Isolation precautions

Dr. Satti M. SalehChief of Infectious Diseases

DepartmentMedical Director MGH

ISOLATION PRECAUTIONS IN HOSPITAL

Rationale for precautionsInfection Transmission Requires :

Microorganism

Source

Susceptible Host

Means of transmission.

SOURCEPatient , personnel , visitors .Acute cases in incubation .Colonized Patients .Endogenous Flora .Inanimate Environment

( contaminated ) eg; water , food , equipment .

ISOLATION PRECAUTIONS IN HOSPITALs

HOSTAge Underlying diseaseTreatment : 1 -Antimicrobial. 2 – Corticosteroids. 3 – Immunosuppressive agents.Weak in first line of defense mechanisms eg; Surgical

operations . Anesthesia . Catheters .

ISOLATION PRECAUTIONS IN HOSPITALS

Transmission Its main routes : Contact a -Direct contacts. b - Indirect contacts. c - Droplet transmission ( 3 feet ). Common vehicle transmission Water equipment devices. Airborne transmission. Airborne droplet nuclei ( 5 micrometers or small ) Evaporated droplets or dust particles eg TB ,

Measles , chickenpox. Vector borne.


Interruption of transmission of micro-organisms is directed primarily at transmission.

Disadvantages of isolation. Special equipment, environmental

modification , more cost. Patient care may be affected. Deprives patient of normal social

relationship. Disadvantages to be weighed against

prevention values .

Early isolation practices .


1877 Separate facilities. 1910 Cubical system, separate gown , wash hands,

disinfect objects. 1950 Infectious disease hospital begin to close. 1960 T.B Hospitals decreased. 1970 CDC Isolation manual. 1983 CDC Guidelines. 1 - Category specific isolation. Disease specific isolation. Use guidelines to develop a system . 2- Encourage personnel to make decision on what

precautions to be taken. 3 – Encourage personnel to make decision about the

likelihood of exposure to reduce costs.


CATEGORY SPCIFIC ISOLATION Strict isolation Contact isolation. Respiratory isolation T.B isolation. Enteric precaution Drainage , secretion precautions. Blood & body fluid precautions. Protective isolation. DISEASE SPECIFIC ISOLATION


Consider epidemiology of each infectious disease.

Highly educated. To be updated. Universal precautions ( 1985 ) : Applying blood & body fluid precautions

universally to all people. Prevention of needle stick injuries. Traditional barriers e.g gloves . Eye coverings in certain procedures .

Amniotic ,CSF, semen, & vaginal secretions. Not to feces, nasal secretions, sputum,

sweat, &tears.


Body substance isolation ( 1987 ): Isolation of all moist &potentially infectious

body substances ( blood, urine, feces, sputum, saliva, wound drainage, other body fluids regardless of their presumed infection status ).

Stop sign alert (( airborne )). DISADVANTAGES : Added costs. Overprotection of personnel. Difficulty in maintaining routine application. Lack of hands washing after gloves removal. Droplet infection.


New Isolation Guidelines ( 1990 ) : Problem of multi-drug resistance T.B. Multi-drug resistant of micro organisms. New guidelines should : 1- Be epidemiologically sound . 2- Recognize importance of all body

secretions. 3- Adequate precautions of airborne, droplets

contact routes. 4- Simple. 5- Use new terms to avoid confusions. 6- In expensive

New Isolation Precautions, 1996

’‘Standard’’And

’‘Transmission – Based Precautions’’

ISOLATION PRECAUTION IN HOSPITALS

HICPAC Isolation Precautions (1996 ) 1 – Standard precautions a - Blood b - All body fluids c - Non intact skin d - mucous membranes. ( to reduce transmission from organized &

unorganized source of infection.) 2- Transmission based precautions : ( patient documented or suspected to be infectious) a - Airborne precautions b - Droplet precautions c - Contact precautions. ( may be combined for diseases with multiple route of

transmission).

STANDARD PRECAUTIONS

Consider all patients and their bodily fluids (except sweat) to be potentially infectious

Use appropriate barrier precautions when there is a risk of exposure to blood, body fluids, secretions, excretions, mucous membranes and non-intact skin.

Patients with known or suspected infections are NOT to have their medical records labeled as “infectious”.

Specimens of patients with known or suspected infections are NOT to be labeled as “infectious”. All specimens are to be treated in the same safe manner .

Used needles and sharps should be disposed of safely ( in puncture proof sharp boxes ) .

Needles should NOT be recapped . All Health care workers should receive the HBV vaccine .

Transmission-Based Precautions

.Three categories of Transmission-based Precautions:

-Contact Precautions. - Droplet Precautions.

-Airborne Precautions .

AIRBORNE TRANSMISSION

Airborne spreads upon aerosolization of small particles (=< 5 micron) of the infectious agent that can then travel over long distances through the air .

Most common nosocomial pathogens transmitted by this route :

- Mycobacterium tuberculosis .- Varicella-zoster virus (chickenpox) .- Measles .- Smallpox.- ? SARS .

