Infection Control Manual

open all | close all

Quick Links

Coming Soon


Case Studies in Infection

Training in Infection Control


The Bug Blog

Site Search

Search ICS website
Search entire web














Page updated 30 April 2007

Table of Infections

Please select from the list below to see infection control short notes and guidelines for a range of conditions, organisms, and diseases:

Disease or Infective agent
Period of infectivity to others
Source and route of transmission
Isolation required
Relevant section in Infection Control Manual
(Actinomyces israelii)
N/A Mouth, gut No Common commensal organism  
Agranulocytosis: (see
AIDS (see HIV)         Blood Borne Viruses (HIV)
Arboviruses (see Yellow Fever and Dengue)          
Amoebiasis (see Dysentery)          
Anthrax (Bacillus anthracis) Until lesions are free from bacilli

Contaminated animal tissue or hides

Cutaneous inoculation or inhalation

Source Isolate

Transfer to regional ID Unit


Patients with pulmonary disease may be particularly infectious

Dangerous Pathogens
(Ascaris lumbricoides)
Nil Ingestion of mature ova in water or vegetables contaminated with faeces No

Transmission unusual in temperate climate

Direct person-to-person spread virtually impossible

Athlete's Foot (see Ringworm)          
Bedbugs (Cimex lectularius)         Ecoparasites
Bedsores (infected) (see Wounds)         Wound Management
Bornholm Disease Pleurodynia Coxsackie A & B viruses While symptomatic, 5 days or longer Respiratory and faecal-oral Source Isolate

Organism may be isolated from the faeces for as long as 3 weeks

Keep in isolation for duration of illness

Bronchiolitis of infants While symptomatic (up to 10 days) Respiratory tract; airborne and by hands Source Isolate

Common organisms: respiratory syncytial virus, parainfluenza, etc

Highly infectious

(Brucella melitensis, etc.)

Ingestion of contaminated food, especially milk products

Handling infected animals


Transmission from man to man not known

Laboratory workers are susceptible when handling cultures



non infected: susceptible during the healing phase


Protectively Isolate

Degree of protective isolation determined by medical staff

Wound Management
infected ( MRSA,
Group A strep, Pseudomonas etc):
While colonised
Direct or indirect contact with colonised patients and staff or environment Source Isolate Isolation continued until bacteriologically negative
Campylobacter infection (see Diarrhoea)          
(C. albicans, etc.)
Susceptible while immuno-suppressed Usually endogenous No Normal flora  
Carbuncles (see Staphylococcal Infections)          
Cat-scratch fever
(Bartonella spp.)
N/A Scratches or bites or flea bites, from cats or dogs. No

Unusual bacterial infection

Organism difficult to grow

Not transmitted to others

May cause fungating lesions in AIDS

Cellulitis While colonised Direct contact Source Isolate

Isolation until organism eradicated on culture

Note organisms may be shed from certain lesions for longer than this period

Chancroid Open lesions Direct sexual contact No Rare in UK  
Chicken pox (see Varicella-Zoster Virus)         Varicella-Zoster virus (Chickenpox & Shingles)
(Vibrio cholerae)
During diarrhoea Usually infected drinking water Source Isolate

Isolate until stools are negative on culture

Case to case transmission is rare but diligent precautions must be observed


Recommend transfer to regional Infectious Diseases Unit

Clostridium difficile While colonised, increased during diarrhoea Faecal-oral and environmental-oral Source Isolate for diarrhoea   Antibiotic Associated Diarrhoea
Clostridium perfringens, etc. N/A Contamionation from faeces No

May colonised necrotic (dead) tissue

Cause of gas gangrene

Also cause of septic abortion and serious post-operative sepsis

Common cold
Parainfluenza viruses

Until symptoms cease

May be 13 days

Respiratory and direct contact Preferably Source Isolate

Often cannot be distinguished from influenza during an outbreak

Preferably discharge patients until recovered

Serious infections in immunocompromised patients

Respiratory Viruses in Immunosuppressed Patients
Conjunctivitis While symptoms present Usually respiratory or direct contact Preferably Source Isolate Many agents involved, may suggest highly infectious diseases such as measles or adenovirus  
(Cryptococcus neoformans)
Susceptible when immunosuppressed Environment No

