Infections ( Alert Organisms And Conditions ) That Require Source Isolation - Protocol

Publication: 01/05/2009  --
Last review: 04/08/2020  
Next review: 01/10/2020  
Clinical Protocol
CURRENT 
ID: 1671 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Clinical Protocol is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Infections That Require Source Isolation Protocol

This protocol provides information on those patients who are diagnosed with an infection, or are identified as colonised, with micro-organisms that are easily transmitted to other people and constitute an infection risk to other patients, staff or visitors. This protocol also specifies the Infection Prevention and Control (IPC) actions that are required when a patient is diagnosed, or identified as colonised with, a specific organism or condition, as detailed in the list below. It should be used in conjunction with other relevant LTHT Infection Prevention and Control Policies and Guidelines.

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Aims

  • To prevent and control the spread of communicable infections within LTHT
  • To promote a safe environment for all patients within LTHT
  • To provide the information required to ensure that appropriate IPC measures are applied when patients are found to be colonised by, or infected with, micro-organisms that are either easily transmitted and/or associated with potentially significant implications if acquired by someone else

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Background and indications protocol

A requirement for source isolation may be suggested by a clinical presentation e.g. diarrhoea / vomiting with unknown cause or a positive microbiological result. Source isolation must be carried out according to the Isolation guidelines.

If source isolation is not possible, the clinical team should contact the IPCT (in hours) or the Clinical Site Manager should contact the on call Consultant Microbiologist (out of hours), with the required patient information for a risk assessment to be completed

There are certain transmissible micro-organisms that are of a rare incidence within the United Kingdom (see Appendix F). If an organism within this category is suspected or identified the IPCT (in hours) or the Consultant Microbiologist on call (out of hours) should be contacted immediately.

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Routes and modes of transmission

Direct Contact
Transfer of micro-organisms from a colonised or infected person to a person who is not colonised or infected by direct physical contact.

Indirect Contact
Transfer of micro-organisms via a fomite (an inanimate object e.g. BP machine or ultrasound probe) or vector (human or animal).

Droplet
Transfer of micro-organisms by production and dissemination of large droplets e.g. by coughing or sneezing.

Airborne
Transfer of micro-organisms by production and dissemination of droplet nuclei (very small droplets), or dust particles or skin scales. The difference between Droplet and Airborne spread is subtle and depends on the fact that droplet nuclei and dust particles remain airborne for long periods of time.

Ingestion
Transfer of micro-organisms from a human, animal or environmental source by ingestion of food, water or other contaminated material. If the organism is subsequently excreted in faeces this constitutes the “faecal-oral” route of infection.

In practice multiple modes of transmission may apply to a single organism type e.g. norovirus may be transmitted by direct contact, indirect contact (via staff or objects), droplet spread (via projectile vomit) and faecal-oral (via diarrhoea), although the final acquisition is by ingestion.

(Control of Communicable Diseases Manual 20th Edition (2015))

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Precautions

Standard Precautions - A risk assessment is required for all patient / environment contact regardless of infection status - see below.

No Risk of exposure to blood or bodily fluid

No Protective Clothing
(Aprons should be worn for bed making to reduce contamination of clothing by skin commensals)

Blood/body fluid - low risk of splash, (for example toileting a patient, removing or inserting a cannula).

Disposable single use aprons and gloves

Blood/body fluid -
high risk of splash, (for example, endoscopy, some dental procedures, large abscess drainage).

Disposable gloves/plastic aprons/eye protection/face masks/ water resistant gowns

Hand hygiene precautions to be used in the care of all patients.

Source Isolation Precautions - Disposable single use aprons and gloves as a minimum. A risk assessment as above is required for ‘high risk of splash’. All waste arising out of the isolation room/cohort area must be treated as infected, using an orange infectious waste bag even if it has not been used. Linen must be placed in an alginate bag inside a red laundry bag ( Refer to Isolation guideline). Hand hygiene should be performed prior to entering the room, before leaving the room and after exiting the room (Refer to Hand Hygiene Policy - LTHT). Sharps Bins (Orange & Yellow) required.

Enhanced (organism Specific) Precautions - See individual organism. These precautions must be undertaken in addition to the standard precautions indicated from the above assessment. IMPORTANT - you must adhere to the sample processing requirements defined in the below table (‘hazard group category column’) to ensure that samples can be processed safely in the lab and the risk of infection is adequately controlled).

Full relevant clinical details are required on request forms for Microbiology to allow the laboratory to fully assess the risk of isolating a HG3 pathogen from a sample, especially when a patient first attends for investigation and before anything has been isolated - see Appendix F for clinical details associated with increased risk of exposure.

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Table of infections: A - Z

Infection (Alert Organism/ Condition)

Source Isolation Required

Mode of Transmission

Duration of Isolation

Precautions Required

Hazard group (HG#) category(MUST detail in ‘clinical details’ field on request) & follow any additional instructions detailed below

Acinetobacter baumanni
if multi-resistant (see Appendix E).

For screening and source isolation requirements for potential carbapenemase-producing organisms
Please See Guideline:-

Carbapenemase-Producing Enterobacteriaceae (CPE)

For Neonates please see guideline:-

Infections that require Source Isolation on the Neonatal Unit Protocol

Yes

Commonly found within the environment on both wet and dry surfaces (often found in dust).

Transmission can occur via direct or indirect contact with contaminated surfaces or patient shared equipment.

Duration of admission and all future admissions

Source Isolation Precautions

Enhanced precautions-

If CPE positive: long sleeved gowns

HG2

Anthrax
Bacillus anthracis

All cases to be reported;
Please refer to Appendix E

Please contact IPC to discuss all suspected or confirmed cases

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

No

Animals infected shed the bacilli in haemorrhagic stage at death. Direct contact with tissues of infected animals or through the bites of insects who have fed on infected animals.
Indirect contact by inhalation of B. anthracis spores

Incubation period is 1- 12 days, although periods up to 60 days are possible.

N/A

Standard Precautions

Enhanced precautions-

FFP3 masks( if undertaking aerosol generating procedures)

HG3

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Bacillus cereus (only if associated with food poisoning).

Further information:-
Food Safety.gov

No

This is a common organism found in the soil, the environment and also found at low levels in raw, dried and processed foods.

Ingestion of contaminated foods and cooked foods left at ambient temperatures.

Incubation 0.5 to 6 hours in cases where vomiting is the predominant symptom. Diarrhoea predominates 6-24 hours after.

