Policy for the management and control of diarrhoea and vomiting

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Winchester & Eastleigh Healthcare NHS Trust POLICY FOR THE MANAGEMENT AND CONTROL OF DIARRHOEA AND VOMITING (NOROVIRUS) INFECTIONS iii. Frequency; please state the number of times the patient has an episode of either diarrhoea or vomiting. The data collection form is downloadable from the intranet and to be used daily (one sheet per day). iv. Data should also be collected on patients who are nauseous. It will not be necessary to close an area if no vomiting or diarrhoea develops but nausea may be an early symptom of infective gastro-enteritis. 9.2It is the responsibility of the nurse in charge to ensure that accurate documentation is maintained on all symptomatic patients throughout the duration of the outbreak, as per CP033 (NP 14) Policy for Standards for Record Keeping by Nurses and Midwives 10 Stool Samples 10.1 Please take a stool sample from every patient who has diarrhoea. If the sample is contaminated with urine it can still be sent. Faeces scraped off the sheet or incontinence pad can also be used if you are unable to obtain a sample from a bedpan. The sample should contain the runniest part of the sample. All samples which are liquid will be tested for Clostridium difficile. During unsocial hours diarrhoeal samples can be collected for testing during the day after discussion with a consultant microbiologist. 10.2 Stool testing for norovirus is carried out if an outbreak is suspected. It is important that a representative number of patients provide samples and these are sent to the laboratory as soon as possible. Never wait for positive results before implementing infection control precautions and outbreak control measures. Viral gastroenteritis is most infectious in the early stages. 10.3 The IPCT will co-ordinate with the microbiology laboratory to ensure a relevant sample of affected patients receives norovirus testing. The current hospital laboratory test may confirm some patients have norovirus, but if the samples are all negative they will be sent to another hospital laboratory for further investigation. This molecular test may become available locally in the future. Confirmation of norovirus often is not known until the outbreak is either resolving or has resolved if the samples have to be sent to another hospital. For financial reasons, once a ward has confirmed norovirus, it is not usual practice to continue to test new patients with the same symptoms during an ongoing outbreak on that ward. 10.4 The IPCT will provide the microbiology laboratory with the HPA epidemiological outbreak log number to link the outbreak samples which may be referred for typing, to the particular outbreak or ward closure which has been reported by the IPCT as part of the national enhanced surveillance programme for norovirus. Authorities Document Control Information Author: Dr Parnaby Type: Policy Consultant Microbiologist Sponsor: Members of the Infection Prevention & Scope: Major Control Committee Reference: CP101 Issue Number: 2 Date July 2011 Status: Published Page 10 of 26
Winchester & Eastleigh Healthcare NHS Trust POLICY FOR THE MANAGEMENT AND CONTROL OF DIARRHOEA AND VOMITING (NOROVIRUS) INFECTIONS 11. Isolation 11.1 Depending on the number of symptomatic patients involved, he/she/they will either be nursed in single rooms, or cohort nursed in a bay. Some patients cannot be moved to a side room as this would place them in an ‘unsafe’ environment. For example patients who are at falls risk, are confused or under the Mental Health Act. Consideration must be taken of patients’ clinical and psychological needs when assessing where to place patients during an outbreak of diarrhoea and vomiting. Please refer to the CP022 Isolation Policy for further information. 11.2 If necessary the whole ward will be closed to admissions, transfers and discharges except to the patient’s own home. 11.3 Patients who have to be moved to another ward due to their clinical condition e.g. ITU must be isolated and barrier nursed until symptom free for at least 48 hours but ideally 72 hours. The sending ward must inform the receiving ward and ensure adequate facilities are provided. 11.4 The nurse in charge must ensure that a sign is placed on the door of the isolation room or affected bay alerting all staff and visitors that this is an isolation area. If the whole ward is closed a sign should be placed on the door at the entrance to the ward informing staff and visitors of the situation and asking them to report to the nurse in charge before seeing a patient. 11.5 The affected bay or ward should be closed to all new admissions or transfers unless approved by the consultant microbiologist. If the clinical condition of a patient dictates that their treatment requires them to be admitted to a ward closed with diarrhoea and vomiting, the admitting medical team have a responsibility to inform the patient of the ward status and also document in the patient’s notes that their clinical condition outweighs their risk of entering a ward which is currently closed due to diarrhoea and vomiting. 11.6 When a patient has had no diarrhoea or vomiting for 72 hours they are deemed no longer infectious. A ‘closed’ bay can be re-opened when there have been no new cases and all affected patients have been asymptomatic for 72 hours. When a whole ward has been closed, bays may be opened gradually towards the end of the outbreak. Bays can only be re-opened when there have been no new cases and all affected patients have been asymptomatic for 72 hours. All areas must be deep cleaned or ideally decontaminated using hydrogen peroxide technology (Bioquell®) before opening, please refer to section 15.0 on environmental cleaning. The decision to re-open an infected ward can only be made by the consultant microbiologist. In some circumstances the Consultant Microbiologist may reduce the 72 hour limit to 48 hours but this decision cannot be taken without Authorities Document Control Information Author: Dr Parnaby Type: Policy Consultant Microbiologist Sponsor: Members of the Infection Prevention & Scope: Major Control Committee Reference: CP101 Issue Number: 2 Date July 2011 Status: Published Page 11 of 26
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Policy for the management and control of diarrhoea and vomiting

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