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

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 17.07.2009 17.07.2009 17.07.2009 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

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 18.1 18.2 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

POLICY FOR THE CONTROL OF OUTBREAKS OF INFECTIOUS DISEASE IN THE THREE COMMUNITY HOSPITALS OF NHS DARLINGTON

1.0

AIM

To ensure that procedures are in place to control outbreaks of infectious disease within NHS Darlingtons community hospitals 2.0 SCOPE

This policy applies to all health care workers working within NHS Darlington. Her Majestys Prisons (HMP) and hospices to follow policy for the investigation and control of community outbreaks of infectious diseases in County Durham and Darlington. County Durham and Tees Valley Health Protection Unit (2007). 3.0 INTRODUCTION

Outbreaks of infection occur within community hospitals for a number of reasons, these include: 3.1 3.2 3.3 3.4 4.0 Increased susceptibility to infection eg immunosuppression. Presence of microbes that spread easily between individuals eg Norovirus. Consumption of contaminated food or water eg Salmonella. Exposure to airborne pathogens eg Tuberculosis. 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. The difference between an outbreak and cross-infection is difficult to define and is a matter of degree. Single cases of unusual pathogens such as multi drug resistant Tuberculosis, Severe Acute Respiratory Syndrome, or Smallpox will require an infection control response similar to that applied to an outbreak. 5.0 RECOGNITION

Outbreaks may be identified and reported to the ICT by the most senior nurse on duty in the community hospitals. Ward staff or medical teams may note an increased incidence of infection. This increased incidence may be obvious, such as in an outbreak of viral gastro-enteritis, or subtle such as an increase in wound infections due to MRSA.
Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9
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6.0

REPORTING OF OUTBREAKS

Suspected outbreaks of infectious disease should be reported to the Infection Control Team for the Primary Care Trusts. Contact details during office hours: Infection Control Nurses (secretary and answer machine) Contact details out of hours: Dr John Sloss, Consultant Microbiologist DMH Dr D Allison, Consultant Microbiologist, 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. The response to an outbreak will depend on assessment by the Infection Control Team. Small outbreaks will be managed within existing resources, but larger outbreaks may require a more formal response with assistance from external organisations eg Health Protection Agency. 7.0 OUTBREAK CONTROL TEAM

The Outbreak Control Team comprises a group of health care professionals consulted or assembled to control a particular outbreak. It usually consists of the Infection Control Team plus additional individuals, for example the ward manager/matron, chief executive management, and clinicians. The chair would be the Acute Trust Consultant Microbiologist. If the outbreak involves specialised areas, for example kitchens, then the relevant expertise must be co-opted onto the group, eg Environmental Health Officer. 8.0 8.1 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. Minutes will be taken. The initial meeting will: i ii iii iv v Establish the perceived problem. Agree action plan. Ensure that any control measures instigated have been effective. Monitor the outbreak. Review effectiveness.
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8.2

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8.3

The significance of the outbreak will be discussed and a decision taken, in consultation with the Consultant in Communicable Disease Control (CCDC), whether to inform higher authorities such as the Strategic Health Authority, Communicable Disease Surveillance Centre or Department of Health. In an important outbreak notification should be made by telephone by the chair of the Outbreak Control Team. In any significant outbreak the Communications Department must be fully briefed. The Outbreak Control Team may make a number of recommendations. These may include: i ii iii iv v Closure of ward/site to admissions. Prevent transferring and discharging. Restrict staff movement to other clinical areas. Provision (if necessary) of additional staff. Provision of extra equipment.

8.4

8.5

Individual responsibilities of Outbreak Control Team members must be clearly defined. 8.6 The Outbreak Control Team should be prepared to reconvene at regular intervals and at short notice. 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. 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. COMMUNICATIONS

8.7

8.8

8.9

9.0

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.

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

The CCDC may be part of the Outbreak Control Team if there is a significant community aspect to the problem. 10.0 FINAL REPORT

Following an outbreak a report will be written and presented to the Infection Control Committee by the Chair of the Committee. The report will also be presented to the Trust Boards of NHS Darlington and NHS County Durham. The report should contain recommendations designed to prevent recurrences as far as possible. 11.0 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. 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. 12.0 AUDIT/IMPACT ASSESSMENT STATEMENTS

The tables below summarise reviews with respect to: Strategic and operational risks, including risks to health and safety. Current equality and diversity legislation. Rights under the European Convention on Human Rights.

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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, patients, public, etc) a Location (access, environment, working No conditions) b Equipment (medical, electrical, 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. identified Significant risks identified Complete a full risk assessment form and action plan for all risks identified. Include in the Appendices. There is some doubt about Take further advice from appropriate whether risks are significant directorate or department. If unresolved, or relevant. refer to Governance and Assurance Committee.

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

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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, and how?

Will the proposals involve, 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, for example in terms of access to a service, or the ability to take advantage of proposed opportunities? Is there any evidence that any part of the proposals No could discriminate unlawfully, directly or indirectly, against any section of the population? Is the proposed policy likely to affect relations between No certain groups of people, 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. 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, 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. 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

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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, i.e.: The action is prescribed by law It pursues a legitimate aim. It is necessary in a democratic society. OUTCOME (tick appropriate box) No rights affected Proceed with ratification process. Potential to affect a right Amend the document as appropriate to has been identified clarify exceptions or remove potential. If this is not possible, take further advice from There is doubt about the Corporate Services Manager/Legal Advisers. potential to affect a right.

POLICY DATED REVIEW

July 2009 A review of this policy will be undertaken every two years.

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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. In the case of an outbreak outside of normal working hours, eg after 5.00pm and on weekends and bank holidays, contact the Microbiologist on call via DMH (01325 380100). Actions to be taken: If possible move patients with symptoms into single rooms. If large number of patients try to nurse all of the patients with symptoms in the same ward area/bay. 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. 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. In the case of outbreaks of diarrhoea - staff with symptoms should be sent off duty and stool samples collected. Staff should not return to work until they have been symptom free for 48 hours. Staff who prepare food may need to take further advice from the Occupational Health Department.
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Policy for the Control of Outbreaks of Infectious Disease in the Three Community Hospitals of County Durham Primary Care Trust Policy Number 9

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). Review of Law on Infectious Disease Control. HMSO, London Department of Health (1992). Definition of Food Poisoning (PL/CMO (92) 14). HMSO, London Department of Health (1995). Hospital Infection Control. Health Service Guidance HSG (95) 10 London DH Health and Safety Executive (2003) Health and Safety Regulation. A short guide. London HSE Health and Safety Executive (2005) COSHH: a brief guide to the regulations. What you need to know about the Control of Substances Hazardous to Health (COSHH) Regulations 2002 London: HSE, 2005 Northern and Yorkshire NHS Region (1998) Guidance on the Investigation, Management and Control of Incidents and Outbreaks of Communicable Disease and Infection. Northern and Yorkshire NHS Region Public Health in England and Wales (1988), The Public Health (Infectious Diseases) Regulations HMSO, London The Infection Control Standards Working Party (1993). Standards in Infection Control in Hospitals. HMSO. 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.HMSO London

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