INFECTION PREVENTION PRECAUTIONS FOR THE DECEASED PATIENT

Policy Details NHFT document reference Version Date Ratified Ratified by

Implementation Date Responsible Director Review Date Related Policies & other documents

Freedom of Information category

ICP 010 Version 2 – 07.07.2014 13.01.2015 Infection Prevention and Control Strategic Group – 26.10.2014 The Safer Service and Environment Group – 21.08.2014. Trust Policy Board - 04.11.2014 14.01.2015 Director of Nursing, Quality and Professional Development 14.01.2017 ICP 000 – Infection Prevention and Control Assurance Framework; ICP 002 – Standard Precaution Policy; ICP 003 – Cleaning and Disinfection Policy; ICP 004 – Decontamination Policy; ICP 009 – Outbreak and Isolation Policy; NHFT Chaplaincy Handbook Policy

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TABLE OF CONTENTS

1.

DOCUMENT CONTROL SUMMARY ...................................................... 3

2.

INTRODUCTION ..................................................................................... 4

3.

PURPOSE ............................................................................................... 4

4.

DEFINITIONS .......................................................................................... 5

5.

DUTIES .................................................................................................... 5

6.

PROCESS ............................................................................................... 6 6.1. Management of the deceased patient ............................................. 6 6.2. Use of body bags ............................................................................ 6 6.3. Procedure for infection control management of deceased service user with Suspected / confirmed infection. ...................................... 7 6.4. Performing last offices..................................................................... 7 6.5. Veiwing the body ............................................................................. 8 6.6. Death of an Infectious Patient ......................................................... 8 6.7. Specific Infections ........................................................................... 8

7.

TRAINING ............................................................................................. 10 7.1. Mandatory Training ....................................................................... 10 7.2. Specific Training not covered by Mandatory Training ................... 10

8.

MONITORING COMPLIANCE WITH THIS DOCUMENT ...................... 10

9.

REFERENCES AND BIBLIOGRAPHY ................................................. 11

10. RELATED TRUST POLICY ................................................................... 12 APPENDIX 1 – EQUALITY ANALYSIS REPORT......................................... 13 APPENDIX 2 - LIST OF NOTIFIABLE DISEASES …………………………..16 APPENDIX 3 - NOTIFIABLE DISEASES NOTIFICATION FORM……….....17 APPENDIX 4 - GUIDANCE FOR THE UNDERTAKERS OR FUNERAL WORKERS…………………………………………………………………………………19

APPENDIX 5 - GUIDANCE TABLE FOR THE MANAGEMENT OF DECEASED PATIENTS WITH CONFIRMED OR SUSPECTED KEY INFECTIONS ……………………………………………………………………..20

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1. DOCUMENT CONTROL SUMMARY Document Title Care of the deceased patient within infection control Document Purpose (executive brief)

Status: - New / Update/ Review

To ensure that staff working within the Trust are awareness of infection prevention and control precautions necessary when involved in the care of the deceased patient; to minimize the associated risk of transmission of infection to other patients, staff and visitors. Review

Areas affected by the policy

Trust-wide

Policy originators/authors

Harriet Ddungu – Head of infection prevention and control Members of the Infection Prevention and Control Strategic Group – 26.07.2014 The Safer Service and Environment Group – 21.08.2014.

Consultation and Communication with Stakeholders including public and patient group involvement Archiving Arrangements and register of documents Equality Analysis

The Risk Management Team is responsible for the archiving of this policy and will hold archived copies on a central register See Appendix

(including Mental Capacity Act 2007)

Training Needs Analysis

See section 7

Monitoring Compliance and See section 8 Effectiveness Meets national criteria with regard to NHSLA Yes NICE N/A NSF N/A Mental Health Act N/A CQC Yes Other Department of Health, NPSA Further comments to be Health and Social Act 2008 (10) code of considered at the time of practice for health and social care on the ratification for this policy (i.e. prevention and control of infections and national policy, commissioning related guidance. requirements, legislation)

If this policy requires Trust Board ratification please provide specific details of requirements

Yes – 2nd September 2014

2.

