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MANAGING INCIDENTS PRESENTING ACTUAL
OR POTENTIAL RISKS TO THE PUBLIC HEALTH:
Guidance on the Roles and Responsibilities of Incident Control Teams
Annex 4
Management of outbreaks of healthcare associated infection (HAI)
Material in this Annex is of a provisional nature, given that a number of initiatives are currently in progress, notably the establishment of the HAI Task Force. Specific tasks within the remit of the Task Force relating to healthcare outbreaks and incidents will include development of:
model infection control policies and procedures
a code of practice for local management of hygeine
training programmes for HAI outbreak management
surveillance of HAI, including outbreaks
Many or most of the principles laid out in the main document apply to outbreaks or incidents in the healthcare setting. The primary difference lies in the roles and responsibilities of the hospital Infection Control Doctor (ICD) and the Infection Control Team in first-line management of outbreaks and incidents.
Many incidents will be managed effectively within the hospital, and the Outbreak or Incident Control Team would normally be chaired by the ICD. However, the NHS Board Public Health department should be involved at an early stage where there are, or may potentially be, significant risks to the public health, or where an incident is unusually extensive or complex.
SCIEH should be involved where the issues require specialist expertise or assistance with special investigations such as case-control studies. SCIEH would normally be invited to attend by the CPHM. Even when not required to attend, SCIEH provides information and advice by phone on a 24-hour basis.
Issues relating to the impact of an outbreak in a healthcare setting may include:
the effect of ward closures on service provision
making alternative provision for key clinical services
provision of post-discharge advice for patients discharged early
minimisation of rotation of staff and movement of patients between wards or care areas
Surveillance of outbreaks, including HAI outbreaks, is co-ordinated within Scotland by SCIEH. Specifically, SCIEH should be informed about outbreaks of gastrointestinal infection: surveillance of other outbreaks is another area under development.
Decisions on the appropriate level of action required can be complex, and a draft risk matrix is attached which attempts to relate multiple criteria of seriousness with specified risk levels and appropriate actions. This matrix is taken from the Watt Report (2002) and represents a pragmatic interim tool for Infection Control Teams pending further work on risk matrices by the HAI Task Force.
Clear communications with agencies beyond the hospital (Trust, NHS Board, SCIEH, Food Standards Agency, SEHD and others) are essential, and their extent is largely defined by the nature and scope of the incident in question. One of the functions of the attached risk matrix is to assist in deciding the required communications actions based on specific criteria.
In addition to the criteria specified in the attached matrix, SEHD should be informed immediately if the incident is likely to cause significant disruption to healthcare delivery, or if there is likely to be Press interest.
Healthcare associated infection (HAI) outbreak/incident risk matrix[adapted from the Watt Report 2002]
The Infection Control Team will quantify the infection control risk criteria and ascertain the associated risk, which will determine the appropriate action to be taken. Four infection risk categories can be identified: Red - High Risk, Orange - Moderate Risk, Yellow - Low Risk, Green - Very Low Risk
Criteria | Quantification Criteria | Risk Category | Action Required | Communications |
3 or more met | Death and/or serious illness
Major implications for public health
Exceptional or unusual infection episode
Major disruption of health and/or public services
Major public anxiety and concern | Red - High Risk | Implement Area Major Outbreak Plan | Full (e.g., Trust, Health Board, SCIEH, FSA, SEHD) and others as appropriate (e.g., Local Authority, Water Authority, SEPA, HSE etc.) |
1 or 2 met | Death and/or serious illness
Major implications for public health
Exceptional infection episode
Major disruption of health and/or public services
Major public anxiety and concern | Orange - Moderate Risk | Implement Trust Outbreak Plan - Full Outbreak Control Team | Full (e.g., Trust, Health Board, SCIEH, FSA, SEHD) and others as appropriate (e.g., local authority, water authority, SEPA, HSE etc.) |
3 or more met | Serious illness and/or moderate infection episode and/or cases
Moderate impact on public health
Short-term disruption of health and/or public services
Moderate public anxiety and concern | Yellow -
Low Risk | Implement Trust Outbreak Plan - Infection Control Team | Trust and Health Board communications |
All 4 met | Minimal infection episode and/or case
Minimal impact on public health
Minimal disruption of health and/or public services
Minimal public anxiety and concern | Green -
Very Low Risk | Implementation- Infection Control Team Investigation | Trust communications |
N.B. Infection risk category coding may vary slightly from Trust to Trust. No more than four risk categories should apply to this infection control risk matrix.
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