Download Management of Infectious Diseases

YMCA TEES VALLEY
Management of Infectious Diseases, Conditions and Infestations Procedure
1.
Introduction
1.1. Management of residents with specific infections is essential. All precautions must be taken
to ensure that the spread of the infection to other residents/ service users/ staff or the
environment are taken. Individuals with certain infections will require certain specific
precautions and/or treatment to be undertaken.
1.2. The Infection Control Lead will give specific advice and support which may include:
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Care pathways related to specific organisms
Advice on isolation
Environmental advice
Use of Personal protective clothing
Information Leaflets
1.3. Further advice may be sought from a Individuals General Practitioner, Health Protection
Agency or Public Health.
1.4. Once a resident is suspected or confirmed as having a specific infection, please contact the
Infection Prevention and Control Team as soon as possible to ensure the correct procedures
have been put in place.
2.
General information
2.1. Gastrointestinal Infections
2.1.1. All cases of gastroenteritis should be regarded as infectious, although diarrhoea and
vomiting are caused by a variety of infective and non-infective agents.
2.1.2. Agents causing gastroenteritis may infect people without causing symptoms or be
excreted for long periods after recovery from illness.
2.1.3. General Practitioners take primary responsibility for cases in Residential / Housing
Settings. If there is an outbreak situation the Infection Prevention and Control Team and
the Health Protection Agency must be informed. They will lead and investigate the
situation.
2.1.4. All cases should be cared for using enteric precautions (see below).
Enteric Precautions
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Thorough hand washing
Use of personal protective clothing when necessary
All soiled clothing/bed linen should be washed in a washing machine on a hot
cycle. (Request the resident to follow this procedure and follow Laundry
Procedure).
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Toilet seats, flush handles, taps, door handles, should be cleaned daily with
hot water and detergent, or more frequently depending on how often they
are used.
Thorough environmental cleaning.
People with diarrhoea should be isolated pending diagnosis.
Everyone should be instructed on personal hygiene and in the hygienic
preparation and serving of food.
2.2. Salmonella
2.2.1. Salmonella is the second most common reported cause of gastrointestinal disease in
England and Wales.
2.2.2. Salmonella is acquired by the ingestion of the organism. In most cases this is through the
consumption of contaminated foods such as undercooked poultry, meat, raw eggs. Cross
contamination is a particular problem and good hygiene practices are necessary.
2.2.3. Salmonella may be transmitted from person to person and is spread via the faecal oral
route. Other rarer causes include direct contact with animals including exotic pets.
2.2.4. The incubation period ranges from six hours to three days, but in most cases is between
12-36 hours after ingestion. The infectious period varies enormously from a few days to
months, but is usually about five weeks.
2.2.5. The severity of the illness varies; in most cases stools are loose, but do not contain blood
or mucous. Diarrhoea usually lasts for 3-7 days accompanied by fever, abdominal pain
and headache.
2.2.6. Diagnosis is usually confirmed by culture of a stool specimen.
2.2.7. Methods of prevention include:
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Good personal hygiene
Good food practices – paying particular attention to care with raw poultry and
eggs .
2.2.8. If there is a suspected case of Salmonella in the enteric precautions should be used
Health Protection should be informed.
2.3. Escherichia coli
2.3.1. There are many different strains of E-coli associated with gastrointestinal illness, the
most serious being E-coli 0157.
2.3.2. The natural reservoir of E-coli 0157 is the gastrointestinal tract of animals, particularly
cattle, but also sheep, goats, deer, horses, dogs, birds and flies.
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2.3.3. Humans can be infected via:
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Contaminated foods
Direct contact with animals – farm visits etc.
Faecal oral spread (in families and institutions)
2.3.4. Symptoms include diarrhoea, haemorrhagic colitis and bloody diarrhoea, severe
abdominal pains but usually no fever. Haemolytic Uremic Syndrome (HUS), renal failure
and anaemia.