N/A

Standard Precautions

LTHT workers to contact Occupational Health for advice

HG2

Body Lice (Pediculus corporis) and Crab Lice (Phthirus pubis)

No; however for patient privacy and dignity whilst undergoing treatment placement in a side room is recommended.

Direct contact with an infested person or by indirect contact with personal belongings e.g. clothing.

P. pubis by sexual contact

Life cycle involves 3 stages; eggs, nymphs and adults. Life cycle is similar to that of head lice.

A person will remain an infectious source as long as lice or eggs remain alive on an infested person or fomite

N/A

Standard Precautions

N/A

Brucella spp.
Brucellosis, Malta fever, Undulant fever, Mediterranean fever

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

No.

Contact through breaks in the skin with infected animal tissues, blood and body fluids, ingestion of unpasturised milk or cheeses from infected animals.

Incubation is variable and difficult to ascertain (5-60 days).

N/A

Standard Precautions

HG3

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Campylobacter spp.

 

 

No

Usually through ingestion of under cooked meats, poultry or contaminated food and water.

Also through contact with infected pets (puppies and kittens), farm animals.

Incubation period usually 2-5 days with a range of 1-10.

The infective dose is usually low; person to person transmission is relativity uncommon

N/A

Standard Precautions

LTHT workers to contact Occupational Health for advice

HG2

Carbapenemase Producing Enterobacteriaceae / organism (CPE)
e.g.
Escherichia coli
Klebsiella spp
Proteus spp
.
Serratia spp
Acinetobacter baumannii
Pseudomonas aeruginosa

Including patients assessed as being HIGH RISK.

Please refer to:-

The Early Detection, Management and Control of Carbapenemase-Producing Enterobacteriaceae (CPE) guideline

For Neonates please refer to

Infections That Require Source Isolation on the Neonatal Unit Protocol

Contact tracing and screening will need to be completed on those individuals that have had contact with the index case.

Yes

Person to person through direct contact with blood and body secretions from those infected or potentially colonised.

Indirect contact from environmental surfaces, linen and patient care equipment that has been contaminated with infected blood or body fluids.

Duration of admission

Confirmed CPE positive -
Source Isolation Precautions

Enhanced Precautions-

Long sleeved gowns and gloves

High risk -
Source Isolation Precautions.

HG2

CJD and vCJD

Please refer to
Transmissible Spongiform Encephalopathies (TSEs) / Creutzfeldt Jakob Disease (CJD) guideline

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

No

The mode of transmission in conventional and sporadic CJD is unknown:

Likelihood that direct contact with affected body fluids and tissue.

Indirectly through medical equipment, for example surgical devices contaminated with body fluids or tissue.

Care when managing contaminated equipment: please refer to policy

N/A

Source isolation precautions


Enhanced precautions -

Certain clinical procedures please refer to guidelines.

(NB: Specific handling of surgical /other instruments may be required, depending on nature of risk & procedure being performed).

HG3*

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Clostridium botulinum

Foodborne, wound and intestinal botulism

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

No

Ingestion of contaminated foods which have been insufficiently heated to inactivate toxin/ destroy spores.
Contamination of wounds from ground in soil, gravel or improper treatment of open compound fractures

Incubation -12-72 hours before neurological symptoms appear.

N/A

Standard Precautions

HG2

Clostridium difficile

Please refer to the guidelines:
Clostridium difficile - Prevention of Transmission

And

Clostridium difficile Infection (CDI) in Adults (>16 years of age)

For under 16 years please refer to:-

Clostridium difficile infection (CDI) in children (<16 years of age)

Yes

Person to person through direct contact with faecal matter
Indirectly through contact with spores that can contaminate surfaces, linen and patient shared equipment.

C. difficile likely present - source isolate until further results

Toxin positive - for duration of hospital stay.

Toxin negative but toxigenic strain present - for duration of hospital stay.

If toxin negative & non-toxigenic strain: Source isolation can be discontinued

Source Isolation Precautions

Enhanced Precautions-

Hand hygiene with soap and water

Enhanced environmental & patient care equipment cleaning required.

LTHT workers to contact Occupational Health

HG2

Clostridium perfringens
(if associated with food poisoning).

Yes

Ingestion of contaminated foods that have been left to allow the organism to germinate and not cooked at the appropriate temperature
Incubation 6-24 hours

Until 48 hrs symptom free

Source Isolation Precautions

LTHT workers to contact Occupational Health

HG2

Corynebacterium ulcerans

Yes

Direct or indirect contact with a patient or carrier, contact with soiled articles that are contaminated with discharge fluids from lesions of infected people. In rare circumstances, milk has acted as a vehicle for transmission.

Incubation is usually 3-5 days.

Duration of admission

Source Isolation Precautions

Enhanced precautions -

Certain clinical procedures; please liaise with IPC Team on 22691

HG2

Cryptosporidium spp.

Yes

Faecal/ oral route which requires direct and / or indirect contact with faecal matter. The parasite can survive under adverse environmental conditions for long periods of time

Incubation is variable between 1-12 days. The parasites that appear in the stools at the onset of symptoms are infectious immediately upon excretion.
They will be present in the stool for several weeks after symptoms have resolved.

Until 48 hrs symptom free

Source Isolation Precautions

LTHT workers to contact Occupational health

HG2

Diarrhoea +/- vomiting
(presumed infectious; but no clear microbiological diagnosis)

Please refer to

Viral Gastroenteritis Clinical Guideline

If specific infectious cause(s) identified, please refer to section for relevant organism(s)

Yes

From person to person by direct contact with airborne particles (vomit) and /or faecal matter.

Indirectly through contaminated surfaces, linen and patient shared equipment.

N.B. If viral gastro is suspected as a cause, this can be found in the stools of the affected person for up to 3 weeks

Until 48 hours symptom free

Source Isolation Precautions

Enhanced Precautions

Hand hygiene with soap and water

LTHT workers to contact Occupational Health

N/A

Diphtheria
Corynebacterium diphtheriae

All cases to be reported;
Please refer to Appendix E.

If a case is suspected please contact IPC for advice.

Yes

Rare but highly contagious.

Person to person contact usually through respiratory droplets (coughing or sneezing) , In rare cases contact with soiled articles that are contaminated with discharge fluids from lesions of infected people.

Incubation is usually 2-5 days.

Until 2 cultures taken 24 hours apart are negative.

