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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
BASINGSTOKE AND NORTH HAMPSHIRE NHS FOUNDATION TRUST
Isolation precautions for patients with confirmed or
suspected infectious illness
IC/278/10
Supersedes: IC/278/07
Owner
Name
Job Title
Final approval
committee
Name
Authoriser
Hazel Gray
Senior Infection Control
Nurse
Infection Control Committee
Date of meeting
Name
Job title
23 July 2010
Dr Nicki Hutchinson
Director Infection Prevention
and Control
Signature
Review date
Audience
Standards
Date of authorisation
(maximum 3 years from date of
authorisation)
(tick all that apply)
24.08.10
July 2013
Trust staff √
NHS √
General public
Standards for Better Health
NHSLA
The Health and Social Care Act 2008
Reviewed in accordance with The Health and Social Care Act 2008:
Code of Practice for health and adult social care on the prevention and control of
infections and related guidance published 16 December 2009
Executive Summary
It is important to minimise the risk of the spread of infection between patients.
This policy outlines the measures which should be taken to prevent the spread of
infection from patients who are known to be a potential source of infection.
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Implementation Plan
Summary of changes
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Contact number changes
Isolation sign changes
Roles and responsibility
Education
Evaluation of policy
Standard Precautions update
Action needed and owner of action
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All staff need to be aware of which patients may need isolating and what type
of isolation is necessary
All staff need to be aware of the role they play in trying to reduce the spread
of infection
All staff need to adhere to this policy
The Infection prevention and control team IPCT will evaluate policy when
required
The IPCT will monitor infection rates via alert organism surveillance
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Contents:
1.0
1.1
1.2
1.3
2.0
3.0
4.0
4.1
4.2
4.3
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
5.9
5.10
5.11
5.12
5.13
5.14
5.15
5.16
5.17
6.0
Summary
Roles and Responsibilities
Education and training
Evaluation of this policy
Introduction
Policy Objectives
Categories of isolation
Ring fencing
Source isolation
Protective isolation
Source isolation
Patient placement
Preparation of the isolation room
Hand Decontamination
What if you have cuts and breaks in your skin?
Hand hygiene - patient
Gloves
Aprons and gowns
Masks, face shields or eye protection
Patient care equipment
Environmental cleaning
Linen
Sharps Management
Crockery/cutlery
Bathing
Transport of infected patients
Visitors/patients/carers
References and further reading
Appendix 1: Diarrhoea and/or Vomiting Risk Assessment Algorithm
Appendix 2: Respiratory Risk Assessment
Appendix 3: Skin Infection Risk Assessment Algorithm
Appendix 4: Isolation Priorities
Appendix 5: Risk Assessment using the Isolation Priority Scoring
System
Appendix 6: Priority Scoring System: Infectious Diarrhoea
Appendix 7: Priority Scoring System: MRSA
Appendix 8: Priority Scoring System: Antimicrobial-Resistant
Bacteria
Appendix 9: Priority Scoring System: Respiratory Infections
Appendix 10: Priority Scoring System: Other Infectious Diseases /
Conditions
Appendix 11: Components of standard and transmission based
isolation precautions
Appendix 12: Signage
Appendix 13: Cleaning Procedure for a Vacated Single Isolation
Room
Appendix 14: Cleaning Procedure for a Single Isolation Room
Appendix 15: Notifiable infectious diseases & food poisoning
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
1.0 Summary
Isolation precautions are adopted to minimise the risk of spread of an infectious
disease in the hospital setting. This policy is based on national guidelines that review
and require assurance that there is a managed environment, which minimises the
risk of infection to patients, staff and visitors.
This policy is limited to the description of isolation precautions and must be
supplemented by the relevant hospital policies and procedures for other aspects of
infection and environmental control, occupational health, administrative and legal
issues, and any other issues beyond the scope of this guideline.
The policy uses a two-tier approach to isolation of patients: standard precautions,
which should be used for ALL inpatients and transmission based precautions.
Transmission based precautions use the likely pathogen and its’ mode of spread as
the main determinant of type of precautions required. Therefore these precautions
are classified by these 3 main transmission vehicles contact, droplet and air borne.
The policy contains quick reference guidance attached as appendages. They are:
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Standard, airborne, droplet and contact precautions
Applications of standard precautions
Type and duration of precautions needed for selected infections
Empiric isolation precautions for clinical conditions to prevent spread pending
confirmation of diagnosis
Isolation signs
Cleaning procedure for vacated room
Daily cleaning procedure for a single isolation room
Notifiable infectious diseases (see Appendix 15)
Risk assessment should precede isolation of patients especially when single rooms
are in short supply and patient isolation has to be prioritised. Some new flowcharts
have been added to this document to try and help you with this process (please see
Appendices 1-5).
The decision to isolate a patient should always be discussed with the infection
prevention and control team. The decision to isolate/close a whole ward/s will be
undertaken by a Consultant Microbiologist.
For further information and/or assistance contact the infection control team on
extension 6774 or via bleeps.
Hazel Gray
}
Linda Swanson } Bleep 2364
Out of hours, please contact a Consultant Microbiologist via the switchboard.
1.1 Roles and Responsibility
The Executive Director of Nursing on behalf of the Chief Executive will ensure that
the Clinical Directors take clinical ownership of the policy.
The Clinical Directors on behalf of the executive director of nursing will ensure that:
• all health care workers comply with this policy
• all healthcare workers attend mandatory infection control training
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
The Senior Nurses and Matrons on behalf of the Executive Director of Nursing and
the Clinical Directors will ensure that:
• all health care workers comply with this policy
• all healthcare workers attend mandatory training
The infection prevention and control team will:
• act as a resource for information and support
• monitor the implementation of this policy within clinical areas
• regularly review and update the policy
The senior nurse and doctor must ensure that all staff are aware and comply with
the infection control precautions that need to be taken and follow the advice in this
policy.
1.2 Education and training
All staff that may come into contact with either potential or confirmed infectious
patients i.e. clinical staff; porters, domestics etc must attend their annual infection
control mandatory training session.
1.3 Evaluation of this policy
It is important to minimise the risk of the spread of infection to and from patients and
staff. This policy outlines the measures, which should be taken to prevent the spread
of infection from patients who are known to be a potential source of infection. This
can be monitored by:
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monitoring the trends of infections in the trust by analyzing alert organism
figures
ensuring when timely isolation of infected patients cannot occur that
untoward incident forms are filled in
monitoring that the correct signage and isolation guidelines are adhered
to by all staff by undertaken ad hoc observational audits
ensuring that non compliance to the policy is challenged
2.0 Introduction
Aim of the policy is to ensure that source isolation procedures are instigated in order
to minimise the risks of cross infection. The correct and timely placement of infected
patients (suspected or proven) into single rooms can be very effective in reducing the
overall numbers of infective patients (DH 2007).
