Royal United Hospital Bath NHS Trust Outbreak Control Policy

POLICY AND PROCEDURE

OUTBREAK CONTROL POLICY
609 2009

Reference Number:

Author Manager Responsible:

Julia Bloomfield - Infection Control Nurse Yvonne Pritchard- Senior Infection Control Nurse

Deadline for ratification: (Policy must be ratified within 6 December 2011 months of review date)

Review Date:

May 2012

Ratified by:

Infection Prevention and Control Committee

Date Ratified:

May 2009

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Management of diarrhoea and vomiting outbreaks Universal precautions Influenza policy

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Royal United Hospital Bath NHS Trust Outbreak Control Policy

CONSULTATION AND RATIFICATION SCHEDULE

Name and Title of Individual Francesca Thompson-Director of Nursing and DIPC Yvonne Pritchard Senior Infection Control Nurse Sarah Meisner Infection Control Doctor Infection Control Team Members

Date Consulted November 2008 November 2008 November 2008 November 2008

Name of Committee Infection Control Committee RUH Saving Lives Committee Medical Division Surgical Division Speciality Division Operational Governance Committee Clinical Governance Committee

Date of Committee 17th November 2008 09/09/2008 09/09/2008 29/10/2008 09/09/2008 14/01/2009 20/05/2009

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Royal United Hospital Bath NHS Trust Outbreak Control Policy

INDEX

Section 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 Purpose of the Policy Introduction Definition of Outbreak Reporting procedure Membership of the Outbreak Control Team (OCT) Responsibilities Terms of reference of the OCT Guidance notes for the OCT End of the Outbreak References

Page 3 4 4 5 5 6 8 9 9 9

Appendix 1. Outbreak Control Plan Flowchart 11

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1.0

THE PURPOSE OF THE POLICY To promptly identify and manage any outbreak of infection Quickly identify the source, method of spread and causative organisms responsible for the outbreak. Prevent further spread of the organism through implementation of appropriate control measures and restrictions To ensure all individuals, departments and any outside agencies likely to be involved in an outbreak have a clear understanding of their roles and are fully briefed. Disseminate information concerning the outbreak efficiently to ensure the rapid mobilisation of resources.

2.0

INTRODUCTION The Trust has an obligation to manage any outbreak of infection to prevent spread and protect staff patients and visitors. Where the outbreak may have an impact on the wider community the Health Protection Agency must be involved. Inter-Trust communication and collaboration between the RUH and other acute Trusts and PCTs will also be important, especially when they may be directly involved through joint patient management or there is an impact on their service delivery. Major outbreaks occurring in the community are the responsibility of the Consultant for Communicable Disease Control (CCDC) and the Environmental Health Officer for the relevant local authority, outbreak control plans are in place for the management of outbreaks of infection in the community. In some instances community outbreaks may put a heavy burden on hospital services, where the number of patients requiring admission exceeds the normal. Additionally, a hospital or community outbreak may have such an impact that the Trusts ability to admit unaffected patients could be compromised. This situation may have a profound affect on other normal elective activity within the Trust. In these circumstances this policy would need to be actioned.

3.0

DEFINITION OF AN OUTBREAK It is the responsibility of the Infection Control Team/Microbiologist on call, or CCDC in the community, to define an outbreak and decide on the need to bring the Outbreak Control Plan into action An outbreak may be defined as two or more related cases of an infective
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disease. Acute outbreaks are those that lead to a sudden increase in the number of people with symptoms and non-acute outbreaks are those that develop over a number of days or weeks.

3.1 Major Outbreak Generally a Major outbreak will be characterised by similar clinical signs affecting a significant number of people (e.g. 20 people, patients and/or staff) in one hospital within a 48-hour period. This may affect one unit/ward or more. There will be occasions when the severity of the infection necessitates the serious outbreak procedures being observed for much smaller numbers, perhaps only one affected individual. E.g. legionnaires 3.2 Minor Outbreak A minor outbreak may be more difficult to define but generally it will be characterised by similar signs affecting people in one area of the hospital. This may occur over a period of days or even weeks. The Infection Control Team will usually manage the outbreak but if necessary an outbreak control team will be convened. 4.0 REPORTING PROCEDURE 4.1 4.2 Any member of staff who suspects an outbreak will report it to their duty manager or person in charge of the ward/department The duty manager will assess the situation and report the matter to either the Infection Control Doctor (extension RUH 5428) or the Infection Control Nurses (extension RUH 4754). If an outbreak is suspected out of hours or at a weekend then the on call microbiologist must be contacted via the hospital switchboard. Once the Infection Control Doctor has confirmed an outbreak s/he will notify the Trust's Managers of the need to set up an Outbreak Control Team, agreeing the composition of the team and agreeing the date of the initial meeting. The Trust will be responsible for convening meetings and providing secretarial support. The Infection Control Doctor, or CCDC, will usually chair the Outbreak Control Team meetings.

