Académique Documents
Professionnel Documents
Culture Documents
Replacement.
Replaces: Policy for the Management of Gastroenteritis in
Healthcare
Version:
Author Title:
Owner/Title:
Approved by:
Ratified:
Related Trust Strategy
and/or Strategic Aims
Implementation Date:
Review Date:
Key Words:
Associated Policy or
Standard Operating
Procedures
v1.0
Date:
November 2015
Date:
17/12/15
Date:
17/12/15
Contents
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Introduction .............................................................................................................. 2
Purpose ..................................................................................................................... 3
Scope ........................................................................................................................ 3
Clinical Features, Signs and Symptoms of Norovirus ........................................... 3
Mode of Transmission ............................................................................................. 4
Identification and Reporting of a Suspected Outbreak.......................................... 4
Control Measures ..................................................................................................... 5
Patient Care .............................................................................................................. 5
Patient Movement in Hospital .................................................................................. 6
Discharge/Transfer of Patients ................................................................................ 6
11.
12.
13.
14.
15.
16.
Dates
Amendments
1. Introduction
In the UK, gastroenteritis causes a huge burden of disease in the community and hospitals
and is responsible for much time missed from work. Patients and/or staff with gastroenteritis
can infect other patients leading to healthcare associated outbreaks of diarrhoea and
vomiting. Strict infection prevention and control precautions are therefore necessary for
patients with symptoms suggestive of gastroenteritis.
Organisms that cause infectious diarrhoea are spread by the faecal/oral route. For an
individual to become infected the organism must be ingested and most commonly this will
result from unwashed and contaminated hands coming in contact with the mouth. It may also
occur via ingesting contaminated food.
It is important to consider all cases of diarrhoea and vomiting as potentially infectious until
appropriate investigations are completed.
Patients presenting with unexplained diarrhoea and / or vomiting Must be isolated in single
rooms. If this is not possible the Infection Prevention and Control (IPC) team should be
informed.
The IPC team should be contacted whenever there are two or more patients presenting with
unexplained diarrhoea and / or vomiting in a clinical setting.
In a healthcare setting it is important to distinguish between infectious and non-infectious
diarrhoea. Infective diarrhoea can be caused by both viral and bacterial pathogens.
Examples most commonly seen in healthcare settings include:
Viral causes:
Norovirus (previously known as Small round structured virus (SRSV) or
Norwalk virus)
Rota virus
Adenovirus
Bacterial causes:
Page 2 of 9
Clostridium difficile toxin (C.difficile) For further advice access trust policy
management of Clostridium Difficile
Campylobactor *
Salmonella.spp*
Shigella*
Escherichia coli*
Listeria*
staphylococcal enterotoxins
* see isolation SOP
for
Food Poisoning
In a healthcare setting it is also important to identify any case of diarrhoea that may have
resulted from suspected food poisoning. This is of particular relevance in areas where
service users may have access to external food sources e.g. take away outlets and / or
prepare their own food that is sourced from local shops. Further guidance can be found in
the trust protocol for take away food.
Food poisoning or suspected food poisoning is also notifiable, although not specifically listed
as a " notifiable disease". Further information can be found in the isolation policy regarding
notification.
2. Purpose
The Purpose of the SOP is to provide advice about the management of an outbreak of
gastroenteritis infection within the trust. The aim is to prevent cross infection and minimise
the disruption caused by ward closures.
3. Scope
This policy applies to healthcare personnel working within the trust. It also applies to private
contractors working on Trust premises including, locum and agency staff and volunteers.
Page 3 of 9
Headache
The Illness is generally mild and people usually recover fully within 2-3 days. Infections can
occur at any age because immunity is not long lasting.
Definition of diarrhoea The passage of stool loose enough to take the shape of the
container used to sample it or as Bristol Stool Chart types 5-7 (DH, HPA 2009), see Bristol
stool form Chart (Associate document 5)
5. Mode of Transmission
Noroviruses are highly infectious and are primarily transmitted, via the faecal-oral route or
direct person to person spread.
The projectile nature of vomiting leads to widespread aerosol dissemination of virus particles
also leading to environmental contamination and subsequent indirect person-to-person
spread.
Page 4 of 9
The nurse / person in charge of the affected clinical area must contact the on call manager
without delay
The on-call manager must then assess the situation. This involves taking details of the
affected patients / staff and a history of the illness.
