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1 Outbreak of Infection/Major Outbreak (Infection Prevention and Control Policy: Appendix 8) Author: Jacky Hunt, Infection Prevention & Control Nurse Version: 2 June 2017

SH CP 103

Outbreak of Infection/Major Outbreak (Infection Prevention and Control Policy:

Appendix 8)

This Outbreak of Infection/Major Outbreak Appendix must be read in conjunction with the Infection Prevention and Control Policy

Version: 2

Summary:

This appendix has been drawn up to ensure prompt action is taken in the event of an outbreak of infection which occurs within Southern Health NHS Foundation Trust.

Keywords (minimum of 5): (To assist policy search engine)

Outbreak of infection, infectious incident, notifiable diseases, communicable diseases.

Target Audience:

All staff of all disciplines, Non-Executive Directors, Volunteers, Governors and Contractors

Next Review Date: June 2021

Approved & Ratified by:

Infection Prevention & Control & Decontamination Group

Date of meeting: 12 May 2017

Date issued:

June 2017

Author:

Jacky Hunt, Infection Prevention & Control Nurse (N).

Sponsor:

Sara Courtney, Chief Nurse


Version Control

Change Record

Date Author Version Page Reason for Change

Jacky Hunt original Original policy 2009 for HCHC

Mary Pilgrim 1 Merger of HPFT and HCHC

28.3.17 Jacky Hunt 2 Policy due for renewal

Reviewers/contributors

Name Position Version Reviewed & Date

IPC Committee members

Steve Mennear Lead Pharmacist, ICS

Sharon Gomez Essential Training Lead

Modern Matron Fiona Richey Version 1, 23/11/12

Helen Chesterfield Consultant Microbiologist, Portsmouth Hospitals NHS Trust.

David White Health and Safety and Fire Safety Manager Version 1, 23/11/12

PHE Lesley Chandler HPU, Whiteley , Hants Version 1, 23/11/12

IPC Team Version 2 31.3.17

IPC Committee members Version 2

Sue Eastwood Senior Practitioner PHE [email protected]

Version 2 31.3.17


Contents Page

1. Introduction 4

2. Definitions 4

3. Process

6

4. References

12

Appendices

8.1 Actions to be taken by clinical staff

13

8.2 Draft Agenda for meetings of OCG

14

8.3 Chairpersons checklist for management of outbreaks

16

8.4 (1) Action Card 1, for ICD/Microbiologist

18

(2) Action card 2, for Chair OCG/MOCG/DIPC

19

(3) Action card 3, for CCDC (or Deputy)

20

(4) Action card 4, for Lead Infection Control Nurse

21

(5) Action card 5, for IPCN’s

22

(6) Action card 6, for Nurse in Charge of Affected area

23

(7) Action card 7, for Occupational Health Service

24

8.5 Reporting of injuries, Diseases & Dangerous Occurrences Regulations 1995 (RIDDOR)

25

8.6 Diseases Notifiable under the Public Health Regulations 1988

26

8.6a Registered Medical Practitioner Notification Template

28

8.7 Outbreak of Infection or an Infection Control Incident Summary flowchart

29

8.8 Local Contact Details

30


Outbreak of Infection/Major Outbreak

1. Introduction/Background 1.1 The rapid recognition of an outbreak is one of the most important objectives

of routine surveillance. All staff must be vigilant at all times and must report any concerns to the Infection Prevention and Control Team (IPCT ) by day or the on call manager out of hours (weekends, bank holidays, evenings).

1.2 Outbreaks will be graded as either an outbreak/incident or major outbreak

depending upon the severity or number of cases involved. Outbreak control measures will depend on the individual needs of each location within the Trust.

1.3 The responsibilities, the lines of management and communication that are

essential for the rapid control of an outbreak lie initially with the IPCT under the auspice of the IPC Group. But the ultimate responsibility rests with the Chief Executive and the Trust Board.

2. Definitions 2.1 Bed Management and the movements of patients the risks of healthcare

associated infections are greatly increased by the extensive movements of hospital patients within the hospital/healthcare environment. The Health and Social Care Act (DOH 2015) states that there should be joint working between the IPCT and the bed/ward managers in planning patient admissions, transfers, discharges and movements between departments and other healthcare facilities. Where necessary ambulance trusts may need to be involved in planning.

2.2 Case Definition the public health action required depends on the case

definition. A case can be defined as:

Confirmed e.g. clinical diagnosis of the condition confirmed microbiologically as caused by an identified organism.

Probable e.g. clinical diagnosis of a condition without microbiological confirmation in which consultation took place with the clinician managing the case, considers that it is most likely caused by the condition under investigation.

Possible e.g. as probable case, but the consultation with the clinician managing the case, considers that it is unlikely to be caused by the condition under investigation.

2.3 Communication Clear concise and effective communication must be given

at all times. Where media interest is expressed, please direct all enquires to the Southern Health NHS Foundation Trust Communication Team.

2.4 Consultant of Communicable Disease (CCDC) sometimes known as

Consultant in Health Protection. As well as communicable disease control a CCDC usually also prepares and advises on non-communicable environmental hazards. This role has legal responsibilities.


