution on removal. Disposal of body fluids Standard precautions must be taken when handling body fluids, including the use of apron, gloves and face protection as necessary. Body fluids should be

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disposed of via the usual route in the dirty utility room or the patient’s own toilet. Spillages Staff must always wear appropriate PPE to manage body fluid spillages. Blood or blood stained spillages must be inactivated using a solution of 10,000 parts per million (ppm) of available chlorine (or chlorine granules left to soak up the spillage for 2 minutes and then scooped up into a clinical waste bag). Other body fluids should be mopped up with disposable wipes and the area disinfected with Clinell universal sanitising wipes. For further detail staff must refer to the Waste Management policy. Sharps Extreme care must be taken to ensure that needles and other sharp instruments are handled safely to prevent inoculation injury. All sharps must be disposed of at point of care. Source isolation only - It is advisable to limit the number of items stored in the room as all disposable opened items/packets must be discarded prior to terminal cleaning

6.7 Source Isolation Patient Management

6.7.1 Strict Isolation

Patients in strict/high level isolation will be managed on ward 19 RVI in the high level isolation suites or the Trexler Isolation unit and the appropriate policies followed: Trexler Isolation Operational Policy, Viral Haemorrhagic Fever (VHF) Patient Management Policy (with focus on Ebola Virus Disease (EVD)).

6.7.2 Standard/Respiratory Isolation

A patient in these categories of source isolation should be nursed in single room accommodation with en-suite sanitary facilities, where possible. Additionally the use of single room accommodation with extract ventilation may be used in certain clinical areas. In addition to the principles in section 6.5 and the implementation of Standard Precautions the following practices must be implemented:

Patient transfer or movement Patients in isolation should not leave the isolation room, except for essential investigations or procedures (where possible). Before any such visit is arranged it is important to determine that: the visit is absolutely necessary the special procedure cannot be carried out satisfactorily in the

isolation room with portable apparatus






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When an isolated patient is to be transferred to another department for care, the receiving department MUST be informed of the isolation circumstances in advance of the transfer and in accordance with the Transfer of Patients Policy, to ensure that appropriate isolation can continue. Porters and other staff should not wear PPE during the transfer of a patient to other wards / departments unless it is likely there will be a requirement to perform clinical interventions during the transfer. If the patient requires assistance to transfer onto a chair or bed prior to or after transfer, PPE should be worn at that point, then it should be removed and hands washed. Patients with respiratory illnesses as listed in appendix 1 should wear a surgical mask during transfer. PPE Clean hands and don appropriate PPE prior to entering the isolation cubicle/area. As a minimum this includes gloves and an apron, if the patient has a respiratory infection a mask may be required, please refer to table 1 in section 6.7. The PPE must then be removed and hands washed with soap and water prior to leaving the isolation cubicle/area. Equipment Full diagnostic kit should be available, and once taken into the patient’s room, equipment should remain until the patient is discharged. It should then be cleaned in accordance with the Cleaning and Disinfection Procedure. Linen All items must be sealed in an alginate/soluble bag and tied at the top, inside the cubicle, taking care not to contaminate the outside of the bag. This must then be placed in a white plastic laundry bag. The white plastic laundry bag should be kept outside of the isolation room. All used linen must be managed as per the Laundry Management Policy. Waste All waste must be disposed of as Clinical Waste (orange waste bag), in accordance with the Waste Management Policy. Crockery and cutlery If ward stock these items should be washed separately in the ward kitchen. If from the hospital kitchens they must be send back on the food trolley, as normal, where they will be washed at high temperatures in the washer disinfector. The use of disposable items is not necessary for standard/respiratory isolation. Terminal cleaning When isolation has ceased or the patient is discharged/transferred the cubicle must be terminally cleaned as per Decontamination of the







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Patient Environment (including Terminal and Deep Cleaning) Policy. This may also include use of Hydrogen Peroxide Vapour (HPV) () disinfection. Deployment of HPV adds significant time to a terminal clean and there may be circumstances, following risk assessment, where HPV cannot be deployed for patient safety reasons.

