Page updated 30 April 2007
Table of Infections
Please select from the list below to see infection control short notes and guidelines for a range of conditions, organisms, and diseases:
Disease or Infective agent |
Period of infectivity to others |
Source and route of transmission |
Isolation required |
Comments |
Relevant section in Infection Control Manual |
| Actinomycosis (Actinomyces israelii) |
N/A | Mouth, gut | No | Common commensal organism | |
| Agranulocytosis: (see Immunosuppression) |
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| AIDS (see HIV) | Blood Borne Viruses (HIV) | ||||
| Arboviruses (see Yellow Fever and Dengue) | |||||
| Amoebiasis (see Dysentery) | |||||
| Anthrax (Bacillus anthracis) | Until lesions are free from bacilli | Contaminated animal tissue or hides Cutaneous inoculation or inhalation |
Source Isolate | Transfer to regional ID Unit NOTIFY Patients with pulmonary disease may be particularly infectious |
Dangerous Pathogens |
| Ascariasis (Ascaris lumbricoides) |
Nil | Ingestion of mature ova in water or vegetables contaminated with faeces | No | Transmission unusual in temperate climate Direct person-to-person spread virtually impossible |
|
| Athlete's Foot (see Ringworm) | |||||
| Bedbugs (Cimex lectularius) | Ecoparasites | ||||
| Bedsores (infected) (see Wounds) | Wound Management | ||||
| Bornholm Disease Pleurodynia Coxsackie A & B viruses | While symptomatic, 5 days or longer | Respiratory and faecal-oral | Source Isolate | Organism may be isolated from the faeces for as long as 3 weeks Keep in isolation for duration of illness |
|
| Bronchiolitis of infants | While symptomatic (up to 10 days) | Respiratory tract; airborne and by hands | Source Isolate | Common organisms: respiratory syncytial virus, parainfluenza, etc Highly infectious |
|
| Brucellosis (Brucella melitensis, etc.) |
Nil | Ingestion of contaminated food, especially milk products Handling infected animals |
No | Transmission from man to man not known Laboratory workers are susceptible when handling cultures |
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non infected: susceptible during the healing phase |
Nil |
Degree of protective isolation determined by medical staff |
Wound Management | |
| infected ( MRSA, Group A strep, Pseudomonas etc): While colonised |
Direct or indirect contact with colonised patients and staff or environment | Source Isolate | Isolation continued until bacteriologically negative | ||
| Campylobacter infection (see Diarrhoea) | |||||
| Candidiasis (C. albicans, etc.) |
Susceptible while immuno-suppressed | Usually endogenous | No | Normal flora | |
| Carbuncles (see Staphylococcal Infections) | |||||
| Cat-scratch fever (Bartonella spp.) |
N/A | Scratches or bites or flea bites, from cats or dogs. | No | Unusual bacterial infection Organism difficult to grow Not transmitted to others May cause fungating lesions in AIDS |
|
| Cellulitis | While colonised | Direct contact | Source Isolate | Isolation until organism eradicated on culture Note organisms may be shed from certain lesions for longer than this period |
|
| Chancroid | Open lesions | Direct sexual contact | No | Rare in UK | |
| Chicken pox (see Varicella-Zoster Virus) | Varicella-Zoster virus (Chickenpox & Shingles) | ||||
| Cholera (Vibrio cholerae) |
During diarrhoea | Usually infected drinking water | Source Isolate | Isolate until stools are negative on culture Case to case transmission is rare but diligent precautions must be observed NOTIFY Recommend transfer to regional Infectious Diseases Unit |
|
| Clostridium difficile | While colonised, increased during diarrhoea | Faecal-oral and environmental-oral | Source Isolate for diarrhoea | Antibiotic Associated Diarrhoea | |
| Clostridium perfringens, etc. | N/A | Contamionation from faeces | No | May colonised necrotic (dead) tissue Cause of gas gangrene Also cause of septic abortion and serious post-operative sepsis |
|
| Common cold Rhinoviruses Coronaviruses Parainfluenza viruses |
Until symptoms cease May be 13 days |
Respiratory and direct contact | Preferably Source Isolate | Often cannot be distinguished from influenza during an outbreak Preferably discharge patients until recovered Serious infections in immunocompromised patients |
Respiratory Viruses in Immunosuppressed Patients |
