Infections that require Source Isolation on the Neonatal Unit Protocol

Publication: 13/04/2015

Next review: 01/04/2024

Clinical Protocol

CURRENT

ID: 4153

Approved By: Trust Clinical Guidelines Group

This Clinical Protocol is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Infections That Require Source Isolation on the Neonatal Unit Protocol

Aims
Background and indications protocol
Commonly occuring alert organisms and conditions requiring source isolation on NNU
Appendix A
Appendix B Neonatal MRSA Screening Pathway

This protocol provides information on those babies, or their mothers that are diagnosed with an infection or are identified as colonised with micro-organisms that are easily transmitted to other people and constitute an infection risk to other patients, staff or visitors.

This protocol also specifies the Infection Prevention and Control (IPC) actions that are required when a patient is diagnosed or identified as colonised in the list below.

Aims

To prevent and control the spread of communicable infections within the neonatal service
To promote a safe environment for all patients and staff within the neonatal service
To provide the information required to ensure that IPC measures are applied when babies/parents are found to be colonised by or infected with an Alert Organism* or diagnosed with an Alert Conditions*.
To ensure that babies with (alert organisms or conditions) are placed in source isolation if as required.

*Alert organisms and conditions are those that are easily transmitted and constitute an infection risk to other babies, staff or visitors.

Background and indications protocol

A requirement for source isolation may be suggested by a clinical presentation e.g. an alert condition or a microbiological result e.g. isolation of an Alert Organism such as MRSA.

The need to source isolate is based on whether the patient has an infection (Alert Organism or Alert Condition) and how that is transmitted.

Source isolation must be carried out according to the Infection Prevention And Control Policy.

If source isolation is not possible, due to lack of side room/capacity or stability of the patient, the nurse in charge is required to have discussions with the named consultant on call and microbiology to complete a risk assessment - both in and out of hours.

The risk assessment is only to be completed in conjunction with the consultant microbiologist and neonatologist and nurse in charge. In exceptional circumstances source isolation may not be possible but this decision should be made at the senior level and the baby put into source isolation at the earliest opportunity.

Measures should be taken in these cases to prevent contamination and spread of infection, this includes highlighting a space around the patient, placing screens around the patient, move babies surrounding the patient into bed spaces further away, highlighting a designated entry and exit point, have PPE at these points of access and communicate with all staff source isolation is taking place out of the norms.

Carbapenem-resistant organisms (CPO)

Carbapenem resistant organisms are rare but are emerging. Their transmission characteristics and pathogenesis resemble those of more sensitive Enterobacteriaceae, but the infections are more difficult to treat. For this reason, it is vital that NHS trusts prevent their spread and introduce the identification and screening of high risk patient groups. Please refer to Carbapenemase-Producing Organisms (CPO) policy; for flowsheet see appendix A