6.7.3 Cohort Isolation

It may be necessary to isolate patients infected / colonised with the same communicable organisms in the same room/bay in some circumstances e.g. norovirus outbreaks. The decision to implement this will be taken by the IPCT and advice given as necessary. When patients are in cohort isolation the same principles for source isolation must apply, to include; changing apron and gloves and washing hands between patient contacts and disinfecting equipment between patients.

6.8 Personal Protective Equipment (PPE) Requirements for Respiratory Illnesses

Additional respiratory and facial protection is required for certain micro-organisms that are transmitted via the droplet/airborne route. It is important that the correct type of protection is chosen when caring for patients with these illnesses (known or suspected). All patients who are known or suspected to have these infections must be isolated in a single cubicle, whenever possible.

These recommendations are based on national guidance (see references) after agreement from appropriate clinicians to give a safe and pragmatic approach to the wearing of masks for respiratory organisms. Rationale for use of PPE including masks Use of PPE by healthcare workers not only prevents the healthcare worker acquiring potentially serious infection, but also prevents transmission of infection to other vulnerable patients. For example although RSV is normally a mild infection in adults, with minimal symptoms, an infected healthcare worker could transmit infection to other vulnerable children and infants for whom they are caring. Types of PPE The types of PPE available to protect against these organisms are; aprons, long sleeved gowns/aprons, gloves, visors, goggles, surgical masks and FFP3 masks. Masks Surgical masks provide a barrier to splashes and droplets impacting on the wearer’s nose, mouth and respiratory tract. They do not provide protection against airborne (aerosol) particles.


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Surgical masks must be changed after each use, and if they become damaged or contaminated with respiratory secretions. These can be removed when more than 1 metre away from the patient. Surgical masks are only required for general care of patients with influenza, however if a patients has a very productive cough and staff are directly exposed to respiratory secretions they should risk assess the need to wear a surgical mask, in line with standard precautions. FFP3 respirator masks provide protection against airborne (aerosol) particles produced in certain infections and also during aerosol generating procedures (AGPs). AGPs include; suctioning, cough inducing procedures (e.g. CPAP & induction of sputum) bronchoscopy, CPR, intubation, extubation and related procedures, surgery/post-mortem involving high speed devices. Staff must be face fit tested for FFP3 respirator masks and a supply of those masks made available on the ward/department. All areas where AGPs are undertaken must have staff trained to face fit test who must then complete face fit testing on all staff who may be involved in these procedures. Staff requiring training to face fit test should contact infection prevention and control on ext: 24996. Details of when FFP3 respirator masks are required can be seen in table 1, below. FFP3 masks must be changed after each use, if damaged or if they become contaminated with respiratory secretions or other body fluids. Gloves, aprons and long sleeved aprons/gowns Gloves and aprons must be worn when having contact with all isolated patients. Long sleeved aprons/gowns (single use), must be worn when undertaking AGPs (aerosol generating procedures). Eye protection Visors or goggles must be worn if there is a risk of eye contamination by splashes or droplets of body fluids. Isolation requirements Patients admitted with suspected viral or bacterial respiratory infection detailed below must be placed in isolation in a single cubicle and staff entering the cubicle must wear the appropriate PPE. These precautions should be based on symptoms rather than awaiting laboratory confirmation, and must continue until asymptomatic or following a clinical decision that the patient is no longer infectious. If isolation is not possible this should be discussed with the IPCN/a Microbiologist.

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In critical care areas such as PICU, a risk assessment should be undertaken as to the appropriate actions necessary to maintain staff and patient safety. PPE must be removed in the following order as described in appendix 2; gloves, apron/gown (from ties at back/side), eye protection using strap, mask, placed into clinical waste and hands washed with soap and water prior to leaving the isolation cubicle. Table 1

Microorganism

PPE required

Gloves Apron Visor /

goggles Surgical

mask

Long sleeved apron

FFP3 mask

Pulmonary TB (smear positive) unless>14 days treatment received

as required for splashes

- Clinician decision

AGP – as a

minimum

Multi-drug resistant TB

as required for splashes -

Influenza as required for splashes

AGP AGP

Bordetella pertussis (whooping cough)

as required for splashes - AGP AGP

Haemophilus influenza B (Epiglottitis only)


Human Metapneumovirus


Adenovirus as required for splashes

- AGP AGP

Parainfluenza as required for splashes

- AGP AGP

Respiratory syncytial virus (RSV)