| Conjunctivitis | While symptoms present | Usually respiratory or direct contact | Preferably Source Isolate | Many agents involved, may suggest highly infectious diseases such as measles or adenovirus | |
| Cryptococcosis (Cryptococcus neoformans) |
Susceptible when immunosuppressed | Environment | No | Organism common in pigeon faeces. Disease common in AIDS Causes pneumonia, meningitis, etc |
|
| Cytomegalovirus (CMV) | Chronic carriage and intermittent shedding for life Immuno-suppression may cause reactivation of disease |
Blood, urine, secretions Blood transfusion, Intimate contact |
Not usually (caution with infected neonates) | Although the defined risk to the fetus of a mother acquiring CMV in pregnancy is very low, pregnant nurses should exercise great care when caring for high excretors (e.g. congenitally infected infants, neonates or HIV-infected patients) | |
| Dengue | N/A | Mosquito borne | No | Common in epidemics particularly S.E. Asia and Caribbean, second attacks may cause S.E. Asian haemorrhagic fever | |
| Dermatitis, Eczema | Susceptible to bacterial infections and then infectious while shedding | Infectious by direct or indirect contact | Source Isolate only for Group A Strep., MRSA, etc. | Susceptible to pathogenic Gram-positive organisms when disease active Highly infectious to others because of high shedding If in doubt, source isolate until screening results available |
|
Diarrhoea (see pseudomembranous colitis) |
Treat as infection risk during diarrhoeal phase | Faecal-oral Case to case spead common |
Source Isolate | Even if considered to be "non-infectious" diarrhoea, await stool culture results before removing from isolation Always wear gloves and aprons when dealing with diarrhoeal stools Viruses such as rotavirus and Norwalk agent are a particular cross-infection hazard especially in paediatric wards Transmission from man to man of Campylobacter appears to be very unlikely but has been seen from mother to baby NOTIFY (Food hygiene regulations) There are many non-microbial causes of food poisoning which should be considered when investigating clusters of cases |
Food Poisoning |
| Diphtheria (Corynebacterium diphtheriae) |
Infectious until throat swabs negative | Carriers. Respiratory or direct contact | Source Isolate | Transfer to Infectious Disease unit NOTIFY Most infected patients come from abroad. Vaccinate in infancy but effective antibodies may not persist Contact tracing with screening is required |
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1. Bacillary Shigella spp: Infectious while shedding in stools |
Faecal-oral |
Source Isolate |
NOTIFY Highly infectious disease Nursery outbreaks are usually not food-borne but occur by direct and indirect handborne transmission |
|
| 2. Amoebic Entamoeba histolytica: During faecal carriage |
Contaminated food or water Faecal-oral |
No | No transmission in temperate climes, although outbreaks have occurred from using uncleaned equipment (colonoscopes, enemas) | ||
| Ebola Fever | While symptomatic | Blood (possibly respiratory) |
Source Isolate | Patients will be transferred to Regional Infectios Diseases Unit Call Control of Infection Officer Microbiologist on call |
Viral Haemorrhagic Fevers |
| Eczema (see Dermatitis) | |||||
| Encephalitis (viral) |
Varies according to cause | Faecal-oral, respiratory |
Source Isolate | Many enteroviruses and mumps are infectious Isolate until cause identified |
|
| Enteric Fever Salmonella typhi or S. paratyphi |
While excreting organism in stools. | Faecal-oral | Preferable but not essential | A patient with acute typhoid fever will rarely infect another Healthy carriers may inadvertantly infect food NOTIFY |
|
| Enterobius vermicularis (see Threadworm) |
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| Enteritis (see Diarrhoea) | Food Poisoning | ||||
| Erysipelas Group A Streptococci |
While lesions (and carrier sites) still microbiologically positive | Direct contact from a respiratory carrier or infected patient, often a child | Source Isolate | Generally isolate until 48 hours' antibiotics given but some cases may require negative screening swabs before allowing into sensitive areas (e.g. open paediatric ward) | |
| Fleas | See full protocol | Ectoparasites | |||
| Food poisoning: (see Diarrhoea) |
Food Poisoning | ||||
| Fungal Infections (Systemic) (see also Ringworm) | N/A | From spores in environment. Inhalation Rarely from infected carriers |
