Document name:
The Management of Viral Haemorrhagic
Fever
Document type:
Policy
What does this policy
replace?
This is a new Policy
Staff group to whom it
applies:
All Clinical Staff in Inpatient Areas
Distribution:
The whole of the Trust
How to access:
Intranet
Issue date:
Reviewed:
October 2014
Next review:
August 2017
Approved by:
Executive Management Team
Developed by:
Julie Hartley
Infection Prevention and Control Nurse
Director leads:
Director of Nursing, Clinical Governance
and Safety, acting as Director of Infection
Prevention and Control
Contact for advice:
Infection Prevention & Control Team,
01226 433364
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Contents
Page
1
2
3
4
5
6
7
8
9
10
Introduction
Scope
Policy Statement
Roles and Responsibilities
Risk Assessment
Diagnostic Investigations
Management of a Patient Categorised as ‘HIGH
POSSIBILITY OF VHF’
Other Requirements
Last Offices
References/Information
Appendix A Viral Haemorrhagic Risk Assessment
Appendix B Equality Assessment
Appendix C Checklist for the Review and Approval of Procedural
Document
Appendix D Version Control Sheet
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3
4
4
5
6
8
8
10
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1. Introduction
Viral Haemorrhagic Fevers (VHFs) are severe and life-threatening viral diseases that
have been reported in parts of Africa, South America, the Middle East and Eastern
Europe. VHFs are of particular public health importance because they can spread
within a hospital setting; they have a high case-fatality rate; they are difficult to
recognise and detect rapidly; and there is no effective treatment.
Experts agree that there is no circumstantial or epidemiological evidence of an
aerosol transmission risk from VHF patients. Following the revised risk assessment,
this guidance recommends control options for the isolation of VHF patients in the
UK. These options now include flexibility in the isolation of a patient with a VHF
infection within a specialist High Security Infectious Disease Unit (HSIDU).
IN THE UNLIKLY EVENT THAT A PATIENT IS SUSPECTED OF HAVING VHF
URGENT AND IMMEDIATE ADVICE MUST BE SOUGHT FROM THE IMPORTED
FEVER SERVICE ON 0844 7788990
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947382005
Environmental conditions in the UK do not support the natural reservoirs or vectors
of any of the haemorrhagic fever viruses, and all recorded cases of VHF in the UK
have been acquired abroad, with the exception of one laboratory worker who
sustained a needle-stick injury.
VHFs are of particular public health importance because:




