Alert Organisms Respiratory Viruses

Transcription

1 Infection Prevention and Control Assurance Standard Operating Procedure 24 (IPC SOP 24) Alert Organisms Respiratory Viruses Why we have a procedure? To ensure employees of the Black Country Partnership NHS Foundation Trust have a standard procedure to follow when caring for patients symptomatic with respiratory viruses to minimise and manage the risks of transmission. The Health and Social Care Act 2008: Code of Practice for the NHS for the Prevention and Control of Healthcare Associated Infections (revised January 2015) stipulates that NHS bodies must, in relation to preventing and controlling the risk of Health Care Associated Infections (HCAI), have in place appropriate core policies/procedures. Implementation of this procedure will contribute to the achievement and compliance with the Act. What overarching policy the procedure links to? This procedure is supported by the Infection Prevention and Control Assurance Policy Which services of the trust does this apply to? Where is it in operation? Group Inpatients Community Locations Mental Health Services all Learning Disabilities Services all Children and Young People Services all Who does the procedure apply to? This document applies to all staff employed by or working on behalf of the Black Country Partnership NHS Foundation Trust caring for patients as part of their role and job description. When should the procedure be applied? Effective prevention and control of healthcare associated infection (HCAI) must be embedded into everyday practice and applied consistently. This procedure must be applied when caring for patients symptomatic with known or suspected respiratory viral infections. Additional Information/ Associated Documents Infection Prevention and Control Assurance Policy Hand Hygiene Policy Seasonal Influenza Policy Pandemic Influenza Policy Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP 1) - Standard Infection Control Precautions Alert Organisms Respiratory viruses Page 1 of 16 Version 1.0 July 2016

2 Infection Prevention and Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) - Transmission Based Precautions Infection Prevention and Control Assurance - Standard Operating Procedure 3 (IPC SOP 3) - Surveillance of Infection and Data Collection Infection Prevention and Control Assurance - Standard Operating Procedure 4 (IPC SOP 4) - Reporting Incidents of Infection to Public Health England and/or the Local Authority Infection Prevention and Control Assurance - Standard Operating Procedure 5 (IPC SOP 5) - Management and Recognition of Outbreaks of Communicable Infection/Disease Infection Prevention and Control Assurance - Standard Operating Procedure 6 (IPC SOP 6) - Isolation Care of Patients in Isolation due to Infection or Disease Infection Prevention and Control Assurance - Standard Operating Procedure 7 (IPC SOP 7) - Decontamination - Cleaning, Disinfection and Sterilisation Infection Prevention and Control Assurance - Standard Operating Procedure 13 (IPC SOP 13) - Closure of Wards due to an Infection Control Issue Infection Prevention and Control Assurance - Standard Operating Procedure 14 (IPC SOP 14) - Undertaking a Patient Infection Risk Assessment Aims To reduce the risk of transmission of respiratory viruses by ensuring that Trust staff: Are alert to the risks of individual patients symptomatic with viral respiratory illness Ensure patients with respiratory viruses have appropriate infection prevention and control related care and management by isolating symptomatic patients promptly to reduce the risks of transmission To aid diagnosis by sending appropriate specimens to the laboratory in a timely manner To administer appropriate treatment as/when indicated Inform other healthcare providers of the patients infectious status when any transfers of care are planned either internally within the Trust or to external care providers Definitions Aerosol generating procedure Healthcare Acquired Infection (HCAI) Infection IPCT Pathogenic Risk Assessment WHO Procedures likely to generate aerosols e.g. endotracheal intubation, extubation, manual ventilation, respiratory and airway suctioning, sputum induction and resuscitation (emergency intubation or CPR). Healthcare associated infection (HCAI) refers to infections that occur as a result of contact with the healthcare system in its widest sense from care provided in the patient s own home, to general practice, hospital and nursing home care. The presence of microorganisms on/in the body that is causing an adverse effect or hostresponse the person is unwell and has signs and symptoms of an infection Infection Prevention and Control Team A medical term that describes micro-organisms that can cause some kind of disease. A process used to identify and potential hazards and analyse what could happen and to identify steps to be taken to reduce or minimise the risk. World Health Organisation Alert Organisms Respiratory viruses Page 2 of 16 Version 1.0 July 2016