It is also a requirement of the Health Act 2008 (DH) that an evidence based isolation
policy exists incorporating local risk assessment findings and measures. This policy
must include indications and procedures for the infection control management of
isolated patients.
3.0 Policy Objectives
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To identify patients presenting with colonisation, infection or infectious
diseases that may be a risk to others.
To take timely action to prevent the spread of potentially infectious conditions
by appropriate isolation of the source patient and the appropriate use of
personal protective equipment.
To ensure that patients at high risk of infections due to immunosuppression or
neutropenia are appropriately isolated and protected to minimise the
acquisition of such infections. (Please see Trust Protective Isolation Policy)
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
•
To ensure that all staff, departments and any outside agencies likely to be
involved in the care of patients care have a clear understanding of their roles
and responsibilities in preventing the spread of infection.
4.0 Categories of isolation
Isolation must not compromise the clinical care of the patient
There are two categories of isolation (Ayliffe 2001):
• Source isolation: when a patient poses an infection risk to others
• Protective isolation: when a patient is at risk from others
4.1 Ring fencing
It is sometimes necessary to ring fence a high-risk area e.g. Orthopaedic or Surgical
Units as a protective isolation measure. This is due to the significant implications of
infections amongst these patients. When an area is ring fenced admissions are
scrutinised to allow ONLY specific groups of patients sharing the same medical
conditions and risk factors for infection, to be admitted to the ring fenced area. Ring
fencing works as part of a complete infection control programme with active
surveillance. It also allows for national targets to be met.
The decision to ring fence an area should be undertaken between the Hospital
Infection Control doctor, directorate leads and trust management teams.
4.2 Source isolation
Source isolation is the physical separation of one patient from another, in order to
prevent the spread of infection. Single room isolation will not by itself prevent the
transmission of organisms; it should be used in conjunction with standard (universal)
infection control precautions which must be observed at all times with all patients.
Additional precautions may need to be implemented dependant on the source and
mode of spread.
All hospitals providing in-patient care must ensure that they are able to provide or
secure the provision of adequate isolation facilities for patients sufficient to prevent or
minimise the spread of Healthcare Associated Infection (DOH 2000) Hospital Trusts
have a responsibility to ensure that the policy includes the potential risk of infection
and the use of effective protective measures and equipment (DOH 2006)
4.3 Protective Isolation
Protective isolation is the physical separation of patients who are
Immunocompromised / Immunosuppressed in order to prevent the acquisition of
infection from other patients, staff or visitors. (Please see separate Trust Protective
Isolation Policy IC/201/10).
In both categories:
• The decision to isolate a patient should be based on the infection risk to other
patients, staff and visitors
• An appropriate isolation notice is required and must be placed on the outside
of the door, outlining the precautions required (see appendix 1)
• In order to minimize the risks of anxiety and depression that are often
experienced by many isolated patients, a full explanation of the nature of
infection, including the symptoms, treatment and the rationale for the control
measures should be given to the patient
• Daily assessment and evaluation of the need for ongoing isolation
precautions must take place
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
•
The infection prevention and control team is available for advice and
guidance.
5.1 Source Isolation
Source Isolation is indicated for conditions such as
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Pulmonary tuberculosis
Patients with diarrhoea and or vomiting clinically thought to of infectious origin
MRSA,
Clostridium difficile
Chicken Pox
Infections with Extended spectrum β lactamase producing organisms
(ESBLs)
Glycopeptide resistant enterococci including Vancomycin resistant organisms
(GRE and VRE)
Influenza and fevers from the tropics in which an infectious cause cannot be
ruled out (refer to table and specific policies for further information
Amp C producing organisms
Scabies
NB: Please note that this list is not exhaustive. If you think that a patient may
have an infectious condition that will put others at risk, please discuss with the
clinical team in the first instance, and consider discussion with the infection
prevention and control team or microbiologist if indicated.
5.2 Patient Placement
Ideally a single room should be allocated to patients with these conditions, but given
the limited availability of side rooms a risk assessment needs to be undertaken. The
risk assessment will include the risk factors of the other patients in isolation and the
patients in the bays. Some new flowcharts have been added to this document to try
and help you with this process (Please see Appendices 1-5).
Appropriate patient placement is a significant component of isolation precautions. A
single room is important to prevent direct- or indirect-contact transmission when the
source patient has poor hygienic habits, contaminates the environment, or cannot be
expected to assist in maintaining infection control precautions to limit transmission of
micro organisms (i.e., infants, children, and patients with altered mental status).
Where possible, a patient with highly transmissible or epidemiologically important
microorganisms must be placed in a single room with hand washing and toilet
facilities, to reduce opportunities for transmission of microorganisms.
When a single room is not available, an infected patient could be placed with an
appropriate contact. Patients infected by the same microorganism usually can share
a room, provided they are not infected with other potentially transmissible
microorganisms and the likelihood of re-infection with the same organism is minimal.
Such sharing of rooms, also referred to as cohorting patients, is useful especially
during outbreaks or when there is a shortage of side rooms. When a side room is not
available and cohorting is not achievable or recommended, it is very important to
consider the epidemiology and mode of transmission of the infecting pathogen and
the patient population being served in determining patient placement. Under these
circumstances, consultation with infection control professionals is advised
before patient placement. Moreover, when an infected patient shares a room with a
non-infected patient, it is also important that staff looking after the patient and visitors
take precautions to prevent the spread of infection.
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
A single room with appropriate air handling and ventilation is particularly important for
reducing the risk of transmission of microorganisms from a source patient to
susceptible patients and other persons in hospitals when the microorganism is
spread by airborne transmission. Some hospitals use an isolation room with an
anteroom as an extra measure of precaution to prevent airborne transmission.
Unfortunately the only side rooms with anterooms in the Trust are on the
Oncology/Haematology unit and are for use by immunocompromised patients only.
Under no circumstances should these rooms be used for any other patients
An alternative to side room is to barrier nursing the patient on the general bay or
cohorting of patients with the same condition. However please note that not all
patients with similar symptoms e.g. diarrhoea, have the same aetiology, and
cohorting should only be done following discussion with the
Infection prevention and control team/or consultant microbiologist. (Out of hours
number may be obtained via the switchboard).
If there are no side rooms available in the immediate vicinity, consult the site team for
availability on another ward if appropriate. Where a patient is nursed in a general bay
all appropriate precautions must be implemented and the whole bay isolated. The
infected patient should be nursed away from other patients at risk .i.e.
immunocompromised patients and an appropriate sign must be displayed on the
outside of the bay.
Once the risk assessment has identified that the patient requires isolation the
following precautions must be considered:5.3 Preparation of the isolation room
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All unnecessary equipment and furniture must be removed from the room to
facilitate cleaning and limit the potential for contamination.
