Isolation and infectious diseases policy - Hampshire Hospitals NHS ...

ISOLATION AND INFECTIOUS DISEASES POLICY 

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Document Control Information 

Author: Sue Dailly Lead Nurse 

Infection Prevention and 

Control 

Kordo Saeed 

Consultant Microbiologist 

Sponsor: Paula Shobbrook Director of 


Control (DIPC) 

Reviewer(s): 

Approval 

body: 


Control Committee 

Nursing & Midwifery Policy 

Group 

Type: 

Scope: 

Policy 

Major 

Trust Reference 

Number: CP022 

Issue Number: 4 

Policy Approval Group Status: Published 

Effective Date: 01/08/11 

Review Date: 01/08/14 

Disposal Date: 01/08/36 

Document Authorisation Control 

Prepared By: 

Dr Kordo Saeed 

Consultant Microbiologist 

Signature: 

Authorised Officer 

Chris Gordon 

Acting Chief Executive 

Signature: 

Authorities 


Author: 

Kordo Saeed Consultant Microbiologist Type: 

Policy 

Sue Dailly, Lead Nurse Infection 

Prevention and Control 

Sponsor: Paula Shobbrook Director of Infection Scope: 

Major 

Prevention and Control (DIPC) 

Reference: 

CP022 


Date 01/08/11 Status: Published 

Page 1 of 61

Winchester & Eastleigh Healthcare NHS Trust 


DOCUMENT CONTROL 

Document Amendments 

Number Details By Whom Date 

1.0 Change of hypochlorite disinfectant R Parnaby 20 th 

within Trust 

Consultant December 

2.0 Updated protective isolation 

separated out 

Microbiologist 

S Dailly Lead 

Nurse 

Infection 

Prevention 

and Control 

3.0 Updated to reflect new guidance K Saeed 

Consultant 


4.0 Addition of appendix 8 information 

sheet on New-Delhi metallo betalactamase 

(NDM-1) and 

carbapenem resistance 

K Saeed 

Consultant 


2004 

September 

2007 

August 2010 

July 2011 

Review Timetable 

Date Reason By Whom Date 

Completed 

20 th 

December 

2004 

September 

2007 

September 

2010 

Three year review cycle for 

policy document 

Three year review cycle 

Three year cycle review 

R Parnaby 

Consultant 


S Dailly Lead 

Nurse 

Infection 

Prevention 


Kordo Saeed 

Consultant 


January 2008 

October 2010 

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CP022 



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Distribution List 



No Title 

1 All Winchester Eastleigh Healthcare Trust employees available via 

WEHCT Internet 

2 WECHT external web site for public consultation 

RELATED TRUST POLICIES 

OP001 Policy for the Management of Controlled Documents 

CP021 Surveillance Policy 

CP028 Management of Suspected Cases of Viral Haemorrhagic Fever Policy 

CP029 New Strain Respiratory Virus Policy 

CP030 Overarching Decontamination Policy 

CP047 Tuberculosis and multiple drug resistant tuberculosis policy 

OP049 Learning and Development Policy 

CP055 MRSA 

CP061 Policy for the inter ward transfer of patients with infection control 

issues 

CP064 Clostridium difficile policy 

CP070 Deceased infected patient policy 

CP071 Major Outbreak Plan 

CP077 Policy for Ward Closure Due to an Infection Control Issue 

CP073 Hand Hygiene Policy Standard Precautions and CP076 PPE Policy 

CP101 Policy for the Management and Control of Diarrhoea and Vomiting 

(Norovirus) Infections 

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Page 3 of 61



Contents 

Section Title Page 

1.0 PURPOSE 5 

2.0 SCOPE 5 

3.0 INTRODUCTION 6 

4.0 DUTIES OF PERSONNEL 6 

5.0 SOURCE, HOST AND TRANSMISSION 8 

6.0 ISOLATION AIMS 9 

7.0 ISOLATION FACILITIES 10 

8.0 STANDARD ISOLATION 11 

9.0 PRACTICE AND RATIONALE 12 

10.0 VISITING OTHER DEPARTMENTS 15 

11.0 TRANSFER OF ISOLATED PATIENTS WITHIN 16 

AND BETWEEN HOSPITALS 

12.0 HOUSEKEEPING STAFF AND CLEANING 16 

13.0 REVIEW OF ISOLATION REQUIREMENT 17 

14.0 DEATH 17 

15.0 TRAINING 17 

16.0 MONITORING COMPLIANCE WITH THIS POLICY 18 

17.0 DEFINITIONS 19 

18.0 CONCLUSION 

19.0 REFERENCES 19 

Appendix 1 UTILISATION OF SIDE ROOMS/ISOLATION 20 

FACILITIES 

Appendix 2 NOTIFIABLE DISEASES/CONDITIONS 21 

Appendix 3 CLEANING OF ISOLATION ROOM 24 

Appendix 4 ACINETOBACTER 28 

Appendix 5 (VRE) GRE – (VANCOMYCIN) GLYCOPEPTIDE 30 

RESISTANT ENTEROCOCCI 

Appendix 6 (ESBL)EXTENDED SPECTRUM BETA 

32 

LACTAMASE PRODUCERS 

Appendix 7 GUIDE TO ISOLATION OF PATIENTS WITH 34 

COMMUNICABLE DISEASES 

Appendix 8 NDM-1 Information Sheet New-Delhi metallo betalactamase 

(NDM-1) and carbapenem resistance 

51 

Appendix 9 EQUALITY IMPACT TOOL 58 

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1 PURPOSE 

1.1 This policy has been developed to provide a practical document to equip 

all healthcare staff with the necessary information to enable them to identify 

which patients require isolation in a side room or need to be cohort nursed. 

1.2 Isolation refers to the use of a single room as a barrier in order to prevent 

the transmission of organisms responsible for infection. The use of protective 

clothing is essential in prevention of cross infection and contributes to barrier 

precautions. When a patient is found to be or thought to be suffering from an 

infection, it is necessary to consider the mode of transmission of the infection 

and to institute appropriate measures to prevent cross infection (Hospital 

Infection Society 2001). 

1.3 This policy also explains the practical issues encountered in barrier nursing 

patients. Transmission of infection within a hospital requires three elements: a 

source of the infecting micro-organism, a susceptible host and a means of 

transmission. Establishing the source and route of transmission of infection is 

essential in order to institute appropriate control measures including isolation. 

1.4 Important Note: Numerous factors influence differences in transmission 

risks among the various healthcare settings. These include the population 

characteristics (e.g., increased susceptibility to infections, type and 

prevalence of indwelling devices), intensity of care, exposure to environmental 

sources, length of stay, and frequency of interaction between patients with 

each other and with Health Care Workers (HCWs). These factors, as well as 

organizational priorities, goals, and resources, influence how different 

healthcare settings adapt transmission prevention guidelines to meet their 

specific needs. 

2 SCOPE 

2.1 This policy applies to all staff employed by the Winchester & Eastleigh 

Healthcare NHS Trust and visitors to the Trust. 

2.2 This policy has been ratified in line with the OP001 Policy on Management of 

Controlled Documents 2009. 

3 INTRODUCTION 

3.1 Isolation procedures are expensive to operate: they should only be brought 

into operation when necessary and must be monitored when in use. Isolation 

methods should be tempered by the particular needs of the patient, taking in 

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Policy for Isolation and Infectious Diseases Policy 

to account other clinical conditions, social and mental health needs of e.g. 

psychiatric patients, patients with altered mental status and prison inmates. 

3.2 However, the decision on where to nurse the patient will depend on 

assessment considering the patient safety, privacy, dignity and the identified 

or potential risks to other patients in that area. Patients maybe moved to 

another ward or another hospital because of their infection or disease. There 

must be effective communication to relatives, escorts and visitors regarding 

reasons for isolation and use of personal protective equipment (PPE). 

3.3 Remember – Standard precautions must be used with all patient 

including those in isolation. See also CP073 Hand Hygiene Policy and 

Standard Precautions and CP076 PPE Policy. 

4 DUTIES OF PERSONNEL 

4.1 The Chief Executive Officer (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 by 

ensuring adequate provision of isolation facilities. 

The Trust CEO is accountable for establishing and maintaining an adequately 

resourced Infection Prevention and Control Team (IPCT) and infection 

prevention and control arrangements throughout the Trust. 

4.2 The Director of Infection Prevention and Control (DIPC) is the lead 

Executive within the Trust whilst the daily management of infection prevention 

and control is the remit of the IPCT, supported by the DIPC. 

4.3 Line managers are responsible for ensuring that all Infection Prevention and 

Control (IPC) policies and procedures are accessible for all their staff and that 

they have read them. Also ensuring that any changes in practice are 

implemented. Ensure systems exist to identify staff training needs and the 

implementation of new and updated IPC policies. Matrons, Lead Nurses and 

ward managers should ensure that all healthcare workers comply with this 

policy and attend mandatory infection prevention and control induction and 

updates, or complete the relevant e-learning modules. 

4.4 All staff have a duty of care to adhere to all Trust policies and protocols 

applicable to infection prevention and control and ensure their practice follows 

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the current IPC policies in use. Information regarding the failure to comply with 

the policy e.g. lack of training or inadequate equipment, must be reported to 

the line manger and the incident reporting system used where appropriate. If 

patients 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 Risk Coordinator. 

4.5 All healthcare workers have a duty to act on and report at the earliest 

opportunity infection that may be deemed infectious to others i.e. 

communicable/notifiable disease or resistant organisms (the Trust has a duty 

of care to patients, visitors and staff). 

4.6 All Trust staff have a duty to ensure that visitors, contractors, locum and 

agency staff to the hospital are made aware of the Trust Infection Prevention 

and Control Policies, if appropriate by producing those sections relevant to 

their visit or area of work. Patient Information leaflets are available on the 

Trust intranet. 

5 SOURCE, HOST AND TRANSMISSION 

5.1 Source 

Human sources of the infecting organism in hospitals may be patients, staff, 

or on occasion, visitors and may include those with acute disease, those in 

the incubation period of the disease, those who are colonised by an infectious 

agent but have no apparent disease and those who are chronic carriers of an 

infectious agent. Other sources of infecting micro-organisms can be the 

patient’s own endogenous flora, which maybe difficult to control, and 

inanimate environmental objects that have become contaminated, including 

equipment and medications. 

5.2 Host 

Infection is the result of a complex interrelationship between a potential host and 

an infectious agent. Resistance among individuals to pathogenic microorganisms 

varies greatly. Some people may be immune to infection, some 

may be able to resist colonization by an infectious agent: others exposed to 

the same agent may establish a commensal relationship with the infectious 

micro-organism and become asymptomatic carriers: still others may develop 

clinical disease. Age, underlying disease, antimicrobials, irradiation, breaks in 

the defense mechanism like surgical wounds or invasive devices reduce 

immunity. 

