Incubation and Exclusion Periods

Transcription

1 Incubation and Exclusion Periods rmal Period of Minimal Period of Exclusion Disease Incubation Period (Days) Communicability Cases Subject to Clinical Recovery Cont Who ar Chickenpox day prior to, and 5 days after, appearance of rash 5 days from onset of rash or all sores are dry Diarrhoea (general advice) Varies according to cause Varies according to cause Until at least 48 hours after diarrhoea has stopped unl risk g Diphtheria 2-5 Until virulent bacilli have disappeared from discharges and lesions Until bacteriological examination is clear At the dis the H Glandular Fever 4-6 weeks Prolonged Hand, Foot and Mouth Disease 3-5 From a few days to a few weeks from onset of illness Hepatitis A average days prior to, and up to 7 days after, onset of illness 5 days for children under 5 years of age. 5 years and older until clinically well Hepatitis B average t transmissible through general / social contact Hepatitis C average t transmissible through general / social contact H.I.V. Variable t transmissible through general / social contact Impetigo Usually 1-3 Until skin healed or 24 hours after antibiotics Until skin healed or 24 hours after antibiotics Infective Conjunctivitis Varies from 24 hrs to several days While symptoms persist While symptoms persist Measles 7-18 commonly 10 to onset of illness and 14 to appearance of rash From a few days before to 4 days after onset of rash 5 days from onset of rash and until clinically well

2 Disease rmal Period of Minimal Period of Exclusion Incubation Period Communicability Cases Subject to Contacts Who (Days) Clinical Recovery Are Well Meningitis 2-10 commonly 3-4 Whilst organism is present in nose and throat Molluscum 7 days 6months While lesions persist Mumps commonly 18 From 7 days before onset of symptoms and until subsidence of swelling Until swelling has subsided (7 days minimum) Parvovirus B19 (Slapped Cheek Syndrome) 4-20 Before the onset of rash Polio 3-35 commonly 7-14 Whilst virus is present in stools At the discretion of HPU staff At the discretion of HPU staff Ringworm Persists while active lesions are present (treatment should be obtained) Rubella (German Measles) From 7 days prior and until at least 4 days after onset of rash 4 days from onset of rash Scabies 2-6 weeks Until 24 hours after treatment Until 24 hours after treatment Scarlet Fever 1-3 days days Until 48hrs after treatment Shingles - 1 day prior to and 10 days after exposure to rash Tetanus 3 21 days t directly passes person to person. Until exposed rash dry. Threadworm Life cycle requires 2-6 weeks to be completed As long as eggs are being discharged (usually 2 weeks) Exclude persons in high risk groups until treatment completed, otherwise none Tuberculosis 2 12 weeks As long as bacilli are discharged in sputum After 2 weeks treatment and until clinically well Verruca 2-3 months Several Weeks Pertussis (Whooping Cough) 7-10 From the simple cough stage and until 21 days after onset of episodic cough 21 days from onset of episodic cough or 5 days post Erythromycin antibiotic High Risk Groups are: Children under the age of 5 years Other children or adults who are unable to practice hand hygiene unsupervised Health Care Workers Food Handlers 86