3 What are Respiratory Viruses? A respiratory tract infection (RTI) is an infectious process affecting any part of the upper and/or lower airways. Respiratory infections are common, principally causing colds in both adults and children. The majority of RTIs are self-limiting, viral infections of the upper respiratory tract but they can result in severe disease and even death, usually in vulnerable patient groups including the elderly, infants and those with other co-morbidities. The viruses which cause RTIs are easily transmitted between people and therefore additional infection control precautions are required for those affected and who are admitted to health care facilities. There is a wide variety of viral causes of respiratory infection including: Influenza A, B and C Human Para-influenza (HPIV) Respiratory Syncytial Virus (RSV) Rhinovirus (common cold) Coronavirus Adenovirus Human metapneumovirus (hmpv) (See Appendix 1 for more information on these viruses) More severe disease with a high mortality rate have been associated with newly emerging respiratory viral infections such as MERS CoV (Middle East Respiratory Syndrome Coronavirus), SARS (Severe Acute Respiratory Syndrome) and Avian Influenza, therefore such infections require higher levels of precautions in hospitalised patients. In addition bacteria may cause lower respiratory tract infections, some of which follow an initial viral infection. Outbreaks of respiratory virus infection are associated with increased hospitalisations and mortality. Patients with compromised immune, cardiac or pulmonary systems are at increased risk of serious complications of infection. Infected healthcare workers and visitors are potential sources of healthcare acquired infection. Symptoms Symptoms of a viral RTI can include any of the following: Fever Rhinorrhoea (runny nose) Sore throat Cough Limb or joint pain Headache Lethargy Chest pain and breathing difficulty In general the symptoms start 1-2 days after the person catches the virus and may last 1-10 days depending on which virus is causing the illness. If staff suspect a patient has a viral RTI advice should be sought from the IPCT. Alert Organisms Respiratory viruses Page 3 of 16 Version 1.0 July 2016

4 Routes of Transmission for Respiratory Viruses The pathogens that cause respiratory tract infections are spread through one or more of four main routes: Large Droplet Transmission: Virus containing droplets greater than 5 microns in size may be generated from the respiratory tract during coughing, sneezing or talking. If droplets from an infected person come into contact with the mucous membranes (mouth or nose) or surface of the eye of a recipient, they can cause infection. These droplets remain in the air for a short period and travel about one metre, so closeness is required for transmission Direct Contact Transmission: Infectious agents are passed directly from an infected person to a recipient who then unknowingly transfers the organism into their mouth, nose or eyes Indirect Contact Transmission: A recipient has contact with a contaminated object (fomite) e.g. furniture or equipment. The recipient then unknowingly transfers the organism from the object to their mouth, eyes or nose Airborne transmission during and after Aerosol Generating Procedures (AGPs): AGPs (e.g. endotracheal intubation, open suctioning, bronchoscopy etc.) can produce droplets <5 microns in size. These small droplets can remain in the air, travel more than one metre from the source and still be infectious, either by mucous membrane contact or inhalation Laboratory Diagnosis For patients in a hospital setting hospital with suspected influenza or respiratory viral infection, viral swabs should be taken. These are sent to the laboratory where they will undergo molecular PCR (polymerase chain reaction) testing for a panel of respiratory viruses including influenza. The Infection Prevention and Control Team or Consultant Microbiologist should be contacted prior to collecting specimens to ensure the correct viral transport swabs are available and the type of specimen is appropriate. N.B. When collecting specimens staff must wear PPE including gloves, apron, face and eye protection. Key Recommendations Advice about specific issues such as seasonal influenza and pandemic influenza are covered in separate policies which can be found on the Trust intranet site. Measures to Prevent Transmission All patients with a suspected respiratory viral infection should be nursed in a single room (door closed) with standard and transmission based precautions - see Infection Prevention and Control Assurance - Standard Operating Procedure 6 (IPC SOP 6) - Isolation Care of Patients in Isolation due to Infection or Disease for further information. Symptomatic patients must be transferred and nursed in single room isolation as soon as possible after diagnosis (within 2 hours). Patients should be reminded about the importance of remaining in isolation and should themselves avoid contact with other patients/carers in the ward. Alert Organisms Respiratory viruses Page 4 of 16 Version 1.0 July 2016

