SECTION FOUR
SPECIFIC INFECTIOUS
ILLNESSES
4.
SPECIFIC INFECTIOUS ILLNESSES
4.0 VIRUS INFECTIONS
NB – See Section 6 (Appendix) for additional information on Hepatitis A,
B &C and other specific infectious diseases
4.1
BLOOD-BORNE VIRUS INFECTIONS
What are blood-borne viruses and how do you get them?
Blood-borne viruses may be present in any body fluids including blood, saliva,
vaginal fluid and semen. The viruses may be transmitted by needle stick injury
or puncture of the skin by another sharp object contaminated by infected
blood or body fluids, including bite injuries. The viruses may also be spread by
drug injectors sharing infected needles or during sexual intercourse
unprotected by the use of a condom. Infection can be passed on through the
use of infected equipment used for tattooing and body-piercing. Very
occasionally, blood-borne viruses have been passed on by blood splashing
into the eyes, mouth or onto a part of the body with exposed cuts and grazes.
In a household setting, blood-borne viruses can be transmitted through the
sharing of razors and toothbrushes that have become contaminated with
infected blood. Infection can be passed on from an infected mother to her
baby during childbirth. All pregnant women are now offered a blood test during
early pregnancy to check if they are carriers of Hepatitis B or HIV infection.
Blood-borne viruses cannot be transmitted by everyday contacts such as the
use of crockery and other utensils. People who are known to have these
viruses should not be excluded from work, including food preparation, or from
socialising. Isolation is not necessary.
BLOOD-BORNE VIRUS INFECTIONS – cont.
4.1
How do we prevent the spread of blood-borne virus infections?

Standard Precautions (see Section 2.1) should be applied at all times
to all equipment and for all service users because it may not be
apparent who has a blood-borne virus infection.

The guidance in Section 2.7 on the safe handling of needles and
sharps instruments should be followed.

Although the risk of being infected whilst carrying out First Aid is small,
precautions can be taken to reduce risk. In particular:- covering cuts or
grazes on the skin with waterproof dressings; wearing disposable
gloves when dealing with blood or other body fluids; using suitable eye
protection and a disposable apron (where significant splashing is
possible) and washing hands after each procedure.

The risk of contracting a blood-borne infection through mouth-to-mouth
resuscitation is generally considered small. However, for general
hygiene reasons and added protection, resuscitation devices should be
used. Face shields should be available and used to prevent the risk of
exposure in mouth-to-mouth resuscitation, but only if staff are trained to
use them correctly.

Should a sharps injury or other possible exposure to blood-borne virus
occur, the procedures in Section 2 should be followed.

Blood specimens from people known or suspected to have a bloodborne virus infection should be submitted in plastic bags labelled
‘biohazard’ and ‘danger of blood-borne virus infection’ stickers attached
to request forms.
4.1.1 SEXUALLY TRANSMITTED INFECTIONS
What are sexually transmitted diseases and how are they caught?
Sexually transmitted infection is the name given to any infections that are
passed on to another person through sexual contact between individuals of
the same or different sex. Sexual infections are particularly common among
young people. They may be carried by an individual without any symptoms or
signs of illness. In addition, more than one infection can be carried at a time.
However, anyone with a sexual infection can pass it on to others through
sexual contact. The table 6.0.1 lists the main sexual infections and how they
are treated. Blood-borne virus infections (see Section 4.1), Pubic lice and
Scabies (see Section 4.5) can also be transmitted by sexual contact.
How are sexual infections diagnosed?
It is important that all service users know that they should have a check up if
they feel they may have been at risk of acquiring a sexual infection.
These illnesses should be diagnosed and treated promptly.

To protect the individual from the risk of complications that can occur
with these infections.

To protect others by preventing the infection from being passed on.
Any service user complaining of a penile discharge or genital ulcers should be
seen at a Genito-urinary Medicine (GUM) Clinic as a matter of urgency.
4.1.1 SEXUALLY TRANSMITTED INFECTIONS – cont.
How are sexual infections spread and prevented?
Sexual infections are usually only spread from person to person by
unprotected sexual intercourse.
Always using a condom for any sexual
contact will offer protection against catching these diseases. As long as good
personal hygiene is practised such as adequate hand washing and avoiding
the sharing of towels, there is no reason to restrict the activities of service
users in any way.
Control of infection may involve tracing sexual contacts of the affected person.
This will be done confidentially and may involve a visit by a specially trained
health adviser/contact tracer.
Single dose medications are now available for a number of the conditions.
Genital warts can be self-treated if the appropriate creams are available and
provided explicit instructions are given.
4.1.2
HEPATITIS B
Hepatitis B virus is transmitted through blood and body fluids. A puncture
injury with a needle or sharp contaminated with Hepatitis B to someone who is
not immune carries a 30% risk of infection. Hepatitis B virus can survive in the
environment for up to a week.
Who gets Hepatitis B infection?
Hepatitis B occurs throughout the world. Approximately 850 people are
diagnosed with acute infection each year in England and Wales. Only a small
proportion of those infected will become chronic carriers. Hepatitis B Infection
is more common in:

