Isolation precautions

Contact Isolation Precautions—used for infections, diseases, or germs that are spread by touching the ... Enteric infections( C.diff,entero virus,

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Isolation precautions Patama Suttha M.D. 16 Dec 2014 Bamrasnaradura Infectious diseases Institute

Precautions to Prevent Transmission of Infectious Agents  Standard


1990s  Recommended in care of all hospitalized patients  Apply when contact with blood, other body fluids, nonintact skin, mucous membranes and secretions and excretions except sweat

 Transmission

– based

precautions - Contact Precaution Direct contact Indirect contact - Droplets Precaution - Airborne Precautions

Isolation precautions 3 

different types :

Contact Isolation Precautions—used for infections, diseases, or germs that are spread by touching the patient or items in the room (ex: MRSA, VRE, diarrheal illnesses, open wounds, RSV). Droplet Isolation Precautions—used for diseases or germs that are spread in tiny droplets caused by coughing and sneezing (ex: pneumonia, influenza, Pertussis, Meningococcemia). Airborne Isolation Precautions—used for diseases or very small germs that are spread through the air from one person to another (ex: TB, measles, chickenpox

 Hand

hygiene  PPE (personal protective equipment )  Prevention of needle stick and injuries from other sharp instruments  Respiratory hygiene and cough etiquette  Environmental cleaning  Linens  Waste disposal  Patient care equipment

Contact precaution  Direct

contact  Indirect contact

Direct contact

Norwegian scabies

Herpetic Whitlow Common:Children, Dentists , Med care providers

Contaminated Surfaces tested positive for VRE (+) in patient environment.

Hayden M. ICAAC,2001, Chicago, IL

Contact Precautions  Apply

to patients with any of the following conditions and/or disease:  Presence of stool incontinence (may include patients with norovirus, rotavirus, or Clostridium difficile)  Draining

wounds, uncontrolled secretions, pressure ulcers, or presence of ostomy tubes and/or bags draining body fluids

 Presence

of generalized rash or exanthems

Contact Precautions  Colonization

of with MDR bacteria  Enteric infections( C.diff,entero virus,E.coli  Respiratory virus ( RSV, Rhinovirus, Influenza etc)  Ebola viral diseases  Skin infection: Scabies,Noncontained abcesses or decubitus ulcers

Contact Precautions  Perform


hygiene  PPE use:  Wear gloves / gown when touching the patient and the patient’s environment or belongings

 Use

separate bathroom in patients with infectious diarrhea, if available

 Clean/disinfect

the bathroom before it can be used again

Droplet Precautions  Apply

to patients known / suspected to be infected with a pathogen that can be transmitted by droplet route ( > 5 micron)

 Respiratory

virus  Bordetella pertusis, pharyngeal diphtheria  For first 24 hrs of Rx : Neisseria meningitides, group A streptococcus ,  Scarlet fever  Mumps  Parvovirus B19 , Rubellla  Plague( Pneumonic),  Mycoplasma pneumoniae

Droplet Precautions  Place

the patient in an exam room with a closed door if an exam room is not available,patient is provided a facemask and placed in a separate area as far from other pts

 PPE 


Wear a facemask, such as a procedure or surgical mask, for close contact with the patient

Droplet Precautions  Perform

hand hygiene before and after touching the patient

 Instruct

patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients, and practice respiratory hygiene and cough etiquette

 Clean

and disinfect the exam room accordingly

Airborne Precautions  Apply

to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route  Tuberculosis  Measles  Chickenpox (until lesions are crusted)  Localized (in immunocompromised pt) or diss. herpes zoster (until lesions are crusted over)  Patient enter through a separate entrance to the facility if available, to avoid the reception and registration area

Airborne Precautions  Place

the pt immedialty in airborne infection isolation room (AIIR)

 If

an AIIR is not available: For patients  Provide a surgical mask to the pt and place the pt in an exam room with a closed door  Instruct pt to keep facemask on while in the exam room, if possible, and to change the mask if it becomes wet

Airborne Precautions  PPE

use for HCW:

Wear a fit-tested N-95 or higher level disposable respirator,when caring for pt; the respirator should be donned prior to room entry and removed after exiting room

If substantial spraying of respiratory fluids is anticipated, gloves and gown as well as goggles or face shield should be worn

 Perform

hand hygiene

Airborne Precautions 

 If

Once the patient leaves, the exam room should remain vacant for generally 1 hour before anyone enters; however, adequate wait time may vary depending on the ventilation rate of the room

staff must enter the room during the wait time, they are required to use respiratory protection

AIIR  Single-occupancy

patient-care room used to isolate persons with a suspected or confirmed airborne infectious disease  Negative pressure in the room  air

flow rate of 6-12 ACH

 Direct

exhaust of air from the room to the outside or recirculation of air through a HEPA filter before returning to circulation

Fit check

Transmission - based Precautions for Hospitalized Patients Category of Precautions

Air borne

single room

Yes, with negative air pressure ventilation













( Particulate mask)

Yes (surgical mask)




* prefered but not required, cohorting patients with the same disease are acceptable