Source Isolation Precautions

Enhanced precautions:

Surgical face mask

LTHT workers to contact Occupational Health

HG2

E. coli O157:H7 and other verotoxin-producing E. coli (e.g. E. coli O104:H4)
Haemorrhagic colitis and haemolytic uraemic syndrome, HUS

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Yes

Ingestion of contaminated meat, foods and unpasteurised dairy products. This includes foods that are insufficiently cooked or prepared.

Ingestion also occurs through contaminated drinking/ recreational water.

Person to person contact with immediate family, childcare and other institutional facilities.

Incubation 2-10 days.

Until 48 hours symptom free

Source Isolation Precautions

LTHT workers to contact Occupational Health for advice.

HG3*

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

ESBL (Extended Spectrum Beta-Lactamase producing) - Multi resistant organism
e.g.
“Coliform”
Enterobacter spp
Escherichia coli (E. coli)

Klebsiella spp

Proteus spp
.
Serratia spp

For Neonates please refer to

Infections That Require Source Isolation on the Neonatal Unit Protocol

Yes

Person to person through direct contact with blood and body secretions from those infected or potentially colonised.

Indirect contact from environmental surfaces, linen and patient care equipment that has been contaminated with infected blood or body fluids.

Duration of admission - and subsequent admissions 

Source Isolation Precautions

HG2

Entamoeba histolytica
Amoebiasis, amoebic dysentery

No

Parasitic infection -
Person to person or through ingestion of faecally contaminated food or water

N/A

Standard Precautions

HG2

Giardia lamblia
(Giardiasis)

Yes

Person to person via direct/ indirect contact of faecal matter of an infective person, contaminated drinking water or recreational water that may have been contaminated with faecal matter

Incubation can be from 3-25 days.

Until 48 hours symptom free

Source Isolation Precaution

HG2

Hepatitis A, E

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Yes

Person to person direct / indirect contact with contaminated faecal matter or with water / food products contaminated by faeces.

Indirectly from water and foods (either insufficiently prepared or previously cooked) contaminated by an infected person.

Two weeks from onset of jaundice

Source Isolation Precautions

LTHT workers to contact Occupational Health.

A = HG2

E = HG3*

E: Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Hepatitis B, C, D

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F 

No; unless actively haemorrhaging

Through direct contact with blood and body fluids.

This also includes sexual transmission.

Indirectly through surfaces, linen and patient shared equipment contaminated by blood or body fluids.

Only if active haemorrhaging

Standard Precautions

Enhanced Precautions-

If waste contaminated with blood or body fluids (treat as clinical infectious waste)

HG3*
Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F 

Human immunodeficiency virus (HIV)

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

No; unless actively haemorrhaging OR significant opportunistic infections and/ or if indicated by CD4 count.

Person to person through unprotected sexual contact and other body secretions such as blood, CSF and Semen.

Other types of body fluids-saliva, tears, urine; transmission has not been reported

Indirectly through contact with contaminated needles and syringes; also through contaminated equipment such as surgical devices.
baby transmission.

No; unless actively haemorrhaging OR if significant opportunistic infection and/ or indicated by CD4 count

Standard Precautions

Enhanced Precautions -

Certain clinical procedures; please liaise with IPC Team on 22691
If waste is contaminated with blood (treat as clinical infectious waste)

HG3*

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Influenza

Please see

Respiratory Viruses - Guideline for the prevention of transmission

Yes

Predominately through airborne spread via droplet particles (coughs and sneezes) expelled by those that are infected.

Indirectly through surfaces, linen and patient shared equipment contaminated by droplet particles.

Incubation is around 2 days for seasonal influenza. The infected individual is most infectious for the first 3-5 days. In younger children this can be up to 7-10 days and longer for those who are immunocompromised

See
Respiratory Viruses - Guideline for the prevention of transmission

Source Isolation Precautions

Enhanced Precautions-

Surgical mask or FFP3 mask if undertaking aerosol generating procedures.

HG2

Legionella spp.

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

No

Reservoir-aqueous environments, e.g. hot water systems, air conditioning, cooling towers, humidifiers, respiratory therapy devices. The organism has also been isolated from creeks, pond and soil from their banks. It can survive for months in distilled water

No

Standard Precautions

HG2

Leprosy
(Mycobacterium leprae, Hansen’s disease)

If a case is suspected please contact IPC

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Please see below for further information:-

Leprosy: memorandum (2012) - GOV.UK

No

Close contact with infected person.

Predominately through airborne spread via respiratory secretion (coughs and sneezes) expelled by those that are infected.

Exact mechanism of transmission is not truly understood.

Incubation period can vary from between 3 and 10 years.

NA

Standard Precautions

LTHT workers to contact Occupational Health.

HG3

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Leptospira interrogans
Leptospirosis, Weil’s disease

Source isolation is not routinely required;

Please contact IPC for further advice

Direct contact with infected animal urine, fluids or tissue.

Indirect exposure through water or soil (and in some countries foodstuffs) contaminated by urine from infected animals.

Person-to-person transmission is rare.

Symptoms usually develop 7-21 days after initial infection with leptospires, though rarely the incubation period can be as short as two to three days or as long as 30 days

N/A

Standard Precautions

HG2

Listeria monocytogenes
Listeriosis

Source Isolation is not routinely required

Please contact IPC for further advice

Reservoir- Environmental sources include soil, forage, water, mud and silage.

Unlike other food borne pathogens, Listeria tends to multiply in refrigerated foods that are contaminated

Ingestion of raw or contaminated milk, soft cheeses, vegetables and ready to eat meats such as pate

Incubation can vary form 3-70 days following exposure to an implicated product.

Discuss with IPC

Standard Precaution

OR

Source Isolation Precautions If isolation required

LTHT workers to contact Occupational Health.

HG2

Lyme disease
Borrelia bergdorferi.

No

Infected ticks. The tick maybe attached for 24 hours before transmission.
Person to person transmission is rare

Incubation of 3-32 days after tick exposure (mean 7-10 days).

N/A

Standard Precautions

HG2

Malaria
Plasmodium falciparum, vivax, ovale, malariae, knowlesi

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

No

The organism is usually transmitted by the bite of an infective Anopheles mosquito - (Vector) - with most species feeding at night

Incubation time between infective bite and the appearance of clinical symptoms
P. falciparum 9-14 days
P. vivax 12-18 days
P. ovale 12-18 days
P. malariae 18-40 days
P. knowesi 8-10 months or longer

N/A

Standard Precautions

HG3*

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Measles

If a case is suspected please contact IPC for advice.

