Due to the current Covid-19 pandemic, it is recommended anyone showing symptoms of respiratory illness to refer to the current national guidance and take action accordingly.
Preventing and controlling infections remains a challenge. There is increasing antimicrobial/antibiotic resistance meaning that new and emerging infections are becoming harder to treat.
Read more about tackling antimicrobial resistance:
Covid-19 is a viral infection caused by a coronavirus, in particular SARS-CoV-2. Since January 2020, Covid-19 has transmitted across the world causing a nationwide pandemic. Covid-19 is an airborne virus and can be transmitted by people breathing in aerosols and droplets.
Carbapenemase-producing Enterobacterales (CPE)
CPE organisms may also be referred to as:
- Carbapenem-resistant organism (CRO)
- Carbapenemase-producing organism (CPO)
- Carbapenem-resistant enterobacteriaceae (CRE)
- Carbapenemase-producing coliforms (CPC)
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. A person who has been identified as having CPE can either be colonised or infected:
- Colonised - CPE bacteria is present on the body, not causing any harm and is not showing any signs of infection
- Infected - the person affected with CPE is showing signs and symptoms of infection. This can present through the person being unwell, having a fever or inflamed wounds.
If any care home residents are identified as being colonised with CPE, standard infection prevention precautions should be implemented. A risk assessment should also be performed to reduce the risk of cross-infection. All findings from the risk assessment should be incorporated into an individualised care plan for the resident, outlying how staff are to continue to meet their care needs.
Multidrug-resistant Organisms (MDRO)
MDROs are common bacteria that have developed a resistance to a variety of antibiotics. These bacteria are commonly found within the bowel and don't cause any harm, however, if they are transferred to another part of the body (e.g. through a wound on the skin), this makes them more difficult to treat.
There are several different types to MDROs and some might require added infection prevention and control measures (e.g. Source Isolation). It is advised that you contact the Local Authority Infection and Precebtion Control Service (LAIPCS) for information on the most appropriate actions to follow.
Methicillin 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 (e.g., 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.
Clostridioides Difficile (C-diff)
Clostridioides Difficile is formerly known as Clostridium Difficile, but is still know as C-diff, CDT and CDI.
This bacteria, commonly found within the bowel, is part of the normal gut flora/good bacteria and for many it causes no threat. C-diff can cause an infection resulting in severe diarrhoea and inflammation of the bowel (colitis). Infection occurs when someone has recently taken a course of antibiotics which has disrupted the good bacteria within the bowel, which will then produce toxins.
Common symptoms to look out for if C-diff is suspected:
- Raised temperature
- Distended/bloated abdomen
- Abdominal pain
- Changes in normal bowel movement and/or frequency
If C-diff is suspected, a stool sample will need to be sent to confirm the infection. When looking at the Bristol stool chart, type 5, 6, or 7 stools can be sent for testing, as it would be very unlikely for someone to be infected with C-diff if they are passing a formed bowel movement.
If C-diff is confirmed, the LAIPCS will contact care services directly, to provide guidance and support on the source isolation and cleaning requirements needed to prevent transmission to others. You will need to contact the GP to receive the recommended treatment. After the treatment has finished, some people can still have symptoms of loose bowels for 1-2 weeks. If this occurs, please contact the GP for further advice. Following any positive C-diff case, no further samples should be sent within 28 days from the initial sample.
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, UK Health Security Agency (formerly known as Public Health England) should be notified. If an outbreak occurs, staff can access further information and guidance within the Prevent the spread of infection page or can contact the LAIPCS.
Group A streptococcus (GAS)
Group A Streptococcus 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 infections - include strep throat, scarlet fever, impetigo, and ear infections. These infections are less severe and more contagious than invasive GAS infections.
- Invasive GAS (iGAS) infections - more aggressive and may cause conditions like Streptococcal toxic shock syndrome and necrotizing fasciitis.
Respiratory tract infections and 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 65 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 65 and others in the 'at risk' category should also receive a pneumococcal vaccine.
In the event of a respiratory outbreak, staff should notify the UK Health Security Agency for further advice by calling 0344 225 4524. If an outbreak occurs, staff can access further information and guidance within the Prevent the spread of infection page or can contact the LAIPCS.
