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Infection control
After reading this chapter you should:
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be able to follow the UK national guidelines on notification of communicable diseases
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know the principles of infection control
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be able to advise on immunisation in children with certain medical conditions
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know about the appropriate use of antimicrobials
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know the current infection control strategies for local, epidemic and pandemic infections
Notification of communicable diseases
Public health services in the UK provide a nationwide system of identifying and managing infectious diseases within the community. The aim is to detect possible outbreaks of disease and epidemics as early and as rapidly as is possible. It is recognised, however, that underreporting is widespread. Registered medical practitioners have a statutory duty to refer a patient to Public Health officials if they are considered to have one of the conditions listed on the UK schedule of Notifiable Disease. Additionally, if the patient is thought to be infected in a way that may cause significant harm to others, then the doctor must notify the local health protection team. Laboratories must also report to the Public Health Service if they isolate any of the listed causative organisms.
The list is updated periodically and does change with local disease outbreaks or worldwide health threats. In 2020 there were 33 infectious diseases which required notification.
Table 13.1
Infectious diseases which require notification to Public Health Services (This list shows examples and is not exhaustive)
| Description | Examples |
|---|---|
| those preventable by routine vaccines | mumps, measles, rubella, diphtheria, whooping cough |
| those which spread quickly and for which a ‘source’ may be identifiable | food poisoning, haemolytic uraemic syndrome, Legionnaires’ disease |
| those from overseas | malaria, viral haemorrhagic fever, enteric fever |
| those which spread through populations and can be carried asymptomatically | tuberculosis, meningococcal septicaemia, SARS, COVID-19 |
| other common paediatric conditions | acute encephalitis, acute meningitis, invasive Group A streptococcal disease, scarlet fever |
Infection control
Knowledge of common infections in children, their routes of transmission, incubation periods and methods to prevent transmission is important and timely clinical diagnosis or suspicion of an infection is the first step in infection control. Microbiological samples should then be sent promptly for confirmation.
Modes of transmission
Droplet
Droplets may be generated from the respiratory tract during coughing, sneezing, talking or singing. If droplets from an infected person come into contact with the mucous membranes or surface of the eye of a recipient, they can transmit infection. These droplets remain in the air for a short period of time and travel up to two metres, so physical distancing helps limit transmission.
Airborne
Aerosols are smaller than droplets and can remain in the air for longer and, therefore, potentially transmit infection by mucous membrane contact or inhalation. Aerosol-generating procedures are therefore high risk for spreading infection.
Contact
Contact transmission may be direct or indirect. Infectious agents can be inadvertently passed directly from an infected person to a recipient who may then transfer the organism to the mucous membranes of their mouth, nose or eyes. Indirect contact transmission takes place when a recipient has contact with an object, such as furniture or equipment that an infected person may have contaminated by coughing or sneezing. Correct hand hygiene is, therefore, important in controlling the spread of disease.
Infectious period
The time period during which an infected person can transmit infection to someone else varies depending on the pathogen and person.
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