Group A Streptococcal Infections - Policy for the Prevention and Control of

Size: px
Start display at page:

Download "Group A Streptococcal Infections - Policy for the Prevention and Control of"

Transcription

1 Grup A Streptcccal Infectins - Plicy fr the Preventin and Cntrl f Pst hlder respnsible fr Prcedural Dcument Authr f Plicy Divisin/Department respnsible fr Prcedural Dcument Cntact details Lead Nurse/Directr f Infectin Preventin & Cntrl Alaric Clville, Cnsultant Micrbilgist/Jint DIPC Specialist Services/Infectin Preventin & Cntrl x2355 Date f riginal plicy 22 nd March 2012 Impact Assessment Perfrmed Ratifying bdy and date ratified: Review date and (frequency f further reviews) Yes/N Infectin Cntrl & Decntaminatin Assurance Grup: 21 st Octber 2014 April 2017 (every 3 years) Expiry date Octber 2017 Date dcument becmes live: 5 th Nvember 2014 Please specify standard/criterin numbers and tick ther bxes as apprpriate Mnitring Infrmatin Strategic Directins Key Milestnes Patient Experience Waiting Assurance Framewrk Privacy and Dignity Mnitr/Finance/Perfrmance Efficiency and Effectiveness Delivery f Care Clser t Hme CQC Regulatins/Outcmes: Infectin Cntrl NHSLA Risk Management Standards fr Acute Trusts NHSLA CNST Maternity Clinical Risk Management Standards: Other (please specify): Nte: This plicy has been assessed fr any equality, diversity r human rights implicatins Cntrlled dcument This dcument has been created fllwing the Ryal Devn and Exeter NHS Fundatin Trust Develpment, Ratificatin & Management f Prcedural Dcuments Plicy. It shuld nt be altered in any way withut the express permissin f the authr r their representative. Review date: April 2017 Page 1 f 28

2 Versin: Versin Date Authr (Title nt name) /03/2012 Cnsultant Micrbilgist/DIPC /07/2014 Senir Infectin Preventin & Cntrl Nurse Status: Final Reasn In respnse t new natinal guidance Rutine Review Assciated Plicies: Surce Islatin Plicy In cnsultatin with and date: Medical Micrbilgists: June 2014 Infectin Cntrl Operatinal Grup: 22 nd July 2014 Plicy Expert Panel (PEP): 1 st September 2014 Infectin Cntrl & Decntaminatin Assurance Grup: 21 st Octber 2014 Review Date (Within 3 years) April 2017 Cntact fr Review: Lead Nurse/Directr f Infectin Preventin & Cntrl Executive Lead Signature: (Only applicable fr Strategies & Plicies) Medical Directr Review date: April 2017 Page 2 f 28

3 CONTENTS 1. INTRODUCTION PURPOSE DEFINITIONS DUTIES AND RESPONSIBILITIES OF STAFF INFECTION PREVENTION AND CONTROL CONTACTS OF GAS INFECTIONS ANTIBIOTIC PROPHYLAXIS CASES OF GAS IDENTIFIED IN HEALTHCARE SETTINGS MANAGEMENT AND SCREENING OF HEALTH CARE WORKERS COMMUNICATION AUDIT ARCHIVING ARRANGEMENTS PROCESS FOR MONITORING COMPLIANCE WITH AND EFFECTIVENESS OF THE POLICY REFERENCES ASSOCIATED TRUST POLICIES OTHER ASSOCIATED TRUST DOCUMENTS APPENDIX 1: INFORMATION LEAFLET FOR HOSPITAL INPATIENTS APPENDIX 2: INFORMATION LEAFLET FOR THOSE IN CONTACT WITH GROUP A STREPTOCOCCAL INFECTION APPENDIX 3: INFORMATION LEAFLET FOR STAFF IN CONTACT WITH HEALTHCARE ACQUIRED GROUP A STREPTOCOCCAL INFECTION APPENDIX 4: ALGORITHM 1 - MANAGEMENT OF A SINGLE CASE OF GAS INFECTION APPENDIX 5: ALGORITHM 2 - MANAGEMENT OF AN OUTBREAK OF GAS INFECTION APPENDIX 6: ALGORITHM 3- MANAGEMENT OF COLONISED AND INFECTED HEALTHCARE WORKERS BY OCCUPATIONAL HEALTH APPENDIX 7: HCW SCREENING LETTER FOR MANAGEMENT OF A SINGLE CASE OF GAS ACQUIRED IN THE ACUTE CARE SETTING APPENDIX 8: RAPID IMPACT ASSESSMENT SCREENING FORM Review date: April 2017 Page 3 f 28

4 1. INTRODUCTION 1.1 Grup A streptccci (GAS) are als knwn as Streptcccus pygenes and cause a range f infectins. Mild nn-invasive infectins include sre thrats and skin infectins such as impetig are cmmn and highly infectius. Invasive Grup A Streptcccal (igas) infectins, including necrtising fasciitis (NF) and txin mediated cnditins such as scarlet fever and streptcccal txic shck syndrme (STSS) are serius and have a significant mrtality. 1.2 The rate f GAS thrat carriage in the healthy adult ppulatin is prbably less than 5%, with mst studies reprting a rate f abut 1%. Research in 2003/4 shwed that the annual rate f igas infectin in England, Wales and Nrthern Ireland was 3.33 cases per 100, 000. Reprted mrtality f igas infectin ranges frm 8 t 23%. 1.3 A significant prprtin, between 5 12% f igas infectin is healthcare assciated. In additin 2-11% f all severe GAS infectins are assciated with recent childbirth, a rate f apprximately 0.06 per 1000 births. Infectin in the mther carries a risk f infectin in the baby. 1.4 GAS causes utbreaks f infectin in healthcare settings, including acute care, maternity, residential and nursing hme settings. In acute care surgical and bstetric units are mst cmmnly affected. Outbreaks may ccur ver prlnged perids, ver 6 mnths, and invlve spread frm clnized staff t patients, patient t patient spread and infectin frm fmites. 1.5 Failure t cmply with this plicy culd lead t disciplinary actin. 2. PURPOSE 2.1 The purpse f this plicy is t ensure that GAS infectins in patients and staff are managed apprpriately t minimize the risk f spread f GAS in the healthcare envirnment in patients and staff at the Ryal Devn & Exeter NHS Fundatin Trust (hereafter referred t as the Trust ). 3. DEFINITIONS 3.1 Grup A Streptcccal Infectins GAS infectin is illness assciated with GAS, it may be clinically likely frm signs and symptms r micrbilgically cnfirmed. Invasive GAS (igas) is illness assciated with islatin f GAS frm bld r a nrmally sterile site. It als includes severe disease including necrtising fasciitis (NF) r Streptcccal Txic Shck Syndrme (STSS) where the GAS was islated frm a nrmally nn sterile site Peripartum GAS infectin is defined as islatin f GAS frm a mther up t 7 days after delivery in assciatin with clinical signs f infectin such as endmetritis r STSS, wund infectin r ther infectin f a sterile site GAS clnisatin ccurs when GAS is islated frm a nn sterile site withut clinical evidence f infectin Review date: April 2017 Page 4 f 28

5 3.1.4 A fmite (Sectin 1.4) is an inanimate bject r substance, such as clthing, furniture, r sap, that is capable f transmitting infectius rganisms frm ne individual t anther. 3.2 Healthcare Assciated GAS infectin A healthcare-assciated GAS infectin is defined as a GAS infectin that is neither present nr incubating at the time f admissin but cnsidered t have been acquired fllwing admissin t hspital r as a result f healthcare interventins in ther healthcare facilities. Typically, nset f GAS infectin is >48 h after admissin, r pstperatively at any time after admissin and fr up t seven days pst discharge. 3.3 Outbreak f GAS An utbreak shuld be cnsidered if there are tw r mre cases f suspected GAS infectin linked by persn r place. These cases will usually be within a mnth f each ther but the interval may extend t several mnths especially if detected due t typing f islates ver an extended perid. 4. DUTIES AND RESPONSIBILITIES OF STAFF 4.1 Medical Directr and Assciate Medical Directrs are respnsible fr: Ensuring that relevant medical staff are aware f this plicy Ensuring that medical staff maintain high standards in perfrmance f hand hygiene and use f apprpriate Persnal Prtective Equipment (PPE) Ensuring medical staff with ptential GAS infectins are referred t Occupatinal Health and d nt wrk while ptentially infectius Cntributing t utbreak investigatins including staff screening and cntrl measures as necessary 4.2 Infectin Preventin and Cntrl Team (IPCT) is respnsible fr: Maintaining active alert rganism surveillance fr GAS infectins Ensuring patients with GAS infectins are islated apprpriately Acting as a resurce fr best practice fr clinical staff Cnducting rutine retrspective surveillance f GAS infectins frm IPCT and Micrbilgy Labratry recrds six mnthly t identify pssible linked cases. Investigating cases f ptentially healthcare acquired GAS and undertaking apprpriate immediate measures t prevent spread f GAS Alert apprpriate clinical and peratinal staff shuld a ptential utbreak f GAS be detected. If ptential utbreaks f healthcare acquired GAS are detected the IPCT will cntribute t the cre cmpetencies f the Outbreak Cntrl Team 4.3 Senir Nurses and Assistant Directrs f Nursing (ADNs) are respnsible fr: Ensuring that all relevant nursing staff are aware f this and related plicies Cntributing t utbreak investigatins and cntrl measures as necessary Review date: April 2017 Page 5 f 28

6 4.4 Ward Matrns are respnsible fr: Ensuring that the IPCT is infrmed f patients admitted with GAS r wh develp GAS infectin in hspital Ensuring patients with GAS are apprpriately islated Ensuring that hand hygiene, use f PPE and envirnmental hygiene standards are maintained t reduce the risk f transmissin f infectin Ensuring staff with ptential GAS infectins are referred t Occupatinal Health and d nt wrk while ptentially infectius Cntributing t utbreak investigatins, including staff screening and cntrl measures as necessary 4.5 Other Medical and Nursing Staff are respnsible fr: Maintaining standards f hygiene and use f PPE fr the preventin f transmissin f infectin Nt wrking with ptential GAS infectins, such as sre thrat r skin infectins, and taking apprpriate measures t btain treatment frm their General Practitiner (GP). Infrming Occupatinal Health and an apprpriate senir manager if aware that they may be infected r clnized with GAS Cntributing t utbreak investigatins including cperating with staff screening and ther cntrl measures as necessary 4.6 Occupatinal Health is respnsible fr: Prviding advice t staff abut expsure t GAS, and prviding antimicrbial prphylaxis if apprpriate Investigating and treating staff with carriage f GAS Cntributing t utbreak investigatins including staff screening when it is determined t be apprpriate 4.7 Public Health England (PHE) is respnsible fr: Prviding advice t cntacts f cases f GAS and igas in the cmmunity Identifying significant cntacts f cmmunity cases f igas Cntributing t utbreak investigatins f healthcare acquired GAS 4.8 Micrbilgy Department is respnsible fr: Prviding a diagnstic and clinical advice service fr GAS Ensuring the IPCT is infrmed prmptly f hspital inpatients with GAS infectin, and als ther patients nt in hspital wh may have healthcare acquired infectin. This includes infectins ccurring within 7 days f delivery. Ensuring GAS islatins frm hspital patients are reprted thrugh the labratry infrmatin system t the ICNet surveillance system. Ensuring that all GAS islates frm in-patients, peri-partum patients, nenates, and thse frm pst perative wunds are saved fr six mnths s that typing can be perfrmed shuld retrspective surveillance indicate the pssibility f linked healthcare assciated cases. Ensuring all micrbilgically diagnsed cases f igas are ntified thrugh the COSURV surveillance system t the PHE. In additin, when apprpriate, serius cases f igas and thse in high risk envirnments such as nursing hmes, Review date: April 2017 Page 6 f 28