The uptake of the annual seasonal influenza vaccine is a way of protecting people from becoming seriously unwell from the flu virus. Frontline health and social care workers can get this vaccine for free from their GP or pharmacy. In some cases, individual care providers might arrange for influenza vaccines to be administered at the workplace. Further information on the influenza vaccine can be found on the NHS website.
Sepsis is a medical emergency. It is essential for all staff to recognise the symptoms and know what immediate steps they must take.
When a person gets an infection, the body's immune system responds to fight it. In some cases, the body's response to this infection overreacts or simply goes into 'overdrive' causing it to attack its own tissues and organs - this is known as Sepsis. Severe cases of Sepsis can lead to septic shock - a medical emergency. Death from Septic shock increases with each hour antibiotics are delayed.
Seek urgent medical help if a resident develops any of these signs or symptoms:
- Slurred speech or confusion
- Extreme shivering or muscle pain
- Passing no urine (in a day)
- Severe breathlessness
- It feels like they are going to die
- Skin mottled or discoloured
If you think it could be Sepsis, call 999 immediately.
Although anyone can get Sepsis, infections such as pneumonia and kidney infections appear more likely to trigger Sepsis. Survival rates for Sepsis depend on a person's underlying medical conditions and how quickly it is recognised, diagnosed and, managed.
Urinary Tract Infection (UTI)
UTIs occur when bacteria in any part of the urine system cause symptoms, and treatment with antibiotics may be required. Severe urine infections can be life threatening and lead to uro-sepsis – a medical emergency.
It is therefore important to take measures to prevent UTIs and ensuring residents are adequately hydrated is a key measure. Another important measure is ensuring that any resident with a urinary catheter has that catheter safely inserted, correctly cared for and removed when appropriate.
Knowing the signs of a UTI and what actions to take when one is suspected is important for all care staff.
National guidelines advise that urine dipsticks should not be used to diagnose a UTI in those over 65 years old. Instead, an assessment tool should be completed.
The Leicester City's East and West CCG Medicines Management Team have developed a pack of information for use by health and social care staff across Leicester, Leicestershire and Rutland, which explains how to recognise a UTI, what actions to take, and how to promote adequate hydration.
Cellulitis is a bacterial skin infection that causes areas of the body (e.g hand, foot or lower leg) to become inflamed, swollen and hot to the touch. Skin can also look red in colour in those with Caucasian/fair skin and a more purple colour in those with darker or black skin. Celulitis will have a clear and defined outer line/margin.
Cellulitis is not contagious to others within the care homes. The inflammation results in the skin surface being put under added tension, giving the appearance of a tissue paper/transparent look. Fluid (oedema) can make the area have a spongy type texture and can leave an indent when gentle pressure is applied. Fluid can leak through the skin surface and a dry dressing should be applied, and the GP contacted immediately. Cellulitis can be successfully treated with a course of antibiotics.
Candidiasis is caused by the candida fungi and can cause a skin infection, and is commonly know as Thrush. This infection can occur anywhere on the body, but is most common in warm, moist areas of the body particularly skin folds, mouth cavity, groin, armpits and genitals (male and female).
The main symptoms of Thrush are a red rash, localised irritation/itching, discharge or white coating to the affected area. Despite these symptoms, Thrush is not infectious or transmissible to others.
The best way to treat and prevent Thrush is good personal hygiene and keeping external skin dry. The GP might prescribe an anti-fungal cream to be applied to affected areas of the body. For oral/mouth Thrush, increased dental hygiene and increased fluid intake can help ease symptoms. The GP might prescribe an oral solution (Nystain) to be administered several times per day.
Scabies is a skin infection caused by mites that live on the skin surface. During reproduction, these mites burrow into the skin surface to lay eggs and this causes a red and irritating rash to form on the skin.
Scabies can be transmitted via infected clothing, towels, bed linen, and through direct contact with an infected person. Those who are infected with scabies should isolate until the first treatment has been completed. If crusted (Norwegian) scabies is diagnosed, source isolation would be required until the full treatment is completed.
Scabies can be successfully treated with a prescribed cream, lotions, and ointments. In a care home environment where more than one person is diagnosed, the treatment should all be administered on the same day.