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Trigger response strategies

Environmental cleaning

Processes and equipment

  • Monitor and review cleaning practices and the standard of environmental cleaning - consider quality and frequency of decontamination.
  • Depending on the organism and the extent of the situation, consider cleaning all areas of the ward/unit using an appropriate one step cleaning product that contains neutral detergent and 1000 ppm available chlorine.
  • Provide appropriate cleaning equipment-including mops with detachable heads, laundered or single  - use cloths, and vacuums fitted with appropriate filters should be available.
  • Complete a thorough discharge room clean (including transmission based contact precautions) when the patient has their accommodation changed or is discharged from a room.
  • Consider increasing the frequency environmental cleaning if patients are experiencing diarrhoea of likely infectious origin.
  • Floors are not a significant source of transmission of organisms and do not require special cleaning procedures. However they should be cleaned, and mop heads must be changed and bucket emptied and cleaned after each room.
  • For a trigger situation, follow the Discharge clean process (PDF, 187KB)


  • Ensure that all staff know whose role it is to clean the environment, high touch surfaces and patient equipment.
  • Ensure that cleaning staff are aware of items and surfaces that require specific attention such as high touch surfaces and bathrooms.
  • Consider implementing specialised cleaning teams.

Cleaning resources:

All facilities should also have cleaning services policies, standards and operational guidelines for staff to refer to. Search your intranet or follow up with the appropriate unit in your facility or HHS.

Monitoring, reporting and review

  • Review local significant organism surveillance to determine potential triggers.
  • Record the number of confirmed or suspected patients daily (at least) and more frequently if the situation changes. If staff are infected (e.g. CDI) this should also be recorded.
  • Investigate each new case of the organism in the ward/unit.
  • Keep a log of patients who were within the environment of an infected patient - before they were isolated.
  • Consider extending precautions to patients who have moved to another ward/unit after being in an area that is in a trigger response situation. Monitor them for relevant symptoms (e.g. diarrhoea if exposed to CDI).

You may find you need to escalate the trigger response, and move to outbreak management strategies. Manage this decision by continual assessment of the situation. The HHS risk management matrix is a useful tool to help make this call.

Following the resolution of the situation undertake a review to determine if practices could be improved to prevent such occurrences in the future. Include assessment of patients and their management, infection control and antimicrobial prescribing to establish the cause.

Monitoring, reporting and review resources:


You will need to consult with a multi-disciplinary group, including Hospital and Health Service Executive representation, through the incident. This group should meet regularly to assess the situation and review situation reports. You should also:

  • Escalate the situation to the Hospital and Health Service (HHS) Chief Executive and the Department of Health (e.g. Director General, Chief Health Officer) as required.
  • Seek the expert advice of an infectious diseases physician.
  • Determine if additional assistance is required. Contact the Communicable Diseases Unit. phone: (07) 3328 9755; email:
  • Update stakeholders regularly
  • Communicate trigger management strategies to all staff, including volunteers, that enter the ward/unit for any purpose


Another aspect of your communication strategy is to advise key groups that may be affected by the trigger response about the situation, this would include:

  • all patients in the ward/unit and their visitors so they can assist in minimising transmission.
  • the laboratory
  • all wards/units and departments that are likely to receive or treat patients from the affected ward/unit
  • facilities receiving patients from the affected ward/unit
  • antimicrobial stewardship team. They also need details about the trigger organisms.

Communication resources

Isolation/ward closures

The appropriate transmission based precautions should be implemented and communicated. This could include:

  • Reviewing bed/room allocation and deciding isolation or cohorting
  • Keeping patients under transmission-based contact precautions until cleared of their organism.

If the patient has recurrent CDI,consider leaving the patient in a single room even after resolution of symptoms to minimise the risk of transmission.

If all control measures are in place and new cases of the trigger organism continue to be detected, the facility may want to consider closing the affected ward/unit to admissions until there are no new cases.

Isolation resources

Hand hygiene

  • Remind staff about hand hygiene, especially after having contact with the patient and their surroundings-in accordance with the Five Moments for Hand Hygiene.
  • Encourage patient hand hygiene.
  • Check hand hygiene auditing data for the affected ward/unit to ensure ward compliance is acceptable. Consider further education specific to hand hygiene if not adequate.
  • Increase auditing - active observation can increase hand hygiene compliance.
  • Audit the availability of hand hygiene product for staff and patients.

Hand hygiene resources:

Managing transmission risks for staff and visitors

Cohorted patients should be managed by designated staff, where possible, to minimise the risk of infection of other patients.

You should also minimise the use of bank or agency staff and assign them to areas where there are no cases.

Staff who have diarrhoea should not work, and if CDI is confirmed, should not return to work until treatment is completed and symptoms (i.e. diarrhoea) have been absent for at least 48 hours.

Depending on the size of the situation facilities should consider restricting the number of visitors.

Ensure educational material on the trigger organism is available in the ward/unit.


Education sessions should be arranged for all staff who work in the ward/unit. These should reinforce all infection prevention and control measures for staff including routine practices, transmission based precautions, hand hygiene, and cleaning practices.

Information on the organism and preventative strategies should be readily available for all staff on all shifts.

Patients and visitors should be provided with educational material about the organism.

Resources - staff


CDI-specific response strategies

  • Ribotyping-consider ribotyping CDI specimens during this phase to determine if the strains are the same and/or if a hypervirulent strain is present.
  • antibiotic management-arrange a medical review of all CDI patients, review and cease all antimicrobial treatment as soon as possible. Treatment of CDI should be initiated based on assessment of symptoms and severity of disease while taking into account individual risk factors of the patient. Read more about Antibiotic stewardship in Australian Hospitals, 2011 (PDF, 7.1MB)
  • bed movements - only transfer patients with CDI to other wards when it is considered medically necessary.

Read more about managing CDI infections (PDF, 134KB)

Last updated: 9 May 2016