Download The Management of Meningitis Policy Infection Prevention and Control

The Management of Meningitis Policy
Infection Prevention and Control
This policy describes the key processes and protocols for
patients with a known or suspected diagnosis of meningitis. It
includes the appropriate personnel and organisational contact
details for further advice.
Key Words:
Infection Prevention and Control
Meningitis
Septicaemia
Version:
7
Adopted by:
Quality Assurance Committee
Date adopted:
17 May 2016
Main author:
Name of responsible
committee:
Amanda Hemsley
Senior Nurse Advisor, Infection
Prevention and Control
Infection Prevention and Control
Committee
Date issued:
May 2016
Review date:
January 2018
Expiry date:
April 2019
Target audience:
All LPT staff
Type of policy
(tick appropriate box)
Clinical
√
Non-clinical
Contents
Definitions that apply to this policy
1.0
Summary………………………………………………………………….
7
2.0
Introduction……………………………………………………………….
7
3.0
Purpose……………………………………………………………………
7
4.0
Justification for the document…………………………………………..
7
5.0
The Management of Suspected (or confirmed) Meningitis……...…..
8
5.1
Background……….………………………………………………………
8
5.2
General information.…………………………………………………….
8
5.3
Investigation of meningitis………………………………………………
9
5.4
Specific meningitis infection prevention and control measures for
inpatient facilities…………………………………………………………
9
6.0
Training……………………………………………………………………
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7.0
References and associated documents……………………………….
11
Appendices
1.
Source Isolation Poster………………………………………………….
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The Management of Meningitis Policy
Contribution List
Key individuals involved in developing the document
Name
Amanda Hemsley
Antonia Garfoot, Mel
Hutchings, Fiona
Drew, Annette
Powell, Jackie
Chown
Designation
Senior Nurse Advisor, Infection Prevention and Control
Infection Prevention and Control Team
Circulated to the following individuals for consultation
Name
Dr Philip Monk
Dr Andrew Swann
Adrian Childs
Jo Wilson
Victoria Peach
Michelle Churchard
Claire Armitage
Kathy Feltham
Emma Wallis
Katie Willetts
Bernadette Keavney
Elizabeth Compton
Sarah Latham
Greg Payne
Bal Johal
Amin Pabani
Liz Tebbutt
Designation
CCDC Consultant, Public Health England
Consultant Microbiologist UHL
Chief Nurse / DIPaC
Lead Nurse, FYPC
Lead Nurse, CHS
Lead Nurse AMH&LD
Lead Nurse AMH&LD
Lead Nurse MHSOP
Lead Nurse CHS
Senior Nurse, FYPC
Health Safety and Security Manager
Matron
Matron
Training and Development
Deputy Chief Nurse
Service Manager Podiatry
Performance and Quality Assurance Manager
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The Management of Meningitis Policy
Version Control and Summary of Changes
Version
number
Date
Version 1 2005
Version 2 February
2009
Version 3 June 2010
Version 4 July 2010
Draft2
Comment
(Description change and amendments)
Review and rewriting of guideline based on the community
infection control guidelines
Reviewed and updated in line with national guidance
Reviewed by Amanda Howell and rewritten incorporating
abbreviations, definitions and associated policies and
guidelines. Sent out for comments to link staff for adult and
children’s services, occupational health, HPU, service
managers, Infection control subcommittee members.
Comments received and incorporated from: Una Willisinfection control matron, Shelley Jacques-Clinical
Governance Lead, Heidi Scott-Smith-Clinical Governance
Manager, Helen Burchnall-clinical lead for Childrens
physiotherapy, Diane Shields-occupational Health Advisor
and Philip Monk- consultant in communicable Diseases
Agreed through the clinical Governance Committee
Version 5
Final
Copy
Version 6 August 2011 Harmonised in line with LCRHS, LCCHS, LPT (historical
organisations)
Version 7
Updated to review current NICE guidance102 and in line with
format of LPT policies
For further information contact: Infection Prevention and Control Team
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The Management of Meningitis Policy
Definitions that apply to this Policy
Consultant in Public
Health
A consultant who is knowledgeable in infectious diseases
and works within the field of public health
Contact Tracing
The identification and diagnosis of person who may have
come into contact with an infected person.
Cerebrospinal fluid
CSF
Haemophilus
influenza type B (Hib)
Bacterium capable of causing a range of diseases
including ear infections, cellulitis (soft tissue infection),
upper respiratory infections, pneumonia, and such serious
invasive infections as meningitis with potential brain
damage and epiglottitis with airway obstruction, It spreads
by droplet through coughs and sneezing.
Infection
An organism presents at a site and causes an
inflammatory response, or where an organism is present
in a normally sterile site.
Immunocompromised An immune system that is impaired by disease or
treatment, where an individual’s ability to fight infection is
decreased.
