Isolation precautions for patients with confirmed or suspected ...

IC/278/10 Isolation precautions for patients with confirmed or suspected infectious illness 

BASINGSTOKE AND NORTH HAMPSHIRE NHS FOUNDATION TRUST 

Isolation precautions for patients with confirmed or 

suspected infectious illness 

IC/278/10 

Supersedes: IC/278/07 

Owner Name Hazel Gray 

Job Title 

Senior Infection Control 

Nurse 

Final approval Name 

Infection Control Committee 

committee 

Date of meeting 23 July 2010 

Authoriser Name Dr Nicki Hutchinson 

Job title 

Director Infection Prevention 

and Control 

Signature 

Date of authorisation 24.08.10 

Review date (maximum 3 years from date of July 2013 

authorisation) 

Audience (tick all that apply) Trust staff √ 

NHS √ 

General public 

Standards Standards for Better Health 

NHSLA 

The Health and Social Care Act 2008 

Reviewed in accordance with The Health and Social Care Act 2008: 

Code of Practice for health and adult social care on the prevention and control of 

infections and related guidance published 16 December 2009 

Executive Summary 

It is important to minimise the risk of the spread of infection between patients. 

This policy outlines the measures which should be taken to prevent the spread of 

infection from patients who are known to be a potential source of infection. 

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Implementation Plan 

Summary of changes 

• Contact number changes 

• Isolation sign changes 

• Roles and responsibility 

• Education 

• Evaluation of policy 

• Standard Precautions update 

Action needed and owner of action 

• All staff need to be aware of which patients may need isolating and what type 

of isolation is necessary 

• All staff need to be aware of the role they play in trying to reduce the spread 

of infection 

• All staff need to adhere to this policy 

• The Infection prevention and control team IPCT will evaluate policy when 

required 

• The IPCT will monitor infection rates via alert organism surveillance 

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Contents: 

Page 

1.0 Summary 4 

1.1 Roles and Responsibilities 4 

1.2 Education and training 5 

1.3 Evaluation of this policy 5 

2.0 Introduction 5 

3.0 Policy Objectives 5 

4.0 Categories of isolation 6 

4.1 Ring fencing 6 

4.2 Source isolation 6 

4.3 Protective isolation 6 

5.1 Source isolation 7 

5.2 Patient placement 7 

5.3 Preparation of the isolation room 8 

5.4 Hand Decontamination 8 

5.5 What if you have cuts and breaks in your skin? 9 

5.6 Hand hygiene - patient 9 

5.7 Gloves 9 

5.8 Aprons and gowns 9 

5.9 Masks, face shields or eye protection 10 

5.10 Patient care equipment 10 

5.11 Environmental cleaning 10 

5.12 Linen 10 

5.13 Sharps Management 10 

5.14 Crockery/cutlery 11 

5.15 Bathing 11 

5.16 Transport of infected patients 12 

5.17 Visitors/patients/carers 12 

6.0 References and further reading 12 

Appendix 1: Diarrhoea and/or Vomiting Risk Assessment Algorithm 13 

Appendix 2: Respiratory Risk Assessment 14 

Appendix 3: Skin Infection Risk Assessment Algorithm 14 

Appendix 4: Isolation Priorities 16 

Appendix 5: Risk Assessment using the Isolation Priority Scoring 17 

System 

Appendix 6: Priority Scoring System: Infectious Diarrhoea 18 

Appendix 7: Priority Scoring System: MRSA 19 

Appendix 8: Priority Scoring System: Antimicrobial-Resistant 20 

Bacteria 

Appendix 9: Priority Scoring System: Respiratory Infections 21 

Appendix 10: Priority Scoring System: Other Infectious Diseases / 22 

Conditions 

Appendix 11: Components of standard and transmission based 23 

isolation precautions 

Appendix 12: Signage 24 

Appendix 13: Cleaning Procedure for a Vacated Single Isolation 27 

Room 

Appendix 14: Cleaning Procedure for a Single Isolation Room 28 

Appendix 15: Notifiable infectious diseases & food poisoning 29 

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1.0 Summary 

Isolation precautions are adopted to minimise the risk of spread of an infectious 

disease in the hospital setting. This policy is based on national guidelines that review 

and require assurance that there is a managed environment, which minimises the 

risk of infection to patients, staff and visitors. 

This policy is limited to the description of isolation precautions and must be 

supplemented by the relevant hospital policies and procedures for other aspects of 

infection and environmental control, occupational health, administrative and legal 

issues, and any other issues beyond the scope of this guideline. 

The policy uses a two-tier approach to isolation of patients: standard precautions, 

which should be used for ALL inpatients and transmission based precautions. 

Transmission based precautions use the likely pathogen and its’ mode of spread as 

the main determinant of type of precautions required. Therefore these precautions 

are classified by these 3 main transmission vehicles contact, droplet and air borne. 

The policy contains quick reference guidance attached as appendages. They are: 

• Standard, airborne, droplet and contact precautions 

• Applications of standard precautions 

• Type and duration of precautions needed for selected infections 

• Empiric isolation precautions for clinical conditions to prevent spread pending 

confirmation of diagnosis 

• Isolation signs 

• Cleaning procedure for vacated room 

• Daily cleaning procedure for a single isolation room 

• Notifiable infectious diseases (see Appendix 15) 

Risk assessment should precede isolation of patients especially when single rooms 

are in short supply and patient isolation has to be prioritised. Some new flowcharts 

have been added to this document to try and help you with this process (please see 

Appendices 1-5). 

The decision to isolate a patient should always be discussed with the infection 

prevention and control team. The decision to isolate/close a whole ward/s will be 

undertaken by a Consultant Microbiologist. 

For further information and/or assistance contact the infection control team on 

extension 6774 or via bleeps. 

Hazel Gray } 

Linda Swanson } Bleep 2364 

Out of hours, please contact a Consultant Microbiologist via the switchboard. 

1.1 Roles and Responsibility 

The Executive Director of Nursing on behalf of the Chief Executive will ensure that 

the Clinical Directors take clinical ownership of the policy. 

The Clinical Directors on behalf of the executive director of nursing will ensure that: 

• all health care workers comply with this policy 

• all healthcare workers attend mandatory infection control training 

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The Senior Nurses and Matrons on behalf of the Executive Director of Nursing and 

the Clinical Directors will ensure that: 

• all health care workers comply with this policy 

• all healthcare workers attend mandatory training 

The infection prevention and control team will: 

• act as a resource for information and support 

• monitor the implementation of this policy within clinical areas 

• regularly review and update the policy 

The senior nurse and doctor must ensure that all staff are aware and comply with 

the infection control precautions that need to be taken and follow the advice in this 

policy. 

1.2 Education and training 

All staff that may come into contact with either potential or confirmed infectious 

patients i.e. clinical staff; porters, domestics etc must attend their annual infection 

control mandatory training session. 