Suspected MERS / SARS / Avian influenza

-

Long sleeved

fluid repellent

gown

Measles as required for splashes -

NB: masks are not required for intubated patients with closed circuit suction in situ, unless there is a risk that the circuit will be broken. The guidance detailed above gives the minimum standard of PPE required. Staff may wear additional PPE if they feel this is necessary, this may be the case if they feel that they are more vulnerable to infection. However the staff member should explain that they are using a higher level PPE for their own protection. The use of FFP3 masks for general care in patients with smear positive TB should be on a risk assessment basis, as clinicians may feel additional

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precautions are required for patients with very productive coughs are necessary, in line with standard precautions.

Measles and Varicella Zoster Virus Only staff who have immunity to these infections must have contact with these patients. For measles staff with known immunity are still required to use FFP3 masks as re-infection has been documented. MERS, SARS and Avian Flu Patients with these organisms will be nursed in negative pressure rooms on ward 19, RVI (ward 1A, RVI for paediatrics) Patient requirements Patients must wear a surgical mask when being transferred to other departments which should be changed hourly. PPE ordering Valved FFP3 masks need only be used when staff are required to wear the masks for extended periods of time e.g. critical care areas. Wards/depts. must ensure that there is a supply of the necessary PPE required for the protection of all staff, including any Physiotherapists who attend to treat patients.

6.9 Management of Patients with Diarrhoea

Patients with diarrhoea; type 5-7 stool as described on the Bristol Stool Chart (see appendix 3) must be managed appropriately and in a timely manner to prevent transmission of infection. All patients who develop diarrhoea must in the first instance have a medical review. Medical staff should review the patients:

Normal bowel habits

Condition for signs of infection, including WBC and CRP

Medication, including antibiotics, PPIs and laxatives/aperients If infection is suspected or cannot be discounted the patient must be isolated in a cubicle; as described above, commenced on a Diarrhoea Care Pathway and a stool sample taken as detailed in section 6.8.1. Hand must be washed with soap and water following contact with the patient or the patient’s environment, in-line with the 5 moments for hand hygiene. Alcohol hand gel (hand sanitizer) should not be used as it is not effective against many organisms that cause infective diarrhoea.

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6.9.1 Sending Stool Samples

When to send a stool sample posters should be displayed in all dirty utility rooms for reference (as seen in appendix 4). These can be found on the IPC intranet page. If a patient is admitted with or develops diarrhoea of unknown cause within 3 days of admission a stool sample should be sent for culture and sensitivity, as soon as possible. If a patient develops diarrhoea of unknown cause/suspected infective cause 3 days after admission a stool sample must be sent for Clostridium difficile (C. difficile) on the second episode of diarrhoea, following a medical review unless: .

The patient is clinically unwell and Clostridium difficile infection (CDI) or other infection is suspected

The patient is admitted with diarrhoea of unknown cause/suspected infective cause (as described above)

There is a viral outbreak on the ward when advice will be given by the IPCN when a stool sample can be sent on the first episode of diarrhoea.

Stool samples MUST NOT BE SENT if the patient:

Has had laxatives/aperients, bowel prep or an enema within the last 24 hours – unless clinically unwell and C. difficile is suspected or it is essential for the laxatives to continue due to the patient’s medical condition.

If a patient continues to have diarrhoea following a negative C. difficile result; the medical staff should discuss the case with a Microbiologist prior to further testing.

If a patient continues to have diarrhoea following a positive C. difficile carrier result/ treatment of CDI OR re-develops diarrhoea within 28 days of their last C. difficile positive result; the medical staff should discuss the case with a Microbiologist prior to further testing.

If a known C. difficile positive/C. difficile carrier patient re-develops suspected infective diarrhoea during the same hospital admission; the medical staff should discuss the case with a Microbiologist prior to further testing

If a known C. difficile positive/C. difficile carrier patient re-develops suspected infective diarrhoea during the same hospital admission; the medical staff should discuss the case with a Microbiologist prior to further testing

When sending stool samples the specimen container must be a least 1/5 full of diarrhoeal specimen to ensure all tests can be completed. Staff must ensure that samples reach the Microbiology laboratory as soon as possible to facilitate timely diagnosis.

