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PH Protection

Planning treatment in a European Country   

If you are thinking about any sort of planned medical or dental treatment outside the UK, please discuss this fully with your GP, hospital consultant or dentist. Make sure you are fully informed as it is important to have the information you need to make the right choices. You will need to be fully informed about your European healthcare provider and the details of the treatment you are planning to have. You may also need to consider:

  • when you will be able to travel
  • how your medical notes will be exchanged between teams
  • arrangements for after-care or follow-up treatment either abroad or at home
  • how you would deal with any complaint or problem should something go wrong following your treatment abroad
S2 Scheme

All treatment under the S2 scheme requires Health Board approval before treatment can commence. Please click on the linked heading above for more information. 

EU Cross Border Healthcare Directive

The arrangements for reimbursing health care costs to people who live in Scotland and receive treatment in EEA states stopped on 31 December 2020 (EU Exit Implementation Period completion day). Click on link above for more information

White Powder Incident

Members of the public who have been exposed to a suspect biological agent should receive an initial 10 days’ ciprofloxacin as prophylaxis against anthrax, plague, tularaemia or other biological agent (unless contraindicated – doxycycline is an alternative – see below). This is a precaution until laboratory results for the agent are known. Initial and follow-up treatments can be provided under the emergency PGDs below.

Anthrax – children aged 12 yrs and over and adults

Tularemia – children aged 12 yrs and over and adults

Plague – children aged 12 yrs and over and adults

Anthrax – children under 12 yrs

Tularemia- children under 12 yrs

Plague – children under 12 yrs

NHSGGC Authorisation Forms for PGDs

Exposure to Radiactive Iodine – adults and children 

Measles

Measles is a notifiable disease under the Public Health (Scotland) Act 2008.

Measles should be considered if the patient has:

  • Fever ≥38°C AND
  • Generalised maculopapular rash AND
  • Either cough, coryza or conjunctivitis (ref HPS)

GPs should take a throat swab as soon as possible when measles is clinically suspected. The swab should be expressed into the Viral PCR Sample Solution vial (VPSS) and sent off to the West of Scotland Specialist Virology Centre at the GRI.  If VPSS is not available, swabs can be cut off and sent dry in a sterile container. This should be avoided whenever possible as the virus remains infectious and sensitivity is reduced. VPSS inactivates and preserves the pathogen genome for PCR testing.

TrakCare item: Adult maculopapular rash – virus PCR – Set (See WoSSVC under Rash testing – maculopapular)

TrakCare item: Paediatric maculopapular rash – virus PCR – Set 

GP electronic request (ICE / EMIS / Vision) item: Maculopapular rash PCR-current infection

Measles Communication

Letter 1

Letter 2

Notification

GPs should notify the PHPU Health Protection Nurse by calling 0141 201 4917  

On notification, the HPN will assess the individual epidemiological features of the case: –

Immunisation history –  any known vaccination history or history of measles?     (The vaccine effectiveness of a single dose of MMR is around 90% and approximately 95% for two doses.  Although vaccine failure is rare, it can occur, particularly after a single dose)

Travel – any travel within and outside the UK during the incubation period, with an assessment of whether travel was in an area where measles is known to be circulating?

Ethnic and cultural/religious background – are there details on the patient’s ethnicity, and importantly, whether the patient is a member of an under-vaccinated population group (e.g. Charedi Orthodox Jewish community, Steiner community)?

Epidemiological link – is there a known epidemiological link with another laboratory or epidemiologically confirmed case?

WHO Measles Surveillance

If the PHPU clinician agrees that the case meets the definition of a possible measles, an oral fluid kit (MMR salivary kit) for IgM testing will be sent out – previously sent to GP surgeries, these are now being posted from the PHPU directly to patients/parents/guardians who are requested to forward the sample directly to PHE Colindale using the labelled packaging supplied. MMR kits, which meet the WHO requirements of measles investigation to satisfy elimination criteria, are sent out even if PCR testing is negative.

