Influenza (Flu) and Viral Respiratory Tract Infection ...

[Pages:13]Influenza (Flu) and Viral Respiratory Tract Infection Testing and Isolation Precautions for Adults UHL Guideline

Trust reference: B35/2017

1. Introduction

1.1. Seasonal influenza and other viral respiratory tract infections are very common and are usually acquired and managed in the community. This guideline focuses on those patients with more severe illness which requires hospital admission and the measures taken to limit spread within the hospital.

1.2. In the event of a seasonal Influenza outbreak, hospitals are likely to be working to maximum capacity, even in the absence of `winter pressures'. The increased demand upon services will be further compounded by staff sickness and the absence of staff caring for members of their family. Lack of staff is likely to impact the number of beds and level of service that the Trust can maintain. Therefore it is imperative that there should be contingency plans in place to deal with these eventualities.

1.3. The following guideline is to be used for all patients with respiratory illness of a known or suspected viral cause including Influenza. This document is not intended to provide clinical treatment advice but to highlight the precautions used when managing patients with viral respiratory tract infection

1.4. UHL Antiviral treatment/ prophylaxis information is available; For guidance on influenza antiviral treatment

2. Scope

2.1. The guidance is intended for use by Medical and Nursing staff involved with adults presenting with symptoms of seasonal influenza or respiratory viruses within UHL For children's; guidanceRespiratory Viral Illness (Including Flu) Infection Prevention UHL Childrens Guideline. Trust reference: D10/2019

2.2. This document is not intended to provide advice on episodes of pandemic flu. In the event of a pandemic (defined as a higher than normal level of influenza activity in the population of Leicester/shire), a UHL pandemic outbreak group will be convened, the aspiration of which would be:

Patients will be admitted through the ED at LRI and CDU at Glenfield Hospital. Wherever possible patients will be isolated in side rooms. Where a patient's condition deteriorates and they require intensive support the

ITUs at the LRI and Glenfield will be used.

2.3. An influenza pandemic would impact on ITUs because of the need to provide respiratory support to many patients. This will affect the ability of the ITUs to support post-operative patients and emergency medical patients admitted for other reasons. Decisions on how to respond to this extra workload and its impact on other patients and patient flow would be directed by the pandemic outbreak group.

2.4. Consequently, UHL's intention would be to try to maintain an emergency and elective

Influenza (Flu) and Viral Respiratory Tract Infection - Testing and Isolation Precautions for Adults Guideline Latest version approved by Policy and Guideline Committee on 20 December 2019 Trust Ref: B35/2017

Page 1 of 13

Next Review: Dec 2022

NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents

Influenza (Flu) and Viral Respiratory Tract Infection Testing and Isolation Precautions for Adults UHL Guideline

Trust reference: B35/2017

service at the LGH, whilst there are the appropriate support facilities there. Should the position deteriorate further UHL could seek surgical support from the private sector hospitals (Spire and Nuffield).

3. Guidelines and Procedures

3.1. It is important to inform the Infection Prevention Team (IPT) using the electronic system on ICE of any patients who are being investigated for influenza or respiratory viruses to ensure that patients are isolated appropriately.

3.2. The fundamental principles of managing patients during an outbreak of influenza are meticulous use of infection control requiring segregation, isolation and cohort nursing including stringent attention to hand and respiratory hygiene. The use of surgical masks and respirators has a role to protect staff, provided they are used correctly in conjunction with other infection control measures.

Influenza (Flu) and Viral Respiratory Tract Infection - Testing and Isolation Precautions for Adults Guideline Latest version approved by Policy and Guideline Committee on 20 December 2019 Trust Ref: B35/2017

Page 2 of 13

Next Review: Dec 2022

NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents

Influenza (Flu) and Viral Respiratory Tract Infection Testing and Isolation Precautions for Adults UHL Guideline

Trust reference: B35/2017

4. Early Detection of Influenza type symptoms

Public Health England have developed a flowchart to identify symptoms of Influenza and appropriate management as below

Management of patients with flu like symptoms

For further advice please contact Infection Prevention on 5448 or Out of Hours via Microbiology via Switchboard

Influenza (Flu) and Viral Respiratory Tract Infection - Testing and Isolation Precautions for Adults Guideline Latest version approved by Policy and Guideline Committee on 20 December 2019 Trust Ref: B35/2017

Page 3 of 13

Next Review: Dec 2022

NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents

Influenza (Flu) and Viral Respiratory Tract Infection Testing and Isolation Precautions for Adults UHL Guideline

Trust reference: B35/2017

Please use this Source Isolation poster for patients with suspected / confirmed Influenza

Please isolate in side room with door closed, Inform IP on ICE Complete Source Isolation Risk Assessment, Where isolation into a side room is not possible complete a Datix report

Use IPP influenza -INsite - Infection Prevention Pathways

This information is to be used for seasonal influenza strains. More information on Influenza and respiratory infections is available on

INsite - Influenza/Respiratory Precautions

This includes; Flu Algorithm Ordering codes for masks and other PPE.

