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OUTBREAK POLICY

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					                                                                                       Outbreak Policy / Version 2
                                                                         Ratified by: Infection Control Committee
                                                                                 Date of Ratification: 29 Jan 2008
                                                                                   Date of Review: January 2010




                                            Outbreak Policy

                                                 Chapter I




Author’s Name                                               Frances Stratford / Katrina Walker
Author’s Job Title                                          Infection Control Nurses
Division                                                    Corporate Nursing
Department                                                  Infection Control Department
Version Number                                              2
Ratifying Committee                                         Infection Control Committee
Ratified Date                                               January 2008
Review Date                                                 January 2010
Name of Manager Responsible for Review                      Graham Ramsay
Job title of Manager Responsible for Review                 Director of Infection Prevention and Control
Email Address for this Manager                              Graham.Ramsay@whht.nhs.uk
Source of Evidence (if applicable)
Level of Evidence Indicated
Referenced (Yes/No)                                         Yes (Adapted from Royal Devon & Exeter
                                                            NHS Trust’s Outbreak Policies)
Key words (to aid searching)                                Infection control, outbreak, disease.
                                                            isolation
User Group                                                  All Staff

The Trust is committed to promoting an environment that values diversity. All staff are responsible for
ensuring that all patients and their carers are treated equally and fairly and not discriminated against on the
grounds of race, sex, disability, religion, age, sexual orientation or any other unjustifiable reason in the
application of this Policy, and recognising the need to work in partnership with and seek guidance from
other agencies and services to ensure that special needs are met.
                             Outbreak Policy / Version 2
               Ratified by: Infection Control Committee
                       Date of Ratification: 29 Jan 2008
                         Date of Review: January 2010




Page 2 of 10
                                                                                                                 Outbreak Policy / Version 2
                                                                                                   Ratified by: Infection Control Committee
                                                                                                           Date of Ratification: 29 Jan 2008
                                                                                                             Date of Review: January 2010
Contents

1.     Introduction .....................................................................................................................................4
       1.1 Definition of an Outbreak .......................................................................................................... 4
2.     Responsibility ..................................................................................................................................4
        2.1 Organisational ........................................................................................................................... 4
        2.2 Managerial ................................................................................................................................ 4
        2.3 Ward/Department ...................................................................................................................... 4
        2.4 Infection Control Team.............................................................................................................. 5
    2.5 Communication Flow Chart ...................................................................................................... 6
3. Re-opening the Ward ......................................................................................................................7
4. References......................................................................................................................................7
Appendix 1 – Suspected / Confirmed Gastro-Enteritis Outbreak Checklist ........................................... 7
Appendix 2 – D&V Outbreak Form ....................................................................................................... 9




                                                                    Page 3 of 10
                                                                                Outbreak Policy / Version 2
                                                                  Ratified by: Infection Control Committee
                                                                          Date of Ratification: 29 Jan 2008
                                                                            Date of Review: January 2010
1.    Introduction

      The purpose of this document is to provide clear infection control guidelines and a
      management process for the suspicion or confirmed outbreak of a transmissible infection.

1.1   Definition of an Outbreak

      An outbreak is normally characterised by a cluster of similar infections occurring in one area of
      the Trust within a concentrated period of time. Total or partial ward closure may be necessary
      to prevent transmission if significant risks to patients and staff are identified following a risk
      assessment.

      A closed ward/department is unable to accept new admissions or inter ward transfers, neither
      can it discharge patients to other health or social care premises without consultation with the
      infection control team (ICT). Staff transfers both into and out of the ward and use of
      bank/agency staff would normally be discouraged.

2.    Responsibility

2.1   Organisational

      •   To provide suitable and sufficient resources and facilities to enable effective management
          during a ward closure or an outbreak that is associated with significant risks to patients and
          staff

2.2   Managerial

      •   To maintain well informed operational control of outbreak in relation to the Trust’s
          responsibility to provide health care for patients.

      •   To liaise directly with and seek advice from the ICT.

2.3   Ward/Department

      •   To inform the ICT immediately of any suspected outbreaks/infection control concerns.

      •   To provide accurate documented and verbal information on patients and staff to the ICT at
          the earliest opportunity for a full assessment to be undertaken

      •   In cases of a suspected outbreak of gastro-intestinal illness, the ICT will need to be
          informed of the information listed in Appendix 1 for each symptomatic patient. This
          information can be provided by the ward staff either verbally or by completing the form in
          Appendix 1 for each patient.

      •   In cases of a suspected outbreak of any other transmissible infection, advice should be
          sought from the ICT as to what specific information needs to be collected in relation to each
          affected patient.

      •   To inform relevant persons of any imposed restrictions on patient and staff movement and
          measures to control the outbreak. A suggested contact list is included in the flow chart.

                                             Page 4 of 10
                                                                                Outbreak Policy / Version 2
                                                                  Ratified by: Infection Control Committee
                                                                          Date of Ratification: 29 Jan 2008
                                                                            Date of Review: January 2010
          Concerns regarding specific vulnerable groups, eg. Children, pregnant women, should be
          discussed with a member of the ICT.

      •   To provide ongoing, accurate documented and verbal information on patients and staff to
          the ICT if an outbreak is confirmed by the ICT. In the case of an outbreak of gastro-
          intestinal infection, a stool chart for each symptomatic patient should be maintained.

2.4   Infection Control Team

      When contacted by ward staff the ICT will complete a risk assessment and decide if an
      outbreak exists. The ICT will advise on the management required to limit further spread.

      •   In the case of an outbreak of gastro-intestinal infection, the ICN will update the information
          on a D&V outbreak form (Appendix 2) on a daily basis.

