Infectious Diseases - Appendix of Additional Information
SECTION SIX
APPENDICES: DETAILED
INFORMATION ABOUT SPECIFIC
CONDITIONS AND HEALTH
CARE INCLUDING TABLES
Contents
TABLE OF DISEASES ......................................................................... 4
SEXUALLY TRANSMITTED DISEASES .................................................... 11
How soon can someone return to school/work? .................................................. 16
How soon should a child be back at school after Impetigo? ............................... 23
MRSA (Methicillin-resistant Staphylococcus aureus) .................... 24
What care will a resident with MRSA need? – cont. ............................................. 26
Will any treatment, screening or other precautions be necessary? ................... 28
CLOSTRIDIUM DIFFICILE ................................................................. 29
What are the symptoms of Clostridium difficile infection? ................................. 29
How do doctors diagnose Clostridium difficile infection? .................................. 30
What should I do to prevent the spread of Clostridium difficile to others? ....... 31
How can hospitals prevent the spread of Clostridium difficile? ......................... 31
Has a new type of Clostridium difficile infection been detected? ....................... 32
GOOD PRACTICE GUIDANCE – PREVENTING OCCUPATIONAL
DERMATITIS ...................................................................................... 34
CARE OF URINARY CATHETERS .................................................... 39
PACEMAKERS AND DEFIBRILLATORS (ICDs) .............................. 41
Will electrical devices and household appliances affect a pacemaker? ............ 42
6.0 TABLE OF DISEASES
Disease or causative organism
Mode of transmission
Diarrhoeal illness
(undiagnosed)
Hand to mouth
Food
Airborne
Campylobacter spp. Food
Hand to mouth
Pet faeces
Clostridium difficile Hand to mouth
Environmental
Contamination
Cryptosporidium spp.
Water
Hand to mouth
Giardia lamblia
Viral gastroenteritis
(undiagnosed)
Water
Hand to mouth
Hand to mouth
Droplet
Period of infectivity
Infection Control precautions
Treatment of linen
GASTROENTERITIS (DIARRHOEA AND VOMITING)
Depends on organism but usually until 48 hours after diarrhoea has stopped
Single room
Separate toilet
Treat as infected
While diarrhoea persists
While diarrhoea persists
While diarrhoea persists
Until treated
Variable. May be several days after symptoms resolve
Single room if incontinent
Separate toilet
Single room
Separate toilet
Single room
Separate toilet
Single room if incontinent
Single room
Separate toilet
Treat as infected
Treat as infected
Treat as infected
Treat as infected
Treat as infected
Notes Notify CCDC
Food-borne infections can be preformed toxin mediated or an infection. Incubation is a few hours for the former, and up to 24 hours for the latter
All pets in contact with service users should be examined by a vet
Follows treatment with antibiotics.
Likely to cause outbreaks
If more than 2 cases occur
Yes (as potential food poisoning)
Yes
Yes
Yes
Very likely to cause outbreaks
If more than 2 cases occur
6.0 TABLE OF DISEASES – cont.
Disease or causative organism
Mode of transmission
Period of infectivity
Infection Control precautions
Treatment of linen
GASTROENTERITIS (DIARRHOEA AND VOMITING)
Up to 48 hours after symptoms resolve
Single room
Separate toilet
Treat as infected Norovirus is the name for a group of viruses which are also known as “winter vomiting viruses
” or “SRSV” small round structured viruses)
Rotavirus
Hand to mouth
Droplet
Escherichia coli including Verotoxin producing E.coli
(VTEC O157)
Hand to mouth
Droplet
Food
Hand to mouth
Salmonella spp. Food
Hand to mouth
Up to 48 hours after symptoms resolve
Variable, but unlikely to infect others by 48 hours after diarrhoea stops unless poor hygiene/incontinent
Single room
Separate toilet
Single room until 48 hours after diarrhoea stops
Separate toilet
Treat as infected
Treat as infected
Variable, but unlikely to infect others by 48 hours after diarrhoea stops unless poor hygiene/incontinent
Single room until 48 hours after diarrhoea stops
Separate toilet
Treat as infected
Shigella spp.
Bacillus cereus food poisoning
Hand to mouth
Water or food contaminated by infected water
Food (preformed toxin)
Variable, but unlikely to infect others by 48 hours after diarrhoea stops unless poor hygiene/incontinent
Single room until 48 hours after diarrhoea stops
Separate toilet
Treat as infected
Not infectious None
Notes
Very likely to cause outbreaks
Very likely to cause outbreaks
Retain food samples.
Complications include haemolytic uraemic syndrome
Retain food samples. Organism can be carried in stools for weeks or months after infection
Very likely to cause outbreaks.
Complications include haemolytic uraemic syndrome
Notify CCDC
Yes
Yes
Yes
Yes
Yes
No special treatment Retain food samples Yes
6.0 TABLE OF DISEASES – cont.
Disease or causative organism
Mode of transmission
Clostridial food poisoning
(C. perfringens)
Staphylococcal food poisoning
Influenza or influenzalike illness
Food
Food (preformed toxin)
Droplet
Environmental
Contamination
Period of infectivity
Infection Control precautions
Treatment of linen
Notes
GASTROENTERITIS (DIARRHOEA AND VOMITING)
Not infectious
Not infectious
None
None
No special treatment Toxin formed in gut after ingestion
Retain food samples
No special treatment Retain food samples.
Food contamination from infected fingers, eyes etc of food handlers likely
RESPIRATORY (CHEST) INFECTIONS
While symptomatic Single room No special treatment Immunisation
( see section 4.7
)
Pulmonary tuberculosis
Airborne if ‘open’ case
(sputum smear positive). Otherwise not infectious
Normally 2 weeks after starting treatment
Single room if sputum smear positive
Treat as infected CCDC will advise on the management of contacts (residents and staff)
Notify CCDC
Yes
Yes
If influenza is confirmed by laboratory. Otherwise if more than 2 cases suspected
Yes
Cold sore (herpes simplex)
Shingles (herpes zoster)
Direct contact with lesions
Until lesions crusted
Usually reactivation
(of chickenpox). Direct contact with rash.