1.3 Evaluation of this policy 

It is important to minimise the risk of the spread of infection to and from patients and 

staff. This policy outlines the measures, which should be taken to prevent the spread 

of infection from patients who are known to be a potential source of infection. This 

can be monitored by: 

• monitoring the trends of infections in the trust by analyzing alert organism 

figures 

• ensuring when timely isolation of infected patients cannot occur that 

untoward incident forms are filled in 

• monitoring that the correct signage and isolation guidelines are adhered 

to by all staff by undertaken ad hoc observational audits 

• ensuring that non compliance to the policy is challenged 

2.0 Introduction 

Aim of the policy is to ensure that source isolation procedures are instigated in order 

to minimise the risks of cross infection. The correct and timely placement of infected 

patients (suspected or proven) into single rooms can be very effective in reducing the 

overall numbers of infective patients (DH 2007). 

It is also a requirement of the Health Act 2008 (DH) that an evidence based isolation 

policy exists incorporating local risk assessment findings and measures. This policy 

must include indications and procedures for the infection control management of 

isolated patients. 

3.0 Policy Objectives 

• To identify patients presenting with colonisation, infection or infectious 

diseases that may be a risk to others. 

• To take timely action to prevent the spread of potentially infectious conditions 

by appropriate isolation of the source patient and the appropriate use of 

personal protective equipment. 

• To ensure that patients at high risk of infections due to immunosuppression or 

neutropenia are appropriately isolated and protected to minimise the 

acquisition of such infections. (Please see Trust Protective Isolation Policy) 

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• To ensure that all staff, departments and any outside agencies likely to be 

involved in the care of patients care have a clear understanding of their roles 

and responsibilities in preventing the spread of infection. 

4.0 Categories of isolation 

Isolation must not compromise the clinical care of the patient 

There are two categories of isolation (Ayliffe 2001): 

• Source isolation: when a patient poses an infection risk to others 

• Protective isolation: when a patient is at risk from others 

4.1 Ring fencing 

It is sometimes necessary to ring fence a high-risk area e.g. Orthopaedic or Surgical 

Units as a protective isolation measure. This is due to the significant implications of 

infections amongst these patients. When an area is ring fenced admissions are 

scrutinised to allow ONLY specific groups of patients sharing the same medical 

conditions and risk factors for infection, to be admitted to the ring fenced area. Ring 

fencing works as part of a complete infection control programme with active 

surveillance. It also allows for national targets to be met. 

The decision to ring fence an area should be undertaken between the Hospital 

Infection Control doctor, directorate leads and trust management teams. 

4.2 Source isolation 

Source isolation is the physical separation of one patient from another, in order to 

prevent the spread of infection. Single room isolation will not by itself prevent the 

transmission of organisms; it should be used in conjunction with standard (universal) 

infection control precautions which must be observed at all times with all patients. 

Additional precautions may need to be implemented dependant on the source and 

mode of spread. 

All hospitals providing in-patient care must ensure that they are able to provide or 

secure the provision of adequate isolation facilities for patients sufficient to prevent or 

minimise the spread of Healthcare Associated Infection (DOH 2000) Hospital Trusts 

have a responsibility to ensure that the policy includes the potential risk of infection 

and the use of effective protective measures and equipment (DOH 2006) 

4.3 Protective Isolation 

Protective isolation is the physical separation of patients who are 

Immunocompromised / Immunosuppressed in order to prevent the acquisition of 

infection from other patients, staff or visitors. (Please see separate Trust Protective 

Isolation Policy IC/201/10). 

In both categories: 

• The decision to isolate a patient should be based on the infection risk to other 

patients, staff and visitors 

• An appropriate isolation notice is required and must be placed on the outside 

of the door, outlining the precautions required (see appendix 1) 

• In order to minimize the risks of anxiety and depression that are often 

experienced by many isolated patients, a full explanation of the nature of 

infection, including the symptoms, treatment and the rationale for the control 

measures should be given to the patient 

• Daily assessment and evaluation of the need for ongoing isolation 

precautions must take place 

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• The infection prevention and control team is available for advice and 

guidance. 

5.1 Source Isolation 

Source Isolation is indicated for conditions such as 

• Pulmonary tuberculosis 

• Patients with diarrhoea and or vomiting clinically thought to of infectious origin 

• MRSA, 

• Clostridium difficile 

• Chicken Pox 

• Infections with Extended spectrum β lactamase producing organisms 

(ESBLs) 

• Glycopeptide resistant enterococci including Vancomycin resistant organisms 

(GRE and VRE) 

• Influenza and fevers from the tropics in which an infectious cause cannot be 

ruled out (refer to table and specific policies for further information 

• Amp C producing organisms 

• Scabies 

NB: Please note that this list is not exhaustive. If you think that a patient may 

have an infectious condition that will put others at risk, please discuss with the 

clinical team in the first instance, and consider discussion with the infection 

prevention and control team or microbiologist if indicated. 

5.2 Patient Placement 

Ideally a single room should be allocated to patients with these conditions, but given 

the limited availability of side rooms a risk assessment needs to be undertaken. The 

risk assessment will include the risk factors of the other patients in isolation and the 

patients in the bays. Some new flowcharts have been added to this document to try 

and help you with this process (Please see Appendices 1-5). 

Appropriate patient placement is a significant component of isolation precautions. A 

single room is important to prevent direct- or indirect-contact transmission when the 

source patient has poor hygienic habits, contaminates the environment, or cannot be 

expected to assist in maintaining infection control precautions to limit transmission of 

micro organisms (i.e., infants, children, and patients with altered mental status). 

Where possible, a patient with highly transmissible or epidemiologically important 

microorganisms must be placed in a single room with hand washing and toilet 

facilities, to reduce opportunities for transmission of microorganisms. 

When a single room is not available, an infected patient could be placed with an 

appropriate contact. Patients infected by the same microorganism usually can share 

a room, provided they are not infected with other potentially transmissible 

microorganisms and the likelihood of re-infection with the same organism is minimal. 

Such sharing of rooms, also referred to as cohorting patients, is useful especially 

during outbreaks or when there is a shortage of side rooms. When a side room is not 

available and cohorting is not achievable or recommended, it is very important to 

consider the epidemiology and mode of transmission of the infecting pathogen and 

the patient population being served in determining patient placement. Under these 

circumstances, consultation with infection control professionals is advised 

before patient placement. Moreover, when an infected patient shares a room with a 

non-infected patient, it is also important that staff looking after the patient and visitors 

take precautions to prevent the spread of infection. 

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A single room with appropriate air handling and ventilation is particularly important for 

reducing the risk of transmission of microorganisms from a source patient to 

susceptible patients and other persons in hospitals when the microorganism is 

spread by airborne transmission. Some hospitals use an isolation room with an 

anteroom as an extra measure of precaution to prevent airborne transmission. 

Unfortunately the only side rooms with anterooms in the Trust are on the 

Oncology/Haematology unit and are for use by immunocompromised patients only. 

Under no circumstances should these rooms be used for any other patients 

An alternative to side room is to barrier nursing the patient on the general bay or 

cohorting of patients with the same condition. However please note that not all 

patients with similar symptoms e.g. diarrhoea, have the same aetiology, and 

cohorting should only be done following discussion with the 

Infection prevention and control team/or consultant microbiologist. (Out of hours 

number may be obtained via the switchboard). 

