Visors and goggles (eye protection), headwear and footwear

Visors and goggles (eye protection), headwear
and footwear
CHOOSING Goggles should protect you against splashes to your eyes. They should wrap
around the eye area to ensure side areas are protected.
Visors may be worn instead of a mask and goggle combination when there is a high risk
of splattering or spray of blood or other body fluids.
USING
• Visors/goggles should be worn to protect the eyes whenever there is a risk of splashing
to the face. They should be removed when no longer required.
• Visors/goggles should be worn during aerosol generating procedures (intubation, oro/
nasopharyngeal suctioning, tracheostomy care, chest physiotherapy, bronchoscopy/
cardiopulmonary resuscitation).
• Visors/goggles should be worn by all theatre staff directly participating in an invasive
procedure where there is a risk of splashing to the face.
• Torn or otherwise damaged face protection should not be used and should be removed
immediately (safety permitting) if this occurs during a procedure.
REMOVI N G Remove goggles/visors promptly after use, avoiding contact with most likely
contaminated areas, e.g. the front surface. This should be done by handling the straps/ear
loops/goggle legs only (manufacturers’ instructions should be followed).
HEADWARE Theatre hats should be worn in theatres, sterile services departments and
clean rooms. They should cover the hair entirely and should be changed between sessions
or if contaminated with blood or body fluids.
FOOTWARE Footwear should be clean and well maintained. It should support and
cover the whole foot to protect from dropped sharps and blood/body fluid spillages.
Footwear dedicated to a specific clinical area, such as theatre, should be removed before
leaving that area.
Summary of when to use PPE
The guidance contained within Table 1 is not exhaustive; it offers examples of common care
activities where blood/other body fluid exposure may occur and protection must be worn.
As standard, a risk assessment must be undertaken to consider the risks of blood/other
body fluid exposure prior to activities. For further information refer to your local infection
control team/policy.
Table 1 Summary of when to use PPE
Activity
Aprons/gowns
(depending on
significant splashing/
exposure)
Face, eye, mouth
protection
(surgical masks,
goggles) Gloves
Contact with intact skin – no
visible blood/ body fluids, rashes
Not required Not required Not required
Sterile procedures Required Risk assessment Required
Contact with wounds, skin lesions Required Risk assessment Required
Managing spillages of urine and
faeces
Required Risk assessment Required
Potential exposure to blood/other
body fluids, e.g. performing
suctioning, cleaning up spillages,
taking specimens
Required Risk assessment Required
Venepuncture/cannulation Required Not required Required
Vaginal examination Required Not required Required
Applying topical creams, etc. Not required Not required Required
Touching patients with unknown
skin rash
Risk assessment Not required Required
Emptyichanging urinary catheter
bags, urinals, bedpans, etc.
Required Risk assessment Required
Handling specimens Required Not required Required
Handling used instruments Required Not required Required
Using disinfectants, cleaning
agents
Required Risk assessment Required
General cleaning of clinical
areas and equipment
Risk assessment Not required Risk
assessment
Bed making, dressing patients Risk assessment Not required Risk
assessment
Oral care Risk assessment Risk assessment Required
Feeding patient Required Not required Risk
assessment
Handling waste Risk assessment Risk assessment Required

Masks CHOOSING

Masks
CHOOSING
• A wide range of masks are available: reusable and disposable surgical and FFP3 masks;
masks with visors; masks without visors, etc. Make sure you know what is available in
your place of work, how to wear it and how to use it – always follow the manufacturer’s
guidance on use, make sure each item fits comfortably and check expiry dates.
• If there is any possibility that blood, body fluids, medications or fluids of any type may be
splashed in your face, you should wear a surgical mask.
• If you are caring for someone with an infection that is transmitted via the airborne route,
e.g. influenza, and will be performing an aerosol generating procedure such as intubation,
oro/nasopharyngeal suctioning, tracheostomy care, chest physiotherapy, bronchoscopy/
CPR, etc., you should wear an FFP3 mask.
• Manufacturers’ instructions should be adhered to while donning masks to ensure the
most appropriate fit and optimum protection.
USING The purpose of wearing a mask is to prevent splashes from going in your mouth
or up your nose. Specialist masks also filter the air you breathe. Torn or damaged masks
should not be worn as they may not provide the desired level of protection.
SURGICAL MASKS These provide a physical barrier against splashes to the mouth and
nose. They do not filter the air you inhale and are not an effective barrier for fine aerosol
droplets that float through the air and are inhaled. Care should be taken to ensure that
surgical masks fit snugly around the nose and chin.
Surgical masks are single-use, disposable items and should be removed when no longer
required. They should not be worn around the neck and should be changed when moist/
wet/contaminated.
F I LT E R I N G FA C E P I E C E M A S K S ( F F P M A S K S ) These provide a physical barrier
against splashes to the mouth and nose and also filter the air you inhale. They are capable
of filtering fine aerosols. FFP3 masks are the mask of choice, providing a higher level of
filtration than FFP2 masks.
FFP3 masks should be worn when aerosolising procedures are underway with patients
with infections transmitted via the airborne route, e.g. influenza, tuberculosis, etc. They
must be fitted to ensure the best possible fit on to your face. A ‘fit test’ should be carried
out to check how well the mask fits (Box 1).
Box 1 Fit test for masks
FFP3 mask fit testing
• Fit testing is a one-off test but should be repeated if facial shape changes/following
significant weight gain/loss.
• FFP3 fit testing is a legal requirement.
• The wearer must achieve an adequate fit with each specific model of FFP3.
Factors affecting face seal
• Jewellery – may need to be removed.
• Facial markings, e.g. scar/mole.
• Safety or prescription glasses (should be worn during fit test).
• Facial hair. A small goatee or beard than will be covered by the mask may be okay,
otherwise staff must be clean shaven for a proper fit and face seal. Otherwise,
those with facial hair should shave/do not perform aerosolising procedures/use a
hood with powered extraction.
Carry out a fit check before the fit test
• Cover the mask surface with flat hands. For valved masks inhale sharply and for
unvalved masks exhale sharply. If leaks around the seal are detected, correctly fit
the mask before entering a hazardous area