2.3.4. The incubation period ranges from 109 days. HUS may follow after a further 5-10 days.
The infectious period is unclear.
2.3.5. Methods of prevention include:
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Good kitchen practices – separation of raw and cooked food
Cooked meat to a minimum of 70°C for 2 minutes.
Good hygiene practices
2.3.6. Enteric precautions must be used. Isolate the resident in a single room if available.
Consult for specific advice.
2.4. Norovirus
2.4.1. Norovirus is generally a mild illness, which spreads rapidly, particularly in residential
care settings.
2.4.2. Outbreaks of Norovirus occur throughout the year but are more common in the cooler
months.
2.4.3. Symptoms include abdominal cramps, nausea or vomiting and diarrhoea. They are mild,
lasting 12-60 hours.
2.4.4. The incubation period is usually 15-50 hours but can range from 4-77 hours.
2.4.5. People remain infectious until 48 hours after the resolution of symptoms.
2.4.6. Humans are the only known reservoir of Norovirus. Spread occurs via:
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Infected food handlers
Contaminated foods
Person to person
2.4.7. Enteric precautions are required if there is an outbreak of this illness.
2.4.8. Vomit is extremely infectious when associated with Norovirus and the environment
must be cleaned as soon as possible. Consideration should be given to the fact that the
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vomit may have spread over a large area in the form of droplets. All gross
contamination must be removed before the surface is cleaned. Hypochlorite should be
used for hard surfaces and then steam cleaned, carpets and soft furnishing should be
washed and steam cleaned. Routine cleaning is not effective and steam cleaning must
be undertaken.
2.5. Scabies
2.5.1. Scabies is caused by a tiny mite Sarcoptes scabiei which burrows in to the skin and lays eggs.
The mites produce faecal pellets, from which an allergen diffuses into the deeper skin and
eventually enters the bloodstream and causes symptoms of scabies.
2.5.2. As with all allergies the appearance of symptoms is delayed, usually appearing four to six
weeks after infection.
2.5.3. During the incubation period the person may be infectious without having any signs or
symptoms of scabies. This can make the spread very difficult to contain and is the reason for
treating contacts and cases at the same time.
2.5.4. The appearance, severity of symptoms and their precise nature are influenced by the
immune status of the individual.
2.5.5. Classical Scabies:
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This is the form of scabies, which is generally found in healthy people with
normal immune systems. The main symptom is a rash, which is extremely
itchy, especially at night. Burrows may appear anywhere, but mainly on the
hands, particularly the finger webs and arms.
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The rash has a characteristic distribution being found on the fingers, wrist,
forearms, elbows, around the waist, lower buttocks, inside thighs and around
the ankles. It is always bilateral and affects both sides of the body alike.
2.5.6. Crusted Scabies (Norwegian Scabies):
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This form of scabies is extremely rare and occurs in those whose immune
systems are severely impaired. Because there is no allergic response, the itchy
rash does not appear and the disease is not uncomfortable.
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The mites are numerous and may be anywhere on the body including the
head. This form of the disease is extremely contagious and usually results in
an outbreak.
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2.5.7. Atypical Scabies:
 Scabies is atypical in any person with immune or impaired response. Symptoms
are variable, scaling or crusting may be present, but is usually slight. Itching may
also be very slight or absent, and it may be some time before the infections
diagnosed. A high proportion of atypical cases occur in people in various longterm institutions such as residential homes.
2.5.8. Diagnosis:
 A doctor must make the diagnosis of scabies, the decision to treat any skin
contacts of the case will depend if the diagnosis is a possible or definite
(probable) case of scabies and the type of contact with the case.
 If scabies is diagnosed in housing and it is a single case (resident and/or staff), is
the diagnosis possible or definite scabies?