If there are no side rooms available in the immediate vicinity, consult the site team for 

availability on another ward if appropriate. Where a patient is nursed in a general bay 

all appropriate precautions must be implemented and the whole bay isolated. The 

infected patient should be nursed away from other patients at risk .i.e. 

immunocompromised patients and an appropriate sign must be displayed on the 

outside of the bay. 

Once the risk assessment has identified that the patient requires isolation the 

following precautions must be considered:- 

5.3 Preparation of the isolation room 

• All unnecessary equipment and furniture must be removed from the room to 

facilitate cleaning and limit the potential for contamination. 

• All equipment in the room must be dedicated to the isolated patient. 

• The room must not be overstocked as equipment that cannot be cleaned will 

need to be disposed of. 

• All personal belongings and equipment must be washable, cleanable or 

disposable. 

• The patient should not keep unnecessary belongings in the room. 

• The source isolation poster must be placed on the door 

• Single use gloves and aprons must be set up outside the room. If these are 

not wall mounted in the Danicenters a trolley/table/shelf must be used. This 

must be well stocked at all times. 

• Patient notes (charts and kardex) must be kept outside the room to 

reduce the risk of contamination. 

• A yellow plastic bag (for clinical waste) and a water soluble alginate bag and 

red plastic bag (for infected linen) must be available inside the isolation room. 

Use Standard Precautions for the care of all patients. (Please refer to Trust Standard 

Precautions Policy) 

5.4 Hand Decontamination 

• Hands must be decontaminated before each and every episode of direct 

patient contact and/or the patient’s direct environment and after any activity 

that could potentially result in hands becoming contaminated. 

• Hands that are visibly soiled with contaminated dirt or organic material, i.e. 

blood/body fluids must be washed immediately with liquid soap and water 

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• Hands can be decontaminated, with an alcohol based hand rub unless hands 

are visibly contaminated, between caring for different patients and between 

different care activities for the same patient. (Please refer to Trust Hand 

Hygiene Policy) 

5.5 What if you have cuts and breaks in your skin? 

• Cover any existing cuts or lesions with a waterproof dressing, paying 

particular attention to hands and forearms. 

• Any staff with chronic skin lesions to hands or forearms or persistent skin 

problems should avoid undertaking invasive procedures and seek advice 

from the dermatology and Occupational Health Department. 

5.6 Hand hygiene – patient 

The patient is a potential source of spread of organisms to staff, visitors and the 

environment. He/she should be instructed to decontaminate hands before eating and 

after going to the toilet. Liquid soap and water should be used in these circumstances 

5.7 Gloves 

• Selection of protective equipment should be based on an assessment of the 

risk of transmission of microorganisms to the patient and the risk of 

contamination of the healthcare worker’s clothing and skin by patients’ blood, 

body fluids, secretions or excretions. 

• Gloves must be worn for invasive procedures, contact with sterile sites and 

non-intact skin or mucous membranes and all activities that have been 

assessed as carrying a risk of exposure to blood, body fluids, secretions or 

excretions. 

• Gloves must be worn as single use items. They must be put on immediately 

before an episode of patient contact or treatment and removed as soon as 

the activity is completed. Gloves must be changed between caring for 

different patients and between different care and treatment for the same 

patient. 

• Gloves must be disposed of as clinical waste after every procedure/episode 

of care and hands decontaminated thoroughly after the gloves have been 

removed. 

• Neither powdered nor polythene gloves should be used in healthcare 

activities. Any sensitivity to natural rubber latex in patients, carers and 

healthcare staff must be documented and alternative gloves must be 

available. (Please refer to Trust Glove Policy) 

• Wearing gloves does not replace the need for hand washing, because gloves 

may have small, unapparent defects or may be torn during use, and hands 

can become contaminated during removal of gloves. Failure to change 

gloves between patient contacts is an infection control hazard. (Please refer 

to Trust Standard Precautions Policy and Glove Policy 

5.8 Aprons and gowns 

• Disposable plastic aprons should be worn where there is a risk that clothing 

may be exposed to blood, body fluids, secretions and excretions with the 

exception of sweat. 

• Full body fluid repellent gowns must be worn where there is a risk of 

extensive splashing of blood, body fluids, secretions or excretions onto 

the skin or clothing of healthcare workers 

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• Plastic aprons and fluid repellent gowns should be worn as single use items 

for one procedure or episode of patient care and then discarded and 

disposed of as clinical waste. 

• Remove a soiled gown or apron as promptly as possible and wash hands to 

avoid transfer of microorganisms to other patients or environments. 

5.9 Masks, face shields or eye protection 

Wear a mask and eye protection or a face shield to protect mucous membranes of 

the eyes, nose, and mouth during procedures and patient-care activities that are 

likely to generate splashes or sprays of blood, body fluids, secretions, and 

excretions. 

5.10 Patient care equipment 

Handle used patient-care equipment soiled with blood, body fluids, secretions, and 

excretions in a manner that prevents skin and mucous membrane exposures, 

contamination of clothing, and transfer of micro organisms to other patients and 

environments. Ensure that reusable equipment is not used for the care of another 

patient until it has been cleaned and reprocessed appropriately. Ensure that singleuse 

items are not reused and are discarded of properly. 

5. 11 Environmental cleaning 

• There should be clear hospital procedures for the routine care, cleaning, and 

disinfection of environmental surfaces, beds, bedrails, bedside equipment, 

and other frequently touched surfaces with an audit programme to ensure 

that these procedures are being followed. All isolated areas should be 

cleaned 3 times a day with an Actichlor + solution as per Trust Cleaning 

Standards. (Please refer to the Hospital Cleaning Standards) 

• Isolation rooms should be cleaned last; after other rooms, bays and general 

areas on the ward 

• Single use gloves and aprons must be worn when cleaning isolation rooms 

and hands washed before leaving the room. 

• Special attention must be given to all horizontal surfaces and frequently 

touched surfaces, such as door handles/door push plates, nurse call system, 

toilet areas and sink taps. 

5.12 Linen 

• Handle, transport, and process used linen soiled with blood, body fluids, 

secretions, and excretions in a manner that prevents skin and mucous 

membrane exposures and contamination of clothing and that avoids transfer 

of micro organisms to other patients and environments. 

• Ensure that any linen contaminated with blood or body fluids is placed into a 

red alginate bag and then red plastic bag. 

• If linen is excessively wet please ensure that this item is wrapped in another 

item of linen or the alginate bag may leak/split. 

5.13 Sharps Management 

• Sharps must not be passed directly from hand to hand and handling should 

be kept to a minimum 

• Needles must not be resheathed, bent, broken or disassembled prior to 

disposal 

• Always dispose of sharps at the point of use in an appropriate container. 

• Syringes/cartridges and needles should be disposed of intact. 

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• Sharps containers must comply with BS 7320 and UN3291 standards 

• Do not fill sharps containers above the manufacturer’s marked line, which 

indicates that they are full. 

• Lock the used sharps container in accordance with manufacturer’s 

• Do not dispose of sharps with other clinical waste. 

• Do not place used sharps containers in yellow bags for disposal. 

• Ensure that sharps bins are safely positioned away from children/general 

public 

• Ensure the temporary closure lid is in place when not in use 

• Do not remove sharps from the clinical setting. 

