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Beechdale Health Centre Contagious Illness Policy Document Control A. Confidentiality Notice This document and the information contained therein is the property of Beechdale Health Centre. This document contains information that is privileged, confidential or otherwise protected from disclosure. It must not be used by, or its contents reproduced or otherwise copied or disclosed without the prior consent in writing from Beechdale Health Centre. B. Document Details Classification: Author and Role: Organisation: Document Reference: Current Version Number: Current Document Approved By: Date Approved: C. Public Arun Venugopal & Jane Smith Beechdale Health Centre CIP 1 Jane Smith 07.03.2013 Document Revision and Approval History Version Created By: Version Approved By: 1 Version 07.03.2013 Jane Smith Arun Venogupal Staff to read. 1.1 01.04.2014 Arun Venugopal Arun Venugopal Reviewed from Initial Document Doc. Ref – Date Version – Filename: Contagious Illness Policy Comments Page 1 of 19 Introduction Infection control is an important and integral part of the function of each and every General Practice. This is the case for services provided within the community (e.g. in a patient’s home) as well as on Practice premises. Many infection control problems and outbreaks can be curtailed quickly if action is taken at the earliest opportunity, so timely communication with the appropriate specialists is essential. Ensuring that the principles of infection control are incorporated throughout the Practice can help to ensure the best possible environment for the prevention and control of infection. The Practice has many, readily-accessible, policies to enable managers to educate their staff about infection control precautions and actions to be taken in the event of incidents, for example: needle-stick or inoculation injuries. These policies are also underpinned by a high standard of training in infection control precautions and procedures. By ensuring that staff members practise a good standard of infection control at all times the Practice will play a significant role in reducing infection in our local community. Newly employed staff will, during the first week of their induction process, be made familiar with the Practice’s various infection control policies. Refresher training will also be mandatory for all staff on an annual basis and / or when new practices / methods become available. Practice nurse will also periodically undertake an assessment of the infection risks in the Practice and ensure that everything necessary is in place to manage those risks. Practice nurse is the Infection Control Lead for Beechdale Health Centre. This person will act as the link between the PCT Infection Control / Health Protection Team(s) and the Practice. Occupational Health Arrangements The Practice has arrangements in place for occupational health support and advice, together with appropriate policies for the protection of staff from infection through immunisation, the avoidance and management of incidents, and training and compliance with health and safety legislation. Each new member of staff must complete a pre-employment health questionnaire and provide information about previous immunisation against relevant infections. Patients and other staff also need to be protected from staff infected with a communicable disease. The Practice’s occupational health policies set out the responsibilities of staff members to report episodes of their own illness, (e.g. vomiting, diarrhoea), to the Practice manager. Doc. Ref – Version – Filename: Contagious Illness Policy Page 2 of 19 Clinical Waste Infectious Waste Practice staff must assess any waste produced during consultations and determine the risk of infection that it could cause if handled and disposed of incorrectly. Assessment should be based on professional judgement, clinical signs and symptoms, and prior knowledge of the patient. Wounds should be treated as infectious if they have apparent signs of infection or are being treated with antibiotics. Waste products must be disposed of using orange sacks / containers and local waste collection arrangements made. Non-infectious waste Where the waste products from consultations are assessed as non-infectious, (e.g. non-infectious wound dressings, incontinence pads), the waste should be discarded as ‘offensive / hygiene waste’ in a yellow bag with black stripe. Infectious Diseases in Staff Staff members who are suffering from any sickness, diarrhoea or have a heavy cold or flu symptoms should not attend the Practice for work. This also applies to any staff members who may be suffering from septic skin conditions. The member of staff should notify their Practice Manager as soon as possible before they are due to start work if they are suffering from any of the above conditions. The Practice Manager must then assess the situation and make sure the appropriate action is taken (e.g. excluding the staff member from work if necessary). Staff members who are ill must be symptom-free for 48 hours before returning to work to ensure