Policies & Procedures Effective Date : 12/9/2019 Date of Review: 2/3/2020 110324.406 INFECTION CONTROL ISOLATION TRANSMISSION 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 hospital 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 patients with suspect or confirmed communicable diseases or conditions, infections, or colonization with highly transmissible or epidemiologically important pathogens 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 Patient Care Providers RATIONALE: Transmission-based precautions (or isolation) are used in conjunction with Hand Hygiene 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 Respirator-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 Virus (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 (Ebola, 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