sign in sign up
<<
Home , Isolation (health care)

Policies & Procedures Effective Date : 12/9/2019 Date of Review: 2/3/2020

110324.406 CONTROL ISOLATION BASED PRECAUTIONS

Copy of version 1.1 (approved and current)

Last Approval or Controlled Copy ID 236083 2/3/2020 Periodic Review Completed New Physician Orientation Portal Location Next Periodic Review 04.2020 2/3/2022 Needed On or Before Organization St. Mary's Medical Center Effective Date 12/9/2019

Author

Comments for version 1.1

References were updated. Eliminated Addendum B regarding Re use of TB masks, this content already included in body of policy under Airborne Precautions. New review date.

Approval and Periodic Review Signatures Type Description Date Version Performed By Notes Periodic Hospital 2/3/2020 1.1 Sarah Gonzalez review Administration

Periodic Review 12/30/2019 1.1 Barbara Miller review

Hospital Medical Recorded when document uploaded to Approval 12/15/2016 1.0 Administrator Epidemologist MediaLab

Periodic Designated Medical Recorded when document uploaded to 12/15/2016 1.0 review Reviewer Epidemologist MediaLab Approvals and periodic reviews that occured before this document was added to the MediaLab Document Control system may not be listed.

Version History Version Status Type Date Added Date Effective Date Retired 1.1 Approved and Current Minor revision 12/9/2019 12/9/2019 Indefinite

1.0 Retired First version in Document Control 4/24/2019 7/29/1998 12/9/2019

Prime Healthcare SMAMO - St Mary's Medical Center - Blue Springs, MO 64014 Approved and current. Effective starting 12/9/2019. 110324.406 (version 1.1) INFECTION CONTROL ISOLATION TRANSMISSION BASED PRECAUTIONS

SM INFECTION CONTROL ISOLATION TRANSMISSION BASED PRECAUTIONS Summary: Transmission-based precautions (Isolations) are indicated for with suspect or confirmed communicable diseases or conditions, , or colonization with highly transmissible or epidemiologically important for which additional measures beyond standard precautions are needed.

Effective Date: 7/29/1998 Revision History: 12/15/2016, 12/14/14, 6/24/14, 12/3/13, 2/8/13, 12/17/09, 10/9/08, 6/7/07, 2/05, 11/04, 7/04 Reviewed Date: 11/25/2019,12/15/2016 Facilities: SMMC Approved By: CEO; Medical Epidemiologist Policy Impacts: All Care Providers

RATIONALE: Transmission-based precautions (or isolation) are used in conjunction with Hand and Standard Precautions with infections or communicable diseases and other conditions for which additional precautions are indicated. Adherence to infection prevention and control precautions, as recommended by the Centers for Disease Control and Prevention (CDC) can minimize the risk for transmission of infections in the healthcare setting.

KEY POINTS: EARLY IMPLEMENTATION OF TRANSMISSION-BASED PRECAUTIONS IS CRITICAL IN PREVENTING UNPROTECTED EXPOSURE OF PATIENTS, FAMILY, STAFF AND VISITORS. THEREFORE, PRECAUTIONS MUST BE IMPLEMENTED FOR PATIENTS WITH SUSPECT OR CONFIRMED INFECTIONS, DISEASES OR CONDITIONS INCLUDED IN THIS PROCEDURE. THE DECISION TO IMPLEMENT PRECAUTIONS SHOULD NOT BE DELAYED UNTIL CONFIRMATION OF THE DIAGNOSIS.

A COMPLETE LIST OF DISEASES PUBLISHED BY THE CDC THAT REQUIRE ISOLATION CAN BE FOUND ON THE C-NET HOME PAGE LISTED AS “ISOLATION QUICK REFERENCE BY DISEASES A-Z”. . I. TRANSMISSION: Contact transmission is the most significant and frequent mode of transmission of organisms in the healthcare setting and includes two types of contact transmission; 1. Direct contact (or person-to-person transmission): takes place when organisms are transmitted directly from the source (or infected person) to a susceptible host.

Policy Reference: Prime Health Policies & Procedures Page 1 of 8

Controlled copy ID 236083. Printed on 4/3/2020 12:21 PM (EDT). Page 1 of 8 Approved and current. Effective starting 12/9/2019. 110324.406 (version 1.1) INFECTION CONTROL ISOLATION TRANSMISSION BASED PRECAUTIONS

2. Indirect contact transmission takes place when organisms are transmitted from a source (animate or inanimate) to a host by means of an inanimate object. For example: equipment used on one patient and then used on another patient without appropriate cleaning and disinfection.

