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HPA - New Guidelines to Control Group A Streptococcal (GAS) Infections in UK Hospitals Launched

The Health Protection Agency (HPA) together with the group A streptococcal (GAS) Working Group* has yesterday launched new guidelines for the investigation, control and prevention of GAS infection in acute healthcare settings, including maternity units, in the UK.

The Working Group comprised of a wide range of healthcare specialists from across the UK involved in the identification, treatment and control of infectious diseases.

Group A streptococcus is a bacterium occasionally found in the throat and on the skin and may be carried for long periods of time without causing any illness (also known as colonised). It is spread by direct person-to-person contact with an infected or colonised person and can cause a range of infections, from relatively mild sore throats and skin infections to rare but life-threatening invasive disease. Most severe infections are acquired in the community with around one in ten acquired in hospital settings. GAS infection can be treated with penicillin and many other antibiotics.

Although general guidelines for controlling infections in healthcare settings exist, these new guidelines will give hospitals clear, evidence-based advice on how to minimise the risk of spread of GAS infections in hospitals and maternity settings such as midwife-led units.

Dr Joe Kearney, Chair of the GAS Working Group said: “Group A strep is a common bacterium found in the throat and on the skin and may be carried for long periods of time without causing any illness. Whilst most GAS infections are relatively mild they can on rare occasions become very serious.

“These new recommendations are specifically aimed at assisting healthcare workers in controlling the spread of these infections. They have been drawn up with expert colleagues from a wide range of organisations, including a patient support group, to ensure that we have developed comprehensive advice for managing GAS infections in hospitals and other acute healthcare settings.

“Although cases of hospital-acquired GAS infection are rare, it’s important that appropriate control measures are implemented quickly if a case is identified to reduce the risk of further spread to other patients.”

The guidance provides recommendations for hospital staff in carrying out investigations of every inpatient with GAS infection to determine how the infection was probably acquired. GAS infections diagnosed in women who have recently given birth or patients discharged within the last seven days should be similarly investigated. Where the infection was acquired in hospital or as result of contact with healthcare services (e.g. following a home birth), further investigations are recommended to find the source of the infection.

There are three main routes of transmission of GAS infections in healthcare settings: patient-to-patient, from healthcare worker to patient (and vice-versa) and through the immediate hospital environment. Implementing a targeted investigation to locate the source of the infection will help hospital staff to eliminate it and safeguard patient care.

The guidance also gives clear recommendations on how hospital staff should manage and investigate outbreaks such as identifying healthcare workers linked to cases, identifying any signs or symptoms of possible GAS infections in close contacts and recommending appropriate antibiotic treatment, if necessary.

Notes to Editors:

  1. *The Working Group membership consists of the Association of Medical Microbiologists, British Infection Society, British Society of Antimicrobial Chemotherapy, Faculty of Occupational Medicine of the Royal College of Physicians, Health Protection Agency, Health Protection Scotland, Hospital Infection Society, Infection Prevention Society, Lee Spark Foundation, Public Health Agency for Northern Ireland, Public Health Medicine Environmental Group, Public Health Wales, Royal College of Midwives and the Royal College of Obstetrics and Gynaecology.
  2. The guidelines are available on the Journal of Infection and HPA website at: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/StreptococcalInfections/Guidelines/
  3. The most common presentation of GAS infection in the UK is a mild sore throat known as 'strep throat', with approximately 15-30% of sore throats seen by doctors thought to be caused by this. Less common is scarlet fever, with around 2-4000 notifications received each year.
    The incidence of more serious invasive infections is relatively low. Around 3 cases per 100,000 population of bacteraemia were reported in England, Wales and Northern Ireland for 2010 (approximately 1600 cases). Latest data on streptococcal bacteraemia can be found in the Health Protection Report here: http://www.hpa.org.uk/hpr/archives/2011/hpr4611.pdf
  4. Severe respiratory tract infections account for around 17% of all invasive GAS infections, and skin/soft tissue infections around 42%. Cases of necrotising fasciitis are even less common, accounting for approximately 5% of invasive GAS infections and usually associated with patients presenting with skin trauma as the main predisposing factor.
  5. Further information can be found on the HPA website at http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/StreptococciGroupA/  
  6. If you have concerns about your health contact NHS Direct on 0845 4647 or visit the website http://www.nhsdirect.nhs.uk, or see your family doctor.
  7. The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. In April 2013, subject to the usual approvals procedures for establishing new bodies, the Health Protection Agency will become part of a new organisation called Public Health England, an executive agency of the Department of Health. To find out more, visit our website: http://www.hpa.org.uk or follow us on Twitter@HPAuk.
  8. For more information please contact the national HPA press office at Colindale on 0208 327 7901 or email colindale-pressoffice@hpa.org.uk . Out of hours the duty press officer can be contacted on 0208 200 4400.