Download Infection Control Guidelines

KARE.
Infection Control Guidelines
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Table of Contents:
Introduction............................................................................................................ 4
Advice on HANDWASHING ............................................................................. 17
Guidelines for Glove usage................................................................................. 19
Guidelines for glove usage. ................................................................................ 20
Infection Control Issues Regarding Staff Health ...................................... 21
Prevention of Catheter Associated Urinary Tract Infection. .................. 24
Infection Control Issues Regarding Last Rites ......................................... 28
Management of Enteral Feeding. ..................................................................... 30
Disease Specific Information........................................................................... 38
Cytomegalovirus (CMV) ....................................................................................... 42
Conjunctivitis ........................................................................................................ 45
Chickenpox............................................................................................................. 47
Cryptosporidiosis ................................................................................................. 50
Dysentery .............................................................................................................. 53
E-coli O157 ............................................................................................................ 55
Food Poisoning....................................................................................................... 58
Giardiasis ............................................................................................................... 61
Glandular Fever .................................................................................................... 63
Head Lice ............................................................................................................... 65
Hepatitis A ............................................................................................................ 68
Hepatitis B ............................................................................................................ 71
Herpes Simplex .................................................................................................... 74
Hand, Foot & Mouth Disease ............................................................................. 76
HIV/AIDS ............................................................................................................. 78
Impetigo ................................................................................................................. 81
Influenza................................................................................................................ 83
Tips for Swine Influenza Prevention ............................................................ 836
Legionnaires Disease ........................................................................................... 90
Listeriosis (Listeria) ........................................................................................... 92
Measles................................................................................................................... 94
MRSA ...................................................................................................................... 96
Mumps ................................................................................................................... 100
Parvovirus B19 Infection ................................................................................. 102
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Pertussis also known as (Whooping Cough) ................................................. 105
Ringworm .............................................................................................................. 107
Rotavirus .............................................................................................................. 109
Rubella (German Measles) ................................................................................ 111
Salmonella ............................................................................................................ 114
Scabies ................................................................................................................. 117
Scarlet Fever ...................................................................................................... 120
Shingles ................................................................................................................ 122
Tuberculosis ........................................................................................................ 124
Tetanus................................................................................................................. 128
Toxoplasmosis ..................................................................................................... 130
Threadworms ...................................................................................................... 133
Viral-Gastroenteritis ........................................................................................ 136
Cleaning Cloths ................................................................................................... 139
Viral Meningitis .................................................................................................. 141
Bacterial Meningitis/Meningococcal Disease ................................................ 86
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Introduction.
The purpose of infection control is to limit the acquisition and spread of
pathogenic micro-organisms by using scientifally based knowledge, Using
planning, surveillance, education and research as part of the overall
guidelines of achieving high quality health care.
The chain of infection.
Knowledge of potential sources of micro-organisms, and an understanding
of how they spread, enables us to take appropriate measures to prevent
transmission of infection in KARE. The process by which infection is
spread can be thought of as a continuous chain. All links must be
maintained, and in the proper order, for the chain to remain intact and
infection to be spread. Infection control measures aim to interrupt or
break a link in the chain and to prevent the spread of infection.
The chain of infection consists of six links i.e.
1. Causative organism
2. Reservoirs
3. Portals of exit
4. Mode of spread
5. Portal of entry
6. Susceptible host
The Causative organism.
In order to break the chain of infection, the causative organism must be
destroyed or rendered harmless. Within KARE infection control measures
(i.e. cleaning and disinfection) are aimed at removing this link.
Reservoirs.
Dust insects and vermin may all act, as reservoirs and a clean environment
will remove this link. Also any Service user or member of staff may also
act as a reservoir and any sign of infection should be noted, investigated
and treated. All equipment used by staff or service users is a potential
reservoir and staff must be clear about how the equipment should be
made safe for reuse or the methods of disposal if single use.
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Portals of entry and exit.
The route by which a causative organism leaves its host is called the
portal of exit, and the route by which it enters is called the portal of
entry. The main portals of entry are

The respiratory tract through the inhalation of organisms e.g. TB

The alimentary tract, through ingestion of contaminated food or
water e.g. Salmonellosis.

The skin and mucous membranes, either by passage of organisms
through damaged skin, as with infected wounds, or by inoculation of
organism e.g. Hepatitis B
There are several ways by which infectious agents leave the host and are
the same as the portals of entry.
Mode of spread
Infection may be transmitted in the following ways:
1. Indirect or direct contact with contaminated body fluids,
equipment or via hands of service users and staff. Contact is the
main consideration and hand washing is therefore the most
important method of avoiding cross infection.
2. Vectors such as mice, rats, flies, blue bottles, and other insects
that may harbour infections.
3. Airborne spread of contaminated skin scales, infectious secretions
through an aerosol of contaminated droplets. E.g. sneezing or
vomiting.
4. Faecal-oral contact with contaminated faecal matter, or poorly
prepared or contaminated food or water.
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Susceptible host.
Only if the host is susceptible to infection will the chain be complete.
Within KARE all service users and staff are considered to be susceptible
due to large numbers of people and shared areas. Therefore all staff has
responsibility to assess each service user for their risk of acquiring or
transmitting infection. Staff may also be susceptible hosts and therefore
have the responsibility to enforce and adhere to the infection control
measures outlined in this document, and reduce potential risks to a
minimum.
Standard Precautions.
It is the responsibility of all staff working in KARE to be diligent in good
Infection Control practice, in order to reduce the risk to our service
users and other staff acquiring infections and reducing the incidence of
cross infection. All staff has an important role to play in the prevention
and control of infection.
Occupational risks of transmission of blood borne viruses (BBVs) to
health care workers arise from the possibility of exposure to blood and
to other body fluids or tissue from an infected person. Before carrying
out any procedures, staff must assess the risk of exposure to blood and
any other body fluids and then choose the appropriate protective
clothing. In addition, staff should devise safe and reasonably practicable
procedures and routines for performing clinical tasks.
The first tier standard precautions are designed to reduce the risk of
transmission of blood borne and other pathogens for all service users and
staff when handling:

Blood

All body fluid secretions except sweat, regardless of whether they
contain visible blood.

Any other body fluid containing visible blood including saliva in
Dentistry

Non intact skin

Unfixed tissue and organs
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
Mucous membranes of the eyes and the mouth
Standard Infection Control precautions are a set of broad principles that
all staff should use to minimise the risk of cross infection amongst
service users and staff.
Standard Infection Control precautions include:








Hand Hygiene
Protective clothing
Isolation Nursing
Laundry Management
Waste Management
A clean environment
Decontamination of equipment
Management of exposure to blood and body fluids.
Hand Hygiene.
Hand hygiene is the single most important means of preventing infection.
Hand Hygiene removes or destroys any micro-organisms picked up on the
hands. Many infections acquired in a community health care setting, are
as a result of staff not washing their hands.
Hand Hygiene must be carried out:
Before
 Giving treatment/care
 Touching wounds, dressings etc
 Giving medications
 Handling Invasive devices
 Handling food
 Undertaking invasive devices.
After
 Giving treatments/care
 Handling body fluids
 Removing protective clothing
e.g. gloves and aprons.
 Contact
with
wounds,
catheters etc
 Handling
contaminated
equipment or environment.
 Using the toilet
Hand wash basins should be available in rooms where care is given. Liquid
soap and paper towels, together with a pedal-operated waste bin must be
available at every wash hand basin. Alcohol hand rubs i.e. “Prevacare”
should also be available. Hand washing using liquid soap, followed by
applying alcohol hand rub is considered to be best practice.
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Protective Clothing.
Protective clothing and equipment i.e. single use disposable gloves are
provided to protect staff from exposure to contamination from body
fluids.
Disposable gloves and aprons must be worn if contact with blood or body
fluids is anticipated. These should be discarded as soon as the task for
which they were worn is completed. Gloves may become ineffective if
worn for too long, or can become a source of cross contamination.
Following removal of gloves, hands must be washed. Any wounds or broken
shin should be covered with a waterproof dressing. All staff for general
care duties or food preparation should use Non Powdered vinyl gloves.
When cleaning “Marigold” household gloves should be used for household
cleaning. Non Powdered Latex Examination gloves are only recommended
for staff who are involved in minor surgical or other aseptic procedures
with potential exposure to blood or blood stained body fluids. This is due
to the increase in incidences of latex allergies worldwide.
Isolation Nursing.
There is no need to segregate from others, any service users who have an
antimicrobial-resistant infection/colonisation.
Laundry Management.
Contaminated clothing and linen are a potential means of transmission of
micro-organisms. For this reason it is important that laundry is handled in
a manner that minimises the risk of transmission. In community
residential houses, clothes and bed clothes should be washed with
reasonable frequency using the hottest temperature the material will
withstand. If clothing or bed clothes are contaminated with body fluids,
it should be laundered separately from other linen. Laundered items
should be dried as quickly as possible, preferably in the open air. Hands
should be washed after handling dirty washing.
Waste Management.
Cross contamination can occur due to contact with clinical waste and
contaminated sharps. It is the duty of all staff to handle and dispose of
waste in the correct manner,
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Decontamination of equipment and maintaining a clean environment.
Decontamination of the service user’s environment and equipment is an
important part of reducing the spread of infection. Some infectious
organisms can survive for long periods of time in dust or dried organic
matter. The environment therefore should be clear of any spillages of
body fluids, dust and fluff, and moist damp reservoirs i.e. damp cloths,
nailbrushes etc. Cleaning is a process that uses water and detergent to
remove visible contamination, however it does not necessarily destroy
micro-organisms. Good cleaning should remove all contaminants including
dust, soil, faeces, blood pus, urine, other body fluids and large numbers of
micro-organisms. Good cleaning is a prerequisite to disinfection and
sterilisation. In a community setting sterilisation is not often required; it
is effective cleaning and disinfection that is deemed necessary.
Generally detergent and water is suitable for most environmental
cleaning, detergents classed as “anionic” and “non-ionic” have the best
detergent activity i.e. a good quality washing-up liquid.
Chlorine-releasing agents i.e. Domestos, Milton, and Presept are best
used for disinfecting blood or other body fluids from the environment or
equipment. It is important to remember when using Chlorine-releasing
agents to check the dilution strength as the odours from these chemicals
can be an irritant, they may also corrode some fabrics or metals.
Detergents and disinfectants should not be diluted together, they are
not compatible, and it is possible by doing this to inactivate both
products.
Toys and Play equipment.
Where toys are frequently shared amongst people they can become a
source of infection. They can become contaminated with micro-organisms
from unwashed hands, body fluids or by people putting their mouth to
them. Although many micro-organisms will not grow in the absence of
water, some can survive on the surface of a toy in sufficient numbers to
present a risk of infection.
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Recommended cleaning procedures.
Equipment
Routine
Method
cleaning Acceptable
alternative if
required
Waste bins and Only use bins that If
the
bin
other containers have lids. Use contains
for waste.
appropriate size difficult stains
liner bags. It is or
organic
necessary
to matter, it may
empty or remove be
necessary
these bags on a to
use
a
daily basis. Bins chlorineshould be washed releasing
once a week using agent.
detergent.
Carpets
Vacuum
For
daily.
contamination
Steam
spills,
clean
clean periodically with detergent
and
disinfectant
(Not together)
some
disinfectants
will
damage
carpets.
Fridge’s
The inside of the The
freezer
and Freezers
fridge should be should
be
cleaned
with defrosted
as
detergent once a required. And
week,
any
spillages
And as required. cleaned
with
The
outside detergent.
surface of the
fridge should be
wiped down as
stains are noted.
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Additional
information
The wall surface
behind the bin
should
Be
cleaned
regularly
using
detergent or a
chlorinereleasing agent.
Ensure
vacuum
filters
are
changed
frequently.
Drains
Clean regularly
Chemical
disinfection is
not advised.
Equipment
surfaces,
including lamps.
Damp dust with
freshly prepared
detergent solution
and dry.
Disinfection
of
floors
is
not
required routinely.
Wash daily with
freshly prepared
detergent
solution.
It
is
advisable to rinse
with water once a
week to remove
detergent
residue. This is
good practice as it
prevents
people
slipping when the
floors get wet.
Clean and wipe
with alcohol to
disinfect.
Damp dust with
freshly prepared
detergent solution
daily.
For
known
contaminated
surfaces, clean
and then use a
chlorine based
solution
Floors,
Wet cleaning
Furniture
and fittings.
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For
known
contaminated
surfaces, use a
chlorine-based
solution.
Mattresses
Wash with freshly
prepared
*************** detergent solution
Frequent use of daily. It is equally
disinfectants
important to dry
will
mattresses
damage covers
thoroughly before
************** putting them back
on beds.
For
known
contamination
with blood or
faeces,
clean
and then use a
chlorine-based
solution.
When
washing
mattresses,
observe for any
rips, tears, snags
or
any other
signs of “wear
and tear” If you
do notice any
faults,
Please
inform the Head
of Unit.
Mops.
Wash and rinse Disinfect
by
after each use, boiling or soak
wring and store clean
in
a
dry.
chlorine based
product for 30
minutes, rinse
and store dry.
Mops
should
never be left to
soak overnight.
Fluid will become
a growing medium
for bacteria.
Toilet seats.
Clean
with
a
freshly prepared
detergent
and
water solution and
dry.
Toilets
Wash inside of
toilet with toilet
brush
and
detergent.
This prevents the
build
up
of
limescale
and grime.
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If
grossly Clean toilet areas
contaminated
at least twice a
with
organic day.
matter, use a
chlorine-based
solution. Rinse
and dry.
It
is
necessary
chlorinereleasing
into the
contained
pan.
not
to put
agents
water
in the
Toilet areas.
Clean as required.
Lower
wall with detergent or
surfaces.
a
proprietary
cleaner such as
“CIF”
Washbasins and Clean at least
sinks.
once daily using a
Proprietary
cleaner i.e. CIF to
remove
stains.
Disinfection is not
normally
necessary.
Kitchen
appliances used
on a daily basis.
E.g.
liquidiser,
health
grills
Juice-makers
etc
These appliances
must be cleaned
after each use.
The
appliances
should be cleaned
with hot water
and
detergent.
They must be
dried and stored
correctly.
Microwave
ovens.
All spillages must
be
wiped
up
immediately.
If
the
microwave
rotating plate is
removable
–
remove and clean
in hot water and
detergent.
Actively dry and
replace
in
microwave.
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If
grossly
contaminated
with
organic
matter,
a
chlorinereleasing agent
may be used.
Clean and then
disinfect
if
contaminated.
Cleaning recommendations for toys.
Toys
Clean
with
freshly prepared
detergent
and hot water
solution. Ensure
that toys are
dry
before
storage. Machine
wash soft toys.
Clean toys on a
regular basis and
more frequently
during a period
of Infection.
It
may
be
necessary
to
disinfect
contaminated
toys with alcohol
wipes
or
chlorine-based
products.
All toys should
be
wipeable.
Soft toys are
not
recommended.
Points to remember.
 Ensure that toys can be cleaned.
 Check toys regularly for breaks or cracks, discard any damaged toys.
 Remove dust regularly-dust is primarily dead skin cells
 Clean and disinfect toys during an outbreak of infection or illness.
 Immediately clean and disinfect toys that are contaminated with body
fluids (e.g. blood, nasal and eye discharge. saliva, urine and faeces.)
 If soft toys cannot be laundered, they should not be there. They
should be destroyed or discarded.
 Store clean toys in a clean container or clean cupboard.
 Always wash your hands after handling contaminated toys.
 Don’t allow shared toys to be taken to the toilet area.
 Don’t put toys back into storage if they are dirty.
Management of exposure to blood or body fluids.
All healthcare workers working in the community need to know the
correct procedure for the management of inoculation injury, or any other
exposure to blood or body fluids. Staff and service users who are likely
to be exposed to blood need to be protected with vaccination against
Hepatitis B. In addition to vaccination all healthcare staff in the
community needs to understand the principles of infection control or
standard precautions and how to apply these standards to their work
place.
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Immediate action following an inoculation accident/needle stick injury.
IMMEDIATE ACTION
STOP WHAT YOU ARE DOING AND
AND ATTEND THE INJURY
Encourage bleeding of the wound
By applying gentle pressure
Do not suck
Dry and apply a waterproof dressing, as necessary
Report the incident to manager or on-call
Complete accident form
Initiate investigation as to the cause of the incident.
If injury from clean/unused needle-No further action is likely.
If injury is from a used needle, KARE will carry out appropriate follow up
procedures.
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Hand Washing
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Advice on HANDWASHING
Why should I wash my hands?
Hands may look clean but invisible micro-organisms are always present,
some harmful, some not. Removal of micro-organisms is the most
important factor in preventing them from being transferred to other
people.
Hand washing is the simplest and easiest way of preventing the
spread of infection and disease.
When do I wash my hands?
For example:
 Before preparing food
 Before meal times
 After visiting the toilet or changing nappies
 Whenever hands are visibly dirty
General hand care
 Keep nails short, to prevent bacteria growing under your nails.
 Dry hands well to prevent chapping.
 Protect hands with hand cream.
How do I wash my hands?
In the hospital setting, wash hands using soap under running water at a
sink, and dry thoroughly using a clean disposable paper towel.
The following six steps describe the best way to effectively wash your
hands.
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Hand washing Technique:
The following technique is recommended and need only take 20 seconds.
1
2
3
Palm to palm
Right palm over
left dorsum, and
vice versa
Palm to palm, fingers
interlaced
4
5
6
Back of fingers
to opposing
palms with
fingers
interlaced
Rotational
rubbing of right
thumb clasped
over left palm,
and vice versa
Rotational rubbing
backwards and
forwards with fingers
of right hand in palm
of left, and vice versa
Thorough rinsing under running water is an important part of the
procedure. Finally, dry the hands thoroughly using one paper towel for
each hand - this also helps to prevent soreness.
It is important to pay particular attention to the following areas, which
have been shown to be those most commonly missed following hand
washing.
Most frequently
missed
Less frequently
missed
Not missed
Remember,
Good hand washing can prevent the spread of infection.
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Guidelines for Glove usage
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Guidelines for glove usage.
Reasons for wearing gloves.
Expert opinion agrees that they are two main reasons for wearing gloves
1. To protect the hands from contamination with organic matter and
micro-organisms.
2. To reduce the transmission of micro-organisms to both Service
Users and staff.
Types of gloves.
Disposable gloves are manufactured in a variety of materials and have to
conform to various national and international standards. They include
 Natural Rubber Latex. (NRL)
 Combination NRL with hydrogel lining.
 Neoprene (Polychloprene)
 Vinyl
 Polythene

General principles of glove wearing.





