Evaluation article: Managing the risk of E. coli

Published: Monday, 16 June 2014

Suzanne Averill explains E. coli and looks at preventative measures, outbreak management and treatment for individuals.

Key points

  • E. coli (Escherichia coli) are bacteria that usually live in the intestines, although they are not confined to the intestines and some can migrate to other areas such as the urinary tract.
  • Most of the time the E. coli bacteria are harmless, although there are some types that can be harmful.
  • The most common infection caused by these bacteria is a urinary tract infection. This type of infection may be characterised by a painful burning sensation during urination and may even result in back pain and fever.
  • E. coli may also cause more serious infections of the intestine.
  • E. coli can be transmitted through eating contaminated food, such as undercooked beef or raw fruit and vegetables, or by drinking contaminated water or unpasteurised milk.
  • Good hand washing is key to preventing E. coli infection.
  • Anyone can be affected by E. coli, although generally the elderly are more at risk of contracting an E. coli infection as they have a weaker immune system.
  • The Department of Health has requested that cases of E. coli are reported to the Health Protection Agency.

What is E. coli?

E. coli (Escherichia coli) are bacteria which usually live in the intestines although they are not confined to the intestines. Sometimes the bacterium migrates to other areas such as the urinary tract. There are many different types of E. coli. Most of the time these bacteria are harmless, although there are some types that can be harmful. The most common infection caused by these bacteria is a urinary tract infection. This type of infection may be characterised by a painful burning sensation during urination and may even result in back pain and fever. E. coli may also cause more serious infections of the intestine. The most serious common infection is known as E. coli 0157. In this case the individual will experience signs of severe diarrhoea that may be bloody, severe abdominal pain, nausea and vomiting.

How is it transmitted?

There are numerous ways that E. coli can be transmitted. It may be through eating contaminated food, such as undercooked beef or raw fruit and vegetables, or by drinking contaminated water or unpasteurised milk. Animals are another source for transmission, as well as faeces from infected people via the oral faecal route.

How is it prevented?

Good hand washing is key in the prevention of E. coli infection. Hands should be washed particularly before preparing food, or after contact with faeces, cows, sheep and goats.

Are some people more at risk?

Anyone can be affected by E. coli, although generally the elderly are more at risk of contracting an E. coli infection as they have a weaker immune system. Urinary tract infections occur more commonly in females, especially those who are sexually active. And intestinal infections may have a greater impact on children due to their inability to tolerate much fluid or blood loss.

How is it diagnosed and treated?

If there are either confirmed or suspected cases of an individual suffering from E. coli then it is essential that a doctor’s advice is sought. The infection can be diagnosed through a laboratory test of either a stool, urine or blood sample. There are some types of infection, such as E. coli 0157, that can be detected by a serum antibody test. Over recent years the bacteria have become resistant to several antibiotics. The type of antibiotic required will depend on the strain. Antibiotics are not usually given for intestinal infections; however urinary tract infections are treated with antibiotics. If an individual has an E. coli infection it is essential that they drink plenty of fluids and rest.

Providing care for those diagnosed with E. coli

When providing care for those diagnosed with E. coli it is important to carry out preventative measures to reduce the spread of infection. Any carer looking after a person with E. coli should care for the individual using aprons and gloves. Hands should be washed after removing the gloves to reduce the spread of the infection. Any residents/patients who have the diagnosis should use their own bathroom facilities and where possible they should stay in their own rooms while they are unwell or recovering.

Any clothing should be put in red soluble bags, placed directly into the washing machine and washed at the highest possible temperature for the fabric. Any other items should be washed separately. It is important not to share any towels or bedding.

Discharge from hospital

Should any resident be diagnosed with E. coli 0157 while they are in hospital, they should not be discharged to a residential or nursing home until they have either completed treatment or been free from diarrhoea for two days. If an individual is being transferred back to their own home, there is no reason to delay a discharge once the person is well.

Cleaning

Hot soapy water should be used to clean touch point areas on a daily basis to prevent an outbreak. Areas should also be cleaned thoroughly if there are visible signs of dirt. A sodium hypochlorite solution should be used to clean equipment, but it is important to wear gloves when using this product as it may damage the skin. Good practice for cleaning would be to use a disposable cloth each day. Any mops should be washed at the end of the day in a washing machine; if available, disposable mop heads should be used instead.

Outbreak management

As with any outbreak, early detection is crucial in order to prevent transmission and to manage cases correctly. Good hand hygiene is essential. All cases should be isolated and gloves and aprons should be used when caring for the resident. Cleaning should be increased as per the advice above. Regular reporting to your local health protection agency and environmental health department should be ongoing. Any treatment provided should be administered as per prescription and it is important that the fluid intake of residents is monitored.

Staff

If any staff are diagnosed with the E. coli infection then they should not return to work until 48 hours after the symptoms have stopped. If a staff member who handles food is affected then a discussion should take place with the environmental health department to decide on when it is appropriate for them to return. The staff member may need a negative test before they can return to work.

Reporting

The Department of Health has requested that cases of E. coli are reported to the Health Protection Agency. This is so that cases can be managed appropriately and, through time and enhanced surveillance, interventions can become more accurate.

Toolkit

Use the following items in the toolkit to put the ideas in the article into practice:

About the author

Suzanne Averill, MSc, RGN, Nurse Consultant, Global Infection Prevention, currently works for the United Nations in South Sudan as the Health and Nutrition Cluster Coordinator. She has previously worked for the Health Protection Agency as the International Lead and in commissioning in the NHS as Head of Infection Control.

This article was first published in the April 2013 issue of Quality & Compliance Magazine.

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