No | Systemic fungal infections contracted in the UK are probably not infectious to others Immuno-compromised patients are susceptible to non-virulent fungi (e.g. Aspergillus spp.) Coccidioidomycosis and histoplasmosis are examples of more virulent organisms acquired in certain specific well-defined areas in the tropics and Americas These may be infectious to others and to laboratory workers |
|
Furuncles (see Staphylococcal Infections) |
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| Gas gangrene (Clostridium perfringens, etc) | N/A | Own bowel flora or direct inoculation | No | Trauma patients susceptible Infection caused by anaerobic organisms which are part of normal gut flora or are inoculated with soil at the time of an injury These organisms do not cause disease in contacts |
|
| Gastroenteritis (see Diarrhoea) | Food Poisoning | ||||
| German measles (see Rubella) | See detailed protocol | Rubella | |||
| Giardiasis (Giardia lamblia) |
N/A | Contaminated drinking water | No | Often acquired abroad (e.g. Russia)
Cryptosporidium acquired in the same way |
|
| Glandular fever (Infectious mononucleosis) | Infective for life after exposure | Direct, intimate contact Probably exchanging saliva |
No | Epstein Barr virus (a herpes virus) excreted intermittently from the pharynx into mouth secretions Other organisms (Toxoplasma gondii, HIV, CMV) may cause monospot negative glandular fever-like syndrome |
|
| Gonorrhoea Neisseria gonorrhoeae Genital infection Neonatal infection e.g. Ophthalmia neonatorium |
Until organism eradicated (particularly females) | Sexually transmitted Intrapartum infection |
No Source Isolate |
Women commonly asymptomatic carriers. Separate from other neonates NOTIFY |
|
| Granuloma inguinale Calymmatobacterium granulomatis |
Sexually transmitted | Nil | Now exceedingly rare in UK | ||
| Hepatitis Acute viral hepatitis |
Variable | Variable | Yes | Isolate until cause established NOTIFY |
|
| Hepatitis A virus | Preicteric phase | Faecal-oral | No | NOTIFY "Infectious Jaundice" Usually sewage-contaminated food, (e.g. shellfish), water, etc Isolate patients before they are jaundiced if they can be identified Give gamma globulin to family contacts of cases Use gloves and aprons when handling excreta Active immunisation available |
|
| Hepatitis B virus | Preicteric and early icteric phase or during chronic carrier state | Sexually transmitted or blood inoculation (e.g. needlestick accident or shared needles) | No (unless bleeding) | HBeAg or lack of anti-'e' indicates risk of high infectivity See policies relating to Hepatitis B and Sharps accidents Active and passive immunisation available NOTIFY |
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| Hepatitis C virus | variable | Blood transfusion, or blood inoculation in shared needles, needlestick accidents and sexual intercourse | No | Hepatitis C antibodies rise late in the course of an illness. PCR can detect virus replication before this Most infections in hospital are acquired through blood transfusion NOTIFY all new diagnosed cases |
Bloodborne Viruses (HCV) |
| Non A,non B (hepatitis E etc) | as for hepatitis A | Foodborne non-A,non-B | No | Acquired like hepatitis A Wear gloves and aprons handling excreta Theoretically transmitted by poor hygiene in family groups NOTIFY |
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| Delta virus | Not known | Inoculation by needle | No | Infection by this RNA virus can only occur in those with chronic HBsAg carriage Probably blood borne and transmitted as hepatitis B NOTIFY |
|
| Herpes Simplex Type 1 (cold sores) |
Active lesions infectious, also intermittent shedding into oral secretions | Direct and close contact | No | Risk of staff with active cold sores or whitlows to non-immune, immunosuppressed and eczematous patients and to neonates Personal hygiene is crucial to prevent transmission |
|
| Herpes Simplex Type 2 (genital herpes) | Active lesions infectious | Sexually transmitted | No | ||
| Herpes Simplex Type 2 (neonatal herpes) | May be present at birth or begin within days of birth | Intrapartum | Source Isolate | Separate child from other neonates because of high virus load | |
| Herpes zoster (shingles): (see Varicella-Zoster Virus) |
Varicella-Zoster virus (Chickenpox & Shingles) | ||||
| Histoplasmosis Histoplasma capsulatum |