If there is any history of foreign travel associated with respiratory symptoms please inform IP, isolate and investigate other organisms in line with; Fever in the Returning Traveller ? Adult Guideline Fever in the Returning Traveller ? Adult UHL Guideline.pdf Trust reference: B4/2019 ment_data/file/732267/Algorithm_case_v31-Aug2018.pdf

Influenza (Flu) and Viral Respiratory Tract Infection - Testing and Isolation Precautions for Adults Guideline Latest version approved by Policy and Guideline Committee on 20 December 2019 Trust Ref: B35/2017

Page 4 of 13

Next Review: Dec 2022

NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents

Influenza (Flu) and Viral Respiratory Tract Infection Testing and Isolation Precautions for Adults UHL Guideline

Trust reference: B35/2017

During Flu season there will be an escalating framework to manage patients with influenza; A guide to Manage Patients and Beds: Flu-like illness possible Influenza nza%20Beds.pdf

5. Testing for Influenza

5.1. Green top viral swabs. Viral samples can be taken from the nose or throat using a green topped viral swab

Influenza (Flu) and Viral Respiratory Tract Infection - Testing and Isolation Precautions for Adults Guideline Latest version approved by Policy and Guideline Committee on 20 December 2019 Trust Ref: B35/2017

Page 5 of 13

Next Review: Dec 2022

NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents

Influenza (Flu) and Viral Respiratory Tract Infection Testing and Isolation Precautions for Adults UHL Guideline

Trust reference: B35/2017

5.2. If a POCT is available some of the fluid from this swab tube can be used for the rapid POCT (see appendix 1) before sending it to the Virology lab. All samples are sent to the lab to test for Influenza and respiratory viruses (parainfluenza PIV, respiratory syncytial - RSV, adenoviruses - AdV, etc.). Request sample on ICE If rapid tests are being used ; please sample for rapid test and then send swab to virology.

All other areas send swab to virology with request from ICE.

Access ICE Log in Requesting Input patients s number Click on correct patient New request Micro/ virology ( Top boxes) Left hand side- UHL PCR test Respiratory virus PCR

5.3. The lab test will take approximately 4 hours from the start of the test so should be sent promptly to the labs for testing to avoid prolonged delays. Transportation of samples will be arranged across the 3 sites, contact Porters for specific site details.

6. Management of patients with suspected or confirmed Influenza

6.1. All patients with suspected Influenza should be nursed in a side room. When there is no side room capacity, where possible, draw the side curtains around the bed space to reduce aerosolisation to patients either side. Maintain source isolation precautions in bed space, until a side room is available.

7. Patients with high suspicion of Influenza- awaiting results

7.1. Any patients with an influenza-like illness should be treated with antiviral medication immediately, tested as quickly as possible while waiting for results the patient should be isolated in a side room.

7.2. Please note that empirical treatment with antivirals for influenza does not stop viral shedding immediately. The antiviral drugs only prevent further viral replication of influenza ? any existing virus can still be shed for several days until the host immune response clears this. Thus, in immunocompromised patients, this period of viral shedding may be prolonged as a weakened immune response will more slowly clear any existing virus from the respiratory tract.

7.3. If a side room is not available the patient should be nursed in a bed space in a bay, with the side curtains drawn, creating a temporary makeshift isolation cubicle. Surveillance and increased monitoring of other patients should be undertaken and on discussion with

Influenza (Flu) and Viral Respiratory Tract Infection - Testing and Isolation Precautions for Adults Guideline Latest version approved by Policy and Guideline Committee on 20 December 2019 Trust Ref: B35/2017

Page 6 of 13

Next Review: Dec 2022

NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents

Influenza (Flu) and Viral Respiratory Tract Infection Testing and Isolation Precautions for Adults UHL Guideline

Trust reference: B35/2017

Virology and the IP team antivirals may be considered for patients in the bay.

