Unless this copy has been taken directly from the Trust intranet site (Pandora) there is no assurance that this is the most up to date version.

Transcription

1 Policy No: IC19 Version: 10.0 Name of Policy: Management of Bacterial Meningitis And Meningococcal Disease Policy Effective From: 21/09/2015 Date Ratified 15/09/2015 Ratified Infection Prevention and Control Committee Review Date 01/09/2017 Sponsor Director of Nursing and Midwifery Expiry Date 14/09/2018 Withdrawn Date Unless this copy has been taken directly from the Trust intranet site (Pandora) there is no assurance that this is the most up to date version. This policy supersedes all previous issues. Management of Bacterial Meningitis And Meningococcal Disease Policy v10

2 Version Control Version Release Author / Reviewer Ratified By / Authorised By Date 6.0 Jan 2007 Dr GM Horne IPCC March 2007 Changes (Please identify page no.) 7.0 Jan 2008 Dr GM Horne IPCC Jan Dec 2009 Dr GM Horne Mr M Young IPCC October 2009 Page 8 now use IV ceftriaxone /08/2012 Dr H Coutinho IPCC July 2012 See summary of changes /09/2015 Dr H Coutinho IPCC 15/09/2015 See summary of changes Management of Bacterial Meningitis and Meningococcal Disease Policy v10 2

3 Contents Section Page 1 Introduction Policy scope Aim of policy Duties (roles and responsibilities) Definitions Bacterial meningitis and meningococcal disease When a case occurs Notification of cases Treatment Prophylaxis of contacts Vaccination Disseminating information Information for patients Training Equality and diversity Monitoring compliance with the policy Consultation and review Implementation of policy (including raising awareness) References Associated documentation (policies) Appendix 1 Ciprofloxacin Information for patients Management of Bacterial Meningitis and Meningococcal Disease Policy v10 3

4 Management of Bacterial Meningitis And Meningococcal Disease Policy 1 Introduction This document has been amended following the updated PHE guidance 2012 for control measures. This has been necessary following changes in epidemiology, advent of new vaccines and new evidence on risk and control measures. 2 Policy scope This policy covers care of patients with suspected/confirmed meningitis/meningococcal disease who come into hospital. It includes clinical management, infection control, control of infection spread (including pre-admission treatment), further investigation and treatment, prophylaxis and vaccination of cases and contacts notification 3 Aim of policy This policy outlines arrangements within Gateshead Health NHS Trust to minimise the risk of infection to patients, visitors and staff. The Trust is committed to working towards compliance with Standards for Better Health, Saving Lives and Winning Ways. All Trust staff have a responsibility to adhere to Trust policy and ensure that appropriate measures are taken to reduce risks associated with infection. In addition Service Managers and identified leads within departments/directorates have a duty to ensure compliance with Trust policy. The Infection Prevention and Control Team management structure is enclosed, as Appendix 1. Leads for Infection Prevention and Control are required for each staff group within the Trust, See Appendix 2. Actions required when an increase in the number of associated infections occur is explained in the Outbreak Management Policy No. 24. Performance indicators for this policy are the achievement of the following standards. NHSLA Risk Management Standards for Acute Trusts Code of Professional Practice for the Prevention and Control of Healthcare Associated Infections Standards for Better Health Saving Lives Winning Ways Epic 3 Guidelines Health & Social Care Act 2012 (See reference list) Contact points: Duty Medical Microbiologist: - Bleep 2092 Head of Infection Prevention & Control: Mr Philip Pugh - Ext 3592 Infection Control Nurses: - Ext 3161 Surveillance - Bleep 2057 Director of Infection Prevention & Control: Mrs H Lloyd - Ext 6045/6102 Supplies Contact: Mrs Bellwood - Ext 2805 Management of Bacterial Meningitis and Meningococcal Disease Policy v10 4