All equipment in the room must be dedicated to the isolated patient.
The room must not be overstocked as equipment that cannot be cleaned will
need to be disposed of.
All personal belongings and equipment must be washable, cleanable or
disposable.
The patient should not keep unnecessary belongings in the room.
The source isolation poster must be placed on the door
Single use gloves and aprons must be set up outside the room. If these are
not wall mounted in the Danicenters a trolley/table/shelf must be used. This
must be well stocked at all times.
•
Patient notes (charts and kardex) must be kept outside the room to
reduce the risk of contamination.
•
A yellow plastic bag (for clinical waste) and a water soluble alginate bag and
red plastic bag (for infected linen) must be available inside the isolation room.
Use Standard Precautions for the care of all patients. (Please refer to Trust Standard
Precautions Policy)
5.4 Hand Decontamination
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Hands must be decontaminated before each and every episode of direct
patient contact and/or the patient’s direct environment and after any activity
that could potentially result in hands becoming contaminated.
Hands that are visibly soiled with contaminated dirt or organic material, i.e.
blood/body fluids must be washed immediately with liquid soap and water
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
•
Hands can be decontaminated, with an alcohol based hand rub unless hands
are visibly contaminated, between caring for different patients and between
different care activities for the same patient. (Please refer to Trust Hand
Hygiene Policy)
5.5 What if you have cuts and breaks in your skin?
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Cover any existing cuts or lesions with a waterproof dressing, paying
particular attention to hands and forearms.
Any staff with chronic skin lesions to hands or forearms or persistent skin
problems should avoid undertaking invasive procedures and seek advice
from the dermatology and Occupational Health Department.
5.6 Hand hygiene – patient
The patient is a potential source of spread of organisms to staff, visitors and the
environment. He/she should be instructed to decontaminate hands before eating and
after going to the toilet. Liquid soap and water should be used in these circumstances
5.7 Gloves
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Selection of protective equipment should be based on an assessment of the
risk of transmission of microorganisms to the patient and the risk of
contamination of the healthcare worker’s clothing and skin by patients’ blood,
body fluids, secretions or excretions.
Gloves must be worn for invasive procedures, contact with sterile sites and
non-intact skin or mucous membranes and all activities that have been
assessed as carrying a risk of exposure to blood, body fluids, secretions or
excretions.
Gloves must be worn as single use items. They must be put on immediately
before an episode of patient contact or treatment and removed as soon as
the activity is completed. Gloves must be changed between caring for
different patients and between different care and treatment for the same
patient.
Gloves must be disposed of as clinical waste after every procedure/episode
of care and hands decontaminated thoroughly after the gloves have been
removed.
Neither powdered nor polythene gloves should be used in healthcare
activities. Any sensitivity to natural rubber latex in patients, carers and
healthcare staff must be documented and alternative gloves must be
available. (Please refer to Trust Glove Policy)
Wearing gloves does not replace the need for hand washing, because gloves
may have small, unapparent defects or may be torn during use, and hands
can become contaminated during removal of gloves. Failure to change
gloves between patient contacts is an infection control hazard. (Please refer
to Trust Standard Precautions Policy and Glove Policy
5.8 Aprons and gowns
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Disposable plastic aprons should be worn where there is a risk that clothing
may be exposed to blood, body fluids, secretions and excretions with the
exception of sweat.
Full body fluid repellent gowns must be worn where there is a risk of
extensive splashing of blood, body fluids, secretions or excretions onto
the skin or clothing of healthcare workers
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
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Plastic aprons and fluid repellent gowns should be worn as single use items
for one procedure or episode of patient care and then discarded and
disposed of as clinical waste.
Remove a soiled gown or apron as promptly as possible and wash hands to
avoid transfer of microorganisms to other patients or environments.
5.9 Masks, face shields or eye protection
Wear a mask and eye protection or a face shield to protect mucous membranes of
the eyes, nose, and mouth during procedures and patient-care activities that are
likely to generate splashes or sprays of blood, body fluids, secretions, and
excretions.
5.10 Patient care equipment
Handle used patient-care equipment soiled with blood, body fluids, secretions, and
excretions in a manner that prevents skin and mucous membrane exposures,
contamination of clothing, and transfer of micro organisms to other patients and
environments. Ensure that reusable equipment is not used for the care of another
patient until it has been cleaned and reprocessed appropriately. Ensure that singleuse items are not reused and are discarded of properly.
5. 11 Environmental cleaning
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There should be clear hospital procedures for the routine care, cleaning, and
disinfection of environmental surfaces, beds, bedrails, bedside equipment,
and other frequently touched surfaces with an audit programme to ensure
that these procedures are being followed. All isolated areas should be
cleaned 3 times a day with an Actichlor + solution as per Trust Cleaning
Standards. (Please refer to the Hospital Cleaning Standards)
Isolation rooms should be cleaned last; after other rooms, bays and general
areas on the ward
Single use gloves and aprons must be worn when cleaning isolation rooms
and hands washed before leaving the room.
Special attention must be given to all horizontal surfaces and frequently
touched surfaces, such as door handles/door push plates, nurse call system,
toilet areas and sink taps.
5.12 Linen
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Handle, transport, and process used linen soiled with blood, body fluids,
secretions, and excretions in a manner that prevents skin and mucous
membrane exposures and contamination of clothing and that avoids transfer
of micro organisms to other patients and environments.
Ensure that any linen contaminated with blood or body fluids is placed into a
red alginate bag and then red plastic bag.
If linen is excessively wet please ensure that this item is wrapped in another
item of linen or the alginate bag may leak/split.
5.13 Sharps Management
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Sharps must not be passed directly from hand to hand and handling should
be kept to a minimum
Needles must not be resheathed, bent, broken or disassembled prior to
disposal
Always dispose of sharps at the point of use in an appropriate container.
Syringes/cartridges and needles should be disposed of intact.
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
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Sharps containers must comply with BS 7320 and UN3291 standards
Do not fill sharps containers above the manufacturer’s marked line, which
indicates that they are full.
Lock the used sharps container in accordance with manufacturer’s
Do not dispose of sharps with other clinical waste.
Do not place used sharps containers in yellow bags for disposal.
Ensure that sharps bins are safely positioned away from children/general
public
Ensure the temporary closure lid is in place when not in use
Do not remove sharps from the clinical setting.
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NB: In the event of a sharps injury or contamination of broken skin/ mucous
membranes with blood or body fluids, ensure that the Needlestick injury procedure is
followed. (Please refer to Trust Sharps Contamination Policy and Safe Handling of
Sharps Policy)
5.14 Crockery/cutlery
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All crockery/cutlery must be decontaminated in a dishwasher with a final
rinse temperature of 80°C.
Washing by hand is inadequate.
