Page Page 1 of 6 Policy Objective To ensure that HCWs are aware of the actions and precautions necessary to minimise the risk of cross-infection and the importance of diagnosing patients clinical conditions promptly. Document Control Summary Approved by and BICC 10 th of November 2008 Date of Publication 10 th of November 2008 Developed by Infection Control Policy Sub-Group - 0141 201 4931 Related Documents NHSGGC Standard Precautions Policy NHSGGC Hand Hygiene Policy NHSGGC Decontamination of Medical Devices Policy NHSGGC Transmission Based Precautions Policy NHSGGC SOP Twice Daily Clean of Isolation Rooms NHSGGC Staff Screening Policy NHSGGC Terminal Clean of a Isolation Room Distribution/Availability NHSGGC Infection Prevention and Control Policy Manual and the Internet Implications of Race This policy must be implemented fairly and without prejudice Equality and other diversity whether on the grounds of race, gender, sexual orientation or duties for this document religion. Equality & Diversity Impact November 2008 Assessment Completed Lead Nurse Consultant Infection Control Responsible Director/Manager Board Infection Control Manager
Page Page 2 of 6 1. Responsibilities HCWs must: - Follow this policy. Inform a member of the ICT if this policy cannot be followed. Managers must: - Support HCWs and ICTs in following this policy. ICTs must: - Keep this policy up to. Audit compliance with this policy. Provide education opportunities on this policy. 2. General Information on Group A Streptococcus Communicable Disease / Alert Organism / Clinical Condition(s) Mode of Spread Incubation period Notifiable disease Period of communicability Persons most at risk Group A Streptococcus (Streptococcus pyogenes). Strep. pyogenes is an important human pathogen and causes a wide variety of infections including: acute pharyngitis, scarlet fever, erysipelas, streptococcal cellulitis, necrotising fasciitis, toxic shock syndrome, myositis, lymphantitis, impetigo, puerperal fever. Secondary complications include: acute rheumatic fever, acute glomerulonephritis. Group A Streptococcus is an uncommon but important cause of nosocomial infections. Outbreaks of infection most often occur in surgical, burns and obstetric patients. Large respiratory droplets or direct contact with patients or carriers especially those with acute upper respiratory tract infections. On rare occasions indirect contact with objects or fomites. 1-3 days. 2-5 days for tonsillitis/scarlet fever Puerperal fever, erysipelas, scarlet fever. High-level communicability in symptomatic patients until treated with appropriate antibiotics for 48hrs and there is definite clinical improvement. If no clinical improvement consider patient still infectious. Until Group A Strep is no longer isolated from wound. Untreated uncomplicated cases 10-21 days. Untreated with purulent discharge weeks-months. Most invasive disease occurs in adults, while the majority of noninvasive infections occur in children.
Page Page 3 of 6 3. Transmission Based Precautions for Group A Streptococcus Accommodation (Patient Placement) Care plan available Clinical Waste Crockery / Cutlery Decolonisation Domestic Advice Equipment Exposures Hand hygiene Last Offices Linen Marking Notes Moving between wards, hospitals and departments (including theatres) Where possible, place a patient with suspected/confirmed Group A streptococcal disease into a single. The patient must remain in the single room until they have had at least 48hrs appropriate antibiotic therapy or a different diagnosis is confirmed. (If the patient is clinically unsuitable for isolation, a risk assessment must be undertaken by the clinical team, in conjunction with a member of the ICT). If a single room is unavailable, consult a member of the ICT. If there is no clinical improvement continue isolation until swab is confirmed negative. Yes. Discard all waste in clinical waste bags within the room. No special precautions. Not required. Follow recommendations in SOP for twice daily cleaning of isolation rooms. This SOP is contained within the Infection Prevention and Control Manual. http://www.nhsggc.org.uk/content/default.asp?page=s708_4 Take only equipment that is to be used into the room. Prior to removal from the room decontaminate any reusable equipment with detergent, warm water and disposable cloths or detergent wipes. Prevent exposures by isolating the patient and implementing Standard Precautions. Avoid droplet exposure for first 48 hours. Wear plastic aprons and disposable gloves to prevent direct contact with the patient or the patient s immediate environment. Wash any skin contaminated with droplets. Hands must be decontaminated before and after each direct patient contact, after contact with the environment after exposure to body fluids, e.g. respiratory droplets and before any aseptic tasks. Special precautions are required if the patient dies before completion of 48-hours appropriate antibiotic therapy. See SOP for Last Offices. http://www.nhsggc.org.uk/content/default.asp?page=s708_4 Discard linen as fouled / infected, i.e. placed in a red water soluble bag then into a clean plastic bag and lastly into a laundry bag. Not required. Try not to transfer patients, if possible, until patient is no longer in isolation. Prior to transfer, inform any receiving ward that the patient has suspected/confirmed Group A Strep and if a specimen has been taken. Prior to transfer, ensure the ward receiving the patient has suitable
Page Page 4 of 6 Notice for Door Notification Outbreak Personal Protective Equipment (PPE) Precautions Required Until Procedure Restrictions Risk assessment required Screening on Admission / Readmission Screening HCW Specimens required Specimens Mark as Danger of Infection Terminal Cleaning of Room Toys and Games Visitors accommodation. Prior to transfer inform the local infection control team. Yes. Hospital clinician should inform Public Health Protection Unit to reduce the risk of invasive disease among close contacts of an index case of invasive Group A streptococci. 0141 201 4917. Can sometimes occur in healthcare and non healthcare settings. The ICT will advise. Wear plastic aprons and disposable gloves to prevent direct contact with the patient or the patient s immediate environment. 48-hours after treatment with appropriate antibiotics - and definite signs of clinical improvement, e.g. wounds. None required. See Moving Between Wards. Assess patients with wounds, burns or post partum patients and those in close proximity to patients diagnosed with Group A Strep. Seek advice if required from the ICT. Assess all patients on admission for infection. Isolate where possible patients with large areas of cellulitis and probable diagnosis of Group A Streptococcus. Swab any inflamed wounds / lesions on admission. During outbreaks of infection, HCW screening may be required. Occupational Health & ICT will advise. Send specimens as clinically indicated. If wound(s) are not improving after 48-hours appropriate antibiotic therapy, re-swab wound. No. Follow Standard Operating Procedure for Terminal Cleaning of Isolation Rooms. http://www.nhsggc.org.uk/content/default.asp?page=s708_4 Use only toys / games, which can be wiped / washed with detergent and water, and dry thoroughly. Alternatively use patient s own toys. No specific restrictions.
4. Audit NHS GREATER GLASGOW & CLYDE Effective Nov 2008 Page Page 5 of 6 Criteria Guide Score 1. HCW are aware of how Streptococcus pyogenes can be transmitted. 2. HCW in clinical areas are aware that isolation is necessary. 3. HCW are aware of incubation / communicability period. 4. HCW can explain the correct procedure for the decontamination of near patient equipment. 5. HCW can explain the correct procedure for the segregation of contaminated laundry. Audit undertaken by: Action plan: Results fed back to: Date: This audit may be undertaken by ward staff or by the ICT as part of their annual audit programme
Page Page 6 of 6 6. Evidence Base Heymann D.L. Control of Communicable Diseases in Man Manual. 18 th Edition 2004. Ayliffe GAJ. Fraise AP. Geddes AM. Mitchell K. Control of Hospital Infection (4 th ed). Oxford University Press. USA/UK, 2000. Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases (6 th ed). Churchill Livingstone. USA. 2005. Interim UK guidelines for the management of close community contacts of invasive group A streptococcal disease 2004.