Exclusion of a confirmed case

People with confirmed measles should be excluded from their usual place of work or study or from shared childcare facilities or any other shared space until at least four days after the rash has developed. The case should be advised to self isolate and to avoid contact with vulnerable groups during this time. For more info click on link

MUMPS

Mumps is a notifiable disease under the Public Health (Scotland) Act 2008.  

Oral fluid testing (MMR salivary kit) for suspected mumps cases ceased on 1st April 2018.  

Mumps can be diagnosed clinically. However, if a GP is keen to have laboratory confirmation of suspected mumps cases, the PCR test is available from the WoSSVC.  A buccal (inner cheek) mouth swab should be expressed into the VPSS vial and sent off to the WoSSVC (GRI).  When Viral PCR Sample Solution (VPSS) is not available, swabs can be cut off and sent dry in a sterile container.  

TrakCare item:  Mumps PCR – current infection

GP electronic request (ICE / EMIS / Vision) item: Mumps PCR – current infection

Ordering VPSS

Please email the WoSSVC (west.ssvc@nhs.net ) to order Viral PCR solution (VPSS) and include:

  1. The requesting location address (inc. the postcode)
  2. The number of VPSS vials required
  3. Name, telephone number and email address of a contact in case of questions regarding the order 

Alternatively requests for VPSS can be made via the office 0141 201 8722.

A total of 271 cases of TB were reported in Scotland in 2018.

127 of these were in NHS Greater Glasgow and Clyde.

This represents an annual incidence of 5.0 cases per 100,000 population for Scotland overall and  10.8 per 100,000 within NHS GGC.

There has been a 46% decrease in the annual number of cases reported in Scotland since 2010.

Approximately 60% of all the TB cases in Scotland were born outside of the UK.

The risk factors for developing TB among the indigenous population of Greater Glasgow and Clyde include deprivation, homelessness, and drug and alcohol misuse.

TB commonly infects the lungs and respiratory tract, but it can infect almost any part of the body. The symptoms of TB vary, depending on which part of the body is infected. 

For more info click on the HPS link

NHSGGC TB Liaison Nurses

NHSGGC has 4 TB Liaison Nurses who are responsible for the case management of patients diagnosed with TB. A patient is  assigned  to a TB nurse by postcode, each nurse being responsible for an area within NHSGGC.   

Primary care staff who require any advice regarding TB or guidance about screening potential contacts of a TB case should call the TB Liaison Nurse responsible for the individual’s postcode area. The TB nurse will advise if any action has to be taken. Enquiries about a patient’s TB medication should also be directed to the responsible nurse. 

TB nurses will identify close contacts of a TB case and organise Mantoux testing or Chest X Ray.  They are also responsible for administering BCG vaccine to both children and adults.  

TB leaflets

If travelling abroad go to the Fit For Travel website for travel health information.

School trips – travel guidance

Please note the Health Protection Scotland Travel Health Guidance Aug 2017 for children on school trips (Version 4 still current in 2018) 

Schistosomiasis

Schistosomiasis and post travel screening 

It is important that all travellers to tropical destinations – including pupils or students on cultural exchange trips – receive accurate travel health advice. A range of travel health issues should be considered for these groups including the risk of exposure to schistosomiasis. The PHPU was recently involved in the coordination of post travel screening for two separate school parties. In addition, NHS Highland public health reported an incident where 21 students required to be screened after one of the party presented to urology with haematuria and a history of exposure to untreated water in Malawi; 13 tested positive for schistosomiasis and of those only two were symptomatic. The incident and conclusions were reported in Journal of Public Health Advance Access, published online in December. Schistosomiasis is a parasitic infection which is present in fresh water in many tropical countries, especially African countries. It is contracted following exposure to untreated fresh water including swimming, paddling, washing, and showering. It is usually asymptomatic but an itchy rash, swimmers itch, can occur at the site of entry. Two to four weeks later fever, diarrhoea, cough, or a rash may develop. Long standing infection can lead to bowel, liver, kidney and bladder problems including bladder cancer.