NB: In the event of a sharps injury or contamination of broken skin/ mucous 

membranes with blood or body fluids, ensure that the Needlestick injury procedure is 

followed. (Please refer to Trust Sharps Contamination Policy and Safe Handling of 

Sharps Policy) 

5.14 Crockery/cutlery 

• All crockery/cutlery must be decontaminated in a dishwasher with a final 

rinse temperature of 80°C. 

• Washing by hand is inadequate. 

• There is no requirement for disposable crockery and cutlery to be used. 

5.15 Bathing 

• To reduce the risk of cross-infection, patients with infections must be 

bathed last. 

• The bath should be cleaned with Actichlor + (1,000 ppm) after use by the 

isolated patient (this method of disinfection is adequate for use after 

bathing infected patients). 

• If showers are used the procedure is as for baths. 

5.16 Transport of Infected Patients 

Limiting the movement and transport of patients infected with virulent or 

epidemiologically important microorganisms and ensuring that such patients leave 

their rooms only for essential purposes reduces opportunities for transmission of 

microorganisms in hospitals. When patient transport is necessary, it is important that: 

• Movement of infectious or potentially infectious patients should be kept to a 

minimum. When it is necessary to transport patients to other wards or 

departments, precautions to minimize the risks of transmission must 

continue. 

• If it is possible to delay an investigation without adversely affecting the 

patients management this should be considered. However the presence of an 

infectious disease should not delay urgent clinical investigations. 

• The receiving area must be informed prior to transfer to ensure that they have 

the appropriate precautions in place and that appropriate facilities are 

available. 

• Patients with known or suspected infections must as far as possible be seen 

at the end of the list and not be left in the waiting areas. This will allow 

adequate cleaning of the environment and equipment following the 

appointment and reduce the risks to other patients. 

• Check specific infection control policies for advice and guidance. 

• Consult the infection prevention and control team for any further advice or 

guidance 

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5.17 Visitors/Patients/Carers 

• Explain the precautions required whilst maintaining the patient’s 

confidentiality. 

• Visitors should be advised to wash their hands with liquid soap and water in 

the following circumstances: 

o Hands are visibly soiled; 

o Following close physical contact with the patient or his/her immediate 

o 

environment. 

In addition, visitors should be advised to clean their hands with liquid 

soap and water after removing gloves and apron (if worn, see below) 

and immediately before entering and leaving the isolation 

room(alcohol rub may be used as an alternative for hand 

decontamination in this instance unless the reason for source isolation 

is C. difficile 

• Discourage visitors from having contact with other patients in the ward or 

hospital 

• Check with specific policies regarding specific diseases to ascertain whether 

visitors should be excluded due to particular susceptibility. 

• Visitors do not need to wear aprons and gloves unless helping with personal 

care or otherwise advised by Infection Control. 

6.0 Post isolation/discharge/death 

New patients must not be admitted to the room until it has undergone a deep 

clean. 

• A patient should be removed from isolation when he/she is no longer at risk of 

spreading infection to others (refer to the new LTHT alert organism/condition 

policy). This may be decided following consultation with a member of the 

infection prevention and control team or on the basis of an infection 

prevention and control policy (e.g. after 72 hours symptom free following 

gastroenteritis or C. difficile infection) 

• At a minimum, daily assessment and evaluation of the patient's symptoms are 

therefore important 

• Some specific disease policies give criteria on when isolation precautions can 

be stopped 

• If in doubt, discuss with the infection prevention and control team 

• The vacated room must be cleaned thoroughly using Actichlor + solution (1 

tablet to a litre of water) all equipment and belongings must be cleaned before 

being brought out of the room or used again. Any unused disposable items, 

which may be contaminated and cannot be cleaned must be disposed of 

(Please see Trust cleaning Standards). 

7.0 References and further reading 

• Ayliffe GAJ, Lowbury EJL, Geddes AM and Williams JD. Control of Hospital 

Infection a Practical Handbook, 3rd Edition. London: Blackwell Scientific 

Publications, 1988: 70. 

• Horton R. Hand washing: the Fundamental Infection Control Principle. British 

Journal of Nursing, 1995; 4 (16): 226-233. 

• Maurer IM. Hospital Hygiene, 3rd Edition. London: Edward Arnold, 1985: 50. 

• Lewis AM, Gammon J, Hosein I. The Pros and Cons of isolation and 

Containment. Journal of Hospital Infection, 1999; 43: 19-23. 

• Wilson J. Theory and Practice of Isolation Nursing. Nursing Standard, 1992; 6 

7): 30- 31 

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Appendix 1 

Diarrhoea and/or Vomiting Risk Assessment Algorithm 

Ask: does the patient usually suffer from: 

No 

• Colitis 

• Diverticulitis 

• Irritable bowel syndrome 

• Take laxatives Yes 

Urgent nursing assessment required 

Consider overflow/constipation/diet related eg enteral feeding/ 

high fibre diet 

Is this normal bowel habit for the patient (ask!)? 

If still unexplained diarrhoea +/- vomiting potentially infectious: 

• Isolate in sideroom as a priority. Send stool sample 

• Obtain prompt medical review. Seek Gastroenterologist 

advice with diagnosis if necessary 

No 

Yes 

Unlikely to be infectious 

Isolation not usually 

required unless for 

purposes of patient dignity 

Laboratory confirmed diagnosis of C.Diff/Norovirus/Campylobacter/Salmonella/Shigella? 

Patient to remain in isolation until 72 hrs clear of symptoms. All except Norovirus may be considered for Isolation Ward transfer. 

Confirmed Norovirus cases MUST remain in isolation on base ward to reduce the risk of spread of outbreak to other areas. 

Page 13 of 37


Appendix 2 

Respiratory Risk Assessment 

Suspected/confirmed TB lungs/larynx? 

(TB in “closed sites” eg not in 

lung/larynx/discharging wound does not 

usually require isolation). 

Suspected /confirmed 

H1N1/Flu A? 

Suspected/confirmed Bacterial 

Meningitis (viral meningitis does 

not require isolation) 

Yes No Yes No 

No 

Yes 

• Respiratory 

isolation required* 

• If multi resistant TB 

suspected seek 

immediate duty 

microbiologist 

advice 


isolation not 

required 

• Use of 

appropriate 

PPE required 

when 

performing 

aerosol 

generating 

procedures 


isolation 

required* 

• Prompt 

transfer to 

Isolation Ward 

E floor 

required 

• Prompt 

medical review 

required 

Respiratory 

isolation not 

required 


isolation* required 

for the first 24hrs of 

IV Antibiotic 

treatment 

*Respiratory isolation requires the use of aprons/gloves/ FFP2 or FFP3 mask. 

Please contact a member of the Infection Prevention and Control team or the Consultant Microbiologist for any specialist advice 

regarding respiratory isolation. Out of hours please contact the duty Consultant Microbiologist via the hospital switchboard. 

Page 14 of 37


Appendix 3 

Skin Infection Risk Assessment Algorithm 

Suspected/confirmed: 

Shingles 

Chicken 

Pox 

Scabies 

Lice 

Evidence of 

lesions/weeping 

vesicles of unknown 

origin 

TB suspected in 

oozing/ 

discharging 

wounds? 