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Please see below for further information:-

PHE National Measles Guidelines

Yes

Airborne spread via droplet particles from infected individuals--nasal and respiratory secretions.

Less commonly transmitted from articles that contain secretions.

Incubation - from exposure to rash onset the average is 14 days with a range of 7 - 21 days.

The person will be infectious 4 days prior to the onset of the rash to 4 days after the rash has developed.

Those who are immunocompromised may be infectious for a greater length of time

Until 4 full days after the rash appears.

Source Isolation Precautions

Enhanced Precautions-

FFP3 mask if the patient is highly suspected or a known positive

HG2

Neisseria meningitidis Meningococcal Meningitis and Septicaemia

Please contact IPC for advice

Refer to

Public Health England
Guidelines for Meningococcal Disease

and

Bacterial meningitis and meningococcal septicaemia in adults

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Yes; until 24 hrs appropriate antibiotics to eradicate bacteria from mouth and throat

Airborne contact via droplet particles from respiratory and nasal secretions.

Indirectly through surfaces, linen and patient shared equipment contaminated by blood or body fluids.

5%-10% of those infected have asymptomatic carriage.

Less than 1% of those colonised will progress to invasive disease.

Until patient has received 24 hours of appropriate treatment

Any furtherquestion please contact IPC/ Microbiology.

Source Isolation Precautions

After 24 hours of appropriate treatment
Standard Precautions

Antibiotic prophylaxis for staff who come into close contact with respiratory secretions (i.e. during resuscitation or intubation, without appropriate PPE)

HG2

Meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, viruses and other organisms)

Please contact IPC for advice

or refer to

Bacterial meningitis and meningococcal septicaemia in adults

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Yes

For bacterial meningitis, prior to completion of 24 hrs appropriate antimicrobial treatment.

H. influenzae; close contact requires prophylaxis

Airborne contact via droplet particles from respiratory and nasal secretions.

Pneumococcal –direct contact with an infected person would usually result in nasopharyngeal carriage rather than the disease.

Indirectly through contaminated surfaces, linen and patient shared equipment.

Until patient has received 24 hours of appropriate treatment.

Any further question please contact IPC / Microbiology.

Source Isolation Precautions

After 24 hours of appropriate treatment
Standard precautions

HG2

Meticillin-resistant Staphylococcus aureus (MRSA)

Please refer to
Meticillin Resistant Staphylococcus Aureus (MRSA) Guideline

Yes

Person to person through direct contact with blood and body secretions from those infected or potentially colonised.

Indirect contact from environmental surfaces, linen and patient shared equipment that has been contaminated with infected blood or body fluids.

N.B. Airborne transmission poses significant risk if isolated in respiratory secretions.

Evidence of 3 negative MRSA screens - see MRSA guideline for specific advice

Source Isolation Precautions

HG2

Middle East Respiratory Syndrome (MERS-CoV)

Contact IPC / Infectious Diseases

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Please see :-

PHE: MERS-CoV Infection Prevention and Control Guidance

Yes - placement into a negative pressure room is indicated as soon as possible. If not immediately available a neutral pressure room until it is,

Primarily via droplets.
Direct contact with secretions or body fluids of an infected individual

Duration of admission

Enhanced precautions:-

Long sleeved gown, double gloves, FFP3 masks and visors

HG3

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “” labelling Danger of infection required w.r.t sample submissions:
Please refer to appendix F

Multi-drug resistant
e.g
Pseudomonas spp.
Serratia spp
Acinetobacter baumannii
E. coli (Escherichia coli)
Klebsiella spp
Proteus spp.
Coliform
ESBL

Yes

Direct contact with infected person.

Indirect contact from surface areas, linen or patient shared equipment that has been contaminated by droplet particles/ saliva.

For the duration of hospital admission

Source Isolation Precautions

HG2

Mumps

If a case is suspected please contact IPC for advice.

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Yes

Airborne via droplet particles from infected respiratory secretions or an infected person’s saliva.

Direct contact with infective saliva.

Indirect contact from surface areas, linen or patient shared equipment that has been contaminated by droplet particles/ saliva.

Incubation period between 16 - 18 days

9 days from onset of parotitis (swelling of the salivary glands)

Source Isolation Precautions

Enhanced Precautions-

Surgical mask for close contact /airway management

HG2

Poliomyelitis
Poliovirus (genus Enterovirus) types 1, 2 and 3

If a case is suspected please contact IPC

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Yes

Primarily person to person through the faecal oral route or respiratory secretions
Or
Indirect contact with contaminated surfaces/ materials. The virus has longer viability in faeces than secretions.

Incubation can average 7-14 days from initial exposure with a range of 3 - 35 days.

Duration of hospital admission

Source Isolation Precaution

Enhanced Precautions-

Respiratory precautions may be necessary in certain cases (please liaise with IPC for further advice).

HG3

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Panton-Valentine Leukocidin Staphylococcus aureus

Please refer to
Meticillin Resistant Staphylococcus Aureus (MRSA) Guideline - which also includes guidance on PVL +ve S. aureus

And

Public Health England -
Guidance on the diagnosis and management of PVL associated SA infections in England

Yes

Person to person through direct contact with blood and body secretions from those infected or potentially colonised.

Indirect contact from environmental surfaces, linen and patient shared equipment that has been contaminated with infected blood or body fluids.

N.B. Airborne transmission poses significant risk if isolated in respiratory secretions.
Panton-Valentine Leukocidin (PVL) is a toxin that destroys white blood cells and
is a virulence factor in some strains of Staphylococcus aureus

For the duration of hospital admission.

Source isolation precautions

Enhanced Precautions -

Certain clinical procedures; please liaise with IPC Team

HG2

Pneumocystis jiroveci
(Pneumocystis carinii)
PCP 

No

Avoid placement of patient in the same room with an immunocomprosed patient.

If patient is immunocompromised please contact IPC for isolation advice

Transmission is unknown, potentially airborne

N/A

Standard Precautions

N/A

Rabies
(Rhabdovirus of the genus Lyssavirus)

If a case is suspected please contact IPC for advice.

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

No

Virus laden saliva of a rabid animal introduced to the human through a bite or a scratch - usually from a dog

Person to person transmission is theoretically possible, however this is rare.

Incubation can be 3-8 weeks dependant of severity, wound site.