3 Appendix 3 87

4 Appendix 4 GUIDELINES FOR ENVIRONMENTAL CLEANING Persons responsible for environmental cleaning should have the ability and support to ensure that appropriate standards, appropriate training and supervision are maintained. 1. General Environment Floors, walls, kitchens, toilet areas, furniture, toys and equipment should be kept physically clean and dust free through a regular cleaning schedule. Dust is largely made up of skin cells and organisms, with increased production caused by increased numbers of people and increased activity within an area. Regular cleaning and damp dusting, using single use, disposable cloths and a freshly prepared solution of neutral detergent and warm water, is recommended. All surfaces should then be dried, using disposable cloths. Larger areas e.g. floors may be allowed to air dry, after cleaning providing associated health and safety risks are assessed. Where there is obvious contamination of an area with body fluids or other solid matter, (unless this is blood or blood stained body fluids), before any disinfection process is undertaken, it is important to remove any solids. Use disposable paper towels to soak up any excess liquid, and then transfer the towels containing any solid matter directly into an agreed alternative appropriate waste system and then disinfect (see section 6). When there has been contamination with blood or blood stained body fluids refer to section Personal Protective Equipment Personal protective equipment (PPE) should be readily available for all cleaning purposes and should include appropriate gloves and where necessary water repellent aprons. The emphasis should be on good hand hygiene technique and practices but the use of appropriate PPE will add to the protection for the individual undertaking the cleaning. Gloves - Wearing gloves is not a substitute for thorough hand washing. Household type gloves or synthetic non-sterile vinyl gloves are adequate for most routine environmental cleaning. Gloves that are not single use should be washed while on the hands using neutral detergent and water, rinsed and then hung up to dry. Gloves should be replaced when they become damaged in any way. Re-usable gloves (household type gloves) should be retained for individual use and not for communal use. Disposable Latex or Vinyl gloves that meet EN standard 455 are recommended for all cleaning where there is blood or body fluid contamination. Disposal of these gloves should be into clinical waste or an agreed alternative appropriate waste disposal system. Aprons If the cleaning has involved blood or body fluids aprons should be used and after use be disposed of into clinical waste or an agreed appropriate waste system. 3. Cleaning Equipment Brooms re-disperse dust and bacteria into the air and, therefore, should not be used routinely. They certainly must not be used in food preparation areas. Vacuum cleaners or dust-attracting mops are suitable. Used, non-disposable mop heads should be laundered using a hot wash, preferably with a disinfect ion cycle or as an alternative, rinse the mop head - followed by a soak in 1000ppm chlorine (section 6) for 30 minutes. Then re-rinse and allow the mop head to dry. Any buckets used should be washed, rinsed and dried and then stored inverted. This method of decontamination should be undertaken in a secure and non-clinical area. 88

5 Any cloths used in food preparation areas or toilet areas should be kept separate and individually colour coded. 4. Toys Toys should have a cleaning schedule to ensure safety and reduce cross contamination. Preferably toys should be made from a plastic or other washable material. Toys should be washed in a neutral detergent and warm water solution daily or at least weekly and when visibly soiled. They should be thoroughly dried after cleaning. Soft toys should be laundered when visibly soiled or at least once weekly at temperatures of 60 C and allowed to dry thoroughly. 5. Cleaning up of vomit and faeces Where a room is contaminated with vomit or faeces it is advisable to remove people from the area as soon as practically possible to allow for appropriate and thorough disinfection. Any room where there has been contamination with vomit or faeces should be disinfected with particular attention to objects soiled and/ or frequently handled. These will include taps, door handles, toilet and bath rails, flush handles and telephones. Once solids are removed, clean the area with neutral detergent and warm water and dry. All items should then be disinfected with a solution containing 1000 ppm chlorine using separate, disposable cloths for each room/area. Hypochlorite (bleach) based products may remove colours from fabrics, therefore, it is recommended that soft furnishings where possible should be initially cleaned as above then steam cleaned (if heat labile) or as a minimum washed and dried using industrial machines. 6. Cleaning and Disinfection Procedures Hypo chlorite Solutions The recommended level is 1000ppm (0.1%) chlorine (bleach) solution. 0.1% is 1 part of bleach in 1000 parts water. This is equivalent to 10ml bleach to 10 litres of water. 7. Cleaning Blood or Blood Stained Body Fluid Spillage Soak up excess fluid using disposable towels and wear appropriate PPE. Cover the area with towels soaked in 10,000ppm chlorine (100mls bleach to 10 litres of water), and leave for at least 2 minutes. Remove organic matter using the paper towels and then discard into an appropriate waste disposal system, preferably clinical waste. Clean the area with detergent and hot water and dry thoroughly. Clean all equipment thoroughly and leave to dry Discard PPE into the appropriate waste system (clinical waste if possible). Wash and dry hands thoroughly. 8. Outbreak During outbreaks of infectious disease it is extremely important that the number of times cleaning is undertaken each day should be increased. Additionally, proper use of PPE, cleaning products and equipment, as indicated above, will reduce the risk of cross infection from ill to well people. Steam cleaning of soft furnishings, including carpets, is also encouraged and thorough airing of rooms is also helpful. NOTE: Employers and employees must follow the Control of Substances Hazardous to Health (COSHH) Regulations, HMSO 1999 in relation to these guidelines. 89