Patients with active lung lesions may be infectious Laboratory cultures are infectious |
Spores in environment in certain restricted tropical areas Inhalation |
No | Fungal infection very rarely seen in UK Common in Southern Staes of USA and in the Tropics Common in AIDS patients |
|
| HIV Human Immunodeficiency viruses |
After virus acquired, then for life Highest risk of transmission during acute seroconversion and in terminal AIDS |
Blood transfer, sexual intercourse, inoculation | Not usually
|
See detailed protocol Take special care with specimens and sharps disposal Special awareness of risks of tuberculosis in AIDS |
Bloodborne Viruses (HIV) |
| Hookworm Necator americanus Ankylostoma duodenale |
N/A | Environment contaminated by faeces, containing eggs, larvae | No | No direct transmission from patient to patient Larvae penetrate skin of legs or ingested in contaminated drinking water Common in tropics |
|
| Hydatid diseases Echinococcus granulosus and E. Multilocularis |
N/A | Eggs in dog faeces. Ingested | No | No person-to-person spread | |
Opportunistic organisms N/A |
Usually endogenous or saprophytic infections |
Usually not |
Many hospitalised patients are more |
Respiratory Viruses in Immunosuppressed Patients | |
2. Granulocytopenia, N/A |
Usually endogenous or saprophytic infections |
Protective Isolate | Isolation prescribed by physicians at a certain level of neutropenia See separate policy |
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| Impetigo Staphyloccus aureus Group A streptococcus (S. pyogenes) |
While shedding | Direct contact | Source Isolate | Often highly infectious to other children Outbreaks in toddlers and primary school children |
|
| Infectious mononucleosis See Glandular Fever, Toxoplasmosis, HIV, Cytomegalovirus infections |
Depends on the agent | Variable, mostly by close, intimate contact or by inoculation | No | Variable implications depending on aetiology | |
| Influenza | When symptomatic | Respiratory tract, inhalation or direct inoculation to mucous membranes | Source Isolate | Management of infected staff and patients during an epidemic will be arranged by Infection Control Team Vaccination of staff and patients or use of amantadine may be suggested |
Travellers with Respiratory or Rash Illness |
| Keratoconjunctivitis Adenovirus Also Enteroviruses Herpes simplex etc |
While symptomatic | Infected secretions Direct inoculation into mucous membranes. Some airborne transmission from respiratory secretions Non-sterilized instruments (esp. ophthalmic) |
Source Isolate | Source isolation precautions recommended for any patient with undiagnosed conjunctivitis Adenoviruses and enteroviruses highly infectious |
|
| Lassa fever | While symptomatic, perhaps longer | Infected rodent urine Some patient to patient spread especially by unsterilized needles or "sharps" accident Respiratory spread is doubtful |
Source Isolate | Disease restricted to a belt across West Africa. Diagnosis often not clear on presentation. Refer to Infection Control Team immediately diagnosis considered possible. Arrange transfer to high security isolation in regional Infectious Diseases Unit. Body fluids, particularly blood, may continue to contain high titres of virus after clinical improvement. NOTIFY. | Viral Heamorrhagic Fevers |
| Legionnaires' Disease (Legionella pneumophila) | N/A | Inhaled infected aerosol Organism ubiquitous in aquatic environment |
No | No person to person spread occurs Note history of travel and work place Special reporting required (via Microbiology) |
Legionnaire's Disease |
| Leprosy (Mycobacterium leprae) |
Possibly life of untreated "lepromatous" patient | Respiratory secretions in lepromatous leprosy | Untreated lepromatous: Source Isolate (5 days) Otherwise No |
Infection load in respiratory secretions is reduced within days by treatment regimes including rifampicin Tuberculoid leprosy is considered non-transmissable |
|
| Leptospirosis (Weil's disease) (Canicola fever) L. icterohaemorrhagica etc |
N/A | Water: Inhalation or inoculation to mucous membranes Rat and dog urine |
No | Occupational or pastime disease Blood and urine contain organism but direct person-to-person transmission most unlikely NOTIFY |
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| Lice (see Pediculosis spp) Phthirus pubis |
No | Ectoparasites | |||