5 4 Duties (Roles and responsibilities) The Chief Executive has responsibility for ensuring the Trust has robust and effective Infection and Prevention Control Policies. Trust Board has a responsibility to ensure that the risk of infection to patients, staff and visitors is minimised to its lowest potential and therefore supports the full implementation of this policy. The Directors of Infection Prevention and Control (DIPC) have executive responsibility for Infection Prevention Control and oversee Infection and Prevention Control activity via the Infection and Prevention Control Committee. Initiate a root cause analysis and where necessary convene a Hospital Coordinating Group meeting to ensure that patients, staff and visitors are protected. Consultant Microbiologist - will give advice against this policy and follow up positive suspected meningitis and/or infected patients with clinical staff that need Medical Microbiologist input. Out of hours and at weekends will follow up suspected meningitis, needing urgent input on a daily basis. Head of Infection Prevention and Control - will give advice against this policy and ensure that it is updated every two years or in line with current national guidance via the nominated Infection Prevention & Control Nurse lead within the review of policies section of the Infection Prevention & Control Committee. The Infection and Prevention Control Nurse (IPCN) will give advice and support on suspected or known cases of bacterial meningitis management and policy interpretation. Microbiology Secretary - coordinates IPC policy updates ensuring the OP27 is completed via DIPC and appropriate IPCN/Microbiologist and sent forward to the Membership Co-ordinator, Trust Headquarters in order that the policies can be uploaded to the Trust intranet. The Infection Prevention and Control Committee - is responsible for the ratification of Trust wide infection prevention and control policies, procedures and guidance, providing advice and support on the implementation of policies and monitoring the progress of the annual infection control programme. Acknowledging progress against action plans presented by the Divisions related to Healthcare associated infection RCA incidents. Heads of Department - Must ensure that appropriate training is available and that staff understand and comply with this Policy Divisional Managers will ensure that all staff are aware of and follow this policy and are aware of their own roles and responsibilities to ensure safe practice. That staff have access to intranet copies of Infection Prevention & Control Policies. All Trust staff - have a responsibility to adhere to Trust policy and ensure that appropriate measures are taken to reduce risks associated with infection. All Trust staff have a responsibility to ensure they attend annual Infection Prevention and Control mandatory training. Public Health England Health Protection Team ( PHE HPT) Will investigate suspected / confirmed cases and manage the public health actions required following notification of a single case and management of clusters. Management of Bacterial Meningitis and Meningococcal Disease Policy v10 5

6 5 Definitions Cases requiring notification to Public Health England Health Protection Team for public health (PHE HPT) action. Confirmed case Clinical diagnosis of meningitis, septicaemia or other invasive disease (eg. Orbital cellulitis, septic arthritis.) Confirmed microbiologically (microscopy and/or culture/pcr/antigen in a normally sterile site) as being caused by Neisseria meningitidis. Although not meeting the definition of a confirmed case, meningococcal infection of the conjunctiva is considered an indication for public health because of the high immediate risk of invasive disease. Probable case Clinical diagnosis of meningitis or septicaemia or other invasive disease where the CCDC/CPH, in consultation with the physician and microbiologist, considers that meningococcal infection is the most likely diagnosis. PHE HPT should be informed of probable cases. Cases not requiring public health action Possible case Clinical diagnosis of meningitis or septicaemia or other invasive disease where the CCDC/CPH, in consultation with the clinician and microbiologist, considers that diagnoses other than meningococcal disease are at least as likely. This category includes cases who may have been treated with antibiotics but whose probable diagnosis is viral meningitis. In such cases, prophylaxis for contacts is not indicated, but giving out information about meningococcal disease may be helpful. 6 Bacterial Meningitis And Meningococcal Disease 6.1 When a case occurs: Infection Control Ensure that the local policy for isolation nursing is implemented. The patient should be admitted to a negative pressure isolation room where available and respiratory precautions be instituted. See Isolation Policy IC: 6. Following 48 hours of antibiotic treatment (see 1.6) a patient no longer requires respiratory isolation. Ensure proper use of PPE including wearing a face mask and eye protection or other mechanical protection during facial contact with droplets/secretions especially when using suction (use closed suction) during airway management, inserting an airway or intubating. Notify HPU who will carry out a risk assessment of close contacts in community and arrange for prophylaxis via GP. Visiting relatives who require prophylaxis following HPU risk assessment are prescribed this by a hospital doctor. Management of Bacterial Meningitis and Meningococcal Disease Policy v10 6