There is no requirement for disposable crockery and cutlery to be used.
5.15 Bathing
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To reduce the risk of cross-infection, patients with infections must be
bathed last.
The bath should be cleaned with Actichlor + (1,000 ppm) after use by the
isolated patient (this method of disinfection is adequate for use after
bathing infected patients).
If showers are used the procedure is as for baths.
5.16 Transport of Infected Patients
Limiting the movement and transport of patients infected with virulent or
epidemiologically important microorganisms and ensuring that such patients leave
their rooms only for essential purposes reduces opportunities for transmission of
microorganisms in hospitals. When patient transport is necessary, it is important that:
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Movement of infectious or potentially infectious patients should be kept to a
minimum. When it is necessary to transport patients to other wards or
departments, precautions to minimize the risks of transmission must
continue.
If it is possible to delay an investigation without adversely affecting the
patients management this should be considered. However the presence of an
infectious disease should not delay urgent clinical investigations.
The receiving area must be informed prior to transfer to ensure that they have
the appropriate precautions in place and that appropriate facilities are
available.
Patients with known or suspected infections must as far as possible be seen
at the end of the list and not be left in the waiting areas. This will allow
adequate cleaning of the environment and equipment following the
appointment and reduce the risks to other patients.
Check specific infection control policies for advice and guidance.
Consult the infection prevention and control team for any further advice or
guidance
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5.17 Visitors/Patients/Carers
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Explain the precautions required whilst maintaining the patient’s
confidentiality.
Visitors should be advised to wash their hands with liquid soap and water in
the following circumstances:
o Hands are visibly soiled;
o Following close physical contact with the patient or his/her immediate
environment.
o In addition, visitors should be advised to clean their hands with liquid
soap and water after removing gloves and apron (if worn, see below)
and immediately before entering and leaving the isolation
room(alcohol rub may be used as an alternative for hand
decontamination in this instance unless the reason for source isolation
is C. difficile
Discourage visitors from having contact with other patients in the ward or
hospital
Check with specific policies regarding specific diseases to ascertain whether
visitors should be excluded due to particular susceptibility.
Visitors do not need to wear aprons and gloves unless helping with personal
care or otherwise advised by Infection Control.
6.0 Post isolation/discharge/death
New patients must not be admitted to the room until it has undergone a deep
clean.
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A patient should be removed from isolation when he/she is no longer at risk of
spreading infection to others (refer to the new LTHT alert organism/condition
policy). This may be decided following consultation with a member of the
infection prevention and control team or on the basis of an infection
prevention and control policy (e.g. after 72 hours symptom free following
gastroenteritis or C. difficile infection)
At a minimum, daily assessment and evaluation of the patient's symptoms are
therefore important
Some specific disease policies give criteria on when isolation precautions can
be stopped
If in doubt, discuss with the infection prevention and control team
The vacated room must be cleaned thoroughly using Actichlor + solution (1
tablet to a litre of water) all equipment and belongings must be cleaned before
being brought out of the room or used again. Any unused disposable items,
which may be contaminated and cannot be cleaned must be disposed of
(Please see Trust cleaning Standards).
7.0 References and further reading
• Ayliffe GAJ, Lowbury EJL, Geddes AM and Williams JD. Control of Hospital
Infection a Practical Handbook, 3rd Edition. London: Blackwell Scientific
Publications, 1988: 70.
• Horton R. Hand washing: the Fundamental Infection Control Principle. British
Journal of Nursing, 1995; 4 (16): 226-233.
• Maurer IM. Hospital Hygiene, 3rd Edition. London: Edward Arnold, 1985: 50.
• Lewis AM, Gammon J, Hosein I. The Pros and Cons of isolation and
Containment. Journal of Hospital Infection, 1999; 43: 19-23.
• Wilson J. Theory and Practice of Isolation Nursing. Nursing Standard, 1992; 6
7): 30- 31
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Appendix 1
Diarrhoea and/or Vomiting Risk Assessment Algorithm
Ask: does the patient usually suffer from:
No
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Colitis
Diverticulitis
Irritable bowel syndrome
Take laxatives
Urgent nursing assessment required
Consider overflow/constipation/diet related eg enteral feeding/
high fibre diet
If still unexplained diarrhoea +/- vomiting potentially infectious:
•
Isolate in sideroom as a priority. Send stool sample
•
Obtain prompt medical review. Seek Gastroenterologist
advice with diagnosis if necessary
Yes
Is this normal bowel habit for the patient (ask!)?
No
Yes
Unlikely to be infectious
Isolation not usually
required unless for
purposes of patient dignity
Laboratory confirmed diagnosis of C.Diff/Norovirus/Campylobacter/Salmonella/Shigella?
Patient to remain in isolation until 72 hrs clear of symptoms. All except Norovirus may be considered for Isolation Ward transfer.
Confirmed Norovirus cases MUST remain in isolation on base ward to reduce the risk of spread of outbreak to other areas.
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Appendix 2
Respiratory Risk Assessment
Suspected/confirmed TB lungs/larynx?
(TB in “closed sites” eg not in
lung/larynx/discharging wound does not
usually require isolation).
Yes
No
•
Respiratory
isolation required*
•
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If multi resistant TB
suspected seek
immediate duty
microbiologist
advice
•
Yes
Respiratory
isolation not
required
Use of
appropriate
PPE required
when
performing
aerosol
generating
procedures
Suspected/confirmed Bacterial
Meningitis (viral meningitis does
not require isolation)
Suspected /confirmed
H1N1/Flu A?
•
•
•
Respiratory
isolation
required*
Prompt
transfer to
Isolation Ward
E floor
required
Prompt
medical review
required
No
No
Respiratory
isolation not
required
Yes
Respiratory
isolation* required
for the first 24hrs of
IV Antibiotic
treatment
*Respiratory isolation requires the use of aprons/gloves/ FFP2 or FFP3 mask.
Please contact a member of the Infection Prevention and Control team or the Consultant Microbiologist for any specialist advice
regarding respiratory isolation. Out of hours please contact the duty Consultant Microbiologist via the hospital switchboard.
Page 14 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 3
Skin Infection Risk Assessment Algorithm
Suspected/confirmed:
Shingles
Isolate into
side room
until
dry/healed
skin
Chicken
Pox
Isolate into side
room until
vesicles
dry/healed
Scabies
Isolate in side room until
1st treatment completed.
May then be de-isolated.
Patients with Norwegian
scabies need to remain in
isolation
Lice
Isolate in side
room until
treated.
May then be
de-isolated.
Evidence of
lesions/weeping
vesicles of unknown
origin
TB suspected in
oozing/
discharging
wounds?
Isolate into side
room and obtain
prompt medical
review/dermatologist
opinion.
