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Isolation Precautions. Infectious Disease Epidemiology Section Office of Public Health Louisiana Dept of Health & Hospitals 800-256-2748 www.infectiousdisease.dhh.louisiana.gov Your taxes at work. Main Modes of Transmission. Isolation guidelines in Institutions are based on these. - PowerPoint PPT Presentation
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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
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