Infection prevention and control

The NHS in Cornwall and the Isles of Scilly and the UK Health Security Agency (UKHSA) are extremely well prepared for outbreaks of new infectious diseases. The NHS has put in place measures to ensure the safety of all patients and NHS staff while also ensuring services are available to the public as normal. Read the latest guidance on COVID-19 for healthcare professionals

What is infection prevention and control?

Our infection prevention and control programme is led by our nurse consultant directors of infection prevention and control. Healthcare associated infections (HCAI) can occur as a result of healthcare or contact with healthcare environments. HCAIs arise across a wide range of clinical conditions and can affect people of all ages. They can worsen existing or underlying conditions, delay recovery and adversely affect quality of life. They can occur in otherwise healthy people, especially if invasive procedures or devices are used. Healthcare workers, family members and carers are also at risk of acquiring infections when caring for people.

A number of factors can increase the risk of acquiring an infection, but high standards of infection prevention and control practice, including providing clean environments, can minimise the risk. It is estimated that 300,000 patients a year in England acquire a HCAI as a result of care within the NHS. More than four million people in Europe acquire a healthcare-associated infection (HAI) every year, of whom approximately 37,000 die as a direct result of the infection, for further information please see 2016 point prevalence survey for healthcare associated infections, antimicrobial use and antimicrobial stewardship in England.

Collaboration

Close collaboration with local acute and community trusts as well as neighbouring trusts and commissioners ensures monitoring and improvement is shared.

Commissioning expectations

We expect the services we commission to comply with specific regulations. In relation to infection prevention and control the expectation is that services will be delivered as set out in The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance, more commonly known as The Hygiene Code.

All services registered with the Care Quality Commission are required to declare compliance with a specific standard relating to infection prevention and control and this relates directly to the Hygiene Code.

In addition to these standards there are additional annual improvement expectations relating to some infections. These are set by NHS England and included in our contracting processes.

Hospitals

Our local hospitals all have their own infection prevention and control teams and details of their work can be found at the links below:

We engage with the infection prevention and committees and/or steering groups of these organisations.

Expectations specific to infection prevention and control are embedded within our contracts with providers and evidence of compliance is checked every month.

Antimicrobial resistance

Antimicrobial resistance (AMR) arises when the micro-organisms which cause infection survive exposure to a medicine that would normally kill them or stop their growth. This means that the treatments usually used to treat infections caused by a resistant organism will not be effective.

Many of the medical advances in recent years, for example organ transplantation and cancer chemotherapy, need antibiotics to prevent and treat the bacterial infections that can be caused by the treatment. Without effective antibiotics, even minor surgery and routine operations could become high risk procedures if serious infections can’t be treated.

The UK government published a 20-year vision for AMR in January 2019. Some key information from this document is shown below.

  • No poverty: AMR strikes hardest on the poor; treatment of resistant infections is more expensive.
  • Zero hunger: Untreatable infections in animals threatens sustainable food production for growing populations.
  • Good health and wellbeing: Antimicrobials are fundamental components of all health systems.
  • Clean water and sanitation: Reduces infections and antibiotic residues from multiples sources contaminate water.
  • Decent work and economic growth: Cost of AMR is predicted to be US $100 trillion by 2050, driving an extra 28 million people into poverty.
  • Responsible consumption and production: It is crucial to balance access and conservation of antimicrobials with innovation, to contain AMR.

The World Bank estimates that an additional 28 million people could be forced into extreme poverty by 2050, through shortfalls in economic output, unless resistance is contained.

The 20-year vision for AMR

By 2040, the vision is of a world in which AMR is effectively contained and controlled through strong mitigation.

The UK is determined to sustain its efforts to:

  • combat resistance
  • taking local, national and global one-health approaches across humans, animals, the environment and food

This is in line with global ambitions and in collaboration with other nations, partners and the international community.

