SECTION ONE
INTRODUCTION
AND
NOTIFICATION
1.
INTRODUCTION AND NOTIFICATION
1.0
INTRODUCTION
The guidance is divided into sections as follows:
Section 1
Introduces infection control and explains notification;
Section 2
deals with general infection control procedures;
Section 3
gives guidance on the management of outbreaks;
Section 4
describes specific infectious diseases;
Section 5
contact numbers and sources of information;
Section 6
contains additional detailed information and a table of diseases;
Section 7
contains risk assessments relevant to infection control;
Section 8
research sources, references and useful web sites
Further information is available from the Food Safety Adviser at Leicestershire
County Council and from the Health Protection Agency – East Midlands
South. Contact numbers are listed in Section 5. The aim of this document is
to provide simple advice on the actions needed in the majority of situations
likely to be encountered in social care settings. It is written in everyday
language and presented so that individual subject areas can be easily copied
for use as a single sheet.
1.1
HOW ARE INFECTIONS TRANSMITTED?
Infectious diseases are usually caused by viruses or bacteria and can be
transmitted from one person to another in a number of ways:

By direct skin to skin contact
This is unusual, as the majority of infections cannot penetrate the skin
without an open wound. An infection that can spread in this way is
Scabies. Infections, which do not spread this way, include HIV,
Hepatitis B and Tuberculosis.

By swallowing contaminated material
Most infections of the gut are spread by this route. For example: food
poisoning and Typhoid. Other infections, including HIV and Hepatitis B,
cannot be caught this way as the acid in the stomach destroys them.

By droplets in the air
Many infections are spread by the airborne route. Measles, the
common cold and influenza are spread in this way, by coughing and
sneezing.

By sexual intercourse
Infections such as Syphilis, Gonorrhoea, HIV infection, Hepatitis B and
Hepatitis C can be spread by sexual contact.

By blood to blood transmission
A small number of infections can be spread through blood transfusion
and some can also be transmitted sexually, including HIV, Hepatitis B
and Hepatitis C.

Vertical transmission from a pregnant mother to her child
Transmission can occur at any stage during pregnancy, at the time of
birth and during breast feeding. Examples include HIV, Syphilis and
some common viral infections such as Rubella (German Measles).

Insects and Parasites e.g. Malaria is spread via a mosquito’s bite.
1.2
INFECTION CONTROL GUIDANCE
Infection control forms part of our everyday lives, usually in the form of
common sense and basic hygiene procedures. Where large numbers of
people come in contact with each other, the risk of spreading infection
increases. This is particularly so where people are in close contact and share
eating and living accommodation.
It is important to have guidelines to protect service users, staff and visitors.
Adopting these guidelines and standard infection control practices will
minimise the spread of infectious diseases to everyone.
External Factors
If you or someone in your immediate family has a “Notifiable Disease” such as
Measles (see 1.3) or infection such as Impetigo, diarrhoea, vomiting or
Scabies, please inform your line manager before coming to work.
If you regularly visit people in hospital please be aware of the potential risk of
cross infection to yourself and the person you are visiting.
Above all when dealing with service users and their families we must all
remember we are dealing with people. There will be personal issues of
privacy and sensitivity, which we must handle with tact and discretion at
all times.
What are Infection Control Practices?
Infection control practices are ways that everyone (staff, service users &
volunteers) can prevent the transmission of infection from one person to
another. They are practices which should be routinely adopted, at all times
with every individual, on every occasion, regardless of whether or not that
person is known to have an infection.
1.2
INFECTION CONTROL GUIDANCE – cont.
Infection control practices include:
Effective hand
washing and
hand hygiene
Safe
Management
of blood or
body fluid
spillages
Safe use and
disposal of
sharps
Appropriate
use of
personal
protective
equipment
STANDARD
INFECTION
CONTROL
PRACTICES
Safe
Management
of
contaminated
waste
Maintenance
of a clean
environment
by
appropriate
use of
cleaning
equipment
Safe Management
of laundry
TRAINING
Underpins all these Routine Infection Control Practices
1.3
NOTIFICATION OF INFECTIOUS DISEASES
A number of infectious diseases are statutorily notifiable under The Public
Health (Control of Disease) Act 1984 and The Public Health (Infectious
Diseases) Regulations 1988. There are three main reasons for such
notification.