that any infection is not passed to other staff members and patients. Infectious Disease in Patients The Practice will ensure that patients who are suffering from any sickness that may be linked to an infectious disease will be provided during their consultation / telephone consultation / home visit with suitable leaflets / patient information sheets / information that will give them details on their particular illness (e.g. how long the illness will be contagious). When an ill patient does not attend the Practice and contacts the doctor by telephone. If the illness can be clearly identified over the telephone, then the correct information in relation to the illness will be provided by telephone consultation. If a home visit is required, the doctor will follow the same procedures contained in the Patient Isolation Protocol, (i.e. wear gloves / apron etc.). Any clinical waste will be destroyed at the patient’s home as per the clinical waste policy. Doc. Ref – Version – Filename: Contagious Illness Policy Page 3 of 19 Notifiable Diseases Under the Public Health (Control of Diseases) Act 1984 there are certain diseases which must be notified to the PCT. It is the responsibility of the doctor who diagnoses the disease to notify it to a ‘Proper Officer’ at the PCT. The doctor should fill out a notification certificate immediately on diagnosis of a suspected notifiable disease and should not wait for laboratory confirmation of the suspected infection or contamination before notification. The certificate should be sent to the Proper Officer within three days or verbally within 24 hours if the case is considered urgent. The following list of diseases are notifiable under the Health Protection (Notification) Regulations 2010: Acute encephalitis; Acute meningitis; Acute poliomyelitis; Acute infectious hepatitis; 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 and scarlet fever; Legionnaires’ disease; Leprosy; Malaria; Measles; Meningococcal septicaemia; Mumps; Plague; Rabies; Rubella; SARS; Smallpox; Tetanus; Tuberculosis; Typhus; Viral haemorrhagic fever (VHF); Whooping cough; Yellow fever. For some of these diseases, such as tuberculosis or food poisoning, there may be further control measures to be taken. The Health Protection Agency can offer advice on any special arrangements required. Doc. Ref – Version – Filename: Contagious Illness Policy Page 4 of 19 Notifying the CQC of Serious Injury to a person who uses the Service Practice Manager at the Practice is responsible for notifying the CQC without delay about events that lead to: Serious injury to any person who uses the service. An injury requiring treatment by a healthcare professional to avoid death or serious injury. These serious injuries include: Injuries that lead to or are likely to lead to permanent damage – or damage that lasts or is likely to last more than 28 days – to: A person’s sight, hearing, touch, smell or taste Any major organ of the body (including the brain and skin) Bones Muscles, tendons, joints or vessels Intellectual functions, such as Intelligence Speech Thinking Remembering Making judgments Solving problems. Injuries or events leading to psychological harm, including: Post-traumatic stress disorder Other stress that requires clinical treatment or support Psychosis Clinical depression Clinical anxiety The development after admission of a pressure sore of grade 3 or above that develops after the person has started to use the service (European Pressure Ulcer Advisory Panel Grading) Any injury or other event that causes a person pain lasting or likely to last for more than 28 days Any injury that requires treatment by a healthcare professional in order to prevent: Death Permanent injury Any of the outcomes, harms or pain described above. Where the Registered Person is unavailable, for any reason, practice nurse will be responsible for reporting the serious injury to the CQC. There is a dedicated Notification form for this type of incident. The form is contained in the Outcome 20 document “Notification of Other Incidents – Outcome 20 Composite Statements and Forms” Doc. Ref – Version – Filename: Contagious Illness Policy Page 5 of 19 Chickenpox / Shingles (Herpes Varicella-Zoster Virus) Chickenpox is an acute, generalised viral infection, commonly affecting children. The rash tends to affect central areas of the body more than the limbs. The scalp, mucous membrane of the mouth and upper respiratory tract and eye may also be affected. It is infectious from about 2 days before, to 5 days after, the rash appears. Shingles occurs only in people who have previously had Chickenpox infection. Following Chickenpox, the virus remains dormant in the body, usually in a sensory nerve root. In later months or years the virus reactivates and causes a shingles rash at the skin site supplied by the nerve. Therefore anyone with shingles must have had Chickenpox in the past, even if they don't remember it. Certain individuals have additional risks if infected, including the immuno-compromised (e.g. those receiving steroids or cytotoxic drugs), non-immune pregnant women and neonates. If