2.5 Consultant Microbiologist of the nearest Acute Trust or at the Laboratory where the specimens have been sent for testing may be available to (depending on local Service Level Agreement):

Advise on the collection of specimens

Advise clinicians on appropriate treatment 2.6 Director of Infection Prevention and Control (DIPC) has responsibility to

give assurance to the Trust Board and to have direct accountability for the management of outbreaks within the Southern Health NHS Foundation Trust.

2.7 Endemic An endemic disease is one, which is constantly present in a given

geographical area; although it may temporary increase its incidence to become epidemic

2.8 Epidemic An epidemic is an increase in the frequency of occurrence of a

disease in a population above its baseline level for a specified period of time.

2.9 Public Health England (P.H.E) – P.H.E is an executive agency of the

Department of Health in the United Kingdom that began operating on 1 April 2013 to protect the public from threats to their health including those of communicable disease.

2.10 Infection Prevention and Control Team (IPCT) will:-

Ensure this appendix to the Infection Prevention and Control Policy is reviewed as required and work with Service Leads to implement necessary changes in practice.

Act as a link between the Trust and specialist agencies and networks.

Take a lead in investigating outbreak incidents and the dissemination of findings.

2.11 Microbiology Laboratory of the nearest Acute Trust will be responsible to:-

Issue specimen containers

Process specimens and analyse results

Disseminate information as appropriate

2.12 Major Outbreak A major outbreak is where action requires resources greater than are routinely available to the IPCT, where action is likely to seriously disrupt the running of the clinical area or where the outbreak has serious consequences outside the trust. e.g. a significant number of cases of diarrhoea & vomiting involving several ward closures at the same site

A Major Outbreak Control Group (MOCG) will be called to co-ordinate actions.

2.13 Outbreak (not Major) 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. The IPCT in conjunction with the ward manager/head of service, will manage this type of outbreak

https://en.wikipedia.org/wiki/Executive_agency

https://en.wikipedia.org/wiki/Department_of_Health_(United_Kingdom)

https://en.wikipedia.org/wiki/United_Kingdom


2.14 Notifiable Diseases – Diseases notifiable to Local Authority Proper Officers under the Health Protection (notification) Regulations 2010 (Appendix 8.5)

2.15 Pandemic Influenza - For guidance refer to “SH NCP 58 Addendum to

SHFT Incident Response Plan Seasonal Influenza Management and Pandemic Influenza Plan & Action Cards.

2.16 Surveillance is a process of observing/monitoring the progress of a disease

in a community. 3.0 Process 3.1 This Appendix links to the following appendices of the Infection Prevention

and Control Policy:-

Appendix 5 Standard Precautions (SH CP19)

Appendix 6 Hand Hygiene (SH CP12)

Appendix 9 Isolation (SH CP 32)

Appendix 11 Ward Closure (SH CP 99)

Appendix 13 Diarrhoea and Vomiting (SH CP 21)

Appendix 14 MRSA (SH CP 20)

Appendix 15 Clostridium difficle (SHCP33) Other useful documents include

Legionella Management and Control Policy, Version 1 Southern Health NHS Foundation Trust, 2012

The “SH NCP 58 Addendum to SHFT Incident Response Plan Seasonal Influenza Management and Pandemic Influenza Plan & Action Cards

The Communicable Disease Outbreak Plan: Operational Guidance, Public Health England 2014 HPA.

Water Safety Policy (SH NCP 40)

3.2 Recognition of an Infectious Incident/Outbreak

Outbreaks may be identified by the

Infection Prevention & Control Team

The Microbiology laboratory, or

By nursing and medical staff in the clinical area, particularly if the onset is rapid and affects a significant number of patients.

The number of cases that constitute an outbreak will vary with the type of disease. In suspected food poisoning related to food supplied, or serious communicable disease such as Smallpox, SARS, Rabies or rare diseases such as Legionella and diphtheria, one case would constitute taking action as in an outbreak. Not all outbreaks are major ones and the Trust has policies for dealing with this. For gastrointestinal infection causing diarrhoea and/or vomiting, two or more cases occurring at the same time would constitute an outbreak. In the case of viral gastroenteritis, symptoms among staff as well as patients are suggestive of this, as there is a sudden onset of symptoms, including projectile vomiting. In this situation, please refer to ‘Appendix 13 Diarrhoea and Vomiting of the Infection Prevention and Control Policy’


For Clostridium difficile associated diarrhoea two or more cases that are linked to the same ward/unit must be considered to be an outbreak of infection. Please refer to Appendix 15 Clostridium difficile of the Infection Prevention and Control Policy in conjunction with this document.

3.3 Outbreak suspected

All staff should be vigilant and report any suspicions’ of an outbreak of infection to the IPCT immediately or the Area on –call manager out of normal IPC working hours. Any member of staff suspecting an outbreak of infection i.e. abnormally high number of cases of common infection, (diarrhoea and vomiting, chickenpox, flu) unusual infection, food poisoning etc. will report this to the person in charge immediately. If the person in charge feels there is an outbreak occurring they must contact the IPCT during normal working hours or out of hours, during bank holidays and weekends they must contact their on-call duty manager for their area immediately. Some outbreaks can take weeks to months to develop before they become apparent, especially if the infectious agent has a long incubation period (e.g. tuberculosis, scabies). These types of outbreaks are frequently detected by laboratory surveillance but again staff awareness can be decisive. The IPCT will take immediate steps to collect and collate information from the affected area(s) to determine the severity and extent of the problem and to implement control measures in accordance with existing Trust policies. The IPCN should undertake a site visit in the event of:

a ward closure,

a second outbreak of the same infection in the same area within 6 months,

a major outbreak

any concerns are raised about practice or the environment; a site visit should be carried out by the IPCN.