II. TRANSMISSION-BASED PRECAUTIONS In additional to Standard Precautions and hand hygiene some infections, diseases or conditions require additional precautions to minimize the risk of transmission. These additional precautions can include but are not limited to the use of gowns, gloves, masks, private room placement, or placement in a designated airborne isolation room (negative airflow room). 1. The categories of Transmission-based Precautions used at St. Mary’s Medical Center include: Contact, Special Contact, Droplet, Airborne. Transmission-based precautions can be combined for diseases with multiple routes of transmission. 2. Standard Precautions and the use of PPE (gowns, gloves, mask and eye covering) must continue to be observed in the setting of Transmission-based Precautions when exposure to blood or body fluids is a possibility.

III. IMPLEMENTING TRANSMISSION-BASED PRECAUTIONS (ISOLATION) 1. The physician or the nurse who is first aware of, or SUSPECTS a communicable disease, infection, or condition must initiate Transmission-based Precautions as soon as possible. 2. Unit staff will submit a computer order to Central Services for an isolation cart. Isolation carts are pre-stocked with personal protective equipment a disposable stethoscope, digital thermometer and blood pressure cuff. Supplies also include signage and patient education materials 3. Isolation carts are placed outside the patient room. 4. Unit staff are responsible for monitoring and stocking isolation carts with supplies. 5. Dedicated equipment is preferred for patients in transmission-based precautions. If not, equipment/devices must be cleaned and disinfected prior to using on another patient. 6. An isolation sign will be posted outside the door. Examples Addendum A 7. A Physician and/or nurse should provide education regarding isolation precautions to the patient (and family when appropriate) and document. 8. Patients in transmission-based precautions should remain in their rooms unless medically necessary. 9. Isolation carts are sent back to Central Services for cleaning and restocking. 10. All personal protective equipment (except the N-95 Particulate -see specific IFU) are to be disposed of after each use (i.e. gowns are never to be re-used).

IV. CONTACT PRECAUTIONS Diseases requiring Contact Precautions include, but are not limited to: patients with colonization or infection with multi-drug resistant organisms (MDROs i.e., Methicillin Resistant Staphylococcus aureus (MRSA), Vancomycin Resistant Enterococcus (VRE), Extended Spectrum Beta-lactamase (ESBL) producing organisms, etc.) Multi-drug resistant gram negative organisms with only two drug classification susceptible per culture results, Respiratory Syncytial (RSV) for infants, young children & immunosuppressed patients (transplants) only, impetigo, lice, scabies, Herpes Zoster or shingles (however shingles in a

Policy Reference: Prime Health Policies & Procedures Page 2 of 8

Controlled copy ID 236083. Printed on 4/3/2020 12:21 PM (EDT). Page 2 of 8 Approved and current. Effective starting 12/9/2019. 110324.406 (version 1.1) INFECTION CONTROL ISOLATION TRANSMISSION BASED PRECAUTIONS

immunocompromised individual require Airborne & Contact Precautions until disseminated shingles ruled out), drainage not contained by dressings, or a patient who is mobile/ambulatory with uncontrolled diarrhea, blood, or other body fluids. 1. Personal Protective Equipment: When entering room gloves will be worn. Gown and gloves will be used for working with patients. 2. Gloves will be changed when moving from dirty to clean areas on the patient during care or suspected contamination. 3. Gloves must be removed and hand hygiene performed before leaving the patient's room.

V. SPECIAL CONTACT PRECAUTIONS Diseases requiring Special Contact Precautions, include but are not limited to patients with potential Clostridium-difficile infections, infection or colonization with a multiple-multiple drug resistant (organisms resistant to all but one antibiotic class); 1. In general, special contact precautions will be maintained throughout the hospitalization for patients with C. difficile infection and multiple multiple resistant organisms. 2. Hand hygiene with soap and water is required for C. difficile. 3. Personal Protective Equipment: gown and gloves should be worn by all staff. Visitors are encouraged to do the same. 4. Gown and gloves will be removed prior to leaving room and hand hygiene performed with soap and water.

VI. AIRBORNE PRECAUTIONS Diseases requiring Airborne Precautions include but are not limited to: suspect or confirmed active Mycobacterium tuberculosis disease, patients with a sputum specimen positive for AFB until Mycobacterium tuberculosis is ruled out. In addition, patients with suspect or confirmed measles, varicella (chickenpox), disseminated herpes zoster (shingles), SARS, Smallpox, hemorrhagic fevers (, Lassa, Marburg) require Airborne Precautions. MERS (Middle East Respiratory Syndrome) requires airborne and special contact. MERS requires gown, gloves, and eye protection.