Gloves should not be worn unnecessarily as their prolonged and
indiscriminate use may cause adverse reactions and skin sensitivity.
Gloves should only be worn as single use items. They must be
discarded after each care activity for which they were worn in
order to prevent the transmission of micro-organisms to other
sites in that individual or to other Service Users.
Hands should be washed following the removal of gloves.
Powdered vinyl or latex gloves should not be used.
When using chemicals double gloves should be worn, unless wearing
“Marigolds”
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Infection Control Issues Regarding Staff
Health
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Introduction
Staff has the responsibility of ensuring they do not transmit infection to
others. In addition, staff with Service Users contact have the
responsibility of reporting any serious condition they have that may pose
a risk to other staff and Service Users.
These conditions include the following:
If a member of staff develops diarrhoea
Diarrhoea and vomiting
Sore Throats.
Infectious Lesions
Varicella Zoster Virus (VZV)
Mumps
Head lice
and/or vomiting they must inform their
manager immediately, who together will
make a decision on whether there is a
need for the individual to go home. If
symptoms persist for more than a few
hours the cause is likely to be viral and
the individual should remain away from
work for 24 hours after the last
symptoms have stopped.
If symptoms persist they should visit
their GP.
Severe sore throats accompanied by a
fever may be due to a Group A
streptococcus. The individual should have
a throat swab taken by their GP.
Antibiotics should be prescribed by a
GP.
Staff should not work with infected
cuts, boils or other infected skin lesions
particularly on the hands or face. If
allowed by the senior physician all cuts
must be covered with a waterproof
plaster.
VZV can manifest as either chickenpox
or shingles. Members of staff who have
had chickenpox are in no danger of
contracting or spreading the virus again.
However staff or Service Users who
have not had had the virus and are
exposed to chickenpox or shingles may
develop chickenpox. For this reason
staff that has not had chickenpox should
be excluded from caring for Service
Users with shingles or chickenpox.
Mumps is spread by droplet infection and
by direct contact with the saliva of an
infected person. Staff who are not
immune and who have been in direct
contact with an infected person should
seek advice from their own G.P.
Any member of staff who has head lice
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Scabies
should commence the appropriate
treatment. Once treatment has been
applied the staff member can continue
working as normal. The initial treatment
should be repeated 7 day after the first
treatment.
Any member of staff who believes that
they have a scabies infestation should
see their GP to confirm this and
commence the appropriate treatment.
Staff may return to work 24 hours
after treatment. The initial therapy
should be repeated 4-7 days after the
first treatment.
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Prevention of Catheter Associated
Urinary Tract Infection.
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Prevention of Catheter Associated Urinary Tract Infection.
Background.
The major complication associated with catheterisation is urinary tract
infection. The risk of infection is increased as the catheter is a foreign
body and interferes with the normal process of urine excretion and the
mechanical flushing effect. Furthermore the catheter represents a
means of access to the bladder for the perineal flow. The decision to
catheterise therefore should only be taken after the implications and
risks of the procedure have been carefully considered and should only be
left in place for the minimum period passed.
Bacteria Entry Points.
The risk of acquiring urinary tract infection depends on the method and
duration of catheterising, the quality of the catheter care and the
susceptibility of the host. Although not all catheter associated urinary
tract infections can be prevented, it is believed that the proper
management of the indwelling catheter could avoid a significant
percentage of infections.
The following bacterial entry points have been identified in people who
have an indwelling catheter:






The catheter tip during insertion
The junction between the catheter and the drainage tubing.
The sleeve used to aspirate urine.
Punctures in the bag itself
The outlet of the drainage bag
The meatus.
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General precautions for minimising infection.
The main precautions for reducing catheter-associated infection include:




Strict adherence to aseptic technique when inserting or manipulating
the catheter.
Hand washing before and after touching any component of the
catheter
Use of gloves
Maintenance of the closed system of bladder drainage.
Specific Preventative Measures.
3.1 Catheter Insertion.






Use an aseptic technique and sterile equipment for catheter insertion.
Use a ‘single use’ packet of lubricant jelly or a ‘single use’ packet of
‘Instagel’ for lubricating the catheter.
Cleanse the meatus well using aqueous hibitane e.g. Hibidil.
Use as small a catheter as possible, consistent with good drainage e.g.
sizes 12-14 catheter for females and 14-16 for males.
The catheter balloons are of two standard sizes 10ml and 30ml. Under
normal circumstances the smaller balloon should be used. Use sterile
water to inflate the balloon.
Secure catheter after insertion to prevent movement and urethral
traction except where otherwise stated.
3.2 Maintaining Urinary Flow.




Avoid kinking of catheter and tubing and ensure unobstructed urine
flow.
Poorly functioning or obstructed catheters should be irrigated or if
necessary replaced.
Drainage bags should always be kept below the level of the bladder.
Empty bag regularly using a separate decontaminated jug or container
for each Service Users.
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3.3 Ensuring Closed Sterile Drainage.



A sterile continuously closed drainage system should be maintained.
The catheter and drainage tube should not be disconnected unless the
catheter must be irrigated.
The greatest risk of contamination occurs when changing the catheter
bag.
3.4 Change of Bag.



Whenever the catheter is changed.
If the catheter leaks or becomes contaminated.
When the bag becomes smelly or if there is an accumulation of
sediment in the bag.
3.5 Meatal Care.
 Daily meatal care with soap and water.
3.6 Specimen Collection.




Wear gloves
Swab the sampling port with an alcohol swab.
Aspirate urine with needle and syringe
Larger volumes of urine for special analyses should be obtained
aseptically from the bag.
3.7 Emptying the Drainage bag.




Hands should be washed and non-sterile gloves worn before emptying
each bag.
Use a separate decontaminated jug or container for each Service
Users.
Ensure the outer valve does not come into contact with the jug.
When the bag is empty, the tap should be closed securely. The
container into which the urine is emptied should be washed in hot
water and detergent, dried and stored dry
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Infection Control Issues Regarding Last
Rites
28
Infection control issues regarding the Last Rites.
Dignity and respect should be maintained at all times. These are
suggested guidelines for staff unfamiliar in preparing a person for the
Last Rites.

Standard precautions apply in the care of the diseased.

Wash hands and put on protective clothing i.e. gloves and apron.

Collect and prepare equipment.

Remove all upper bed linen and place in laundry bag.

Remove all tubes and drains (unless otherwise instructed). Redress
all wounds with a waterproof dressing.

Wash the Service User.

Put on a suitable incontinence pad and secure properly.

Ensure that any equipment used is decontaminated appropriately.

Following the removal of the deceased Service User the area is
ready for terminal cleaning.
29
Management of Enteral Feeding.
30
Enteral Feeding
Definitions and abbreviations

Enteral feeding: Feeding via a tube that can include any method of
providing nutrition via the gastrointestinal tract.

Routes of Enteral Feeding
Naso-gastric feeding - Delivers food directly into the stomach. This is
the most common route for short term feeding.
Percutaneous Endoscopic Gastrostomy (PEG) feeding - Feed is
delivered directly into the stomach via a feeding tube, which is
inserted through an opening (stoma) in the abdominal wall. This is the
preferred route for long term feeding.
Jejunostomy tube – This is a surgically placed tube through the
abdominal wall directly into the jejunum.
Buried bumper syndrome – A complication of PEG tubes where the
internal disc becomes buried in the stomach lining.
Hang time – The total time during which the feed is held in the
nutrient container at room temperature while being administered. This
includes periods of time when administration of the feed is
interrupted temporarily.
No touch technique – Avoiding direct contact of the hands with feed
ingredients.
Single use – For use on one occasion only.
Feed Preparation:
There are three types of enteral feed presentations:
1. Ready to use sterile feeds requiring the attachment of a giving
set.
31
2. Decanted sterile feeds where the feed is transferred into a
reservoir such as a bag, bottle or syringe.
3. Special or modified feeds:
 A powder feed or products added to sterile or non-sterile
liquid
 A non-sterile liquid product added to a sterile or nonsterile liquid.
Preparation and Storage of feeds.
 Wherever possible pre-packaged, ready to use feeds should be
used in preference to feeds requiring decanting, reconstitution
or dilution.
 The system selected should require minimum handling to
assemble, and be compatible with the Service User’s enteral
feeding tube.
 Prior to use feeds should be stored in a clean dry environment
according to the manufacturers instructions. The temperature
in the storage area should not drop below 8 Celsius or rise
above 25 Celsius. Stock should be rotated to ensure that older
stock is used first.
 Prior to use, check the feeds expiry date and look for signs of
damage to the container. Never use feeds that have expired or
are in damaged containers.
 Do not add any water, medication or other substances directly
to the feed unless prescribed for this purpose.
 Hand washing with soap and drying with disposable paper towel
must be carried out before starting feed preparation.
 When decanting, reconstituting or diluting feeds, a clean
working area should be prepared and equipment dedicated for
enteral feed use only should be used.
 Where ready-to-use feeds are not available, feeds may be
prepared in advance, stored in a fridge, and used within 24
hours.
Administration of feeds
 Administration sets and feed containers are for single use only, and
must be discarded after each feeding session. Maximum of 24
hours.
 Ready-to-use feeds can be given for a whole administration session,
up to a maximum of 12 hours.
32









Reconstituted feeds should be administered over a maximum 4
hour period.
Select a system that minimises the risk of contamination, use the
minimum number of connections and use giving sets with recessed
spikes.
Prior to preparing/setting up a feed, hands must be washed and
dried thoroughly, or alcohol gel may be used on visibly clean hands.
Wear gloves if in contact with body fluids and if a Service Users
poses a risk of infection.
Use a mediswab to clean the top of bottles and cans.
Connect the feed container to the administration set using a nontouch technique. This involves ensuring that no part of the
equipment, which comes into contact with the feed, be allowed to
touch the hands, skin or clothing.
Minimal handling and an aseptic no-touch technique should be used
to connect the administration set to the enteral feeding tubes.
Avoid contact with the Service Users clothes and skin when
administration set to the feeding tube.
The feed container should be clearly labelled with the date and the
start time of the feed.
Check for correct tube position.
During administration
 Ideally feeds should not be interrupted once in progress. If it is
necessary to disconnect use a non-touch technique, flush tube and
cap giving set with a sterile cap, or the cap supplied by the
manufacturer with the set. (once the cap from the distal end of
the giving set has been removed from the giving set, it should be
stored in a clean, covered container until required, clean as
manufacturers instructions, discard the cap after 24 hours).
 The time which the feed is disconnected counts as part of the
total hanging time.
 A non-touch technique should be used when reconnecting the giving
set to the enteral tube.
 Avoid unnecessary handling of ports or connections as this
increases the risk of introducing bacteria into the system from
hands or the environment.
After feed administration
 Giving sets should be changed every 24 hours or as per
manufacturer’s instructions.
33

Always flush the enteral tube at the end of a feed using a syringe
in accordance with the manufacturer’s instructions and the
dieticians recommended volume and Service Users fluid balance
status.
Use of water in enteral feeding.
Water is used for a variety of purposes during enteral feeding e.g. for
flushing the tube, reconstituting powder fed, administrating medication
or hydration.
Sterile water is recommended for:
 Reconstituting or diluting feeds for ALL Service Users
 Continuous water feed (for hydration treatment purposes)
 All infants under 12 months of age.
 All Service Users that are fed via the jejunum (bypasses the
gastric acid secretions.)
 All immuno-compromised Service Users.
Fresh tap water (from an approved drinking water tap) mat be used for:
 Tube flushing and administration of medication of IMMUNOCOMPETENT Service Users.
Cooled freshly boiled tap water may be used instead of sterile water:
 In all community houses
 Where commercially prepared sterile water is not available.
Tube Flushing
(note: any fluid restrictions.)
Flushing the tube is essential to:
 Reduce the risk of microbial colonisation of the surface of the
enteral feeding tube.
 To prevent blockage.
 The tube should be flushed:
__ before and after feeding
__ before and after drug administration
__ when more than one drug is being administered flush with –10mls
of water between each drug.
__ If feed is stopped or interrupted.
34


A 30 ml or larger syringe should be used as the pressure from
smaller syringes may cause the tube to rupture.
30mls of water should be used to flush each time unless the
Service Users is on restricted fluids or is a child.
Enteral feeding administration equipment






Syringes used for aspiration, flushing, administrating
medication and bolus feeding are “single use”. Therefore must
be discarded following one use.
Syringes may be discarded into a sharps container, 50ml
syringes used for feeding may be discarded into household
waste. (provided it is not contaminated)
Feeding pumps and must be cleaned daily with hot water and
detergent.
Bottle openers should be dedicated for use with enteral feeding
products only. Prior to use wipe with a mediswab and allow to
dry. After use wash in the dishwasher or wash with hot water
and detergent, dry with a paper towel and store covered in a
clean place.
Scissors if required should be sterile.
Utensils required for reconstitution of feeds should be heat
disinfected in a dishwasher.
Long term site care,
 No dressings necessary
 Inspect site daily
 Wash with soapy water and rinse daily, dry thoroughly with a
clean towel.
 Apply a dressing if there is a discharge
 Do not apply antiseptic creams to the site as they might damage
the tube.
Change of PEG tube
 Usually following 1-2 years or as manufacturers instructions.
Feed storage and hanging times.
Feed type
Maximum
time
Sterile,
ready-to- 24 hours
use feeds if not
decanted.
Hanging Maximum
storage
time in fridge.
Not applicable
35
Sterile
feeds 24 hours
decanted
into
a
sterile
reservoir
using
aseptic
technique
Non-sterile
feeds 4 hours
e.g.
reconstituted
powders,
mixed
feeds
and
breast
milk decanted into a
sterile reservoir
24 hours
24 hours
Possible sources of contamination in an enteral feeding system.
Problem
Possible source
Touch contamination of equipment
1. Lack of or poor hand hygiene
2. Poor non touch technique
3. Excessive manipulation of
system
1. stored in a contaminated
area
2. failure to refrigerate where
appropriate.
3. opened feeds kept too long
1. prolonged use or re-use of
administration sets syringes
and connectors
Inappropriate storage of feed
Misuse of equipment
Poorly designed equipment
1. Multiple exposed parts prone
to touch contamination
during assembly/use
1. Colonisation or infection of
the PEG site.
1. Failure to adequately
decontaminate hands and/or
equipment
1. Use of non-sterile
ingredients
2. Reconstitution of powdered
feeds
3. Decanting
Site problems
Cross infection
Contaminated feed
36
4. Handling
5. Damage to container during
transportation.
1. Medications or flush
solutions
2. Addition of supplements.
Contaminated additive
37
Disease Specific Information
38
Campylobacter
What is Campylobacter?
It is a bacterium - a germ -, which is present in many foods and can cause:




Diarrhoea
Vomiting (especially in children)
Stomach pains and cramps
High temperature
How is Campylobacter caught?

Usually from raw and undercooked food. Campylobacter is found in
raw meat (particularly poultry), unpasteurised and contaminated milk
and contaminated water.

Also through contact with infected pets and animals.

Occasionally person to person spread – but this is uncommon
Who can it affect?
ANYONE - But the very young and the elderly are particularly vulnerable.
The diarrhoea usually lasts for about 7 days, but symptoms can persist
for longer
Do you need to stay off work or school?
YES - Until you have been free from any symptoms for 48 hours
Children should not play with other children or attend school or nursery
until they are fully recovered and have been symptom free for 48 hours.
39
How do you prevent it?

By thoroughly cooking all foods especially meat - Campylobacter is
destroyed by cooking.

Avoid contaminating cooked food by allowing contact with raw food or
dirty knives and chopping boards etc. Keep cooked and raw food
separate.