8. Cohorting patients with Laboratory confirmed Influenza

8.1. Patients with a laboratory confirmed diagnosis of the same strain of Influenza may be cohorted together in a bay or designated area. Patients with influenza A should not be cohorted with patients infected with influenza B (i.e. a different influenza type)

8.2. The decision to cohort patients with the same respiratory strain of virus is made by the Infection Prevention team or Microbiologist. The Duty Manager must be informed. Please refer to Managing increased Incidence and Outbreaks of Infection in Hospitals Policy. - Infection in Hospital Increased Incidence UHL Policy.pdf

8.3. If patients with laboratory confirmed influenza have other infectious conditions such as Clostridium difficile or MRSA then they should not be cohorted with other patients but placed in a side room in source isolation.

8.4. Where a bay of patients are cohorted; Separate dedicated teams of nursing/domestic staff must be allocated to the cohort area and they must follow correct infection control procedures, including the use of PPE and hand hygiene. This must be maintained across all shift patterns during the outbreak. If separate staff cannot be allocated across all shift patterns then the whole ward will need restricting to admissions.

8.5. Separate domestic staff are required for cleaning in the cohort area, paying close attention to surfaces that staff and patients frequently touch such as door handles and cot sides. A second team will clean unaffected areas of the ward and provide food preparation to unaffected patients.

8.6. Any staff attending the ward to offer therapy services should limit their number to the minimum required to provide safe care.

8.7. Clear Infection Prevention stop signs should be clearly visible to alert staff and visitors to a restricted area.

8.8. Gloves and aprons must be changed and hands decontaminated before and after contact with different patients in the cohort bay. Surgical masks must be removed when leaving the cohort area but can be kept on between patients.

8.9. Patients may be encouraged to wear masks (Surgical masks)if they are highly symptomatic/ sneezing / coughing etc during cohorting, this reduces the risk of transferring their viruses to others, however this may be difficult for patients to tolerate and priority should be given for side rooms for highly infectious patients. For more advice consult the Consultant Virologist.

8.10. Patients with confirmed or suspected influenza must not visit communal parts of the hospital such as the canteen.

8.11. Visitors entering the area should clean their hands before leaving the area. The use of a mask is dependent upon the level of contact with the patient and should be advised

Influenza (Flu) and Viral Respiratory Tract Infection - Testing and Isolation Precautions for Adults Guideline Latest version approved by Policy and Guideline Committee on 20 December 2019 Trust Ref: B35/2017

Page 7 of 13

Next Review: Dec 2022

NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents

Influenza (Flu) and Viral Respiratory Tract Infection Testing and Isolation Precautions for Adults UHL Guideline

by staff.

Trust reference: B35/2017

8.12. Segregation of patients in some specialist areas may be difficult. Examples of this may include areas such as critical care. In this instance side rooms in the area may be required for the protective isolation of patients without flu symptoms and patients with flu may need to be cohorted in the bays.

9. Aerosol generating procedures

9.1. Aerosol generating procedures produce droplets less than 5 microns in size which may cause infection if they are inhaled. These small droplets containing pathogens can remain in the air, travel over distances and still be infectious.

9.2. Aerosol generating procedures should ideally take place within a side room, or enclosed area and must only be carried out if absolutely necessary. Examples of aerosol generating procedures include intubation, CPR, bronchoscopy and non-invasive ventilation. If a side room is not available the curtains must be closed around the bed space during the aerosol generating procedure.

Aerosol generating procedures include:

? Intubation, extubating and related procedures e.g. manual ventilation and open suctioning

? Chest physiotherapy ? Cardiopulmonary resuscitation ? Bronchoscopy ? Surgery and post mortem procedures in which high-speed devices are

used ? Dental procedures ? Non-invasive ventilation ? High frequency oscillatory ventilation

9.3. Although PHE guidance has suggested that aerosol generating procedures currently do not include nebulisation of medication or administration of pressurised humidified oxygen, evidence is accumulating that there is a potential risk from this. Please draw the side curtains around such patients during the use of these devices wherever possible. The curtains can be opened once the use of these masks has finished.

9.4. Aerosol generating procedures must only be carried out when essential and should be done ideally in a well-ventilated single room with the doors shut.

9.5. The rate of clearance of aerosols in an enclosed space is dependent on the extent of any ventilation. The greater the number of air changes per hour the sooner aerosol will be cleared.

9.6. Fans should not be used in affected areas, windows can be opened, and curtains drawn at the side of beds in cohort areas where possible to reduce the risk of aerosol transmission.

10. Criteria for ceasing source isolation

Influenza (Flu) and Viral Respiratory Tract Infection - Testing and Isolation Precautions for Adults Guideline Latest version approved by Policy and Guideline Committee on 20 December 2019 Trust Ref: B35/2017

Page 8 of 13

Next Review: Dec 2022

NB: Paper copies of this document may not be most recent version. The definitive version is held on INsite Documents

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download