Isolate into side
room until wound
dry and
completely
healed
Please note in the case of shingles and chicken pox special precautions are required with certain groups of healthcare workers e.g
pregnant healthcare workers. These workers and those who do not have immunity (have not previously had chicken pox) should not enter
the isolation room of these patients where at all possible.
For any further advice regarding this please contact either a member of the Infection Prevention and Control Team or the Consultant
Microbiologist.
Page 15 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Isolation Priorities
Appendix 4
HIGH
MEDIUM
LOW
Do not remove from isolation without prior
discussion with duty microbiologist/ICT
•
•
•
•
•
•
•
•
•
•
Diarrhoea and/or vomiting of unknown
origin
Suspected/confirmed Norovirus
Suspected/confirmed C.diff
Suspected/confirmed Pulmonary TB
including MDRTB. Possible MDRTB
must be discussed immediately with
the duty microbiologist
Suspected/confirmed Chicken
pox/Shingles/Measles
MRSA in sputum/exudating
wound/MRSA skin shedder/high
mupricin resistance/MRSA 16 or 18
E.coli 0157/Shigella/Salmonella
Norwegian scabies
Pandemic influenza
Viral haemorrhagic fever – possible
cases must be discussed with the duty
microbiologist immediately
•
•
•
•
•
•
•
ESBL/AMP C/Acinetobacter
GRE
RSV/Influenza
Mumps
Meningitis with cough (isolation for 24
hrs IVABX)
Strep A/Strep G on high risk areas
(isolation for first 24 hrs of IVABX)
Open weeping TB lesions to skin
•
•
•
•
MRSA 15 or 16 post full screen and on
Mupiricin
Meningitis (undiagnosed or
meningococcal) no cough
Strep A/G (after 24 hrs IVABX)
Scabies (isolate until first treatment
completed)
NB: MRSA 16 and 18 strains can be more resistant to antibiotics and also resistant to Mupiricin 5 and 200, due to the resistance of the strain these
patients cannot be placed in an open bay or with any other MRSA positive patient
Page 16 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 5: Risk Assessment using the Isolation Priority Scoring System
The isolation priority scoring system is based on factors likely to influence the
transmission of a pathogen and its impact e.g. pathogenic potential, mechanism of
transmission, antibiotic resistance, susceptibility of other patients, prevalence in the
hospital (see Table 2, pg11).
All patients considered for admission to the Isolation Ward must be risk
assessed and assigned a score using the Isolation Priority Scoring System for
the relevant infectious disease/condition (see Tables 3-7, pg12 – pg16). This
assessment will be guided by the nurse in charge of the Isolation Ward with
the support of the Infection Control Team. The level of priority: high, medium
or low, can be determined depending on the score as indicated in Table 1
Table 1: Appropriate Isolation Facility according to Level of Priority
Score
>45
Priority
High
Appropriate Isolation Facility
Single room on Isolation Ward with ensuite bathroom
facilities
OR
If indicated, negative pressure room at a regional specialist
unit (Southampton or London)
25-45
Medium
Single room on Isolation Ward with ensuite bathroom
facilities
<25
Low
Single room on Isolation Ward, single room on general ward
or Cohort bay if established
Disease-Specific Isolation Risk Assessment Priority Scoring Tables
The relevant table should be used for determining the score of individual patients
who are suspected or known to be colonised or infected with an infectious disease or
condition.
If the condition is not listed, the Infection Control Team or on-call Medical
Microbiologist (out of hours) should be contacted.
The risk assessment score should be reviewed and documented daily to ensure that
optimal use is made of isolation facilities and to ensure that patients are not kept in
isolation for longer than necessary
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 6: Priority Scoring System: Infectious Diarrhoea
Table 3: Priority Scoring Table for Infectious Diarrhoea
Infection
Route
Evidence Antimicrobial Variable
Risk
of
for
resistance
factors, e.g.
category
spread spread in
patient
hospital
susceptibility,
dispersal risk
High
Little
Profuse
Clostridium Contact Strong
(faecaldiarrhoea with
difficile
oral)
faecal
incontinence,
patient
confused/
Uncooperative
Continent and Medium
cooperative
Norovirus
Aerosol
and
Contact
(faecaloral)
Strong
Little
E. coli
0157,
Salmonella
Shigella
Contact
(faecaloral)
Moderate
Little
To remain in
isolation in
base ward
/area due to
risk of
spreading
outbreak to
other
wards/areas
Profuse
diarrhoea with
faecal
incontinence,
patient
confused/
Uncooperative
Continent and
cooperative
Page 18 of 37
Score
Length of
isolation
>45
Until
diarrhoea
resolved
for 72hrs
35
>45
Until
diarrhoea /
vomiting
resolved
for 72hrs
High
>45
Until
diarrhoea
resolved
for 72hrs
Medium
35
High
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 7: Priority Scoring System: MRSA
Table 4: Priority Scoring Table for MRSA
Condition Route
Evidence Antimicrobial
or
of
for
resistance
infection
spread spread in
hospital
MRSA15
or 16
MRSA 17
or MRSA
with high
level
mupirocin
resistance
Contact
Contact
Strong
Strong
Moderate
Serious
Variable
factors, e.g.
patient
susceptibility,
dispersal risk
Skin shedder
(e.g. eczema,
psoriasis),
discharging
wound or
sputum
colonised
>1 site
colonised or
uncovered
wound
Nasal carriage
only - post full
screen and on
mupirocin
Skin shedder
(e.g. eczema,
psoriasis),
discharging
wound or
sputum
colonised
Not a skin
shedder
Page 19 of 37
Risk
category
Score
Length of
isolation
>45
Indefinite
High
Medium
35
Low
0
High
50
>45
High
Continue
screening,
aim to
clear
Indefinite
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 8: Priority Scoring System: Antimicrobial-Resistant Bacteria
Table 5: Priority Scoring Table for Antimicrobial-Resistant Bacteria
Condition or Route
Evidence Antimicrobial Variable
Risk
Score
infection
of
for
resistance
factors, e.g.
category
spread spread
patient
in
susceptibility,
hospital
dispersal risk
ESBL,
Contact Moderate Serious
Sputum
45
Medium
Acinetobacter and
colonised
droplet
Oncology
ward, ICU
Glycopeptide
resistant
enterococci
(GRE)
Contact
Strong
Serious
Medium
45
Oncology ward Medium
or immunocompromised
patients
Other wards,
Medium
diarrhoea
>45
Other wards,
faecal
colonisation –
no diarrhoea
20
Page 20 of 37
Low
30
Length
of
isolation
Indefinite
Indefinite
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 9: Priority Scoring System: Respiratory Infections
Table 6: Priority Scoring Table for Respiratory Infections
Condition or Route
Evidence Antimicrobial Variable
resistance
factors, e.g.