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6.9.2 Care Pathways

Stool charts are also available for documenting patient’s bowel movements, as seen in appendix 5. All patients who have had positive C. difficile results (carrier or toxin) on the current admission or previous admissions must have their bowel movements documented on stool charts for the duration of any admissions. If the patient has a positive C. difficile toxin or carrier result a Clostridium difficile Care Pathway must be commenced, as seen in appendix 7. Examples of the Stool Chart, Diarrhoea and Clostridium difficile Care Pathway can be seen in appendix 5, 6 & 7. These must be ordered from the Supplies Department, code numbers; NUTH322, NUTH324 and NUTH 323 respectively. For management of specific organisms please refer to the table in appendix 1. Isolation of patients with diarrhoea can stop after they have been asymptomatic for 48 hours, at which point the cubicle must be terminally cleaned (see the Decontamination of the Patient Environment (including; Terminal & Deep Cleaning) Policy), even if the patient is to remain in the cubicle, to prevent re-infection/transmission of infection.

6.10 Protective Isolation

The nature and degree of immunosuppression, and therefore the susceptibility to infection, varies considerably between patients. Isolation requirements vary accordingly, and the IPCT should be contacted for advice on individual cases where any doubt exists.

There are several indications for protective isolation, including:

Neutropenia (any cause)

Primary immunodeficiency

Immunodeficiency associated with: o haematological malignancy (leukaemia, lymphoma) o immunosuppressive therapy

Severe uninfected dermatitis

Extensive burns.

6.10.1 Protective Isolation Practices

Patients in protective isolation should be nursed in the same way as those in source isolation as these precautions will also protect the patient. There are only some slight differences as detailed below: Infections

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Patients, staff, or visitors with an infection or a potential infection should not enter a room in which a patient is being nursed in protective isolation. Hands Hands and forearms should be washed thoroughly with an antiseptic solution e.g. chlorhexidine, triclosan, or povidone iodine, before entering the room. Hand washing on leaving the room is also always essential to prevent transfer of colonising organisms. Room A single room is necessary, and the patient must remain in it. This should not be in the proximity of infected patients and should, if possible, have an air lock

Apron and gloves Should be worn as for standard precautions i.e. if the staff member is to nurse or examine the patient, or carry out a clinical procedure. Masks (for staff) Not necessary, unless the patient has an infection where masks are required. Linen Clean linen from the laundry is satisfactory Crockery and cutlery Usually food and crockery direct from the kitchen is satisfactory, but certain dietary restrictions may apply depending on the patient’s condition

Waste Normal segregation of waste applies.

Some patients (e.g. children with Severe Combined Immune Deficiency (SCID), or bone marrow transplant recipients) may have special additional requirements for protective isolation; in such cases, the procedures of the relevant unit concerned should be followed.

7 Training

Staff will be given education on correct isolation practices as appropriate to their role annually via their IPC mandatory training e-learning programmes. Additional education and advice will be given as necessary by the IPCNs at ward/department level. Staff required to deliver high level isolation will undergo specific training for this. These include staff from Infectious Diseases and other volunteers from specialist areas around the Trust.

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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 any grounds. This document has been appropriately assessed.

9 Monitoring Compliance

Compliance with this policy is audited via the Clinical Assurance Tool (CAT) on a monthly basis. The CAT Scorecard is reported to Trust Board, IPCC and Directorate Managers on a monthly basis.

Standard / process / issue

Monitoring and audit

Method By Committee Frequency

Appropriate isolation of patients

Clinical Assurance Tool (CAT)

Matron IPCC Monthly

Adherence to isolation practices as detailed in section 6.5 & 6.6

Clostridium difficile ward audits

IPCN and SR/CN

IPCC Quarterly (within HCAI report)

Availability of correct isolation equipment

Isolation Equipment audit

Practice Development Lead IPC

IPCC Annual

Timely isolation of patients with MRSA and C. difficile

MRSA, diarrhoea and C. difficile Care Pathway Audit

IPCNs IPCC Annual

Compliance with fit testing

Audit of compliance Practice Development Lead IPC

IPCC Annual

Implementation of correct and timely isolation

Root course analysis following MRSA bacteraemia and C. difficile positive cases

IPCT and Directorate

IPCC Quarterly (within HCAI report)

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10 Consultation and review

Consultation for the review of this policy has been sought from the members of IPCC, the IPC team, paediatric Matrons and Consultants, critical care Matrons and consultants

11 Implementation

Clinical Directors/Matrons/Sisters/Charge Nurses and Clinical Leads should ensure that staff are aware of this policy. This policy is available for staff to access via NUTH intranet. IPC information is available via the Trust Intranet and Internet; additionally, patient information leaflets are available across the organisation.

