Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of NHS Darlington IC 09 Version Number

: Issue Date: Review Date: Sponsoring Director: 3 July 2009 June 2011 Director of Public Health NHS County Durham and NHS Darlington Prepared By: Consultation Process: Jean Armstrong, Lead Infection Prevention and Control Nurse NHS County Durham and NHS Darlington Infection Control Committee meeting 23 July 2009.

Formally approved on behalf of the Board: In respect of NHS Darlington In respect of NHS County Durham by the Infection Control Committee 23 July 2009. by Management Group 15 September 2009.

POLICY VALIDATION STATEMENT This policy is due for review on the latest date shown above. After this date, policy and process documents may become invalid. Policy users should ensure that they are consulting the current valid version of the documentation.

Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9

1

07.2009 17.07.DOCUMENT HISTORY AND RECORD OF CHANGES Document Title: Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of NHS Darlington June 2005 Initial Issue: Version 2 3 4 Date Significant Changes June 2007 * July 2009 * * CURRENT AUDIT ASSESSMENT: Audit Assessment Risk Audit Equality Audit Human Rights Audit Date 17.2009 Result Risks identified and risk assessment included at Appendix 1 No or very low potential for discrimination No breach of Human Rights Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9 2 .2009 17.07.

2 18.3 Risk Audit Equality Audit Human Rights Audit Page 4 4 4 4 4 5 5 5 6 7 7 7 8 9 10 Appendices Appendix 1 Action to be Taken in the Event of an Outbreak of Diarrhoea and/or Vomiting References Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9 3 .1 18.POLICY FOR THE CONTROL OF OUTBREAKS OF INFECTIOUS DISEASE IN THE THREE COMMUNITY HOSPITALS OF NHS DARLINGTON CONTENTS Section 1 2 3 4 5 6 7 8 9 10 11 12 Title Aim Scope Introduction Definition of an Outbreak Recognition Reporting of Outbreaks Outbreak Control Team Actions of the Outbreak Control Team Communications Final Report Outbreaks of Infectious Disease in the Community Audit/Impact Assessment Statements 18.

County Durham and Tees Valley Health Protection Unit (2007). Presence of microbes that spread easily between individuals eg Norovirus. or subtle such as an increase in wound infections due to MRSA. these include: 3.3 3. Ward staff or medical teams may note an increased incidence of infection. The difference between an outbreak and cross-infection is difficult to define and is a matter of degree. such as in an outbreak of viral gastro-enteritis. or Smallpox will require an infection control response similar to that applied to an outbreak. Consumption of contaminated food or water eg Salmonella.POLICY FOR THE CONTROL OF OUTBREAKS OF INFECTIOUS DISEASE IN THE THREE COMMUNITY HOSPITALS OF NHS DARLINGTON 1.0 SCOPE This policy applies to all health care workers working within NHS Darlington. This increased incidence may be obvious.0 Increased susceptibility to infection eg immunosuppression.0 AIM To ensure that procedures are in place to control outbreaks of infectious disease within NHS Darlington’s community hospitals 2. Severe Acute Respiratory Syndrome.2 3.4 4. 3. 5. Exposure to airborne pathogens eg Tuberculosis. Her Majesty’s Prisons (HMP) and hospices to follow policy for the investigation and control of community outbreaks of infectious diseases in County Durham and Darlington.0 INTRODUCTION Outbreaks of infection occur within community hospitals for a number of reasons.0 RECOGNITION Outbreaks may be identified and reported to the ICT by the most senior nurse on duty in the community hospitals. DEFINITION OF AN OUTBREAK An outbreak exists when there are more cases of a particular disease than expected in a given area or among a specific group of people over a particular period of time. Single cases of unusual pathogens such as multi drug resistant Tuberculosis. Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9 4 .1 3.