5 Route of transmission Measures to prevent transmission Direct person to person by large Segregation (isolation) of the coughing/sneezing patient droplet transmission (from direct close contact with an infected person during the period of infectivity) Standard infection control precautions [See Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP 1) - Standard Infection Control Precautions] Droplet precautions (wear a surgical mask when in isolation room or within 1m of the infected person Contact precautions [See Infection Prevention and Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) - Transmission Based Precautions] Indirect contact with items contaminated by large droplets (from respiratory tract of infected person which may contaminate the Standard infection control precautions [See Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP 1) - Standard Infection Control Precautions] environment for short periods. Virus can be transmitted by indirect Hand hygiene after every contact with patient and their immediate environment (see Hand Hygiene policy) contact from contaminated surfaces Environmental and equipment cleaning Infection onto hands) Prevention and Control Assurance [see Infection Prevention and Control Assurance - Standard Operating Procedure 7 (IPC SOP 7) - Decontamination - Cleaning, Disinfection and Sterilisation] Contact precautions [See Infection Prevention and Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) - Transmission Based Precautions] Airborne fine droplet transmission in some activities where risk of aerosol is high Standard infection control precautions [See Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP 1) - Standard Infection Control Precautions] Contact precautions [See Infection Prevention and Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) - Transmission Based Precautions] Additional PPE for staff performing aerosol generating procedures - IPCT will advise re face protection. N.B. Fit Testing will be required for use of FFP3 respirator masks N.B. Avoid use of fans that re-circulate the air. Respiratory Etiquette Respiratory hygiene/ cough etiquette: Patients should receive active instruction and supplies to ensure they cover their mouth and nose when coughing/sneezing and use tissues to contain respiratory secretions. Some patients (e.g. elderly, children) may need help with containment of respiratory secretions Provision should be made for patients to dispose of tissues immediately into an appropriate waste receptacle prior to discarding into yellow clinical waste bag Provision should be made for patients to perform hand hygiene after contact with respiratory secretions and contaminated items Some respiratory virus patients may be able to mobilise within non-clinical areas depending on their symptoms and the type of ward they are on. Individual patient advice regarding the Alert Organisms Respiratory viruses Page 5 of 16 Version 1.0 July 2016

6 mobilisation and participation in therapeutic activities can be obtained from the IPCT; however communal activities should be suspended while the patient is symptomatic. Personal Protective Equipment (PPE) for care of patients with viral respiratory infection PPE Entry to isolation room or close patient contact (within 1 metre) Aerosol Generating Procedures Hand Hygiene Gloves Plastic apron X Long-sleeved gown X Surgical face mask X Eye protection Risk assessment (risk of aerosol/splash) Respirator Mask X Gloves and aprons MUST be used when handling secretions from the nose and mouth Hand hygiene MUST always take place after removal of personal protective equipment Key Observations Each patient should be reviewed daily by the medical team to review the following observations made by the nursing team: Clinical vital signs e.g. temperature, pulse, respirations and blood pressure should be observed and recorded 4-hourly for all patients symptomatic with a respiratory viral illness, to monitor for clinical signs of infection/sepsis/deterioration until the patient has been symptom free for at least 48 hours. Any concerns must be brought to the attention of the Nurse-in-Charge and the medical team The infection Prevention Team and Consultant Microbiologist should be contacted immediately where clinical signs, travel history and exposure suggest infection with a new or re-emerging respiratory disease such as SARS CoV, Avian Influenza or MERS CoV (See Appendix 2): Clinical signs- fever > 38 C OR history of fever and respiratory symptoms OR other lifethreatening illness with both geographical and exposure criteria fulfilled Geographical travel in the last 2 weeks to any area of the world known to have cases of severe unexplained respiratory illness Exposure within 7 days of onset of symptoms (See Appendix 2 for more information) On presentation - prior to medical assessment the patient should be placed immediately in a single room. The patient must wear a surgical mask. Healthcare workers must wear a mask (ideally wear a tight fitting (respirator) mask, or if not available immediately then a surgical mask), long sleeved gown and gloves. Use of a mask does not substitute for good infection control management. It should be used as an extra precaution to reduce any aerosols generated by coughing or sneezing. Cleaning Ensure the rooms of patients with respiratory viral infections are prioritised for frequent cleaning (at least daily) with a focus on frequently touched surfaces and equipment in the immediate vicinity of the patient Alert Organisms Respiratory viruses Page 6 of 16 Version 1.0 July 2016