Injecting drug users; through sharing needles or equipment

Men who have sex with men

Heterosexuals who have multiple partners
What are the symptoms of Hepatitis B infection?
The usual incubation period for Hepatitis B is 60-90 days. Symptoms vary
from person to person from mild to a severe, overwhelming illness that can be
fatal. Common symptoms include:

Anorexia

Joint pains

Nausea and vomiting

Abdominal discomfort

Jaundice and dark urine
90 – 95% of those who are infected as adults recover fully, but 5-10% of
adults with acute infection become long-term carriers. Carriers may have no
symptoms but are infectious. A small number of chronic carriers may go on to
develop chronic active Hepatitis, cirrhosis or liver cancer.
4.1.2
HEPATITIS B – cont.
How can Hepatitis B be prevented and who should be vaccinated?

As well as precautions to prevent blood-borne virus infections in
general, Hepatitis B may be prevented by immunisation. Immunisation
is not routinely available to the general population, but is advised for
health care workers who due to the nature of their work are at
increased risk.

Vaccination is available from your GP for staff in high-risk jobs e.g. staff
working with people with behavioural problems where there is a risk of
service users biting and/or scratching. For this reason staff working in
Mental Health & Learning Disability Services are advised to be
immunised.

Where known Hepatitis B infected service users with behavioural
problems, such as biting and/or scratching, are being cared for, only
those staff known to have been immunised and have responded to the
immunisation should be involved in their care.

Should you wish to be immunised, please check with your GP as to
whether there will be a charge. Where there is a charge and you are
deemed to work with high risk service users, the department can repay
the costs incurred. Line Managers will then be asked to keep a note of
your immunisation date.
4.1.3
HEPATITIS C
A puncture injury with a needle or sharp contaminated with Hepatitis C carries
a 3% risk of infection. The virus does not survive for very long in the
environment.
Who gets Hepatitis C infection?
Between 0.1% and 1% of people in England and Wales have evidence of
infection with Hepatitis C with 6000 people having a positive test each year.

There is a high risk of spreading Hepatitis C when injecting drug users
share drug injecting equipment (unclean works).

It is uncommon for Hepatitis C to be transferred during unprotected
sexual intercourse but cases can occur.

It is very rare for saliva or bites to be responsible for the transmission of
Hepatitis C.
What are the symptoms of Hepatitis C?
The incubation period is approximately 6-9 weeks although it can range from
2 weeks to 6 months. Following infection with hepatitis C virus, symptoms are
usually mild with some people developing acute Hepatitis with jaundice. A
large number of people with Hepatitis C will go on to develop chronic active
hepatitis and possibly develop a very serious cirrhosis or in some people liver
cancer, although this may be after a delay of many years.
How can Hepatitis C be prevented?

The general guidance for prevention of blood-borne viruses should be
followed to reduce the risk of infection.

There is no vaccine available.

New antiviral treatment may be successful in preventing long-term
carriage and chronic liver disease in some cases.
4.1.4
HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND AIDS
The Human Immunodeficiency Virus (HIV) that causes Acquired Immuno
Deficiency Syndrome (AIDS) was formally identified in 1983. However there is
evidence that it existed in Europe and the USA in the 1950’s and possibly
much earlier.
How is HIV passed on?
HIV is an infectious disease with a transmission pattern similar to Hepatitis B,
but it is much less infectious than Hepatitis B.
A puncture injury with a needle or sharp contaminated with HIV carries a 0.3%
risk of infection. The virus does not survive for very long in the environment.
The HIV virus is not as easy to catch as many other viruses, like a cold or ‘flu.
It is NOT passed on by social contact or through kissing, coughing, sneezing,
touching, hugging, insect bites, sharing toilets, cups, plates, cutlery, swimming
pools, bedding or clothing.
The main fluids that can pass on HIV include:

Blood

Semen

Vaginal fluid

Breast Milk
4.1.4
HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND AIDS – cont.
How does HIV get inside another person’s body?

Having penetrative vaginal or anal sexual intercourse without a
condom.

Sharing any of the equipment used for injecting drugs if it has already
been used by someone with HIV.

Getting any blood infected with HIV inside the body, such as when
sharing razors, toothbrushes or the equipment used for tattooing or
body/ear piercing.

Blood transfusions if the appropriate precautions aren’t taken.

Possibly through oral sex without using a protective barrier over the
penis or vagina.