In our vision, stakeholders at local, national and global levels are:

  • collectively strengthening policy and practice
  • ever improving understanding through research and surveillance
  • developing effective regulation and advocacy to contain and control resistance

In the UK, we will contribute to the global effort through:

  • a lower burden of infection, treatment of resistant infection and minimised transmission in communities, the NHS, farms, the environment and all other settings
  • optimal use of antimicrobials and good stewardship across all sectors, including access to the safe and effective medicines that have been manufactured responsibility or all who need them, achieving usage levels, by sector, as good as the best countries in the world where comparable data is available
  • new diagnostics, therapies, vaccines and interventions in use, and a full AMR research and development pipeline for antimicrobials, alternatives, diagnostics, vaccines and infection prevention across all sectors

Local AMR work

In response to the first UK national strategy in 2013 a Cornwall antibiotic resistance group (CARG) was convened.

Purpose of the group

  • Responsible for ensuring implementation of UK 5-year AMR national action plan, specifically supporting delivery of 3 main strategic aims.
  • Reports to health and wellbeing boards via health protection committee.
  • Also reports into various committees within each stakeholder organisation. For example the medicines optimisation programme board.

Work streams

  • Education and engagement with the public.
  • Education and engagement with healthcare workers and vets.
  • Comprehensive stewardship programme for all sectors.

Primary care

GP practices in Cornwall and the Isles of Scilly have been implementing the TARGET antibiotics toolkit:

  • Treat
  • Antibiotics
  • Responsibly
  • Guidance
  • Education
  • Tools

The toolkit aims to help influence:

  • prescribers and patients personal attitudes
  • social norms and perceived barriers to optimal antibiotic prescribing

It includes a range of resources that can each be used to support prescribers’ and patients’ responsible antibiotic use. Therefore helping to fulfil continuing professional development (CPD) and revalidation requirements.

Quarterly antibiotic prescribing data is sent out to GP practices, including data for individual prescribers. This data helps them to monitor their total antibiotic items and numbers of broad spectrum antibiotics that should be kept to a minimum because of AMR.

Education

An e-learning healthcare module on reducing AMR was launched in November 2015.

This module was designed to support all health and social care staff, both clinical and non-clinical, in a variety of settings. The module can help you understand the threats posed by AMR, and ways to tackle this major health issue. This programme has been developed by Health Education England in collaboration with Public Health England and NHS England.

Antimicrobial prescribing and stewardship competencies

The antimicrobial prescribing and stewardship competencies can be used by any independent prescriber and can help with the professional development of prescribing antimicrobials. There are 5 competencies:

  1. Infection prevention and control.
  2. AMR and antimicrobials.
  3. Prescribing antimicrobials.
  4. Antimicrobial stewardship.
  5. Monitoring and learning.

Care home resources

The outbreak prevention and control team is part of the infection prevention and control (IPC) team at NHS Cornwall and Isles of Scilly

Outbreak site visits will be offered as appropriate as part of the current collaborative oversight process which links with UKHSA.

Resilience visits can be requested as an opt-in service for care homes and the team hope to engage with care home providers to learn from their experiences and share this learning with the care home community.

We can help you:

  • Assess and improve your care homes outbreak risk and preparedness
  • Get help during an outbreak (including influenza like illness, norovirus and coronavirus
  • With recommendations within 48 hours
  • Develop staff members to become IPC Champions

Care homes are required to register with the Care Quality Commission (CQC) and declare compliance with various standards. The care home annual report template has been designed to support providers in evidencing their CQC requirements, please email the infection prevention and control team  if you would like support with using the template.

The standard that relates to infection prevention and control comes from the Health and Social Care Act 2008: Code of practice on the prevention and control of infections and related guidance, a document that is commonly referred to as the hygiene code.

Catheter passports

In 2019 we launched our catheter passport (PDF, 751 KB). The passport was developed to be likened to a log book for each resident to give them information on how to care for their catheter as well as a clinical section in the back for their nurses, doctors and carers to fill in as necessary.

Unfortunately, catheters can significantly increase the risk of urinary tract infections and whilst these infections are usually mild, they can on occasion be serious and can impact the general health and wellbeing of residents, which is what we’re trying to prevent.

The catheter passport also includes useful information including; a pee-o-meter to ensure that the resident is hydrated.

Our aim is not just for residents to be equipped with these catheter passports, but for them to be used county-wide throughout the NHS in Cornwall for anyone that has been fitted with a catheter. If you would like any information or require a supply of catheter passports email the infection prevention and control team.