Immunosuppression Suppression of the immune response, usually by disease
or by drugs
Inflammation
The body’s immune reaction to presumed foreign
substances like germs. Inflammation is characterised by
increased blood supply and activation of defence
mechanisms. It can produce redness, swelling, heat and
pain.
Meningitis
Inflammation of the meninges (lining of the brain)
Meningococcal
Meningococcal disease is any infection caused by
bacteria
meningococcal bacteria
Neisseria
Neisseria meningitides is a heterotrophic gram-negative
meningitides
diplococcal bacterium best known of its role in meningitis
and other forms of meningococcal disease such as
meningococcemia
Organisms
This is defined as any living thing, in medical terms
bacteria and viruses are referred to as organisms.
Outbreak
The occurrence of two or more cases of the same
infection linked in time or place or, the situation when the
observed number of cases exceeds the number expected
PCR
Polymerase Chain Reaction – a laboratory technique for
rapidly synthesising large quantities of a specific DNA
segment
Personal Protective
Specialised clothing or equipment worn by employees for
Equipment (PPE)
protection against health and safety hazards, gloves,
aprons, gowns masks and eye protection.
PHE
Public Health England
Source Isolation
Isolation for the control of infection is used to prevent
infected patients from infection others
Streptococcus
The bacteria that most often causes pneumonia
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The Management of Meningitis Policy
pneumonia
Symptomatic
LPT
Occupational Health
Department
Physical or mental sigh of disease
Leicestershire Partnership Trust
Baldwin Lodge
Glenfield Hospital Site
Groby Road
Leicester
LE3 9QP
TEL: 0116 225 5432
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The Management of Meningitis Policy
1.0
Summary
This policy has been developed to give clear organisational wide guidance for the
management of a patient with suspected or confirmed infectious meningitis or
meningococcal septicaemia, it is intended to provide infection prevention and
control guidance to minimise the risk of transmission of the organism from the
patient to other patients, staff or members of the public. It is not a treatment
therapy guide, and alternative guidance must be sought.
Further guidance for healthcare workers and other staff work who work in prisons
and places of detention can be found in Prevention of Infection & Communicable
Disease Control in Prisons & Places of Detention – A Manual for Healthcare
Workers and other Staff.
2.0
Introduction
This policy applies to all staff employed by Leicestershire NHS Partnership Trust
(LPT).
LPT has a wide range of teams and services operating from a large number of
properties making up the overall estate. LPT also delivers healthcare to people in
their own homes.
The provision of healthcare carries with it inherent risks to the health care worker.
The purpose of this document is to ensure that all staff are aware of their
responsibilities for the safe practice in relation to the management of a patient with
suspected or confirmed meningococcal disease.
3.0
Purpose
It is the intention of this policy to provide guidance to ensure that staff are aware of
the appropriate steps they need to undertake to ensure the safety of all patients
within LPT, whether receiving healthcare in LPT inpatient facilities, within their own
home environment or as outpatients visiting LPT on a daily basis. This includes
those patients that have or suspected of having meningococcal disease.
The purpose of this policy is to ensure that all staff employed by LPT are providing
evidence based care which is in accordance with the Health & Social Care Act
(2008) updated 2015, and the latest guidance provided by Public Health England
(PHE).
4.0
Justification for Document
Meningococcal disease continues to be a concern within the realms of infection
prevention and control, with particular relation to sepsis; and it imperative that
persons who have or are suspected of the disease receive care and intervention in
a timely manner. As a duty of care LPT must ensure that staff are given guidance
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The Management of Meningitis Policy
as to the appropriate steps they need to undertake to ensure that they can protect
the patients within their care.
5.0
The Management of Suspected (or confirmed) Meningitis
5.1
Background
Meningitis is inflammation of the coverings of the brain and/or spinal cord.
Infections (viral and bacterial) are the most common causes of this condition;
however, meningitis caused by meningococcal bacteria can develop rapidly and
cause serious illness. Meningococcal disease occurs throughout the world, many
risk factors have been identified and transmission usually needs either frequent or
prolonged close contact with the respiratory secretions of someone carrying the
organism. The incidence of meningococcal disease is highest in children aged one
to five years followed by infants under one year of age, The next highest risk group
is you people aged 15 – 19 years, But subarachnoid haemorrhage, chemical
irritation, granulomatous conditions, neoplastic conditions (e.g. carcinomatous
meningitis), and other inflammatory conditions may produce this syndrome. The
clinical features of meningitis include severe headache, irritability, fever, neck
stiffness, rash, nausea and vomiting, confusion and reduced levels of
consciousness.
Infection prevention and control responses to patient with meningitis can be divided
into two categories, general, for all patients regardless of infection organism, and
specific. Actions in the latter category depend on the infecting organism
5.2
General Information
Patients with known or suspected meningitis should be referred immediately to
the emergency department by dialling 999.