Aprons and gowns CHOOSING

Aprons and gowns
CHOOSING
• Aprons and gowns should be water repellent and should allow you a full range of movement
when worn and not interfere with your clinical activity.
• Check expiry dates on sterile gowns before use – never use an out of date gown.
USING
• An apron or gown should be worn when contamination of your clothing or uniform
might occur.
• Disposable aprons and gowns are single-use items and should be disposed of via the
clinical waste stream immediately after use.
• Disposable, single-use plastic aprons should be worn when there is a risk of contact with
blood/body fluids.
• An impermeable gown should be worn rather than a plastic apron when there is a risk
of significant splashing of body fluids, e.g. in an operating theatre or during invasive
procedures.
• Disposable long-sleeved gowns should be worn when caring for patients known or
suspected to have scabies or any other parasitic skin infestation.
• Colour-coded aprons and gowns are often worn for different tasks in a ward setting, e.g.
a specific colour may be worn when patients are isolated and another for serving meals –
ensure that you wear the correct colour for the task in hand in accordance with local policy.
• Reusable gowns, such as those worn in operating theatres, should be worn once and
then laundered. They must be changed between patients.
• Disposable aprons and gowns must never be cleaned and reused.
• An apron or gown should be worn for one patient and then removed. It may be necessary
to change your apron or gown between tasks on the same patient to prevent
cross-contamination.
• A torn or damaged apron or gown should not be used and should be removed immediately
(safety permitting) if this occurs during a procedure.
• An apron or gown should be removed as soon as the task for which it was worn is complete,
before touching non-contaminated and clean areas, items, environmental surfaces
and contact with other patients and staff.
REMOVI N G
• When removing an apron or gown you should avoid touching the most heavily soiled/
contaminated areas. You should also take care not to touch your clothing or uniform
worn underneath to avoid contamination.
• Turn the outer contaminated side of the gown inward, roll the aprons or gown into a ball
and dispose of it via the clinical waste stream.

Gloves

Gloves
CHOOSING Gloves are a medical device and should be treated as such:
• Choose the right size to ensure a good fit in order to avoid friction, excessive sweating,
finger and hand muscle fatigue and interference with dexterity.
• Check the expiry date of the gloves you use – never use gloves that are out of date
(glove material can deteriorate over time and an out of date glove might not perform
as well).
• Never use disposable latex gloves containing powder (due to the risks associated with
aerosolisation and latex allergies).
USING
• Gloves should be donned before commencing a procedure where you might come into
contact with blood/body fluids/chemicals/therapeutic creams/lotions and as required for
the preparation of medications.
• Gloves should be changed if they become punctured, damaged or torn, or if damage to
the glove is suspected.
• Two pairs of gloves should be worn (double gloving) during some exposure prone procedures
(EPPs), e.g. orthopaedic and gynaecological procedures.
• Gloves should be removed promptly after use (as soon as the procedure is complete)
before touching non-contaminated/clean areas/items, environmental surfaces or other
persons (including yourself), with hands washed immediately afterwards.
• Gloves being worn for a procedure/activity should not be worn to handle or write on
charts, or to touch any other communal, clean surfaces.
• Gloves should not be decanted from the original box to ensure the expiry date is known
and the integrity maintained.
• Gloves should never be washed or have alcohol handrub applied to them. Instead, 
should be removed, hands cleansed and a new pair of gloves donned, if required.
• Wearing gloves does not mean that hands do not need to be washed – hands should be
washed before donning gloves and after removing them.
• Jewellery should not be worn under gloves. Plain metal bands are generally tolerated
but stoned rings may tear the glove material and should not be worn during clinical
activity.
REMOVI N G Care should be taken when removing used gloves to avoid contamination.
Holding the wrist end of the glove, pull it down over itself so that it goes inside out as you
pull it down your hand. Hold the removed glove in the hand that pulled it down. Now using
the ungloved hand, slowly pull the other glove down, inside out, in the same way, over the
fingers and the first glove and dispose of them into the clinical waste as a wrapped
package.
• Gloves should be changed between patients and between procedures on the same
patient to prevent cross-contamination.
• Torn, punctured or otherwise damaged gloves should not be used and should be
removed immediately (safety permitting) if this occurs during a procedure

Gloves, aprons, visors and masks – personal protective equipment (PPE)

Gloves, aprons, visors and masks – personal
protective equipment (PPE)
This section is broken down into smaller sections on general principles of PPE use – gloves,
aprons and gowns, masks, visors and goggles, headwear and footwear – and a summary
of when to use PPE is included.
General principles
The principles described here apply to all situations and all clinical settings. The term PPE
refers to gloves, aprons, gowns, masks, goggles and visors. The appropriate use of PPE is
essential for infection control. The benefit of wearing PPE is twofold in that it provides
protection to both the wearer and the patient.
Before donning PPE you should risk assess the situation – which items are most appropriate
for the task/situation, depending on what you might be exposed to, e.g. blood/other
body fluids? Not all items will be required each time.
You should also consider sensitivities and the risk of latex allergy (your infection control
team and occupational health department will be able to advise you on local policy).
ORDE R O F A P P L I C AT I O N A ND REMOVAL The order of applying PPE is less critical
than the order of removal – remember that when removing PPE each item is contaminated
and it is important to take each item off in the correct order for your protection.
PPE should be applied in the following order:
1. Apron/gown.
2. Mask.
3. Goggles.
4. Gloves.
PPE should be removed in the following order:
1. Gloves.
2. Apron/gown.
3. Goggles.
4. Mask.
After removing PPE you must wash your hands. This is necessary to ensure that any microorganisms
that may have got on to your hands when wearing and removing PPE are not
transmitted to other surfaces/patients/staff that you come into contact with.
PPE should be appropriate, fit for purpose and suitable for the person using/wearing it,
with supplies located close to the point of use. It is your responsibility to ensure you have
what you need, that it fits you properly and you know how to wear/use it.
PPE should be worn only when required and removed when no longer required, with
hands washed immediately afterwards.
PPE should not be worn by staff when transferring patients.
Disposable gloves, aprons, gowns and masks are single-use items and their packaging
will clearly state this. They should never be reused. They should be removed and disposed
of when the task for which they were worn is completed, with hands washed immediately
afterwards.
Reusable masks and visors must be cleaned after each use. Soapy water or a detergent
wipe may be used unless blood/body fluid contamination has occurred, in which case disinfection
with hypochlorite solution at 10 000 parts per million available chlorine strength
is required. See the section on spillage management
Face protection should not be touched whilst being worn as this can lead to hand
contamination.

Manufacturer’s guidance on the use of PPE should always be adhered to.