Communicability is usually 3-7 days before the appearance of clinical symptoms and throughout infection.

NA

Standard Precautions

Enhanced Precautions -

Respiratory precautions may be necessary in certain cases (please liaise with IPC for further advice).

HG3

(Rabies = HG3*

Vesicular stomatitis virus= HG2)

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Rhinovirus spp

Please refer to
Respiratory Viruses - Guideline for the prevention of transmission

For Neonates please refer to
Infections That Require Source Isolation on the Neonatal Unit Protocol

Yes

Direct contact or inhalation of airborne droplets from an infected person, indirect contact with contaminated surfaces.

Incubation is between 12 hours and 5 days; the usual period is on average 48 hours

Until symptoms resolve.
If symptoms are no longer present isolation can be discontinued 7 days after onset of illness.

N.B. Cohorting of symptomatic patients can be undertaken with consultation of IPC Team.

Source Isolation Precautions

HG2

Rickettsia spp.
Rickettsiosis (spotted fever group)

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

No

Reservoir- maintained in nature among ticks species; however the rickettsia can be found in dogs, various rodents and other animals found to be infected.

Mode of transmission is usually through the bite (Vector) of an infected tick. The tick would need to attach for 4-6 hours before the organism becomes reactivated and infectious.

Incubation is 2-21 days

N/A

Standard Precautions

HG3

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Rotavirus

Refer to Viral Gastroenteritis Clinical Guidelines

Yes

Person to person contact through
Droplet spread
Faecal oral route

Until 48 hours symptom free

Source Isolation Precaution

LTHT workers to contact Occupational Health

HG2

Respiratory Syncytial Virus (RSV)

Please refer to

Respiratory Viruses - Guideline for the prevention of transmission

For neonates please refer to
Infections That Require Source Isolation on the Neonatal Unit Protocol

Yes

Person to person through direct contact or inhalation of droplet particles (respiratory secretions).

Indirectly through contaminated surfaces, linen and patient shared equipment.

Contaminated hands carry virus to mucous membranes of the eyes and nose

Until symptoms resolve. If symptoms are no longer present isolation can be discontinued 7 days after onset of illness.

N.B. Cohorting of symptomatic patients can be undertaken with consultation of IPC Team.

Source Isolation Precautions

Enhanced Precautions-

Masks to be used by staff entering the room whilst RSV nebuliser treatment being administered (please liaise with IPC for further advice).

HG2

Rubella

If a case is suspected please contact IPC for advice.

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Yes

Person to person through direct contact or inhalation of droplet particles (nasopharyngeal secretions).

Indirectly through contaminated surfaces, linen and patient shared equipment.

N.B. Infants shed large quantities of the virus in their secretions and urine.

Incubation period - 14-17 days with a range of 14-21 days

Period of communicability - 1 week before - 4 days after appearance of rash

1 week before - 4 days after appearance of rash

Source Isolation Precaution

HG2

Salmonella spp.
Salmonella gastroenteritis

If Salmonella typhi or Salmonella serovar:
NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Note: if suspecting typhoid / paratyphoid: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Yes

Through ingestion of the organisms in foods derived from animals or contaminated by the faeces of infected animals/ persons.

Person to person through direct contact with faeces.

Indirectly through contaminated surfaces, linen or patient shared equipment.

Until 48 hours symptom free

Source Isolation Precaution

LTHT workers to contact Occupational Health

HG2

(paratyphi & typhi = HG3*)

Note: if suspecting typhoid / paratyphoid: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Scabies

Please refer to
Scabies Guideline

Yes

Transfer of parasites occurs through prolonged direct contact with infested skin or sexual contact.

Indirectly through immediate contact with bedclothes or undergarments contaminated by an infected person

Risk of transmission is low; unless Norwegian scabies is suspected.

A person is considered to be infectious from the time of infestation until treatment is completed


N.B. Until mites and eggs are dead.

Source Isolation Precaution

Enhanced Precaution-

Long sleeved gowns during the patients shower and treatment application should be worn. Cuffs of the gowns should go under the gloves.

N/A

Severe Acute Respiratory Syndrome
SARS (Coronavirus)

If a case is suspected please contact IPC for advice.

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Yes

Primarily via droplets.
Direct contact with secretions or body fluids of an infected individual.

Incubation is 2-10 days

Communicability is still not fully understood, However, evidence has suggested that infectivity does not commence until symptoms are event and for no greater than 21 day from onset.

Duration of Symptoms

Source Isolation Precaution

Enhanced Precautions-

Surgical mask or
FFP3 mask if undertaking aerosol generating procedures.

N.B: Enhanced precautions required in immuno-compromised patients’ will require appropriately ventilated side room (Contact IPC ).

HG3*

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Shigella spp.
Shigellosis, bacillary dysentery

Yes

Direct/ indirect contact via the faecal oral route from symptomatic infective or asymptomatic carrier.
Infection may also occur after ingestion of contaminated food or water.
The infective dose of this organism is low

Incubation is around 1-3 days

Communicability is at the onset of symptoms and can persist for a period of greater than 4 weeks.

Until symptom free for 48 hours or the organism is no longer detected in the faeces.

Source Isolation Precaution

LTHT workers to contact Occupational Health

HG2

(Shigella dysenteriae (Type 1) = HG3*)

Note: if suspecting Shigella dysenteriae: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Tetanus 
Clostridium tetani

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

No

Tetanus spores are usually introduced into the body via open wounds that come into contact with contaminated soil, street dust, or animal or human faeces.
incubation period;-
Usually 3-21 days but can range from 1 day to several months.

N/A

Standard Precautions

HG2

Group A Streptococcal (Streptococcus pyogenes) Infection (scarlet fever and some cases of impetigo and erysipelas)

Please refer to LTHT IPC Group A Streptococcal Infections ( GAS ) Guideline

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Yes

Respiratory secretions
Fluid from lesions

Indirectly through contaminated surfaces, linen or patient shared equipment.

Incubation is normally 1-3 days.

In untreated, uncomplicated cases the person can potentially be infectious for 7-21 days. In cases where there is a purulent discharge the person has the potential to be infectious for months.

Until 24 hours of appropriate antimicrobial treatment is completed.

Some patients should remain source isolated for longer- Cases of necrotising fasciitis;
Other cases where there is significant discharge of potentially infected body fluids or high risk of shedding;

Mothers and neonates on maternity units;

Invasive Group A Streptococcal infection - source isolation may be extended for longer. IPC advice should be sought in these cases.