Airborne
Until lesions crusted
SKIN INFECTIONS
Use gloves for handling lesions, feeding or mouth care
Should sleep in single room but may mix with other service users during the day if rash can be covered
No special precautions
Treat as infected
No
Staff and service users should not be in contact unless immune to chickenpox
If management of case poses difficulties
6.0 TABLE OF DISEASES – cont.
Disease or causative organism
Mode of transmission
Impetigo
(staphylococcal)
Fleas
Head lice
Body lice
Pin worms and threadworms
Scabies
Direct contact with lesions
From pets
Person to person
Person to person
Person to person
Hand to mouth
Person to person
(close contact)
Period of infectivity
Until crusted over
Until treated
Until treated
Until treated
Until treated
Until treated
Infection Control precautions
Treatment of linen
Notes Notify CCDC
SKIN INFECTIONS
Single room until 48 hours after treatment started. Cover lesions if mixing with other residents
If new resident, single room until treated
Treat pets
Launder service users clothing and bedding
Combing egg cases
(nits) and live lice from hair
If new service user, single room until treated
Launder resident’s clothing and bedding
Personal hygiene including hand hygiene
Treat as infected
No special precautions but may be desirable to wash separately from other laundry
No special precautions but may be desirable to wash separately from other laundry
Avoid aerosols during bed making
The bacterium may be carried in the nose of infected person
(staff/service users)
No special precautions Vacuum room of infected person daily for several days, with particular attention to pest resting sites
No special precautions
Vacuum room of infected person daily for several days
If more than 2 cases suspected
No
No
No
If more than 2 cases suspected
Single room until 24 hours after treatment
Launder service user’s clothing & bedding
No special precautions but may be desirable to wash separately from other laundry
Untreated or the immuno-suppressed may develop a more severe form of scabies. In this case it may be necessary to treat other service users, staff & family members
If more than 2 related cases suspected
6.0 TABLE OF DISEASES – cont.
Disease or causative organism
Mode of transmission
HIV / AIDS
Hepatitis B
Hepatitis C
Contact with infected blood or other body fluids
Sexual transmission
Contact with infected blood or other body fluids
Sexual transmission
Contact with infected blood or other body fluids
Chickenpox (varicella) Airborne
Contact with rash
Period of infectivity
Infection Control precautions
Treatment of linen
BLOOD – BORNE INFECTIONS
For life
Variable, but can be for life
Standard precautions, including care with sharps ( see section
2.8
) and body fluids
Strict application of standard precautions, including care with sharps ( see section
2.8
) and body fluids
Standard precautions including care with sharps ( see section
2.8
) and body fluids
Treat as infected if contaminated with blood or blood-stained body fluids
Treat as infected if contaminated with blood or blood-stained body fluids
For one or more weeks prior to onset of the first symptoms: may persist in most persons indefinitely.
May be infectious for life
Treat as infected if contaminated with blood or blood-stained body fluids
OTHER INFECTIOUS DISEASES
Infectious for 1-2 days before the onset of symptoms and 6 days after rash appears or until lesions are crusted (if longer)
Single room Treat as infected
Whooping cough
(pertussis)
Droplet 5 days after start of antibiotic treatment
Single room Treat as infected
Notes
Service user’s GP, consultant and the
CCDC will collaborate with management
Immunisation of some staff may be recommended ( see section 4.1.1
)
Pregnant staff and visitors who are not immune should avoid contact. CCDC will advise on the management of contacts
CCDC will advise on the management of contacts
No
Notify CCDC
Yes
– for acute infection (jaundice)
No
– for chronic carrier state
Yes – for acute infection (jaundice)
No
– for chronic carrier state
Yes
Yes
6.0 TABLE OF DISEASES – cont.
Disease or causative organism
Mode of transmission
Measles (rubella)
German measles
(rubella)
Mumps
Conjunctivitis
Airborne
Droplet
Droplet
Direct contact with the discharge
Period of infectivity
Infection Control precautions
Treatment of linen
Incubation period is approximately 10 days from exposure to onset of fever and, usually, 14 days before the rash appears. The person is infectious from 3 days before the rash onset and 4 days after rash appearance
Incubation period of rubella may last for
14-17 days.
Individuals are infectious from about
1 week before and at least 4 days after the onset of the rash
Incubation period 15-
18 days after exposure. Greatest infectivity is from 2 days before the onset of symptoms to 4 days after symptoms appear
Until 48 hours after treatment
Single room
Single room
Single room
Treat as infected
Treat as infected
Treat as infected
Gloves/no touch technique when dealing with discharge.
Personal hygiene/hand hygiene
Consider need to treat as infected
Notes
CCDC will advise on the management of contacts
Pregnant staff and visitors who are not immune should avoid contact. CCDC will advise on the management of contacts
CCDC will advise on the management of contacts
Notify CCDC
Yes
Yes
Yes
If 2 or more related cases are suspected
6.0 TABLE OF DISEASES – cont.
Disease or causative organism
Mode of transmission
Hepatitis A
Infectious mononucleosis
(glandular fever)
Hand to mouth
Food
Contact with saliva
Period of infectivity
Infection Control precautions
Treatment of linen
Notes
OTHER INFECTIOUS DISEASES
The incubation period is 15-50 days, average 28-30 days.
Maximum infectivity occurs during the latter half of the incubation period and continues until 7 days after jaundice appears
Variable – may be several weeks
Single room
Separate toilet
Care with articles soiled with nasal or throat discharges
Encourage hand hygiene
Treat as infected
No special treatment
May be asymptomatic but can be severe and prolonged in elderly people.
No carrier state
Notify CCDC
Yes
No
6.0.1 SEXUALLY TRANSMITTED DISEASES
What are the symptoms?
