Purpose
The purpose of this document is to describe the Standard Operating Procedure and IPC measures required for managing patients with Notifiable or High Consequence Infectious Diseases (HCID).
High Consequence Infectious Diseases are listed here: https://www.gov.uk/guidance/high-consequence-infectious-diseases-hcid#list-of-high-consequence-infectious-diseases
Notifiable Diseases are listed here: https://www.gov.uk/guidance/notifiable-diseases-and-causative-organisms-how-to-report#list-of-notifiable-organisms-causative-agents
This SoP must be used for all people with suspected/confirmed cases of either of these groups of diseases. The table below offers specifics on currently prevalent diseases.
Inclusion Criteria
Disease | Unlikely | Suspected/Likely | Confirmed |
Measles | Case does not meet the definition of a suspected case (either because it is not clinically classical or the epidemiological features are not present)
If there have been no confirmed recent cases, despite adequate surveillance, in the area and the index case has not visited an area where cases are occurring, (either in the UK or internationally) during the incubation period, most cases can be assumed to be unlikely. |
Clinical features
Clinical symptoms of classical primary measles (generally very unwell and considered measles until proven otherwise). · Fever ≥ 39 in the absence of antipyretic, AND · Generalised maculopapular rash, AND · One or more of: o Conjunctivitis o Cough o Coryza AND
Epidemiological risk factors (These are a better predictor of measles than clinical features). Increased risk associated with: · Epidemiological link to a confirmed case · Known local outbreaks · Incomplete vaccination/ lack of immunity (including babies not yet due to have completed the full vaccination schedule) · Likelihood of suspected case being confirmed is higher amongst adolescent and young adults. Differentials are common in infants and toddlers. · Membership of community known to be more susceptible (e.g. Orthodox Jewish, traveller, local community with low MMR coverage) · Visited local or international area where measles is circulating · Attendance at large international mass gathering event with substantial mixing and individuals potentially travelling from area where measles is circulating (e.g. festival) |
Either laboratory or epidemiologically confirmed
Suspected case with laboratory confirmation of acute infection
Epidemiologically confirmed (by HPT) Confirmed case in the absence of laboratory evidence with • Combination of classical clinical features present AND a direct epidemiological link to a confirmed case (where onset happened within 7-21 days of exposure) • OR clinically classical case AND related to another epidemiologically confirmed case (eg outbreak) |
Pertussis
(Whooping Cough) |
You should suspect pertussis infection and report it to the Health Protection Team if someone presents with an acute cough lasting for 14 days or more without an apparent cause plus one or more of the following:
paroxysms of coughing post-tussive vomiting inspiratory whoop undiagnosed apnoeic attacks in young infants
Or
someone with signs and symptoms consistent with pertussis who has been in contact with a confirmed case in the previous 21 days
Or
someone who is known to be part of any ongoing outbreak investigation in a specific group of people. For example, children attending the same school or nursery where pertussis is known to be been circulating |
Clinical guidance for the management of these cases is out of scope of this document but is available on the BrisDoc Clinical Toolkit. This includes background clinical information, Health Protection Team (HPT) notification, and national and local guidance.
Infection Prevention Control
Clinicians are responsible for ensuring that the correct PPE is worn for face-to-face assessment of a patient with suspected notifiable or HCID, and the subsequent cleaning of equipment as set out in this section of the SOP.
IPC measures
PPE | Cleaning requirements | Ventilation of room | Fallow time | |
Measles | · Powered respiratory equipment (PRE) this is a respiratory hood*
· Apron · Gloves |
· Actichlor chlorine-based solution to be used on all high frequency touch points – please see guidance below
· No mopping of floor required. · Respiratory hood system to be Cleaned in sluice with clinell wipes. |
· Open window at all times. | · Do not use the room for 2 hours after a suspected measles patient.
· Close the isolation room door and use signage provided. Please write the time cleaned and the time the room can be used again. |
Pertussis (Whooping Cough) | · Goggles
· Surgical mask · Apron · Gloves |
· Actichlor chlorine-based solution to be used on all high frequency touch points – please see guidance below
· No mopping of floor required. |
· Open window at all times. | · None required |
* Note that the respiratory hood affords a higher level of protection than the nationally recommended FFP3 masks. We are using these because individual fitting is not required, and they are reuseable.
Handwashing
Please follow guidance on National Cleaning Standards.
Donning and Doffing PPE
The correct way to put on PPE and remove PPE can be found in the UK Health Security Agency guidance.
High frequency Touch Points
The definition of high frequency touch points are all surfaces or items that have had the most frequent contact with many hands. These areas require more cleaning and disinfecting as they pose a significant risk for the spread of infectious diseases. High frequency touchpoints include all patient facing reusable equipment, all surfaces, all furniture including chairs and couch, doorknobs, or handles.
