Prevention and control measures, Infection prevention and control, Advice and support, For patients, carers and visitors, The Royal Free

Prevention and control measures

Infection prevention and control measures at Royal Free London hospitals

Infection prevention and control measures aim to protect patients, visitors and staff from acquiring an infection and to control infection transmission when it is identified. The basic principles of infection prevention and control are:

  • environmental hygiene – providing a clean and safe hospital for patients to receive the medical care they need
  • trained staff, who will always act to prevent infections, and recognise how to control the spread of any identified new infection
  • to provide a high standard of support services alongside clinical care, such as laundry, sterile medical equipment, waste management and cleaning
  • to provide information to patients and carers about infection prevention and what to expect when an infection is identified
  • to include patients in the provision of good infection prevention measures by encouraging and enabling good hygiene and handwashing and providing information to enable patients to make choices in their care.

Good hygiene at the Royal Free London – what can you do to help?

The single most important tool we have to aid us in the prevention of spreading infection and enforcing good hygiene is to have staff decontaminate their hands before and after caring for you by hand washing or using an alcohol-based cleanser. If you are worried that we might have forgotten, it is OK to remind us! We welcome your help in keeping you safe.

Viral tick-borne illnesses that occur in the United States

In the United States, some species of ticks can cause a viral tick disease in humans. For example, Colorado tick fever, Heartland virus infection and Powassan virus disease are common in the U.S. Fortunately, cases of these illnesses are rare and occur only in several regions. The only way to prevent the infection is to avoid the tick bites in areas where tick-borne viruses circulate.

Tick bites can cause great problems as infected ticks can transmit various pathogens to humans and animals. They can spread viruses, bacteria and parasites during blood-feeding through the bitten area. The more time ticks spend on human body, the more risk is that the person will get some viral or bacterial infection. Physicians treat any viral tick disease only symptomatically. In most severe cases, serious complications and death are possible.

Colorado tick fever

Colorado tick fever (CTF) is a rare viral tick disease. The CTF virus, that causes the disease, is spread to people through bites of infected Rocky Mountain wood ticks (scientific name: Dermacentor andersoni).

In fact, the virus can’t be spread from person to person, except in rare cases via blood transfusion. The virus is circulating in the western Canada and western USA. The cases of Colorado tick fever typically occur in the Rocky Mountain areas that are 4,000-10,500 feet above sea level. People who live in or visit the highlands can get infected with CTF virus primarily from March to August. During spring and summer months Rocky Mountain wood tick females are most hungry and active.

To detect CTF virus genetic material (RNA) or antibodies against the virus in blood, physicians typically apply laboratory tests. The incubation period (time from tick bite to onset of illness) ranges from 1 to 14 days. The most common symptoms of CTF are fever, headache, chills, body aches, fatigue, and feeling exhausted. However, in some cases the patients have sore throat, stomachache and vomiting, skin rash, or stiff neck. About half of all people infected with CTF virus have several days of fever followed by several days of improvement. Then, a second short period of fever and disease occurs.

In fact, there are no specific medical treatments of CTF. However, in some severe cases, patients need supportive therapy to keep the fever down and to reduce pain. The best measure to prevent CTF is to reduce your risk of tick bites.

Heartland virus infection

Heartland virus infection is caused by the virus that belongs to a family of Phleboviruses. This viral tick disease primarily occurs among residents of Missouri and Tennessee during May – September. It is still unknown nowadays if the virus may be found in other areas of the USA. However, phleboviruses can be identified all over the world and can cause illnesses in people via the bites of mosquitoes, sandflies, or ticks. It is not yet fully known how people become infected with Heartland virus in the USA. However, recent studies suggest that most cases were caused by the bites of Lone Star ticks.

The clinical signs of Heartland virus infection can be initially identified as ehrlichiosis. The most comon symptoms are fever, headache, body aches, fatigue and different stomach problems (anorexia or loss of appetite, nausea and vomiting, diarrhea). Beside, patients also have thrombocytopenia, leukopenia and mildly to moderately elevated liver transaminases.

There are no specific medications or therapies for treatment of Heartland virus disease. Patients get supportive care to keep the fever down and to make up for the loss of fluids. Fortunately, most cases end in full recovery.

Powassan virus disease or Powassan encephalitis

Powassan encephalitis or POW virus disease is a serious viral tick disease. It is caused by a virus spread by infected blacklegged (Ixodes scapularis) and groundhog (Ixodes cookei) ticks. POW virus belongs to a group of arboviruses that can cause inflammation of the brain (encephalitis). Fortunately, POW viruses can’t be transmitted directly from person to person.