7 shuld be reprted t Public Health England by telephne in rder that apprpriate cntact management can be undertaken. Ensuring GAS islates frm invasive disease are rutinely referred fr typing. 5. INFECTION PREVENTION AND CONTROL 5.1 Transmissin The mde f spread f GAS is: Drplets expelled frm the respiratry tract f carriers and/r infected persns Cntact: direct cntact with mucus frm nse r thrat f infected persn, r cntact with infected sres/wunds Indirect cntact with cntaminated fmites Invasin and thus infectin ccurs 1-3 days after initial clnisatin. 5.2 Management f Cases Detailed infrmatin n infectin cntrl precautins fr infectins including GAS can be fund in the Trust Surce Islatin Plicy. Certain pints are expanded belw. 5.3 Patient islatin Patients will require infrmatin abut their infectin and why they require islatin. A patient infrmatin leaflet is attached in Appendix Natinal guidance advises that patients with suspected r cnfirmed GAS infectin shuld be islated in a side rm, preferably with en-suite facilities, fr a minimum f 24 hurs after the initiatin f effective antimicrbial therapy. Hwever, the Micrbilgists and IPCT in this Trust advise islatin fr 48 hurs after the initiatin f effective antimicrbial therapy Sme patients with severe r extensive GAS infectin, fr example necrtising faciitis and thse with infected eczema where there is a high risk f shedding, may require lnger perids f islatin. Islatin shuld in these cases cntinue until culture negative r n advice frm Micrbilgy. 5.4 Mthers and Babies Pregnant wmen fund t be infected r clnized with GAS during pregnancy shuld be treated. The GAS status shuld be clearly dcumented in bstetric care recrds t ensure cmmunicatin between hspital and cmmunity midwifery services If GAS is detected in either mther r baby in the first 28 days fllwing birth, bth shuld receive apprpriate antibitic treatment In hspital mthers and babies shuld nly be separated in exceptinal circumstances, e.g. ITU admissin Breast feeding shuld nrmally be cntinued. Review date: April 2017 Page 7 f 28

8 5.5 Persnal Prtective Equipment Minimum PPE fr healthcare wrkers when in cntact with infectius GAS patients, cnsists f dispsable glves and aprns. A fluid repellent surgical mask and eye shield r visr shuld be used fr perative debridement / change f dressings fr necrtising fasciitis and prcedures likely t generate drplets until the patient is culture negative Health care wrkers with breaks in their skin must cver lesins with a waterprf dressing. 5.6 Visitrs Visitrs, especially husehld cntacts, must be asked abut signs f GAS, e.g. sre thrat r infected skin lesins. Thse with symptms f infectin shuld be directed t their GP r the apprpriate NHS Walk in Centre fr treatment. Visitrs with untreated infectin shuld nly visit if essential n the advice f the IPCT Visitrs shuld be advised n hand hygiene and given and shwn hw t use persnal prtective equipment, glves and aprns, if apprpriate Visitrs shuld be given apprpriate infrmatin n GAS infectin. An infrmatin leaflet fr Cntacts f GAS patients is attached in Appendix Mrtuary & Pathlgy Departments Pathlgy staff shuld als be infrmed when unfixed tissue frm a case f necrtising fasciitis is sent fr examinatin In the event f a patient death: the mrtuary staff shuld be infrmed f the risk f infectin. A cadaver bag shuld be used. the bdy can be viewed, but n embalming r ther preparatin f the bdy shuld take place. undertakers shuld be infrmed f the risk f infectin 6. CONTACTS OF GAS INFECTIONS 6.1 Cmmunity cntacts and Visitrs Clse persnal cntacts are defined as husehld r kissing cntacts within 7 days prir t nset f infectin Management f cntacts f igas is nrmally the respnsibility f the PHE, which must be ntified f igas cases (HPA 2004) Clse persnal cntacts f a case f igas shuld be given written infrmatin n signs and symptms f igas and advice n actins. If there are 2 related cases f igas antibitic prphylaxis is recmmended fr all clse cntacts. Prphylaxis in the cmmunity is the respnsibility f the PHE and the Acute Respnse Centre shuld be cntacted ( r ut f hurs via the Trust switchbard.) See als Patient Cntact Infrmatin Leaflet at Appendix 2. Review date: April 2017 Page 8 f 28

9 6.2 Health Care Wrkers (HWC) HCW are prtected by crrect use f hand hygiene and PPE If breaks in prtectin frm PPE ccur, e.g. during resuscitatin, HCW shuld seek advice frm Occupatinal Health r Micrbilgy. Written infrmatin shuld be given fr significant expsure, see Appendix Fr severe expsure, e.g. a needle stick injury antibitic prphylaxis may be recmmended n the advice f Occupatinal Health r Micrbilgy. 7. ANTIBIOTIC PROPHYLAXIS 7.1 Antibitic prphylaxis is nrmally nly required in limited circumstances and shuld nly be given when advised by a Cnsultant in Cmmunicable Disease Cntrl, Cnsultant Micrbilgist r Occupatinal Health Physician. See Table 1 Table 1. Indicatins fr antimicrbial prphylaxis Individuals requiring antibitic prphylaxis Mther and/r baby if either develps GAS infectin during the first 28 days f life (nenatal perid) Clse cntacts wh develp symptms suggestive f GAS infectin, i.e. sre thrat, fever r skin infectin As a cntrl measure in clusters r utbreaks On Micrbilgy, PHE r Occupatinal Health advise fllwing risk assessment fr severe expsure t infected case, e.g. needle stick injury. Individuals requiring a Patient Infrmatin Leaflet and advice These cntacts may als be ffered a screen t detect GAS thrat carriage (ie thrat swab). Clse cntacts wh d nt have symptms suggesting GAS infectin. Health care wrkers wh have been expsed t drplet particles frm a patients respiratry tract i.e. during intubatin Injecting drug users fllwing a case ccurring in a lcal injecting drug user. 7.2 Antibitic chice fr adults Fr adults ral penicillin V 500mg qds fr 10 days is the first line drug f chice if chemprphylaxis is indicated r azithrmycin 500mg daily fr 5 days is a suitable alternative fr thse with penicillin allergy. 7.3 Antibitic chice fr children Fr children use penicillin r azithrmycin accrding t dses advised in the BNF fr Children. 8. CASES OF GAS IDENTIFIED IN HEALTHCARE SETTINGS 8.1 Investigatin f a single case f GAS On identificatin f a single case f GAS, the IPCT shuld establish whether the case is likely t be cmmunity r healthcare-assciated. See Appendix 4 fr Algrithm 1, Management f a single case f GAS Infectin. Initial investigatin shuld establish Review date: April 2017 Page 9 f 28

10 whether the patient had any clinical signs cnsistent with GAS infectin at r prir t admissin Enquiry shuld include symptms in husehld and ther clse cntacts. Any such cntacts with symptms shuld be referred t their GP and excluded frm the healthcare setting until apprpriately diagnsed and treated. Thse diagnsed with GAS require a minimum f 24 hurs antibitic treatment befre cnsidered safe in the healthcare setting If the case is likely t be healthcare acquired then the IPCT shuld cnsider prspective enhanced surveillance. This culd include sampling f infected wunds f patients in the vicinity f the index case r wh are being cared fr by the same HCWs; enquiry fr pssible linked cases ccurring pst discharge r clinically identified withut an islate; ther apprpriate measures relevant t a particular case Review surveillance recrds fr pssible linked cases identifiable retrspectively Any islates f GAS identified either retrspectively r prspectively shuld be typed and cmpared with patient islates If a case is cnsidered t be hspital acquired, and n likely surce is identified then screening f HCWs shuld be cnsidered see sectin Investigatin f utbreaks f GAS infectin An utbreak is defined as tw r mre linked cases f GAS infectin. These may be detected cntempraneusly r ccur ver an extended perid f time and be detected by prspective r retrspective surveillance activities Fr any utbreak, initial cntrl will invlve the same measures as wuld be taken fr an individual healthcare acquired case. This includes identificatin f cases, treatment and islatin, and management f cntacts In additin, t cntrl and identify the surce f an utbreak the IPCT shuld fllw the steps utlined in Algrithm 2 (Appendix 5) Management f an utbreak f GAS infectin. This includes an epidemilgical review, envirnmental audit and is likely t include screening f patients and asymptmatic HCWs When a ptential utbreak is detected, an utbreak cntrl team shuld be frmed. The exact team cmpsitin will depend n the nature f the utbreak but is likely t include : Infectin Preventin & Cntrl Senir Nurse Cnsultant Micrbilgist Matrn and Medical Cnsultant frm the affected ward / department Htel Services Divisinal Directr/ Directr frm affected Divisin Medical Directr and r Chief Nurse Cmmunicatins Officer Public Health England representatives shuld be invited Fr sme utbreaks it is pssible that the Majr Outbreak Plan may be invked. Review date: April 2017 Page 10 f 28