Hand hygiene equipment

Hand hygiene equipment
SOAP AND WAT E R Plain liquid soap and water are adequate for hand washing for the
majority of clinical care activities – the technique used to clean the hands is more important
than the type of soap used. The six-step technique for hand washing is already discussed.
It is also important that hands are washed under running water and not in static water, as
the objective is to remove microorganisms from the hands and flush them down the drain;
washing hands in static water, i.e. in a hand washbasin with a plug in, does not clean the
hands as effectively as washing under running water.
A N T I B A C T E R I A L S O A P S Antibacterial soaps are not required for general clinical activity;
they are most useful in surgery due to their ability to lower the number of bacteria on
the skin to a lower level than washing with plain soap would achieve, plus they have a
residual effect, which means that it takes longer for the number of bacteria on the skin to
return to normal.
Antibacterial soaps also have a cumulative effect in that the more often they are used,
the greater the number of bacteria removed. Subsequently it takes longer for the number
of bacteria on the skin to return to normal.
ALCOHOL HANDRUB Alcohol handrub can be used to decontaminate the hands providing
they look and feel clean. It should not be used on hands that are soiled or contaminated,
as it will have no effect. Alcohol handrubs sanitise the hands by killing microorganisms
on the skin’s surface; they do not remove soil or organic matter from the skin.
• Alcohol is a disinfectant and is inactivated by dirt and organic matter. As such, if applied
to a soiled or dirty hand it will not have the desired effect.
• Alcohol handrub should be applied to all surfaces of the hands and the hands rubbed
until dry in order to be effective.
• The six-step technique for hand washing should be used when applying alcohol handrub.
• After 4–5 applications of alcohol handrub, hands should be washed using soap and water.
• Alcohol handrub can be used to clean the hands after removing gloves providing hands
look and feel clean.
• Alcohol handrub is not reliable against the bacteria and viruses that cause diarrhoea and
should not be used whenever patients have diarrhoea symptoms. Hands should be
washed with soap and water at these times.
• Alcohol handrub should be applied directly to the skin – it should not be applied to
gloves. Gloves should be removed and a new set donned. Gloves are single-use items
and should not be cleaned and reused under any circumstances.
N A I LBRUSHES Nailbrushes should not be used as they can tear and damage the skin,
creating more places for bacteria to accumulate on the hands. If used for theatre scrubbing
they should be used once and discarded or returned to sterile services for decontamination
before being used again.
S K I N C A R E
• Any cuts or abrasions on the hands should be covered with a waterproof dressing.
• Hand cream should be applied during breaks and when off duty.

• Shared tubs or pots of hand cream should not be used, as they can become contaminated
and lead to hand contamination. Pump dispensers and tubes are ideal.
• Hand creams that make it more difficult to clean the hands after application should not
be used.
• Hand creams that cause any type of deterioration in glove material should not be used.
HAND E T I Q U E T T E Clinical staff should have short clean nails free from dirt, nail varnish,
false nails or nail attachments in order that hands can be cleaned effectively. (False
nails are known to harbour more bacteria than natural nails.)
B A R E B E LOW THE ELBOW It is Department of Health policy in the United Kingdom
for clinical staff working with patients to be ‘bare below the elbow’ during clinical care
activities, in order that hands can be cleaned most effectively, which is best achieved in the
absence of long sleeves and hand and wrist jewellery. A plain metal band (wedding ring)
can be worn but should be moved up and down the finger during hand washing in order
to cleanse the skin underneath.
HAND WASHBASINS To support effective hand washing, hand washbasins in clinical
areas should have the following features:
• Mixer taps.
• Elbow/wrist/pedal/knee/sensor-operated taps, i.e. hands-free operation.
• No plug and not capable of taking a plug.
• No overflow.
• The water from the tap should not flow directly into the drainage aperture.
• Hand washbasins and taps should be wall mounted, not countersunk.
Hand washbasins in clinical areas should be used exclusively for hand washing, as using
them for other activities such as emptying basins and cleaning equipment or crockery
allows the sink to become contaminated, which can lead to contamination of the hands
during hand washing.

Hand hygiene

Hand hygiene
Washing the hands is the most effective way to prevent the spread of infection. This section
is broken down into two subsections: the first covers when to wash the hands and the
technique for doing so effectively; the second section discusses hand hygiene equipment,
including soap, nailbrushes and hand washbasins.
When and how to clean the hands
WHEN Hands should be cleaned at the ‘five moments for hand hygiene’:
1. Before touching a patient.
2. Before a clean/aseptic procedure.
3. After exposure to blood/body fluids.
4. After touching a patient.
5. After touching a patient’s surroundings.
More broadly speaking, this includes:
• Before and after handling invasive devices (moments 1, 2 and 3).
• Before and after dressing wounds (moments 1, 2 and 3).
• Before and after contact with immunocompromised patients (moments 1 and 4).
• After contact with equipment contaminated with blood/body fluid (moment 3).
• After contact with blood/body fluid (moment 3).
• After handling used laundry and clinical waste (moment 3).
• After glove removal (moment 3).
• Before leaving the clinical area (moments 4 and 5).
• After using the toilet (not specific to healthcare, but essential).
• Before and after handling food/drink (not specific to healthcare, but essential).
HOW Using the six-step technique for hand washing (below) described by Ayliffe et al.
(1978) should take approximately 15–20 seconds and allows all surfaces of the hands to be
cleaned effectively. The mechanical action of rubbing the hands together is important in
hand washing to dislodge bacteria from the skin’s surface.
Hands should be wet before soap is applied in order to get a better lather and spread of
the soap and to avoid the irritation that can occur when soap is applied directly to the skin,
repeatedly.
1. Rub hands together palm to palm.
2. Rub hands together, palm to palm with fingers interlaced.
3. Rub left hand over right hand with palm of left hand rubbing back of right hand, with
fingers interlaced, and then right hand over left hand with palm of right hand rubbing
back of left hand, with fingers interlaced.
4. Rub fingertips of left hand into right palm and fingertips of right hand into left palm.
5. Rub hands together with backs of fingers to opposing palms.
6. Grip thumb of left hand with right hand and rub in a rotational manner and then repeat
on the other side.
The hands should then be rinsed and dried thoroughly.
Surgical scrubbing/rubbing
Surgical scrubbing/rubbing involves using the six-step technique described above to wash
the hands, including the forearms. An antibacterial soap is used and the process takes
around two minutes.
• Surgical scrubbing/rubbing is essential before donning sterile theatre gowns, gloves, etc.
• All hand and wrist jewellery must be removed.

• Nailbrushes should not be used but nail picks can be used if the nails appear dirty.

Standard principles of infection prevention and control

Standard principles of infection prevention

and control

These principles were originally referred to as ‘universal precautions’ and are often referred

to as ‘standard precautions’.

To break the chain of infection the standard principles of infection control should be

applied, which are:

1. Hand hygiene.

2. Correct use of personal protective equipment (gloves, aprons, visors and masks).

3. Control of the environment, which incorporates:

°°decontamination (of healthcare equipment and the healthcare environment; management

of blood and body fluid spillages);

°°isolation and cohorting;

°°respiratory hygiene;

°°safe management of sharps and splash injuries;

°°safe sharps practice;

°°safe disposal of clinical waste;

°°safe handling of linen and laundry.

The aseptic non-touch technique is included here, as it is essential for infection prevention

and control.

