Transcript Document

OUTBREAK SCENARIO
food poisoning
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 1
• You are in charge of a 34 bed, mixed age and mixed
sex acute ward and responsible for infection control.
The ward has 5 bays of 6 beds and 4 single rooms
• Members of staff on duty are 2 qualified, 2 students
and 1 healthcare assistant
• You start work at 7am with the other staff to find that
3 patients have developed diarrhoea during the night
and the isolation ward is full
• List the managerial actions that you would take
on starting duty
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 1
• Managerial actions include:
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Check the patients are isolated
Check specimens have been sent to the laboratory
Inform infection control team and line manager
Make sure there are adequate supplies, laundry, gloves,
aprons, etc
– Allocate a dedicated nurse to the isolated patients
– Make sure menu cards have been saved from the previous
day
– Contact the catering department to save food samples
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 2
• What are the most important areas you will cover in
your preliminary investigation?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 2
• Preliminary investigation includes:
– The time symptoms started
– Common factors amongst the infected patients,
e.g. antibiotics, type of food eaten, geographical location
of each patient
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 3
• Examine patient menu cards and preliminary
investigation form to try to identify any common
causative factor
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 3
• Are there any common food sources in the menu
cards?
• Are there any similarities between cases from the
information on the preliminary investigation form?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 4
• The laboratory specimens have not shown a result.
What specific precautions should be taken with the
patients?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 4
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Hand hygiene
Disinfection
Cleaning
Waste disposal
Isolation precautions
Protective clothing
Visitors
Communication
Patient education
Psychological support
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 5
• You are to receive three new admissions to the ward,
what are the implications?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 5
• Staff skill mix
• Allocation of staff to isolated patients
• Who decides to close the ward to new admissions?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 6
• One of the student nurses tells you that the bedpan
washer/disinfector has broken down, what are your
alternatives?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 6
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Alternative methods for disposal of faeces
Hand hygiene
Protective clothing
Choice of disinfectant
Inform the estates department to prioritise the repair
of the washer/disinfector
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 7
• At lunchtime, two nurses due to start the late shift
ring in and report that they are sick with diarrhoea,
what would you do?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 7
• Contact occupational health
• Ask for faecal specimens
• Investigation to include agency work, travel, food
history
• Line manager to maintain staffing levels
• Use of agency staff
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 8
• Visiting starts at 2pm. What action is needed?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 8
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Speaking to relatives and visitors
Providing an explanation/reassurance
Information and education
Hand hygiene
High risk foods from visitors
Restricting visitors who are ill
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 9
• By 6pm two further patients have developed
diarrhoea
• What action is needed?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 9
• Isolate patients
• Inform infection control of new cases as they occur
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 10
• The infection control doctor has visited the ward and
decided to call a meeting of the outbreak group
• Who should be members of this group?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 10
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ICD
ICN
Consultant in charge
Senior nurse
General manager
Consultant in communicable disease
Others as required
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 11
• The nurse in charge from ward 8 contacts you to say
that Mrs Smith, who was transferred from your ward,
has developed diarrhoea.
• There had been a celebration party by one of the
qualified nurses who was leaving and the sandwiches
she had eaten tasted ‘strange’
• What action do you now take?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 11
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Establish a source
Investigate who brought food
Where was the food purchased, cooked and stored
Liaise with environmental health officer
List all the people who had eaten food at the party
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Scenario 12
• All those who were ill had eaten chicken sandwiches
prepared some time before the party and brought into
the ward by the nursing staff
• Laboratory specimens showed that those with
diarrhoea have grown salmonella
• What recommendations will you now make?
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Key points 12
• Observe and adhere to food hygiene policy
• Patients should only consume food provided by the
hospital catering department
• Staff food must be labelled and stored separately
from patients food and not given to patients
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby
Action summary
• Early identification
• Correct management of patients, staff,
resources
• Investigation should be prompt, thorough,
written/recorded
• Clear communication to patients, staff,
visitors
• Outbreak team, lessons learned,
recommendations
original content, Mrs. Viv Duncanson, Snr. Infection Control Nurse and Paul Watson Infection Control Nurse, Diana Princess of Wales Hospital, Grimsby