Organism common in pigeon faeces. Disease common in AIDS

Causes pneumonia, meningitis, etc

Cytomegalovirus (CMV)

Chronic carriage and intermittent shedding for life

Immuno-suppression may cause reactivation of disease

Blood, urine, secretions

Blood transfusion, Intimate contact

Not usually (caution with infected neonates) Although the defined risk to the fetus of a mother acquiring CMV in pregnancy is very low, pregnant nurses should exercise great care when caring for high excretors (e.g. congenitally infected infants, neonates or HIV-infected patients)  
Dengue N/A Mosquito borne No Common in epidemics particularly S.E. Asia and Caribbean, second attacks may cause S.E. Asian haemorrhagic fever  
Dermatitis, Eczema Susceptible to bacterial infections and then infectious while shedding Infectious by direct or indirect contact Source Isolate only for Group A Strep., MRSA, etc.

Susceptible to pathogenic Gram-positive organisms when disease active

Highly infectious to others because of high shedding

If in doubt, source isolate until screening results available


Salmonella spp
Shigella spp
Campylobacter spp etc
C. difficile (see Clostridum difficile)
Shigella spp

(see pseudomembranous colitis)

Treat as infection risk during diarrhoeal phase

(often from
contaminated food)

Case to case spead common

Source Isolate

Even if considered to be "non-infectious" diarrhoea, await stool culture results before removing from isolation

Always wear gloves and aprons when dealing with diarrhoeal stools

Viruses such as rotavirus and Norwalk agent are a particular cross-infection hazard especially in paediatric wards

Transmission from man to man of Campylobacter appears to be very unlikely but has been seen from mother to baby

NOTIFY (Food hygiene regulations)

There are many non-microbial causes of food poisoning which should be considered when investigating clusters of cases

Food Poisoning
(Corynebacterium diphtheriae)
Infectious until throat swabs negative Carriers. Respiratory or direct contact Source Isolate

Transfer to Infectious Disease unit


Most infected patients come from abroad. Vaccinate in infancy but effective antibodies may not persist

Contact tracing with screening is required



1. Bacillary
Shigella spp:
Infectious while shedding in stools


Source Isolate


Highly infectious disease

Nursery outbreaks are usually not food-borne but occur by direct and indirect handborne transmission

2. Amoebic
Entamoeba histolytica:
During faecal carriage

Contaminated food or water


No No transmission in temperate climes, although outbreaks have occurred from using uncleaned equipment (colonoscopes, enemas)
Ebola Fever While symptomatic Blood
(possibly respiratory)
Source Isolate

Patients will be transferred to Regional Infectios Diseases Unit

Call Control of Infection Officer Microbiologist on call

Viral Haemorrhagic Fevers
Eczema (see Dermatitis)          
Varies according to cause Faecal-oral,
Source Isolate

Many enteroviruses and mumps are infectious

Isolate until cause identified

Enteric Fever
Salmonella typhi or
S. paratyphi
While excreting organism in stools. Faecal-oral Preferable but not essential

A patient with acute typhoid fever will rarely infect another

Healthy carriers may inadvertantly infect food


Enterobius vermicularis
(see Threadworm)
Enteritis (see Diarrhoea)         Food Poisoning
Group A Streptococci
While lesions (and carrier sites) still microbiologically positive Direct contact from a respiratory carrier or infected patient, often a child Source Isolate Generally isolate until 48 hours' antibiotics given but some cases may require negative screening swabs before allowing into sensitive areas (e.g. open paediatric ward)  
Fleas See full protocol       Ectoparasites
Food poisoning:
(see Diarrhoea)
        Food Poisoning
Fungal Infections (Systemic) (see also Ringworm) N/A

From spores in environment. Inhalation

Rarely from infected carriers


Systemic fungal infections contracted in the UK are probably not infectious to others

Immuno-compromised patients are susceptible to non-virulent fungi (e.g. Aspergillus spp.)