Urine infections

Recognising urine infections can be difficult in older people. The UTI diagnostic tool (PDF, 835 KB) should be used to assess symptoms and communicate with the GP.

Useful links

General practice resources

NHS Cornwall and Isles of Scilly provide data and learning opportunities for primary care. The resources below may be useful in primary care.

Primary care resources

Handwashing

Healthcare associated infections

Guidelines and specifications

MRSA

Methicillin resistant staphylococcus aureus (MRSA) is a bacterium or germ quite commonly found on the skin or in the nose. Sometimes MRSA causes infections and these can be more difficult to treat as MRSA is resistant to and cannot be treated with some of the usual antibiotics.

MRSA can live on people who are healthy and have no symptoms. This is called colonisation the person is a carrier of MRSA. It is usually found by taking a screen. This is a swab from your nose, groin and/or skin, a sample of urine or sputum. These will then be sent to the laboratory to be tested.

Your provider may recommend MRSA testing as part of an evaluation. This gives opportunity to reduce any MRSA from your skin and limit risk of infection.

Your provider may recommend MRSA testing as part of an evaluation. This gives opportunity to reduce any MRSA from your skin and limit risk of infection.

For planned admissions screening is carried out in advance to give time for a course of suppression to be used before the admission date. With unplanned admissions screens are taken on the first day and suppression begins as soon as a positive result is known.

The risk to a carrier is greater in hospital where surgery or treatment, which breaks the skin or uses tubes or lines, can allow the germ to enter the body and even the bloodstream. Some hospital treatment reduces the ability of the body to protect itself from infection. MRSA is not a risk to healthy people.

People with MRSA are not a risk to visitors or family members (including children and pregnant women). It is not usually necessary for visitors to wear gloves and aprons. Hands should always be washed before leaving. Visitors who are not in good health, should ask the nurses to help decide how to visit safely.

Sometimes people with MRSA are given a single room. This is more likely to happen if other patients on the ward are very sick or are having high risk surgery. The door is a barrier that reminds everyone to follow all the rules to prevent spreading germs. The room should be kept free from clutter to help with cleaning.

You will be able to leave the room for treatment and you may be able to visit shared areas if you have had your wash, put on clean clothes and all wounds are covered. Please check with staff as rules may be different in some areas.

Your hospital stay should not be any longer due to MRSA colonisation. If you have an infection you may need further treatment, usually antibiotics, before you are ready to leave.

Further precautions at home if you have MRSA

MRSA should not affect any aspects of your normal lifestyle, nor any activities you are involved in. Often no further treatment is needed on your discharge from hospital.

Remember to mention any MRSA history to anyone who may need to prescribe antibiotics for you for any reason and to anyone who needs to carry out treatment which may break the skin or insert a needle, tube or line.

If you have a wound or a medical device, closely follow instructions from the person monitoring you (district, practice or clinic nurse). Avoid touching your wound or devices such as catheters. If it is necessary to touch them, wash your hands before and after.

Wash linen and towels in the normal way. If you still need to have dressings at home it may be necessary to arrange for the council to collect your medical waste, ask your district nurse. To reduce the amount of dust in the environment, dust and vacuum the house regularly.

Patient information

Hand hygiene

Washing your hands is one of the easiest ways to protect yourself and others from illnesses such as food poisoning and flu. Washing your hands properly should take about as long as singing Happy Birthday twice (around 20 seconds). Use the following steps from the World Health Organisation while you hum:

  1. Wet your hands with water (warm or cold).
  2. Apply enough soap to cover all over your hands. You can use alcohol-based hand rub if you don’t have immediate access to soap and water.
  3. Rub hands palm to palm.
  4. Rub the back of your left hand with your right palm with interlaced fingers. Repeat with the other hand.
  5. Rub your palms together with fingers interlaced.
  6. Rub the backs of your fingers against your palms with fingers interlocked.
  7. Clasp your left thumb with your right hand and rub in rotation. Repeat with your left hand and right thumb.
  8. Rub the tips of your fingers in the other palm in a circular motion, going backwards and forwards. Repeat with the other hand.
  9. Rinse hands with water (warm or cold).
  10. Dry thoroughly, ideally with a disposable towel.
  11. Use the disposable towel to turn off the tap.

