Contents
1 Introduction
The Health and Social Care Act (2008) requires NHS organisations to have a policy for the control and management of outbreaks. This procedure is primarily concerned with the investigation, management and control of outbreaks of infection within the trust. Outbreaks in the wider community will normally be managed by the consultant in communicable disease control (CDDC) for the relevant locality. This guidance aims to ensure an effective and coordinated approach is taken to outbreak management, from initial detection to formal closure and review of lessons identified.
2 Purpose
2.1 Inpatient services
Staff who suspect two or more, linked cases of infection and clusters of similar infection in inpatient settings must:
- escalate to service managers as per usual protocols
- isolate where possible
- obtain appropriate specimens for laboratory examination
- inform the medic responsible for the care of the affected patients
- contact the Infection Prevention and Control team (IPCT) at the earliest opportunity for advice
If urgent specialist advice is required out of hours for the Doncaster and North Lincolnshire localities the Consultant Microbiologist at Doncaster and Bassetlaw Teaching Hospital Foundation Trust (DBTHFT) can be contacted on 01302 366666. For the Rotherham locality the consultant microbiologist at The Rotherham Foundation Trust (TRFT) can be contacted on 01709 820000. This must be at the discretion of the on call service manager.
An Outbreak Control team (OCT) meeting will be held with appropriate representation from the relevant care group and corporate services utilising the silver (tactical) and bronze (operational) principles of command and control. This will be chaired by the executive director of nursing and allied health professions or deputy chief executive, who is also the director of infection control.
The core function of the trust’s OCT is to:
- establish case definitions
- provide specific infection prevention and control (IPC) guidance
- meet regularly and review the progress of the outbreak of infection
- formulate press releases
- communicate with the following as appropriate:
- Public Health England (PHE)
- environmental health
- NHS England and NHS improvement
- Department of Health and Social Care
- clinical commissioning groups
- integrated care systems
- local authorities
If the outbreak is related to SARS-CoV-2 (COVID-19) infection there is a specific reporting process as identified in supporting documents, accessed in the infection prevention and control manual.
In the event of a critical or major outbreak that causes the closure of multiple wards the chair of the OCT will notify the trust’s accountable emergency officer (AEO) and directors of all the care groups.
If the trust declares a critical or major incident the trust’s OCT may be absorbed into the trust’s gold command arrangements depending on the rationale decided by the AEO. The trust’s gold command provides strategic leadership. Full details of which can be found in the trust’s major incident plan.
If a critical or major incident is declared the AEO will be required to conduct an internal trust debrief when the incident is over and will liaise with the IPCT to facilitate a report for presentation to the trust board. The debrief will concentrate on the Trust’s response and how it worked internally and its liaison with external agencies. This is to ensure lessons are learned which may inform future actions.
Following a minor outbreak, a report will be completed by the affected area’s ward manager in conjunction with the IPCT. This will be escalated to the trust board via the infection prevention and control committee, safety and quality group and quality committee.
2.2 Community outbreaks
Community outbreaks are managed by PHE and local authority departments of public health. Intelligence on these outbreaks is communicated to the IPCT via a daily alert system.
During operational hours if the IPCT become aware of a possible outbreak they will inform:
- PHE
- local authority department of public health
- consultant microbiologist (CM)
- executive director of nursing and allied health professions and deputy chief executive, who is also the director of infection control.
On call staff may receive notification of clusters of cases or an outbreak in the community direct from PHE. In such instances they must inform the IPC team at the earliest opportunity.
It is the responsibility of the consultant in communicable disease control (CCDC) PHE to declare a major outbreak in the community. If declaring a major outbreak, the trust Major Outbreak Control team will be convened by the AEO or director of nursing. Where appropriate this will be following consultation with a CM or senior environmental health officer (EHO).
The decision on whether the trust Major Outbreak Control team will be absorbed into the trust gold command arrangements will be made by the AEO.
A representative from the OCT may be asked by PHE or local authority department of public health to attend the Multiagency Outbreak Control team as described in the national PHE communicable disease outbreak management operational guidance.
The Doncaster multi agency outbreak plan, available from the IPCT or AEO contains details of roles and responsibilities for RDaSH in the event of a Multiagency Outbreak Control team being convened. supporting documents accessed of the infection prevention and control manual details RDaSH responsibilities. Any trust representative at multiagency OCT should have authority to be able to commit Trust resources if required. Supporting documentation in the form of the Memorandum of Understanding for South Yorkshire Local Health Protection can be accessed from the IPCT and it is also contained in the on call folder at “L:\Corporate\Trust OnCall Rotas\Gold and Silver” on call folder documents.
If a critical or major incident is declared the AEO will be required to conduct an internal Trust debrief when the incident is over and will liaise with the IPCT to facilitate a report for presentation to the trust board. The debrief will concentrate on the trust response and how it worked internally and its liaison with external agencies. This is to ensure lessons are learned which may inform future actions.
Most inpatient area outbreaks are normally managed locally by the IPCT but at any point if deemed appropriate the OCT can escalate it to a major outbreak.
3 Definitions and explanation of terms used
Outbreak:
- an incident in which two or more people experiencing a similar illness are linked in time or place
- a greater than expected rate of infection compared with the usual background rate for the place and time where the outbreak has occurred
- a single case for certain rare diseases such as diphtheria, botulism, rabies, viral haemorrhagic fever or polio
- a suspected, anticipated or actual event involving microbial or chemical contamination of food or water
4 Responsibilities, accountabilities and duties
Refer to section 4 of the IPC manual.
5 Links to any other associated documents
- RDaSH major incident plan
- RDaSH pandemic influenza plan
6 References
- Department of Health (2015), The Health and Social Care Act 2008: Code of practice for health and adult social care on the prevention and control of infections and related guidance.
- Wilson, J. (2019) Infection control in clinical practice. Updated third edition London Elsevier.
- PHE (2014) Communicable disease outbreak management operational guidance. Accessed 25 March 2021.
Document control
- Version: 10.1.
- Unique reference number: 69.
- Ratified by: Gold command.
- Date ratified: 9 September 2021.
- Name of originator or author: Senior clinical nurse specialist infection prevention and control and emergency planning officer.
- Name of responsible individual: Executive director of nursing and allied health professionals and deputy chief executive.
- Date issued: 16 September 2021.
- Review date: June 2024.
- Target audience: All clinical staff.
Page last reviewed: April 24, 2024
Next review due: April 24, 2025