Infectious Disease and Health Protection Agency

7 July 2016

The guidance is divided into sections as follows: Section 1Introduces infection control and explains notification; Section 2deals with general infection control procedures; Section 3gives guidance on the management of outbreaks; Section 4describes specific infectious diseases; Section 5contact numbers and sources of information; Section 6contains additional detailed information and a table of diseases; Section 7contains risk assessments relevant to infection control; Section 8 research sources, references and useful web sites

Further information is available from the Food Safety Adviser at Leicestershire County Council and from the Health Protection Agency – East Midlands South. Contact numbers are listed in Section 5. The aim of this document is to provide simple advice on the actions needed in the majority of situations likely to be encountered in social care settings. It is written in everyday language and presented so that individual subject areas can be easily copied for use as a single sheet. 1. 1 HOW ARE INFECTIONS TRANSMITTED? 1. 2 INFECTION CONTROL GUIDANCE

Infectious Disease and Health Protection Agency Essay Example

Infection control forms part of our everyday lives, usually in the form of common sense and basic hygiene procedures. Where large numbers of people come in contact with each other, the risk of spreading infection increases. This is particularly so where people are in close contact and share eating and living accommodation. It is important to have guidelines to protect service users, staff and visitors. Adopting these guidelines and standard infection control practices will minimise the spread of infectious diseases to everyone. External Factors

If you or someone in your immediate family has a “Notifiable Disease” such as Measles (see 1. 3) or infection such as Impetigo, diarrhoea, vomiting or Scabies, please inform your line manager before coming to work. If you regularly visit people in hospital please be aware of the potential risk of cross infection to yourself and the person you are visiting. Above all when dealing with service users and their families we must all remember we are dealing with people. There will be personal issues of privacy and sensitivity, which we must handle with tact and discretion at all times. What are Infection Control Practices?

Infection control practices are ways that everyone (staff, service users & volunteers) can prevent the transmission of infection from one person to another. They are practices which should be routinely adopted, at all times with every individual, on every occasion, regardless of whether or not that person is known to have an infection. 1. 2 INFECTION CONTROL GUIDANCE – cont. include: 1. 3 NOTIFICATION OF INFECTIOUS DISEASES A number of infectious diseases are statutorily notifiable under The Public Health (Control of Disease) Act 1984 and The Public Health (Infectious Diseases) Regulations 1988.

There are three main reasons for such notification. So that control measures can be taken To monitor preventative programmes For surveillance of infectious diseases in order to monitor levels of infectious diseases and to detect outbreaks so that effective control measures can be taken. All doctors diagnosing or suspecting a case of any of the infectious diseases listed overleaf have a legal duty to report it to the Proper Officer of the Local Authority, who is usually the Consultant in Communicable Disease Control based at the Health Protection Agency.

Notification should be made at the time of clinical diagnosis and should not be delayed until laboratory confirmation is received. Infections marked (T) should be notified by telephone to the Consultant in Communicable Disease Control (see Section 5) and confirmed by completion of a written notification form. 1. 3 NOTIFICATION OF INFECTIOUS DISEASES – cont. Notifiable Diseases Acute encephalitis Paratyphoid(T) Acute poliomyelitisPlague(T) AnthraxRabies(T) Cholera(T)Relapsing Fever(T) Diphtheria(T)Rubella Dysentry(T)Scarlet Fever Food poisoning orSmall Pox suspected food poisoning LeprosyTetanus LeptospirosisTuberculosis

MalariaTyphoid fever(T) MeaslesTyphus fever(T) Meningitis * (T)Viral haemorrhagic fever(T) Meningococcal septicaemia(T)Viral hepatitis ** (without meningitis) MumpsWhooping cough Opthalmia neonatorumYellow fever * meningococcal, pneumococcal, haemophilus influenzae, viral, other specified, unspecified ** Hepatitis A, Hepatitis B & Hepatitis C, other (T)Please notify the Consultant in Communicable Disease Control or person on call for the Health Protection Agency by telephone. Other specific diseases are designated by the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 as “Reportable Occupational Diseases” e.

g. Legionellosis. Please contact the Health & Safety Team for further information (see section 5 for details). 1. 3 NOTIFICATION OF INFECTIOUS DISEASES – cont. Notification of suspected outbreaks An outbreak is defined as two or more cases of a condition related in time and location with suspicion of transmission. Prompt investigation of an outbreak and introduction of control measures depends upon early communication. Suspicion of any association between cases should prompt contact with the Health Protection Agency. 1. 4 IMMUNISATION

COSHH requires that if a risk assessment shows there to be a risk of exposure to biological agents for which vaccines exist, then these should be offered if the employee is not already immune. In practice, with Social Care Services, this generally amounts to care staff within the Mental Health and Learning Disabilities Services being offered Hepatitis B vaccination. Care home managers, after assessing risks, may also offer ‘flu vaccination to staff and individual cases may indicate the need for immunisation in certain circumstances. The pros and cons of immunisation/non-immunisation should be explained when making the offer of immunisation.

The Health & Safety at Work Act 1974 requires that employees are not charged for protective measures such as immunisation. A few GPs will make vaccinations available free to Social Care workers but they are not obliged to do so and can charge at their discretion. Departmental funding for the provision of vaccine, through Occupational Health, is restricted and so it is vital that only those to whom it is essential to provide immunisation are offered this service. The majority of staff will have received immunisation from childhood and have received the appropriate booster doses e. g. Tetanus, Rubella, Measles and Polio.