      •   The findings of the risk assessment will be documented by the ICT. The outcome of the
          assessment and, if appropriate, recommendations on ward closure will be given, during
          working hours to the relevant clinicians, managers and executive director or, out of hours,
          to the on-call senior nurse/manager.

      •   The ICT will review any new information on patient and hospital status as and when
          required and advise on outbreak management as appropriate.

      •   The ICT will liaise with the bed management team to advise regarding the placement of
          patients and admission to the ward.

      The above process can be viewed on the following flow chart:




                                             Page 5 of 10
                                                                                   Outbreak Policy / Version 2
                                                                     Ratified by: Infection Control Committee
                                                                             Date of Ratification: 29 Jan 2008
                                                                               Date of Review: January 2010
2.5     Communication Flow Chart

                                  Suspected outbreak in clinical areas


                                        Clinical area to inform ICT
                            Collect information and pass immediately to ICT


                                  Risk assessment undertaken by ICT


                  Outbreak confirmed by ICT             Outbreak not confirmed – Ward
                                                      to keep ICT informed of any
                                                             further development


      ICT recommends appropriate control measures, which may include ward closures, to relevant
                                clinicians, managers and executive director.
          Out of hours, on-call microbiologist to liaise with on-call senior nurse/on-call manager.


                       ICT informs affected ward and operations team of decision


                   ICT issues outbreak management advice in writing or by e-mail to:
                                         Affected ward/department
                                            Director of operations
                           Senior nurse/s (cascade information to nursing staff)
                         Clinical director/s (cascade information to medical staff)
                    Directorate managers/s (cascade information to any other staff)
                                                Bed manager
           Director of facilities (cascade information to heads of departments within facilities)
                                               On-call manager
                                     Occupational health (if staff involved)
                                              Director of nursing
                                         Communications manager
                                              Nurse bank office


                                 Ward advises control measures to:
                                                 Patients
                                     Visitors (families and friends)
                        Any other person who needs to enter the clinical area
 eg. OT’s physio’s, pharmacy, phlebotomy, porters, estates staff, chaplains, housekeeping staff etc.
 And staff in other departments that patients pay need to visit for investigations eg. X-ray, cardiology
                                                   etc.




                                               Page 6 of 10
                                                                               Outbreak Policy / Version 2
                                                                 Ratified by: Infection Control Committee
                                                                         Date of Ratification: 29 Jan 2008
                                                                           Date of Review: January 2010
3.   Re – Opening the Ward

     Ongoing review of the need for closure will be undertaken by the ICT and reported to the
     interested parties at bed management meetings and/or outbreak control meetings. The ICT
     will recommend the re-opening of a ward as soon as it is appropriate, and arrange for terminal
     cleaning.

4.   References

     Owen Caul, E. (1994) Small round structured viruses; airborne transmission and hospital
     control. Lancet. 343, 1240-1242.

     PHLS. (2000) Viral gastroenteritis working group. Management of hospital outbreaks of
     gastro-enteritis due to small round structured viruses. Journal of Hospital Infection. 45, 1-10.

     This Policy should be read in conjunction with the following Policies:

            •   Management of Infection Prevention & Control Policy (February 2008)
            •   All other related Infection Control Policies as outlined within the Management of
                Infection Prevention & Control Policy under Section 6.2. (Please refer to Section 6.2
                for the list of Policies and dates)




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                                                                             Outbreak Policy / Version 2
                                                               Ratified by: Infection Control Committee
                                                                       Date of Ratification: 29 Jan 2008
                                                                         Date of Review: January 2010

Addressograph                                                                    APPENDIX 1




               SUSPECTED/CONFIRMED GASTRO-ENTERITIS OUTBREAK
                                 CHECKLIST

    Information the infection control team will require on each patient to assist in the
                 assessment of suspected viral gastro-enteritis outbreak

1    Date and time of onset of symptoms

2    Diarrhoea (liquid stools – J, K, L on Kings stool chart

3    Vomiting (more than one episode, continued retching)

4    Has patient had antibiotics?

5    Has patient had laxatives/aperients?

6    Does the patient have a pre-existing medical condition
     which may predispose them to diarrhoea?
7    Is this the patient’s normal bowel habit?

8    Is the patient pyrexial?

9    Specimen obtained/date sent

10 Has the patient been exposed to symptomatic
   patients/family/staff/visitors?
11 Position on ward? 6 or 4 bed bay / side room

12 Are there any other family members affected?

13 Has the patient been reviewed by the medical team to
   exclude other causes?
14 Is the patient receiving naso-gastric feeding/TPN?




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                                                                     Outbreak Policy / Version 2
                                                       Ratified by: Infection Control Committee
                                                               Date of Ratification: 29 Jan 2008
                                                                 Date of Review: January 2010
If the answer to 4,5,6 or 7 is YES, think ‘is this infectious origin or could there be
another cause?’




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                                                                                                                         Outbreak Policy / Version 2
                                                                                                           Ratified by: Infection Control Committee
                                                                                                                   Date of Ratification: 29 Jan 2008
                                                                                                                     Date of Review: January 2010
                                                                                         D&V OUTBREAK FORM
                                                            Appendix 2

Date reported:                             Ward:                                                  Hospital:

     Name        Bed   Symptoms   Start   Spec   Resul   Relevant drug                                    Progress on subsequent days
                 No.   D    V     date    sent   t       therapy or medical   Date         Date       Date         Date       Date       Date          Date
                                          date           condition
                                                                              D      V     D      V   D      V     D      V   D      V   D      V      D      V




                                                            Page 10 of 10

				
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