they have contact with a case during the infectious phase they may need immunoglobulin. Transmission Chickenpox is spread by contact with infected respiratory droplets or fluid from the blisters. It is very infectious to people who have not had Chickenpox before. Shingles cannot be spread from person to person. However, the blister fluid contains the varicella virus. Therefore people who have never had Chickenpox should avoid contact with cases of both Chickenpox and Shingles. Symptoms Shingles causes a rash of tiny blisters, usually affecting a clearly defined area of the body. After a few days, the blisters crust over and form scabs. The rash is not itchy, but it can be very painful. The pain may start a day or so before the rash appears. The area is infectious for about a week after the blisters appear. Prevention Within the Practice, non-immune members of staff should be immunised against varicella. Nonimmune staff who have direct contact with high-risk groups and are exposed to the virus, should be redeployed to a lower-risk environment from the 8th to 21st day (28 days, if immunoglobulin has been given) after initial contact with a case during the infectious phase. Doc. Ref – Version – Filename: Contagious Illness Policy Page 6 of 19 Clostridium Difficile Clostridium Difficile bacteria are normally present in small numbers in the human bowel without causing any problems. However, when taking certain antibiotics, the Clostridium Difficile microbes may begin to multiply and produce toxins. The toxins cause the bowel to become inflamed and for diarrhoea to develop. An emerging strain (O27) is increasingly associated with outbreaks of severe infection. Infection can be prevented by avoiding the unnecessary use of broad-spectrum antibiotics, for example: Cephalosporins. Transmission Spread is more common in secondary care institutions and primarily in older people (65+), however that does not mean that Practices can overlook the possible risk of infection. When a person is infected with Clostridium Difficile, they pass the micro-organisms in their faeces or diarrhoea. A susceptible person (i.e. elderly, taking antibiotics) can pick up the infection if they come into contact with the infected faeces or contaminated surfaces and transfer the bacteria to their mouth. Symptoms Symptoms can range from mild diarrhoea to severe life threatening pseudo-membranous Colitis or Peritonitis. Prevention The following actions are to be used to prevent the spread of Clostridium Difficile: People with diarrhoea must, as at any time, wash their hands carefully after using the toilet; Clothing soiled with diarrhoea should be washed separately on a hot wash; Equipment contaminated with diarrhoea, should be cleaned immediately using a chlorinereleasing agent; Staff members who may come into contact with diarrhoea or soiled equipment should wear disposable gloves and wash their hands with soap and water. Doc. Ref – Version – Filename: Contagious Illness Policy Page 7 of 19 Cryptosporidiosis Cryptosporidium is a parasite that causes an infection called Cryptosporidiosis which can affect both humans and livestock. Cryptosporidium is found in lakes, streams and rivers, untreated water and sometimes in swimming pools. Transmission A person can get Cryptosporidiosis directly from another person or animal by touching faeces (e.g. when changing a nappy, or for persons working in a farm environment) and putting their hands near or in their mouth without washing them thoroughly. It is also possible to get Cryptosporidiosis from infected pets or by swimming in, or drinking contaminated water. Occasionally a person can be infected by eating and drinking contaminated food, particularly unpasteurised milk, offal (liver, kidneys, and heart) or undercooked meat. Symptoms Symptoms include watery diarrhoea, stomach pains, dehydration, weight loss and fever. These symptoms could last for up to three weeks, but it can affect people with weak immune systems for much longer. An infected person might think they are getting better and have shaken off the infection but then find that they get worse before the illness eventually goes. As symptoms are similar to many other infections, the only way to make an accurate diagnosis is for a sample of the infected person’s faeces to be tested in a laboratory. Prevention Staff members should use gloves if contact with patients is made or if handling soiled items from patients; Careful hand-washing with soap and water is essential; Single-use equipment and disposables must be used during any consultation. These must be correctly and safely disposed of; Cleaning staff must wear gloves and ensure that toilet seats are carefully disinfected, along with flush-handles, hand-wash basin, taps and toilet door handles; Special care must be taken to make sure hands are clean before handling food and drink items; If a member of staff contracts the disease from a patient they must stay away from the Practice and make sure they are symptom-free for 48 hours before returning to work at the Practice. Doc. Ref – Version – Filename: Contagious Illness Policy Page 