Travellers are advised to seek pre-travel health advice and, to allow accurate advice to be given, should provide the clinician with as much information as possible about the trip, including arrangements for washing and showering. Travellers to endemic areas should be advised not to bathe, swim or wade in freshwater lakes or rivers.

Those intending to wash or shower, as well as those who swim or paddle, in untreated fresh water will need post-travel screening for schistosomiasis and they should be advised at the pre-travel consultation to attend for screening 8 weeks after return. Screening requires a serum sample – 5mls clotted blood in either a red or yellow-topped tube – obtained after a minimum of 8 weeks since last exposure to be sent to the Scottish Parasite Diagnostic Laboratory. This is the shortest time it takes for worms to mature, reproduce and lay eggs. The test examines levels of Schistosoma antibodies. Results for any new positive cases are phoned directly by the Consultant Clinical Scientist to the GP and a written report is issued for all positive and negative tests. Serologically positive patients should be referred to an infectious disease physician at the Brownlee where further investigation and treatment will be carried out.

Other useful links for advice/information are listed below:-

Health Protection Scotland has produced a national guidance document on the prevention and control of infection in childcare settings. This guidance was updated in 2018. The guidance is for childminders and staff working within nurseries, day-care centres, playgroups, crèches, children’s centres, after-school and holiday clubs. It should also be used by staff involved in all outdoor activities for children. 

Infection Prevention and Control in Childcare Settings 2018  

For a quick guide to the exclusion criteria for children in the settings above please click on the link. This Guidance can be downloaded and laminated for display in relevant areas. 

For further information/advice please call 0141 201 4927 or email PHPU@ggc.scot.nhs.uk

Novovirus 

The 2018 HPS national guidance documents and resource pack for care home staff responsible for the prevention and control of Norovirus cases are listed below: 

Flu 

The 2018 HPS national guidance documents and resource pack for care home staff responsible for the prevention and control of cases of influenza are listed below:

Invasive Group A Strep

Interim UK guidelines for management of close community contacts of invasive group A streptococcal disease – 2004 (still current in 2019)

Community guidance on management of invasive group A streptococcal disease (iGAS).  Outbreaks of GAS infection in nursing homes have been reported. Prevention of the spread of iGAS is especially important because of the high mortality rate in this population. See PHPU Newsletter Feb 2019 for more info on iGAS in NHSGGC  

Clostridium difficile

Protocol for clostridium difficile testing which includes recommendations for sample selection, sample storage and transportation, and testing protocol

Carbapenemase-producing Enterbacteriaceae

This guidance contains a set of recommendations and practical advice to reduce the spread of carbapenemase-producing Enterobacteriaceae (CPE) in non-acute and community settings in Scotland 

Updated Feb 2019

National Infection control manual
National infection and control manual

The NHSScotland National Infection Prevention and Control Manual was first published on 13 January 2012. It is an evidence based National Infection Prevention and Control (NIP&C) Manual for Scotland and is intended to be used by all those involved in care provision. 

The manual contains information on Standard Infection Control Precautions (SICPs), Transmission Based Precautions (TBPs), Healthcare Infection incidents, outbreaks and data exceedance. It is mandatory for NHS Scotland and considered best practice in all other care settings. It should be adopted for all infection prevention and control practices and procedures

Infection prevention and control powerpoint training slides
Clostridium difficile –  PHPU Presentation slides 2017
National Guidance for Safe Management of Linen in NHS Scotland

This national guidance, is complemented by the National Infection Prevention and Control Manual Chapter 1 – Standard Infection Control Precautions – which covers safe management of linen at care area level. It is a useful resource for care homes when formulating policy and procedures governing safe management of linen within their facility. 