A woman to her baby during pregnancy, at birth or through breastfeeding; although the likelihood of this happening can know be
significantly reduced through medical intervention.
What are the symptoms of HIV infection?
An acute febrile illness, similar to glandular fever, may occur one to three
months after the initial infection with HIV. HIV infection damages the immune
system, which can lead to the development of a number of opportunistic
infections, various types of cancers and mental illness. Without treatment the
time period between becoming HIV positive and developing AIDS can vary
from less than a year to up to ten years. New antiviral treatments mean that
increasingly, many people remain relatively well for years after becoming HIV
positive. Deaths from AIDS declined by 70% after 1996 and have remained
constant.
4.1.4
HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND AIDS – cont.
When should you test for HIV infection?
The HIV test does not detect the HIV virus, but an antibody produced by the
body in response to the infection. It may take anything from 45 days to 3
months (and in some people longer) from the time of exposure to HIV and the
development of enough antibodies for the HIV test to become positive. During
this time, the test will be negative but the infection can still be transmitted to
other people. A positive HIV test is not a test for AIDS, nor does it predict
whether a person will get so ill that AIDS will be diagnosed.
How can HIV Transmission be prevented?

The general guidance for prevention of blood-borne viruses should be
followed to reduce the risk of infection through blood.

Using condoms for penetrative vaginal or anal sex or using barriers
over the penis or vagina for oral sex.

There is no vaccine available.

Antiviral drugs (Post Exposure Prophylaxis – PEP) begun within hours
of a significant exposure to HIV virus may prevent infection occurring.
Further detailed information, support and advice can be obtained from
GUM (Genito-Urinary Medicine) Clinics, Consultants in Infectious Diseases
at Leicester Royal Infirmary and the Consultant in Communicable Disease
Control, Leicestershire AIDS Support Service (LASS)
(See Section 5 for details)
NB Anyone diagnosed with HIV is now covered by the Disability
Discrimination Act 2005 and must not be treated less favourably in
employment or service provision
4.2
MENINGITIS AND MENNINGOCOCCAL DISEASE
What is Meningitis and how do you get it?
Meningitis means inflammation of the lining of the brain (meninges). It can be
caused by a number of viruses and bacteria. Anyone can get meningitis
although it is more common in children and young adults.

Bacterial meningitis is uncommon. It is a serious infection that needs to
be recognised and treated urgently with antibiotics to prevent severe
disability or sometimes death.

Meningococcal meningitis is the most serious form of the disease.
Sometimes this germ invades the blood stream (septicaemia) without
causing the typical symptoms of meningitis, but causing the rash as
described below. Meningococcal disease is the term used to describe
either form of the illness. The germ is usually spread by the airborne
route and requires close and prolonged contact.

Viral meningitis is generally less serious and does not need antibiotic
treatment.
What are the symptoms of Meningitis?
Meningitis usually causes a combination of some of the following symptoms.
Early symptoms:








Fever
Vomiting
Back or joint pains
Headache
Neck stiffness
Photophobia – patient finds looking at the light painful and avoids it
Confusion
Red-purple rash anywhere on the body that does not go pale under
pressure
MENINGITIS AND MENNINGOCOCCAL DISEASE – cont.
4.2
Late symptoms:



Unrousable, i.e. coma
Pale/clammy i.e. shocked
Widespread red-purple rash
What action should be taken if Meningitis is suspected?
It is important if meningitis is suspected that medical advice is obtained
immediately and an emergency ambulance called. If Meningococcal disease
is suspected, and the patient has no record of Penicillin allergy,
Benzylpenicillin should be given immediately by intravenous or intramuscular
injection if a doctor is available, while awaiting emergency ambulance
transfer.
Untreated, meningococcal disease can cause death within hours.
Notification of Meningitis or Meningococcal disease
Meningitis and meningococcal diseases are Notifiable Diseases (See Section
1.3). The Consultant in Communicable Disease Control or person on call for
Public Health should be notified by telephone (see Section 5) of cases in
service users or staff.
MENINGITIS AND MENNINGOCOCCAL DISEASE – cont.
4.2
What action should be taken following a case of Meningitis in a
community care setting?
The Consultant in Communicable Disease Control will take the following
action.

Confirm the diagnosis with the hospital

If Viral Meningitis is suspected no further action is required

If Meningococcal meningitis or disease is suspected, close contacts*
should be identified following discussion between the Health Protection
Team, the affected person, close contacts and staff.

Close contacts of meningococcal disease may be carrying the germ in
their throats and are at an increased risk of developing the disease.
They will therefore be offered antibiotic prophylaxis e.g. Ciprofloxacin
or Rifampicin. These should only be prescribed on the advice of the
Consultant in Communicable Disease Control or the person on call for
Public Health.