The initial assessment will allow the situation to be classified as one of the following: Outbreak / Incident: e.g. 2 or more cases of unexplained diarrhoea &/or vomiting on one ward over a 2 day period, or a single case of a certain disease (TB)

Reporting Outbreaks on Safeguard Ulysses Selected infection control incidents must be reported as a SI. These include:

1) A significant infection prevention issue eg TB 2) An outbreak of a health care acquired infection (HCAI), which

necessitates the closure of a ward 3) All HCAI related deaths where MRSA or Clostridium difficile has been

mentioned on part 1 of the death certificate.

Please refer to Trust policies: - SH NCP 17 Procedure for Reporting and Managing Incidents


The initial assessment may need to be up or downgraded as events unfold and more information becomes available to the IPCT. The CCDC will be informed at all times of the current situation and classification of the problem. The Infection Prevention and Control Lead or deputy will inform key staff eg ward manager, matron, DIPC with daily progress reports. All cases of staff illness must be reported to the Occupational Health Service and if an outbreak is suspected amongst staff the IPCT must also be informed. The IPCN will also gather symptomatic staff personal information as part of the outbreak management daily report so that the clinical picture of the outbreak is robust.

3.4 Management of an Infectious outbreak/Incident

An infectious outbreak or incident can be understood to be a small number of cases as previously mentioned. This is dealt with by the IPCT in conjunction with the relevant clinicians and nurses in the affected areas and supported in some cases by the Estates and Facilities team e.g. Legionella. On suspicion of a possible problem, ward staff should immediately take precautions to prevent further spread by instigating appropriate isolation precautions. (Please refer to the Appendix 9 Isolation and Appendix 13, Diarrhoea and Vomiting, IPC Policy) isolating the patient(s) if possible, collect appropriate specimens and inform a member of the IPCT. Members of the IPCT will carry out initial investigations and their findings will be conveyed to the DIPC, Operational Manager and ward manager of the area concerned. Infectious incidents can usually be controlled by standard infection control precautions with occasional need for extra measures such as increasing the frequency of cleaning on affected wards. The need for the introduction of such further measures will depend on the nature of the infection and/or infectious agent and mechanism(s) of spread. These decisions will be taken by the IPCT with regular review during the course of the incident.

The daily management of the infectious incident will be left to ward staff under the direction of the IPCT. Clinicians in charge must notify, by law, (to the Proper Officers under Health Protection (Notification) Regulations 2010) any patient considered to have a notifiable disease. See appendix 8.5. If the infectious outbreak cannot be managed locally it will be necessary to form an Outbreak Control Group (OCG) to oversee management. See appendix 8.2 for checklist or management of outbreaks.

Members of the Outbreak Control Group (OCG)

On call executive / DIPC (Chair) Infection Control Lead IPCN Medical Director or designate CCDC or deputy (if appropriate) Senior nurse from the affected area(s)


Operational manager from affected area Secretarial assistance Other representatives may be co-opted e.g. If investigating an outbreak of Legionella other representatives will include Legionella Steering Group members, Occupational Health Doctor/nurse, Hospital Engineer(s), Clinical Risk Manager, Health and Safety Advisor and an Environmental Health Officer. (please refer to Legionella Management and Control Policy)

Functions of the OCG Once an infection control incident or outbreak cannot be managed locally but has not reached major outbreak status the functions of the OCG will be to:

Agree on a working case definition for outbreak management

Collate all results from the clinical areas and laboratory

Agree and co-ordinate policy decisions on the investigation and control of the outbreak and to ensure they are implemented

Take all necessary steps to ensure optimal continuing clinical care of all patients (affected or unaffected) during the outbreak.

Take all necessary steps to ensure the well-being and safety of all staff involved.

Assess the resource implications of outbreak management and how these will be met e.g. additional supplies

Agree arrangements for providing information to patients, relatives and visitors if required

Meet on a regular basis to review progress on outbreak investigation and control

Define the end of the outbreak/incident and evaluate its management

Instigate and complete a SI investigation if required 3.5 Escalation to Major Outbreak

In cases where an outbreak reaches a level where CCDC or DIPC classifies the situation as a major outbreak it is necessary to form a Major Outbreak Control Group to oversee management. An outbreak may be judged as MAJOR after consideration of its complexity, the number of people affected, the pathogenicity of the organism involved, the potential for transmission and any other unusual or exceptional features.

The person declaring the ‘Major Outbreak’ must contact the senior manager for the area concerned and request that the on-call Executive convene a meeting of the Major Outbreak Control Group. On the advice from the Infection Control Lead or DIPC the initial membership of this meeting and time must be agreed. They must inform the Chair of the MOCG who will be the DIPC or on-call Executive. (If the outbreak is wider than Trust buildings i.e. in the community, then the chair of this meeting will probably be the CCDC). Any Major Outbreak will be recorded on the Safeguarding risk reporting system and also activate the Serious Incident (SI) reporting system.