Coccidioidomycosis and histoplasmosis are examples of more virulent organisms acquired in certain specific well-defined areas in the tropics and Americas

These may be infectious to others and to laboratory workers


Furuncles (see Staphylococcal Infections)

Gas gangrene (Clostridium perfringens, etc) N/A Own bowel flora or direct inoculation No

Trauma patients susceptible

Infection caused by anaerobic organisms which are part of normal gut flora or are inoculated with soil at the time of an injury

These organisms do not cause disease in contacts

Gastroenteritis (see Diarrhoea)         Food Poisoning
German measles (see Rubella) See detailed protocol       Rubella
(Giardia lamblia)
N/A Contaminated drinking water No

Often acquired abroad (e.g. Russia)

Isolate if diarrhoea or incontinent

Cryptosporidium acquired in the same way

Glandular fever (Infectious mononucleosis) Infective for life after exposure

Direct, intimate contact

Probably exchanging saliva


Epstein Barr virus (a herpes virus) excreted intermittently from the pharynx into mouth secretions

Other organisms (Toxoplasma gondii, HIV, CMV) may cause monospot negative glandular fever-like syndrome

Neisseria gonorrhoeae
Genital infection

Neonatal infection
e.g. Ophthalmia neonatorium
Until organism eradicated (particularly females) Sexually transmitted

Intrapartum infection

Source Isolate

Women commonly asymptomatic carriers.

Meticulous hand hygiene is necessary. Use gloves and aprons when handling babies with ophthalmia

Separate from other neonates


Granuloma inguinale
  Sexually transmitted Nil Now exceedingly rare in UK  
Acute viral hepatitis
Variable Variable Yes

Isolate until cause established


Hepatitis A virus Preicteric phase Faecal-oral No

NOTIFY "Infectious Jaundice"

Usually sewage-contaminated food, (e.g. shellfish), water, etc

Isolate patients before they are jaundiced if they can be identified

Give gamma globulin to family contacts of cases

Use gloves and aprons when handling excreta

Active immunisation available

Hepatitis B virus Preicteric and early icteric phase or during chronic carrier state Sexually transmitted or blood inoculation (e.g. needlestick accident or shared needles) No (unless bleeding)

HBeAg or lack of anti-'e' indicates risk of high infectivity

See policies relating to Hepatitis B and Sharps accidents

Active and passive immunisation available


Bloodborne Viruses (HBV)

Sharps Injuries

Hepatitis C virus variable Blood transfusion, or blood inoculation in shared needles, needlestick accidents and sexual intercourse No

Hepatitis C antibodies rise late in the course of an illness. PCR can detect virus replication before this

Most infections in hospital are acquired through blood transfusion

NOTIFY all new diagnosed cases

Bloodborne Viruses (HCV)
Non A,non B (hepatitis E etc) as for hepatitis A Foodborne non-A,non-B No

Acquired like hepatitis A

Wear gloves and aprons handling excreta

Theoretically transmitted by poor hygiene in family groups


Delta virus Not known Inoculation by needle No

Infection by this RNA virus can only occur in those with chronic HBsAg carriage

Probably blood borne and transmitted as hepatitis B


Herpes Simplex
Type 1 (cold sores)
Active lesions infectious, also intermittent shedding into oral secretions Direct and close contact No

Risk of staff with active cold sores or whitlows to non-immune, immunosuppressed and eczematous patients and to neonates