infection
of
for
patient
spread spread
susceptibility,
in
dispersal risk
hospital
Penicillin
Droplet
Strong
Moderate
Cough
resistant
Streptococcus
pnemoniae
No cough
Respiratory
syncytial virus
(RSV) /
influenza
Droplet
and
contact
Strong
N/A
High
50
Medium
40
Non-epidemic
situation
Medium
40
Epidemic
situation
Medium
35
High
55
Refer to
TB Policy
25
Refer to
TB Policy
65
Transfer
to
regional
specialist
unit
Pulmonary /
Laryngeal
Tuberculosis
– ‘open’
(untreated)
Tuberculosis
lesions
(weeping)
Airborne Strong
N/A (see
below –
MDRTB)
Refer to TB
Policy
Contact
N/A (see
below MDRTB)
Refer to TB
Policy
Pulmonary
Tuberculosis
– multi-drug
resistant
Airborne Strong
Serious
Refer to TB
Policy
Poor
Risk
Score Length of
category
isolation
Page 21 of 37
Medium Low
High
Until
cough
resolves
Until
symptoms
resolve
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 10: Priority Scoring System: Other Infectious Diseases / Conditions
Table 7: Priority Scoring Table for other Infectious Diseases / Conditions
Condition or
Route
Evidence Antimicrobial Variable
Risk
Score Length
infection
of
for
resistance
factors, e.g.
category
of
spread spread
patient
isolation
in
susceptibility,
hospital
dispersal risk
50
Until
Chicken pox
Airborne Strong
Little
Antenatal,
High
spots/
(varicella) /
and
postnatal,
lesions
shingles
contact
oncology,
crusted
immunocompromised
patients
All other wards Medium
40
Measles
Mumps
Airborne Strong
Droplet
Moderate
Little
Little
Droplet
Meningitis
(undiagnosed
or
meningococcal)
Poor
Little
Scabies
Contact
Strong
N/A
Scabies –
disseminated
(Norwegian)
Contact
Strong
N/A
Streptococcus
Groups A and
G
Droplet
Strong
Little
Antenatal,
postnatal,
oncology,
immunocompromised
patients
All other wards
High
50
Medium
40
Antenatal,
postnatal,
oncology,
immunocompromised
patients
All other wards
Medium
35
Medium
25
Cough
Medium
25
No cough
Low
15
Avoid
prolonged skin
to skin contact
Avoid direct
contact with
skin and
environmental
surfaces (use
PPE)
Surgical wards
Low
20
Other wards
Page 22 of 37
High
>45
Medium
30
Low
20
14 days
9 days
24 hrs
with
effective
antibiotic
therapy
24 hrs
after
treatment
Indefinite
24 hrs
with
effective
antibiotic
therapy
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 11: Components of standard and transmission based isolation
precautions
Hand
washing
Gloves
Masks
Eye/face
protection
Apron/gown
Equipment
Cleaning
Linen
Isolation
room
Standard
√
Contact
√
Droplet
√
Airborne
√
When likely to
touch, blood,
body fluids and
contaminated
items
During
procedures
likely to
generate
contamination
with blood and
body fluids
During
procedures
likely to
generate
contamination
with blood and
body fluids
During
procedures
likely to
generate
contamination
with blood and
body fluids
√
√
√
Single room
not required
On entering
room, during
care
As per
standard
As per
standard
As per
standard
As per
standard and if
within 1 metre
of patient
On entering if
non-immune.
Non-essential,
susceptible
people should
be excluded
As per
standard
As per
standard and if
within 1 metre
of patient
On entering if
non-immune.
Non essential,
susceptible
people should
be excluded
On entering if
contact with
patient or
environment
anticipated
As per
standard
As per
standard
√
√
√
Single room
and minimise
time outside
√
√
√
Single room
and minimise
time outside
when patient
may wear
mask
√
√
√
Single room
+/- negative
pressure
ventilation,
minimise time
outside and
patient should
wear mask,
exclude non
essential
susceptible
staff
Page 23 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 12: Signage
•
•
•
•
•
•
ALL VISITORS PLEASE:
Ask a nurse before entering so she/he can explain any precautions you need to take, such as wearing gloves, aprons or masks.
Use the alcohol gel provided before entering the room and wash your hands with soap and water before leaving the room.
Close the door behind you.
ALL STAFF PLEASE:
Wash your hands and wear appropriate protective equipment prior to contact with the patient and/or patient environment.
Wash your hands prior to leaving the room.
Close the door behind you.
Page 25 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
•
•
•
•
•
•
•
•
ALL VISITORS PLEASE:
Ask a nurse before entering so she/he can explain any precautions you need to take, such as wearing gloves, aprons or
masks.
Use the alcohol gel provided before entering the room and wash your hands with soap and water before leaving the
room.
Please do not visit if you have a cough/cold or sore throat or have been unwell within the last 7 days
Close the door behind you.
ALL STAFF PLEASE:
All Staff members entering the room MUST wear aprons and gloves
Please do not visit if you have a cough/cold or sore throat or have been unwell within the last 7 days
Please adhere to standard infection control precautions at all times
Please ensure door is closed at all times
Page 26 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 13:
Cleaning Procedure for a Vacated Single Isolation Room
Required:
•
•
•
•
•
•
•
Caution sign
Yellow apron and disposable gloves
Mop and bucket
Cleaning clothes
Detergents/hypochlorite solution
Yellow bag for clinical waste
Mask & Goggles (optional depending on operators risk assessment)
Clean fixtures & Fittings:
•
•
•
•
Remove toilet rolls if soiled with body fluids
Remove clinical and domestic waste
Clean sanitary ware and overhead bed lamps with Actichlor + solution
Note: Hand towels do not need to be thrown away if they are in the dispenser
or still wrapped
Equipment use:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Use Actichlor + hypochlorite solution to clean and disinfect items.
Remove from 'Dirty Area' to corridor clean area e.g. corridor etc
Remove/take down all curtains including door curtains and place in red
alginate bag and then Purple plastic bag
Spot clean visibly soiled area on walls
Liaise with Infection prevention and control/Estate Services if full height wall
washing is considered necessary
Clean edges, ledges, pipes and radiators thoroughly
Ensure the floor is cleaned thoroughly including corners
Cleaning is complete when the room, furniture and fittings are free from dust,
debris, spillage and moisture
Dispose of gloves and apron correctly and wash hands thoroughly
Return clean furniture to clean room.
Replace/re hang curtains correctly if hooks are loose or missing
Replenish toilet rolls and paper towels.
Replace clinical and domestic waste bin liners
Inform nursing staff that the room is now ready for use
Page 27 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 14:
Cleaning Procedure for a Single Isolation Room
All cleaning equipment used in these rooms will be kept exclusively for use within
these rooms.