AIRBORNEPRECAUTIONS

Place the patient in a negative pressure room with at least 6 – 12 air exchanges per hour .

Room exhaust must be appropriately discharged outdoors or passed through a HEPA ( high – efficiency particulate aerator ) filter before recirculation within the hospital .

The door of the room should be kept closed .

DROPLET TRANSMISSION

Respiratory droplets are large particles (>5 micron) expelled during .

- Coughing .- Sneezing .- Talking.- During procedures such as suctioning and

bronchoscope . Droplets travel < 1,5 meter from the source patient . Example :• Neisseria meningitides .• Haemophilus influenza type b ( invasive ) .• Streptococcus pyogenes (group A Streptococcus) . • Mycoplasma pneumonia .

DROPLET PRECAUTIONS

Private room preferred; cohorting allowed if necessary.

Special air handling and ventilation are unnecessary .

The door of the room may remain open .

Wear a mask when within 1 meter of the patient .

Mask the patient during transport .

DROPLET TRANSMISSION

Respiratory droplets are large particles (>5 micron) expelled during .

- Coughing .- Sneezing .- Talking.- During procedures such as suctioning and

bronchoscope . Droplets travel < 1,5 meter from the source patient . Example :• Neisseria meningitides .• Haemophilus influenza type b ( invasive ) .• Streptococcus pyogenes (group A Streptococcus) . • Mycoplasma pneumonia .

Phlebotomy Handbook: Blood Collection Essentials, Seventh EditionDiana Garza • Kathleen Becan-McBride

Pearson EducationCopyright 2005

TB Transmission

TRANSMISSION Requires

1)Pt’s Hands of health care workers .

2)Survive for several minutes .3)Non or Inadequate hand hygiene .4)Contaminated Hands Pt’s

ISOLATION PRECAUTION IN HOSPITALS

Air borne precautions : Dissemination of droplet nuclei . Small particle residue of 5 micrometers or less of

evaporated droplets. Suspended on the air for long time. Dust particles containing the infectious agents. Special air handling & ventilation required e.g measles

, varicella , TB . Droplet precautions : Large particles droplets Invasive HI type b. Invasive N Meningitides. Diphtheria , Mycoplasma , sterptococcal infection. Viral infections : adenovirus , mumps, rubella .


Contact precautions : Patient known or suspected to have serious

illness transmitted by contact. a - GIT, Respiratory , skin or wound infection

with multi drug resistant bacteria or colonization.

b – Enteric infections : shigella, HIV, E.coli, O157, 117 .

c – Respiratory viruses . d – Skin infections Diphtheria , Herpes,

Cellulitis Scabies , VHF.

Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Diana Garza • Kathleen Becan-McBride


Herpes

Neonatal infection with herpes simplex virus type 1, showing ulcerating and

vesicular skin lesions .Lesions may be present in small numbers .The virus was transmitted during birth .


Additional Emperic Precautions : Diarrhea Enteric organism contact Vesicular rash Varicella air borne Maculopapular rash measles air borne cough, fever, upper lobe infilterate TB air borneRisk of multi drug resistant bacteria contact Abscess draining wound strept, staph contact

FUNDAMENTAL OF ISOLATION PRECAUTIONS 1- Hand washingAfter touching blood , body fluid….etcAfter removing glovesBetween pt’s contact.



Standard Precautions

Figure 5.9 Rinse Hands in a Downward Motion with Water


2- Gloves : a – for touching blood, body fluid …etc. b – Mucous membranes . c – contaminated items d- a septic procedures .

3 - Patient placing: a - Private room. b - Hand wash & other facilities. c - With appropriate room mate ( cohorting ). d - Private room with appropriate ventilation e.g T.B.

4- Transport of infected patients : a – limit movement . b – Appropriate measure if needed .




Figure 5.11 Supplies for Isolation Procedures

Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition

Diana Garza • Kathleen Becan-McBride


ISOLATION PRECAUTIONSIN HOSPITALS

c – Notify other departments. d – Patient education.

5 – Mask respiratory, Eye precautions , Eye shields.

6 – Gowns , boots, shoe covers, leg coverings ( remove gown before leaving). .

7 – Environmental control .

8- linen9- proper waste disposal ( e.g sharp)




4 .Face shields

Figure 5.18 Face shields or goggles may be worn




Specific Isolation Techniques and

Procedural Steps .2Gowning

Figure 5.13 Gowns should be large enough to cover all clothing




5 .Completing the protection

Figure 5.19 Gloves should be pulled over the ends of gown sleeves

Precautions Needed for Cases

Condition Type Duration Pulmonary TB S+A Till sputum

Negative Chicken Pox S+A Till rash crusted M-meningitis S+D 24 Hrs HIV S Duration of stay

Clinical Syndromes: Empiric precautions as per clinical

presentation

THANK YOU

Dr. Satti Mohammed