4.3

5.0

MEMBERSHIP OF THE OUTBREAK CONTROL TEAM (OCT)

In a Major Outbreak the Outbreak Control Team will include: Infection Control Doctor DIPC Chief Executive Director of Public Health Laboratory Infection Control Nurse Consultant for Communicable Disease Control Nursing Director(s) Medical Director(s)
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Clinical Site Team & Bed Manager Ward Manager of clinical area affected Modern Matron for the affected area Occupational Health Director Medical Consultant for affected area Director of Patient Care Delivery Press office Other representatives may be seconded at the discretion of the Chair of the OCT, e.g.: Director of HR Environmental Health Officer Catering/Hotel Services Managers Estates Manager Sterile Services Dept Manager Supplies Manager Laundry Manager Pharmacy Manager Ambulance Service Representative Water Company representative Health & Safety Committee Representative Director of Facilities Head of Patient Safety Note: This list is not exhaustive.

In a minor outbreak the Outbreak Control Team may include: 6.0 Infection Control Doctor DIPC Infection Control Nurse Senior Nurse of the affected ward and/or Modern Matron Medical representatives of the affected ward and/or Medical Director Other representatives as appropriate Consultant for Communicable Disease Control (where relevant) Cleaning/Facilities Manager Clinical Site Team & Bed Manager RESPONSIBILITIES

Department managers are responsible for ensuring that staff are aware of, have access to and comply with this policy. Outbreak Control Team Members Responsibilities Designation Chief Executive Responsibilities - Inform the Strategic Health Authority, Department of Health, NHS Medical Executive, Regional Outpost, Health and Safety Executive, and other local Providers. - Direct and co-ordinate the management of
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Infection Control Doctor or deputy

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Royal United Hospital Bath NHS Trust Outbreak Control Policy

Trust Infection Control Team

DIPC

Divisional Managers, Modern Matrons and Ward Managers

the outbreak - Ensure members of the control group understand their role and responsibilities - Be available for consultation and advice - Responsible for ensuring communication between members of the Outbreak Control Team and others such as Chief Executive and Health Protection Agency - Determine the frequency of subsequent meetings - Ensure a full record of the meetings and incident is maintained - Responsible for declaring conclusion of the outbreak - Inform Head of Patient Safety, Risk Management Team and other Outbreak Committee Members that an outbreak has occurred. - Attend all OCT meetings - Identify the procedures required to control the incident and provide support and advice for staff - Monitor the implementation of these procedures - Responsible for epidemiological investigations (data collation daily) - Any other duties deemed necessary by the OCT - Ensures appropriate staff are informed of the resources required by ward/unit - Provides adequate accommodation and clerical support to the OCT - Communicates with the Chief Executive and Communications Officer - Any other necessary duties - Attend OCT meetings - Give daily updates on the outbreak in their department - Complete Incident form reporting on HCAI - Implements the recommended control procedures - Supervise and liaise with the cleaning team - Ensures all specimens are collected as necessary - Communicates daily and offer support to relevant staff, patients and relatives - Responsible for implementing ward
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Royal United Hospital Bath NHS Trust Outbreak Control Policy

Cleaning and Facilities Manager

Occupational Health Manager

Head of Patient Safety

closures or visitor restrictions as recommended by OCT - Any other necessary duties - Attend all OCT meetings - Organizes staff for increased and deep cleaning as necessary - Ensures cleaning and disinfection procedures carried out according to policy - Ensure extra supply of linen is available - Update their staff daily - Any other actions recommended by OCT - Attend all OCT meetings - Provide update if staff members involved in outbreak - Provides specific advice to any affected staff - Responsible for specimen collection from staff as necessary - Any other actions recommended by OCT - Upon receipt of outbreak notification of a ward closure, to notify the Lead Commissioner (BaNES) and the SW SHA of the ward closure, by means of the Strategic Executive Information System (STEIS), of: - the ward closure - progress and/or the end of the outbreak (ward reopening) - any actions identified to prevent reoccurrence

7.0

TERMS OF REFERENCE OF THE OUTBREAK CONTROL TEAM The objectives of the OCT will be: To advise on all necessary steps to provide for the continuing clinical care of patients during the outbreak. To co-ordinate arrangements for the investigation of the source and cause of the outbreak, and the control measures to be implemented. To establish clear communication channels; and to consider the need for outside help and expertise. To provide a report on the outbreak To make recommendations to prevent further outbreaks occurring

The Outbreak Control Team will:

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1. 2. 3. 4. 5. 6. 7. 8.