7 Keep the environment clean and clutter free Use disposable cloths Clinical equipment should as far as possible be allocated to the individual patient Re-usable equipment MUST be decontaminated after patient use and between each patient See Infection Prevention and Control Assurance - Standard Operating Procedure 7 (IPC SOP 7) - Decontamination - Cleaning, Disinfection and Sterilisation for more information. Environmental cleaning is vitally important in preventing the spread of infection. The cleaning regime incudes the standard daily clean followed by disinfection with 1,000ppm chlorine solution. N.B When a patient with a respiratory virus is transferred/discharged the room/bed space must have a terminal deep clean undertaken before its re-use this includes replacing curtains. Contact the Estates and Facilities Helpdesk to arrange on or ext.: 8010 Discontinuation of precautions Providing symptoms are no longer present, isolation can usually be discontinued 7 days after onset of clinical illness. If symptoms persist for longer than 7 days isolation should be continued until these resolve. N.B. Immunocompromised patients may excrete viruses for a longer period. The Infection Prevention Team should be contacted for advice in these situations. On discontinuation of precautions a thorough isolation clean should be carried out using detergent and hot water followed by a 1,000PPM chlorine solution. Visitors All visitors with symptoms of respiratory viral infections should be discouraged from visiting. Where patients are particularly predisposed to infection such as caring for the elderly and immune-compromised it is strongly advised that anyone with symptoms of a cold/respiratory virus should not be allowed to visit. (Information for patients and carers can be seen in Appendix 3) Staff Healthcare staff with flu-like symptoms should stay at home and report sick in the normal way to their line manager. Advice can be sought from Occupational Health and the Infection Prevention and Control Team Staff should be encouraged to have the annual flu vaccination to protect themselves and their patients, especially if working with vulnerable patients. Influenza vaccines give 70-80% protection, they are inactivated, do not contain live organisms and cannot cause the diseases against which they protect. These are available to Trust frontline healthcare care staff from October through to February each year but early uptake is recommended in October and November in order to reduce the risks to patients Pregnant healthcare staff or those with health-related concerns or risks (e.g. respiratory problems) about providing care for patient with influenza-like illness should seek advice from Occupational Health Discharge/Transfer of Patients with a Respiratory Viral Illness Good communication is essential to ensure a safe transfer of patients with a respiratory virus. Alert Organisms Respiratory viruses Page 7 of 16 Version 1.0 July 2016

8 Transfers out - If a symptomatic patient is to be transferred to another hospital or other care provider, the receiving ward/department/care home should be notified prior to the transfer taking place this is the responsibility of the Nurse-in-Charge. When transferring to another hospital the IPCT will liaise with the receiving Trusts IPCT [see Infection Prevention and Control Standard Operating Procedure 16 (IPC SOP 16) - Sharing Information with other Health and Social Care Providers]. Transfers between wards Patients with a respiratory virus must only be transferred to another area due to clinical necessity. If these patients are transferred within the Trust, the receiving area must be fully aware of the precautions necessary prior to transfer. The patient must not be transferred until the receiving area is prepared. In addition the IPCT must also be informed of the planned transfer PRIOR to the transfer taking place so that appropriate information and advice can be given. Outbreaks/Periods of Increased Incidence of Respiratory Viral Illness In the unlikely incident of a period of increased incidence of respiratory viral illness involving patients and or staff, the Infection Prevention and Control Team will convene an Outbreak Management Group if deemed necessary [See Infection Prevention and Control Assurance - Standard Operating Procedure 5 (IPC SOP 5) - Management and Recognition of Outbreaks of Communicable Infection/Disease]. Where there is evidence of respiratory viral illness transmission and acquisition, the advice of the Consultant Microbiologist will be sought. Where do I go for further advice or information? Infection Prevention and Control Team Physical Health Matron Your Service Manager, Matron, General Manager, Head of Nursing, Group Director Your Group Governance Staff Training Staff may receive training in relation to this procedure, where it is identified in their appraisal as part of the specific development needs for their role and responsibilities. Please refer to the Trust s Mandatory and Risk Management Training Needs Analysis for further details on training requirements, target audiences and update frequencies. Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness. Equality Impact Assessment Please refer to overarching policy Data Protection Act and Freedom of Information Act Please refer to overarching policy. Alert Organisms Respiratory viruses Page 8 of 16 Version 1.0 July 2016