Isolate into 

side room 

until 

dry/healed 

skin 

Isolate into side 

room until 

vesicles 

dry/healed 

Isolate in side room until 

1 st treatment completed. 

May then be de-isolated. 

Patients with Norwegian 

scabies need to remain in 

isolation 

Isolate in side 

room until 

treated. 

May then be 

de-isolated. 


room and obtain 

prompt medical 

review/dermatologist 

opinion. 


room until wound 

dry and 

completely 

healed 

Please note in the case of shingles and chicken pox special precautions are required with certain groups of healthcare workers e.g 

pregnant healthcare workers. These workers and those who do not have immunity (have not previously had chicken pox) should not enter 

the isolation room of these patients where at all possible. 

For any further advice regarding this please contact either a member of the Infection Prevention and Control Team or the Consultant 

Microbiologist. 

Page 15 of 37

Appendix 4 

Isolation Priorities 


HIGH 

Do not remove from isolation without prior 

discussion with duty microbiologist/ICT 

MEDIUM 

LOW 

• Diarrhoea and/or vomiting of unknown 

origin 

• Suspected/confirmed Norovirus 

• Suspected/confirmed C.diff 

• Suspected/confirmed Pulmonary TB 

including MDRTB. Possible MDRTB 

must be discussed immediately with 

the duty microbiologist 

• Suspected/confirmed Chicken 

pox/Shingles/Measles 

• MRSA in sputum/exudating 

wound/MRSA skin shedder/high 

mupricin resistance/MRSA 16 or 18 

• E.coli 0157/Shigella/Salmonella 

• Norwegian scabies 

• Pandemic influenza 

• Viral haemorrhagic fever – possible 

cases must be discussed with the duty 

microbiologist immediately 

• ESBL/AMP C/Acinetobacter 

• GRE 

• RSV/Influenza 

• Mumps 

• Meningitis with cough (isolation for 24 

hrs IVABX) 

• Strep A/Strep G on high risk areas 

(isolation for first 24 hrs of IVABX) 

• Open weeping TB lesions to skin 

• MRSA 15 or 16 post full screen and on 

Mupiricin 

• Meningitis (undiagnosed or 

meningococcal) no cough 

• Strep A/G (after 24 hrs IVABX) 

• Scabies (isolate until first treatment 

completed) 

NB: MRSA 16 and 18 strains can be more resistant to antibiotics and also resistant to Mupiricin 5 and 200, due to the resistance of the strain these 

patients cannot be placed in an open bay or with any other MRSA positive patient 

Page 16 of 37


Appendix 5: Risk Assessment using the Isolation Priority Scoring System 

The isolation priority scoring system is based on factors likely to influence the 

transmission of a pathogen and its impact e.g. pathogenic potential, mechanism of 

transmission, antibiotic resistance, susceptibility of other patients, prevalence in the 

hospital (see Table 2, pg11). 

All patients considered for admission to the Isolation Ward must be risk 

assessed and assigned a score using the Isolation Priority Scoring System for 

the relevant infectious disease/condition (see Tables 3-7, pg12 – pg16). This 

assessment will be guided by the nurse in charge of the Isolation Ward with 

the support of the Infection Control Team. The level of priority: high, medium 

or low, can be determined depending on the score as indicated in Table 1 

Table 1: Appropriate Isolation Facility according to Level of Priority 

Score Priority Appropriate Isolation Facility 

>45 High Single room on Isolation Ward with ensuite bathroom 

facilities 

OR 

If indicated, negative pressure room at a regional specialist 

unit (Southampton or London) 

25-45 Medium Single room on Isolation Ward with ensuite bathroom 

facilities 


Appendix 6: Priority Scoring System: Infectious Diarrhoea 

Table 3: Priority Scoring Table for Infectious Diarrhoea 

Infection Route 

of 

spread 

Antimicrobial 

resistance 

Clostridium 

difficile 

Contact 

(faecaloral) 

Evidence 

for 

spread in 

hospital 

Variable 

factors, e.g. 

patient 

susceptibility, 

dispersal risk 

Strong Little Profuse 

diarrhoea with 

faecal 

incontinence, 

patient 

confused/ 

Uncooperative 

Continent and 

cooperative 

Risk 

category 

Score 

Length of 

isolation 

High >45 Until 

diarrhoea 

resolved 

for 72hrs 

Medium 35 

Norovirus 

E. coli 

0157, 

Salmonella 

Shigella 

Aerosol 

and 

Contact 


Contact 


Strong Little To remain in 

isolation in 

base ward 

/area due to 

risk of 

spreading 

outbreak to 

other 

wards/areas 

Moderate Little Profuse 

diarrhoea with 

faecal 

incontinence, 

patient 

confused/ 

Uncooperative 

Continent and 

cooperative 


diarrhoea / 

vomiting 

resolved 



diarrhoea 

resolved 


Medium 35 

Page 18 of 37


Appendix 7: Priority Scoring System: MRSA 

Table 4: Priority Scoring Table for MRSA 

Condition Route 

or of 

infection spread 

MRSA15 

or 16 

MRSA 17 

or MRSA 

with high 

level 

mupirocin 

resistance 

Evidence 


spread in 

hospital 

Antimicrobial 

resistance 

Variable 


patient 



Contact Strong Moderate Skin shedder 

(e.g. eczema, 

psoriasis), 

discharging 

wound or 

sputum 

colonised 

>1 site 

colonised or 

uncovered 

wound 

Nasal carriage 

only - post full 

screen and on 

mupirocin 

Contact Strong Serious Skin shedder 

(e.g. eczema, 

psoriasis), 

discharging 

wound or 

sputum 

colonised 

Not a skin 

shedder 

Risk 


High 


Medium 35 

Length of 

isolation 

>45 Indefinite 

Low 0 Continue 

screening, 

aim to 

clear 

High 50 Indefinite 

High 

>45 

Page 19 of 37


Appendix 8: Priority Scoring System: Antimicrobial-Resistant Bacteria 

Table 5: Priority Scoring Table for Antimicrobial-Resistant Bacteria 

Condition or 

Antimicrobial 

infection 

resistance 

ESBL, 

Acinetobacter 

Route 

of 

spread 

Contact 

and 

droplet 

Evidence 


spread 

in 

hospital 

Variable 


patient 



Moderate Serious Sputum 

colonised 

Risk 



Length 

of 

isolation 

Medium 45 Indefinite 

Oncology 

ward, ICU 

Medium 45 

Glycopeptide 

resistant 

enterococci 

(GRE) 

Contact Strong Serious Oncology ward 

or immunocompromised 

patients 

Other wards, 

diarrhoea 

Medium >45 Indefinite 

Medium 30 

Other wards, 

faecal 

colonisation – 

no diarrhoea 

Low 20 

Page 20 of 37


Appendix 9: Priority Scoring System: Respiratory Infections 

Table 6: Priority Scoring Table for Respiratory Infections 


Antimicrobial 

infection 

resistance 

Penicillin 

resistant 

Streptococcus 

pnemoniae 

Route 

of 

spread 

Evidence 


spread 

in 

hospital 

Variable 


patient 



Risk 


Score Length of 

isolation 

Droplet Strong Moderate Cough High 50 Until 

cough 

resolves 

No cough Medium 40 


syncytial virus 

(RSV) / 

influenza 

Droplet 

and 

contact 

Strong N/A Non-epidemic 

situation 

Epidemic 

situation 

Medium 40 Until 

symptoms 

resolve 

Medium 35 

Pulmonary / 

Laryngeal 

Tuberculosis 

– ‘open’ 

