The answer to this question can be found in the OHA/OMA Communicable Disease Surveillance Protocols - Group A Streptococcal Disease, September 2006 (available online here).

The use and effectiveness of antimicrobial prophylaxis for HCWs who are close contact of invasive GAS infections is controversial and an optimal regimen has not been established. Antimicrobial prophylaxis may be considered on a case-by-case basis for HCWs who have been exposed.

Exposure is defined as direct, indirect or droplet contact of oral or nasal mucous membranes with respiratory secretions or direct contact of non-intact skin with wound secretions from patients with invasive GAS disease from 7 days before the onset until 24 hours after the start of effective therapy.

If fluid from the nose, mouth or wound of the infected case did not contact a HCW's mucous membranes or non-intact skin, that HCW was not exposed and does not need preventive antibiotics. If personal protective equipment (i.e. surgical mask and eye protection or face shield) has been worn, there is no exposure.

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2.What is Group A Streptococcus or GAS?

Group A Streptococcus (GAS) is a bacterium commonly found in the throat and on the skin. In general, it does not cause the individual who has it any problems. Some GAS, however, can cause infection. These infections can range from a relatively mild sore throat or skin infection to life-threatening invasive diseases such as necrotizing fasciitis (flesh eating disease) and streptococcal toxic shock syndrome.

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3. I work in a LTC home that has a child care centre attached to it. On a regular basis, children from the centre join our residents for inter-generational activities. One of the children has been identified as a carrier of GAS. What is the impact of this on our inter-generational activities? 

At any given time, 10-15% of the population is carrying GAS. The risk of spreading the infection is highest when there is direct contact with mucous from the nose or throat of persons who are infected or when there is contact with infected wounds. Persons who carry GAS without symptoms are much less contagious. Household objects like plates, cups, and toys do not play a major role in the spread of GAS bacteria.

Education is an important focus in this situation. If the "carrier” is ill with GAS and coughing, for example, he/she should not be involved in inter-generational activities as this increases the risk of transmission to residents. If the "carrier” is asymptomatic, participation need not be restricted. As always, teaching about the importance of hand hygiene to both residents and children is important.

 

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4. How can group A strep infections be prevented?