Isolation Precaution

presented during orientation

1. Isolation Precaution Ross Ibabao KJO Hospital IC Coordinator

2. Learning Objectives Discuss chain of infection and different types of mode of transmission Define isolation precautions and describe different types isolation precautions. Describe contact precautions and conditions under which to use contact precautions. Describe conditions under which to use droplet precautions. Describe conditions under which to use airborne precautions. 2

3. Chain of infection 3

4. Mode of transmission A microorganism may be spread by a single or multiple routes. Contact, direct or indirect Droplet Airborne Vector-borne (usually arthropod) and Common environmental sources or vehicles - includes food-borne and waterborne, medications e.g., contaminated IV fluids 4

5. Contact Transmission Direct-contact Direct body surface-to-body surface contact and Physical transfer of microorganisms between a susceptible host and an infected or colonized person Indirect-contact Contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated hands or gloves 5

6. D roplet T ransmission Droplet generation coughing, sneezing, talking, procedures such as suctioning and bronchoscopy Droplet deposited on the host’s conjunctivae, nasal mucosa, or mouth. 6

7. Airborne Transmission Small-particle residue {5µm or smaller} of evaporated droplets containing microorganisms Suspended in the air for long periods of time Dispersed by air currents Inhaled by a susceptible host within the same room or over a longer distance 7

8. Definition of Isolation Precautions Source: Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier. Special precautionary measures, practices, and procedures used in the care of patients with contagious or communicable diseases 8

9. Fundamentals of Isolation Precautions Handwashing and gloving Personal protective equipment's: Masks, respiratory protection, eye protection, face shields, g owns and protective apparel Patient-care equipment and articles Linen and laundry Routine and terminal cleaning Patient placement Transport of infected patients 9

10. 10 Isolation Precautions Patient Transport Linen & laundry Patient care equipment And articles Routine and Terminal Cleaning PPE Hand hygiene Patient placement Isolation Precautions

11. Types of Isolation Precautions Standard Precautions Transmission-based precautions Contact precautions Airborne precautions Droplet precautions 11

12. TRANSMISSION-BASED PRECAUTIONS Patient Placement Single patient rooms is always indicated for patients placed on airborne precautions and preferable for those who require contact or droplet precautions Cohort patients with same organism. 12

13. TRANSMISSION-BASED PRECAUTIONS Management of Visitors Visitors as sources of healthcare associated infections – e.g., pertussis, influenza, tuberculosis Cough etiquette Isolation Logbook Use of barrier precautions by visitors Educate patients and family members Follow signs for isolation precautions 13

14. TRANSMISSION-BASED PRECAUTIONS Contact Precautions Infections spread by direct or indirect contact with patients or patient-care environment Limit patient movement Private/SINGLE room or cohort with patients with same infection or diagnosis Wear disposable gown and gloves when entering the patient room Remove and discard used disposable gown and gloves inside the patient room Wash hands immediately after leaving the patient room Clean patient room daily using a hospital disinfectant, with attention to frequently touched surfaces Use dedicated equipment if possible (e.g., stethoscope) 14

15. Contact Precautions cont. GLOVES Use gloves when entering the room. Change gloves after contact with infective material. Remove gloves before leaving the room. Wash hands or use appropriate gel after glove removal. Do not touch infective material or surfaces with hands. Clean, non-sterile gloves are usually adequate. GOWN Use protective gown when entering the room if direct contact with patient or potentially contaminated surfaces or equipment near patient is anticipated or if the patient has diarrhea or colostomy or wound drainage that is not covered by a dressing. 15

16. Contact Precautions Signage 16

17. Droplet Precautions Reduce the risk of transmission by large particle droplets (larger than 5 m in size). Requires close contact between the source person and the recipient Droplets usually travel 3 feet or less 17

18. Droplet Precautions cont. A private/single room or Cohort with patient with active infection with same microorganism Use a mask when entering the room and definitely if within 3 feet of patient Limit movement and transport of the patient. Use a mask on the patient if they need to be moved and follow respiratory hygiene/cough etiquette Keep at least 3 feet between infected patient and visitors 18

19. Droplet Precautions Signage 19

20. Airborne Precautions Tuberculosis, measles, varicella Place the patient in an airborne infection isolation room (AIIR) Pressure should be monitored with visible indicator is recommended Use of respiratory protection (e.g., fit tested N95 respirator) or powered air-purifying respirator (PAPR) when entering the room Limit movement and transport of the patient. Use a mask on the patient if they need to be moved Keep patient room door closed. 20

21. Airborne Precautions Signage 21

22. S ummary Isolation precautions is important in all healthcare settings to prevention transmission of infections 2 types of isolation precautions Usage of each type of precautions 22

23. References 2007 Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings: http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html CDC guidelines for isolation precautions in hospitals 1996, Hospital Infection Control Practices Advisory Committee (HICPAC): http://wonder.cdc.gov/wonder/prevguid/p0000419/p0000419.asp Principles of Epidemiology in public health practice, 3 rd edition 23