7 6.1.2 Pre-Admission Treatment NICE recommends that children and young people with suspected bacterial meningitis without a non-blanching rash get transferred directly to secondary care without giving parenteral antibiotics (except if urgent transfer is NOT possible when antibiotics should be administered immediately). In patients with suspected bacterial meningitis who have non-blanching rash/meningococcal septicaemia need to administer parenteral antibiotics immediately but urgent transfer to hospital must not be delayed on this account Investigations As soon as the patient is seen in hospital, specimens should be taken where possible for microscopy (rash aspirate, CSF) and culture (blood, throat swab, rash aspirate and CSF). In addition the Microbiology department will arrange for any CSF, EDTA blood sample and serum to be forwarded to the Meningococcal Reference Laboratory for PCR and serology. If the diagnosis remains unconfirmed it is helpful to collect a convalescent serum specimen days after onset of the illness. 6.2 Notification of Cases Suspected Meningococcal Disease When meningococcal disease is suspected always notify one of the Medical Microbiologists immediately. PHE HPT should be notified directly, or if asked, the Medical Microbiologist will do this. Copies of laboratory reports are routinely sent to PHE HPT Notification of Cases and Treatment of Contacts All cases of acute bacterial meningitis and all forms of invasive meningococcal disease and invasive Haemophilus influenzae type b (Hib) disease are notifiable This policy should be read in conjunction with the following policies in order to maintain a high standard of care and protection for Trust users and staff: PPE IC Policy No: 2 Standard Precautions IC Policy No: 3 Hand Hygiene IC Policy No: 4 Isolation IC Policy No: Contact Details MEDICAL MICROBIOLOGISTS: Duty Medical Microbiologist: Bleep 2092 (Out of hours via Microbiology BMS on-call QEH Switchboard) North East Public Health England Centre Health Protection Team Floor 2 Citygate Gallowgate Newcastle upon Tyne NE1 4WH Telephone: option 1 Out of hours access to PHE HPT telephone option 1, a recorded message will provide you with the appropriate contact number. Management of Bacterial Meningitis and Meningococcal Disease Policy v10 7

8 6.3 Treatment Treatment of suspected bacterial meningitis where no microscopy is available is CEFTRIAXONE 2g IV BD. ADD AMOXICILLIN 2g IV 4 hourly if the patient is over 55 years, immunocompromised, pregnant or diabetic. The treatment of choice for bacterial meningitis caused by Neisseria meningitidis (meningococci), Streptococcus pneumoniae (pneumococci) or Haemophilus influenzae type b is CEFTRIAXONE 2g IV BD. If microscopy indicates presumed Listeria monocytogenes then give AMOXICILLIN 2G IV 4 hourly. If anaphylaxis to beta-lactams (Penicillins and Cephalosporins), under 55 years and NOT immunocompromised give CHLORAMPHENICOL 25mg/kg IV QDS plus VANCOMYCIN 1g IV BD (if pregnant in 3 rd trimester contact Medical Microbiologist). ADD CO-TRIMOXAZOLE 1.44g IV BD to the above regimen if over 55 years and / or immunocompromised (if pregnant in 1 st or 3 rd trimester contact Medical Microbiologist). FOR FULL DETAILS ON ALL ANTIMICROBIALS PLEASE REFER TO BRITISH NATIONAL FORMULARY (BNF). 6.4 Prophylaxis of Contacts Chemoprophylaxis Unless index cases have been given IV Ceftriaxone they should receive chemoprophylaxis as soon as they are able to take oral medication Family and Social Contacts PHE HPT will carry out a risk assessment to identify and define household / close contacts and advise on prophylactic treatment. Prophylaxis is prescribed by the hospital clinician looking after the index case, on the advice from PHE HPT. Prophylaxis is mainly offered to close contacts living in the same household as the case. Household contacts are defined as people who have had close/prolonged contact with the case in a household type setting. In addition to those sleeping in the same house and close intimate saliva exchange contacts (girlfriend/boyfriend), both grandparents and childminders may be included School and Work Chemoprophylaxis is not usually indicated for one sporadic case, but is indicated if there are 2 or more connected cases. Necessary arrangements will be made by PHE HPT Healthcare Personnel Prophylaxis would be appropriate only in exceptional circumstances, for example if mouth to mouth resuscitation had been undertaken or when staff have been exposed to aerosols of respiratory secretions in known or suspected meningococcal disease. A member of the Infection Prevention and Control Team (IPCT) should be contacted for advice. Out of hours the on call Medical Microbiologist should be contacted for advice. See Personal Protective Policy No: 2 and Standard Precautions Policy No: 3 Management of Bacterial Meningitis and Meningococcal Disease Policy v10 8

