IsolationPrecautions

Infectious Disease Epidemiology SectionOffice of Public Health

Louisiana Dept of Health & Hospitals800-256-2748

www.infectiousdisease.dhh.louisiana.govYour taxes at work

Isolation guidelines in Institutions are based on these

CONTACTDirect Indirect

AIRBORNE

DROPLETAND Vectorborne, Common source: Water, Food, Equipment, Rx

Main Modes of Transmission

Isolation Precaution System for Institutions

is an expansion of Universal Precautions

Standard Precautions• Same concept as UNIVERSAL PRECAUTIONS

• Precautions should be taken for any contact with Blood and Body Fluid (UP)

• AND for any contact with secretions and excretions, mucous membranes, damaged skin, contaminated environment and equipment

Handwashing• Beginning and end of day• Before & after each patient contact• Before and after gloving• Anytime after contact with

• Blood & body fluid• Secretions /excretions• Mucous membranes• Damaged skin• Contaminated environment • Contaminated equipment 10-

15s

Humans sheds #

300,000,000 squames/day

(4 to 25 mm) able to carry

bacteria

What Does Handwashing Do?• RESIDENT FLORA • Survives on the skin

more than 24 hours• Not easily removed,

hours of scrubbing • Complete stelirization

impossible• Low virulence• Staphylococci,

diphteroides,• mostly Gram + ,• very few Gram -

• TRANSIENT FLORA• Survive on skin less than 24

hours• Easily removed with soap and

water• Acquired during contacts with

contaminated areas mouth, nose, perineal area,genitals, anal area

• catheter, bedpan, urinal, patient care casual contact

• May have high virulenceð Enterobacteria, Gram - bacilli, Pseudomonas...

Patient care

Activity

Seroytpe 21

Klebsiella cultured

Hands of nurses washed and cultured:NO Klebsiella

What Does Handwashing Do?Activity Number of Klebsiella on nurse’s hand

In Colony Forming Units (CFU)Pulse, blood pressure 100-1,000Touching hand 10 - 100Touch shoulder 7,0000Oral temperature 100 – 1,000Caswell & Phillips British Med J Nov 1977: 1316

Handwashing

Hand Sanitizer• Washing hands with soap and water is

the best way to reduce the number of germs on them. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations,

• but sanitizers do not eliminate all types of germs: Not effective on spores (particularly Clostridium difficile) 

• Hand sanitizers are not effective when hands are visibly dirty. 

GlovesFOR ANY CONTACT WITH• Blood and Body Fluids• Secretions & excretions• Mucous membranes• Damaged skin• Contaminated

environment or equipment

GLOVES

DO NOT

REPLACE

HANDWASHIN

G

If it is wet, red or dirtyWash, glove then wash

Eye ProtectionFace Shield

RISK OF SPRAY or SPLASH

• of blood, • body fluid, • secretion • excretion in FACE OR EYE

Surgical Masks

• STANDARD PRECAUTIONSFor personnel to

protect from splashes /sprays of BBF/ S E

• DROPLET PRECAUTIONSto prevent large

droplets (>5m) on/from patient

• For patientsto prevent emission of

droplet (large and droplet nuclei)

Gown

• STANDARD PRECAUTIONTo protect from

splashes /sprays of large quantities of BBF/S E

• CONTACT PRECAUTIONTo protect contamination

of personnel clothing

Patient Placement• AIRBORNE

Private room with ventilation control

• DROPLET & CONTACT• Private room preferred• or cohort with same

infection• or at least 3 feet between

beds• Use common sense: do not

mix in immunocompromised patient with infected one

Airborne Precautions

1-ROOM WITH VENTILATION CONTROL• Negative air

pressure• >6 air exchange

/hour• HEPA filtered or

exshaust out

2-PERSONAL RESPIRATOR

3-PATIENT wears surgical mask if coughing & when transported

Small droplets (<5) emitted when coughing, & performance of procedures

Use STANDARD PRECAUTIONS at ALL times for ALL patients

Airborne Precautions: Personal Respirator

For Personnel • In AIRBORNE

ISOLATION ONLY• To prevent inhalation

of droplet nuclei • Main leak comes from

poor fit around face

PAPR Powered Air

Purifying Respirators

N95 Mask

Use STANDARD PRECAUTIONS at ALL times for ALL patients

Airborne Precautions: Signage

Use STANDARD PRECAUTIONS at ALL times for ALL patients

Droplet Precautions

• Private room • Mask when

entering room

Large particle droplets (>5) emitted when coughing, sneezing, talking & performance of procedures

Use STANDARD PRECAUTIONS at ALL times for ALL patients

Respiratory Etiquette

Contact Precautions

• Private room (*)• Gloves when entering

room, • change glove after

infectious contact• Gown when entering

room if substantial contact will occur

Use STANDARD PRECAUTIONS at ALL times for ALL patients

1 Wash * Touch * Wash

If red, wet or dirtyWash * Glove Touch Unglove * Wash

Know what is cleanKnow what is dirtyKeep them apart

OK

3 2

Standard Precaution: Ridiculously SimpleSTANDARD PRECAUTIONS = Universal precautions: Any one may be infectious, there is no way of

predicting who is infected and may transmit blood borne pathogens (HBV, HCV, HIV…) or other microorganisms (MRSA, Cdiff, MDRO…) USE STANDARD PRECAUTIONS WITH ALL PATIENTS ALL THE TIME

AIRBORNE PRECAUTIONS• Personal Respirator: N95 • Room with Ventilation Control:

• Negative pressure• > 6 air exchange• Air filtrated before recirculation

or vented outside

CONTACT PRECAUTIONS• Private room or 3ft separation between patients • Gloves when entering• Gown IF extensive contact

DROPLET PRECAUTIONS• Private room or 3ft separation between patients• Mask when within 3 ft of patients

Tuberculosis, Measles, Varicella, Any suspect of TB: chronic pulmonary symptoms >3 weeks

MOST BACTERIAL & VIRAL RESPIRATORY INFECTIONS except RSVInvasive H.influenzae, N.meningitidis, Invasive drug resistant S.pneumoniae, All serious bacterial respiratory infections spread by droplets, Diphtheria, Pneumonic Plague, Pertussis, Mycoplasma pneumoniae, Streptococcal pharyngitis, streptococcal pneumonia, scarlet fever, Adenoviral infections, Influenza, Mumps, Parvovirus 19, Rubella, Paroxysmal cough (?Pertussis)

INFECTIONS TRANSMITTED BY CONTACTMulti-Drug Resistant Organisms (MDRO), gastrointestinal, respiratory, skin, wound, infections or colonization with multidrug resistant bacteria, Enteric infections, enteroviral infections in infant, RSV, parainfluenza, Infectious skin infections: HSV, impetigo, cellulitis, scabies, staphylococcal furunculosis,Viral hemorrhagic conjunctivitis, viral fevers, abscess, draining wounds that cannot be covered. Respiratory infections: bronchiolitis in infants & children.

Use STANDARD PRECAUTIONS WITH ALL PATIENTS ALL THE TIMEAnd these other precautions may be added

We do not use these terms any longer: Strict Isolation, Blood & body fluids,Drainage and secretions, Enteric, Respiratory, AFB

A droplet of will fall in

100 m 10 seconds

40 m 1 minute

20 m 4 minutes

10 m 20 minutes

5-10 m 30-45 minutes

£5 mDroplet Nuclei

Stay suspended for hours, travels far