| Listeriosis (Listeria monocytogenes) |
Products of conception highly infectious | Unpasteurised or failed pasteurisation, infected dairy products, contaminated food Oral route Direct cross-infection |
No | Neonatal infections acquired in utero May be very infectious to other neonates delivered around the same time Immunocompromised and elderly patients at increased risk |
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| Lyme Disease (Borrelia burgdorferi) |
N/A | Tick borne | No | Endemic in deer in UK
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| Malaria (P. falciparum P. vivax, ovale P. malariae) |
N/A | Mosquito bite
|
No | Recrudescence of infection may occur long after leaving endemic area No person-to-person spread except by blood transfusion NOTIFY |
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| Marburg virus (Green monkey disease) |
Infectivity months (semen) |
Monkey bites Usually source not known in the tropics Needlestick transmission may occur in tropics and cause major hospital outbreaks |
Source Isolate | Exceedingly rare Arrange transfer to high security bed at regional ID Unit Inform ICT or on-call microbiologist if suspected Spread by sexual intercourse, not significantly by respiratory route NOTIFY |
Viral Heamorrhagic Fevers |
| Measles | Before rash appears, until rash +5 days | Respiratory tract, close contact, direct inoculation of mucous membranes | Source Isolate | Transfer to home or Regional ID Unit NOTIFY Causes outbreaks in paediatric units and dangerous to immunosuppressed children Gamma globulin available for susceptible exposed patients |
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Neisseria meningitidis: carriers are infectious to others (weeks) |
Respiratory tract, close contact, direct inoculation of mucous membranes |
Isolate until diagnosis is known
NOTIFY Rifampicin or ciprofloxacin prophylaxis to close family contacts but not to hospital staff Source isolate for 24h following appropriate antibiotic therapy |
Meningitis | |
| Streptococcus pneumoniae: organisms present in carriers | Respiratory tract Direct inoculation of mucous membranes |
Source Isolate | Strains which cause meningitis may be particularly pathogenic so observe strict hygienic precautions when handling secretions | ||
| Haemophilus influenzae: before and during acute illness | Respiratory tract Direct inoculation of mucous membranes |
Not usually | Isolate if penicillin-resistant Streptococcus pneumoniae present | ||
| Viral meningitis (enteroviruses, mumps, etc): Before and during acute illness |
Faecal-oral aerosol, respiratory | Source Isolate | Some agents are infectious and can cause outbreaks in neonates, etc. | ||
| MRSA (see Staphylococcal Infections) | see full detailed policy | MRSA | |||
| Mumps | 7 days before definitive symptoms, then for about 9 days | Virus in saliva Aerosol, respiratory and direct contact |
Source Isolate | Highly infectious. Preferably transfer home or to ID Unit Staff who are known to have had mumps should care for patient NOTIFY |
|
| Mycoplasma |
Mycoplasma. pneumoniae |
Respiratory secretions Direct contact and inoculation of mucous membranes |
No |
Causes common cold or pneumonia Transmission not often documented in hospital |
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| Mycoplasma. hominis: Chronic carriage in genital tract | Sexually transmitted, also at parturition | No | Mother to baby transmission may occur, organism may cause post-partum pyrexia Also pelvic inflammatory disease |
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| Nocardiasis N. asteroides |
N/A | Environment (soil) Inhalation | No | Usually occurs in immunocompromised Outbreaks may occur in hospital |
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| Ophthalmia neonatorum N. gonorrhoeae C. trachomatis |
While symptomatic until treated | Maternal genital tract | Caution with other neonates | Examine and treat mother Special transport medium for Chlamydia required Microbiologists should take specimens and plate directly for N. gonorrhoeae NOTIFY, arrange contact tracing for mother and mother's partner |
|
| Orf virus | Until healed | Infected animal lesion Direct contact |
No | Pox virus Zoonosis from sheep Rare Person to person spread most unlikely Stop animal contact until healed |
|
| Paratyphoid fever: see Enteric Fever |
