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 8 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 Any patient diagnosed as having a food borne illness, whose symptoms developed after admission A patient whose relatives/contacts have had gastrointestinal symptoms in the last 24 - 48hrs WHEN A SUSPECTED OUTBREAK OCCURS Any member of staff who suspects that an outbreak may be occurring must as soon as is reasonably practicable, report his/her suspicion to the person in charge. The staff must ensure standard/transmission based precautions are being observed throughout the ward area (Section C, Control of Infection Manual). Where possible, patients should be isolated in a single room, or cohort nursed if the patient developed symptoms whilst in a 4/6 bedded bay (see Appendix 9). The person in charge must then report the possibility of an outbreak, as soon as is reasonably practicable to: The Infection Control Team (out with office hours, the on-call Microbiologist/Infection Control Doctor must be informed) The Senior Manager for Nursing responsible for that area The Clinician or General Practitioner on duty/on-call A member of the Infection Control Team will visit the area (as soon as is practical) and communicate with the relevant individuals as to the control measures to be implemented. IN THE CARE HOME SETTING General care and management of a resident with gastrointestinal symptoms (diarrhoea and or vomiting) • If any resident has diarrhoea and/or vomiting report this immediately to the person in charge. • Check that the resident is not taking prescribed laxatives or any other drugs that could cause diarrhoea. • Organise stool sampling (appendix 2). • As long as this does not compromise their safety, ask any resident who is suspected of having a gastrointestinal infection (symptoms of diarrhoea and or vomiting) to remain in their room (with the door closed) whilst they are unwell and not to visit communal areas until 48 hours after they are symptom free. Those residents who Residents with dementia must be closely monitored • Explain to the resident why they need to stay in their room. The resident may feel unhappy at being isolated so make sure they can access help easily and are not ignored or suffer as a consequence of having the door closed. E 8
Note: Completion of Review NHS Lanarkshire Health Protection Committee Section E1 Effective From Sep 2010 Replaces Jun 2010 Pages 9 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 • Where there is a difficulty in employing isolation measures, such as residents with comprehension problems/ dementia, close monitoring is essential to prevent the spread of infection. • Monitor the resident closely to make sure they do not become dehydrated (start a stool and fluid balance recording chart). • As prescribed by the GP, use oral rehydration solutions to prevent or reduce the risk of dehydration. Signs of dehydration include loss of appetite, dry skin, dark coloured urine, dry mouth, fatigue, headaches and increased respirations. • If any resident(s) becomes more unwell as a consequence of the diarrhoea and /or vomiting, report this immediately to the GP. OUTBREAK CONTROL MEASURES IN THE CARE HOME SETTING If there are 2 or more residents or staff with symptoms - a possible outbreak • Report this to the person in charge immediately who should seek advice from the NHS Board’s HPT (Mon – Friday 9am – 5pm 01698 858232 and Out of Hours 01236 748748), the GP and notify Care Inspectorate (01698 208150). • The HPT will assess the situation and provide all the necessary advice, including the need for daily updatres. The advice can be seen in appendix 12. • If any resident requires admission to hospital, inform the clinical area receiving the resident and the ambulance/transport service that the resident has/has had diarrhoea and/or vomiting, or that there are residents with diarrhoea and/or vomiting in the care home. • Do not resume normal admissions of new residents until the NHS Board HPT advises. Information for residents and visitors • Ensure all residents, relatives and visitors are aware of what they should do in any outbreak situation and what they can do to prevent additional personal risk. • Provide written information e.g. how to wash personal laundry (refer to Section D) and how to wash hands ( refer to Section H). • If an outbreak occurs, there should be a management approved notice on the door of the care home to alert visitors to the possibility of a norovirus, or diarrhoea and vomiting, outbreak. • The notice should advise visitors to speak to the person in charge in order that the following messages should be reinforced. Visitors should be advised to: • wash and dry their hands on entering the care home, on leaving the care home and not to put fingers in their mouth or consume food or drink whilst in the care home. • reduce (or avoid) the number of visits whilst the outbreak lasts. • refrain form visiting if they themselves are suffering from any gastrointestinal symptoms (diarrhoea and/or vomiting) until they are 48 hours symptom free. • stop children visiting the care home during an outbreak. E 9
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Management of In-patients with Loose Stools ... - NHS Lanarkshire

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