Other Infections and Conditions

Flu – [Overview] [Prevention Strategies] [Tools and resources] | Norovirus –[Overview] [Prevention Strategies] [Tools and resources] | Scabies –[Overview] [Prevention Strategies] [Tools and resources]
Tuberculosis (TB) –[Overview] [Prevention Strategies] [Tools and resources]

Overview

Several other infections or conditions such as influenza, norovirus, scabies, and tuberculosis (TB) may be transmitted in healthcare facilities. It is important that both the patient and the healthcare providers take the appropriate steps to help prevent the spread of these infections and conditions.

Flu and Respiratory Illnesses
Respiratory illnesses are infections that affect the respiratory system, which includes the nose, sinuses, throat, and lungs. Respiratory illnesses can be caused by viral or bacterial pathogens and range in severity from mild head colds to severe influenza or pneumonia infections. Symptoms may include nasal congestion, runny nose, sore throat, cough, shortness of breath, chest congestion, wheezing, fever, headaches, and/or body aches.

Influenza (flu) is a respiratory illness caused by the influenza virus. Flu is spread when droplets containing the virus are spread into the air when an ill person coughs, sneezes, talks, or sings. Influenza can also be spread through direct and indirect contact with respiratory secretions.  Patients with seasonal influenza require droplet precautions.

Norovirus and Gastrointestinal Illnesses
Gastrointestinal (GI) illnesses are infections that affect the gastrointestinal system, most commonly the stomach, small intestine, and large intestine, causing symptoms such as nausea, vomiting, and/or diarrhea. Fever, abdominal cramps, and headache or body aches may also occur.

Norovirus is one type of GI illness. The virus is found in the stool and vomit of infected people and spreads easily from person to person. People can become infected in several ways, including eating food or drinking liquids that are contaminated with norovirus, touching surfaces or objects contaminated with norovirus and then touching one’s mouth, or having direct contact with another person who is infected (a healthcare worker, visitor, or another patient) and then touching one’s mouth. In an outbreak, and in some other situations, patients with norovirus in an outbreak require contact precautions.

Scabies
Scabies is an infestation of the skin caused by a small mite that burrows under the skin in order to feed and reproduce. Intense itching, often at night, is the most common symptom of scabies infestation. The skin may appear red and bumpy and blisters or rashes may appear. Most often, infestation will occur in areas of skin that have folds or webs such as the underarms, genitalia, thighs, and between fingers and toes. Symptoms appear two to six weeks after infection, but may appear much faster in those who have had scabies before.

Scabies is most commonly transmitted through direct person-to-person skin contact. Mites do not jump from one person to another, but it is possible to transfer mites on clothing, bedding, or furniture that has been contaminated by an infested person. Patients with scabies require contact precautions.

Tuberculosis
Tuberculosis (TB) is a disease caused by a bacterium called Mycobacterium tuberculosis that is spread from person-to-person through the air when a person with TB disease of the lungs or throat coughs, sneezes, talks, or sings.  TB usually affects the lungs, but it can also affect other parts of the body.  If a person inhales air containing M. tuberculosis droplets, he or she may become infected.  However, not everyone infected with TB bacteria becomes sick or can spread the disease. Patients with TB require airborne precautions.

Prevention Strategies

• Encourage and administer seasonal influenza vaccine.
• Promote good respiratory hygiene practices.
• Provide tissues, face masks, and hand hygiene supplies.
• Encourage people with respiratory symptoms to distance themselves from others.
• Instruct patients, visitors, and healthcare workers to cover their nose and mouth when coughing or sneezing.
• Monitor and manage ill healthcare workers.
• If sick with flu-like illness, healthcare workers should stay home for at least 24 hours after your fever has gone away (without the use of a fever-reducing medicine) and limit contact with other people.
• Implement droplet precautions for patients with influenza.
• Administer antiviral treatment and chemoprophylaxis of patients and healthcare personnel when appropriate.

To prevent the spread of norovirus in healthcare facilities:

• Follow hand hygiene guidelines, and carefully wash hands with soap and water after contact with patients with norovirus infection.
• Implement contact precautions.
• Use gowns and gloves when in contact with, or caring for patients who are symptomatic with norovirus.
• Routinely clean and disinfect high touch patient surfaces and equipment with an Environmental Protection Agency-approved product with a label claim for norovirus, or use a freshly prepared dilute bleach solution.  CDC recommends a minimum concentration of 1,000 ppm (i.e., 1 part household bleach solution to 50 parts water) with a one minute contact time. However, areas with high levels of soiling may require up to 5,000 ppm chlorine bleach (i.e., 1 part bleach to 9 parts water) and a contact time of up to 10 minutes.
• Remove and wash contaminated clothing or linens.
• Healthcare workers who have symptoms consistent with norovirus should be excluded from work.

To prevent the spread of scabies infestation in healthcare facilities:

• Avoid contact with people with scabies until 24 hours after the completion of treatment.
• Asymptomatic, close (skin-to-skin) contacts should receive chemoprophylaxis (a scabicide).   Asymptomatic contacts should also monitor for symptoms of infestation for up to six weeks after treatment.
• Those with scabies should not share personal items, clothing, bedding, linens, or furniture with other people.
• Potentially contaminated items should be washed in hot water and dried in a hot dryer or placed in a sealed plastic bag for at least 7 days.