8 of 19 Escherichia Coli (E coli) E. coli 0157:H7 is one of hundreds of strains of the bacterium Escherichia Coli. Most strains are harmless and live in the intestines of humans and animals, but this strain produces a powerful toxin which can cause severe illness. It is a strain of Verocytotoxin producing Escherichia Coli (VTEC) and is found in the intestines of some livestock and other domesticated animals, such as goats, and also in the intestines of infected people. Transmission The bacterium can be transmitted by three main routes: Through food (undercooked minced beef, unpasteurised milk); Person-to-person contact; Direct and indirect animal contact. Symptoms E. Coli 0157 is often very mild, but some people develop diarrhoea, which can be severe and bloody, with abdominal cramps. A few cases (especially in children under 5 years of age and older people) may develop a complication called Haemolytic Uraemic Syndrome, which is a form of kidney failure. They may need admitting to hospital for renal dialysis or blood transfusion. Prevention Don’t eat undercooked meat products, e.g. beef burgers and minced beef; Thoroughly cook meat until the juices run clear; Drink only pasteurised milk; Wash hands before handling food, after using the toilet or changing nappies; Wash animal faeces from shoes and clothing, followed by hand-washing; If a member of staff contracts the disease from a patient they must stay away from the Practice and make sure they are symptom-free for 48 hours before returning to work at the Practice. Doc. Ref – Version – Filename: Contagious Illness Policy Page 9 of 19 Hand, Foot and Mouth Disease This illness is caused by Coxsackie virus. Anyone can be infected, but the infection most frequently affects children under 3 years of age. Cases often occur in the spring and autumn and outbreaks of infection may occur especially in pre-schools and nurseries. The illness lasts about 7 - 10 days and usually gets better without treatment. Transmission This is usually by airborne droplets passed into the atmosphere during coughing or sneezing, or by these droplets landing on objects, then being passed on through hand-to-mouth contact. Symptoms Early symptoms can include: Fever and malaise; Loss of appetite; Sore throat; Small red spots in mouth, throat or on skin. Later symptoms can include: Mouth lesions; Skin rash. Prevention The best way to prevent spread is to avoid close contact with people who have the disease and to practise good hygiene. Additionally, the following points should be observed: Always wash hands after going to the toilet, handling nappies or before preparing food; Avoid sharing any equipment or cooking utensils with people who are already infected; Make sure that shared work surfaces are cleaned with an anti-bacterial surface spray. Doc. Ref – Version – Filename: Contagious Illness Policy Page 10 of 19 Hepatitis This is a viral infection that causes inflammation of the liver resulting in jaundice (yellowing of the skin) and dark urine. People with Hepatitis often feel generally unwell, with fever, nausea or abdominal pain, for 1-2 weeks before the jaundice starts. Some people, especially children, may have no symptoms at all and do not have jaundice, but adults often feel quite sick. Almost everyone recovers completely without special treatment and with no long-term effects. However, certain people are at risk of more severe infection. These include people aged over 50 who have existing liver cirrhosis or a pre-existing hepatitis B or C infection. Transmission Hepatitis A This is caught by putting something in your mouth that has been contaminated with the stools (faeces) of someone with Hepatitis A. This is because an infected person excretes the virus in their faeces for one or two weeks before starting to feel ill. This continues for about one week after symptoms start. They can pass on the infection to others if they don’t wash their hands after using the toilet. Others acquire the infection by eating food prepared by an infected person or by the shared use of contaminated items, including equipment for injecting drugs. By the time a person with Hepatitis A infection has had jaundice for a week they will no longer be infectious to others, even if they still have symptoms. They develop antibodies that protect them from future infection. Hepatitis B This is caused by the Hepatitis B virus that can be present in body fluids such as blood, saliva, semen and vaginal fluid. It can be passed from person to person through unprotected sex or by sharing needles to inject drugs, for example. Hepatitis B is not very common in the UK: approximately one in 1,000 people are thought to have the virus. The vast majority of people who are infected with Hepatitis B are able to fight off the virus and fully recover from the infection within a couple of months. Vaccinations for Hepatitis B are available. Hepatitis C This is caused by the Hepatitis C virus, present in the blood and, to a much lesser extent, the saliva and semen or vaginal fluid of an infected person. It is particularly concentrated in the blood, so it is usually