New Strain Respiratory Virus Policy - Hampshire Hospitals NHS ...

New Strain Respiratory Virus Policy 

(E.g. Avian Influenza, SARS) 

Guidance and Infection Control Protocols 

Authorities 

Document Control Information 

Author: 

Sue Dailly 

Lead Nurse Infection 

Control 

Type: 

Policy 

Sponsor: 

Reviewer(s): 

Paula Shobbrook, Director 

of Infection Control 

Prevention (DIPC) 

Infection Control 

Committee 

Nurse & Midwifery Policy 

Group 

Pandemic Flu Steering 

Group 

Scope: 

Major 

Trust Reference CP104 

Number: 

Issue Number: 2 

Approval body: Policy Approval Group Status: Final 

Effective Date: May 2010 

Review Date: May 2013 

Disposal Date: 2033 

Document Authorisation Control 

Prepared By: 

Sue Dailly 

Lead Nurse Infection Control 

Signature: 

Authorised Officer 

Chris Gordon 

Acting Chief Executive 

Signature: 

Authorities 


Author: Sue Daillly Lead Nurse Infection Type: 


Control 

Sponsor: Paula Shobbrook Director of Infection Scope: 

Major 

Prevention & Control 

Reference: 

CP104 


Date May 2010 Status: Final 

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Winchester & Eastleigh Healthcare NHS Trust 


DOCUMENT CONTROL 

Document Amendments 

Number Details By Whom Date 

1 Reviewed as a new strain of S.Dailly 

December 

influenza has occurred and Lead Nurse Infection 2009 

caused a pandemic 

Control 

Review Timetable 

Date Reason By Whom Date 

Completed 

Dec 2009 Reviewed as a new strain of 

influenza has occurred and 

caused a pandemic 

S.Dailly 

Lead Nurse Infection 

Control 

Feb 2013 Three year review Infection Control team 

Distribution List 

No Title 

1 Core Policy Holders 

2 Intranet 

3 Winchester & Eastleigh Healthcare NHS Trust Website 

RELATED TRUST POLICIES 

CP074 Infection control assurance framework and roles and responsibilities 

CP076 Standard precautions and PPE policy 

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CP072 Training policy for employees of WECHT in infection control 

CP062 Pandemic Influenza Plan 

CP077 Policy for ward closure 

CP061 Policy for the Intraward Transfer of Patients with Infection Control 

Issues 

CP070 Deceased Infected Patient Policy 

CP073 Hand hygiene policy 

CP061 Policy for the inter and intra ward transfer of patients with infection 

control issues. 

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Contents 

Section Title Page 

1.0 Purpose 5 

2.0 Scope 5 

3.0 Duties and responsibilities 5 

4.0 Introduction 6 

5.0 Pandemic strain 8 

6.0 Symptoms 8 

7.0 Illness in travellers returning to UK 8 

8.0 Travel to affected countries 9 

9.0 New vaccines 9 

10.0 The beginning of a pandemic 9 

11.0 Who to contact for advice 11 

12.0 Case definition 11 

13.0 Investigations 12 

14.0 Microbial testing 13 

15.0 Isolation and infection control precautions 14 

16.0 Laboratory samples 17 

17.0 Patient transfers 18 

18.0 Decontamination of equipment and room 18 

19.0 Family contacts 18 

20.0 General considerations 19 

21.0 Larger number of cases 19 

22.0 Training 20 

23.0 For More Information 21 

Appendix 1 Infection Control Action card 22 

Appendix 2 Putting on and removing PPE 23 

Appendix 3 Contacts 25 

Appendix 4 Equality impact assessment 26 

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New Strain Influenza Policy 

1 PURPOSE 

This plan deals with the first one or few cases of a new strain of respiratory 

virus e.g. Rhinoviruses, respiratory syncytial virus, influenza viruses A, B and C, 

para-influenza viruses and coronaviruses including SARS or emerging strain, 

which may present to this Trust via primary care or Accident and 

Emergency(A&E). Planning is based on maximal efforts to contain spread of a 

new strain to other susceptible patients, staff and visitors whilst providing 

optimal care for the affected individuals. 

Please note instructions will be reviewed when more information regarding the 

new strain become available. 

2 SCOPE 

This policy extends to cover all Winchester and Eastleigh Healthcare NHS 

Trust employees. This policy will also apply to honorary contract holders and 

staff employed by other organizations, who work with the Winchester and 

Eastleigh Healthcare NHS Trust patients and for the Trust’s other staff. 

This policy complements professional and ethical guidelines and the Nursing 

and Midwifery Council Code of Professional Conduct (NMC 2008). 

The policy is ratified in line with the CPO01Policy for the Management of 

Controlled Documents. 

3 DUTIES AND RESPONSIBILITIES 

Chief Executive (CEO) 

The CEO has overall responsibility for ensuring the Trust has appropriate 

strategies, policies and procedures in place to ensure the Trust continues to 

work to best practice and complies with all relevant legislation. The CEO has 

responsibility to ensure there is a safe environment for staff and patients 

Trust Board 

The Board is responsible for ensuring the strategic context of this policy is 

appropriate and meets the needs of the Trust. 