To prevent the spread of TB in healthcare facilities:

• Implement administrative measures to ensure prompt detection of TB, including (but not limited to) conducting a TB risk assessment, implementing effective work practices for the management of patients with suspected or confirmed TB disease, and screening and evaluating healthcare workers who are at risk for TB disease or who might be exposed to M. tuberculosis.
• Use environmental controls to prevent the spread and reduce the concentration of M. tuberculosis particles in the air.
• Primary environmental controls
• Use local exhaust ventilation.
• Dilute and remove contaminated air by using general ventilation.
• Secondary environmental controls
• Control the airflow to prevent contamination of air in areas near the source [airborne infection isolation (AII) rooms].
• Clean the air by using high efficiency particulate air (HEPA) filtration or ultraviolet germicidal irradiation.
• Follow airborne precautions and use appropriate respiratory protective equipment in situations that pose a high risk of exposure to M. tuberculosis.

Tools and Resources

Influenza and Respiratory Illnesses
Fact sheets

• Influenza – for Patients
• Influenza – for Residents
• Influenza – for Providers (for assisted living facilities and nursing homes)
• Influenza – for Providers (for general settings)
• Respiratory illnesses (for assisted living facilities and nursing homes)
• Respiratory illnesses (for general settings)

Guidelines and recommendations

• Antiviral Agents for the Treatment and Chemoprophylaxis of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. January 21, 2011. MMWR.
• Guidelines for the Prevention and Control of Influenza in Assisted Living Facilities and Other Non-Healthcare Group Settings (VDH)
• Guidelines for the Prevention and Control of Influenza in Nursing Homes (VDH)
• Infection Control Measures for Preventing and Controlling Influenza Transmission in Long-Term Care Facilities (CDC)
• Influenza Vaccination of Health-Care Personnel (February 2006)
• Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. August 26, 2011. MMWR.

• Prevention Strategies for Seasonal Influenza in Healthcare Settings (CDC)

• Articles
• Influenza Vaccination Coverage Among Health-Care Personnel – United States, 2010-2011 Influenza Season, MMWR (August 2011)
• Signs and print materials
• Fever and Cough (for Patients) (sign)
• Help Protect Our Patients (sign)
• Help Protect Our Residents (sign)
• Help Protect Your Coworkers (sign)
• Letter to Family Members and Sign (template for assisted living facilities and nursing homes) (Summer 2011)
• Letter to Family Members and Sign (template for general settings) (Fall 2011)
• Seasonal influenza print materials (CDC)
• Strategies for improving influenza vaccination rates
• Immunizing Healthcare Personnel Against Influenza: A Report on Best Practices (National Foundation for Infectious Diseases)
• Surveillance
  • Influenza surveillance (VDH)
  • NHSN Healthcare Personnel Influenza Vaccination Module – protocol and instructions, forms, and FAQs
    • Enables a healthcare facility to record healthcare personnel (HCP) influenza vaccination summary-level data so that HCP influenza vaccination percentages are consistent over time within a single healthcare facility and comparable across facilities.
    • Can be used in all types of healthcare facilities.
    • Reporting required by the Centers for Medicare and Medicaid Services (CMS) for acute care hospitals participating in the Hospital Inpatient Quality Reporting Program (start date January 2013).
• Vaccination page

Websites

• Seasonal influenza (CDC website)
• Information for health professionals
  • Seasonal influenza vaccination resources for health professionals
• Influenza vaccination information for healthcare workers
• Preventing seasonal flu with vaccination
• Seasonal influenza (HHS website)

Norovirus and Gastrointestinal Illnesses
Fact sheets:

• Gastrointestinal (GI) Illnesses (for assisted living facilities and nursing homes)
• Gastrointestinal (GI) Illnesses (for general settings)
• Norovirus

Guidelines:

• Summary of Guidelines for the Control of a Suspected or Confirmed Outbreak of Viral Gastroenteritis (Norovirus) in an Assisted Living Facility or Nursing Home
• Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings, 2011
  • Norovirus Prevention Toolkit – resource designed to help healthcare providers manage and stop outbreaks. Includes infection control recommendations, as well as tools for outbreak response, coordination, and reporting.
• Norovirus Prevention Guidance for Institutions/Facilities (2010)
• Updated Norovirus Outbreak Management and Disease Prevention Guidelines.  March 4, 2011.  MMWR.

Websites:

• Environmental Protection Agency’s (EPA) Registered Antimicrobial Products Effective Against Norovirus, January 9, 2009.
• Norovirus (VDH website)
• Prevention of Norovirus in Healthcare Settings (CDC website)

Scabies

• Scabies (CDC website)
• Scabies fact sheet (for assisted living facilities and nursing homes)
• Scabies fact sheet (for general settings)

Tuberculosis
Fact sheets:

• Tuberculosis (for assisted living facilities and nursing homes)
• Infection Control in Healthcare Settings

Guidelines:

• Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005

Websites:

• Respiratory protection (OSHA website)
• Tuberculosis (CDC website)
• Tuberculosis (OSHA website)
• Tuberculosis (TB) Control and Prevention Program (VDH)

For more patient resources, please see the Consumer and Public Information page.