Whooping cough

Whooping cough
Whooping cough is a respiratory infection caused by the bacterium Bordetella pertussis.
Whooping cough is a notifiable disease.
SPREAD B Y Close direct contact with an infected person, by droplet spread. It is highly
contagious – up to 90% of susceptible household contacts will develop the disease.
I N F E C T I O U S P E R I OD The incubation period is usually 7–10 days (rarely it can be up
to 21 days). The infectious period is up to 3 weeks after the onset of symptoms. Beyond
3 weeks, risk of transmission of infection is minimal, even if the cough persists.
I N F E C T I O U S C O N T R O L P R E C A U T I O N S
1 Isolation Required
2 Hand washing Required
3 Gloves Required
4 Apron Required
5 Mask Required
6 Eye protection Not required
The risk of transmission is minimal after 3 weeks of illness, but in a few cases (up to 20%)
infectivity can persist for up to 6 weeks. Therefore the above infection control precautions
should be taken in all hospitalised cases. Discuss with your Infection Prevention and Control
Team if required.
S TA F F All staff looking after a patient with whooping cough should have had a full
course of whooping cough vaccination. If vaccination history is incomplete or unknown,
arrange for other staff to care for the patient and discuss with Occupational Health.
VI S I T O R S Visitors should be kept to a minimum number and should be limited to adults
with a history of vaccination against whooping cough. Children under the age of 1 year
should not visit under any circumstances. Visitors should comply with all above
precautions.
PAT I E N T T R A N S F E R Patient transfer should be kept to a minimum. The patient should
wear a mask during transfer. The receiving ward/department should be informed in advance
of the diagnosis.
MORE INFORMAT I O N Whooping cough may occur at any age. Young infants are
the most at risk because they are not yet vaccinated and because infection at this age can
cause severe illness with breathing difficulties.
Epidemics of whooping cough occur every 3 to 4 years, and the highest number of cases
is usually in July–September annually.
Whooping cough is a vaccine-preventable disease. In the UK it is given as part of the
routine childhood immunisation programme and is also given to high-risk groups as
needed, e.g. to pregnant women during the 2012–2013 national outbreak. Immunity
wanes over time and it is possible to catch whooping cough even if you have previously had
the illness or a course of vaccinations.
The illness begins with coryzal symptoms and progresses to a dry cough, which may
occur in paroxysms (outbursts of coughing) and may end with vomiting or with an intake
of air, which makes a ‘whooping’ sound. The cough may go on for weeks or months

Whooping cough is treated with antibiotics (usually erythromycin, clarithromycin or
azithromycin) within the first 3 weeks of symptoms. Treatment is not necessary later in the
course of the illness. Treatment duration used to be 14 days but has now been reduced
to 7 days (3 days if taking azithromycin). Unvaccinated/partially vaccinated cases up to
10 years of age should complete their course of primary immunisation and booster vaccine
once they have recovered from their acute illness.
Contacts of cases may be offered antibiotic prophylaxis and/or vaccination if identified
promptly.
Laboratory confirmation is possible by culture or PCR of pernasal swab or nasopharyngeal
aspirate, or by serology. Discuss with your microbiologist or Health Protection Unit to
ascertain the most appropriate test.

Viral haemorrhagic fevers (VHFs)

Viral haemorrhagic fevers (VHFs)
Viral haemorrhagic fevers (VHFs) are imported infections caused by a range of viruses. VHF
infection is uncommon but is important because it is difficult to diagnose, has a high casefatality
rate with no effective treatment and it can spread rapidly within the hospital setting
unless correct precautions are taken. All units admitting returning travellers should have
policies in place to risk assess and identify possible cases. Standard principles of infection
control should be used while the assessment is carried out. Following the assessment, the
patient is categorised as one of the following: highly unlikely to have VHF, possibility of VHF,
high possibility of VHF or confirmed VHF. Further management, including the level of infection
control precautions, depends on the outcome of the risk assessment. Always inform
the Infection Prevention and Control Team and a consultant microbiologist of any suspected
case of VHF. VHF is a notifiable disease: notify high possibility/confirmed cases
urgently.
SPREAD B Y
• Direct contact – if blood or body fluids come into contact with broken skin or mucous
membranes.
• Indirect contact – with an environment contaminated with splashes or droplets of blood
or body fluids.
I N F E C T I O U S P E R I OD The incubation period ranges from 3 to 21 days. The patient is
considered potentially infectious until an alternative diagnosis is confirmed or until there
has been a negative VHF screen and the patient has been afebrile for 24 hours. If VHF is the
confirmed diagnosis, the patient is considered infectious for an indefinite period (seek
expert guidance).
I N F E C T I O N C O N T R O L P R E C A U T I O N S
For patient highly unlikely to have VHF (no risk/ minimal risk)
1 Isolation Not required
2 Hand washing Required
3 Gloves Required
4 Apron Required
5 Mask Not required
6 Eye protection Not required
If possibility of VHF
1 Isolation Required. Should have dedicated en suite facilities
or dedicated commode
2 Hand washing Required
3 Gloves Required
4 Apron Required
5 Mask Not generally required, but if patient is bruising or
bleeding wear a fluid-repellent surgical facemask
for routine care and FFP3 mask for aerosol- or
splash-generating procedures
6 Eye protection Not generally required, but disposable visor
recommended if patient is bruising or bleeding