Infection Control Team 

The Infection Control Team is responsible for updating this policy and 

ensuring it represents best practice and is based on current evidenced based 

information. 

Line managers 

Line mangers are responsible for ensuring adequate dissemination and 

implementation of this policy. They are responsible for identifying any training 

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Author: Sue Dailly Lead Nurse Infection Type: 


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Sponsor: Director of Infection Prevention and Scope: 

Major 

Control 

Reference: 

CP0 


Date January 2010 Status: draft 

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needs on the implementation of new or updated policies. They are 

responsible for ensuring adequate facilities and resources are available to 

adhere to this policy and that any changes in practice are implemented. Line 

managers are responsible for ensuring that all Infection Control (IC) policies 

and procedures are accessible for all their staff and that their staff have read 

them. 

All Trust employees 

All staff are responsible for ensuring their compliance to this policy to ensure 

the safety of all patients, staff, visitors and contracted staff to this Trust. 

Information regarding the failure to comply with this policy e.g. lack of training 

or inadequate equipment must be reported to the line manager and the 

incident reporting system used where appropriate. If patient or staff safety is 

compromised as a result of the revised policy, staff must inform their line 

manager and ensure that a risk assessment is completed and reported 

through divisional risk forums and the Trust Patient Safety Manager. 

It is the responsibility of individual practitioners to ensure they receive the 

education they require to improve their knowledge, skills and competence as 

stated in CP072 Training policy for employees of WECHT in infection control. 

They are accountable to themselves, their line manager and the patient in 

acknowledging their limitations and to verbalize their concerns in caring for 

patients who have a new strain of respiratory virus such as influenza. 

4 INTRODUCTION 

Viral diseases pose a continual threat to human populations. As we live in 

ever-increasing populations and become increasingly mobile so it is inevitable 

that new viruses, such as SARS-CoV or new hyper-virulent influenza stain will 

appear. 

Respiratory infections are common including rhinoviruses, respiratory 

syncytial virus, influenza viruses A, B and C, para-influenza viruses and 

coronaviruses including SARS. Most infections with these viruses are fairly 

mild, self-limiting and confined to the upper respiratory tract. However, these 

viruses can undergo genetic changes and mutations and can emerge or reemerge 

as more virulent agents and cause more severe infections and even 

death. A new type or sub type of respiratory viruses may arise at any time, 

the main processes in the evolution of emerging new viruses are not fully 

clear, particularly the selection pressures faced by viruses in new host 

species. Although the high mutation rates of RNA viruses like Influenza and 

SARS provide them with great adaptability and explain why they are the main 

cause of emerging diseases, their limited genome size means that they are 

also subject to major evolutionary constraints. Viral genetic factors have also 

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been implicated in the emergence of SARS-CoV, with the suggestion that this 

virus is a recombinant between mammalian and avian coronaviruses. 

Outbreaks of respiratory virus infection derive their importance from the 

rapidity with which epidemics evolve and the widespread morbidity and the 

seriousness of complications, notably increased hospitalizations and mortality 

due to viral and bacterial pneumonias. Patients with compromised immune, 

cardiac, or pulmonary systems, pregnant ladies and patients at extremes of 

age are at increased risk of serious complications of infection. There is a 

seasonal problem of epidemic respiratory virus infections in the UK 

Respiratory Syncitial virus (RVS) causes annual winter epidemics usually 

occurring in children from November to January. Influenza also occurs during 

winter months and can affect all age groups, particularly the elderly and the 

immunocompromised. Newly emerging diseases such as SARS and Avian 

Influenza or even a new respiratory virus have the potential to cause severe 

human illness. Generally these infections can be acquired by direct and 

indirect contact. Transmission occurs from person to person by close contact, 

predominantly by large droplet/airborne respiratory secretions and/or 

contamination of hands. Infected healthcare workers and visitors are potential 

sources of hospital acquired infection. 

In general the clinical picture of these infections is generally similar to flu e.g. 

fever, headache, myalgia (muscle pain), prostration (collapse), rhinorrhoea 

(runny nose), sore throat and cough. They derive their importance from the 

rapidity with which epidemics evolve and the widespread morbidity and the 

seriousness of complications, notably viral and bacterial pneumonias. During 

major epidemics, severe disease and deaths occur primarily among not only 

the elderly and those debilitated by chronic disease: pulmonary, cardiac, renal 

or metabolic disease, anaemia or immunosuppression, but also in previously 

fit and healthy individuals. 

To aid healthcare planning, surveillance of infections is used to alert healthcare 

providers to diagnostic considerations, management and prevention 

options. Every NHS body under The Health Act (2006) must ensure ‘ so far as 

is reasonably practicable, patients staff and other persons are protected 

against risks of acquiring HCAIs...’ The principles of managing a new strain in 

this country are the same where ever it originates from, and however it arrives 

here. This guidance for new strain influenza can be adapted to manage any 

new influenza or viral respiratory infection e.g. SARS, Avian or Swine flu. If 

many cases occur, a pandemic will be declared and the CP062 Pandemic 

Influenza Plan available on the intranet should be followed. 