INTRODUCTION

Northamptonshire Healthcare Foundation Trust has no mortuary, however if a patient / service user with a high risk infection dies while an in-patient, it is expected that the body will be made ready for the undertakers and if necessary placed in a body bag before removal. Please note: - this policy deals only with the care in relation to infection prevention and control, for other procedural guidelines regarding death of a patient / service user. Throughout this policy wherever the term patient occurs, it incorporates residents/clients and service users. It is important to ensure that staff or relatives who may have to care for a recently deceased patient’s body are protected from risk of infections due to exposure to blood or body fluids. The deceased will pose no greater risk of infection than when they were alive. However, not all cases of infection will have been identified before death, therefore the same high level of standard infection control precautions i.e. personal protective equipment, hand hygiene, safe disposal of waste, sharps management, decontamination of the environment and equipment should be kept. Ensuring that staff cover any cuts / wounds at all times. Infectious conditions and pathogens in a recently deceased person that may pose a risk include tuberculosis, Group A streptococcal infections, gastrointestinal organisms, Transmissible Spongiform Encephalopathies (TSE’s), hepatitis B and C virus, HIV and possibly meningitis and septicaemia (meningococcal). If the deceased patient’s death involved a notifiable infection as indicated in Appendix 2, the responsible clinician should inform Public Health England (PHE) using Appendix 3 and if necessary advice can be sought from the Consultant in Communicable Disease Control (CCDC). At all times utmost attention to dignity and respect for the patient’s body and confidentiality must be maintained. Only those who may be at risk from contact with the body should be informed and the exact infection does not in most cases always have to be divulged to everyone. If relatives are not aware of the presence of the infection, explanation of the additional labelling and infection control precautions necessary must be handled with sensitivity. 3.

PURPOSE

This policy aims to ensure that all Northamptonshire Healthcare NHS Foundation Trust (NHFT) staff involved in the care of a deceased patient are The current version of any policy, procedure, protocol or guideline is the version held on the NHFT internet. It is the responsibility of all staff to ensure that they are following the current version Infection Prevention Precautions for the Deceased Patient

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aware of the infection control precautions necessary to prevent the spread of healthcare associated infections to other patients, relatives and staff. 4.

DEFINITIONS

NHFT – Northamptonshire Healthcare NHS Foundation Trust Hygienic preparation (also known as last offices) means cleaning and tidying the body to present a suitable appearance for viewing (appendix 4). Advised - advisable and may be required by local health regulations. Viewing means allowing bereaved relatives to see and touch the body before removal. Cadaver / body bags are heavy-duty plastic bags used to contain leaking body fluids or infection. Embalming means injecting certain chemical preservatives into the body to slow the process of decay and may also include cosmetic work. 5.

DUTIES

5.1. Trust Board Has overall responsibility for this policy and provision of adequate resources. 5.2. Director of Infection Prevention and Control Is responsible for:  Overseeing the policy and its implementation, monitoring and reporting areas of concern.  Compliance with the advice and NHS England guidance. 5.3. Deputy Director of Nursing Is responsible for:  Co-ordinating Infection Prevention and Control / Patient Safety activities.  To ensure that decisions are implementated in accordance with the policy. 5.4. Head of Infection Prevention and Control Responsible for:  Review and implementation of any urgent communications from NHS England or other relevant services.  Policy formulation and review  Implementation of the Policy.  Policy audits and monitoring. The current version of any policy, procedure, protocol or guideline is the version held on the NHFT internet. It is the responsibility of all staff to ensure that they are following the current version Infection Prevention Precautions for the Deceased Patient

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5.5. Infection Prevention and Control Team Responsible for:  Compliance with the NHS England guidance  Working within the policy.  Implementation of this Policy.  Advising staff  Providing training  Policy audit and monitoring. 5.6. Clinical Team Leaders, Managers and Matrons Are responsible for:  Ensure that staff are aware of this policy  Ensure that staff are aware of their responsibilities.  Report concerns via Datix  Ensure staff are up to date with mandatory training.  Work in partnership with the IP&C team 5.7. Employees / Staff Responsibility to:  Comply with the policy ans associated policies / guidelines.  Inform the Infection Prevention and Control of any relevant issues.  Report any concerns via datix. 5.8. Occupational Health Are responsible for:  Compliance with NHS England guidance  Advising staff  Working within the policy. 6.

