Beechdale Health Centre

Contagious Illness Policy

Document Control

A.Confidentiality Notice

This document and the information contained therein is the property of Beechdale Health Centre.

This document contains information that is privileged, confidential or otherwise protected from disclosure. It must not be used by, or its contents reproduced or otherwise copied or disclosed without the prior consent in writing from Beechdale Health Centre.

B.Document Details

Classification: / Public
Author and Role: / Arun Venugopal & Jane Smith
Organisation: / Beechdale Health Centre
Document Reference: / CIP
Current Version Number: / 1
Current Document Approved By: / Jane Smith
Date Approved: / 07.03.2013

C.Document Revision and Approval History

Version / Date / Version Created By: / Version Approved By: / Comments
1 / 07.03.2013 / Jane Smith / Arun Venogupal / Staff to read.
1.1 / 01.04.2014 / Arun Venugopal / Arun Venugopal / Reviewed from Initial Document

Introduction

Infection control is an important and integral part of the function of each and every General Practice. This is the case for services provided within the community (e.g. in a patient’s home) as well as on Practice premises.

Many infection control problems and outbreaks can be curtailed quickly if action is taken at the earliest opportunity,so timely communication with the appropriate specialists is essential.

Ensuring that the principles of infection control are incorporated throughout the Practice can help to ensure the best possible environment for the prevention and control of infection.

The Practice has many, readily-accessible, policies to enablemanagers to educate their staff about infection control precautions and actions to be taken in the event of incidents, for example: needle-stick or inoculation injuries. These policiesare also underpinned by a high standard of training in infection control precautions and procedures.

By ensuring that staff members practise a good standard of infection control at all times the Practice will play a significant role in reducing infection in our local community.

Newly employed staff will, during the first week of their induction process, bemade familiar with the Practice’s variousinfection control policies. Refresher training will also be mandatory for all staff on an annual basis and / or when new practices / methods become available.

Practice nursewill also periodically undertake an assessment of the infection risks in the Practice and ensure that everything necessary is in place to manage those risks.

Practice nurse isthe Infection Control Leadfor Beechdale Health Centre. This person will act as the link between the PCT Infection Control/Health Protection Team(s) and the Practice.

Occupational Health Arrangements

The Practice has arrangements in place for occupational health support and advice, together with appropriate policies for the protection of staff from infection through immunisation, the avoidance and management of incidents, and training and compliance with health and safety legislation.

Each new member of staff must complete a pre-employment health questionnaire and provide information about previous immunisation against relevant infections. Patients and other staff also need to be protected from staff infected with a communicable disease.

The Practice’s occupational health policies set out the responsibilities of staff members to report episodes of their own illness,(e.g. vomiting, diarrhoea), to the Practice manager.

Clinical Waste

Infectious Waste

Practice staff must assess any waste produced during consultations and determine the risk of infection that it could cause if handled and disposed of incorrectly.Assessment should be based on professional judgement, clinical signs and symptoms, and prior knowledge of the patient.

Wounds should be treated as infectious if they have apparent signs of infection or are being treated with antibiotics.

Waste products must be disposed of using orange sacks / containers and local waste collection arrangements made.

Non-infectious waste

Where the waste products from consultations are assessed as non-infectious, (e.g. non-infectious wound dressings, incontinence pads), the waste should be discarded as ‘offensive/hygiene waste’ in a yellow bag with black stripe.

Infectious Diseases in Staff

Staff members who are suffering from any sickness, diarrhoea or have a heavy cold or flu symptoms should not attend the Practice for work. This also applies to any staff members who may be suffering from septic skin conditions.

The member of staff should notify their Practice Manager as soon as possible before they are due to start work if they are suffering from any of the above conditions.

The Practice Manager must then assess the situation and make sure the appropriate action is taken (e.g. excluding the staff member from work if necessary).

Staff members who are ill must be symptom-free for 48hours before returning to work to ensure that any infection is not passed to other staff members and patients.

Infectious Disease in Patients

The Practice will ensure that patients who are suffering from any sickness that may be linked to an infectious disease will be provided during their consultation / telephone consultation / home visit with suitable leaflets / patient information sheets / information that will give them details on their particular illness (e.g. how long the illness will be contagious).

When an ill patient does not attend the Practice and contacts the doctor by telephone.

If the illness can be clearly identified over the telephone, then the correct information in relation to the illness will be provided by telephone consultation.

If a home visit is required, the doctor will follow the same procedures contained in the Patient Isolation Protocol, (i.e.wear gloves/apron etc.). Any clinical waste will be destroyed at the patient’s home as per the clinical waste policy.

Notifiable Diseases

Under the Public Health (Control of Diseases) Act 1984 there are certain diseases which must be notified to the PCT. It is the responsibility of the doctor who diagnoses the disease to notify it to a ‘Proper Officer’ at the PCT.