Source Isolation Precaution

Enhanced Precaution

Where risk of transmission from droplets is identified, fluid repellent surgical masks and eye shields/ visors are recommended. These must be worn for dressing changes and any operative debridement of cases of necrotising fasciitis.

HG2

Pneumococcal Pneumonia (Streptococcus pneumoniae)

No

NB: if resistant strain or clinical area has severely immune-compromised patients, source isolation may be required.

Airborne contact via droplet particles from respiratory and nasal secretions.

Indirectly through surfaces, linen and patient care equipment contaminated by blood or body fluids.

Incubation- usually 1-3 days

N/A

.

Standard Precautions

To liaise with IPC if source isolation required.

HG2

Tuberculosis

Pulmonary Tuberculosis
For all suspected or confirmed cases please contact IPC for advice

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Also refer to Tuberculosis (Including Multi drug and Extensively Drug Resistant Tuberculosis)

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Yes

Airborne via respiratory droplet or direct contact with droplet particles (sneezing/ coughing) of those infected.

Until at least 2 weeks of anti-TB treatment has been completed

N.B. A risk assessment must be completed by clinicians prior to removing isolation precautions

Standard precautions ( 
Enhanced precaution:
Single room.
FFP 3 masks must be worn at all times by staff, whilst patient in source isolation

Negative pressure ventilation preferable.

HG3

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Multi Drug Resistant (MDR) / Extremely Drug Resistant (XDR)

For all suspected or confirmed cases please contact IPC for advice.

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Also refer to Tuberculosis (Including Multi drug and Extensively Drug Resistant Tuberculosis)

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Yes

Airborne via respiratory droplet or direct contact with droplet particles (sneezing/ coughing) of those infected.

Liaise with the supervising physician in conjunction with Microbiology/ IPC Team.

Source Isolation Precaution

Enhanced precautions:
Must be nursed in negative pressure isolation and FFP3 mask worn at all times.

HG3

Samples must be hand delivered and clearly document the hazard group category in the clinical details field

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Extra Pulmonary Tuberculosis

No
(NB: need to confirm no evidence of concurrent pulmonary disease)

No Spread

NA

Standard Precautions

Enhanced precautions if aerosolising procedures are being under taken or draining wounds

HG3

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Latent Tuberculosis

No

Non Infectious

NA

Standard Precautions

HG3

Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Vancomycin Resistant Enterococcus - VRE

Please refer to
Vancomycin (Glycopeptide) Resistant Enterococci guideline

Yes

Person to person through direct contact with blood and body secretions from those infected or potentially colonised.

Indirect contact from environmental surfaces, linen and patient care equipment that has been contaminated with infected blood or body fluids.

VRE is not usually spread through the air by cough or sneezing.

Duration of admission

Source Isolation Precaution

HG2

Varicella zoster virus (VZV)
Chicken Pox or Shingles

In all suspected or confirmed cases please contact IPC.

Refer to Chickenpox-Shingles (Varicella-Zoster Virus Infections) : Prevention And Control

Yes

Person to person by direct contact with droplet particles or airborne spread of vesicle fluid or respiratory secretions

Indirectly through contaminated equipment, linen and environmental surfaces that have had contact with vesicle fluid and secretions.

Chicken pox has an incubation period of around 10- 21 days (usually 10-14 days). The infected individual is infectious to others 2 days prior to the development of the rash.

Until crusting and drying of all lesions has occurred

N.B. Isolation maybe required for a longer period if patients are immuno-compromised.

Source Isolation Precaution

Enhanced Precautions -
Ensure that patient is nursed by VZV immune staff/ staff that have been immunised.

HG2

Cholera (Vibrio cholerae )

NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

Yes in severe illness

Reservoir Humans

Ingestion of faecally contaminated water or shellfish and other foods
Contamination can occur via
Person-to-person spread through the faecal–oral route. Tends to spread if food and, in particular water become contaminated with the stools of an infected person
Incubation- 12 hours and 5 days after ingesting contaminated food or water
Communicability will last as long as the infective persons stool remains positive

Duration of illness in severe cases

Source Isolation Precaution in severe illness

Discuss all suspected or confirmed cases with IPC

LTHT workers to contact Occupational Health.

HG2

Viral Gastroenteritis
E.g. Norovirus

Please refer to LTHT IPC Viral Gastroenteritis guidelines

Viral Gastroenteritis Clinical Guidelines

Also refer C.difficile Guidance if either are suspected.

Clostridium Difficile Infection ( CDI ) in Adults ( >16 years of age )

Yes

Contact via faecal oral route
Transmitted from infected faeces or vomit by person-to-person contact, Ingestion of contaminated food/water
Contact with contaminated surfaces/ patient shared equipment or aerosolisation

Average incubation period is between 24-48 hours.

N.B. If viral gastro is suspected as a cause, this can be found in the stools of the affected person for up to 3 weeks

Until 48 hours symptom free

Source Isolation Precaution

Enhanced precautions:
Hand hygiene with soap and water

LTHT workers to contact Occupational Health.

HG2

Viral Haemorrhagic Fevers

These include the Ebola, Marburg, Lassa fever, and yellow fever viruses, Crimean-Congo Haemorrhagic fever virus

In all suspected or confirmed cases please contact IPC immediately.
NOTIFIABLE DISEASE
All cases to be reported;
Please refer to appendix E

NB: please see Appendix F prior to submitting sample(s)

Also refer to Managing patients who require assessment for Ebola virus disease

Yes

N.B. Please consult/ discuss all cases with IPC
Team

Person to person through direct contact with symptomatic patient or contaminated blood and body fluids.

Indirectly through contact with contaminated surfaces, linen and patient shared equipment.

The risk of transmission increases significantly in the latter stages of the infection due to excretion through body fluids (vomit, diarrhoea and haemorrhaging).

As advised by IPC

Please contact IPC immediately as patient will require Specialised Isolation in Bio-safety facility.

Enhanced precautions:
IPC and Infectious Diseases to advice

HG4 - contact microbiology consultant for further guidance

HG3 - Yellow Fever, Samples must be hand delivered and clearly document the hazard group category in the clinical details field.

Note: “Danger of infection” labelling required w.r.t sample submissions:
Please refer to appendix F

Whooping cough
(Bordetella pertussis)

In all suspected or confirmed cases please contact IPC for advice.