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5.3 Modes of transmission 

The emergence of Severe Acute Respiratory Syndrome (SARS) in 2002, the 

importation of monkeypox into the United States in 2003, and the emergence of 

avian influenza present challenges to the assignment of isolation categories 

because of conflicting information and uncertainty about possible routes of 

transmission. Although SARS-CoV is transmitted primarily by contact and/or 

droplet routes, airborne transmission over a limited distance (e.g. within a room), 

has been suggested, though not proven. 

5.3.1 Certain diseases may be transmitted between patients and potentially 

between patients and members of staff e.g. Methicillin Resistant 

Staphylococcus aureus (MRSA). Therefore it is sometimes necessary to 

isolate patients who are infected or those who are particularly vulnerable to 

infection. 

5.3.2 The aim of isolation is to control, confine and minimize the spread of microorganisms. 

As understanding of transmission of infection has improved, 

isolation practices have become more evidence based and targeted (Damaini 

2003) 

5.3.3 Infection can be spread by a number of methods: airborne, droplet, contact 

and blood borne spread. 

5.3.4 Airborne transmission occurs by dissemination of droplet nuclei or dust 

particles containing the infectious agent; microorganisms are therefore 

dispersed widely over long distances. 

5.3.5 Droplet transmission. Droplets (1-10um in diameter) are generated from the 

source person primarily during coughing with influenza, sneezing and talking 

and are propelled a short distance only; hence special ventilation is not 

required to prevent transmission. 

5.3.6 Direct contact transmission is the most important and frequent mode of 

transmission contact transmission and involves either direct person-to-person 

contact or indirect contact via a contaminated intermediate object (sometimes 

called a fomite). Direct is by skin to skin contact and therefore the physical 

transfer of microbes from an infected or colonized patient to a susceptible 

host. 

5.3.7 Indirect contact transmission occurs when a susceptible patient comes into 

contact with a contaminated object e.g. equipment such as a commode. 

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5.3.8 Blood borne infection via inoculation e.g. sharps injuries is minimised by 

adopting standard precautions which should, therefore, be applied to all 

patients. 

6 ISOLATION AIMS 

6.1 Risk assessment should precede isolation of patients especially when single 

rooms are in short supply and patients’ isolation has to be prioritized. 

Specific considerations must be taken to accommodate the clinical, social and 

mental health needs of e.g. psychiatric patients, patients with altered mental 

status and prison inmates The decision to isolate a patient should be 

discussed with the Infection Prevention and Control team (IPCT). The 

decision to isolate (close) a whole ward/s should be undertaken by a 

Consultant Microbiologist see CP077 Policy for Ward Closure Due to an 

Infection Control Issue, CP101 Policy for the Management and Control of 

Diarrhoea and Vomiting (Norovirus) Infections and CP071 Major Outbreak 

Policy. 

Isolation aims are: 

6.1.1 To prevent the transmission of infective organisms from an infected/ colonized 

patient to others. 

6.1.2 To give psychological support and reassurance to the patient whilst s/he is in 

isolation. 

6.1.3 To ensure all staff (including domestic staff) and visitors are aware of the 

correct precautions to take. 

7.0 ISOLATION FACILITIES 

7.1 Appropriate patient placement 

Ideally a patient should be placed in a single room with a sink and toilet 

facilities and shower if possible, to limit and reduce the opportunities for direct 

or indirect transmission of micro-organisms. See appendix 3. 

7.2 Where a single room is not available patients with the same infection or 

colonized with the same micro-organisms may be nursed in an identified 

designated area e.g. a double room or if that is not possible, a bay. This is 

provided they are not infected with other potentially transmissible microorganisms 

and the possibility of re-infection with the same organisms is 

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minimal. For further advice contact the IPCT. 

7.3 High security isolation units are available in London and Newcastle for viral 

haemorrhagic fevers (e.g. Ebola and Lassa fevers). See CP028 Management 

of Suspected Cases of Viral Haemorrhagic Fever Policy for full details. Such 

patients must not be admitted to the Royal Hampshire County Hospital or to 

the Andover War Memorial Hospital. 

7.4 In Oxford, Southampton and London there are units with a number of negative 

pressure single rooms. There are rare occasions when a patient may need to 

be transferred to such a unit e.g. Multi –drug resistant tuberculosis (MDR-TB). 

See CP047 Tuberculosis and multiple drug resistant tuberculosis policy for 

further details. 

7.5 Isolations facilities at the Royal Hampshire County Hospital and Andover War 

Memorial Hospital consist of single or double rooms on the wards, with or 

without bathroom facilities. Some patients will be cohort nursed in a bay if a 

side room is not available. The number of side rooms is limited and the 

decision as to which patients must be nursed in a side room is based upon the 

organism, its resistance profile, the mode of spread and transmissibility and 

the number of patients involved. See Appendix 1 for utilization of side rooms’ 

guidance. 

8 STANDARD ISOLATION 

Standard isolation is necessary when a patient has or is suspected of having 

a communicable or infectious disease or is or may be colonized with resistant 

pathogen. 

8.1 SINGLE ROOM ACCOMMODATION 

Remove all unnecessary equipment from the room before the patient is 

admitted in order to facilitate the cleaning and limit the number of items which 

may become contaminated. 

A yellow isolation sign should be displayed prominently on the outer door of 

the isolation room. However care must be taken to maintain patient 

confidentiality and to avoid stigmatization of the isolated patient. 

8.2 Equipment inside the room 

Wash basin and en suite toilet if possible 

Hibiscrub and paper towels 


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Foot operated waste bin with orange waste bag 

Alginate laundry bag 

Patient’s wash bowl 

Dinomap and any other equipment necessary 

8.2.1 Equipment must be dedicated to the patient until the patient is discharged or 

deemed no longer to require isolation. The equipment must then be 

appropriately decontaminated before it can be used on another patient. No 

equipment used for a patient in isolation should be used on any other patient 

without adequate decontamination. 

8.2.2 Do not over stock the room as equipment which cannot be cleaned will need 

to be disposed of. All equipment should be washable, cleanable or 

disposable. 

8.2.3 Discourage the patient from keeping unnecessary belongings in the room, but 

remember the need for psychological care of the patient whilst in isolation. 

8.3 Equipment outside the room 

Isolation sign to be placed in a prominent position 

Disposable gloves and yellow aprons 

Red plastic bag for used linen 

Alcohol hand gel. For symptoms of diarrhea/vomiting soap and water 

is necessary for hand hygiene not alcohol gel. 

Patient’s charts if possible. For Intensive Therapy Unit and Neonatal 

Unit where patients are nursed one-to–one and observations recorded 

more frequently, it may more appropriate to have the patient’s charts 

inside the room. 

8.4 Doors 

Side room doors are to be kept closed at all times 

If closing the door would cause distress to the patient or put their safety at 

risk, the door can be left open. This should be an exceptional circumstance 

and not the norm. The door must be kept closed when changing the bed 

sheets to reduce the dispersion of skin scales and spores, and when carrying 

out change of dressing or cough inducing procedures on patients with 

respiratory infections. 

8.5 Specimens 

Specimens sent to the Clinical Pathology Accredited laboratory must be 

placed in a self-sealing polythene bag with the request form and the specimen 

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bottle labelled ‘Danger of Infection’ and placed in separate sections. The first 

specimen bag should then be resealed within another, i.e. double bagged. 

The laboratory will follow standard operating procedures to ensure the 

specimen is handled and processed correctly. 

9 PRACTICE AND RATIONALE 

Isolated patients may experience more anxiety and depression. Isolation may 

hamper rehabilitation. To reduce these risks, preparatory information should 

be given wherever possible. When a patient requires isolation staff should 

ensure effective communication for patients, staff and visitors. 

Explain to the patient if possible 

the reason for isolation, 

explanation of the nature of disease or organism, 

symptoms and treatment – a leaflet maybe helpful, 

control methods and their rationale 

advice for patients regarding their responsibility and their 

adoption of correct measures 

give reassurance to reduce patient’s anxiety. 

9.1 APRONS/GOWNS 

9.1.0 Plastic aprons afford more protection to uniforms/clothes than gowns because 

they are water repellent and impervious to microbial contamination. Yellow 

plastic aprons should be worn when in contact with the patient, the immediate 

environment, body substances and when handling laundry/making the bed. 

Aprons are single use items and should be discarded after each use and 

before leaving the room, with the exception of moving bedpans and 

commodes to the sluice. 

9.1.1 Put on a yellow plastic apron before entering the room. Remove it in the room 

and place in the yellow clinical waste bag before leaving the room. 

9.1.2 Non- sterile disposable gowns are required for caring for patients with scabies 

and when recommended by the IPCT. 

9.2 GLOVES 

Gloves are worn to provide a protective barrier and to prevent cross 

contamination of the hands when touching blood, body fluids, secretions, 

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excretions, mucous membranes and non-intact skin. 

9.2.1 Gloves are worn to reduce the likelihood that micro-organisms present on the 

hands of personnel will be transmitted to patients during invasive or other 

patient-care procedures that involve touching a patient’s membranes and nonintact 

skin. 

9.2.2 Gloves are worn to reduce the likelihood that hands of personnel 

contaminated with micro-organisms from a patient or an object can transmit 

these micro-organisms to another patient. 

9.2.3 Put on non- sterile gloves before entering the room. Dispose of before leaving 

the room. Change gloves between dirty and clean procedures in the room as 

necessary. Vinyl gloves are adequate for most procedures (see CP076 

Standard Precautions and PPE Policy). If patients are cohorted, gloves must 

be changed and hands washed between each patient contact. 

9.3 MASKS 

Masks are very rarely required; they should only be worn if necessary as they 

have a negative impact on communication. For patients who rely on lip 

reading to communicate staff must use alternative methods of communication 

e.g. pen and paper or electronic hand held computer. For certain airborne 

infections e.g. new strain respiratory virus or for cough inducing procedures, 

the use of an FFP2 or FFP3 mask is recommended for staff entering a 

controlled environment to provide patient care. The mask should always be 

put on before entering the room, removed after leaving the room, and 

disposed of as clinical waste. Hands must then be thoroughly decontaminated 

with soap and water. 

Staff must have received suitable and sufficient information, instruction and 

training with regard to FFP2/FFP3 mask donning and have been successfully 

‘fit tested’ and certificated. 

Refer to CP076 Standard Precautions and PPE Policy. 

9.4 HAND HYGIENE 

Always clean hands using Hibiscrub before leaving the room. Apply alcohol 

gel after leaving the room and closing the door. Hand washing is essential to 

prevent the transfer of organisms to other patients. When the patient has 

diarrhea or vomiting please use soap and water or Hibiscrub, alcohol gel is 

ineffective. 

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See CP073 Hand hygiene Policy 

Unnecessary precautions must be avoided; they will only worry the 

patient and waste valuable time and equipment. 

9.5 LINEN 

The door must be closed when changing the bed linen to reduce 

dissemination of skin scales/spores. Place all linen in an alginate bag in the 

room, then transfer into a red plastic bag at the doorway. This is to prevent 

dissemination of organisms and to give additional protection to laundry staff. 

9.6 WASTE 

Discard disposable items or those soiled with infected material into an orange 

plastic bag in a foot operated bin. 

