Adventure Safe Health Issues

Meningitis Procedures and Guidance Notes:-

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Meningitis Procedures and Guidance Notes:-

1 If a case of meningitis is suspected or confirmed an incident report should be completed

2 It is not necessary to move our customers or evacuate any accommodation as meningitis is not spread via buildings but from close person to person contact.
3 Medical treatment of the patient and anyone close will be the responsibility of the attending Doctor.
4 Further information can be obtained from The National Meningitis Trust:

Letter to Customers re: Bacterial meningitis

You may be aware that one of our customers has been diagnosed as having bacterial meningitis and is currently receiving expert medical attention.

There is no cause for alarm and in order to reassure you we have compiled some information about bacterial meningitis:-

  • The bacteria which can cause meningitis live naturally in the nose, throat and upper respiratory tract.

  • The bacteria CANNOT survive outside the body and only those in very close, regular contact with an infected person are considered at risk.

  • Usually the only people at risk are immediate family and those in “kissing” contact.

  • The bacteria cannot be transmitted via surfaces, cutlery, bed linen, swimming pools etc., so simply being in the same accommodation as an infected person does not increase the risk of catching the disease.

  • Meningitis can affect all ages but those under five years, teenagers and the elderly are more susceptible.

Given the information above, there is no reason to be unduly concerned but it may be useful to be aware of the following facts:-

  • The time taken for the disease to develop varies between 2 - 10 days.

  • About 10% - 25% of the population are carriers, only rarely does the bacteria overcome the body’s defences and cause meningitis.

  • There is no increased risk of contracting meningitis overseas as opposed to the UK

In view of this advice, if you or any of your party, show any symptoms such as fever, severe headache, feel lethargic, drowsy and generally unwell and/or develop a rash then please ensure you seek immediate medical advice.

Yours sincerely

Macs Adventure

Letter re – Viral meningitis

You may be aware that one of our customers has been diagnosed as having viral meningitis and is currently receiving expert medical attention.

There is no cause for alarm and in order to reassure you we have compiled some information about viral meningitis:-

  • Viral meningitis is more common than bacterial meningitis, but is generally less serious.

  • Usually only people at risk are those in very close, regular contact such as immediate family and those in “kissing” contact.

  • The virus can survive in contaminated water but chlorine such as the levels in swimming pools, kills the virus. Simply being in the same accommodation as an infected person does not increase the risk of catching the disease.

  • Meningitis can affect all ages but those under five years, teenagers and the elderly are more susceptible.

Given the information above, there is no reason to be unduly concerned but it may be useful to be aware of the following facts:-

  • The time taken for the disease to develop varies and can be up to three weeks.

  • There is no increased risk of contracting meningitis overseas as opposed to the UK

In view of this advice, if you, or any of your party, display any of the following symptoms such as fever/flu, severe headache, feel lethargic, drowsy and generally unwell then please ensure you seek immediate medical advice.

Yours sincerely

Macs Adventure

Gastric Illness

Food poisoning
Gastric illness can be caused by a wide variety of food borne bacteria or chemical or physical contamination of food.
Well known bacterial sources include salmonella, campylobacter, staphylococcus and clostridium.

All have various onset times and durations but the symptoms tend to be diarrhoea, stomach cramps, vomiting and sometimes headache and fever.

Food can become infected from a variety of sources, in a hotel or restaurant the most likely cause will be poor food handling practices including food handlers having poor standards of personal hygiene.
Our customers need to be advised of the risks associated with eating from street vendors, and should follow the simple rules as outlined in their health & safety information:
Food Safety

  • In order to avoid the possibility of stomach upsets

  • Make sure your food has been thoroughly cooked

  • Hot food should be hot, cold food should be cold

  • Avoid any uncooked food, except fruit and vegetables, (notably those you can peel or shell yourself)

  • In many countries you should only drink bottled water and ensure the seal is intact when purchasing

  • The tap water can be used for brushing your teeth, unless advised otherwise

  • Avoid ice in drinks as this can cause upset stomachs in hot climates.

If anyone experience’s gastric illness then they should seek out medical advice as soon as possible. Suppliers should ensure we are notified of gastric illness via the incident form.

