IPC 3.6 Enteric Diseases
Contents
1.0 Introduction
2.0 Definitions
2.1 Mode of transmission
2.2 Risk factors
2.3 Signs and symptoms - clinical indications
2.4 Screening
3.0 Antimicrobial treatment guidance
4.0 Infection prevention and control principles
4.1 Isolation
4.2 Hand hygiene
4.3 Respiratory / Cough hygiene
4.4 Personal protective equipment
4.5 Equipment
4.6 Environmental cleaning
4.7 Linen
4.8 Body fluids
4.9 Occupational exposure
4.10 Care of deceased
5.0 Surveillance
Appendix 1
1.0 Introduction
Enteric diseases are caused by micro-organisms such as viruses, bacteria and parasites that cause intestinal illness. Gastroenteritis is a common condition that affects an individual’s gut and is often highly contagious. It is triggered by an infection that causes inflammation of the lining of the digestive system. Symptoms usually include vomiting, diarrhoea, stomach pain and nausea. Common causes of Gastroenteritis are Norovirus, Rotavirus and Salmonella.
Organism
Common organisms (however not limited to) that can induce enteric diseases:
- Norovirus
- Rotavirus
- Adenovirus
- Salmonella
- Campylobacter
- Cryptosporidium
Incubation period
Dependent on organism:
- Norovirus: 12 - 48 hours
- Rotavirus: 24 - 48 hours
- Adenovirus: 3 - 10 days
- Salmonella: 12 - 72 hours
- Campylobacter bacterium: 1 - 5 days, however can be up to 11
- Cryptosporidium: 7 - 10 days, but can be as long as 28 days
Period of communicability
The infectious period is dependent on the type of organism. The patient must be nursed in isolation, if this cannot be achieved to complete risk assessment with Infection Prevention Control Team (IPC), until they have been asymptomatic for 48 - 72 hours.
Individuals at risk
All age groups can be affected.
Notifiable disease
Organism dependent.
Informing IPC team
Inform the IPC team if a patient has unexplained loose stools and infection is suspected.
Details found on the Infection Prevention and Control (The page is available from the 'Infection Prevention and Control Team (IPC)' page on the Connect site).
2.0 Definitions
To be confirmed.....
2.1 Mode of transmission
- Direct spread from patient to patient (faecal oral route).
- Direct spread through contaminated hands.
- Indirect spread from the infected patient to the surroundings and from the contaminated environment to the patient.
- Contaminated food sources.
2.2 Risk factors
Organism dependent:
- Exposure to other service users displaying enteric symptoms
- Sharing of personal items
- Weakened immune system
- Nonadherence to food hygiene requirements
2.3 Signs and symptoms - clinical indications
The main symptoms of enteric disease / gastroenteritis are:
- sudden, watery diarrhoea (type 6 / 7 on the Bristol Stool chart)
- feeling sick / nausea
- vomiting, which can be projectile.
- a mild fever / pyrexial
Other symptoms can include:
- loss of appetite
- abdominal cramps
- aching limbs / joints
- headaches
In instances of occurrences of sudden unexplained loose stools, clinicians should apply the following mnemonic protocol (SIGHT) if suspecting potentially infectious diarrhoea.
|
S |
Suspect that a case may be infective where there is no clear alternative cause for diarrhoea. |
|
I |
Isolate the patient and consult with the Infection Prevention and Control Team. |
|
G |
Gloves and aprons must be used for all contacts with the patient and their environment. |
|
H |
Hand washing with soap and water should be carried out before and after each contact with the patient, and the patient’s environment. |
|
T |
Test the stool for toxin, mc + s, norovirus by sending a specimen immediately. |
2.4 Screening
IPC 4.1 Obtaining a clinical sample
3.0 Antimicrobial treatment guidance
Not all causative agents are treatable with antibiotics. The treatment will be guided by the microbiology results in consultation with the Microbiologist. Deviations from the policy must have associated rationale documented in the patient’s medical notes. Antimicrobial prescriptions must state an approximate course length in the form of a stop or review date.
Refer to local primary care antimicrobial guidelines (The page is available from the 'Antimicrobial Stewardship and Guidelines' page on the Connect site)
4.0 Infection prevention and control principles
Discuss any suspected / confirmed infections with the Infection Prevention Control Team.
4.1 Isolation
The door should remain closed. If this is not possible, a risk assessment must be included in the nursing notes e.g. patient at risk of falls. Dedicated toilet facilities are required. The patient must be nursed in isolation, until they have been asymptomatic for 48 - 72 hours.
Visiting protocol to be discussed with the IPC team.
Patient placement/assessment of infection risk
4.2 Hand hygiene
Hands should be washed with soap and water when caring for patients with vomiting or diarrhoeal illnesses.
Alcohol Based Hand Rub (ABHR) cannot be used to decontaminate hands as they are ineffective against some enteric microorganisms.
Best Practice: How to hand wash step by step images
4.3 Respiratory / Cough hygiene
To be confirmed.....
4.4 Personal protective equipment
Plastic aprons and disposable gloves should be worn when in direct contact with the patient or the patient’s immediate environment.
To follow droplet precautions if patients are vomiting (eye protection and fluid repellent face masks).
Personal protective equipment (PPE) when applying transmission based precautions (TBPs)
Putting on and Removing Personal Protective Equipment (PPE)
4.5 Equipment
Shared or reusable equipment to be cleaned with an approved chlorine releasing agent or sporicidal wipes (e.g. red Clinell wipes).
Safe management of patient care equipment in an isolation room/cohort area
Decontamination of reusable non-invasive care equipment
4.6 Environmental cleaning
To be cleaned using an approved chlorine releasing agent or sporicidal wipes (red Clinell wipes). Ensure the domestic team are informed for enhanced daily cleaning using approved disinfectant. Deep clean, including curtain change to be undertaken once the patient has been 48 - 72 hours without symptoms.
Safe management of the care environment
4.7 Linen
Infected linen to be placed in red alginate bag before placed into the clean outer linen bag.
Best Practice - Linen Bagging and Tagging
4.8 Body fluids
Management of blood and body fluid spills
4.9 Occupational exposure
Contact Occupational Health. In outbreak scenarios staff may be requested to give stool samples.
4.10 Care of deceased
NHS England » Chapter 2: Transmission based precautions (TBPs)
5.0 Surveillance
Seek IPC advice on the presentation of unexplained loose stools when there is suspiscion of infection. The IPC Team may request further sampling in the event of outbreak recognition.
Appendix 1
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