So that control measures can be taken

To monitor preventative programmes

For surveillance of infectious diseases in order to monitor levels of
infectious diseases and to detect outbreaks so that effective control
measures can be taken.
All doctors diagnosing or suspecting a case of any of the infectious diseases
listed overleaf have a legal duty to report it to the Proper Officer of the Local
Authority, who is usually the Consultant in Communicable Disease Control
based at the Health Protection Agency.
Notification should be made at the time of clinical diagnosis and should not
be delayed until laboratory confirmation is received. Infections marked (T)
should be notified by telephone to the Consultant in Communicable Disease
Control (see Section 5) and confirmed by completion of a written notification
form.
1.3
NOTIFICATION OF INFECTIOUS DISEASES – cont.
Notifiable Diseases
Acute encephalitis
Paratyphoid
(T)
Acute poliomyelitis
Plague
(T)
Anthrax
Rabies
(T)
(T)
Cholera
(T)
Relapsing Fever
Diphtheria
(T)
Rubella
Dysentry
(T)
Scarlet Fever
Food poisoning or
Small Pox
suspected food poisoning
Leprosy
Tetanus
Leptospirosis
Tuberculosis
Malaria
Typhoid fever
(T)
Measles
Typhus fever
(T)
(T)
Meningitis *
(T)
Viral haemorrhagic fever
Meningococcal septicaemia
(T)
Viral hepatitis **
(without meningitis)
Mumps
Whooping cough
Opthalmia neonatorum
Yellow fever
* meningococcal, pneumococcal, haemophilus influenzae, viral, other
specified, unspecified
** Hepatitis A, Hepatitis B & Hepatitis C, other
(T)
Please notify the Consultant in Communicable Disease Control or
person on call for the Health Protection Agency by telephone.
Other specific diseases are designated by the Reporting of Injuries, Diseases
and Dangerous Occurrences Regulations 1995 as “Reportable Occupational
Diseases” e.g. Legionellosis. Please contact the Health & Safety Team for
further information (see section 5 for details).
1.3
NOTIFICATION OF INFECTIOUS DISEASES – cont.
Notification of suspected outbreaks
An outbreak is defined as two or more cases of a condition related in time and
location with suspicion of transmission. Prompt investigation of an outbreak
and introduction of control measures depends upon early communication.
Suspicion of any association between cases should prompt contact with the
Health Protection Agency.
1.4
IMMUNISATION
COSHH requires that if a risk assessment shows there to be a risk of
exposure to biological agents for which vaccines exist, then these should be
offered if the employee is not already immune.
In practice, with Social Care Services, this generally amounts to care staff
within the Mental Health and Learning Disabilities Services being offered
Hepatitis B vaccination.
Care home managers, after assessing risks, may also offer ‘flu vaccination to
staff and individual cases may indicate the need for immunisation in certain
circumstances. The pros and cons of immunisation/non-immunisation should
be explained when making the offer of immunisation. The Health & Safety at
Work Act 1974 requires that employees are not charged for protective
measures such as immunisation. A few GPs will make vaccinations available
free to Social Care workers but they are not obliged to do so and can charge
at their discretion. Departmental funding for the provision of vaccine, through
Occupational Health, is restricted and so it is vital that only those to whom it is
essential to provide immunisation are offered this service.
The majority of staff will have received immunisation from childhood and have
received the appropriate booster doses e.g. Tetanus, Rubella, Measles and
Polio. However, it is important for the immunisation state of staff to be
checked e.g. women of childbearing age should be protected against Rubella.
Good practice and common sense should indicate that the immunisation state
of staff is checked and appropriate action taken. If there is a potential risk of
infection, change of work rotas or areas of responsibility can sometimes avoid
the risk of contamination. Vaccination is not always the only course of action
and in some cases staff may not agree to be vaccinated.
1.4.1
IMMUNISATION SCHEDULE
Vaccine
D/T/P and Hib Polio
Age
1st dose at 2 months
2nd dose at 3 months
3rd dose at 4 months
Notes
Primary Course
Measles / Mumps /
Rubella (MMR)
12 – 15 months
Can be given at any age
over 12 months
Booster DT and Polio,
MMR second dose
3 – 5 years
Three years after
completion of primary
course
BCG
10 – 14 years or infancy
Only offered to certain
high risk groups after an
initial risk assessment
Booster Tetanus,
Diphtheria and Polio
13 – 18 years
Children should therefore have received the following vaccines:
By 6 months:
3 doses of DTP, Hib and Polio
By 15 months:
Measles / Mumps / Rubella
By school entry:
4th DT and Polio; second dose of
Measles / Mumps / Rubella
Between 10 & 14 years:
BCG (certain high risk groups only)
Before leaving school:
5th Polio and Tetanus Diphtheria (Td)
Adults should receive the following vaccines:
Women sero-negative
Rubella
For Rubella:
Previously un-immunised
Polio, Tetanus, Diphtheria
Individuals:
Individuals in high
Hepatitis B, Hepatitis A, Influenza
risk groups:
Pneumonococcal vaccine
1.5
EXCLUSION FROM WORK
The following table gives advice on the minimum period of exclusions from work for staff members suffering from infectious disease (cases) or
in contact with a case of infection in their own homes (home contacts). Advice on work exclusions can be sought from CCDC (Consultant in
Communicable Disease Control) / HPN (Health Protection Nurse) / CICN (Community Infection Control Nurse) / EHO (Environmental Health
Officer) or GP (General Practitioner)
Minimum exclusion period
Home contact
Disease
Period of Infectivity
Case
Chickenpox
Infectious for 1-2 days before the
onset of symptoms and 6 days after
rash appears or until lesions are
crusted (if longer)
6 days from onset of rash
None. Non-immune pregnant women
should seek medical advice
Conjunctivitis
Until 48 hours after treatment
Until discharge stops
None
Erythema infectiosum
(slapped cheek syndrome)
4 days before and until 4 days after
the onset of the rash
Until clinically well
None. Pregnant women should seek
medical advice
Gastroenteritis (including
salmonellosis and shigellosis)
As long as organism is present in
stools, but mainly while diarrhoea
lasts
CCDC or EHO will advise on local
policy
Glandular fever
Giardia lamblia
Hand, foot and mouth disease
When symptomatic
While diarrhoea is present
As long as active ulcers are present
Hepatitis A
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
For life
Until clinically well and 48 hours
without diarrhoea or vomiting. CCDC
or EHO may advise a longer period
of exclusion
Until clinically well
Until 48 hours after first normal stool
1 week or until open lesions are
healed
1 week after onset of jaundice
None
None
HIV/AIDS
None
None
None
None – immunisation
advised (through GP)
may
be
1.5
EXCLUSION FROM WORK – cont.
Minimum exclusion period
Home contact
Disease
Period of infectivity
Case
Measles
Up to 4 days before and until 4 days
after the rash appears
Varies with organism
Greatest infectivity from 2 days
before the onset of symptoms to 4
days after symptoms appear
1 week before and until 5 days after
the onset of the rash
As long as the organism is present in
the throat, usually up to 48 hours
after antibiotic is started
Until after the last of the lesions are
dry
Depends on part infected. Patients
with open TB usually become noninfectious after 2 weeks of treatment
As long as eggs present on perianal
skin
As long as case harbours the
organism
1 week before and until 3 weeks after
onset of cough (or 5 days after the
start of antibiotic treatment)
4 days from the onset of the rash
None
Until clinical recovery
4 days from the onset of the rash
None
None
4 days from the onset of the rash
None
Until clinically improved (usually 48
hours after antibiotic is started)
None
Until all lesions are dry – minimum 6
days from the onset of the rash
In the case of open TB, until cleared
by TB clinic. No exclusion necessary
in other situations
None but requires treatment
None
Seek advice from CCDC
Seek advice from CCDC
Until clinically well, but check with
CCDC
None
Meningitis
Mumps
Rubella (German measles)
Streptococcal sore throat and Scarlet
fever
Shingles
Tuberculosis
Threadworm
Typhoid fever
Whooping cough
Will require medical follow-up
Treatment is necessary
1.5
EXCLUSION FROM WORK – cont.
SKIN CONDITIONS
Minimum exclusion period
Home contact
Disease
Period of infectivity
Case
Impetigo
As long as purulent lesions are
present
As long as lice or live eggs are
present
Until skin has healed or 48 hours
after treatment started
Exclude until treated
None. Avoid sharing towels
As long as active lesions are present
Exclusion not always necessary until
an epidemic is suspected
None
None
None
Until day after treatment is given
None
None (GP should treat family)
None (warts should be covered with
waterproof dressing for swimming
and barefoot activities)
None
Head lice
Ringworm
1. Tinea capitis (head)
2. Tinea corporis (body)
As long as active lesions are present
3. Tinea pedis (athlete’s foot)
Scabies
As long as active lesions are present
Until mites and eggs have been
destroyed
As long as wart is present
Verrucae (plantar warts)
Exclude until treated
None