How often should we wash our hands?

We should wash our hands:

  • after using the toilet
  • after handling raw foods like chicken, meat and vegetables
  • before eating or handling ready to eat food
  • after having contact with animals, including pets

Why is it so important to wash hands properly?

Washing your hands properly removes dirt, viruses and bacteria to stop them spreading to other people and objects, which can spread illnesses such as food poisoning, flu or diarrhoea.

Washing your hands with soap and water is sufficient to remove dirt, viruses or bacteria and it can reduce the risk of diarrhoea by nearly 50%.

Who is most at risk from the effects of poor hand hygiene?

Children are particularly at risk of picking up infections and spreading them to other people. It’s especially important to make sure that hands are washed when you’re visiting someone in hospital or other healthcare setting, to help prevent the spread of infection.

Health care associated infections (HCAIs)

What is an HCAI?

This is an infection that may affect people when they are receiving healthcare. People may catch these infections in hospitals, care homes, doctors’ surgeries, health centres and even at home if they are being cared for there.

Why do some people get an HCAI when receiving healthcare?

There are lots of reasons why someone can develop an HCAI. Being ill or receiving treatment can make your natural defence system (immune system) weaker than usual. Most people won’t pick up an HCAI while they are being treated but it is impossible to completely remove all the risk during healthcare. This is because every disease, condition or procedure and sometimes medication can reduce your natural defences against infection.

What are the most common types of HCAI in hospital?

The most common types of HCAI in hospitals are urine infections, wound infections, skin infections, chest infections and sickness and diarrhoea.

What type of germs cause HCAI?

Some are caused by germs that live normally on our bodies and usually do us no harm such as Staphylococcus aureus, which many people can carry harmlessly in their nose. The most well-known are methicillin resistant staphylococcus aureus (MRSA), clostridium difficile (c-diff) and norovirus.

MRSA can cause an infection if it gets into a wound, the bloodstream, bladder or lungs.

C-diff is bacteria that some people have living naturally in their bowel. For some people unfortunately, this can develop into diarrhoea and fever and usually after certain kinds of antibiotics.

Norovirus causes sickness and diarrhoea. This may last for a couple of days and usually has no lasting effects. This virus is often reported as causing outbreaks of infection in hospitals and care homes.

What do we do to prevent HCAIs spreading?

Preventing and controlling HCAI is a national priority and all care settings are working hard to prevent the spread of infection in the NHS and care homes. This includes:

  • educating staff, patients and visitors on how to prevent and control infections, for example, washing hands regularly; getting support and advice from specialist infection control or health protection staff
  • making sure that the NHS and care homes meet government standards on HCAI
  • giving people information on how to prevent and control HCAI within all care settings and among members of the public

HCAIs are monitored and reported to Public Health England, for learning and improvement purposes.

What happens if I get an infection?

Your infection could require treatment, which probably can be given to you at home. You may be asked to stay at home for the duration of the treatment and not visit the GP surgery, they may arrange a home visit instead. If you don’t understand your condition and/or treatment please ask a member of staff.

Hydration

Dehydration is a state in which our bodies do not have enough water. NHS England defines dehydration as a relative deficiency of fluid that causes adverse effects on function and clinical outcome. Dehydration can be mild, moderate or severe.

A number of poor health outcomes are associated with avoidable dehydration including some infections.

Dehydration should always be considered as a cause for any of the following:

  • dry mouth, feeling thirsty
  • headache, poor concentration, unexpected confusion, increasing agitation
  • feeling dizzy when standing up
  • lethargy, malaise, increasing sleepiness
  • noticeably drier inelastic skin
  • dark concentrated urine
  • reduced urine output

We have produced bookmarks as part of a hydration project to provide a handy reminder to drink enough fluid and check urine for signs of dehydration. If you would like any information or would like a supply of bookmarks, email the infection prevention and control team.

Infections

How do infections spread?

You need a germ. The germ lives in or on its host, another person, an animal or a contaminated surface, for example a door handle, worktop or equipment.

The germ is passed on by either direct or indirect contact which can be coughing, sneezing, hand contact with someone who carries the germ on their hand or by touching a contaminated surface.