1. Floors should be cleared of debris by the use of a disposable dust control
mop. The disposable strip will be removed from the head and placed in a
yellow refuse bag before leaving the room.
2. A single bucket and mop handle will be kept within the room for damp
mopping of the floor.
3. Disposable yellow cloths will be used for damp dusting and washing of
furniture /equipment. They will be placed in a yellow refuse bag inside the
room.
4. Protective clothing will be worn as instructed.
5. Blood and blood stained body fluid spillages must be cleaned using a
hypochlorite solution as per Trust Cleaning Standards.
6. All horizontal surfaces must be wiped over with an Actichlor + solution.
7. It is not necessary to wash walls unless they are visibly soiled.
8. Dust must be kept to a minimum.
9. Clinical waste (e.g. protective clothing contaminated with body fluids) must be
bagged in yellow bags.
10. Domestic waste (e.g. hand towels) must be bagged in yellow bags.
11. All waste bags for disposal must be secured with tape.
12. When room is vacated follow cleaning procedure for a vacated single isolation
room.
Page 28 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Appendix 15: Notifiable infectious diseases & food poisoning
The statutory notification of infectious diseases has been a crucial health protection
measure in this country since the late 19th century. The purpose of notification is to
enable the prompt investigation, risk assessment and response to cases of infectious
disease and contamination that present a significant risk to human health.
Notification has the secondary benefit of providing data for use in the epidemiological
surveillance of infection and contamination.
Notification duties of Registered Medical Practitioners (RMPs)
RMPs attending a patient are required to notify the proper officer of the local authority
in which the patient resides when they have “reasonable grounds for suspecting” that
the patient:
•
•
•
•
has a notifiable disease as listed in this appendix of the Notification
Regulations; or
has an infection not included in Schedule 1 which in the view of the RMP
presents, or could present, significant harm to human health (e.g. emerging or
new infections); or
is contaminated (such as with chemicals or radiation) in a manner which, in
the view of the doctor presents, or could present, significant harm to human
health; or
has died with, but not necessarily because of, a notifiable disease, or other
infectious disease or contamination that presents or could present, or that
presented or could have presented significant harm to human health.
RMPs should not wait for laboratory confirmation or results of other investigations in
order to notify a case. This will ensure prompt notification so that health protection
interventions and control measures can be initiated as soon as possible.
If laboratory test results refute the clinical diagnosis later, the RMP is not required to
de-notify the case. However, they should contact the proper officer if they made
administrative errors in the notification process. When a statutory notification is
made, it is useful to mention the notification in the patient’s records. This will help to
avoid duplicate notifications.
When a patient is referred from one RMP to another, the first RMP who forms a
clinical suspicion that a patient suffers from a notifiable disease or other infectious
disease or contamination that presents, or could present, harm to human health
should notify the case. This is to prevent unnecessary delay in advising or
implementing public health measures
Time frame for notifications
The RMP should send a written notification to the proper officer of the local authority
so that it is received within three days, beginning with the day on which the RMP
forms the clinical suspicion or makes the clinical diagnosis. However, if the RMP
considers the case requires urgent notification, they need to notify it orally – usually
by telephone – as soon as reasonably practicable and follow this up with written
notification within three days. It is recommended that urgent notifications are made
as soon as possible after the RMP forms the clinical suspicion or makes the
clinical diagnosis, and always within 24 hours.
In determining whether a case is urgent or not, factors that should be considered
include the:
Page 29 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
•
•
•
•
Nature of the suspected notifiable disease, other relevant infection or relevant
contamination including morbidity, case-fatality and epidemiology of the
disease – a rare disease, or one that is re-emerging, is likely to need urgent
notification.
Ease of spread of that disease or infection, route of transmission (for
example, a highly infectious respiratory disease) or potential spread of
contamination.
Ways in which the spread of the notifiable disease, other relevant infection or
contamination can be prevented or controlled, for example by immunisation,
disinfection, isolation or prophylactic treatment.
Specific circumstances of the case which might represent particular risks,
such as occupation, age and sex. These details have a bearing if, for
example, a patient is a healthcare worker, a child attending nursery or a
woman of child-bearing age.
There may be other circumstances where urgent notification is necessary, for
example, if a disease appears to be a cluster of cases rather than a single case.
Providing relevant information
The notification by RMPs must include the following information about the patient in
so far as it is known to them:
•
•
•
•
•
•
•
•
•
•
•
•
•
name, date of birth and sex;
home address including postcode;
contact telephone number;
current residence (if it is not the home address);
NHS number;
occupation (if the RMP considers it relevant);
name, address and postcode of place of work or educational establishment (if
the RMP considers it relevant);
ethnicity;
relevant overseas travel history;
contact details of a parent (if the patient is a child);
disease or infection which the patient has or is suspected of having or the
nature of the patient’s contamination or suspected contamination;
date of onset of symptoms; and
date of diagnosis.
The notification should also include the name, address and telephone number of the
RMP making the notification.
Page 30 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Alogorithm 1: The notification process
Patient
Seen by Registered Medical
Practitioner (RMP)
Clinically suspected or
diagnosed notifiable disease
NO
Other infection or
contamination that presents, or
could be present, significant
harm to human health is
suspected or diagnosed
YES
URGENT
RMP considers case
urgent and notifies the
proper officer by
telephone. It is
recommended that
urgent notifications are
made as soon as
possible after clinical
suspicion or diagnosis
and always within 24
hours. Oral
notification needs to
be followed by a
written notification
within three days
NON URGENT
NO
RMP notifies the
proper officer in writing
within three days
No requirement to
notify
Proper officer receives notification
YES
Proper officer considers the
case to be urgent
URGENT
Proper officer passes on notification specified below
orally – normally be telephone – as soon as
reasonably practicable. Oral notification needs to be
followed by written notification within three days
NO
NON URGENT
Proper officer passes on notifications
specified below in writing within three
days
The proper officer of the local authority (LA) sends a copy of the notification to the HPA,
the proper officer of the LA in whose area the patient usually resides (if different) or
proper officer of the port health authority or the LA of the patient’s port of
disembarkation (if relevant)
Page 31 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Page 32 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Table 1: Notifiable diseases, with explanatory notes and guidance on the need
for urgent notification
NB: This table is only for guidance and each case should be considered individually.
Notifiable diseases
Acute encephalitis
Acute meningitis
Acute poliomyelitis
Acute infectious hepatitis
Definition/comment
Viral and bacterial
Close contacts of acute
hepatitis A and hepatitis B
cases need rapid
prophylaxis. Urgent
notification will facilitate
prompt laboratory testing.
Hepatitis C cases known to
be acute need to be followed
up rapidly as this may signify
recent transmission from a
source that could be
controlled.