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5 THE NEW PANDEMIC STRAIN 

SARS, Avian or swine and human influenza viruses can exchange genes 

especially when similar viruses simultaneously infect the same host. This can 

give rise to a completely new subtype of the virus to which few, if any, 

humans would have natural immunity. This could give rise to a global 

epidemic or (a pandemic) in humans. 

Existing vaccines may not be effective against a completely new influenza 

virus. 

A pandemic may be prevented by reducing human exposure to infected hosts 

by rapid detection of outbreaks followed by appropriate infection control and 

public health measures. 

6 SYMPTOMS 

Incubation period and symptoms varies depending on the strain, but in 

general the median incubation period is around 3 days (range 2-7 days). Early 

symptoms in humans are fever, cough, sore throat, rhinorrhoea, myalgia, 

conjunctivitis, watery diarrhea, vomiting and severe unexplained respiratory 

illness. The severity of illness varies from mild symptoms to severe respiratory 

infection and death. 

Infectivity period again would depend on the infectious agent it is not 

unreasonable to assume that people are infectious while symptomatic for a 

period five days from the onset of symptoms. Immunosuppressed individuals 

are usually infectious for a prolong period of time. 

7 ILLNESS IN TRAVELERS RETURNING TO THE UK FROM 

AFFECTED COUNTRIES 

When a new respiratory strain is identified outside the UK, travel restrictions 

will be announced and placed on the web sites of the Department of Health 

(www.dh.gov.uk) and Health Protection Agency (www.hpa.org.uk). 

The Infection Control Team will advise the Flu Planning Group and the IM&T 

department to ensure there is a link set up to an up to date list of affected 

areas on the Flu Pandemic intranet site during this time. 

The key to the risk assessment is whether the returning traveler has visited a 

country on the list of countries affected by the new strain within the past seven 

days and had close contact with other infected hosts or whatever the ‘source’ 

has been identified as. 

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The case should be discussed with a Consultant Microbiologist or 

Communicable Disease specialist. 

8 TRAVEL TO AFFECTED COUNTRIES 

Latest travel advice is posted on the Department of Health website 

(www.dh.gov.uk). When a new strain is identified the Infection Control Team 

will keep advice on the link to an up to date list of affected countries on the 

intranet. 

9 VACCINES AGAINST NEW STRAINS 

The WHO recommends which prototype vaccine to be used in the event of a 

pandemic. Manufacturers will be advised to produce a vaccine based on their 

advice. 

9.1 Priority groups for vaccine 

The Department of Health will make the decision based on advice from the 

Joint Committee on Vaccination and Immunisation (JCVI). The JCVI has 

provisionally advised the following order for vaccinating people: 

• Healthcare workers most at risk 

• Clinical ‘high-risk’ groups – e.g. chronic illness, pregnant women, 

children under 5 years of age 

• Closed communities such as nursing homes 

• Essential service workers 

• General population. 

9.2 Anti-viral drugs for prevention (prophylaxis) and treatment 

The use of antivirlas e.g. (amantadine and rimantadine) and the 

neuraminidase inhibitors (oseltamivir (Tamiflu) and zanimivir (Relenza) 

against influenza or ribavirin against RSV must be revised and discussed with 

a microbiologist or communicable diseases specialist particularly in the early 

stages of a pandemic. 

10 THE BEGINNING OF A PANDEMIC 

The World Health Organization will announce the start of a pandemic and will 

inform governments. These viruses can be highly infectious, and they are 

likely to spread despite efforts to contain them. Travelers may bring viruses 

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into the UK but there is a well-developed laboratory based surveillance, which 

will help identify the pandemic strain as early as possible. 

Once introduced into the UK, pandemic strains are likely to spread widely in 

the UK within 2 - 3 weeks of first arriving in the country, peaking at around 6 

weeks and likely to last for about 3 - 5 months. There may be a second wave 

of infection a few weeks or months later and this may be more severe. 

All ages may be affected but children and otherwise fit adults may be at 

relatively greater risk if older people have residual immunity from past 

exposure to similar stains. This will depend on the nature of the pandemic 

strain. 

A pandemic will place considerable pressure on health and social services 

due to the number of patients requiring treatment, a reduced workforce due to 

illness and the general disruption that is likely to occur. 

In a worse case scenario around a quarter (25%) of the population or more is 

likely to develop infection. Depending on the use of anti-viral drugs and how 

quickly a vaccine becomes available over 50,000 deaths could occur in the 

UK. The expected hospital admission rate is expected to rise by at least 50% 

and this will be higher if the attack rate is predominantly in the elderly. 

A pandemic will impact on all sectors of the community through the illness 

itself and the consequences of staff sickness, travel restrictions, reduced 

transport and deliveries etc. Viruses tend to spread rapidly in schools and 

other closed institutions. 

