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IsolationPrecautionsInfectious Disease Epidemiology SectionOffice of Public HealthLouisiana Dept of Health & Hospitals800-256-2748www.infectiousdisease.dhh.louisiana.govYour taxes at workIsolation guidelines in Institutions are based on theseCONTACTDirect IndirectAIRBORNEDROPLETAND Vectorborne, Common source: Water, Food, Equipment, RxMain Modes of Transmission6665554Isolation Precaution System for Institutionsis an expansion of Universal PrecautionsStandard Precautions33333

Standard PrecautionsSame concept as UNIVERSAL PRECAUTIONSPrecautions 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

19191918181817HandwashingBeginning and end of dayBefore & after each patient contactBefore and after glovingAnytime after contact withBlood & body fluidSecretions /excretionsMucous membranesDamaged skinContaminated environment Contaminated equipment

10-15s8887776 Humans sheds # 300,000,000 squames/day (4 to 25 mm) able to carry bacteriaWhat 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 virulence Enterobacteria, Gram - bacilli, Pseudomonas...

Patient care Activity

Seroytpe 21Klebsiella culturedHands of nurses washed and cultured:

NO KlebsiellaWhat Does Handwashing Do?ActivityNumber of Klebsiella on nurses handIn Colony Forming Units (CFU)Pulse, blood pressure100-1,000Touching hand10 - 100Touch shoulder7,0000Oral temperature100 1,000Caswell & Phillips

British Med J Nov 1977: 1316

Handwashing

Hand SanitizerWashing 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 donoteliminate all types of germs: Not effective on spores (particularly Clostridium difficile)Hand sanitizers are not effective when hands are visibly dirty.

GlovesFOR ANY CONTACT WITHBlood and Body FluidsSecretions & excretionsMucous membranesDamaged skinContaminated environment or equipmentGLOVES DO NOT REPLACE HANDWASHINGIf it is wet, red or dirtyWash, glove then wash1010109998Eye ProtectionFace ShieldRISK OF SPRAY or SPLASH of blood, body fluid, secretion excretion in FACE OR EYE

1111111010109Surgical MasksSTANDARD 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)

12121211111110GownSTANDARD PRECAUTIONTo protect from splashes /sprays of large quantities of BBF/S E

CONTACT PRECAUTIONTo protect contamination of personnel clothing

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Patient PlacementAIRBORNEPrivate room with ventilation control

DROPLET & CONTACTPrivate room preferredor cohort with same infectionor at least 3 feet between bedsUse common sense: do not mix in immunocompromised patient with infected one15151514141413

Airborne Precautions1-ROOM WITH VENTILATION CONTROLNegative air pressure>6 air exchange /hourHEPA filtered or exshaust out

2-PERSONAL RESPIRATOR

3-PATIENT wears surgical mask if coughing & when transportedSmall droplets (5m) emitted when coughing, sneezing, talking & performance of proceduresUse STANDARD PRECAUTIONS at ALL times for ALL patients2323232222Respiratory Etiquette

Contact PrecautionsPrivate room (*)Gloves when entering room, change glove after infectious contactGown when entering room if substantial contact will occur

Use STANDARD PRECAUTIONS at ALL times for ALL patients252525241 Wash * Touch * WashIf red, wet or dirtyWash * Glove Touch Unglove * WashKnow 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 TIMEAIRBORNE PRECAUTIONSPersonal Respirator: N95 Room with Ventilation Control: Negative pressure> 6 air exchangeAir filtrated before recirculation or vented outsideCONTACT PRECAUTIONSPrivate room or 3ft separation between patients Gloves when enteringGown IF extensive contactDROPLET PRECAUTIONSPrivate room or 3ft separation between patientsMask when within 3 ft of patientsTuberculosis, Measles, Varicella, Any suspect of TB: chronic pulmonary symptoms >3 weeksMOST 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 addedWe do not use these terms any longer: Strict Isolation, Blood & body fluids,Drainage and secretions, Enteric, Respiratory, AFB

A droplet ofwill fall in100 m10 seconds 40 m1 minute 20 m4 minutes 10 m20 minutes5-10 m30-45 minutes5 mDroplet NucleiStay suspended for hours, travels far