9 Appendix 1 Respiratory Virus Overview Influenza Pandemic Influenza Influenza or 'flu' is a respiratory illness caused by infection by influenza virus. It affects mainly the nose, throat, bronchi and, occasionally, lungs. Infection usually lasts for about a week, and is characterized by sudden onset of high fever, aching muscles, headache and severe malaise, non-productive cough, sore throat and rhinitis. Influenza occurs most often in winter and usually peaks between December and March in the northern hemisphere. Illnesses resembling influenza that occur in the summer are usually due to other viruses. There are two main types that cause infection: Influenza A and Influenza B, Influenza A usually causes a more severe illness than Influenza B. The influenza virus is unstable and new strains and variants are constantly emerging, which is one of the reasons why the flu vaccine should be given each year. The typical incubation period for influenza can be up to 7 days, with an average of 2-5 days. Individuals infected with influenza are regarded as being infectious for one day before the onset of symptoms and up to 7 days after the onset of the symptoms. Severely immunocompromised persons can shed virus for weeks or months. Most infected people recover within one to two weeks without requiring medical treatment. However, in the very young, the elderly, and those with other serious medical conditions, infection can lead to severe complications of the underlying condition, pneumonia and death. (See the Seasonal Influenza Policy for further guidance) Pandemics arise when a new influenza virus emerges which is capable of spreading in the worldwide population. Pandemic Influenza may occur when a new Influenza A virus subtype emerges which is markedly different from recently circulating strains and is able to infect humans and spread efficiently from person to person, and cause significant clinical illness in a high proportion of those infected. This was the situation during the influenza pandemic of , when a completely new influenza virus subtype emerged and quickly spread around the globe. The H1N1 (2009) 'swine flu' pandemic virus emerged in Mexico in 2009 and spread around the world causing mild/asymptomatic disease in the majority of cases but severe illness and death in a small proportion of cases, particularly in more vulnerable groups. In August 2010 the WHO officially declared the H1N1 (2009) pandemic over. As of April 2016, this strain still accounts for 84% of the circulating seasonal Influenza A virus. (See the Pandemic Influenza Policy for guidance on actions in the event of a new Influenza pandemic). Alert Organisms Respiratory viruses Page 9 of 16 Version 1.0 July 2016

10 Avian Influenza Parainfluenza (HPIV) Avian Influenza (bird flu) is a disease of birds caused by Influenza A viruses closely related to human influenza viruses. It naturally circulates in wild waterfowl such as ducks and geese; other bird species are susceptible and it may cause severe disease in birds with high mortality. Since December 2003 there have been outbreaks of an avian influenza caused by a virulent H5N1 subtype of the influenza A virus, affecting poultry in central and east Asia. Avian influenza A subtype H7N9 has also emerged in China since March 2013 and a few cases of avian Influenza A H10N8 have been reported in Although human infections with these viruses have occurred, usually after close contact with poultry, these viruses do not currently infect humans easily. There have been no reports to date of sustained human-to-human transmission, although the associated mortality has been high. However, the potential for transformation of avian influenza into a form that both causes severe disease in humans and spreads easily from person to person leading to an avian influenza pandemic is a great concern for world health. Additional precautions are indicated if epidemiology suggests possible exposure to avian influenza (including returning travellers) There are four types of Human Parainfluenza Virus (Types 1 to 4) and two subtypes (4A and 4B). They are generally considered community acquired respiratory pathogens. HPIV1-4 infection is one of the common causes of upper and lower respiratory tract disease, especially in young children. The incubation period is from 1-7 days, initiation of infection occurs when contact is made between the virus and nasal mucosa. HPIV types 1-4 can cause a full spectrum of respiratory illness, including the common cold, croup, and severe lower respiratory tract illness, such as bronchitis, bronchiolitis and pneumonia. Treatment is generally supportive, requiring maintenance of airway and hydration. Steroids can be beneficial in treatment of croup. No vaccinations have yet proved successful. The incubation period ranges from 2-8 days. The communicability ranges from 2 days prior to onset of symptoms to 10 days after their resolution. However in young infants viral shedding may continue for as long as 3-4 weeks. Respiratory Syncytial Virus (RSV) For most people, RSV infection causes a respiratory illness that is generally mild. For a small number of people who are at risk of more severe respiratory disease, RSV infection might cause pneumonia or even death. Those most at risk of developing severe illness due to RSV are the very young, aged 1 year and under and the elderly. RSV is best known for causing bronchiolitis in infants. The virus is transmitted by large droplets and secretions from the respiratory tract of infected individuals. Studies have demonstrated that most cross infection is due to direct contact or indirect contact or through fomites rather than airborne spread. There are no vaccines against RSV although children at high risk from infection may be offered passive immunity with monoclonal antibody preparation (Palivizumab) in line with Department of Health guidelines. Alert Organisms Respiratory viruses Page 10 of 16 Version 1.0 July 2016