transmitted through blood-to-blood contact. The most common way a person can become infected is by sharing contaminated needles to inject drugs. The cause of Hepatitis C is unpredictable. Some people can fight-off the infection and experience no ill-health. Others may develop liver damage, which sometimes progresses to cirrhosis and even liver failure. There is currently no vaccine to prevent Hepatitis C. Treatment with drugs called Interferon and Ribavirin can clear the infection in approximately half of those who are infected, but there are significant side effects. Doc. Ref – Version – Filename: Contagious Illness Policy Page 11 of 19 Symptoms Often in young children with Hepatitis, no symptoms are shown. Adults, however, usually become quite unwell. The symptoms to watch out for are the following: Flu-like symptoms, such as tiredness, general aches and pains, headaches and fever; Loss of appetite; Nausea or vomiting; Diarrhoea; Abdominal pains; Jaundice. The symptoms are quite similar in Hepatitis A and B. Hepatitis C also shares the above symptoms in the acute stage, but has the following additional ones during the chronic stage (i.e. longer than 6 months): Extreme tiredness; Depression; Short-term memory problems or difficulty concentrating; Mood swings; Digestive problems; Pain or discomfort in the liver area; Itching. Cirrhosis of the liver is also a possibility for about one in five chronic Hepatitis C sufferers. Prevention Good hand hygiene is of benefit to help prevent Hepatitis A, and there are vaccinations available for both Hepatitis A and B, though these are only normally necessary for those in high-risk occupations (e.g. healthcare workers), or those travelling to certain foreign countries. Hepatitis C has no vaccine available, but the following preventative measures will help reduce the risk of spread: Keeping personal items, such as toothbrushes or razors, for your own use; Cleaning and covering any cut or a graze with a waterproof dressing; Cleaning any blood from surfaces with household bleach; Not sharing needles or syringes with others; Not donating blood; Using condoms when having sex with new partners. Doc. Ref – Version – Filename: Contagious Illness Policy Page 12 of 19 Influenza Influenza is an acute viral respiratory infection that tends to be more prevalent during the winter months. The two main types of influenza causing disease in the UK are influenza type A and B, but new strains and variants of the virus emerge each year. The incubation period is 2- 3 days and cases are infectious from 1 day before the onset of symptoms and remain infectious for up to 5 days. Outbreaks may occur in communities and communal settings, in fact, anywhere where there is a large concentration of people. When the number of cases exceeds that normally expected, this is defined as an epidemic. If a completely new strain of influenza virus emerges - to which the population has no previous immunity - it may result in a global outbreak, known as a pandemic, which can have a high mortality rate. Transmission Transmission occurs either through breathing in airborne droplets from an infected person’s coughing or sneezing, or by touching surfaces contaminated with such droplets and then touching your own nose or mouth. Symptoms Influenza can give any of the following symptoms: Sudden fever - a temperature of 38°C or above; Dry, chesty cough; Headache; Tiredness; Chills; Aching muscles; Limb or joint pain; Diarrhoea or upset stomach; Sore throat; Runny or blocked nose; Sneezing; Loss of appetite; Difficulty sleeping. Symptoms usually peak after two to three days and the person should begin to feel much better within five to eight days. However, they may have a lingering cough and still feel very tired for a further two to three weeks. Doc. Ref – Version – Filename: Contagious Illness Policy Page 13 of 19 Prevention The main ways of preventing the spread of flu are: Good hygiene. Specifically the following: Wash hands regularly with soap and water (particularly before preparing or eating food); Clean surfaces that are touched regularly, possibly by many people (e.g. telephones, door handles); Cover your nose and mouth with a tissue when coughing or sneezing (and bin it immediately afterwards). Flu vaccination. For the following high-risk individuals: Those aged 65 or over; Pregnant women; Those with a serious medical condition; Those living in close-quarters (e.g. nursing home residents); Personal carers; Healthcare professionals. Doc. Ref – Version – Filename: Contagious Illness Policy Page 14 of 19 Meningococcal Disease Meningococcal disease is where Meningitis and Septicaemia are present together. Meningitis can be either caused by virus or a bacteria and is an infection of the meninges (membranes surrounding the brain and spinal cord), leading to it becoming inflamed and casing possible nerve and brain damage. Septicaemia is a secondary illness, in this case, caused by the body’s immune system overreacting to fight-off the Meningitis infection. All cases of suspected Meningococcal disease must be notified to the PCT under the Health Protection (Notification) Regulations 2010 in order to prevent further transmission into the community. Transmission The meningococcal bacteria that cause Meningitis do not live long outside of the body. However, it is possible for them to pass by the following actions: Sneezing; Coughing; Kissing; Sharing utensils, such as cutlery; Sharing personal possessions, such as a toothbrush or cigarette. Symptoms Bacterial Meningitis Bacterial Meningitis has a number of early warning signs that can occur earlier than the other symptoms. These are: Pain in the muscles, joints or limbs, such as in the legs or hands; Unusually cold hands and feet, or shivering; Pale or blotchy skin and blue lips. The early symptoms of Bacterial Meningitis are similar to those of many other conditions, and include: A severe headache; Fever; Nausea; Vomiting; Feeling generally unwell. Doc. Ref – Version – Filename: Contagious Illness Policy Page 15 of 19 As the condition gets worse it may also cause: Drowsiness; Confusion; Seizures or fits; Being unable to tolerate bright lights (photophobia) – this is less common in young children; A stiff neck – also less common in young children; A rapid breathing rate; A blotchy red rash that does not fade or change colour when you place a glass against it (not always present). Bacterial Meningitis usually leads to Septicaemia (see below). Viral Meningitis This is a much less dangerous condition that the bacterial type. Symptoms for this type are usually like common flu, such as: Headaches; Fever; General malaise. More severe cases may also cause: Neck stiffness ; Muscle or joint pain ; Nausea; Vomiting; Diarrhoea; Photophobia. Unlike Bacterial Meningitis, Viral Meningitis does not usually lead to Septicaemia. Septicaemia The symptoms of sepsis usually develop quickly and include the following: Fever or high temperature over 38°C; Chills; Fast heartbeat; Fast breathing. Symptoms of severe sepsis or septic shock include: Low blood pressure that makes the person feel dizzy when they stand up; Change in the person’s mental state, such as confusion or disorientation; Diarrhoea; Nausea and vomiting; Cold, clammy and pale skin. Doc. Ref – Version – Filename: Contagious Illness Policy Page 16 of 19 Prevention A number of vaccines are available that could prevent many of the cases of Meningitis occurring. Some are given at childhood, but boosters should also be given to adults periodically. Others would only be given to persons visiting foreign countries where the prevalence is much greater. Vaccinations include: Measles, Mumps and Rubella (MMR); Meningitis C vaccination; DTaP/IPV/Hib vaccination (which provides protection against the Hib virus, Diphtheria, Whooping Cough, Tetanus and Polio; Pneumococcal Conjugate Vaccine (PCV). Doc. Ref – Version – Filename: Contagious Illness Policy Page 17 of 19 Scarlet Fever The predominant symptom of Scarlet Fever is a widespread, fine pink-red rash that feels like sandpaper to touch. It may start in one area, but will soon spread to many parts of the body, such as the ears, neck and chest. The rash may be itchy. The rash does not usually affect the face, although the checks may be flushed and the area around the mouth may be more pale than usual. The tongue may also appear red and coated. As the patient improves, the skin on some parts of the body, especially the tips of fingers and toes, may begin to peel. Scarlet Fever is caused by a bacterial infection, and may result in a high fever, vomiting and sore throat. Scarlet Fever is a notifiable disease under the Health Protection (Notification) Regulations 2010. Transmission Scarlet Fever is particularly contagious and can be transmitted by the following methods: Inhaling bacteria suspended in airborne droplets from an infected person's coughs and sneezes; Touching the skin of a person with a streptococcal skin infection; Sharing contaminated towels, baths, clothes or bed linen; It can also be spread by people who have the bacteria in their throat but do not show any symptoms (known as carriers). A person can only develop the symptoms of Scarlet Fever if they are susceptible to the toxins released by streptococcal bacteria. Symptoms Red blotches, turning into a fine pink-red rash which has the texture of sandpaper and looks like sunburn; Headache; Swollen neck glands; Loss of appetite; Nausea or vomiting; Stomach pain; Broken blood vessels in the folds of the body; A white coating on the tongue, which peels a few days later leaving the tongue red and swollen (this is known as strawberry tongue); A general feeling of malaise. Prevention Infected persons should stay at home (do not let children attend school until they have been of a course of antibiotics for at least 24 hours); Tissues should be disposed of immediately, then hands washed with soap and water; Do not share utensils, cups, glasses, clothes, baths, bed linen or towels with an infected person. Doc. Ref – Version – Filename: Contagious Illness Policy Page 18 of 19 EBOLA ! 140808 NHS England EBOLA operational update ATproviders (2).pdf Doc. Ref – Version – Filename: Contagious Illness Policy Page 19 of 19