If an outbreak is suspected, or the situation is unclear, the on-call manager must then
contact the Consultant Microbiologist, via Queens Switchboard. A decision will then be made
as to whether the ward should be closed.
Contact telephone numbers (Associate document 6)
Once an outbreak or incident has been recognised within normal working hours, the
Consultant Microbiologist and Director of Infection Prevention and Control will be the
persons primarily responsible for action within the Trust.
Some outbreaks / incidents are of such a limited extent that the Consultant Microbiologist
and the IPC team can jointly deal with them. In such circumstances The Director of Infection
Prevention and Control and all other relevant managers will be kept informed of any
investigation and actions taken by the IPC Team. However, other outbreaks / incidents may
require the Outbreak Control Team (OCT) to be established. A decision whether an OCT is
required will be made jointly by the Consultant Microbiologist and Director of Infection
Prevention and Control, based on the individual circumstances of the incident.
7. Control Measures
Refer to the following trust policies
The clinical area should use Outbreak information in Infection Prevention and Control Folder,
this includes; See associate documents
8. Patient Care
1. Isolate symptomatic patients in single rooms, en suite where possible .The door should
remain closed .If this is not possible please discuss with the IPC team
2. Isolation is required until the patient is 48 hours free of symptoms.
Page 5 of 9
Page 6 of 9
2. Nursing staff and domestic staff working in an affected area should not move and work in
an unaffected area of the hospital during one shift
3. Between shifts uniforms must be changed
4. Agency Staff should not work in affected areas unless absolutely necessary.
5. Any staff member, who develops symptoms of diarrhoea /vomiting on duty, should leave
work immediately and report to the Occupational Health Department. If diarrhoea is
present, a faecal sample should be submitted to the Microbiology department.
6. Non-essential personnel should be excluded from the ward.
7. Personnel who visit several wards e.g. phlebotomist, pharmacist, physiotherapists etc.
should visit the ward last in their routine visits. If possible, a designated individual should
be assigned to that ward for the duration of the outbreak. These staff should also follow
the patient care guidelines above.
12. Visitors
1. Visitors with diarrhoea and/or vomiting should be advised not to visit the ward until
symptom free for 48 hours.
2. Children should be excluded from visiting, wherever possible.
3. Visitors should be restricted to a minimum. They must be informed that they may be
exposed to infection and must wash hands with soap and water on entry to the ward
and on leaving the ward.
4. Visitors do not need to wear aprons or gloves unless they are involved in patient
handling/care.
Page 7 of 9
Monitoring
method
Individual or
department
responsible
for the
monitoring
Investigation
into
outbreaks
Infection
prevention
and control
team
Page 8 of 9
Frequency
of the
monitorin
g activity
Group/
Committee/
forum which
will receive
the
findings/mon
itoring report
As
Infection
appropriate Prevention
and Control
committee
Committee/
individual
responsible
for ensuring
that the
actions are
completed
Matrons and
Ward Managers
Organisations
expectations in relation
to staff training, as
identified in the training
needs analysis
Training
Reports
Learning and
Development
Department
Monthly
HRODE
Committee
HRODE
Committee
16. References
Chadwick et al. Management of hospital outbreaks of gastro-enteritis due to small round
structured viruses. J. Hosp. Infection. (2000); 45: 1-10.
Health Protection Agency (2004). Preventing person-to-person spread following
gastrointestinal infections: guidelines for public health physicians and Environmental
Health officers. HPA.
Available from: www.hpa.org.uk/cdph/issues/CDPHvol7/No4/guidelines2_4_04.pdf
(Last accessed 3rd September 2009)
Health Protection Agency (2004). Norovirus Outbreaks in England and
Wales. CDR Weekly. 14:47.
http://www.hpa.org.uk/cdr/archives/2004/cdr4704.pdf (Last accessed 3rd September
2009)
Health Protection Agency ( 2006). Norovirus frequently asked questions.
http://www.hpa.org.uk/infections/topics_az/norovirus/faq.htm (Last accessed 3rd
September 2009)
DH/HPA. Clostridium difficile infection: how to deal with the problem, 2009. Available
at: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1232006607827.(last accessed
15th December 2009)
Page 9 of 9