Members of the Major Outbreak Control Group (MOCG)

On call executive / DIPC (Chair) Infection Control Lead IPCN CCDC or representative (Chair if in wider community) Consultant / GP from affected area Senior nurse from affected area Operational manager / Locality manager Facilities Manager Director of Nursing Medical Director Head of Communications Occupational Health rep Chief Environmental Health Officer or nominee – if infection is likely to be food or water borne Secretarial assistance Other representatives may be co-opted NB: some members may represent a number of roles, if chaired by the CCDC then the regional epidemiologist will phone in. Functions of the MOCG

Once a major outbreak has been identified the functions of the MOCG are to:

Agree on a definition for outbreak management

Investigate the source and cause of the outbreak and implement measures to control the outbreak

Facilitate optimal continuing care of all patients (affected and unaffected) during the outbreak

Take all necessary steps to ensure the well-being and safety of the staff involved

Assess the resource implications for the outbreak and its management, and how these will be met.

Provide clear guidelines for communications with patients, staff patients relatives, the media and other health services as appropriate

Consider the need for outside help / expertise agree arrangements for providing information to patients, relatives and visitors

Ensure communication with Communicable Disease Surveillance Centre, (CDSC) and Health Protection Agency Laboratory

Meet frequently and review progress on outbreak investigation and control measures

Evaluate the overall experience of controlling the outbreak and implement the lessons learnt

Prepare a report for the IPC Group and Trust Board

All meetings of the MOCG should have a clear agenda, minutes and action notes must be produced. Members of the IPCT will be responsible for providing status reports at each meeting for MOCG deliberation.


3.6 Procedure for OCG/MOCG Meetings

Chair: The Chair will normally be the DIPC or on-call Executive. The Chair will be responsible for providing adequate secretarial and clerical assistance, to ensure accurate recording of all issues discussed and all decisions made by the team. The objectives of the meetings and the checklist of issues to be considered are detailed in Appendix 8.1. The checklist in Appendix 8.2 should be used by the Chair at every meeting as appropriate, and completed by his/her nominee. This checklist should be held by the Chair for the duration of the outbreak and a final copy held with the Outbreak Report. Each member of the OCG / MOCG should have an ACTION CARD, outlining their responsibilities and duties, as a checklist of tasks to be undertaken – see appendices 8.3 (1-7). Each member of the OCG / MOCG is personally responsible for the duties outlined on his/her Action Card. These duties and responsibilities may only be passed onto a deputy by direct personal communication subject to the consent of the Chair of the OCG. The IPCT will keep a set of ACTION CARDS available at all times for the use of the Chair of the OCG / MOCG so that they may be aware of the responsibilities of all team members. The OCG / MOCG will meet as often as necessary and will systematically review the situation. Individual ACTION CARDS should be consulted. The date, time, and place of subsequent meetings will be stated at the end of each meeting. The need for further assistance, from any source should be formally considered at each meeting, e.g. Communicable Disease Surveillance Centre, Public Health England (PHE).

3.7 Release of information

Requirements for patient confidentiality must be observed. The Chair will usually be responsible, for the release of information to people other than the immediate relatives of those patients affected. The Operational Managers of the affected area(s) are responsible for informing staff in their directorate. The CCDC will be responsible for liaison between the MOCG and Public Health England and will inform them of the outbreak, of the implementation of the Outbreak Plan, and of all subsequent developments. The CCDC has a duty to provide information to the public and press about communicable disease matters. In the event of an outbreak with major community implications the CCDC will be responsible for this function. If the outbreak is confined to the hospital but has no community implications the


Chair of the OCG (on behalf of the Trust) should nominate a person to be responsible for the release of information to the public and press. This person will usually be the Public Relations Manager.

3.8 At the end of the Outbreak

After the outbreak has been declared over, the OCG / MOCG should hold a final meeting with the following objectives.

Review the experience of all participants involved in the management of the outbreak.

Identify particular difficulties that were encountered.

Revise the Outbreak Policy on the basis of lessons learned.

Monitor the effectiveness of the policy.

Recommend, if necessary, structural or procedural improvements which would reduce the chance of recurrence of an outbreak.

Communicate that the outbreak is closed to all those who were informed throughout the outbreak.

3.9 Reports

The Chair with the assistance of the IPC Lead, CCDC and Service Leads will provide any interim reports required by the Trust Chief Executive and also a final report at the end of the outbreak. All major outbreaks will be reported as a SI (serious incident) under the mandatory reporting surveillance scheme.

3.10 Monitoring Compliance

After each major outbreak there will be a formal review of the events to examine compliance with the policy, lessons learnt and additional training requirements. Any recommendations will be shared with the IPC Group.