People are likely to be advised not to travel to affected areas abroad or attend 

international gatherings such as large conferences and sports events. Later, 

depending on how the pandemic develops, it may be necessary to limit nonessential 

travel and discourage mass gatherings of people. 

There will be regular updates on the television, radio and in the national 

press, telling people what is happening and what to do. People with mild to 

moderate symptoms will be advised to stay at home. Help lines will be 

available for advice which will include: 

• Cover your mouth and nose when you sneeze or cough, using a tissue 

• Promptly and carefully throw the tissues away into the rubbish – “bagging 

and binning”. 

• Wash your hands often – especially after coming in from outside 

• Avoid touching your eyes, nose or mouth 

• Avoid non-essential travel and mass gatherings as far as you can 

• Make sure children follow this advice 

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• Clean hard surfaces with ordinary cleaning agent frequently e.g. door 

handles, kitchen work surfaces. 

• Stay at home when you are sick. If you have a cough and a fever, it is 

best to rest at home, take paracetamol or ibuprofen to relieve the 

symptoms and drink plenty of fluids. This will speed your recovery and 

help prevent the spread of infection. If you need medical advice or 

assistance, phone NHS Direct on 0845 4647 or your GP surgery. 

Throughout the pandemic GPs and PCTs and secondary care staff should 

implement and emphasise public health measures that are recommended by 

the HPA and the DoH. These may include: 

• Hand washing and respiratory hygiene 

• Encouraging those suffering from the disease to stay at home 

• Voluntary quarantine of contacts of known cases 

• Local restriction on movement and public gatherings 

• School closures 

• The use of face masks to reduce droplet infection 

• Reducing unnecessary international or long distance travel 

• Health screening at ports 

There will be a National Communications Centre to: 

• Disseminate information on vaccination and treatment 

• Explain the causes and potential impact of an influenza pandemic and the 

control measures 

• Provide advice and balanced messages 

• Deliver advice and instructions 

• Inform the public of any measures required to preserve essential services 

• Provide information on the progress of the pandemic 

11 WHO TO CONTACT FOR ADVICE 

If you suspect that a patient might have a new pandemic strain please 

contact a Consultant Microbiologist and notify the Consultant in Health 

Protection IMMEDIATELY via the switchboard. See Appendix 2 for 

contact details. 

12 CASE DEFINITION 

1. Clinical presentation (new strain) 

Fever (> or = 38 o C) OR history of fever AND respiratory symptoms 

(cough or shortness of breath) requiring hospitalization 

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OR 



Death from unexplained respiratory illness 

AND 

2. Epidemiological criteria: 

History of travel in the 7 days prior to onset of symptoms to an area of 

the world with outbreaks of new strain AND close contact (within one 

metre) of the ‘source’ e.g. humans or other hosts. 

Or one of the following: 

a. Close contact (touching/speaking distance) with other case(s) of 

severe respiratory illness or unexplained death from above areas 

b. Part of a health care worker cluster of severe unexplained 

respiratory illness 

c. A laboratory worker with potential exposure to new pandemic strain 

13 INVESTIGATIONS: 

13.1 Base line investigations: 

The following base line investigations are recommended as they help with the 

risk assessment of the case: 

a. Chest X-ray 

b. Total and differential White Blood cell Count (WBC) 

c. Liver Function Tests (LFTs) 

d. Urea & electrolytes (U&Es) 

In Paediatric cases the volumes of blood may be difficult and this should be 

discussed with a Consultant Pediatrician. 

13.2 Risk assessment: 

Is based on probability of infection in the presence of appropriate travel and 

contact history as well as clinical presentation from range below: 

a. Fever 

b. Cough 

c. Sore throat 

d. Rhinorrhoea 

e. Myalgia 

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f. Conjunctivitis 

g. Watery diarrhoea 

h. Severe unexplained respiratory illness 

Probability of infection in the presence of positive travel and contact 

history: 

Low risk 

Medium risk 

High risk 

Clinical 

presentation 

Base line 

investigations 

(Suspect) (Possible) (Probable) 

Any two from As in suspect + Fever+ severe 

a-f above diarrhoea respiratory 

illness 

Normal Borderline Abnormal 

14 MICROBIOLOGICAL TESTING: 

The case should be discussed early with a Consultant Microbiologist and 

Consultant in Health Protection to ensure appropriate management and 

investigations and to seek approval for rapid testing to be undertaken. Viral 

excretion is highest early in the disease. See also Appendix B. 

Nasopharyngeal aspirate (NPA), Broncho-alveolar lavage (BAL), 

Endotracheal aspirates (ETA); Nose and throat swabs can be investigated in 

Southampton and maybe set up within WEHCT labs. All specimens for viral 

investigation should be sent in viral transport medium (VTM), available from 

Pathology Stores or in an emergency out of hours, via the on call Microbiology 

Biomedical Scientist. 

