Skill 37

Isolation Precautions

In 2007 the Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) published revised guidelines for isolation precautions (Box 37-1). These recommendations were based on current epidemiological information regarding disease transmission in health care settings. Although primarily intended for care of patients in acute care, you can apply the recommendations to patients in subacute care or long-term care facilities. HICPAC recommends that hospitals modify the recommendations according to their needs and as dictated by federal, state, or local regulations (CDC, 2007b).

Box 37-1

CDC Isolation Guidelines

Standard Precautions (Tier 1)* for Use with All Patients

▪ Standard Precautions apply to blood, blood products, all body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes.

▪ Perform hand hygiene before, after, and between direct contact with patients (e.g., between contact: cleaning hands after a patient care activity, moving to a nonpatient care activity, and cleaning hands again before returning to perform patient contact).

▪ Perform hand hygiene after contact with blood, body fluids, secretions, and excretions; after contact with surfaces or articles in a patient room; and immediately after gloves are removed.

▪ When hands are visibly soiled or contaminated with blood or body fluids, wash them with either a nonantimicrobial soap or an antimicrobial soap and water.

▪ When hands are not visibly soiled or contaminated with blood or body fluids, use an alcohol-based hand rub to perform hand hygiene.

▪ Wash hands with nonantimicrobial soap and water if contact with spores (e.g., Clostridium difficile) is likely to have occurred.

▪ Do not wear artificial fingernails or extenders if duties include direct contact with patients at high risk for infection and associated adverse outcomes.

▪ Wear gloves when touching blood, body fluids, secretions, excretions, nonintact skin, mucous membranes, or contaminated items or surfaces is likely. Remove gloves and perform hand hygiene between patient care encounters and when going from a contaminated to a clean body site.

▪ Wear personal protective equipment when the anticipated patient interaction indicates that contact with blood or body fluids may occur.

▪ A private room is unnecessary unless the patient’s hygiene is unacceptable (e.g., uncontained secretions, excretions, or wound drainage).

▪ Discard all contaminated sharp instruments and needles in a puncture-resistant container. Health care agencies must make available needleless devices. Any needles should be disposed of uncapped, or a mechanical safety device should be activated for recapping.

▪ Respiratory hygiene/cough etiquette—Have patients:

▪ Cover the nose/mouth when coughing or sneezing.

▪ Use tissues to contain respiratory secretions and dispose of them in nearest waste container.

▪ Perform hand hygiene after contacting respiratory secretions and contaminated objects/materials.

▪ Contain respiratory secretions with procedure or surgical mask.

▪ Sit at least 91.4 cm (3 feet) away from others if coughing.

^* Formerly universal precautions and body substance isolation.

Standard Precautions are the primary strategies for prevention of infection transmission and apply to contact with blood, body fluids, nonintact skin, and mucous membranes and with equipment or surfaces contaminated with these potentially infectious materials. The strategy of respiratory hygiene/cough etiquette applies to any person with signs of respiratory tract infection, including cough, congestion, rhinorrhea, or increased production of respiratory secretions when entering a health care site. Education of health care staff, patients, and visitors to cover the mouth and nose with a tissue when coughing, dispose properly of used tissues, and perform hand hygiene is among the elements of respiratory hygiene.

The second tier (Table 37-1) includes precautions designed for care of patients who are known or suspected to be infected, or colonized, with microorganisms transmitted by the contact, droplet, or airborne route (Brisko, 2011; CDC, 2007a) or by contact with contaminated surfaces. The three types of transmission-based precautions—airborne, droplet, and contact—may be combined for diseases that have multiple routes of transmission (e.g., chickenpox). They are used either singly or in combination when Standard Precautions are implemented.

TABLE 37-1

CDC Isolation Guidelines: Transmission-Based Precautions (Tier 2) for Use With Specific Types of Patients