Most cases of POW disease in humans occur in the northeastern states and the Great Lakes region of the USA during the late spring, early summer, and mid-fall when ticks are most active.

The incubation period ranges from 7 to 30 days. In most cases Powassan virus disease is asyptomatic. However, POW virus can develop inflammation of the membranes that surround the brain and spinal cord (meningitis) and inflammation of the brain (encephalitis). Patients can have fever, fatigue and weakness, loss of coordination, headache, confusion, vomiting, speech difficulties, and seizures.

A combination of signs and symptoms and laboratory tests of blood or spinal fluid typically help physicians to make a diagnosis. There is no specific medicine to cure POW virus disease, therapy is only supportive to reduce symptoms and pain. Treatment for Powassan encephalitis includes hospitalization, respiratory support, and intravenous fluids.

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How to avoid viral tick disease

There is no vaccine to prevent tick-borne illnesses. The best way to prevent viral tick disease is to reduce your risk of tick bites. Preventive measures and thorough tick checks are the most effective.

Try to avoid wooded and shrubby areas with high grass. If possible, postpone your picnics, bbqs, rambling and hiking in the areas where tick-borne viruses are circulating during spring and summer months.

Wear light-colored clothing, better long sleeves and pants. When outdoors, apply tick repellents to bare skin (containing DEET) and to clothing and gear (containing permethrin), as directed on the product label.

Perform full-body tick checks after spending time outdoors. Remove ticks immediately before they have a chance to bite, attach and suck your blood. In addition, examine your clothing, gear and pets.

Consult a physician if fever, rash, or other symptoms of concern develop. Indeed, they can be clinical signs of a viral tick disease.

Chapter 6 Infection Prevention and Control

Термины в модуле (128)

1. monitoring temperature and white blood cell count.

2. placing the patient on strict intake and output.

3. instituting respiratory precautions.

2. Deficient fluid volume

3. Deficient knowledge

1. Wash your hands.

2. Monitor urine color.

3. Reduce stress.

1. washes hands with soap under running water, using friction, for 20 seconds.

2. removes rings and jewelry before washing hands with soap and water.

3. washes hands before donning clean gloves to remove the old dressing.

1. elevated white blood cells.

2. culture and sensitivity.

3. erythrocyte sedimentation rate.

1. Keep the door open to maintain continuous airflow.

2. Wear a properly fit-tested N-95 mask.

3. Don sterile gloves.

2. Altered nutrition.

3. Deficient knowledge.

1. Limit the number of visitors to immediate family.

2. Suggest alternative means of contact such as e-mail and phone calls.

3. Arrange for a nursing assistant to sit with the patient.

1. Alert the rapid response team for suspected sepsis.

2. Call the physician to obtain an order for blood cultures.

3. Take a full set of vital signs and compare them to the baseline.

1. Share personal items.

2. Practice hand hygiene.

3. Use bleach to clean surfaces.

4. Seal used dressings in impermeable bags.

Know the Signs and Symptoms of Infection

Call your doctor right away if you notice fever or any of the signs and symptoms of an infection.

During your chemotherapy treatment, your body may not be able to fight off infections like it used to. When your white blood cell counts are low, you must take infection symptoms seriously. Infection during chemotherapy can lead to hospitalization or death.

Call your doctor right away if you notice any of the following signs and symptoms of an infection—

  • Fever (this is sometimes the only sign of an infection).
  • Chills and sweats.
  • Change in cough or a new cough.
  • Sore throat or new mouth sore.
  • Shortness of breath.
  • Nasal congestion.
  • Stiff neck.
  • Burning or pain with urination.
  • Unusual vaginal discharge or irritation.
  • Increased urination.
  • Redness, soreness, or swelling in any area, including surgical wounds and ports.
  • Diarrhea.
  • Vomiting.
  • Pain in the abdomen or rectum.
  • New onset of pain.

Find out from your doctor when your white blood cell count is likely to be the lowest, since this is when you’re most at risk for infection. This usually occurs between 7 and 12 days after you finish each chemotherapy dose, and may last up to one week.

Infections and Asthma

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When you have asthma, any upper respiratory infection — like a cold or the flu — can affect your lungs, causing inflammation and airway narrowing. It is important to take measures to stay healthy and be aware of any asthma symptoms, even mild, so that you avoid a more serious asthma attack.

What Are the Symptoms of Infection?

Call your doctor if you experience any of the warning symptoms of a possible infection that can trigger an asthma attack (listed below). Also call your doctor if you have any other symptoms of an asthma attack that cause concern.