The doctor should fill out a notification certificate immediately on diagnosis of a suspected notifiable disease and should not wait for laboratory confirmation of the suspected infection or contamination before notification. The certificate should be sent to the Proper Officer within three days or verbally within 24 hours if the case is considered urgent.

The following list of diseases are notifiable under the Health Protection (Notification) Regulations 2010:

  • Acute encephalitis;
  • Acute meningitis;
  • Acute poliomyelitis;
  • Acute infectious hepatitis;
  • Anthrax;
  • Botulism;
  • Brucellosis;
  • Cholera;
  • Diphtheria;
  • Enteric fever (typhoid or paratyphoid fever);
  • Food poisoning;
  • Haemolytic Uraemic Syndrome (HUS);
  • Infectious bloody diarrhoea;
  • Invasive group A streptococcal disease and scarlet fever;
  • Legionnaires’ disease;
  • Leprosy;
  • Malaria;
  • Measles;
  • Meningococcal septicaemia;
  • Mumps;
  • Plague;
  • Rabies;
  • Rubella;
  • SARS;
  • Smallpox;
  • Tetanus;
  • Tuberculosis;
  • Typhus;
  • Viral haemorrhagic fever (VHF);
  • Whooping cough;
  • Yellow fever.

For some of these diseases, such as tuberculosis or food poisoning, there may be further control measures to be taken. The Health Protection Agency can offer advice on any special arrangements required.

Notifying the CQC of Serious Injury to a person who uses the Service

Practice Manager at the Practice is responsible for notifying the CQC without delay about events that lead to:

  • Serious injury to any person who uses the service.
  • An injury requiring treatment by a healthcare professional to avoid death or serious injury.

These serious injuries include:

  • Injuries that lead to or are likely to lead to permanent damage – or damage that lasts or is likely to last more than 28 days – to:

A person’s sight, hearing, touch, smell or taste

Any major organ of the body (including the brain and skin)

Bones

Muscles, tendons, joints or vessels

Intellectual functions, such as

Intelligence

Speech

Thinking

Remembering

Making judgments

Solving problems.

  • Injuries or events leading to psychological harm, including:

Post-traumatic stress disorder

Other stress that requires clinical treatment or support

Psychosis

Clinical depression

Clinical anxiety

The development after admission of a pressure sore of grade 3 or above that develops after the person has started to use the service (European Pressure Ulcer Advisory Panel Grading)

Any injury or other event that causes a person pain lasting or likely to last for more than 28 days

Any injury that requires treatment by a healthcare professional in order to prevent:

Death

Permanent injury

Any of the outcomes, harms or pain described above.

Where the Registered Person is unavailable, for any reason, practice nurse will be responsible for reporting the serious injury to the CQC.

There is a dedicated Notification form for this type of incident. The form is contained in the Outcome 20 document “Notification of Other Incidents – Outcome 20 Composite Statements and Forms”

Chickenpox / Shingles (Herpes Varicella-Zoster Virus)

Chickenpox is an acute, generalised viral infection, commonly affecting children. The rash tends to affect central areas of the body more than the limbs. The scalp, mucous membrane of the mouth and upper respiratory tract and eye may also be affected. It is infectious from about 2 days before, to 5 days after, the rash appears.

Shingles occurs only in people who have previously had Chickenpox infection. Following Chickenpox, the virus remains dormant in the body, usually in a sensory nerve root. In later months or years the virus reactivates and causes a shingles rash at the skin site supplied by the nerve. Therefore anyone with shingles must have had Chickenpox in the past, even if they don't remember it.

Certain individuals have additional risks if infected, including the immuno-compromised (e.g. those receiving steroids or cytotoxic drugs), non-immune pregnant women and neonates. If they have contact with a case during the infectious phase they may need immunoglobulin.

Transmission

Chickenpox is spread by contact with infected respiratory droplets or fluid from the blisters. It is very infectious to people who have not hadChickenpox before. Shingles cannot be spread from person to person. However, the blister fluid contains the varicella virus. Therefore people who have never had Chickenpox should avoid contact with cases of both Chickenpox and Shingles.

Symptoms

Shingles causes a rash of tiny blisters, usually affecting a clearly defined area of the body. After a few days, the blisters crust over and form scabs. The rash is not itchy, but it can be very painful. The pain may start a day or so before the rash appears. The area is infectious for about a week after the blisters appear.

Prevention

Within the Practice, non-immune members of staff should be immunised against varicella. Non-immune staff who have direct contact with high-risk groups and are exposed to the virus, should be redeployed to a lower-risk environment from the 8th to 21st day (28 days, if immunoglobulin has been given) after initial contact with a case during the infectious phase.

Clostridium Difficile

Clostridium Difficile bacteria are normally present in small numbers in the human bowel without causing any problems. However, when taking certain antibiotics, the Clostridium Difficile microbes may begin to multiply and produce toxins. The toxins cause the bowel to become inflamed and for diarrhoea to develop.

