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

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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.
Note: Completion of Review NHS Lanarkshire Health Protection Committee SECTION E 1 - Management of In-patients with Loose Stools: Gastrointestinal Outbreak NOROVIRUS INFECTION CONTROL STAFF INFORMATION E 31 Section E1 Effective From Sep 2010 Replaces Jun 2010 Pages 31 of 31 Review Date Dec 2012 Appendix 11 NOROVIRUS – AN OVERVIEW Noroviruses (NV), previously known as small round structured viruses (SRSV’s) and Norwalk like viruses (NLV’s) are the most common cause of outbreaks of gastro-enteritis in hospitals, schools, nursing/residential homes etc. These viruses can be highly infectious causing high attack rates among patients and staff within the hospital setting. Attack rates can reach as high as 50%-70% in patients and staff. Gastro-enteritis caused by Norovirus infection produces a self-limiting, mild to moderate disease with clinical symptoms of nausea, vomiting (often projectile), diarrhoea, abdominal pain, myalgia, headache, malaise, low grade fever or a combination of these symptoms which can last 12-72 hours. The elderly and patients with preexisting chronic medical conditions may develop more serious symptoms. Treatment in most cases is replacement fluids. IDENTIFICATION The virus may be identified in stool or vomit specimens, particularly if the specimen is obtained at the onset of symptoms. RESERVOIR Humans are the only known reservoir. ROUTE OF TRANSMISSION Probably by the faecal – oral route, although indirect transmission from environmental contamination and via aerosol has been suggested to explain the rapid spread in hospital settings. Food may also be a vehicle for transmission of infection. CHARACTERISTICS A rapid onset of diarrhoea and/or vomiting is commonly seen with a rapidly rising attack rate in both staff and patients alike. INCUBATION PERIOD Usually 12-48 hours. PERIOD OF COMMUNICABILITY During the acute stage of the disease, and up to 48 hours after diarrhoea/vomiting stops. SUSCEPTIBILITY Susceptibility is widespread and short-term immunity lasting up to 14 weeks has been reported.
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Management of In-patients with Loose Stools ... - NHS Lanarkshire

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