They can spread readily within a hospital setting;
They have a high case-fatality rate;
They are difficult to recognise and detect rapidly;
There is no effective treatment.
The Advisory Committee on
Dangerous Pathogens’ (ACDP)
Hazard Group 4 viral
haemorrhagic fevers viruses
1.ARENAVIRIDAE
BUNYAVIRIDAE
Old World arenaviruses
Lassa
Lujo fever
New World arenaviruses
Chapare
Guanarito
Junín
Machupo
Sabiá
3. FILOVIRIDAE
Ebola
Marburg
4. BUNYAVIRIDAE
Nairoviruses
Crimean Congo haemorrhagic
2. FLAVIVIRIDAE
Kyasanur forest disease
Alkhurma haemorrhagic fever
Omsk haemorrhagic fever
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2. Scope
The purpose of this policy is to provide concise guidance for all staff and to minimise
the potential risks associated with the management of a patient suffering from one of
the viral haemorrhagic fevers. This document applies to all staff either employed or
contracted within in-patient areas in South West Yorkshire Partnership NHS
Foundation Trust.
3. Policy Statement
This policy will be implemented to ensure adherence to safe practice.
4. Roles and Responsibilities
It is the responsibility of all staff to ensure that they adhere to best practice.
4.1 Chief Executive
The Chief Executive has overall responsibility for reducing the risk of HCAI by
ensuring that there are arrangements for the management of VHF within the
organisation
He/she is responsible for ensuring that all Directors, the Executive Management
Team, BDUs and all other staff understand and accept their responsibilities in
relation to this policy.
He/she is responsible for ensuring that Infection Prevention and Control (IPC) is
embedded at all levels of the organisation.
4.2 Trust Board
Trust Board is responsible for signing off the approval, dissemination and implementation
of this policy.
The Trust Board will review and monitor relevant IPC data, including compliance with
education and training.
4.3 Executive Management Team (EMT)
The Executive Management Team is responsible for approving the contents of the
policy.
4.4 Clinical Governance & Clinical Safety Committee
The Clinical Governance & Clinical Safety Committee is responsible for the
dissemination and implementation of this policy on behalf of the Trust Board. They will
review relevant Infection Control data.
4.5 Director of Infection Prevention and Control (DIPC)
The DIPC will report directly to the chief executive and the board, and not through
any other officer.
He/she will challenge inappropriate clinical hygiene practice, as well as antibiotic
prescribing decisions.
He/she will be an integral member of the organisation’s clinical governance and patient
safety teams and structures.
He/she will assess the impact of all policies and plans on infection, and make
recommendations for change.
He/she is the lead director responsible for engaging relevant stakeholders in the
development of the policy.
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He/she will ensure appropriate arrangements are in place for managing any resource
implications, including dissemination, implementation and training.
He/she is responsible for ensuring the most current version of the policy is in use and
obsolete versions have been withdrawn from circulation.
He/she will produce an annual report on the state of HCAI in the organisation, and release
it publicly.
4.6 Infection Prevention and Control Trust Action Group (IPC TAG)
The IPC TAG will review new legislation and guidance and ensure that its implications are
fully understood within the Trust.
4.7 Infection Prevention and Control Team
The IPCT will develop, disseminate, implement and review this policy.
The IPCT will co-ordinate audit activity to monitor compliance with this policy.
The IPCT will provide corporate mandatory infection prevention and control training to
educate and monitor staff awareness of the policy content.
The IPCT will also provide other timely reports to Trust Board, EMT, the Clinical
Governance & Clinical Safety Committee, BDUs, Modern Matrons and any other relevant
groups throughout the year. These will include lessons learnt, performance management
and changes to policy and procedures.
4.8 Business Delivery Units
BDUs will be consulted in the development of the policy.
BDUs will ensure that the policy is implemented within their areas.
BDUs will ensure that adequate resources and facilities are made available to fulfil the policy
requirements.
BDUs are responsible for ensuring that all their staff complete mandatory training sessions.
BDUs will ensure staff compliance with this policy.
4.9 Matrons
Modern Matrons and Community Matrons have a key responsibility for the environment in
which care is provided. They have a pivotal role in supporting the IPCT to ensure effective
implementation of, and compliance with this policy and associated campaigns to raise
awareness and improve compliance.
4.10 Unit / Department Managers
Managers will ensure that all staff for whom they have line management responsibility are
aware of, and comply with this policy.
Managers will seek advice as soon as possible from the IPCT with regard to any relevant
issues related to this policy.
4.11 Link IPC Practitioners
Link IPC Practitioners will actively promote compliance with this policy.
They will reinforce good practice by attending the Link IPC Professionals
meetings/updates.
They will lead by example
4.12 Staff
Infection prevention and control is everyone’s business. All staff are responsible for taking
reasonable care of themselves, service users and any other people affected by their acts or
omissions when practicing hand hygiene in accordance with Health and Safety at Work Act
1974. Staff have an individual responsibility to ensure they are working within legal and
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ethical boundaries. It is each member of staff’s responsibility to seek out guidance and help
in implementing this policy where they have difficulty. If any member of staff is aware of
difficulties in following the policy they must alert their line manager as soon as is practical.
All staff must be aware of this policy and how it impacts on their practice.
All staff must be aware of the risks to others as a consequence of non-compliance with this
policy.
Individual staff are responsible for accessing and complying with this policy.
4.13 Volunteers, Agency Staff, External Contractors and visitors/members of the
public
Visitors, agency staff and external contractors are expected to comply with reasonable
instructions given by staff who are seeking to protect them from risk of infection by
requesting compliance with the policy.
5. Risk assessment
See Appendix 1 (page 11) for algorithm
The patient risk assessment should be led by a senior member of the medical team
responsible for the acute care of patients, for example the admitting team consultant.
The consultant microbiologist must also be involved.
Standard precautions and good infection control are paramount to ensure staff are
not put at risk whilst the initial risk assessment is carried out. It is assumed
throughout this guidance that staff will be using standard precautions as the norm. If
these measures are not already in place, they must be introduced immediately when
dealing with a patient in whom VHF is being considered.
The patient’s VHF risk category can change depending on the patient’s symptoms
and/or the results of diagnostic tests. It is important to note that a patient with a VHF
infection can deteriorate rapidly.
Patients with a fever >38 °C are highly unlikely to have a VHF infection if:





