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Diarrhoea and Vomiting Outbreak Management in Care Homes (Wales) Policy

Policy Statement

Any case of diarrhoea or vomiting in a community such as a care home is a cause for concern as it may, if caused by an infectious agent such as Clostridium difficile, be spread to other people if urgent steps are not taken to prevent this. The spread of such an infection can easily lead to an outbreak which may have serious implications for the health of all people receiving care, especially elderly ones, and staff.

The policy is in line with regulatory requirements, including Regulation 56: Hygiene and Infection Control and Regulation 57: Health and Safety of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.

Legal Considerations

This care service will adhere to all relevant legislation, including:

• the Health and Safety at Work, etc Act 1974
• the Health Protection (Notification) (Wales) Regulations 2010
• the Control of Substances Hazardous to Health Regulations 2002 (COSHH).

Under the above legislation, and associated codes of practice, {{org_field_name}} understands its legal and moral duty to ensure the health and safety of both staff and people who use the service, and to protect them, wherever practicable, from dangerous substances in the workplace, including the risk of transmission of infections.

Guidance

{{org_field_name}} understands that Public Health Wales have collaborated with NHS Scotland to host and utilise the Scottish electronic National Infection Control Manual (NICM). All healthcare organisations in Wales are encouraged to access the manual and apply its standards.

The home complies fully with regulatory requirements, including Regulation 56: Hygiene and Infection Control of the Regulation and Inspection of Social Care (Wales) Act 2016.

Procedures

In {{org_field_name}}, two or more unexpected cases of diarrhoea and/or vomiting occurring at the home within a few days of each other will be considered an outbreak.

The aim is then to ensure that any cases of diarrhoea occurring within the home are appropriately managed and that effective precautions are taken to minimise the risks of cross-infection.

Indicators

{{org_field_name}} recognises key indicators of a viral outbreak as being:

1. sudden onset of vomiting or diarrhoea with victims sometimes not having sufficient warning to reach a toilet
2. a rapidly rising attack rate
3. a high attack rate also affecting staff.

Procedures

In {{org_field_name}}, any cases of diarrhoea will be viewed as infectious until advised otherwise and the following actions taken.

1. While a person who uses the services has diarrhoea, their contact with other people should be restricted. They should be cared for in his or her own room and designated a specific commode or toilet for exclusive use.
2. Faecal samples should be obtained from symptomatic people and the microbiology form accompanying the sample should clearly state it is part of an outbreak.
3. Staff should wear disposable gloves and aprons when caring for people with diarrhoea and the need to observe careful hand washing practice should be stressed. Antibacterial alcohol gels should be used routinely during an outbreak by healthcare staff between attending to people receiving care, but hands must always be washed very thoroughly with soap and water before attending to a person.
4. Environmental cleaning should be increased, and particular attention should be paid to toilets, bathrooms, door handles, commodes and support handrails. For the duration of the outbreak, environmental cleaning should be performed using detergent and hot water followed by a chlorine-releasing solution at concentrations of 1000ppm. Disinfectants need to be used on surfaces and floors to ensure that the spread of infection is controlled.
5. Soiled linen should be bagged and dealt with separately as potentially infectious according to individual care home policies and practices. Laundering of soiled bed linen or clothing should be on a hot cycle of the washing machine (at 71°C for three minutes or more where possible).
6. People who use the services should be encouraged to wash their hands after using the toilet or commode and before eating.
7. Where required, the person’s GP should be called, and any prescribed treatment administered as per their instructions.
8. Visitors should be informed of the outbreak and unnecessary visits should be discouraged. Those who choose to visit should wash their hands as they enter and leave the home and comply with all other hygiene practices in place. In the event of a serious outbreak all visitors should be discouraged.
9. The local infection control team should be contacted, and any advice acted upon without delay.
10. The home should be closed to admissions until 48 hours after the last symptomatic person has recovered.
11. Symptomatic staff should go off duty immediately and go to see their GP. They should have a faecal sample taken and should remain off work until symptom free for 48 hours.
12. If any infected person requires admission to hospital, the receiving unit should be informed of the outbreak so that they can institute appropriate measures.

{{org_field_name}} recognises that confirming the diagnosis as early as possible is essential in outbreak management. Stool samples should, therefore, be taken early in the course of illness as soon as possible after people develop symptoms. In {{org_field_name}}, a supply of stool specimen pots are kept readily accessible for use in emergencies. Samples should be appropriately labelled as “outbreak” to ensure it will be tested for viruses.

Training

All new and current staff are trained to implement this policy as required.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

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