If the surface is visibly unclean use Clinell wipes first and then the disposable cloth with Actichlor to disinfect surfaces by wiping down. Let the equipment dry naturally.
Respiratory Hood System
The Facilities Team have responsibility for the maintenance of the respiratory hood system and making sure it is ready for use.
Using respiratory hood systems
The system consists of a wipeable hood, an air tube, and air pump with integrated filter. Step by step laminated instructions (appendix three) on how to use the equipment are in the Respiratory hood box.
Fresh filtered air is pumped into the hood and the exhaled air is removed through positive pressure from the bottom of the hood, like a balloon.
Cleaning the respiratory hood
The hood, air tube and air pump will be cleaned by the clinicians with Clinell wipes using standard infection precautions. The clinician will leave the isolation room (see below section on cleaning the isolation room) wearing respiratory hood and go directly to the sluice. The clinician will don gloves and an apron, turn off and remove the respiratory hood then clean the hood, tube and pump.
Using Clinell wipes, clean the inside and outside of the hood, the outer air tube and the respirator. Doff PPE. Take the respiratory equipment and place it back in the respiratory equipment box.
There will be PPE and Clinell wipes in the sluice to facilitate cleaning.
Where is it stored & what is in the Respiratory hood box
The Respiratory hood will be stored in a plastic box on the Personal Protective Equipment Trolley.
Testing and changing the battery/filter of the Respiratory hood system
The filter and battery of the airflow unit will be changed if the air flow is not adequate, the filter is 75% full, or annually, or as indicated by the light on the Respiratory hood system, whichever is sooner. This will be checked weekly by facilities and the battery and filter changed/charged as required. Fully charged there is enough charge for 11 hours. This will be done by facilities every week.
High Consequence of Infectious Disease (HCID) Cleaning Box
This box will be available in the Isolation Room. There will be a mixing bottle for acticlor, actichlor tablets and disposable J-clothes. When an assessment of a notifiable/HCID case is performed, the clinician will mix the solution up using tap water. Instructions will be in the box (appendix four). Actichlor is a disinfectant and to be used for high frequency touch points. Once cleaning is completed the clinician will dispose of the cloth and take the actichlor with them to the sluice to be disposed of.
SevernSide Guidance
Roles and responsibilities
The below describes the responsibilities of the operational team in addition to their usual duties to safely manage patient with a notifiable or HCID during face-to-face appointments in SevernSide IUC.
Notifying the Health Protection Team (HPT)
Notifiable or HCID cases must be reported to HPT by the consulting clinician. Details of how to contact HPT are on the notifiable disease page on the Clinical Toolkit (https://www.clinicaltoolkit.co.uk/knowledgebase/notification-of-infectious-diseases-to-public-health-2/). Clinicians should provide HPT with the SevernSide Professional Line number, 0117 244 9283, to enable them to contact us if they need any further information.
Vaccination requests
The Health Protection Team may seek vaccination for unvaccinated contact(s) of confirmed/ likely cases. SevernSide does not stock or have access to vaccines so would be dependent on HPT accessing/ providing the vaccine. Should this be agreed, please ensure to follow the face to face/ PPE/ cleaning guidance, and the Green Book provides details about administration.
WaCCs
- When adding the consultation finish times to a case in the non-clinical queue, please also highlight if the advice clinician has selected ‘yes’ to the suspected notifiable/HCID question. This will ensure the Clinical Co-Ordinator (CC) picks this up appropriately
- If after the CC review a patient requiring an appointment is a notifiable/HCID case, when booking the appointment please ensure:
- You ask the patient to wear a face mask on entering the building and throughout the consultation
- You ask the patient to attend the appointment alone. If this is not possible, for example the patient is a child, please ask accompanying people to also where a face mask
- Advise the patient due to their symptoms the clinician will need to wear high level PPE, this will involve a respiratory hood
- Add ‘?Notifiable/HCID Isolation room’ tag
- Advise the Shift Manager a Notifiable/HCID appointment has been booked
- Advise the Host a Notifiable/HCID appointment has been booked at their base
- Do not book an appointment in the isolation room for the required shut down period after the notifiable/HCID appointment
If a person with a notifiable/HCID requires a home visit, the Respiratory Hood will need to be collected from the nearest base.