9.7 DECONTAMINATION OF EQUIPMENT 

Non-disposable items must be decontaminated before removing from the 

room to prevent transfer of organisms. See CP030 Overarching 

Decontamination Policy. 

9.8 CUTLERY AND CROCKERY 

Use normal cutlery and crockery. These must be washed in the ward 

dishwasher or main kitchen dishwasher with a final rinse temperature of 80 

degrees centigrade. Meal trays will be the same as those for other patients 

and should be returned to the kitchen in the meal trolley with everyone else’s. 

These items must not be washed by hand as the temperature is inadequate to 

decontaminate. 

9.9 TOILETING 

Faeces/urine/vomit should be disposed of directly into a macerator. Then 

remove apron and gloves and wash hands. Prompt disposal and disinfection 

is essential to prevent transmission of organisms to other patients. 

NB Protective clothing worn in the isolation room may be worn when walking 

straight to the sluice room and discarded into an orange clinical waste bag 

immediately after disposal of excreta. Hands must then be washed and dried 

and alcohol gel applied. 

9.10 VISITORS (FRIENDS AND FAMILY) 

Explain the reason for isolation, ensuring confidentiality is maintained at all 

times. Visitors must be instructed to wash their hands before entering and 

leaving the room. Usually no other precautions are necessary, unless 

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requested by the IPCT. Susceptible visitors including children should be 

discouraged. For most infections the risk to visitors is minimal. Encourage 

visitors not to have contact with other patients in the ward, or if visiting more 

than one patient, to visit the isolated patient last. 

Visitors need only wear protective clothing if they are going to be involved in 

direct patient care activities i.e. assisting with personal hygiene, toileting or 

carrying out dressing changes. 

Infection Prevention and Control leaflets are available on the intranet. The 

Health Protection Agency and NHS Direct also produce leaflets staff may find 

useful to give to patients and visitors. Care must be taken to only use leaflets 

of professional healthcare web sites in the UK. 

10.0 VISITING OTHER DEPARTMENTS 

Patients should avoid visits to other departments whenever necessary. The 

receiving department must be contacted prior to the patient’s arrival to ensure 

adequate precautions can be taken. Infected lesions should be covered with a 

dressing. The patient should be asked to cover their mouths and use tissues if 

coughing or sneezing. 

10.1 Portering staff do not need to wear protective clothing but should wash their 

hands on completion of the journey. If they are handling and lifting the patient 

they should wear gloves and apron for that procedure, wear gloves when 

wheeling the bed, but do not need to wear them when taking the patient in a 

wheelchair down the corridors. The chair or trolley should be cleaned 

afterwards by the portering staff who used it. 

10.2 The patient should be seen at the end of the clinic list or operated on at the 

end of the theatre list. This will enable the receiving department to take 

appropriate precautions and decontaminate equipment before the next 

patient. 

10.3 In order to minimize contact and reduce the risk of cross infection, isolated 

patients should be taken directly to and from other departments and not left in 

waiting areas. When these patients are away from the side room, contact with 

other patients and staff should be kept to a minimum. 

11.0 TRANSFER OF ISOLATED PATIENTS WITHIN AND BETWEEN 

HOSPITALS 

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Transfers should only take place if unavoidable, and in the patient’s best 

interest, i.e. the health of the patient should take priority over the infection 

problem. The receiving ward must be informed and a single room or 

appropriate cohort area arranged. 

Please see CP061 Policy for the Interward and Intraward Transfer of patients 

with infection control issues. 

12.0 HOUSEKEEPING STAFF AND CLEANING 

12.1 Housekeeping staff must wear the same protective clothing as the nursing 

staff when entering an isolation room. The yellow isolation sign on the door 

warns that the patient is being isolated but not the reason why. Housekeeping 

staff must check with the nurses what precautions are required before 

entering the room. 

See Appendix 2 for details on how to clean the isolation room (single or 

cohort) on a daily basis and a how to carryout a ‘terminal clean’ when the 

patient is discharged from the room. Hydrogen Peroxide Vapour technology 

(currently Bioquell machine) may be used to disinfect the room. 

Housekeeping provide this service. 

12.2 The staff must inform the housekeeping staff that a patient is being isolated 

and what precautions, gloves and aprons etc are required. The isolation room 

or bay should be thoroughly cleaned every day to minimize the dust and 

reduce airborne spread. When the patient is discharged the room should be 

‘deep cleaned’. Please refer to CP030 Overarching Decontamination Policy 

for specific details. 

13 REVIEW OF ISOLATION REQUIREMENT 

Regular assessment and evaluation of the continued need for isolation should 

be taken in conjunction with the IC team. To find out the suggested duration of 

isolation please refer to the Appendix 8 Communicable Disease Table or 

contact the Infection Prevention and Control Team. 

Isolation can be stopped when: 

The patient is no longer at risk of spreading infection to others 

The duration of isolation dictated by the specific disease and treatment 

criteria are met. 

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If in doubt contact the IPCT. 


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14 DEATH 

In the case of a death please carry out the usual last offices wearing the same 

protective clothing as when the patient was alive. Place the deceased in a 

body bag, as normal. Inform the mortuary of the type of infection/disease the 

patient has. Place a yellow “Danger of Infection” tape across the closure of the 

body bag. Please refer to CP070 Deceased Infected Patient Policy since 

deceased patients with some specific infections must be placed in a body bag 

that closes with a zip fastener. 

15 TRAINING 

 

 

 

 

 

 

 

 

Infection prevention and control training on basic principles including 

isolation principles and practice as part of the Trust wide mandatory 

training scheme for all staff and is monitored via attendance records. Refer 

to OPO49 Learning and Development Policy. 

Training is provided to all staff at induction 

Training is provided to all staff at annual update 

Specialty based training is offered via divisional meetings on an ongoing 

basis by members of the Infection Prevention and Control Team. 

The Infection Prevention and Control Link Practitioners participate in a 

specialist programme of on going training including sessions about specific 

infections and diseases. 

It is the responsibility of individuals and their line managers to ensure 

attendance at training. The Training Department feedback non attendance 

to line managers and it is their responsibility to follow up non attenders and 

ensure their subsequent attendance. 

Training and education attendance is monitored by the Patient Safety and 

Quality Committee (PSQC). 

Training attendance reports are presented to the PSQC. 

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E-learning for infection prevention and 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. 

Completion of the Infection Prevention and Control booklet can also be 

carried out on alternate years, available from the Education & Training 

Department. 

16 MONITORING COMPLIANCE WITH THIS POLICY 

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It is important to minimize the risk of the spread of infection to and from patients 

and staff. This policy outlines the measures, which should be taken to prevent 

the spread of infection from patients who are known to be a potential source of 

infection. 

This will be monitored by: 

Monitoring the trends of infections in the Trust by analyzing alert 

organism figures. 

Ensuring when isolation of infected patients cannot occur that clinical 

incident forms are filled in. 

Site coordinators collecting data when patients cannot be isolated. 

Monitor that the correct signage and isolation guidelines are adhered to 

by all staff by undertaking ad hoc observational audits during ward 

visits. 

Ensuring that non compliances to policy are challenged appropriately 

by any member of staff and not left. Any complaints must not be 

discriminated against. 

Compliance with this policy should be audited regularly by bed 

managers or divisions and noncompliance reported divisionally and to 

the Infection Prevention and Control Committee. The IPCNs will 

facilitate the audit process if required. 

There is a regular programme of audits, led by the DIPC and coordinated 

by the IPCT, which are reported to the Infection Prevention 

and Control Committee (IPCC), e.g. Hand Hygiene, use of Isolation 

facilities, infection control policy compliance, High Impact Interventions. 

Divisional audits are reported via the divisions to the IPCC and 

Divisional Governance Committees 

Alert organism surveillance and trends are reported to the IPCC 

Mandatory surveillance is reported to the IPCC, divisions and Trust 

Board. 

Serious Incidents Requiring Investigation (Infection) are discussed at 


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IPCC and reported to the Patient Safety and Quality Committee, Health 

Protection Agency, Primary Care Trust and Strategic Health Authority 

Monthly reports on infection prevention and control and surveillance 

are taken by the DIPC to the Trust Board. 

17 CONCLUSION 

Patients nursed in isolation either for their own protection, or for the protection 

of others, require a lot of support and reassurance from staff. Being nursed in 

a single room can be distressing for some patients. Patients should only be 

isolated if absolutely necessary and for as short a time period as possible. 

Caring for patients in isolation can be daunting for housekeeping staff and 

those new to the hospital. Staff are encouraged to take time to explain to staff 

visiting the ward what precautions are required for each patient in isolation. 

For visitors too it can be a cause of anxiety to have a relative nursed in 

isolation. It is important that healthcare staff offer information, advice and 

support so that a patient’s stay in isolation can be as stress free and as 

comfortable as possible. 

18 DEFINITIONS 

CEO – Chief Executive Officer 

DIPC – Director of Infection Prevention and Control 

IPC – Infection Prevention and Control 

IPCC – Infection Prevention and Control Committee 

IPCT – Infection Prevention and Control Team 

FFP2 and FFP3 are standards used to differentiate between the filtering 

ability of face masks 

PPE – personal protective equipment 

19 REFERENCES 

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Damani (2003) Manual of infection control procedures 2 nd edition. Greenwich 

Medical Media Ltd. 

Hospital Infection Society (2001) Review of hospital isolation and infection 

control related precautions – report of the joint working party. 

Philpott-Howard J and Casewell M (1995) Hospital Infection Control: Policies 

and Practical Procedures. W B Saunders 


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Wilson J, (1995) Infection Control in Clinical Practice. Balliere Tindall 

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Appendix 1: Utilisation of side rooms/ isolation facilities 

The Trust has a duty to provide adequate isolation facilities to prevent or minimise 

the spread of infection. Site coordinators and other Trust can use the side room 

spread sheet to prioritise the use of the sides based on a risk assessment. 

The following types of patients MUST be isolated 

1 Patients with known or suspected pulmonary TB or new strain of respiratory 

virus 

These patients can only move out of isolation if a new strain of respiratory virus or 

TB is excluded. If confirmed positive for TB AND 2 weeks of effective anti-TB therapy 

is completed the patients physician or consultant microbiologist must confirm that 

isolation can be discontinued. 

2 Patients admitted with diarrhoea or vomiting of undiagnosed cause 

These patients can only move out of isolation if the physician considers that the 

diarrhoea or vomiting is not related to an infectious agent or in an outbreak situation 

after consultation with the IPC team, similarly infected patients may be cohort nursed 

in a bay. 

3 Patients diagnosed with Clostridium difficile diarrhoea 

These patients should remain in isolation until discharge due to the high levels of 

relapses. Any move out of isolation must be carried out after consultation with a 

microbiologist. See CPO64 Clostridium difficile Policy. 

4 Patients with scabies or Norwegian scabies 

Patients with suspected scabies must be isolated, a diagnosis made and if found to 

have scabies to be treated. Anyone with Norwegian scabies must be isolated until a 

dermatologist says the patient is no longer infectious. 