4. References Diseases, and Dangerous Occurrences Regulations 1995 (RIDDOR)

Public Health England 2014 : The Communicable Disease Outbreak Plan: Operational Guidance, Department of Health (2015) The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance. London

The Health Protection (Notification) Regulations 2010.Reporting

Notifiable Diseases

Public Health England https://www.gov.uk/government/organisations/public-health-england

https://www.gov.uk/government/organisations/public-health-england

https://www.gov.uk/government/organisations/public-health-england


Appendix 8.1 Actions to be taken by staff

Contact the Infection Prevention and Control Service if:

An unusual infection is confirmed

A number of patients and/or staff display symptoms of infection

An unusually high number of “common” infections are confirmed

You suspect an incident that has infection control implications has occurred

Inform Senior Nurse of situation and Hospital Manager (if applicable) and Senior

Manager on call

Ensure infection control measures are in place, as directed by the IPCT

Prepare information on affected cases, as directed by the IPCT

Document clearly the incident, if an incident has occurred.

Follow any further instructions by IPCT

Check adequate supplies of disposables are available at ward level

Make a list of any items you may need to order more of

Await the outcome of the outbreak control or incident meeting if one is held

Follow the advice and guidance of the IPCT until the outbreak is declared over

Notify the IPCT of any difficulty in implementing the

advice


Appendix 8.2: Draft Agenda for Meetings of the Outbreak Control Group

Complete list of attendees to be taken

Background

Actions to date

Current Situation

Recommended control measures

Implications of control measures, available resources

Agree action plan

Chair to distribute action cards to key members - see appendices 8.3 (1-7)

Clarify individual responsibilities

Communication strategy

Completion of Trust incident form

Any other business

Next meeting


List of Attendees at Outbreak Control Meeting

Date:

Name (Print) Signature Representing/Dept Phone no/Bleep


Appendix 8.3: Chair’s Checklist for Management of Outbreaks To be used by the Chair at every meeting as appropriate and completed by his/her nominee Initial Assessment

1. Is an Outbreak Control Group or Major Outbreak Control group

necessary Yes/No

2. Is there any involvement with an Acute Trust Yes/No

3. Has the CCDC (in PHE) been notified or otherwise involved Yes/No

4. Is the OCG or MOCG appropriately constituted Yes/No

Communication

1. Senior management of Trust informed Yes/No

2. Health & Safety informed Yes/No

3. Catering manager informed Yes/No

4. Occupational Health Services informed Yes/No

5. Communications Officer informed Yes/No

6. Appropriate information provided to staff Yes/No

7. Appropriate information provided to patients, visitors and relatives Yes/No

8. Communication with relevant personnel and departments considered Yes/No

9. Microbiologist informed Yes/No

10.PHE contacted Yes/No

11. Other Healthcare facilities informed Yes/No

12. Other relevant bodies contacted Yes/No

Managerial / Organisational aspects

1. Need for increased clinical care considered eg extra staff Yes/No

2. Need for extra cleaning resources considered Yes/No

3. Need for increased laundry, ancillary staff considered Yes/No

4. Need for increased clerical staff considered Yes/No

5. Isolation facilities defined Yes/No

6. Isolation ward considered (if applicable) Yes/No

7. Isolation and nursing procedures defined Yes/No

8. Nursing, medical and para medical staff informed of procedures Yes/No

9. Domestic / housekeeping procedures defined Yes/No

10. Availability of supplies assessed Yes/No

Investigation

1. Case definition established on clinical epidemiology and microbiology Yes/No

2. Need for microbiological screening of staff and patients considered Yes/No

3. Need for serological screening of staff and patients considered Yes/No

4. Engineers involved Yes/No

5. Need for environmental samples considered Yes/No

6. Need for food samples considered Yes/No

7. Epidemiological investigation started Yes/No


Control

1. Need for active and passive immunisation considered Yes/No

2. Need for antibiotic prophylaxis considered Yes/No

3. Isolation / ward closure policies implemented (if applicable) Yes/No

4. Policy on patient transfer, discharge and admissions defined Yes/No

5. Policy on movement of patients and staff within the hospital defined Yes/No

6. Visiting arrangements defined Yes/No End of Outbreak

1. Preliminary report compiled Yes/No

2. Meeting of OCG / MOCG held to consider long term implications Yes/No

3. Final report compiled and circulated Yes/No


Appendix 8.4 (1): For the Acute Hospital: Infection Control Doctor / Microbiologist /Lead IPC Nurse

Action Card 1

Verify Outbreak Inform the Trust IPCT, Consultant Medical Microbiologists and the Laboratory. Determine the appropriate response to the outbreak: A: Local management by the IPCT B: Declare an outbreak and activate the plan On activating the plan, inform:

Consultant in Communicable Disease Control (CCDC) or deputy.

DIPC or On-call Executive Provide advice to the Infection Prevention and Control Nurses and clinical staff of any specific control measures and treatment prior to the OCG meeting. Either attend the first OCG Meeting or provide expert advice on management of the outbreak. Ensure daily review and documentation of the outbreak, in collaboration with the IPCN’s. Provide continuing expert advice to clinical staff on management of the outbreak and treatment of patients affected. Attend subsequent and final OCG meetings if necessary. In collaboration with the lead IPCN, recommend appropriate isolation of patients, particularly if single rooms not available. This will include advice on the use of cohort bays or isolation wards. Advise the OCG on the need to escalate to the Major Incident Plan, or disease specific control plans.