Source isolation precautions are required even without an identified organism.
These precautions may be modified after appropriate chemotherapy or once the
infecting organism is known. Hence patients should be investigated thoroughly as
soon as possible, although immediate treatment should take priority.
It is essential that all cases of meningitis are notified immediately to Public Health
England (East Midlands Unit):
• Telephone 0344 225 4524 (option 1)
• East Midlands Ambulance Service 0115 9296477
Ask for the doctor on-call for public health who will decide which contacts should
be offered antibiotic chemoprophylaxis or vaccination
Do Not wait until a microbiological diagnosis has been made.
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The Management of Meningitis Policy
Close contacts are best defined by the consultant for public health or deputy. In
general close contacts are those:
•
•
•
5.3
Living with an infected patient
Having a recent history of kissing contact or mouth-to-mouth
resuscitation
Individuals involved in procedures such as emergency
intubation.
Investigation of Meningitis
5.3.1 The following investigations must be sent urgently to microbiology:
•
•
•
•
•
•
•
5.4
Throat swab for (Neisseria meningitides)
Throat swab for viral culture
Blood culture
CSF (where appropriate) for bacteriological culture and viral
investigations and PCR
Blood in EDTA (full blood count bottle) for Neisseria
meningitides and Streptococcus pneumoniae PCR
Serum (5ml clotted blood) for antibody tests.
Faeces for viral culture
Specific meningitis infection prevention and control precautions for
Inpatient facilities
5.4.1 Viral Meningitis
Source isolation precautions required until clinical recovery or discharge home, as
there is a risk of transmitting the virus.
5.4.2 Bacterial Meningitis
Bacterial meningitis is an infection of the surface of the brain (meninges) by
bacteria that have usually travelled there from mucosal surfaces via the
bloodstream.
Organism
Groups at risk
Neisseria
Meningitides
All ages,
3 months to 3 years
highest incidence.
Specific
hospital
infection
Source isolation
precautions can
be discontinued
after 4 hours of
appropriate
antibiotic
Public health
actions
The Consultant
for Public Health
(or deputy) will
decide who
close contacts of
the patient
regarding
antibiotic
prophylaxis are.
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The Management of Meningitis Policy
Streptococcus
pneumoniae
All ages
None required
once diagnosis
confirmed
microbiologically
Any patient with
pneumococcal
meningitis should
be reviewed to
identify if they are
in the at risk group
and require
vaccination post
discharge.
All children under
5 years of age
should be given a
dose of
pneumococcal
conjugate vaccine
irrespective of the
vaccination
history.
Children under 13
months who are
unvaccinated or
partially
vaccinated should
complete the
immunisation
schedule.
The Consultant
for Public Health
(PHE) will
decide who are
close contacts of
the patient and
will require
antibiotic
prophylaxis and
vaccination.
None
Haemophilus
influenzae type
B (Hib)
Less than 4 years of
age, although Hib
vaccine has virtually
eradicated Hib
meningitis,
immunological
investigations
required in patients
with this diagnosis
Source isolation
precautions can
be discontinued
after 24 hours
of appropriate
antibiotic
treatment
Group B
Streptococcus
Listeria
Infants less than 3
months
Neonates,
None
Monogytogenes
55yrs of age and
immunocompromised
Neonates, patients
with ventricular
disease
None
Inform public
health as actions
are necessary
None
Source isolation
None
Coagulase
negative
staphylococcus
None
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The Management of Meningitis Policy
6.0
Training
There is no specific training requirement regarding this policy. However staff that may
come into contact with patients who may have a potential prerequisite to this disease
may require further training and/or development.
7.0
References and Associated documents
LPT documents
The supporting Infection Prevention and control policies can be located at:
http://www.leicspart.nhs.uk/SupportServices
This policy was drafted with reference to the following:
Meningitis Research Foundation: http://www.meningitis.org/
National Collaborating Centre for Women’s and Children’s Health. Bacterial
meningitis and meningococcal septicaemia in children. JUNE 2010. NICE Clinical
Guidance.
National Institute for Health and Clinical Excellence: June 2010. Bacterial meningitis
and meningococcal septicaemia. Clinical Guideline 102, implementing NICE
guidance.
Prevention of Infection & Communicable Disease Control in Prisons & Places of
Detention – A manual for Healthcare Workers and other Staff. August 2011 © Health
Protection Agency. HPA Gateway Reference: HPA11-02DH Gateway reference:
16314
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The Management of Meningitis Policy
APPENDIX 1
SOURCE ISOLATION PRECAUTIONS
FOR IN-PATIENT FACILITIES
Visitors: Before entering the room please speak to the nurse
looking after the patient
All Staff: Before entering the room and having contact with the
patient or any items in the room you MUST
Wear disposable gloves
Wear a disposable plastic apron
All visitors and staff please wash your hands before leaving the room
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The Management of Meningitis Policy