NHSCT TRUST OUTBREAK ACTION PLAN TO REDUCE CLOSTRIDIUM DIFFICILE ASSOCIATED DIARRHOEA (CDAD)

AREA	ACTION NEEDED	WHO	WHEN
Management of Outbreak	Set up Outbreak Control Team to develop and implement an effective strategy to manage outbreak.	Chief Executive	Outbreak Control Team with supporting subgroups established in Jan 2008. Meet weekly.
Communication Communication (continued)	Notification of CDAD Outbreak to DHSSPS and NHSSB Reports to CEO, Medical Director, Outbreak Control Team, Infection Prevention and Environmental Hygiene Committee, Drug and Therapeutic Committee, NAPF. Monthly Report to Trust Board Weekly Updates to SMT Communicate the necessity of reducing the incidence of CDAD in the NHSCT to all clinical and senior managers Communicate to all Health Care Workers the duty of care to comply with Trusts CDAD reduction plan Issue CDAD information sheet to all clinical staff Inform GPs of outbreak and encourage them to try to avoid hospital admission of patients with diarrhoea Updated information CDAD leaflets for Patients/Visitors Information sheet for visitors in English and translated into relevant languages.	Governance Department Chairpersons and Leads Dr Flanagan Senior Management Team Dr P Kearney Dr Flanagan	8 January 2008 As required Jan/Feb 2008. 8^th Jan onwards Discussed at SMT and Clinical Directors meetings from December 2007 onwards Included in Chief Executive’s letter January and February 2008. In Trust Newspaper in February 2008 Regular contact with all relevant clinical staff on an ongoing basis January 2008 January 2008
Education	Infection Control Training for all staff. Medical, Nursing, Allied Health Professionals and Hotel Services staff Education re death certification for medical staff.	Medical Educational Officer. Senior Nurse Infection Control. Clinical Directors. Ward Managers. Hotel Services Managers. Head of Nursing Education and Development.	January onwards
Incident Reporting	Report any delays or failure to isolate patient as a clinical incident Report non-compliance with infection control policies as a clinical incident Medical staff to complete a proforma for each death associated with CDAD	Ward Manager of deputy Ward Manager or deputy Medical staff	Ongoing Ongoing Ongoing
Collect Surveillance Data	Clinical staff monitor occurrence of diarrhoea in wards and report any increase above expected level to line manager and infection control Continue alert organism surveillance by 1.C Nurse Develop ICT programme for data collection on all CDAD patients for analysis with feedback of information to wards	Ward clinical team (medical, nursing and pharmacist) Infectious Disease Team Dr P Kearney and Dr E Davies	Ongoing Ongoing February 2008 Ongoing
Infection Control	Monitor adherence to infection control policies to include dress code and hand hygiene Review need for additional infection control measures in light of changing circumstances and new best practice evidence Patients with suspected CDAD isolated and/or cohorted immediately The bodies of patients who have died with CDAD should be transferred to the mortuary in a body bag Develop visiting policy	Ward Managers Link Nurses All Clinicians Infection Control Team Outbreak Control Team with supporting subgroups Support Services SMT	Ongoing Cohort isolation ward opened in A1, Antrim Hospital in January 2008 Scrubs for medical staff at Antrim Hospital introduced 6 February 2008 Letter to relevant Directors issued January 2008 February 2008
Microbiological Testing	Lab Toxins for C Difficile toxin testing 24/7 Store all toxin positive samples for 1 year All toxin positive test samples are cultured and sent for PCR Ribotyping	Medical Microbiologists General Managers/Service Manager Microbiology	In place In place In place
Antibiotic Guidelines	Review antibiotic guidelines for primary and secondary care (to minimise use of Fluroquinolones) Develop and circulate to all clinical staff an aide memoir for antibiotic prescribing Produce guidance on Penicillin hypersensitivity Produce a list of restricted antibiotics which will require completion of a policy exemption form	Dr Kearney Dr Kearney Dr Kearney Dr Kearney	January 2008 December 2007 December 2007 December 2007
Enhanced Environmental cleaning for patients in isolation	Use of chlorine based disinfectant to reduce environmental contamination Enhanced environmental cleaning Development of Rapid Response Cleaning Teams Decontamination of affected areas by Hydrogen Peroxide	Hotel Services Infection Control Team Ward managers M Bermingham M Bermingham	January 2008 FE Bid developed February 2008 February 2008
Monitoring of implementation of CDAD action plan	Completion of performance indicators to evidence that various aspects of action plan have been carried out	Relevant staff as per performance indicator table	February 2008