Anthrax
Botulism
Brucellosis
Cholera
Diptheria
Enteric fever (typhoid or
paratyphoid fever)
Food poisoning
Haemolytic uraemic
syndrome (HUS)
Infectious bloody diarrhoea
Clinical diagnosis of a case
before microbiological
confirmation (e.g. case with
fever, constipation, rose
spots and travel history)
would be an appropriate
trigger for initial public health
measures, such as exclusion
of cases and contacts in high
risk groups (e.g. food
handlers).
Any disease of infectious or
toxic nature caused by, or
thought to be caused by
consumption of food or water
(definition of the Advisory
Committee on the
Microbiological Safety of
Food)
Likely to be urgent?
No
Yes, if suspected bacterial
infection
Yes
Yes
Yes
Yes
No – unless thought to be UK
acquired
Yes
Yes
Yes
Clusters and outbreaks, yes.
For specific organisms see
Table 2
Yes
See also HUS in Schedule 1
and VTEC in Schedule 2
Invasive group A
streptococcal disease and
scarlet fever
Legionnaires’ disease
Leprosy
Malaria
Yes
Yes, if IGAS. No, if scarlet
fever
Yes
No
No, unless thought to be UK
acquired
Yes
Yes
Measles
Meningococcal septicaemia
Page 33 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Notifiable diseases
Mumps
Plague
Rabies
Rubella
Definition/comment
Post-exposure immunisation
(MMR or HNIG) does not
provide protection for
contacts
A person bitten by a
suspected rabid animal
should be reported and
managed urgently but if a
patient is diagnosed with
symptoms of rabies they will
not pose a risk to human
health
Post-exposure immunisation
(MMR or HNIG) does not
provide protection for
contacts
SARS
Smallpox
Tetanus
Likely to be urgent?
No
Yes
Yes
No
Yes
Yes
No, unless associated with
injecting drug use
No, unless healthcare worker
or suspected cluster or multi
drug resistance
No
Yes
Tuberculosis
Typhus
Viral haemorrhagic fever
(VHF)
Whooping cough
Yes, if diagnosed during
acute phase
No, unless thought to be UK
acquired
Yellow fever
NB: RMPs are also required to notify suspected cases of other infections (“other
relevant infection”) or contamination (“relevant contamination”) that present, or could
present, significant harm to human health (see 3.2 and 3.3).
Page 34 of 37
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Table 2: Causative agents, with explanatory notes and guidance on the need
for urgent notification
As regards urgency, the key consideration will be the likelihood that an intervention is
needed to protect human health and the urgency of such an intervention. The
likelihood of the diagnosis of an infection being considered urgent may also increase
if it is part of a known or suspected cluster, or in someone with increased risk of
transmission such as enteric infection in a food handler.
NB: This table is only for guidance and each case should be considered individually.
Notifiable organisms
Bacillus anthracis
Bacillus cereus
Definition/comment
Only if associated with food
poisoning
Bordetella pertussis
Borrelia spp
Brucella spp
Burkholderia mallei
Burkholderia pseudomallei
Camplyobacter spp
Chikungunya virus
Chlamydophila psittaci
Clostridium botulinum
Clostridium perfringens
Only if associated with food
poisoning
Clostridium tetani
Corynebacterium diphtheriae
Corynebacterium ulcerans
Notify without delay, before
results of toxigenicity tests
are known
Notify without delay, before
results of toxigenicity tests
are known
Likely to be urgent?
Yes
No, unless part of a known
cluster
Yes, if diagnosed during
acute phase
No
No, unless thought to be UK
acquired
Yes
Yes
No, unless part of a known
cluster
No, unless thought to be UK
acquired
Yes if diagnosed during
acute phase or part of a
known cluster
Yes
No, unless known to be part
of a cluster
No, unless associated with
injecting drug use
Yes
Yes
Yes if diagnosed during
acute phase or part of a
known cluster
Yes
Coxiella burnetii
Crimean-Congo
haemorrhagic fever virus
Cryptosporidium spp
No, unless part of known
cluster, known food handler
or evidence of increase
above expected numbers
No, unless thought to be UK
acquired
Yes
No, unless known to be part
of a cluster or known food
handler
Yes
No, unless part of known
cluster, known food handler
Dengue virus
Ebola virus
Entamoeba histolytica
Francisella tularensis
Giardia lamblia
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IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Notifiable organisms
Guanarito virus
Haemophilus influenzae
Definition/comment
Invasive i.e. from blood,
cerebrospinal fluid or other
normally sterile site
Hanta virus
Hepatitis A, B, C, delta and E
viruses
All acute and chronic cases
Influenza virus
Junin virus
Kyasanur Forest disease
virus
Lassa virus
Legionella spp
Leptospira interrogans
Listeria monocytogenes
Machupo virus
Marburg virus
Measles virus
Mumps virus
Mycobacterium tuberculosis
complex
Neisseria meningitidis
Omsk haemorrhagic fever
vrius
Plasmodium falciparum,
vivax, ovale, malariae,
knowlesi
Polio virus
Rabies virus
Excluding asymptomatic
cases (e.g. throat carriage)
No, unless thought to be UK
acquired
All acute cases and any
chronic cases who might
represent a high risk to
others, such as healthcare
workers who perform
exposure-prone procedures
No, unless known to be a
new sub-type of the virus of
associated with known
cluster or closed
communities such as care
homes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
No, unless healthcare worker
or suspected cluster or multidrug resistance
Yes
Yes
No, unless thought to be UK
acquired
Wild or vaccine types
Classical rabies and rabies
related lyssaviruses
Rickettsia spp
Rift Valley fever virus
Rubella virus
Sabia virus
Salmonella spp
or evidence of increase
above expected numbers
Likely to be urgent?
Yes
Yes
Including S. Typhi and S.
Paratyphi
SARS coronavirus
Shigella spp
Page 36 of 37
Yes
Yes
No, unless thought to be UK
acquired
Yes
No
Yes
Yes, if S. Typhi or S.
Paratyphi or suspected
outbreak or food handler or
closed communities such as
care homes
No, if sporadic cases of other
Salmonella species
Yes
Yes, except Sh. Sonnei
unless suspected outbreak or
IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness
Streptococcus pneumoniae
Streptococcus pyogenes
Varicella zoster virus
Variola virus
Verocytotoxigenic
Escherichia coli
Vibrio cholerae
West Nile virus
Invasive i.e. from blood,
cerebrospinal fluid or other
normally sterile site
Invasive i.e. from blood,
cerebrospinal fluid or other
normally sterile site, or
associated with necrotising
soft tissue infection
Including E. coli O157
food handler or closed
communities such as care
homes
No, unless part of a known
cluster
Yes
No
Yes
Yes
Yes
No, unless thought to be UK
acquired
No, unless thought to be UK
acquired
Yes
Yellow fever virus
Yersinia pestis
Page 37 of 37