COMMONLY OCCURING ALERT ORGANISMS AND CONDITIONS REQUIRING SOURCE ISOLATION ON NNU

Infection (Alert Organism/ Condition)	Source Isolation Required	Mode of Transmission	Duration of Isolation	Precautions Required
Multiresistant E. coli ESBL coliform Multiresistant Pseudomonas *Listeria* *Serratia*spp; (if multi-drug resistant, carbapenemase-producing or ESBL producing)	yes	Person to person through direct contact with blood and body secretions from those infected or potentially colonised. Indirect contact from environmental surfaces, linen and patient care equipment that has been contaminated with infected blood or body fluids.	Duration of admission	Hand Hygiene PPE- Gloves and Apron Sharps Bins (Orange & Yellow) Alginate and linen bags Clinical infectious waste
*NB: Any baby admitted from outside Yorkshire should be put in too source isolation and the CPO (carbapenemase-producing organism) policy followed - see appendix A*
MRSA Meticillin-resistant Staphylococcus aureus Please refer to LTHT IPC MRSA Policy for Neonates.	Yes	Person to person through direct contact with blood and body secretions from those infected or potentially colonised. Indirect contact from environmental surfaces, linen and patient shared equipment that has been contaminated with infected blood or body fluids. N.B. Airborne transmission poses significant risk if isolated in respiratory secretions.	Once course of decolonisation has been completed and there is evidence of 3 negative MRSA screens taken 72 hours apart. Please refer to LTHT IPC MRSA policy for neonates	Hand Hygiene PPE- Gloves and Apron Sharps Bins (Orange & Yellow) Alginate and linen bags Clinical infectious waste
Any respiratory virus e.g. RSV, influenza, Rhinovirus etc Also see Trust Policy Respiratory Viruses	Yes	Direct contact or inhalation of airborne droplets from an infected person, indirect contact with contaminated surfaces. Incubation is between 12 hours and 5 days; the usual period is on average 48 hours dependant on infectious agent.	Source isolation should commence at the onset of symptoms and time of sampling if symptoms are no longer present isolation can be discontinued 7 days after onset of illness. N.B. Cohorting of symptomatic patients can be undertaken with consultation of IPC Team.	Hand Hygiene PPE- Gloves and Apron Sharps Bins (Orange & Yellow) Alginate and linen bags Clinical infectious waste
Group A Streptococcal Infection Please refer to LTHT IPC Group A Streptococcal Infections guidelines All cases to be reported; Please refer to appendix F	Yes	Person to person through airborne or direct contact with infective respiratory secretions or contact with body fluids. Indirectly through contaminated surfaces, linen or patient shared equipment. Incubation is normally 1-3 days.	Until 24 hrs of appropriate antimicrobial treatment is completed In cases of Invasive Group A Strep source isolation may be extended for a longer period. IPC advice should be sought in these cases.	Hand Hygiene PPE- Gloves and Apron Sharps Bins (Orange & Yellow) Alginate and red linen bags Clinical infectious waste
*Staphylococcus capitis*	Yes	Direct or indirect contact with contaminated person or object	Once Staph. Capitis has been isolated the patient should remain in source isolation for the duration of the admission	Hand Hygiene PPE- Gloves and Apron Sharps Bins (Orange & Yellow) Alginate and red linen bags Clinical infectious waste
COVID -19	Yes	Direct contact or inhalation of airborne droplets from a positive patient Indirect contact with contaminated areas and surfaces	Please refer and follow LTHT local COVID policy/SOP on isolation guidelines.	Hand Hygiene PPE - Gloves and Apron Sharps bin (Orange and yellow) Alginate and red lined bags Clinical infectious waste Googles Extra measures for a COVID positive patient - FRSM, surgical cap and full length aprons/gowns

Maternal infections affecting the infant
Infection (alert organism / condition)	Duration of source isolation	Guideline link
Pulmonary TB	Mother and baby should be isolated until mother has received at least 2 weeks treatment. Infant may require treatment. See policy. Discuss with Chest and Infection Control teams before moving out of isolation.	Infant Exposed to Maternal Tuberculosis Policy
MRSA	To remain in isolation until mother and baby decolonised and negative swabs as per policy.
Clostridium difficile		Clostridium difficile
Chicken Pox Varicella Zoster	If mother has been in contact with varicella (Chicken pox) a week before or a week after delivery she should be kept in isolation for duration of incubation period. The infant should have VZIgG - discuss with virology.	Green Book Varicella Chapter.
CMV Cytomegalovirus	Mother nor baby require source isolation. Universal precautions only.
COVID-19	If mother tests positive for COVID-19 they must isolate subject to local guidelines - baby should isolate to. If baby requires admission to the NNU the baby will need to isolate following local COVID guidelines.

For all other organisms please refer to the Trust Policy Infections (Alert Organisms And Conditions) That Require Source Isolation and seek advice from Infection Prevention and Control (Extension 28536 or through switchboard out of hours).

Appendix A

Appendix B: Neonatal MRSA Screening Pathway

Provenance

Record:	4153
Objective:
Clinical condition:
Target patient group:	Neonates
Target professional group(s):	Secondary Care Doctors Secondary Care Nurses
Adapted from:

Evidence base

LTHT Source isolation policy

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

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