Hosts
- To ensure Isolation room clinical box is placed in the Isolation Room at the beginning of the shift
- Ensure HCID cleaning box is in the Isolation Room at the beginning of the shift
- Open all windows in the Isolation Room at the beginning of the shift
- Be vigilant for notifiable/HCID appointments being booked
- Flag notifiable/HCID appointments to the base clinician as soon as they are booked
- Advise the Shift Manager immediately if a clinician informs you they are unable to see any notifiable/HCID patients
- Ensure the patient and anyone accompanying them wear a face mask on entry to the building
- Ensure you wear a face mask when directing the patient to the isolation room
- Minimise the time you are with the patient (this should not exceed 15 minutes)
- Please note you are unable to chaperone a notifiable/HCID patient as we only have one respiratory hood at each base
- Ensure the base clinician is aware of and has access to this SOP guidance including cleaning procedures and clinical guidance on the Clinical Toolkit
- Be aware of the guidance for clinicians regarding the correct PPE to wear, cleaning process of the room and respiratory hood, ensuring windows are open
- Ensure the isolation room door is closed throughout and after the consultation
- Ensure the door sign (appendix one) is added to the door once the clinician has finished cleaning the room
- Include the time the room has been cleaned and the time the room can be back in use
Shift Managers
- Be vigilant for notifiable/HCID appointments being booked
- Ensure the WaCCs and Hosts are aware of the above
- Ensure the base clinician is aware of and has access to this SOP guidance including cleaning procedures and clinical guidance on the Clinical Toolkit
- Plan for how isolation room patients booked within any required shut down period will be managed, this can be one of the following ways:
- If there is an empty F2F room at the base this can been ringfenced as the isolation room
- Redirect patients to an alternative base or later appointment
- Offer another remote assessment either on the phone or video
- Send out the following message to all staff throughout the shift to identify clinicians who are unable to see notifiable/HCID patients
“If you are not able to see patients with notifiable/HCID because you are immunosuppressed, pregnant, or do not have full vaccination/ immunity, please ensure that the rota team are aware of this and/ or flag to the shift manager at the start of your shift”
SevernSide Clinical Coordinator Role
The Clinical Coordinators play a key role in providing clinical support and advice to IUC telephone and F2F clinicians, and to the Shift Manager. This includes minimising the risk of avoidable exposure to notifiable and HCIDs. We ask you to proactively:
- Familiarise yourself with this IUC guidance, including the specific definitions of notifiable and HCID as well as others which may require this specific response (clinical and epidemiological)
- Support clinicians to manage patients with potential notifiable/HCIDs wherever it is clinically safe and reasonable to do so
- Be vigilant for notifiable/HCID when reviewing F2F requests. This will include cases which have been flagged as having notifiable/HCID by the triaging clinician AND cases where the criteria are met but have not been flagged by the triaging clinician.
- Have a low threshold for speaking to the triaging clinician about F2F requests for notifiable/HCID to ensure that all options for remote management have been considered, and/ or to confirm whether the notifiable or HCID is indeed suspected as per national definitions
- Select the correct notifiable/HCID F2F drop down if approving the F2F for a person with a notifiable/HCID, to ensure that the operational processes are implemented and the F2F clinician knows that additional PPE (potentially including the hood) is required.
- Please note that it will not be possible to chaperone a patient with a notifiable/HCID (there is only one hood at each Treatment Centre) so please bear this in mind
- Provide clinical advice/ support to the shift manager if required
Overview of patient appointment journey
The flow chart in appendix two gives an overview of a notifiable/HCID patient journey to an appointment including the roles of each person.
Charlotte Keel Medical Practice
At Charlotte Keel Medical practice – Room 30 is the isolation room.
The Process followed for notifiable/HCID patients is:
Pt presents at desk and is unable to go home as too unwell.
- Pt to be given a mask to wear and directed immediately to the isolation room.
Pt booked into face-to-face appointment in isolation room.
- Pt must be informed not to come into health centre via main entrance.
- Pt to access entrance at GP carpark by pressing the bell to alert Health Nav manager.
- Direct the pt to isolation room (Health Nav manager to surgical face wear mask)
Clinical Assessment
- Clinician must Don PPE before assessing the patient.
(PPE and Hood is kept in a box in treatment room)
Post Assessment
- Clinician to make up chlor-clean solution and wipe any touch points.
- Doff gloves and apron and wash hands.
- Open window/door to outside and leave the isolation room.
- Doff respirator hood.
- Don gloves and apron, turn off respiratory hood, clean hood, and associated equipment with clinell wipes.
- Return hood to box and take it back to the Treatment room.
- Inform Ops manager.
- Ops Manager will add “Room Closed” sign to door with shut down time, then remove sign after time has elapsed.
Broadmead Medical Centre
At Broadmead Medical Centre – Room 5 is the isolation room.
The Process followed for notifiable/HCID patients is:
Pt presents at desk and is unable to go home as too unwell.
- Pt to be given a mask to wear and directed immediately to the isolation room.
Pt booked into face-to-face appointment in isolation room.
- Patient to wait outside and call the clinician on the practice bypass number (0117 9549825) on arrival.
- GP to collect patient and go directly to Room 5 using the stairs (Wearing a surgical face mask)
- Division between Room 4 and 5 to be closed.