Advice about meningococcal disease should be given to close contacts
to raise awareness about the disease. The Health Protection Agency
will provide information leaflets for distribution to those who require
them.
MENINGITIS AND MENNINGOCOCCAL DISEASE – cont.
4.2
*Close contacts include people who have had close and prolonged contact
with the service user during the 7 days before the onset of symptoms. This will
include anyone who:

Shared a room with an infected service user overnight or for more than
8 hours

Was an intimate kissing contact

Shared eating or drinking utensils with them

Shared intravenous drug taking equipment with them

Gave mouth to mouth resuscitation to them
Other service users, staff and visitors who have not had this type of close
contact would not usually require antibiotic prophylaxis.
Isolation or exclusion is not necessary for contacts or those convalescing after
infection.
Who should be immunised against Meningitis C?
There is more than one strain of meningococcus. Meningitis C vaccination is
available to prevent the Group C strain and should be offered to:

close contacts (as defined above) of cases confirmed as having
Group C disease

all children and young people under the age of 25 years.
4.3
TUBERCULOSIS (TB)
The number of Tuberculosis cases in England has been increasing over the
last 10 years, and is still rising. Most TB in England occurs in people who live
in inner cities.
What is TB and how do you get it?
Tuberculosis (TB) is still an important infectious disease particularly in
Leicestershire. People may become infected 4 to 12 weeks after inhaling the
bacteria that spread through the air when someone who has TB of the lungs
coughs or sneezes. The initial infection may be inactivated, or it can spread
within the lungs (Pulmonary TB) and to other parts of the body (NonPulmonary TB) sometimes many years later. Pulmonary TB is infectious,
particularly when the sputum of a person has bacteria visible when examined
under a microscope (smear positive). Transmission of infection usually
requires close and prolonged contact and is more likely to occur in confined
and poorly ventilated spaces.
Anyone can get TB. The following groups are at higher risk:

Co-existing HIV infection

Ethnic groups from high prevalence countries such as Africa, South
Asia and Eastern Europe

Chronic alcohol or drug misuse

Homelessness and rough sleeping

Very socially deprived.
TUBERCULOSIS (TB) – cont.
4.3
What are the symptoms of TB?
TB often mimics other diseases and the possibility of TB is often overlooked.
The diagnosis of Pulmonary TB should be considered in anyone presenting
with typical symptoms:

Cough (often with sputum)

Haemoptysis (coughing up blood)

Chest pains

Fever and night sweats

Weight loss or loss of appetite.
TB should also be considered in anyone, particularly high-risk groups, with
prolonged unexplained fever and weight loss. Early diagnosis is important
both for treatment of the individual and to reduce the risk of spreading
infection to others.
How is TB treated?
TB is treatable, but is often fatal is left untreated. A combination of several
anti-tuberculosis drugs needs to be taken for at least six months. The drugs
have a number of side effects and people may find continuing treatment
difficult particularly when they are feeling better. If treatment is not completed,
relapse of the disease may occur and drug resistant disease may develop,
which is much more difficult to treat.
4.3
TUBERCULOSIS (TB) – cont.
Notification of TB
TB is a Notifiable Disease (See Section 1.3). Notification is important to
protect public health: support the person to comply with treatment; to trace
and screen close contacts; for surveillance and identification of possible
outbreaks. Notification should be made when TB is suspected without waiting
for laboratory confirmation.
Contacts will normally include service users who share a room or live/lived
with the affected person during the three-month period before the onset of
symptoms.
How should a service user with TB be managed?
If TB is suspected, the service user should be referred to a consultant with
expertise in the management of the disease (a consultant in respiratory
medicine or infectious diseases). This will ensure that the service user
receives appropriate investigation, treatment and care. It is important that
treatment is taken, monitored and completed.
What infection control and isolation procedures are necessary?
People with smear positive Pulmonary TB are considered very infectious.
Smear negative Pulmonary TB is less infectious, Non-Pulmonary TB is least
infectious of all. Services users, staff and visitors who have HIV infection are
most at risk of becoming infected.
4.3
TUBERCULOSIS (TB) – cont.
What infection control and isolation procedures are necessary? – cont.
A person with infectious TB who is being treated or any person with
suspected TB should be cared for in standard isolation (see Section 3) and
advice obtained from the Consultant in Communicable Disease Control and
Leicestershire Infection Control Nurses. As well as standard isolation
procedures, the use of special facemasks may be needed to prevent airborne
transmission in certain circumstances. TB should be considered noninfectious after two weeks of appropriate treatment.
If TB is suspected, sputum specimens should be submitted in plastic bags
labelled ‘biohazard’ and ‘danger of infection stickers’ attached to request
forms.
4.4
FOOD POISONING AND INFECTIOUS INTESTINAL DISEASE
What is infectious intestinal disease?
Infectious intestinal diseases (IID) usually cause symptoms of vomiting and or
diarrhoea and are caused by a wide range of viruses and bacteria or their
toxins. Much IID is acquired by eating or drinking contaminated food or water;
some is passed from person to person, or from contamination in the
environment. Sickness and diarrhoea are common symptoms and although
not always due to infection, in the enclosed environment of a communal care
setting, it is important to presume an infectious cause and institute appropriate
infection control procedures. Most episodes are short-lived and self-limiting,
caused by viruses which are airborne and can spread rapidly in a communal
care setting. It is important that service users with diarrhoea or vomiting are
isolated.
Table 6 contains details of common Infectious Intestinal Diseases (IIDs) with
notes on incubation periods, symptoms, mode of spread and period of
infectiousness.
How are infectious intestinal diseases managed?
Most people with diarrhoea and vomiting will get better by drinking plenty of
water and not eating anything for a day or two. Oral rehydration solution
should be used for more severe and persistent symptoms. Culture of stool
specimens should be considered for those with severe, bloody or prolonged
diarrhoea and from all cases during an outbreak, however mild. Antibiotic
treatment should not be used except on the advice of a microbiologist or
Consultant in Communicable Disease Control for a few specific infections.
4.4
FOOD POISONING AND INFECTIOUS INTESTINAL DISEASE – cont.
Notification and outbreaks of infectious intestinal disease
All cases of food poisoning or suspected food poisoning should be notified to
the Health Protection Agency (see Section 1 and Section 5). An outbreak
should be suspected if there are an increased number of people experiencing
similar symptoms. Guidance for the management and control of an outbreak
is given in Section 3.
What isolation and exclusion is necessary?
Service users with diarrhoea and vomiting should be isolated, with a lavatory
and wash hand basin for their personal use. Particular attention should be
given to hand washing, personal hygiene and the use of Standard
Precautions (See Section 2.1).
Service users or staff with diarrhoea or vomiting should be excluded from food
handling duties for a minimum of 48 hours after becoming symptom free.
Some specific infections may necessitate a longer period of exclusion and
evidence that the individual is not transmitting or carrying the organism.
Advice should be sought from the Consultant of Health Protection Agency for
clarification in individual situations.
4.4.1
HOW TO COLLECT A SAMPLE OF FAECES (MOTION)
Diarrhoea can be infectious, so it is important to follow the instructions
carefully.
A sample pot should be labelled with:

