Communicable Disease Control: Methods of Control
This section covers:
- Methods of control
- Organisation of infection control
- Organisations Involved in Communicable Disease Control
- Prevention of infection
- Organisation of infection control
- Notification of communicable diseases to HPU's
- HPU Response to a patient with an infectious disease
Organisations Involved in Communicable Disease Control
In the UK, one of the key organisations involved in the control of communicable diseases is The Health Protection Agency (HPA), established as a non-departmental public body in April 2005. The HPA has a large network of approximately 3000 staff based at three major centres in addition to regional and local staff throughout England (see below).
Health Protection Units (HPUs) control communicable disease at a local level with support from the HPA Centre for Infections if a communicable disease affects a larger geographical area or is of national significance.
In addition to the HPA's role of reducing the dangers to health from infections, chemical and radiation hazards, it also provides support to, and works in partnership with others who have health protection responsibilities and advises, through the Department of Health, all government departments and devolved administrations throughout the UK.
The HPA provides local disease surveillance, laboratory services, investigation and management of health protection incidents and outbreaks.
Role of the Health Protection Agency (HPA)
- Provides an integrated approach to protecting UK public health, reducing dangers to health from infections, chemical and radiation hazards
- Supports and advises the NHS, local authorities, emergency services, other Arms Length Bodies, the Department of Health and the Devolved Administrations.
Structure of HPA
The HPA consists of three national specialist centres
- The Centre for Infections (CfI) which undertakes;
- Infectious disease surveillance
- Specialist and reference microbiology and microbial epidemiology
- Co-ordination of investigations of national significants and uncommon outbreaks
- Advises government on risks posed by specific infections
- Responds to international health alerts.
- The Centre for Radiation, Chemical and Environmental Hazards
- The Centre for Emergency Preparedness and Response
In addition, local and regional services provide the front line response. These include:- 9 regional offices which assist in managing response to major incidents and support the activities of local Health Protection Units (HPUs)
- 39 HPUs, each covering an area broadly similar to a county boundary.
Role of Health Protection Units (HPUs)
The Health Protection Unit (HPU) provides specialist health protection advice as well as operational support on all health protection matters to NHS trusts, local authorities, community health services (including schools and social services), and the general public. HPUs are staffed by CCDC's (Consultants in Communicable Disease Control), Health Protection Nurses, epidemiologists and admin support staff.
The HPU is responsible for the following functions:
- Surveillance and analysis of trends in communicable disease
- Liaison with key stakeholders involved in the control of infectious disease
- Prevention, investigation, and control of health protection incidents including the prevention, investigation and control of outbreaks and incidents involving communicable diseases, chemical, radiological and other environmental hazards
- Chemical, biological and radiological incident planning and management
- Provision of advice and support to PCTs, local authorities, hospital and primary care staff and the public on health protection issues
- Infection control advice and support to nursing and residential homes and schools
- Acting as the 'proper officer' in relation to public health legislation
- Advise local PCTs on commissioning services to prevent, control and treat infection
- Support the development and implementation of prevention and health promotion programmes
- Teaching and training of local health professionals in health protection
Ultimately the HPUs mainly work with primary and secondary care providers plus local authorities to control the spread of infectious / communicable diseases.
Prevention of infection
Methods to prevent infection can be directed either to host or environment and include:
Standard Precautions
- Hand Hygiene
- Single most important part of infection control
- Hand washing before any contact with patients, after any activity that contaminates the hands, after removing protective clothing, after using the toilet and before handling food
- Use of personal protective equipment (PPE): gloves, aprons, eye protection, face masks etc.
- Handle and dispose of sharps safely
- Dispose of contaminated waste safely
- Managing blood and body fluids: spillages and transport of specimens
- Decontaminating equipment: cleaning, disinfection and sterilization
- Maintain a clean clinical environment
- Prevent occupational exposure to infection
- Manage sharps injuries & blood splash incidents
- Manage linen safely
- Place patients with infections in appropriate accommodation
Enteric Precautions
- Handwashing (see above)
- Correct disposal of excretions & soiled material
- Soiled clothing & bed linen - place in a hot wash (>60)
- Disinfection, especially important in nurseries, schools & residential institutions
- Education
- Emphasise personal hygiene & hygienic preparation and serving of food
- Children and adults in jobs likely to spread infection should stay away from school for 48 hours after any diarrhoea has stopped
Routine and selective immunisation > (see Immunisations)
Tuberculosis screening services
Changes to risk behaviour -
This can be achieved through general or targeted education campaigns e.g. avoid sharing personal items, safe sex, careful disposal of needles / clinical waste with blood borne pathogens
Organisation of infection control
Settings & persons responsible
- Hospital -
- HOSPITAL infection control
Healthcare-associated infections (HCAI) are infections that occur in patients or health care workers as a result of healthcare interventions. Control of HCAI is an important part of risk management and clinical governance programmes. Overall responsibility rests with the chief executive and the trust board and the Director of Infection, Prevention and Control (DIPC).
A hospital infection control team (ICT) comprises an Infection Control Doctor (usually a medical microbiologist), one or more infection control nurses and clerical support. They report to a multi-disciplinary Infection Control Committee who liaises with senior management.
Aims of an Infection Control team
- Maintain an effective programme for the prevention of hospital acquired infection
- Containment of infections brought into the hospitals by patients, staff or visitors
Roles and Responsibilities of Infection Control Team
- Hospitals must ensure the management of infection control programmes is undertaken by competent, qualified Infection control nurses
- Provision of ongoing education for all healthcare staff
- Develop infection control policies and ensure accessible to all staff
- Facilities and equipment are available to enable compliance with policies
- Ensure all clinical staff have received appropriate training
- Infection control audit s
- Surveillance
The hospital infection control team works with the Hospital Infection Control Committee. A Hospital Infection Control Committee consists of the ICT(see above), hospital chief executive or senior director, CCDC, Occupational Health Consultant and others as needed.