What complications can happen?
Gonorrhoea Discharge from Urethra
(penis)
How is it treated? How common is it in young people?
Antibiotics Common
Are there any restrictions on work
/ location?
None
Chlamydia
Non-specific urethritis
(NSU)
Herpes
Genital warts
Discharge from Urethra
(penis)
Discharge from Urethra
(penis)
Painful genital ulcers
Development of ‘warty’ spots
Epididymitis
(swollen painful testicles)
Epididymitis
(swollen painful testicles)
Epididymitis
(swollen painful testicles)
May recur
May recur
Antibiotics
Antibiotics
Very common
Very common
Aciclovir or similar tablets Commonest cause of genital ulcers
Very common
None
None
None
None
Syphilis Solitary painless genital ulcers
Serious heart and nervous disease if untreated
Local application of
Podophyllin paint,
Warticon cream, liquid
Nitrogen, Trichloroacetic acid or a combination
Antibiotics Very rare None
6.1 TETANUS
What is Tetanus?
Tetanus, commonly called lockjaw, is a bacterial disease that affects the nervous system. It is contracted through a cut or wound that becomes contaminated with Tetanus bacteria. The bacteria can get in through even a tiny pinprick or scratch, but deep puncture wounds or cuts like those made by nails or knives are especially susceptible to such infection. Tetanus bacteria are present worldwide and are commonly found in soil, dust and manure.
Infection with Tetanus causes severe muscle spasms, leading to “locking” of the jaw so the patient cannot open his/her mouth or swallow, and may even lead to death by suffocation. Tetanus is not transmitted from person to person.
Prevention
Vaccination is the best way to protect against Tetanus. Due to widespread immunisation, Tetanus is now a rare disease. A combination shot, called the
Td vaccine, protects against both Tetanus and Diphtheria. A Td booster shot is recommended every 10 years. Adults who have never received immunisation against Tetanus should start with a 3-dose primary series given over 7-12 months.
Symptoms
Common first signs of Tetanus are a headache and muscular stiffness in the jaw (lockjaw) followed by stiffness of the neck, difficulty in swallowing, rigidity of abdominal muscles, spasms, sweating and fever.
Symptoms usually begin 8 days after the infection, but may range in onset from 3 days to 3 weeks.
6.1 TETANUS – cont.
Who should get Td vaccine?
All adults who have not had a Td booster shot in the last 10 years
Adults who have recovered from Tetanus (lockjaw) disease
Adults who have never received immunisation against Tetanus.
Vaccine safety
Tetanus vaccine and the combination Td vaccine are very safe and effective.
Most people have no problems with either. When side effects do occur, they usually include soreness, redness or swelling at the injection site and a slight fever. As with any medicine, there are very small risks that serious problems could occur after having a vaccination. However, the potential risks associated with Tetanus disease are much greater than the potential risks associated with the Tetanus vaccine. You cannot get Tetanus from the vaccine.
FACT: Tetanus can be prevented with a safe and effective vaccine.
FACT: You cannot get Tetanus from the vaccine.
FACT: Tetanus is caused by a bacteria found worldwide in soil, dust and manure
FACT: Tetanus is not transmitted from one person to another.
FACT: Almost all reported cases of Tetanus occurred in persons who had never been vaccinated or those who completed a primary series but have not had a booster vaccination in the past 10 years.
FACT: Approximately 30% of reported cases of Tetanus are fatal. In the
U.S, where 40-50 cases of Tetanus occur each year, most deaths occur in persons more than 50 years of age.
FACT: People with Tetanus may have to spend several weeks in hospital under intensive care.
FACT: For adults, a Tetanus-Diphtheria (Td) shot every 10 years ensures protection against these two diseases.
6.1 TETANUS – cont.
Vaccine safety – cont.
FACT: Recovery from Tetanus illness may not result in immunity. Another infection could occur unless a Tetanus booster shot is received every 10 years.
6.2 HEPATITIS A
What is it?
Hepatitis A is a viral disease which affects the liver. It occurs most often in school children and young adults. It may also be known as infectious
Hepatitis. It is a different disease from Hepatitis B.
How do I know if someone has it?
The illness usually begins with a sudden onset of fever (temperature), feeling unwell, and loss of appetite, nausea and stomach pain. This is followed within a few days with jaundice: a yellow discolouration of the whites of the eyes and often the skin. Children may have mild infections without jaundice.
Is it infectious?
Yes, the infection is most commonly spread from person to person by infected faeces (stools). The faeces is infectious for 2 weeks before the person becomes ill and for about a week after the jaundice appears. The greatest risk of spread occurs where there is a possibility of contact with untreated sewage.
People travelling abroad to developing countries where sanitation is poor are therefore at risk of becoming infected.
What is the incubation period?
Illness may appear between 2 to 6 weeks after contact with an infected person (average 28-30 days).
6.2 HEPATITIS A – cont.
Can it be prevented?
Yes. Ensure that hands are thoroughly washed after using the toilet and before preparing food or eating. Avoid swimming where water may be contaminated with untreated sewage. Also make sure that shellfish such as oysters and mussels are obtained from a reputable supplier.
People going abroad to countries outside Northern and Western Europe,
North America, Australia and New Zealand can be protected against the virus through a single injection given at least 10 days before travelling. For frequent travellers a booster can be given 6 – 12 months after the first injection, which will give protection for up to 10 years.
Is there any treatment?
There is no specific treatment for Hepatitis A. Most patients can be looked after at home.
What should I do if someone has the illness?
Seek advice from your GP. Close contacts can be protected from infection by immunisation. Ensure high standards of personal hygiene
– hands must be washed after using the toilet and before handling food. Toilets (handles and seats) must be kept clean. In health care settings reinforce and promote good hand hygiene and use individual disposable towels or electric hand dryers.
How soon can someone return to school/work?
A person should stay away till they feel well and for 7 days after the onset of the jaundice.