Ensure your fridge and freezer are operating at the correct
temperatures (between 1-4°C and minus 18°C respectively).

Only drink pasteurised milk

Always wash hands thoroughly with soap and warm water:  After going to the toilet;
 After contact with pets and animals;
 After changing a baby’s nappy
 Before preparing and serving food;
 After handling raw food;
 Before eating food.

Always ensure you practice good food hygiene procedures.
How do you stop the spread of Campylobacter?
If you or a member of your household has Campylobacter:

Clean the following after use with detergent and hot water, followed
by a suitable disinfectant.
40




Toilet seat
Toilet bowl
Flush handles
Taps and wash hand basin

If you use a disinfectant ensure it is stored safely out of the reach
of children.

Ensure all household members wash their hands thoroughly with warm
water and soap after going to the toilet and after contact with
excreta, soiled clothes and bedding and pets.

Use a separate towel.

Wash soiled clothes, bedding and towels on a “hot cycle” of the
washing machine.
41
Cytomegalovirus (CMV)
What is Cytomegalovirus?
It is a type of virus (germ), which can cause infection. It can cause a
glandular fever like illness and infection in many parts of the body such
as:

The eye

The liver

The gastrointestinal system

The nervous system
Who can it affect?
ANYONE - It is a very common virus - in fact between 60% and 90% of
adults have been in contact with cytomegalovirus and have immunity to it.
Usually it causes a person no problems or just a mild fever type illness,
but it can cause problems and more serious infections in vulnerable groups
of people such as:

Pregnant women

New born and premature babies

People with a weakened immune system
Is Cytomegalovirus important?
42
It is for the vulnerable groups as it can be a cause of serious infection.
It may also cause harm to a developing baby in its mother’s womb - called
congenital cytomegalovirus disease - if the mother gets her first
cytomegalovirus infection during her pregnancy, but only a minority of
these infections have any adverse effects upon mother or the unborn
baby.
How is it spread?
Cytomegalovirus can be passed from a mother to her baby:



In the mother’s womb
During the birth
By breast milk
It is also spread by intimate contact and poor personal hygiene, between
family members and close contacts.
It is also passed on from person to person by:


Sexual transmission
Intimate “wet” kissing
How do you prevent it?

By adopting good hygiene practices and always washing hands
thoroughly with hot water and soap:






Before eating food
Before preparing and serving food
After changing a baby’s nappy
After hands have been contaminated with any body fluid
After going to the toilet
By always promptly & thoroughly cleaning surfaces contaminated by
body fluids listed below, with household cleansing agents and wearing
disposable gloves if possible.





Urine
Saliva
Blood
Stool/faeces
Semen
43

By being aware of the risks especially if you are in one of the
vulnerable groups and taking extra care with hygiene practices,
cleaning practices and by adopting safer sexual practices – for
example – using condoms.
44
Conjunctivitis
What is Conjunctivitis?
It is inflammation of the conjunctiva or the lining of the eyelid causing:





Swollen eyelids - sometimes causing the eye to almost fully close;
Pink/red eyes;
Sore, itchy and sometimes painful eyes;
A discharge causing the eye to be sticky and crusty;
Sometimes the sticky discharge may cause the eyelids to stick
together after sleeping.
What causes Conjunctivitis?
It can be caused by a number of things including infection, allergy or
foreign bodies (e.g. piece of grit).
Infective Conjunctivitis
 Can occur in isolation or be part of another illness such as measles.
 Bacteria or viruses can cause infective Conjunctivitis.
 Bacterial Conjunctivitis will require antibiotic eye drops and/or
ointment from the GP.
 Viral conjunctivitis is not helped by antibiotics and will clear up on its
own, taking between 5-14 days.
 Sometimes it will not be clear whether the infection is bacterial or
viral, so the GP may take eye swabs, which will be sent to the
laboratory for testing.
Allergic Conjunctivitis
 Allergic conditions such as hay fever can cause Conjunctivitis.
 Allergies to eye make-up can cause Conjunctivitis.
45
Foreign bodies
 Foreign bodies such as a piece of grit can cause Conjunctivitis;
 Conjunctivitis of only one eye may well indicate the presence of a
“foreign body”.
Who can it affect?
ANYONE can get Conjunctivitis.
How do you prevent spread?
The spread of infective Conjunctivitis is not uncommon in families, so it is
important to adopt good hygiene practices to prevent spread of the
infection.
 Complete the course of any drops and/or ointment prescribed by the
GP and only use on the person it/they are prescribed for.
 Do not share towels or flannels etc.
 Try not to touch or scratch the infected eye/eyes and wash hands
thoroughly if you do.
 Some viral Conjunctivitis is spread by the air-borne route and is more
difficult to control.
Do you need to stay off work/school?
NOT USUALLY - if the person is feeling well, but sometimes the
discomfort of Conjunctivitis can make the affected person feel generally
unwell and “miserable”. Young children especially may suffer more than
adults, so should be kept off school until they feel better.
Occasionally there may be a number of cases in one nursery or school. In
these circumstances, parents may be requested to keep their children
away from school until the infection has cleared, but this is not usually
required.
46
Chickenpox
What is chickenpox?
Chickenpox is an infection caused by a virus (germ) called the Varicella
Zoster Virus, and causes:

A rash with blister-like spots, which contain fluid. They are usually
worse on the trunk and face, but can affect the scalp, hands, feet,
eyes and mouth

Fever
in adults, usually mild in children

Headache
in adults

Muscle aches
in adults
Who does it affect?
Usually children - especially young children under 10 years of age.
Adults and older children can be affected, but over 90% of people will
have acquired natural immunity by the time they are young adults.
Immunity is usually life-long so it is rare to get a second attack of
chickenpox.
The virus remains dormant in the body so it is possible to get an illness
called SHINGLES later in life, especially if your immune system is
weakened by illness or medical treatments such as high dose steroids or
chemotherapy. You cannot develop shingles from your contact with
someone who has chickenpox.
Can it be passed on?
YES – chickenpox is highly infectious and is easily passed on to someone
who does not have natural immunity.
47
The virus is passed in:

The secretions of the nose and throat

The liquid from the blister-like spots of the rash

Items recently contaminated by both of these secretions, for example
hankies, towels and bed linen.
Should you stay off work or school?
YES – chickenpox is infectious for 1-2 days before symptoms develop and
for 5-7 days after the first crop of spots appeared.
The crusts/scabs from the dried spots are not infectious.
Do you need any treatment?
Treatment is rarely required for chickenpox, but the infection usually
affects adults more severely.
Occasionally anti-viral treatment may be needed for those people most
severely affected.
The rash may be itchy so the use of calamine lotion or anti-histamines
may help this. Also, the rash is less likely to cause irritation if the skin is
kept cool.
Sometimes the rash may get infected (usually from scratching). If this
happens then the doctor will prescribe some antibiotics to treat this
secondary infection.
Also, the rash may be painful so the use of pain-killers (analgesics) may
be needed, but do not use aspirin in children.
48
Are there any special risks?
YES – in certain people chickenpox can be more severe. This includes
people whose immune systems are impaired by illness, medication or
medical treatment.
Some adults may develop a chest infection from chickenpox (particularly
smokers and pregnant women) so inform your doctor immediately if this
happens.
Also, chickenpox can affect the developing baby of a pregnant woman
(especially during the early and very late stages) if she does not have
natural immunity. This is rare, but if you are pregnant and you have been
in contact with chickenpox always discuss this with your doctor (GP)
immediately so that he/she can advise you if you need any blood tests or
treatments.
REMEMBER – over 90% of people will have natural immunity by the time
they become young adults, whether they know it or not.
Vaccination for chickenpox is only available for those people who are most
at risk. This includes those with a severely weakened immune system,
especially children with Leukaemia or who have had organ transplants.
Currently vaccine is not available for general use.
49
Cryptosporidiosis
What is Cryptosporidiosis?
Cryptosporidiosis is a germ, which causes infection of the bowel. The
illness usually starts between 1 and 12 days after becoming infected.
The symptoms are diarrhoea, stomach pains and fever, often lasting
around 10 days. However, the illness can be more severe and prolonged
in people with impaired immune systems.
How is Cryptosporidiosis caught?
The organism that causes Cryptosporidiosis is found in the gut of many
animals, including domestic and farm animals, poultry, fish and reptiles
and is present in their faeces/stool. Cryptosporidiosis can be caught
from:
 Contact with another person who already has Cryptosporidiosis
infection
 Direct contact with infected animals
 Travelling abroad in countries whose water supply may not be of such
good quality as Irelands
 Water contaminated by animal faeces or “slurry”
Hygiene Advice
Hand washing is particularly important after contact with animals, after
using the toilet and before eating. Only drink water from safe sources. If
it is suspected that water is contaminated with Cryptosporidiosis, it
should be boiled before drinking.
Returning to Work, School or Day unit
50
Generally people should not return until free from diarrhoea or vomiting
for 48 hours. High-risk groups include food handlers, certain staff in
health care facilities, children under five years of age, and people who
have difficulty maintaining personal hygiene. The Environmental Health
Officer will advise in particular circumstances.
Ten Tips for Food Safety
TAKE CHILLED AND FROZEN FOOD HOME QUICKLY – then put in
the fridge or freezer at once.
PREPARE AND STORE RAW AND COOKED FOOD SEPARATELY – keep
raw meat, fish and poultry in the bottom of your fridge and away from
salads.
COOK FOOD THOROUGHLY – follow instructions on the pack.
reheat food make sure it is piping hot.
If you
KEEP HOT FOODS HOT AND COLD FOODS COLD – don’t just leave
them standing around at room temperature.
KEEP YOUR FRIDGE AT 0 - 5C – get a fridge thermometer.
CHECK ‘USE BY’ DATES – use food within the recommended period.
KEEP PETS AWAY FROM FOOD – and dishes and worktops.
WASH HANDS THOROUGHLY - before preparing food, after going to
the toilet or after handling pets.
KEEP YOUR KITCHEN CLEAN – wash worktops and utensils between
handling raw and cooked foods.
51
DO NOT EAT RAW OR UNDERCOOKED EGG – keep eggs in the fridge.
How do you stop the spread of Cryptosporidiosis?
If you, or a member of your household has Cryptosporidiosis:

Clean the following after use with detergent and water & disinfectant:
-
Toilet seat
Toilet bowl
Flush handles
Taps and wash hand basins

If you use a disinfectant, ensure it is stored safely out of the reach
of children.

Ensure all household members wash their hands thoroughly with hot
water and soap after going to the toilet and after contact with
excreta or soiled clothes and bedding.

Use a separate towel

Wash soiled clothes, bedding and towels on a “hot cycle” of the
washing machine.
52
Dysentery
(Shigella)
What is Dysentery?
Dysentery is an infectious illness caused by a germ called shigella. It
causes diarrhoea, fever, stomach ache, and sometimes vomiting. The
illness may last for only a day or continue for one or two weeks.
How do you catch it?
Most people catch it by eating shigella germs, which have been passed by
someone who is ill with dysentery. It is often passed on unwashed hands.
Very rarely it can be spread by food or water.
How can I avoid it?
By scrupulous attention to hygiene. Always wash and dry your hands
after using the toilet. The person who used it before you may have left
dysentery (or other) germs on the seat, door handle or taps.
What is the treatment?
If you have diarrhoea then drink plenty of fluids. Antibiotics are not
usually helpful in dysentery, although if you are extremely poorly your
doctor may prescribe them.
Is there anything else I should do while I am ill?
 Stay away from other people until your diarrhoea has stopped,
especially vulnerable people like the elderly and very young children
 Avoid preparing and serving food for other people if you can.
 Make sure you have a separate towel to other people in your home.
53
 Clean toilet seats, flush handles, door handles and taps frequently with
hot soapy water. You do not need to use disinfectants, but if you want
to then follow the manufacturers’ instructions, store them carefully keep them away from children.
 Soiled clothes should be laundered on as hot a wash as possible. Do
not overfill your washing machine or it will not clean them properly.
Keep soiled washing separate from the rest of the washing.
When can I go back to work/school?
You should stay away from work or school at least until your
diarrhoea has stopped for 48 hours. The Department of Public Health
may tell you to say off longer or may ask for further faeces specimens.
You must always follow their advice.
Remember to wash you hands well with soap and water
 After using or cleaning the toilet
 After changing nappies
 Before preparing food or drink
 Before eating or drinking
 After washing soiled bedding or clothes
 After clearing up after pets
 After gardening
 After any cleaning
 Before leaving the house
After attending to another person who has diarrhoea and/or vomiting
54
E-coli O157
What is E coli ?
E-coli are bacteria, which live in the gut of humans and animals.
Usually they cause no harm but some strains can cause diarrhoea, which
usually only lasts for a few days. Many cases of travellers’ diarrhoea are
caused by E-coli.
A few strains of E-coli can produce toxins (poisons) that lead to more
serious illness and complications in other parts of the body.
What is E-coli O157 and where does it come from?
The main source of E-coli O157 is cattle, and the bacteria can spread to
humans via contaminated meat, and less frequently, dairy products.
This strain of E coli can cause diarrhoea ranging from mild diarrhoea of
short duration to severe bloody diarrhoea with fever, abdominal pain and
lack of energy.
Severe complications can include anaemia and kidney problems.
Who can it affect?
ANYONE - but the very young and the elderly are most vulnerable.
What is the incubation period & how long will I be infectious?
The incubation period (the period after exposure to the infection but
before a person displays symptoms) ranges from 1 – 9 days.
55
The infectious period (the period when the infection can be passed from
person to person) for E-coli O157 is not clear, but it is known to be longer
in young children (at least 3 weeks).
How do you prevent it?

By thoroughly cooking all foods, especially red meat – E-coli 0157 is
destroyed by cooking.

Avoid contaminating cooked foods by allowing contact with raw meat
or dirty knives and chopping boards.

Only drink pasteurised milk and dairy products made with pasteurised
milk.
Do you need to stay off work or school?
YES - until you have been free from any symptoms for 48 hours.
Children should not play with other children or attend school until they
are fully recovered and have been symptom free for 48 hours.
Young children (pre-school and infants), and people in certain high-risk
occupations such as food-handlers and health care workers, should not
return until they have been given clearance to do so by the Environmental
Health Officer. The Environmental Health Officer may require the
affected child/person to provide specimens to ensure that the infection
has completely cleared.
What else should I do while I am ill?

Hand washing is extremely important not only for the person with Ecoli 0157 but also for everyone in the household.

Hands must be washed after using the toilet and before handling food.

Young children should be supervised when washing hands, or have their
hands washed for them.

Each person affected should have his or her own towel.

Ensure crockery and cutlery are washed in hot soapy water.
56

Keep kitchen surfaces clean at all times and especially when preparing
foods.

Clean toilet seats, flush handles, door handles and taps every day with
hot soapy water, and also when they are visibly soiled.

Use your usual toilet cleaner and brush to clean the pan.

When there is accidental soiling of clothes, wash them on a hot wash
cycle.
NB: If you are using a disinfectant, ensure that it conforms to a
European Standard and follow the manufacturer’s recommendations.
Keep all chemical cleaning agents away from children.
57
Food Poisoning
What is Food Poisoning?
Food poisoning is an illness that occurs after eating or drinking anything
that is contaminated. Usually it is germs on the food that cause illness,
but sometimes it can be chemicals. The symptoms depend on the kind of
germ or chemical, but diarrhoea, sickness, stomach pains and sometimes
fever are most common. Illness may last for only a day or continue for
one or two weeks.
How can I tell if food is contaminated?
You can’t!
Even food, which looks and tastes good, can cause food poisoning.
What can I do to avoid it?
Most raw meats and poultry contain germs, which can cause food
poisoning.
Do not let these germs get on to other foods: 
Always wash hands before preparing or serving food.

Store raw and cooked foods apart. Raw meats should be kept at the
bottom of the fridge so they do not drip blood or juices onto other
foods.

Use separate utensils and chopping boards for raw and cooked foods.

Wash your hands after handling raw foods.

Do not smoke or eat when handling food.
Kill the germs before you eat the food
58

Thaw all frozen poultry and joints of meat completely, preferably in
the fridge before cooking.

Cook food thoroughly. Be especially wary of undercooked poultry.

If you want to keep food for later, cool it quickly and put it in the
fridge as soon as possible or keep it hot in the oven.
If food is
stored at the right temperature germs cannot multiply.
Having a party?

Follow all the advice given in this sheet

Do not prepare food too far in advance. Keep hot food hot (i.e. 65C)
and cold food refrigerated until it is served.

Keep the menu simple. The more dishes you prepare, the more likely
things are to go wrong.