164 VIRAL HAEMORRHAGIC FEVERS (VHFs)
For high possibility of VHF in a stable patient
1 Isolation Required. Should have dedicated en suite facilities
or dedicated commode
2 Hand washing Required
3 Gloves Required
4 Apron Required
5 Mask Required: fluid-repellent surgical mask generally
adequate, FFP3 mask for aerosol- or splashgenerating
procedures
6 Eye protection Required – disposable visor
For high possibility of VHF in patient with bruising, bleeding or uncontrolled diarrhoea/
vomiting
1 Isolation Required. Should have dedicated en
suite facilities or dedicated commode
2 Hand washing Required
3 Gloves Double gloves required
4 Apron Fluid-repellent disposable gown
required
5 Mask FFP3 mask required
6 Eye protection Disposable visor required
EQUIPMENT Equipment used in high-possibility/confirmed cases of VHF should be
single
use and disposable.
S TA F F If there is a high possibility of VHF, or a confirmed case, the number of staff caring
for the patient should be restricted to essential staff only and a record of these staff should
be kept. Remember to inform the laboratory of a suspected case of VHF so that laboratory
staff can take appropriate precautions when handling specimens.
VI S I T O R S Visitors should not be allowed if there is a high possibility or confirmed case
of VHF.
PAT I E N T T R A N S F E R Patient transfer should not take place unless absolutely essential
for medical reasons. The receiving department should be informed in advance of the possibility
of VHF. The Infection Prevention and Control Team should also be informed of any
planned patient movement.
MORE INFORMAT I O N Symptoms include fever, sore throat, headache, muscle or joint
pain, diarrhoea and vomiting. Obvious bleeding occurs at a late stage of the illness. Cases
of VHF are rare in the United Kingdom and are always imported from other countries. Any
patient with high-possibility VHF, or with possible VHF with bruising or bleeding, must be
discussed with an infectious disease unit. Any patient with confirmed VHF must be transferred
to a high-security infectious disease unit. Management of a confirmed VHF case is a
highly specialist subject and is not within the scope of this book
Whooping cough
Whooping cough is a respiratory infection caused by the bacterium Bordetella pertussis.
Whooping cough is a notifiable disease.
SPREAD B Y Close direct contact with an infected person, by droplet spread. It is highly
contagious – up to 90% of susceptible household contacts will develop the disease.
I N F E C T I O U S P E R I OD The incubation period is usually 7–10 days (rarely it can be up
to 21 days). The infectious period is up to 3 weeks after the onset of symptoms. Beyond
3 weeks, risk of transmission of infection is minimal, even if the cough persists.
I N F E C T I O U S C O N T R O L P R E C A U T I O N S
1 Isolation Required
2 Hand washing Required
3 Gloves Required
4 Apron Required
5 Mask Required
6 Eye protection Not required
The risk of transmission is minimal after 3 weeks of illness, but in a few cases (up to 20%)
infectivity can persist for up to 6 weeks. Therefore the above infection control precautions
should be taken in all hospitalised cases. Discuss with your Infection Prevention and Control
Team if required.
S TA F F All staff looking after a patient with whooping cough should have had a full
course of whooping cough vaccination. If vaccination history is incomplete or unknown,
arrange for other staff to care for the patient and discuss with Occupational Health.
VI S I T O R S Visitors should be kept to a minimum number and should be limited to adults
with a history of vaccination against whooping cough. Children under the age of 1 year
should not visit under any circumstances. Visitors should comply with all above
precautions.
PAT I E N T T R A N S F E R Patient transfer should be kept to a minimum. The patient should
wear a mask during transfer. The receiving ward/department should be informed in advance
of the diagnosis.
MORE INFORMAT I O N Whooping cough may occur at any age. Young infants are
the most at risk because they are not yet vaccinated and because infection at this age can
cause severe illness with breathing difficulties.
Epidemics of whooping cough occur every 3 to 4 years, and the highest number of cases
is usually in July–September annually.
Whooping cough is a vaccine-preventable disease. In the UK it is given as part of the
routine childhood immunisation programme and is also given to high-risk groups as
needed, e.g. to pregnant women during the 2012–2013 national outbreak. Immunity
wanes over time and it is possible to catch whooping cough even if you have previously had
the illness or a course of vaccinations.
The illness begins with coryzal symptoms and progresses to a dry cough, which may
occur in paroxysms (outbursts of coughing) and may end with vomiting or with an intake

of air, which makes a ‘whooping’ sound. The cough may go on for weeks or months.
Whooping cough is treated with antibiotics (usually erythromycin, clarithromycin or
azithromycin) within the first 3 weeks of symptoms. Treatment is not necessary later in the
course of the illness. Treatment duration used to be 14 days but has now been reduced
to 7 days (3 days if taking azithromycin). Unvaccinated/partially vaccinated cases up to
10 years of age should complete their course of primary immunisation and booster vaccine
once they have recovered from their acute illness.
Contacts of cases may be offered antibiotic prophylaxis and/or vaccination if identified
promptly.
Laboratory confirmation is possible by culture or PCR of pernasal swab or nasopharyngeal
aspirate, or by serology. Discuss with your microbiologist or Health Protection Unit to

ascertain the most appropriate test.

Typhoid

Typhoid
A systemic infection with pronounced gastrointestinal symptoms, caused by infection with
Salmonella typhi (also known as Salmonella enterica serovar typhi). Typhoid is a notifiable
disease.
SPREAD B Y The infection is present in the stools and sometimes in the blood and urine
of an infected person. The commonest mode of spread is faecal–oral, usually through contaminated
water (mainly in the developing world) or by contamination of food. Direct
person-to-person faecal–oral transmission can occur in poor hygiene conditions or in men
who have sex with men.
Household transmission of infection may occur, probably through lapses in food hygiene.
Most cases in the UK are acquired abroad.
I N F E C T I O U S P E R I OD The incubation period is 7–14 days. Patients may remain infectious
for several weeks after infection. Approximately 5% of cases become chronic carriers
who continue to shed bacteria in the stool indefinitely.
I N F E C T I O N C O N T R O L P R E C A U T I O N S
1 Isolation Required
2 Hand washing Required
3 Gloves Required
4 Apron Required
5 Mask Not required unless there is a significant
risk of splashing to the face
6 Eye protection Not required
S TA F F No additional precautions.
VI S I T O R S Visitors should be reminded not to eat or drink in the patient’s room. They
should wear PPE as above and should wash their hands when leaving the isolation room.
PAT I E N T T R A N S F E R Patient transfer should only occur if necessary and the receiving
ward/department must be informed of the diagnosis.
MORE INFORMAT I O N Infection with typhoid or paratyphoid is known as enteric fever.
Clinical features of typhoid include fever of 39–40 °C, myalgia, abdominal pain and severe
headache. Some patients have a rash on the trunk known as ‘rose spots’. Diarrhoea is
present in less than half of patients. Typhoid is a serious illness, with 20% mortality if
untreated due to intestinal perforation or haemorrhage. Even when treated it may take
several days to respond, with resolution of fever over 2–5 days and convalescence over
several weeks.
The choice of antibiotic depends on sensitivity test results, as resistance is becoming
increasingly common. The drug of choice is ciprofloxacin but alternatives include ceftriaxone
and azithromycin.
Diagnosis is usually by stool sample, but blood or urine culture may also be positive.
Serology is rarely useful.
Typhoid patients who are at high risk of passing it on, such as food handlers, should be
screened for clearance by stool sample analysis on the advice of public or environmental

health. The famous ‘Typhoid Mary’ was a cook and typhoid carrier in the early twentieth
century who caused numerous outbreaks of typhoid!
Preventative measures include pre-travel hygiene advice and vaccination. Vaccination is
not recommended for contacts of cases as it has not been shown to be effective in these
circumstances.