and clinicians. Contact details during office hours: Infection Control Nurses (secretary and answer machine) Contact details out of hours: Dr John Sloss.1 ACTIONS OF THE OUTBREAK CONTROL TEAM An initial meeting or consultation of the Outbreak Control Team will occur in a timely manner/as soon as possible at an agreed site.0 OUTBREAK CONTROL TEAM The Outbreak Control Team comprises a group of health care professionals consulted or assembled to control a particular outbreak. The chair would be the Acute Trust Consultant Microbiologist. Consultant Microbiologist. Small outbreaks will be managed within existing resources. 7. Consultant Microbiologist DMH Dr D Allison.6. Review effectiveness. 8. but larger outbreaks may require a more formal response with assistance from external organisations eg Health Protection Agency. UHND 01325 380100 0191 333 2333 0191 333 3320 Action to be taken in the event of an outbreak of Diarrhoea and Vomiting – see Appendix 1. for example kitchens. for example the ward manager/matron. It usually consists of the Infection Control Team plus additional individuals. The response to an outbreak will depend on assessment by the Infection Control Team. Agree action plan.0 REPORTING OF OUTBREAKS Suspected outbreaks of infectious disease should be reported to the Infection Control Team for the Primary Care Trusts. Minutes will be taken. Ensure that any control measures instigated have been effective. 5 8. Monitor the outbreak. If the outbreak involves specialised areas. chief executive management. eg Environmental Health Officer.2 Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9 .0 8. The initial meeting will: i ii iii iv v Establish the perceived problem. then the relevant expertise must be co-opted onto the group.

whether to inform higher authorities such as the Strategic Health Authority. COMMUNICATIONS 8.8 8.7 8. Provision of extra equipment. In an important outbreak notification should be made by telephone by the chair of the Outbreak Control Team.3 The significance of the outbreak will be discussed and a decision taken. The Outbreak Control Team may make a number of recommendations.5 Individual responsibilities of Outbreak Control Team members must be clearly defined.0 Minutes of any meetings will be disseminated: Director of Public Health Community Hospital Matron or Head of Service Clinician(s) involved Chief Executive Director of Nursing Consultant in Communicable Disease Control (CCDC) Communications Manager Any significant others who have been co-opted.6 The Outbreak Control Team should be prepared to reconvene at regular intervals and at short notice. Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9 6 . 8. These may include: i ii iii iv v Closure of ward/site to admissions.8. Restrict staff movement to other clinical areas. 8. The Chairperson of the team must be available in case unforeseen developments arise. The outbreak should be formally closed at the final meeting of the OCT by agreement of the group. in consultation with the Consultant in Communicable Disease Control (CCDC). Depending on the size and type of outbreak. the decision may be made by the Consultant Microbiologist not to convene a meeting but to communicate/ assess the situation regularly via telephone. Communicable Disease Surveillance Centre or Department of Health. Prevent transferring and discharging.9 9. Provision (if necessary) of additional staff. In any significant outbreak the Communications Department must be fully briefed.4 8.

0 FINAL REPORT Following an outbreak a report will be written and presented to the Infection Control Committee by the Chair of the Committee. including risks to health and safety. Rights under the European Convention on Human Rights.The CCDC may be part of the Outbreak Control Team if there is a significant community aspect to the problem. The report will also be presented to the Trust Boards of NHS Darlington and NHS County Durham.0 AUDIT/IMPACT ASSESSMENT STATEMENTS The tables below summarise reviews with respect to: Strategic and operational risks. Current equality and diversity legislation. 12. The report should contain recommendations designed to prevent recurrences as far as possible. In this case the CCDC will act as Chairperson of the Outbreak Control Team and the Primary Care Trusts will provide Infection Control support as required. Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9 7 .0 OUTBREAK OF INFECTIOUS DISEASE IN THE COMMUNITY The Primary Care Trusts may be required to support an outbreak in which the main focus is in the Community. 10. 11.

public. patients. etc) a Location (access. identified Significant risks identified Complete a full risk assessment form and action plan for all risks identified.1 Risk Audit Risk Audit for RISK CATEGORIES 1 2 3 4 5 6 7 8 Risks relating to organisational objectives Risks to patient experience/outcome Risk to or from service/business interruption Risks relating to staffing and competence Financial risks Risks to compliance with inspection/audit standards General risks to organisational reputation Specific health and safety (inc fire) risks to persons (staff. If unresolved. environment. other) No c Hazardous substances No d Lone working No e Moving and handling No f Potential to cause undue stress No g Anti-social behaviour (violence. harassment. No theft) OUTCOME (tick appropriate box) ACTION No significant risks Proceed with ratification process. There is some doubt about Take further advice from appropriate whether risks are significant directorate or department. refer to Governance and Assurance Committee. electrical. Include in the Appendices. working No conditions) b Equipment (medical. Significant Risks Identified Yes/No Yes Yes No Yes No Yes Yes Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9 8 . or relevant.12.