If you are giving food to a large number of guests it is best to use
commercial caterers, they have equipment to prepare and store large
amounts of food safely.
Ten Tips for Food Safety
TAKE CHILLED AND FROZEN FOOD HOME QUICKLY – then put in
the fridge or freezer at once.
PREPARE AND STORE RAW AND COOKED FOOD SEPARATELY – keep
raw meat, fish and poultry in the bottom of your fridge and away from
salads.
COOK FOOD THOROUGHLY – follow instructions on the pack.
reheat food make sure it is piping hot.
If you
KEEP HOT FOODS HOT AND COLD FOODS COLD – don’t just leave
them standing around at room temperature.
KEEP YOUR FRIDGE AT 0 - 5C – get a fridge thermometer.
59
CHECK ‘USE BY’ DATES – use food within the recommended period
KEEP PETS AWAY FROM FOOD – and dishes and worktops.
WASH HANDS THOROUGHLY – before preparing food, after going to
the toilet or after handling pets
KEEP YOUR KITCHEN CLEAN – wash worktops and utensils between
handling raw and cooked foods.
DO NOT EAT RAW OR UNDERCOOKED EGG – keep eggs in the fridge.
60
Giardiasis
What is Giardiasis?
Giardiasis is an illness caused by a germ called Giardia. It causes
diarrhoea, which is often very smelly causing cramping stomach ache and
wind. The illness may last for several weeks.
How do you catch it?

From someone else who is ill, especially if hygiene is poor?

From drinking water which contains the germ. This is more likely to
happen abroad, and Giardia is one of the causes of traveller’s
diarrhoea.

From pets and animals that are infected.

The incubation period for Giardia (the period after exposure to the
infection but before a person displays symptoms) is usually 7 – 10
days.
What is the treatment?
If you have diarrhoea then drink plenty of fluids. Giardiasis is one of
the few stomach bugs where antibiotics help. The treatment is usually
with a drug called metronidazole (Flagyl). It is very important that you
do not drink alcohol while you are having this treatment.
Is there anything else I should do while I am ill?

Avoid unnecessary contact with other people until your diarrhoea has
stopped.

Avoid preparing food for other people if you can.

Make sure everyone at home has his or her own personal towel.
61

Clean toilet seats, flush handles, door handles and taps frequently
with hot soapy water. You do not need to use disinfectants, but if you
want to then ensure it conforms to a European Standard and follow
the manufacturer’s instructions carefully, and store them away from
children.

Soiled clothes should be laundered on as hot a wash as possible. Do
not overfill your washing machine or it will not clean them properly.
When can I go back to work/school?
You should stay away from work or school at least until your
diarrhoea has stopped for 48 hours.
Remember to wash your hands well with soap and water

After using or cleaning the toilet

After changing nappies

Before preparing food or drink and before eating

After washing soiled bedding or clothes

After clearing up after pets

After gardening

After any cleaning
62
Glandular Fever
What is Glandular Fever?

Glandular Fever, sometimes known as infectious mononucleosis, is
caused by the Epstein-Barr virus and this virus persists within the
patient for life, even after the illness has resolved.

It is an infectious disease of children, young people, and occasionally
adults.

In children the infection may pass unrecognised or with only a few
days trivial illness with a sore throat, fever, swollen tonsils and glands
in the neck.
In young people the disease is often abrupt in onset with profound
tiredness, aching muscles, fever, very swollen tonsils and enlarged neck
glands. There may be a short or prolonged period (days or weeks) after
the initial illness when the tiredness continues and the patient may feel
dispirited and debilitated.
How is Glandular Fever caught?

This virus is caught by close contact between children or young people.

It is known as the “kissing disease” in that it is very common in
adolescence when it spreads amongst young people of similar ages
when sexual activity first begins.

It can occur in playgroups and crèches where there is close contact
between large groups of young children.

Even if you feel better, the virus may be present in your saliva for up
to 1 year, and 15 – 20% of infected people may become long-term
carriers.
63
How do you diagnose this illness?

The appearance of a sore throat, swollen tonsils and neck glands and
profound debility in an adolescent is very often the first indication of
this illness.

The hospital laboratory can diagnose glandular fever by testing a
blood sample from a patient.

Antibiotic treatment, occasionally given by a general practitioner, in
the belief that the sore throat is a bacterial infection, is associated
with the appearance of a widespread rash. This is characteristic of
glandular fever and is a reason to avoid certain antibiotics during
adolescence.
Is there any treatment?

There is no drug, which is useful in reducing the activity of the
Epstein-Barr virus, which causes this disease.

The best advice for the individual suffering from glandular fever is to
ensure that they have plenty of fluids and enough rest during the
period that they are actually ill.

Stress may extend the period of recovery and for adolescents working
for exams; this may present a real problem.

On rare occasions, a patient may require admission to hospital if the
tonsils become excessively swollen.
64
Head Lice
The Facts about Head Lice









Head Lice are small parasites (about the size of a sesame seed when
fully grown) that live very close to the scalp.
Nits are not the same as lice. Nits are the empty egg cases, which
stick to the hair – they are harmless.
You only have head lice if you find living moving lice (not a nit).
Anybody can get head lice – adults and children.
Head lice do not care if the hair is dirty or clean, short or long.
A lot of infections are caught from close family and friends in the
home and community, not at school.
Head lice can walk from one head to another, if the heads are pressed
together for some time. They do not fly, jump or swim.
Regular hair care may help to spot lice at an early stage.
The best way to stop infection is for families to check their heads
regularly using detection combing.
How to detect head lice
You will need - A Plastic Detector Comb
(These are available from your pharmacist – ask for help if there are none
on display)
1. Wash the hair well and towel until damp, but not dripping.
2. Ensure that there is good lighting – daylight is best.
3. First, comb the hair with an ordinary comb. Then, using the detector
comb, begin at the top of the head and making sure that the comb is
touching the scalp, slowly draw the comb towards the ends of the hair
(applying a small quantity of hair conditioner may assist with this).
4. Check the teeth of the comb carefully.
5. Repeat steps (3) and (4), working your way around the head from the
top of the scalp to the ends of the hair. This should take 10 to 15
minutes.
6.
If there are head lice, you will find one or more on the teeth of the
comb.
65
6. If you find lice, or something which you are unsure about, stick it on
to a piece of paper with clear sticky tape and take it to your GP or
local pharmacist.
The best way to stop Head Lice infection is to do detection combing
regularly.
NEVER use insecticidal liquids or lotions to PREVENT
infection, or just in case.
How to treat head lice
DO NOT TREAT UNLESS YOU ARE SURE YOU HAVE FOUND
A LIVING, MOVING LOUSE.
Ask your GP or pharmacist which head louse lotion or liquid to use.
Do NOT use head louse shampoo.
In a well ventilated room....
1. Apply the lotion or liquid to dry hair.
2. Part the hair near the top of the head, put a few drops of the lotion
or liquid on to the scalp and rub in. Part the hair again a bit further
down the scalp and rub in some more of the lotion or liquid. Do this
again and again until the whole scalp is wet. You don’t need to take the
lotion or liquid any further than where you would put a ponytail band.
Take care not to get the lotion or liquid in the eyes or on the face.
You should use at least one small bottle of lotion or liquid per head,
more if the hair is thick.
3. Let the lotion or liquid dry on the hair naturally. Keep well away from
naked flames, cigarettes or other sources of heat. Do NOT use a hair
dryer.
4. Leave on the hair for 8 - 12 hours or overnight. Then, wash and rinse
hair as normal.
5. Repeat the entire treatment seven days later, using a second bottle of
the same lotion or liquid.
6. Check the head two days after the second application. If you still find
living, moving lice ask your pharmacist or GP for advice.
66
7. If you wish to remove the nits, (the harmless empty egg cases) comb
the hair, while wet, with a metal nit comb.
Contact Tracing
You need to identify where the lice came from or you may become
reinfected. The source is probably a family member or close friend, who
probably does not know they have head lice.
Suggested check list:
Mother _____
Father
_____
Brothers
_____
Sister’s _____ Grandparents _____
Aunts/Uncles _____
Cousin’s _____
Children’s clubs _____
Childminders _____
Playmates
_____
Friends
_____
REMEMBER – it does not matter how many nits you have, or how
itchy your scalp is – if you cannot find a living, moving louse you don’t
have head lice.
The Problem Won’t Go Away?
DID YOU....
... Use enough lotion or liquid?
... Apply it correctly?
... Let it dry naturally?
... Leave it on for the correct amount of time?
... Use a second bottle 7 days after the first?
... Check all your close family and friends?
... Check adults as well as children?
... Treat all infected contacts at the same time?
67
Hepatitis A
What is hepatitis A?
It is a type of virus (germ), which can cause an infection when it is
present in a person’s bowel and can cause:






Nausea and vomiting
Abdominal pain
Fever
Loss of appetite
Malaise
Sometimes jaundice - yellowing of the skin, whites of the eyes, dark
coloured urine and pale coloured stools/motions.
But often a person may have no symptoms at all.
Who can it affect?
ANYONE who is not immune - but particularly children, as many adults
over 40 have already developed immunity.
How is hepatitis A caught?
 From another person infected by hepatitis A
 From contaminated food and water e.g. shell fish
 From travelling to another country where hepatitis A is more common
than in Ireland.
How do you prevent hepatitis A?
 By avoiding contaminated food and water.
 By good hygiene practices, particularly hand washing and environmental
cleaning.
 Always wash hands thoroughly with soap and warm water: -
-
After going to the toilet
After changing a baby’s nappy
68
-
After contact with pets and animals
After contact with soiled linen
Before preparing and serving food
Before eating
 Always ensure that toilets are cleaned thoroughly after someone known
to have hepatitis A has used it.
 By being vaccinated if you are travelling abroad to a country, which has
a higher incidence of hepatitis A than the Ireland – your GP will advice
you about this.

Do you need to stay off work or school?
YES - for seven days after the start of symptoms e.g. jaundice.
Food Handlers in particular need to be especially careful and should take
advice from the department of Public Health, Infection Control Nurse
and senior physician in KARE.
How do you stop the spread of hepatitis A?
Hepatitis A spreads from the bowel to the hands so good hand washing
after going to the toilet is the most important way of preventing spread.
If you, or a member of your household has hepatitis A: 
The following items should be cleaned at least twice a day, and after
an infected person has used them, using detergent and hot water
followed by a suitable disinfectant or bleach:




Toilet seat
Toilet bowl
Flush handles
Taps and wash hand basins

If you use a disinfectant or bleach, ensure it conforms to a European
Standard and store it safely out of the reach of children.

Wear household gloves when cleaning toilets, and then thoroughly
wash your hands.
69

Ensure all household members wash their hands thoroughly with warm
water and soap after going to the toilet and after contact with
excreta or soiled clothes and bedding.

Use a separate towel – do not share your towel with others.

Wash all crockery in very hot water

Wash soiled clothes, bedding and towels on a “hot cycle” of the
washing machine.

By seeking advice about vaccination against Hepatitis A, if you are
travelling abroad from your GP or practice nurse.

Cases of Hepatitis A in homosexual males are increasing in Ireland at
present so those whose lifestyle may place them at risk should seek
immunisation.
70
Hepatitis B
What is hepatitis B
Hepatitis B is a virus (germ) that can cause an infection of the liver.
Symptoms include:






Nausea and vomiting
Loss of appetite
Abdominal pain
Aching joints and tiredness
Fever
Jaundice - yellowing of skin and the whites of the eyes, dark urine and
pale coloured stools/motions.
Many people have no symptoms at all, or will feel only mildly unwell. Most
people will recover completely, getting rid of the virus from their bodies.
However, a small number (2-10%) of people will go on to become carriers,
and a few carriers may go on to develop serious, long-term liver trouble
like cirrhosis (scarring) of the liver, or occasionally liver cancer.
Who can it affect?
Hepatitis B can affect anyone who is not immune, although some people
will have a higher risk. These include:
 Anyone who injects (or has ever injected drugs) and has shared
injecting equipment including needles, syringes, filters, spoons or
water.
 Anyone who has had sex (homosexual or heterosexual) with an infected
person without using a condom.
 Anyone who has had a sexually transmitted disease (they may have
caught hepatitis B as well).
 Anyone who has had medical or dental treatment in a country with
higher levels of hepatitis B infection than Ireland.
 People from parts of the world with a high prevalence e.g. Asia, Africa.
 Babies born to mothers who have acute hepatitis B during
pregnancy or to mothers who are carriers of hepatitis B.
71
How is hepatitis B caught?
 Hepatitis B is passed from an infected person through the transfer of
body fluids such as blood, semen, or vaginal secretions and very rarely
saliva with blood in it.
 A pregnant woman with hepatitis B may pass the virus on to her child.
 From sharing needles and other injecting equipment, razors,
toothbrushes, or any other article contaminated with infected blood.
 The hepatitis B virus can enter the body via cuts or needle stick
injuries or via open wounds such as weeping eczema.
 Hepatitis B cannot pass through intact skin.
How do you prevent hepatitis B?
 Practice safer sex (using a condom), especially if you change partners
regularly.
 Do not share injecting equipment, toothbrushes or razors.
 Always go to reputable places for tattooing, body piercing and
electrolysis, and ask for a new unused sterile needle.
 Make sure you cover all cuts and grazes with waterproof plasters,
especially on your hands.
 An effective vaccine is available so people at high risk of contracting
hepatitis B should be immunised.
 Mothers are screened for hepatitis B during pregnancy. The babies of
those who test positive are immunised to prevent them developing
hepatitis B.
What should I do if I think I am at risk?
See your GP or practice nurse or, if appropriate the GUM Clinic or
Community Drugs Team, especially if you inject drugs and share injecting
equipment or have had unprotected sex. There is a simple blood test
that can diagnose hepatitis B - remember you may have no obvious
symptoms.
Immunisation is available to anyone who may be at risk of contracting
hepatitis B. If you fall into one of the high-risk categories listed over
the page then you may want to contact your GP and talk to them about
being immunised.
72
Most people become immune once they have had a course of 3
injections - although it may take up to six months before protection
is complete, and a booster vaccination may who should be immunised?
 Babies whose mothers have hepatitis B or are carriers of hepatitis B.
 People who inject drugs and share injecting equipment.
 People who change their sexual partners frequently and have
unprotected sex.
 Men who have unprotected sex with other men.
 Close family contacts or sexual partners of someone with hepatitis B
infection or who is a carrier of hepatitis B.
 Haemophiliacs
 People with chronic renal failure.
 Health care workers and others whose jobs may put them at risk - such
as morticians, etc.
 Staff and residents of residential accommodation for people with
severe learning difficulties.
 People who are in prison.
73
Herpes Simplex
(Cold Sores)
What is Herpes Simplex?
A type of herpes virus called Herpes Simplex causes cold sores.
What are the symptoms?

The first symptom of cold sores is often of tingling in the area
(usually the mouth or nose) where a blister will appear.

This blister then develops a crust but will heal without scarring.

Children who get their first attack can have more widespread blisters
and may also have mouth ulcers and fever, which makes them feel
rather miserable. These blisters and ulcers will also heal without
scarring and if the child has any further attacks they will simply take
the form of a cold sore.

Genital Herpes shares a similar pattern on both male and female
genitals.
Why do cold sores recur?
Once someone has the herpes virus it does not completely disappear from
the body but remains dormant.

Repeat colds sores can be triggered by factors such as sunlight, cold,
stress and illness.
Are they infectious?
YES. Cold sores are usually spread by kissing (because the virus is active
in the cold sore blister and can be transferred onto another person’s skin
during a kiss).
People who know they have an active cold sore should avoid kissing young
children.
74
Genital herpes are spread by direct contact; individuals with genital
herpes should avoid sexual contact until the sores have healed.
There is a risk of spread of the virus with oral sex.
Is there any treatment?
Most cold sores do not need any treatment at all and will heal up quickly
on their own. Anaesthetic cream, soothing lotions (e.g. calamine) and
antiviral ointments can be helpful.
Some people have frequent
recurrences and may receive tablets from their GP to prevent these.
When can I go back to work/school?
Children do not need to be excluded from school or nursery provided they
feel well. Children with their first attack can go back to school as soon
as they feel well.
Most people will not need to take any time off work at all.
How do you prevent spread?
Children (and adults) should be encouraged not to touch the cold sore and
to wash their hands frequently and after touching the sore.
Sharing of lip gloss/lipstick should be avoided.
75
Hand, Foot & Mouth Disease
What is Hand, Foot & Mouth Disease?
This is a disease caused by a group of viruses, which usually affects young
children. It causes blisters on hands and feet, and mouth ulcers inside
the cheeks and on the tongue. Also a sore throat and high temperature.
These last for 7 to 10 days.
Is it dangerous?
NO. Complete recovery is the rule.
Is it the same as foot and mouth disease in cows?
NO. A completely different virus causes foot and Mouth disease in
cows.
How is it spread?
The virus is spread by coughs and sneezes, and is also found in the
faeces of infected children.
Some children infected with the virus
do not have symptoms but can pass it to others.
Is there any treatment?

There is no specific treatment for Hand, Foot and Mouth Disease – it
is usually a mild and self-limiting illness.

If a child feels unwell paracetamol (such as Calpol or Disprol) may help.

Antibiotics and creams or ointments for the blisters are not
effective. Children recover just as quickly without them.
76
What is the incubation period?
The incubation period (the period after exposure to the infection but
before a person displays symptoms) is 3 – 5 days.
How long are children infectious?
Children who are ill are infectious. They can carry the virus in their
faeces for many weeks after they have recovered and so may continue to
pass it on.
How long should children stay off school?