Antibody tests on paired sera, molecular test (PCR) and virus culture are also 

done in the reference labs. 

14.1 Handling of specimens in the lab: 

New strains must be treated and classified as a containment level 3 organism, 

until proved otherwise. Handling of specimens should be done after risk 

assessment is undertaken as above and communicated to lab staff. 

Processing of samples should be undertaken in containment level 2 if case is 

low-medium risk and in level 3 if high risk. For high risk cases bio-safe cabinet 

class 1 can be used 

Samples from known positive cases should NOT be handled in the hospital 

laboratory and should be transferred to the reference lab for investigations as 

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per standard procedure for transportation. This should be couriered to 

Southampton/Colindale and respiratory samples should be kept in wet ice 

during transportation. 

As the virus is shed primarily in respiratory secretions and there is no 

evidence of viraemia or shedding in other body fluids, there is no need for 

specialist handling of biochemical, hematology or serology samples. 

15 ISOLATION AND INFECTION CONTROL PRECAUTIONS 

• If a suspected case arrives in the A&E department please call the 

Consultant Microbiologist immediately. If out of hours he/she can be 

contacted through switchboard. 

• All suspected cases should be seen in A&E in the designated cubicle and 

NOT in EMAU/Northbrook ward. 

• After initial assessment and management in A&E, Patients with possible 

New Strain should be admitted to a single room on respiratory ward 

/Paediatric Northbrook ward (or other ward if subsequently designated) 

without delay and using the recommendations below. 

15.1 GP referrals: 

• Patients should be seen in their own home for initial assessment if 

possible 

• Patients should be cared for in their own homes if possible 

• If the patient requires hospital admission, the GP should inform Consultant 

in Health Protection, Consultant Microbiologist and A&E department first. 

• Specific guidance will be issued to all GPs by the Consultant in Health 

Protection when each new pandemic strain is identified. 

15.2 In A&E: 

• A sign should be clearly displayed asking if anyone has been overseas 

within the last 10 days to inform the reception staff immediately. If they 

have been to an affected area, they should be admitted to one of the 

designated cubicles immediately 

• The names of all the people who have been in close contact with a 

probable or a possible case should be recorded and given to the Infection 

Control Team. This includes patients in the waiting room. 

• Ideally only one doctor and one nurse wearing recommended personal 

protective equipment should care for the patient. If not possible the 

number should be kept to the minimum. 

• Relatives/ household contacts can be allowed in the examination room but 

must wear a fluid repellent mask 

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• Patients who potentially have new strain virus should wear FFP3 masks as 

soon as they arrive in hospital. (Fluid repellent masks are better than no 

mask if an FFP3 mask is not immediately to hand.) FFP3 masks are not 

manufactured for children so fluid repellent masks are indicated for these 

patients whenever practicable. 

• Staff must wear FFP3 masks for the initial assessment. Fluid repellent 

surgical masks can be worn IF the patient is not coughing or receiving an 

aerosol generating procedure e.g. chest physio. The patient should be 

kept in the cubicle at all times and should not be allowed to wander to 

other areas. 

• Full precautions as described below should be followed. 

15.3 In the ward: 

• The patient should ideally be isolated in a single room with negative 

pressure ventilation. As there are no such rooms in this hospital and very 

few in Southampton, a single room should be used instead with door kept 

shut at all times. 

• If the patient requires ITU admission they should be admitted to the 

pressure controlled side room ensuring that the door is closed at all times 

and the pressure control panel is switched to negative pressure. 

• A special FFP3 filter mask should be used by anyone entering the room. 

This mask has a high filtering efficiency and meets the current standard. 

The wearing of protective masks and other protective clothing also applies 

to those caring for ventilated patients. 

• No masks of Paediatric size are manufactured so staff must protect 

themselves by wearing FFP3 masks and all other Personal Protective 

Equipment when caring for the child and when moving them out of the side 

room. 

• Parents staying with children will be assessed and advised on a case by 

case basis to reduce the risk to parents, staff and other children on the 

ward. 

• If the adult patient has to leave the side room they should wear an FFP3 

mask. Staff must assist in getting a good fit on the patient’s face. 

• All units need to ensure they have enough supplies in place in the event of 

a pandemic being declared. There is currently a small stock in A&E, ITU, 

Respiratory (Shawford) ward and the supplies department. 

• A trigger number (equal to the number of side rooms on respiratory 

(Shawford) ward of cases in the hospital at any one time will be used as 

an indication for clearing respiratory (Shawford) ward of other patients and 

using it as an isolation ward. If another ward is subsequently designated 

then the trigger number is taken as the number of side rooms on that 

ward. On Paediatric (Northbrook) ward staff will isolate or cohort cases as 

appropriate after consultation with the infection control team. 

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• In the event of a pandemic of influenza being declared please see the 

CP062 Pandemic Influenza Plan, available on the intranet. 

