Isolation Precautions *CDC 2007

Toney ThomasLecturer / Course Coordinator,Assistant Director of Nursing

Infection Prevention & Control DepartmentRCSI / Beaumont Hospital

A quick recap

how isolation precautions evolved

over time

1970Isolation Techniques, 1st edtn.

-Introduced seven isolation precaution categories with color-coded cards: Strict, Respiratory, Protective, Enteric, Wound and Skin, Discharge, and Blood- No user decision-making required- Simplicity a strength; over isolation prescribed for some infections

1975 Isolation Techniques, 2nd edtn.

Same conceptual framework as 1st edition

1983 CDC Guideline for Isolation Precautionsin Hospitals

-Provided two systems for isolation: category-specific and disease specific- Protective Isolation eliminated; Blood Precautions expanded to include Body Fluids- Categories included Strict, Contact, Respiratory, AFB, Enteric, Drainage/Secretion, Blood and Body Fluids- Emphasized decision-making by users

HISTORY OF GUIDELINES FOR ISOLATION PRECAUTIONS IN HOSPITALS

HISTORY OF GUIDELINES FOR ISOLATION PRECAUTIONS IN HOSPITALS contd--

1985-1988

Universal precautions

Developed in response to HIV/AIDS epidemic- Blood and Body Fluid precautions to all patients, regardless of infection status- Did not apply to feaces, nasal secretions, sputum, sweat, tears, urine, or vomitus unless contaminated by visible blood- Added personal protective equipment to protect HCWs from mucous membrane exposures- Handwashing recommended immediately after glove removal- Added specific recommendations for handling needles and other sharp devices;

1987 Body substance isolation

- Emphasized avoiding contact with all moist and potentially infectious body substances except sweat even if blood not present- Shared some features with Universal Precautions- Weak on infections transmitted by large droplets or by contact with dry surfaces- Did not emphasize need for special ventilation to contain airborne infections- Handwashing after glove removal not specified in the absence of visible soiling

1996 Guideline for Isolation Precautions inHospitals

Prepared by the Healthcare Infection Control Practices Advisory Committee (HICPAC)- Melded major features of Universal Precautions and Body Substance Isolation into Standard Precautions to be used with all patients at all times- Included three transmission-based precaution categories: contact, droplet & airborne- Listed clinical syndromes that should dictate use of empiric isolation until an etiological diagnosis

“Standard Precautions include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered”

The application of Standard Precautions during patient care is determined by the nature of the HCW-patient interaction and the extent of anticipated blood, body fluid, or pathogen exposure

Standard precautions* CDC 1996

1. Hand hygiene2. PPE: Gloves, Gowns, Face & Eye

protection3. Patient placement4. C&D of patient care equipment5. Environmental hygiene6. Textiles & laundry7. Safe injection practices

Revision of 1996 guidelines, why?

1. Transition of health care delivery

2. Emergence of new pathogens

3. Successful experience & reaffirmation of Standard precautions *1996

4. Environmental controls – Protective environment

5. Organisational characteristics

6. HAI & MDROs – surveillance & control

New additions to Standard precautions

– Respiratory hygiene

– Safe injection practices

– Use of mask when performing spinal or epidural procedures

Respiratory Hygiene/Cough Etiquette

The elements include

1) Education of healthcare staff, patients, & visitors

2) Posted signs, in language(s) appropriate

3) Source control measures (e.g. covering the mouth/nose with a tissue when coughing & prompt disposal of used tissues, using surgical masks on the coughing person when tolerated and appropriate

4) Hand hygiene after contact with respiratory secretions

5) Spatial separation, ideally >3 feet,

Safe injection practices

• Large outbreaks of HBV and HCV among patients in the United States

• The primary breaches – 1) reinsertion of used needles into a multiple-dose

vial or solution container (e.g.saline bag)

– 2) use of a single needle/syringe to administer

intravenous medication to multiple patients.

Spinal canal punctures & Infection prevention

• Bacterial meningitis following myelogram and other spinal procedures

• Face masks are effective in limiting the dispersal of oro-pharyngeal droplets & are recommended for the placement of central venous catheters.

• HICPAC recommendation 2005 – use of a face mask when placing a catheter or injection to epidural space.

Transmission based precautions

• Three categories– Contact

• Direct• Indirect

– Droplet– Airborne

An important change!

Don PPE upon entry into patients room for patients who are in contact / Droplet precautions

Change is often painful, but we are quick to forget the painonce we taste the fruits of change!