(untreated) 

Tuberculosis 

lesions 

(weeping) 

Airborne Strong 

N/A (see 

below – 

MDRTB) 

Contact Poor N/A (see 

below - 

MDRTB) 

Refer to TB 

Policy 

Refer to TB 

Policy Medium - 

Low 

High 55 Refer to 

TB Policy 

25 Refer to 

TB Policy 

Pulmonary 

Tuberculosis 

– multi-drug 

resistant 

Airborne Strong Serious Refer to TB 

Policy 

High 65 Transfer 

to 

regional 

specialist 

unit 

Page 21 of 37


Appendix 10: Priority Scoring System: Other Infectious Diseases / Conditions 

Table 7: Priority Scoring Table for other Infectious Diseases / Conditions 


Antimicrobial 

infection 

resistance 

Chicken pox 

(varicella) / 

shingles 

Route 

of 

spread 

Airborne 

and 

contact 

Evidence 


spread 

in 

hospital 

Variable 


patient 



Strong Little Antenatal, 

postnatal, 

oncology, 

immunocompromised 


Risk 



Length 

of 

isolation 

High 50 Until 

spots/ 

lesions 

crusted 

All other wards Medium 40 

Measles Airborne Strong Little Antenatal, High 50 14 days 

postnatal, 

oncology, 




Mumps Droplet Moderate Little Antenatal, Medium 35 9 days 

postnatal, 

oncology, 




Meningitis 

(undiagnosed 

or 

meningococcal) 

Droplet Poor Little Cough Medium 25 24 hrs 

with 

No cough Low 15 effective 

antibiotic 

therapy 

Low 20 24 hrs 

after 

Scabies Contact Strong N/A Avoid 

prolonged skin 

to skin contact 

Scabies – 

disseminated 

(Norwegian) 

Streptococcus 

Groups A and 

G 

Contact Strong N/A Avoid direct 

contact with 

skin and 

environmental 

surfaces (use 

PPE) 

treatment 

High >45 Indefinite 

Droplet Strong Little Surgical wards Medium 30 24 hrs 

with 

Other wards Low 20 effective 

antibiotic 

therapy 

Page 22 of 37


Appendix 11: Components of standard and transmission based isolation 

precautions 

Hand 

washing 

Gloves 

Masks 

Eye/face 

protection 

Apron/gown 

Standard Contact Droplet Airborne 

√ √ √ √ 

When likely to 

touch, blood, 

body fluids and 

contaminated 

items 

During 

procedures 

likely to 

generate 

contamination 

with blood and 

body fluids 

During 

procedures 

likely to 

generate 

contamination 


body fluids 

During 

procedures 

likely to 

generate 

contamination 


On entering 

room, during 

care 

As per 

standard 

As per 

standard 

On entering if 

contact with 

patient or 

environment 

anticipated 

As per 

standard 

As per 

standard and if 

within 1 metre 

of patient 

As per 

standard and if 

within 1 metre 

of patient 

As per 

standard 

body fluids 

Equipment √ √ √ √ 

Cleaning √ √ √ √ 

Linen √ √ √ √ 

Isolation 

room 

Single room 

not required 

Single room 

and minimise 

time outside 

Single room 

and minimise 

time outside 

when patient 

may wear 

mask 

As per 

standard 


non-immune. 

Non-essential, 

susceptible 

people should 

be excluded 


non-immune. 

Non essential, 

susceptible 

people should 

be excluded 

As per 

standard 

Single room 

+/- negative 

pressure 

ventilation, 

minimise time 

outside and 

patient should 

wear mask, 

exclude non 

essential 

susceptible 

staff 

Page 23 of 37


Appendix 12: Signage 

ALL VISITORS PLEASE: 

• Ask a nurse before entering so she/he can explain any precautions you need to take, such as wearing gloves, aprons or masks. 

• Use the alcohol gel provided before entering the room and wash your hands with soap and water before leaving the room. 

• Close the door behind you. 

ALL STAFF PLEASE: 

• Wash your hands and wear appropriate protective equipment prior to contact with the patient and/or patient environment. 

• Wash your hands prior to leaving the room. 


Page 25 of 37


ALL VISITORS PLEASE: 

• Ask a nurse before entering so she/he can explain any precautions you need to take, such as wearing gloves, aprons or 

masks. 

• Use the alcohol gel provided before entering the room and wash your hands with soap and water before leaving the 

room. 

• Please do not visit if you have a cough/cold or sore throat or have been unwell within the last 7 days 


ALL STAFF PLEASE: 

• All Staff members entering the room MUST wear aprons and gloves 

• Please do not visit if you have a cough/cold or sore throat or have been unwell within the last 7 days 

• Please adhere to standard infection control precautions at all times 

• Please ensure door is closed at all times 

Page 26 of 37


Appendix 13: 

Cleaning Procedure for a Vacated Single Isolation Room 

Required: 

• Caution sign 

• Yellow apron and disposable gloves 

• Mop and bucket 

• Cleaning clothes 

• Detergents/hypochlorite solution 

• Yellow bag for clinical waste 

• Mask & Goggles (optional depending on operators risk assessment) 

Clean fixtures & Fittings: 

• Remove toilet rolls if soiled with body fluids 

• Remove clinical and domestic waste 

• Clean sanitary ware and overhead bed lamps with Actichlor + solution 

• Note: Hand towels do not need to be thrown away if they are in the dispenser 

or still wrapped 

Equipment use: 

• Use Actichlor + hypochlorite solution to clean and disinfect items. 

• Remove from 'Dirty Area' to corridor clean area e.g. corridor etc 

• Remove/take down all curtains including door curtains and place in red 

alginate bag and then Purple plastic bag 

• Spot clean visibly soiled area on walls 

• Liaise with Infection prevention and control/Estate Services if full height wall 

washing is considered necessary 

• Clean edges, ledges, pipes and radiators thoroughly 

• Ensure the floor is cleaned thoroughly including corners 

• Cleaning is complete when the room, furniture and fittings are free from dust, 

debris, spillage and moisture 

• Dispose of gloves and apron correctly and wash hands thoroughly 

• Return clean furniture to clean room. 

• Replace/re hang curtains correctly if hooks are loose or missing 

• Replenish toilet rolls and paper towels. 

• Replace clinical and domestic waste bin liners 

• Inform nursing staff that the room is now ready for use 

Page 27 of 37


Appendix 14: 

Cleaning Procedure for a Single Isolation Room 

All cleaning equipment used in these rooms will be kept exclusively for use within 

these rooms. 

1. Floors should be cleared of debris by the use of a disposable dust control 

mop. The disposable strip will be removed from the head and placed in a 

yellow refuse bag before leaving the room. 