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| Pediculosis spp. (lice) | No | No | Disinfect clothes for body lice and apply currently recommended lotions according to the manufacturer's instructions | Ectoparasites | |
| Pemphigus neonatorum | While shedding from active lesions | Direct contact | Source Isolate | Usually a particularly virulent organism (Staphylococcus aureus) acquired from a nasal carrier or staff member with and hand lesion Screening may be necessary Decontamination of isolation room needed |
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| Pertussis (see Whooping Cough) | |||||
| Plague Yesinia pestis |
Until organism eradicated | Flea bite or inhalation | Source Isolate | Most likely imported from tropical or sub-tropical areas Low level endemicity in USA Pneumonic plague infectious to attendants |
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| Poliomyelitis | While respiratory symptoms present Faecal carriage |
Infected respiratory secretions, faeces
|
Source Isolate | NOTIFY Transfer to Regional Infectious Diseases Unit Faecal shedding of virus prolonged in children Immunise staff routinely |
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| Pneumonia Streptococcus pneumoniae |
Upper respiratory tract carriers | Respiratory aerosol | Not usually | Outbreaks occasionally occur Penicillin-resistant S. pneumoniae infections should be isolated |
|
| Pseudomembranous colitis Clostridium difficile |
While excreting in the stools | Faecal-oral and from environment | Source Isolate | Organism often acquired by many hospitalised patients, overt disease less common Depends on toxin and use of antibiotics Source isolate if diarrhoea See full policy |
Antibiotic Associated Diarrhoea |
| Pseudomonas spp | While shedding | From environment or carriers | No (unless resistant) | Common environmental saprophytes which colonise many hospitalized patients and may cause infections in immunocompromised patients | |
| Psittacosis Chlamydia psittaci |
While shedding. Cultures highly infectious to lab staff | From bird dander and faeces | No | Case to case transmission is unlikely Strict hygiene with secretions required because some strains ("TWAR") seem more easily to pass from man to man via respiratiry route and indirect contact |
|
| Puerperal fever Puerperal sepsis |
Streptococcus pyogenes: while shedding | Normal carriage From respiratory tract |
Source Isolate |
Lochia heavily contaminated |
|
| Clostridium perfringens: while shedding | From gut Direct inoculation to genital tract |
Nil | Isolate until cultures are negative | ||
| Mycoplasma hominis: while shedding | Genital tract | Nil | Isolate until cultures are negative | ||
| PUO (pyrexia of unknown origin) | N/A | N/A | Source Isolate | Pyrexia or fever of unknown origin sometimes caused by transmissable agents (e.g. viruses, salmonellae) Therefore isolate until diagnosis made |
|
| Q Fever Coxiella burnetti |
N/A | From animals, carcases, especially placentae | No | Case to case transmission is very unlikely | |
| Quinsy | While shedding S. pyogenes |
Throat carriage respiratory and direct contact | Source Isolate | See Streptococcus pyogenes | |
| Rabies | N/A | Infected mammals particularly dogs. Foxes and bats important reservoirs | Source Isolate | Patients with rabies do excrete virus in their saliva However, health care workers have never acquired the disease from an infected patient Nevertheless, strict hygiene to be observed, gloves while handling secretions Staff to be immunised if a patient is admitted NOTIFY |
|
| Relapsing Fever |
Borrelia recurrentis: N/A |
Louse-borne |
No |
NOTIFY Transmitted from man to man by lice (body and head lice) Common in Egypt N & E Africa and India |
|
| Borrelia duttoni: N/A | Tick-borne | No | Central Africa | ||
| Respiratory illness (undiagnosed) | Usually while symptomatic | Respiratory secretions, aerosol, direct mucosal contact | Source Isolate | Most virus infections are highly infectious to others In children, non-specific symptoms herald many exanthems |
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| Rheumatic Fever | N/A | N/A | No | Late immunological response to Group A streptococcal infection Isolate if Group A strep infection still present |
|
| Rickettsial disease | Rickettsia conori: N/A | Tick borne |
No |
