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					SECTION ONE




INTRODUCTION

    AND

NOTIFICATION
1.    INTRODUCTION AND NOTIFICATION

1.0   INTRODUCTION

               The guidance is divided into sections as follows:

Section 1    Introduces infection control and explains notification;
Section 2    deals with general infection control procedures;
Section 3    gives guidance on the management of outbreaks;
Section 4    describes specific infectious diseases;
Section 5    contact numbers and sources of information;
Section 6    contains additional detailed information and a table of diseases;
Section 7    contains 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?


Infectious diseases are usually caused by viruses or bacteria and can be
transmitted from one person to another in a number of ways:

         By direct skin to skin contact
          This is unusual, as the majority of infections cannot penetrate the skin
          without an open wound. An infection that can spread in this way is
          Scabies. Infections, which do not spread this way, include HIV,
          Hepatitis B and Tuberculosis.


         By swallowing contaminated material
          Most infections of the gut are spread by this route. For example: food
          poisoning and Typhoid. Other infections, including HIV and Hepatitis B,
          cannot be caught this way as the acid in the stomach destroys them.


         By droplets in the air
          Many infections are spread by the airborne route. Measles, the
          common cold and influenza are spread in this way, by coughing and
          sneezing.


         By sexual intercourse
          Infections such as Syphilis, Gonorrhoea, HIV infection, Hepatitis B and
          Hepatitis C can be spread by sexual contact.


         By blood to blood transmission
          A small number of infections can be spread through blood transfusion
          and some can also be transmitted sexually, including HIV, Hepatitis B
          and Hepatitis C.


         Vertical transmission from a pregnant mother to her child
          Transmission can occur at any stage during pregnancy, at the time of
          birth and during breast feeding. Examples include HIV, Syphilis and
          some common viral infections such as Rubella (German Measles).


         Insects and Parasites e.g. Malaria is spread via a mosquito‟s bite.
1.2   INFECTION CONTROL GUIDANCE


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.


Infection control practices include:


                                 Effective hand
                                  washing and
                                 hand hygiene


          Safe                                             Appropriate
      Management                                              use of
       of blood or                                          personal
       body fluid                                           protective
        spillages                                          equipment

                                                           Maintenance
                                 STANDARD                   of a clean
                                 INFECTION                 environment
      Safe use and                CONTROL
       disposal of                                              by
                                 PRACTICES
         sharps                                            appropriate
                                                              use of
                                                             cleaning
                                                            equipment
          Safe
      Management
           of                                       Safe Management
      contaminated                                      of laundry
         waste




                               TRAINING
        Underpins all these Routine Infection Control Practices
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 poliomyelitis                        Plague                     (T)
Anthrax                                    Rabies                     (T)
Cholera                            (T)     Relapsing Fever            (T)
Diphtheria                         (T)     Rubella
Dysentry                           (T)     Scarlet Fever
Food poisoning or                          Small Pox
suspected food poisoning
Leprosy                                    Tetanus
Leptospirosis                              Tuberculosis
Malaria                                    Typhoid fever              (T)
Measles                                    Typhus fever               (T)
Meningitis *                       (T)     Viral haemorrhagic fever   (T)
Meningococcal septicaemia          (T)     Viral hepatitis **
(without meningitis)
Mumps                                      Whooping cough
Opthalmia neonatorum                       Yellow 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         Primary Course
                            3rd dose at 4 months

Measles / Mumps /           12 – 15 months               Can be given at any age
Rubella (MMR)                                            over 12 months

Booster DT and Polio,       3 – 5 years                  Three years after
MMR second dose                                          completion of primary
                                                         course

BCG                         10 – 14 years or infancy     Only offered to certain
                                                         high risk groups after an
                                                         initial risk assessment
Booster Tetanus,            13 – 18 years
Diphtheria and Polio



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-immunised            Polio, 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          6 days from onset of rash                 None. Non-immune pregnant women
                                   onset of symptoms and 6 days after                                                    should seek medical advice
                                   rash appears or until lesions are
                                   crusted (if longer)

Conjunctivitis                     Until 48 hours after treatment              Until discharge stops                     None

Erythema infectiosum               4 days before and until 4 days after        Until clinically well                     None. Pregnant women should seek
(slapped cheek syndrome)           the onset of the rash                                                                 medical advice

Gastroenteritis (including         As long as organism is present in           Until clinically well and 48 hours        CCDC or EHO will advise on local
salmonellosis and shigellosis)     stools, but mainly while diarrhoea          without diarrhoea or vomiting. CCDC       policy
                                   lasts                                       or EHO may advise a longer period
                                                                               of exclusion
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          None
                                                                               healed
Hepatitis A                        The incubation period is 15-50 days,        1 week after onset of jaundice            None – immunisation    may   be
                                   average 28-30 days. Maximum                                                           advised (through GP)
                                   infectivity occurs during the latter half
                                   of the incubation period and
                                   continues until 7 days after jaundice
                                   appears
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      4 days from the onset of the rash       None
                                        after the rash appears
Meningitis                              Varies with organism                      Until clinical recovery                 None
Mumps                                   Greatest infectivity from 2 days          4 days from the onset of the rash       None
                                        before the onset of symptoms to 4
                                        days after symptoms appear
Rubella (German measles)                1 week before and until 5 days after      4 days from the onset of the rash       None
                                        the onset of the rash
Streptococcal sore throat and Scarlet   As long as the organism is present in     Until clinically improved (usually 48   None
fever                                   the throat, usually up to 48 hours        hours after antibiotic is started)
                                        after antibiotic is started
Shingles                                Until after the last of the lesions are   Until all lesions are dry – minimum 6   None
                                        dry                                       days from the onset of the rash
Tuberculosis                            Depends on part infected. Patients        In the case of open TB, until cleared   Will require medical follow-up
                                        with open TB usually become non-          by TB clinic. No exclusion necessary
                                        infectious after 2 weeks of treatment     in other situations
Threadworm                              As long as eggs present on perianal       None but requires treatment             Treatment is necessary
                                        skin
Typhoid fever                           As long as case harbours the              Seek advice from CCDC                   Seek advice from CCDC
                                        organism
Whooping cough                          1 week before and until 3 weeks after     Until clinically well, but check with   None
                                        onset of cough (or 5 days after the       CCDC
                                        start of antibiotic treatment)
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          Until skin has healed or 48 hours      None. Avoid sharing towels
                                     present                                  after treatment started
Head lice                            As long as lice or live eggs are         Exclude until treated                  Exclude until treated
                                     present
Ringworm
    1. Tinea capitis (head)          As long as active lesions are present    Exclusion not always necessary until   None
                                                                              an epidemic is suspected
      2. Tinea corporis (body)       As long as active lesions are present    None                                   None

   3. Tinea pedis (athlete‟s foot)   As long as active lesions are present    None                                   None
Scabies                              Until mites and eggs have been           Until day after treatment is given     None (GP should treat family)
                                     destroyed
Verrucae (plantar warts)             As long as wart is present               None (warts should be covered with     None
                                                                              waterproof dressing for swimming
                                                                              and barefoot activities)