Appendix 8.4 (2): For Chair of OCG / MOCG - DIPC or on call Executive

Action Card 2 Notify Chief Executive (or in their absence the on call senior manager) and continue to act as a link between the OCG / MOCG and Chief Executive. Approve or seek approval for extra funding and resources. Inform other Senior Managers as appropriate. Set up Outbreak Control Group / Major Outbreak Control Group, convene meetings and provide secretarial support to team meetings. Ensure clear lines of communication are established within the Trust, and with external agencies Nominate a manager to coordinate activity of all non-clinical directorate staff. Hold copies of action cards for all OCG members. Delegate and record specific areas of responsibility to named individuals Agree the strategy for communication with the Media, including information to be released Ensure the outbreak is documented for national reporting, and that this information is sent to the Strategic Health Authority and to the Regional Epidemiologist, HPA. This includes a final outbreak report. Approve release of outbreak funds from the Infection Control outbreak contingency budget, as requested by the Community Infection Control Service. Action escalation to the Major Incident Plan, or disease specific control plans if appropriate.


Appendix 8.4 (3): For CCDC (Or Deputy) –

Action Card 3 Act as link between the OCG / MOCG and South Central Strategic Health Authority. Provide support and expert advice on the control of the outbreak. Inform Local Authorities, Regional Epidemiologist and CCDC’s in neighbouring Districts, if appropriate. Advise on the collection of epidemiological data and its interpretation. Provide public information and media handling if required. The CCDC has overall responsibility for the control of communicable disease within Southampton and Hampshire and the Isle of Wight. In outbreaks that have major public health implications the CCDC will normally lead and co-ordinate outbreak control, working closely with the Trusts and HICD/on call Microbiologist. The HICD/on-call Microbiologist will be responsible for the hospital


Appendix 8.4 (4): Lead Infection Prevention and Control Nurse (IPCN)

Action Card 4 In conjunction with the Microbiologist verify there is an outbreak Cancel planned IPCN activities, if required, in order to respond immediately to the outbreak. Co-ordinate and direct IPCN’s to visit affected areas and collect information immediately. Assess the level of information that can be gathered prior to the OCG / MOCG Meeting (Initial assessment, further assessment, and additional information if time allows - see action card 5) Institute outbreak control measure and commence outbreak documentation. Collate initial information on the extent of the outbreak, incorporating information provided by IPCN’s visiting affected areas. Assess the requirements for isolation of patients, particularly if single rooms not available. Consider the options of cohort bays/isolation wards and advise the OCG accordingly. Provide initial briefing to direct and advise IPCN’s as per their action card. Liaise with laboratory to inform them of outbreak. Report findings and advise the OCG / MOCG Meeting Liaise with key people, as allocated by the OCG / MOCG Chair Report outcome of OCG / MOCG Meeting to IPCN’s, and continuing actions required Produce written infection control advice for dissemination to affected areas Direct IPCN’s to:

ensure OCG / MOCG actions are implemented

visit affected areas as allocated

complete individual outbreak documentation

disseminate written infection control advice Collate information on facilities and additional supplies required in affected areas and liaise with key staff to ensure these are provided. Review the outbreak daily, in collaboration with the on-call microbiologist and/or CCDC Attend meetings of the OCG / MOCG, and report on current situation, control measures and difficulties with implementation. Contribute to outbreak reports, including the final report.


Appendix 8.4 (5): For Infection Prevention & Control Nurses (IPCN) Assisting the Lead IPCN

Action Card 5 Undertake an initial visit or phone call to affected areas. Information required: Initial assessment must include:

a list of affected patients, staff and visitors

a patient location sheet should be completed Further assessment will include:

name, hospital number, date of birth,

date of admission

diagnosis, antibiotic therapy

onset date

symptoms Additional information required may include:

use of aperients

food history

recent travel

other as determined by Lead IPCN Discuss the situation with the Lead IPCN Provide support to clinical staff. In collaboration with the Nurse-in-charge, assess the adequacy of supplies and facilities, including:

Availability and sighting of alcohol foam hand sanitiser

Liquid soap and paper towels

Protective clothing

Disposable equipment

Linen

Cleaning products

Waste bags


Appendix 8.4 (6): For Nurse In Charge Of Affected Area

Action Card 6 Inform IPCT of the outbreak/incident. Out-of-hours contact the on-call area manager Inform the Senior Nurse/Bleep holder of the outbreak/incident. Collect the following information ready for the IPCN:

a list of affected patients, staff and visitors Information should include:

name, hospital number, date of birth,

date of admission

diagnosis, antibiotic therapy

Additional information required may include:

use of aperients

food history

recent travel

other as determined by the IPCN

onset date

symptoms Assess the availability of isolation nursing facilities. In collaboration with the IPCN, assess the adequacy of supplies and facilities, including:

Availability and sighting of alcohol foam sanitiser

Liquid soap and paper towels

Protective clothing

Disposable equipment

Linen

Cleaning products

Waste bags Restrict patient movement until advised by IPCN. If patient movement is restricted inform patients (offer interpreter services if English is not understood by the patient). If the patient requires access to worship, religious representatives should seek advice on precautions they must take if entering the ward. Report back to the IPCN, clearly identifying additional requirements for the area. Keep clear written records of resources needed and actions taken. Utilise the Ward Outbreak Pack (Appendix 13 Diarrhoea and Vomiting of the IPC Policy) which is available on the Trust Intranet site and/or from the IPCT