Personal hygiene is crucial to prevent transmission

Herpes Simplex Type 2 (genital herpes) Active lesions infectious Sexually transmitted No    
Herpes Simplex Type 2 (neonatal herpes) May be present at birth or begin within days of birth Intrapartum Source Isolate Separate child from other neonates because of high virus load  
Herpes zoster (shingles):
(see Varicella-Zoster Virus)
        Varicella-Zoster virus (Chickenpox & Shingles)
Histoplasma capsulatum

Patients with active lung lesions may be infectious

Laboratory cultures are infectious

Spores in environment in certain restricted tropical areas



Fungal infection very rarely seen in UK

Common in Southern Staes of USA and in the Tropics

Common in AIDS patients

Human Immunodeficiency viruses

After virus acquired, then for life

Highest risk of transmission during acute seroconversion and in terminal AIDS

Blood transfer, sexual intercourse, inoculation

Not usually

Chek no infectious opportunistic infections

See detailed protocol

Take special care with specimens and sharps disposal

Special awareness of risks of tuberculosis in AIDS

Bloodborne Viruses (HIV)
Necator americanus
Ankylostoma duodenale
N/A Environment contaminated by faeces, containing eggs, larvae No

No direct transmission from patient to patient

Larvae penetrate skin of legs or ingested in contaminated drinking water

Common in tropics

Hydatid diseases
Echinococcus granulosus
and E. Multilocularis
N/A Eggs in dog faeces. Ingested No No person-to-person spread  


Opportunistic organisms
1. General:


Usually endogenous
or saprophytic infections
Usually not

Many hospitalised patients are more
susceptible to infection because of drugs, operations, tumours, etc

Respiratory Viruses in Immunosuppressed Patients

2. Granulocytopenia,
(neutropenia) or agranulocytosis (e.g. bone marrow transplant recipients):


Usually endogenous
or saprophytic infections
Protective Isolate

Isolation prescribed by physicians at a certain level of neutropenia

See separate policy

Staphyloccus aureus
Group A streptococcus
(S. pyogenes)
While shedding Direct contact Source Isolate

Often highly infectious to other children

Outbreaks in toddlers and primary school children

Infectious mononucleosis
See Glandular Fever,
Toxoplasmosis, HIV,
Cytomegalovirus infections
Depends on the agent Variable, mostly by close, intimate contact or by inoculation No Variable implications depending on aetiology  
Influenza When symptomatic Respiratory tract, inhalation or direct inoculation to mucous membranes Source Isolate

Management of infected staff and patients during an epidemic will be arranged by Infection Control Team

Vaccination of staff and patients or use of amantadine may be suggested

Travellers with Respiratory or Rash Illness
Also Enteroviruses
Herpes simplex etc
While symptomatic

Infected secretions

Direct inoculation into mucous membranes.

Some airborne transmission from respiratory secretions

Non-sterilized instruments (esp. ophthalmic)

Source Isolate

Source isolation precautions recommended for any patient with undiagnosed conjunctivitis

Adenoviruses and enteroviruses highly infectious

Lassa fever While symptomatic, perhaps longer

Infected rodent urine

Some patient to patient spread especially by unsterilized needles or "sharps" accident

Respiratory spread is doubtful

Source Isolate Disease restricted to a belt across West Africa. Diagnosis often not clear on presentation. Refer to Infection Control Team immediately diagnosis considered possible. Arrange transfer to high security isolation in regional Infectious Diseases Unit. Body fluids, particularly blood, may continue to contain high titres of virus after clinical improvement. NOTIFY. Viral Heamorrhagic Fevers
Legionnaires' Disease (Legionella pneumophila) N/A

Inhaled infected aerosol

Organism ubiquitous in aquatic environment


No person to person spread occurs

Note history of travel and work place

Special reporting required (via Microbiology)

Legionnaire's Disease
(Mycobacterium leprae)
Possibly life of untreated "lepromatous" patient Respiratory secretions in lepromatous leprosy

Untreated lepromatous: Source Isolate (5 days)

Otherwise No

Infection load in respiratory secretions is reduced within days by treatment regimes including rifampicin