Children who are unwell should be kept off school until they are
feeling better.

Keeping children off school for longer than this is unlikely to stop the
virus spreading. There may be other children in the school who
appear well but are spreading the virus.
How can spread be prevented?

Since the virus is found in faeces, scrupulous attention must always be
paid to hand washing after using the toilet.

Soiled clothes, bedding and towels should be washed on the “hot cycle”
of the washing machine.
Can you catch it more than once?
YES, but children who are ill during an outbreak at school or nursery are
unlikely to get it again during the same outbreak.
77
HIV/AIDS
What is HIV?





HIV stands for Human Immunodeficiency Virus.
Against infections and cancers HIV attacks white blood cells called
CD4 cells, which protect the body.
When a person has HIV, infectious amounts of the virus can be found
in their blood, semen, vaginal fluids and breast milk.
Following infection with HIV, some people develop an illness like
glandular fever but many remain well. It usually takes many years for
the virus to weaken the body’s immune system and cause ill health.
HIV can develop into a condition called AIDS.
What is AIDS?
AIDS stands for Acquired Immunodeficiency Syndrome.
When a person has AIDS they have HIV infection and have developed one
or more of a list of illnesses (infections or cancers), which result from
the breakdown of the body’s immune system
Who can get HIV Infection?
Anyone can become infected with HIV if he or she is exposed to infection
through unprotected sex or contaminated blood or body fluids.
In
Ireland, the groups at particular risk of infection are:




Men who have unprotected sex with other men
Injecting drug users who share injecting equipment
Men and women who have had unprotected sex with someone from a
country where HIV is more common
Children of infected mothers
How do you catch HIV?
HIV is passed from an infected person through the transfer of body fluids,
such as blood, semen, fluid from the woman’s vagina or breast milk.
There are five main ways to catch HIV:
78




By unprotected sexual intercourse (anal or vaginal) and oral sex with
an infected partner.
By drug users sharing needles, syringes or other injecting equipment
contaminated with HIV infected blood.
From an infected mother to her baby during birth or through breastfeeding.
By a blood transfusion or organ donation from an infected person –
NB: ALL donations in Ireland are screened for HIV.
HIV is NOT passed on through everyday contact such as touching,
shaking hands, kissing, coughing or sneezing, or via sharing cutlery,
crockery or toilet seats.
Not everyone who comes into contact with HIV will catch the infection.
For example, most babies born to HIV positive mothers are not infected
with the virus. HIV cannot pass through intact skin.
How do you know you have HIV Infection?
A person with HIV may have no symptoms and remain well for a long
period of time. There is a blood test, which will detect antibodies to
HIV, but it can take up to three months for the antibodies to show up in a
test after a person has become infected.
How do you prevent HIV Infection?

By practising safer sex (using a condom), especially if you change
partners regularly. This applies to anal, vaginal and oral sex.

Injecting drug users should never share needles, syringes or other
injecting equipment with anyone else. Needle exchange programmes
provide clean supplies of injecting equipment and safe disposal of used
items.

Since 1985, all blood donations and organ/tissue donors in Ireland
have been screened for HIV so there is very little risk of infection
through hospital treatment in this country.

Mothers are screened for HIV during pregnancy. Those who test
positive receive treatment to reduce the risk of transmission of HIV
79

to the baby, and are advised on issues such as delivery by caesarean
section and the avoidance of breast-feeding.
Health Education - raising public awareness and providing advice on
reducing risks.
What should I do if I think I am at risk?
Confidential HIV tests can be obtained from any Sexual Health/GUM
(Genito-urinary Medicine) Clinic. Details can be found in the telephone
book or from your local hospital/GP.
There is complete confidentiality between the person tested and the
healthcare professional responsible for the test. This covers the
fact that a test has been taken as well as the result of that test.
If a test is taken at a GUM Clinic, the result does not appear in the
normal hospital records.
There is no vaccine to prevent HIV infection.
There is no cure for HIV but modern treatment can suppress the virus so
that an infected person remains well for many years. These treatments
can be complex and may have side effects.
If you think you are infected remember you could pass the virus on to
other people. Always practice safer sex using a condom and do not allow
your body fluids to pass to another person e.g. by sharing razors, tooth
brushes or injecting equipment.
80
Impetigo
INFORMATION SHEET
What is Impetigo?
Impetigo is a bacterial infection of the skin. It is most common on the
face around the nose and mouth. The infection starts with a few small
blisters, which then become filled with pus. These blisters crust over
and become yellow in colour.
How do you get it?
Impetigo is very infectious.
It can be caught from other people by
direct skin contact. Sharing objects such as towels, face flannels and
toys, which have been handled by someone who already has the infection,
can also catch it.
The incubation period (the period after exposure to the infection but
before a person displays symptoms) is usually 4 – 10 days.
How is it treated?
Antibiotics treat impetigo quickly and effectively. The doctor may give
you antibiotics as a cream or as a medicine.
You must follow the
instructions and complete the course.
Can it be passed on to someone else?
YES. Someone else can catch it off you as easily as you caught it off
another person. The infection can be passed on until treatment has been
started and the infected area begins to heal.
Covering the area with a dressing does reduce the chance of spread but
it also keeps the infected area moist and so delays the infection healing.
Fingers that have been in contact with the infected areas are an ideal
way of spreading germs to another person.
Frequent hand washing will reduce the chances of this happening.
must always be washed after touching the infected area.
81
Hands
Do I need to keep this child off school or day care?
YES.
Children who have Impetigo should not be sent to school or
nursery until 24 hours of treatment has been completed and the affected
area has stopped weeping. If the infection can reliably be kept covered,
exclusion may be shortened.
What about playing with brothers and sisters?
Children should not be treated as outcasts at home.
Reducing skin
contact with brothers and sisters is advisable but may not be possible.
As sharing towels and flannels also spreads the infection, it would help if
everyone could have their own towel and flannel until the infection is
cleared. Avoid the use of shared bar soap.
What should I do if the Impetigo keeps coming back?
If Impetigo keeps coming back despite following the advice given above,
it may be that your child is carrying the germ in their nose. This is not
uncommon and can be simply treated by using a special nose cream that
your doctor can prescribe.
I manage a day unit or a School, what should I do?
If you suspect that a child may have Impetigo, they need to see their GP.
The child should not be allowed to return to Nursery/School until 24
hours of treatment has been completed and the affected area has
stopped weeping or is covered.
Because Impetigo can be caught from objects as well as from people, you
will need to ensure that surfaces, floors and toys are cleaned. You do
not have to use any special cleaning agent, ordinary detergent and hot
water will do, so long as cleaning is thorough. Ideally, any carpets should
be shampooed.
Care should also be taken to ensure that children do not share facecloths
and towels. Towels should be laundered on a hot wash.
Avoid shared bar soap.
82
Influenza
INFORMATION SHEET
What is influenza (flu)?
Influenza (flu) is an illness caused by a virus. Flu viruses are always
changing, so this winter’s flu will be slightly different from last winter’s.
How is flu spread?
Flu is spread by the coughs and sneezes of people who are already
infected with the virus. It can spread very rapidly.
How do I know if I have flu?
A lot of people confuse flu with a heavy cold. But flu has symptoms that
you do not get with a cold:





A high fever
A ‘shivery’ feeling
A headache
Aching limbs
No energy
What also makes flu different from a cold is that it usually starts
suddenly.
How long does flu last?
You may feel ill and have a temperature for up to a week, but you could
feel weak and in low spirits (‘washed-out’) for several weeks longer.
83
How serious is flu?
For most people flu is a nasty experience. For some people though, flu can
lead to more serious illnesses such as bronchitis and pneumonia that may
require hospital treatment. For those most at risk to serious
complications of flu, there is a vaccine available, which offers them some
protection, and these people should have a flu vaccination every year.
You are advised to have a flu vaccination if you have:
 A chronic heart or chest complaint, including asthma (that requires
continuous or repeated treatment)
 Chronic kidney disease
 Diabetes
 Lowered immunity due to disease or treatment such as steroid
medication or cancer treatment
 Any other serious medical condition - check with your doctor if you are
unsure.
 Are over 65 years of age?
If in doubt, ask your doctor or practice nurse.
What should I do if I get flu?
Medicines aren’t much use when you’ve got flu - flu is a virus so
antibiotics won’t help unless the flu has led to another illness. You can
take painkillers such as paracetamol or aspirin to help relieve the
headache and muscle pains and reduce your temperature. BUT DON’T
GIVE ASPIRIN TO CHILDREN UNDER 12 YEARS OLD.
The best way to treat flu is to:
 Stay at home, keep warm and rest - this will help you recover more
quickly in the long run
 Drink plenty of non-alcoholic liquids to replace the fluid lost in
sweating
 Eat what you can.
84
You can make a feverish child more comfortable by sponging them with
tepid (not cold) water.
Should I contact my doctor?
There is no need to contact your doctor, unless:






You have one of the medical conditions listed above
You are frail or elderly
Your temperature doesn’t settle after four or five days
Your symptoms get worse
You think you are seriously ill
You develop chest pain or become short of breath.
If you are just worried, it’s best to discuss your symptoms over the
phone rather than making an appointment to see the doctor.
Can I avoid getting flu?
It is difficult to avoid flu if there is an epidemic. Keeping away from
crowded places can help. You can also encourage people with flu to stay
at home to avoid infecting others.
What about helping others?
Be a good neighbour:
 Watch out for signs that a neighbour may be ill - for example, milk
bottles left on the doorstep or curtains closed during the daytime
 Offer to make drinks or do the shopping for a sick neighbour if they
live alone or if you think they may not be able to cope.
85
TIPS FOR SWINE INFLUENZA PREVENTION
HOW IS INFLUENZA TRANSMITTED?

Contact transmission
Direct
– Touching an infected human
Indirect
– Touching an object that an infected human touched

Droplet transmission
Large droplets generated by sneezing, coughing or talking
Occurs over a distance of 3-4 feet

Airborne transmission
Due to small droplet nuclei
Occurs over many feet
HOW LONG DOES INFLUENZA VIRUS SURVIVE?

Stainless steel and plastic
Survived 24-48 hours
Transferred to hands up to 24 hours

Cloth, paper, tissues
Survived 8-12 hours
Transferred to hands up to 15 minutes

Hands
Survived up to 5 minutes
TOP 10 GENERAL INFLUENZA PREVENTION METHODS
MEDICAL
#1 Vaccination
#2 Antiviral medications
Must start within 2 days of illness
Treatment as advised by your health care provider
NON-MEDICAL
Personal Hygiene
#3 Cough Etiquette
o
Properly cover your mouth and nose with a tissue or sleeve
when coughing or sneezing
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– See CDC “Cover Your Cough” at:
www.cdc.gov/flu/protect/covercough.htm
#4 Hand Washing
o
Proper Hand Washing Procedures

Wet hand with warm water

Apply soap to hands

Rub hands together vigorously for 15 – 20 seconds,
covering all surfaces of hands and fingers

Rinse hands with warm water

Thoroughly dry hands with disposable towel or air
blower

Use towel to turn off tap
#5 Hand Sanitation (Alcohol rub/gel)
o
Proper Use of Hand Sanitizer

Apply product to palm

Rub hands together covering all surfaces of hands and
fingers

Rub until dry (15-20 seconds)

Use on visibly clean hands

Consider offering in public areas
#6 Avoid Touching Eyes, Nose and Mouth

Germs are often spread when a person touches
something that is contaminated with virus and then
touches his or her eyes, nose or mouth.
HARD SURFACE CLEANING AND DISINFECTING
#7 Clean


Organic material could protect the virus from
sanitizers
Removal of the organic material is a key part of
effective disinfection
#8 Rinse

Detergents should be rinsed off to avoid dilution or
inactivation of disinfectant
#9 Disinfect
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Follow directions for use on the product label of a properly
EPA registered disinfectant which has claims of
effectiveness against influenza viruses listed on the label.

Wipe down frequently touched surfaces with a
properly registered disinfectant
– Light and air control switches
– Faucets and toilet flush levers
– Door knobs, TV and radio controls and telephones
– Public restroom doors
– Other surfaces as needed

Disinfect all surfaces in the bathroom that may have
contacted respiratory secretions, urine or feces
according to standard infection control procedures

Carefully read and follow all product directions
according to the EPA registered product label.
#10 Stay Home When You’re Sick
o
With cold or flu symptoms, stay home and get plenty of rest
o
Check with your local health care provider as needed
o
The information contained in this guide is in accordance with U.S. Centers
for Disease Control and Prevention (CDC) and World Health Organization
(WHO) recommendations. No vaccine is currently available for Avian
Influenza H5N1 or Swine Influenza H1N1 strain. These recommendations
are offered as a set of best practices to help lower the probability of
contracting influenza type viruses.
ADDITIONAL RESOURCES
CDC “Stopping the Spread of Germs at Work”
Downloadable PDF file available in five languages.
www.cdc.gov/germstopper/work.htm
CDC “Stop the Spread of Germs”
Printable formats of “Cover Your Cough” flyers and posters in five
languages.
www.cdc.gov/flu/protect/covercough.htm
FDA “What to do for Colds and Flu”
88
www.fda.gov/opacom/lowlit/clds&flu.htm
l
US Department of Health & Human Services “Pandemic Flu Planning
Checklist for Individuals and Families”
www.pandemicflu.gov/planguide/checklist.html
US Department of Health & Human Services “Business Pandemic
Influenza Planning Checklist”
www.pandemicflu.gov/plan/businesschecklist.html
FDA “Questions and Answers on Avian Influenza and Food Safety”
www.cfsan.fda.gov/~dms/avfluqa.html
89
Health Protection Agency
Legionnaires Disease
INFORMATION SHEET
Introduction
An outbreak of the disease in a group of ex-servicemen attending an
American Legion Conference in Philadelphia in 1976 led to the naming of
this disease. The bacterium causing the disease was identified and is
called Legionella pneumophila.
What is Legionnaires’ disease?
Legionnaires’ Disease is a bacterial infection, which may cause pneumonia.
The majority of the reported cases are single cases, however, outbreaks
do occur. About half the cases occurring in Ireland are linked to travel
abroad.
Who gets Legionnaires’ disease?
Legionnaires’ disease can affect anyone. The disease is more common and
more severe in men, people over 50 years of age, smokers and those who
already have underlying lung conditions.
What are the symptoms?
The symptoms of Legionnaires’ disease are similar to those experienced
when you have flu. They are fever; headache; dry cough; muscle aches and
pains; and tiredness. If the disease progresses the temperature goes up,
vomiting and diarrhoea may start, chest problems can worsen and the
patient can become confused.
How soon do symptoms occur?
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The incubation period, (the period after exposure to the infection but
before a person displays symptoms) is between 2-10 days. In rare cases
it can be as long as 3 weeks.
Where is the Legionella organism found?
The Legionella organisms can be found in many places within the
environment, fresh water such as ponds, water systems and air
conditioning systems.
Legionellae in the environment usually cause no harm. Problems only arise
when the organism finds itself in an ideal environment in which to
multiply, such as stagnant water, and is then given an opportunity to
spread.
How is Legionnaires Disease spread?
It is NOT spread from one person to another person. The disease is
spread from an infected water source through the air. For example spray
from infrequently used shower units. Probably the greatest hazard are
roof top cooling systems where a cascade of water is used to cool pipes,
this produces spray which can enter the air conditioning system or fine
droplets can fall onto passers by.
How can Legionnaires’ disease be prevented?
Storing water below 25°C or above 60°C can prevent Legionnaires’
disease. Water storage tanks, air conditioning systems and humidifiers
should be checked and cleaned regularly.
How is it diagnosed?
It is diagnosed through testing a sample of urine?
Can Legionnaires’ disease be treated?
YES, Legionnaires’ disease can be treated with specific antibiotics.
91
Listeriosis (Listeria)
INFORMATION SHEET
What is Listeriosis?
Listeriosis is an infection caused by a bacteria (germ), which can cause a
very mild illness with symptoms of:  Fever
-
usually mild
 Flu-like illness
short lasting but in RARE cases can cause a
type of meningitis and/or septicaemia (blood
poisoning)
Who does it affect?
ANYONE - but young children, the elderly, people with a weakened
immune system, and pregnant women are most at risk.
How do you get Listeriosis?
The bacteria, which cause Listeriosis, are present in the environment in
water, silage and soil, so animals and humans can become infected from
these sources.
Most human infections are caught by:
 Eating dairy products made from unpasteurised milk e.g. soft cheeses
such as Brie, Camembert and some blue cheeses;
 Drinking unpasteurised milk;
92
 Eating unwashed and/or uncooked vegetables;
 Eating patés
 Eating ‘cook-chill’ ready meals which have not been heated through
properly;
 Farm workers or vets may also be at risk if they come into contact
with infected animal material e.g. during lambing.
What is special about Listeriosis?
Listeriosis is one of the few infections, which can affect the developing
baby in a pregnant woman. If a pregnant woman develops Listeriosis she
may pass the infection to her developing baby, either in the womb or
during birth, which may lead to abortion, stillbirth, and premature birth
or may affect the health of the baby when it is born.
How do you prevent Listeriosis?
Pregnant women and people with severely weakened immune systems (e.g.
people with HIV disease) should avoid eating and drinking the foods
previously listed, especially soft cheeses and patés. Also, if their job
involves contact with animals e.g. they are farm workers or vets, they
should avoid contact with potentially infected animal material such as
aborted foetus during lambing.
Do you need treatment?
Most healthy persons will require no treatment, and may not even be
aware they have the infection. In rare severe cases, people will require
hospitalisation and antibiotic treatment.
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Measles
INFORMATION SHEET
What is measles?
Measles is an infection caused by a virus (germ) and can cause:
Fever
Irritability
Cold-like symptoms - running nose
Sore and runny eyes
Dry “croupy” cough
White spots on the gums (2nd and 3rd day)
Rash (4th day) starting on the face and behind the ears, then
spreading down the body.
 Diarrhoea - often in the early stages in children.







