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North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DOCUMENT CONTROL Ann Bateson, Senior Infection Prevention and Control Nurse Tel: 01946 693181 ext 4339 Email: [email protected] Author/Contact Equality Impact Assessed 27/06/2011 Version 1.0 Status Approved Publication Date 19/07/2011 Review Date 31/07/2014 Approved by: Control of Infection committee Date: 17/05/2011 Trust Policy Group Date: 06/07/2011 Governance Committee Date: 19/07/2011 Please note that the Intranet version of this document is the only version that is maintained. Any printed copies should therefore be viewed as “uncontrolled” and as such, may not necessarily contain the latest updates and amendments. Approved documents related to this policy Name Policy Inoculation Policy MRSA Policy Fact Sheet Policy Theatre Policy Document Reference / Hyperlink http://nww.staffweb.cumbria.nhs.uk/acute/policies/h_l/innoculation%20injury.pdf http://nww.staffweb.cumbria.nhs.uk/acute/policies/m_s/mrsa%20policy.pdf awaiting http://nww.staffweb.cumbria.nhs.uk/acute/policies/h_l/InfectionPreventionandControlTheatrepolicyV10ApprovedMarch2011.pdf Innoculation http://nww.staffweb.cumbria.nhs.uk/acute/policies/h_l/InnoculationInjuryPolicyV30.pdf Injury Policy Statement of changes made Version 0.1 Date 17/05/2011 Changes / comments received from Sent to IPCT Committee for comments Page 2 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 List of Stakeholders who have reviewed the document Name Dr M Meda Dr C Hamson Title Consultant Microbiologist Consultant Microbiologist TABLE OF CONTENTS 1. INTRODUCTION.......................................................................................................4 2. PURPOSE OF THE DOCUMENT.............................................................................4 3. DEFINITION OF TERMS USED / ABBREVIATIONS................................................4 4. SCOPE .....................................................................................................................4 5. DUTIES (ROLES & RESPONSIBILITIES) ................................................................4 5.1 CEO / Board Responsibilities ....................................................................................4 5.2 General Manager / Clinical Director Responsibilities ................................................4 5.3 Line Managers Responsibility ...................................................................................4 5.4 Staff Responsibility....................................................................................................5 5.5 Infection Prevention and Control Committee Responsibility......................................5 6. PROCESS ................................................................................................................5 6.1 Standard Infection Control Precautions (SICP) .........................................................5 6.2 Personal Protective Equipment / Clothing.................................................................5 6.2.1 Introduction............................................................................................................5 6.2.2 Gloves Guidelines for Selection.............................................................................6 6.2.3 Disposable Aprons Or Gowns ...............................................................................7 6.2.4 Facial/Respiratory Protection.................................................................................8 6.3 Routes Of Spread Of Infection ..................................................................................9 6.3.1 Contact ..................................................................................................................9 6.3.2 Airborne .................................................................................................................9 6.3.3 Parenteral ..............................................................................................................9 6.3.4 Faecal Oral ...............................................................................................................10 6.4 Safe Use And Disposal Of Sharps ..........................................................................10 6.4.4 Safe disposal of Sharps bins ...............................................................................11 6.5 A-Z Of Routes Of Spread Of Infection.....................................................................12 7. IMPLEMENTATION AND TRAINING REQUIREMENTS........................................26 8. PROCESS FOR MONITORING COMPLIANCE WITH POLICY / PROCEDURE ...26 9. REFERENCES........................................................................................................26 APPENDIX.........................................................................................................................27 Page 3 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 1. INTRODUCTION In order to reduce the risk of transmission of Healthcare Associated Infections (HCAI) it is important that all staff have clear and concise guidance on how this can be prevented. This policy contains the necessary information to reduce the risk of spread of HCAI transmission. 