Agree case definition Agree data collection and reporting process in order to: Measure the extent of the outbreak, Monitor the progress of the outbreak, Monitor the effectiveness of control measures, Monitor staff levels. Investigate the source of infection and method of spread Assess risks to patients and staff and define control measures seeking advise from local and national experts where indicated 9. Review patient admissions and transfers 10. Assess the need for additional supplies and staff 11. Implement agreed control measures 12. Monitor the effectiveness of the control measures 13. Liaise with the Trust Operational Management Team 14. Establish clear channels of communication and provide clear instruction and information for staff, patients and visitors, GPs and other local purchasers 15. Ensure timely reporting to external agencies 16. Agree a media spokesperson and a strategy for dealing with the media and other enquiries 17. Define the end of the outbreak and mechanism for returning to normal service 18. Review management of the outbreak, produce a report and make recommendations for future outbreak management.

8.0

GUIDANCE NOTES FOR THE OUTBREAK CONTROL TEAM 1. The Outbreak Control Team will ensure all issues are covered in a systematic manner (see Appendix 1) by setting an agenda for each meeting. 2. Roles will be ascribed to individual members of the Outbreak Control Team. These roles may be delegated to a deputy if consent is obtained from the Chair of the OCT. 3. Meetings will be held as often as the situation demands at the discretion of the Infection Control Doctor. In a Serious Outbreak, meetings will usually be held daily. 4. The Infection Control Doctor will liaise with the Trust Operational Management Team, particularly in a Major Outbreak, and a spokesperson will be appointed by the Trust to handle press enquiries. 5. Reports of each meeting will be produced by the OCT and will form the basis for communications with external agencies. 6. External agencies will be kept informed.

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9.0

END OF THE OUTBREAK At the end of the outbreak the OCT will meet with the following objectives: To review the experience of all those involved in the management of the outbreak. To identify any shortfalls encountered and highlight areas which worked particularly well. To revise the Outbreak Plan based on this information. To produce a written report. This will include a full review of the outbreak, its cause, management and recommendations for changes in procedures to prevent a further recurrence, to be submitted/reported to the Infection Prevention and Control Committee Any actions identified as required to prevent reoccurrence to be identified in a formal action plan to be submitted to the Divisions for completion

10.0

REFERENCES

Ayliffe GAJ et al (2000) Control of Hospital Infection: a practical handbook. London: Arnold p 22-23 DoH (2008) The Health Act 2006. Code of Practice for the Prevention and Control of Healthcare Associated Infections. Revised January 2008. DoH (1995) HSG (95) 10: Hospital Infection Control-Guidance on the Control of infection in Hospitals. PHLS

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Royal United Hospital Bath NHS Trust Outbreak Control Policy

APPENDIX 1

OUTBREAK CONTROL PLAN

Infection Control informed by Ward, Manager, Laboratory, GP or CCDC Infection Control Doctor informs: Chief Executive - (Serious Outbreak) Senior Nurse - (Minor Outbreak)

Outbreak Control Team Meeting convened (see 5.0)

1. 2. 3. 4. Refer to Outbreak Control Plan Agree terms of reference Agree objectives Set agenda to include consideration of:

a) Isolation of affected individuals - cohort nursing - single rooms - designate isolation ward - exclude affected staff from work - review staffing levels

b) Admissions

c) Control measures -Personal protective equipment - clinical procedures - decontamination - restricted visiting - catering procedures - maintenance procedures - immunisation - antibiotic therapy Contact tracing

d) Liaison with departments - Hotel Services - Engineering - Laboratory - Ambulance - Other Facilities

e) Surveillance

- stop admissions to affected areas - discharge/transfer of non-affected patients or those not at risk as appropriate

- data collection methods - design of questionnaires - sample collection - use of other laboratories - flagging specimens - Screening

f) Communications (who is told what, and how?) - operational management team - Head of Patient Safety - patients - relatives/visitors - staff - media - external agencies (see 7.0 f) - bulletins

g) Review progress - date of next meeting - venue - agenda - seconded members

Chair of OCT liaises with Operational Management Team On Resolution of Outbreak OCT will:
a) agree date for return to normal working b) review management of outbreak and the Outbreak Plan c) issue a report