Category: Infection Control
Antibiotics Guides
Sepsis – Click Here
Suspected Covid-19 – Click Here
Site Specific – Click Here
Paediatric – Click Here
Can’t find it in our drug cupboard
try the Emergency Drug Cupboard
Sex, Bites, and Needle Sticks
First Aid (ALL)
- Encourage bleeding
- Wash with copious amounts of water or saline
- Don’t Suck
- Don’t use Caustic agents
Mpox (Formerly: Monkeypox)
Wear Gloves & Wash Your Hands!!!
There have been >100 patients identified as having Mpox in the UK during the current outbreak. Most of these cases have been amongst men who have sex with men.
Reports have suggested that although lesions occur any where including palms and soles. Genital lessons and lymphadenopathy are very common
March 2024 – UKHSA warn there is increasing cases in DRC (Democratic Republic of Congo), so stay vigilant in travellers from central Africa.
Acute Cystitis and Pyelonephritis Pathway
A joint Medical-Urology pathway has been agreed for Pyelonephritis
Study Running – Send Urine Sample prior to Antibiotics
(if this does not interfere with treatment of Red-Flag Sepsis)
Imaging in ED is only required if ED suspects:
- Ureteric Obstruction – Renal colic symptoms/Hx of stone
- Acute Surgical Abdomen
- Emphysematous pyelonephritis – Rare necrotising infection of the renal tract, presenting with flank pain and fever, 90% in uncontrolled diabetes mellitus (but immunocompromise and stones also increase chances)
- Renal Abscess – Presents with flank pain and fever, risk factors include; diabetes mellitus, Renal stones, obstruction
Legionnaires Disease
There has been a resent increase in cases of Legionnaires Disease in the North West. So remember to request Urine Legionella Antigen test, if you have suspicions.
SEPSIS
Rabies [notifiable disease]
Recent Incident: Bat contact was not recognized (effectively touching a bat without gloves means treatment is recommended)
Rabies is an acute viral encephalomyelitis caused by members of the lyssavirus genus. The UK has been declared “Rabies-Free”. However, it is known that even in “Rabies-Free” counties the bat population posse a risk.
In the UK the only bat to carry rabies is the Daubenton’s Bat [Picture on the Left] and this is not a common bat in the UK. The UK and Ireland are Classified as “low-risk” for bat exposure. Despite our “low-risk” status in 2002 a man died from rabies caught in the UK from bat exposure.
Although rabies is rare it is fatal so we must treat appropriately, Public Health England – Green book details this.
Risk Assessment
To establish patients risk and thus treatment you need to establish the Exposure Category and Country Risk [Link to Country Risk]
Exposure Category
Combined Country/Animal & Exposure Risk
Treatment
Obviously patients with wounds will need appropriate wound care and cleaning, specifics for rabies are below.
If in ANY doubt, or you feel you need advice about treatment contact: On-Call Microbiologist (who will contact PHE or Virology advice)
You will likely need to liaise with the duty pharmacist to obtain vaccine or HRIG – which may need to be sent from a different hospital. [it is probably worth trying to obtain the 1st weeks treatment if possible, to avoid treatment delays]
Rabies and Immunoglobulin Service (RIgS), National Infection Service, Public Health England, Colindale (PHE Colindale Duty Doctor out of hours): 0208 327 6204 or 0208 200 4400
Measles
Suspected/Confirmed patients should be ISOLATED & wear PPE
Treating Staff – (should not be; non-immunised, pregnant or immunocompromised)
- single-use, disposable gloves
- single-use, disposable apron (or gown if extensive splashing or spraying, or performing an aerosol generating procedure (AGP))
- FFP3 – respiratory protective equipment (RPE)
- eye/face protection (goggles or visor)
Patient
- Surgical face mask
Background
- Measles is highly infectious – (4 day prior to and after rash appears) suspected patients should be isolated within the ED
- Measles Immunisation – 1 dose 90% effective, 2 doses 95% effective
- Measles is a notifiable disease

Meningitis – Adults
- Keep your suspicions high – early signs it may not be clear
- Sepsis Kills – give antibiotics & fluid early
- Consider Acyclovir
- Give Dexamethasone with Antibiotics – it can reduce neurological sequelae
- Consider indications for CT before LP
- Get SENIOR support early