Section Navigation. Facebook Twitter LinkedIn Syndicate. Transmission-Based Precautions. Minus Related Pages. On This Page. Contact Precautions. See Guidelines for Isolation Precautions for complete details. Ensure appropriate patient placement in a single patient space or room if available in acute care hospitals.
In long-term and other residential settings, make room placement decisions balancing risks to other patients. In ambulatory settings, place patients requiring contact precautions in an exam room or cubicle as soon as possible. Use personal protective equipment PPE appropriately, including gloves and gown. Donning PPE upon room entry and properly discarding before exiting the patient room is done to contain pathogens.
The room should have an en-suite and hand washing facilities and the doors s should be kept closed at all times. For maximum effect, only one of the doors in the ante-room should be open at any time when entering or leaving the cubicle.
Patients should remain in isolation whilst they remain symptomatic; a risk assessment should be undertaken to ascertain if and when isolation precautions can be relaxed. It is the responsibility of ALL members of staff to comply with isolation and Infection Control procedures. If isolation is not possible the Matron will contact the IPCT in hours and the CSM will contact the on call microbiologist out of hours, with the required patient information Appendix J , for a risk assessment.
The date and time isolation is achieved must be documented. This must be in bay areas with doors and floor to ceiling partitions. Where cohorting is advisable in certain situations cohorting must be agreed with a member of the IPCT in hours or the on-call Consultant microbiologist out of hours.
The Microbiologist will require specific information, found in Appendix J, in order to provide accurate advice. There may be instances in which a more significant operational or clinical risk is identified and where assessment of the risks indicates the impact of IPC recommendation would be detrimental. When it is not considered possible to implement the recommendations of the consultant microbiologist or IPCT this must be escalated to the Matron in normal working hours or Clinical Site Manager out of hours.
Full details of escalation process can be found in Appendix K. The matron for the clinical area must record all inability to isolate daily and report to the directorate manager. Out of hours the clinical site managers will include all inability to isolate in the clinical site managers daily out of hours report which is received by the Directorate Manager and Matron for that area.
The continuing requirement for isolation must be re-assessed at a minimum daily and documented in the nursing notes, in consultation with the IPCT if necessary. Back to top Appendix B - Protective isolation Protective isolation is the term used to describe a range of practices to protect patients who are at increased risk of infection due to a compromised immune system.
Management of patients Patients in protective isolation should be managed as non-infected patients using standard infection prevention and control precautions Ref.
Ensure a protective isolation notice is displayed on the door. The isolation room door must be kept closed. Hand hygiene should be performed prior to entering the room, before and after patient contact and before leaving the room Ref. Personal protective equipment PPE , including disposable gloves and apron, is not required for routine entry into the room. This need not be worn unless the staff member is to nurse or examine the patient or undertake a clinical procedure.
PPE must always be worn where risk assessment identifies a risk of exposure to blood and body fluids according to the Standard Infection Prevention and Control Precautions guideline. All unnecessary equipment should be removed from the room in order to facilitate cleaning. Equipment must be dedicated for use with that patient whenever possible. Flowers dried and fresh and potted plants should be removed because moulds, including Aspergillus and Fusarium species, have been isolated from the soil of potted ornamental plants e.
Charts and patient notes should be kept outside the room to reduce the risk of cross infection. The requirement for protective isolation should be constantly reviewed and documented in the light of on-going clinical assessment.
Back to top Appendix C - Management of patients in source isolation A source isolation notice must be displayed on the door of the room. The isolation room door must be kept closed, with minimal entrances and exits. Hand hygiene should be performed prior to donning gloves when entering the room, before and after patient contact and before leaving the room Ref. Soap and water must be used for hand hygiene purposes in all instances whilst inside the room.
Personal protective equipment PPE , including disposable gloves and apron, must be worn for routine entry into the room.
Single patient use equipment must be used e. An explanation of the need for and implications of Source Isolation should be given to the patient along with the relevant information leaflets including source isolation and organism specific. The explanation should include the need to remain in the source isolation room and the importance of the patient adhering to good hand hygiene practices. A Source Isolation care plan should be commenced.
The requirement for source isolation should be constantly reviewed and documented daily in the light of on-going clinical assessment. All equipment within the source isolation room must be cleaned using a solution of ppm available chlorine. Chlorine based wipesor Chlor-Clean. Staff must be trained in the use of any cleaning products before use. If chlorine based wipes areused by healthcare workers it theybe stored in the isolation room unless the nursing specialist assessment triggers the requirement for enhanced care when they should be removed for safety.
If Chlor-clean is used it should be made up in a separate room and any remaining fluid removed from the isolation room and carefully disposed of. Any items that cannot be cleaned must be discarded as infectious clinical waste. Information regarding environmental cleaning of source isolation rooms can be found in Appendix M. The bedpan should be covered and carefully transported to the sluice, changing PPE and washing hands as you leave the room.
There may be circumstances when the patient requests to go out of the ward in which case a risk assessment must be undertaken; in no circumstances should the patient go to any communal areas of the hospital including waiting areas or mix with other patients unless this has been agreed by the IPC team. Back to top Appendix D - Visitors to patients in isolation Explain the reason for isolation, maintaining confidentiality where appropriate. The IPCT may advise on other situations when this is necessary.
Visitors should be advised not to have contact with other patients on the ward. For some infections it may be necessary to exclude visitors from isolated patients, due to disease susceptibility. If there are any problems the IPCT should be contacted immediately. The patient from the isolation room should be seen last in the visiting department. If waiting occurs in that department the patient in isolation needs to be physically separated in another room to minimise contact with other non- infected patients.