-
COMMUNITY Infection Control
The HPU takes a main role in community infection control. It works with all community organisations that provide care, healthcare or treatments outside hospital including nursing / residential homes, nurseries and schools. The HPU advises and helps maintain good infection control practices in these community settings. This is achieved through the direct input of health protection nurses, who provide most of the HPU infection control advice and the CCDCs being the main link between PCT infection control teams and hospital ICTs. Health Protection Nurses work through educational means to raise awareness of infection control issues, undertaken community audits and provide advice on infection controls measures, exclusion, risk / hazard reduction and screening to the community organisations listed above as needed.
For example the HPU advises and trains private nursing home staff about infection control principles, it advises schools and nurseries on infection control principles and in conjunction with the local authority, reviews the infection control practices of tattoo parlours and beauticians.
Regulations and legal powers used in the control of infection
The HPU in conjunction with the local authority have responsibility for enforcing key regulations relating to protecting the health of the public. These include:-
· Public Health Law
The Public Health (Control of Disease) Act 1984 and the Public Health Infectious Diseases Regulations 1988 give UK local authorities powers to control communicable disease. These powers are exercised either directly or indirectly through the 'Proper officer', an officer appointed by the local authority for a specific purpose. The Proper Officer is usually the Consultant in Communicable Disease Control (CCDC) and their individual powers include:
- Notification of infectious diseases
- Preventing sale of infected articles
- Preventing infected people from using public transport
- Cleaning and disinfection of premises
- Excluding people from work and school
- Offering immunisation
- Compulsory exclusion
- Removal to hospital and detention in hospital
- Obtaining information from households and schools in order to prevent the spread of infectious diseases
· Local Authority Environmental Health Department
have legal powers to control aspects of the environment that could be a source of infection- Supplies and suppliers of food and water
- Disposal of sewage
- Waste management
- Pest control
· Food Safety Act 1990
Framework for regulations that govern- activity of food businesses
- composition and labelling of foods
- chemical safety
- food hygiene
Enforcement is the responsibility of local authority environmental health officers.
Notification of communicable diseases to HPU's
HPU's are notified of patients with communicable diseases via a Statutory Notification form or a lab report
Statutory Notification of Infectious Diseases (NOIDS)
Any clinician suspecting one of the list of notifiable infectious diseases is required by law to notify the 'Proper Officer' of the local authority, usually the CCDC. The CCDC then acts on this as appropriate.
The proper officer sends a weekly return to the HPA CDSC and the data are collated and published.
Diseases notifiable (to Local Authority Proper Officers) under the
Public Health (Infectious Diseases) Regulations 1988
- Acute encephalitis
- Acute poliomyelitis
- Anthrax
- Cholera
- Diphtheria
- Dysentery
- Food poisoning
- Leptospirosis
- Malaria
- Measles
- Meningitis
meningococcal
pneumococcal
haemophilus influenzae
viral
other specified
unspecified - Meningococcal septicaemia (without meningitis)
- Mumps
- Ophthalmia neonatorum
- Paratyphoid fever
- Plague
- Rabies
- Relapsing fever
- Rubella
- Scarlet fever
- Smallpox
- Tetanus
- Tuberculosis
- Typhoid fever
- Typhus fever
- Viral haemorrhagic fever
- Viral hepatitis
Hepatitis A
Hepatitis B
Hepatitis C
other - Whooping cough
- Yellow fever
Leprosy is also notifiable, but directly to the HPA, CfI, IM&T Dept
HPU Response to a patient with an infectious disease
- What investigations (microbiological / environmental / epidemiological) are needed to identify the agent, the cause of the incident?
- What is the Source of Infection?
- Is it a continuing source that may need to be controlled
- If so, what generic control measures can be applied to limit morbidity whilst awaiting confirmation e.g. enhanced hand washing, environmental cleaning etc
- Are there others exposed who may need advice / treatment
- What is the likelihood of transmission?
- Advice / prophylaxis to close contacts e.g. hepatitis B immunization
- Occupational transmission e.g. exclusion of food handlers with gastrointestinal infection
- Is public health action necessary?
Risk Assessment - how infectious is the source; how close is the contact; how susceptible are those exposed- Is the index case at risk of a poor outcome
- Is the index case likely to pass the infection to others
- Is there likely to be an ongoing source that needs controlling
- Do contacts and others exposed to the same source need to be traced
- Do the public need information or reassurance
- Does public health action need to be done immediately?
To determine this consider:- Seriousness of disease
- Transmissibility of infection
- Length of incubation period
- Vulnerability of people exposed
- Public/ media / political reaction
- What is good practice
- Possible interventions
- Improve outcome for cases e.g. antibiotics, immunoglobulin
- Trace others exposed to source or cases to provide advice, antibiotics or vaccines
- Prevent others being exposed to cases / contacts by rendering them non-infectious by use of antibiotics and / or isolation
- provision of hygiene advice
- exclusion from work / school
- closure of premises associated with incident e.g. cooling towers, food premises
- Identify possible source and implement and monitor control measures to contain this source
- Communication
- Cases / contacts / clinicians
- Internal - specialist advice within HPA / microbiology
- External - local authorities, press e.g. outbreak of meningococcal disease in a school
© Sarah Anderson, Gayatri Manikkavasagan 2008