PROCESS 6.1. Management of the deceased patient The deceased should be treated with due respect and dignity appropriate to their religious and cultural background. Last offices can vary according to religious and cultural beliefs. The presence of known or suspected infection may require some changes to be made to the usual cultural rituals. 6.2. Use of body bags Also known as Cadaver bags are heavy-duty plastic bags. Body bags must only be used for cases according to Appendix 4. However on rare occasions a body bag may be needed regardless of the infection status,

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if there is a risk of heavy leakage of body fluids and it cannot be contained by dressings for instance large exudation of pressure sores / gangrenous limbs. N.B: Presence of MRSA and Clostridium difficile infection or colonisation do not require routine use of body bags. Body bags should not be used inappropriately as this may cause unnecessary upset to grieving relatives. There should be a balance between what is required for safety, sensitivity and dignity of the bereaved. Each inpatient unit should keep the body bag in a central location (one on the Berrywood Hospital, Welland Centre and Forest Centre. Please indicate where your bag is kept and make sure staff are aware. Name of Ward: --------------------------------------------------------------------------Body Bag kept: ------------------------------------------------------------------------------In the Community beds and Learning Disability Respite homes, the undertaker should supply a body bag if necessary. 6.3. Procedure for infection control management of deceased service user with Suspected / confirmed infection. Adhering to standard infection prevention and control precautions, perform hygienic preparations (last offices) unless contraindicated in appendix 5. 6.4. Performing last offices In some cultures and religious groups, relatives expect to carry out the last offices and certain rituals (see Chaplaincy handbook) and in most cases, this can be permitted but where a risk of infection exists the hazard has to be assessed and appropriate advice given (see Appendix 5). This may mean only partial preparation and the use of personal protective clothing, and relatives should be informed and supervised as necessary. •

Place deceased body in body bag if indicated in Appendix 5 or if there is a risk of leakage from body fluids on movement.

•

Death notification label should be placed in pocket on front of the body bag and a danger of infection label attached to the bag only if an infectious condition as in Appendix 5 has been identified.

•

If the body of the deceased had been placed in a body bag, the form at Appendix 4 should be completed and given to undertaker or whoever is responsible for removing the body.

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•

Remove personal protective equipment (PPE) and dispose of as per policy and wash hands.

•

Once the body has been removed, the room/area should be thoroughly cleaned and disinfected as per cleaning and decontamination policy.

6.5. Veiwing the body In the majority of cases viewing of the body by relatives can be allowed, therefore the body bag can be opened for viewing unless viewing contraindicated as in Appendix 5. In high risk cases relatives may only be allowed to view the face and may be strongly discouraged from touching the body. Relatives should be advised to carry out hand hygiene after viewing the body. 6.6. Death of an Infectious Patient The funeral director must be informed of the infectious status of the patient by the healthcare professionals who certifies the death or by the member of staff who is responsible for handing over the body to the funeral director. All staff should ensure that the notification has been completed (Appendix 4). A copy of this form needs to be attached to the outside covering of the body; a copy will need to be kept in the deceased patient’s medical notes. 6.7. Specific Infections Very High Risk – Group A • Body bag must be used. • Viewing and touching prohibited. • No embalming • Hygienic preparation should not be carried out. Applies to:• Anthrax • Lassa, Ebola, Marburg and other viral haemorrhagic fevers • Yellow Fever • Rabies • SARS (WHO guidance currently states that family may view the body if they wear Personal Protection Equipment). • Septicaemia due to invasive Group A streptococcal infection, if patient has not had 24 hours of appropriate antibiotic therapy. • Smallpox The current version of any policy, procedure, protocol or guideline is the version held on the NHFT internet. It is the responsibility of all staff to ensure that they are following the current version Infection Prevention Precautions for the Deceased Patient