NOTIFIABLE DISEASE

All cases to be reported;
Please refer to Appendix E

Please refer to Pertussis (Whooping Cough) and
PHE guidelines

Yes

Direct contact from respiratory secretions (coughing, sneezing, respiratory procedures)

Incubation period is average 9-10 days (range 6-20)

Highly infectious in the first 2 weeks.5

Until the patient has received 48 hours of appropriate antibiotic treatment OR 21 days from onset of symptoms if no appropriate antibiotic therapy has been received

Source isolation for immuno-compromised patients will need to be for the duration of their admission.

Source Isolation Precaution

Enhanced precautions:
Surgical face masks , when working within 2 metre proximity of the infectious patient or performing cough inducing procedures

LTHT workers to contact Occupational Health

HG2

Provenance

Record: 1671
Objective:
Clinical condition:
Target patient group: All patients in LTHT
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

References

Centre for Disease Control and Prevention (CDC) (2007): Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Available at: https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines.pdf

Department of Health (2011). Health Protection Agency and Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections, Advice on Carbapenemase Producers: Recognition, infection control and treatment

Health Protection Agency (2012). Guidance for public health management of meningococcal disease in the UK.

Health Protection Agency. Investigation into multi-drug resistant ESBL producing Escherichia coli strains causing infections in England
http://www.hpa.org.uk/hpa/publications/esbl_report_05/

Health Protection Agency (2008). Guidance on the diagnosis and management of PVL-associated Staphylococcus aureus infections (PVL-SA) in England. Available at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1218699411960

Heymann D, (ED) (2015) Control of Communicable Diseases Manual, 20th Edition, American Public Health Association

Public Health England (2013). Interim Guidance for the Control of Carbapenemasse-Producing Enterobacteriaceae in England: Advice for NHS Boards and Health Professionals in the Public and Independence Sector (DRAFT). Available at:
http://www.rcn.org.uk/__data/assets/pdf_file/0007/503458/Draft_Interim_CPE_Guidance_7_Feb_2013.pdf

Public Heath England (2012). Memorantum on leprosy 2012 on behalf of the Panel of Leprosy Opinion

Public Health England (2016). PHE Guidelines for the Public Health Management of Pertussis Incidents in Healthcare Settings. Available at:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/564657/Guidelines_for_the_
Public_Health_Management_of_Pertussis_in_Healthcare_Settings_2016.pdf

Public Health England (2017). PHE National Measles guidelines. Available at:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/637338/PHE_Measles_guidance
_August_2017.pdf

Public Health Department (2010). The Health Protection (Notification) Regulations. Available at:
http://www.opsi.gov.uk/si/si2010/uksi_20100659_en_1

US Department of Health and Human Services. Bacillus cereus. Available at: www.foodsafety.gov/poisoning/causes/bacteriaviruses/bcereus/index.html

Working party guidance on the control of multi-resistant Acinetobacter outbreaks
http://www.hpa.org.uk/infections/topics_az/acinetobacter_b/guidance.htm

Evidence levels:
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus. (where no national guidance exists or there is wide disagreement with a level C recommendation or where national guidance documents contradict each other)

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.3

Related information

Appendix A - Definitions

ß-lactamase. Bacterial enzymes that inactivate β-lactam antibiotics (penicillins and cephalosporins) and therefore cause resistance to these antibiotics.

Carbapenemase. Bacterial enzyme that inactivates carbapenems (e.g. meropenem), which are very broad-spectrum “last line” antibiotics.

Colonisation. The presence, growth and multiplication of an organism at a body site without observable clinical symptoms.

Extended spectrum ß-lactamases (ESBL). Bacterial enzymes produced by MRGNB (see below) that inactivate multiple β-lactam antibiotics.

Fomite. Inanimate object that can act as an intermediate reservoir for the transmission of micro-organisms. Fomites include mobile items (stethoscopes, ultrasound probes etc.) and fixed items (door handles, telephones).

Gram-negative bacilli (GNB).Organisms that are commonly found in the gastro-intestinal tract, water and soil.

Multi-resistant GNB (MRGNB). GNB that are resistant to multiple antibiotics or antibiotic classes. Common MRGNB include Klebsiella spp., Pseudomonas spp., Enterobacter spp. and Acinetobacter spp. (Please see appendix D).

Source isolation. Physical separation of a patient within a single side room or similar cohort facility to reduce the risk of transmission of infection

Transmissible infection. Infection that can be communicated from a patient to another person (patient, member of staff or visitor).

Vector. Human or animal (including insect) that can act as an intermediate reservoir for the transmission of micro-organisms. In the hospital setting vectors are usually staff, patients or visitors.

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Appendix B - List of Other Organisms/Conditions That Pose a Risk to other in-patients at LTHT

If a case is suspected please contact IPC for advice.

Chikungunya Virus
Chlamydophila psittaci
Coxiella burnetii
Dengue virus
Francisella tularensis
Guanarito virus
Hanta virus
Junin virus
Kyasanur Forest disease virus
Machupo virus
OSMK haemorrhagic fever virus
Rift Valley fever virus
Small Pox
West Nile virus
Yersinia pestis

Note: Please also refer to Appendix G if the above organisms is suspected for danger of infection samples

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Appendix C - List of Groups Posing a Special Risk of Spreading Gastro-intestinal Infections

  1. Food Handlers: who work involves touching unwrapped foods to be consumed raw or without further cooking
  2. Health care facilities staff: who have direct contact, or contact through serving food, with susceptible patients or persons in whom an gastro-intestinal infection would have serious consequences
  3. Children under 5 years old: who attend nursery or a similar group
  4. Older children and adults: who may find it difficult to implement good standards or personal hygiene; for example, a confused elderly person or those with a learning disabilities.

Those identified in risk groups 1 and 2 please contact Infection Prevention and Control for advice

For those in risk groups 3 and 4, assume that once they have passed a normal stool, and they can practice hand hygiene under supervision, they may no longer require exclusion.

Please risk assess each case individually, and if you remain unsure, please contact the Infection Prevention and Control Team.

N.B. For further guidance please refer to LTHT Food Safety policy

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Appendix D - Multi Drug Resistant Micro-organisms

This criterion will ONLY apply to Enterobacteriaceae (e.g. ‘coliforms’), P. aeruginosa and Acinetobacter spp (predominantly A. baumannii).

The need to source isolate patients with other multi-resistant Gram negative organisms will be determined on a case-by-case basis on the advice of a consultant medical microbiologist.

All ESBL-positive and all carbapenemase-positive examples of the above.