Stenotrophomonas

Stenotrophomonas
Stenotrophomonas maltophilia is an environmental bacterium that may be found in hospitals
and that can cause infections including respiratory tract infections, urinary tract infections,
surgical site infections and bacteremia. It is intrinsically resistant to many antibiotics.
Infections occur mainly in patients who are immunocompromised, have had a prolonged
hospital stay, have had broad-spectrum antibiotics (particularly meropenem) or have been
ventilated.
SPREAD B Y Direct contact: transfer on hands from an environmental source.
Indirect contact: transfer from equipment/environment.
I N F E C T I O U S P E R I OD Stenotrophomonas is not readily transferred between patients
provided standard principles of infection control are followed, but theoretically a patient
may remain colonised and potentially infectious for months or years.
I N F E C T I O N C O N T R O L P R E C A U T I O N S In a community setting or in a general ward,
standard principles of infection control are adequate. In high-dependency areas such as
ITU, isolation may be required.
1 Isolation Not usually required (seek
advice if patient on ITU/HDU)
2 Hand washing Required
3 Gloves Not required
4 Apron Not required
5 Mask Not required
6 Eye protection Not required
S TA F F No additional precautions required.
VI S I T O R S No restrictions.
PAT I E N T T R A N S F E R No restrictions.
MORE INFORMAT I O N Stenotrophomonas does not commonly cause clinical infections.
It can usually be treated with co-trimoxazole if antibiotics are required.
Frequent detection of Stenotrophomonas in patient samples from a ward may indicate
overuse of carbapenem antibiotics (such as meropenem) and may require increased antibiotic
stewardship.

Tuberculosis (TB)

Tuberculosis (TB)
Infection is caused by the bacterium Mycobacterium tuberculosis. Respiratory TB is the
commonest presentation, but TB can infect other body sites. Only respiratory TB is infectious.
TB is a notifiable disease.
SPREAD BY Droplet spread: patients with respiratory TB may expel droplets containing
infectious TB bacteria into the air when they cough or sneeze. If these droplets are inhaled
they can cause TB infection. Prolonged or close exposure is generally required to catch TB.
I N F E C T I O U S P E R I OD The incubation period is variable: approximately 4–12 weeks from
exposure to primary infection, though the disease may reactivate months or years later.
A patient with infectious respiratory TB will remain infectious indefinitely if untreated.
Patients are usually no longer infectious once they have completed 2 weeks of appropriate
therapy.
I N F E C T I O N C O N T R O L P R E C A U T I O N S Patients with known or suspected TB should
not be admitted to hospital unless necessary. Patients with respiratory TB should always be
isolated in a side room pending laboratory results, and should always be separated from
immunocompromised patients (HIV, transplant, oncology, etc.), either by admission to a
single room on a separate ward or in a negative-pressure room on the same ward. NICE
guidance states that mask, gown and isolation precautions are not required unless the
patient has multidrug-resistant TB (MDR-TB) or is undergoing an aerosol-generating procedure.
This is a change from previous practice and some hospitals still recommend apron,
gloves and FFP3 masks. Check your local policy.
1 Isolation Smear-positive patients – required until 2 weeks treatment
completed
Smear-negative or non-respiratory disease – not required
Children – required*
Drug-resistant TB – requires negative pressure isolation room
2 Hand washing Required
3 Gloves Not required unless handling body fluids
4 Apron Not required unless handling body fluids
5 Mask FFP3 mask required for MDR TB or aerosol-generating
procedures
6 Eye protection Not required
*Children with TB should be isolated until the source case has been identified, regardless of
AFB smear results. This is because the source case is likely to be a relative who visits the ward.
These visitors should only visit the isolation room and then leave – they should not spend time
in communal areas until they have been screened and infection excluded.
Patients should perform respiratory hygiene (Chapter 2). Aerosol-generating procedures
such as bronchoscopy should be carried out in a negative pressure room or bronchoscopy
suite. Staff should wear gowns, gloves and FFP3 masks.
S TA F F The number of staff caring for infectious TB patients should be kept to a reasonable
minimum, without compromising patient care. Staff who are likely to work with TB
patients should be fit tested for FFP3 mask use. Staff who work with patient or clinical
materials should complete a health check including TB assessment when they start in the
job. This includes a history/health questionnaire and BCG scar check. Mantoux skin testing
or interferon-gamma testing may be offered if appropriate.

VI S I T O R S Visitors should be restricted to immediate family and those who have already
been in close contact with the patient before diagnosis. Visitors are discouraged from
bringing in babies and children.
PAT I E N T T R A N S F E R Patient transfer should be kept to a minimum until the patient has
completed 2 weeks of treatment. Inpatients with smear-positive respiratory TB should wear
a surgical mask whenever they leave their room until they have had 2 weeks of treatment.
The receiving ward/department must be informed of the diagnosis. Patients should not
wait in communal areas such as waiting rooms.
L I N E N A ND LAUNDRY Linen and laundry should go into a red linen bag.
MORE INFORMAT I O N Tuberculosis infection rates are increasing, both in the UK and
worldwide. There are approximately 9000 cases in the UK each year, most of which occur
in cities (particularly in London).
Respiratory tuberculosis is active TB affecting any of the following: lungs, pleural cavity,
medastinal lymph nodes, larynx. Symptoms may include a cough lasting longer than
3 weeks, fatigue, weight loss, night sweats, dyspnoea, haemoptysis or chest pain. Some
patients are asymptomatic. Chest X ray is abnormal.
Non-respiratory tuberculosis may affect various body sites to cause bone and joint infection,
meningitis, lymphadenitis, pericarditis, disseminated (miliary) TB, genitourinary TB or
gastrointestinal TB.
HIV patients are at increased risk of symptomatic TB infection.
DI A G N O S I S O F T B Diagnosis of TB is usually by chest X-ray and three sputum samples
sent on consecutive days for acid-fast bacilli (AFB) investigation. Other samples such as
bronchial washings or gastric washings in children (who swallow sputum instead of coughing
it up) are acceptable. For non-respiratory TB, pus or tissue may be sent in a universal
container (not formalin).
A ‘smear’ of the sputum is examined under a microscope for AFBs. Results are used to
establish whether the patient is likely to be infectious to others: smear-positive patients are
infectious; smear-negative patients where the culture result is not yet known are potentially
infectious but low risk for transmission; and patients who are sputum smear and culturenegative,
or who have non-respiratory TB, are non-infectious. Patients whose bronchial
washings are smear-positive are not regarded as infectious unless their sputum is also
smear-positive or becomes so after bronchoscopy.
PCR and/or culture are required for full identification and sensitivity testing of AFBs.
Other tests for TB include interferon-gamma testing (a blood test for latent TB) and
Mantoux testing (a skin test used to diagnose latent TB).
MANAGEMENT The respiratory medical team and a specialist TB nurse should always be
involved in the management of TB. They oversee diagnosis, treatment and contact tracing.
Treatment requires at least 6 months of combination antibiotics with close follow-up.
Contact tracing in the hospital setting is only required if there was a delay in isolating the
patient. Other patients are considered at risk of infection if they have spent more than
8 hours in the same bay as an inpatient with sputum smear-positive TB who had a cough.
DR U G R E S I S TANCE Drug-resistant strains are more difficult to treat and have worse
outcomes. Patients with suspected MDR TB must be managed in a negative pressure room
and preferably transferred to a specialist unit. Staff and visitors should wear FFP3 masks.
Mono-resistant = resistant to one drug; poly-resistant = resistant to >1 drug (but not
MDR); multidrug resistant (MDR) = resistant to at least rifampicin and isoniazid; extensively
drug resistant (XDR) = resistant to rifampicin, isoniazid, a quinolone and an injectable agent