They have not visited a VHF endemic area within 21 days of becoming ill;
They have not become unwell within 21 days of caring for or coming into
contact with the bodily fluids of / handling clinical specimens from a live or
dead individual or animal known or strongly suspected to have a VHF;
If their UK malaria screen is negative and they are subsequently afebrile for
>24 hours;
If their UK malaria screen is positive and they respond appropriately to
malaria treatment;
If they have a confirmed alternative diagnosis and are responding
appropriately.
The risk of VHF in the patient should be reassessed if a patient with a relevant
exposure history fails to improve or develops one of the following:

Nosebleed;

Bloody diarrhoea;
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
Sudden rise in aspartate transaminase (AST);

Sudden fall in platelets;
Clinical shock;
Rapidly increasing oxygen requirements in the absence of other diagnosis.
NOTE: It is recommended that, if a patient is bruised or bleeding, the lead
clinician should have an urgent discussion with the nearest High Security
Infectious Disease Unit or the local/regional Infectious Diseases Unit
concerning further management.
Infection control measures
1. A patient categorised as ‘possibility of VHF’ should be isolated in a single side
room immediately to limit contact until the possibility of VHF has been ruled
out. The side room should have dedicated en-suite facilities or at least a
dedicated commode.
Patient’s symptoms
Bruising
OR
bleeding
Staff protection
Standard plus droplet precautions required:
hand hygiene
gloves
plastic apron
fluid repellent surgical facemask
disposable visor
In addition, for potential aerosol-or
splash-inducing procedures:
FFP3 respirator or EN certified equivalent
None of the above
Standard Precautions:
hand hygiene
gloves
plastic apron
2. Potential aerosol-or splash-inducing procedures include:








Endotracheal intubation;
Bronchoscopy;
Airway suctioning;
Positive pressure ventilation via face mask;
High frequency oscillatory ventilation;
Central line insertion;
Aerosolised or nebulised medication administration;
Diagnostic sputum induction.
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3. Communication with staff about potential infection risks is paramount. Staff
must be informed about and understand the risks associated with a VHF
patient, for example:
The severity of a VHF if infection is confirmed;
That virus may be present:
 in blood;
 in body fluids, including urine;
 on contaminated instruments and equipment;
 in waste;
 on contaminated clothing
 on contaminated surfaces.
That exposure to virus may occur:
directly, through exposure (broken skin or mucous membranes) to blood and/or
body fluids during invasive, aerosolising or splash procedures;
indirectly, through exposure (broken skin or mucous membranes) to environments,
surfaces, equipment or clothing contaminated with splashes or droplets of blood or
body fluids.
6. Diagnostic investigations
All samples from patients in the ‘possibility of VHF’ category can be treated as
standard samples. Investigations required will include URGENT Malaria
investigations. Other investigations, as locally appropriate, may include urine, stool
and blood cultures, and chest x-ray (CXR). However, liaison with the local
Microbiologist/Virologist is advised, particularly if the patient has bruising or bleeding.
7. Management of a Patient Categorised as ‘HIGH POSSIBILITY OF VHF’
Immediately inform the IPC team and consultant microbiologist of the high
possibility.
Contact the IPC Team on 01226 433364 in hours 9am-5pm. Out of Hours call the
On-call microbiologist with the numbers below
Barnsley Hospital NHS Foundation Trust Consultant Microbiologist