11 9. MANAGEMENT AND SCREENING OF HEALTH CARE WORKERS 9.1 Surgens, nurses, anaesthetists, midwives and wund care teams have been implicated in transmissin and utbreaks f healthcare acquired GAS. 9.2 HCW with symptms suggestive f GAS shuld infrm their line manager and seek advice n whether they shuld cntinue clinical duties frm their line manager r Occupatinal Health. Treatment shuld be undertaken in liaisn with the HCW s GP. If a HCW pses a risk t patients she/he shuld be excluded frm wrk be fr a minimum f 24 hurs f apprpriate antimicrbial treatment and reslutin f symptms f GAS infectin has ccurred. 9.3 The IP&C team may cnsider it necessary t screen epidemilgically linked HCWs fr asymptmatic carriage as part f the investigatin f a single case f healthcare acquired, r an utbreak f, GAS infectin see Algrithm 2 (Appendix 5). Thse wh require screening fr GAS carriage will be identified by the IP&C team. Appendix 7 is a draft letter fr staff linked t a case f GAS. Please make the usage cnsistent. 9.4 Fllwing identificatin f the ptential cntact grup, screening f HCWs shuld be cnducted by an ccupatinal health practitiner and shuld fllw a stepwise prgressin. Initial screening swabs f thrat and skin lesins. Fr dry skin lesins a swab mistened with sterile saline shuld be used HCWs shuld be examined fr skin lesins and dermatitis Additinal sites knwn t be implicated in asymptmatic carriage include anterir nares, anus and vagina. It may be necessary t swab additinal sites if the initial investigatin fails t identify implicated carriers. If screening f additinal, sensitive, sites is deemed necessary, it shuld nly be dne after careful cnsideratin and explanatin t the HCWs invlved 9.5 HCWs may wrk pending the results f the screen. 9.6 Any HCW fund t be culture psitive fr GAS shuld be referred t ccupatinal health fr treatment and refrain frm wrk r at least wrk withut patient cntact until they have received 24 hurs f an apprpriate antibitic treatment. Algrithm 3 (Appendix 6) is fr the management f clnised and infected healthcare wrkers and includes antimicrbial treatment and clearance screens. 9.7 Fr HCW pst treatment clearance screens shuld be taken 24 h after the end f treatment and again at ne, three, six, and twelve weeks pst treatment. Hwever if strain typing shws that the HCW was carrying a strain distinct frm the utbreak r patient strain then clearance swabs can be discntinued after agreement with Micrbilgy and Occupatinal Health COMMUNICATION 10.1 General principles Gd cmmunicatin is central t the effective management f GAS infectins and preventin f spread in the healthcare envirnment. It is als imprtant t supply timely infrmatin t affected patients and staff if indicated The IPCT shuld be prmptly infrmed f suspected cases by clinical teams. Review date: April 2017 Page 11 f 28

12 The micrbilgy labratry shuld infrm the IPCT and clinical teams prmptly f GAS islatin frm hspital patients and ther cases that may be healthcare acquired GPs in the cmmunity shuld be infrmed f GAS islatins by phne during wrking hurs frm sites ther than the thrat. Ptential igas cases in general practice shuld be cmmunicated t n call services ut f hurs PHE shuld be ntified f cases f igas Patient and Staff Cmmunicatin Suitable and accurate infrmatin shuld be prvided prmptly t the patient (Appendix1) and clse persnal and staff cntacts fr igas infectins (Appendices 2 & 3) Effective hand ver between health care teams shuld ensure cmmunicatin with the patient with igas infectin and their clse persnal cntacts is cnsistent, accurate and dcumented Healthcare acquired GAS infectins and Outbreaks Patients, clse cntacts and HCWs shuld be prvided with clear, cncise infrmatin abut the utbreak. Infrmatin shuld be prvided t relevant HCWs t encurage heightened awareness f the symptms f GAS, t take specimens frm symptmatic patients, give early treatment where GAS is suspected, and prmptly ntify the utbreak cntrl team. Effective cmmunicatin shuld be assisted by cmmunicatins department All media enquiries must be referred t the Cmmunicatins Department. 11. AUDIT 11.1 Audit is necessary t evaluate whether utbreaks f GAS infectin are detected and apprpriately managed The fllwing audits are apprpriate: IPCT - six mnthly retrspective audit f Hspital GAS infectins t determine if there is any evidence f undetected utbreaks. Outbreaks may ccur ver a prtracted perid at a lw level and review may reveal ptential utbreaks which require investigatin including strain typing. Micrbilgy - audits f strage f strains frm in-patients, peri-partum patients, nenates, and thse frm pst perative wunds fr six mnths, and submissin f strains frm igas infectin fr typing. These shuld be cnducted annually. Patients with GAS infectins are apprpriately islated if infectius, mnitred by annual patient placement audit 12. ARCHIVING ARRANGEMENTS The riginal f this plicy will remain with the authr Lead Nurse, Infectin Preventin and Cntrl. An electrnic cpy will be maintained n the Trust Intranet (IaN), P Plicies G Grup A Streptcccal Archived cpies will be stred n the Trust's archived plicies shared drive, and will be held fr 10 years. Review date: April 2017 Page 12 f 28

13 13. PROCESS FOR MONITORING COMPLIANCE WITH AND EFFECTIVENESS OF THE POLICY 13.1 In rder t mnitr cmpliance with this plicy, the auditable standards will be mnitred as fllws: N Minimum Requirements Evidenced by NHSLA standard 1. Patients are apprpriately placed n wards s as t minimise the risk f infectin t thers Annual audit f patient placement N/A 2. Hspital Acquired GAS infectins Islates are stred fr a minimum f 6 mnths Annual Audit by Micrbilgy Department N/A 3. Islates f GAS frm invasive infectins are referred fr typing Annual Audit by Micrbilgy Department N/A 4. Retrspective surveillance f GAS infectins frm IPCT and Micrbilgy Labratry recrds six mnthly t identify pssible linked cases IPCT Surveillance meeting minutes N/A 13.2 Frequency In each financial year, the IPCT and Micrbilgy Department s quality lead will audit their respective areas f cmpliance t be mnitred annually t ensure that this plicy has been adhered t and a frmal reprt will be written and presented at the ICOG Undertaken by Infectin Preventin & Cntrl Team and Audit & Surveillance Nurse and clinical Micrbilgy Department staff 13.4 Disseminatin f Results Results will be disseminated at the Infectin Cntrl Operatinal Grup which is held six weekly and the Infectin Cntrl and Decntaminatin Assurance Grup which is held quarterly Recmmendatins/ Actin Plans Implementatin f the recmmendatins and actin plan will be mnitred by the ICOG which meets six weekly 13.6 Any barriers t implementatin will be risk assessed and added t the risk register Any changes in practice needed will be highlighted t Trust staff via the Gvernance Managers cascade system. 14. REFERENCES Steer, J.A. et al (2012). Guidelines fr preventin and cntrl f grup A streptcccal infectin in acute healthcare and maternity settings in the UK. Jurnal f Infectin (2012) 64, Review date: April 2017 Page 13 f 28

14 Health Prtectin Agency (2004). Interim UK guidelines fr management f clse cmmunity cntacts f invasive grup A streptcccal disease. HPA, [nline] Available at: 0/Interim_guidelines_fr_management_f_clse_cntacts_f_iGAS.pdf Health Prtectin Agency (2008) Invasive Grup A Streptcccal Infectins Infrmatin Leaflet. Lndn: HPA, ASSOCIATED TRUST POLICIES Surce Islatin Plicy 16. OTHER ASSOCIATED TRUST DOCUMENTS Majr Outbreak Plan Review date: April 2017 Page 14 f 28

15 APPENDIX 1 - INFORMATION LEAFLET FOR HOSPITAL INPATIENTS Invasive Grup A Streptcccal Infectins Infrmatin Leaflet fr Hspital Inpatients What is grup A streptcccus? Grup A streptcccus (GAS) is a bacterium fund in the thrat and n the skin and in mst peple it des nt cause any symptms. Hw des it spread? As the bacterium is fund in the thrat and n skin it may be passed frm ne persn t anther thrugh sneezing, kissing and skin cntact. Sme peple may carry it withut any symptms f illness. This is knwn as being clnised. In ther peple the bacterium can cause illness. This is knwn as being infected. What kinds f infectins are caused by GAS? Mst GAS infectins are relatively mild illnesses such as sre thrat (therwise knwn as strep thrat ), impetig (a crusted skin infectin usually arund the muth that ften affects children) r cellulitis (an infectin causing redness f the skin). Mst cases f thrat infectin will pass withut the need fr treatment and skin infectins may require a shrt curse f antibitics. On rare ccasins, GAS can cause severe diseases called invasive GAS disease. Wh is at risk f GAS infectins? Anyne can becme infected with GAS. Hwever, peple with lng-term illnesses like cancer, diabetes and kidney disease, and thse wh use medicatins such as sterids, are at higher risk fr invasive disease. Breaks in the skin, such as surgical wunds, r cuts can als prvide an pprtunity fr the bacteria t enter the bdy and cause infectin. What is invasive GAS disease? Invasive GAS disease ccurs when the bacterium gets int parts f the bdy where it is nt usually fund, such as the bld, muscle, r lungs. Tw f the mst severe, but rare, frms f invasive GAS disease are necrtising fasciitis (a deep tissue infectin with tissue destructin requiring surgery) and Streptcccal Txic Shck Syndrme (an illness with sme f the fllwing: high fever, lw bld pressure, muddled thinking, bdy rash as in scarlet fever, diarrhea and vmiting, difficulty breathing, kidney r liver damage and bld cltting prblems). Why des invasive GAS disease ccur? Invasive GAS infectin ccurs when the bacterium gets past the bdy s natural defences. This may ccur when sres r ther breaks in the skin allw the GAS bacteria t get int the bldstream and deep tissue, r when the persn s ability t fight ff infectin is decreased because f lng-term illness r an illness that affects the immune system. Sme types (called strains ) f GAS are mre easily able t cause severe disease than thers. I have been tld I have GAS disease - what will happen t me nw and hw will it be treated? Review date: April 2017 Page 15 f 28

