INCREASED INCIDENT /OUTBREAK OF DIARRHOEA AND/OR VOMITING Documentation to support the management of an increased incident or outbreak of Diarrhoea and/or Vomiting including Norovirus 1
Contents Page Introduction 3 Infection Prevention and Control Team Contact details 4 Increased Incident/Outbreak/Norovirus checklist 5 Notification details (form) 9 Summary Record of Patients 10 Daily Record of Symptomatic patients 11 Summary Record of Symptomatic staff 13 Norovirus Outbreak Data Record 15 Norovirus Factsheet 15 Notice to Visitors 17 Poster 19 Stop the spread of the winter vomiting bug Poster 20 2
Introduction Increased Incidence / Outbreak of Infection Record This paperwork is to be used in conjunction with all other policies and guidelines which relate to an increased incidence or outbreak of infection which affects patients and/or staff An increased incident or outbreak of infection can be defined as significant increase in the occurrence of a specific organism or infection usually 2 or more cases linked in time or place. During the course of the increased incident some or all of the paperwork will be used and it should support documentation of care delivery, plans and actions in response to the management of the increased incident. This paperwork should be used in addition to the normal documentation required and not replace the information. Contact with the Infection Prevention and Control must take place once the incident is identified. If it occurs over the weekend or out of hours the on call manager should be contacted and the IPC team informed as soon as possible. The following Policies should be consulted in conjunction with this paperwork (although this is not an exhaustive list): Management of an increased incidence or outbreak of diarrhoea and/or vomiting policy Management of a patient with diarrhoea and/or vomiting that is of a suspected infectious nature policy Management of a ward with an increased incidence or outbreak of diarrhoea and or vomiting policy If an outbreak of infection or increased evidence is suspected please contact the Infection Prevention and Control Team. Please ensure that this includes patients and staff. 3
Infection Prevention and Control Team contact details Amanda Hemsley Senior Nurse Advisor Antonia Garfoot Senior Infection Prevention and Control Nurse Mel Hutchings Infection Prevention and Control Nurse Andy Knock Infection Prevention and Control Nurse Annette Powell Infection Prevention and control Nurse Leicestershire Partnership Trust Riverside House Bridge Park Road Thurmaston LE4 8BL Tel: 0116 2951668 For Out of hours please contact the On Call Manager and/or local Public Health England contact Public Health England 0844 225 4524 option 1 4
Increased Incident/Outbreak/Norovirus Checklist This checklist is intended for use by healthcare staff within a hospital environment when dealing with a suspected case(s) of gastrointestinal infection, it is not intended to replace standard infection prevention and control measures Ward Staff to Action Action when complete Put up source isolation for at bedside/door to single room Ensure staff wear gloves and aprons for direct patient contact or contact with equipment and environment Identify single patient use toilet. Where toilets are used by more than one patient they must be cleaned and decontaminated between use Provide dedicated patient equipment if available; clean according to LPT policy for cleaning and decontamination. If equipment is for communal use it must be cleaned and decontaminated between use Obtain medical review to include review of medication i.e. aperients, PPI s, antibiotics Complete clinical assessment to confirm symptoms are of an infectious origin (i.e. sudden onset, projectile vomit, history of contact, diarrhoea of unknown origin) Assess risk of other infectious origins i.e. food history, travel Record fluid balance and accurately record bowel movements Commence diarrhoea care plan to include date of onset of symptoms and origin of admission (home, acute hospital etc.) Check for previous history or diagnosis of CDT 5
Obtain 2 specimens of stool 1 for MC&S and CDT for microbiology and 1 for Norovirus to Virology Ensure trust policy for environmental cleaning is implemented areas with affected patients require a second clean. Ensure trust policy for management of infected linen is implemented Ensure trust policy for the management of clinical waste is implemented Report suspected case(s) to the Infection Prevention and Control Team Before Every Patient contact with all Staff Action Hand Hygiene (wash hands with soap and water Identify and use appropriate PPE Between/After Every Patient contact all Staff Action Clean and disinfect patient equipment using chlor clean Dispose of infected linen and waste in designated bags Dispose of PPE as clinical waste Wash hands with liquid soap and water and dry with single use disposable paper towels Disinfect hands with alcohol sanitiser Advise visitors to wash hands with liquid soap and water and disinfect with alcohol sanitiser on entrance to and exit from the ward and after visiting patients 6