Surname and forename

Date of birth

Address

Date the sample is obtained
A sample of faeces (motion) is required, not urine. The lid of the sample pot lid
has an integral scoop.
If the motion is formed
A sample may be collected by sitting over the lavatory and passing the motion
on to toilet paper. The scoop is then used to transfer a small sample of motion
into the sample pot and the lid screwed on tightly.
If the motion is loose
Pass the motion in a disposable bedpan, and then transfer a small sample of
motion into the sample pot using the scoop. Screw the lid on firmly. Dispose of
the soiled bedpan into a yellow bag and treat as clinical waste (see Section 2).
Place the sample pot into the transparent plastic transport bag and seal it.
NOW WASH YOUR HANDS THOROUGHLY
WITH WARM WATER AND SOAP
4.5
HEADLICE, PUBIC LICE AND SCABIES
HEADLICE – what are they?
Headlice are small wingless parasitic insects that live and feed on the human
scalp. They can be difficult to see. Their egg cases are firmly cemented to the
hair shafts (nits).
HEADLICE – what are the symptoms and how are they caught?
Headlice are spread from person to person by direct head to head contact.
They cannot jump or fly, nor are they transmitted indirectly from the
environment. They have no preference for clean or dirty hair. Anyone can get
headlice but they are more common in children of primary school age.
Infection is usually asymptomatic, but can occur after prolonged untreated
infection.
HEADLICE – how are they treated?
Treatment involves the application of aqueous insecticidal lotion (Malathion or
Permethrin) with a second application after seven days. Treatment should
only be applied after detection of living, moving lice on the scalp. Apparent
treatment failure can be due to re-infection or resistance. Re-infection is
common, so anyone who has had close head to head contact in the preceding
month should use a narrow-toothed detection comb and be treated if living,
moving lice are detected. If resistance is suspected another insecticide may
be tried, Carbaryl being reserved as third line treatment.
4.5
HEADLICE, PUBIC LICE AND SCABIES – cont.
PUBIC LICE (CRABS)
Pubic lice are parasitic insects that live and feed on hair-bearing skin of
humans, particularly groins, axillae and eyebrows. They are spread by
intimate body contact, particularly sexual contact. Treatment involves the
application of aqueous insecticidal lotion (Malathion) to all of the body – not
just the affect part, with a second application after 7 days. Intimate contacts
should be identified and treated if lice are detected.
SCABIES – what is it?
A parasitic mite that burrows and lives under the skin of humans causes
scabies.
SCABIES – how is it caught and what are the symptoms?
Scabies is transmitted by direct skin to skin contact with someone with
Scabies, usually among family members, people who are living in close
proximity to each other, and sexual contact. A characteristic itchy rash occurs
as the result of an allergic reaction to the presence of the mite under the skin.
It may take up to 6 weeks from the beginning of the infection for this rash to
appear. This is why Scabies can spread so readily and why treatment of all
close and intimate contacts needs to be done at the same time as treatment
of the person with confirmed infection.
People who are immunosupressed such as those with HIV infection can have
a very severe form of Scabies with an atypical crusting rash that is more
difficult to treat. Atypical Scabies is extremely infectious and may be
transmitted by environmental contact with skin scales from such an individual.
HEADLICE, PUBIC LICE AND SCABIES – cont.
4.5
SCABIES – how is it treated?