9 6.4.5 Prophylaxis in healthcare settings A risk assessment will be undertaken by the Consultant Microbiologist and Infection Control Team. Chemoprophylaxis is recommended only for those whose mouth or nose is directly exposed to large particle droplets/secretions from the respiratory tract of a probable or confirmed case of meningococcal disease during acute illness until completed 24 hours of systemic antibiotics. This type of exposure will only occur among staff who are working close to the face of the case without wearing a mask or other mechanical protection. In practice this implies a clear perception of facial contact with droplets/secretions and is unlikely to occur unless using suction during airway management, inserting an airway, intubating, or if the patient coughs in your face. General medical or nursing care of cases is not an indication for prophylaxis. Ciprofloxacin 500 mg as a single dose is recommended for prophylaxis. Exposure of the eyes to respiratory droplets is not considered an indication for prophylaxis. Such exposure may however carry a low risk of meningococcal conjunctivitis and subsequent invasive disease. Staff should be counselled about this risk and advised to seek early treatment if conjunctivitis should develop within 10 days of exposure Chemoprophylaxis for Contacts Should be given as soon as possible, ideally within 24 hours of diagnosis of the index case. Ciprofloxacin is the recommended drug for chemoprophylaxis. The advantages of ciprofloxacin over rifampicin are that it is given as a single dose, does not interact with oral contraceptives, and is more readily available in community pharmacies. (Recommended for use in all age groups and in pregnancy). Rifampicin was the drug of choice, however due to new evidence of Ciprofloxacin, this has now changed. Please check the BNF for contraindications before prescribing (Side Effects/Precautions: The administration of ciprofloxacin may, however, be followed by anaphylactic reactions, 81,82 (P Monk, M Evans, unpublished data). Healthcare staff should give out information sheets that include the risk of side effects (Appendix A), and be prepared to deal with allergic reactions. It can also interact with other drugs but a single dose is unlikely to have a significant effect. It has an unpredictable effect on epilepsy but may be preferable to rifampicin if the patient is on treatment with Phenytoin) Age Adults and Children > 12 years Children aged 5 12 years Children under 5 yrs Ciprofloxacin dosage 500mg stat 250mg stat 30mg/kg up to a maximum of 125mg stat *Ciprofloxacin suspension contains 250mg/5ml Rifampicin Recommended for use in all age groups. Evidence grade B Rifampicin is contraindicated in the presence of jaundice or known hypersensitivity to rifampicin. Interactions with other drugs, such as anticoagulants, phenytoin, and hormonal contraceptives should be considered. Side effects should be explained including staining of urine and contact lenses. Management of Bacterial Meningitis and Meningococcal Disease Policy v10 9