2. PURPOSE OF THE DOCUMENT To provide staff working within the clinical setting clear guidance on the required infection prevention and control requirements to ensure safe working practice for patients/clients and staff. 3. DEFINITION OF TERMS USED / ABBREVIATIONS PPE – Personal Protective Equipment HCW – Healthcare Worker ANTT – Aseptic Non Touch Technique MRTB – Multidrug Resistant Tuberculosis TB – Tuberculosis SARS – Severe Acute Respiratory Syndrome HCAI –Healthcare Associated Infection SICP – Standard Infection Control Precautions IPCT – Infection Prevention and Control Team 4. SCOPE Policy applies to all NCUH NHS Trust staff 5. DUTIES (ROLES & RESPONSIBILITIES) 5.1 CEO / Board Responsibilities To ensure that there is adequate guidance and information for all staff on safe working 5.2 General Manager / Clinical Director Responsibilities To act as role model’s for their area of responsibility. To make sure staff are aware of this policy. To make sure staff are released to attend mandatory training where updates regarding infection prevention and control policies are given. 5.3 Line Managers Responsibility Managers must ensure that all staff involved in the care and management of patients read and understand this policy. Line Managers have a responsibility to monitor the compliance of their staff in adherence to this policy and should ensure that regular auditing of practice is carried Page 4 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 out. They must disseminate the results of audits and implement appropriate action plans. 5.4 Staff Responsibility All staff must familiarise themselves with the contents of this policy. It is the individual responsibility of all Trust staff to read, understand and comply with the policy. 5.5 Infection Prevention and Control Committee Responsibility The Infection Prevention and Control Committee will be responsible for updating this policy every 3 years and will oversee the implementation of the policy. 6. PROCESS 6.1 Standard Infection Control Precautions (SICP) SICP are designed to prevent cross transmission from recognised and unrecognised sources of infection. These sources of (potential) infection include blood and other body fluids secretions or excretions (excluding sweat), non-intact skin or mucous membranes and any equipment or items in the care environment which are likely to become contaminated. They are necessary to ensure the safety of patients/clients and HCW who visit the environment. SICP must be applied at all times within the Trust. The application of SICP during delivery of care is determined by: • The level of interaction between the HCW and the patient/client • The anticipated level of exposure to blood and or body fluids. 6.2 Personal Protective Equipment / Clothing 6.2.1 Introduction The use of PPE is essential for health and safety. The use of PPE is considered standard in certain situations i.e. contact with blood/other body fluids, non intact skin and mucous membranes. The benefit of wearing PPE is two –fold, offering protection to both patients/clients and those caring for them. A risk assessment may be required in order to decide which PPE is most appropriate to prevent the transmission of microorganisms to the patient and to the HCW. For the purpose of this policy, the PPE described includes: • • • Gloves Disposable plastic aprons Face, mouth/eye protection e.g. masks, goggles etc This policy does not contain details of theatre apparel which is often more comprehensive due to the risks encountered therefore a Trust theatre policy is Page 5 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 available providing detailed information, please refer to http://nww.staffweb.cumbria.nhs.uk/acute/policies/h_l/InfectionPreventionandControlTheatrepolicyV10ApprovedMarch2011.pdf 6.2.2 Gloves Guidelines for Selection The purpose of gloves is a two way protection for staff and patients from blood and body fluids during clinical procedures, protection for the patient from staff’s resident and transient hand flora during procedures, protection for immuno-compromised patients and protection from direct exposure to chemicals e.g. cytotoxics, disinfectants etc. Gloves are not a substitute for hand hygiene and hands must be decontaminated after gloves are removed. Gloves must be worn if there is a risk of exposure to:• blood/body fluids • non-intact skin • mucous membranes • chemicals, hazardous substances (COSHH assessment) Gloves are routinely not required for procedures where there is a minimal risk of cross infection between patients and staff:• Basic care procedures without contact with blood or body fluids • Making uncontaminated beds/changing or removing patient’s uncontaminated clothing • Taking cardiovascular recordings e.g. blood pressure, temp, pulse etc A risk assessment prior to glove selection should include:• the nature of the task • the likelihood of contact with body substances • sterile or non sterile procedure • patient or user sensitivity to natural rubber latex All gloves must:• be powder free • conform to European Standards • not be made from polythene • be worn as single use • be put on immediately