Category: Infection Control

MERS

Middle East respiratory syndrome coronavirus (MERS-CoV)

MERS is classified as a High Consequence Infectious Disease (HCID), and although unlikely is serious and could be imported into the UK at ANY time. Risks are higher when there is increased travel to endemic areas such as Hajj.

Symptoms include fever and cough that progress to a severe pneumonia causing shortness of breath and breathing difficulties. In some cases, a diarrheal illness has been the first symptom to appear.

UK Health Security Agency:

Suspected = Isolate & Full PPE

  • Trust Guidance
  • PPE Notes:
    • FFP3 (can’t use hoods)
    • Buddy System vital
  • Senior Review needed
    • Collect relevant information
    • Contact Microbiologist immediately (as may de-escalate without tests)

SITE Specifics

HRI:

  • Primary site for Pre-alerts
  • 1 Patient – goes to Isolation. room
  • 2 Patients  – second patient goes to Minors 5
    • end of corridor and lounge closed off
  • 3+ Patients – ALL MERS patients moved to Minors Corridor
    • Minors corridor closed
    • Minors/UCH moved to uSDEC
    • Internal Trust Majax

CRH:

  • 1 Patient – goes to “Old Relatives”
    • Corridor closed from treatment room to door to ambulance corridor
    • Patients moving from majors wait to department will need to go outside to ambulance entrance
  • 2 Patients  – second patient goes to treatment room to left of reps room
    • Corridor closed sure extended to reception
    • Patient 1 MUST move out of ED and cubicle cleaned 

Useful Videos

Donning:

Doffing:

Taking Bloods:

Think -TB

The prevalence of Tuberculosis in our region is increasing and has significant issues for both the patient and public health if we miss it.

Symptoms

  • Cough
  • Fever
  • Night Sweats
  • Lymphadenopathy
  • Weight loss

High-Risk factors to consider

Characteristics

  • Previous/Latent TB
  • TB Contact
  • Immunocompromised
  • Substance Misuse
  • Homeless/Prision
  • Pubs – esp. Vulcan Hudds

Travel/Ethnicity

  • Eastern Europe
  • India/Pakistan
  • East Asia
  • Africa

CXR Changes

  • Upper Lobe Consolidation
  • Hilar Lymphadenopathy
  • Cavities

Actions

  • Provide 3 AFB samples – Ideally performed in ED/Ward (but if patient fit for discharge and unable provide samples in ED give patient pots and request which they return to their GP.
  • Don’t Commence TB treatment – unless instructed by respiratory team
  • If admitted isolation requested
  • If discharged Patient told to isolate and if must go into public wear face mask
  • Contact TB team:
    • Huddersfield/Halifax – Based on GP postcode
    • In-Hours: either through Switch board or as EPR referral
    • Out of Hours: Though EPR referral
    • They will ensure appropriate notification of Public Health

Huddersfield

  • Dr Anneka Biswas
  • Chantelle Lashington
  • Deborah Howgate

Halifax

  • Dr Nicholas Scriven
  • Mary Hardcastle
  • Manjinder Kaur

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.

 

Trust SOP -HERE

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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

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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

 

 

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