Tuberculoid leprosy is considered non-transmissable

(Weil's disease)
(Canicola fever)
L. icterohaemorrhagica etc

Water: Inhalation or inoculation to mucous membranes

Rat and dog urine


Occupational or pastime disease

Blood and urine contain organism but direct person-to-person transmission most unlikely


Lice (see
Pediculosis spp)
Phthirus pubis
    No   Ectoparasites
(Listeria monocytogenes)
Products of conception highly infectious

Unpasteurised or failed pasteurisation, infected dairy products, contaminated food

Oral route

Direct cross-infection


Neonatal infections acquired in utero

May be very infectious to other neonates delivered around the same time

Immunocompromised and elderly patients at increased risk

Lyme Disease
(Borrelia burgdorferi)
N/A Tick borne No

Endemic in deer in UK

Ticks may bite man

(P. falciparum
P. vivax, ovale
P. malariae

Mosquito bite

Blood transfusion


Recrudescence of infection may occur long after leaving endemic area

No person-to-person spread except by blood transfusion


Marburg virus
(Green monkey disease)
Infectivity months

Monkey bites

Usually source not known in the tropics

Needlestick transmission may occur in tropics and cause major hospital outbreaks

Source Isolate

Exceedingly rare

Arrange transfer to high security bed at regional ID Unit

Inform ICT or on-call microbiologist if suspected

Spread by sexual intercourse, not significantly by respiratory route


Viral Heamorrhagic Fevers
Measles Before rash appears, until rash +5 days Respiratory tract, close contact, direct inoculation of mucous membranes Source Isolate

Transfer to home or Regional ID Unit


Causes outbreaks in paediatric units and dangerous to immunosuppressed children

Gamma globulin available for susceptible exposed patients



Neisseria meningitidis: carriers are infectious to others (weeks)

Respiratory tract, close contact, direct inoculation of mucous membranes

Source Isolate

Isolate until diagnosis is known


Secondary cases in hospital do not occur


Rifampicin or ciprofloxacin prophylaxis to close family contacts but not to hospital staff

Source isolate for 24h following appropriate antibiotic therapy

Streptococcus pneumoniae: organisms present in carriers

Respiratory tract

Direct inoculation of mucous membranes

Source Isolate Strains which cause meningitis may be particularly pathogenic so observe strict hygienic precautions when handling secretions
Haemophilus influenzae: before and during acute illness

Respiratory tract

Direct inoculation of mucous membranes

Not usually Isolate if penicillin-resistant Streptococcus pneumoniae present
Viral meningitis
(enteroviruses, mumps, etc):
Before and during acute illness
Faecal-oral aerosol, respiratory Source Isolate Some agents are infectious and can cause outbreaks in neonates, etc.
MRSA (see Staphylococcal Infections) see full detailed policy       MRSA
Mumps 7 days before definitive symptoms, then for about 9 days

Virus in saliva

Aerosol, respiratory and direct contact

Source Isolate

Highly infectious. Preferably transfer home or to ID Unit

Staff who are known to have had mumps should care for patient



Mycoplasma. pneumoniae

Respiratory secretions

Direct contact and inoculation of mucous membranes


Causes common cold or pneumonia

Transmission not often documented in hospital

Mycoplasma. hominis: Chronic carriage in genital tract Sexually transmitted, also at parturition No

Mother to baby transmission may occur, organism may cause post-partum pyrexia

Also pelvic inflammatory disease

N. asteroides
N/A Environment (soil) Inhalation No

Usually occurs in immunocompromised
patients (e.g. renal transplant recipients)

Outbreaks may occur in hospital

Ophthalmia neonatorum
N. gonorrhoeae
C. trachomatis
While symptomatic until treated Maternal genital tract Caution with other neonates

