Recent outbreaks of the deadly bug E. coli 0157 in day nurseries in Fife and Aberdeenshire in Scotland and a school nursery in Wales have highlighted the need for childcarers to be aware of the infection's symptoms and, essentially, how they can help prevent contamination.
What is E. coli?
E. coli is the abbreviated name of Escherichia coli. It is a bacteria that is everywhere in the environment and normally found in the intestines of cattle and people.
The presence of E. coli helps us to remain healthy - E. coli, along with other species of bacteria, helps provide our bodies with necessary vitamins, including Vitamin K and B-complex vitamins. But there are potentially fatal strains of E. coli, including the 0157 strain which is responsible for the recent outbreaks. E. coli 0157 infection is particularly severe when contracted by babies, young children or elderly people.
The 0157 strain was first detected in Britain in the early 1980s. It is technically known as Verocytotoxin-producing E. coli, or VTEC.
What are the symptoms?
Symptoms of an E. coli 0157 infection can range from mild to bloody diarrhoea and occasionally permanent kidney damage.
Kidney failure is caused by a complication called haemolytic uremic syndrome (HUS), which kills the red blood cells. Children under the age of five are particularly vulnerable to contracting HUS. This complication occurs in about 5 to 10 per cent of cases.
Symptoms may appear within hours or days. It depends on a number of factors, including the age and state of health of the person infected, the number of organisms that they ingested and their natural resistance to the bug. Ingesting fewer than 100 E. coli organisms can cause illness.
How is it spread?
Humans can become infected with E. coli 0157 through a number of routes.
The majority of illnesses have been associated with eating undercooked, contaminated ground beef, such as burgers. But other contaminated food products can also be to blame.
It can also be transmitted through direct contact with infected animals, particularly cattle, and person-to-person spreading, most often found in families or institutions such as childcare settings. Outbreaks have also been linked to swimming in contaminated water.
Bacteria found in the stools of infected people can be transmitted if handwashing and hygiene controls are inadequate. E. coli is easily spread among groups of young children, especially toddlers who are not toilet trained. They are vulnerable to the infection if they come into contact with it and then put their fingers in their mouths or do not wash their hands thoroughly.
Children can continue to shed the 0157 organisms in their stools for a week or two after they have recovered from the illness.
How is the infection diagnosed?
E. coli 0157 is diagnosed by detecting the bacterium in the stool. You should contact a doctor immediately if you notice blood in a child's stools. Children with watery diarrhoea should also be taken to a doctor.
Doctors must inform the local Environmental Health department of any outbreaks of the bug.
How is it treated?
There is no evidence that antibiotics are effective against the infection.
In some cases it is thought that treatment with some antibiotics may lead to kidney complications. Anti-diarrhoea medicines should also be avoided.
Most people recover without antibiotics or other treatment in between five and ten days.
People are deemed clear of infection after they have passed two stools that do not test positive for E. coli 0157.
If the life-threatening HUS complication occurs, patients are often admitted to intensive care. Blood transfusions and kidney dialysis may then be required.
What are the long-term consequences of infection?
Those whose only symptoms are diarrhoea usually make a full recovery.
HUS, however, can result in people developing abnormal kidney function that could require long-term dialysis. Other complications include high blood pressure, seizures, blindness, paralysis or the effects of having part of the bowel removed.
The fatality rate of people infected by E. coli 0157 is variable, depending on the age and general health of the person. Fatality rates ranging from one to 5 per cent have been reported, but they could be higher.
How do we guard against E. coli in childcare settings?
Following strict hygiene procedures at all times will not necessarily prevent a child or staff member from contracting E. coli 0157, but it is essential and does minimise the risk of a large-scale outbreak.
Good practice advice to reduce spreading infection includes:
* Children who have diarrhoea should be carefully handled and kept separate from well children. All nappies and soiled clothing should also be kept separate.
* Children should not be allowed to attend the setting if they are ill with sickness and diarrhoea.
* Staff should always wash their hands carefully before and after changing a nappy.
* Staff and children should also wash their hands carefully after going to the toilet and before eating food.
* Much care should be taken when children visit farms or come into contact with livestock - wearing gloves is advisable, as well as regularly washing hands, especially before eating. Children should also be advised to keep their hands away from their face.
* Necessary procedures to avoid spreading bacteria in the setting's kitchen include keeping raw meat separate from ready-to-eat food, and never putting cooked meat on the plate or surface that previously held the raw meat. Wash hands, surfaces and utensils with hot soapy water after they touch raw meat.
* Ensure that meat is thoroughly cooked throughout before eating
* Check that raw fruit and vegetables have been washed thoroughly before consumption.
Further information
* Health Protection Agency, www.hpa.org.uk
* Institute of Food Science and Technology - E. coli, www.ifst.org/hottop1.htm