10 Written information for patients should be supplied with the prescription (Appendix A). This is the responsibility of the prescriber. Dosage All to be given twice daily for 2 days: Adults and children over 12 years 600 mg Children aged 1 12 years 10 mg/kg Infants (under 12 months of age) 5 mg/kg Suitable doses in children based on average weight for age are: 0 2 months 20 mg (l ml*) 3 11 months 40 mg (2 ml*) 1 2 years 100 mg (5 ml*) 3 4 years 150 mg (7.5 ml*) 5 6 years 200 mg (10 ml*) 7 12 years 300 mg (as capsule/or syrup) * Rifampicin syrup contains 100 mg/5 ml CONTACTS SHOULD CONTACT THEIR GENERAL PRACTITIONER URGENTLY IF THEY BECOME UNWELL OR ATTEND THE NEAREST ACCIDENT AND EMERGENCY DEPARTMENT. In cases/ contacts of meningitis or other invasive infections with Haemophilus influenzae type b ie meningitis/septicaemia however rifampicin is still used for prophylaxis : Rifampicin induces enzymes in the liver and may affect other medication the patient is taking. Drug: Rifampicin (note precautions) Dose: Adults and children over 12 years 20MG/KG/DAY (Max.600 mg)od X 4 days Child 1 12 years 10 mg per kilogram OD X 4 days In cases of invasive infections with Haemophilus influenzae type i.e. meningitis/septicaemia please contact a Medical Microbiologist for advice regarding treatment of contacts Side effects/precautions: Rifampicin is contra-indicated in the presence of jaundice or known sensitivity. Red discolouration of urine/tears/sputum. May permanently stain soft contact lenses. Rifampicin may significantly interfere with a variety of drugs. Important interactions arise with ANTICOAGULANTS, ANTICONVULSANTS, ANTI-ARRHYTHMICS AND ORAL CONTRACEPTIVES. This may influence the choice of chemoprophylaxis. When given with oral contraceptives additional contraceptive precautions will be needed during that entire menstrual cycle. (British National Formulary (BNF) recommends use additional precautions for four weeks). Household contacts able to attend hospital may be given Rifampicin (available in the hospital on a 24 hour basis) and the GP should be informed by PHE HPT. PHE HPT will liaise with the GP regarding prophylaxis for contacts unable to attend hospital. Chemoprophylaxis should be initiated as soon as possible after diagnosis of the index case. Ceftriaxone is now available as an alternative to Rifampicin or Ciprofloxacin for Management of Bacterial Meningitis and Meningococcal Disease Policy v10 10

11 chemoprophylaxis. A single injection is given (250 mg IM in adults, children less than 12 years, 125 mg). Ceftriaxone is contraindicated in patients with hypersensitivity and in the first 6 weeks of life. PHE HPT will inform the GP of all contacts who have received chemoprophylaxis. CONTACTS SHOULD CONTACT THEIR GENERAL PRACTIONER URGENTLY IF THEY BECOME UNWELL OR ATTEND THE NEAREST ACCIDENT AND EMERGENCY DEPARTMENT 6.5 Vaccination: Meningitis - MenACWY a) 1 August 2015 a MenACWY conjugate vaccine will replace the MenC vaccine routinely administered to first time university entrats1 up to the age of 25 years. (First time entrants 1 aged less than 25 years who have previously received a dose of MenACWY conjugate vaccine 10 years or over do not require an additional dose of vaccine. b) 1 September 2015, a MenACWY conjugate vaccine will replace the MenC vaccine routinely administered around 14 years of age (adolescent booster). The recommended vaccines for the programme are the MenACWY conjugate vaccines Menveo or Nimenrix. These two vaccines will continue to offer protection against meningococcal capsular group C, whilst offering additional protection against groups W,A and Y. Both vaccines are licensed for use in adolescents and adults and can be safely given with other routine adolescent vaccines. Travellers to areas of the world where the risk of acquiring meningococcal infection is much higher than in the UK, may be offered an alternative meningococcal polysaccharide vaccine, which is effective against serogroups A, C, W135 and Y. c) 1 September all infants born on or after the 1 July 2015 will be eligible for the meningococcal B vaccine which will be administered together with the other primary immunisations at 2,4 and 12 months. The recommended vaccine is Bexsero. d) Individuals who were identified as close prolonged contacts of cases due to vaccine preventable strains of N. meningitidis who received chemoprophylaxis should be offered an appropriate vaccine once the serogroup has been confirmed and up to four weeks after illness onset. PHE HPU would normally follow this action up. e) For confirmed serogroup C infection, MenC conjugate vaccination should be offered to all close contacts who are previously unimmunised with MenC conjugate vaccine. Close contacts who are partially immunised should complete a course of MenC conjugate vaccination. Close contacts of any age who were only immunised in infancy and those who completed the recommended immunisation course (including the 12 month booster) more than one year before should be offered an extra dose of MenC conjugate vaccine. In addition vaccination may be offered along with chemoprophylaxis to contacts of index cases using the quadrivalent conjugate vaccine to all contacts of any age (2 doses 1 month apart if < 1 year) if it is know that N. meningitidis group A, C, W135 or Y is the causative organism. For confirmed cases and probable cases (if NPS swab +ve for serogroups A, W 135 or Y). Management of Bacterial Meningitis and Meningococcal Disease Policy v10 11

