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 8 PATIENT MANAGEMENT AND TREATMENT 8.1 Treatment 8.2 Currently there is no effective antiviral treatment for noroviruses. It is a self limiting illness which will usually cease within a few days. It is important to ensure prompt fluid replacement to prevent dehydration and its complications. 8.3 There is a sample patient, relatives and carer’s information leaflet available on the intranet, ref 308 “Norovirus”. Copies of this leaflet are available from the IPC team. 8.4 What to do if you suspect there is an outbreak? 8.5 If you have 2 or more cases of unexplained diarrhoea and / or vomiting or nausea on your ward, either staff or patients, you may be at the start of an outbreak. It is the responsibility of the nurse in charge to contact the Infection Prevention & Control Team (IPC Team) on ext 4483 or 5170 immediately for further advice. (See Appendix 1). 8.6 Out of hours and during the weekend the nurse in charge must discuss this with the on-call Consultant Microbiologist or night site coordinator and either email the Infection Prevention & Control Nurses (IPCNs) via their generic email address or leave a message on their answer-phone (x5170) so they can follow up on the next working day. See 8.9 below for a provisional decision on ward closure. 8.7 There are several different actions which must be taken, some according to the number of patients who are affected, but isolation of cases on the same ward and prevention of transfers from the ward are both critical. Further, the Consultant Microbiologist will make a decision as to whether to close or partially close the ward to admissions to bring the situation under rapid control. Early discussion is key as every situation is different. Examples of requirements for control are as follows: a. Move symptomatic patients into side rooms, close the bay for 48 hours, consider other patients in that bay as contacts and monitor for development of diarrhoea and / or vomiting. Review this with the IPC team. b. If numbers exceed side room capacity, cohort nurse, symptomatic patients and their contacts. Patients with a positive Clostridrium difficile result must not be cohort nursed with patients with diarrhoea due to another cause. Patients with Clostridium difficile should be moved to the cohort ward (Victoria Ward or other ward if so designated in the future). c. Send specimens on all affected cases to the Microbiology laboratory. 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 8 of 26
Winchester & Eastleigh Healthcare NHS Trust POLICY FOR THE MANAGEMENT AND CONTROL OF DIARRHOEA AND VOMITING (NOROVIRUS) INFECTIONS d. Stop all transfers to other wards. e. Monitor all unaffected patients for symptom development and affected patients for frequency of symptoms. Keep a symptom chart on each patient and update on each shift. f. Close one or more bays as necessary. g. Close the whole ward. 8.8 The Consultant Microbiologist is the ONLY person with designated responsibility to close and open a ward because of infection. Please refer to the Ward Closure policy and Major Outbreak Plan for further information. 8.9 If incidents of diarrhoea and/or vomiting occur during the night, ward staff and night coordinator can make a provisional decision to close the bay or ward and institute barrier nursing, aiming to collect diarrhoeal samples and then contacting the microbiologist or IPCNs in the morning for follow up action. 8.10 The nurse in charge must inform the site coordinator that there is a problem on their ward with diarrhoea / vomiting/ nausea. The site coordinator must discuss with the IPC Team what action needs to be taken. 8.11 The IPCT will visit the ward daily or more often if required to assess the situation and set an action plan for the next 24 hours. On a Friday an action plan will be set for the weekend or Bank Holiday period. This action plan will be verbally discussed with the nurse in charge of the ward and the site coordinator. In addition a generic email will be sent out each day from the IPCT to all staff on the outbreak contact list to help ensure all relevant staff, including the Occupational Health Department, are kept fully informed with the latest information. Unexpected events that occur over the weekend or Bank Holiday should be discussed with the Consultant Microbiologist on call by the site coordinator or on call manager. IPCNs will aim to visit or contact the wards at the weekend when outbreaks are affecting several wards within the Trust. 9.0 Documentation 9.1 Once an outbreak is suspected the IPCT will ask the ward staff to complete a daily record sheet for all symptomatic patients. (See intranet for copies – diarrhoea and vomiting outbreaks – data collection form). Patients are most infectious during the early stages when diarrhoea / vomiting is profuse. Accurate documentation on all symptomatic patients is vital in order for the IPCT to make an accurate assessment of the infection and plan the correct course of action. The following information is necessary for all symptomatic patients: i. Name; first and surnames ii. Position in ward; state bed number and bay or single room 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 9 of 26
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Policy for the management and control of diarrhoea and vomiting

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