Examine and treat mother

Special transport medium for Chlamydia required

Microbiologists should take specimens and plate directly for N. gonorrhoeae

NOTIFY, arrange contact tracing for mother and mother's partner

Orf virus Until healed

Infected animal lesion

Direct contact


Pox virus

Zoonosis from sheep


Person to person spread most unlikely

Stop animal contact until healed

Paratyphoid fever:
see Enteric Fever
Pediculosis spp. (lice)   No No Disinfect clothes for body lice and apply currently recommended lotions according to the manufacturer's instructions Ectoparasites
Pemphigus neonatorum While shedding from active lesions Direct contact Source Isolate

Usually a particularly virulent organism (Staphylococcus aureus) acquired from a nasal carrier or staff member with and hand lesion

Screening may be necessary

Decontamination of isolation room needed

Pertussis (see Whooping Cough)          
Yesinia pestis
Until organism eradicated Flea bite or inhalation Source Isolate

Most likely imported from tropical or sub-tropical areas

Low level endemicity in USA

Pneumonic plague infectious to attendants


While respiratory symptoms present

Faecal carriage

Infected respiratory secretions, faeces

Direct, respiratory, faecal-oral

Source Isolate


Transfer to Regional Infectious Diseases Unit

Faecal shedding of virus prolonged in children

Immunise staff routinely

Streptococcus pneumoniae
Upper respiratory tract carriers Respiratory aerosol Not usually

Outbreaks occasionally occur

Penicillin-resistant S. pneumoniae infections should be isolated

Pseudomembranous colitis
Clostridium difficile
While excreting in the stools Faecal-oral and from environment Source Isolate

Organism often acquired by many hospitalised patients, overt disease less common

Depends on toxin and use of antibiotics

Source isolate if diarrhoea

See full policy

Antibiotic Associated Diarrhoea
Pseudomonas spp While shedding From environment or carriers No (unless resistant) Common environmental saprophytes which colonise many hospitalized patients and may cause infections in immunocompromised patients  
Chlamydia psittaci
While shedding. Cultures highly infectious to lab staff From bird dander and faeces No

Case to case transmission is unlikely

Strict hygiene with secretions required because some strains ("TWAR") seem more easily to pass from man to man via respiratiry route and indirect contact

Puerperal fever
Puerperal sepsis

Streptococcus pyogenes: while shedding

Normal carriage

From respiratory tract

Source Isolate

Lochia heavily contaminated

Clostridium perfringens: while shedding

From gut

Direct inoculation to genital tract

Nil Isolate until cultures are negative
Mycoplasma hominis: while shedding Genital tract Nil Isolate until cultures are negative
PUO (pyrexia of unknown origin) N/A N/A Source Isolate

Pyrexia or fever of unknown origin sometimes caused by transmissable agents (e.g. viruses, salmonellae)

Therefore isolate until diagnosis made

Q Fever
Coxiella burnetti
N/A From animals, carcases, especially placentae No Case to case transmission is very unlikely  
Quinsy While shedding
S. pyogenes
Throat carriage respiratory and direct contact Source Isolate See Streptococcus pyogenes  
Rabies N/A Infected mammals particularly dogs. Foxes and bats important reservoirs Source Isolate

Patients with rabies do excrete virus in their saliva

However, health care workers have never acquired the disease from an infected patient

Nevertheless, strict hygiene to be observed, gloves while handling secretions

Staff to be immunised if a patient is admitted


Relapsing Fever
Borrelia recurrentis: N/A


Transmitted from man to man by lice (body and head lice)

Common in Egypt N & E Africa and India

Borrelia duttoni: N/A Tick-borne No Central Africa
Respiratory illness (undiagnosed) Usually while symptomatic Respiratory secretions, aerosol, direct mucosal contact Source Isolate