  • Increased shortness of breath, difficulty breathing, or wheezing
  • Coughing up increased amounts of mucus
  • Abnormally colored mucus
  • Fever (temperature over 101В°F) or chills
  • Increased fatigue or weakness
  • Sore throat, scratchy throat, or pain when swallowing
  • Sinus pressure or drainage, nasal congestion, or headaches

How Can I Prevent Infections That Trigger Asthma?

  • Good hygiene can decrease viral infections. Prevent the spread of infection by making sure you and your family members wash their hands regularly with soap and warm water.
  • Check with your health care provider about receiving a flu shot every year. In addition, discuss the possibility of getting a pneumococcus — or pneumonia — vaccine. Pneumococcus is a common cause of bacterial pneumonia, an illness that can be particularly serious in a person with asthma. Depending on your age and any risk factors you may have, you may need two different types of pneumonia vaccines.
  • Sinusitis with asthma can be very serious. Be aware of the symptoms of a sinus infection and report them immediately to your doctorВ to prevent asthma attacks.
  • Keep breathing equipment clean. Do not let others use your asthma medications or asthma treatment, including your asthma inhaler, asthma nebulizer, and nebulizer tubing and mouthpiece.

What Do I Do If I Have an Infection?

If you have asthma and are showing signs of an infection, call your doctor immediately for advice.

10 Best Strategies for Infection Prevention and Control

According to the Centers for Disease Control and Prevention, one out of every 20 hospitalized patients will contract a healthcare-associated infection. The spread of these infections, however, can be controlled. There are several simple and cost-effective strategies that can help prevent infections, from the basic tenet of hand hygiene to the team-oriented approach of Comprehensive Unit-based Safety Programs.

Four infection prevention and process improvement experts weigh-in on the 10 best strategies for prevention of infections.

1. Hand Hygiene. According to the CDC, this is the simplest approach to preventing the spread of infections and needs to be incorporated into the culture of the organization. Surgical team personnel should wash their arms and forearms before a procedure and put on sterile gloves, according to CDC guidelines for infection control. Steven J. Schweon, RN, MPH, infection prevention consultant and member of The Society for Healthcare Epidemiology of America, suggests the «clean in, clean out» approach, wherein hands and equipment are cleaned or disinfected on the way into the patient’s room and on the way out again.

2. Environmental hygiene. According to J. Hudson Garrett, PhD, MSN, MPH, FNP-BC, CSRN, VA-BC, senior director for clinical affairs at PDI, one of the most common sources of transmission of infection is environmental surfaces. Certain types of microbial bacteria are capable of surviving on environmental surfaces for months at a time, according to Mr. Garrett. When healthcare providers or patients touch these surfaces with their skin, the bacteria can be transmitted, causing infection. Thus, it is essential that the environment be kept clean and disinfected. Patients and their families are now the biggest advocates of medical safety, and Mr. Garrett suggests including them in infection prevention protocols, especially with respect to maintaining a clean and sanitary environment. It is also important to involve multidisciplinary environmental hygiene teams in meetings regarding adherence to infection prevention protocols. Irena L. Kenneley, PhD, APRN-BC, assistant professor at the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland and member of the Association for Professionals in Infection Control and Prevention, says that meeting with environmental services and sharing in-house surveillance data helps them relate housekeeping tasks with the spread of infection and helps ensure optimal environmental hygiene.


3. Screening and cohorting patients. Part of the preoperative health evaluation process should include consistent screening of patients, says Siew Lee Grand-Clément, a black belt in robust process improvement at the Joint Commission Center for Transforming Healthcare. These patients must then be treated prior to surgery or any other procedure. However, it is essential that patients who are suffering from the same disease or infection should be kept together in a designated area. «This is essential to ensure that cross infections do not happen,» says Dr. Kenneley. Infections can spread easily from one patient to another if they are being treated in the same area, with the same staff and shared patient care equipment. Some infectious agents are even airborne, says the CDC. Organizations must also evaluate whether the staff is adhering to specific protocols for specific infections, Dr. Kenneley says.

4. Vaccinations. The staff at a healthcare organization may sometimes be the cause of the spread of infections. They come into contact with patients with different types of diseases and may contract infections, according to the CDC. As a result, organizations must make sure that recommended vaccinations are being administered to their staff as recommended. «Keeping healthcare professionals healthy pays dividends,» says Mr. Schweon. It results in decreased transmission risk to co-workers and patients.

5. Surveillance. Through surveillance, organizations should gather data regarding infection patterns at their facility. They should also regularly assess current infection prevention protocols. Having a robust infection surveillance program helps organizations measure outcomes, assess processes of care and promote patient safety, says Mr. Schweon. Sharing the data that the infection surveillance program gathers is the next step. «Communicate, display and discuss all process and outcomes measures with all stakeholders,» says Dr. Kenneley.