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With the exception of Group A streptococcal septicaemia, the above infections are rare in the UK. High Risk – Group B • The bereaved should be warned of the potential infection risk. If they wish to carry out ritual washing or preparation of the body; this should be done under supervision with advice about the use of infection prevention and control standard precautions. • A body infected with typhus, Creutzfeldt–Jakob disease (CJD) and other transmissible spongiform encephalopathies (TSE’s) must be considered a high risk to others if there is body fluids leakage. • Embalming should not be done.

This applies to: • CJD and other transmissible spongiform encephalopathies TSE’s). • Typhus And for the following diseases only if there is seepage of body fluids: • Hepatitis B • Hepatitis C • Other blood borne Hepatitis i.e. Hepatitis D • HIV / AIDS Medium Risk – Group C • Hygienic preparation of the body is permitted. • Viewing and touching is allowed. • Embalming may be carried out. This applies to: • Cholera • Diphtheria • Dysentery (amoebic or bacillary) • Meningococcal disease (untreated) • Typhoid and Paratyphoid fever • Relapsing Fever • Scarlet Fever • Tuberculosis • Brucellosis • Salmonellosis Low Risk – Group D The current version of any policy, procedure, protocol or guideline is the version held on the NHFT internet. It is the responsibility of all staff to ensure that they are following the current version Infection Prevention Precautions for the Deceased Patient

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• Body bag not required • Hygienic preparation of the body is allowed • Body can be handled – viewing and touching allowed. • Embalming may be carried out. MRSA (Group D) is not a problem, but can cause concern amongst funeral directors, infection prevention and control standard precautions are all that are required. 7.

TRAINING 7.1. Mandatory Training Training required to fulfil this policy will be provided in accordance with the Trust’s Training Needs Analysis. Management of training will be in accordance with the Trust’s Statutory and Mandatory Training Policy’ 7.2. Specific Training not covered by Mandatory Training Ad hoc training sessions based on an individual’s training needs as defined within their annual appraisal or job description.

8.

MONITORING COMPLIANCE WITH THIS DOCUMENT

The table below outlines the Trusts’ monitoring arrangements for this document. The Trust reserves the right to commission additional work or change the monitoring arrangements to meet organisational needs.

Individual responsible for the monitoring

Group or committee who receive the findings or report

Aspect of compliance or effectiveness being monitored

Method of monitoring

Duties

To be addressed by the monitoring activities below.

Awareness of the Care of the deceased patient within infection control

Induction Appraisal

Staff

Monitoring frequency

Annual

Group or committee or individual responsible for completing any actions

Manager

Staff

Manager

IP&C team

Manager

IP&C team

IP&COG

Learning & Development Department

IP&CSG Safer Services and Environmental Group

There can be more than one aspect to be monitored so list each separately The current version of any policy, procedure, protocol or guideline is the version held on the NHFT internet. It is the responsibility of all staff to ensure that they are following the current version Infection Prevention Precautions for the Deceased Patient

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If there is mandatory Training will be monitored in line with the Statutory and Mandatory Training Policy. training associated with this document state the mandatory training here Where a lack of compliance is found, the identified group, committee or individual will identify required actions, allocate responsible leads, target completion dates and ensure an assurance report is represented showing how any gaps have been addressed.

9.