Toxoplasmosis

Toxoplasmosis
A zoonotic (animal-transmitted) infection caused by infection with the parasite Toxoplasma
gondii. Infection is more serious in pregnant women and immunocompromised patients.
SPREAD B Y Contact with cat faeces, e.g. cleaning out cat litter trays. Ingesting water,
food or soil contaminated with the faeces of infected animals, e.g. unwashed salad. Eating
undercooked meat containing cysts. Vertical transmission from mother to foetus. Receiving
an organ transplant from a donor with acute or latent toxoplasmosis.
Direct person-to-person transmission does not occur, except from mother to foetus. See
below for an explanation of the life-cycle and how transmission occurs.
I N F E C T I O U S P E R I OD The incubation period is 5–20 days for acute infection.
Reactivation of infection can occur years after the original exposure.
There is no recognised infectious period because person-to-person transmission does
not occur.
I N F E C T I O N C O N T R O L P R E C A U T I O N S
1 Isolation Not required
2 Hand washing Required
3 Gloves Not required
4 Apron Not required
5 Mask Not required
6 Eye protection Not required
S TA F F No further precautions.
VI S I T O R S No further precautions.
PAT I E N T T R A N S F E R No restrictions.
MORE INFORMAT I O N Toxoplasma gondii infects all mammal and bird species worldwide
and it is estimated that up to one billion people worldwide have been exposed.
The life-cycle is complicated, but essentially cats are the main ‘definitive’ host in which
the parasite completes its life-cycle. An infected cat sheds the parasite as cysts in its stool,
which can subsequently infect people or other mammals who ingest them. Once
Toxoplasma has entered the body, it causes a primary infection and then disseminates via
the bloodstream to form tissue cysts, which lie latent for years but which can reactivate
if you become immunocompromised.
The primary infection is often asymptomatic but can cause an illness resembling glandular
fever with fever, generalised lymphadenopathy, headache and myalgia.
Other clinical scenarios are: ocular infection (usually due to reactivation of the disease);
toxoplasmosis in the immunocompromised, which is usually due to reactivation and often
affects the central nervous system; and congenital toxoplasmosis.
Pregnant women should avoid exposure to toxoplasmosis by modifying their diet and
avoiding contact with cat faeces. Congenital toxoplasmosis can cause foetal abnormalities
or death – the effect depends upon the gestation at the time of infection. Any pregnant
woman who is concerned about toxoplasmosis should seek medical advice.
Treatment for toxoplasmosis is available but is not generally required in immunocompetent,
non-pregnant patients. In other

Glossary infection

Adhesins Microbial factors that enable bacteria to adhere to cells.
Aerosol-generating procedure A procedure that can create an aerosol of the patient’s
secretions, e.g. oro/nasopharyngeal suctioning, positive pressure ventilation, cardiopulmonary
resuscitation, chest physiotherapy, bronchoscopy, creating droplets small and
light enough to become airborne, increasing the possibility for transmission of infection
to occur.
Alcohol handrub An alcohol-based liquid, foam or gel for use on the hands to disinfect
the skin.
Alert organisms Organisms that can cause outbreaks of infection that are difficult to
treat due to antibiotic resistance.
Antibiogram A report that shows which of the antibiotics that are routinely tested will
inhibit the growth of or kill the infectious agents they are tested on. Used to help make
decisions about which antibiotics to use.
Asepsis The freedom from contamination by pathogenic organisms.
Aseptic technique A procedure or practice used to avoid introducing bacteria to a
susceptible site, e.g. wound care, intravenous infusion management, insertion of invasive
devices.
Augmented care unit Clinical areas with a high level of intervention, such as intensive
therapy, high dependency and neonatal care units.
Auto-infection When microorganisms already present on the body cause an infection.
Bacteraemia The presence of an infectious agent in the blood.
Bactericidal Kills bacteria.
Bacteriostatic Inhibits bacterial growth but does not kill bacteria.
Bay A hospital room where more than one inpatient can stay that may have between two
and six beds.
Bloodborne virus Viruses that are carried in the bloodstream, e.g. HIV, hepatitis B,
hepatitis C.
Cadaver Dead body.
Case A person with clinical signs of infection (see below).
CE mark A visible sign that the manufacturer of the product is declaring conformity with
all of the Directives relating to that product.
Cleaning The complete removal of soil from a medical device employing manual or automated
processes.
Clinical signs of infection Typically, these are pyrexia, diarrhoea, an unexplained rash,
localised redness, heat, pain, swelling and loss of function at the site. Other signs include
increased exudate or slowness to heal or show any signs of improvement in a wound. If
the patent has a urinary tract infection they may have dysuria, confusion, frequency of
micturition. It is essential to look for clinical signs of infection when managing patients
and not to focus solely on microbiological reports.