16 Depending n where the GAS infectin has been identified and hw severe the symptms are, yu will be given varius antibitics t treat the infectin. Very ccasinally, immunglbulin (antibdies that will help yu fight the infectin, btained frm bld dnrs) is given as well. While yu have this infectin yu are likely t be kept in a single rm - nt in a bay with ther patients. This is t help prevent the infectin spreading t thers and may nly be fr a few days. Hwever if the infectin is quite severe then yu may be need t remain in a single rm fr a lnger perid f time. The hspital wrkers caring fr yu may smetimes wear dispsable glves, aprns and very ccasinally a mask when in cntact with yu. The prtective clthing they wear will depend n which part f yur bdy has the infectin, and als what they are actually ding with yu during that time. T help prevent GAS infectin spreading t thers it is imprtant yu wash yur hands with sap and water r use the alchl hand rub ften. If yu have a thrat infectin it is imprtant that yu cugh/sneeze int dispsable tissues, thrw these away prmptly and then wash yur hands r use the alchl hand rub. Are my relatives, visitrs, husehld cntacts at risk f getting GAS disease frm me? Mst peple in clse cntact with GAS remain well and symptm free, thugh sme develp a sre thrat r mild skin infectins. Althugh healthy peple can get invasive GAS disease frm a relative r a member f their husehld with GAS, it is very rare. If yur visitrs are helping with yur care activities then they may als need t wear dispsable aprns r glves, s they shuld check with the nurses if this is necessary. It is very imprtant that that visitrs and carers wash their hands r use the alchl hand rub ften, and especially when leaving yur rm. Other imprtant times fr them t wash their hands r use the hand rub are: befre eating, after ging t the tilet, and befre and after helping yu with persnal care activities such as washing, dressing, eating r using the tilet. Hw wuld they knw if they have develped the infectin? The mst imprtant thing t be aware f are the early signs and symptms f invasive GAS disease, which are: High fever Severe muscle aches Pain in ne area f the bdy Redness at the site f a wund Vmiting r diarrhea What shuld they d if they develp any f these symptms? Cntact their GP r seek medical advice immediately. Tell the GP they have been in cntact with smene recently diagnsed with invasive GAS disease and nw have develped sme symptms that are causing cncern. It is likely that the GP will want t see them in the surgery. If they are t unwell t visit the surgery r it is clsed they shuld nt delay seeking medical advice. Remember, mst peple wh cme int cntact with GAS remain well and symptm free, r may develp mild thrat r skin infectins. Cntracting invasive GAS disease frm a relative r husehld member is very rare. If yu have any further questins speak t the ward staff r ask them t cntact the hspital infectin cntrl team Review date: April 2017 Page 16 f 28

17 Yu can als btain useful infrmatin frm the fllwing websites that als prvide links t patient supprt grups: Public Health England NHS Chices Review date: April 2017 Page 17 f 28

18 APPENDIX 2 - INFORMATION LEAFLET FOR THOSE IN CONTACT WITH GROUP A STREPTOCOCCAL INFECTION Invasive Grup A Streptcccal Infectins Infrmatin Leaflet fr thse in cntact with grup A streptcccal infectin Yu have been given this leaflet because yu have been in cntact with a case f grup A streptcccal (GAS) infectin. Althugh it is very unlikely that yu will be affected by GAS infectin, the medical team wuld like yu t be able t recgnise the signs f a mre serius infectin. Questins and answers fr clse cntacts f cases f GAS What is grup A streptcccus (GAS)? GAS is a bacterium ften fund in the thrat and n the skin. In mst peple it des nt cause any symptms. Hw are GAS infectins spread? The bacteria survive in thrats and n hands fr lng enugh t allw easy spread between peple thrugh sneezing, kissing and skin cntact. Peple may carry GAS in the thrat r n the skin and have n symptms f illness. This is smetimes knwn as being clnised. What kind f illnesses are caused by GAS? Mst GAS infectins are relatively mild illnesses such as a sre thrat (called strep thrat ) r a skin infectin such as impetig. On rare ccasins, these bacteria can cause ther mre severe diseases. What is invasive grup A streptcccal disease (igas)? Smetimes serius GAS disease may ccur when bacteria get int parts f the bdy where bacteria usually are nt fund, such as the bld, muscle, lungs r the birth canal after childbirth. These infectins are called invasive GAS disease. Tw f the mst severe, but rare, frms f invasive GAS disease are necrtising fasciitis and Streptcccal Txic Shck Syndrme. Why des invasive GAS disease ccur? Invasive GAS infectins ccur when the bacteria get past the defences f the persn wh is infected. This may ccur when a persn has sres r ther breaks in the skin that allw the bacteria t get int the tissue, including just after childbirth, r when the persn's ability t fight ff the infectin is reduced because f lng-term illness r an illness that affects the immune system. Als, sme types f GAS are thught t be mre likely t cause severe disease than thers. Am I at risk f getting invasive grup A streptcccal disease frm clse cntact with a patient with igas? Mst peple wh cme int cntact with GAS remain well and symptm-free, r develp mild thrat r skin infectins. These infectins can be easily treated by yur GP. Healthy peple can get invasive GAS disease frm a relative r a member f their husehld but it is very rare. Certain grups f peple might be mre at risk f cntracting a mre serius infectin, fr example, peple wh have recently given birth, r had surgery. Review date: April 2017 Page 18 f 28

19 What d I need t be aware f? The mst imprtant thing t be aware f are the early signs and symptms f invasive disease, which are shwn in the bx belw. Early signs and symptms f invasive GAS disease High fever Severe muscle aches Pain in ne area f the bdy Redness at the site f a wund Vmiting r diarrhea What shuld I d if I develp any f these symptms? If yu develp any f these symptms cntact yur GP r seek medical advice immediately. Tell yur GP that yu have been in cntact with smene recently diagnsed with invasive GAS disease and that yu have develped sme symptms that yu are wrried abut. It is very likely that yur GP will ask yu t cme int the surgery s yu can be examined. If yu are t unwell t visit the surgery r it is clsed yu shuld nt delay in seeking medical advice Mst peple wh cme int cntact with GAS remain well and symptm-free, r develp mild thrat r skin infectins. Cntracting invasive GAS disease frm a clse cntact is very rare. Review date: April 2017 Page 19 f 28

20 APPENDIX 3 - INFORMATION LEAFLET FOR STAFF IN CONTACT WITH HEALTHCARE ACQUIRED GROUP A STREPTOCOCCAL INFECTION Invasive Grup A Streptcccal Infectins Yu have been given this leaflet because yu have been identified as a member f staff in cntact with a patient with grup A streptcccal (GAS) infectin, wh may have acquired their infectin thrugh cntact with healthcare. Althugh it is very unlikely that yu will be affected by GAS infectin, we wuld like yu t be able t recgnise the signs infectin s that yu can btain the best treatment and avid spreading infectin t clse cntacts and patients. In additin as part f the investigatin f healthcare acquired GAS it is smetime necessary t screen staff fr asymptmatic carriage. The leaflet explains the prcess f screening and treating healthcare wrkers wh carry utbreak strains f GAS ABOUT GAS What is grup A streptcccus (GAS)? GAS is a bacterium, full name Streptcccus pygenes, and it is nrmally fund in the thrat r n the skin and usually causes n symptms. Hw are GAS infectins spread? GAS is spread by drplets frm the respiratry tract, when sneezing r cughing, r by tuch. Peple may carry GAS in the thrat r n the skin and have n symptms f illness. This is referred as being clnised r a carrier. Mst peple wh cme int cntact with GAS remain well and symptm-free, r develp mild thrat r skin infectins. Cntracting invasive GAS disease frm a clse cntact is very rare. Indeed mst staff wh develp GAS infectins will have cntracted them by chance frm a cntact utside the wrkplace. What infectins are caused by GAS? Mst GAS infectins are relatively mild illnesses such as a sre thrat (called strep thrat ) r a skin infectin such as impetig. On rare ccasins, these bacteria can cause ther mre severe diseases. What is invasive grup A streptcccal disease (igas)? Serius invasive -igas disease is rare. It may ccur when bacteria invade the bld, muscle, lungs r the birth canal after childbirth. These infectins are called invasive GAS disease. Tw f the mst severe, but rare, frms f invasive GAS disease are necrtising fasciitis (NF) and Streptcccal Txic Shck Syndrme TSST). The mst imprtant thing t be aware f are the early signs and symptms f invasive disease, which are shwn belw. Early signs and symptms f invasive GAS disease High fever Severe muscle aches Pain in ne area f the bdy Redness at the site f a wund Vmiting r diarrhea Review date: April 2017 Page 20 f 28

21 What shuld I d if I develp any f these symptms? If yu develp any f these symptms cntact yur GP r seek medical advice immediately. Tell yur GP that yu have been in cntact with smene recently diagnsed with invasive GAS disease and that yu have develped sme symptms that yu are wrried abut. It is very likely that yur GP will ask yu t cme int the surgery s yu can be examined. If yu are t unwell t visit the surgery r it is clsed yu shuld nt delay in seeking medical advice. HEALTHCARE ASSOCIATED GAS AND STAFF SCREENING The Trust Infectin Preventin and Cntrl Team cnducts surveillance f GAS infectins identified in the Trust because ccasinally utbreaks f healthcare acquired GAS have been reprted. Infectin may be spread frm patient t patient, r frm a staff carrier t patients. If a ptential utbreak is detected it is necessary t cnduct investigatins t find the surce f infectin. On ccasin this will mean screening staff wh have been in cntact with cases t see if they are unwittingly carrying an utbreak strain. If staff screening is necessary it will be undertaken in cnfidence by the Occupatinal Health Team. Screening usually invlves swabbing the thrat and any skin lesins, e.g. eczema. Occasinally ther sites may need t be screened als. Any staff carriers identified are declnised with antibitic treatment. Fllw up screening t check that declnisatin is successful is undertaken. If staff screening is ever required it will nly be undertaken if abslutely necessary. A full explanatin and pprtunity t ask questins will be given befre any investigatins are undertaken. Review date: April 2017 Page 21 f 28

22 APPENDIX 4 - ALGORITHM 1 - MANAGEMENT OF A SINGLE CASE OF GAS INFECTION Identificatin f suspected r cnfirmed GAS infectin in acute healthcare r maternity setting Hspital Inpatients Islate in single rm with wn tilet/washbasin whilst cnsidered infectius Manage as infected patient as per lcal infectin cntrl plicies Infrm the IPCT Infrm patient s clinical team Micrbilgy labratry t save islate fr 6 mnths. If igas send directly t reference labratry YES Des case have igas infectin? NO Ntify lcal health prtectin specialist refer t igas cmmunity guidelines Ascertain if healthcare assciated? Review surveillance recrds t identify pssible linked HCAI GAS cases in last 6 mnths (see Algrithm 2 if additinal cases identified) YES N further investigatin NO See Algrithm 3 NO NEGATIVE POSITIVE Any cntacts 1 with signs and symptms f pssible GAS infectin in previus 7d? HCWs OH t invite fr swabbing (thrat/skin lesins) + treatment as apprpriate Refer t Occupatinal Health (OH) fr management YES Patients IPCT t manage see Algrithm 2 Visitrs Refer t GP 1. Includes hspital inpatients, patients recently discharged ( 7 days) and wmen wh gave birth in any setting including at hme. 2. Invasive GAS infectin (igas) is defined thrugh islatin f GAS frm a nrmally sterile bdy site. Infectins where GAS is islated frm a nn-sterile site in cmbinatin with a severe clinical presentatin shuld be managed as per igas infectin 3. Cnsider healthcare-assciated if symptms/signs f infectin nt present n admissin r if discharged frm hspital r gave birth within the previus 7 days and where there is n ther bvius surce f transmissin e.g. frm clse husehld cntacts 4. Cnsider HCWs, visitrs, ther patients/husehld members in direct cntact/ clse prximity t case (same bed space, theatre delivery rm) within 7 days prir t diagnsis 5. IPCT t cnsider whether asymptmatic HCWs shuld be invited fr screening by Occupatinal health. Indicatins fr this may include strng epidemilgical link, absence f alternative ptential surce fr the infectin and/r where patient develped invasive GAS infectin Review date: April 2017 Page 22 f 28