1. Personal Protective Equipment requirements: a. All staff should wear an N-95 particulate respirator to enter the room. b. Employees are fit tested for the N-95 Particulate Respirator on hire and fit tested annually thereafter. c. Visitors and family will be instructed to wear the N95 particulate respirator. They do not need to be fit tested. Staff are available to assist with mask fit. d. An N-95 Particulate Respirator for a Tuberculosis patient may be worn continuously for one patient for one entire shift unless the mask is contaminated or integrity is compromised. For use with Influenza patient during aerosolizing procedures N95 mask to be discarded after procedure completed. e. Between uses during one shift, for a Tuberculosis patient the mask should be stored in a clear bag labeled with employee’s name. Dispose of bag at end of shift. (Never write on the N95 particulate mask directly) f. Discard respirator after use (as defined above) in the regular waste container unless saturated with blood or body fluids.

Policy Reference: Prime Health Policies & Procedures Page 3 of 8

Controlled copy ID 236083. Printed on 4/3/2020 12:21 PM (EDT). Page 3 of 8 Approved and current. Effective starting 12/9/2019. 110324.406 (version 1.1) INFECTION CONTROL ISOLATION TRANSMISSION BASED PRECAUTIONS

2. Room Requirements: Designated Airborne Isolation/Negative Pressure Isolation Room a. will notify Plant Services to verify negative pressure prior to the patient being placed in room, or as soon as possible. b. Plant Services will monitor the negative pressure in the room daily, while the room is used for airborne precaution and maintain a documented log. 3. Discontinuing Airborne Precautions will be done by the Hospital Epidemiologist, Infection Prevention and Control Department (in collaboration with Pulmonologist. 4. Airborne precautions will be maintained for two hours after a measles patient is dismissed and a minimum of 65 minutes after a tuberculosis patient dismissal.

VII. DROPLET PRECAUTIONS Droplet Precautions are indicated for patients known or suspected to be infected with that are transmitted during coughing, sneezing, talking, or during cough/sputum inducing procedures. Transmission occurs via large respiratory droplets generated when coughing, sneezing, or talking. Exposure risk is highest when a susceptible person comes within six (6) feet of the source patient. Droplets generally do not remain suspended in the air for long periods and settle on surfaces around the patient. Diseases requiring Droplet Precautions include but are not limited to: adults, infants and children with suspect or confirmed: invasive Haemophilus influenza type B disease (epiglottitis, meningitis), invasive Neisseria meningitidis disease (pneumonia, meningitis, , blood), pharyngeal diphtheria, mycoplasma pneumonia, , influenza (+ influenza A or B), and patients with symptoms suggestive of influenza, but swab negative), mumps, parvovirus 19, immunosuppressed patient, pertussis (whooping cough) and rubella. Diseases applicable only to infants and young children: Haemophilus influenza type B pneumonia, Streptococcus A pharyngitis and scarlet fever. 1. Personal Protective Equipment: mask must be worn to enter room and gloves for touching infectious material. 2. An N-95 Particulate Respirator must be worn – NO EXCEPTIONS during high-risk aerosol-generating procedures like: bronchoscopy, open suctioning of airway secretions, sputum induction, CPR, and endotracheal intubation for patients with influenza. 3. Room requirements: Keep door closed unless safety issues. 4. Discontinuing Droplet Precautions will be done by Infection Prevention and Control Department. 5. Transport the patient from the room only when essential. Place a on the patient during transport, if possible. KEYPOINT – DURING INFLUENZA SEASON For Seasonal Influenza - the CDC recommends continuing isolation for five (5) days. However, this can be addressed on a case-by-case basis in collaboration with the Infection Prevention and Control Department.

VIII. STRICT ISOLATION: MERS (Middle East Respiratory Syndrome) and Ebola requires airborne and special contact precautions. You must wear N95 mask, gown, gloves, and eye protection when entering room.

Policy Reference: Prime Health Policies & Procedures Page 4 of 8

Controlled copy ID 236083. Printed on 4/3/2020 12:21 PM (EDT). Page 4 of 8 Approved and current. Effective starting 12/9/2019. 110324.406 (version 1.1) INFECTION CONTROL ISOLATION TRANSMISSION BASED PRECAUTIONS

IX. PROTECTIVE PRECAUTIONS

1. Requires physician order. 2. Perform scrupulous hand hygiene and assist the patient to do the same. 3. Do not allow visitors or staff with infections into the room 4. No flowers or potted plants in the room. 5. Keep sinks and bathroom fixtures dry. 6. Designated for neutropenic or immunocompromised individuals. Note: Patients with Neutropenia is defined as follows:  Patients with a WBC < 1000 cells/mm3 are considered at moderate risk for infection.  Patients with a WBC < 500 cells/mm3 are considered at severe risk for infection.  Patients with a WBC < 100 cells/mm3 are considered at extreme risk for infection.

X. ENVIRONMENTAL TRANSMISSION from FOMITES (Objects in the environment that can harbor organisms: furniture, stethoscopes, common equipment, etc.)

