The Management of Meningitis Policy Infection Prevention and Control

This policy describes the key processes and protocols for patients with a known or suspected diagnosis of meningitis. It includes the appropriate personnel and organisational contact details for further advice. Key Words:

Infection Prevention and Control Meningitis Septicaemia

Version:

7

Adopted by:

Quality Assurance Committee

Date adopted:

17 May 2016

Main author:

Name of responsible committee:

Amanda Hemsley Senior Nurse Advisor, Infection Prevention and Control Infection Prevention and Control Committee

Date issued:

May 2016

Review date:

January 2018

Expiry date:

April 2019

Target audience:

All LPT staff

Type of policy (tick appropriate box)

Clinical √

Non-clinical

Contents Definitions that apply to this policy 1.0

Summary………………………………………………………………….

7

2.0

Introduction……………………………………………………………….

7

3.0

Purpose……………………………………………………………………

7

4.0

Justification for the document…………………………………………..

7

5.0

The Management of Suspected (or confirmed) Meningitis……...…..

8

5.1

Background……….………………………………………………………

8

5.2

General information.…………………………………………………….

8

5.3

Investigation of meningitis………………………………………………

9

5.4

Specific meningitis infection prevention and control measures for inpatient facilities…………………………………………………………

9

6.0

Training……………………………………………………………………

11

7.0

References and associated documents……………………………….

11

Appendices 1.

Source Isolation Poster………………………………………………….

12

2 The Management of Meningitis Policy

Contribution List Key individuals involved in developing the document Name Amanda Hemsley Antonia Garfoot, Mel Hutchings, Fiona Drew, Annette Powell, Jackie Chown

Designation Senior Nurse Advisor, Infection Prevention and Control Infection Prevention and Control Team

Circulated to the following individuals for consultation Name Dr Philip Monk Dr Andrew Swann Adrian Childs Jo Wilson Victoria Peach Michelle Churchard Claire Armitage Kathy Feltham Emma Wallis Katie Willetts Bernadette Keavney Elizabeth Compton Sarah Latham Greg Payne Bal Johal Amin Pabani Liz Tebbutt

Designation CCDC Consultant, Public Health England Consultant Microbiologist UHL Chief Nurse / DIPaC Lead Nurse, FYPC Lead Nurse, CHS Lead Nurse AMH&LD Lead Nurse AMH&LD Lead Nurse MHSOP Lead Nurse CHS Senior Nurse, FYPC Health Safety and Security Manager Matron Matron Training and Development Deputy Chief Nurse Service Manager Podiatry Performance and Quality Assurance Manager

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Version Control and Summary of Changes

Version number

Date

Version 1 2005 Version 2 February 2009 Version 3 June 2010

Version 4 July 2010 Draft2

Comment (Description change and amendments) Review and rewriting of guideline based on the community infection control guidelines Reviewed and updated in line with national guidance Reviewed by Amanda Howell and rewritten incorporating abbreviations, definitions and associated policies and guidelines. Sent out for comments to link staff for adult and children’s services, occupational health, HPU, service managers, Infection control subcommittee members. Comments received and incorporated from: Una Willisinfection control matron, Shelley Jacques-Clinical Governance Lead, Heidi Scott-Smith-Clinical Governance Manager, Helen Burchnall-clinical lead for Childrens physiotherapy, Diane Shields-occupational Health Advisor and Philip Monk- consultant in communicable Diseases Agreed through the clinical Governance Committee

Version 5 Final Copy Version 6 August 2011 Harmonised in line with LCRHS, LCCHS, LPT (historical organisations) Version 7 Updated to review current NICE guidance102 and in line with format of LPT policies For further information contact: Infection Prevention and Control Team

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Definitions that apply to this Policy Consultant in Public Health

A consultant who is knowledgeable in infectious diseases and works within the field of public health

Contact Tracing

The identification and diagnosis of person who may have come into contact with an infected person. Cerebrospinal fluid

CSF Haemophilus influenza type B (Hib)

