Isolation Policy

ISOLATION POLICY

Version / 6
Name of responsible (ratifying) committee / Infection Prevention Management Committee
Date ratified / 02 August 2017
Document Manager (job title) / Infection Prevention
Date issued / 05 September 2017
Review date / 04 September 2020
Electronic location / Infection Prevention and Control Policies
Related Procedural Documents / Hand Hygiene policy
MRSA/MSSA policy
Standard Infection Control Precautions policy
Clostridium difficile infection (CDI) management policy
Management of Outbreaks of Viral Diarrhoea & Vomiting policy
Decontamination policy
Viral Haemorrhagic Fever Policy
Key Words (to aid with searching) / Isolation, transmission precautions, source isolation, protective isolation

Version Tracking

Version / Date Ratified / Brief Summary of Changes / Author
6 / 02/08/2017 / Minor revision (no change to process) / IPT
5 / 14/05/2015 / Update of Notification of Infectious Diseases, contact details for PHE Wessex Centre, addition of quick reference guide / Caroline Mitchell

CONTENTS

QUICK REFERENCE GUIDE 3

1. INTRODUCTION 4

2. PURPOSE 4

3. SCOPE 4

4. DEFINITIONS 4

5. DUTIES AND RESPONSIBILITIES 4

6. PROCESS 5

7. TRAINING REQUIREMENTS 10

8. REFERENCES AND ASSOCIATED DOCUMENTATION 10

9. EQUALITY IMPACT STATEMENT 11

10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS 12

EQUALITY IMPACT SCREENING TOOL 13

APPENDIX 1: Standard Isolation Signage (available from Infection Prevention Team) 15

APPENDIX 2: Standard Isolation Signage (available from Infection Prevention Team) 16

QUICK REFERENCE GUIDE

For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.

1.  INTRODUCTION

Isolation refers to the use of a single room as a physical barrier to help prevent the transmission of potentially infectious organisms. Isolation has been shown to be effective in reducing onwards spread of infection but is only one element of a successful infection prevention strategy. Other measures, such as environmental and equipment cleaning, the correct use of personal protective equipment (PPE) and above all hand hygiene are equally or more important.

2.  PURPOSE

The aim of this policy is to ensure appropriate use of isolation facilities based on local risk assessment in accordance with the Health & Social Care Act (DH 2010).

This policy should be used with reference to the:

·  Hand Hygiene policy

·  MRSA/MSSA policy

·  Standard Infection Control Precautions policy

·  Clostridium difficile infection (CDI) management policy

·  Management of Outbreaks of Viral Diarrhoea & Vomiting policy

·  Decontamination policy

·  CPE

3.  SCOPE

This policy applies to all PHT Healthcare workers (HCW), including agency, bank and locum staff, Carillion staff including porters and house keepers and visiting HCW’s from other organisations.

‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’

4.  DEFINITIONS

Nil

5.  DUTIES AND RESPONSIBILITIES

Infection Prevention Team:

·  Review and update Isolation policy

·  Give additional advice regarding the management of patients requiring isolation where required

·  Include isolation precautions in all induction and update training for clinical staff

·  Promote good practice and challenge poor practice

·  Conduct audit and inspection of isolation practice with feedback to clinical staff

Microbiologists:

·  Alert Infection Prevention Team and clinical teams of patients requiring isolation following confirmation of certain infections

·  Advise clinical staff of the need for isolation at the time of notification of an infectious (or potentially infectious) disease

Patient Flow / Duty Hospital Managers:

·  Facilitate placement of patients with potential or known infections into appropriate isolation rooms as soon as possible

·  Monitor the appropriate usage of isolation rooms

·  Escalate difficulties in isolation to the Infection Prevention Team

·  Report breaches of isolation to Infection Prevention Team and by incident reporting

Matrons / Senior and Ward Sisters:

·  Must establish a cleanliness culture across their units and promote compliance with infection prevention guidelines

·  Promote good practice and challenge poor practice

Medical Staff:

·  Ensure compliance with infection prevention policies

·  Follow advice from the Infection Prevention Team relating to isolation of patients

·  Review the need for isolation on a daily basis

All Healthcare Staff:

·  Must be familiar with and adhere to the relevant infection prevention policies to reduce the risk of cross infection of patients

·  Must adhere to the full terms and conditions of isolation documented in this policy

