Infections

Yes. If you’re in hospital with an MRSA infection, you can still have visitors. However, it’s a good idea to warn vulnerable people at risk of MRSA, so they can take special precautions.

Visitors at risk of MRSA

MRSA does not usually affect healthy people, including pregnant women, children and babies.

Some visitors, however, are more at risk of MRSA. This includes people with:

• serious health problems
• long-term skin conditions, such as eczema
• open wounds

How is MRSA spread?

If you have MRSA, it can be spread to a visitor if you have contact with their skin, especially if it’s sore or broken, or if they handle personal items you have used, such as towels, bandages or razors. Visitors can also catch MRSA from contaminated surfaces or hospital devices or items.

How to stop visitors catching MRSA

Visitors can reduce the risk of catching MRSA from a hospital patient they are visiting (and the other way around) by:

• cleaning their hands just before and just after touching the patient
• cleaning their hands before entering and after leaving the ward

Remind your visitors to clean their hands with soap and water or alcohol gel. Alcohol gel or hand rub dispensers are often placed near hospital beds and at the entrances to wards and bays or near lifts. Visitors can pick up organisms from the environment around you without even touching you.

If visitors have breaks in their skin, such as a sore or cut, they should keep them covered with a dressing to limit the risk of the MRSA getting into their body.

Get advice before visiting other hospital patients

If you have an MRSA infection, get advice from hospital staff before visiting other patients in the hospital.

Yes, clothes and towels can spread germs.

There are 3 main ways that germs are spread by clothes and towels:

• when towels or bedlinen are used by more than 1 person germs can spread between them
• when someone handles dirty laundry they can spread germs onto their hands
• when clothes are washed, germs can spread between items in the process of being washed

How do germs get onto clothes and towels?

Germs on clothes and towels can come from our own body. We all have bacteria on the surface of our skin, in our noses and in our gut. These are often harmless, but some can cause infection, particularly in people with skin problems or wounds.

Most germs cannot penetrate through normal skin but may harmlessly colonise it. Washing your hands regularly is likely to be significantly more important than clothes washing at preventing most infections.

Underwear is more likely to have germs on it than outer clothing like jumpers or trousers. Underwear may contain germs from traces of faeces (poo) and from genital infections, such as thrush.

However, you can also pick up germs on your outer clothes, for example if you nurse someone with an illness or clean up vomit. Germs can also get onto outer clothing if you handle contaminated food or brush against a soiled object.

How to stop clothes spreading germs

Normal washing of clothes will reduce the risk of germs being transmitted. In certain situations clothes should be washed at higher than normal temperatures and with a bleach-based product to minimise the transmission risk as much as possible.

Washing high-risk items

If the items you are washing are likely to cause illness (high risk), they should be washed at 60C with a bleach-based product. Items are likely to cause illness if you have someone in your home who has an infectious illness. The following items are also high risk:

• clothes soiled with vomit or poo (including reusable nappies)
• sports clothes
• cloths used in food preparation
• healthcare workers’ uniforms
• shared towels
• clothing worn over a wound or infected skin
• farmers’ clothing, especially during lambing season

Always remove any vomit or poo from clothing before washing and flush it down the toilet. Heavily soiled items and items used in food preparation should be washed separately from other items.

You can protect yourself from infection by wearing gloves when handling high-risk laundry and always washing your hands thoroughly afterwards.

Washing everyday items

If you are washing lightly soiled everyday items that are not likely to cause illness, a normal wash with a detergent will be very effective at reducing the risk of transmitting any infection.

• keep and wash heavily soiled clothes separately from other items
• wash high-risk items separately from other items
• wash your hands after handling unwashed clothes

Yes, it is possible to get chickenpox more than once, but this is extremely rare.

Most people who have had chickenpox won’t get it again because they’re immune to it for life.

However, some people who have had chickenpox will develop a related condition called shingles later on. This is caused by the chickenpox virus being reactivated, usually several decades later.

You can get chickenpox from someone who’s got shingles.

You can’t get shingles from someone who’s got chickenpox.

It depends on the type of bacteria or virus, what kind of surface they are on and what the surrounding environment is like, for example, if it’s hot, cold, damp or sunny.

Cold viruses

Many different types of viruses can cause colds. The viruses can sometimes survive on indoor surfaces for more than 7 days. In general, viruses survive for longer on non-porous (water resistant) surfaces, such as stainless steel and plastics, than porous surfaces, such as fabrics and tissues. Although cold viruses have been shown to survive on surfaces for several days, their ability to cause an infection reduces rapidly and they don’t often survive longer than 24 hours.

Most viruses which cause colds only survive on hands for a short amount of time. Some only last for a few minutes but 40% of rhinoviruses, a common cold-causing virus, are still infectious on hands after an hour.

Respiratory syncytial virus (RSV), another cold-like virus that can cause serious illness in children, can survive on worktops and door handles for up to 6 hours, on clothing, and tissues for 30 to 45 minutes and on skin for up to 20 minutes.

Flu viruses

Flu viruses capable of being transferred to hands and causing an infection can survive on hard surfaces for 24 hours. Infectious flu viruses can survive on tissues for only 15 minutes.