Bacterium capable of causing a range of diseases including ear infections, cellulitis (soft tissue infection), upper respiratory infections, pneumonia, and such serious invasive infections as meningitis with potential brain damage and epiglottitis with airway obstruction, It spreads by droplet through coughs and sneezing. Infection An organism presents at a site and causes an inflammatory response, or where an organism is present in a normally sterile site. Immunocompromised An immune system that is impaired by disease or treatment, where an individual’s ability to fight infection is decreased. Immunosuppression Suppression of the immune response, usually by disease or by drugs Inflammation The body’s immune reaction to presumed foreign substances like germs. Inflammation is characterised by increased blood supply and activation of defence mechanisms. It can produce redness, swelling, heat and pain. Meningitis Inflammation of the meninges (lining of the brain) Meningococcal Meningococcal disease is any infection caused by bacteria meningococcal bacteria Neisseria Neisseria meningitides is a heterotrophic gram-negative meningitides diplococcal bacterium best known of its role in meningitis and other forms of meningococcal disease such as meningococcemia Organisms This is defined as any living thing, in medical terms bacteria and viruses are referred to as organisms. Outbreak The occurrence of two or more cases of the same infection linked in time or place or, the situation when the observed number of cases exceeds the number expected PCR Polymerase Chain Reaction – a laboratory technique for rapidly synthesising large quantities of a specific DNA segment Personal Protective Specialised clothing or equipment worn by employees for Equipment (PPE) protection against health and safety hazards, gloves, aprons, gowns masks and eye protection. PHE Public Health England Source Isolation Isolation for the control of infection is used to prevent infected patients from infection others Streptococcus The bacteria that most often causes pneumonia 5 The Management of Meningitis Policy

pneumonia Symptomatic LPT Occupational Health Department

Physical or mental sigh of disease Leicestershire Partnership Trust Baldwin Lodge Glenfield Hospital Site Groby Road Leicester LE3 9QP TEL: 0116 225 5432

6 The Management of Meningitis Policy

1.0

Summary

This policy has been developed to give clear organisational wide guidance for the management of a patient with suspected or confirmed infectious meningitis or meningococcal septicaemia, it is intended to provide infection prevention and control guidance to minimise the risk of transmission of the organism from the patient to other patients, staff or members of the public. It is not a treatment therapy guide, and alternative guidance must be sought. Further guidance for healthcare workers and other staff work who work in prisons and places of detention can be found in Prevention of Infection & Communicable Disease Control in Prisons & Places of Detention – A Manual for Healthcare Workers and other Staff.

2.0

Introduction

This policy applies to all staff employed by Leicestershire NHS Partnership Trust (LPT). LPT has a wide range of teams and services operating from a large number of properties making up the overall estate. LPT also delivers healthcare to people in their own homes. The provision of healthcare carries with it inherent risks to the health care worker. The purpose of this document is to ensure that all staff are aware of their responsibilities for the safe practice in relation to the management of a patient with suspected or confirmed meningococcal disease.

3.0

Purpose

It is the intention of this policy to provide guidance to ensure that staff are aware of the appropriate steps they need to undertake to ensure the safety of all patients within LPT, whether receiving healthcare in LPT inpatient facilities, within their own home environment or as outpatients visiting LPT on a daily basis. This includes those patients that have or suspected of having meningococcal disease. The purpose of this policy is to ensure that all staff employed by LPT are providing evidence based care which is in accordance with the Health & Social Care Act (2008) updated 2015, and the latest guidance provided by Public Health England (PHE).

4.0

Justification for Document

Meningococcal disease continues to be a concern within the realms of infection prevention and control, with particular relation to sepsis; and it imperative that persons who have or are suspected of the disease receive care and intervention in a timely manner. As a duty of care LPT must ensure that staff are given guidance

7 The Management of Meningitis Policy

as to the appropriate steps they need to undertake to ensure that they can protect the patients within their care.

5.0

The Management of Suspected (or confirmed) Meningitis

5.1

Background

Meningitis is inflammation of the coverings of the brain and/or spinal cord. Infections (viral and bacterial) are the most common causes of this condition; however, meningitis caused by meningococcal bacteria can develop rapidly and cause serious illness. Meningococcal disease occurs throughout the world, many risk factors have been identified and transmission usually needs either frequent or prolonged close contact with the respiratory secretions of someone carrying the organism. The incidence of meningococcal disease is highest in children aged one to five years followed by infants under one year of age, The next highest risk group is you people aged 15 – 19 years, But subarachnoid haemorrhage, chemical irritation, granulomatous conditions, neoplastic conditions (e.g. carcinomatous meningitis), and other inflammatory conditions may produce this syndrome. The clinical features of meningitis include severe headache, irritability, fever, neck stiffness, rash, nausea and vomiting, confusion and reduced levels of consciousness. Infection prevention and control responses to patient with meningitis can be divided into two categories, general, for all patients regardless of infection organism, and specific. Actions in the latter category depend on the infecting organism

5.2

General Information

Patients with known or suspected meningitis should be referred immediately to the emergency department by dialling 999. Source isolation precautions are required even without an identified organism. These precautions may be modified after appropriate chemotherapy or once the infecting organism is known. Hence patients should be investigated thoroughly as soon as possible, although immediate treatment should take priority. It is essential that all cases of meningitis are notified immediately to Public Health England (East Midlands Unit): • Telephone 0344 225 4524 (option 1) • East Midlands Ambulance Service 0115 9296477 Ask for the doctor on-call for public health who will decide which contacts should be offered antibiotic chemoprophylaxis or vaccination Do Not wait until a microbiological diagnosis has been made.

