Infections

Guidance on the most common infections.

Antibiotic-resistant bacteria

Residents may be transferred from hospital while colonised or infected with a variety of antibiotic-resistant bacteria. Often these bacteria will be colonising the skin or gut, without causing harm to the resident, and will not cause harm to healthy people. Because colonisation can be very long-term, it is not necessary to isolate residents known to be colonised with antibiotic-resistant bacteria. Good hand hygiene and the use of standard precautions will help minimise the spread of these organisms in a care home environment.

Carbapenemase-producing enterobacteriaceae (CPE)

CPE organisms may also be referred to as:

CRO (carbapenem-resistant organism)
CPO (carbapenemase-producing organism)
CRE (carbapenem-resistant Enterobacteriaceae)
CPC (carbapenemase producing coliforms)

Enterobacteriaceae are bacteria that usually live harmlessly in the gut of humans. This is called colonisation. However, if the bacteria get into the wrong place, such as the bladder or bloodstream, then they can cause infection. CPE are a type of bacteria which has become resistant to carbapenems, a group of powerful antibiotics.

Doctors rely on carbapenem antibiotics to successfully treat certain complicated infections when other antibiotics have failed.

The spread of these resistant bacteria can cause problems to vulnerable patients in hospitals and care homes.

Carbapenemase-producing Enterobacteriaceae: non-acute and community toolkit – Gov.uk

Multi-resistant drug organism (MDRO)

Checklist for an individual case of a gram negative organism DOC, 1.8 mb

Meticillin Resistant Staphylococcus Aureus (MRSA)

People with MRSA do not present a risk to the community at large and should continue their normal lives without restriction. MRSA is not a contraindication to admission to a care home or a reason to exclude an affected person from the life of a care home. However, in residential settings where people with wounds, medical devices eg, urinary catheters are cared for, infection control advice should be sought if a person with MRSA is to be admitted or has been identified amongst residents.

Methicillin-resistant Staphylococcus aureus (MRSA) - Guidance for nursing staff

Clostridioides (Clostridium) difficile

Clostridioides difficile (formerly known as Clostridium difficile but still also known as C. difficile, C. diff, CDT, and CDI), is a major cause of antibiotic associated diarrhoea and colitis (inflammation of the intestines). C. difficile is a bacterium that can be found in the large intestine (gut) of adults. It is usually kept in check by the normal bacterial flora found in the intestine. For many it poses no threat, but certain antibiotics given to individuals may disturb this balance and allow the C. difficile to multiply in the intestine and produce toxins.

For information on how to manage adults with C. difficile please see the outbreaks page and also refer to:

Primary care clinical guidelines - Leicestershire medicines strategy group has information about Clostridium difficile management.

What is clostridium difficile? a simple guide - NHS East Leicestershire and Rutland clinical commissioning group PDF, 141 kbOpens new window

What is clostridium difficile? a simple guide - NHS Leicester City clinical commissioning group PDF, 99 kbOpens new window

What is clostridium difficile? a simple guide - NHS West Leicestershire clinical commissioning group PDF, 101 kbOpens new window

Diarrhoea and vomiting (D&V)

There are many causes of D&V, only some of which are due to infection. All cases of unexplained diarrhoea and/or vomiting should be taken seriously and presumed to be infectious until advised otherwise. The resident’s GP should be notified in all cases. Residents with unexplained diarrhoea and/or vomiting should be placed in source isolation until an infectious cause has been ruled out.

If two or more cases, suspected or known to be infectious occur within a few days of each other, Public Health England (PHE) should be notified. If an outbreak occurs, staff can access further information and guidance within the Outbreaks page or can contact the Local Authority Infection Prevention and Control Service.

I-Hydration resource pack – University of west London

Blood-borne virus infections

Residents infected with HIV, hepatitis B or hepatitis C do not need to be isolated. Standard precautions, including care with sharps disposal, should however be strictly observed. Special precautions may need to be taken when the resident has a clinical procedure at the dentist, hospital or podiatrist.

Group A Streptococcus (GAS)

Group A Streptococcus (GAS) are bacteria commonly found in the throat and on the skin. People can carry these bacteria and have no symptoms of illness. When they do cause illness, it can occur in one of two forms:

non-invasive GAS infection
invasive GAS (iGAS) infection; or

Common non-invasive GAS infections include Strep. throat, scarlet fever, impetigo, and ear infections. These infections are less severe and more contagious than invasive GAS infections.

Invasive GAS infections are more aggressive and may cause conditions like Streptococcal toxic shock syndrome and necrotizing fasciitis.

If you have concerns about a resident or staff member then please contact Public Health England for further advice.Opens new window

Invasive group A streptococcal (iGAS)

Invasive group A streptococcal disease: managing close contacts – Gov.uk

Respiratory tract infections (including influenza)

Respiratory infections are very common and may be serious in older or debilitated people. They may be viral or bacterial in origin. If a respiratory infection is suspected in a resident, then staff should contact the resident’s GP to enable a clinical review to be completed.

The risk of respiratory infections can be reduced by annual influenza vaccination of residents aged 65yrs or older, and younger residents with serious underlying health problems. Influenza immunisation for care staff can also reduce the likelihood of an influenza outbreak occurring. Residents over 65yrs and others in the ‘at risk’ category should also receive a pneumococcal vaccine.

In the event of a respiratory outbreak then staff should notify Public Health England. If an outbreak occurs, staff can access further information and guidance within the Outbreaks page, or can contact the Local Authority Infection Prevention and Control Service.Opens new window

Flu (influenza)

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Skin infections/infestations (including scabies)

Scabies is a very common infestation which anyone can acquire. It is very infectious, but it can take up to 8 weeks for the rash to appear.

One of the first symptoms you may notice is intense itching, especially at night. Tiny scabies mites lay eggs in the skin, leaving silvery lines with a dot at one end. The scabies rash can appear anywhere on the body, but it often starts between the fingers. The rash usually spreads across the whole body – apart from the head. Elderly people, young children and those with a weakened immune system can however develop a rash on their head and neck.

If scabies is suspected, the GP should be notified immediately as treatment should be started quickly to minimise the spread to other residents and staff.

If two or more cases, suspected or known to be infectious occur within a few days of each other, Public Health England (PHE) should be notified. If an outbreak occurs, staff can access further information and guidance within the ‘Outbreak’ section of this web page or can contact the Local Authority Infection Prevention and Control Service.

The Public Health England scabies guidance is currently under review. If you only have one resident with scabies, the guidance contained in the Action Checklist for Scabies (on the outbreak page), is still relevant.

Urinary tract infection

See: Genito-urinary system for information relating to the prevention and treatment of urinary tract infections, which also includes information on hydration and urinary catheters.