National Guidance for Safe Management of Linen in NHS Scotland
Patient Information Leaflets

Influenza vaccination leaflets

Norovirus

MRSA (meticillin resistant staphylococcus aureus)

Clostridium difficile advice leaflets

(CPE) Carbapenemase-producing Enterobacteriaceae advice leaflets

HPS compendium of Healthcare Associated Infection Guidance 2019

The HAI Compendium contains links to current national policy and guidance on HAI, antimicrobial prescribing and resistance, decontamination and other related topics. The compendium aims to provide NHSScotland staff with an overview of all up to date guidance from stakeholders/organisations. 

The Compendium includes links to the National Infection Prevention and Control Manual (NIPCM) which is the mandatory practice guide for all NHSScotland care settings. As well as the practice guide for Standard Infection Control Precautions, Transmission Based Precautions and HAI Incidents and Outbreaks it includes supporting materials such as literature reviews, tools and posters. The NIPCM can be accessed on a standalone website.

BBV Guidelines
  • For up to date BBV guidelines, please refer to the NHSGGC Clinical Guideline Portal
  • August 2022 – BBV Patient Risk Assessment Letter and Form is being reviewed, and will be updated soon.
What are Blood Borne Viruses?

Blood borne viruses are transmitted (spread) from person to person via blood and or other bodily fluids for example through sharing of injecting equipment and to varying degrees through sexual activity. The most prevalent BBVs are HIV, Hepatitis C and Hepatitis B.

People can often live for many years without experiencing any symptoms, therefore not knowing they are infected. Unfortunately this can mean that by the time the virus is diagnosed, the impact on an individual’s health are far more serious.

The risk of transmission will depend on a number of factors for example:

  •  route of transmission,
  •  infectiousness of the virus
  •  whether or not the person is receiving treatment for example for HIV.
Hep C

Hepatitis C is a virus that damages the liver. left untreated, hepatitis C can lead to liver disease and liver cancer. People often have no symptoms and therefore the only way to know for sure if someone has hepatitis C is via testing.

In the UK, Hepatitis C is almost exclusively transmitted through sharing of injecting equipment. While possible, it is far less commonly acquired through unprotected sex, mother to baby transmission, blood transfusions abroad, sharing of toothbrushes/razors. Like HIV, it is not passed through social contact with those who are affected.

Although there is no vaccine to protect against the infection, hepatitis C is curable with a short course of tablets, without significant side effects. With new treatments, everyone who is diagnosed positive is eligible for assessment and treatment, regardless of stage of disease or other health and social factors.

While it is important to test those who have ever been at risk, or who are at on-going risk to find undiagnosed infection, if elimination in Scotland is to be achieved, there is also need to re-engage those individuals who were previously diagnosed with hepatitis C, but did not stay in treatment or were not able to engage with the old interferon-based treatment regimes. These individuals should also be offered re-referral to treatment services.

HIV

HIV (Human Immunodeficiency Virus) is a blood borne virus that is most commonly passed on through unprotected sex. It can also be transmitted through:

  • sharing needles, syringes and other injecting equipment,
  • and from mother to baby during pregnancy, birth or breastfeeding.

If left untreated, a person’s immune system can become severely damaged and they may develop a number of opportunistic infections which can be life threatening. This late stage of HIV infection is referred to as AIDS (Acquired Immune Deficiency Syndrome).  There are very effective treatments for HIV which can stop most people from developing AIDS. The earlier someone is tested and diagnosed, the better their outcomes will be.

Adhering to treatment not only means an individual can live a healthy life, it can also stop the onward spread of HIV. This is known as Treatment as Prevention – Those individuals who take their treatment regularly and have an undetectable viral load for 6 months or more, have been shown not to be able to pass the virus to others during sexual intercourse.

The risk of transmitting and/or acquiring HIV can also be reduced through use of

Treatment and care for HIV is provided in NHSGGC via the Brownlee service.