If the germ then enters your system and you’re not immune to it, you can catch the infection. Generally healthy people are less likely to catch infections, as their immune system should protect them well. But if for any reason your immune system is weaker than normal, you will be more vulnerable and therefore need to protect yourself even more against any infection.

Any infection can be caught or spread were there are ill people together, this can be in a hospital, a care home a GP surgery or in a public place. The information below explains how you can help the staff to reduce infection and provide a clean and safe environment in which you receive treatment and/ or care. By following the points in this advice, you can help us to prevent vulnerable individuals picking up an infection and prevent the spread of infections. If people pick up an infection, it can cause discomfort, pain and anxiety.

Vaccination

Vaccines are the most effective way to prevent infection diseases. They are the most important thing that we can do to protect ourselves and our children against ill health. They prevent up to 3 million deaths worldwide every year.

Since vaccines were introduced in the UK, diseases like smallpox, polio and tetanus that used to kill or disable millions of people are either gone or very rare.

Other diseases like measures and diphtheria have been reduced by up to 99.9% since their vaccines were introduced. However, if people stop having vaccines, it’s possible for infectious diseases to quickly spread again.

Vaccine hesitancy is where people with access to vaccines delay or refuse the vaccination. The World Health Organisation (WHO) recently listed vaccine hesitancy as 1 of their top 10 biggest threats to global health.

How do vaccines work?

Vaccines teach your immune system how to create antibodies that protect you from diseases. It’s much safer for your immune system to learn this thought vaccination than by catching the diseases and treating them. Once your immune system knows how to fight a disease, it can often protect you for many years.

Are vaccines safe?

All vaccines are thoroughly tested to ensure that they won’t harm you or your child. It often takes many years for a vaccine to make it through the trials and tests it needs to pass for approval. Once a vaccine is being used in the UK it’s also monitored for any rare side effects by the Medicines and Healthcare Products Regulatory Agency (MHRA).

What’s in a vaccine?

Most people aren’t concerned about vaccine ingredients and know that they’re safe. The main ingredient of any vaccine is a small amount of bacteria, virus or toxin that’s been weakened or destroyed in a laboratory first; this means there’s no risk of healthy people catching a disease from a vaccine. It’s also why you might see vaccines being called live or killed vaccines.

Pneumococcal vaccine

The pneumococcal vaccine helps protect against serious pneumococcal infections, which can lead to pneumonia, septicaemia (a kind of blood poisoning) and meningitis. In some cases they can lead to permanent brain damage, or even death.

A pneumococcal infection can affect anyone. Some people are at higher risk of serious illness and can get the pneumococcal vaccine free from the NHS.

Who is eligible for the free vaccine?

  • Adults aged 65 or older need a single pneumococcal immunisation, which will help protect them for life.
  • Children younger than 2 years are offered doses of the vaccine as part of the routine childhood immunisation programme. Some children with a health condition, older than 2 years, may require additional doses.
  • People with long term conditions usually need a single 1 off immunisation or 5 yearly immunisation, depending on their underlying health condition.

What is pneumococcal infection?

This infection is caused by pneumococcal bacteria. It can cause serious illness, such as pneumonia and meningitis.

How is pneumococcal infection spread?

Some adults and up to 60% of children, carry the bacteria in the back of their nose and throat, and can pass them around by coughing, sneezing and close contact. Usually this doesn’t result in serious illness.

Why should I worry about pneumococcal infection?

Pneumococcal infection can cause bronchitis, ear and sinus infections, life-threatening infection of the blood (septicaemia), meningitis and pneumonia (which can also be life-threatening).

Children younger than 2 years of age, people aged 65 or older, and children and adults with certain health conditions have a higher chance of becoming unwell with pneumococcal infection. People aged 65 or older are more likely to suffer serious long-term health problems, and can even die.

How serious is pneumococcal meningitis?

About 85% of people who get pneumococcal meningitis recover, usually without any long-term problems. Survivors of pneumococcal meningitis, however, are more likely to develop complications than survivors of other bacterial causes of meningitis. These complications include deafness, seizures and long-term brain damage.

Who should get the vaccine?

The pneumococcal vaccine is recommended for many of the same people who get an annual flu vaccine.