If they are potentially aware of where they contracted the illness and it is linked to our holiday then we will need to investigate and make any necessary hygiene checks on the accommodation or restaurant concerned.
Viral Infections
In addition to food related illnesses there are also viral illnesses that can occur amongst groups of travellers, such as SRSV or Norovirus.
The following pages detail these along with the prevention of spread of infection procedures and illness reporting in cases of gastric outbreaks.

SRSV (small round structured viruses)

Norovirus (Norwalk like virus)
Background information:-
Noroviruses are a group of related, single strand RNA, non enveloped viruses that cause acute gastroenteritis in humans. The primary transmission route is the faecal – oral route. This can be via contaminated food or water, direct person to person spread or even from surfaces such as door handles, stair rails.
The Noroviruses can survive a variety of temperatures including freezing and up to 60 deg C, they also have some resistance to chlorine at levels of less than 10ppm.
The initial outbreak is likely to arise through contamination of food by a food handler. Noroviruses do not require the same conditions as bacteria and they can survive in and on a whole range of foods as well as inanimate surfaces. Outbreaks have frequently been associated with cold foods such as salads and cold meats and pastries.
These viruses are highly contagious with an extremely low infective dose needed to result in illness – as few as 10 viral particles may be sufficient to infect and cause illness.
Hotels are susceptible to large outbreaks due to the number of occupants and the space confinements. Cruise ships, planes and coaches have also suffered outbreaks.
Norovirus outbreaks are common all over the world and approximately 10% of all outbreaks happen in hotel accommodation.
The virus can affect all ages and can be serious for young children, elderly and those with conditions which lower their immune system.
Outbreaks can occur in extremely short time periods, with large numbers affected and secondary infections can also occur after a few weeks.


The incubation period is usually between 24 – 48 hours, but cases can occur within 12 hours of exposure.

Norovirus usually start with acute-onset vomiting, diarrhoea, abdominal cramps and nausea. Dehydration is the most common complication, especially among the young and elderly.
Symptoms can be extremely acute and debilitating and usually last 24 – 60 hours.
Recovery is usually complete with no long term consequences.
Due to the fact that the viruses are microscopic and able to cause illness in low numbers, it is very difficult to diagnose. Electron microscopy of faecal samples may detect the virus or specific antibodies, but the results are often negative or inconclusive.
Confirmation of an outbreak is usually due to analysis of symptoms, duration and numbers affected.
As viruses do not respond to antibiotics, treatment is usually rehydration by drinking lots of water and ensuring minerals such as salt are replaced.
Ensuring high standards of food hygiene, especially personal hygiene amongst food handlers would reduce the risk of the virus being introduced.
If an outbreak has occurred then deep cleaning must be implemented immediately. Disinfection of all areas, especially bathrooms, contact surfaces such as door handles and stair rails must be carried out using strong solutions. There should especially be immediate deep cleaning and disinfection of all areas where anyone has been ill.
Deep cleaning and disinfection should be carried on until all cases have subsided and all those affected are recovered.
Those ill should also be isolated in order to prevent spread of the infection, meals taken to their rooms and thorough sanitisation of toilet, bath, bedding and general contact surfaces, utensils used etc.

If more than 5 persons are affected by Gastric Illness (viral or bacterial) this would be deemed to be an outbreak, the following record chart can be completed in order to track those infected.





Completed by:


Total Number of ALL customers in Accommodation:

Date reported:

Total Number of our customers affected:

Time reported:

Percentage of customers ill =

Reported to:

Please collect the following details for all affected:





Date illness


Symptoms (use code)

Duration of illness

Doctor seen

Y or N

Diagnosis tests done?

Any food/drink consumed outside the accommodation

Any additional comments or information regarding investigations being carried out locally or the potential source of the illness

Symptom codes:- D – Diarrhoea, V – Vomiting, S – Stomach cramps, F – Fever , O - Other

Additional comments (including details of any testing / sampling planned or completed)

Prevention of Spread of Infection Procedures
Recognising an outbreak
The first cases may not initially be reported, but when people become aware that others are ill they will usually then report their symptoms.
If there are five or more people who become ill (with similar symptoms) within a 1-3 day period, this may be defined as a potential outbreak, and should be reported promptly.
Accommodation providers should maintain records of those who become ill using the form provided. This data will be required by those who are involved in the investigation of the outbreak.
Staff Health
Staff who are suffering from gastro-enteritis must remain off work whilst they have symptoms, and for a further 48 hours following recovery, as they may still be highly infectious. It is advised that management ensure that this does not result in a loss of pay. If staff are under pressure to come to work when ill or still infectious, it may easily result in a continuing outbreak with resultant financial loss to the business.
As soon as an outbreak has been identified, the following actions should be implemented:
Arrange for anyone who requires medical attention to be seen by the local doctor
Increase frequency of cleaning (see below)
Everyone should be given information about viral gastro-enteritis and the importance of hand washing.
Anyone who is ill (vomiting) should not come into contact with other customers