before an episode of patient contact or treatment and removed as soon as the activity is completed. • be changed between caring for different patients or between different care/treatment activities for the same patient • disposed of into the orange waste stream Page 6 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 TYPE OF GLOVES Non sterile nitrile examination gloves EXAMPLES OF USE Peripheral cannulation, venepuncture, direct contact with chronic wounds, handling soiled dressings, direct mouth care, emptying urine collection bags, cleaning spillages of blood and body fluids, handling soiled bed linen, rectal/vaginal examinations, endoscopy procedures and cleaning of equipment etc. Reconstitution and manipulation of intravenous medicines/solutions. Direct contact with cytotoxic agents and disinfectants. Ensure that non sterile gloves selected are compatible for use when handling these products. Sterile surgeon/examination gloves For in invasive procedures e.g. catheterisation, direct contact with post operative wounds, manipulation of central venous catheters etc. For any operative/surgical procedure in theatre/labour ward or involving invasion of tissues. Vinyl gloves Heavy duty domestic gloves Catering department Domestic cleaning Full guidance on glove usage and skin sensitivity can be found within the Trust Glove Policy at http://nww.staffweb.cumbria.nhs.uk/acute/policies/d_g/home.aspx 6.2.3 Disposable Aprons Or Gowns Protective clothing must be worn by all HCW when close contact with the patient, materials or equipment as this may lead to contamination of uniforms or other clothing with microorganisms or, when there is a risk of contamination with blood, body fluids, secretions, or excretions (with the exception of perspiration). The following equipment is recommended for use within clinical areas: • Disposable plastic aprons are recommended for general clinical use e.g. risk of contamination with blood, body fluids, bed making, cases of suspected confirmed infection e.g. MRSA, cleaning, preparation of chemicals etc. Plastic aprons should be worn as a single-use item, for one procedure or episode of patient care and disposed into the orange clinical waste stream. Unused disposable aprons must be stored away from possible sources of contamination. Page 7 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 • Fluid-repellent gowns must be worn where is a risk of extensive splashing of blood, body fluids, secretions or excretions with the exception of perspiration e.g. childbirth, theatres etc. Dispose into the orange clinical waste stream. 6.2.4 Facial/Respiratory Protection The HCW may have to wear facial protection to prevent respiratory droplets from mouth and nose that are expelled into the environment being inhaled and to protect mucous membranes e.g. eyes, nose etc from exposure to blood and or body fluids when splashing occurs. Masks must always fit comfortably, covering the mouth and nose. When not in use, they should be removed, disposed of and not worn around the neck. A risk assessment must be carried out to identify the type of protection required taking into account the suspected/confirmed diagnosis of the patient. The following equipment is recommended for use within clinical areas (detailed guidance is contained within the A-Z modes of transmission section 6.5 within this policy): • Standard surgical masks for use during routine operating procedures, suspected confirmed meningococcal infection etc. • Standard surgical masks with eye visors when there is a risk that eyes may become contaminated with blood/body fluids during operations, suctioning etc • Filter masks with a filtration rate of >95% for nuclei of 1-5 microns e.g. Tecnol N95/FFP3 etc when there are minute airborne respiratory particles present e.g. TB etc. These masks are kept on Larch C CIC and Emergency cupboard WCH. • Eye protection e.g. goggles or shield, can be used in conjunction with surgical mask, must be used when risk of blood and or body fluid contamination may occur. • Respirator masks for use when caring for patients with MRTB, SARS, pandemic flu etc. It is vital that staff undertake education and training on using these masks before use to ensure the mask fits correctly. Unused masks must be stored away from possible sources of contamination. N.B. There is no evidence that HCW’s wearing surgical facemasks protected patients from HCAI during routine ward procedures e.g. wound dressings etc When to change face protection: • Face protection should be changed between patients/clients procedures. It may be necessary to change between tasks on the same patient/client to prevent Page 8 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 • • 6.3 unnecessary cross-contamination. Remove immediately you have finished the task and dispose of into the orange waste stream If the mask becomes wet or soiled they must be changed in order to ensure continued protection. Reusable items e.g. respiratory etc should have a decontamination schedule and this must be carried out immediately after use. Routes Of Spread Of Infection The main routes of spread of infection are listed below. Some infections may be transmitted by more than one route. 