6. Antibiotic stewardship. The misuse and overuse of antibiotics can put patients at a risk of contracting infections, according to the Association for Professionals in Infection Control and Epidemiology. Inappropriate antibiotic use may also result in patients becoming resistant to some drugs. If those patients contract an infection, it becomes harder to treat them and the risk of it spreading increases. Mr. Schweon suggests establishing a program to assist with appropriate antibiotic selection and dosing. This helps optimize patient outcomes and minimize adverse events like C. difficile infection and antibiotic toxicity, he says.

7. Care coordination. Breakdown of communication in the surgical preparation, planning and postoperative care management among various care providers during the care transition process can lead to surgical site infections that could otherwise be avoided, says Ms. Grand-Clément. Often, the concept of «stopping the line» is not practiced, which is when care providers are doubtful if certain necessary infection prevention or surgical preparation activities have been completed by the previous care providers, and they halt the care transition process until the matter is resolved. Organizations must avoid situations where a certain process is overlooked by a department that assumes another department has already completed that it. «Activities must be timed and accountability should be specifically assigned,» she says. There needs to be coordination of care and communication within the surgical team as well. There is a risk of breaking the sterile field in the surgery room particularly around the portion of the surgical procedure when multiple, critical activities are taking place at the same time that require staff to multitask, she says. Care coordination goes a long way in preventing surgical site infections.

8. Following the evidence. Keeping abreast of the latest findings regarding the spread of infections and strategies for prevention is essential for a successful infection prevention program. «Infection preventionists must continually monitor the professional literature and attend educational conferences for the latest information with preventing infections,» says Mr. Schweon. However, it is also important to first look at the reality of your organization’s processes and perform your own gap assessment before adopting new practices. What is new in the infection prevention field may not necessarily be the best fit for your organization, says Ms. Grand-Clément.

9. Appreciating all the departments that support the infection prevention program. An organization’s culture may need to shift from thinking that only infection preventionists are accountable for infection prevention, because every patient encounter throughout the care continuum presents all healthcare workers with an infection prevention opportunity, says Ms. Grand-Clément. All caregivers are accountable, and to encourage infection prevention protocols, healthcare professionals should show appreciation for all the people who help keep infections at bay, from the people who prepare surgical instruments for the operating room to those preparing the food safely for patients, staff and visitors, says Mr. Schweon.

10. Comprehensive Unit-based Safety Programs. The Comprehensive Unit-based Safety Program is a structured strategic framework for patient safety improvement that integrates communication, teamwork and leadership, according to the Agency for Healthcare Research and Quality. Each unit should have its own infection prevention champions, with these individuals becoming an extension of the infection prevention and control department, adds Mr. Garrett. «The CUSP program has demonstrated time and time again how effective unit-based champions can be in influencing positive change and improving outcomes,» says Mr. Garrett.

Each of these strategies helps organizations keep the spread of infections at bay. When implemented, supported and carried out together, these 10 strategies are instrumental in ensuring the success of an infection prevention program at an organization.

Crimean-Congo haemorrhagic fever

Key facts

  • The Crimean-Congo haemorrhagic fever (CCHF) virus causes severe viral haemorrhagic fever outbreaks.
  • CCHF outbreaks have a case fatality rate of up to 40%.
  • The virus is primarily transmitted to people from ticks and livestock animals. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons.
  • CCHF is endemic in Africa, the Balkans, the Middle East and Asia, in countries south of the 50th parallel north.
  • There is no vaccine available for either people or animals.

CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north – the geographical limit of the principal tick vector.

The Crimean-Congo haemorrhagic fever virus in animals and ticks

The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats. Many birds are resistant to infection, but ostriches are susceptible and may show a high prevalence of infection in endemic areas, where they have been at the origin of human cases. For example, a former outbreak occurred at an ostrich abattoir in South Africa. There is no apparent disease in these animals.

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Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus Hyalomma are the principal vector.


The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians.

Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons. Hospital-acquired infections can also occur due to improper sterilization of medical equipment, reuse of needles and contamination of medical supplies.

Signs and symptoms

The length of the incubation period depends on the mode of acquisition of the virus. Following infection by a tick bite, the incubation period is usually one to three days, with a maximum of nine days. The incubation period following contact with infected blood or tissues is usually five to six days, with a documented maximum of 13 days.

Onset of symptoms is sudden, with fever, myalgia, (muscle ache), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). There may be nausea, vomiting, diarrhoea, abdominal pain and sore throat early on, followed by sharp mood swings and confusion. After two to four days, the agitation may be replaced by sleepiness, depression and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly (liver enlargement).