12 For confirmed serogroup A, W135 or Y infection, vaccination with quadrivalent conjugate vaccine should be offered to all close contacts of any age (2 doses one month apart if aged <1 year). For probable cases with serogroup A, W135 or Y from a nasopharyngeal swab, the quadrivalent conjugate vaccine should be offered to close contacts of any age (2 doses one month apart if aged <1 year). Index case vaccination Men C conjugate vaccine should also be offered to any unimmunised index cases under the age of 25 years (whatever the serogroup). Cases of confirmed serogroup C disease who have previously been immunised with MenC conjugate (or polysaccharide) vaccines should be offered a booster dose of MenC conjugate vaccine around the time of discharge from hospital Index cases who are in the risk-group for meningococcal disease (e.g. asplenia, complement deficiency)and have not been immunised (or are incompletely immunised for age) with the quadrivalent MenACWY conjugate vaccine should complete the recommended immunisation course (2 doses one month apart if aged <1 year; 1 dose after first birthday), while those who received the quadrivalent MenACWY conjugate vaccine more than 12 months previously should receive an extra dose of the quadrivalent MenACWY conjugate vaccine. Meningitis B: a) In early 2013, a new vaccine developed specifically to prevent disease caused by group B meningococci (MenB) was licensed in Europe. Index cases should not be immunised with Bexsero unless they are at-risk and were previously unimmunised or partially immunised with Bexsero. b) After a single case of confirmed or probable IMD, Bexsero should not be routinely offered to household contacts, even if the strain is subsequently identified as vaccine-preventable (immunity develops only 4 weeks after the dose). c) After a single case of confirmed or probable IMD, ensure that any at-risk household contact (asplenia, splenic dysfunction or known complement deficiency) has received both the Meningitis ACWY conjugate vaccine and Bexsero according to national recommendations. If not immunised or partially immunised, then immunise as soon as possible according to the recommended schedule. There is no accelerated immunisation schedule for Bexsero. d) Bexsero should be offered in addition to chemoprophylaxis for all household contacts after a second Meningitis B case occurs in the same family, even if the interval between the two cases is >30 days and/or the strains are subsequently identified to be different. Routine vaccination of healthcare workers is not recommended. H. influenza : Haemophilus influenzae type b (Hib) vaccine is offered routinely to all infants at 2,3 and 4 months of age. Management of Bacterial Meningitis and Meningococcal Disease Policy v10 12