All affected people must be asked to remain in their rooms whilst they have symptoms. Ideally they should remain isolated for 24 hours following the cessation of their symptoms. Ideally anyone with whom they are sharing the room should also be given this advice. This can be facilitated by serving meals to them in their room.

If a buffet is provided:
Consider making available wet hand wipes for everyone to clean their hands as they come into the buffet.

Change serving spoons frequently (every 30-60 minutes)

Consider making staff available to serve the food from the buffet
If anyone vomits where uncovered food is present, such food must be discarded as there is a strong likelihood that it will have become contaminated with virus particles.

Norovirus is extremely infectious – this means that only a few virus particles are necessary to cause illness. The virus is also extremely hardy, and can live in the environment for 2-3 weeks, so thorough and appropriate cleaning is essential.
All cleaning staff should have training in cleaning procedures.
Equipment used in the control of an outbreak should be identified and kept solely for this purpose. Staff should know where it is stored and how to access it at all times.
It is advisable that specialised “hit-squads” should be formed and given extra training in the cleaning of affected rooms and public areas, and in the cleaning up of vomit spillages. Other cleaning staff should only clean the rooms of unaffected customers.
Public areas must be cleaned frequently, and shared toilet facilities should be cleaned hourly for the duration of the outbreak.
Place hand washing notices in all toilets
Cleaning the rooms of affected people:
Whilst someone is ill, their room should be given extra attention, particularly the bathroom. In addition to the usual cleaning, all hard surfaces that are handled frequently such as taps, cistern handles, door handles, telephones, bedside tables, etc should be disinfected with a solution of hypochlorite 1000ppm using disposable cloths. Start by disinfecting hard surfaces in the bedroom before proceeding to the bathroom, ending with the toilet itself. Then dispose of cloth immediately into plastic waste bag. Use a fresh cloth for each room.
If mops are used the head must either be disposable or capable of being laundered. Re-usable ones should be laundered daily.
When affected people depart:
Clean their rooms first so that they are left vacant for as long as possible.

Open all windows but ensure that the door remains closed.

Remove all bed linen. Soluble bags should be available for soiled linen to prevent further handling and sorting by laundry staff.

All bedding should be laundered by a process in which the temperature in the load is maintained at 65° for not less than 10 minutes, or preferably at 71°for not less than three minutes.

Thoroughly air mattresses.

If weather permits, place soft furnishings in sunlight for several hours, as ultraviolet light is known to inactivate viruses.

Consider steam cleaning of carpets and soft furnishings. There is evidence that the virus can survive temperatures of up to 60ºC, so steam cleaning will only kill the virus if water at temperatures above this has contact with the carpet/soft furnishing. However, vacuuming will re-circulate the virus so is to be discouraged, unless a wet system is utilised.
Procedure for dealing with vomit spillages:
Materials required:

Disposable vinyl or latex gloves

Disposable apron

Absorbent paper towels

Plastic waste bag

Hypochlorite solution 1000ppm

Warm water and detergent
Put on disposable gloves and apron.

Gather the spillage together, using absorbent paper towels, and place in plastic waste bag.

Wash area with warm water and detergent using a disposable cloth

Disinfect area using hypochlorite solution; allow solution to remain in contact with surface for 10 minutes if practicable.

Remove gloves and apron and place in plastic waste bag.

Wash hands thoroughly with soap and running water, ensuring that all surfaces are covered.