2.5.9. Treatment of Scabies:
a) Possible/ Suspected Scabies;
 Treat the case and observe for symptoms in all other skin-to-skin contacts for
the next 4-6 weeks. If further possible or definite cases develop refer to “When
more than one case is diagnosed” below (resident and/or staff).
b) Definite Scabies;
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Treat the case, make a list of all those who have had skin-to-skin contact with
the case and ask the residents GP to prescribe treatment. Staff should contact
their GP to request treatment and treatment should be considered for
household contacts.
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If there is more than one person diagnosed (staff or resident) as a possible or
definite case of scabies in a residential care setting it is usually necessary to
treat further residents and/or staff whether they have symptoms or not.
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The Infection Control Lead must provide printed information regarding
treatment and management of the outbreak.
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A risk assessment and management plan must be put in place to manage the
outbreak.
c) To assess who requires treatment the following information has to be considered:
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Are the cases possible or definite?
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For each case the duration and location of the symptoms on the body.
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Have any of the cases received treatment for scabies or any other skin
condition?
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Location of affected residents in the home.
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Areas of work in the care home if a member of staff
d) Scabies is spread from one person to another by close skin to skin contact with an
infected person, e.g. holding hands/intimate contact.
e) Application of treatment (staff to advise and not administer treatment);
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Scabies mites rapidly dry out away from the human body, therefore the
environment does not present a risk of transmission, this includes bed linen
and towels.
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It is essential that all close contacts of a person with scabies be treated at the
same time, whether they are showing symptoms or not. It must be assumed
that they are incubating the disease.
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It is not necessary to have a bath before commencing treatment, as the
treatment should be applied on cool dry skin.
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It is essential that the whole skin area of the body is treated from the neck
downwards, paying particular attention to the ears, between fingers, and toes,
under the fingernails, the soles of the feet. It is important to stress to the
affected individuals to ensure that no part of the skin is missed.
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The treatment should be left for 8-24 hours (depending on preparation).
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People with crusted scabies also need to be treated on the scalp, ears and
face.
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Persons are non-infectious immediately after treatment and can resume
normal life, but should be warned that itching may persist for some weeks.
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Two treatments are recommended and should be given 7 days apart. Contacts
of a case may require only one treatment.
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It is normal for symptoms (itch and/or rash) to persist for some weeks
following treatment but this does not mean the treatment has failed. The
symptoms may be alleviated with treatments prescribed by the GP.
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Any individuals with persistent symptoms 6 weeks after the second treatment
requires medical assessment to exclude treatment failure or re-infection.
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Severe cases of encrusted scabies may need to be treated under the guidance
of a Consultant Dermatologist.
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A record sheet needs to be completed for cases of scabies outlining residents
affected, symptoms etc.
Please note: During an outbreak of scabies it is advisable not to admit or transfer residents
until treatment is successful. If a resident requires hospital admission The Housing Team must
inform the admitting ward of the situation in the home (this applies to all residents regardless
of symptoms).
2.6. Head lice
2.6.1. Head lice can be found on adults and children. They are transferred from person-toperson wherever head-to-head contact occurs. This is generally at social gatherings
or within a household environment.
2.6.2. Treatment should be commenced when head lice are found.
2.6.3. The Pharmacist or GP should offer advice to the Infection Control Lead. Information
on head lice can be found on the HPA website.
2.6.4. Head lice are parasitic insects and only live on the heads of people. Head lice cannot
jump from head to head. The type of louse which affects the head is particularly
common and anyone can catch them, although they favour clean, mid-length hair
and female heads. There are three stages of head lice:
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Nits are head lice eggs. The eggs or nits are glued to the hair and only
become easily visible when they have hatched. Nits remain in the hair
until it falls out, which may take up to two years.
Nymphs hatch from the nits. The baby lice look like the adults, but are
smaller. They take about 7 days to mature to adults and feed on blood
to survive.
Adults are about the size of a sesame seed. They have six legs and are
tan to greyish-white. The legs have hook-like claws to hold onto the hair
with. Adults can live up to 30 days and feed on blood.