However, it is important for the immunisation state of staff to be checked e. g. women of childbearing age should be protected against Rubella. Good practice and common sense should indicate that the immunisation state of staff is checked and appropriate action taken. If there is a potential risk of infection, change of work rotas or areas of responsibility can sometimes avoid the risk of contamination. Vaccination is not always the only course of action and in some cases staff may not agree to be vaccinated. 1. 4. 1 IMMUNISATION SCHEDULE Vaccine Age Notes D/T/P and Hib Polio 1st dose at 2 months

2nd dose at 3 months 3rd dose at 4 months Primary Course Measles / Mumps / Rubella (MMR) 12 – 15 months Can be given at any age over 12 months Booster DT and Polio, MMR second dose 3 – 5 years Three years after completion of primary course BCG 10 – 14 years or infancy Only offered to certain high risk groups after an initial risk assessment Booster Tetanus, Diphtheria and Polio 13 – 18 years Children should therefore have received the following vaccines: By 6 months:3 doses of DTP, Hib and Polio By 15 months:Measles / Mumps / Rubella By school entry:4th DT and Polio; second dose of Measles / Mumps / Rubella

Between 10 & 14 years:BCG (certain high risk groups only) Before leaving school:5th Polio and Tetanus Diphtheria (Td) Adults should receive the following vaccines: Women sero-negative Rubella For Rubella: Previously un-immunisedPolio, Tetanus, Diphtheria Individuals: Individuals in high Hepatitis B, Hepatitis A, Influenza risk groups:Pneumonococcal vaccine 1. 5 EXCLUSION FROM WORK The following table gives advice on the minimum period of exclusions from work for staff members suffering from infectious disease (cases) or in contact with a case of infection in their own homes (home contacts).

Advice on work exclusions can be sought from CCDC (Consultant in Communicable Disease Control) / HPN (Health Protection Nurse) / CICN (Community Infection Control Nurse) / EHO (Environmental Health Officer) or GP (General Practitioner) Minimum exclusion period Disease Period of Infectivity Case Home contact Chickenpox Infectious for 1-2 days before the onset of symptoms and 6 days after rash appears or until lesions are crusted (if longer) 6 days from onset of rash None. Non-immune pregnant women should seek medical advice Conjunctivitis Until 48 hours after treatment Until discharge stops None

Erythema infectiosum (slapped cheek syndrome) 4 days before and until 4 days after the onset of the rash Until clinically well None. Pregnant women should seek medical advice Gastroenteritis (including salmonellosis and shigellosis) As long as organism is present in stools, but mainly while diarrhoea lasts Until clinically well and 48 hours without diarrhoea or vomiting. CCDC or EHO may advise a longer period of exclusion CCDC or EHO will advise on local policy Glandular fever When symptomatic Until clinically well None Giardia lamblia While diarrhoea is present Until 48 hours after first normal stool

None Hand, foot and mouth disease As long as active ulcers are present 1 week or until open lesions are healed None Hepatitis A The incubation period is 15-50 days, average 28-30 days. Maximum infectivity occurs during the latter half of the incubation period and continues until 7 days after jaundice appears 1 week after onset of jaundice None – immunisation may be advised (through GP) HIV/AIDS For life None None 1. 5 EXCLUSION FROM WORK – cont. Minimum exclusion period Disease Period of infectivity Case Home contact Measles Up to 4 days before and until 4 days after the rash appears

4 days from the onset of the rash None Meningitis Varies with organism Until clinical recovery None Mumps Greatest infectivity from 2 days before the onset of symptoms to 4 days after symptoms appear 4 days from the onset of the rash None Rubella (German measles) 1 week before and until 5 days after the onset of the rash 4 days from the onset of the rash None Streptococcal sore throat and Scarlet fever As long as the organism is present in the throat, usually up to 48 hours after antibiotic is started Until clinically improved (usually 48 hours after antibiotic is started) None

Shingles Until after the last of the lesions are dry Until all lesions are dry – minimum 6 days from the onset of the rash None Tuberculosis Depends on part infected. Patients with open TB usually become non-infectious after 2 weeks of treatment In the case of open TB, until cleared by TB clinic. No exclusion necessary in other situations Will require medical follow-up Threadworm As long as eggs present on perianal skin None but requires treatment Treatment is necessary Typhoid fever As long as case harbours the organism Seek advice from CCDC

Seek advice from CCDC Whooping cough 1 week before and until 3 weeks after onset of cough (or 5 days after the start of antibiotic treatment) Until clinically well, but check with CCDC None 1. 5 EXCLUSION FROM WORK – cont. SKIN CONDITIONS Minimum exclusion period Disease Period of infectivity Case Home contact Impetigo As long as purulent lesions are present Until skin has healed or 48 hours after treatment started None. Avoid sharing towels Head lice As long as lice or live eggs are present Exclude until treated Exclude until treated Ringworm

1. Tinea capitis (head) 2. Tinea corporis (body) 3. Tinea pedis (athlete’s foot) As long as active lesions are present As long as active lesions are present As long as active lesions are present Exclusion not always necessary until an epidemic is suspected None None None None None Scabies Until mites and eggs have been destroyed Until day after treatment is given None (GP should treat family) Verrucae (plantar warts) As long as wart is present None (warts should be covered with waterproof dressing for swimming and barefoot activities) None

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