5 Patients diagnosed with MRSA on this admission 

These patients should only move out of isolation if they have had 2 negative sets of 

MRSA swabs, taken 5 days apart. See CPO55 MRSA Policy. Patients diagnosed 

with ESBL or Acinetobacter on this admission need to be isolated. 

6 Patients known to be previously positive for MRSA at any site 

These patients should be isolated if they have had a recent positive swab/screen for 

MRSA i.e. within the last 12 months. Prompt screening on admission is essential. 

7 Patients with neutropenia / immunosupression 

These patients should be isolated if, in the opinion of a senior doctor, they require 

protective isolation. In general the level of additional protection offered by residing in 

a side room in the hospital is minimal. 

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Appendix 2: Notifiable diseases, alert organisms and alert conditions 

Please refer to DOH and Health Protection Legislation (England) Guidance 

2010 (Table 1)Website: http://www.dh.gov.uk/publications 

The early reporting of communicable disease is an essential element in the control of 

these largely preventable diseases. Some may require a prompt and immediate 

follow up of those affected, whereas others may require a review of the immunisation 

status of the affected individual or their close contacts. 

Notification of certain infectious diseases is a statutory duty for the medical 

practitioner who makes a provisional or definite diagnosis listed below, as well as 

being a valuable tool in the prevention and control of disease. The doctor is 

statutorily required to notify the Consultant in Health Protection at the Health 

Protection Unit. 

The hospital doctor must also inform the hospital Infection Prevention and Control 

team and the ward staff so that adequate precautions such as isolation can be 

immediately commenced. 

The following diseases are notifiable (Bold ones require urgent notifications): 

Acute encephalitis 

Acute meningitis (if bacterial) 

Acute poliomyelitis 

Acute infectious hepatitis (hepatitis A,B,C other) 

Anthrax 

Avian influenza 

Botulism 

Brucellosis 

Cholera 

Diphtheria 

Dysentery 

Enteric fever (typhoid & paratyphoid fever) 

Food poisoning 

Haemolytic uraemic syndrome (HUS) 

Invasive Group A streptococcal infection 

Legionnaires’ disease 

Leprosy 

Leptospirosis 

Malaria 

Measles 

Meningococcal septicaemia (without meningitis) 

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Mumps 

Ophthalmia neonatorum 

plague 

rabies 

relapsing fever 

rubella 

SARS 

scarlet fever 

small pox 

tetanus 

tuberculosis 

typhus fever 

viral haemorrhagic fever 

whooping cough 

yellow fever 


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Alert conditions 

Any infectious agents transmitted in healthcare settings may, under defined conditions, 

become targeted for control because they are epidemiologically important. 

All conditions and organisms listed in the notifiable diseases plus the following are 

generally considered a trigger for investigation and enhanced control measures because 

of the risk of additional cases and severity of illness associated with these infections. 

 

 

 

 

Suspected infective diarrhoea and/or vomiting 

Pyrexia of unknown origin (especially related to travel abroad) 

Severe soft tissue infections 

Chicken pox/shingles (herpes zoster) 

Alert organisms for full list please refer to DOH and Health Protection 

Legislation (England) Guidance 2010 Website: http://www.dh.gov.uk/publications 

Bacterial isolates: 

Organisms causing alert conditions and/or notifiable diseases previously listed 

MRSA 

Other highly resistant Staphylococcus strains(e.g. gentamicin/fucidic acid 

resistance) 

Group A beta-haemolytic Streptococcus 

Penicillin- resistant Streptococcus pneumoniae 

Vancomycin resistant Enterococci (VRE) 

Clostridium difficile or clostridium perfringes toxin related diarrhoea 

Legionella species (including serology results) 

Verotoxin producing strains of Escherichia coli ( e.g. E.coli 0157) 

Salmonella or shigella species 

Gentamicin resistant, multi-resistant or extended spectrum beta-lactamase 

producing gram negative bacilli - ESBLs 

Other bacteria isolated with unusual antibiotic resistance 

Burkholderia cepacia (Pseudomonas cepacia) – particularly relevant to cystic 

fibrosis patients 

Resistant Pseudomonas aeruginosa 

Stenotrophomonas maltophilia (Xanthomonas maltophilia) 

Viral isolates 

Rotavirus 

Respiratory syncytial virus (RSV) 

Influenza 

SARS 

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Varicella zoster 

Parvovirus B19(particularly antenatal wards and paediatrics) 

Norovirus 

Fungi – in specialist units (like ITU, NNU) 

Candida species 

Aspergilus 

There are separate mechanisms for notifying and responding to cases of healthcare 

associated infections, Human Immunodeficiency Virus (HIV)/Sexually Transmitted 

Infections (STIs) and Creutzfeldt-Jakob Disease. Therefore, cases of these diseases 

should not be reported routinely under this requirement. 

Healthcare associated infections: Mandatory reporting of healthcare associated 

infections has proved to be effective in providing real time surveillance data that infection 

control teams routinely use for control measures. Such surveillance systems include all 

laboratory reports of bacteraemia for a variety of microorganisms, some of which are 

associated with healthcare settings; Staphylococcus aureus (including MRSA); 

Clostridium difficile; Surgical Site Infection Surveillance Service (SSISS); and 

glycopeptide-resistant enterococcal bacteraemia. See CPO21 Surveillance Policy. 

HIV and STIs: Genitourinary medicine (GUM)/sexual health clinics routinely follow up 

contacts of cases and take necessary public health actions. Clusters or outbreaks of 

disease are managed in collaboration with the HPA. Patient confidentiality is of vital 

importance in HIV and STI settings to retain patients’ trust in health services and to 

encourage access to clinics and services for information and advice, testing, diagnosis 

and treatment. However, notification is required if a patient attending a GUM clinic is 

diagnosed with acute infectious hepatitis. This disease is also spread by non-sexual 

means and so notification will ensure that contact tracing is undertaken and control 

measures offered to non-sexual contacts that could be at risk. 

CJD: The incidence of Creutzfeldt-Jakob Disease is monitored in the UK by the National 

CJD Surveillance Unit (NCJDSU) and all suspected cases should be reported to this 

unit. The unit assists clinicians with the investigation of this disease and works in 

collaboration with the HPA and the CJD Incidents Panel in the investigation and 

management of CJD incidents. See CPr031 CJD and other Transmissible Spongiform 

Encephalopathy Guidelines. 

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Appendix 3 

DAILY CLEANING PROCEDURE FOR A SINGLE ISOLATION ROOM / 

BEDSPACE OF PATIENTS WHO ARE KNOWN TO BE INFECTIOUS. 

To help prevent the spread of infection, the patients’ immediate environment needs 

to receive an enhanced cleaning regime on both a daily basis and following 

discharge. 

Single isolation rooms / bedspaces where there are patients with infection must be 

cleaned daily using a chlorine containing agent e.g. Actichlor Plus. This is a 

combined detergent and chlorine agent. The nurse in charge of the ward is 

responsible for ensuring housekeeping are notified. 

These areas should ideally be cleaned last, after the other rooms, bays and general 

ward areas. 

All cleaning equipment used in these rooms must be kept exclusively for use within 

these rooms. 

PROCEDURE 

a. Put on single use gloves and yellow aprons before entering isolation 

room. Discuss with nursing staff whether additional PPE is required. 

b. Make up chlorine containing agent e.g. Actichlor Plus in dilution bottle 

supplied using COLD WATER. Warm water results in the production 

of toxic chlorine gas. 

c. Empty made up solution into a bucket / bowl (you may need to make 

up more than 1 litre to clean the entire room). The dilution bottle 

must always be used when making the solution. 

d. Collect all equipment needed together. 

DILTUTION INSTRUCTIONS TABLET SIZE = 1.7G 

General environmental cleaning and 

equipment 

(1,000ppm) 

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1 tablet + 1 litre of Cold Water 

= Correct dilution 


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e. Wherever possible, ensure good ventilation of the room by opening 

the window. 

f. Damp dust all surfaces using a single use cloth and the Actichlor Plus 

solution. Make sure all hand contact surfaces are cleaned and dried 

thoroughly eg door handles, taps and toilet handles. 

NB: It is the responsibility of the ward nursing staff to damp dust daily 

any nursing/medical equipment with detergent and chlorine e.g. 

Actichlor Plus. Commodes dedicated to patients should be cleaned 

with a disinfectant wipe after every use and daily or when visibly soiled 

with a chlorine agent eg Actichlor. If the commode is removed from the 

room and will be used by others it must be dismantled and cleaned 

with Actichlor Plus. 

g. Clear floors of debris using disposable dust control cloths. The 

disposable cloths should be removed and disposed of in a yellow 

bag. 

h. Mop the floor with a solution of chlorine containing agent e.g. 

Actichlor Plus. When finished, remove the mop head and send to 

the Mop Room for laundering. 

i. Renew waste bags; isolation rooms should have orange waste bags. 

j. Check soap and alcohol gel wall dispensers 

k. Wash hands with soap and water on leaving the cubicle and use 

alcohol gel. 

l. Dispose of the chlorine containing agent e.g. Actichlor Plus solution in 

the sluice. Wash and dry the bucket. Store in the cleaning cupboard. 

The solution should be freshly made for use for each room, and thrown away down 

the sluice after each cleaning session. 

A new solution should be made up every day. 

The Actichlor Plus solution should be changed when it becomes visibly dirty. 

Chlorine based products eg Actichlor Plus will bleach fabrics. 

NB: Only personnel trained in the use of Actichlor plus should use this product. 

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CLEANING PROCEDURE FOR A VACATED SOURCE ISOLATION ROOM OR 

BEDSPACE FOR INFECTED PATIENT 

The isolation rooms / bedspaces of patients who have infections must be thoroughly 

cleaned with both a detergent and chlorine agent, e.g.Actichlor Plus. (detergent 

alone will not effectively remove the C diff spores, bacteria or viruses). 

The cleaning of the source isolation room / bedspace is the responsibility of both the 

domestic services and ward staff. 

The nurse in charge of the ward is responsible for ensuring that a terminal clean 

using a chlorine agent is requested when patients are discharged from isolation 

rooms or transferred from bedspaces. 

Ward staff responsibility 

1. The patient must have vacated the bed space or room before cleaning 

commences. 

2. All items of medical equipment should be surface cleaned with both detergent 

and a chlorine agent, such as Actichlor Plus (safety permitting), and then 

should be removed from the vacated area. 

3. All disposable fittings and medical devices should be disposed of as clinical 

waste eg oxygen tubing and suction tubing. 

4. The room or area should be cleared of miscellaneous items. 

5. Following discharge of the patient, the bed mattress should be cleaned with 

detergent and chlorine eg Actichlor Plus. 

For bed spaces in a four or six bedded bay a risk assessment of the other patients in 

the bay should be made regarding the risks of exposure to a chlorine based agent. 

Housekeeping responsibility 

1. Put on single use gloves and yellow aprons before entering isolation room. 

2. Remove curtains and send to laundry. Wash and dry all hooks in Actichlor 

plus. 

3. Remove clinical and domestic waste. 

4. Ensure room / area is well ventilated eg open windows. 

5. Remove any gross soiling from horizontal surfaces with Actichlor Plus and 

water using disposable clothes. 

