Respiratory Viruses Policy Page 1 of 8
Document Control Sheet Name of document: Version: 3 Status: Owner: File location / Filename: Respiratory viruses policy Date of this version: February 2013 Infection Prevention and Control Team Produced by: Infection Prevention and Control Team Synopsis and outcomes of consultation undertaken: Joint Infection Control Committee. Reference to key guidance documents IPACC Synopsis and outcomes of Equality and Diversity Impact Assessment: No specific issues. National EIA give more details on measures to reduce Healthcare Acquired Infections Approved by (Committee): Joint Infection Control Committee (JICC) Professional Executive Committee IPACC Date ratified: 18/2/2013 Copyholders: Next review due: February 2015 Enquiries to: ecch.infectionprevention@nhs.net. Revision History Revision Date Summary of changes Author(s) Version Number January 2011 Updated reference inserted IPCT 2 December 2012 IPCT 3 Approvals This document requires the following approvals either individual(s), group(s) or board. Name Title Date of Issue Version Number JICC January 2011 2 IPACC 18/2/2013 3 Page 2 of 8
Contents 1 Introduction 4 2 Purpose and scope 4 3 Policy statement 4 4 Roles and responsibilities 4 5 Policy monitoring 4 6 Review 4 7 Key points 4 8 The problem 5 9 What to do if you have a patient with suspected viral respiratory infection 5 10 Management of patients with viral respiratory infection 6 11 Ending isolation 6 12 Members of staff 6 13 Visitors 6 14 References 7 15 Author 7 Posters 8/9 Page 3 of 8
1. Introduction Respiratory infections are common, principally causing colds in both adults and children. Most are fairly mild, self-limiting and confined to the upper respiratory tract. However, these can progress and cause more severe infections and even death. There is a wide variety of viral causes of respiratory infection including rhinoviruses, respiratory syncytial virus, influenza viruses A, B and C, para-influenza viruses and coronaviruses. 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. To aid healthcare planning, surveillance of infections in the community is used to alert health-care providers to diagnostic considerations, management and prevention options. Under criterion 10 of The Health Act (2008) organisations must ensure so far as is reasonably practicable, that care workers are free of and protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection. 2. Purpose and scope The purpose of this document is to provide concise instructions for all staff to minimize the potential risks of infection and to ensure prompt recognition of those patients who are at risk of infection. This document applies to all staff either employed or contracted within in-patient areas in East Coast Community Healthcare CIC (ECCH). 3. Policy statement This policy will be implemented to ensure adherence to safe practice. 4. Roles and responsibilities It is the responsibility of all staff to ensure that they adhere to best practice 5. Policy monitoring It is the responsibility of all department heads/professional leads to ensure that the staff they manage adhere to this policy. 6. Review This policy will be reviewed every two years by the Infection Prevention and Control Team. 7. Key points Infected healthcare workers and visitors are potential sources of infection by respiratory viruses Influenza vaccine is strongly recommended and expected for all front line clinical staff each year, staff who choose not to be vaccinated must discuss the rational for this with their line manager Patients admitted with upper respiratory tract infection (URTI) should not be nursed in close location with immunocompromised patients Where viral respiratory infection is suspected in adults they should be nursed in isolation When clinical signs or history suggest infection with new or re emerging respiratory diseases, such as SARS, TB or Avian Influenza the patient must be placed in a single room prior to medical assessment and the infection prevention and control team/doctor contacted immediately Patients with signs and symptoms of respiratory infection should receive active instruction on respiratory hygiene/cough etiquette 8. The problem Page 4 of 8