23 APPENDIX 5 - ALGORITHM 2 - MANAGEMENT OF AN OUTBREAK OF GAS INFECTION Identificatin f suspected r cnfirmed GAS utbreak 1 in acute healthcare r maternity setting 2 Individual cases managed as per Algrithm 1 Infrm the IPCT, patients clinical team and lcal health prtectin unit Reprt as SUI if apprpriate Infrm and send islates t reference labratry 3 IPCT t cnvene utbreak cntrl team 4 Undertake epidemilgical investigatin including review f micrbilgy and surveillance recrds f pssible healthcareassciated GAS cases ver 6 mnths 5 Review methds f decntaminatin, cleaning and ther infectin cntrl plicies and adherence t plicies Take immediate actin t rectify any deficiencies Cnsider screening (thrat and skin lesins) f HCWs epidemilgically linked t cases Identify any cmmn surce equipment including fixed facilities such as baths and shwers Cnsider repeat screening f shwers HCWs epidemilgically linked t utbreak and screen at ther sites (nse, anus & vagina) Surce f utbreak established? Cnsider envirnmental sampling f epidemilgically linked equipment r facilities NO YES Take remedial actin 1. An utbreak shuld be cnsidered if there are tw r mre cases f suspected GAS infectin related by persn r place. These cases will usually be within a mnth f each ther but the interval may extend t several mnths. 2. Includes hspital inpatients, patients recently discharged ( 7 days) and wmen wh gave birth in any setting including at hme. 3. Clearly label islates sent t the reference labratry as being part f a suspected utbreak t priritise prcessing. Epidemilgical investigatins and preventive measure shuld nt await results f typing 4. Outbreak cntrl team may include infectin cntrl dctr and nurses, cnsultant micrbilgist, cnsultant frm the specialty invlved, ccupatinal health adviser, lcal health prtectin specialist, cleaning manger, bed manager, apprpriate healthcare manager, lcal cmmissining lead and cmmunicatins adviser. 5. Other patients, HCWs, equipment and the envirnment are pssible surces f utbreaks. Develp time lines and inpatient jurneys t identify verlaps f hspital stays and cmmn expsures. Review date: April 2017 Page 23 f 28

24 APPENDIX 6 - ALGORITHM 3- MANAGEMENT OF COLONISED AND INFECTED HEALTHCARE WORKERS BY OCCUPATIONAL HEALTH HCW identified as clnised r infected with GAS Enquire abut symptmatic clse husehld cntacts f HCW in liaisn with GP +/- health prtectin specialist Start eradicatin therapy 1 and perfrm risk assessment t determine duratin f exclusin frm wrk (min 24 hrs see 5.4) Micrbilgy sends islates t reference labratry 2 Repeat screening 24h after end f treatment + at 1, 3, 6 and 12 weeks pst-treatment POSITIVE NEGATIVE YES Implicated in transmissin f GAS t patient? NO Return t wrk if previusly excluded frm patient cntact? Exclude frm clinical wrk Risk assess return t nn-clinical duties Risk assess return t clinical duties and/r need fr further treatment and screening Cnsider pets as surce and discuss screening with vet if apprpriate Screen all ptential carriage sites (nse, thrat, skin lesins, anus & vagina) Cnsider alternative regimen fr treatment, based n site f clnisatin 3 Cnsider screening clse persnal cntacts Unable t clear carriage after multiple attempts and with screening (and treatment, if necessary) f clse persnal cntacts Senir medical management perfrms and dcuments risk assessment, based n supprting evidence frm IPCT and ccupatinal health, detailing actin required t prevent further health-care assciated infectins 1. Pharyngeal carriage treatment ptins (adults) include ral penicillin V (500mg fur times a day fr 10 days), amxicillin (500mg th times a day fr 10 days), r azithrmycin 500mg nce a day fr 5 days. Nn-pharyngeal carriage penicillin treatment alne may be sufficient. Treatment ptins include clindamycin 300 mg fur times a day fr 10 days, r azithrmycin 500mg nce a day fr 5 d with sme limited reprts in literature f cmbining with ral rifampicin r ral vancmycin 2. Clearly label islates sent t the reference labratry as being part f a suspected utbreak t priritise prcessing. Epidemilg investigatins and preventative measures shuld nt await results f typing 3. Clindamycin 300mg (fur times a day fr 10 days) shuld be used fr eradicatin f thrat carriage in cases where first-line therapy penicillin has been unsuccessful Review date: April 2017 Page 24 f 28

25 APPENDIX 7 - HCW SCREENING LETTER FOR MANAGEMENT OF A SINGLE CASE OF GAS ACQUIRED IN THE ACUTE CARE SETTING Letter fr HCWs in cntact with case f GAS (can be adapted fr screening in utbreaks) Occupatinal Health Department Date: Dear member f staff, Patient n XXX ward with grup A streptcccus (GAS) infectin This letter is being distributed t all staff members wh have been in cntact with a patient wh has develped an infectin with GAS while in hspital. By cntact we mean direct cntact during nrmal care activities, r present in the delivery suite r theatre, r wrking within the patient s rm r bed space. Occasinally, staff can transmit GAS t patients while wrking with a sre thrat, an infected skin lesin, eczema r dermatitis, r very ccasinally frm vaginal r rectal clnisatin). If, in the last seven days, yu have had a sre thrat, an infected skin lesin, eczema r dermatitis r itching r sreness in the perineal area, please attend the ccupatinal health department t be screened fr GAS tday. Results will be available the fllwing day r within 48 hurs. Our aim is t reduce the risk f further cases f GAS arising. Any healthcare wrker fund t be carrying GAS will receive treatment t eradicate the infectin r carriage f this rganism. Mst infectins with GAS are mild and yu are very unlikely t pick up GAS frm a patient. Hwever, if yu becme cncerned abut any symptms that culd be attributable t GAS in the next 30 days, such as thse mentined abve, r mre serius prblems such as severe pain r muscle tenderness, high fever with diarrhea r vmiting, r redness at the site f a wund, please seek medical attentin. Infectin Cntrl Dctr Occupatinal Health Dctr Review date: April 2017 Page 25 f 28

26 APPENDIX 8 - RAPID IMPACT ASSESSMENT SCREENING FORM Name f prcedural dcument Plicy fr the Preventin and Cntrl f Grup A Streptcccal Infectins Directrate and Service Area Trust wide Name, jb title and cntact details f persn cmpleting the assessment Judy Ptter, Lead Nurse/Directr Infectin Preventin and Cntrl Date: 22/7/2014 EXECUTIVE SUMMARY This sectin summarises: the impacts identified fr actin mitigating actin the likely severity f the impact as a result f that actin ( result ). Impact Actin Result Cntinued implementatin f Reductin in risk t ther Psitive impact fr patients the plicy patients (If yu need t prgress t a full impact assessment, please include this as an actin, abve.) 1. What is the main purpse f this plicy / plan / service? reduce transmissin f Grup A Streptcccus in hspital ensure that patients with GAS are managed apprpriately patients are prvided with accurate infrmatin abut GAS infectin,. 2. Wh des it affect? Please tick as apprpriate. Carers Staff X PatientsX Other (please specify) 3. What impact is it likely t have n different sectins f the cmmunity / wrkfrce, cnsidering the prtected characteristics belw? Please insert a tick in the apprpriate bx Prtected Characteristics Psitive impact -- it culd benefit Negative impact -- it treats them less favurably r culd d Negative impact -- they culd find it harder than thers t benefit frm it r they culd be disadvantaged by it Nn-impact missed pprtunities t prmte equality Neutral -- unlikely t have a specific effect Age X Disability X Sex including Transgender and Pregnancy / Maternity X Race X Review date: April 2017 Page 26 f 28

Group A Streptococcal Infections - Policy for the Prevention and Control of

Group A Streptococcal Infections - Policy for the Prevention and Control of Grup A Streptcccal Infectins - Plicy fr the Preventin and Cntrl f Pst hlder respnsible fr Prcedural Dcument Authr f Plicy Divisin/Department respnsible fr Prcedural Dcument Cntact details Judy Ptter, Lead

More information

H1N1 Influenza 09 Guidance for Residential Aged Care

H1N1 Influenza 09 Guidance for Residential Aged Care H1N1 Influenza 09 Guidance fr Residential Aged Care 11 June 2009 As knwledge abut H1N1 Influenza 09 develps, further advice will be prvided. Please check www.healthemergency.gv.au fr the latest infrmatin.

More information

Hospital Preparedness Checklist

Hospital Preparedness Checklist Hspital Preparedness Checklist http://pandemicflu.gv Preparedness Subject 1. Structure fr planning and decisin making An internal, multidisciplinary planning cmmittee fr influenza preparedness has been

More information

Injury, Incident & Illness Procedure

Injury, Incident & Illness Procedure Injury, Incident & Illness Prcedure Injury / Incident Includes any child, adult, r emplyee injured n site. A first aid kit will be available at all times. It will be maintained in accrdance with criterin

More information

Swindon Joint Strategic Needs Assessment Bulletin

Swindon Joint Strategic Needs Assessment Bulletin Swindn Jint Strategic Needs Assessment Bulletin Swindn Diabetes 2017 Key Pints: This JSNA gives health facts abut peple with diabetes r peple wh might get diabetes in Swindn. This helps us t plan fr medical

More information

Human papillomavirus (HPV) refers to a group of more than 150 related viruses.