Pneumococcal immunisation is available in the England for all people aged 65 years and older. For anyone younger than 65, including children, GPs may provide immunisation for people with the following serious medical conditions:

  • problems with the spleen, either because the spleen has been removed or doesn’t work properly
  • chronic lung disease, including chronic bronchitis or emphysema
  • serious heart conditions
  • severe kidney disease
  • long-term liver disease
  • diabetes that requires medication
  • lowered immunity due to disease or treatment (people with HIV, receiving chemotherapy, or are on long-term oral steroids)
  • cochlear implants
  • cerebrospinal fluid leaks
  • children younger than 5 years who have previously had invasive pneumococcal disease, such as meningitis or bacteraemia (presence of bacteria in the blood)

If you’re unsure whether you or your child should get the vaccine, speak to your GP or practice nurse.

Why shouldn’t everyone have the pneumococcal vaccine?

Not everyone is at high risk of developing serious illness. The maximum risk is in those aged 65 or older, and those younger than 65 with any of the serious medical conditions listed. Children younger than 2 years are also at increased risk.

Does the vaccine have any possible side effects?

The pneumococcal vaccine is very safe. Although, like all vaccinations, it can cause side effects. It’s not possible to catch a pneumococcal infection from the vaccine, as the vaccine does not contain any live bacteria.

Possible side effects in babies:

  • a decreased appetite
  • a slightly raised temperature
  • irritability
  • redness and swelling at the site of the injection
  • feeling sleepy or not sleeping well

Side effects in adults and children older than 2:

  • mild soreness or hardness at the site of the injection lasting 1 to 3 days
  • a slightly raised temperature

More serious side effects of the vaccine, such as allergic reactions, are rare. Contact NHS 111 if you’re concerned.

How effective is the vaccine?

Getting the vaccine is the best way to help protect yourself against infections caused by the most common types of pneumococcal bacteria. It doesn’t protect you against infections caused by all pneumococcal bacteria.

How safe is the vaccine?

Before they are allowed to be used, all medicines (including vaccines) are tested to assess their safety and effectiveness. Once they have been licensed for use, their safety continues to be monitored.

Vaccine allergy

Tell your GP if you, or your child, has had a bad reaction to any vaccination in the past.

If there’s been a confirmed severe allergic reaction, called an anaphylactic reaction, to the pneumococcal vaccine or any ingredient in the vaccine, it may not be possible for you to have it. If it was only a mild reaction, such as a rash, it’s generally safe to have the vaccine.

Report side effects

You can report suspected side effects online on the Yellow Card website. You can also call the Yellow Card hotline on 0808 100 3352.

Where can I get more information

Visit nhs.uk for more information. You can also talk to your practice nurse or GP, or contact NHS 111.

Say no to norovirus

Norovirus affects everyone. It can close hospitals, care homes and schools. It is the most common cause of stomach bugs in England and Wales.

How does norovirus spread?

Norovirus can be caught from contact with an infected person:

  • by consuming contaminated food or water
  • contact with contaminated surfaces or objects

They are a group of viruses that are the most common cause of stomach bugs in England and Wales. In the past, noroviruses have also been called the winter vomiting virus or Norwalk virus.

Symptoms begin around 12 to 48 hours after you become infected and can last for 12 to 60 hours. They start with the sudden onset of nausea followed by projectile vomiting and watery diarrhoea. Some people will have a raised temperature, headaches and aching limbs. Most make a full recovery within 1 to 2 days. Some people, usually the very young or elderly, may require rehydration treatment, either at home on in hospital.

Norovirus is easily spread from 1 person to another. The virus is able to survive in the environment for many days. As there are many different strains, immunity is short-lived. Outbreaks tend to affect more than half of susceptible people. They usually happen in semi-closed environments like nursing homes, hospitals, schools and cruise ships.

Outbreaks can be difficult to control and long-lasting because the virus is easily transmitted and survives in the environment for a long time.

The most effective way to help stop an outbreak, is to disinfect the contaminated areas and ensure good hygiene. For example thorough handwashing and good food hygiene. Alcohol gel is not effective against norovirus.

Anyone who has the symptoms should be isolated or avoid contact with others for a minimum of 48 hours after their symptoms have stopped. Those affected should not go to work or school until they have been symptom free for 48 hours.