Serious complications of measles infection can occur such as ear
infections (approx. 1 in 20), bronchitis/pneumonia (approx. 1 in 25),
convulsions (approx. 1 in 200), and in rare cases, encephalitis (infection of
the brain) or meningitis (approx. 1 in 1,000) may occur. The likelihood of
problems varies with age, and complications are generally more common in
young babies, older children and adults.
Who does it affect?
ANYONE - who has not developed natural immunity or has not been
vaccinated against measles, Children are most vulnerable though, but
their mother’s antibodies protect babies up to approximately 6 months.
How do you get measles?
MEASLES IS VERY INFECTIOUS and you catch it by being in close
contact with someone who already has the infection. The virus is passed
in the secretions of the infected person’s nose and throat and is spread
by their sneezing and coughing. Also it is possible to catch measles from
94
direct contact with articles which have been contaminated by these
infected secretions e.g. hankies.
How do you prevent measles?
 By immunisation - there is a safe and effective vaccine, which
protects against measles. It is one of the “M” components in MMR
vaccine and a child needs two doses of this vaccine, one at 13 - 15
months and another dose pre-school.
Protection is life long.
An
unvaccinated person has very little chance of going through life
without becoming infected.
 By avoiding close personal contact with a person with measles if you are
at risk.
Because measles vaccine is a “live” vaccine, it is not
recommended that children who have a weakened immune system e.g.
because of medication or chemotherapy, should be vaccinated so these
children are particularly vulnerable and should avoid contact whenever
possible.
Do you need to stay off school/work?
YES - MEASLES IS VERY INFECTIOUS. Measles is infectious from
just before the symptoms first occur and for approximately 4 days after
the appearance of the rash, so general advice is to stay off school or
work for at least 7 days after symptoms first develop.
Do you need treatment?
There is no specific treatment for measles but an appropriate medicine
to help bring down a high temperature should be used (DO NOT USE
ASPIRIN IN CHILDREN) and if necessary, sponging down with tepid
water.
Also, if a secondary infection develops then the doctor may
prescribe antibiotics to treat this e.g. an ear or chest infection.
2 – 6 weeks after the illness, your GP or infection control nurse may take
a swab from the mouth of the infected person. This is to confirm if it
was a definite case of measles.
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MRSA
METHICILLIN RESISTANT
STAPHYLOCOCCUS AUREUS
INFORMATION SHEET
What is MRSA?

MRSA stands for methicillin resistant Staphylococcus aureus.

Staphylococcus aureus is a very common bacterium (germ) that around
30% of the population carries on their skin or in their nose without

knowing it.

Most of the time the bacterium does not cause any harm. Sometimes
though the bacterium can cause skin infections such as boils. These
infections are normally mild and are easily treated.

Some strains of the Staphylococcus aureus bacterium have developed
a degree of resistance to the more commonly used antibiotics (e.g.
Penicillin) and are called MRSA.

It is this resistance to certain antibiotics that makes MRSA
different, as it may not be as easy to treat if it does cause an
infection.

People can carry MRSA in the same way as the usual Staphylococcus
aureus without causing harm to themselves or others.

MRSA was first identified in hospitals but it is now found in the
general community and in nursing and residential homes.

It usually only causes problems to the very sick in the hospital
setting.
96
How will you know if you have it?

MRSA is only detected by a laboratory. This is usually only when a
wound or another area of the body becomes infected and it is
identified e.g. by a wound swab or urine specimen

Testing for MRSA is usually only carried out as part of a hospital
screening policy. It is not necessary to screen healthy individuals
within the community.
Are family and friends at risk if you have MRSA or visit someone
with it?

NO (including babies and pregnant women).
How can you stop it spreading?
MRSA is mainly spread on hands so hand washing is the most
important way to stop it spreading.
It is particularly important that carers and healthcare workers wash
and dry their hands thoroughly between caring for Service Users.
Always wash hands:





After using the toilet
Before eating/preparing food
After handling soiled linen/bedding/nappies
After touching animals
When hands appear dirty
No special cleaning methods are required though good general cleanliness
is important in helping prevent the spread of infection generally.
Clothing and bedding do not generally need to be washed separately or
differently.
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Infection Control Precautions In Nursing/Residential/Respite/Day
Units/For The Control Of Mrsa In The Community:
The basic principles of infection control in the Community are the same
as those for hospitals. Service Users colonized with MRSA frequently
return to the Community, either to their own home, to Nursing Homes or
Residential Homes and day services. MRSA carriers normally do not
require special treatment after discharge from hospital. They do not
have to be carried by special ambulances.
If basic good hygiene precautions are followed, MRSA carriers are not a
hazard to other service users, to members of their family, visitors or
staff including babies, children and pregnant women.
Carriage of MRSA should not be a reason for stopping admission to a
Nursing or Residential Home or day service or for discharge to their own
home. It should not be a reason for discriminating against these people.
Isolation of MRSA carriers is not recommended generally in Residential
Homes, Respite services, day services, etc. as this may adversely affect
rehabilitation of the service user.
The colonized service user should be encouraged to practice normal good
hygiene with handwashing after using the toilet and before eating and
they should have regular baths. They should be assisted with
handwashing if their mental or physical condition makes it difficult for
them to do so on their own. The colonized service user may join other
service users in communal areas such as sitting or dining rooms as long as
any sores or wounds are covered with dressing.
The colonized service user may receive visitors and go out of the home,
e.g. to visit family or friends.
If an MRSA carrier from the community has to visit hospital for
treatment, the hospital Doctor should be informed of the service users
MRSA status.
If a staff member who provides direct care to an MRSA carrier is going
to hospital for surgery, the hospital should be informed that this person
has been in contact with an MRSA positive patient.
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SCREENING FOR MRSA
There is no need to screen routinely for the presence of MRSA in a unit
with a known MRSA carrier. Other service users or staff in the unit
would be screened only if there is a clinical indication. In such situations,
KARE will seek advice from the Occupational Doctor who will make the
decision to screen or not to screen and swabs if taken would be sent not
only for MRSA screening but also for general microbiological infections.
Should I stay away from work/school?
NO. As with any infection all infected cuts or wounds should be
covered with a waterproof dressing.
Additional Information

Hospitals have policies to minimise the spread of MRSA.

If you have MRSA, it is important that you let the hospital know prior
to, or as soon as possible after admission.

Hospitals may ask your GP or practice or district nurse to take swabs
before you go into hospital for some types of surgery e.g. ophthalmic
(eye) surgery. This is to reduce the risk of post-operative (after
surgery) infection.
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Mumps
INFORMATION SHEET
What is Mumps?
Mumps is an infection caused by a virus (germ) and can cause:
 Fever
 Headache
 Swelling and tenderness of glands in one or both sides of the neck
(called parotitis)
 Running nose and eyes, sore throat and ears – particularly in young
children
Occasionally serious complications of mumps infection can occur. These
less common but more serious symptoms include:




A mild form of meningitis (inflammation of the layers surrounding the
brain)
Ear infections which can lead to hearing impairment
Swelling and tenderness of the testicles in adult men (orchitis), and
inflammation of the ovaries (oophoritis) in women, though it is very
rare for these to cause serious complications such as infertility
Pancreatitis – inflammation of the pancreas.
Who does it affect?
ANYONE - who has not developed natural immunity or has not been
vaccinated against mumps,
How do you get mumps?
You catch mumps by being in close contact with someone who already has
the infection.
The virus is passed in the secretions of the infected
100
person’s nose and throat. Also, it is possible to catch mumps from direct
contact with articles which have been contaminated by the saliva of an
infected person e.g. hankies.
How do you prevent mumps?
 By immunisation - there is a safe and effective vaccine, which
protects against mumps. It is one of the “M” components in MMR
vaccine and a child needs two doses of this vaccine, one at 13 - 15
months and another dose pre-school.
 If a child or young adult has not received 2 doses of MMR vaccine, this
can be given at any age.
 Protection can be life long.
 By avoiding close personal contact with a person with mumps if you are
unvaccinated.
Do you need to stay off school/work?
YES - Mumps is infectious for 2 – 7 days before the symptoms first
occur and for approximately 9 - 10 days after the appearance of the
symptoms. General advice is to stay off school or work for at least 5
days after symptoms first develop.
The incubation period (the time between infection and the onset of
symptoms) is between 14 – 21 days.
Do you need treatment?
There is no specific treatment for mumps but an appropriate medicine to
help bring down a high temperature should be used (DO NOT USE
ASPIRIN IN CHILDREN UNDER 16) and if necessary, sponging down
with tepid water.
101
Parvovirus B19 Infection
Also known as (Slapped Cheek Syndrome)
(Fifth Disease)
INFORMATION SHEET
What is parvovirus B19 infection?
Parvovirus B19 infection is a viral infection, which can cause:




Fever
Rash - a lace-like red rash usually on the limbs and across the
shoulders
Red cheeks - this symptom is most common in children and is the
reason for the infection’s other name “slapped cheek syndrome”
Joint aches and pains
Human parvovirus infection is also called:
 Slapped cheek syndrome
 Fifth disease
 Erythema infectiosum
It is not the same disease as parvovirus in pets, and there is no
protective vaccine.
How is parvovirus B19 caught?




By being in close personal contact with someone who already has the
infection.
By breathing in the aerosol spray from an infected person via their
coughing and sneezing.
Occasionally from direct contact with the blood or urine of someone
who already has the infection.
It is not caught from animals or inanimate objects like towels or from
food.
Who can it affect?
102
 Usually children The infection is most common in children between the
ages of 5-14 years.
 Some adults- approximately half (50%) of all adults will have been
infected at some time in their lives and have gained immunity.
Infections are most common in the spring or early summer
Do you need to stay off school/nursery/work?
NOT USUALLY - Usually children will feel quite well. They only need to
stay off school /nursery if they are ill. This is the same for adults, but
adults do tend to be affected with symptoms more commonly, particularly
joint pains and general aches.
What is the incubation period?



The incubation period (the period between infection and the
appearance of signs and symptoms) is between 7-22 days - average 14
days.
A person developing the disease is infectious (capable of spreading the
virus to other people) for 7 days before the onset of the rash
Once the rash has appeared the risk of passing on the infection drops
dramatically.
How do you prevent spread?
 This is almost impossible because people are infectious before they
show symptoms of the infection and we do not, as yet, have a vaccine
to prevent the infection occurring.
 Washing hands with soap and warm water after contact with urine or
blood is a sensible precaution.
Advice to pregnant women during an outbreak
Pregnant women in the first 20 weeks of pregnancy should do as much
as possible to avoid close contact with pupils at the school until the
outbreak is over.
After 20 weeks of pregnancy, there is no known
risk to the baby. If you have had close contact with a case during
the infectious period before the rash appears, see your doctor.
Your doctor will wish to consider testing for immunity or infection,
and monitoring the baby.
103
The virus does not cause malformations in the baby in the way German
measles (rubella) does.
Advice to other groups
The infection may be more serious for people who have diseases, which
impair their immune system, and for people who have certain serious
blood disorders such as sickle cell disease.
Parents of children who have inherited anaemia or immune deficiency
should seek advice from their doctors.
104
Pertussis also known as (Whooping Cough)
INFORMATION SHEET
What is pertussis?
Pertussis, or whooping cough, is a respiratory infection caused by a
bacterium. It is most common in children but can occur at any age.
What are the symptoms of pertussis?
Initial symptoms are of catarrh and a cough. Children often whoop or
vomit (often at night) after a spasm of coughing. Babies can become
quite exhausted by the coughing and may have difficulty in feeding
because of it. The illness may last for one or two months.
Is it infectious?
YES. People with whooping cough are infectious from 2 to 4 days
before they start coughing until up to 21 days afterwards.
Antibiotics can shorten the infectious period to 5 days if started
early in the illness.
What is the incubation period?
Usually between 5 and 10 days, but occasionally up to 21 days.
How do you prevent pertussis?

BY IMMUNISATION – there is a safe and effective vaccine, which
protects against pertussis.

By avoiding close personal contact with a person with pertussis if you
are at risk or are unvaccinated.
105

If there is an unvaccinated baby in the same house as a case of
pertussis, ask your GP about protection with an antibiotic.
Do you need to stay off school/work?
YES - Pertussis is most infectious in the early stages when the person
has the ‘cold like’ symptoms prior to the cough developing. The person will
then remain infectious for about 3 weeks after the cough developed if
they do not receive antibiotic treatment.
If a person receives antibiotic treatment they will only be infectious for
5 days after the cough developed.
Do you need treatment?
YES – antibiotics are used to treat pertussis infection. Antibiotic
treatment also reduces the period of time that a person is infectious –
the period when they can pass the infection onto others.
106
Ringworm
INFORMATION SHEET
What is it?
Ringworm is an infection caused by a microscopic fungus, similar to the
fungus, which causes athlete’s foot. Ringworm may occur on the scalp
(tinea capitis) or elsewhere on the skin (tinea corporis). On the scalp it
causes a small circular bald patch with broken hairs at the edges. On the
skin it causes a reddish ring-shaped area with healthy looking skin in the
centre.
Is it a worm?
NO. Ringworm gets its name because it produces a ring-shaped mark,
which gradually gets bigger. It has nothing to do with worms.
How is it caught?
From infected animals or people. The fungus can survive on furniture,
clothes, hairbrushes, towels, etc. so it is not always necessary to have
close contact with an infected person.
Can it be treated?
YES. There are several creams, which are very effective against
ringworm of the skin. Your family doctor can prescribe these. It is
important to continue treatment until the skin is completely clear.
For scalp ringworm, a course of tablets or medicine is usually needed.
These may have to be taken for several months. Using a cream at the
same time may help to stop the infection spreading to other people.
Once treated the hair will grow back normally.
107
Is it infectious?
If left untreated some ringworm infections may be passed to other
people. Skin ringworm stops being infectious soon after treatment is
started.
No one knows for how long scalp ringworm is infectious, but if cream is
used as well as tablets, spread to other people is extremely unlikely.
Can my child attend nursery/school?
YES, once treatment has been started.
Can it be prevented?
Since it is not always clear where ringworm comes from, it can be
difficult to avoid infection.
It is important that anyone with the infection is treated to prevent
spread. Other people in the same household or class should be checked
for infection.
Pets or other animals should also be checked and, if infected, must be
treated. A vet can advise about this.
REMEMBER

Treatment should be started as soon as possible.

It should continue until cured.

Infected people should not share towels, flannels or hairbrushes.

Other people in the house or class may be infected.

Infected pets should be treated.

