Scope of Service

• To provide individualized nursing care to patients with infectious diseases
• To provide critical care and other nursing procedures for patients complicated with infectious diseases
• To organize training for nursing and other staff in areas of infection control and infectious diseases
• To provide support in managing infectious disease outbreaks as first responder
  

Ward Duty

• All nurses are required to report to the WM when first deployed to work in IDC
• Information on the leave balance and PH, CO status should be provided to the WM before arrival
• Immunization status is provided to the WM on chickenpox, MMR, HBV
• All nurses are subject to rotation within IDC and to other wards as designated by WM / DOM
• All nurses are to follow the infection control guidelines while working in IDC
• All nurses shall be familiar with all the infectious diseases and their reporting procedures, clinical management and nursing care
• Nurses are required to provide contact information after working hours
  

Duty Hours

• Morning Shift 7:00 am to 2:20 pm Meal Break – 45 minutes
• Afternoon Shift 2:20 pm to 9:20 pm Meal Break – 45 minutes
• Night Shift 9:20 pm to 7:20 am Meal Break – 60 minutes
• Day Shift 9:00 am to 5:00 pm Meal Break – 45 minutes

For Emergency Level – duty hours would be adjusted according to the scale of the outbreak

 

Nurse In-Charge

• Reinforce infection control practice
• Co-ordinates care activities
• Assign job duties and patient allocation as appropriate to the workload and patient care needs
• Supervise nurses and care workers to ensure safety
• Review nurse’ documentation against patient / families’ needs
• Offer assistance to team members
• Assign new admission according to mode of transmission and level of care

Documentation

• Patient labels and medical records are generated in the ID ward with information from Admission Office
• Focus charting is employed for timely and accurate documentation of infectious status
• Electronic notification using “NDORS” in normal period and “eflu” systems at emergency level
• All patient records should kept in nurses station and not to be taken into isolation areas
• Should paper record be necessary in patient area, it should be kept to the minimal. Such papers should be put in clear plastic bags for 14 days before returning to HIRD in a complete set of record

Focus areas:

• diagnosis and treatment of ID patients
• personal care, early recognition and intervention to complications
• education of patients, caregivers, and other staff members taking care of the ID patients
• prevention of the spread of infections

Admission

• Patients are received with adequate precautions
• For children <12 years – parents / care giver should be screened of suspected ID
• For adolescent (10-18 years) – attend to the developmental need such as privacy and mixed ward setting
• For patients with critical condition, such as multi-organ failure and other complications, get ICU ready

Assignment

• Single room isolation for all cohort cases with unconfirmed infection
• Double room only allowed for the same disease nature
• Each patient is assigned with a primary nurse and a primary doctor

Information to Family / Caregivers

1. Information of the infection, precautions to be taken at home and in public areas
2. For adults – advice on self care, treatment, personal hygiene and visiting arrangement
3. For children – advice on child care, special arrangement to address parental needs

Assessment

• Patients are assessed in the isolation room with adequate and appropriate transmission precautions
• Individualized equipment should be used as far as possible
• Obtain detailed history on working and traveling, activities, contacts and cluster of infections
• Conduct careful physical assessment on vital signs and symptoms of suspected ID
• Identify risk of other opportunistic infections and complications
• Identify barriers to treatment compliance and means to reduce risk of spread of the infections
• Disease specific incubation and latent period has to be accounted for cohorting purpose

Care Plan

• Develop individualized care plan to address the specific problems and isolation precautions
• Patient should be informed and involved in the care plan to ensure compliance
• Initial and timely review of care plan during the entire stay by the primary nurse to ensure continuity of care

Principles of Patient Care

• All nursing procedures should be planned, organized and grouped to minimize unnecessary exposures
• All necessary equipment should be made ready before entering the patient area
• Should misses occur, get assistance and pass the necessity through the hatch
• Appropriate use of disposable items to reduce chance of transmission
• Special attention to disposal of contaminated items, wastes, and linen
• For high risk procedures, such as bronchoscopy, intubation, CPR, NPA or similar procedures, prior checking of room negative pressure, appropriate PPE and sufficient manpower is required

Patient Education

• Pamphlet of the infectious disease is given to patient and relatives upon admission
• Special instructions on the mode of transmission and isolation precaution are given
• Information on hand hygiene is provided with demonstration
• Educate patient to avoid spread of infection or contaminate the environment
• Orientation of the ward, room and facilities is given to the patient and relatives
• In case tele-visiting is to be used, clear instruction is to be given to ensure understanding
• Counseling is indicated to ensure drug compliance to minimise drug-resistant infections

Discharge Planning

• In general, the patient discharged from IDC should not be infectious and the discharge planning should focus on continuity of care and in the transition to home care setting
• In cases of novel infections, such as HIV, Hepatitis or other emerging infections, infectious risk to others is not able to be ruled out. Special discharge planning to address the risk is then indicated including educating the patient of ways to prevent the transmission of their disease
• Related to novel infections, the vulnerable group inclusive of aged, children below age of 4 or other immuno-compromised patients, special attention to prevent further attack by opportunistic infection on their discharge is warranted
  Psychosocial Care
  
• Attend to patient needs including physical, psychological, social and spiritual needs
• Show respect to patient privacy, protect patient from unnecessary exposure or embarrassment
• Arrange communication means internally with staff and externally with friends and relatives
• Organize TV and other means to keep patient connected with the society
• Seek every opportunity to communicate with patient while performing care
• Involve patient and family members in planning and reviewing their own care

Supervision of Support Workers

• Ensure all supporting staff are provided with infection control training
• Give clear instructions on hand hygiene, use of PPE and handling of waste
• Monitor closely of the daily practices and reinforce the isolation precaution and infection control practices
• Work together and supervise in direct patient care such as feeding, bathing, turning, transfer