6 Appendix 5 Avoiding ill health on school visits to the countryside and farms All animals carry different types of bacteria and other organisms some of which can be passed to humans and cause disease, e.g. salmonella or E coli O157. The sort of illnesses that can be caught from animals vary from mild diarrhoea to very severe life-threatening illnesses. People usually catch the illness by touching their mouth with their hands or fingers that have become contaminated from direct contact with animals or other articles e.g. footwear or the environment. Your hands may become contaminated by: touching animals touching animal faeces touching land that is contaminated with animal faeces touching objects that are contaminated with animal faeces, e.g. dirty shoes. Any visit to the countryside, farm, zoo or anywhere where animals or their faeces are present can provide an opportunity for adults and children to catch infection from animals or their faeces. This applies to school visits and to family outings. How to reduce the risk of catching an infection? The risk of someone catching an infection from animals can be greatly reduced by following the simple hygiene rules below. These rules should be followed by adults and children during any trips to the countryside, farms and zoos to make the visit healthy and safe. 1. Wash their hands well: Before eating or drinking, including sweets, ice cream, crisps etc After touching animals After contact with animal faeces After going to the toilet Before leaving a farm or zoo. 2. Children may require supervision to ensure adequate hand hygiene 3. Keep hands out of mouths in case hands have become contaminated e.g. do not suck fingers, pens or pencils. 4. A waterproof plaster should be used to protect any cuts or grazes 5. Do not kiss the animals or let the animals lick faces. 6. Do not eat any food or sweets that have been dropped on the ground. 7. Do not eat any animal food. 8. Only eat in the places designated for food consumption and after washing hands appropriately. Teachers and other staff on school visits should closely supervise children and encourage them to follow these rules. References Prepared by County Durham & Tees Valley Health Protection Unit March

7 1. Aston R, Duggal H, Simpson J. Head lice: A report for Consultants in Communicable Disease Control. Public Health Environmental Group (1998). 2. Association of Medical Microbiologists. The Facts About. (Accessed on10th January 2005) (1993). 3. Ayliffe G, Fraise A, Geddes A, Mitchell K. 4 th edition. Control of Hospital Infection. Arnold (2000). 4. Bannister B, Begg N, Gillespie S. Infectious Disease. Blackwell Science (1996). 5. Burgess I. Human Lice and their Management. Advances in Parasitology. Vol 36. Academic Press limited (1995). 6. Chin J. Control of Communicable Diseases Manual. 17 th edition. Washington. American Public Health Association (2000). 7. Department of Health. Immunisation Against Infectious Disease (1996 plus updates 2004). London. HSMO. 8. Department of Health. Food Handlers Fitness to Work. (1995). London HSMO 9. Department of Health. Management of Outbreaks of Food borne Illness. London HMSO. (1994) 10. Department of Health. Guidance for Clinical Health Care Workers: Protection Against Infection with Blood-borne Viruses. London HMSO(1998) Department of Health. Hepatitis C: Essential information for professionals. London HMSO(2002) 12. Hawker J, Begg N, Blair I, Reintjes R et al. Communicable Disease Control Handbook. Blackwell Science (2001) 13. Health and Safety Executive. Avoiding ill health at open farm Advice to farmers (with teachers supplement). Agriculture Information Sheet 23 (revised). London. HSMO. (2000). 14. Infection Control Nurses Association. Glove Usage Guidelines. London ICNA (1999) 15. Infection Control Nurses Association. Protective Clothing Principles and Guidance. London ICNA (2002) 16. Infection Control Nurses Association. Hand Decontamination Guidelines London ICNA (2002) 17. Infection Control Nurses Association. Reducing sharps injury: prevention and risk management. London ICNA (2003) 18. Lawrence J, May D. Infection Control in the Community. Churchill Livingstone (2003). 19. Meers P, Sedgewick J, Worsley M. The Microbiology and Epidemiology of Infection For Health Science Students. Chapman Hall (1995). 20. PHLS Advisory Committee. Guidelines for Public health management of meningococcal disease in the UK. Communicable Disease and Public Health Vol 3, 3 September (2002). 21. PHLS Advisory Committee. Guidelines for the control of hepatitis A virus infection. Communicable Disease and Public Health Vol 4, 3 September Robert R, Casey D, Morgan D, Petrovic M. Comparison of wet combing with malathion for treatment of head lice in the UK, a pragmatic randomised control trial. Lancet 2000:356: Shanson D (1999) Microbiology in Clinical Practice. 4 th edition. Butterworth Heinemann 24. Joint Tuberculosis Committee of the British Thoracic Society. Control and Prevention of Tuberculosis in the United Kingdom: Code of Practice Thorax 1998; 53: Working Party Report. Revised Guidelines on the control of methicillin-resistant Staphylococcus aureus in the community. Journal of Hospital Infection :