There is a seasonal problem of epidemic respiratory virus infections in the UK Respiratory Syncitial virus (RVS) causes annual winter epidemics usually occurring in children from November to January. Influenza also occurs during winter months and can affect all age groups, particularly the elderly and the immunocompromised. Often, the need for hospitalisation is due to complications such as pneumonia. Newly emerging diseases such as SARS and Avian Influenza have the potential to cause severe human illness. Infection can be acquired by direct and indirect contact. Transmission occurs from person to person by close contact, predominantly by large droplet/airborne respiratory secretions and/or contamination of hands. Infected healthcare workers and visitors are potential sources of hospital acquired infection. 9. What to do if you have a patient with suspected viral respiratory infection Any patient admitted with URTI should not be nursed on a ward with immunocompromised patients unless nursed in a side room. During RVS annual epidemic it may be necessary to cohort symptomatic patients (who are presumed to have the same infection) this decision should be based on clinical symptoms. Where possible if URTI is suspected the patient should be nurse in a sideroom. During RSV annual epidemic it may be necessary to cohort nurse symptomatic patients. Patients and visitors should be reminded about the importance of hand hygiene A normal chest x-ray does not rule out respiratory virus infection. The infection prevention and control team should be contacted immediately where clinical signs, travel history and exposure suggest infection with new or re-emerging respiratory diseases such as SARS or Avian Influenza: o Clinical signs fever >38oc o Or history of fever and respiratory symptoms o Or other life threatening illness with both geographical and exposure criteria fulfilled o Geographical travel in the last two weeks to any area of the world known to have cases of severe unexplained respiratory illness o Exposure within 7 days of onset of symptoms 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 FFP3 mask or if not available immediately then a surgical mask) long sleeved gown and gloves. 10. Management of patients with viral respiratory infection The door must be kept closed Staff contact should be kept to a reasonable minimum without compromising patient care Hand hygiene is essential after contact with the patient or his/her environment, and on leaving the patient s room in order to prevent contact transmission 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 Page 5 of 8
Provision must be made for patients to dispose of used tissues into an appropriate waste receptacle prior to discarding into an orange clinical waste bag Provision must be made for patients to perform hand hygiene after contact with respiratory secretions and contaminated items and should be encouraged to use them at appropriate opportunities The movement of patients must be restricted Healthcare workers in direct contact with the patient or their bed linen must wear disposable gloves and aprons Linen must be treated as infected and placed in a red dissolvable bag inside a red laundry bag Standard precautions must be maintained at all times Standard surgical masks must be worn for close contact with infected patients with an active cough 11. Ending isolation Isolation of the patient may be discontinued after 7 days of the onset of clinical illness providing symptoms are no longer present, if symptoms persist for longer than 7 days isolation should be continued until these resolve. NB Immunocompromised patients may excrete viruses for a longer period. The infection prevention and control team may be contacted for advice. 12. Members of staff Seasonal influenza vaccine is strongly recommended and uptake expected for all front line clinical staff on an annual basis. It is the responsibility of all front line clinical staff to access this service in order to minimise the risk to patients, staff and their families. Staff who do not take up the offer must explain the rational for this with their line manager Staff suffering from persistent, unexplained respiratory symptoms, especially following foreign travel, must report to their General Practitioner and should not attend work Staff suspected and/or diagnosed with a communicable respiratory disease must inform the occupational health service and their line manager immediately In the event of new and re-emerging respiratory diseases, such as SARS and Avian Influenza, relevant advice will be given by infection control and the occupational health service 13. Visitors All visitors with symptoms of respiratory disease should be discouraged from visiting 14. References http://www.hpa.org.uk/infections/topics_az/sars/htm National Institute for Health and Clinical Excellence (2008) Respiratory tract infectionsantibiotic prescribing. NICE Clinical Guideline 69. London Department of Health (2006) Immunisation against infectious disease. (The Green Book) London Department of Health (2010) The Health and Social care Act 2008, Code of Practice on the prevention and control of infections and related guidance. London. Gateway reference 14808 Goldman D A (2001) Epidemiology and Prevention of Viral Respiratory Infection in Healthcare Institutions. Emerging Infectious Diseases, 7(2), 249-253 15. Author Infection Prevention and Control Team Page 6 of 8
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