Control of Designated Area (Single room or Bay/Ward) Action Instigate trust policy for the management of a known or a suspected outbreak of infection when complete Post restricted entry and infection control signs at designated area Inform identified partner agencies i.e. EMAS as appropriate Source isolation trolley outside rooms/bay (where appropriate) to include: Alcohol sanitiser if permissible based on patient safety risk assessment Aprons Gloves Orange bags for clinical waste Red alginate and white plastic bags for infected linen Change apron and gloves between each patient, wash hands with liquid soap and running water, dry thoroughly, dispose of paper towels and PPE as clinical waste, use alcohol hand sanitiser as a secondary process Isolate toilet facilities (commode/bedpan or toilet) for affected patients use only Check that the bedpan washer/macerator is functioning correctly Are the bedpans clean following washing? Does the washer go through a cold clean cycle followed by a hot wash (hot wash = 65 C for 10 min or 71 C for 3 min) If no macerator/bedpan washer available use specialist gel product to solidify any liquid, double bag in orange clinical waste bags and dispose of as clinical waste Affected areas should be cleaned thoroughly and disinfected once a day with chlor clean. A second daily clean must be organised with cleaning services, paying attention to toilets, waste bins, door handles and horizontal surfaces. 7
Entrances Ward staff/ Hotel services Action Provide patient/visitor/carer/staff information (i.e. Norovirus information) when complete Restrict visiting according to local policy Ensure trust protocol for enhanced environmental cleaning and decontamination is implemented Patient and Staff Movement Action Advice on placement of further suspected cases should be sought from the IP&C team. Patients should not be routinely moved in order to cohort them on the ward when complete Restrict movement of ward/bank staff/ medical staff/anp across wards on the same shift if possible. If staff need to work across wards then they should be visiting the affected wards last wherever possible. Allied Health Professionals (AHP) to allocate nominated individual to designated area or to visit last on round Allocate nursing staff to designated area if limited to Bay/Rooms and avoid cross working between affected and unaffected patients where possible during a single shift. Movement of patients from ward to ward for cohort management is NOT recommended Agree patient transfers with receiving areas following individual assessment and for urgent clinical need only Symptomatic staff should remain absent until symptom free for 2 working days (>48hrs) and inform Occupational Health 8
Notification details Ward/Area: Number of beds open: Number of patients: Date commenced: Date ward closed (if applicable): Number of beds: Number of beds closed: Symptoms: Date concluded: Date ward open (if applicable): Persons to be notified immediately (as applicable) Infection Prevention and Control Team *Bleep holder/on call manager (if out of hours) Bed Bureau at UHL Physiotherapy Date and person notified (Start of outbreak) Date and person notified (Outbreak ended) Signature Occupational Therapy Catering Domestic Services Manager Occupational Health if staff affected 9
Increased incident Ward Checklist Macerator operational Vernagel available should macerator not be operational Notices on ward doors to alert staff and visitors Patients NOK informed of increased incident and advised not to visit unless necessary Visitors aware of importance of hand hygiene Visiting Staff aware Source Isolation forms ins itu Ward requested 2nd clean from domestics Domestics and staff aware to use chlor clean Staff Aware to send samples for Norovirus to virology & MC&S +CDT to microbiology. Inform microbiology of increased incident Incident Form completed Ward aware not to move patients in order to co-hort Actioned Yes/No Date Comments Signed 10
Summary Record of Patients - Increased Incidence/Outbreak Total number of patients affected: No. of cohort bays: No. of beds single rooms: No. of beds closed: No. of patients in single rooms: Date Patient s name Date of Birth NHS No Symptoms Room Number Bed location Date/time symptoms commenced (BSC type) Specimen sent/date Date symptoms finished 11
Date Patient s name Date of Birth NHS No Symptoms Room Number Bed location Date/time symptoms commenced (BSC type) Specimen sent/date Date symptoms finished 12
Daily Record of Symptomatic Patients At the start of the increased incident/outbreak fill in the start date and continue until the incident is closed, this will give you a daily total of symptomatic patients Patient Names Date and time - if symptomatic, X if symptom free Total number of patients symptomatic 13