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Close contacts are best defined by the consultant for public health or deputy. In general close contacts are those: • • •

5.3

Living with an infected patient Having a recent history of kissing contact or mouth-to-mouth resuscitation Individuals involved in procedures such as emergency intubation.

Investigation of Meningitis

5.3.1 The following investigations must be sent urgently to microbiology: • • • • • • •

5.4

Throat swab for (Neisseria meningitides) Throat swab for viral culture Blood culture CSF (where appropriate) for bacteriological culture and viral investigations and PCR Blood in EDTA (full blood count bottle) for Neisseria meningitides and Streptococcus pneumoniae PCR Serum (5ml clotted blood) for antibody tests. Faeces for viral culture

Specific meningitis infection prevention and control precautions for Inpatient facilities 5.4.1 Viral Meningitis

Source isolation precautions required until clinical recovery or discharge home, as there is a risk of transmitting the virus. 5.4.2 Bacterial Meningitis Bacterial meningitis is an infection of the surface of the brain (meninges) by bacteria that have usually travelled there from mucosal surfaces via the bloodstream. Organism

Groups at risk

Neisseria Meningitides

All ages, 3 months to 3 years highest incidence.

Specific hospital infection Source isolation precautions can be discontinued after 4 hours of appropriate antibiotic

Public health actions The Consultant for Public Health (or deputy) will decide who close contacts of the patient regarding antibiotic prophylaxis are. 9

The Management of Meningitis Policy

Streptococcus pneumoniae

All ages

None required once diagnosis confirmed microbiologically

Any patient with pneumococcal meningitis should be reviewed to identify if they are in the at risk group and require vaccination post discharge. All children under 5 years of age should be given a dose of pneumococcal conjugate vaccine irrespective of the vaccination history. Children under 13 months who are unvaccinated or partially vaccinated should complete the immunisation schedule. The Consultant for Public Health (PHE) will decide who are close contacts of the patient and will require antibiotic prophylaxis and vaccination. None

Haemophilus influenzae type B (Hib)

Less than 4 years of age, although Hib vaccine has virtually eradicated Hib meningitis, immunological investigations required in patients with this diagnosis

Source isolation precautions can be discontinued after 24 hours of appropriate antibiotic treatment

Group B Streptococcus Listeria

Infants less than 3 months Neonates,

None

Monogytogenes

55yrs of age and immunocompromised Neonates, patients with ventricular disease

None

Inform public health as actions are necessary None

Source isolation

None

Coagulase negative staphylococcus

None

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6.0

Training

There is no specific training requirement regarding this policy. However staff that may come into contact with patients who may have a potential prerequisite to this disease may require further training and/or development.

7.0

References and Associated documents

LPT documents The supporting Infection Prevention and control policies can be located at: http://www.leicspart.nhs.uk/SupportServices This policy was drafted with reference to the following: Meningitis Research Foundation: http://www.meningitis.org/ National Collaborating Centre for Women’s and Children’s Health. Bacterial meningitis and meningococcal septicaemia in children. JUNE 2010. NICE Clinical Guidance. National Institute for Health and Clinical Excellence: June 2010. Bacterial meningitis and meningococcal septicaemia. Clinical Guideline 102, implementing NICE guidance. Prevention of Infection & Communicable Disease Control in Prisons & Places of Detention – A manual for Healthcare Workers and other Staff. August 2011 © Health Protection Agency. HPA Gateway Reference: HPA11-02DH Gateway reference: 16314

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APPENDIX 1

SOURCE ISOLATION PRECAUTIONS

FOR IN-PATIENT FACILITIES

Visitors: Before entering the room please speak to the nurse looking after the patient

All Staff: Before entering the room and having contact with the patient or any items in the room you MUST

Wear disposable gloves

Wear a disposable plastic apron

All visitors and staff please wash your hands before leaving the room 12 The Management of Meningitis Policy