Co-infection When a person is infected with more than one infective agent at the same
time.
Cohort A group.
Cohorting Nursing patients grouped together because they either have the same infection
or have been exposed to the same type of infection.
Coliforms Gram-negative bacilli of the Enterobacteriaceae spp. found in the intestines of
humans and animals. Many coliforms are human pathogens.
Colonisation The presence of an infectious agent in or on the body without causing
injury or infection. It may persist indefinitely.
Commensal A microorganism that lives on the body and benefits from being there whilst
causing no harm to the host.
Contact A person exposed to the risk of infection from being in close proximity to an
infected person.
Contact bay An area where contacts of a person known to be infected with or carrying
an infection are nursed together to minimise the risk of spreading the infection to others
who have not been exposed.
Contact tracing Process of identifying contacts of an infected person.
Contamination
1. Transient presence of microorganisms in or on the body without causing injury or
infection.
2. Not clean – soiled.
3. A contaminated sample has extraneous matter in it, e.g. skin flora in a blood culture
sample.
COSHH Control of substances hazardous to health.
Cross-infection Infection of a person with microorganisms from another person.
Cumulative effect Increasing antimicrobial effect associated with repeated application
of a given antiseptic.
Cytostatic Inhibits cell growth and division.
Cytotoxic Toxic to cells.
Disinfection The removal of most viable organisms using heat or chemicals (does not
necessarily inactivate some viruses and bacterial spores).
Ectoparasite A parasite that lives on the surface of the host.
EIA Enzyme immunoassay – a test to detect antigens and antibodies. Often referred to as
enzyme linked immunosorbent assays (ELISA).
Endemic A persistent low or moderate level of disease in a population.
Endogenous infection An infection where the source is thought to be the patient, e.g.
MRSA in a wound in a patient known to carry MRSA on their skin.
Endoparasite A parasite that lives inside the host.
Epidemic An outbreak of an infectious disease that spreads rapidly and widely.
Exogenous infection An infection where the source is thought to be external to the
patient, i.e. transmitted from another source.
Exposure-prone procedure (EPP) A procedure where there is a risk that injury to the
healthcare worker may result in exposure of the patient’s open tissues to the blood of
the healthcare worker, e.g. where the healthcare worker’s gloved hands are exposed to
blades, needles and other sharp items inside the patient’s open body cavity, wound or
confined anatomical space where the hands or fingertips may not be fully visible at
all times.
Fit testing A series of movements carried out in a controlled setting whilst wearing an
FFP3 mask to test how well it fits the wearer
Fomites Inanimate objects that can become contaminated and provide a vehicle for
transmission of infection.
Herd immunity Due to a high vaccine uptake there is reduced opportunity for a microorganism
to be transmitted within a population.
Host The person infected/infested with an organism.
Hyperendemic A persistent high level of disease in a population.
Impedins Factors that impede host defence mechanisms.
Incidence The number of new cases of an infection over a given period of time.
Incubation period The time when a person has been infected by an infectious agent but
does not yet have clinical signs of infection.
Index case The first person to have symptoms in an outbreak of infection.
Infection Injury or invasion of the tissue caused by an infectious agent.
Infectious agent The specific agent(s) causing the disease.
Infectious period The time during which an infection can be passed from one person
to another.
Infective dose The number of microbes necessary to cause infection.
Inoculation injury Sharps injury.
Invasiveness The ability of an infectious agent to enter and spread in the body.
Liquor Amniotic fluid.
Low-use outlet A tap that is not used daily in augmented care areas or every three days
in general areas.
Medical device A product that has a medical use that is not medicine.
Mode of transmission The mechanisms by which infectious agents are spread (direct
contact, indirect, droplet and airborne).
Normal bacterial flora
Site Normal flora
Mouth Alpha-haemolytic streptococci
Neisseria spp.
Anaerobes
Nose, throat and sputum Alpha-haemolytic streptococci
Neisseria spp.
Diphtheroids (Corynebacteria)
Skin Coagulase-negative staphylococci
Non-haemolytic streptococci
Enterococci
Diphtheroids (Corynebacteria) Propionibacteria
Bowel and faeces Enterobacteriaceae (coliforms) Enterococci
Anaerobes
Candida
Vagina Lactobacilli
Alpha-haemolytic streptococci Diphtheroids (Corynebacteria)
Group B streptococcus
Normal flora The community of microorganisms that live on the human body.
Nosocomial Hospital acquired.
Occurrence Where the disease is known to occur and the population groups affected.
Opportunistic pathogen A microorganism that would not normally cause disease
under normal circumstances that is capable of causing disease when host defence mechanisms
are impaired.
Outbreak Two or more cases of the same infection that are linked, e.g. same ward/cared
for by same healthcare worker/members of the same household, etc.
Pandemic A global outbreak of an infectious disease.
Parasite A parasite living in a close relationship with another organism (its host) and
causing it harm.
Pathogen A microorganism capable of causing disease.
Pathogenicity The ability of a microorganism to cause disease.
PCR Polymerase chain reaction – a test used to identify bacteria and viruses, quantify
viral loads (the amount of virus in the bloodstream) and sometimes to test antibiotic
sensitivities.
Period of infectivity/ communicability Time when a person is shedding microorganisms
and is infectious to others.
Personal protective equipment (PPE) Gloves, aprons, gowns, masks and eye protection,
which may be goggles or visors.
Post-exposure prophylaxis Medicinal products given following a sharps/splash injury to
prevent the injured person from developing a bloodborne virus infection.
PPM Parts per million.
Prevalence The total number of people with an infection over a given period of time.
Prophylaxis Treatment given as a preventative measure.
Protective isolation Nursing a person who is vulnerable to infection in a single room to
protect them from transmission of infection.
Pyogenic Pus forming.
Reservoir of infection A permanent source of infection. This can be a person, an insect,
an animal, a plant, a substance or an environment where an infectious agent can survive,
live and multiply before transmission to a susceptible host.
Resident flora Microorganisms residing under the superficial cells of the stratum corneum
and also found on the surface of the skin.
Resistance Mechanisms by which bacteria avoid destruction.
Respiratory hygiene The practice of covering the mouth or nose when coughing or
sneezing (using a tissue) followed by hand washing to prevent the spread of infection.
Screening Taking of samples for microbiological testing to determine carriage of a microorganism
in the absence of clinical signs of infection.
Sepsis Clinical infection.
Septicaemia The presence of an infectious agent in the blood with symptoms of
infection.
Sharps injury Needle prick, cut, scratch or bite injury.
Single use Use item once and discard.
Single patient use Item can be used more than once on same patient.
Source isolation Nursing a person who has an infection in a single room to prevent
transmission to others.
sp. Species (singular).
Splash-generating procedure An activity that creates a risk of splashing of blood or
body fluids.
Splash injury Blood/body fluid splash into the eyes, mouth or on to broken skin.
Sporadic Occasional cases of a disease occurring at irregular intervals.
Spore A tough protective coat that forms around a bacterial cell making it resistant to
drying, heat and chemicals for months or even years.
spp. Species (plural).
Sterilisation The removal of all viable microorganisms, including viruses and bacterial
spores.

Super-infection When a person is infected with an infective agent and subsequently
becomes infected with another infective agent at a later time.
Surveillance Systematic process of observation, analysis and reporting of the incidence
of disease in a population.
Susceptibility Information on populations at risk of or resistant to infection/disease.
Susceptible host A person at risk of infection/ disease.
Toxin A substance released by a bacterial cell that causes ill effects within the body.
Transient flora (transient microbiota) Microorganisms that colonise the superficial layers
of the skin and are more amenable to removal by routine hand washing.
Vector An organism that passes on a means of causing infection without becoming
infected itself, e.g. mosquitoes are vectors in the transmission of malaria, as they carry
the malarial parasites, which they inject into the host when they bite.
Vertical transmission Transmission of infection from mother to child during pregnancy
or childbirth.
Viral load The number of viral particles in the blood used to measure disease progression
or response to treatment.
Virulence Characteristics of bacteria that enable them to cause infection and disease
such as the ability to produce toxins, adhesins and impedins.
Visibly soiled hands. Hands on which dirt or body fluids are readily visible.
Zoonoses Diseases that can be passed from animals to humans.