Appendix 8.4 (7): For Occupational Health Service

Action Card 7

Liaise closely with the Infection Prevention & Control Team to identify any specific Occupational Health measures that should be taken as soon as you are informed of the outbreak. Ensure colleagues in your department are informed of the outbreak. Attend the outbreak control meeting, and advise on occupational health measures required. Provide advice and support for staff, with regard to their own health, and support managers in managing any staff health issues. Check communicable disease immunity status and vaccination records during an outbreak of communicable disease staff exposure to communicable disease in the work place. Ensure records are kept if staff are given treatment as part of a communicable disease outbreak/incident When appropriate advise manager of the need to report under Reporting of Injuries disease and Dangerous Occurrence Regulations (RIDDOR). See Appendix 8.4 RIDDOR reporting. Carry out any other actions as agreed at the outbreak control meeting.


Appendix 8.5: Reporting Of Injuries, Diseases, & Dangerous Occurrences Regulations 1995 (R.I.D.D.O.R) The reporting of Injuries, Diseases, and Dangerous Occurrences Regulations 1995 (RIDDOR) require employers and others to report accidents and some diseases that arise out of or in connection with work to the enforcing authority (Health & Safety Executive). For more information about RIDDOR or Health and Safety, visit www.hse.gov.uk This will be carried out as below: The Trust Safeguard Ulysses Incident form should be completed in the normal way and sent to the Trust Risk Manager. Alternatively, the Risk Manager or Health and Safety Advisor should be telephoned immediately a RIDDOR Reportable event occurs, an incident form should still be completed and forwarded as usual. RIDDOR Reportable Events will be reported to the HSE by the Trust’s Risk Manager or the Trust Health and Safety Advisor. Managers are required to notify RIDDOR reportable events to: Trust Health and Safety and Fire Manager 02380 475775 Trust Risk Manager: 02380 296902 These serious events below will be reported to the HSE by the quickest available means, generally e-mail, fax or telephone:

Death at work

Major injury to a person

Injuries to people not at work (patients, member of public, visitor, Contractor)

Dangerous occurrences The incidents below will be reported within 10 days: 1. Incapacity to carry out normal work for over 3 days 2. Prescribed diseases 3. The death of an employee if this occurs sometime after a reportable injury that

led to their death Examples of the above: Diseases

Certain poisonings

Some skin diseases

Lung diseases including occupational asthma, asbestosis

Infections e.g. hepatitis, legionellosis, tuberculosis

Other conditions such as occupational cancer, certain musculo-skeletal disorders & hand –arm vibration syndrome

For an accident to be reportable, it must arise out of or in connection with work. Accidents which arise solely from the condition of the injured person are not reportable, neither are suicides.


Appendix 8.6: The Health Protection (Notification) Regulations 2010 Reporting Notifiable Diseases There are 30 diseases which are statutory notifiable to the Proper Officers under the revised Public Health (Control of Disease) Act 1984 and the Health Protection (notification) Regulations 2010. Schedule 1: Diseases

Acute encephalitis

Acute infectious hepatitis

Acute meningitis

Acute poliomyelitis

Anthrax

Botulism

Brucellosis

Cholera

Diptheria

Enteric fever (typhoid or paratyphoid fever)

Food poisoning

Haemolytic uraemic syndrome (HUS)

Infectious bloody diarrhoea

Invasive group A streptococcal disease

Legionnaires’ disease

Leprosy

Malaria

Measles

Meningococcal septicaemia

Mumps

Plague

Rabies

Rubella

SARS

Scarlet fever

Smallpox

Tetanus

Tuberculosis

Typhus

Viral haemorrhagic fever (VHF)

Whooping cough

Yellow fever

Schedule 2: Causative Organisms

Bacillus anthracis

Bacillus cereus (only if associated with food poisoning)

Bordetella pertussis

Borrelia spp

Brucella spp

Burkholderia mallei

Burkholderia pseudomallei

Campylobacter spp

Chikungunya virus

Chlamydophila psittaci

Clostridium botulinum

Clostridium perfringens (only if associated with food poisoning)

Clostridium tetani

Corynebacterium diphtheriae

Corynebacterium ulcerans

Coxiella burnetii

Crimean-Congo haemorrhagic fever virus

Cryptosporidium spp

Dengue virus

Ebola virus

Entamoeba histolytica

Francisella tularensis

Giardia lamblia

Legionella spp

Leptospira interrogans

Listeria monocytogenes

Machupo virus

Marburg virus

Measles virus

Mumps virus

Mycobacterium tuberculosis complex

Neisseria meningitides

Omsk haemorrhagic fever virus

Plasmodium falciparum vivax, ovale, malariae, knowlesi

Polio virus (wild or vaccine types)

Rabies virus (classical rabies and rabies related lyssaviruses)

Rickettsia spp

Rift Valley fever virus

Rubella virus

Sabia virus

Salmonella spp*

SARS coronavirus

Shigella spp

Streptococcus pneumoniae (invasive)

Streptococcus pyogenes (invasive)

Varicella zoster virus


Guanarito virus

Haemophilus influenzae (invasive)