It is possible to catch ringworm more than once.
108
Rotavirus
INFORMATION SHEET
What is rotavirus?
Rotavirus is the name of a virus, which can cause the following:



Severe vomiting and diarrhoea
Stomach cramps
Occasionally fever accompanied by convulsions
In rare circumstances a child may need to be admitted to hospital.
The virus lives in the bowel and spreads via the diarrhoea it causes,
either directly from hand to mouth or indirectly from droplets in the air,
which then get into the nose and mouth. The virus can still be found in
the motions for a few days after the diarrhoea has finished.
Who does it affect?
Rotavirus occurs mainly between the ages of 6 months and 2 years, most
children having gained immunity to the virus by 3 years of age. It often
causes problems in the winter months. It has been known to cause
sickness in adults.
What is the treatment?
There is no treatment for the rotavirus at present. The illness runs its
own course, generally taking between 4-6 days.
How do you prevent it?
Hand washing is the most important method of preventing spread of
rotavirus (and many other infections).
Teach children
toilet/potty.
to
always
wash
their
hands
after
using
Hands should always be washed well with soap and warm water
109
the
AFTER:






Going to the toilet
Assisting children with toileting
Changing nappies
Handling soiled linen and clothing
Cleaning up diarrhoea or vomit
Assisting your child to wash his/her hands after toileting
BEFORE:



Preparing or serving foods and drinks
Eating
Smoking
Preventing the of spread of rotavirus at home


Diarrhoea or vomit soiled linen, towels and clothing should be
laundered on as hot a wash as possible. Do not overfill your washing
machine or it will not clean them properly. Keep soiled washing
separate from the rest of the washing.
Clean toilet seats, flush handles, door handles and taps frequently
with hot soapy water. You do not need to use disinfectant or
bleach, but if you want to then follow the manufacturers’
instructions, store them carefully - keep them away from children
and use ones which conforms to the European Standard

Clean toilets and potties with bleach after use (if you use a bleach

Whilst your child has diarrhoea it is important that they do not
play or associate with other children, generally for up to 48 hours
after the symptoms have subsided.
110
Rubella (German Measles)
INFORMATION SHEET
What is Rubella?
Rubella is an infection caused by a virus and can cause: Sore Throat
Sore Eyes
Fever
Rash
usually mild
often just a “gritty” feeling
usually mild
a pink rash that appears 2-3
days after the first symptoms
usually appearing on the face and
neck first then spreading to the
body and limbs.
Swollen lymph glands
Joint Pain
-
usually in the neck
usually in adults and can last for
several weeks
Rubella is usually a very mild illness, which often causes children no real
problems but may be worse in adults. Treatment is not usually required.
Who does it affect?
ANYONE - who has not developed a natural immunity, or has not been
vaccinated against Rubella,
How do you get Rubella?
You get Rubella from being in close contact with someone who already has
the infection.
The virus is passed in the secretions of the infected
person’s nose and throat and is spread by them coughing and sneezing.
Also, by close personal contact with that person such as contact that
takes place within a household or family setting.
111
How do you prevent Rubella?
 By immunisation - there is an effective and safe vaccination to protect
against Rubella. It is the “R” component of the MMR vaccine and a
child needs two doses of this vaccine at 13 - 15 months and a second
dose pre-school. Protection will usually be life-long and both girls and
boys need to be vaccinated.
Also, adults who have no history of
immunisation and have not developed natural immunity can be
vaccinated. This is usually only required in special circumstances (e.g.
health care workers) when a blood test will discover if they already
have immunity.
 If a woman is planning to have a baby and she is unsure if she has ever
had Rubella or has been vaccinated against Rubella, she should discuss
this with her doctor or practice nurse and they will advise her.
 By avoiding close personal contact with a person with Rubella whenever
possible if you think you are at risk.
 As the Rubella vaccine is a “live” vaccine, it is not recommended for
people with severely weakened immune systems or pregnant women.
Do you need to stay off School/Work?
YES - Rubella is infectious for about 5-7 days before the rash appears
and for 5-7 days after, so the general advice is to stay off school or work
for
5 days after the rash first appears.
What is special about Rubella?
Rubella is one of the few infections, which can affect the developing
baby of a pregnant woman. The risk to the baby depends upon when
the mother gets the infection - the earlier in her pregnancy the
higher the risk of the infection affecting the baby - in very late
pregnancy the risks are very low. Rubella infection can cause death
112
of the baby, premature birth, hearing and sight defects, heart
problems and mental defects.
If a pregnant woman comes into contact with Rubella and she is unsure if
she has previously had either the infection or the vaccination, she should
SEEK IMMEDIATE ADVICE from her doctor or midwife.
All pregnant women are encouraged to be tested for immunity to Rubella.
Her doctor or midwife will discuss her past history of Rubella infection or
vaccination and take a blood specimen to test for past exposure and
immunity to Rubella.
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Salmonella
INFORMATION SHEET
What is Salmonella?
It is a bacterium (a germ), which is present in many foods and can cause:






Diarrhoea
Nausea and vomiting
Stomach pains and cramps
High temperature
Headache
Malaise
How is Salmonella caught?


Usually from raw and undercooked food, particularly meat, poultry and
eggs.
Occasionally person to person spread.
Who can it affect?
ANYONE - but the very young and the elderly are particularly vulnerable.
Do you need to stay off work or school?
YES - until you have been free from any symptoms for 48 hours
Children should not play with other children or attend school or nursery
until they are fully recovered and have been symptom free for 48 hours.
How do you prevent it?

By thoroughly cooking all foods, especially meat, poultry and eggs.
Cooking destroys salmonella.

Avoid contaminating cooked food by allowing contact with raw food e.g.
dirty knives and dirty chopping boards, etc.
114

Ensure your fridge and freezer are operating at the correct
temperatures (between 1-4°C and minus 18°C respectively).

Only drink pasteurised milk.

Always wash hands thoroughly with soap and warm water: 





After going to the toilet;
After contact with pets and animals;
After changing a baby’s nappy
Before preparing and serving food;
Before eating food.
Always ensure you practice good food hygiene.
TAKE CHILLED AND FROZEN FOOD HOME QUICKLY – then put in
the fridge or freezer at once.
PREPARE AND STORE RAW AND COOKED FOOD SEPARATELY – keep
raw meat, fish and poultry in the bottom of the fridge and away from
salads.
COOK FOOD THOROUGHLY – follow instructions on the pack.
reheat food make sure it is piping hot.
If you
KEEP HOT FOODS HOT AND COLD FOODS COLD – don’t just leave
them standing around at room temperature.
KEEP YOUR FRIDGE AT 0 - 5 - get a fridge thermometer.
CHECK ‘USE BY’ DATES – use food within the recommended period.
KEEP PETS AWAY FROM FOOD – and dishes and worktops.
WASH HANDS THOROUGHLY – before preparing food, after going to
the toilet or after handling pets.
KEEP YOUR KITCHEN CLEAN – wash worktops and utensils between
handling raw and cooked foods.
DO NOT EAT RAW OR UNDERCOOKED EGG – keep eggs in the fridge.
115
How do you stop the spread of Salmonella?
If you, or a member of your household has Salmonella:

Clean the following after use with detergent and hot water, followed
by a suitable disinfectant:




Toilet seat
Toilet bowl
Flush handles
Taps and wash hand basins

If you use a disinfectant, ensure it conforms to a European Standard
and store it safely out of the reach of children.

Ensure all household members wash their hands thoroughly with hot
water and soap after going to the toilet and after contact with
excreta, soiled clothes and bedding, and pets.

Use a separate towel
 Soiled clothes should be laundered on as hot a wash as possible. Do not
Overfill your washing machine or it will not clean them properly. Keep
Soiled washing separate from the rest of the washing.
116
Scabies
INFORMATION SHEET
What is Scabies?
It is a skin problem, which is caused by a tiny parasite (mite), which
burrows into the skin.
There may be no symptoms for the first 2-3 weeks after catching
scabies, but it will develop into: 
An allergic type rash anywhere on the body, but often on the fingers,
wrists, around the waist and on the buttocks.


Itching - particularly at night, or after a hot bath.
How is Scabies caught?

From prolonged person to person contact (for several minutes or
more).

Often hand to hand contact - 80% of infections are confined to hands.

It is NOT a condition caused by poor hygiene.

Clothes, bedding or towels do NOT spread it.

117
Who can it affect?
ANYONE who has had close personal contact with someone infected by
the scabies mite. So it is important that family members and close
friends of someone infected by scabies are treated even if they do not
have any symptoms or itching.
How do you treat Scabies?


By treatment with a special lotion or cream that can be obtained from
your pharmacist or on prescription from your doctor.
Do not bath or shower before applying the cream

The lotion or cream is applied to every area of the body, including the
face and head. When applying treatment to the face it is important
to avoid the eyes and mouth.

Particular attention should be paid to the toes, fingers, the private
parts and areas where the rash is seen.

It should be left on for between 8 - 24 hours depending on which
preparation is used (follow the manufacturers instruction leaflet).

Your GP should prescribe enough to enable two applications, one week
apart.

Itching may persist for some weeks after completing the treatment.
This can be relieved by Calamine Lotion or see your doctor or
pharmacist to advise on creams or anti-histamines to reduce this
irritation.

ALL close family and ‘skin to skin’ contacts must be treated at the
same time to prevent re-infection. Even if symptoms are not evident.

Do not be embarrassed to tell all close family/friends/school and
other contacts, as Scabies is NOT a condition of poor hygiene.
118
Do you need to stay off Work or School?

You should treat immediately – once the correct cream/lotion has
been used there is no need to stay off work or school.

It is important to inform all close contacts, as they will require
treatment as well, even if they have not symptoms or itching.
119
Scarlet Fever
INFORMATION SHEET
What is Scarlet Fever?
It is an acute bacterial childhood infectious disease. It may also be
referred to as ‘Scarletina’.
It usually affects:
The pharynx (back of the mouth & throat) but, may also affect the skin.
The disease tends to be most common in the late winter and spring.
How is Scarlet Fever spread?
Scarlet Fever is usually spread by:

The secretions from the nose and throat of an infected person – when
they cough or sneeze.

Objects contaminated by the secretions of an infected person e.g.
hankies, clothes, and toys – though this method of spread is unusual.

Contaminated foodstuffs, especially unpasteurised milk.
What is the incubation period of Scarlet Fever?

The incubation period is usually 2-5 days, although it may be as short
as 1 day and as long as 7 days.
What are the symptoms of Scarlet Fever?

The symptoms vary a great deal. In some cases there is only a sore
throat and swelling of the glands in the neck.

The tonsils may be covered by a patchy white discharge.
120

The bright red rash (from which the disease takes its name)
appears on the 2nd day and can be mild or widely spread.

The rash is usually fine and red, will ‘blanch’ (fade) under pressure,
and is commonly marked with points or punctures that feel like
sandpaper to touch.

The rash mainly occurs on the neck, chest, in the folds of the
underarm, elbows, groin, and on the inner thighs.

Typically, the rash does not involve the face, but there may be
‘flushing’ of the cheeks and paleness around the mouth.

A high temperature (fever), nausea and vomiting sometimes occur
in severe infections.

During recovery, the skin can peel, particularly from the fingers
and toes.
What is the treatment for Scarlet Fever?

If treated promptly with penicillin or an alternative antibiotic, the
condition will quickly become non-infectious. However, untreated
patients can be infectious for 2 – 3 weeks.

These days with treatment, the infection rarely causes any
complications.
How long should I stay off work, school or nursery?
It is recommended that someone with Scarlet Fever should stay off
work/school or nursery for at least 5 days after starting their
antibiotic treatment.
121
Shingles
(Herpes Zoster)
INFORMATION SHEET
What is Shingles? (Herpes Zoster)
Shingles is an infection caused by the reactivation of a virus called the
Varicella Zoster Virus - the virus that causes chickenpox.
When a person has chickenpox the virus remains inactive in their body.
Later in life, if their immune system is weakened (a person is run down or
stressed), this virus can reactivate.
A person can have shingles more
than once.
Shingles causes:
 A rash - with blister-like spots which contain fluid
 The rash usually follows the area where there are nerve pathways - the
trunk, the face and around the eyes are often affected.
 Pain - because the rash follows the nerve pathways it can cause severe
pain. Sometimes this pain will persist for some time, even after the
shingles infection has cleared up.
 The severity of shingles depends upon age - the older you are the
worse it is likely to be.
Who does if affect?
Mainly adults, particularly those over the age of 40 years, but shingles
can affect anyone who has previously had chickenpox.
122
Can it be passed on?
You cannot ‘catch’ shingles, it is always caused by the reactivation of the
virus, which previously caused you to have chickenpox.
It is possible though for a child or adult who does not have immunity to
chickenpox to develop a chickenpox infection from someone who has
shingles.
If a person has no natural immunity to chickenpox they may develop the
infection if they come in direct contact with the following secretions of
someone who has shingles:

The fluid contained in the blister-like spots of the rash

Items recently contaminated, for example, towels and bed linen.
Do you need any treatment?
YES, most people with shingles will require pain-killers (analgesics) as the
rash can cause severe pain. Sometimes analgesics are ineffective so your
doctor may prescribe other types of medication, which may be more
helpful in relieving the severe pain and discomfort.
Anti-viral treatment can be given but the treatment must be started
early (within 72 hours of the onset of the shingles) if it is to be
effective.
Sometimes the rash may get infected (e.g. from scratching), if this
happens then your doctor may prescribe some antibiotics to treat this
secondary infection.
Occasionally, shingles may affect a person’s eye (if the rash affects the
area of the face around the eye) and the doctor may refer you to an eye
specialist.
Should you stay off Work or School?
If the rash is only on your body and will be completely covered by
clothing, then the risk to other people who have no natural immunity to
chickenpox will be greatly reduced, so you will be able to return to
work/school if you feel well enough.
123
Tuberculosis
(TB)
INFORMATION SHEET
What is Tuberculosis (TB)?
It is an infection caused by a bacterium (germ). It can affect any part of
the body, but commonly affects the lungs.
Tuberculosis used to be more common in Ireland. There were nearly 7000
cases a year in the early 1950’s. The incidence of TB has declined steadily
since then, but there are still over 400 cases notified in Ireland each
year. Doctors are obliged to notify each case of TB to the local
Department of Public Health in the Health Board.
What are the symptoms?

Cough - sometimes blood streaked

Shortness of breath

Weight loss/loss of appetite

Sweating - particularly at night

Occasionally lumps in the neck or swelling of the joints

Severe tiredness
How is Tuberculosis (TB) caught?
The bacteria are spread by the coughing and sneezing of someone whose
lungs are infected with tuberculosis.

Tuberculosis infection NOT in the lungs is not usually considered
infectious.

Tuberculosis caught from cow’s milk (Bovine TB) is now rare, as
pasteurisation of milk removes the risk.
124
How is TB diagnosed?
Tuberculin Test- this is done in the skin of the arm. A few days later, a
red area or a slight bump can appear. This can tell if TB infection is
recent or if the immune system could react to TB infection if it should
come in contact with it.
Who can it affect?
ANYONE:

All adult household contacts or others who have had exposure of
greater than 10 conversation hours with someone whose lungs are
infected with tuberculosis. In children the length of conversation time
is greatly reduced to 5 hours.

The very young, the elderly and people with a compromised immune
system are particularly vulnerable to infection, including tuberculosis.

The elderly who have had previous TB (known or unknown) are at risk
of re-activation, as they get older.
Are there different types of TB?
There are three main types of TB,
 TB infection- this is an early and mild kind of TB. It is not
infectious, as the germ cannot be passed on to anyone else.
 Non-infectious TB disease- this is a more severe type of TB. The
person usually has some symptoms, but the germ cannot be passed
onto anyone else.
 Infectious TB disease- The TB has progressed to the stage that
the germ can be coughed up from the lungs and so close contacts
may become infected.
What is the difference between latent tuberculosis and active
tuberculosis?
Most people who are exposed to TB are able to overcome the bacteria.
The bacteria become inactive, but they remain alive in the body and can
become active later. This is called latent TB.
125
People with latent TB:
·
·
·
·
·
Have no symptoms
don’t feel sick
can’t spread TB to others
usually have a positive skin test reaction
Can develop TB disease later in life
Most people who have latent TB may never develop active TB disease. In
these people, the TB bacteria remain inactive for a lifetime without
causing disease. But in other people, who have weak immune systems, the
bacteria can become active and cause active TB disease.
How long does it take to become ill?
TB develops slowly usually taking weeks or months to cause symptoms,
sometimes even years later, perhaps after some serious illness.
How do you treat Tuberculosis?

It is treated with a course of medicines.

The course of treatment is often taken for several months to
completely cure the tuberculosis.

It is very important to take the medicine as instructed AND to take
the full course.

You can continue with a normal life whilst taking the treatment.

People who live in the same house or have close prolonged personal
contact with someone with tuberculosis in their lungs may be asked to
go to the Chest Clinic for a simple skin test and/or chest x-ray.
Should you stay off work or school?

Someone who has tuberculosis in his or her lungs should stay off until
having had at least two weeks of tuberculosis treatment - but the
doctor will advise you.
126

Contacts of someone with tuberculosis in their lungs do NOT need to
stay off work or school.
How do you prevent the spread of Tuberculosis?

BCG vaccination is a protection against tuberculosis and is offered to
children in school when they are 12-14 years of age or to babies who
are considered to be at higher than normal risk.

CLOSE personal contacts of someone with tuberculosis in their lungs
may be asked to attend the Chest Clinic for a simple skin test and/or
chest x-ray to make sure they have not caught the infection.

Report any persistent cough or any of the other symptoms to your
doctor for assessment.