Scabies treatments are effective and outbreaks of infection can be
stopped if treatment is planned carefully and appropriate lotions are
applied correctly to the right people, at the same time.

Usual lotions include:
Malathion aqueous liquid – Derbac-M
Permethrin – Lyclear dermal cream
Treatment usually consists of 2 applications of the lotion 1 week apart.
Before treating Scabies

Always confirm the diagnosis before commencing treatment.

If an outbreak is suspected, please contact the Health Protection
Agency for advice before treatment.
Planning Scabies treatment

Set a date for everyone identified as a close contact to be treated.

Make sure that everyone knows what to do and when.

Order adequate amounts of the lotion well in advance.

Issue lotion to relevant staff members (including those who will be offduty) so that they can treat themselves on the set date.

Close contacts of infected persons who have had prolonged skin to
skin contact should also be encouraged to treat themselves.
HEADLICE, PUBIC LICE AND SCABIES – cont.
4.5
On Scabies treatment day

Treatment should be applied to cool dry skin, not after a bath. The
lotion may evaporate or be absorbed too quickly into warm skin and
consequently not work properly. If a bath or shower is necessary allow
the skin time to cool before applying the lotion.

The lotion should be applied all over the body including hands, armpits,
genital area and penis, soles of feet and the head, avoiding face and
eyes etc.

Fingernails should be cut short and underneath the nails thoroughly
cleaned. The lotion should then be applied under the nails (it may be
easier to do this with a cotton bud or similar).

Lotion must be left on for the recommended time period, usually 24
hours.

Lotion must be re-applied after washing any part of the body, including
hands.

After 24 hours the lotion can be washed off. Clothing and bed linen
should be changed.
After Scabies treatment

The treatment will kill the Scabies mites but they remain in the skin and
so the rash and itching may persist for several weeks after treatment.
The presence of the rash or continued itching after treatment does not
necessarily mean the treatment has failed.

Monitoring of service users and staff should continue after treatment to
ensure that no new cases of Scabies occur.

Apparent treatment failure may be due to inadequate contact tracing or
treatment not being applied correctly or not repeated 1 week later.
4.6
MRSA (Methicillin-resistant Staphylococcus aureus)
What is MRSA?
Most staphylococci are common germs that may be harmlessly carried by
many people on their skin without causing any infection. Sometimes they may
cause infections such as Impetigo, boils or wound infections.
Some staphylococci have developed resistance to the antibiotics normally
used to treat them. These are Methicillin Resistant Staphylococcus aureus
usually known as MRSA.
Is MRSA dangerous?
Most people with MRSA do not suffer any ill effects. However, if it infects a
wound, particularly deep surgical wounds, the infection can be particularly
difficult to treat because it is resistant to most of the antibiotics used for such
infections. Such infections are more likely to occur in people who are already
unwell.
How to manage a service user with MRSA
Because MRSA can be harder to treat than other germs if it causes an
infection, good standards of basic hygiene are needed to prevent the spread,
as with all other germs.

General hygiene precautions should be carried out on a person with
MRSA as with anyone. (See Standard Precautions, Section 2).

Service users with MRSA do not normally require isolation and can join
others in communal areas. If they have a wound make sure that it is
covered with an appropriate dressing that does not leak.

Clothing and bedding of service users with MRSA can be handled as
normal linen. (See Section 2).
MRSA (Methicillin-resistant Staphylococcus aureus) – cont.
4.6
How to manage a service user with MRSA – cont.

Care staff should carry out any clinical activity on other service users
first before attending the service user with MRSA.

Care staff with eczema or psoriasis should ensure that lesions are
covered with a waterproof dressing. If this is not possible they should
seek medical advice before providing personal care to this service
user.
4.7
INFLUENZA OR ‘FLU
What is influenza and how is it caught?
Influenza is a viral infection, causing an acute illness of the respiratory tract.
Typical symptoms include malaise, fever, headache, myalgia (aching
muscles), sore throat and cough.
Influenza is usually self-limiting, lasting up to a week. Serious disease and
complications such as Bronchitis and Pneumonia can occur and are more
likely in the elderly and those with underlying diseases such as heart disease
and respiratory problems. Infections follow a cyclical pattern with a peak
during the winter months.
Influenza is spread by the respiratory route when an infected person talks,
coughs or sneezes and also hand to face contact - if hands are contaminated.
It has an incubation period of 1-4 days: typically 2-3 days.
People are most infectious soon after they develop symptoms though they
continue to shed the virus up to 5 days after the onset of symptoms (7 days in
children). Some studies have shown that people can be infected without
showing symptoms and, as they may shed the virus, be able to pass on the
infection. The influenza virus may survive on hard non-porous surfaces for up
to 72 hours and can be recovered from soft porous items for up to 24 hours.
Studies have also shown that careful hand washing, commercially available
alcohol hand disinfectant and domestic cleaning products can easily de-active
the virus.
There are 3 main types of influenza virus: A, B and C, each with a number of
subtypes. Types A and B are the most common. Influenza viruses undergo
gradual progressive mutation (change) from one season to the next.
Periodically major changes occur which result in the emergence of new
epidemic sub-types. These can spread very rapidly as populations may have
little immunity to them.
INFLUENZA OR ‘FLU – cont.
4.7
How should influenza be managed?
Most people with ‘flu need no special treatment. Usual advice includes rest,
Paracetamol to reduce fever and plenty of fluids to drink. In a communal
setting people with acute symptoms should ideally be kept in isolation. Antiviral drugs may be indicated for vulnerable close contacts of cases or more
widely if there is an outbreak in an institution. Contact the Consultant in
Communicable Disease Control if an outbreak of influenza is suspected
(Sections 3 and Section 5).
Influenza vaccination
Influenza vaccination is prepared each year using strains considered to be
most likely to be circulating in the winter. The Department of Health
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPol
icyAndGuidance/DH_129872 recommends annual influenza vaccination each
autumn before the start of the influenza season for the following groups:

Chronic respiratory disease (including asthma)

Chronic heart disease

Diabetes mellitus

Chronic renal failure

Immunosupression due to treatment or disease, including those without
a functioning spleen

People aged 65 years or over

People in nursing and residential homes and other long-stay facilities

Front-line healthcare staff e.g. nurses
4.7
INFLUENZA OR ‘FLU – cont.
What is an Influenza Pandemic?
Influenza Pandemics occur in cycles. There have been 3 in the last century.
Around 25% or more of the population can suffer clinical symptoms (fever,
cough, rapid onset). The infection could be more serious than seasonal ‘flu
and because of this there is a greater risk of death for people of every age.
The spread of any newly emerging ‘flu virus to pandemic level is incremental
and would probably take around a month to build up from a few, to around a
thousand cases, then perhaps take only 2/4 weeks to spread from Asia to the
UK. Once in the country the disease would be expected to spread to all major
UK centres of population within 1-2 weeks. A pandemic ‘flu outbreak could not
be contained in the UK because of the large number of seed cases that would
be expected.
Most pandemics last for a period of approximately 15 weeks with the peak
coming around the 7/8th week. It is thought there will be a ‘flu pandemic in the
foreseeable future but we do not know when and we do not know what form
the virus will take or its impact. If it does come it could spread very quickly,
which is why we need to be prepared by contingency planning.
What is Prophylaxis?
Prophylaxis – a drug, procedure or piece of equipment used to prevent
disease. The process of prevention is called prophylaxis.
4.7
INFLUENZA OR ‘FLU – cont.
What are Interventions?
1. Antivirals prevent the ‘flu virus from reproducing and are used for
treatment or prophylaxis – they can shorten the illness by 1 day and
reduce hospitalisations by an estimated 50% in the case of seasonal
‘flu. Antivirals do not prevent infection, but they can reduce the severity
of the disease. If all those with symptoms are treated with antivirals it
could possibly reduce the overall attack rate by reducing transmission.
2. Vaccines the ordinary seasonal ‘flu jab protects against ordinary
seasonal ‘flu. It offers no protection against any new emerging ‘flu
strains. A sample of any new virus is required before the process of
vaccine production can take place. Vaccines may be 70-80% effective,
however first supplies could take up to 4-6 months to produce after the
initial outbreak.
3. Antibiotics (may be used to treat complications in high risk groups).
4. Health care equipment (respirators, gloves and other personal
protective equipment - PPE).
5. Hygiene Measures (Standard Infection Control Practices, Hand
Hygiene, Respiratory Etiquette).
4.7
INFLUENZA OR ‘FLU – cont.
What is Respiratory Etiquette?
“If someone coughs in your face and you breathe it in there’s probably
quite a high chance of transmission of cold or ‘flu”.
Charles Penn, Professor in microbiology
The spray from a sneeze can travel at 80mph and droplets can land 10
metres away. Just one sneeze can project 100,000 ‘flu germs into the air.
“Coughs and Sneezes Spread Diseases”, was the old campaign message
from the 1942 Ministry of Health. Coughs and sneezes always have spread
diseases, especially colds and ‘flu and they still do! Examples of diseases that
can spread this way include Influenza, Bacterial meningitis, Whooping cough,
SARS, Measles and Chickenpox.
Respiratory etiquette and hand hygiene are important for EVERYONE,
especially in health care settings, AT ALL TIMES. Hand washing is a vitally
important part of respiratory etiquette. When you are coming indoors think
about where your hands have been.
During the cough, cold and ‘flu season, there are some simple tips that will
keep respiratory infections from spreading. The spread of ‘flu germs can be
stopped by practising respiratory etiquette – good health manners – such as
covering your nose and mouth every time you sneeze, cough or blow your
nose, putting used tissues in the waste bins and washing your hands well and
often; whenever you or someone you are close to is sick.
INFLUENZA OR ‘FLU – cont.
4.7
Respiratory Etiquette – Simple Precautions for Healthy People
These simple actions can prevent the spread of the viruses and bacteria that
are passed from person-to-person in the tiny droplets of moisture that come
out of the nose or mouth of an infected person when they cough, sneeze or
talk. Respiratory etiquette should be promoted as a method to contain
respiratory viruses and to limit spread of influenza. The following are simple
precautions that healthy people can take to prevent catching germs:-

Avoid touching your eyes, nose or mouth. ‘Flu germs enter through the
nose, mouth and eyes.