12 References

Coia, J.E. Ritchie, L. Adisesh, A. et al (2013) Guidance on the use of respiratory

and facial protection equipment. Journal of Hospital Infection. Vo. 85. P. 170-

182.

Health Protection Agency (2012) Infection control precautions to minimise

transmission of Respiratory Tract Infections (RTIs) in the healthcare setting.

Available at: https://www.gov.uk/government/publications/respiratory-tract-

infections-infection-control

Public Health England (2013) When to use a surgical mask or FFP3 respirator.

Available at: http://www.england.nhs.uk/wp-content/uploads/2013/12/nhs-

england-poster-v1.pdf

Steer et al (2012) Guidelines for prevention and control of group A streptococcal infection in acute healthcare and maternity settings in the UK. Journal of Infection January; 64(1):5.

13 Associated Documents

Cleaning and Disinfection Procedure

Clostridium difficile Policy

Control of MRSA in Newcastle Hospitals

CPE (Carbapenemase-Producing Enterobacteriaceae) Policy

Decontamination of Healthcare Equipment following Patient Use Prior to Service and//or Repair

Decontamination of the Patient Environment (including Terminal and Deep Cleaning)

Hand Hygiene Policy

Laundry Management Policy

Major Outbreaks, Investigation and Control

Patients with Blood borne Viral Infections

Personal Protective Equipment

Standard Precautions

https://www.gov.uk/government/publications/respiratory-tract-infections-infection-control

https://www.gov.uk/government/publications/respiratory-tract-infections-infection-control

http://www.england.nhs.uk/wp-content/uploads/2013/12/nhs-england-poster-v1.pdf

http://www.england.nhs.uk/wp-content/uploads/2013/12/nhs-england-poster-v1.pdf









http://policies.app/Launchit.asp?launchit=185




http://policies.app/Launchit.asp?launchit=381


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Transfer of Patients Policy

Trexler Isolation Operational Policy

Tuberculosis: Prevention and Control in Newcastle Hospitals

Used Laundry Management Policy

Viral Haemorrhagic Fever (VHF) Patient Management Policy (with focus on Ebola Virus Disease (EVD))

Waste Management Policy

Author: Practice Development Lead IPC








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Appendix 1

Organisms Requiring Source Isolation Standard/Respiratory Isolation Suspected or proven cases of the following infections/colonisations should be placed in standard isolation. NB in certain circumstances it may be deemed necessary to cohort groups of patients this must only be done in full consultation with the IPC Team and after a risk assessment.

Infection Type of isolation

Indications for ending isolation Type of clean

Anthrax None but see comments

Isolation is not strictly necessary, but patients with any form or anthrax should be isolated until after discussion with the IPCT

Discharge

Bronchiolitis in infants

Respiratory

Clinical recovery. Note that cohort nursing of infants with RSV infection is acceptable if single-room isolation is not possible

Terminal

Burns, wounds, and bedsores with extensive sepsis

Protective Depends on the infecting organism(s) - discuss with the IPCT

Discharge unless known infection -then terminal

Campylobacter infection

Standard 48 hours clear of type 5-7 stool Terminal

Chickenpox Respiratory

Until all lesions have scabbed and no new lesions are appearing (minimum 7 days from onset of rash)

Terminal

Cholera Standard 48 hours clear of type 5-7 stool Terminal

Clostridium difficile-associated diarrhoea or pseudomembranous colitis


CPE (Carbapenemase-Producing

Enterobacteriaceae)

Standard Three negative rectal swabs/stool specimens at weekly intervals

Suspected or know - terminal

X3 negative screens - discharge

Croup Respiratory Isolation may be appropriate in some circumstances. Discuss with the IPCT Terminal