When hands are visibly dirty, contaminated with proteinaceous material, or visibly soiled with blood or body fluids, wash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water IA IV. If hands are not visibly soiled, or after removing visible material with nonantimicrobial soap and water, decontaminate hands in the clinical situations described in IV.
The preferred method of hand decontamination is with an alcohol-based hand rub. Alternatively, hands may be washed with an antimicrobial soap and water. Frequent use of alcohol-based hand rub immediately following handwashing with nonantimicrobial soap may increase the frequency of dermatitis. IB IV. Before having direct contact with patients IB IV. After contact with blood, body fluids or excretions, mucous membranes, nonintact skin, or wound dressings IA IV.
If hands will be moving from a contaminated-body site to a clean-body site during patient care. II IV. After contact with inanimate objects including medical equipment in the immediate vicinity of the patient II IV. After removing gloves IB IV. Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if contact with spores e.
The physical action of washing and rinsing hands under such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores II IV. Do not wear artificial fingernails or extenders if duties include direct contact with patients at high risk for infection and associated adverse outcomes e. Develop an organizational policy on the wearing of non-natural nails by healthcare personnel who have direct contact with patients outside of the groups specified above II Top of Page IV.
Personal Protective Equipment PPE see Figure Recommendation number, description, and category for standard precautions for personal protective equipment and Ebola for healthcare worker updates.
Recommendation Category IV. Prevent contamination of clothing and skin during the process of removing PPE see Figure. Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intact skin e. Wear gloves with fit and durability appropriate to the task Wear disposable medical examination gloves for providing direct patient care.
Wear disposable medical examination gloves or reusable utility gloves for cleaning the environment or medical equipment. Do not wear the same pair of gloves for the care of more than one patient. Do not wash gloves for the purpose of reuse since this practice has been associated with transmission of pathogens IB IV.
Change gloves during patient care if the hands will move from a contaminated body-site e. Wear a gown, that is appropriate to the task, to protect skin and prevent soiling or contamination of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions, or excretions is anticipated. Do not reuse gowns, even for repeated contacts with the same patient. Routine donning of gowns upon entrance into a high risk unit e.
Use PPE to protect the mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. During aerosol-generating procedures e. Educate healthcare personnel on the importance of source control measures to contain respiratory secretions to prevent droplet and fomite transmission of respiratory pathogens, especially during seasonal outbreaks of viral respiratory tract infections e.
Implement the following measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at the point of initial encounter in a healthcare setting e. Post signs at entrances and in strategic places e. Provide tissues and no-touch receptacles e. Provide resources and instructions for performing hand hygiene in or near waiting areas in ambulatory and inpatient settings ; provide conveniently-located dispensers of alcohol-based hand rubs and, where sinks are available, supplies for handwashing IB IV.
During periods of increased prevalence of respiratory infections in the community e. Some facilities may find it logistically easier to institute this recommendation year-round as a standard of practice. Patient placement Recommendation number, description, and category for patient placement Recommendation Category IV. Include the potential for transmission of infectious agents in patient-placement decisions.
Place patients who pose a risk for transmission to others e. Determine patient placement based on the following principles: Route s of transmission of the known or suspected infectious agent Risk factors for transmission in the infected patient Risk factors for adverse outcomes resulting from an HAI in other patients in the area or room being considered for patient-placement Availability of single-patient rooms Patient options for room-sharing e.
Wear PPE e. Care of the environment. Recommendation number, description, and category for care of the environment Recommendation Category IV. Establish policies and procedures for routine and targeted cleaning of environmental surfaces as indicated by the level of patient contact and degree of soiling.
Clean and disinfect surfaces that are likely to be contaminated with pathogens, including those that are in close proximity to the patient e.
Use EPA-registered disinfectants that have microbiocidal i. Review the efficacy of in-use disinfectants when evidence of continuing transmission of an infectious agent e. In facilities that provide health care to pediatric patients or have waiting areas with child play toys e.
Use the following principles in developing this policy and procedures: Select play toys that can be easily cleaned and disinfected Do not permit use of stuffed furry toys if they will be shared Clean and disinfect large stationary toys e.
Include multi-use electronic equipment in policies and procedures for preventing contamination and for cleaning and disinfection, especially those items that are used by patients, those used during delivery of patient care, and mobile devices that are moved in and out of patient rooms frequently e. No recommendation for use of removable protective covers or washable keyboards. Unresolved issue Top of Page IV. Textiles and laundry Recommendation number, description, and category for handling textiles and laundry Recommendation Category IV.
Safe injection practices The following recommendations apply to the use of needles, cannulas that replace needles, and, where applicable, intravenous delivery systems. Recommendation number, description, and category for safe injection practices Recommendation Category IV.
Use aseptic technique to avoid contamination of sterile injection equipment IA IV. Do not administer medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed. Needles, cannulae and syringes are sterile, single-use items; they should not be reused for another patient nor to access a medication or solution that might be used for a subsequent patient IA IV.
Use fluid infusion and administration sets i. Use single-dose vials for parenteral medications whenever possible IA IV. Do not administer medications from single-dose vials or ampules to multiple patients or combine leftover contents for later use IA IV. If multidose vials must be used, both the needle or cannula and syringe used to access the multidose vial must be sterile IA IV. Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients IB Show More.
Show More. Transmission-Based Precautions. General principles Recommendation number, description, and category for general principles of transmission-based precautions Recommendation Category V. In addition to Standard Precautions, use Transmission-Based Precautions for patients with documented or suspected infection or colonization with highly transmissible or epidemiologically-important pathogens for which additional precautions are needed to prevent transmission see Appendix A IA V.
Extend duration of Transmission-Based Precautions, e. Contact precautions Recommendation number, description, and category for contact precautions Recommendation Category V.
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