National Data Portal

PHS  produce reports which provide up-to-date epidemiological summaries in relation to BBVs and STIs in Scotland, highlighting key trends and identifying areas for priority action. HPS Website – All surveillance reports

For information on the epidemiology of HIV in UK  see Public Health England website.

Injecting Equipment Services in NHSGGC

The NHSGGC Injecting Equipment Provision service offers sterile needles, syringes and other equipment free of charge to people who inject drugs.  The service provides a valuable public health benefit for individuals and communities by reducing the spread of blood borne viruses and other related infections.  This service is provided by community pharmacies throughout Greater Glasgow and Clyde NHS area, the Glasgow Drug Crisis Centre some Alcohol and Drug Recovery Services and some third sector organisations for example Waverley Care and the Simon Community may also be able to provide.  Community pharmacies provide a wide range of health care information and advice and are important contact points that give immediate access to a health care professional.

To find out where you or someone else can access Injecting Equipment Provision in NHSGCG visit www.needleexchange.scot

Public Health Scotland and SDF have produced good practice guidance on Injecting Equipment Provision in Scotland.

Public Health Scotland provides information on the provision of injecting equipment. This includes the number of outlets, attendances and the types of injecting equipment distributed to people who inject illicit drugs (including Novel Psychoactive Substances and Image and Performance Enhancing Drugs) in Scotland.

Patient Information

Leaflet 1 – BBV Testing leaflet – currently being updated

Leaflet 2 – Waiting for results

Leaflet 3 – BBV – negative results

Leaflet 4 – HIV – Newly Diagnosed

Leaflet 5 – Hep C – Newly Diagnosed 

Leaflet 6 – Hep B – Newly Diagnosed

Leaflet 7 – Basic information on HIV 

Leaflet 8 – What you need to know about PEP  This leaflet is also available in French; Urdu; Arabic   

Leaflet 9 – Living with Hep C (2017)

BBV Training

It is important that staff and services who work with anyone who might be at risk are aware of BBVs, key prevention messages and either how to do a test or refer someone for testing.

A range of free BBV training is available to those working within NHSGGC.

NHS Learn Pro – GGC116 Blood Borne Viruses

NHS Learn Pro – GGC149 HIV Stigma       

The Scottish Drugs Forum also provides both online and in person see Scottish Drugs Forum (SDF) and has a number of resources relating to BBV Staff who require further advice, information or support around HIV/BBV testing or related patient issues should contact the Sandyford BBV Failsafe on 0141 211 8639 or email the professional helpline ggc.sandyfordprofessionalsupport@nhs.scot

For Staff – Occupational Exposure to BBV

If you need to report an incident or require advice, please contact Occupational Health on 0141 201 5610. The line is open Monday – Friday, 8am – 6pm.

Any incidents that occur out with these times should be reported to your local Accident & Emergency unit. Please ensure that you then report your injury to Occupational Health on the next working day.

BBV Guidelines – Occupational Health – Needlestick and other injuries

Patient Group Directions (PGDs) are legal documents that enable healthcare professionals to administer and supply medication in an identified clinical situation where the patient may not be individually identified before presenting for treatment. For most clinical situations the preferred method is for an appropriately qualified healthcare professional to prescribe for an individual patient on a one-to-one basis. In order to comply with the necessary clinical governance arrangements NHS Greater Glasgow & Clyde must be aware of all PGDs in use.

National template PGDs are published by Public Health Scotland (filter by type), and can be accessed for information only – boards are required to have their own approved PGDs for use within their services and NHSGGC PGDs can be obtained by emailing Patient.GroupDirections@ggc.scot.nhs.uk

For any other enquiries relating to the use and authorisation of PGDs please contact Patient.GroupDirections@ggc.scot.nhs.uk

PSD (NHSGGC Patient Specific Directive) for completion for
Adult Non Routine Vaccinations out with the Green Book Guidance