Human papillomavirus (HPV) refers to a group of more than 150 related viruses. HUMAN PAPILLOMAVIRUS This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between

More information

Frequently asked questions: Influenza A (H1N1)v

Frequently asked questions: Influenza A (H1N1)v July 30 th 2009 V1.0 Frequently asked questins: Influenza A (H1N1)v (Swine Flu) infrmatin fr parents The fllwing advice is fr parents f children in all educatinal institutins, including crèches, childcare,

More information

Little Angels Schoolhouse

Little Angels Schoolhouse Little Angels Schlhuse Sickness and Illness Plicy Aim Early Years Fundatin Stage Statutry Guidance The Prvider must prmte the gd health f the children, take necessary steps t prevent the spread f infectin

More information

Influenza (Flu) Fact Sheet

Influenza (Flu) Fact Sheet Influenza (Flu) Fact Sheet What is the flu? The flu is a cntagius respiratry illness caused by influenza viruses. It can cause mild t severe illness, and at times can lead t death. Sme peple, such as lder

More information

BLOOD BORNE PATHOGENS

BLOOD BORNE PATHOGENS BLOOD BORNE PATHOGENS GALVESTON ISD ANNUAL TRAINING 2018-2019 Galvestn Independent Schl District Special Prgrams/ECH Health Services Required Training Ò Training is required by the Texas Department f Health

More information

Health Screening Record: Entry Level Due: August 1st MWF 150 Entry Year

Health Screening Record: Entry Level Due: August 1st MWF 150 Entry Year Health Screening Recrd: Entry Level MIDWIFERY EDUCATION PROGRAM HEALTH SCREENING REQUIREMENTS (Rev. June 2017) 1. Hepatitis B: Primary vaccinatin series (3 vaccines 0, 1 and 6 mnths apart), plus serlgic

More information

Vaccine Information Statement: LIVE INTRANASAL INFLUENZA VACCINE

Vaccine Information Statement: LIVE INTRANASAL INFLUENZA VACCINE Vaccine Infrmatin Statement: LIVE INTRANASAL INFLUENZA VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están

More information

Ministry of Health and Long-Term Care

Ministry of Health and Long-Term Care Ministry f Health and Lng-Term Care Infrmatin n Nvel H1N1 Influenza A - Frequently Asked Questins fr Primary Care Practitiners May 7, 2009 This infrmatin is subject t change based n evlving infrmatin n

More information

Pain relief after surgery

Pain relief after surgery Pain relief after surgery Imprtant infrmatin fr patients www.mchft.nhs.uk We care because yu matter This leaflet is designed t help yu cntrl any pain yu may have at hme fllwing yur peratin. Please read

More information

Breast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018)

Breast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018) Breast Cancer Awareness Mnth 2018 Key Messages (as f June 6, 2018) In this dcument there are tw sectins f messages in supprt f Cancer Care Ontari s Breast Cancer Awareness Mnth 2018: 1. Campaign key messages

More information

Recommendations for Risk Management at Swine Exhibitions and for Show Pigs August 2012

Recommendations for Risk Management at Swine Exhibitions and for Show Pigs August 2012 Recmmendatins fr Risk Management at Swine Exhibitins and fr Shw Pigs August 2012 Backgrund: The Natinal Prk Bard facilitated in develping this dcument. These recmmendatins were develped by a wrking grup

More information

Immunisation and Disease Prevention Policy

Immunisation and Disease Prevention Policy Immunisatin and Disease Preventin Plicy Quality Area 2: Children s Health and Safety 2.1 Each child s health is prmted 2.1.4 Steps are taken t cntrl the spread f infectius diseases and t manage injuries

More information

Tick fever is a cattle disease caused by any one of the following blood parasites:

Tick fever is a cattle disease caused by any one of the following blood parasites: Tick fever Tick fever is a cattle disease caused by any ne f the fllwing bld parasites: Babesia bvis Babesia bigemina Anaplasma marginale These parasites are all transmitted by the cattle tick (Bphilus

More information

TOP TIPS Lung Cancer Update Dr Andrew Wight Consultant respiratory Physician - WUTH

TOP TIPS Lung Cancer Update Dr Andrew Wight Consultant respiratory Physician - WUTH Tpic Circulatin list In case f query please cntact Executive Summary TOP TIPS Lung Cancer Update Dr Andrew Wight Cnsultant respiratry Physician - WUTH All Wirral GP s JaneFletcher2@nhs.net Dear Clleagues,

More information

This standard operating procedure applies to stop smoking services provided by North 51.

This standard operating procedure applies to stop smoking services provided by North 51. Authr Name/Title Melanie McIlvar, Bid Develpment Manager Authr Signature Date: 4 th September 2017 Apprver Name/Title Jasn Shelley, Grup Directr f QA/RA Apprver Signature Date: 4 th September 2017 Issue

More information

Infection Control Guidelines for Cabin Crew Members on Commercial Aircraft

Infection Control Guidelines for Cabin Crew Members on Commercial Aircraft Infectin Cntrl Guidelines fr Cabin Crew Members n Cmmercial Aircraft PURPOSE These guidelines prvide cabin crew members (flight attendants) with practical measures t prtect themselves, passengers, and

More information

BRCA1 and BRCA2 Mutations

BRCA1 and BRCA2 Mutations BRCA1 and BRCA2 Mutatins ROBERT LEVITT, MD JESSICA BERGER-WEISS, MD ADRIENNE POTTS, MD HARTAJ POWELL, MD, MPH COURTNEY LEVENSON, MD LAUREN BURNS, MSN, RN, WHNP OBGYNCWC.COM v Cancer is a cmplex disease

More information

Commissioning Policy: South Warwickshire CCG (SWCCG)

Commissioning Policy: South Warwickshire CCG (SWCCG) Cmmissining Plicy: Suth Warwickshire CCG (SWCCG) Treatment Indicatin Criteria FreeStyle Libre Flash Cntinuus Glucse Mnitring System Type I Diabetes Prir apprval must be requested frm the Individual Funding

More information

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red.

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red. Key Pints Entervirus D68 in the United States, 2014 Nte: Newly added infrmatin is in red. The United States is currently experiencing a natinwide utbreak f entervirus D68 (EV-D68) assciated with severe

More information

Completing the NPA online Patient Safety Incident Report form: 2016

Completing the NPA online Patient Safety Incident Report form: 2016 Cmpleting the NPA nline Patient Safety Incident Reprt frm: 2016 The infrmatin cntained within this dcument is in line with the current Data Prtectin Act (DPA) requirements. This infrmatin may be subject

More information

CDC Influenza Division Key Points MMWR Updates February 20, 2014

CDC Influenza Division Key Points MMWR Updates February 20, 2014 CDC Influenza Divisin Key Pints MMWR Updates In this dcument: Summary Key Messages Seasnal Influenza Vaccine Effectiveness: Interim Adjusted Estimates Influenza Surveillance Update: September 29, 2013-February

More information

Alcohol & Substance Misuse Policy. St Mary s CE Academy Trading Company. Date: Spring 2017 Date of Next Review: Summer 2018

Alcohol & Substance Misuse Policy. St Mary s CE Academy Trading Company. Date: Spring 2017 Date of Next Review: Summer 2018 St Mary s CE Academy Trading Cmpany Alchl & Substance Misuse Plicy Date: Spring 2017 Date f Next Review: Summer 2018 Signed by: Family Supprt Crdinatr Signed by: Grup Manager Alchl and Substance Misuse

More information

Infection Control. Three Ways Germs Are Spread Germs are spread in the environment three ways: direct contact, indirect contact, and droplet spread.

Infection Control. Three Ways Germs Are Spread Germs are spread in the environment three ways: direct contact, indirect contact, and droplet spread. Infectin Cntrl Infectin cntrl is preventing the spread f germs that cause illness and infectin. Infectin cntrl starts with understanding germs and hw they are spread. Abut Germs Everyne cmes in cntact

More information

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red.

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red. Key Pints Entervirus D68 in the United States, 2014 Nte: Newly added infrmatin is in red. Over the last several mnths, the United States has experienced a natinwide utbreak f entervirus D68 (EV- D68) assciated

More information

CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION

CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION INSTRUCTIONS This is an infrmed cnsent dcument which has been prepared t help yur Dctr infrm yu cncerning fat reductin with an injectable medicatin, its risks,

More information

Assessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams

Assessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams Assessment Field Activity Cllabrative Assessment, Planning, and Supprt: Safety and Risk in Teams OBSERVATION Identify a case fr which a team meeting t discuss safety and/r safety planning is needed r scheduled.

More information

Vaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE

Vaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE Vaccine Infrmatin Statement: PNEUMOCOCCAL CONJUGATE VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están

More information

GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH

GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH Aurra Health Care s Research Subject Prtectin Prgram (RSPP) This guidance dcument will utline the prper prcedures fr btaining and dcumenting

More information

WHAT IS HEAD AND NECK CANCER FACT SHEET

WHAT IS HEAD AND NECK CANCER FACT SHEET WHAT IS HEAD AND NECK CANCER FACT SHEET This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice

More information

Code of employment practice on infant feeding

Code of employment practice on infant feeding Cde f emplyment practice n infant feeding An Emplyer s guide t: Sectin 69Y f the Emplyment Relatins Act 2000 Frewrd As Minister f Labur, I am pleased t publish the Cde f Emplyment Practice n Infant Feeding.

More information

MESSAGE GUIDE EBOLA VIRUS DISEASE. (For Health Promotion Team)

MESSAGE GUIDE EBOLA VIRUS DISEASE. (For Health Promotion Team) MESSAGE GUIDE EBOLA VIRUS DISEASE (Fr Health Prmtin Team) 1 NOTE This guide brings tgether the main messages that cmmunity health wrkers (CHWs) need t knw. All activities at the health facilities shuld

More information

Annex III. Amendments to relevant sections of the Product Information

Annex III. Amendments to relevant sections of the Product Information Changes t the Prduct infrmatin as apprved by the CHMP n 13 Octber 2016, pending endrsement by the Eurpean Cmmissin Annex III Amendments t relevant sectins f the Prduct Infrmatin Nte: These amendments t

More information

ALCAT FREQUENTLY ASKED QUESTIONS

ALCAT FREQUENTLY ASKED QUESTIONS 1. Is fasting required befre taking the Alcat Test? N. It is recmmended t drink water and t avid stimulants like caffeine prir t the test. 2. With regard t testing children, must a child be a certain age

More information

ACSQHC National Consensus Statement: Essential Elements for High Quality End-oflife Care in Acute Hospitals.

ACSQHC National Consensus Statement: Essential Elements for High Quality End-oflife Care in Acute Hospitals. 27 March 2014 Prfessr Debra Picne Chief Executive Officer Australian Cmmissin n Safety and Quality in Health Care c/ Ms Jennifer Hill, Senir Prject Officer Level 5, 255 Elizabeth Street SYDNEY NSW 2000

More information

1.11 INSULIN INFUSION PUMP MANAGEMENT INPATIENT

1.11 INSULIN INFUSION PUMP MANAGEMENT INPATIENT WOMEN AND NEWBORN HEALTH SERVICE CLINICAL GUIDELINES SECTION A: GUIDELINES RELEVANT TO OBSTETRICS AND GYNAECOLOGY 1 STANDARD PROTOCOLS 1.11 INSULIN INFUSION PUMP MANAGEMENT - INPATIENT Authrised by: OGCCU

More information

Head and neck cancers are often treated with radiotherapy. Radiotherapy can lead to faster rates of tooth decay and poor healing in the mouth.