6.3 HEPATITIS B
What is it?
Hepatitis B is a virus which causes inflammation of the liver. It is quite different from Hepatitis A.
What are the symptoms?
The main symptom is jaundice
– yellowish skin or eyes and dark urine with pale stools. People can have general
‘flu-like symptoms; feel a bit tired with general aches and pains, headaches and fever. Some people with Hepatitis B infections do not develop any of these symptoms and continue to feel well.
Is it infectious?
Yes. It is transmitted in 3 ways
– by sexual contact, blood contact (e.g. sharing equipment for injecting drugs) and from an infected mother to her child. Hepatitis B is not common in Britain, but is more common in other parts of the world.
What is the incubation period?
The usual incubation period is anything from between 40 – 160 days, the average incubation period is between 60 and 90 days.
6.3 HEPATITIS B – cont.
Can it be prevented?
Yes. Safer sex (using condoms) will help to prevent the sexual spread of
Hepatitis B. Sterile needles must be used for all injections. Other measures to prevent spread include never sharing toothbrushes, razors, etc, and taking care when handling sharp objects such as knives and broken glass or crockery. People should have cuts covered when they are clearing up any spillages of blood or other bodily fluids. Blood donors are checked before being allowed to give blood.
Is there any treatment?
Most people with Hepatitis B infection will get better on their own without any treatment apart from rest.
Some people will get better from their jaundice and symptoms but will still have the virus in their blood. It is important for these people to see their doctor regularly to have liver tests and discuss treatment.
There is a vaccine available. People who are at higher risk of catching
Hepatitis B (such as the sexual partners and families of people carrying the virus) can be vaccinated against Hepatitis B.
Certain occupational groups e.g. emergency services personnel, nurses, doctors and surgeons, who may regularly come into contact with blood in the course of their work, should also be protected by vaccination.
How soon can you return to school/work?
Hepatitis B is not infectious in normal school, work or social situations. People can return to work as soon as they feel well.
6.4 HEPATITIS C
What is it?
Hepatitis C is a virus which causes inflammation of the liver. It is different from the Hepatitis A and Hepatitis B viruses. All blood donors are now routinely screened and all blood products for transfusion are heat treated to kill the virus.
What are the symptoms?
The symptoms of Hepatitis C infection are generally mild and
‘flu-like. Very few people develop jaundice or nausea. The majority of people are unaware of their infection and continue to feel well.
Is it infectious?
Yes. The main way it is now transmitted is by blood to blood contact (e.g. sharing equipment for injecting drugs). It may also be passed on via unprotected sexual intercourse and from an infected mother to her baby at birth. It is not known for certain how many people are infected with Hepatitis C in Britain but it is known to be more common in areas where there are high rates of injected drug use.
What is the incubation period?
It can be anything between 2 weeks and 6 months, but on average the incubation period is usually 6 to 9 weeks.
6.4 HEPATITIS C – cont.
Can it be prevented?
Yes. Safer sex (using condoms) will help to prevent the sexual spread of
Hepatitis C. Sterile needles must be used for all injections. Other measures to prevent spread include never sharing toothbrushes, razors, etc, and taking care when handling sharp objects such as knives and broken glass or crockery. People should have cuts covered when they are clearing up any spillages of blood or other bodily fluids. There is no vaccine available to protect against infection with the Hepatitis C virus at the present time.
Is there any treatment?
Some people with Hepatitis C infection will get better on their own without any treatment. Unfortunately, quite a high proportion will continue to carry the virus in their blood, which may cause slow, ongoing liver damage. These people are encouraged to attend their doctor regularly so that they can have blood tests to check that their liver is working normally.
How soon can you return to school/work?
Hepatitis C is not infectious in normal school, work or social situations. People can attend school, work or their usual social activities as long as they feel well.
6.5 IMPETIGO
What is Impetigo?
Impetigo is an infection of the skin caused by bacteria; either those called Streptococcus or Staphylococcus.
Often bites and cuts become infected, and the infection is then spread by scratching the sores and then touching unaffected areas of the body.
Who catches Impetigo?
Anyone can catch Impetigo. Although most cases are in children, adults can catch it. It is most common in crowded settings, such as schools and nurseries.
Impetigo is found in all parts of the world.
It tends to occur in small outbreaks.
Epidemics are rare.
How infectious is Impetigo?
Impetigo is highly infectious while the sores are still discharging pus.
The risk of infection is especially high among other children living in the same house.
What is Impetigo like?
Itchy blisters or sores appear, expand and burst producing a discharge within the first 24 hours of infection.
The blisters break down over 4-6 days forming thick crusts.
Impetigo tends to affect the hands and face, though it can spread to other parts of the body.
6.5 IMPETIGO – cont.
How do you catch Impetigo?
Although Impetigo often appears suddenly without an apparent cause, it is usually spread through direct contact with an infected person.
It can be imported by travellers returning from overseas, especially the
West Indies and Africa.
It can also be caught by the sharing of towels with an infected person.
It is more common in the summer when the skin tends to get broken by cuts or insect bits.
How serious is Impetigo?
Complications arise if the bacteria invade beyond the skin, though this is very rare. Some of the organisms causing Impetigo are more dangerous than others. One bacterium, Streptococcus pyogenes, can cause damage to the kidneys or heart. It can also affect other major organs.
Can you prevent Impetigo?
Good personal hygiene is the best way to prevent infection.
Keeping fingernails short, frequent hand washing, and using personal or disposable towels may prevent the spread of infection.
Infectious patients should avoid contact with others.
6.5 IMPETIGO – cont.
How soon should a child be back at school after Impetigo?
Impetigo is infectious while the sores are discharging pus.
Children should not attend school until all the sores have crusted over.
Without treatment a person remains infectious with discharging sores for several weeks, but infectivity stops 2 days after the start of treatment.
How can you treat someone with Impetigo?
Impetigo is treated by applying antibiotic ointment to the sores 3-4 times a day for one week.