Most virus infections are highly infectious to others

In children, non-specific symptoms herald many exanthems

Rheumatic Fever N/A N/A No

Late immunological response to Group A streptococcal infection

Isolate if Group A strep infection still present

Rickettsial disease Rickettsia conori: N/A Tick borne

Commonest imported rickettsial infection from Mediterranean coasts and Africa

Characteristic rash and myalgia with fever and evidence of tick bite

Causes true Typhus


Rickettsia typhi
Louse borne No

Endemic in Russia and Balkan states and Africa Large epidemics occur in times of war and famine

Reflect increased prevalence of body louse

(Dermatophyte infections)
While shedding infected skin scales Animal and human contacts No

Most of low infectivity to casual contact

Observe standard hygiene precautions

Standard Precautions
Rotavirus Up to 7 days Faecal-oral ? Respiratory Source Isolate

Isolate until diarrhoea stops

Often presents with upper respiratory symptoms but virus cannot be isolated from the upper respiratory tract

VERY infectious

Use gloves and aprons when handling faeces

Do not use mouth suction when taking pharyngeal samples

Roundworm: See Ascariasis          
RSV (Respiratory Syncytial Virus) While symptomatic Respiratory tract, aerosol and indirect mucosal contact Source Isolate

Highly transmissable in paediatic wards

Like common colds, probably more often transmitted by direct contact than by aerosol

Survives on fomites. Therefore strict hand hygiene is important

Rubella 4 days before onset of rash until 7 days afterwards Respiratory tract and direct contact Source Isolate

Incubation period is 14-21 days

Attendants must be rubella immune

Preferably discharge patient home or move to isolation unit

In congenital rubella, babies will excrete virus for a long period

Check for pregnant women in group

See special rubella policy


Rubella (German Measles)
Salmonellosis (see Diarrhoea)         Food Poisoning
Scabies While infected Direct contact No Scabies is not usually transmitted to casual contacts, but may be acquired from profuse lesions (Norwegian variety) because of poor hand hygiene, usually before the diagnosis made Ectoparasites
Scarlet Fever
Group A streptococcus
While throat colonised Respiratory tract. Inhalation or direct contact Source Isolate NOTIFY  
S. mansoni, S.haematobium
S. japonicum
N/A Intermediate hosts, bathing No Not directly transmissable  
Septic abortion
Group A Streptococcus
C. perfringens
While genital tract colonised Direct contact Source Isolate Isolation precautions until antibiotic treatment is well established in case of Group A Streptococcus  
Serratia spp. infection While colonised Direct or indirect contact Source Isolate (if antibiotic resistant)

Like Enterobacter spp. these organisms are markers of cross-infection especially in urine

They tend to acquire resistance to beta-lactam antibiotics

Isolate if gentamicin-resistant


Severe Actue Respiratory Syndrome (SARS)


During illness

Respiratory secretions and faeces

Droplet and indirect hand inoculation

Source Isolate

Contact trace

When SARS is notified, isolate travellers with fever from epidemic regions

Travellers with Respiratory or Rash Illness
Shigellosis (see Dysentery and Diarrhoea)          
Shingles (see Varicella-Zoster virus)         Varicella-Zoster virus (Chickenpox & Shingles)
Variola virus
When rash has developed Aerosol and direct contact Source Isolate

Smallpox is now eradicated

Vaccinia virus is not used for vaccination

Therefore only white pox or monkey pox are likely to present with a syndrome like smallpox

Such rare patients will have been upcountry in various Central African countries

Staphylococcal infections
While shedding from infected lesions Direct or indirect contact Not usually

See separate detailed protocol for methicillin-resistant S. aureus

It is unwise to nurse a patient with boils or infected eczema (i.e. profuse shedders) on a surgical ward

Isolate if resistant organism (e.g. MRSA)

Decontamination of room may be required

Streptococcus pyogenes
Group A beta-haemolytic
While shedding Throat carriage, respiratory and direct contact Until cultures negative

These organisms cause serious cross-infection on burns, plastics and surgical units

Important diseases: tonsillitis, quinsy, erysipelo-cellulitis, fasciitis, puerperal sepsis, scarlet fever, wound infection with cellulitis

