Three large scale multi-centre trials into Severe Sepsis and Septic Shock: ProCESS (USA), ARISE(Aus), ProMISe(UK), all showed the same thing. What works is good early resuscitation (Not the fancy stuff from ICU – however, that does have its place later on).
Category: Infection Control
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.
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
![](https://i0.wp.com/www.embeds.co.uk/wp-content/uploads/2023/06/measles.png?resize=960%2C540&ssl=1)
Paediatric Infections – School Exclusion/Isolation
Prevent the spread of infections by ensuring: routine immunisation, high standards of personal hygiene and practice, particularly hand-washing, and maintaining a clean environment. However, Public Health England recommend exclusion in some conditions.
OPAT – Cellulitis 2023
Our OPAT service can provide IV antibiotics for cellulitis for those patients that can be managed as out patients but either require IV antibiotics or have failed oral therapy.
Sore Throat and Group A Strep 2022
Avian Flu – 2022
Avian flu is droplet spread and can sometimes effect humans as well as birds. Severity varies in human cases varies widely from mild to severe and deaths have been reported.
Case Definition = Clinical Criteria + Exposure Criteria
Covid-19: Oximetry @home pathway
In 2022 we can now refer Covid-19 patients who are being discharged into the “Oximetry @home” pathway.
CHFT staff need to complete the attached referral form and email it to the LCD email address on the form. LCD will then make contact with the patient within 24 hours and onboard them (as it’s an 8am-6pm service).
Covid-19 Trust Isolation (Dec 2021)
The trust isolation policies have been updated inline with national guidance.
- Scenario 1 – Staff member Symptomatic
- Scenario 2 – Staff member asymptomatic, with a positive contact (inc. within household)
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