6.3.1 Contact This is the most common way that infection can spread. Transmission can be divided into 2 routes: • Direct contact. This is when an infectious agent is transferred directly from one person to another, through direct body contact without involvement of inanimate objects or other people i.e. skin to skin contact, or the transfer of an infectious agent from an open wound to the mucous membranes or skin break in another susceptible individual. Faecal pathogens are also spread through this route. • Indirect contact. This is when an infectious agent is transferred to an individual from an object and/or another person. This can occur in a number of ways e.g. hands of a HCW become contaminated from a patients/clients environment, or equipment etc. 6.3.2 Airborne The spread of organisms by droplet nuclei (aerosol) or dust through the air and enters a person through the respiratory tract. This is spread by inhalation of organisms. Droplet spread by close contact involving direct inhalation of droplets, e.g. upper respiratory tract infection, streptococcal sore throat, Pertussis, Influenza, Meningococcal infections. Some organisms remain suspended in the air for prolonged periods and transmission may occur without close contact e.g. Tuberculosis, Varicella, and Measles. 6.3.3 Parenteral This is spread by inoculation of blood or other body fluids e.g. amniotic, chest drainage etc. Significant exposures for health care workers include needlestick injuries, cuts from scalpel blades and blood splashes to non-intact skin and mucous membranes. Splashes of blood to intact skin are not thought to be a risk. Other examples of parenteral spread are: - Page 9 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 • • • • • Sexual intercourse Transfusion of infected blood Mother-to-baby (“vertical”) transmission Sharing of injecting equipment Acupuncture and tattooing Contaminated food / water may act as a common source of infection. NB. Intravenous fluids or parenteral feeds may become contaminated and act as source of infection. 6.3.4 Faecal Oral This is the transmission of diseases when pathogens in faecal particles are transmitted from one host to another. Causes are food and water that has become contaminated through people not decontaminating their hands when preparing food, after toileting etc and untreated sewage entering drinking water supplies. This allows for the transmission of diseases e.g. Salmonella, Cryptosporidium, Hepatitis A etc. 6.4 Safe Use And Disposal Of Sharps All HCW’s must be aware of their responsibility in avoiding needlestick injuries. It is the personal responsibility of the individual using a sharp to dispose of it safely. There is a risk that injuries sustained to staff and patients through the use of sharps contaminated with blood or other body fluids e.g. amniotic, chest drainage etc may transmit bloodborne infections e.g. Hepatitis C, HIV etc. All sharps injuries must be reported immediately according to the Trust inoculation injury policy, found at Http://nww.staffweb.cumbria.nhs.uk/acute/policies/h_l/InnoculationInjuryPolicyV30.pdf so that the appropriate action can be taken. It is the duty of every employee, under the Health and Safety at work Act to report such incidents and document them properly. Sharps are (this is not an exhaustive list): • needles • syringes • razors • stitch cutters • scalpel blades • trocars • cannulae, • used ampoules 6.4.1 Safe handling of Sharps • • • • Use of sharps should be avoided wherever possible Needles must not be recapped, bent/broken or disassembled after use. Consider the use of needle less and safer needle systems whenever possible Sharps must not be passed directly from hand to hand and handling should be kept to a minimum. Page 10 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 • • • Sharps must not be carried by hand; ideally they should be carried on a purpose made sharps tray with integral sharps bin. Vacutainers should be used for phlebotomy wherever possible. Needles and syringes must be discarded as a single unit. 6.4.2 Safe disposal of Sharps • • • • • Sharps must be disposed of into a sharps container at the point of use. The user must ensure that the size of the sharps bin is appropriate for the clinical activity and size of the equipment Sharps boxes must not be filled above the maximum fill line. It is the responsibility of the user to dispose of their own sharps at point of use. Between uses, the temporary closure device must be activated to prevent accidental spillage from the sharps bin. 6.4.3 Safe use of the sharps bins • • • • Sharps bins must conform to UN 3291 and BS 7320 standards (NB: yellow bins with purple lids must be used for disposal of cytotoxic waste) Sharps bins with open aperture facility are available for disposal of IV giving sets and these bins must be stored away from main patient areas i.e. injection rooms. Sharps bins must be located in a position that is out of reach of children. Sharps bins should not be stored on the floor or above shoulder height; they should be wall or trolley mounted. 