6. Follow the procedure as per a daily clean ensuring all surfaces are cleaned 

with both detergent and chlorine eg Actichlor Plus. Apart from medical 

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equipment and the bed mattress the housekeeping staff are responsible for 

cleaning all other surfaces. 

7. Remove the first twelve or so hand towels from the dispenser and discard 

toilet rolls. Replace with a new supply. 

8. Walls should be washed using a non-malin velmop. 

9. Wash all internal windows with Actichlor plus and dry off with a paper towel. 

10.All equipment, ie buckets, mop handles should be removed, thoroughly 

cleaned using a solution of Actichlor plus, dried and stored in the cleaning 

cupboard. 

The Actichlor Plus solution should be changed when it becomes visibly dirty. 

When cleaning is complete dispose of Actichlor Plus solution in the sluice. 

Replace clinical and domestic waste bin liners and check and refill/replace soap and 

alcohol wall dispensers. 

The room is now ready for use. 

Please note that the IPCT may recommend using Hydrogen Peroxide Vapour 

technology (currently Bioquell) to decontaminate a room after discharge. If there is 

an outbreak of MRSA the bay should be emptied and decontaminated using 

Hydrogen Peroxide Vapour. Housekeeping provide this service. 

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Appendix 4: Acinetobacter 

What is Acinetobacter? 

It is a Gram Negative Bacillus (GNB). It is an environmental organism that is both in 

and outside the hospital environment; it lives in water and damp conditions but can 

survive in dust. It needs little to survive in the environment and can survive for long 

periods and is relatively resistant to routine cleaning. In hospitalised patients 

colonisation of the gastro-intestinal tract and oropharnynx with GNBs is common. As 

with most bugs it is the susceptible patients i.e. the immunosuppressed and/ or the 

critically ill who are at risk. They have been implicated in outbreaks in ITU, neonatal 

and oncology units. Surveillance of patients and the environment will be carried out 

if cases of healthcare acquired aceinetobacter occur. 

Multi-resistant bacteria are seen more frequently in areas that have high usage of 

broad spectrum antibiotics and where patients have diminished immunity e.g. critical 

care and oncology units. GNBs commonly achieve antibiotic resistance by 

producing an enzyme (e.g. beta-lactamase) that counters the effects of specific 

antibiotics. The genes that confer antibiotic resistance that can spread to other 

bacteria. 

Multi-resistant Acinetobacter are defined as isolates which are resistant to any 

aminoglycosides and to any third generation cephalosporin. Some multi-resistant 

Acinetobacter strains are also resistant to carbapenem antibiotics (these strains are 

designated MRAB-C). 

How is it spread and how to prevent it? 

As with all Health Care Acquired Infections (HCAI), Acinetobacter can be part of the 

transient flora on hands, on equipment and the patient’s environment. Hand 

hygiene is therefore important in the prevention of spread. 

Hand hygiene (Policy CPO73), and environmental cleaning are the most important 

areas that need to be concentrated on. Isolate the patients to prevent spread to 

other patients, especially if sputum positive with a productive cough or incontinent of 

urine, in a high risk areas i.e. ITUs, HDU or immunocompromised patients. 

Care of patient 

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Any patient found to be infected with Multi-resistant Acinetobacter or MRAC-C 

should be placed in isolation. They should be nursed in a single room, when these 

are at a premium priority should be given to these patients. See appendix 2. 

Good Standard Precautions and use of Personal Protective Equipment (PPE) (see 

CPO076), should always be adhered to. Disposable plastic yellow aprons and 

gloves must be worn for direct patient contact by all the multidisciplinary team. FFP2 

masks if patients sputum positive and there is a risk of generating infective aerosols. 

Treatment of infection should be based on the susceptibility testing and the clinical 

situation. Clinical staff are encouraged to contact a microbiologist for advice when 

treating an infection caused by this. Serious infections will usually be treated with 

carbapenem antibiotic, depending on the results of susceptibility testing. 

The patient should remain in isolation while in hospital until they can be discharged 

to their own homes or residential homes if clinically suitable. Ward staff must liaise 

with the nursing/residential homes or other hospitals if the patients are to be 

discharged there. 

Visitors 

If visitors are visiting other patients in the hospital, they should be requested to visit 

the infected patient last. Visitors should wear apron and gloves, if they are carrying 

out hands on care, which should be removed immediately before exiting the room. 

After removal of gloves they should wash their hands on leaving the room. 

Movement of patients within the hospital 

This should be kept to a minimum to reduce the risk of spread. 

Outbreak Control 

The Infection control team and consultant microbiologist will consider whether other 

patients on the ward have risk factors for colonisation/infection. These include ITU 

admission, duration of hospital stay, presence of wounds, use of broad-spectrum 

antibiotics including carbapenems, indwelling urinary catheters, central venous 

catheters, mechanical ventilation and Parenteral nutrition. If more than one patient 

is identified then this is an outbreak. It will then be decided whether patient and/or 

environmental screening is needed and whether patient decontamination should take 

place. 

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Appendix 5: GRE - Glycopeptide Resistant Enterococci 

Enterococci are commensals of human and animal bowel. E.faecalis is the 

predominant commensal species of humans and causes about 10-12% of hospital 

acquired infections. Most enterococcal infections are endogenous but cross infection 

between hospitalised patients does occur. Acquired glycopeptide resistance has 

emerged in enterococci which reduces the choice of antibiotics for enterococcal 

infections. 

Glycopeptide Resistant Enterococci is an organism that has developed resistance to 

glycopeptide antibiotics e.g Vancomycin or Teicoplanin. VRE or GRE usually affects 

the most vulnerable of patients and can easily spread from patient to patient, leading 

to outbreaks of infection. It is vital to prevent the spread of GRE as resistant 

organisms tend to have a significant morbidity and mortality and are difficult to treat. 

Enterococcus faecalis and Enterococcus faecium are gram positive cocci which 

colonise the gastro intestinal tract. In vulnerable patients e.g. immunocompromised, 

they can cause infection e.g. UTI, wound infections, invasive line infection, 

septicaemia and endocarditis. 

Risk factors for hospital infection with GRE include prior antibiotic therapy, prolonged 

hospital stay, and admission to intensive care, renal, haematology of liver units. 

Colonisation and infections 

GRE can colonise wound and ulcers and can cause infections like bacteraemia, and 

infections of the abdomen. GRE may also cause infections in the bile duct, heart 

valves or the urinary tract. 

Transmission 

There are two routes of transmission: 

Cross infection from one patient to another (exogenous infection) 

Spread of GRE from a colonised site to a usually sterile site within the 

same patient (endogenous infection) e.g. bacteraemia from a 

colonised urinary catheter 

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Transmission within hospitals is mainly on hands contaminated by contact with 

colonised or infected patients. Hand washing is extremely important as a means of 

controlling infection. 

The environment in close contact with the patient may also be contaminated, 

especially is the patient has diarrhoea, and serves as a source of contamination of 

staff hands. Thorough cleaning of the environment is essential. 

When a patient with GRE is identified, the patient and their contacts within the ward 

must be screened for GRE. 

Faeces are the most useful screening specimen for outbreak situations. 

A GRE screen includes 

Rectal swab and a perineum swab 

Stool sample 

Wound swabs – leg ulcers, IV cannula, tracheostomy sites 

CSU 

Patients at risk of having GRE are 

A history of previous hospitalisation 

Recent antibiotic therapy and/or multiple antibiotic therapies 

Underlying disease especially hepatobilary disease 

Permanent indwelling invasive devices e.g. PEG and urinary catheter 

Patients in ITU / HDU 

Infection Control Precautions 

Isolate in a side room and barrier nurse 

Wear gloves and yellow apron each time you enter the room. 

Deep clean the contact bay after the affected patient has been moved 

out 

Close the bay to admissions and transfers 

Barrier nurse the remaining patients in the bay 

Screen the contacts 

Treatment 

GRE lives in the bowel and research indicates that eradication attempts have not 

been successful or worthwhile. On occasions it will be necessary to teat a patient’s 

clinical infection with GRE. Advice must be sought from the Microbiologist. 

Patients with GRE who are having surgery or insertion of invasive devices may 

require different prophylactic antibiotics from those recommended in the Antibiotic 

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Prescribing Guidelines. Clinicians are requested to discuss each case with the 

microbiologists prior to prescribing. 

Appendix 6:ESBL – Information Sheet 

Extended Spectrum Beta Lactamase producing coiforms 

Coliforms such as Escherichia coli and Klebsiella are very common bacteria that 

normally live harmlessly in the gut. They sometimes cause infections, most 

commonly urinary tract infections, and also bacteraemia/septicaemia e.g. due to 

biliary sepsis which can be life threatening. 

Extended-Spectrum Beta-Lactamases (ESBLs) are enzymes that can be produced 

by coliforms making them resistant to almost all β lactma antibiotics including coamoxiclav, 

piperacillin/ tazobactam and cephalosporins e.g. cefuroxime, cefotaxime 

and ceftazidime - which are widely used antibiotics in many hospitals. Some 

coliforms carry resistant genes to other classes of antibiotics including ciprofloxacin 

and aminoglycosides. This makes treating the infections they cause very difficult to 

manage. There are a number of different organisms that produce ESBL enzymes 

and E. coli and Klebsiella are two of the commonest. 

A number of patients with ESBL are identified in the community. These bacteria can 

be acquired in the community not just in hospital. 

Route of Spread 

The source of the spread is the site on the patient which is colonised or infected. 

Person to person directly 

Faecal oral spread 

Hand contact 

Although ESBL can be spread on equipment the most common route is by contact 

with an infected or colonised patient, which emphasises the importance of good 

hand hygiene before and after patient contact. 

Infection Control Precautions 

 

 

Isolate in a single room or in a cohort bay 

Gloves and yellow apron for all patient contact 

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Follow the steps stated in the Isolation policy to manage patients with 

colonisations or infections that require barrier nursing. 

Contacts will be screened if there is another case of ESBL on the 

ward, or there is suspicion of an outbreak. 

Treatment 

Treatment of infection due to multiple antibiotic-resistant gram negative bacteria 

should be based on susceptibility testing and the clinical situation. Clinical staff are 

encouraged to refer to the Antimicrobial guidelines and for serous infections to 

discuss with the consultant microbiologists 

Giving antibiotics to asymptomatic patients to clear the colonisation is seldom 

effective. Antibiotic treatment should only be given if patients show clinical signs of 

infection. 

Duration of treatment 

Isolation should continue until the patient has completed treatment and culture of a 

repeated specimen is negative. Patients maybe discharged to their own home if 

clinically well. Ward staff must liaise with residential or nursing homes or other 

hospitals if the patient is to be discharged there. 

Screening for ESBL 

If ESBL is suspected take a urine sample for culture and sensitivity on admission or 

when the patient is symptomatic. Patients without a catheter do not need screening 

for ESBL unless they are known, or suspected, to have previously had ESBL 

coliforms. 