The skin should heal completely within 10 days, though some discoloration may persist.
Oral antibiotics are used for severe cases and can clear infection in 4-5 days.
Patients should be discouraged from touching the sores to prevent further spread, and should be reminded about hygiene.
6.6 MRSA (Methicillin-resistant Staphylococcus aureus)
Staphylococcus aureus is a type of bacteria carried in the nose of 20 – 40% of normal, healthy people, and is also commonl y found on people’s skin, usually without causing harm. However, in certain circumstances, particularly when the skin is broken, this germ can cause boils, wounds and other infections.
These do not normally spread to other people outside the care/hospital setting. Hospital patients, however, are more vulnerable to infection with
Staphylococcus aureus because they are generally unwell and may be more susceptible to infection.
MRSA stands for Methicillin-resistant Staphylococcus aureus. It behaves in the same way as ordinary Staphylococcus aureus and does not cause different or more serious infections. However, infections with MRSA can be more difficult to treat as some strains may be resistant to several antibiotics.
This means that we have fewer antibiotics with which to treat them and sometimes, suitable antibiotics cannot be swallowed and must be given by injection. For these reasons, there is concern about MRSA in hospitals and patients with MRSA may be isolated in side rooms or special wards, and strict precautions taken to prevent spread to others. Outside hospitals many people carry MRSA without it causing harm to themselves or others. They are said to be carriers or to be colonised with MRSA.
What are the risks if an MRSA carrier is admitted to a nursing or residential home?
If basic good hygiene precautions are followed, MRSA carriers are not a hazard to other residents, members of their family, visitors or care staff, including babies, children and pregnant women. Carriage of MRSA should not be a reason for stopping admission to a home, or for discharge home. When an MRSA carrier is admitted to a care home the following people should be informed: the Manager, Matron or designated member of staff with infection control responsibilities and the reside nt’s General Practitioner.
6.6 MRSA (Methicillin-resistant Staphylococcus aureus) – cont.
What care will a resident with MRSA need?
Isolation of MRSA carriers is not generally recommended in residential homes as this may adversely affect their rehabilitation. A colonised service user without open wounds may share a room if the other resident does not have open lesions. A colonised service user who has open wounds should be in a single room, if this is available, and if this will not adversely effect their rehabilitation. Dressings or other nursing care on MRSA carriers should be carried out in their own room, after any procedures on other service users have been completed.
Scrupulous hand washing by staff before and after contact with service users and before any procedure is the single most important infection control measure and should be practiced for all service users at all times, whether they are a known carrier of MRSA or not. Hands should be washed well with liquid soap and water and dried thoroughly with disposable paper towels or hot air drier:
Before and after a work shift
Before and after each personal care contact
Before and after an aseptic procedure (clinical procedures developed to prevent contamination of wounds and other susceptible sites)
After contact with body fluids or secretions
After handling dressings, used linen or equipment
Before eating, drinking or handling/serving food or drugs
After using the toilet
6.6 MRSA (Methicillin-resistant Staphylococcus aureus) - cont.
What care will a resident with MRSA need? – cont.
Disposable gloves and apron should be worn when performing catheter care, handling or changing the service user’s dressing or performing aseptic procedures, and should be discarded immediately afterwards. Staff with eczema or psoriasis must ensure that lesions are covered with a waterproof dressing. If this is not possible they should seek medical advice before providing personal care to that particular service user.
The colonised service user should be encouraged in good hand hygiene practice and to have regular baths. They should be assisted with hand washing if their mental or physical condition makes this difficult for them to do so on their own. He or she may join other service users in communal areas, such as sitting or dining rooms, as long as any sores or wounds are covered with a dressing. He or she may receive visitors and go out to visit relatives or friends.
6.6 MRSA (Methicillin-resistant Staphylococcus aureus) - cont.
MRSA – When a person with MRSA is being cared for at home, should the same precautions be followed?
Before a patient leaves hospital be sure to ask the doctor about what precautions should be taken at home. In general, the following precautions are recommended for care at home.
1. Wash your hands with liquid soap and water after caring for a person with MRSA. Either plain or antibacterial soap is acceptable.
2. Periodically clean the person’s room and personal items with a commercial disinfectant or a fresh solution of one part bleach and 100 parts water (for example, one tablespoon of bleach in one quart of water).
3. Wear gloves if you handle body substances (blood, urine, wound drainage) and wash your hands after removing the gloves.
4. When caring for an MRSA positive person at home there are no special precautions needed for the disposal of refuse. However, care staff providing a home care service need to adopt the safe management of contaminated waste guidance as far as is reasonably possible ( see Section 2.4
).
6.6 MRSA (Methicillin-resistant Staphylococcus aureus) - cont.
Will any treatment, screening or other precautions be necessary?
There is no need to screen routinely for the presence of MRSA in service users or staff unless there is a clinical reason, e.g. wound is getting worse or new sores have appeared. In these situations swabs should be taken for general microbiological investigations although when sending swabs from someone who has had or still has MRSA the laboratory should be informed of this. MRSA carriers will not normally require special treatment after discharge from hospital but, if a treatment course still needs to be completed, the hospital will inform the home of this.
If a colonised service user has to travel by ambulance, the ambulance service should be informed, as should the relevant department if he or she has to attend outpatients. If the service user has to be readmitted to hospital the
Infection Control Doctor or Infection Control Nurse of the hospital should be informed, and may be contacted via the hospital switchboard.
6.7 CLOSTRIDIUM DIFFICILE
What is Clostridium difficile?
Clostridium difficile is a spore forming bacteria which is present as one of the
‘normal’ bacteria in the gut of up to 3% of healthy adults. It is much more common in babies. Up to two thirds of infants may have Clostridium difficile in their gut, where it rarely causes problems. People over the age of 65 years are more susceptible to contracting infection.
How do you catch it?