6.4.4 Safe disposal of Sharps bins • • When the maximum fill line is reached, sharps bins must be closed, locked and the label completed by the person doing this. Locked boxes must be stored in an appropriate facility i.e. ward sluice whilst waiting for the collection. Page 11 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 6.5 A-Z Of Routes Of Spread Of Infection DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD ACTINOMYCOSIS Variable AIDS See HIV Fact Sheet From HIV to AIDS has an observed range of less than 1 year to 15 years or longer 1-7 days (Occasionall y up to 8 weeks) ANTHRAX (Cutaneous lesions or pulmonary infection) ATYPICAL MYCOBACTERIA BRONCHIOLITIS Respiratory Syncytial Virus (RSV) Not applicable 3-5 days. BRUCELLOSIS Variable, PERIOD OF MAIN MODE/ ROUTE INFECTIVITY TO OF SPREAD OTHERS Not applicable Contact. Source of infection is patients own normal flora. Patient remains Parenteral spread infectious (Blood & body fluids) throughout life Person to person transmission is rare. Items contaminated with spores e.g. soil may remain infective for several years. Not applicable While respiratory symptoms persist Not applicable ISOLATION REQUIRED COMMENTS/ PRECAUTIONS IMPORTANT NO YES Protective isolation (patient is susceptible to wide range of infections) NB patients may also be a source of infection to other patients; discuss each case with the IPCT. Contact with infected NO animals or animal products, No personperson spread except from direct contact with skin lesions Possible agent for bio terrorism. Contact IPCT urgently if suspected case. Standard precautions. Wear gloves if in contact with skin lesions. Label lab samples as high risk No person-person spread 1. Airborne, inhalation of aerosols 2. Hand contact with respiratory secretions or contaminated surfaces Contact with infected NO Standard precautions YES Single room with door closed Highly infectious. Wear apron & gloves while in single room. May cause serious infections in babies with underlying lung or cardiac problems. NO Page 12 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD usually 5–60 days; commonly 12 months. BURNS a) Non-infected PERIOD OF MAIN MODE/ ROUTE ISOLATION INFECTIVITY TO OF SPREAD REQUIRED OTHERS animals, ingestion raw milk Susceptible to infection Whilst infected b) Infected CAMPYLOBACTER See Fact Sheet 2-5 days (Range 1-11 days) CELLULITIS See also Gp.A Streptococci & S. Aureus CHICKENPOX See (Varicella Zoster) Fact Sheet 1-3 days CHOLERA 2-3 days 10-21 days While patient has diarrhoea Contaminated hands YES Direct hand contact YES Enteric. Raw or undercooked meat (especially poultry), unpasteurised milk, bird-pecked milk on doorsteps, untreated water, and domestic pets with diarrhoea. If breaks in skin or Contact with lesions or exudate present Indirect contact e.g. contaminated bedding etc 1-2 days before 1. Airborne onset of rash until 2. Direct contact of all lesions hands with vesicle fluid dried/crusted approx 5-6 days While patient has 1.Faecal-oral diarrhoea 2.Ingestion YES YES YES Single room with door closed YES Page 13 of 27 COMMENTS/ PRECAUTIONS IMPORTANT Protective isolation required, as burns patients are susceptible to infection. For 1st 24-48 hours of antibiotic therapy (unless multi-resistant organisms). Isolate the patient until 48hrs symptom free. Isolate for 1st 24-48 hours of antibiotic therapy (unless multiresistant organisms isolated, then continue isolation precautions) Staff attending patient should be immune. Consider Varicella Zoster Immunoglobulin for immuno-compromised contacts. Thorough hand hygiene is of major importance to prevent person-to- North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD PERIOD OF MAIN MODE/ ROUTE ISOLATION INFECTIVITY TO OF SPREAD REQUIRED OTHERS contaminated food/water 2.Faecal-oral COMMENTS/ PRECAUTIONS Isolate until 48hrs symptom free. Thorough hand hygiene and environmental cleaning essential. Discuss individual cases with ICT. CL. DIFFICILE See Fact Sheet Not applicable While patient has diarrhoea CONJUNCTIVITIS Variable depending on pathogen. Usually 2472 hrs. Average 710 days (range 1-28 days) While symptoms persist Following organ transplants/b one marrow transfusion, 3-8 weeks and for in utero infection 312 weeks post delivery Variable, excretion of virus may be prolong over many months or years CRYPTOSPORIDIUM See Fact Sheet CYTOMEGALOVIRUS VIRUS (CMV) While patient has diarrhoea Faecal-oral and from environment (direct and indirect contact) Direct contact conjunctivae, upper respiratory tracts of infected person, shared eye equipment e.g. makeup etc 1. Faecal-oral 2.Ingestion contaminated food/water YES Contact with blood & body fluids, including saliva & urine NO Not routinely YES Page 14 of 27 IMPORTANT person spread. Mainly affects children <2 years. Can cause prolonged symptoms in patients with AIDS. North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD DIARRHOEA PERIOD OF MAIN MODE/ ROUTE ISOLATION COMMENTS/ IMPORTANT INFECTIVITY TO OF SPREAD REQUIRED PRECAUTIONS OTHERS For diarrhoea of unknown cause, take general enteric precautions while patient remains symptomatic DIPHTHERIA Corynebacterium diphtheriae 2-5 days The patient should be barrier nursed until two negative cultures from both nose and throat (and skin lesions in cutaneous diphtheria) taken over 24 hours after stopping antimicrobial