is very low or non-existent Potential for discrimination Amend the document as appropriate to exists clarify exceptions or remove potential. If this is not possible.2 Equality Audit Equality Audit for QUESTION What is the purpose of the proposed policy document (or changes to policy document)? Who is intended to benefit.12. directly or indirectly. or have consequences for. the people the PCT serves and employs? Is there any reason to believe that people could be No affected differently by the proposals. Correct patient management and safety No Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9 9 . for example because it is seen as favouring a particular group or denying opportunities to another? Is the proposed policy likely to damage relations No between any particular group(s) of people and the PCT? OUTCOME (tick appropriate box) Potential for discrimination Proceed with ratification process. for example in terms of access to a service. and how? Will the proposals involve. take further advice from There is doubt about the Corporate Services Manager and/or the potential for discrimination Equality Lead Manager (HR Department) RESPONSE Management of Outbreaks of Infection in line with national guidance. or the ability to take advantage of proposed opportunities? Is there any evidence that any part of the proposals No could discriminate unlawfully. against any section of the population? Is the proposed policy likely to affect relations between No certain groups of people.

take further advice from There is doubt about the Corporate Services Manager/Legal Advisers.: The action is prescribed by law It pursues a legitimate aim. i. If this is not possible. It is necessary in a democratic society.12.3 Human Rights Audit Human Rights Audit for QUESTION RESPONSE Does the policy document interfere with a Convention No right? Could the actions described in the policy document No touch on one of the Convention rights? Is there a victim? No Are there circumstances where the right can No legitimately be limited or interfered with? Does the interference meet the general criteria No established by the Strasbourg authorities. POLICY DATED REVIEW July 2009 A review of this policy will be undertaken every two years. potential to affect a right. OUTCOME (tick appropriate box) No rights affected Proceed with ratification process. Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9 10 . Potential to affect a right Amend the document as appropriate to has been identified clarify exceptions or remove potential.e.

11 ¤ ¤ ¤ ¤ Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9 . If it is necessary to transfer a patient with symptoms out to another hospital ensure the ward is informed so that the patient can be nursed in a single room. Actions to be taken: ¤ ¤ If possible move patients with symptoms into single rooms. eg after 5. contact the Microbiologist on call via DMH (01325 380100). If large number of patients try to nurse all of the patients with symptoms in the same ward area/bay. In the case of an outbreak outside of normal working hours.00pm and on weekends and bank holidays.Appendix 1 INFECTION CONTROL DEPARTMENT ACTION TO BE TAKEN IN THE EVENT OF AN OUTBREAK OF DIARRHOEA AND/OR VOMITING In the case of an outbreak in normal working hours contact your infection control nurse on 0191 333 3320 as soon as possible. Do not discharge to Care Homes until outbreak declared over other than by consultation with HPU (Health Protection Unit). Collect and send stool specimens from all patients with diarrhoea. Staff should not return to work until they have been symptom free for 48 hours. In the case of outbreaks of diarrhoea .staff with symptoms should be sent off duty and stool samples collected. Staff who prepare food may need to take further advice from the Occupational Health Department.

Review of Law on Infectious Disease Control. Management and Control of Incidents and Outbreaks of Communicable Disease and Infection. Northern and Yorkshire NHS Region Public Health in England and Wales (1988). London The Infection Control Standards Working Party (1993).REFERENCES 1 County Durham and Tees Valley Health Protection Unit (2007) Policy for the Investigation and Control of Community Outbreaks of Infectious Diseases in County Durham and Darlington Department of Health Consultative Document (1989). London Department of Health (1995). The Public Health (Infectious Diseases) Regulations HMSO. HMSO. A short guide.HMSO London 2 3 4 5 6 7 8 9 10 Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9 12 . Hospital Infection Control. HMSO. Health Service Guidance HSG (95) 10 London DH Health and Safety Executive (2003) Health and Safety Regulation. Definition of Food Poisoning (PL/CMO (92) 14). Standards in Infection Control in Hospitals. London Department of Health (1992). 2005 Northern and Yorkshire NHS Region (1998) Guidance on the Investigation. London The Health and Social Care Act (2008): Code of Practice for the NHS on the prevention and control of healthcare associated infections and related guidance. What you need to know about the Control of Substances Hazardous to Health (COSHH) Regulations 2002 London: HSE. HMSO. London HSE Health and Safety Executive (2005) COSHH: a brief guide to the regulations.