Clostridium difficile can cause illness when certain antibiotics disturb the balance of ‘normal’ bacteria in the gut. Its effects can range from nothing, in some cases, to diarrhoea of varying severity (which may resolve once antibiotic treatment is stopped) through to severe inflammation of the bowel, which can sometimes be life threatening. It is possible for the infection to spread from person to person because, those suffering from Clostridium difficile associated disease, shed spores in their faeces.
Spores can survive for a very long time in the environment and can be transported on the hands of people who have direct contact with infected service users or with environmental surfaces (floors, bedpans, toilets etc.) contaminated with Clostridium difficile.
What are the symptoms of Clostridium difficile infection?
The effects of Clostridium difficile can vary from nothing to diarrhoea of varying severity and much more unusually, to severe inflammation of the bowel. Other symptoms can include fever, loss of appetite, nausea and abdominal pain or tenderness.
6.7 CLOSTRIDIUM DIFFICILE – cont.
How do doctors diagnose Clostridium difficile infection?
It is difficult to diagnose Clostridium difficile infection on the basis of its symptoms alone, therefore the infection is normally diagnosed by carrying out laboratory testing which shows the presence of the Clostridium difficile toxins in the patient’s faecal sample.
Who does it affect?
The elderly are most at risk; over 80% of cases are reported in the over
65-age group.
Immuno-compromised service users are also at risk.
Children under the age of 2 years are not usually affected.
Are some people more at risk?
Repeated enemas and/or g ut surgery increase a person’s risk of developing the disease. Clostridium difficile infection occurs when the normal gut flora is altered, allowing Clostridium difficile to flourish and produce a toxin that causes watery diarrhoea. Antibiotics may also alter the normal gut flora and increase the risk of developing Clostridium difficile diarrhoea.
How can it be treated?
Clostridium difficile can be treated with specific antibiotics. There is a risk of relapse in 20-30% of service users and other treatments may be tried, including pro-biotic (good bacteria) treatment, such as natural yoghurt, with the aim of re-establishing the balance of flora in the gut. Most cases of
Clostridium difficile diarrhoea make a full recovery. However, elderly service users with other underlying conditions may have a more severe course.
Occasionally, infection in these circumstances may be life threatening.
6.7 CLOSTRIDIUM DIFFICILE – cont.
What should I do to prevent the spread of Clostridium difficile to others?
If you are infected you can spread the disease to others. However, only people that are hospitalised or on antibiotics are likely to become ill. In order to reduce the chance of spreading the infection to others: it is advisable to wash hands with soap and water, especially after using the toilet and before eating; keeping surfaces in bathrooms, kitchens and other areas clean.
How can hospitals prevent the spread of Clostridium difficile?
Unfortunately hospital patients with diarrhoea, especially if severe or accompanied by incontinence, may unintentionally spread the infection to other patients, which may lead to outbreaks of Clostridium difficile in hospitals.
In addition, the ability of this bacteria to form spores enables it to survive for long periods in the environment (e.g. on floors and around toilets) and disseminate in the air e.g. during bed making. Staff should wear disposable gloves and aprons when caring for infected patients and affected patients may be segregated from others. Rigorous cleaning with warm water and detergent is probably the most effective means of removing spores from the contaminated environment, whilst staff should observe good hand washing practice. In an outbreak situation, the Health Protection Agency may introduce special measures for staff, patients and visitors to follow.
6.7 CLOSTRIDIUM DIFFICILE – cont.
I’ve heard that some service users are at increased risk from Clostridium difficile – associated disease, is that true?
This is true
– the risk of disease increases in service users with the following:
Antibiotic exposure
Gastrointestinal surgery/manipulation
Long length of stay in healthcare settings
A serious underlying illness
Immuno-compromising conditions
Advanced age.
Has a new type of Clostridium difficile infection been detected?
The Health Protection Agency has initiated a sampling scheme to detect new types of Clostridium difficile infection. A new type of Clostridium difficile closely related to one previously found in North America has recently been detected in the UK, including at Stoke Mandeville Hospital. It is not possible to make an assessment of how prevalent this is in the UK because data has not been collected in sufficient quantities to give us a true picture of the current position.
Is this strain more difficult to treat?
This strain of Clostridium difficile can be treated with antibiotics, in the same way as other types.
6.7 CLOSTRIDIUM DIFFICILE – cont.
Is this infection caused by Clostridium difficile any more difficult to remove from the environment than other health care acquired infections?
Clostridium difficile bacteria produce resistant spores that are able to persist in the environment longer than other bacteria. Clostridium difficile spores are not killed by alcohol hand gels, but they can be removed with soap and water.
Staff, patients, service users and visitors need to wash hands thoroughly with soap and water. Disinfectants containing bleach need to be used on surfaces and floors to ensure that the spread of infection is controlled e.g. Milton.
Carpet shampooing, regular vacuuming and general good housekeeping will also help control the spread of this and other infections.
6.8 GOOD PRACTICE GUIDANCE – PREVENTING OCCUPATIONAL
DERMATITIS
Facts
Occupational dermatitis affects virtually all industry and business sectors and especially catering and the care industry. It is not an infectious disease therefore it can not be passed from one person to another. It can be very painful, but with a little care it can be prevented. If it is spotted early and adequate precautions are taken, most people will make a full recovery. So it makes sense to prevent dermatitis occurring in the first place.
Occupational dermatitis is caused by the skin coming into contact with certain substances at work and because of this it is sometimes called “occupational contact dermatitis” or even “contact eczema”. It can be an acute (short-term) flare up or chronic (long-term) skin reaction where there is sensitivity to materials or substances that come into contact with skin. It may involve allergic or non allergic reactions.
Dermatitis is most likely to occur on the hands and usually affects hands and forearms – the places most likely to touch a substance; but you can get it on your face, neck or chest. The main symptom is an itch, but unfortunately itching and scratching makes the problem worse. Other signs can be inflammation, redness, scaling and blistering of the skin. In extreme cases, if it gets worse, the skin can crack and bleed and dermatitis can spread all over the body. Some people will never recover due to sensitisation.