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Appendix 7 

Royal Hampshire County Hospital 

GUIDE TO ISOLATION OF PATIENTS WITH COMMUNICABLE DISEASES 

The alphabetical index that follows gives advice on the routes of transmission and precautions required for nursing specific infectious 

diseases. The wearing of personal protective equipment (PPE) when handling body fluids is mandatory at all times. Additional PPE is 

required for certain infections and this is indicated where appropriate. 

DISEASE 

ACTINOMYCOSIS 

ADENOVIRUS INFECTIONS 

ROUTE OF 

TRANSMISSION 

Autoinfection from 

own saliva 

Airborne 

Faecal oral 

Direct contact 

ANTHRAX a) Cutanous Direct Contact with 

wound 

b) Pulmonary Not transmitted 

from person to 

person 

No 

ISOLATION 

Single Room 

Isolation is not 

necessary but desirable 

Isolation is not 

necessary but desirable 

ADDITIONAL 

PPE 

No 

Apron, gloves 

Mask - if 

patient has 

respiratory 

symptoms 

COMMENTS 

Use Contact Precautions for incontinence pads or 

incontinent patients for the duration of illness or to 

control institutional outbreaks 

Transmission through non-intact skin contact with 

draining lesions possible, therefore use Contact 

Precautions if large amount of uncontained drainage. 

Hand washing with soap and water, since alcohol 

does not have sporicidal activity. 

Inform CCDC, Infection Control. Notify laboratory in 

advance of sending specimens. Soiled articles must 

be incinerated or autoclaved. Fumigation of room may 

be required. 

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Major 


Reference: 

CP022 



Page 35 of 61



ANTIBIOTIC ASSOCIATED 

DIARRHOEA 

(Pseudo membranous colitis) 

BOTULISM 

(Clostridium botulinum) 

Autoinfection 

Faecal oral 

Ingestion of 

preformed toxin in 

food 

Single Room No Inform Infection Prevention and Control 

No No Inform CCDC and Microbiologist urgently 

BRONCHIOLITIS 

BRUCELLOSIS 

(Undulant Fever) 

CAMPYLOBACTER -Enteritis 

CANDIDIASIS 

Respiratory droplets 

and contact with 

secretions 

Ingestion 

Contact with 

animals 

Lesions 

Ingestion food, 

faeces 

Contact with 

lesions/via hands or 

equipment 

Single room 

No (mask for 

sputum 

inducing 

procedures) 

Yes if lesion is draining No Notify laboratory in advance of sending specimens - 

as hazardous to laboratory staff 

Yes if possible No Notifiable to CCDC if considered food poisoning. 

No 

CAT SCRATCH FEVER Cat scratch or bite No No No person to person transmission 

No 

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CHICKENPOX (Varicella) 

incubation period 8 -21 days 

CHOLERA 

CLOSTRIDIUM DIFFICILE 

CREUTZFELDT JAKOB 

DISEASE - CJD 

Airborne 

Contact with vesicle 

fluid 

Ingestion 

Faecal oral 

Contact direct and 

indirect with faeces 

and spores 

single room 

Apron, gloves 

and mask 

Exclude susceptible staff. Infectious 48 hours before 

rash appears and until all lesions are crusted 

Susceptible staff should not enter room if immune 

caregivers are available; no recommendation for face 

protection of immune staff. In immunocompromised 

host with varicella pneumonia, prolong duration of 

precautions for duration of illness. 

Single room Apron, gloves Notifiable to CCDC 

Inform Infection Prevention and Control 

Single Room Apron, gloves Inform Infection Prevention and Control 

See policy on "Transmissible Spongiform Encephalopathies Isolation not required 

CRYPTOSPORIDIUM Contact with faeces Yes No 

CYTOMEGALOVIRUS - CMV 

including in neonates and 

immunosuppressed patients 

Transplacental 


Sexual 

Transplant/blood transfusion 

recipients 

Yes 

Apron, gloves 


Care with post partum products, urine and saliva. 

Can cause congenital infection in babies. 

No additional precautions for pregnant staff. 

DERMATITIS 

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a) Severe infected Contact 

Airborne – skin scales 

b) Severe non-infected Contact 

Airborne 

Single Room Apron, gloves Source Isolation 

Single Room Apron, gloves Protective Isolation 

DIARRHOEA 

(Unknown origin) 

Various - usually faecal oral 

or foodborne. 


Inform CCDC if food poisoning suspected 

DIPHTHERIA 

Incubation period 2-5 days 

Contact 

Airborne 

Single Room 

Closed door 

Apron, 

gloves, mask 

for direct 

contact or 

prolonged 

contact 

Notify CCDC urgently who will advise on 

management of contacts. Inform Infection Prevention 


Notify laboratory before sending specimens. 

DYSENTERY 

a) Bacillary (Shigellosis) Faecal oral 

Ingestion 

b) Amoebic Faecal oral 

Ingestion 

1 E COLI 0157 Food, water, contact with 

cattle etc and person to 

person (faecal-oral) 

Single Room Apron, gloves Notifiable to CCDC 


Single Room No Notifiable to CCDC 


Single room if 

possible 

Apron, gloves 

Inform CCDC by telephone. Can cause serious 

illness (Haemolytic Uraemic Syndrome). Easily 

transmissible, so strict hand washing and hygiene 

essential 

EBOLA VIRUS INFECTION 

DO NOT ADMIT TO DISTRICT GENERAL HOSPITAL Place in strict isolation until transfer to High Security 

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Infectious Disease Unit at Coppett’s wood. Notify CCDC urgently. See Viral Haemorrhagic Policy IC 12 

ENTERIC FEVER Faecal oral Single Room Apron, gloves Notify CCDC urgently 

Inform Infection Control 

ENTEROVIRUS INFECTIONS 

e.g. Coxsackie and Echovirus 

Faecal oral Single Room No Babies in Newborn Unit at very high risk 

ERYSIPELAS See Streptococcal Infections (Group A) 

FOOD POISONING 

a) Salmonellosis 

b) Staphylococcal & 

Clostridium perfringens 

Faecal oral Single Room No Notifiable to CCDC 


Food borne No No Notifiable to CCDC 


FUNGAL INFECTIONS 

a) Aspergillosis Airborne No No 

b) Candidiasis – Thrush Autoinfection 

Contact 

No 

c) Cryptococcosis Airborne No No Notify laboratory in advance - hazardous to lab staff 

d) Ringworm Contact Single Room * No advisable for Paediatric cases 

No 

GASTROENTERITIS 

a) Cryptosporidiosis Faecal oral 

Waterborne 

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b) Enteropathogenic 

Ecoli 

c) Viral 

e.g. SRSV, Norwalk & 

Rotavirus 

GAS GANGRENE 

GIARDIASIS 

GLANDULAR FEVER 

(Infectious mononucleosis) 

Animal contact 

Faecal oral Single Room No Inform Infection Prevention and Control 

Faecal oral 

Environment 

Autoinfection from own 

bowel flora 

Faecal oral 

Waterborne 

Close contact with 

secretions 

Single Room 

/cohort nurse in 

outbreaks 

Apron and 

gloves 

No No Inform Microbiologist 


Persons who clean areas heavily contaminated with 

faeces or vomit may benefit from wearing masks since 

virus can be aerosolized from these body substances; 

ensure consistent environmental cleaning and 

disinfection. Alcohol gel is not active. Cohorting of 

affected patients to separate bays and toilet facilities 

may help interrupt transmission during outbreaks. 

Single Room No Notifiable to CCDC 


No 

GONORRHOEA Sexual contact No No Care with secretions from infected sites 

HAEMOLYTIC URAEMIC 

SYNDROME 

HAND FOOT AND MOUTH 

See E coli 0157 

see Enterovirus infections 

No 

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HEPATITIS 

a) A 

15-50 days incubation period 

b) B, C & D Inoculation, skin and 

mucous membrane 

contamination, 

sexual, transplacental 

Faecal oral Single Room No 

No No Notifiable to CCDC 

Notifiable to CCDC Inform Infection Prevention and 

Control 

Maintain Contact Precautions in infants and children 

14 yrs. of age for 1 week after onset of 

symptoms 


c) E Faecal oral Single room No Notifiable to CCDC 


HERPES SIMPLEX 

INFECTIONS 

(cold sores and genital sores) 


HERPES ZOSTER 

HAEMOPHILUS INFLUENZA 

TYPE B (Hib) 

Direct contact with vesicle 

fluids 

See Shingles 

No* 

Yes if a 

neonate 

Respiratory secretions yes gloves and 

apron 

No 

* Single room in Maternity Unit 

Staff with lesions must avoid contact with neonates 

and immunocompromised patients 

Notifiable to CCDC 


HIV and AIDS Inoculation, contamination No No 

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with blood and body fluids, 

sexual, transplacental 

IMPETIGO 

Direct contact with the 

lesion 

Single Room No See also Streptococcal infection. 

INFLUENZA A and B 


See New Strain Respiratory 

Virus Policy CP104 

LASSA FEVER 

Airborne Single Room Apron, mask 

and gloves 

Incubation period varies 1-5 days. Single patient room 

or cohort; avoid placement with high-risk patients; 

mask patient when transported out of room; 

chemoprophylaxis/vaccine to control/prevent 

outbreaks. Use gown and gloves according to New 

Strain Respiratory Virus Policy may be especially 

important in pediatric settings. Duration of precautions 

for immunocompromised patients cannot be defined; 

prolonged duration of viral shedding (i.e. for several 

weeks) has been observed. Guidelines regarding 

duration of isolation during pandemics depend on the 

strain, please discuss with infection control and inform 

Microbiologist/CCDC 

DO NOT ADMIT TO DISTRICT GENERAL HOSPITAL Place in strict isolation until transfer to High Security 

Infectious Disease Unit at Coppett’s wood. Notify CCDC urgently. See Viral Haemorrhagic Policy IC 12 

LEGIONNAIRE'S DISEASE Airborne No No Source usually environmental 

Inform microbiologist. 

LEPROSY Contact No No Notifiable to CCDC 


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LISTERIOSIS 

Listeria monocytogenes 

Foodborne or from mother 

to 

baby 

Yes if neonate / 

antenatal ward 

LYME DISEASE Tick bite No No 

No 

Care with exudates 


Inform Infection Control 

MALARIA Mosquito bite No No Notifiable to CCDC 

MARBURG DISEASE 

MEASLES 


MENINGITIS 

DO NOT ADMIT TO DISTRICT GENERAL HOSPITAL Notify CCDC urgently. Place in strict isolation until 

transfer to High Security Infectious Disease Unit at Coppett’s wood. Notify CCDC urgently. See Viral 

Haemorrhagic Policy IC 12 

Airborne via droplet or direct 

contact with secretions 

Single Room 

Gloves, 

apron and 

mask if not 

immune 


Vaccinate susceptible personnel within 72 hours. 

