What is Diphtheria?
Diphtheria is a highly contagious infection that affects the nose and throat, and sometimes the skin. It’s rare in the UK, but there’s a small risk of catching it if you travel to some parts of the world.
Diphtheria can be a serious illness and sometimes fatal, especially in children, if it’s not treated quickly. Vaccination can prevent it.
How does it spread?
Diphtheria is a highly contagious droplet spread bacterial infection. It’s spread by coughs and sneezes, or through close contact with someone who is infected.
You can also get it by sharing items, such as cups, cutlery, clothing or bedding, with an infected person.
The maximum incubation period for diphtheria is 10 days; however, there may be longer duration of carriage in asymptomatic carriers but there is little evidence. Therefore, close contacts should be identified from 10 days before onset of diphtheria symptoms in a case.
What are the symptoms of Diphtheria?
Symptoms usually start 2 to 5 days after becoming infected.
Symptoms of diphtheria include:
- a thick grey-white coating that may cover the back of your throat, nose and tongue
- a high temperature (fever)
- sore throat
- swollen glands in your neck
- difficulty breathing and swallowing
- In countries with poor hygiene, infection of the skin (cutaneous diphtheria) is more common.
If it’s cutaneous diphtheria, it can cause:
- pus-filled blisters on your legs, feet and hands
- large ulcers surrounded by red, sore-looking skin
Why is this important?
If NIAS staff are aware that the patient has a suspected or confirmed Diphtheria this should be communicated to EAC and ED staff when transferring the patient to ensure effective patient care and management. It also ensures that staff adhere to Droplet precautions to prevent staff exposure.
- Hand Hygiene should be completed as per the 5 moments in line with usual practice.
- Eye protection should be worn
- Fluid Resistant surgical mask should be worn
- Gloves and Aprons should be worn.
- The patient should be transported via ambulance with no other patients present.
- All equipment and the ambulance should have a deep clean paying particular attention to touch points.
- Laundry should be treated as contaminated, placed into an alginate bag and placed into a red laundry bag.
Do staff need prophylaxis or follow up?
Immediate Actions: Inform Station Officer / Line Manager and contact the IPC team during working hours for further advice.
If a staff member following a risk assessment is deemed a close contact then prophylaxis will need to be considered.
Staff may be deemed as a close contact and should be considered for prophylaxis:
- This will depend on the presentation of diphtheria in the index case, which body sites were positive on swabbing, and what personal protective equipment (PPE) the HCW wore while attending the case and if there were any breaches in PPE.
- Respiratory cases, HCW who have given mouth to mouth resuscitation to or intubated the index case (without appropriate PPE) would normally be considered as close contacts
- Where eye protection has not been worn and droplet exposure has occurred (for example, a patient has coughed during the collection of a throat swab)
Each case will be individually risk assessed with the staff member, their line manager and the IPC team. If required a referral to Occupational Health will be made.
A nose and throat swab will then be taken and prophylaxis commenced. Staff may be excluded from work but each case will be risk assessed individually.
The IPC team can be contacted for further advice. The team will be able to help staff risk assess the patient and precautions required and to provide support where required.