For organisms that are ESBL and carbapenemase-negative, those that are resistant to two or more of the following classes of antibiotics:

  •  
    1. Broad-spectum beta lactams (defined as piperacillin-tazobactam, third generation cephalosporins, aztreonam, meropenem, Imipenem/ ertapenem)
    2. Quinolones
    3. Aminoglycosides

In addition any patient harbouring colistin-resistant P. aeruginosa, Acinetobacter spp or Enterobacteriaceae (excluding Serratia spp and Proteus spp which are inherently colistin-resistant) should also be source isolated.

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Appendix E - Communicable Notifiable Diseases

Registered Medical Practitioners attending a patient with a known or suspected notifiable disease must notify the local authority (Public Health England):

Has a notifable disease as listed below of the Notifications Regulations or

Has an infection not included in the list below which in the view of the practitioner presents, or could present, significant harm to human health; e.g. emerging or new infections; or

Is contaminated, such as with chemical or radiation, in a manner which, in view of the practitioner presents, or could present, significant harm to human health; or

Has died with, but not necessarily because of a Notifiable disease, or other infectious disease or contamination that presents, or could present, or that presented or could have presented significant harm to human health

NOTE: Notification of cases of infection not included in Schedule 1 and of contamination are expected to be exceptional occurrences.

NOTE: Practitioners should not wait for laboratory confirmation or results of other investigations in order to notify a case

Schedule 1 Diseases

Acute encephalitis
Acute meningitis
Acute poliomyelitis
Acute infectious hepatitis
Anthrax
Botulism
Brucellosis
Cholera
Diphtheria
Enteric fever (typhoid or paratyphoid)
Food poisoning
Haemolytic uraemic syndrome
Infectious bloody diarrhoea
Invasive group A streptococcal disease and scarlet fever
Yellow fever
Malaria

Measles
Meningococcal septicaemia
Mumps
Plague
Rabies
Rubella
SARS
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Legionnaires Disease
Leprosy

For further information refer to Department of Health Protection Legislation (England) Guidance 2010 Notifiable diseases and causative organisms: how to report - GOV.UK

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Appendix F - Danger of Infection Samples

Standards for the Labelling of Request Cards and Specimens for Pathology Investigation
https://leedspath.myeqms.com

Reason for labelling
To comply with National Health and Safety guidance and to alert laboratory staff that the specimen may require processing differently.

What is a “high risk” (Danger of Infection) specimen?
Clinical judgment must be used to label specimens correctly, and the onus for this is on the requestor. Specimens from the following MUST have a “Danger of Infection” label:

  • patients with proven infection with a Hazard Group 3 (HG3) pathogen (see list below)) e.g. hepatitis B and C, HIV, tuberculosis and other mycobacteria, typhoid, brucella and anthrax
  • A patient who is part of an on-going outbreak caused by a HG3 pathogen.
  • Patients suspected of having a HG3 pathogen (information from clinical history and examination - see table below for clinical details that increase risk of isolating HG3 pathogens)

Clinical Detail

High Risk Occupations

High Risk Sports/Pastimes

IVDA

Hospital or Laboratory staff (exposure incident)

Outdoor Water Sports

Return travel/visitor from abroad where HG3 pathogens are endemic*

Veterinary / Animal worker

Caving / pot-holing

Consumption of unpasteurised products (milk/diary)

Farming, visit to farm

Camping & Hunting in endemic areas*

Psoas abscess / cold abscess

Slaughter house/abbatoir worker/butcher

Animal Hide Drum playing/making

Enteric fever

Horse caretakers

 

HUS - (haemolytic uremic syndrome)

Equine Butchers

 

Consumption of raw or undercooked meat products

Industrial processing of wool, hide or hair

 

Prison Inmates

Meat Packing Plant Employees

 

Haemophilliac

 

 

vCJD

 

 

*Endemic areas differ depending on the pathogen but can include European countries for some infections. If unsure what the infection may be caused by include all travel details and the laboratory will assess the risk

If there is doubt as to whether a specimen is “high risk”, please contact the microbiology laboratory. On no account should specimens be taken from patients suspected of having any pathogen in Hazard Group 4, e.g. viral haemorrhagic fever (Lassa, Marburg, Ebola and Congo Crimean), or Hendra or Nipah viruses without prior consultation with the on-call medical microbiologist/virologist.

Handling “Danger of Infection” specimens
“Danger of Infection” labels should have black print on a yellow background, and should be self-adhesive. A label MUST be placed on the high-risk specimen container and its request form, which must give sufficient clinical information to enable the experienced laboratory staff to know what special precautions are necessary in the laboratory. Writing “Danger of Infection” is not adequate and can easily be missed. The request form may be folded so that the information need not be conspicuous to other people, but the “Danger of Infection” label must be clearly visible.
The specimen container must be placed in an individual transparent plastic bag, which should then be sealed. The specimen should then be transported by the usual system.

Danger of Infection Labels can be obtained from the print unit – Code WRN502

Specimens from patients known or suspected to be suffering from the following clinical conditions/micro-organisms must have “Danger of Infection” labels on both specimen and request form. This list is not exhaustive.

Bacteria
Anthrax (Bacillus anthracis)
Bacillary dysentery (Shigella dysenteriae type 1)
Brucellosis (Brucella species)
Ehrlichiosis (Ehrlichia species)
E. coli O157/VTEC
Glanders/Meliodosis (Burkholderia/Pseudomonas mallei and pseudomallei)
Plague (Yersinia pestis)
Q fever (Coxiella burnetti)
Rickettsia species
Tuberculosis and Mycobacterium species
Tularaemia (Francisella tularensis)
Typhoid and paratyphoid (Salmonella typhi and paratyphi)

Viruses
Dengue
Hantaviruses
Hepatitis (unknown cause, hepatitis B, C, D, E and G)
HIV/HTLV
Rabies
Yellow fever
Any pyrexial returning traveller (from non viral haemorrhagic fever area)
Also Transmissible spongiform encephalopathies (CJD, vCJD etc)

Parasites
Echinococcus species
Leishmania species
Falciparum malaria (Plasmodium falciparum)
Naegleria species
Pork tapeworm (Taenia solium)
Sleeping sickness (Trypanosoma species)

Fungi
Blastomyces dermatitidis
Cladophialophora bantana
Coccidioides immitis
Histoplasma species
Paracoccidioides brasiliensis
Penicillium marneffei

Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.