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Infection Prevention and Control Team
(IPCT)
SECTION 30
GROUP A STREPTOCOCCUS
IN A HEATHCARE SETTING
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Section 30, Group A Streptococcus (GAS) in a healthcare setting
Issue No 1, October 2012
Page 1 of 7
Title of Policy:
Group A Streptococcus in a Healthcare Setting
Policy Reference:
Issue no 1, October 2012
Scope:
Organisation Wide
Controlled
document:
This document shall not be copied in part or whole
without the express permission of the author or the
author's representative.
Review Date:
October 2015
Author:
Frances Lafferty, Senior Infection Control Nurse
Policy application /
Target Audience
Throughout NHS Ayrshire and Arran
RESPONISIBILITIES FOR IMPLEMENTATION
Organisation:
Chief Operating Team
Directorate:
Directors
Corporate:
Senior Managers
Departmental:
Heads of Wards or Departments
Local:
All relevant staff
Policy Statement:
It is the responsibility of all staff to ensure that they
consistently maintain a high standard of infection control
practice in accordance with this guidance to prevent the
spread of infections from and between patients with
Group A Streptococcus (GAS)
Last reviewed:
April 2012
Agreed by:
Infection Prevention and Control Policy Review Group
Electronic
approval by:
Professor Robert G Masterton
Executive Medical Director
Date:
5 October 2012
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Section 30, Group A Streptococcus (GAS) in a healthcare setting
Issue No 1, October 2012
Page 2 of 7
TABLE OF CONTENTS
1.0
INTRODUCTION ...................................................................................4
2.0
NON INVASIVE INFECTION ................................................................4
3.0
INVASIVE INFECTION .........................................................................4
4.0
GENERAL INFORMATION ...................................................................5
5.0
INFECTION CONTROL TRANSMISSION BASED PRECAUTIONS
FOR GAS AND IGAS .......................................................................................6
6.0
REFERENCES ......................................................................................7
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Section 30, Group A Streptococcus (GAS) in a healthcare setting
Issue No 1, October 2012
Page 3 of 7
1.0
INTRODUCTION
Group A Streptococcus, (GAS) commonly found in the throat and on the skin,
can cause a large variety of infections. Most GAS infections are relatively
mild e.g. strep throat or impetigo, however, occasionally these bacteria can
cause severe life threatening infections e.g. necrotising fasciitis and toxic
shock syndrome (TSS). Outbreaks of infections have been known to occur in
surgical, obstetric and burns patients.
2.0
NON INVASIVE INFECTION
Most GAS infections are mild and non-invasive, presenting as sore throats,
impetigo and cellulitis and are treated with appropriate antibiotics. In
obstetrics, post partum fever may be accompanied by local and general signs
of GAS infection, however, this can occasionally progress to invasive Group A
Streptococcus (iGAS) infection. Scarlet fever (a notifiable disease) which has
a characteristic rash may be associated with any of these GAS infections.
3.0
INVASIVE INFECTION
Invasive Group A Streptococcal infection (iGAS) occurs when the bacteria get
into parts of the body where bacteria are not normally found e.g. blood, lungs,
muscle tissue.


Necrotising fasciitis destroys muscle, fat and skin tissue
TSS causes rapid hypotension and multi organ failure in the early stages
of the infection
The mortality rate from all forms of iGAS is between 10-20%
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Section 30, Group A Streptococcus (GAS) in a healthcare setting
Issue No 1, October 2012
Page 4 of 7
4.0
GENERAL INFORMATION
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Section 30, Group A Streptococcus (GAS) in a healthcare setting
Issue No 1, October 2012
Page 5 of 7
5.0
INFECTION CONTROL TRANSMISSION BASED PRECAUTIONS
FOR GAS AND iGAS
Section 2 Transmission Based Precautions (see manual page) covered in this
policy document are additional precautions designed to prevent further
transmission to be used when an individual is suspected/known to have an
infectious agent/disease.
Please click here to access all sections of the IPC manual.