REFERENCES AND BIBLIOGRAPHY

Department of Health (2006) The Health Act: Code of Practice for the Prevention and Control of Health Care Associated Infections. Department of Health Expert Advisory Group on AIDS (EAGA) and UK Advisory Panel for Health Care Workers Infected with Blood-borne Viruses (2005) HIV Infected Health Care Workers: Guidance on Management and Patient Notification. Health and Safety Executive (2005) Controlling the risk of infection at work from human remains; A guide for those involved in funeral services (including embalmers) and those involved in exhumation. Healing,T.D, Hoffman,P.N, Young,S.E.J. (1995) The infection hazardsof human cadavers. Communicable Disease Report. 5 (5): 61-68. Young,S.E.J, Healing,T.D. (1995) Infection in the deceased: a survey of management. Communicable Disease Report. 5 (5): 61-68. Bakhshi. S S (2001) Code of practice for funeral workers: managing infection risk and body bagging, Communicable Disease and Public Health 2001; 4: 283-7 Control of Substances Hazardous to Health Regulations (2002) Health Protection Agency (2008) Infection in the deceased: a survey of management. Available at http://www.hpa.org.uk [Accessed 17th June 2014] Health Services Advisory Committee. (2003). Safe working and the prevention of infection in the mortuary and post-mortem room. London. HMSO. Royal Marsden Manual of Clinical Nursing Procedures, 8th Edition Last Offices, Chapter 2, Procedure guideline 2.2 NHS Employers (2013) Health and Safety Essential Guide, Occupational Health: Handling Infected Cadavers National End of Life Care Programme (2011) Guidance for staff responsible for care after death (last offices) The current version of any policy, procedure, protocol or guideline is the version held on the NHFT internet. It is the responsibility of all staff to ensure that they are following the current version Infection Prevention Precautions for the Deceased Patient

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10. RELATED TRUST POLICY ICP 000 – Infection Prevention and Control Assurance Framework; ICP 002 – Standard Precaution Policy; ICP 003 – Cleaning and Disinfection Policy; ICP 004 – Decontamination Policy; ICP 009 – Outbreak and Isolation Policy; NHFT Chaplaincy Handbook

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APPENDIX 1 – EQUALITY ANALYSIS REPORT Equality Analysis Report Name of function: Care of the deceased patient within infection control Date: 01/10/2014 Assessing officers: Harriet Ddungu- Head of Infection Prevention and Control Description of policy including the aims and objectives of proposed: (service review/resign, strategy, procedure, project, programme, budget, or work being undertaken): To ensure that staff working within the Trust are awareness of infection prevention and control precautions necessary when involved in the care of the deceased patient; to minimize the associated risk of transmission of infection to other patients, staff and visitors. Evidence and Impact – provide details data community, service data, workforce information and data relating specific protected groups. Include details consultation and engagement with protected groups. Evidence base:  NHFT Equality Information Report August 2012  Northampton County Council :Northamptonshire Results: 2011 Census Data Summary

2001 2011 % rise

Corby

Daventry

East Northants

Kettering

Northampton

South Northants

Wellingborough

Northants

England

53,400

72,100

76,600

82,200

194,200

79,400

72,500

630,400

49,449,700

61,100 14.4%

77,700 7.8%

86,800 13.3%

93,500 13.7%

212,100 9.2%

85,200 7.3%

75,400 4.0%

691,900 9.8%

53,012,500 7.2%



Ethnicity: 85.7% (White) and 14.3% (BME )- 1.75% (dual heritage); 4.01% (Asian); 2.5%(Black including British, African and Caribbean) ; 0.85 % (Chinese) ; 6.05 % (white other EEA, polish, Gypsy & Traveller)



Gender: 49.6% males; 50.4% females (including 1% transgender)



Disabled people: 19% (including 3.5 % < aged under 18)



Faith communities: 71% Christian; 29% minority faith: (includes Hindu, Muslim, Sikh, atheists, nonbelief)



Sexual orientation (gay, lesbian or bisexual): 5 - 7% (Stonewall estimate)

Service Information: provide any relevant service data or information to inform the Equality Analysis including service user feedback, external consultation and engagements or research.

