Management of In-patients with Loose Stools ... - NHS Lanarkshire

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Note: Completion of Review NHS Lanarkshire Health Protection Committee Section E1 Effective From Sep 2010 Replaces Jun 2010 Pages 14 of 31 SECTION E 1 - Management of In-patients with Loose Stools: Gastrointestinal Outbreak Review Date March 2013 Health Protection Committee approved review date extension to March 2013 As the number of patients decreases it may be that one or two patients remain symptomatic longer than others. When available, these symptomatic patients can be moved into single rooms to further reduce spread, and aid containment of Norovirus. Patient placement assessments should be done on a daily basis. Empty Beds: As patients are discharged, the linen on the beds should be removed and the bed, bed table and locker cleaned with neutral detergent and water and then dried. During the terminal clean, all empty beds should be re-cleaned and the bed cleaning process should include 1000ppm available chlorine. After the terminal cleaning has been completed, the beds can then be remade. The rationale for this is that Noroviruses could survive for up to a week on cleaned beds and on clean bed linen, and also to prevent the need for the double use of hypochlorite solution. Create clean bays – as patients are discharged, try to create clean bay areas, where patients can be admitted to first once the ward is reopened. GENERAL CONTROL MEASURES STAFF MOVEMENT Nurses/bankaide staff imported into an affected area should not return to work in an unaffected area until the outbreak is declared over, following being asymptomatic for fully 48hrs, or fully 48hr after their last shift working within an affected area. The nurse in charge of the affected area must inform the Nurse Bank of any problems ongoing within the ward. Likewise, staff working in an affected area should not go to work elsewhere through a nurse bank. Physiotherapists and Occupational Therapists should not treat patients unless it is deemed essential and so far as is possible, should not go from an affected to an unaffected area. Social work staff should liaise with the nurse in charge of the ward in relation to visiting patients. If necessary it may be possible to arrange to visit patients in a room away from the main ward area. Difficult situations should be discussed with the Infection Control Team. PATIENT MOVEMENT The ward should be closed to all admissions, and the ward doors should be kept closed, and an approved notice should be placed on the door indicating that within the ward there is an outbreak of diarrhoea and vomiting and that the ward is closed and to report to the nurse in charge. Exceptions: In exceptional situations the risk to an individual patient of Norovirus acquisition will be less than the risk of non-admission. In such exceptional events, when alternative possible accommodation for the patient has been excluded, the patient can be admitted to a closed ward, but the patient and relative must be informed of their personal Norovirus risk. The E 14
Note: Completion of Review NHS Lanarkshire Health Protection Committee Section E1 Effective From Sep 2010 Replaces Jun 2010 Pages 15 of 31 SECTION E 1 - Management of In-patients with Loose Stools: Gastrointestinal Outbreak Review Date March 2013 Health Protection Committee approved review date extension to March 2013 aforementioned should not take place without consulting the Infection Control Team. Such events should be recorded via the DATIX system. Avoid transferring any patients to other hospital/clinical areas/nursing homes unless there is a clinical priority. On occasion where wards are cohort isolating patients, and the ward is not closed: patients out with the excluded rooms/bays may be discharged to another healthcare facility, providing they have had no symptoms within the previous 48 – 72 hrs, and have not been cared for next to symptomatic patients. It is essential that a full risk assessment is undertaken by the Infection Control Team prior to transfer, and that the receiving ward/area/care home are fully informed of any ongoing issues within the transferring wards. Patients should only be admitted to another ward/area/care home if there is a single room available to receive the patient into. The patient should remain in the single room for at least forty-eight hours. Patients can be discharged home providing they are asymptomatic; however the patients GP should be informed. If patients require investigative procedures the receiving department must be informed, and the patient should be scheduled last on the list. VISITORS Visitors should be kept to a minimum. They must be encouraged to practice appropriate hand hygiene, i.e. level 1 (soap & water). Visitors should be advised not to eat the patient's food or use their toilet, and any food such as fruit should be placed inside the locker. Ideally, children under the age of twelve should be discouraged from visiting. Visitors should be discouraged from visiting other patients, whether in the affected area/ward or in wards unaffected by the outbreak. FOOD HYGIENE Staff working for the Catering Department should not directly access the affected ward, the trolley/trays being handed over to ward staff at the entrance to the ward. Food trolleys will be delivered to the ward and dishes washed in the normal way. Under no circumstance should any utensils, crockery, napkins or trays be returned to the Catering Department if they are contaminated with vomit. Staff serving meals should decontaminate their hands between serving each room. Staff must not eat food within the ward environment. COMMUNITY STAFF When staff are visiting patients in their homes with suspected or confirmed gastrointestinal illness, it is important that a high standard of hand hygiene is maintained and the appropriate E 15
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Management of In-patients with Loose Stools ... - NHS Lanarkshire

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