Like cold viruses, infectious flu viruses survive for much shorter periods on the hands. After 5 minutes the amount of flu virus on hands falls to low levels.

Flu viruses can also survive as droplets in the air for several hours; low temperatures increase their survival in the air.

Parainfluenza virus, which causes croup in children, can survive for up to 10 hours on hard surfaces and up to 4 hours on soft surfaces.

Stomach bugs

There are many germs that can cause a stomach bug. They include bacteria such as E. coli, salmonella, Clostridium difficile (C. difficile) and campylobacter, as well as viruses such as norovirus and rotavirus.

Salmonella and campylobacter survive for short periods of around 1 to 4 hours on hard surfaces or fabrics. Norovirus and C. difficile, however, can survive for much longer. In one study, C. difficile was shown to survive for 5 months. Norovirus can survive for days or weeks on hard surfaces.

When someone with norovirus vomits, the virus is distributed in small droplets in the air. These droplets can settle on surfaces, causing the virus to spread, so it’s important to clean surfaces thoroughly if someone in your home has norovirus.

Most bugs can be removed effectively by soap and water. To help prevent the spread of stomach bugs wash your hands thoroughly and regularly, particularly after going to the toilet, and prepare food safely.

MRSA

The staphylococcus aureus bacteria that cause MRSA infections can survive for days to weeks on surfaces. MRSA bacteria can live on surfaces for longer than some other bacteria and viruses because they survive better without moisture. Generally, MRSA bacteria survive for longer on hard surfaces than on soft surfaces.

Herpes

The herpes virus, which causes cold sores and genital herpes, dies very quickly when it’s away from your skin. It’s usually passed on by kissing or oral sex while the virus is active on the skin.

Preventing the spread of infection

It’s not always possible to avoid catching an illness, but there are ways to reduce your risk and to prevent infections spreading to others:

Wash your hands regularly, particularly after going to the toilet, before handling food and after coughing, sneezing or blowing your nose.

Keep your home clean and hygienic, particularly if a member of your family is unwell.

Wash fabrics that may be contaminated with bacteria or viruses at 60C (140F) and with a bleach-based laundry product.

The length of time you’re infectious for after having a viral infection depends on the type of virus involved.

The infectious period often begins before you start to feel unwell or notice a rash.

Bronchitis

The length of time that bronchitis is infectious varies, depending on its cause.

In most cases, bronchitis is caused by the same viruses that cause the common cold or flu, and you’re likely to be infectious as long as you have cold or flu symptoms.

Chickenpox

Chickenpox is infectious from 2 days before the spots appear to until they have crusted over, usually 5 days after they first appeared.

Common cold

The common cold is infectious from a few days before your symptoms appear until all of the symptoms are gone. Most people will be infectious for around 2 weeks.

Symptoms are usually worse during the first 2 to 3 days, and this is when you’re most likely to spread the virus.

Flu

Flu is usually most infectious from the day your symptoms start and for a further 3 to 7 days.

Children and people with lowered immune systems may be infectious for a few days longer.

Glandular fever

Glandular fever isn’t particularly contagious and can usually only be spread through direct contact with saliva, which is why it’s sometimes called “the kissing disease”.

There’s no reason not to continue to go to school or work if you feel well enough.

Measles

Symptoms of measles appear around 10 days after you become infected.

Measles is most infectious after the first symptoms appear and before the rash develops.

First symptoms of measles include:

• a high temperature
• red eyes
• cold-like symptoms – such as a runny nose, watery eyes, swollen eyelids and sneezing

Around 2 to 4 days later, a red-brown spotty rash develops that normally fades after about a week.

Mumps

Mumps causes your salivary glands to swell. These glands are just below and in front of your ears.

Mumps is most infectious from a few days before your glands swell until a few days afterwards.

Rubella (german measles)

People with rubella should stay off school or work, and avoid contact with pregnant women where possible, for 6 days after the rash firsts develops.

Shingles

You can’t spread shingles to others. But people who haven’t had chickenpox before could catch chickenpox from you.

Shingles is infectious while the rash oozes fluid.

Tonsillitis

Tonsillitis itself isn’t contagious, but the viruses that cause it are. The length of time you’re infectious will depend on the virus.

When a person is “infectious”, it means they’re able to pass their infection on to others.

You’re usually no longer infectious 24 hours after starting a course of antibiotics, although this time period can sometimes vary.

For example, the antibiotics may take longer to work if your body takes longer to absorb them or if you’re taking other medication that interacts with the antibiotics.

Medical advice

Talk to your pharmacist or GP if you have any questions or concerns about your course of antibiotics.

It’s important to finish your course of antibiotics, even if you’re no longer infectious and feeling better.

Failing to finish the course may result in the infection returning.

You should:

• collect your stool (faeces) sample in a clean container
• store the container in a fridge in a sealed plastic bag if you can’t hand it in straight away

Collecting a stool sample

Your GP or another healthcare professional, such as a nurse, should explain how to collect the stool sample. It should be collected in a clean, dry screw-top container.

Your doctor or a member of staff at the hospital will give you a plastic (specimen) container to use, although you can use any clean container as long as you can seal it.