Hanta virus

Hepatitis A, B, C, delta & E viruses

Influenza virus

Junin virus

Kyasanur Forest disease virus

Lassa virus

Variola virus

Verocytotoxigenic Escherichia coli (including E.coli O157)

Vibrio cholerae

West Nile virus

Yellow Fever virus

Yersina Pestis

As of April 2010, it is no longer a requirement to notify the following diseases:

Amoebic Dysentery or Shigella dysenteriae

Leptosporosis

Ophthalmia neonatorum

Relapsing fever

Viral hepatitis These and other diseases that may present significant risk to human health may be reported under Other significant disease category

HIV/AIDS is not a notifiable disease, but doctors are urged to report in a voluntary confidential scheme. Advice about the reporting of cases may be obtained locally from the CCDC or Consultant in Genito –Urinary Medicine. HIV/AIDS cases should be reported via the national ‘HIV and AIDS Reporting System (HARS)’. Cases are uploaded via the Public Health England HIV and STI web portal accessible via www.gov.uk . Responsibility for Notification Doctors in England and Wales have a statutory duty to notify a ‘Proper Officer’ of the Local Authority (usually Consultant in Communicable Disease Control -CCDC at local Health Protection Unit) of suspected cases of certain infectious disease. The responsibility of notification rests with the attending Registered Medical Practitioner looking after the service user. When As soon as possible after confirmed or suspected diagnosis by the laboratory of a notifiable disease so that Public Health action can be taken immediately. If the clinical diagnosis is subsequently disproved then the notification can be de-notified by informing the Health Protection Unit How to Notify

Complete the Registered Medical Practitioners Notification Form (8.5(1) see below)

Record notification in the service user’s notes.

Notification should be sent/faxed immediately to: Contact details of local Health Protection Unit are: Public Health England South East Fareham Borough Council Civic Offices, Civic Way Fareham PO16 7AZ Tel: 03442253861 option 2 option1, Fax:0345 279 9881 Email: [email protected] Notifications sent to the Public Health England must be made in a secure manner.


8.6a: Registered Medical Practitioner Notification Form Template (Taken from www.gov.uk)

Health Protection (Notification) Regulations 2010: notification to the proper officer of the local authority

Registered Medical Practitioner reporting the disease

Name

Address

Post code

Contact number

Date of notification

Notifiable disease

Disease, infection or contamination

Date of onset of symptoms

Date of diagnosis

Date of death (if patient died)

Index case details

First name

Surname

Gender (M/F)

DOB

Ethnicity

NHS number

Home address

Post code

Current residence if not home address

Post code

Contact number

Occupation (if relevant)

Work/education address (if relevant)

Post code

Contact number

Overseas travel, if relevant (Destinations & dates)


Appendix 8.7: Outbreak of Infection or an Infection Control Incident:

Summary Flowchart

IPCT ALERTED

Out of hours: contact On- Call Manager

Infection control

incident or outbreak Outbreak suspected or confirmed

Activate outbreak plan

Outbreak Control Group

formed

Incident/ Outbreak

can not be managed

locally Major Outbreak

Control Group formed

Ward/area suspect an outbreak is occurring or an

incident has occurred

Regular review

Complete checklist

Report on Safeguard

Activate SI if required

Upgrade or downgrade outbreak if necessary

Complete final report

Dealt with locally by IPCN and local

clinicians

Regular review and complete

report


Appendix 8.8: Local Contact Details

Who to Contact: Telephone Numbers

DURING OFFICE HOURS (MON-FRI): If an outbreak of infection is suspected please contact the Infection Prevention and Control Nurse for your area Lead Nurse 07500 975960 Nurse (West) 07500 975961 Nurse (NE) 07500 975962 Nurse (SE) 07717 714894 IPC Team office 02380 874291 or 02380 874658 (answer phone – checked daily) OUT OF HOURS: Please contact the Area Manager on-call (refer to your on-call pack) For further advice out of hours please contact the on-call Microbiologist via the switchboard of your local Acute Trust:

Local Acute Trust Hospital & Contact Details

Portsmouth Hospitals NHS Trust Queen Alexandra Hospital Tel No: 02392 286000

University Hospital Southampton NHS Foundation Trust

Southampton General Hospital Tel No: 02380 777222

Salisbury NHS Foundation Trust Salisbury District Hospital Tel No: 01722 336262

Hampshire Hospitals NHS Foundation Trust

Basingstoke & North Hampshire Hospital Tel No: 01276 473202

Frimley Park Hospital NHS Foundation Trust

Frimley Park Hospital Tel No: 01276 604604

Great Western Hospital NHS Foundation Trust

Great Western Hospital Tel No: 01793 604020

Dorset County Hospital NHS Foundation Trust

Dorset County Hospital Tel No: 01305 251150

The Consultant for Communicable Disease Control (CCDC) or deputy for Hampshire and Isle of Wight Health Protection Unit has overall responsibility for the control of communicable disease within Hampshire on behalf of the PCT’s During office hours the Public Health England can be contacted on 0344 225 3861 option 2 option 1 There is an on-call public health rota for public health emergencies only

Documents

Outbreak of Infection/Major Outbreak - · PDF fileOutbreak of Infection/Major Outbreak ... The “SH NCP 58 Addendum to SHFT Incident Response Plan Seasonal ... In suspected food poisoning