An emerging strain (O27) is increasingly associated with outbreaks of severe infection. Infection can be prevented by avoiding the unnecessary use of broad-spectrum antibiotics, for example: Cephalosporins.

Transmission

Spread is more common in secondary care institutions and primarily in older people (65+), however that does not mean that Practices can overlook the possible risk of infection.

When a person is infected with Clostridium Difficile, they pass the micro-organisms in their faeces or diarrhoea. A susceptible person (i.e. elderly, taking antibiotics) can pick up the infection if they come into contact with the infected faeces or contaminated surfaces and transfer the bacteria to their mouth.

Symptoms

Symptoms can range from mild diarrhoea to severe life threatening pseudo-membranous Colitis or Peritonitis.

Prevention

The following actions are to be used to prevent the spread of Clostridium Difficile:

  • People with diarrhoea must, as at any time, wash their hands carefully after using the toilet;
  • Clothing soiled with diarrhoea should be washed separately on a hot wash;
  • Equipment contaminated with diarrhoea, should be cleaned immediately using a chlorine-releasing agent;
  • Staff members who may come into contact with diarrhoea or soiled equipment should wear disposable gloves and wash their hands with soap and water.

Cryptosporidiosis

Cryptosporidium is a parasite that causes an infection called Cryptosporidiosis which can affect both humans and livestock. Cryptosporidium is found in lakes, streams and rivers, untreated water and sometimes in swimming pools.

Transmission

A person can get Cryptosporidiosis directly from another person or animal by touching faeces (e.g. when changing a nappy, or for persons working in a farm environment) and putting their hands near or in their mouth without washing them thoroughly.

It is also possible to get Cryptosporidiosis from infected pets or by swimming in, or drinking contaminated water. Occasionally a person can be infected by eating and drinking contaminated food, particularly unpasteurised milk, offal (liver, kidneys, and heart) or undercooked meat.

Symptoms

Symptoms include watery diarrhoea, stomach pains, dehydration, weight loss and fever. These symptoms could last for up to three weeks, but it can affect people with weak immune systems for much longer. An infected person might think they are getting better and have shaken off the infection but then find that they get worse before the illness eventually goes.

As symptoms are similar to many other infections, the only way to make an accurate diagnosis is for a sample of the infected person’s faeces to be tested in a laboratory.

Prevention

  • Staff members should use gloves if contact with patients is made or if handling soiled items from patients;
  • Careful hand-washing with soap and water is essential;
  • Single-use equipment and disposables must be used during any consultation. These must be correctly and safely disposed of;
  • Cleaning staff must wear gloves and ensure that toilet seats are carefully disinfected, along with flush-handles, hand-wash basin, taps and toilet door handles;
  • Special care must be taken to make sure hands are clean before handling food and drink items;
  • If a member of staff contracts the disease from a patient they must stay away from the Practice and make sure they are symptom-free for 48 hours before returning to work at the Practice.

Escherichia Coli (E coli)

E. coli 0157:H7 is one of hundreds of strains of the bacterium Escherichia Coli.

Most strains are harmless and live in the intestines of humans and animals, but this strain produces a powerful toxin which can cause severe illness. It is a strain of Verocytotoxin producing Escherichia Coli (VTEC) and is found in the intestines of some livestock and other domesticated animals, such as goats, and also in the intestines of infected people.

Transmission

The bacterium can be transmitted by three main routes:

  • Through food (undercooked minced beef, unpasteurised milk);
  • Person-to-person contact;
  • Direct and indirect animal contact.

Symptoms

E. Coli 0157 is often very mild, but some people develop diarrhoea, which can be severe and bloody, with abdominal cramps. A few cases (especially in children under 5 years of age and older people) may develop a complication called Haemolytic Uraemic Syndrome, which is a form of kidney failure. They may need admitting tohospital for renal dialysis or blood transfusion.

Prevention

  • Don’t eat undercooked meat products, e.g. beef burgers and minced beef;
  • Thoroughly cook meat until the juices run clear;
  • Drink only pasteurised milk;
  • Wash hands before handling food, after using the toilet or changing nappies;
  • Wash animal faeces from shoes and clothing, followed by hand-washing;
  • If a member of staff contracts the disease from a patient they must stay away from the Practice and make sure they are symptom-free for 48 hours before returning to work at the Practice.

Hand, Foot and Mouth Disease

This illnessis caused by Coxsackievirus. Anyone can be infected, but the infection most frequently affects children under 3 years of age.

Cases often occur in the spring and autumn and outbreaks of infection may occur especially in pre-schools and nurseries. The illness lasts about 7 - 10 days and usually gets better without treatment.

Transmission

This is usually by airborne droplets passed into the atmosphere during coughing or sneezing, or by these droplets landing on objects, then being passed on through hand-to-mouth contact.