2.6.5. Head lice are transmitted through direct, prolonged head-to-head contact with an
infested person. This is especially common during play or sport at school and with
close contacts at home. Transmission is possible through infected clothes, combs,
brushes or towels, but extremely unlikely. The lifespan of a louse is very short once
detached from the hair so fumigation is not necessary.
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2.6.6. Treatment;
a) Chemical treatments are available but only treat those where a living, moving
louse is found.
b) Wet Combing; this method does require perseverance. However, if this
treatment appears to continually fail, treatment with insecticides may still be
required.
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Wash the hair in the normal way with an ordinary shampoo;
Make sure the teeth of the comb slot into the hair at the roots with
every stroke.
This should be done over a pale surface, such as a paper towel or the
bath;
Clear the comb of lice between each stroke;
Wet lice find it difficult to escape, so removal with the comb is easier;
This routine should be repeated every day for 2 weeks, so that any lice
emerging from the eggs are removed before they can mature, mate and
lay more eggs.
c) Insecticides (pesticides); there are three chemical insecticides available.
However, there is evidence that some head lice have become resistant to
particular insecticides. This may lead to problems of eradicating head lice
from an individual's head. Insecticides should ONLY be used if live lice are
found. The insecticides are Malathion, Pyrethroids (Phenothrin and
Permethrin) and Carbaryl. Carbaryl can only be prescribed by a healthcare
professional (e.g. GP and some nurses); the other two chemicals can be
purchased from a pharmacy. All products must be used according to
manufacturer’s guidance. Insecticides are not effective on eggs; therefore a
second application is required a week later to kill the newly hatched lice. Fine
comb the hair every 3-4 days between applications and for at least a further
2 weeks after the final application is recommended. Insecticides are available
in alcohol and aqueous-based preparations. Individuals that suffer from
asthma, eczema etc should avoid alcohol based products. The suitability of
the product should be discussed with the pharmacist. Insecticides must not
be used more than once a week, and not for more than 3 consecutive weeks.
d) Non-pesticide Lotion; Non pesticide lotion – Dimeticone compound
(proprietary name Hedrin) - coats head lice and smothers them. There is no
resistance to this lotion. However careful application is required for effective
killing of the lice. It is important to follow the instructions on the pack,
ensuring that the lotion is applied evenly and is combed throughout the
length of the hair. Two applications, one week apart, are required to kill lice
and hatching lice. To check effectiveness use a detector comb 24 hours after
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the second treatment. Further applications can be used if head lice remain
present after the 2nd course of treatment.
2.6.7. Contact Tracing is an important part of the control of head lice infestation. Contacts
will be other individuals who have had head-to-head contact lasting approximately
one minute or more in the past month. These social contacts outside of the home
may include friends and other social groups.
2.6.8. A contact list should be formulated by each person with head lice. This list will be
fairly short. Every person on the list should then be told that they have been in
contact with a person who has had head lice and that they should have their own
hair checked.
2.7. Chickenpox and Shingles
2.7.1. The incubation period for Chicken Pox (i.e. the time from infection with the virus to
the appearance of symptoms) is 7-21 days. The average time is about 15-18 days.
Humans are the only reservoir of infection.
2.7.2. Chickenpox is highly infectious. Characterised by a blister-like itchy rash, appears
initially on the face, scalp and trunk, but can spread over the entire body. Other
symptoms which may precede the rash by 48 hours include general malaise, fever
and headache. Chickenpox is transmitted through direct person to person contact,
via airborne spread of respiratory droplet nuclei, and vesicle fluid or through contact
with infected articles such as clothing and bedding. The most infectious period is
from one to two days before onset of the rash and continues for one week after
onset or until all lesions are dry and have crusted. NB immunosuppressed patients
may be infective for longer.