Commonest imported rickettsial infection from Mediterranean coasts and Africa Characteristic rash and myalgia with fever and evidence of tick bite Causes true Typhus NOTIFY |
|
| Rickettsia typhi (prowazeki): N/A |
Louse borne | No | Endemic in Russia and Balkan states and Africa Large epidemics occur in times of war and famine Reflect increased prevalence of body louse |
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| Ringworm (Dermatophyte infections) |
While shedding infected skin scales | Animal and human contacts | No | Most of low infectivity to casual contact Observe standard hygiene precautions |
Standard Precautions |
| Rotavirus | Up to 7 days | Faecal-oral ? Respiratory | Source Isolate |
Isolate until diarrhoea stops Often presents with upper respiratory symptoms but virus cannot be isolated from the upper respiratory tract VERY infectious Use gloves and aprons when handling faeces Do not use mouth suction when taking pharyngeal samples |
|
| Roundworm: See Ascariasis | |||||
| RSV (Respiratory Syncytial Virus) | While symptomatic | Respiratory tract, aerosol and indirect mucosal contact | Source Isolate |
Highly transmissable in paediatic wards Like common colds, probably more often transmitted by direct contact than by aerosol Survives on fomites. Therefore strict hand hygiene is important |
|
| Rubella | 4 days before onset of rash until 7 days afterwards | Respiratory tract and direct contact | Source Isolate |
Incubation period is 14-21 days Attendants must be rubella immune Preferably discharge patient home or move to isolation unit In congenital rubella, babies will excrete virus for a long period Check for pregnant women in group See special rubella policy NOTIFY |
Rubella (German Measles) |
| Salmonellosis (see Diarrhoea) | Food Poisoning | ||||
| Scabies | While infected | Direct contact | No | Scabies is not usually transmitted to casual contacts, but may be acquired from profuse lesions (Norwegian variety) because of poor hand hygiene, usually before the diagnosis made | Ectoparasites |
| Scarlet Fever Group A streptococcus |
While throat colonised | Respiratory tract. Inhalation or direct contact | Source Isolate | NOTIFY | |
| Schistosomiasis S. mansoni, S.haematobium S. japonicum etc |
N/A | Intermediate hosts, bathing | No | Not directly transmissable | |
| Septic abortion Group A Streptococcus C. perfringens |
While genital tract colonised | Direct contact | Source Isolate | Isolation precautions until antibiotic treatment is well established in case of Group A Streptococcus | |
| Serratia spp. infection | While colonised | Direct or indirect contact | Source Isolate (if antibiotic resistant) | Like Enterobacter spp. these organisms are markers of cross-infection especially in urine They tend to acquire resistance to beta-lactam antibiotics Isolate if gentamicin-resistant |
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|
Severe Actue Respiratory Syndrome (SARS) coronavirus |
During illness | Respiratory secretions and faeces
|
Source Isolate | Contact trace When SARS is notified, isolate travellers with fever from epidemic regions |
Travellers with Respiratory or Rash Illness |
| Shigellosis (see Dysentery and Diarrhoea) | |||||
| Shingles (see Varicella-Zoster virus) | Varicella-Zoster virus (Chickenpox & Shingles) | ||||
| Smallpox Variola virus |
When rash has developed | Aerosol and direct contact | Source Isolate |
Smallpox is now eradicated Vaccinia virus is not used for vaccination Therefore only white pox or monkey pox are likely to present with a syndrome like smallpox Such rare patients will have been upcountry in various Central African countries |
|
| Staphylococcal infections |
While shedding from infected lesions | Direct or indirect contact | Not usually | See separate detailed protocol for methicillin-resistant S. aureus It is unwise to nurse a patient with boils or infected eczema (i.e. profuse shedders) on a surgical ward Isolate if resistant organism (e.g. MRSA) Decontamination of room may be required |
MRSA |
| Streptococcus pyogenes Group A beta-haemolytic Streptococcus |
While shedding | Throat carriage, respiratory and direct contact | Until cultures negative | These organisms cause serious cross-infection on burns, plastics and surgical units Important diseases: tonsillitis, quinsy, erysipelo-cellulitis, fasciitis, puerperal sepsis, scarlet fever, wound infection with cellulitis May apply at discretion of ICT to groups C and G which may be pathogenic |