Head and neck cancers are often treated with radiotherapy. Radiotherapy can lead to faster rates of tooth decay and poor healing in the mouth. DENTAL EXTRACTION This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins that

More information

PHARYNGO-OESOPHAGECTOMY

PHARYNGO-OESOPHAGECTOMY PHARYNGO-OESOPHAGECTOMY This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins

More information

Chapter 6: Impact Indicators

Chapter 6: Impact Indicators Overview Chapter 6: Impact Indicatrs The best measure f the lng-term impact f all HIV preventin activities is the HIV incidence rate, namely the number f new cases f HIV infectin per year divided by the

More information

US Public Health Service Clinical Practice Guidelines for PrEP

US Public Health Service Clinical Practice Guidelines for PrEP Webcast 1.3 US Public Health Service Clinical Practice Guidelines fr PrEP P R E S ENTED BY: M A R K T H R U N, M D A S S O C I AT E P R O F E S S O R, U N I V E R S I T Y O F C O L O R A D O, D I V I S

More information

Chapter 5 Infection Prevention & Control

Chapter 5 Infection Prevention & Control Chapter 5 Infectin Preventin & Cntrl Chapter 5 Infectin Preventin & Cntrl 1 Intrductin a. Scpe/Purpse b. Mde f Transmissin f Influenza Virus c. Pandemic Influenza Phases d. Infectin Preventin and Cntrl

More information

AUTHORISED BY: CEO. Introduction. Whistle Blowing

AUTHORISED BY: CEO. Introduction. Whistle Blowing GUIDELINE NAME: Field Cmplaints Disclsure Guidelines SECTION : Refer t Excel Guidelines list Dcument N: DISTRIBUTION: All Emplyees FIRST ISSUED: April 2013 DATE UPDATED: Dec 2014 ISSUED/UPDATED BY: Peple

More information

University College Hospital. Pump school Starting on an insulin pump. Children and Young People s Diabetes Service

University College Hospital. Pump school Starting on an insulin pump. Children and Young People s Diabetes Service University Cllege Hspital Pump schl Starting n an insulin pump Children and Yung Peple s Diabetes Service 2 If yu wuld like this dcument in anther language r frmat, r require the services f an interpreter,

More information

Frequently Asked Questions: IS RT-Q-PCR Testing

Frequently Asked Questions: IS RT-Q-PCR Testing Questins 1. What is chrnic myelid leukemia (CML)? 2. Hw des smene knw if they have CML? 3. Hw is smene diagnsed with CML? Frequently Asked Questins: IS RT-Q-PCR Testing Answers CML is a cancer f the bld

More information

FOLLOW-UP IN-DEPTH INTERVIEW GUIDELINES

FOLLOW-UP IN-DEPTH INTERVIEW GUIDELINES Appendix h STUDY NUMBER: COST OF UNSAFE ABORTION FOLLOW-UP IN-DEPTH INTERVIEW GUIDELINES T be administered abut 2-3 weeks after leaving the health facility 1. IDENTIFICATION 101. Patient identificatin

More information

DRAFT Policy for the Management of Ear Wax

DRAFT Policy for the Management of Ear Wax Clinical Cmmissining Grup (CCG) Treatment Plicy NHS Birmingham and Slihull Clinical Cmmissining Grup NHS Sandwell and West Birmingham Clinical Cmmissining Grup DRAFT Plicy fr the Management f Ear Wax 1

More information

To remind workers that contact with poison oak can cause skin irritations. To educate workers about how to recognize poison oak.

To remind workers that contact with poison oak can cause skin irritations. To educate workers about how to recognize poison oak. Safety Training Tpic Purpse f Meeting T remind wrkers that cntact with pisn ak can cause skin irritatins. T educate wrkers abut hw t recgnize pisn ak. T cnsider ways t prtect yurself frm skin irritatins

More information

BP Thresholds for Medical Review

BP Thresholds for Medical Review BP Threshlds fr Medical Review Wmen presents t GP pstnatally with high bld pressure r referred t GP by midwife GP t review patient n the same day if BP>150/100. If BP (dne by midwife) persistently 140-149/90-99,

More information

Advantage EAP Employee Assistance Program

Advantage EAP Employee Assistance Program Advantage EAP Emplyee Assistance Prgram July 2014 In This Issue What might we face? Symptms f SAD Seasnal changes in biplar disrder Tips fr cmbating summer truble When t seek help Tips fr helping thse

More information

Imaging tests allow the cancer care team to check for cancer and other problems inside the body.

Imaging tests allow the cancer care team to check for cancer and other problems inside the body. IMAGING TESTS This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between yu

More information

2018 Medical Association Poster Symposium Guidelines

2018 Medical Association Poster Symposium Guidelines 2018 Medical Assciatin Pster Sympsium Guidelines Overview The 3 rd Annual student-run Medical Assciatin f the State f Alabama Research Sympsium will take place n Friday and Saturday, April 13-14 at the

More information

PROCEDURAL SAFEGUARDS NOTICE PARENTAL RIGHTS FOR PRIVATE SCHOOL SPECIAL EDUCATION STUDENTS

PROCEDURAL SAFEGUARDS NOTICE PARENTAL RIGHTS FOR PRIVATE SCHOOL SPECIAL EDUCATION STUDENTS PROCEDURAL SAFEGUARDS NOTICE PARENTAL RIGHTS FOR PRIVATE SCHOOL SPECIAL EDUCATION STUDENTS INTRODUCTION This ntice prvides an verview f the parental special educatin rights, smetimes called prcedural safeguards

More information

Name of procedure: Removal of submandibular salivary gland

Name of procedure: Removal of submandibular salivary gland Oral facial surgery Surgical prcedure infrmatin leaflet Name f prcedure: Remval f submandibular salivary gland This leaflet explains sme f the benefits, risks and alternatives t the peratin. We want yu

More information

A Phase I Study of CEP-701 in Patients with Refractory Neuroblastoma NANT (01-03) A New Approaches to Neuroblastoma Therapy (NANT) treatment protocol.

A Phase I Study of CEP-701 in Patients with Refractory Neuroblastoma NANT (01-03) A New Approaches to Neuroblastoma Therapy (NANT) treatment protocol. SAMPLE INFORMED CONSENT A Phase I Study f CEP-701 in Patients with Refractry Neurblastma NANT (01-03) A New Appraches t Neurblastma Therapy (NANT) treatment prtcl. The wrd yu used thrughut this dcument

More information

Lyme Disease Surveillance in North Carolina

Lyme Disease Surveillance in North Carolina Lyme Disease Surveillance in Nrth Carlina 2008-2014 Carl Williams DVM Megan Sanza MPH Cmmunicable Disease Branch Divisin f Nrth Carlina Public Health Lyme Disease Surveillance in Nrth Carlina 2008-2014

More information

I am having a Rotator Cuff Repair

I am having a Rotator Cuff Repair I am having a Rtatr Cuff Repair A rtatr cuff repair is surgery t repair a trn tendn in the shulder. The rtatr cuff is a grup f muscles and tendns that frm a cuff ver the shulder jint. The muscles and tendns

More information

Before Your Visit: Mohs Skin Cancer Surgery

Before Your Visit: Mohs Skin Cancer Surgery Befre Yur Visit: Mhs Skin Cancer Surgery Yur Kaiser Permanente Care Instructins Skin Cancer Infrmatin What is skin cancer? Skin cancers are tumrs, r malignancies, f the skin. Skin cancer is assciated with

More information

Year 10 Food Technology. Assessment Task 1: Foods for Special Needs. Name: Teacher:

Year 10 Food Technology. Assessment Task 1: Foods for Special Needs. Name: Teacher: Year 10 Fd Technlgy Assessment Task 1: Fds fr Special Needs Name: Teacher: Due Date: Term 2, Week 1 Type f Task: Design Task Planning Fd Requirements Cllectin f Assessment: Submit in Class Assessment Plicy:

More information

Health for Life Chiropractic At Cloverdale Mall Unit # The East Mall Etobicoke, ON, M9B 3Y

Health for Life Chiropractic At Cloverdale Mall Unit # The East Mall Etobicoke, ON, M9B 3Y Health fr Life Chirpractic At Clverdale Mall Unit #143-250 The East Mall Etbicke, ON, M9B 3Y8 416-232-1822 416-232-0060 Child and Adlescent Health Questinnaire Name:_ Birth date: Address:_ Telephne: Medical

More information

Corporate Governance Code for Funds: What Will it Mean?

Corporate Governance Code for Funds: What Will it Mean? Crprate Gvernance Cde fr Funds: What Will it Mean? The Irish Funds Industry Assciatin has circulated a draft Vluntary Crprate Gvernance Cde fr the Funds Industry in Ireland. 1. Backgrund On 13 June 2011,

More information

DATA RELEASE: UPDATED PRELIMINARY ANALYSIS ON 2016 HEALTH & LIFESTYLE SURVEY ELECTRONIC CIGARETTE QUESTIONS

DATA RELEASE: UPDATED PRELIMINARY ANALYSIS ON 2016 HEALTH & LIFESTYLE SURVEY ELECTRONIC CIGARETTE QUESTIONS DATA RELEASE: UPDATED PRELIMINARY ANALYSIS ON 216 HEALTH & LIFESTYLE SURVEY ELECTRONIC CIGARETTE QUESTIONS This briefing has been specifically prepared fr the Ministry f Health t prvide infrmatin frm this

More information

Administrstrative Procedure

Administrstrative Procedure ELECTRONIC WORKING COPY VERIF. DATE: INITIALS: DIVISION: Envirnment, Safety, Health and Quality FUNCTIONAL AREA: Occupatinal Safety and Health SME: Garrick Schmburg Page 1 f 13 APPROVED BY/DATE: Steve

More information

The principles of evidence-based medicine

The principles of evidence-based medicine The principles f evidence-based medicine By the end f this mdule yu shuld be able t: Describe what evidence based medicine is Knw where t find quality evidenced based medicine n the internet Be able t

More information

Code of Conduct for Employees

Code of Conduct for Employees Crprate Human Resurces Plicy Cntent Updated: 2016-06-22 Wrk Envirnment Plicy N: HR-01-09 Page 1 f 5 Apprval: 2014-09-24 Cde f Cnduct fr Emplyees POLICY STATEMENT The residents and businesses f the City

More information

during Last Days of Life

during Last Days of Life Unit 36: Supprting Individuals during Last Days f Life Unit reference number: F/616/7374 Level: 3 Unit type: Optinal Credit value: 4 Guided learning hurs: 32 Unit summary Prmting respnsive care in the

More information

Measures to Minimize Influenza Transmission at Swine Exhibitions

Measures to Minimize Influenza Transmission at Swine Exhibitions Measures t Minimize Influenza Transmissin at Swine Exhibitins It is estimated that 150 millin peple visit agricultural fairs each year in Nrth America. Agricultural exhibitins prvide valuable educatinal

More information

S.K.J Construction Ltd Groundwork & Civil Engineering

S.K.J Construction Ltd Groundwork & Civil Engineering S.K.J Cnstructin Ltd Grundwrk & Civil Engineering SUBSTANCE MISUSE POLICY 1 2 SUBSTANCE MISUSE POLICY 1 INTRODUCTION Plicy Aims Frm the viewpint f health and safety at wrk, SKJ Cnstructin Ltd (the Cmpany)

More information

UNIT 6. DEVELOPING THREAT/HAZARD-SPECIFIC ANNEXES

UNIT 6. DEVELOPING THREAT/HAZARD-SPECIFIC ANNEXES UNIT 6. DEVELOPING THREAT/HAZARD-SPECIFIC ANNEXES This page intentinally left blank. UNIT INTRODUCTION Visual 6.1 This unit presents infrmatin n annexes that shuld be included in a schl emergency peratins

More information

Q 5: Is relaxation training better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder?