Consultant Microbiologist,
BHNFT
Tel: 01226 730000
Calderdale, Kirklees and Wakefield In-Patients Services Microbiologist



Consultant Microbiologist
Tel: 0844 8110101
The lead clinician who is responsible for the acute care of the patient should
be a senior member of the medical team;
The patient should be isolated in a single side room immediately;
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


Enhanced infection control measures appropriate to the patient’s symptoms
and clinical care procedures should be put in place;
Carry out an urgent VHF and malaria screen, and continue local diagnostic
investigations as appropriate and with additional laboratory precautions
Commence early public health actions; If the patient’s VHF screen is positive,
arrange urgent transfer to the local HSIDU and launch full public health
actions.
Infection control measures
1. The patient should be isolated in a single side room immediately to limit contact.
The side room should have dedicated en-suite facilities or at least a dedicated
commode.
2. The number of staff in contact with the patient should be restricted.
3. The level of staff protection required is dependent on the patient’s symptoms and
is set out in the table below
Patient’s Symptoms
Staff Protection Required
Bruising
OR
bleeding
OR
uncontrolled diarrhoea
OR
uncontrolled vomiting
Enhanced Precautions required (standard
plus droplet plus respiratory protection)

Hand hygiene

Double gloves

Fluid repellent disposable gown, an allin-one disposable should be concerned
as an alternative