1. PATIENT CARE EQUIPMENT AND ARTICLES a. Dedicate non-critical patient-care equipment to a single patient. b. If use of common equipment or items is unavoidable, thoroughly clean and then disinfect before use for another patient.

2. LINEN AND LAUNDRY a. No special precautions are indicated for laundry. However, soiled linen should be minimally handle or agitated to prevent microbial contamination of the air. b. Handle soiled linen to avoid contamination of personal clothing. c. Place laundry in linen bag to prevent the outside of the bag from becoming soiled. Double bagging though generally not indicated may be needed to prevent leaking. d. Bag all soiled linen at the point of use (at the bedside).

3. DISHES, GLASSES, CUPS, AND EATING UTENSILS a. Special precautions are unnecessary for dishes, glasses, cups or eating utensils. The combination of hot water and detergents used in hospital dishwashers are sufficient to decontaminate dishes, glasses and cups, and eating utensils. b. Dietary personnel will wear gloves when handling all dirty dishes and perform hand hygiene after gloves are removed.

4. WASTE/TRASH a. Personal protective attire (i.e., gowns, gloves, face protection) not saturated with Blood, body fluids or other potentially infections material should be discarded in regular trash. b. Personal protective attire that is saturated should be discarded in a biohazard bag.

Policy Reference: Prime Health Policies & Procedures Page 5 of 8

Controlled copy ID 236083. Printed on 4/3/2020 12:21 PM (EDT). Page 5 of 8 Approved and current. Effective starting 12/9/2019. 110324.406 (version 1.1) INFECTION CONTROL ISOLATION TRANSMISSION BASED PRECAUTIONS

5. PAPERBACK BOOKS, MAGAZINES a. Cannot be shared with other patients. b. Will stay in isolation room and be disposed of when patient is discharged.

XI. PATIENT TRANSPORTATION

1. Isolation status must be communicated to the receiving department.

2. Before entering patient room don appropriate Personal Protective Equipment as instructed on the isolation sign.

3. Equipment: a. Transportation equipment must be thoroughly cleaned & disinfected after each use. b. Place a clean barrier (sheet or blanket) covering all sides of the W/C or stretcher before patient occupies. c. Disinfectant wipes are available to clean areas of the W/C, stretcher, or bed for your hands to touch prior to transporting patient (i.e. rails, handles, etc.).

4. Patient a. Apply clean gown. b. All draining wounds should be covered with a dressing. c. Incontinent patients should have urine and stool contained. d. Assist patient with hand hygiene. e. Assist patient with transfer to stretcher or W/C as indicated.

5. Patients in AFB, Airborne, or Droplet Precautions a. Patients in AFB, Airborne or Droplet Precautions must wear a surgical mask whenever out of their hospital room.

6. Transport a. In general, you should not wear PPE (gowns & gloves) during patient transport. b. If “hands on” patient care is unavoidable during transport, the use of PPE will be necessary. c. Consider bringing an extra pair of gloves and/or gown. d. On arrival to the receiving department, don gloves and gown to transfer the patient from the bed, stretcher or wheelchair. e. Remove personal protective equipment & perform hand hygiene (use soap & water if C. difficile or hands visibly soiled).

XII. COMMUNICATION a. Information regarding communicable diseases, infection or colonization with MDROs or other epidemiologically significant organisms will be included in discharge planning and communicated to receiving facilities. b. The Infection Prevention and Control Department will communicate with outside facilities when healthcare associated infections, communicable diseases, infection or

Policy Reference: Prime Health Policies & Procedures Page 6 of 8

Controlled copy ID 236083. Printed on 4/3/2020 12:21 PM (EDT). Page 6 of 8 Approved and current. Effective starting 12/9/2019. 110324.406 (version 1.1) INFECTION CONTROL ISOLATION TRANSMISSION BASED PRECAUTIONS

colonization with MDROs or other epidemiologically significant organisms are identified in patients received from another facility

REFERENCES

1. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee (evergreen document), 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, June 2007. Last updated July 2019. https://www.cdc.gov/infectioncontrol/guidelines/isolation/index.html 2. CDC, Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings, 2005. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm 3. CDC, Middle Eastern Respiratory Syndrome (MERS). www.cdc.gov/coronavirus/mers/faq.html

Policy Reference: Prime Health Policies & Procedures Page 7 of 8

Controlled copy ID 236083. Printed on 4/3/2020 12:21 PM (EDT). Page 7 of 8 Approved and current. Effective starting 12/9/2019. 110324.406 (version 1.1) INFECTION CONTROL ISOLATION TRANSMISSION BASED PRECAUTIONS

Addendum A

(pink) (orange)

(Green) (Gold)

(Lavender)

Policy Reference: Prime Health Policies & Procedures Page 8 of 8

Controlled copy ID 236083. Printed on 4/3/2020 12:21 PM (EDT). Page 8 of 8