2.7.3. The Shingles virus causes severe pain and itching followed by the development of
blister-like lesions, occurring at the site of the affected sensory nerve, typically
causing a strip-like pattern on one side of the body. Is much less infectious than
chickenpox although spread may occur from individuals who have extensive lesions
and susceptible contacts can develop chickenpox. Transmission can occur through
direct contact with exudate. The most infectious period is one week following onset
of eruption or until lesions are dry.
2.7.4. Non-immune staff are at risk of both contracting and transmitting infection. Nonimmune staff who are exposed to chickenpox and themselves become infectious,
risk spreading the disease to others. Thus, staff without a definite history of
chickenpox, who have inadvertently had significant exposure will be part of the
management of any incident. If then found to be non immune; appropriate action to
prevent further spread should be taken, such as exclusion from work for the
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duration of the incubation period. The above risks can be reduced if non-immune
staff are identified before during the recruitment process and encourage to be
vaccinated.
2.7.5. Recommended actions for managing a single chickenpox case in a residential/
housing settings are:
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When a diagnosis is suspected, the doctor providing health care to the
individual should discuss the diagnosis and infection control related
issues. The Health Protection Unit can also be contacted for advice.
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As soon as chickenpox is suspected, the individual should be isolated in
a separate room until the legions have crusted over. Due to residents
having their own flats the risks are lower; however during this period
the resident affected should not have visitors in their rooms. Residents
will be briefed on the risks if they do so.
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Following clinical confirmation of diagnosis, isolation should continue
until the lesions have crusted over. The resident should not take their
meals in communal dining areas during this period. Only confirmed
immune/immunised support workers should work closely with the
resident to reduce risks.
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No special measures are necessary for cleaning or disposal of linen and
laundry or dishes, glasses and eating utensils used by the individual,
assuming a reasonable level of hygiene is maintained.
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Measures need to be put in place for vulnerable contacts such as
pregnant women or immunocompromised individuals.
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There is no need to postpone admissions for a single case of case of
chicken pox or shingles.
2.7.6. The management of any outbreak will vary depending upon the particular
circumstances e.g. who is affected, how many individuals, where they are located. In
this case advice will need to be sought from the local Health Protection Unit.
2.7.7. In the management of an outbreak considerations may include;
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Closure to admissions for 21 days (the maximum incubation period)
from the onset of symptoms in the most recent case.
Admission only to individuals confirmed to be immune to varicella by
G.P. from the onset of symptoms in the most recent case.
Access to affected parts of the premises restricted to staff confirmed to
be immune/immunised for 21 days from the onset of symptoms in the
most recent case.
Please note; the above list are some suggestions to be considered; however actions are
dependent on each case and staff must always follow the advice from the Health
Protection Unit.
2.8. Notifiable Diseases
2.8.1. Diseases notifiable (to Local Authority Proper Officers) under the Health Protection
(Notification) Regulations 2010:
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Acute encephalitis
Acute infectious hepatitis
Acute meningitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
Diphtheria
Enteric fever (typhoid or paratyphoid fever)
Food poisoning
Haemolytic uraemic syndrome (HUS)
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaires’ Disease
Leprosy
Malaria
Measles
Meningococcal septicaemia
Mumps
Plague
Rabies
Rubella
SARS
Scarlet fever
Smallpox
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Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever
These and other diseases that may present significant risk to human health may be
reported under other significant disease category.
2.8.2. A log sheet must be kept to record the following information on clients with suspected and
confirmed infections.
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Name, date of birth and gender.
Name of clinician.
Date of onset of symptoms and Type of symptoms.
Diagnosis and Outcome.
Source of infection if known. Whether the case was reported to the Health
Protection Unit and date of notification/reporting.
 Similar information should be kept for staff who report any infectious
disease.
2.8.3. Infectious diseases in staff; people are a common source of food poisoning organisms. Staff
who are suffering from sickness, diarrhoea or other symptoms of food poisoning or heavy
colds should not handle food and must not enter a food handling area. Staff suffering from
discharges from the ears, eyes, nose or those who have septic skin conditions should not be
allowed to work with food either.
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