2. A single bucket and mop handle will be kept within the room for damp 

mopping of the floor. 

3. Disposable yellow cloths will be used for damp dusting and washing of 

furniture /equipment. They will be placed in a yellow refuse bag inside the 

room. 

4. Protective clothing will be worn as instructed. 

5. Blood and blood stained body fluid spillages must be cleaned using a 

hypochlorite solution as per Trust Cleaning Standards. 

6. All horizontal surfaces must be wiped over with an Actichlor + solution. 

7. It is not necessary to wash walls unless they are visibly soiled. 

8. Dust must be kept to a minimum. 

9. Clinical waste (e.g. protective clothing contaminated with body fluids) must be 

bagged in yellow bags. 

10. Domestic waste (e.g. hand towels) must be bagged in yellow bags. 

11. All waste bags for disposal must be secured with tape. 

12. When room is vacated follow cleaning procedure for a vacated single isolation 

room. 

Page 28 of 37


Appendix 15: Notifiable infectious diseases & food poisoning 

The statutory notification of infectious diseases has been a crucial health protection 

measure in this country since the late 19th century. The purpose of notification is to 

enable the prompt investigation, risk assessment and response to cases of infectious 

disease and contamination that present a significant risk to human health. 

Notification has the secondary benefit of providing data for use in the epidemiological 

surveillance of infection and contamination. 

Notification duties of Registered Medical Practitioners (RMPs) 

RMPs attending a patient are required to notify the proper officer of the local authority 

in which the patient resides when they have “reasonable grounds for suspecting” that 

the patient: 

• has a notifiable disease as listed in this appendix of the Notification 

Regulations; or 

• has an infection not included in Schedule 1 which in the view of the RMP 

presents, or could present, significant harm to human health (e.g. emerging or 

new infections); or 

• is contaminated (such as with chemicals or radiation) in a manner which, in 

the view of the doctor presents, or could present, significant harm to human 

health; or 

• has died with, but not necessarily because of, a notifiable disease, or other 

infectious disease or contamination that presents or could present, or that 

presented or could have presented significant harm to human health. 

RMPs should not wait for laboratory confirmation or results of other investigations in 

order to notify a case. This will ensure prompt notification so that health protection 

interventions and control measures can be initiated as soon as possible. 

If laboratory test results refute the clinical diagnosis later, the RMP is not required to 

de-notify the case. However, they should contact the proper officer if they made 

administrative errors in the notification process. When a statutory notification is 

made, it is useful to mention the notification in the patient’s records. This will help to 

avoid duplicate notifications. 

When a patient is referred from one RMP to another, the first RMP who forms a 

clinical suspicion that a patient suffers from a notifiable disease or other infectious 

disease or contamination that presents, or could present, harm to human health 

should notify the case. This is to prevent unnecessary delay in advising or 

implementing public health measures 

Time frame for notifications 

The RMP should send a written notification to the proper officer of the local authority 

so that it is received within three days, beginning with the day on which the RMP 

forms the clinical suspicion or makes the clinical diagnosis. However, if the RMP 

considers the case requires urgent notification, they need to notify it orally – usually 

by telephone – as soon as reasonably practicable and follow this up with written 

notification within three days. It is recommended that urgent notifications are made 

as soon as possible after the RMP forms the clinical suspicion or makes the 

clinical diagnosis, and always within 24 hours. 

In determining whether a case is urgent or not, factors that should be considered 

include the: 

Page 29 of 37


• Nature of the suspected notifiable disease, other relevant infection or relevant 

contamination including morbidity, case-fatality and epidemiology of the 

disease – a rare disease, or one that is re-emerging, is likely to need urgent 

notification. 

• Ease of spread of that disease or infection, route of transmission (for 

example, a highly infectious respiratory disease) or potential spread of 

contamination. 

• Ways in which the spread of the notifiable disease, other relevant infection or 

contamination can be prevented or controlled, for example by immunisation, 

disinfection, isolation or prophylactic treatment. 

• Specific circumstances of the case which might represent particular risks, 

such as occupation, age and sex. These details have a bearing if, for 

example, a patient is a healthcare worker, a child attending nursery or a 

woman of child-bearing age. 

There may be other circumstances where urgent notification is necessary, for 

example, if a disease appears to be a cluster of cases rather than a single case. 

Providing relevant information 

The notification by RMPs must include the following information about the patient in 

so far as it is known to them: 

• name, date of birth and sex; 

• home address including postcode; 

• contact telephone number; 

• current residence (if it is not the home address); 

• NHS number; 

• occupation (if the RMP considers it relevant); 

• name, address and postcode of place of work or educational establishment (if 

the RMP considers it relevant); 

• ethnicity; 

• relevant overseas travel history; 

• contact details of a parent (if the patient is a child); 

• disease or infection which the patient has or is suspected of having or the 

nature of the patient’s contamination or suspected contamination; 

• date of onset of symptoms; and 

• date of diagnosis. 

The notification should also include the name, address and telephone number of the 

RMP making the notification. 

Page 30 of 37


Alogorithm 1: The notification process 

Patient 

Seen by Registered Medical 

Practitioner (RMP) 

Clinically suspected or 

diagnosed notifiable disease 

NO 

YES 

URGENT 

RMP considers case 

urgent and notifies the 

proper officer by 

telephone. It is 

recommended that 

urgent notifications are 

made as soon as 

possible after clinical 

suspicion or diagnosis 

and always within 24 

hours. Oral 

notification needs to 

be followed by a 

written notification 

within three days 

NON URGENT 

RMP notifies the 

proper officer in writing 

within three days 

Other infection or 

contamination that presents, or 

could be present, significant 

harm to human health is 

suspected or diagnosed 

NO 

No requirement to 

notify 

Proper officer receives notification 

YES 

Proper officer considers the 

case to be urgent 

NO 

URGENT 

Proper officer passes on notification specified below 

orally – normally be telephone – as soon as 

reasonably practicable. Oral notification needs to be 

followed by written notification within three days 

NON URGENT 

Proper officer passes on notifications 

specified below in writing within three 

days 

The proper officer of the local authority (LA) sends a copy of the notification to the HPA, 

the proper officer of the LA in whose area the patient usually resides (if different) or 

proper officer of the port health authority or the LA of the patient’s port of 

disembarkation (if relevant) 

Page 31 of 37


Page 32 of 37


Table 1: Notifiable diseases, with explanatory notes and guidance on the need 

for urgent notification 

NB: This table is only for guidance and each case should be considered individually. 

Notifiable diseases Definition/comment Likely to be urgent? 

Acute encephalitis 

No 

Acute meningitis Viral and bacterial Yes, if suspected bacterial 

infection 

Acute poliomyelitis 

Yes 

Acute infectious hepatitis Close contacts of acute Yes 

hepatitis A and hepatitis B 

cases need rapid 

prophylaxis. Urgent 

notification will facilitate 

prompt laboratory testing. 

Hepatitis C cases known to 

be acute need to be followed 

up rapidly as this may signify 

recent transmission from a 

source that could be 

controlled. 