15.4 Equipment outside the room: 

• Masks: FFP3 masks to be used by every person entering the room 

• Long sleeve fluid repellent gown for use when entering the room 

• Latex or similar non-latex gloves with tight fitting cuffs for contact with the 

patient or their environment 

• Eye protection to be used for close contact and examination of the patient 

• Linen bag 

• Alcohol gel 

• Clinical waste bin 

15.5 Equipment inside the room: Should be kept to the minimum 

• Designated stethoscope 

• Hand washing sink, liquid soap in dispenser and paper towels 

• Clinical waste bin 

• Alginate linen bag 

• Sphygmomanometer 

• Sharps box 

• Cleanable couch/trolley/bed and chair 

• En suite toilet facilities are preferable, otherwise designated commode 

15.6 Staff: 

As few staff as possible should have contact with the patient. Special attention 

should be paid to hand hygiene before and after every patient contact. 

Personal Protective Equipment (PPE) clothing for staff: All should be 

worn before patient contact and disposed of immediately after leaving 

the side room. Masks must not be removed while still in the same room 

as the patient. If an ante-room is attached to the side room, PPE should 

be removed there; otherwise wherever appropriate and nearby. See 

next page “Decontamination of equipment and room” for disposal 

advice. 

• All wounds must be covered with a waterproof dressing/plaster 

• FFP3 masks. Staff should have been mask fit tested. 

• Long sleeved disposable fluid repellent gown 

• Eye protection 

• Staff should avoid touching their face, outside of masks etc, when wearing 

protective equipment and before hand washing. 

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• Staff should remove uniform worn under protective clothing and shower 

before leaving the hospital. Scrubs should be worn if there is time to 

change into these prior to patient contact. 

• Thorough hand washing is essential between each patient contact, and if 

possible, showering after contact with a case when cases are rare, is 

advocated. 

When a patient is confirmed as having new respiratory virus, any staff who 

have been in close contact with the patient, without wearing PPE will be risk 

assessed and antiviral medication may need to be commenced. This decision 

will be made by the consultant microbiologist in conjunction with the 

Occupational Health Team. 

Ideally, pregnant staff and those with chronic health issues should avoid 

contact with patients with new pandemic strain. If this is unavoidable the 

Occupational Health Team should be involved. 

See also CP076 Standard precautions and PPE policy for further information. 

16 LABORATORY SAMPLES 

The lab should be alerted before samples are sent to ensure prompt and 

appropriate processing. In paediatric cases the blood volumes may be an 

issue and the case should be discussed with a Consultant Paediatrician. 

The samples to be collected should include: 

Respiratory samples: Naso Pharyngeal Aspirate, nose and throat swabs in 

viral transport medium. 

Blood: 20 mls clotted sample to be repeated after 3 weeks (paired sera); 

blood cultures; 20 mls EDTA blood. 

Urine: 20-30mls 

Stool sample 

Conjunctival swab in viral transport medium 

Blood for Full BloodCount (FBC) and U&E and LFTs. 

Other microbiology samples are indicated if complications such as pneumonia 

are likely i.e. blood cultures and purulent sputum from patients prior to 

antimicrobial therapy. 

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All Microbiology samples should be clearly labelled and handled as high risk. 

17 PATIENT TRANSFERS 

17.1 To other departments: 

Risk assessment should be undertaken first. Patient transfer should be 

avoided whenever possible and as many investigations as possible should be 

done in the patients room. If unavoidable, the patient should wear the 

recommended FFP3 mask. There are no paediatric size masks manufactured 

at present. Older children can wear an FFP3 mask, younger children will not 

be able to, therefore staff must also wear FFP3 masks and full PPE. Some 

younger children may tolerate a water repellent mask but this does not 

replace staff protection. 

17.2 Ambulance transfer: 

Patient should wear an FFP3 mask. Staff with the patient in the back of the 

ambulance should also wear the masks and the long sleeve water repellent 

gowns. The inside of the ambulance should be cleaned with chlorine releasing 

agent (1000ppm) once the patient has left the ambulance, as per national 

policy. 

18 DECONTAMINATION OF EQUIPMENT AND ROOM 

All disposable items should be disposed of as clinical waste into the bag 

inside the room. 

Any linen should be bagged in the alginate bag inside the room and put in the 

red linen bag outside the room. Sharps box should be closed, have the 

surface wiped with a disinfectant wipe and removed from the room and 

processed as normal. 

All other equipment, items and the floor should be should be washed/wiped 

with chlorine releasing agent 1000ppm Actichlor Plus. Curtains must be 

changed. Ideally the room should be decontaminated with the Bioquell 

process once the patient has left the room. 

Chlorine releasing agent e.g. Actichlor Plus is the recommended disinfectant 

for environmental decontamination of areas where the new strain respiratory 

virus patient has been in the hospital. 

19 FAMILY CONTACTS: 

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Reference: 

CP104 



Page 18 of 27



Visitors should be kept to the minimum and they should wear FFP3 masks 

while in the room. Partners attending the maternity department will be advised 

what PPE precautions are required within the room and outside the room. 

