Download North Cumbria University Hospitals Trust Standard Infection

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
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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
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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
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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.
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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
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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: -
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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
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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