·  Must use the risk assessment process to identify the isolation priorities of individual patients

·  Promote good practice and challenge poor practice

·  Refer to the infection prevention team if unable to follow the policy guidelines

·  Keep their patient informed of their infection status and provide information as necessary

·  Must ensure that patients who are isolated have access to investigations and rehabilitation

6.  PROCESS

6.1 Principles of Isolation:

·  Isolation is one aspect of effective infection prevention policy and standard infection control precautions should be applied to all patients without exception

·  Isolation must never compromise the safety or clinical care of a patient

·  The benefits of isolation should be weighed against the potential risks to the patient (patient’s mental state, severity of illness etc) and to other (public health risk) and patients should receive preparatory and ongoing information relating to their condition, treatment and rationale behind isolation

·  Infection risk should be constantly assessed as part of the ongoing clinical patient assessment and managed accordingly.

·  Isolation must be discontinued as soon as the risk of onwards transmission of infection has diminished or resolved

6.2 Source Isolation:

Refers to the physical isolation of a patient with suspected or confirmed transmissible infection in a single room in order to prevent or reduce the risk of onwards transmission by blocking the route of spread.

Source isolation of infectious patients should occur in:

·  A neutral pressure single room with ante room OR

·  A negative pressure single room with ante room OR

·  A standard single room

·  The room should be cleaned after all other ward cleaning has been carried out

6.3 Protective Isolation:

Refers to the physical isolation of a susceptible patient in a single room in order to reduce the risk of exposure to potentially harmful micro-organisms.

Protective isolation of immunocompromised/susceptible patients should occur in:

·  A positive pressure single room with ante room OR

·  A neutral pressure single room

·  The room should be cleaned before any ward cleaning is carried out

6.4 Cohorting:

An alternative of last resort to single room isolation is the cohorting of patients together with the same condition. However, not all patients with similar symptoms e.g. diarrhoea, have the same aetiology and many patients with the same organism e.g. C.difficile will have different strains. Cohorting should only be undertaken following discussion with and approval by the infection prevention team.

6.5 Escalation Strategy:

·  Potentially infectious patients should be isolated within 2 hours of first suspicion

·  Where no suitable single room is available in the immediate clinical area, staff should escalate to:

1. Specialty flow coordinator and if no flow coordinator to Matron (then)

ii. Duty hospital manager (then)

iii. (On-call) Infection Prevention Team

6.6 Isolation Preference:

1. Isolation room in the immediate clinical area/ward
2. Isolation room within the same Clinical Service Centre
3. Isolation room outside the Clinical Service Centre

It is appropriate in most circumstances to transfer the patient outside the specialty of Clinical Service Centre to achieve isolation, provided the responsible medical team is aware.

6.7 Asset List:

The Trust currently has:

·  10 positive pressure single rooms with ante room (protective isolation) F6 ward

·  6 neutral pressure single rooms with ante room (source or protective) E5 ICU

·  12 neutral pressure single rooms with ante room (source or protective) G5 ward (emergency use only)

·  2 adjustable positive/neutral pressure single rooms with ante room F5 ward

·  >220 standard single rooms across all wards

6.7 Common Principles of Isolation:

·  The need for isolation should be clearly communicated to the patient, family members (if appropriate) and clinical staff

·  The need for isolation should be reviewed on a daily basis. Discuss specific cases with the Infection Prevention Team

·  A generic isolation sign should be prominently displayed on the room door to alert people to potential risk without compromising confidentiality (appendix 1 & 2)

·  Ensure that the door remains closed, especially when airborne infections are suspected/confirmed e.g. pulmonary TB, influenza

6.8 Hand Hygiene & PPE: (see hand hygiene and Standard Infection Control Precautions Policies)

·  Hand hygiene facilities should be easily accessible inside and outside of the single room

·  Clinical staff and visitors must decontaminate hands on entry and exit of the room

·  Patients should be strongly encouraged to clean hands regularly, either with soap and water, or cleansing wipes, particularly after using the toilet and before eating

·  PPE (gloves, aprons/gowns, face masks/visors (where appropriate)) should be prominently available outside the room entrance

·  Protective equipment should only be worn by relatives carrying out direct ‘hands on care’ and not for routine social visiting