Diarrhoea of unknown cause

Standard

Until communicable disease is excluded as the cause of diarrhoea, or on cessation of diarrhoea for 48 hours

Terminal

Dysentery (bacillary Standard 48 hours clear of type 5-7 stool Terminal

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or amoebic)

E. coli gastrointestinal infection (all types)


Encephalitis See note Discuss with the IPC Team Terminal

Gastroenteritis (viral) Standard 48 hours clear of type 5-7 stool and vomiting Terminal

Glycopeptide Resistant Enterococci (GRE)

Standard Discuss with the IPCT Terminal

Gonorrhoea (including conjunctivitis, pharyngitis, and ophthalmia neonatorum)

Standard 24 hours of effective antibiotic therapy Terminal

Group A haemolytic streptococcal infection (sore throat, scarlet fever, puerperal sepsis, erysipelas, impetigo, etc.)

Standard Normally 24 hours effective treatment, but discuss with the IPCT Terminal

Group B haemolytic streptococcal infection in neonates

Standard 24 hours effective treatment1 Terminal

Hepatitis A Standard Until one week after the onset of jaundice Terminal

Hepatitis B, C None but see comments

Isolation is not required to prevent infection of other patients unless the patient is bleeding or felt to be at high risk of bleeding (e.g. oesophageal varices, thrombocytopenia, etc.). However, staff should remain aware that there is a risk to staff from blood-borne virus infections and should take care to avoid needlestick injuries or contamination with blood and body fluids. Isolation may be discontinued when the bleeding or the risk of bleeding ceases

Discharge unless isolated-then terminal

Hepatitis, acute (cause unknown)

Standard Isolate until the diagnosis is made Terminal

Herpes simplex in infants

Standard Clinical recovery Terminal

Herpes zoster (shingles)

Standard Until lesions are dry Terminal

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Human immunodeficiency virus (HIV)

None but see comments

Isolation is not required unless the patient is bleeding or felt to be at high risk of bleeding (e.g. thrombocytopenia). Staff should remain aware that there is a risk from blood-borne virus infections and should take care to avoid needlestick injuries or contamination with blood and body fluids. Isolation may be discontinued when the bleeding or the risk of bleeding ceases. However, HIV-positive patients may also be infected with a communicable disease which does require isolation; the patient should then be isolated to the standard required of the infection concerned

Discharge unless isolated-then terminal

Insect infestation (fleas, lice, scabies) Standard

Until completion of appropriate treatment (see separate Trust policy for the management of these conditions)

Terminal

Invasive Haemophilus influenzae infection (meningitis, epiglottitis, etc.)

Standard 24 hours appropriate antibiotic therapy Terminal

Influenza, Influenza H5N1 human metapneumovirus

Respiratory Asymptomatic and at least 5 days from onset Terminal

Leprosy Standard Duration of hospital stay Terminal

Leptospirosis Standard 24 hours effective antibiotic therapy Terminal

Listeria infection in neonates

Standard 48 hours effective treatment Terminal

Measles Respiratory 5 days after the onset of rash Terminal

Meningitis – viral Discuss with IPC

Discuss with the IPCT Terminal

Meningococcal meningitis or septicaemia

Standard 24 hours effective treatment Terminal

MRSA (Meticillin-resistant Staph. aureus)

Standard Discuss with the IPCT (refer - Control of MRSA in Newcastle Hospitals Policy) Terminal

Multi-resistant Gram-negative organisms Standard Discuss with the IPCT Terminal

Mumps Respiratory 5 days after the appearance of parotid swelling Terminal

Poliomyelitis Respiratory Until stools negative for poliovirus Terminal

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Pulmonary tuberculosis (smear-positive)1,2

Respiratory

2 weeks after start of effective chemotherapy or three consecutive smear-negative sputum results2,3 Staff MUST refer to the Tuberculosis: Prevention and Control in Newcastle Hospitals policy

Terminal

Ringworm (Tinea) Standard Discuss with the IPCT Terminal

Rubella Respiratory 5 days after the onset of rash Terminal

Salmonellosis Standard Cessation of diarrhoea for 48 hours Terminal

Transmissible Spongiform Encephalopathy (e.g. CJD, vCJD)

None

Recipients of pooled plasma products may also fall into this category. Discuss with the IPCT

Discharge

Typhoid or paratyphoid fever

Standard Negative stool cultures (and urine cultures, if applicable) Terminal

Typhus Standard Delousing of confirmed efficacy Terminal

Worm infections - threadworm, tapeworm

Standard Discuss with the IPC Team Terminal

Whooping cough Respiratory 5 days effective chemotherapy Terminal

Strict Isolation The following organisms will require strict isolation in cubicles with negative pressure, and some in the High Level Isolation unit on R19.