11 Adenovirus The incubation period is generally 4 to 10 days and uncomplicated infection usually resolves within 1 week. Adenoviruses can cause a wide range of presentations. Symptoms of adenovirus infection can be similar to the common cold, influenza or even pneumonia, croup, and bronchitis. Conjunctivitis, pharyngoconjunctival fever and gastroenteritis can also be caused by adenoviruses. Respiratory adenovirus infection is spread via droplet, direct contact or indirect via a contaminated surface or object. The virus is relatively resistant to physical and chemical agents, facilitating transmission by direct contact, water, contaminated objects, respiratory droplets and fomites. Their stability at low ph, such as gastric secretions allows faecal-oral spread. Virus enters via the mucosal surfaces of the eye, nose or mouth. Standard respiratory infection control procedures must be implemented for suspected or actual infection. Human metapneumovirus is a respiratory pathogen closely related to RSV. It is associated with a range of illnesses from mild infection to severe bronchiolitis and pneumonia. Human Metapneumovirus (HMpV) HMpV is a common but under diagnosed cause of community-acquired respiratory illness in infants, children and adults. After an estimated incubation period of 5-6 days it causes upper and lower respiratory tract infections (URTI, LRTI), with symptoms ranging from subclinical to severe pneumonitis. In infants/ children under 2 years, HMpV is an important cause of bronchiolitis and pneumonia. An individual patient with HMpV is clinically indistinguishable from one with RSV and so clinical diagnosis is unreliable. Spread of HMpV is presumed to be airborne and by fomites. There is no vaccine and respiratory precautions and hand washing should be used to prevent spread. Rhinovirus Coronavirus Transmission of rhinoviruses is via direct contact, although infections have been documented by both large and small particle aerosols. Initiation of infection occurs when contact is made between the virus and nasal mucosa. Viral shedding persists after the resolution of symptoms and has been cultured from 10-20% of patients 2-3 weeks after the infection. The symptoms of a rhinovirus infection are: discharging or blocked nasal passages often accompanied by sneezes, and perhaps a sore throat. A "runny nose" (rhinorrhoea) may be accompanied by a general malaise, cough, sore throat etc. The characteristic symptoms occur from one to four days after infection at which time extremely high titres of the rhinovirus are found in the nasal secretions (there can be as many as 1000 infectious virus particles per ml). Rhinoviruses do not usually cause lower respiratory tract infection. They are sometimes detected in patients with severe respiratory tract infection but this may be an incidental finding. Their contribution to disease in the immunosuppressed however has not been fully elucidated. Human coronaviruses were first identified in the mid-1960s and are named after the crown like projections that can be seen on the surface of the virus. These viruses cause respiratory infections of varying severity in humans and animals. Although many strains of coronavirus produce mild upper respiratory tract infection, the SARS (Severe Acute Respiratory Syndrome) coronavirus and MERS (Middle East Respiratory Syndrome) viruses are both coronaviruses which can cause severe respiratory disease. Additional precautions are indicated if epidemiology suggests possible exposure to these severe diseases (usually returning travellers). Alert Organisms Respiratory viruses Page 11 of 16 Version 1.0 July 2016

12 Severe Acute Respiratory Syndrome Coronavirus (SARS CoV) Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) SARS is a severe respiratory disease caused by SARS coronavirus (SARS CoV). It was first recognised in Guangdong Province in China in November 2002, and spread worldwide before being contained by 5 July Between July 2003 and May 2004, four small and rapidly contained outbreaks of SARS have been reported; three of which appear to have been linked to laboratory releases of SARS-CoV. The possibility of SARS re-emergence remains and there is a need for continuing vigilance. This new coronavirus was first identified in September 2012 in a patient who died from a severe respiratory infection in June As of May 2016 there have been over than 1728 cases detected globally (in over 26 countries) the majority of these in Saudi Arabia and Korea. However, this is a dynamic situation and more cases may be reported. In around half of the cases reported to date, the patients have died. The primary source of infection is still not known. There is growing evidence that the infection is spread by the fine droplets created when people cough and sneeze, in common with many other respiratory viruses such as the cold virus and influenza. So far there is only evidence of limited, non-sustained person-to-person transmission. If the virus was easily spread, many more cases linked to people caring for cases or in contact with them would have been expected. Alert Organisms Respiratory viruses Page 12 of 16 Version 1.0 July 2016