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Equality Analysis Report Name of function: Date: Protected Groups (Equality Act 2010)

Care of the deceased patient within infection control 01/10/2014 STAGE 3: Consider the effect of our actions on people in terms of their protected status? The law requires us to take active steps to consider the need to:   

Eliminate unlawful discrimination, harassment and victimisation. Advance equality of opportunity Foster good relations with people with and with protected characteristic

Identify the specific adverse impacts that may occur due to this policy, project or strategy on different groups of people. Provide an explanation for your given response. Age None

Disability None Gender (male, female and transsexual, inclu. Pregnancy and maternity)

None

Gender reassignment None Sexual Orientation (incl. Marriage & civil partnerships

None

Race None Religion or Belief (including non belief)

None

Equality Analysis outcome: Having considered the potential or actual effect of your project, policy etc, what changes will take place?

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Equality Analysis Report Name of function: Date:

Care of the deceased patient within infection control 01/10/2014

Action Plan Issue to be addressed

Action

Who Date to be completed

Ratification – a completed copy of the Equality Analysis form must be sent to Equality and Inclusion Officer to be approved. Approving Officers Date of completion:

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APPENDIX 2 LIST OF NOTIFIABLE DISEASES The following diseases or suspicion of are notifiable by law to the Local Authority Proper Officer – usually the Consultant in Communicable Disease Control under the Public Health Infectious Diseases Regulation 1988. The Clinician who suspects or diagnoses the infection is responsible for the notification. ‘Nurses are not responsible for making the notification’. Table of Notifiable Diseases Diseases 1. Acute encephalitis 2. Acute Policmyelitis 3. Anthrax 4. Cholera 5. Diphtheria 6. Dysentery 7. Food Poisoning 8. Leprosy 9. Leptospirosis 10. Malaria 11. Measles 12. Meningitis • Meningococcal • Pneumococcal • Haemophilus Influenza • Viral • Other specified • Unspecified

Diseases 17. Plague 18. Rabies 19. Relapsing fever 20. Rubella 21. Scarlet fever 22. Small pox 23. Tetanus 24. Tuberculosis 25. Typhoid fever 26. Typhus fever 27. Viral Haemorrhagic fever 28. Viral Hepatitis • Hepatitis A • Hepatitis B • Hepatitis C • Other

13. Meningococcal septicaemia without Meningitis 14. Mumps 15. Ophthalmia neonatorum

29. Whooping Cough 30. Yellow fever

16. Paratyphoid fever

Notification should be telephoned through initially and the followed up in writing on the official form to: The Consultant in Communicable Disease Control South Midlands and Hertfordshire PHE Centre Beacon House Dunhams Lane Letchworth Garden City Herts SG6 1BE Telephone: 0300 303 8537 Option 1 The current version of any policy, procedure, protocol or guideline is the version held on the NHFT internet. It is the responsibility of all staff to ensure that they are following the current version Infection Prevention Precautions for the Deceased Patient

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APPENDIX 3 NOTIFIABLE DISEASES NOTIFICATION FORM Notification of Infectious Diseases or Food Poisoning Confidential Certificate Patient Details Surname Date of Birth Home Address

Forename Male

Female

Postcode Telephone No. Food handler Yes / No

Occupation Healthcare Worker Yes / No

Carer Yes / No

Place of work / School / Nursery Is Patient in hospital

Yes / No

Hospital / ward

Was disease contracted in hospital?

Yes / No

Place from which patient admitted to hospital:

Details of illness Disease Date of onset Has the patient Date vaccinated Yes / No been vaccinated against this disease? Was disease If yes, name of Yes / No contracted place and abroad? country: Additional information for certain diseases Food poisoning / Faecal sample requested? suspected food poisoning Suspected source? Meningitis Causal organism if known: Malaria Parasite type if known: Prophylaxis taken Yes / No Tuberculosis Site of disease Specimen sent? Yes / No Sputum smear positive Yes / No I certify and declare that in my opinion the person named above is suffering from the disease stated