Disposable visor

FFP3 respirator
equivalent
or
EN
certified
Droplet precautions (standard plus droplet)
required:
 hand hygiene
 gloves
 plastic apron
 fluid repellent surgical facemask
 disposable visor.
In addition, for potential aerosol-or splashinducing procedures:
FFP3 respirator or EN certified equivalent
None of the Above
Supplies of FFP3 Masks, Disposable Gowns & Eye Protection
For location of personal protective equipment please call the IPC team in hours and
out of hours the on-call microbiologist
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8. Other Requirements
Inform the Infection Control Doctor (ICD) who, in turn, will inform the Consultant in
Public Health. Contact the Consultant in Public Health (West Yorkshire HPU 0113
3860300 or South Yorkshire HPU 0114 321 1177, out of hours for both units ask
for Public Health on-call 0114 304 9843) directly only in the unlikely event of failing
to contact the ICD first.
9. Last Offices
If the patient dies, handling of the body should be minimal. The corpse should be
placed in a sealed body bag, not embalmed, and cremated or buried promptly in a
sealed casket according to Department of Health Guidelines.
10. References
Management of Hazard Group 4 viral haemorrhagic fevers and similar human
infectious diseases of high consequence
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1194947382005
Information
High Security Infectious Disease Units
Royal Free Hampstead NHS Trust, London
Telephone (24 hrs, ask for infectious disease physician on call) +44 (0)20 7794 0500
or 0844 8480700 (local rate number when calling from outside London)
www.royalfree.nhs.uk
The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle
Telephone (24 hrs, ask for infectious disease physician on call) +44 (0)191 233 6161
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Appendix B - Equality Impact Assessment Tool
To be completed and attached to any policy document when submitted to the Executive Management
Team for consideration and approval.
Date of Assessment: 14-8-14
Equality Impact Assessment
Questions:
Evidence based Answers & Actions:
1
Name of the document that you are
Equality Impact Assessing
2
Describe the overall aim of your
document and context?
The overall aim of the policy is to provide staff with
clear and practical evidence based information on
the Management of Viral Haemorrhagic Fever
Who will benefit from this
policy/procedure/strategy?
3
Who is the overall lead for this
assessment?
4
Who else was involved in
conducting this assessment?
5
Have you involved and consulted
service users, carers, and staff in
developing this
policy/procedure/strategy?
All staff
Director of Nursing and Infection Prevention &
Control
Infection Prevention & Control Team
Yes comments incorporated into policy from IPC
team and Trust wide Clinical Policies & Procedures
Group
What did you find out and how have
you used this information?
6
What equality data have you used to
inform this equality impact
assessment?
N/A
7
What does this data say?
N/A
8
Taking into account the
information gathered above,
could this policy
/procedure/strategy affect
any of the following equality
group unfavourably:
No
N/A
8.1
Race
No
N/A
8.2
Disability
No
N/A
8.3
Gender
No
N/A
8.4
Age
No
N/A
8.5
Sexual Orientation
No
N/A
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Equality Impact Assessment
Questions:
Evidence based Answers & Actions:
8.6
Religion or Belief
No
N/A
8.7
Transgender
No
N/A
8.8
Maternity & Pregnancy
No
N/A
8.9
Marriage & Civil
No
N/A
No
N/A
partnerships
8.10
Carers*Our Trust
requirement*
9
What monitoring arrangements are
you implementing or already have in
place to ensure that this
policy/procedure/strategy:-
This policy aims to standardise the approach to
9a
Promotes equality of opportunity for
people who share the above
protected characteristics;
Yes Infection prevention and control is nondiscriminative and applies to everyone.
9b
Eliminates discrimination,
harassment and bullying for people
who share the above protected
characteristics;
Yes
9c
Promotes good relations between
different equality groups;
Yes
9d
Public Sector Equality Duty – “Due
Regard”
Have you developed an Action Plan
arising from this assessment?
Assessment/Action Plan approved
by
Yes
10
11
No
Signed: Julie Hartley Date: 14-8-14
Title: Infection Prevention & Control Nurse
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Appendix C - Checklist for the Review and Approval of Procedural Document
To be completed and attached to any policy document when submitted to EMT for consideration and
approval.
Yes/No/
Unsure
Title of document being reviewed:
1.
2.
Title
Is the title clear and unambiguous?
Yes
Is it clear whether the document is a guideline,
policy, protocol or standard?
Yes
Is it clear in the introduction whether this
document replaces or supersedes a previous
document?
Yes
Rationale
Are reasons for development of the document
stated?
3.
4.
5.
6.
Yes
Development Process
Is the method described in brief?
Yes
Are people involved in the development
identified?
Yes
Do you feel a reasonable attempt has been
made to ensure relevant expertise has been
used?
Yes
Is there evidence of consultation with
stakeholders and users?
Yes
Content
Is the objective of the document clear?
Yes
Is the target population clear and
unambiguous?
Yes
Are the intended outcomes described?
Yes
Are the statements clear and unambiguous?
Yes
Evidence Base
Is the type of evidence to support the
document identified explicitly?
Yes
Are key references cited?
Yes
Are the references cited in full?
Yes
Are supporting documents referenced?
Yes
Approval
Does the document identify which
committee/group will approve it?
Yes
If appropriate have the joint Human
Resources/staff side committee (or equivalent)
approved the document?
Yes
14
Comments
Yes/No/
Unsure
Title of document being reviewed:
7.
8.
Dissemination and Implementation
Is there an outline/plan to identify how this will
be done?
Yes
Does the plan include the necessary
training/support to ensure compliance?
Yes
Document Control
Does the document identify where it will be
held?
Have archiving arrangements for superseded
documents been addressed?
9.
10.
11.
Yes
NA new
policy
Process to Monitor Compliance and
Effectiveness
Are there measurable standards or KPIs to
support the monitoring of compliance with and
effectiveness of the document?
Yes
Is there a plan to review or audit compliance
with the document?
Yes
Review Date
Is the review date identified?
Yes
Is the frequency of review identified? If so is it
acceptable?
Yes
Overall Responsibility for the Document
Is it clear who will be responsible
implementation and review of the document?
15
Yes
Comments
Appendix D
Version Control Sheet
This sheet should provide a history of previous versions of the policy and changes made
Version
Date
Author
1
August 2014
Julie Hartley
IPCN
Status
Comment / changes
New Policy
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