13 Appendix 2 When to Suspect the Diagnosis of Serious Respiratory Illness SARS Coronavirus MERS Coronavirus Avian Influenza SARS should be considered in patients presenting with an acute respiratory illness AND: MERS should be considered as a possible diagnosis in any patient with severe acute respiratory infection requiring admission to hospital AND: Avian influenza A/H7N9 should be considered as a possible diagnosis in a patient who presents with: History of travel to an area Fever of >38 C AND classified by WHO as a Fever of >38 C or history Clinical or CXR findings of potential zone of reemergence of SARS OR Evidence of pulmonary severe illness suggestive of fever and cough AND consolidation OR other A history of exposure to parenchymal disease (e.g. of an infectious process laboratories or institutes clinical or radiological AND which have retained SARS evidence of pneumonia or Patient has visited China virus isolates and/or Acute Respiratory Distress in the 10 days before diagnostic specimens from Syndrome AND onset of symptoms OR patients within 10 days of No alternative diagnosis to Patient has had close onset of illness fully explain the illness contact with avian AND AT LEAST ONE OF: influenza A/H7N9 The respiratory illness should History of travel to or confirmed case in the 10 be severe enough to warrant residence in an area days before onset of hospitalisation and include a where infection with history of: symptoms MERS-CoV could have Fever of 38 C AND been acquired in the 14 One or more symptoms of Avian influenza A/H5N1 days before symptom lower respiratory tract should be considered as a onset OR illness (cough, difficulty possible diagnosis in a Close contact during the breathing, shortness of patient who presents with: 14 days before onset of breath) Fever of >38 C AND illness with a confirmed Radiographic evidence of Clinical or CXR findings of case of MERS-CoV lung infiltrates consistent consolidation OR other infection while the case with pneumonia or severe illness suggestive was symptomatic OR Respiratory Distress of an infectious process Healthcare worker based Syndrome AND AND in Acute ICU caring for No alternative diagnosis to patients with severe acute EXPOSURE within 7 fully explain the illness respiratory infection, days prior to the onset of regardless of travel or use symptoms - Isolate the patient and of PPE OR Close contact (within 1 contact the Infection Part of a cluster of two or metre) with live, dying or Prevention and Control more epidemiologically dead domestic poultry or Team and the Consultant linked cases within a two wild birds, including live Microbiologist immediately week period, regardless of bird markets, in an area history of travel. of the world affected by avian influenza A/H5N1, or with any confirmed Where the diagnosis of avian influenza, SARS, MERS or A/H5N1 infected animal any new severe respiratory viral infection is suspected (e.g. cat or pig) then the Consultant Microbiologist at the local acute Close contact (providing hospital and Public Health England must be notified care/touching/speaking promptly [See Infection Prevention and Control distance within 1 metre Assurance - Standard Operating Procedure 4 (IPC with human case of: SOP 4) - Reporting Incidents of Infection to Public Severe unexplained Health England and/or the Local Authority] respiratory illness Unexplained illness Infection Prevention and Control Standard and resulting in death Alert Transmission Organisms Respiratory based precautions viruses must Page be 13 implemented of 16 Version 1.0 from July WHO 2016 listed immediately. areas.