Yes / No

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Other information Signed Date Doctor’s name, address, telephone / bleep No: Please return to: The Consultant in Communicable Disease Control South Midlands and Hertfordshire PHE Centre Beacon House Dunhams Lane Letchworth Garden City Herts SG6 1BE

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APPENDIX 4 GUIDANCE FOR THE UNDERTAKERS OR FUNERAL WORKERS This form should accompany the body if it has been placed in a body bag. Patient Details Name of deceased: Hospital and Ward: Contact Risk: GP: Reason for using body bag used: (see appendix 2) 1. A known or suspected infection risk as follows: Please tick YES / No • Gastro intestinal risk • Blood borne virus infection risk • Respiratory / airborne infection • Contact risk • Other infection risk (i.e. CJD, Viral haemorrhagic fevers) 2. Likely leakage of body fluids during transportation 3. Poor physical condition of the body 4. Body Preparation • Body can be removed from bag and washed • Body can be viewed with bag opened • Limited viewing of face only with the bag open to allow this • Viewing only permitted with the agreement of the local Consultant in Communicable Disease Control. Phone number: - 0300303 8537 Option 1 5. Standard Precautions • Protective clothing should be worn (water repellent, single use aprons and gloves). • Remove and dispose of apron and gloves between every procedure. • Undertake hand hygiene between every procedure. The current version of any policy, procedure, protocol or guideline is the version held on the NHFT internet. It is the responsibility of all staff to ensure that they are following the current version Infection Prevention Precautions for the Deceased Patient

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APPENDIX 5 GUIDANCE TABLE FOR THE MANAGEMENT OF DECEASED PATIENTS WITH CONFIRMED OR SUSPECTED KEY INFECTIONS (Adapted from the Health and Safety Executive Guidance (2005) controlling the risks of infection at work from human remains. Part 1: Key infections). ** Indicates a notifiable infection 1. Intestinal infections: Transmitted by hand-to-mouth contact with faecal material or faecal contaminated objects. Infection Causative Agent Is a Can Can Can body the hygienic embalmi bag body preparatio ng be needed? be n be carried viewed carried? out? ? (see footnote) ** Dysentery Bacterium – (bacillaey) Shigella Yes Yes Yes Yes dysenteriae **Hepatitis Hepatitis A virus No Yes Yes Yes ** Typhoid paratyphoid fever

Bacterium Salmonella thypi /paratyphi

Yes

Yes

Yes

Yes

2. Blood-borne infections: Transmitted by contact with blood (and other body fluids which may be contaminated with blood) via a skin-penetrating injury or via broken skin. Through splashes of blood (and other body fluids which may be contaminated with blood) to eyes nose and mouth. HIV

Human immunodeficiency Yes Yes Yes No **Hepatitis B and Hepatitis B and C C viruses Yes Yes Yes No 3. Respiratory infections: Transmitted by breathing in infectious respiratory discharges. **Tuberclosis Bacterium (TB) Mycobacterium Yes Yes Yes Yes tuberculosis **Meningo-coccal meningitis **Non meningococcal meningitis

Diphtheria

Bacterium Neisseria meningitides Various bacteria including Haemophilus Influenza and also viruses Bacterium – Corynebacterium

No

Yes

Yes

Yes

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

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diphtheriae 4. Contact: Transmitted by direct skin contact or contact with contaminated objects. Invasive BacteriumStreptococccal Streptococcus Yes Yes Yes No infection pyogenes (Group A) MRSA BacteriumMethicillin No Yes Yes Yes resistant staphylococcus aureus 5. Other infections (neurological) **Viral Various viruses Haemorrhagic e.g.Lassa fever Yes No No Yes fevers virus, Ebola virus (transmitted by contact with blood ) Transmissible Various prions spongiform e.g. Creutzfeld Yes Yes Yes No encephalopathies Jacob disease / (transmitted by variant CJD puncture wounds, ‘sharps’ injuriesor contamination of broken skin by splashing of the mucous membranes.

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