Isolate for 4 days after onset of rash; or for duration of 

illness in immunocompromised. Susceptible staff 

should not enter room if immune care providers are 

available; no recommendation for face protection for 

immune staff. For exposed susceptibles, postexposure 

vaccine within 72 hrs. or immune globulin 

within 6 days IF available and necessary. Place 

exposed susceptible patients on Airborne Precautions 

and exclude susceptible healthcare personnel from 

duty from day 5 after first exposure to day 21 after last 

exposure, regardless of post-exposure vaccine. 

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a) Meningococcal 


Various 

Single Room 

Apron, gloves 

and mask * 

b) Viral Various Single Room Apron, gloves 

Mask * 

c) Haemophilus 

influenzae 

Notify CCDC urgently. Inform Microbiologist 

* until 24 hours of appropriate antibiotic therapy has 

been given. 

Post exposure chemoprophylaxis for household 

contacts (discuss with CCDC), Staff exposed to 

respiratory secretions; post exposure vaccine only to 

control outbreaks after discussion with microbiologist 


* if respiratory symptoms 

Various No No Notifiable to CCDC. Inform Microbiologist 

d) Pneumococcal Various No No Notifiable to CCDC 

e) Tuberculosis Various No * No * *unless patient also has open pulmonary TB 


Coliforms and other 

bacteria 

Various No No Notifiable to CCDC 

Listeria can be transmitted from baby to baby 

MOLLUSCUM CONTAGIOSUM Direct contact No No Care with exudate 

MRSA 

MUMPS 


See MRSA Policy CPO55 

Airborne respiratory droplets 

and contact with saliva 

Single Room Mask Notifiable to CCDC 

Infectious for up to 9 days after the onset of swelling; 

susceptible staff should not provide care if immune 

44 

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caregivers are available. 

MYCOPLASMA PNEUMONIAE Airborne No No Care with respiratory secretions 

New Delhi metallo-betalactamase 

(NDM) see 

Appendix 8 NDM-1 information 

sheet pg 52 


Maybe airborne if 

respiratory symptoms 

yes 

Yes 

Mask & eye 

protection 

maybe 

required 

Similar to an ESBL. People returning from over seas, 

especially those having had surgery, maybe colonised 

or infected with this type of bacteria, and should be 

isolated until screening swabs for all possible 

colonisations and infections have been excluded. 

NOCARDIOSIS Airborne No * No * unless immunocompromised patients on ward 

NOROVIRUS 

(Norwalk like virus, winter 

vomiting 

OPHTHALMIA NEONATORUM 

Chlamydia and gonococcal 

Direct contact with faeces 

and aerosol from vomit 

Yes 

Or cohort 

No 

Direct contact Single Room * No Notifiable to CCDC 

* until 24 hours of the correct antibiotic therapy has 

been given 

ORF Direct contact No No Care with exudates 

PARAINFLUENZA Airborne Single Room Apron, gloves 


Viral shedding may be prolonged in 

immunosuppressed patients. 

PARVOVIRUS (B19) 

INFECTIONS 

45 

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Airborne respiratory 

secretors and urine 

Single Room No Not infectious after rash appears 

Maintain precautions for duration of hospitalization 

when chronic disease occurs in an 


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PLAGUE 

PNEUMONIA 

46 

Authorities 

Flea bite 

Airborne 

Autoinfection 

Airborne 

Single room 


Apron, gloves 


POLIO Faecal oral Single Room Apron and 

gloves 

PSITTACOSIS 

PUERPERAL SEPSIS 

( Group A streptococcus) 

RABIES 

Airborne 

(infected birds) 

No 

No 

immunocompromised patient. For patients with 

transient aplastic crisis or red-cell crisis, maintain 

precautions for 7 days. Duration of precautions for 

immunosuppressed patients with persistently positive 

PCR not defined, but transmission has occurred 

Notify CCDC urgently 

Inform Microbiologist, Infection Prevention and 

Control, Laboratories and CCDC 

Notify CCDC urgently 

Contacts may need vaccination 

Single Room * Mask * * only if coughing 

(person to person spread rare) 

Inform CCDC 

Notify laboratory in advance of sending 

specimens 

Contact Single Room* No * until 48 hours of the appropriate antibiotic therapy 

has been given 

Contamination with 

infectious saliva 

Single Room 

Apron, mask 

and gloves 

Notify CCDC urgently. Care with secretions 

Contacts may need vaccination 

Inform laboratory before samples are sent. Person to 

person transmission rare; transmission via corneal, 

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RESPIRATORY SYNCYTIAL 

VIRUS (RSV) 


ROTAVIRUS 

RUBELLA 


47 

Authorities 

Airborne 

Contamination with fomites 

Faeces and respiratory 

secretions 

Airborne 


Single Room 

yes 

Single Room 


tissue and organ transplants has been reported. If 

patient has bitten another individual or saliva has 

contaminated an open wound or mucous membrane, 

wash exposed area thoroughly and administer post 

exposure prophylaxis. 

Apron, gloves Virus viable for up to 6 hours on surfaces. 

No 

Apron, gloves 


Notifiable to CCDC. Exclude pregnant staff 

Care with post partum products and congenital 

infection in babies. Isolate for 7 days after the onset of 

the rash (longer if immunosuppressed). Susceptible 

staff should not enter room if immune caregivers are 

available. No recommendation for wearing face 

protection (e.g., a surgical mask) if immune. Pregnant 

women who are not immune should not care for these 

patients. Administer vaccine within three days of 

exposure to non-pregnant susceptible individuals. 

Place exposed susceptible patients on Droplet 

Precautions; exclude susceptible healthcare 

personnel from duty from day 5 after first exposure to 

day 21 after last exposure, regardless of postexposure 

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SALMONELLA 

GASTROENTERITIS 

48 

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Ingestion 

Faecal oral 

SARS Airborne, Direct Contact Single room, 

negative 

pressure 

SCABIES 

Norwegian Scabies 

SCARLET FEVER 


SHINGLES 

(Herpes zoster) 

Direct contact skin to skin 

Highly infectious 

See Streptococcal Infections - Group A. 

Airborne 

Direct Contact 

Single Room No Notifiable to CCDC. 



Respiratory 

Masks, 

Apron, gloves 

Notify IC team and CCDC immediately 

Isolate while ill plus 10 days after resolution of fever, 

provided respiratory symptoms are absent or 

improving. Airborne Precautions preferred; FFP3 

respiratory protection; fluid repellent surgical mask if 

FFP3 or FFP2 unavailable; eye protection (goggles, 

face shield); aerosol-generating procedures and 

“supershedders” highest risk for transmission via 

small droplet nuclei and large droplets. Vigilant 

environmental disinfection. 

Single Room Gown, gloves Inform Infection Prevention and Control 

Single Room 

if severe 

Apron, gloves 

and Mask* 

(*if in close 

contact with 

To remain isolated until dermatologist confirms patient 

is no longer infectious. 

Healthcare staff with scabies must be fully treated 

before returning to work. Outbreaks can occur. 

Infectious until all lesions are crusted or if only a few 

spots completely covered. 

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SMALLPOX (suspected) 

STREPTOCOCCAL 

INFECTIONS 

a) Group A 

b) Invasive GAS 

Group A Strep infections 

Airborne 


Contact 

Contact 

Innoculation 

c) Neonatal Group B Contact 

Perinatal 

Place in strict 

isolation until 

transfer to 

High Security 

Infectious 

Disease Unit 

at Coppett’s 

wood. 

Single Room * 

Single room 

Single Room 

lesion) 

Minimise 

access of all 

personnel to 

patient. 

Masks, 

gloves, 

aprons 

No 

Mask and 

eye 

protection 

maybe 

required 

Smallpox is extinct in the natural state so a case 

would have to be deliberate release. 

INFORM CCDC IMMEDIATELY 

* until 24 hours of the correct antibiotic therapy has 

been given. Refer to Group A Streptococcal Policy 

CPO 

Patient isolated until microbiologist confirm patient no 

longer infectious. Report to Health Protection Agency. 

Contact tracing and screening required. Contacts may 

require treatment. 

SYPHILIS Contact No No Care when treating infected sites 

TETANUS Inoculation No Usually environmental source. Inform CCDC. 

No 

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TONSILLITIS 

See Streptococcal Infections 

TOXIC SHOCK SYNDROME Autoinfection, contact No No 

TOXOCARA Ingestion No No 

TOXOPLASMOSIS 

Ingestion 


TRICHOMONIASIS Contact No No 

TUBERCULOSIS 

a) open pulmonary Airborne Single Room 

if smear 

positive 

No 

No 

Respiratory 

masks for 

sputum 

inducing 

procedures 

May require ITU 

b) other Various No No As above 

TYPHOID/PARATYPHOID 

VIRAL HAEMORRHAGIC 

FEVERS 

Ingestion 

Faecal oral 



Refer to Tuberculosis policy 

Patients with suspected or proven multi-drug resistant 

tuberculosis will be transferred to isolation units in 

other trusts. 

Yes No Notify CCDC urgently. Inform Infection Control 

Notify laboratory in advance of sending 

specimens 

DO NOT ADMIT TO DISTRICT GENERAL HOSPITAL Notify CCDC urgently. See appendix Strict isolation single 

room BEFORE TRANSFER TO INFECTION UNIT 

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VRE (GRE) Glycopeptide 

Resistant Enterococci 

Contact Single room Apron, gloves Inform Infection Prevention and Control 

WEILS DISEASE 

(Leptospirosis) 

WHOOPING COUGH 

(Pertussis) 7-10 days incubation 

period 

WORMS – Helminths 

a) Hookworm- 

Ancylotoma 

Ingestion 

Contact 

Single Room 

for neonatal 

cases 

Airborne Single Room No Notifiable to CCDC. 

No 

Various No No 

b) Roundworm - Ascaris Faecal oral No No 

c) Strongyloides Various No No 

d) Tapeworm - Taenia Ingestion No No 

e) Threadworm - 

Enterobius 

WOUND INFECTION with 

resistant organisms 

Faecal oral No Apron, gloves 


when bed 

making 

Notifiable to CCDC if meningitis or encephalitis 

Various yes No Discuss with Consult Microbiologist or Infection 

Control for advice. 

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YELLOW FEVER Insect bite No No Notifiable to CCDC 

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Appendix 8 

NDM-1 information sheet - New-Delhi metallo beta-lactamase (NDM-1) and 

carbapenem resistance 

Note: Infections with these isolates are very rare in the UK and usually there is 

history of hospitalisation in the Indian subcontinent. It is important to adhere 

to good infection prevention practices to prevent spread. 

1.0 Introduction 

Authorities 

Carbapenems (e.g. meropenem) are a group of broad-spectrum antibiotics 

which are often used against multi-resistant strains of bacteria like extended 

spectrum beta-lactamase producing (ESBL) coliforms like Escherichia coli 

and Klebsiella pneumoniae. 

New-Delhi metallo beta-lactamase (NDM-1) is an enzyme capable of 

destroying many antibiotics, including carbapenems. The enzyme NDM-1 is 

encoded by sections of bacterial DNA known as plasmids, which can be 

transferred between different types of bacteria, hence more than one type of 

bacteria can acquire this type of resistance. It is most often seen in Klebsiella 

pneumoniae and E.coli. 

