Guidelines for the Control of Outbreaks of Gastroenteritis Infections in Nursing and Residential Care Homes

Contents:

•	Guidelines for the control of outbreaks of gastroenteritis infections
•	Front door notice
•	Outbreak Log sheets
•	Bristol Stool Chart
•	Inter-healthcare Infection Control Transfer of a Patient Form 
•	Hydration Patient Information leaflet / poster
•	Healthcare waste poster
•	Hypochlorite information poster 

Contact: 

CDC Team Telephone Number: 0113 3785900 

          OUT-OF-HOURS Public Health Advice: 0114 3049843 

Introduction 

An outbreak can be defined as:
An incident in which 2 or more people experiencing a similar illness are linked in time / place (www.phe.org.uk) 

All symptomatic cases must be notified to: 
Communicable Disease Control (CDC) Team: 0113 378 5900. 
Out of hours Public Health Advice Tel: 0114 3049843 

PLEASE ENSURE ALL MEMBERS OF STAFF READ, UNDERSTAND AND KNOW EXACTLY WHERE TO LOCATE THIS DOCUMENT

Containment 

Display a copy of the enclosed notice in a prominent position on each entrance door to the premises. Restrict visitors. Those visitors that do come must be advised of the risks. Any non-emergency maintenance should be cancelled.

Keep a record of symptomatic patients and staff using the outbreak log sheet provided. Where possible isolate and segregate residents with symptoms until they have been 48hrs symptom free.

To prevent symptoms of dehydration monitor and record the patient’s fluid input / output. 
Patient hydration information leaflet enclosed.

One faecal specimen should be collected from symptomatic cases (up to 6 samples per outbreak), even if vomiting only. Sample containers and laboratory forms should be completed correctly prior to submitting to GP surgeries.

Advice will be provided by the Communicable Disease Control (CDC) Team, regarding management of the outbreak until the situation is concluded. However the ultimate responsibility for management of the outbreak remains with the CQC registered Care Home Manager.

Avoid transfers/discharge of residents to other health care settings. In the event of an emergency, telephone and advise receiving hospital and transport of outbreak. 

IMPORTANT: The Inter-healthcare Infection Control Transfer Form must be completed, clearly indicating the patient’s infection status, the completed form must accompany the patient. 

This will enable the receiving party to ensure appropriate infection control measures are 
put in place to prevent the potential spread of infection to other patients/staff/visitors. 

Staff (permanent or temporary) and students should not work at or visit other homes during the outbreak.

Organise the staff rota to minimise potential contamination of unaffected areas (i.e. if possible the same staff to work in affected areas only).
All symptomatic staff must stay off duty until they are 48 hours free of symptoms.

Hygiene

Hand hygiene: staff and visitors should be encouraged to wash hands on entry to and exit from the premises.

Strict hand washing with water and liquid soap only (as alcohol gel is not effective for infections such as Norovirus and Clostridium Difficile), and drying with disposable paper towels (not washable towels).   Hot air hand dryers should not be used during outbreak. 

Gloves and disposable aprons must be worn by all staff in contact with faeces or vomit and discarded after each single episode of use. 

Restrict kitchen access to catering staff only. Kitchen staff should not visit other parts of the home.

Staff should eat and drink in staff designated areas only.

Staff should not wear uniform outside the care home and a clean uniform should be worn each day.

Environment 

In the event of a body fluid spill, spillage kits should be used following the manufactures instructions.  If spillage kit is unavailable, spillages should be removed using disposable paper towels, then decontaminate the area using a Hypochlorite agent diluted to 1,000ppm (see attached Hypochlorite poster for further information).  

Hypochlorite agents may damage carpets and soft furnishings.  For these areas, use hot soapy water/carpet shampoo and use a carpet cleaner/steam cleaner if available. 

As part of enhanced cleaning during the outbreak, thoroughly clean all surfaces at least daily - including frequently touched points (i.e. door handles, hand rails, light pulls, and bed rails), kitchen areas, toilets and commodes.  Use a Hypochlorite solution diluted to 1,000ppm.  High use areas will need more frequent cleaning than daily.  

Hard surfaced floors should be cleaned at least daily and disposable mop heads/washable mops heads should be disposed of/laundered at least daily.  Colour-coded cloths, mops, and buckets should be used.  Disposable cloths/washable cloths should be disposed of/laundered regularly (i.e. at least between each residents room etc).  

Soiled linen and personal clothing must be placed immediately into a hot water soluble bag (or equivalent) and sealed. This bag must then be placed in a clearly identifiable, impermeable outer bag, transferred to the laundry, and laundered as soon as possible. External laundries must be informed of the outbreak.

Commode pots requiring emptying should be covered before being transported to the sluice for emptying. Commode pots should be cleaned via the electronic sluice machine before being returned to individual resident’s rooms.  
Ideally commode pots should be marked with room number to ensure they are returned correctly.  Ensure electronic sluice machine is operational. Faults must be dealt with as urgent.

Prior to flushing toilets used by affected residents, the lid should be closed to prevent aerosol of body fluids, viruses and bacteria into the environment.  Toilets and seat raisers must be thoroughly cleaned after use.

Conclusion/end of the outbreak

The outbreak should be concluded when the last person displaying symptoms is 48 hours symptom free and after the care home has had discussion with the CDC nurse.  After this CDC nurse will give advice on performing a terminal/deep clean of the premises before the premises can re-open.  

Prevention and Education

Ensure all toilets are provided with toilet paper in a wall mounted, sealed dispenser and hand washing facilities with hot water, liquid soap and paper towels are always available.

Ensure staff are trained in Infection Prevention and Control and safe food handling precautions. 
			
If you require any further information or assistance please contact:-

Communicable Disease Control (CDC) Team: 0113 378 5900

Food and Health Team
Environmental Health Services
Leeds City Council
Millshaw Park Way
Leeds 
LS11 0LS

OUT-OF-HOURS Public Health Advice: 0114 3049843 

Updated: July 2019

WOULD ALL VISITORS TO 
THE CENTRE PLEASE REPORT TO THE OFFICER - IN -CHARGE BEFORE CONTINUING WITH THEIR VISIT

THANK YOU FOR ASSISTING WITH THIS INFECTION CONTROL REQUIREMENT 

Symptomatic Log Sheet.  Complete daily and continue to record until outbreak is concluded
																                   (Insert dates)
Room	Name &
Date Of Birth	Date Of Onset	Symptoms 
(see codes below)
D;BD;V;N;A;H,	Recent medication/
antibiotics / laxatives?	Fluid in/out balance chart?	Specimen 
Sent date / & result	Comments e.g. recent visit elsewhere, relatives affected, food brought in, etc.	
Day 1	
Day 2	Day     3	
Day   4	

	

											

	

											

	

											

	

Symptoms code: D=diarrhoea (record type as per Bristol stool chart); BD= diarrhoea containing blood; V=vomiting; N=nausea; A=abdominal pain; H=headache; X=asymptomatic

Room	Name	Date of onset	Day 5

	Day 6	Day 7	Day 8	Day 9	Day 10	Day 11	Day 12	Day 13	Day 14	Day 15	Day 16	

	

														

	

														

	

														

	

Log Continuation Sheet

Symptoms code : D=diarrhoea; (record type as per Bristol stool chart) BD= diarrhoea containing blood; V=vomiting; N=nausea; A=abdominal pain; H=headache; X=asymptomatic