May apply at discretion of ICT to groups C and G which may be pathogenic

Strongyloides stercoralis N/A From soil No Not directly transmissable  
Syphilis Primary chancre Direct sexual contact, Transplacental.
Chancre exudate (1 ), blood or other secretions (2 )

Infectivity reduced rapidly by treatment

Wear gloves when dealing with primary and secondary lesions

Neonates may shed organism as in secondary syphilis

Organism supposedly endowed with property of penetrating intact skin, but this is unlikely


Tapeworms Human:Taenia solium

Taenia saginata(Echinococcus spp (see Hydatid diseases)

N/A Eating uncooked meat containing larva No Theoretically eggs from Taenia solium gravid segments are potentially infectious to man if ingested  
(Cl. tetani)
N/A Direct inoculation from contaminated soil, etc. No Re-immunise with injury or every 10 years  
(Enterobius vermicularis)
While shedding eggs Faecal-oral direct contact No

Transmission prevented by simple hygienic measures

Eggs collect under finger nails after scratching perianal area

T. gondii
N/A Ingesting viable ova in (old) cat faeces or cysts in undercooked meat No Not transmitted from man to man (except by transfusion in unusual circumstances)  
T. vaginalis
N/A Sexual transmission No    
M. tuberculosis, etc
While excreting bacilli

Respiratory tract

Aerosol inhalation

Source Isolate

See full protocol for a detailed description


Typhoid fever (see Enteric Fever)          
Typhus (see Rickettsial disease)          
Urethritis While shedding Direct sexual contact No

Major causes: N. gonorrhoeae (see gonorrhoea) and Chlamydia trachomatis

Others form non-specific urethritis group

Urinary tract infections N/A Direct contact Source Isolate (if antibiotic resistant)

Cross-infection with coliforms in urological and other wards is common

Special precautions should be observed with catheter handling, and when organisms are multiply-resistant

Vaccinia (generalized)
Eczema vaccinatum
Active skin lesions and dried crusts contain live virus Direct contact Source Isolate

Smallpox vaccination has now been discontinued

Eczematous patients were particularly susceptible

The virus may be used in the future as a "carrier" for new vaccines

Occasional imported cases of animal pox occur in man

Varicella-zoster virus
Chicken pox: 1-2 days before rash, until all lesions have dried: 6 days in non-immunosuppressed patients

Vesicles, resp. tract. Inhalation or direct inoculation to mucous membranes

Highly infectious

Source Isolate

Transfer home or to Regional Infectious Diseases Unit

Health care workers are particularly susceptible if not immune

Staff who nurse the patient should be known to have had the disease

Varicella-Zoster virus (Chickenpox & Shingles)
Shingles: during vesicular stage

Direct contact

Inoculation of mucous membranes

Source Isolate

Patients appear to be less likely to transmit virus than those with chicken pox

Caution risk of aerosol transmission especially with trigeminal zoster

Viral Haemorrhagic Fevers (Lassa, Marburg, Ebola, Congo-Crimean viruses) Variable Blood and secretion inoculation
Source Isolate


Transfer to High Security Source Isolation at Regional Infectious Diseases Unit

Viral Heamorrhagic Fevers
Whooping cough
(Bordetella pertussis)
Before and during catarrhal phase Respiratory secretions. Aerosol and direct contact Source Isolate


Infectivity reduced by antibiotic treatment (e.g. 3 days after erythromycin) though symptoms continue for months

Wounds (infected) While shedding organisms

Other patients or staff carriers

Direct or indriect contact

Not usually

If infection with MRSA, Group A Streptococcus or gentamicin-resistant coliforms present, Source Isolate patient

Hands must be washed and thoroughly dried after contact with any wound

Wound Management
Yellow Fever N/A Mosquito borne No


Restricted to West Africa, Central and South America

Travellers to those regions are protected by active immunisation so the disease is rarely imported