Don’t share food, utensils, beverage containers, lipstick, cigarettes or
anything else that might be contaminated with respiratory germs.

If possible avoid close contact with people who are sick.

When coughing or sneezing cover the nose/mouth, (ideally with a
tissue).

Use tissues to contain respiratory secretions and after use dispose of
them in a bag or at the nearest waste receptacle.

If no tissues are available, cough or sneeze into your sleeve not your
hands.

After having contact with respiratory secretions and contaminated
objects/materials, wash hands frequently with soap and water or clean
them with an alcohol based hand sanitizer.
4.7.1 ‘FLU ADVICE SHEET
‘FLU ADVICE SHEET - DO’S & DON’Ts
DO’S









DO wash your hands. Frequent hand washing with soap and hot water is the
single most effective thing we can all do to reduce the transmission of ‘flu
DO avoid touching eyes, nose and mouth and ensure children understand
and follow these instructions.
DO use disposable tissues at all times and dispose of used tissues promptly
– carefully bag and bin them.
DO frequently clean hard surfaces (e.g. kitchen surfaces, door handles, etc)
using a normal cleaning product, in order to prevent picking up the virus from
surfaces and passing it on.
DO take up the offer of vaccination if you are considered to be in a high risk
group.
DO – Anti-virals DO help reduce the symptoms and length of illness but they
DO NOT stop a person passing on the illness.
DO – if you contract ‘flu DO rest and drink plenty of fluids and take
analgesics – Paracetamol for all ages. (Aspirin is not suitable for under 16’s)
DO stay at home if you are ill. It will speed your recovery and limit the spread
of the ‘flu virus.
DO seek medical advice if symptoms continue after a week or become
severe.
DON’Ts


DO NOT forget to wash your hands. ‘Flu sufferers can be infective for up to
24 hours before symptoms show.
DO NOT spread the virus to others. The infection period varies but you can
pass on ‘flu for around 2-3 days after appearance of the first symptoms.

DO NOT use cloth handkerchiefs.

DO NOT leave used tissues lying around.






DO NOT let viruses survive in the environment. The ‘flu virus (and some
bacteria) can survive for up to 72 hours on hard surfaces for example tables,
radiators and washing bowls – and up to 24 hours on soft porous items, such
as linen handkerchiefs, magazines etc.
DOES NOT – Emerging new ‘flu strains DO NOT necessarily affect the same
group of people as ordinary seasonal ‘flu.
DO NOT rely on last year’s ‘flu vaccine, it will not work on this year’s ‘flu virus
because viruses are living organisms that mutate and change.
DO NOT return to work until you are well. In particular with any newly
emerging ‘flu viruses which may spread very quickly because the population
does not have immunity to it.
DO NOT – Anti-viral drugs DO NOT work unless administered very quickly
after symptoms appear (within 12 hours of symptoms appearing).
DO NOT – Anti-virals and vaccinations DO NOT offer total guaranteed
immunity to ‘flu.
4.7.1
‘FLU ADVICE SHEET – cont.
Vaccination – Who needs a ‘flu vaccination?
In August each year a letter from the Chief Medical Officer (CMO) and the Chief Nursing Officer is sent to all Doctors in England
reminding them of the need for patients in certain risk groups to be offered annual influenza vaccination. (See NHS Direct web site
for up to date details). The CMO’s usual advice is that you need a ‘flu vaccination if you have:
1.
2.
3.
4.
5.
A chronic heart or chest complaint including asthma
Chronic kidney disease
Diabetes
Lowered immunity due to disease or treatment such as steroid medication or cancer treatment
Any other serious medical condition – check with your Doctor if you are unsure.
This applies whatever your age. If in doubt ask your Doctor.
Vaccination is also recommended for anyone aged 65 years or more, and for people living in places such as residential homes for
elderly persons and nursing homes where there is a high risk of ‘flu spreading quickly.
In addition, it is recommended that immunisation should be offered to all health care workers involved in the delivery of care and/or
support to patients. Social care services employers have also been asked to consider offering immunisation to all staff involved in
the delivery of care and/or support to clients.
In the event of a newly emerging ‘flu virus leading to a Pandemic, detailed medical advice regarding vaccinations, antivirals and other infection control treatments and procedures will be circulated to the public via the proper authorities.