Q 5: Is relaxation training better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder? updated 2012 Relaxatin training Q 5: Is relaxatin training better (mre effective than/as safe as) than treatment as usual in adults with depressive episde/disrder? Backgrund The number f general health

More information

So where do we go wrong?

So where do we go wrong? GI Suite Cmpliance Review S where d we g wrng? Presented by: Tim Muller Sr. Manager, Clinical Technlgies Octber 16, 2014 The individual respnsibility fr prtecting patients frm infectin isn t new it s always

More information

CDC Influenza Division Key Points November 7, 2014

CDC Influenza Division Key Points November 7, 2014 In this dcument: Summary Key Messages FluView Activity Update LAIV Effectiveness and Vaccinatin f Children H3N2 Match and Vaccinatin Vaccine Supply Summary Key Messages This week s FluView reprt indicates

More information

Zika Virus. Where has Zika virus been found? Zika in the United States and its territories:

Zika Virus. Where has Zika virus been found? Zika in the United States and its territories: Where has Zika virus been fund? Zika Virus Prir t 2015, Zika virus utbreaks have ccurred in areas f Africa, Sutheast Asia, and the Pacific Islands. In May 2015, the Pan American Health Organizatin (PAHO)

More information

ACRIN 6666 Screening Breast US Follow-up Assessment Form

ACRIN 6666 Screening Breast US Follow-up Assessment Form Screening Breast US Fllw-up Assessment Frm N. Instructins: The frm is cmpleted at 12, 24 and 36 mnths pst initial n study mammgraphy and ultrasund by the Radilgist r RA. Reprt all interim infrmatin related

More information

Package leaflet: Information for the user. Dacepton 5 mg/ml Solution for infusion Apomorphine hydrochloride hemihydrate

Package leaflet: Information for the user. Dacepton 5 mg/ml Solution for infusion Apomorphine hydrochloride hemihydrate Package leaflet: Infrmatin fr the user Daceptn 5 mg/ml Slutin fr infusin Apmrphine hydrchlride hemihydrate Read all f this leaflet carefully befre yu start using this medicine because it cntains imprtant

More information

For our protection, we require verification that you have received this notice. Therefore, please sign below.

For our protection, we require verification that you have received this notice. Therefore, please sign below. PATIENT INFORMATION Dear Patient: Sleep prblems are extremely cmmn. Public health and safety are threatened by the increasing prevalence f bstructive sleep apnea, which nw afflicts at least 25 millin adults

More information

This information shows what new challenges are likely to require prevention efforts moving forward.

This information shows what new challenges are likely to require prevention efforts moving forward. Release f CDC s Healthcare-Assciated Infectins (HAI) Pint Prevalence Survey and Annual Natinal and State HAI Prgress Reprt Embarged until: Wednesday, March 26 th at 12 nn ET Key Messages Overall These

More information

Service Change Process. Gateway 1 High-level Proposition. Innovation project name: Patient Self-Monitoring/Management of Warfarin

Service Change Process. Gateway 1 High-level Proposition. Innovation project name: Patient Self-Monitoring/Management of Warfarin Service Change Prcess Gateway 1 High-level Prpsitin Innvatin prject name: Patient Self-Mnitring/Management f Warfarin NHS Bury Please describe the service change being prpsed. Please describe what service(s)

More information

National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQs) For Managed Health Services (MHS)

National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQs) For Managed Health Services (MHS) Questin GENERAL Why did MHS implement a Medical Specialty Slutins Prgram? Natinal Imaging Assciates, Inc. (NIA) Frequently Asked Questins (FAQs) Fr Managed Health Services (MHS) Answer Effective Nvember

More information

National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQs) For Louisiana Healthcare Connections Providers

National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQs) For Louisiana Healthcare Connections Providers Natinal Imaging Assciates, Inc. (NIA) Frequently Asked Questins (FAQs) Fr Luisiana Healthcare Cnnectins Prviders Questin GENERAL Why did Luisiana Healthcare Cnnectins implement a Medical Prgram? Answer

More information

LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST

LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST OPTUM LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY / APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED

More information

Referral Criteria: Inflammation of the Spine Feb

Referral Criteria: Inflammation of the Spine Feb Referral Criteria: Inflammatin f the Spine Feb 2019 1 5.7. Inflammatin f the Spine Backgrund Ankylsing spndylitis and axial spndylarthrpathy are fund in arund 0.3-1.2% f the ppulatin. Spndylarthritis encmpasses

More information

HEALTH SURVEILLANCE INDICATORS: CERVICAL CANCER SCREENING. Public Health Relevance. Highlights.

HEALTH SURVEILLANCE INDICATORS: CERVICAL CANCER SCREENING. Public Health Relevance. Highlights. HEALTH SURVEILLANCE INDICATORS: CERVICAL CANCER SCREENING Public Health Relevance Cervical cancer is 90% preventable by having regular Papaniclau (Pap) tests. The Pap test, als knwn as a cervical smear,

More information

CDC Influenza Technical Key Points February 15, 2018

CDC Influenza Technical Key Points February 15, 2018 CDC Influenza Technical Key Pints In this dcument: Summary Key Pints U.S. Vaccine Effectiveness U.S. Flu Activity Update Summary Key Pints On Thursday, tw influenza-related reprts appeared in the Mrbidity

More information

Applying the OSHA Bloodborne Pathogen Standard Chiropractic Setting

Applying the OSHA Bloodborne Pathogen Standard Chiropractic Setting Applying the OSHA Bldbrne Pathgen Standard Chirpractic Setting 1 Pre test 1. Wh is cvered by the OSHA Bldbrne Pathgen Standard? a) A- All emplyees wh culd be reasnably anticipated as a result f perfrming

More information

LYME DISEASE (taken from 6/20/13)

LYME DISEASE (taken from   6/20/13) LYME DISEASE (taken frm www.lymemd.rg 6/20/13) PREVENTING LYME DISEASE Understand the risks The risk f Lyme disease is year rund. Highest risk late spring t early summer. Learn t enjy the utdrs SAFELY.

More information

FDA Dietary Supplement cgmp

FDA Dietary Supplement cgmp FDA Dietary Supplement cgmp FEBRUARY 2009 OVERVIEW Summary The Fd and Drug Administratin (FDA) has issued a final rule regarding current gd manufacturing practices (cgmp) fr dietary supplements that establishes

More information

Meeting the Nutritional Requirements of Individuals with Dementia

Meeting the Nutritional Requirements of Individuals with Dementia Unit 15: Understanding and Meeting the Nutritinal Requirements f Individuals with Dementia Unit reference number: D/616/7124 Level: 3 Unit type: Optinal Credit value: 3 Guided learning hurs: 26 Unit summary

More information

Occupational Hazards in Home Health Care. Blood Borne Pathogens

Occupational Hazards in Home Health Care. Blood Borne Pathogens Occupatinal Hazards in Hme Health Care Bld Brne Pathgens Healthcare persnnel are at risk fr ccupatinal expsure t bldbrne pathgens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human

More information

Pandemic H1N1 2009: DrillSafe Update. David Blizzard BD Manager, Energy Mining and Infrastructure

Pandemic H1N1 2009: DrillSafe Update. David Blizzard BD Manager, Energy Mining and Infrastructure Pandemic H1N1 2009: DrillSafe Update David Blizzard BD Manager, Energy Mining and Infrastructure Pandemic H1N1 Update CDC.Gv USA Pandemic H1N1 Summary Pints Virus cntinues t spread with nearly all WHO

More information

Percutaneous Nephrolithotomy (PCNL)

Percutaneous Nephrolithotomy (PCNL) Percutaneus Nephrlithtmy (PCNL) What is a percutaneus nephrlithtmy? is the mst effective f the cmmnly perfrmed prcedures fr kidney stnes. It is the best prcedure fr large and cmplex stnes. T perfrm this

More information

Improving Surveillance and Monitoring of Self-harm in Irish Prisons

Improving Surveillance and Monitoring of Self-harm in Irish Prisons HSE Mental Health Divisin Stewart s Hspital, Palmerstwn, Dublin 20 Tel: 01 6201670 Email: inf@nsp.ie www.nsp.ie Imprving Surveillance and Mnitring f Self-harm in Irish Prisns Prject Scpe Dcument 8 th June

More information

Flu Season Key Points ( )

Flu Season Key Points ( ) 2014-2015 Flu Seasn Key Pints (10-31-14) Cntents Overarching Framewrk f CDC Influenza Messaging... 3 Take 3 Messages... 3 Statements fr General Audiences... 4 Disease... 4 Vaccinatin... 6 Vaccinatin Timing...

More information

(Please text me on once you have submitted your request online and the cell number you used)

(Please text me on once you have submitted your request online and the cell number you used) Dear Thank yu fr yur email, nted. Belw steps n hw t register as a service prvider. Please nte that nce yu have requested t becme a service prvider, yu need t sms/what s up me n 0826392585, in rder t activate

More information

Paediatric Sepsis Form. Sinéad Horgan SSWHG Sepsis Lead

Paediatric Sepsis Form. Sinéad Horgan SSWHG Sepsis Lead Paediatric Sepsis Frm Sinéad Hrgan SSWHG Sepsis Lead www.hse.ie/sepsis Definitin A life-threatening rgan dysfunctin due t a dysregulated hst respnse t infectin N cnfirmatry test Bld cultures are psitive

More information

SCALES NW HEARING PROTECTION PROGRAM

SCALES NW HEARING PROTECTION PROGRAM PURPOSE Expsure t excessive nise in the wrkplace can cause permanent hearing lss. The Hearing Prtectin Prgram has been established t help ensure that emplyees f Scales NW, Inc. d nt suffer health effects

More information