chemotherapy, and at least 24 hours apart, have failed to show diphtheria bacilli10 Airborne - close personal contact YES Single room with door closed Notify IPCT & Health Protection Agency immediately. Standard precautions. Contact tracing and screening essential. Erythromycin for contacts. DYSENTERY See Shigella E. COLI 0157 See Fact Sheet 2-10 days While organism in stools YES 8-14 days (Range 3-30 While organism in stools/urine 1.Ingestion of contaminated food/milk/water 2.Faecal-oral Ingestion of contaminated Person-person spread may occur readily. Strict enteric precautions. E coli 0157 can cause haemolytic uraemic syndrome (HUS). Enteric precautions. Acute cases rarely infect others by direct ENTERIC FEVER i.e. Typhoid fever, YES Page 15 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD PERIOD OF MAIN MODE/ ROUTE ISOLATION INFECTIVITY TO OF SPREAD REQUIRED OTHERS food/water (Salmonella typhi or paratyphi) ERYSIPELAS days) FOOD POISONING Take general enteric precautions while diarrhoea persists FUNGAL SKIN INFECTIONS e.g. Ringworm 4 – 14 days While lesions present GAS GANGRENE Cl. perfringens Not applicable Not applicable GASTROENTERITIS See diarrhoea GIARDIASIS Giardia lamblia 5-25 days While organism in stools GLANDULAR FEVER 4-6 weeks May be prolonged German Measles see Rubella HAND, FOOT & 3-5 days While clinical COMMENTS/ PRECAUTIONS IMPORTANT contact. Carriers may infect food. See Group A streptococci Direct contact with lesions Indirect contact with contaminated surfaces No person to person spread NO NO Infection from patient’s own faecal flora or contamination of wound with soil Faecal-oral. Main route is ingestion of contaminated food/water Often acquired abroad. Contact. Person to person spread by close contact with saliva Not routinely If patient has explosive/ uncontrolled diarrhoea may require single room care. Person to person NO NO Page 16 of 27 Virus excreted in stools North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD MOUTH DISEASE Coxsackie virus PERIOD OF MAIN MODE/ ROUTE ISOLATION INFECTIVITY TO OF SPREAD REQUIRED OTHERS symptoms persist spread by contact with respiratory secretions & faecal-oral route COMMENTS/ PRECAUTIONS IMPORTANT HEPATITIS Hepatitis A (HAV) See Fact Sheet Mean 4 wks Range 2-6 weeks 10 days before onset of jaundice and 7 days after Person to person spread by faecal-oral route. Contaminated food/water Not routinely Enteric precautions while infectious. Discuss individual patients with IPCT Hepatitis E (HEV) Mean 4-6 wks Range 2-9 weeks Unknown Contaminated food and water Person to person spread By faecal-oral route Not routinely Rarely seen in UK. Enteric precautions Hepatitis B (HBV) 6-24 weeks Parenteral spread (Blood & body fluids) Not routinely Hepatitis C (HCV) See Fact Sheets 2-24 weeks If chronic infection, patients may remain infectious for many years Care with blood & body fluids. Isolation required if bleeding or patient is HBe antigen positive. (i.e. highly infectious) Discuss individual pts with IPCT HERPES SIMPLEX I & II a) Cold sores, herpetic whitlows b) Genital 2-12 days Until lesions dry & crusted Direct/close contact with lesions Not routinely As above While lesions active Sexual contact Not routinely Wear gloves if contact with lesions. Avoid contact with patients with immuno suppression, burns or eczema. Cover whitlows As above - special risk to neonates Page 17 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD PERIOD OF INFECTIVITY TO OTHERS Consider as potentially infectious while in hospital Patient remains infectious throughout life MAIN MODE/ ROUTE ISOLATION OF SPREAD REQUIRED COMMENTS/ PRECAUTIONS Mother-to-baby at delivery YES Parenteral spread (blood and body fluids) Not routinely Separate from other babies & mothers. Mother & baby's secretions to be handled as infected. Standard Precautions. Care with blood & body fluids Discuss each case with IPCT. c) Neonatal As above HIV Human immunodeficiency virus See Fact Sheet IMMUNOCOMPROMISED PATIENTS IMPETIGO S. Aureus and Gp. A streptococcus INFECTIOUS MONONUCLEOSIS INFLUENZA A&B 1-3 months 1-3 days 3-5 days after onset of symptoms Airborne spread & direct contact with respiratory secretions LEPTOSPIROSIS 1-3 weeks Not applicable Contact with NO contaminated water or soil. Direct contact with infected animals Estimated 3 -70 days Products of conception highly infectious to Faecal Oral. In hospital may be spread by direct IMPORTANT This includes neutropaenic patients (neutrophil count < 1.0) due to their underlying disease or chemotherapy, some patients with congenital immunodeficiency, patients with AIDS or severe burns. These patients require protective isolation in a single room to protect them from acquiring infection while in hospital 1-3 days While crusted Direct contact YES Standard precautions. Children lesions present may be highly infectious See Glandular fever YES Standard precautions. Single room or cohort infected patients LICE See Fact Sheet LISTERIOSIS L. monocytogenes Mother & baby only Page 18 of 27 Main risk is to immunocompromised or pregnant women and neonates. North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD MALARIA 1-4 weeks, may be longer for P. vivax MEASLES See Fact Sheet Mean 10 days Range 7-14 days MENINGITIS See Fact Sheet 2-10 days PERIOD OF MAIN MODE/ ROUTE INFECTIVITY TO OF SPREAD OTHERS neonates contact with products of conception or infected neonates. Ingestion of raw contaminated milk, soft cheese, pate etc Not applicable Mosquito bites. Parenteral via inoculation injuries, contaminated blood products. 