·  Limit and restrict the number of staff and visitors who come into contact with the patient to reduce the potential to spread or introduce infection. Where immunity to a condition occurs e.g. Chicken Pox, staff and visitors should be restricted to those who are non-susceptible

6.9 Cleaning, Linen & Waste:

·  The room must be cleaned twice daily with dedicated cleaning equipment using a suitable agent (hypochlorite e.g. Actichlor plus or chlorine dioxide e.g. Difficil-S (NICU Only)) focusing on common touch points (door handles, bed rails, tables, chair arms, taps etc)

·  The cleaning remit for isolation rooms being used for infectious patients is:

Carillion
·  Floors
·  Sinks and taps
·  Touch points (door handles/dispensers)
·  Chairs
·  Base of bed / Clinical Staff
·  Remove open food and declutter surfaces
·  Bed ends
·  Bed rails
·  Bedside tables and lockers
·  Touch points (door handles/taps/dispensers)
·  Clinical equipment (commode, drip stand etc)

It is vital that all flat surfaces are kept free from clutter to aid enhanced cleaning

·  Ensure that the room is kept clean and uncluttered, with flat surfaces clear of unnecessary items

·  Only stock that is required should be taken into the room

·  Clinical equipment inside the room must be dedicated to the patient until the patient is discharged or no longer deemed to be infectious. The equipment must then be appropriately decontaminated before being used on other patients. If equipment cannot be restricted to a single patient then equipment must receive a thorough clean with a chlorine agent before leaving the room

·  Charts and notes should be kept outside of the room to reduce the risk of contamination

·  Clinical waste bin with either a yellow/black ‘tigerstripe’ bag (non-infectious offensive waste for protective isolation) or orange (infectious offensive waste for source isolation) should be kept in the room as appropriate

·  All linen should be bagged at the bedside, as infectious linen, in appropriate coloured bags

6.10 Transport of Infectious Patients:

·  Movement of infectious or potentially infectious patients should be kept to a minimum. When it is necessary to transfer patients to other wards or departments, precautions to minimise the risk of transmission, based on the route of spread, must continue

·  If it is possible to delay an investigation without adversely affecting the patients management this should be considered. However, infectious disease should not compromise urgent clinical investigations

·  The receiving area must be informed prior to transfer to ensure appropriate precautions are in place and that suitable segregation facilities are available

·  Patients with known or suspected infections should not be placed in waiting areas and adequate time for post procedure cleaning, should be built into clinic/theatre schedules

6.11 Terminal Room Cleaning:

All rooms must be thoroughly cleaned with hypochlorite e.g. Actichlor plus or chlorine dioxide e.g. Difficil-S (NICU only) when vacated. This includes between patients with the same organism.

·  Curtains must be removed and sent to the laundry as infected linen

·  All disposable equipment should be discarded into orange clinical waste bags

·  All clinical equipment, including bed frames should be thoroughly cleaned by clinical staff

·  All areas of the room should be cleaned using dispoable clothes with particular attention paid to touch points and horizontal surfaces e.g. door handles, taps, dispensers, nurse call system, toilet areas, bed frame, tables, lockers, chairs

·  For certain infections (e.g. C.difficile, Carbapenem resistant Organisms, Gylcopeptide resistant Enterococi, Acinetobacter, other multi-drug resistant organisms), decontamination with Hydrogen Peroxide Vapour may be required – contact the Infection prevention Team to arrange.

6.12 Very High Risk Patients:

Adults and children with suspected or known infectious Multi Drug Resistant (MDR TB) and Extensively Drug Resistant TB (XDR-TB) must be admitted to a negative pressure room. These patients should be referred to University Hospital Southampton Isolation Unit via Medical Microbiology.

Clinicians caring for a patient with recent foreign travel with suspected Viral Haemorrhagic Fevers (VHF) must immediately contact the Microbiologist on call for advice on where to refer the patient. The patient must be isolated (preferably in a negative pressure single room – currently designated G5 ward) as soon as possible.

For confirmed VHF, the patient should be transferred to the Royal Free Hospital London which has appropriate facilities for the management of these patients.

Arrangements should be made in conjunction with the Public Health England (Wessex Centre).

Public Health England (Wessex Centre)
Unit8, Fulcrum 2,

Solent Way, Whiteley
Fareham, Hampshire
PO15 7FN

Tel: 0345 055 2022