There is evidence that when a person vomits, the virus particles are aerosolised over an area of approximately 25 feet. Therefore the whole of the room in which this occurs must be thoroughly cleaned and all surfaces wiped with a hypochlorite solution.
There is currently no evidence that proves that this is, or is not, effective. This proviso applies to both the chemicals used, and also their method of application. It may, however, be used as an adjunct to the above.
Chlorine dioxide may be capable of killing norovirus, and therefore if you are going to utilise fogging, use a product that contains chlorine dioxide along with a quaternary ammonium compound. Ask your supplier if their products contain these chemicals. The aqueous content is also important as the fogging liquid will condense around particles suspended in the air. They will thus become heavier, and drop onto a horizontal surface where disinfection may occur.
When fogging the following points apply:
Apply using a suitable fogging generator, and using personal protective equipment as advised by the manufacturers.

Close all windows.

It must be applied adequately, such that all exposed surfaces are covered in a fine mist.

The room should then be closed for 1 hour, after which open all windows to allow thorough airing. This is the minimum time required, preferably rooms should be left unoccupied for 48 hours or longer.

Hypochlorite Solution
Hypochlorite solution made up to 1000 parts per million (ppm) or 0.1% must be freshly prepared daily. There are two methods:
Use ordinary household bleach, diluted 1:50 parts cold water, for example 10mls bleach:500mls water.

Milton 2% may also be used; 50ml Milton 2% to 1 litre of cold water.

There are also tablet formulations that are suitable. Check manufacturer’s instructions to ensure they are reconstituted to give a 1000ppm solution.
Any solution remaining after 24 hours must be disposed of as hypochlorite solutions lose effectiveness on standing.
Accommodation Closure
If the outbreak does not appear to be coming under control within a few days, it may be necessary to consider closure of the accommodation, at which time a deep clean can be undertaken, preferably by a cleaning contractor.
Although the original source of the illness may well be someone who was developing the illness prior to their arrival, there may be some people who perceive the accommodation to be at fault for not preventing transmission to others. It is therefore essential not only that suppliers carry out all the correct remedial actions, but that such actions are recorded and logs made available on request.

It is recommended that suppliers have in place the following documentation:

1. Cleaning protocols to be followed if an outbreak is suspected which detail products to be used, and the frequency of cleaning.

2. Records of staff illness

3. Evidence that staff have been adequately trained in cleaning and decontamination.

4. Evidence that at induction staff have been given information concerning the correct action in case of personal gastro-intestinal illness

5. Evidence of information that has been given to customers

6. Illness Report Forms completed in respect of all ill customers.

Some of our destinations sit within the Malarial region, this will be highlighted to our customers in advance of their visit. They will be advised to seek appropriate anti-malarial prophylaxis from their doctor.
Malaria is a serious sometimes fatal disease, caused by a parasite and there are four kinds of Malaria parasite that infect humans:
Plasmodium Falciparum

Plasmodium Vivax

Plasmodium Orale

Plasmodium Malariae
The parasite is carried by the ‘Anopheles’ mosquito in tropical and sub-tropical countries, transmitted via bites from infected female mosquito’s.
The parasite travels through the bloodstream where it infects the liver and eventually the red blood cells, which subsequently burst releasing toxins into the blood, resulting in the following symptoms:
Typically very sick, with high fevers, shaking chills, flu like illness and often nausea, vomiting, diarrhoea, anaemia and jaundice.
Malaria cannot be transmitted from person to person like flu, though it can be passed via blood transfusion and shared use of needles.
Anyone is susceptible to Malaria, with travellers from non-malaria areas carrying a higher risk of infection unless they take appropriate medication and precautions: Those travelling to Malarial destinations should be advised of the following:
1. Keep mosquito’s from biting, especially at night

2 Take appropriate anti-malarial drugs

  1. Use insecticide within your accommodation

  2. Sleep under bed nets (pref. treated with insecticide)

  3. Use a strong DEET based mosquito repellent

  4. Wear long trousers and long sleeved shirts at night

We should advise everyone to take personal advice from their doctor as the type of anti-malarial required depends on the country being visited, length of stay, health and their previous medical history.

For this reason we cannot give specific advice on anti-malarial prophylaxis. For further information, check the Department of Health, HPA, NATHNAC or FCO websites
Other Communicable diseases
There are a range of other communicable diseases that can be caught whilst traveling in less developed countries
These can be illnesses such as Dengue Fever, Leishmaniasis, Cholera, Hepatitis, Rabies, Giardia, Bilharzia, Avian Flu, SARS to name just a few.
In any notified case of a communicable disease, we will liaise with the Department of Health and take any necessary action for everyone’s safety in conjunction with the authorities and their relevant medical advice.

Section 12 2012

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