There is no specific treatment for norovirus apart from letting the illness run its course. It is important to drink plenty of fluids to prevent dehydration. Medical advice should be sought if symptoms do not resolve themselves.

Although norovirus doesn’t start in hospitals, if brought in from the community, it can make people who are already very ill even more poorly.

People of all ages can be infected. The very young and the elderly should take extra care if infected, as dehydration is more common in these age groups. Outbreaks can be shortened when control measures are implemented quickly. This will include closing infected areas and using strict hygiene measures.

There are no long-term effects from norovirus.

Do not visit health care settings if you, or someone you’ve been in contact with, has had diarrhoea and/or vomiting until 48 hours after symptoms have ceased. There is a real risk that you could introduce the infection into the area.

Wash your hands frequently with warm water and liquid soap, especially after using the toilet and before preparing food. Alcohol gel is not effective against norovirus.

If you’re concerned about the health of the person you are visiting, speak to a member of staff.

Do not handle or prepare food for other people until you have been symptom free for a minimum of 48 hours.

Urinary tract infections

Urinary tract infections are common infections that can affect the bladder (cystitis), the kidneys and the tubes connected to them.

Anyone can get them, but they’re particularly common in women. Some women experience them regularly (called recurrent UTIs).

Urinary tract infection (UTIs) are the second most common type of infection that can occur in the body and are usually caused by bacteria that enter the body via the urethra (tube that carries urine out of the body).

Symptoms of UTIs

Infections of the bladder or urethra are known as lower UTIs. These can cause (not always all of these together):

  • needing to urinate (wee) more often and urgently than normal
  • pain, burning or stinging when you wee
  • feeling as though you’re unable to empty your bladder fully
  • urine that’s dark, cloudy or strong-smelling
  • feeling generally unwell, achy and tired

Infections of the kidneys or ureters are known as upper UTIs. These can cause the above symptoms and also:

  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • pain in your sides or back
  • shivering and chills
  • feeling and being sick
  • confusion, agitation or restlessness

Lower UTIs are common and aren’t usually a cause for major concern. Upper UTIs can be serious if left untreated. If symptoms don’t improve or you are worried, contact your pharmacist, GP or contact NHS 111.

Treatment of UTIs

Mild cases often get better by themselves within a few days. Symptoms of cystitis can also be caused by other conditions, so children and men should always see their GP.

Over-the-counter painkillers such as paracetamol can help with any pain. Drinking fluids may also help you feel better. There’s currently little evidence to suggest that drinking cranberry juice significantly reduces your chances of getting UTIs.

Avoiding sex when you have a UTI may also help because it may make the condition worse.

If symptoms persist, talk to your pharmacist who can assess your symptoms and advise on appropriate treatments. This may involve testing a sample of your urine. You can also contact NHS 111 for advice.

Preventing UTIs

If you get UTIs frequently, there are some things you can try that may stop it coming back.

  • Staying well hydrated (drink six to eight glasses of water daily).
  • Avoiding perfumed bubble bath, soap or talcum powder around your genitals – use plain, unperfumed varieties, and have a shower rather than a bath.
  • Going to the toilet as soon as you need to wee.
  • Wiping your bottom front to back when you go to the toilet.
  • Emptying your bladder as soon as possible after having sex.
  • Not using a contraceptive diaphragm or condoms with spermicidal lubricant on them – consider using alternative products or methods.
  • Wearing underwear made from cotton, rather than synthetic material such as nylon, and avoiding tight jeans and trousers.

Are you drinking enough?

A good rule is to drink enough fluid so that you’re not thirsty for long periods, and to steadily increase your fluid intake when exercising and during hot weather. Passing clear urine (wee) is a good sign that you’re well hydrated.

Try to drink six to eight glasses daily of fluids such as water or diluted squash. These are much more effective than large amounts of tea, coffee or fizzy drinks, which contain caffeine.

We have produced bookmarks as part of a hydration project to provide a handy reminder to drink enough fluid and check urine for signs of dehydration. If you would like any information or would like a supply of bookmarks, email the infection prevention and control team.

Page last reviewed: 25 November, 2022

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