6.8 GOOD PRACTICE GUIDANCE – PREVENTING OCCUPATIONAL
DERMATITIS
– cont.
Causes
1. Water, soaps and detergents
Prolonged contact with water, soaps and detergents causes about 55% of dermatitis cases.
2. Nickel (coins etc.)
3. Rubber
(including rubber gloves – see advice on gloves at the end of these notes.)
4. Chemicals and cleaners
5. Food
A wide variety of foods have been shown to cause dermatitis problems 40% of cases, including:
Sugar
Flour/dough
Citrus fruits and their peel
Other fruits
Vegetables
Spices, herbs and seasonings (e.g. horseradish, mustard, garlic)
Fish and seafood
Meat and poultry
Prevention
Dermatitis is more easily prevented than cured and the costs of prevention are much less than those of a cure. Information and awareness is important so that all staff know the causes and symptoms of dermatitis; early signs can then be spotted and control measures put into place. Staff can protect themselves by adopting the following advice:
Examine skin regularly and report symptoms to your supervisor.
Wear the right kind and size of gloves and change them frequently. Ill fitting gloves can split and stretch causing them to leak or become dislodged and slip off during tasks.
Use a moisturising cream before and after work to help replace natural oils that your skin loses when you wash or come into contact with detergents and solvents.
Keep your skin clean.
6.8 GOOD PRACTICE GUIDANCE – PREVENTING OCCUPATIONAL
DERMATITIS
– cont.
Prevention – cont.
Make sure protective clothes are clean and intact.
If you use diluted chemicals make sure they are diluted to the correct strength. Over strength solutions are more likely to cause dermatitis.
Do you know what chemicals you are using? Look at labels – use
COSHH information.
Can you use a safer alternative, for example replacing a high concentration soap/detergent by a milder one?
Can you do the job in a safer way? Can the contact with the substance or item be prevented in any way, for example by not touching foodstuff or wearing gloves (but remember some people are sensitive to rubber and latex glove materials and may require cotton liners or cotton lined gloves).
Consider alternative control measures such as job rotation or alternative duties.
Sometimes a GP will prescribe emollient creams and ointments to reduce the inflammation of dermatitis. For some people with eczema, ultraviolet light treatment or periodic exposure to sunlight can be helpful.
6.8 GOOD PRACTICE GUIDANCE – PREVENTING OCCUPATIONAL
DERMATITIS
– cont.
To glove or not to glove? – Do gloves leak?
Expert opinion* supports the view that the integrity of gloves cannot be taken for granted and additionally hands may become contaminated during the removal of gloves. In 2003 a N.I.C.E.** review found evidence that VRE (a pathogenic bacteria) remained on the hands of care staff after the removal of gloves. A previous systematic review*** provided evidence that gloves used for clinical practice leak when apparently undamaged. Therefore, the use of gloves as a method of barrier protection reduces the risk of contamination but does not eliminate it and hands are not necessarily clean because gloves have been worn.
Advice on the Use of Gloves
Gloves are just as capable of spreading bacteria around as hands are.
Proper hand washing before putting on gloves, whilst wearing them and after removing them is extremely important to prevent crosscontamination.
Gloves must be discarded after each care activity for which they were worn. Sometimes they will also need to be changed between tasks on an individual, for example, when changing a dressing and then face washing. This is in order to prevent the transmission of microorganisms to other sites on that individual or to other service users.
Gloves should not be worn unnecessarily as their prolonged and indiscriminate use may cause adverse reactions and skin sensitivity.
The natural proteins or the chemical additives in latex gloves can cause contact dermatitis problems in a small minority of cases. Using powdered latex gloves can increase the level of risk or worsen the effects of an allergic reaction.
6.8 GOOD PRACTICE GUIDANCE – PREVENTING OCCUPATIONAL
DERMATITIS
– cont.
Advice on the Use of Gloves – cont.
General advice has been given to all managers to use alternative gloves e.g. vinyl/nitrile, which have virtually no adverse health effects, or ultra low protein allergy, powder-free latex gloves.
In catering situations there is no evidence to suggest that gloves offer any more protection to food than simple but effective hand washing/hand hygiene and as a general rule the use of gloves is not encouraged in catering kitchens.
Research has shown that food handlers wash their hands less if wearing gloves and tolerate worn and dirty gloves.
Synthetic gloves worn when using hot water can make hands sweat and skin can become irritated as a result. Cotton liners or cotton lined gloves can sometimes help with this.
Extracted in part from
LCC The Kitchen Logbook Section 9, Health and Safety Risk Assessments
“Guidelines for preventing healthcare-associated infections using Standard Principles in primary and community care
Section 2 – Standard Principles, June 2003
**N.I.C.E. National Institute for Clinical Excellence
***Pratt RJ, Pellowe C, Loveday HP, Robinson N. epic phase 1: The Development of National Evidencebased Guidelines for Preventing Hospital-acquired infections in England
– Standard Principles:
Technical Report. London: Thames Valley University; 2000:191 from http://www.epic.tvu.ac.uk/
6.9 CARE OF URINARY CATHETERS
Facts
A urinary catheter is a hollow tube that drains urine from the bladder into a special drainage bag.
An indwelling catheter is one that is in place all the time.
Usually the catheter is inserted through the urethra (the tube where urine normally comes out).
Sometimes a catheter is inserted into the bladder through a specially made hole in the side of the abdomen (this type of catheter is called a
‘suprapubic catheter’).
A small balloon keeps the catheter in place inside the bladder.
Causes of Urinary Tract infections
Urinary Tract infections (UTIs) are the largest single group of Healthcare
Associated infections (HCAIs) and the presence of a urinary catheter and the duration of its insertion are contributory factors to the development of a UTI.