Diphtheria High Level Negative cultures High Level

Disinfection

Multidrug-resistant tuberculosis

Respiratory Three consecutive smear-negative sputum results

Terminal

Plague High Level Negative cultures High Level

Disinfection

Rabies Respiratory Clinical recovery Terminal

Viral haemorrhagic fevers (Lassa, Ebola, Marburg)

High Level

Clinical recovery – discuss with IPCT High Level Disinfection

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Appendix 2

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Appendix 3

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Appendix 4

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Appendix 5

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Appendix 6

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Appendix 7

The Newcastle upon Tyne Hospitals NHS Foundation Trust

Equality Analysis Form A

This form must be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval.

PART 1 1. Assessment Date: 2. Name of policy / strategy / service:

Isolation Policy

3. Name and designation of Author:

Allison Sykes, Practice Development Lead IPC

4. Names & designations of those involved in the impact analysis screening process:

Ashley Price, Director of IPC

5. Is this a: Policy yes Strategy Service

Is this: New no Revised yes

Who is affected Employees yes Service Users yes Wider Community

6. What are the main aims, objectives of the policy, strategy, or service and the intended outcomes? (These can be cut and pasted from your policy)

The aim of this policy is to prevent the transmission of infectious diseases between patients and staff through the correct implementation of isolation precautions.

7. Does this policy, strategy, or service have any equality implications? Yes X No

If No, state reasons and the information used to make this decision, please refer to paragraph 2.3 of the Equality Analysis Guidance before providing reasons:

3/9/2015

8. Summary of evidence related to protected characteristics Protected Characteristic Evidence, i.e. What evidence do

you have that the Trust is meeting the needs of people in various protected groups

Does evidence/engagement highlight areas of direct or indirect discrimination? If yes describe steps to be taken to address (by whom, completion date and review date)

Does the evidence highlight any areas to advance opportunities or foster good relations. If yes what steps will be taken? (by whom, completion date and review date)

Race / Ethnic origin (including gypsies and travellers)

Provision of Interpreting service and leaflet translation E&D Training for staff

None None

Sex (male/ female) Male and female practitioners are available to promote the dignity of patients when required

None None

Religion and Belief Chaplaincy service provided with links to leaders of major faiths

None None

Sexual orientation including lesbian, gay and bisexual people

No relevant good practice None None

Age Innovations to support people with Dementia Nurse Specialist Dementia Care available for further advice and support

None None

Disability – learning difficulties, physical disability, sensory impairment and mental health. Consider the needs of carers in this section

Provision of BSL Signers and Deaf Blind Guides

Provision of LD Liaison Nurse

None

None

Gender Re-assignment No relevant good practice None None Marriage and Civil Partnership No relevant good practice None None Maternity / Pregnancy Women’s Health and

Maternity Services will support pregnant women

None None

who require isolation

9. Are there any gaps in the evidence outlined above? If ‘yes’ how will these be rectified?

No

10. Engagement has taken place with people who have protected characteristics and will continue through the Equality Delivery

System and the Equality Diversity and Human Rights Group. Please note you may require further engagement in respect of any significant changes to policies, new developments and or changes to service delivery. In such circumstances please contact the Equality and Diversity Lead or the Involvement and Equalities Officer.

Do you require further engagement? Yes No X

11. Could the policy, strategy or service have a negative impact on human rights? (E.g. the right to respect for private and family

life, the right to a fair hearing and the right to education?

No

PART 2 Name:

Allison Sykes

Date of completion:

3/9/2015

(If any reader of this procedural document identifies a potential discriminatory impact that has not been identified, please refer to the Policy Author identified above, together with any suggestions for action required to avoid/reduce the impact.)