|
| Strongyloides stercoralis | N/A | From soil | No | Not directly transmissable | |
| Syphilis | Primary chancre | Direct sexual contact, Transplacental. Chancre exudate (1 ), blood or other secretions (2 ) |
No | Infectivity reduced rapidly by treatment Wear gloves when dealing with primary and secondary lesions Neonates may shed organism as in secondary syphilis Organism supposedly endowed with property of penetrating intact skin, but this is unlikely |
|
|
Taenia saginata(Echinococcus spp (see Hydatid diseases) |
N/A | Eating uncooked meat containing larva | No | Theoretically eggs from Taenia solium gravid segments are potentially infectious to man if ingested | |
| Tetanus (Cl. tetani) |
N/A | Direct inoculation from contaminated soil, etc. | No | Re-immunise with injury or every 10 years | |
| Threadworm (Enterobius vermicularis) |
While shedding eggs | Faecal-oral direct contact | No | Transmission prevented by simple hygienic measures Eggs collect under finger nails after scratching perianal area |
|
| Toxoplasmosis T. gondii |
N/A | Ingesting viable ova in (old) cat faeces or cysts in undercooked meat | No | Not transmitted from man to man (except by transfusion in unusual circumstances) | |
| Trichomoniasis T. vaginalis |
N/A | Sexual transmission | No | ||
| Tuberculosis M. tuberculosis, etc |
While excreting bacilli | Respiratory tract Aerosol inhalation |
Source Isolate | See full protocol for a detailed description NOTIFY |
Tuberculosis |
| Typhoid fever (see Enteric Fever) | |||||
| Typhus (see Rickettsial disease) | |||||
| Urethritis | While shedding | Direct sexual contact | No |
Major causes: N. gonorrhoeae (see gonorrhoea) and Chlamydia trachomatis Others form non-specific urethritis group |
|
| Urinary tract infections | N/A | Direct contact | Source Isolate (if antibiotic resistant) | Cross-infection with coliforms in urological and other wards is common Special precautions should be observed with catheter handling, and when organisms are multiply-resistant |
|
| Vaccinia (generalized) Eczema vaccinatum |
Active skin lesions and dried crusts contain live virus | Direct contact | Source Isolate | Smallpox vaccination has now been discontinued Eczematous patients were particularly susceptible The virus may be used in the future as a "carrier" for new vaccines Occasional imported cases of animal pox occur in man |
|
| Varicella-zoster virus |
Chicken pox: 1-2 days before rash, until all lesions have dried: 6 days in non-immunosuppressed patients | Vesicles, resp. tract. Inhalation or direct inoculation to mucous membranes Highly infectious |
Source Isolate | Transfer home or to Regional Infectious Diseases Unit Health care workers are particularly susceptible if not immune Staff who nurse the patient should be known to have had the disease |
Varicella-Zoster virus (Chickenpox & Shingles) |
| Shingles: during vesicular stage | Direct contact Inoculation of mucous membranes |
Source Isolate | Patients appear to be less likely to transmit virus than those with chicken pox Caution risk of aerosol transmission especially with trigeminal zoster |
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| Viral Haemorrhagic Fevers (Lassa, Marburg, Ebola, Congo-Crimean viruses) | Variable | Blood and secretion inoculation |
Source Isolate |
NOTIFY Transfer to High Security Source Isolation at Regional Infectious Diseases Unit |
Viral Heamorrhagic Fevers |
| Whooping cough (Bordetella pertussis) |
Before and during catarrhal phase | Respiratory secretions. Aerosol and direct contact | Source Isolate |
NOTIFY Infectivity reduced by antibiotic treatment (e.g. 3 days after erythromycin) though symptoms continue for months |
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| Wounds (infected) | While shedding organisms | Other patients or staff carriers Direct or indriect contact |
Not usually |
If infection with MRSA, Group A Streptococcus or gentamicin-resistant coliforms present, Source Isolate patient Hands must be washed and thoroughly dried after contact with any wound |
Wound Management |
| Yellow Fever | N/A | Mosquito borne | No | NOTIFY Restricted to West Africa, Central and South America Travellers to those regions are protected by active immunisation so the disease is rarely imported |
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