Anthrax 

Yes 

Botulism 

Yes 

Brucellosis 

No – unless thought to be UK 

acquired 

Cholera 

Yes 

Diptheria 

Yes 

Enteric fever (typhoid or 

paratyphoid fever) 

Clinical diagnosis of a case 

before microbiological 

confirmation (e.g. case with 

fever, constipation, rose 

spots and travel history) 

would be an appropriate 

trigger for initial public health 

measures, such as exclusion 

of cases and contacts in high 

risk groups (e.g. food 

Yes 

Food poisoning 

handlers). 

Any disease of infectious or 

toxic nature caused by, or 

thought to be caused by 

consumption of food or water 

(definition of the Advisory 

Committee on the 

Microbiological Safety of 

Food) 

Haemolytic uraemic 

syndrome (HUS) 

Infectious bloody diarrhoea See also HUS in Schedule 1 

and VTEC in Schedule 2 

Invasive group A 

streptococcal disease and 

scarlet fever 

Legionnaires’ disease 

Leprosy 

Malaria 

Measles 

Meningococcal septicaemia 

Clusters and outbreaks, yes. 

For specific organisms see 

Table 2 

Yes 

Yes 

Yes, if IGAS. No, if scarlet 

fever 

Yes 

No 

No, unless thought to be UK 

acquired 

Yes 

Yes 

Page 33 of 37


Notifiable diseases Definition/comment Likely to be urgent? 

Mumps 

Post-exposure immunisation No 

(MMR or HNIG) does not 

provide protection for 

contacts 

Plague 

Yes 

Rabies 

A person bitten by a 

Yes 

suspected rabid animal 

should be reported and 

managed urgently but if a 

patient is diagnosed with 

symptoms of rabies they will 

not pose a risk to human 

health 

Rubella 

Post-exposure immunisation No 

(MMR or HNIG) does not 

provide protection for 

contacts 

SARS 

Yes 

Smallpox 

Yes 

Tetanus 

No, unless associated with 

injecting drug use 

Tuberculosis 

No, unless healthcare worker 

or suspected cluster or multi 

drug resistance 

Typhus 

No 

Viral haemorrhagic fever 

Yes 

(VHF) 

Whooping cough 

Yes, if diagnosed during 

acute phase 

Yellow fever 


acquired 

NB: RMPs are also required to notify suspected cases of other infections (“other 

relevant infection”) or contamination (“relevant contamination”) that present, or could 

present, significant harm to human health (see 3.2 and 3.3). 

Page 34 of 37


Table 2: Causative agents, with explanatory notes and guidance on the need 

for urgent notification 

As regards urgency, the key consideration will be the likelihood that an intervention is 

needed to protect human health and the urgency of such an intervention. The 

likelihood of the diagnosis of an infection being considered urgent may also increase 

if it is part of a known or suspected cluster, or in someone with increased risk of 

transmission such as enteric infection in a food handler. 

NB: This table is only for guidance and each case should be considered individually. 

Notifiable organisms Definition/comment Likely to be urgent? 

Bacillus anthracis 

Yes 

Bacillus cereus 

Only if associated with food 

poisoning 

No, unless part of a known 

cluster 

Bordetella pertussis 

Yes, if diagnosed during 

acute phase 

Borrelia spp 

No 

Brucella spp 


acquired 

Burkholderia mallei 

Yes 

Burkholderia pseudomallei 

Yes 

Camplyobacter spp 


cluster 

Chikungunya virus 


acquired 

Chlamydophila psittaci 

Yes if diagnosed during 

acute phase or part of a 

known cluster 

Clostridium botulinum 

Yes 

Clostridium perfringens Only if associated with food 

poisoning 

No, unless known to be part 

of a cluster 

Clostridium tetani 

No, unless associated with 

injecting drug use 

Corynebacterium diphtheriae Notify without delay, before Yes 

results of toxigenicity tests 

are known 

Corynebacterium ulcerans Notify without delay, before Yes 

results of toxigenicity tests 

are known 

Coxiella burnetii 

Yes if diagnosed during 

acute phase or part of a 

known cluster 

Crimean-Congo 

Yes 

haemorrhagic fever virus 

Cryptosporidium spp 

Dengue virus 

Ebola virus 

Entamoeba histolytica 

Francisella tularensis 

Giardia lamblia 

No, unless part of known 

cluster, known food handler 

or evidence of increase 

above expected numbers 


acquired 

Yes 

No, unless known to be part 

of a cluster or known food 

handler 

Yes 

No, unless part of known 

cluster, known food handler 

Page 35 of 37


or evidence of increase 

above expected numbers 

Notifiable organisms Definition/comment Likely to be urgent? 

Guanarito virus 

Haemophilus influenzae 

Hanta virus 

Hepatitis A, B, C, delta and E 

viruses 

Influenza virus 

Junin virus 

Kyasanur Forest disease 

virus 

Lassa virus 

Legionella spp 

Leptospira interrogans 

Listeria monocytogenes 

Machupo virus 

Marburg virus 

Measles virus 

Mumps virus 

Mycobacterium tuberculosis 

complex 

Neisseria meningitidis 

Invasive i.e. from blood, 

cerebrospinal fluid or other 

normally sterile site 

All acute and chronic cases 

Excluding asymptomatic 

cases (e.g. throat carriage) 

Yes 

Yes 

Omsk haemorrhagic fever 

Yes 

vrius 

Plasmodium falciparum, 

vivax, ovale, malariae, 

knowlesi 

Polio virus Wild or vaccine types Yes 

Rabies virus 

Classical rabies and rabies Yes 

related lyssaviruses 

Rickettsia spp 

Rift Valley fever virus 

Rubella virus 

Sabia virus 

Salmonella spp Including S. Typhi and S. 

Paratyphi 

SARS coronavirus 

Shigella spp 


acquired 

All acute cases and any 

chronic cases who might 

represent a high risk to 

others, such as healthcare 

workers who perform 

exposure-prone procedures 

No, unless known to be a 

new sub-type of the virus of 

associated with known 

cluster or closed 

communities such as care 

homes 

Yes 

Yes 

Yes 

Yes 

No 

Yes 

Yes 

Yes 

Yes 

No 

No, unless healthcare worker 

or suspected cluster or multidrug 

resistance 

Yes 


acquired 


acquired 

Yes 

No 

Yes 

Yes, if S. Typhi or S. 

Paratyphi or suspected 

outbreak or food handler or 

closed communities such as 

care homes 

No, if sporadic cases of other 

Salmonella species 

Yes 

Yes, except Sh. Sonnei 

unless suspected outbreak or 

Page 36 of 37


Streptococcus pneumoniae 

Streptococcus pyogenes 

Varicella zoster virus 

Variola virus 

Verocytotoxigenic 

Escherichia coli 

Vibrio cholerae 

West Nile virus 

Yellow fever virus 

Yersinia pestis 



normally sterile site 



normally sterile site, or 

associated with necrotising 

soft tissue infection 

Including E. coli O157 

food handler or closed 

communities such as care 

homes 


cluster 

Yes 

No 

Yes 

Yes 

Yes 


acquired 


acquired 

Yes 

Page 37 of 37

Isolation precautions for patients with confirmed or suspected ...

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