N.B. Patients pre-booked into Room 5 around the time of appointment need to be rescheduled or moved to a different clinician to enable the notifiable/HCID case to be seen and cleaning to occur afterwards.
Clinical Assessment
- Clinician must Don PPE before assessing the patient.
Post Assessment
- Clinician to make up chlor-clean solution and wipe any touch points.
- Doff gloves and apron and wash hands.
- Leave the isolation room.
- Doff respirator hood.
- Don gloves and apron, turn off respiratory hood, clean hood, and associated equipment with clinell wipes.
- Return hood to box.
- Add “Room Closed” sign to door with shut down wait time, then remove sign after time has elapsed.
Homeless Health Service
At The Homeless Health Service – The Red room is the isolation room.
The Process followed for notifiable/HCID patients is:
Pt presents at desk and is unable to go home as too unwell.
- Pt to be given a mask to wear and directed immediately to the isolation room.
Pt booked into face-to-face appointment in isolation room.
- Patient to wait outside and ring the buzzer on arrival.
- Patient to be asked to go to the rear of the building and to wait by the back door.
- GP to collect patient and take the patient directly to the ‘Red room’ (Wearing a surgical face mask).
N.B. the patient should not come into the rest of the Compass Centre.
Clinical Assessment
- Clinician must Don PPE before assessing the patient.
Post Assessment
- Clinician to make up chlor-clean solution and wipe any touch points.
- Doff gloves and apron and wash hands.
- Open window/door to outside and leave the isolation room.
- Doff respirator hood.
- Don gloves and apron, turn off respiratory hood, clean hood, and associated equipment with clinell wipes.
- Return hood to box.
- Add “Room Closed” sign to door with shut down wait time, then remove sign after time has elapsed.
Appendices
Appendix 1 – Room closure sign
ROOM CLOSED
DO NOT USE
Date Room Cleaned | |
Time room cleaned |
Date Room next available | |
Time room next available |
|
Appendix 2 – SevernSide Process for seeing notifiable/HCID patients F2F
Appendix 3 – Clinicians Guide to using and cleaning the respiratory hoods
- Clip the Versaflo Respirator to your waist by using the belt and adjust as necessary.
- Connect the larger end of the air tube to the hood and click it into place.
- Place the hood over the head, ensure the head band is against your forehead. The hood must be placed in front of your ears and around your chin, ensuring there is a good seal. The hood headband can be adjusted for a tighter fit. The respirator must be in use before entering the isolation room, do not remove the hood & respirator until you are in the sluice.
- Fit the smaller end of the air tube to the Versaflo Respirator, ensuring the 2 metal clips are in-line and twist to lock.
|
Adjusting flow
Once fitted to your waist, press the blue button and air flow will commence, the unit will power up and it will start with a standard flow, this is indicated by 1 green light next to the blue button. If the blue button is pressed again, hi flow will commence, this is indicated by 2 green lights next to the blue button. To take it back to standard flow, press the blue button twice.
Hi flow Standard flow
Lights on the Versaflo Respirator
After a few seconds, the filter light & the battery light will go out and only the air flow indicator light will show.
Turning off the Versaflo Respirator
Do not turn the respirator off unit you have vacated the isolation room and entered the sluice. Press and hold the blue button until the machine stops working, and then let go of the blue button.
Appendix 4 – High Consequence of Infectious Disease (HCID) cleaning box
For use in the Isolation Room only
Contents:
1 x Acticlor Mixing Bottle
1 x Tub of Chlor-Clean Tablets
1 x Box of Disposable Cloths
The clinician will mix the solution up using tap water. Chlor-Clean is a disinfectant and to be used for high frequency touch points.
Instructions for mixing the solution: –
- To make 1000ml solution use 1 litre cold water with 1 tablet Chlor-Clean.
- Fill the empty Actichlor bottle with 1 litre of cold water and add 1 tablet of Chlor-Clean.
- Place the top on the bottle and secure, let the tablet dissolve, and then invert the bottle a few times to ensure mixed thoroughly.
Storing of the solution: –
- Each bottle of made-up solution should be kept in the Isolation room. Along with the disposable cloths and Chlor-Clean tablets.
Disposing of the cleaning solution and cloths: –
- After the Isolation room has been cleaned, the solution is to be taken to the sluice to be disposed of. Discard all disposable cloths and PPE in the clinical waste bag.
Version Control
Version | Author | Date | Changes |
1.0 | Lucy Grinnell | 16/02/2024 | Initial Document |
1.1 | Lucy Grinnell | 23/02/2024 | Addition of Notifying the HPT section |
1.2 | Rhys Hancock | 26/02/2024 | Addition of Practice Services |
1.3 | Rhys Hancock | 27/03/2024 | Move to Notifiable/HCID SOP for BrisDoc |