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Developed by Calderdale & Huddersfield Health Protection Team Feb 2010

OUTBREAK CARE PATHWAY For the Management of Gastroenteritis in Kirklees Care Homes Definition Criteria for an outbreak of viral gastroenteritis: Two or more cases of diarrhoea and/ or vomiting (with more than 2 loose stool episodes in 24 hours), Bristol Stool Chart grading 6 or 7 unusual to the residents or staff members normal bowel action. Outbreak location: ……………………………………………………………………………………………….. Date & time outbreak started…………………………………………………………………………………..

Outbreak Care Pathway Communication


Report cases of diarrhoea and vomiting to the person in charge and enter the symptomatic cases details on the log sheet attached (residents and staff)

All Homes MUST telephone the West Yorkshire Duty Desk to inform them of the outbreak on 0113 3860300 (Monday to Friday 0900 – 1700hrs) The Health Protection Agency will supply an identifying ILog number to be labelled on the lab request form. This number is the personal identifier at the laboratory for the outbreak at your home (it must be on the form otherwise the sample will be discarded by the lab). If the outbreak commences out of office hours (which are 1700hrs – 0800hrs) Monday to Friday or on a weekend or Bank Holiday inform the on-call Public Health Specialist on: For NHS Kirklees 01484 342000 ( Hospital Switchboard) and ask for the Public Health On-Call Specialist For NHS Wakefield 0844 8118110 ( Hospital Switchboard) and ask for the Public Health On-Call Specialist

Close the home to admissions, transfers and hospital outpatient appointments. If appointments are essential discuss with the Health Protection Nurse. If a resident has had to be admitted to hospital /A&E form the home when the outbreak had already started they can be discharged back to the home even though the outbreak may still be ongoing ( this is because they have been exposed to the infection already)



Developed by Calderdale & Huddersfield Health Protection Team Feb 2010

Inform visitors of the closure and put a poster on the entrance of the home. Visitors are advised to stay away until the home is 48 hours fee of symptoms. Visitors must not be stopped from visiting if they wish as long as they are aware they may become ill themselves Inform visiting health care staff of the outbreak i.e. G.Ps, community nurses, physiotherapists, occupational therapists, pharmacists. NON-ESSENTIAL SERVICES MUST BE DEFERRED UNTIL AFTER THE OUTBREAK- i.e. Chiropodist, hairdresser, decorator.

Inform the West Yorkshire Duty Desk if a resident requires an emergency admission to hospital. The GP/ paramedics/ care home manager must inform an admitting hospital of the outbreak so that the resident can be received into a suitable area in A&E/ medical admissions (MAU). Please also place a transfer sticker on any documentation notes identifying the resident as coming from a care home with an outbreak

Outbreak Pathway Infection Control Precautions


Isolate residents in their rooms until 48 hrs symptom free (where condition allows), particularly those with vomiting (to minimise the aerosol effect from the vomit). Where residents are difficult to isolate (EMI units) try as possible to cohort the residents that are symptomatic into one area.

Organise staff work rota to minimise contamination of unaffected areas. Try to avoid moving staff between homes and floors. Cohort staff to work in one area during the duration of the outbreak as much as possible.

Obtain a stool specimen as soon as possible from all symptomatic cases and ensuring the laboratory form has the ILog no completed. Deliver to the hospital microbiology laboratory or local General Practitioner Surgery Stool specimens must fill a maximum of half the specimen pot and can be contaminated with urine. Sampling early may identify the cause of the outbreak and halt the need to take further samples.

Exclude all staff and visitors with symptoms until asymptomatic for 48 hours. Posters can be placed to inform visitors not to visit the home any time of year if they have symptoms of diarrhoea / and/ or vomiting



Developed by Calderdale & Huddersfield Health Protection Team Feb 2010

Staff must not eat and drink except in designated areas. Open boxes of chocolates, sweets, biscuits and fruit bowls must be removed in an outbreak.

Staff should change out of uniforms prior to leaving the home during outbreaks and wear a clean one daily. If uniforms are laundered at home they should be washed immediately on a separate wash to other laundry on the hottest wash the material will tolerate.

Personal Protective Equipment (PPE) should be worn at all times when dealing with bodily fluids. i.e. Spillages. Gloves and aprons should be discarded after each episode of care

Effective hand hygiene is an essential infection control measure. Ensure sinks are accessible and are well stocked with liquid soap and paper towels for staff and visitors.

Provide residents with hand wipes and/or encourage hand washing (a clean individual hand towel should be provided daily). Ensure the macerator/bedpan washer is operational – faults must be dealt with immediate as urgent.

Laundry soiled by faeces or vomit must be placed directly into a water soluble/infected laundry bag and transferred to the laundry so that laundry staff do not have to handle the item. Laundry staff should wear personal protective equipment(gloves and aprons)

Ensure the home is thoroughly cleaned twice daily using hot water and detergent. Hard surfaces, toilet areas and sluice should be cleaned twice daily using a hypochlorite solution 1,000 parts per million (i.e. Milton 1:10, domestic bleach solution chlorclean). Commode and toilet seats require cleaning after each use with soap and water or detergent wipe., and then cleaned with a hypochlorite solution Cover excreta/vomit spillages immediately with paper towels. Always wear an apron and gloves when disposing of faeces/vomit. Contamination of floors/carpets should be cleaned up immediately with detergent and water. Hard surfaces can then be disinfected using a hypochlorite solution as above Carpets should be cleaned with a steam cleaner if soiled.


Infection Control Actions


Inform the Health Protection Nurses and Kirklees/Wakefield IPC team when the home has been 48 hours symptom free.