4 days before to 4 Airborne by droplet days after onset spread. Restrict of rash contact unless confirmation of immunity i.e. having received 2 doses of vaccine or antibody testing, this obviates the need for they themselves to have protection (good hand hygiene etc still required) While organisms present in Contact with respiratory secretions Direct i.e. kissing. Respiratory. Close ISOLATION REQUIRED COMMENTS/ PRECAUTIONS IMPORTANT NO YES Single room with door closed Highly infectious. Contacts are advised to demonstrate own immune status. Wear apron & gloves while in single room. Dangerous to immunocompromised patients. Gamma globulin to susceptible contacts. YES For first 24 For first 24 hrs of antibiotic treatment HCW should wear a Page 19 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD PERIOD OF MAIN MODE/ ROUTE INFECTIVITY TO OF SPREAD OTHERS nose/throat of personal contact, e.g. case within households Haemophilus influenzae 2-5 days As above Close personal contact Pneumococcal Unknown Not applicable Viral e.g. Coxsackie, Echovirus Variable For 7 days after onset Infection from patients own upper respiratory flora Faecal-oral route, virus excreted in stools MUMPS 14 -21 days NECROTISING FASCIITIS PARVOVIRUS Not applicable 1-3 weeks 2 days before onset of symptoms plus 9 days after Not applicable Before onset of Airborne by droplet spread Contact with respiratory secretions Usually from patient’s own flora Airborne spread by ISOLATION REQUIRED hrs of antibiotic treatment YES For first 24 hrs of antibiotic therapy. Not essential COMMENTS/ PRECAUTIONS IMPORTANT mask if close contact with respiratory droplets, e.g. resuscitation, intubation. Antibiotic prophylaxis for household & close contacts. Notify Health Protection Agency No risk to adult contacts, children under 5 may be susceptible. Not routinely Isolation for some patients e.g. babies and younger children. Discuss individual cases with IPCT YES Single room with door closed NO Discuss use of masks with IPCT Contacts are advised to demonstrate own immune status YES Use of mask should be discussed Page 20 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD See Fact Sheet PERIOD OF MAIN MODE/ ROUTE ISOLATION INFECTIVITY TO OF SPREAD REQUIRED OTHERS rash respiratory droplets. PERTUSSIS See Whooping cough PLAGUE Yersinia pestis 1-7 days PUO Until completing 72 hrs of effective antibiotics Bites of infected fleas. YES Person to person Single room spread by respiratory with door droplets if pneumonic closed plague Should be isolated if suspicion of infective cause pending diagnosis PUERPERAL SEPSIS RABIES See Group A Streptococci 2-8 weeks Not applicable (May be longer) RESPIRATORY SYNCYTIAL VIRUS ROTAVIRUS See BRONCHIOLITIS RUBELLA German Measles See Fact Sheet 14-17 days 7 days before Range 14-21 rash until 7 days afterwards Airborne spread by respiratory droplets. YES Single room with door closed SALMONELLA See Fact Sheet 6 -72 hrs Ingestion of contaminated YES Bites or scratches from infected animals e.g. dogs No person to person spread COMMENTS/ PRECAUTIONS IMPORTANT with IPCT Possible agent for bio terrorism. Contact IPCT urgently if suspected case. Filter type masks & eye protection if pneumonic plague NO See Viral Gastro-enteritis and Fact Sheet While diarrhoea persists Page 21 of 27 Congenitally infected babies may excrete virus for months. Discuss use of masks with IPCT. Contacts are advised to demonstrate own immune status Enteric precautions North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD SCABIES See Fact Sheet PERIOD OF MAIN MODE/ ROUTE ISOLATION INFECTIVITY TO OF SPREAD REQUIRED OTHERS food/milk. Faecal-oral if poor hand hygiene While infested Prolonged, direct Until treated skin contact SCARLET FEVER SHIGELLA See Fact Sheet See streptococci infections 1-3 days While diarrhoea persists SHINGLES Varicella Zoster See Fact Sheet Not applicable While lesions are vesicular/moist SMALLPOX 10-16 days From onset fever until crusts shed from skin lesions SMALL ROUND STRUCTURED VIRUS Staphylococcal See Viral Gastroenteritis and Fact Sheet While organism COMMENTS/ PRECAUTIONS IMPORTANT . Not usually transmitted to casual contacts, except for Norwegian scabies. Ingestion of contaminated food Faecal-oral Direct hand contact with exudate from lesions YES Person to person spread may occur readily Not routinely Standard precautions. Exclude non-immune staff. If lesions covered no need to isolate unless to protect immuno-compromised individuals Can cause chickenpox in non- immune contacts. Airborne spread by respiratory droplets. Contact with skin lesions, contaminated laundry or waste YES Single room with door closed Possible agent for bio terrorism. Contact IPCT urgently if suspected case. Full protective clothing i.e. gown, mask and gloves for non-immune staff. Limit staff access. Probable/confirmed cases transferred to high security