The Management of Viral Haemorrhagic Fevers in Ireland - Health ...

3.7 Infection prevention and control precautions for managing a patient withconfirmed VHF pending transfer to the NIU, Mater Misericordiae University HospitalIn addition to this chapter on infection prevention and control, please also refer to:• VHF risk assessment algorithm for use in all acute medical settings (Appendix F);• checklist of supplies for acute hospitals in preparation for High Risk or Confirmed cases of VHF (Appendix I);• Standard Precautions, Health Protection Surveillance Centre, 2009. (http://www.hpsc.ie/hpsc/A-Z/Respiratory/Influenza/SeasonalInfluenza/InfectioncontroladviceStandard plus Droplet plus Contact plus Airborne Precautions1. Patient placementIt is national policy to manage all confirmed cases of VHF in the NIU at the Mater Misericordiae UniversityHospital, as long as it is medically safe to transfer the patient. If it is not possible to transfer the patient due toother medical reasons please adhere where possible to the principles laid out in this document:• The patient should remain in a negative pressure room, or if not available, a single room (keep the doorclosed), with dedicated commode. Restricted entry sign to remain on the door;• Pending transfer, once VHF has been confirmed, ensure that the clinical and non-clinical staff assignedto care for the patient (staff now restricted to caring for this patient only) do not move freely between theisolation area and other clinical areas during the patient’s stay;• Restrict all non-essential staff from the isolation area;• Maintain a log of all personnel entering the isolation area, both visitors and staff;• Visitors (family members only and this should be restricted also) should be strictly limited to only thoseconsidered essential;• Ensure all visitors use personal protective equipment and are provided with instructions in its use and inhand hygiene practices prior to entry into the isolation area.2. Hand hygieneCover cuts and perform hand hygiene as per the WHO “5 Moments for Hand Hygiene”1. before patient contact;2. before an aseptic task;3. after body fluid exposure;4. after patient contact;5. after contact with patient surroundings.Neglecting to perform hand hygiene after removal of PPE will reduce or negate any benefits of the protectiveequipment. This applies to all staff entering and leaving the room. Alcohol hand gels should be at all points ofcare, i.e. end of bed, all trolleys and at entrances and exits of all areas of the isolation unit.3. PPE for HCWs- Standard plus Droplet plus Contact plus Airborne Precautions must be used at all times.- Use the “buddy system” to ensure that the donning and removal of PPE is carried out correctly. A secondperson is always present to guide the individual who is donning / removing PPE. The PPE required for thebuddy is minimal: scrubs, apron and gloves.- Keep hands in front of body once PPE is on.- Medical and nursing staff caring for the patient should wear scrubs beneath PPE.- Gloves should be worn on entering the room. Single gloves should be worn when handling any bodysubstance, mucous membrane and non-intact skin of all VHF patients and when handling any equipment orsurfaces that have been contaminated with body secretions.- Double gloving is advised during invasive procedures that pose an increased risk of blood exposure or inthe final stages of the illness when haemorrhage may occur. Ensure gloves are long enough to cover overthe cuff of the gown; inner glove should be size usually worn and outer glove should be a size larger thenusual. 56 If wearing double gloves, carry out hand decontamination on the outer gloves then remove. Handdecontamination should be carried out immediately after removal of gloves.3. Infection Prevention and Control Guidance The Management of Viral Haemorrhagic Fevers in Ireland/HPSC 2012- 38 -