Other clinical signs include tachycardia (fast heart rate), lymphadenopathy (enlarged lymph nodes), and a petechial rash (a rash caused by bleeding into the skin) on internal mucosal surfaces, such as in the mouth and throat, and on the skin. The petechiae may give way to larger rashes called ecchymoses, and other haemorrhagic phenomena. There is usually evidence of hepatitis, and severely ill patients may experience rapid kidney deterioration, sudden liver failure or pulmonary failure after the fifth day of illness.

The mortality rate from CCHF is approximately 30%, with death occurring in the second week of illness. In patients who recover, improvement generally begins on the ninth or tenth day after the onset of illness.


CCHF virus infection can be diagnosed by several different laboratory tests:

  • enzyme-linked immunosorbent assay (ELISA) ;
  • antigen detection;
  • serum neutralization;
  • reverse transcriptase polymerase chain reaction (RT-PCR) assay; and
  • virus isolation by cell culture.

Patients with fatal disease, as well as in patients in the first few days of illness, do not usually develop a measurable antibody response and so diagnosis in these individuals is achieved by virus or RNA detection in blood or tissue samples.

Tests on patient samples present an extreme biohazard risk and should only be conducted under maximum biological containment conditions. However, if samples have been inactivated (e.g. with virucides, gamma rays, formaldehyde, heat, etc.), they can be manipulated in a basic biosafety environment.


General supportive care with treatment of symptoms is the main approach to managing CCHF in people.

The antiviral drug ribavirin has been used to treat CCHF infection with apparent benefit. Both oral and intravenous formulations seem to be effective.

Prevention and control

Controlling CCHF in animals and ticks

It is difficult to prevent or control CCHF infection in animals and ticks as the tick-animal-tick cycle usually goes unnoticed and the infection in domestic animals is usually not apparent. Furthermore, the tick vectors are numerous and widespread, so tick control with acaricides (chemicals intended to kill ticks) is only a realistic option for well-managed livestock production facilities.

For example, following an outbreak at an ostrich abattoir in South Africa (noted above), measures were taken to ensure that ostriches remained tick free for 14 days in a quarantine station before slaughter. This decreased the risk for the animal to be infected during its slaughtering and prevented human infection for those in contact with the livestock.

There are no vaccines available for use in animals.

Reducing the risk of infection in people

Although an inactivated, mouse brain-derived vaccine against CCHF has been developed and used on a small scale in eastern Europe, there is currently no safe and effective vaccine widely available for human use.

In the absence of a vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus.

Public health advice should focus on several aspects.

  • Reducing the risk of tick-to-human transmission:
    • wear protective clothing (long sleeves, long trousers);
    • wear light coloured clothing to allow easy detection of ticks on the clothes;
    • use approved acaricides (chemicals intended to kill ticks) on clothing;
    • use approved repellent on the skin and clothing;
    • regularly examine clothing and skin for ticks; if found, remove them safely;
    • seek to eliminate or control tick infestations on animals or in stables and barns; and
    • avoid areas where ticks are abundant and seasons when they are most active.
  • Reducing the risk of animal-to-human transmission:
    • wear gloves and other protective clothing while handling animals or their tissues in endemic areas, notably during slaughtering, butchering and culling procedures in slaughterhouses or at home;
    • quarantine animals before they enter slaughterhouses or routinely treat animals with pesticides two weeks prior to slaughter.
  • Reducing the risk of human-to-human transmission in the community:
    • avoid close physical contact with CCHF-infected people;
    • wear gloves and protective equipment when taking care of ill people;
    • wash hands regularly after caring for or visiting ill people.

Controlling infection in health-care settings

Health-care workers caring for patients with suspected or confirmed CCHF, or handling specimens from them, should implement standard infection control precautions. These include basic hand hygiene, use of personal protective equipment, safe injection practices and safe burial practices.

As a precautionary measure, health-care workers caring for patients immediately outside the CCHF outbreak area should also implement standard infection control precautions.

Samples taken from people with suspected CCHF should be handled by trained staff working in suitably equipped laboratories.

Recommendations for infection control while providing care to patients with suspected or confirmed Crimean-Congo haemorrhagic fever should follow those developed by WHO for Ebola and Marburg haemorrhagic fever.

WHO response

WHO is working with partners to support CCHF surveillance, diagnostic capacity and outbreak response activities in Europe, the Middle East, Asia and Africa.

WHO also provides documentation to help disease investigation and control, and has created an aide–memoire on standard precautions in health care, which is intended to reduce the risk of transmission of bloodborne and other pathogens.

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