2.0 Background 

2.1 The first case of a bacterial infection with this resistance was identified in 

January 2008. Monitoring began in 2009 as more cases were identified. 

Isolates producing NDM-1 enzymes do not necessarily lead to more severe 

infections; however, they are much more difficult to treat due to resistance to 

almost all antibiotic classes. The level of risk depends upon which part of the 

body is affected by the infection, and the general health of the patient. There 

is some evidence that the NDM-1 resistance was already circulating in India in 

2007. It is common to name a new type of metallo beta-lactamase after the 

place where it is first identified - another similar enzyme, circulating in Brazil is 

named SPM, as Sao Paulo Metallo, another is VIM, Verona Imipenemase. 

The enzyme was originally named NDM-1 in a conference abstract in 2008. 

The NDM enzyme has now been reported in Australia, the USA, Holland, 

France, Sweden, Canada and the UK, with most patients having had prior 

hospital contact in the Indian subcontinent. 

2.2 Most bacteria with the NDM-1 enzyme do remain susceptible to two types of 

antibiotic, neither of which is ideal for general use - these antibiotics are 

colistin and tigecycline (Discussion with a consultant microbiologist is usually 


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required to treat infections due to organisms producing NDM-1). A few 

isolates with NDM are completely resistant to all known antibiotics, including 

colistin and tigecycline. Control of the spread of these isolates is clearly 

paramount. 

2.3 Cases of NDM-1 are more prevalent in the Indian subcontinent than 

elsewhere; many cases that have been found elsewhere have a history of 

hospitalisation in the Indian subcontinent. Patients acquire these resistant 

bacterial infection strains via a number of means, not just by medical tourism. 

For example, some people contracted the infection when they were in India 

and needed emergency hospitalisation, some people, in poor health, 

contracted it when they divided their time and treatment between the UK and 

the Indian subcontinent. 

There appears to be minimal risk to travelers to the Indian subcontinent who 

are not treated in hospital. If members of the public are travelling for surgery 

overseas they should satisfy themselves that appropriate infection control 

measures are in place. 

3.0 Source of Spread 

 

 

 

 

The source of the spread is the site on the patient which is colonised or 

infected. 

Person to person directly 

Faecal oral spread 

Hand contact 

3.1 Although these organisms can be spread on equipment (e.g. endoscopes) the 

most common route is by contact with an infected or colonised patient, which 

emphasises the importance of good hand hygiene before and after patient 

contact. 

4.0 What can we do in hospitals and as healthcare professionals to prevent 

further spread? 

4.1 Triage/on suspicion 

4.2.1 All healthcare professionals must have a high level of suspicion in cases that 

are transferred back from hospitals in the Indian subcontinent, or where there is 

history of recent hospitalisation in the Indian subcontinent. These cases must be fully 

isolated on admission, to prevent spread of the infection within the hospital. It is 

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important to practice good hygiene especially hand hygiene, and for healthcare 

professionals to wear gloves and gowns. It is important to notify the Infection 

Prevention and Control Team when one of these patients is admitted. 

4.2 Isolation 

Isolation in single room (cohort if > one individual), universal precautions and 

prudent use of antibiotics are key factors! Infected or colonised patients 

MUST remain in strict isolation for the duration of their stay see CPO22 

Isolation and Infectious diseases. 

4.3 Confirmed cases 

When a patient has been identified as being colonized or infected with 

organisms producing NDM-1, the patient needs to be strictly isolated. 

Contacts must be cohorted together and screened by taking faecal specimens 

or rectal swabs plus swabs of any skin breaks e.g. wounds. This is to 

determine the extent of spread and to permit surveillance of these secondary 

contacts via flagging of patients’ records (index case and confirmed contacts). 

Gloves and aprons must be worn for all patient contact. 

Follow the steps stated in the Isolation policy to manage patients with 

colonisation or infections that require barrier nursing – see section 8 (page 11) 

onwards. An en-suite bathroom or dedicated commode is essential. 

Care bundles and the care of indwelling devices must be meticulous. Follow 

Trust policies on indwelling device insertion, monitoring, care, removal and 

documentation see CPO36.central venous access device, CPr012 insertion 

of a peripheral intravenous cannula. 

Enhanced cleaning including high contact and sanitary areas must be 

instigated (twice daily cleaning with a chlorine based cleaning product such as 

Actichlor Plus ®.) Terminal cleaning on discharge with Hydrogen peroxide 

vapour is required. Decontamination of equipment must be particularly 

thorough: single use or dedicated items must be used whenever possible or if 

effective decontamination is not practical see CPO30 overarching 

decontamination policy. 

Ensure adequate communication to other healthcare providers. Cohorting of 

staff will be indicated in certain circumstances. 

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The laboratory has the ability to detect these cases through culture and 

sensitivities and isolates will be sent to the reference laboratory for 

confirmation 

4.4 Antibiotic usage 

Doctors need to pay careful attention to the correct and appropriate use of 

antibiotics. These organisms do not always cause infection and currently are 

not as aggressive as some of the less resistant strains. Consultant 

Microbiologist advice is always available and should be sought early in these 

cases. The Antimicrobial Management Team will monitor antibiotic use in 

general and will extract any learning in particular from management of these 

cases as part of the root cause analysis process. It is unlikely that colonisation 

of bowel will clear and there is no indication to treat uninfected patients with 

antimicrobials to attempt this. These precious resources must be reserved to 

treat infection when this is indicated. Unnecessary use of the few agents to 

which this organism remains susceptible will result in further resistance, see 

CPO91 Antimicrobial prescribing. 

4.5 Screening 

The Infection Prevention and Control Team will advise on further screening, if 

necessary after consultation with national experts for example at the Health 

Protection Agency. It may be that weekly follow up screening and discharge 

screening are indicated 

Screening of staff is NOT indicated unless there is strong evidence to do so 

and this would not be undertaken without consultation. 

4.6 Cross contamination 

If transmission is detected, root cause analysis will be instigated and incident 

management meetings set up. Please refer to the Ward Closure Policy and 

Major Outbreak Plan for further details. Such incidents must be reported via 

the Datix system and as a SIRI (Serious Incident Requiring Investigation) to 

the SHA and Health Protection Unit. HPU representation will be invited to the 

Incident Management Team. 

Analysis and learning from incidents must be shared Trust wide from Board to 

ward. 

4.7 Readmission of known cases 

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Readmission and transfer of known patients must always be to an isolation 

room with a dedicated en suite facility (or dedicated commode). Transfer 

internally must be agreed with the IPCT. 

5.0 Clinical procedures 

5.1 Endoscopy and related procedures 

Several endoscope related transmissions of carbapenem-resistant organisms 

have been reported in the UK and France. Similar risks are likely e.g. with 

colonoscopy. 

Staff should comply with relevant guidance at www.mhra.gov.uk /Publications 

– see both Postersandleaflets section and 

Safetywarnings/MedicalDeviceAlerts. 

Special care should be taken to disinfect or protect equipment used with 

endoscopes e.g. camera which do not undergo the same routine sterilization. 

Please also see: 

www.mhra.gov.uk/Publications/Postersandleaflets/CON2022584 

and 

www.mhra.gov.uk/Publications/Safetywarnings/MedicalDeviceAlerts/CON087 

958 

6.0 Laboratory requirements 

6.1 Generally carbepenmases belong to three molecular classes: IMP, VIM and 

NDM types are metallo enzymes, with zinc at the active site; whereas KPC 

and OXA-48 belong to separate non-metallo families. Other carbapenemases 

(SME, IMI, SPM) occur, but are very rare. Most producers are broadly 

resistant to beta-lactams (but those with OXA-48 may remain susceptible to 

cephalosporins). 

6.2 Enterobacteriaceae with carbapenemases may only have small reductions in 

carbapenem susceptibility, meaning that laboratories must have a high index 

of suspicion for isolates with borderline sensitivity. 

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6.3 Screen by plating faeces, rectal swabs and manipulated site swabs e.g. from 

skin breaks / catheter sites onto MacConkey or CLED agar with meropenem 

or ertapenem discs. Examine for colonies within the zone. Prior broth 

enrichment may be useful: use a rectal swab to inoculate 5-10 ml broth 

containing a 10 ug imipenem disc, then subculture as above. Laboratories 

should participate in NEQAS, which will distribute carbapenemase producers 

in quality assurance exercises during 2011. 

6.4 Exceptions, NOT requiring referral to the reference laboratory for 

carbapenemase investigation are: 

• Proteeae resistant to imipenem only; these species have inherently 

low susceptibility. 

• Enterobacter spp. with cephalosporin and low-level ertapenem 

resistance but susceptibility to imipenem and meropenem – these generally 

have combinations of AmpC and impermeability. 

• Carbapenem-resistant Acinetobacter or P. aeruginosa, unless these 

have exceptional levels of resistance (grow up to carbapenem discs) or give a 

positive EDTA-imipenem synergy test implying metallo-enzyme. 

Carbapenemases have NOT been found in UK cystic fibrosis isolates. 

Laboratories wishing to undertake carbapenemase detection may find the 

following tests useful but none has clear interpretive standards, so suspect 

Enterobacteriaceae should be referred: 

The laboratory in the Royal Hampshire County Hospital would be using the 

Synergy test as a confirmatory test: 

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Synergy tests 

• Metallo carbapenemases (IMP, NDM, VIM) 

are inhibited by EDTA or dipicolinic acid. 

• Synergy between carbapenems and EDTA, 

indicating MBL production, can be detected with 

E-tests or using double disc tests (with EDTA 

discs from e.g., Rosco). 

• Caveats are that false-positive results are 

common with P. aeruginosa and A. baumannii, 

though rare with Enterobacteriaceae. 

KPC carbapenemases are inhibited by boronic 

acids, and synergy between boronic acid discs 

(Rosco) and imipenem indicates their presence. 

Cloverleaf (‘Hodge’) test 

• Agar is spread with E. coli NCTC10418 (or 

ATCC25922), as for a disc test. 

• The test strain is then inoculated, as 3 arms, 

120o apart, cut into or streaked heavily on the 

agar from the plate centre. 

• Imipenem, meropenem and ertapenem 10 ug 

discs are put at the end of these arms. 

• Indentation of the inhibition zone(s) indicates 

that the test strain attacks carbapenems. 

Caveats are that reading is subjective and that 

AmpC enzymes can give weak false positive 

results. 

Dr Kordo Saeed /Dr Roberta Parnaby 

April 2011 V3 

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Appendix 8 - Equality Impact Assessment Tool 

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

appropriate committee for consideration and approval. 

1. Does the policy/guidance affect one 

group less or more favourably than 

another on the basis of: 

Yes/No 

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 

No 

Comments 

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impairment and mental health 

problems 

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? 

No 

N/A 

No 

5. If so can the impact be avoided? N/A 

6. What alternatives are there to 

achieving the policy/guidance 

without the impact? 

No 

7. Can we reduce the impact by taking N/A 

different action? 

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 the Compliance and Governance Manager: Telephone 

Number: 01962 825376 

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Isolation and infectious diseases policy - Hampshire Hospitals NHS ...

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