Patient
Placement
Patients with suspected/confirmed GAS infection should be isolated in a
single room
Isolation should continue until they have had at least 24-hours of the
appropriate antibiotic therapy and there is a definite clinical improvement
If there are no signs of clinical improvement, they should remain isolated until
there is a confirmed negative bacterial culture. Care has to be taken with
patients who have GAS isolated from wounds, as false negative results can be
obtained if the patient is still on antibiotic therapy. In this case they should be
isolated until the wound heals, or a negative screen is obtained following
completion of antibiotic therapy
(also see Section 2 and Section 2 Appendix A of the IPC manual)
Hand Hygiene
Hands must be decontaminated as per WHO (World Health Organisation) 5
moments for hand hygiene. Detailed guidance can be obtained by clicking the
link below
Patients should be encouraged to carry out thorough hand hygiene
(also see Section 1 Standard Infection Control Precautions in the IPC manual)
Personal
Protective
Equipment
(PPE)
Plastic aprons and disposable gloves should be worn to prevent direct contact
with the patient or the patient’s immediate environment. Hand hygiene must be
carried out following removal of PPE.
(also see Section 1 Standard Infection Control Precautions in the IPC manual)
Linen
All linen should be discarded as fouled/infected i.e. placed in a water soluble bag
then into a clear plastic bag and lastly into a red laundry bag. Staff should wear
appropriate PPE when carrying out this task.
(also see Section 1 Standard Infection Control Precautions in the IPC manual)
Clinical Waste
All waste must be discarded as clinical waste within the isolation room.
(also see Section 1 Standard Infection Control Precautions in the IPC manual)
Patient Care
Equipment
Equipment should be kept to a minimum. Prior to removal from the room all
equipment must be decontaminated using a chlorine based solution e.g.
Actichlor™. Please check manufacturer’s instructions
Communal facilities such as baths, bidets and showers should be cleaned
and decontaminated between all patients, especially on delivery suites, postnatal wards and other high risk areas such as burns units
(also see Section 3 Appendix 3 of the IPC manual)
Hotel Services
Enhanced cleaning with a hypochlorite solution should be undertaken by hotel
service staff until instructed otherwise
Following the removal of the patient, the room should have a terminal clean
carried out prior to the next patient being admitted
(also see Section 29 of the IPC manual)
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Section 30, Group A Streptococcus (GAS) in a healthcare setting
Issue No 1, October 2012
Page 6 of 7
Transferring
Patients
If possible, do not transfer patients until isolation is no longer required
Prior to transfer, staff must inform any receiving ward/department that the
patient has suspected/confirmed Group A Strep and if a specimen has been
taken
Prior to transfer, ensure the ward receiving the patient has suitable
accommodation
Inform and discuss with a member of the infection control team
Specimens
Send specimens as clinically indicated. If patient is not clinically improving after
48 hours of appropriate antibiotic therapy, take repeat specimens and contact a
consultant microbiologist for advice.
(also refer to the Laboratory Handbook via Athena)
Care After Death Precautions for patient with iGas should be implemented if the patient dies prior
to having appropriate antibiotic therapy - refer to Section 19 of the IPC Manual
(also see Section 19 of the IPC manual)
Patient Clothing
If a relative or carer wishes to take personal clothing home, staff must place
soiled clothing into a clear plastic bag then into a patients clothing bag. Staff
must also ensure that a Home Laundry Information Leaflet is issued. A copy of
this leaflet can be obtained by clicking on the link below.
(also see Washing Clothes at Home information leafleT)
Visitors
No restrictions
For iGAS during the infectious phase, visitors should be offered suitable
information and relevant PPE following a risk assessment of their level of direct
contact/involvement in the affected person’s care. This includes advice on hand
hygiene. For further information please contact the IPCT or the on-call consultant
Microbiologist.
Outbreak
situations
Outbreaks can sometimes occur in healthcare and non-healthcare settings. The
IPCT will advise staff in these situations. Staff screening may also have to be
undertaken by Occupational Health and the IPCT will advise. An outbreak
should be considered if there are 2 or more cases of suspected GAS infection
related by person or place.
6.0
REFERENCES
1.
Guidelines for prevention and control of group A streptococcal infection
in acute healthcare and maternity settings in the UK, Steer et al,
Journal of Infection (2012) 64, 1e18.
http://www.ips.uk.net/uploads/guidelines/NewStepAGuidelines.pdf last
accessed 7th May 2012
2.
Heymann, D L (2008), Control of Communicable Diseases Manual 19th
Edition, American Public Health Association
3.
CDC
Group
A
strep
(GAS)
Disease
available
at
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_g.ht
m last accessed 7th May 2012
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Section 30, Group A Streptococcus (GAS) in a healthcare setting
Issue No 1, October 2012
Page 7 of 7