Staff should contact the Infection Control Team to provide advice to the family 

whilst visiting. No symptomatic visitors should visit and these should be 

referred to primary care or a national helpline (if in place) for advice. The 

Health Protection Agency will contact the family regarding quarantining and 

possible treatment. 

When cases are occurring in the community the Trust will display public 

notices at the entrances reminding people not to visit the Trust if they have 

any respiratory symptoms. 

20 GENERAL CONSIDERATIONS: 

• Standard precautions including careful attention to hand hygiene. 

• When caring for patients with new strain influenza/respiratory virus 

clinicians/nurses should wear eye protection for all patient contact. 

• Standard precautions when handling any clinical waste which must be 

placed in yellow clinical waste bags or containers and disposed of 

safely 

• Laundry should be classified as infected. 

• If several confirmed cases occur, then cohort nursing is recommended 

under the guidance of the Infection Control Team. Refer to the Trust 

Pandemic Influenza Plan for further guidance, available on the intranet. 

• Disposable crockery or cutlery should be used when caring for the first 

few cases of new pandemic strain patients in hospital. 

21 LARGER NUMBER OF CASES 

Cohort nursing of confirmed cases on Shawford Ward (or other 

designated ward) will initially be carried out. A Hospital Major Outbreak 

Group will be convened and will meet as frequently as necessary (initially 

> once daily) to contain the situation. Please refer to the Trust Major 

Outbreak Plan and the CP062 Pandemic Influenza Plan, available on the 

intranet, for further details. 

Infection control guidance from the Department of Health is different once 

pandemic starin cases are identified in the UK (DOH declares UK 

Pandemic Alert Level 2). This is because acute Trusts together with PCTs 

will be the vanguard of the NHS response in a situation which is not 

“business as usual” and the way the NHS functions will need to be altered 

to accommodate exceptional infection control arrangements. 

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Key considerations are: hand washing and scrupulous attention to 

containment of respiratory secretions, cohorting of affected and nonaffected 

patients, restriction of ill workers and visitors and education of 

staff, visitors and patients. This is dealt with in more detail in the CP062 

Pandemic Influenza Plan (on the intranet) and readers are urged to 

consult the most recent web based guidance from the DOH – see 

References. A link will be provided from the Trust intranet site. 

22 TRAINING 

All clinical staff are required to have annual infection control updates via 

mandatory training days, e learning or workbooks. Line mangers have a duty 

of care to ensure that all staff annually receive infection control updates. The 

line manager keeps a record of staff attendance on the training matrix. Each 

member of clinical staff keeps his/her own records of attendance at study 

sessions within their portfolio. It is the responsibility of individuals and their 

line managers to ensure attendance at training. The Training Department 

feeds back on non attendance to line managers and it is their responsibility to 

follow up non attenders and ensure their subsequent attendance. 

Please see CP072 Training policy for employees of WECHT in infection 

control for more information. 

If staff do not attend, compliance with infection control training must be 

reviewed at their appraisal and prompt training arranged. 

E-learning for infection control is an acceptable alternative on alternate years 

once face to face induction is completed. E learning is accompanied by 

certification which can be used in evidence at appraisal. 

Specific training on new pandemic strain virus will be provided by the Infection 

Control team to be cascaded to all clinical staff when a new strain is identified. 

Specific information will also be provided as it is released by the Department 

of Health or the Health Protection Agency. 

All clinical staff who work in high risk areas A/E, EMAU, respiratory / 

Shawford ward, ITU, paediatric / Northbrook ward and respiratory 

physiotherapists are expected to have at least annual mask fit testing to 

ensure they are ready to attend to any case of new strain respiratory 

virus/influenza. 

23 MONITORING THE PERFORMANCE AND EFFECTIVENESS OF 

THIS POLICY 

In an era of quality improvement it is important to use performance indicators 

in order to evaluate practice and make improvements when necessary. 

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Because of the subject of the policy it is not possible to audit this policy on an 

annual basis. 

If cases of new pandemic strain occur the policy will be reviewed in 

conjunction with new advice from the Health Protection Agency and 

Department of Health. Changes made if required and communicated promptly 

to staff. 

A “lessons learnt” look back exercise will be performed by the Influenza 

Planning Group in a timely way following such an occurrence and the learning 

disseminated as appropriate throughout the Trust. 

The policy will be reviewed every 3 years in line with current practice or if new 

evidence becomes available nationally, the policy will be reviewed and 

updated. The Pandemic Flu Steering Group will continue to meet quarterly to 

prepare the Trust for a future pandemic. 

24 FOR MORE INFORMATION VISIT 

www.dh.gov.uk 

www.hpa.org.uk 

www.immunisation.nhs.uk 

www.who.int/csr 

The algorithm on the following page is updated regularly on 

www.hpa.org.uk and therefore the latest version should be obtained and 

followed. 

