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

Note: Completion
of Review
NHS Lanarkshire
Health Protection Committee
SECTION E 1 - Management of In-patients with
Loose Stools: Gastrointestinal Outbreak
E 30
Section E1
Effective
From
Sep 2010
Replaces Jun 2010
Pages 30 of 31
Review Date Dec 2012
Protocol For Cohort Isolation During Suspected or Confirmed Outbreaks Of Norovirus
Appendix 10
Cohort isolation has long been recognised as a means of assisting with controlling the spread of infection within
ward environments, and if practiced well can result in the avoidance of restrictions being placed on the whole of
the ward.. It is a practice that is often adopted in the absence of available side rooms for patients displaying
similar signs and symptoms. Prior to cohort nursing, Bed managers should risk assess the availability of single
rooms in other clinical areas, this should always be done in conjunction with the ICT. Generally cohort isolation
takes place within 4 – 6 bedded bays
It is imperative that for cohort isolation to be successful in containing the infection, the following points must be
adhered to: -
Where possible cohort patients must be cared for by designated staff especially when there is a high
incidence of vomiting. Bank/Agency staff must not be involved in caring for patients in cohort isolation.
The ICT must be contacted if compliance with the above cannot be achieved
For effective isolation the door to the room must be kept closed at all times to provide physical separation
from other patients
The rooms used for cohort isolation must have a designated toilet and hand washing facilities
Personal Protective Equipment (PPE), where possible should be sited outside the room
Staff caring for patients must practice the highest standard in relation to the use of PPE and hand hygiene
(level two hand wash should be performed at all times as per Section H, CIM
Linen should be treated as foul/infected as per Section D, CIM
Waste should be disposed off in the clinical waste stream as per Section K, CIM
There should be clear signage placed on the door advising all visitors to the area to speak to the nurse in
charge before entering the area
The room must be cleaned on a daily basis following the guidance within Section E1, CIM point 1.19
Environmental Cleaning
Patients must remain cohorted in the same area until at least 48hrs after the last episode of vomiting and/or
loose stools. There should be no patient movement in or out of the room until the restrictions have been
lifted by the Infection Control Team (ICT). The exception to this would be if the patient was being
discharged to their own home, or if the patient was requiring an urgent medical/surgical
investigation/intervention. The ICT must always be fully consulted prior to any decision being made.
Meals and medicine rounds should be carried out last in cohort rooms
It is important for staff to routinely provide affected/unaffected patients and visitors with an
explanation of their infection, isolation procedures and treatment, especially patients who are
asymptomatic, but potentially incubating the infection
The ICT will review the situation on a daily basis, any breach of the above guidelines, or signs that the infection
has not been successfully contained i.e. other patients or staff displaying similar signs and symptoms, may result
in restrictions being applied to the whole ward. A full risk assessment would be undertaken in line with the
Infection Control Doctor and Senior Management before any decision was made.