Infectious Disease unit Yes single Use of PPE. If intubating or Direct, indirect and Page 22 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD Infections PVL STAPHYLOCOCCAL INFECTIONS S. Aureus, e.g. wound infection, boils abscesses, impetigo PERIOD OF INFECTIVITY TO OTHERS present (carriers may transmit infection) While organism present (carriers may transmit infection) MAIN MODE/ ROUTE ISOLATION OF SPREAD REQUIRED COMMENTS/ PRECAUTIONS airborne if respiratory infection room with door closed patient has respiratory infection surgical facial mask with integral eye protection. Main transmission direct and indirect contact. Only if antibiotic resistant, or extensive lesions present During acute infection Airborne & direct contact YES For first 24 hours antibiotic therapy. STREPTOCOCCAL INFECTIONS Group A B-haemolytic streptococcus e.g. cellulitis, impetigo, erysipelas, scarlet fever, pharyngitis, puerperal sepsis TETANUS 3-21 days Not applicable Contact with spores in soil NO TOXOPLASMOSIS 1-3 weeks Not applicable No person to person spread. Ingestion oocysts in contaminated food or via contact with cat faeces NO Page 23 of 27 IMPORTANT May cause life-threatening invasive infections North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD PERIOD OF MAIN MODE/ ROUTE ISOLATION INFECTIVITY TO OF SPREAD REQUIRED OTHERS While bacilli Airborne YES present in sputum Single room (i.e. smear with door positive) closed TUBERCULOSIS M. Tuberculosis. See Fact Sheet 2-10 weeks for primary infection TYPHOID FEVER VARICELLA ZOSTER See Enteric fever See chickenpox & shingles VIRAL GASTROENTERITIS Noro like virus See Fact Sheet While symptoms persist + 48 hours 1. Faecal-oral 2. Ingestion of contaminated food Rotavirus While symptoms persist + 5 days Faecal-oral COMMENTS/ PRECAUTIONS IMPORTANT Use filter type face mask if generating aerosol procedures YES, or cohort nurse Enteric precautions. Spreads very easily. Environmental cleaning & restriction of movement essential. YES Enteric precautions. Contact IPCT urgently if suspected case. Wear full protective clothing, & limit staff access. Patients must not be moved without discussion. Exclude malaria but do not carry out other lab investigations unless essential. Probable/confirmed cases transferred to high security Infectious Diseases unit Highly infectious. Wear apron & gloves while in single room. Use of erythromycin shortens period of VIRAL HAEMORRHAGIC FEVERS e.g. Marburg, Ebola, Lassa Fever Up to 3 weeks Rare in UK travellers from abroad. Contact with urine/faeces of infected rodents Close contact with blood/body fluids YES Single room with door closed WHOOPING COUGH Bordetella pertussis 7-20 days During catarrhal phase, and approx 3 weeks Airborne by droplets & direct contact with respiratory secretions YES Single room with door Page 24 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 DISEASE & OR INCUBATIO INFECTIVE AGENT N PERIOD WORM INFESTATION Threadworms Variable Depends on species. Roundworm, Hookworm, Whipworm YELLOW FEVER PERIOD OF MAIN MODE/ ROUTE INFECTIVITY TO OF SPREAD OTHERS after onset of cough While infestation persists Person to person spread by faeco-oral route. ISOLATION REQUIRED COMMENTS/ PRECAUTIONS closed infectivity to 1 week. Not routinely NO 3-6 days First 3-5 days of clinical illness Contact with soil contaminated with faeces Mosquito bites, no person to person spread No Page 25 of 27 IMPORTANT North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 7. IMPLEMENTATION AND TRAINING REQUIREMENTS The Infection Prevention and Control Team (IPCT) will oversee the implementation of this policy. Staff will be updated via mandatory training, line managers and the policy will be on the NCUHT intranet. 8. PROCESS FOR MONITORING COMPLIANCE WITH POLICY / PROCEDURE Managers must ensure that all staff involved in the care and management of the patients read and understand this policy. Line managers have a responsibility to monitor compliance of this policy. 9. REFERENCES • Pratt RJ, Pellowe C, Loveday HP. et al. The epic project: developing national evidence-based guidelines for preventing health care associated infections. Journal Hospital Infection 2001; 47 (supp):S1-S82 • Garner JS, Hospital infection control practices advisory committee. Guidelines for isolation precautions in hospital. Infection Control Epidemiology 1996; 17:53-80. • Health Protection Agency http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947389261 • Theatre policy http://nww.staffweb.cumbria.nhs.uk/acute/policies/h_l/InfectionPreventionandCo ntrol-TheatrepolicyV10ApprovedMarch2011.pdf • Pratt RJ, Pellowe CM, Wilson JA et al. epic 2 National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. The Journal of Hospital Infection 2007;65 (supplement 1) • The Control of Substances Hazardous To Health Regulation 2002 (COSHH) • Glove Policy – awaiting web link info • Inoculation Injury Policy http://nww.staffweb.cumbria.nhs.uk/acute/policies/h_l/InnoculationInjuryPolicyV 30.pdf Page 26 of 27 North Cumbria University Hospitals NHS Trust North Cumbria University Hospitals Trust Standard Infection Prevention and Control Precautions Policy Publication Date: 19/07/2011 Version 1.0 APPENDIX Page 27 of 27