Try not to collect urine or water from the toilet with the stool sample, but don’t worry if you do. If you need to urinate, do this first before collecting the stool sample.

To collect a stool sample:

• label the container with your name, date of birth and the date
• place something in the toilet to catch the stool, such as a potty or an empty plastic food container, or spread clean newspaper or plastic wrap over the rim of the toilet
• make sure the sample doesn’t touch the inside of the toilet
• use the spoon or spatula that comes with the container to place the sample in a clean screw-top container and screw the lid shut
• if you’ve been given a container, aim to fill around a third of it – that’s about the size of a walnut if you’re using your own container
• put anything you used to collect the sample in a plastic bag, tie it up and put it the bin
• wash your hands thoroughly with soap and warm running water

Follow any other instructions your doctor gives you.

Storing a stool sample

Stool samples should be handed in as soon as possible, as some can’t be analysed if they’ve been refrigerated – your doctor will tell you if this is the case.

If you can’t hand the stool sample in immediately, you should store it in a fridge, but for no longer than 24 hours. Place the container in a sealed plastic bag first.

Stool samples must be fresh – if they aren’t, the bacteria in them can multiply. This means the levels of bacteria in the stool sample won’t be the same as the levels of bacteria in your digestive system. If the levels of bacteria don’t match, the test results may not be accurate.

If you can’t hand your stool sample in immediately, find out how long it can be kept in the fridge. Your GP or the healthcare professional who requested the test will be able to tell you.

What are stool samples used for?

Your GP or another healthcare professional may ask you for a stool sample to help them diagnose or rule out a particular health condition.

Stools contain bacteria and other substances that are present in the digestive system.

By testing the levels of these substances and bacteria in your stools, it’s possible to work out what’s happening in your digestive system.

For example, a stool sample can be tested to help diagnose:

• gastroenteritis – a common condition that causes diarrhoea and vomiting, and is usually the result of a bacterial or viral tummy bug
• inflammatory bowel disease – such as Crohn’s disease, a condition that causes inflammation of the lining of the digestive system, and ulcerative colitis, a condition where the colon and rectum become inflamed

Pneumonia is swelling (inflammation) of the tissue in one or both of the lungs. It’s usually caused by an infection – most commonly, bacteria and viruses, which are both contagious.

Catching pneumonia

The germs that can cause pneumonia are usually breathed in. People often have small amounts of germs in their nose and throat that can be passed on through:

• coughs and sneezes – these launch tiny droplets of fluid containing germs into the air, which someone else can breathe in
• touching an object and transferring germs on to it – someone else can touch this object and then touch their own mouth or nose

Preventing the spread of pneumonia

You can help prevent the spread of a pneumonia by taking some simple hygiene precautions.

These include:

• washing your hands regularly and thoroughly, particularly after touching your nose and mouth, and before handling food
• coughing and sneezing into a tissue, throwing it away immediately and washing your hands
• not sharing cups or kitchen utensils with others

Vaccination

There is a vaccine that protects against Streptococcus pneumoniae, which is the most common cause of bacterial pneumonia.

Vaccination is recommended for:

• babies
• adults aged 65 or over
• children and adults with certain long-term health conditions, such as a serious heart or kidney condition

The Streptococcus pneumoniae vaccine is usually given as part of the routine NHS child vaccination schedule. If you’re unsure if you or your child has been given the vaccine, check with your GP.

The incubation period is the time between catching an infection and symptoms appearing. Incubation periods vary, depending on the type of infection.

Infection incubation periods

The incubation periods for some infections are:

• chickenpox – 1-3 weeks
• flu – usually around 1-3 days
• whooping cough (pertussis) – between 6 and 20 days
• rotavirus – 2 days
• norovirus – 1-2 days

Infectious period

The infectious period isn’t necessarily the same as the incubation period. With some viruses, such as chickenpox, the person may be infectious before symptoms start to show.

Infections that used needles and sharps can pass on to other people include:

• hepatitis B
• hepatitis C
• HIV

Although rare, there’s also a small risk of other infections being transmitted through contaminated blood, such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV).

For immediate first aid advice if you have injured yourself, see What should I do if I injure myself with a used needle?

Needles and sharps

Once someone has used a needle, viruses in their blood may contaminate it. This includes needles used to inject illegal drugs.

Sharps can include other medical supplies, such as syringes, scalpels and lancets, and glass from broken equipment. Blood can also contaminate these.

Injuries from needles used in medical procedures are sometimes called needle-stick or sharps injuries.

People at increased risk

Some people have an increased risk of needle-stick injuries as a result of their job.

These include:

• nurses
• doctors
• surgeons
• dentists
• dental nurses
• phlebotomists
• hygienists
• laboratory technicians
• the police
• prison and probation services
• customs and excise
• social workers
• funeral workers
• piercers and tattooists
• building and demolition workers

If you injure yourself with a used needle at work, report the incident to your supervisor or manager immediately. There may be procedures in place you need to follow.

If you’re at increased risk of needle-stick injuries because of your job, you may also need to take other preventative measures. For example, you may need to have a hepatitis B vaccination.