13 6.6 Disseminating Information General issues: The Medical Microbiologist will liaise with PHE HPT on a regular basis in order to ensure the accuracy of local information. Leaflets for patients are available from: Meningitis Now Tel No: Meningitis Research Foundation Tel No: For further information please refer to Public Health England, Guidance for Public Health Management of Meningococcal Disease in the UK. January Website: Guidance_for_management_of_meningococcal_disease_pdf.pdf 6.7 Information for Patients This is routinely provided by PHE HPT for the patient and all contacts Antibiotics are given to the contacts of patients with meningococcal and invasive Haemophilus influenzae b infection to clear any bacteria they may be carrying in the nose and throat. This prevents the passage of the bacteria to other people and substantially reduces the risk of developing meningitis Meningococcal cases contacts: The antibiotic usually prescribed is Ciprofloxacin. It comes in tablet or liquid form and you will receive either one of two tablets or a single dose of liquid. Please tell the doctor if you are: Allergic to Ciprofloxacin Have epilepsy or G6PD deficiency Ciprofloxacin does NOT interfere with the contraceptive pill Haemophilus influenzae b infection contacts The antibiotic usually prescribed is Rifampicin, but as this may interfere with other medicines you may be taking (anticoagulants, anticonvulsants and some heart drugs) an alternative may be used. As Rifampicin also interferes with the effectiveness of the contraceptive pill, women on the pill must use additional contraceptive methods during the cycle in which Rifampicin was taken. Extra contraceptive precautions are recommended for 4 weeks in the BNF. Rifampicin is red in colour and as it ends up in body fluids, it may cause urine, tears and sputum to develop a red discolouration. Soft contact lenses may become permanently stained You should contact your General Practitioner urgently if you become unwell or attend the nearest Accident and Emergency department. Management of Bacterial Meningitis and Meningococcal Disease Policy v10 13

14 7 Training All staff will be made aware of existence of the policy at induction. Treatment guidelines are also available on the antibiotic policy on the Trust intranet. Training from the IPC perspective included in relevant policies. This is one of the diseases in the notifiable disease list and staff will be reminded by Microbiologists Mandatory training to include guides for hand hygiene, PPE use, isolation and environmental cleaning. 8 Equality and diversity The Trust is committed to ensuring that, as far as reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on the grounds of any protected characteristic (Equality Act 2010). The policy has been appropriately assessed. 9 Monitoring compliance with the policy Standard/process/issue Monitoring and audit Method By Committee Frequency Antimicrobial prescribing in cases of meningitis Retrospective audit of cases Microbiologist +/- pharmacist Antibiotic Prescribing Committee 6 monthly PPE and Respiratory isolation of suspected meningitis cases (or meningococcal sepsis) Prospective audit of case and datix of non compliant cases Microbiologists IPCC Review datix entry 6 monthly 10 Consultation and review Members of Infection Prevention and Control team (IPCT) and Infection Prevention and Control Committee (IPCC) and Antimicrobial prescribing Committee 11 Implementation of policy (including raising awareness) All members of staff will be informed via trust wide e mail, Mandatory Training and Safecare Bulletins and individual team meetings when due for review. 12 References 1. Guidance for Public Health Management of Meningococcal Disease in the UK January British National Formulary (BNF) 52 September British Medical Association and Royal Pharmaceutical Society of Great Britain. 3. Handbook of Common Hospital Infections. S Dundas and P D Welsby. Science Press Ltd, Management of Bacterial Meningitis and Meningococcal Disease Policy v10 14

15 4. The Sandford Guide to Antimicrobial Therapy 38 th edition, D N Gilbert, R C Moellering, G M Eliopoulos and M A Sande. 5. Control of Communicable Diseases Manual. A S Benenson, Editor. American Public Health Association. 19 th edition, Control of Communicable Diseases Manual 17th Ed Edited by James Chin. 7. Preventing secondary cases of invasive meningococcal capsular group B (MenB) disease: benefits of offering vaccination in addition to antibiotic chemoprophylaxis to close contacts of cases in the household, educational setting, clusters and the wider community. (Version 1.1, Dated 01 April 2014) 8. Immunisation against meningococcal B disease for infants aged from two months. Information for health care professionals. Public Health England. July Introduction of a meningococcal ACWY immunisation programme for adolescents. Information for health care professionals. Public Health England. July Associated documentation IC Policy 2 IC Policy 3 IC Policy 4 IC Policy 6 Personal Protective Equipment in Clinical Practice Standard Precautions for the Prevention and Control of Infection Hand Hygiene Policy Isolation Policy (including respiratory isolation) Form: Meningococcal disease: enhanced surveillance forms HC/AB Management of Bacterial Meningitis and Meningococcal Disease Policy v10 15

16 Appendix 1 Management of Bacterial Meningitis and Meningococcal Disease Policy v10 16