Patient Names Date and time - if symptomatic, X if symptom free Total number of patients symptomatic 14
Total number of staff affected: Summary Record of Staff - Increased Incidence/Outbreak Date Staff member s name Symptoms Date/time symptoms commenced Date last at work Date symptoms finished Date returned to work 15
Date Staff member s name Symptoms Date/time symptoms commenced Date last at work Date symptoms finished Date returned to work 16
NOROVIRUS Fact sheet Information for patients, relatives and carers What are Noroviruses? Noroviruses are a group of viruses that are the most common cause of gastroenteritis (stomach bugs). Noroviruses are also called winter vomiting viruses, small round structured viruses or Norwalk-like viruses How does Norovirus spread? The virus is easily transmitted from one person to another. It can be transmitted by contact with an infected person, by consuming contaminated food or water or by contact with contaminated surfaces or objects What are the symptoms? The most common symptoms are nausea, vomiting and diarrhoea. Symptoms often start with the sudden onset of nausea followed by projectile vomiting and watery diarrhoea. However, not all of those infected will experience all of the symptoms. Some people may also have a raised temperature, headaches and aching limbs. Symptoms usually begin around 12 to 48 hours after becoming infected. The illness is self-limiting and the symptoms will last for 12 to 60 hours. Most people make a full recovery within 1-2 days, however some people (usually the very young or elderly) may become very dehydrated and require hospital treatment. Why does Norovirus often cause outbreaks? Norovirus often causes outbreaks because it is easily spread from one person to another and the virus is able to survive in the environment for many days. There are many different strains of norovirus, immunity is short-lived and infection with one strain does not protect against infection with another strain. Outbreaks commonly occur in semi-closed environments such as hospitals, nursing homes, schools and on cruise ships, where people are in close contact with one another 17
for long periods What precautions should be taken to stop outbreaks? Outbreaks can be difficult to control because norovirus is easily transmitted from one person to another, due to its highly infectious particles and because the virus can survive in the environment for lengthy periods. The most effective way to limit an outbreak is to ensure good hygiene measures such as strict adherence to hand-washing especially when handling food, after contact with infected people, and after using the toilet; disinfecting contaminated areas promptly; not allowing infected people to prepare food until 48 hours after symptoms have elapsed and isolating ill people for up to 48 hours after their symptoms have ceased. Outbreaks are shortened when control measures at healthcare settings are implemented quickly, such as closing wards to new admissions and implementing strict hygiene measures. What is the treatment? There is no specific treatment for norovirus apart from letting the illness run its course. It is important to drink plenty of fluids to prevent dehydration. Who is at risk of getting Norovirus? There is no one specific group who are at risk of contracting norovirus it affects people of all ages. The very young and elderly should take extra care if infected, as dehydration is more common in these age groups. Outbreaks of norovirus are reported frequently anywhere that large numbers of people congregate for periods of several days. This provides an ideal environment for the spread of the disease. Healthcare settings tend to be particularly affected by outbreaks of norovirus. Are there any long term effects from Norovirus? No, there are no long-term effects from norovirus. Reference: http://www.hpa.org.uk/topics/infectiousdiseases/infectionsaz/norovirus/generalinformation/norovfrequent lyaskedquestions/ 18
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Stop the spread of the Winter Vomiting bug (Norovirus) Guidance to prevent illness during a known increased incident Wash your hands frequently using warm water and liquid soap, especially after using the toilet and before eating or preparing foods When you have washed your hands thoroughly with a paper towel Wash your hand before and after touching your mouth and coughing or sneezing into your hands Put the toilet lid down before flushing the toilet after you have used it to prevent spray contaminating the environment Make sure that the toilet and toilet area, flush handles, taps and door handles are always kept clean Cover vomit immediately with paper towelling to prevent the spread of the virus and clean area as per trust policy for the management of blood and body fluid spillages Symptomatic staff must stay off work until they have been free from symptoms for 48 hours or more Patients should inform staff if they have been in contact 20