OUTBREAK SCENARIO food poisoning

1
OUTBREAK SCENARIOfood poisoning
2
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

3
Key points 1

• Managerial actions include
• 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

4
Scenario 2

• What are the most important areas you will cover
  in your preliminary investigation?

5
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

6
Scenario 3

• Examine patient menu cards and preliminary
  investigation form to try to identify any common
  causative factor

7
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?

8
Scenario 4

• The laboratory specimens have not shown a result.
  What specific precautions should be taken with
  the patients?

9
Key points 4

• Hand hygiene
• Disinfection
• Cleaning
• Waste disposal
• Isolation precautions
• Protective clothing
• Visitors
• Communication
• Patient education
• Psychological support

10
Scenario 5

• You are to receive three new admissions to the
  ward, what are the implications?

11
Key points 5

• Staff skill mix
• Allocation of staff to isolated patients
• Who decides to close the ward to new admissions?

12
Scenario 6

• One of the student nurses tells you that the
  bedpan washer/disinfector has broken down, what
  are your alternatives?

13
Key points 6

• 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

14
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?

15
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

16
Scenario 8

• Visiting starts at 2pm. What action is needed?

17
Key points 8

• Speaking to relatives and visitors
• Providing an explanation/reassurance
• Information and education
• Hand hygiene
• High risk foods from visitors
• Restricting visitors who are ill

18
Scenario 9

• By 6pm two further patients have developed
  diarrhoea
• What action is needed?

19
Key points 9

• Isolate patients
• Inform infection control of new cases as they
  occur

20
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?

21
Key points 10

• ICD
• ICN
• Consultant in charge
• Senior nurse
• General manager
• Consultant in communicable disease
• Others as required

22
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?

23
Key points 11

• 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

24
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?

25
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

26
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