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Appendix 1 

SUMMARY OF INFECTION CONTROL GUIDANCENFECTION CONTROL 

GUIDANCE 

Action card 

First cases of New pandemic strains: influenza/new respiratory 

infection e.g. SARS 

• Maximum isolation precautions 

• Minimum safe numbers staff to be involved 

• Full PPE including FFP3 respiratory protection 

• Early Health Protection Agency involvement 

• Urgent virological investigations 

• Early oseltamivir if meets case definition and within 48 hours 

onset 

• Management of patient secretions/disposal of PPE appropriately 

• Scrupulous hand hygiene 

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Reference: 

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Appendix 2: 

Putting on and removing personal protective equipment 

Putting on PPE 

The level of PPE used will vary according to the procedure being carried out, 

and not all items of PPE will always be required. PPE should be put on before 

entering a side room or cohorted area. If full PPE is required, for example for 

a potentially infectious aerosol –generating procedure, all staff in the room or 

entering within one hour of the procedure should wear the following PPE put 

on in the following order: 

1 Gown 

2 FFP3 mask 

3 Eye protection – at this stage goggles are required 

4 Disposable gloves 

The order given above is practical but the order for putting on is less 

crucial than the order of removal given below: 

Removal of PPE 

PPE should be removed in an order that minimises the potential for crosscontamination. 

Before leaving the side room or cohorted area, gloves, gown 

and eye protection should be removed (in that order, where worn) and 

disposed of as clinical waste. After leaving the area, the FFP3 mask can be 

removed and disposed of. 

Guidance on the order of removal of PPE is as follows: 

1 Gloves 

Grab the outside of the glove with the opposite gloved hand: peel off. 

Hold the removed glove in the gloved hand 

Slide the fingers of the un-gloved hand under the remaining gloves at the wrist 

Peel the second glove off over the first glove and dispose of in clinical waste 

bin. 

2Gown 

Unfasten 

Pull the gown away from the neck and shoulders, touching the inside of the 

gown only. 

Turn the gown inside out, fold or roll into a bundle and dispose of in clinical 

waste bin 

3 Goggles eye protection 

To remove, handle by headband or earpieces and discard as clinical waste 

If not disposable clean with disinfectant wipe 

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4 FFP3 mask 

Untie or break the bottom ties, followed by top ties or elastic and remove by 

handling the ties only and dispose of as clinical waste. 

To minimise cross-contamination, the order outlined above should be applied 

even if not all items of PPE have been used. 

Wash hands thoroughly using Hibiscrub or other antiseptic. 

Reference: 

Pandemic (H1N1) 2009 Influenza 

A summary of guidance for infection control in healthcare settings. 

Dept of Health & Health Protection Agency. 

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CP104 



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Appendix 3 

Contacts: 



Consultant Microbiologist Ext 4451/ bleep 178 

Dr Matthew Dryden 

Dr Roberta Parnaby 

Dr Kordo Saeed 

Consultant Microbiologist on call out of hours 

via switchboard 

Consultant in Health Protection 0845 055 2022 

out of hours via switchboard 

Infection Control Nurses 

ext 4483/5156/5170 or 

Sue Dailly bleep 177, 194 

Karen Davis-Blues 

Lesley Hollister 

Sheryl Lucero 

Consultants in A & E 

Nurses’ station (A&E) 4950/4951 

Microbiology Department 

hours via 

4466 or out of 

Switchboard 

Occupational Health Department 4326 

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Appendix 3 - Equality Impact Assessment Tool 

To be completed and attached to any controlled document when submitted to the appropriate 

committee for consideration and approval. 

Yes/No 

Comments 

1. Does the policy/guidance affect one group 

less or more favourably than another on the 

basis of: 

• Race No 

• Ethnic origins (including gypsies and 

travellers) 

No 

• Nationality No 

• Gender No 

• Culture No 

• Religion or belief No 

• Sexual orientation including lesbian, 

gay and bisexual people 

No 

• Age No 

• Disability - learning disabilities, 

physical disability, sensory impairment and 

mental health problems 

No 

2. Is there any evidence that some groups are 

affected differently? 

3. If you have identified potential 

discrimination, are any exceptions valid, 

legal and/or justifiable? 

4. Is the impact of the policy/guidance likely to 

be negative? 

5. If so can the impact be avoided? No 

No 

No 

No 

6. What alternatives are there to achieving the 

policy/guidance without the impact? 

7. Can we reduce the impact by taking 

different action? 

No 

No 

If you have identified a potential discriminatory impact of this procedural document, please 

refer it to the Board Secretary, together with any suggestions as to the action required to 

avoid/reduce this impact. For advice in respect of answering the above questions, please 

contact: 01962 825903 

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New Strain Influenza Policy 

Appendix – Communications Log 

Ref Policy Date of 

Issue 

To Whom 

Signed as read 

and 

Understood 

Authorities 


Author: Sue Dailly Lead Nurse Infection Type: 


Control 

Sponsor: Director of Infection Prevention and Scope: 

Major 

Control 

Reference: 

CP0 


Date January 2010 Status: draft 

Page 27 of 27

New Strain Respiratory Virus Policy - Hampshire Hospitals NHS ...

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