Persons who work in high-risk occupations e.g. health care workers,
should ensure they are protected by a BCG vaccination - a small flat
circular scar is often visible on your upper arm, but check with your
doctor or practice nurse if you are unsure.
127
Tetanus
INFORMATION SHEET
What is tetanus?
Tetanus is an acute bacterial disease, which is characterised by the
muscles firstly in the neck and then in the chest becoming rigid, followed
by painful muscular contractions.
A bacterium called tetanus bacilli causes this.
How do you catch it?
The bacterium is present in soil and may be introduced into the body
during injury, often through a puncture wound, but also through a burn or
trivial unnoticed wounds.
Tetanus spores can also be found in the gut of some animals especially
horses and can be detected in the environment generally.
The incubation period is from 4 to 21 days. The average time being 10
days.
Tetanus is not spread from person to person.
How can I avoid it?
By ensuring adequate tetanus immunity through immunisation.
By the age of four months, every child should have had three doses of
tetanus as part of the childhood immunisation programme i.e. the
diphtheria, tetanus and pertussis vaccine (DTP or DTaP).
Further tetanus vaccinations are given at pre-school age and another
before leaving school.
128
A total of five doses are considered to give life long immunity unless
there is a specific exposure. This is known as active immunisation.
Tetanus immunisation (either passive or active) may be given to
individuals who have not completed their immunisation programme and
who have sustained a major wound and/or the wound is contaminated with
soil containing animal excreta. Treatment will be assessed at the time of
injury.
What happens if someone develops tetanus?
The individual will be unwell to the extent that they will require
hospitalisation. This may result in intensive care treatment depending on
his / her condition.
Do I need tetanus vaccination when travelling abroad?
Depending on your travel destination, if you have had your tetanus
immunisation is up to date; you will not require further tetanus vaccine.
However, it is important to check either with your GP, or travel health
clinic.
Additional Information
Women born pre 1950s may not be fully immunised.
129
Toxoplasmosis
INFORMATION SHEET
What is Toxoplasmosis?
Toxoplasmosis is an infection, which is caused by a tiny parasite called
protozoa. Symptoms may be so mild that they do not cause a person any
problems, or they may cause:
Fever
Malaise
Swollen lymph glands
-
usually mild
tiredness and lethargy
often in the neck
Who does it affect?
ANYONE - who has not developed a natural immunity,
Many adults will have developed natural immunity, which will last for most
of their life, but children and people with a weakened immune system are
more vulnerable.
How do you get Toxoplasmosis?
The parasite, which causes Toxoplasmosis, is found in most animals and
birds. However, the cat is the animal, which is commonly associated with
human infection, as the parasite lives in the gut of the cat and is then
passed out in the faeces.
You can also get Toxoplasmosis from:  Eating uncooked meat
 Eating raw or cured meat e.g. Salami
 Eating unwashed and/or uncooked vegetables
130
 Eating dairy products made from unpasteurised milk - especially goats
milk
 From contact with cats faeces e.g. emptying a litter tray
 From contact with soil contaminated by cats faeces e.g. when gardening
How do you prevent getting Toxoplasmosis?
 By not eating the previously mentioned foods.
 By thoroughly washing utensils like knives and chopping boards after
contact with raw meat.
 By washing hands after handling raw meat.
 By washing all vegetables, salad and fruit thoroughly before eating.
 By always washing hands before eating.
 By washing hands after any contact with animals and animal faeces,
especially cats.
 By wearing gloves when gardening and washing both you’re hands and
the gloves when finished.
 By covering over children’s sandpits when not in use to prevent animals
soiling them.
Do you need treatment?
Toxoplasmosis is usually very mild and does not require any treatment but
occasionally certain people may require antibiotics e.g. pregnant women.
131
What is special about Toxoplasmosis?
Toxoplasmosis is one of the few infections, which can affect the
developing baby of a pregnant woman.
Infection, which occurs between the second and sixth month of
pregnancy, is more likely to affect the baby than that occurring later in
pregnancy, and may cause stillbirth or conditions such as cerebral palsy or
epilepsy in the baby.
It is important to know that Toxoplasmosis is a RARE infection in
pregnancy, but pregnant women should take all necessary precautions to
avoid Toxoplasmosis.
Though a healthy cat is NOT a particular risk to a pregnant woman, care
of an ill cat and emptying of litter trays should be left to other people.
Also, in people who have a severely weakened immune system (for example
people with HIV disease) parasites previously acquired in an earlier
infection can reactivate and may cause serious symptoms.
132
Threadworms
INFORMATION SHEET
What are Threadworms?
They are tiny white worms about 2mm long which infect the bowel
and lay their eggs on the skin around the anus / back passage.
Who can they affect?
ANYONE – they are the most common worm infection in Ireland and
are surprisingly common in young children.
How do you know you have Threadworms?

They can be seen in the stools/motions

They look like short threads of white cotton or grains of white rice.

They cause excessive itching around the anus/back passage and the
surrounding skin.

Disturbed sleep due to itching.
How do you treat Threadworms?

The doctor will prescribe a medicine to get rid of them.

The whole family should be treated at the same time as they may have
been passed on in the family – this will prevent re-infection occurring.
133
How are Threadworms caught?

When a person has threadworms they get eggs on their hands and
under their fingernails, when they scratch their anus/back passage or
when wiping themselves after going to the toilet.

If hands and nails are not properly clean the eggs then get into food
or in the mouth and get eaten.

Once eaten, they get into the bowel and start to lay eggs causing a
cycle of re-infection.

From contaminated bed linen, night clothing (pyjamas) flannels and
towels.

From infected pets.

Occasionally from contaminated carpets.
How do you prevent spread?

By keeping fingernails short.

By changing the sheets of an infected person daily.

By thorough hand washing with soap and warm water and scrubbing
finger nails: -
After going to the toilet
Before preparing or eating food

By using separate towels and flannels

By teaching and encouraging children to have good standards of
hygiene

By not allowing dogs and cats to foul play areas, sand pits, etc.
Threadworms are generally not harmful but are a nuisance and can be
upsetting and uncomfortable for the person infected.
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Do you need to stay off work or school?

Once an infection is found it should be treated immediately, but it is
not necessary to stay off work or school.

The nursery or school should be informed of any threadworm
infection, as they may need to take action to prevent spread within
the premises.
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Viral-Gastroenteritis
INFORMATION SHEET
What is Viral Gastroenteritis?
It is an illness that is caused by a number of different viruses, most
commonly Small Round Structured Virus (SRSV), Norovirus and Rotavirus.
It can cause:







Nausea
Vomiting – which may be projectile
Diarrhoea - often watery
Stomach pains and cramps
Headache
Fever
Malaise
These symptoms usually last from between 24 – 48 hours.
How is Viral Gastroenteritis caught?

From other people who are ill with Viral Gastroenteritis – from
contact with their stool or vomit

From food contaminated by someone who has Viral Gastroenteritis

From raw or undercooked food, particularly meat and shellfish.
Who can it affect?
ANYONE
vulnerable.
- but the very young and the elderly are particularly
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Do you need to stay off work or school?
YES - until you have been free from any symptoms for 48 hours and are
feeling quite well.
How do you prevent it?

By always washing hands thoroughly with soap and warm water: -
After going to the toilet;
After contact with pets and animals;
After changing a baby’s nappy
Before preparing and serving food;
Before eating food.

By always practising good food hygiene.

Avoid contaminating cooked food by allowing contact with raw food
and dirty knives or chopping boards etc.

By thoroughly cooking all food, especially meat and shellfish.
When travelling abroad:

Drink bottled water

Avoid ice in your drinks

Clean your teeth with bottled or treated water

Ensure all food is thoroughly cooked and kept in hygienic conditions

Avoid buying food from street vendors

Avoid fruit unless you can peel it yourself

Wash salad with bottled water
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How do you stop the spread of Viral Gastro-enteritis?
Viral Gastro-enteritis is highly infectious, so if you or a member of your
household has viral gastro-enteritis or any type of diarrhoea or vomiting,
be extra careful with hand and general hygiene practices.

Clean the following at least twice daily with detergent and hot water,
followed by a suitable disinfectant or bleach:
-
Toilet Seats
Toilet Bowl
Flush handles
Taps and wash hand basins

If you use a disinfectant or bleach, ensure it conforms to a European
Standard and store it safely out of the reach of children.

Use a separate towel.
 Soiled clothes should be laundered on as hot a wash as possible. Do not
Overfill your washing machine or it will not clean them properly. Keep
Soiled washing separate from the rest of the washing.
Because it is highly infectious, Viral Gastro-enteritis can be a
particular problem in institutions like schools, nursing homes and
hospitals, so extra care with hand and general hygiene is of
particular importance here.
Vomit and Faeces Cleaning
1.
In the event of a member of staff or a member of the public
having a vomit/ faecal accident the area must be cleaned as a
matter of urgency. The area where such an incident has occurred
should be closed, or cordoned off, for at least one hour and all
windows opened to allow thorough air circulation.
2. In the event of an outbreak the frequency of cleaning toilets
should be increased to at least every hour during the day and
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evening. All surfaces in the toilet areas should be cleaned with a
bleach disinfectant using disposable cloths.
Cleaning and disinfection procedures.
As Norovirus or SRSV is a very hardy organism, it is necessary to use a
dilute bleach solution or steam cleaning of surfaces, which have been or
may have been soiled by someone getting sick or having a faecal accident,
to ensure that the virus has been destroyed.
NOTE: ORDINARY WASHING WITH SOAP AND DISINFECTANT
IS NOT SUFFICIENT.
Hypochlorite (Bleach) Solution
The recommended level of 1000ppm is 0.1% hypochlorite or bleach
solution. Bleach of this concentration is most easily made up by adding 2
capfuls of ordinary household bleach to a 1-gallon bucket of water.
Cleaning Cloths

Disposable clothes should be used.

Separate coloured cloths should be used in toilet areas.
Guidance on cleaning up vomit and faeces.
Individuals, who clean up vomit or faeces, in order to minimize the risk of
infection to them selves, should use the following precautions:
1. Wear disposable gloves and plastic disposable apron.
2. Use paper towels to soak up excess liquid. Transfer these and any
solid matter directly into a plastic waste bag.
3. Clean the soiled area with detergent and hot water, using a
disposable cloth.
4. Disinfect the contaminated area with freshly made 0.1%
hypochlorite solution. (Note that bleach is corrosive and may
bleach furnishings and fabrics)
5. Dispose of apron and cloths into a waste bag for burning.
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6. Wash hands thoroughly using soap and water for at least 1 minute
and then dry them.
Treatment of specific materials

Contaminated linen and other materials should be placed carefully
into separate laundry bags. They should be washed in a hot wash. If
an outside laundry is used they should be consulted, as the laundry
is potentially infectious.

Soft furnishings such as chairs can be placed outside in the sun for
a few hours.

Mattresses that have not been soiled can be thoroughly aired in
the sun for a few hours. Soiled mattresses should be removed for
steam cleaning.

Contaminated carpets should be cleaned with detergent and hot
water, then disinfected with hypochlorite (if bleach-resistant) or
steam cleaned.

Contaminated hard surfaces should be washed with detergent and
hot water, using a disposable cloth, then disinfected with 0.1%
hypochlorite solution. Cloths should be disposed of as waste. Nondisposable mop heads should be laundered in a hot wash.

Horizontal surfaces, furniture and soft furnishings in the vicinity
of the soiled area should be cleaned with detergent and hot water,
using a disposable cloth.

Fixtures and fittings in toilet areas should be cleaned with
detergent and hot water using a disposable cloth, then disinfected
with 0.1% hypochlorite solution.
Cleaning up vomit in food preparation areas
1. Using the above principles, carefully remove all vomit and clean the
area.
2. Disinfect the food preparation area (including vertical surfaces)
with a freshly prepared 0.1% solution.
3. Destroy any exposed food, food that may have been contaminated
and food that has been handled by an infected person.
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Viral Meningitis
INFORMATION SHEET
What is Viral Meningitis?
There are two main types of meningitis: viral and bacterial. Viral
meningitis, also known as “aseptic meningitis”, is the commonest type and
is most frequently seen in children. It is a milder disease than bacterial
meningitis and is rarely fatal. People with viral meningitis may have severe
symptoms but they usually recover completely. There is no specific drug
treatment for viral meningitis. Bacterial meningitis, on the other hand, is
usually more severe, can be fatal and requires prompt treatment with
antibiotics.
What are the symptoms of Viral Meningitis?
The symptoms of viral meningitis may include:

High temperature

Severe headache

Stiff neck

Bright lights hurt the eyes

Drowsiness

Confusion

Nausea and vomiting
The symptoms in young babies may be more difficult to identify and
include high temperature, irritability, difficulty in waking the baby from
sleep and refusing to eat. The symptoms of bacterial meningititis may be
identical, particularly in the early stages of the disease. For this reason it
is important that if you think that your child may have meningitis you
should contact your doctor as soon as possible.
How is Viral Meningitis spread?
The viruses that cause viral meningitis are contagious and can be easily
spread from person to person. However most people who get infected
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with these viruses do not become ill, or else just develop a mild cold or
rash with a slight fever. Less than 1 in 1000 people infected with these
viruses develop viral meningitis.
How can I protect myself from infection?
Although the risk of acquiring viral meningitis is small it is sensible to
take precautions to protect yourself and your family against this
infection. The most important protection against the viruses that cause
viral meningitis is hand washing:

You should wash your hands with soap and water after any contact
with someone who has viral meningitis or a similar illness.

You should also wash your hands after using the toilet and before
preparing or eating food.

Because babies frequently carry the viruses that cause viral
meningitis it is particularly important to wash your hands after
changing or handling dirty nappies.

Viral meningitis is mainly seen in children so it is important to
encourage your children to wash their hands after using the toilet,
before eating or if they are in contact with someone who is ill.
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Bacterial Meningitis/Meningococcal
Disease
INFORMATION SHEET
Invasive meningococcal disease is the most common form of bacterial
meningitis in Ireland, causing up to 90% of the cases. This disease may
present as meningitis, septicaemia (blood poisoning) or both.
What is meningitis?
Meningitis is an inflammation of the meninges, which is the name given to
the covering layer of the brain and spinal cord.
What is septicaemia?
Septicaemia is a form of blood poisoning caused by the same organism
that causes meningitis.
What causes invasive meningococcal disease?
Neisseria meningitidis is the name of the bacteria that is responsible.
There are several different types of Neisseria meningitidis, these include
groups A, B, C, W135 and Y. Group B and Group C are the most common
forms seen in Ireland.
What are the signs and symptoms?
a. Adults and older children (see Figure 1)
Classical symptoms and signs would include temperature, severe
headache, neck stiffness, nausea and/or vomiting, dislike of bright
lights, drowsiness and joint or muscle pains. The patient may be
confused and disoriented or have fitting episodes. Not all of these
symptoms may appear.
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Figure 1.
(provided by The National Meningitis Trust)
b. Babies and infants (see Figure 2)
Classical symptoms and signs of meningitis such as dislike of bright lights
and neck stiffness are uncommon and difficult to determine in infants
and small children. Figure 2 gives some of the warning signs to look out
for, but again some or all of these may not be present. Do not
underestimate a parental instinct that "something is wrong".
Figure 2.
(provided by The National Meningitis Trust
Both adults and babies may have a rash. If bacteria enter the
bloodstream, they can release toxins, which can damage the walls of blood
vessels causing a leakage of blood under the skin. The appearance of the
rash can vary. It may start as tiny blood spots which look like red pinprick type marks which if untreated can spread to form bruises or blood
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blisters. Do not wait for a rash to appear. It may be the last sign to
appear and it can spread very quickly.
If you see or suspect a rash seek medical attention immediately.
How do you get invasive meningococcal disease?
The bacteria which cause meningococcal meningitis and meningococcal
septicaemia are common and can live naturally in the back of the nose and
throat. It is spread by respiratory droplets, which are most efficiently
generated by coughing, sneezing and mouth kissing. Depending on the age
group, up to 1 in 10 people may carry these bacteria. Carriage is uncommon
in infancy and early childhood but increases with age. Peak carriage rates
may occur in the 15-19 year old group of whom 25% are carriers. Carriage
is typically followed by the development of immunity. Only a small
minority of carriers will develop meningitis or septicaemia after an
incubation period of 2-3 days. Why some people develop meningitis and
others don’t is not fully known but it is believed that on occasion the
bacteria can overcome the body’s immune system and cause meningitis and
meningococcal septicaemia.
Who is most at risk?
Invasive meningococcal disease may occur at any age but is most common
in infancy and early childhood with an additional smaller peak of disease
activity in adolescents and young adults. In temperate climates such as
Ireland the infection typically shows a seasonal variation with the
majority of cases occurring in winter and early spring.
Can invasive meningococcal disease be treated?
The answer is yes. The earlier the diagnosis, the earlier treatment with
antibiotics can begin and therefore the greater chance that the person
will make a full recovery. Early diagnosis is the key so if you suspect that
someone may have meningitis or septicaemia seek medical attention
immediately.
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Is there a vaccine available for meningococcal meningitis?
When talking about vaccines it is important to remember that there are
several different types of Neisseria meningitidis bacteria, including
groups A, B, C, W135 and Y with groups B and C being the most common in
Ireland.
Group C: The meningococcal group C conjugate vaccine (Men C) was
introduced in Ireland in October 2000 into the infant immunisation
schedule at 2, 4 and 6 months. A catch-up programme was also launched
at the time offering the vaccine to everyone up to and including 22 years
of age. Prior to the introduction of the Men C vaccine to Ireland, group C
accounted for 30-40% of the meningococcal disease cases each year
The Men C vaccine is the vaccine that is given to household and very close
contacts of a patient who becomes ill with group C meningococcal disease.
It is this vaccine that is also used in the control of group C meningococcal
disease outbreaks in for example schools and military establishments.
Note: The Men C vaccine only protects against group C meningococcal
disease and does not protect against other forms of the disease such as
groups A, B, W135 and Y.
Group B: Currently there is no suitable vaccine available against
meningococcus group B, which in Ireland is now responsible for 75-80% of
meningococcal meningitis and septicaemia cases each year. Therefore, it
is important that parents and health care professionals are ever vigilant
to the signs and symptoms of meningococcal disease.
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