Infection may occur:-
At the time of catheterisation
Immediately following catheterisation or
At a later time due to colonisation becoming invasive
6.9 CARE OF URINARY CATHETERS – cont.
Reducing the Risk of Urinary Tract infections
Possible entry points for bacteria to cause infection:-
Hands of staff/carers/service user
Jug/bottle used to collect urine
Drainage outlet valve
Reflux from the bag to the tubing
Sampling port
Junction of catheter with tubing
Meatal (where the urethra opens to the outside of the body) junction
Prevention
Hand washing is the cheapest and most cost effective method of reducing the spread of infection. The risk of developing a urinary tract infection can be reduced by the following actions:-
Hands must be washed before and after handling the catheter or drainage bag.
Daily clean the place where the catheter enters the body using soap and water and then dry.
Service Users, staff and carers should be trained in the techniques of: -
Hand Hygiene, Insertion of Intermittent Catheterisation (where relevant) and Catheter Management.
Encourage service users to drink plenty of water.
“Good standards of patient personal hygiene – routine personal hygiene is all that is needed to maintain meatal hygiene”
Epic Guidelines 2001
References: - Emmerson 1996, cited in Essential steps to safe, clean care 2006
N.I.C.E. Guidelines 2003
6.10 PACEMAKERS AND DEFIBRILLATORS (ICDs)
These notes are a very broad guide, intended to explain what the above devices are and how social care staff can avoid potential hazards to service users. The notes aim to inform and reassure staff. They are not intended as a diagnostic tool or replacement for medical advice or treatment. Social Care staff with any specific concerns about implanted medical devices
(Pacemakers, Implantable Cardioverter Defibrillators (ICDs), and Heart
Failure Devices) must contact their line mangers who will, if necessary, seek expert medical advice.
Social care staff may occasionally provide personal care services to persons fitted with a pacemaker or a defibrillator. Implanted devices are designed to work properly in the presence of most appliances and equipment and when they are initially fitted patients are given appropriate information and advice from the medical profession. Most things the general public handle or work near every day will not cause a problem. But, some strong electrical or magnetic fields may affect Pacemakers or Implantable Cardioverter
Defibrillators (ICDs). Patients/service users should be advised to talk to their doctor if they have more questions about an appliance, tool, medical procedure, or piece of equipment.
Pacemakers
– What is a pacemaker?
A pacemaker system includes a pacemaker and connecting wire(s) that hook into the heart. This allows internal activity to be recognised and if absent the pacemaker will stimulate heart activity.
The wire(s) is passed into the heart along a vein and is connected to the pacemaker, which is then positioned usually on the left side of the chest just below the collarbone. Pacemakers may also be fitted on the right side and less commonly these days, under the left armpit or in the abdomen.
6.10 PACEMAKERS AND DEFIBRILLATORS (ICDs) - cont.
How does a pacemaker work?
The pacemaker has an electrical system and their basic function is to send an electrical impulse after sensing when the heart's natural electrical system fails.
Modern pacemakers are very sophisticated and some can be set to produce an electrical impulse only when one is needed. Some can even tell when the heart stops beating and produce a small electric shock to restart it. (Older pacemakers used to produce the electrical signal at a constant rate and this limited the patient's physical activity).
Will electrical devices and household appliances affect a pacemaker?
Most properly maintained electrical household items are unlikely to interfere with a pacemaker and ordinary household equipment will not present any hazards to them. However, some powerful electrical equipment may generate interference if a person with a pacemaker gets too close. They may experience their heart rate speeding up or becoming irregular. These symptoms will subside if they move away from the source of the interference.
As a general rule people who have pacemakers fitted should:-
Avoid contact with household appliances that are improperly earthed. If you are unsure, have the plugs checked to make sure the wires are properly connected.
Direct contact with running motors, alternators and car ignition.
High powered radar, radio and TV transmitters (normal domestic
TV and radio are perfectly safe).
6.10 PACEMAKERS AND DEFIBRILLATORS (ICDs) - cont.
Defibrillators (ICDs) – What are they?
ICD stands for Implantable Cardioverter
Defibrillator. The ICD is a battery powered electronic device designed to monitor heart rhythm.
It detects if heart rhythms are abnormal and need correction.
If the ICD detects an abnormal heart rhythm it delivers therapy in the form of electrical impulses or shocks to the heart muscle to correct the abnormal rhythm.
Electrical Appliances
Note: Some strong magnetic fields may cause ICD devices to make beeping tones. If you or the service user hears beeping tones from their device they should:
Immediately move away from the object that may be causing the beeping tones.
Call their doctor to report the beeping tones.
Most household appliances that are used on a daily basis will not influence a
Defibrillator.
People with ICDs can continue to operate the following appliances and tools as long as the appliances are properly earthed and in good repair:
Hand held items such as shavers and hairdryers
Televisions & VCRs Radio AM/FM Tumble Dryers
Electric Knives
Washing Machine
Drills
Microwave
Electric Stoves
Lawn Mowers
Table Saws Toasters Blenders
Office/Work Equipment such as: Copy Machines, Electronic Typewriters and
Personal Computers
6.10 PACEMAKERS AND DEFIBRILLATORS (ICDs) - cont.
Magnets
The defibrillator is sensitive to strong electrical magnetic fields from 15cm (6") away for example, speakers in large stereo systems, transistor radios and boom boxes or similar. Strong magnets can also be found in industrial equipment, such as power generators, arc welders and motors, battery powered cordless tools, screwdrivers/drills, etc.
People with ICDs should avoid leaning over an electrical motor that is running
(because alternators in cars frequently contain magnets), as well as radio frequency from remote controlled transmitters for toy cars/aeroplanes/car alarms.
Telephones
Mobile phones can affect defibrillators if they are closer than 15cm (6"). If the telephone transmits more than 3 watts, increase the distance to 30cm (12").
This information applies to mobile phones, NOT household cordless phones.
However, household cordless phone receivers must not be placed directly over a service user's defibrillator.