14 Author: XXX Department: XXX Ref.No: XXX Issue Date: XXX Review Date: XXX Why have I been isolated in my room? In order to reduce the risk of spreading the infection to other vulnerable patients you will be asked to stay in your room for a few days and the staff looking after you will need to wear protective clothing (gloves, apron and face protection) to reduce the risk of them spreading the infection to themselves and others. Appendix 3 Respiratory Etiquette To reduce the risk of spreading your germs to others please: Cover your mouth and nose with a tissue when coughing and sneezing Dispose of the used tissue in the bin/rubbish bag provided after use Wash your hands after contact with your nose, mouth and used tissues Stay in your room as advised by the nursing staff What is the treatment? e Respiratory Viral Infection (e.g. colds and flu) - Taking paracetamol, ibuprofen, or aspirin to reduce a high temperature (fever), and to ease any aches, pains and headaches. (Children aged under 16 should not take aspirin.) - Having plenty to drink if you have a fever, to prevent mild lack of fluid in the body (dehydration). - If you smoke, you should try to stop for good. URTIs and serious lung diseases tend to last longer in smokers. Your local Pharmacist can advise on the best treatment for your symptoms. Information for patients and carers What about antibiotics? Antibiotics are not usually advised if you are normally in good health. Your immune system can usually clear the infection. Antibiotics do not kill germs which are viruses. Antibiotics may be prescribed if you become more unwell or if you already have an underlying chronic lung disease. Infection prevention and control is everyone s responsibility. Patients and visitors all have an important role to play in preventing the spread of healthcare associated infections. Visitors with symptoms of cold/flu are advised not to visit the hospital. If you require further advice or information, please contact the Trust s Infection Prevention and Control Team or a member of the ward/department staff. Alert Organisms Respiratory viruses Page 14 of 16 Version 1.0 July 2016

15 The common cold and most upper respiratory infections are caused by infection with germs (viral infections). They usually get better in a few days. This leaflet gives some tips on what to do, and what symptoms to look out for which may indicate a more serious illness. What is an upper respiratory tract infection (URTI)? A cold is an infection of the nose and upper airways caused by a germ (virus). They are extremely common. An adult can expect 2-4 colds a year, and a young child about 3-8 colds a year. Many different viruses can cause a cold. This is why colds come back (re-occur), and immunisation against colds is not possible. Infections of the throat (larynx), or the main airway (trachea), or the airways going into the lungs (bronchi) are also common. These infections are sometimes called laryngitis, tracheitis, or bronchitis. Doctors often just use the term upper respiratory tract infection (URTI) to include any, or all, of these infections. Most URTIs are due to a viral infection. What are the symptoms of an URTI? The common symptoms of a cold are a blocked (congested) nose, a runny nose, and sneezing. At first there is a clear discharge (mucus) from the nose. This often becomes thick and yellow/green after 2-3 days. It may be difficult to sleep due to a blocked nose. You may feel generally unwell and tired, and you may develop a mildly high temperature (a mild fever). In other upper respiratory infections, cough is usually the main symptom. Other symptoms include fever, headache, aches and pains. Most URTIs do not cause complications. A URTI may trigger coughing, wheezing and shortness of breath in people with asthma or other lung diseases. Sometimes the infection travels to the lung tissue, sinuses, or ears. Germs (bacteria) may thrive in the mucus so some people develop a secondary bacterial infection of the lung tissue (pneumonia), ears or sinuses. Symptoms are typically at their worst after 2-3 days, and then gradually clear. However, the cough may carry on after the infection has gone. This is because swelling (inflammation) in the airways, caused by the infection, can take a while to settle. It may take 2-3 weeks, after other symptoms have gone, for a cough to clear completely Therefore, see a doctor if symptoms do not start to ease within a few days, or if you suspect that a complication is developing. In particular, symptoms to look out for that may mean more than just an URTI include: If high temperature (fever), wheezing or headaches become worse or severe. If you develop fast breathing, shortness of breath or chest pains. If you cough up blood or if your phlegm (sputum) becomes dark or rustycoloured. If you become drowsy or confused. If a cough persists for longer than 3-4 weeks. If you have returning (recurring) URTIs. If any other symptom develops that you are concerned about Good hand hygiene is the most important way to prevent the spread of respiratory viruses Posters showing the best way to wash your hands are available at the hand wash sinks. Alert Organisms Respiratory viruses Page 15 of 16 Version 1.0 July 2016

16 Standard Operating Procedure Details Unique Identifier for this SOP is State if SOP is New or Revised BCPFT-COI-POL New Policy Category Executive Director whose portfolio this SOP comes under Policy Lead/Author Job titles only Committee/Group Responsible for Approval of this SOP Month/year consultation process completed Control of Infection Executive Director of Nursing, AHPs and Governance Infection Prevention and Control Team Infection Prevention and Control Committee May 2016 Month/year SOP was approved July 2016 Next review due July 2019 Disclosure Status B can be disclosed to patients and the public Review and Amendment History Version Date Description of Change 1.0 July 2016 New Procedure established to supplement Infection Control Assurance Policy Alert Organisms Respiratory viruses Page 16 of 16 Version 1.0 July 2016