Infection control
The Hospital Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention (CDC) has developed guidelines for isolation precautions in hospitals. These guidelines have two levels of precautions:
♦ Standard precautions
♦ Transmission-based precautions, which include airborne precautions, droplet precautions, and contact precautions.
Standard precautions
♦ Standard precautions decrease the risk of transmitting microorganisms from recognized and unrecognized sources of infection.
♦ Recognized sources of infection include the following:
– blood
– body fluids, secretions, and excretions (except sweat)
– nonintact skin
– mucous membranes.
♦ Because not all sources of infection can be recognized, standard precautions must be followed at all times and with every patient.
Implementation
♦ Perform hand hygiene before and after donning gloves and before and after each patient contact. Hand hygiene refers to either washing with soap and water or using an alcohol-based sanitizer.
♦ Wash your hands immediately if they become contaminated with blood or body fluids, secretions, or excretions.
♦ Use nonantimicrobial soap, if available, for routine hand washing.
♦ Wear gloves if you will or may come in contact with blood, specimens, tissue, body fluids, secretions, excretions, or contaminated surfaces or objects.
♦ Change your gloves between tasks and procedures performed on the same patient if you touch anything that might have a high concentration of microorganisms.
Wear vinyl or nitrile gloves if you’re allergic to latex.♦ Wear a gown, eye protection (goggles or glasses), and a mask during procedures that are likely to generate droplets of blood or body fluids, secretions, or excretions, such as extubation, surgery, endoscopic procedures, and dialysis.
♦ Carefully handle used patient care equipment that’s soiled with blood, body fluids, secretions, or excretions to prevent exposure to skin and mucous membranes, contamination of clothing, and transfer of microorganisms to other patients and environments.
♦ Clean patient-care equipment with a facility-approved disinfectant between patients.
♦ Discard disposable equipment appropriately.
♦ Make sure that procedures for routine care, cleaning, and disinfection of environmental surfaces and equipment are followed.
♦ Keep contaminated linens away from your body to prevent contamination and transfer of microorganisms.
♦ Place linens in properly labeled containers and make sure that the linens are transported according to facility policy.
♦ Handle used needles and other sharps carefully. Don’t bend them, break them, reinsert them into their original sheaths, or handle them unnecessarily.
♦ Use sharps with safety features whenever available.
♦ Immediately after use, discard sharps intact in an impervious disposal box.
♦ If a glove tears or a needlestick or other injury occurs, remove the gloves and wash your hands and the site of the needlestick injury thoroughly. Then put on new gloves as quickly as patient safety permits. Follow facility policy for reporting and following up on the incident.
♦ Use mouthpieces, resuscitation bags, or other ventilation devices in place of mouth-to-mouth resuscitation whenever possible.
♦ Place a patient who can’t maintain appropriate hygiene or who contaminates the environment in a private room. Notify infection control personnel.
♦ If you have an exudative lesion, avoid direct patient contact until the condition has resolved and your employee health provider clears you.
Transmission-based precautions
♦ Whenever a patient is known or suspected to be infected with highly contagious or epidemiologically important pathogens that are transmitted by air, droplet, or contact with dry skin or other contaminated surfaces, add transmission-based precautions to standard precautions.
♦ Examples of such pathogens include those that cause measles (air); influenza (droplet); and GI tract, respiratory tract, skin, and wound infections (contact).
♦ One or more types of transmissionbased precautions may be combined and followed when a patient has a disease with multiple routes of transmission.
♦ Post a sign identifying the type of precautions in effect so that health care personnel and visitors can comply with the necessary protocol.
Airborne precautions
♦ Add these steps to standard precautions.
♦ Place the patient in a private room with these features:
– monitored negative air pressure in relation to surrounding areas
– 6 to 12 air exchanges per hour
– appropriate outdoor air discharge or high-efficiency filtration of room air.
♦ Keep the patient’s room door closed.
♦ If a private room isn’t available, consult with infection control personnel. As an alternative, the patient may share a room with a patient who has an active infection with the same microorganism. (See Diseases requiring airborne precautions, page 386.)
♦ Wear respiratory protection, such as a surgical mask or N-95 respirator (for tuberculosis [TB]), when entering the room of a patient with a known or suspected respiratory tract infection. If you’re immune to measles and varicella, you don’t need to wear respiratory protection in the room of a patient with these illnesses.
♦ Limit patient transport and movement out of the room. If the patient must leave the room, have him wear a surgical mask.
Droplet precautions
♦ Add these steps to standard precautions.
♦ Place the patient in a private room. Special ventilation isn’t needed.
♦ If a private room isn’t available, consult with infection control personnel. As an alternative, the patient may share a room with a patient who has an active infection with the same microorganism. (See Diseases requiring droplet precautions, page 387.)
Diseases requiring airborne precautions
DISEASE | PRECAUTIONARY PERIOD |
Chickenpox (varicella) | Until lesions are crusted and no new lesions appear |
Herpes zoster (disseminated) | Duration of illness; susceptible persons should avoid entering room |
Herpes zoster (localized in immunocompromised patient) | Duration of illness |
Measles (rubeola) | Duration of illness |
Severe acute respiratory syndrome | Duration of illness |
Tuberculosis (TB) (pulmonary or laryngeal, confirmed or suspected) | Depends on clinical response; patient must be receiving effective therapy, be improving clinically (decreased cough and fever and improved findings on chest radiograph), and have three consecutive negative sputum smears collected on different days; or TB must be ruled out |
♦ Wear a surgical mask when working within 38″ (0.9 m) of the infected patient.
♦ Instruct visitors to stay at least 38″ away from the infected patient.
♦ Limit movement of the patient from the room. If the patient must leave the room, have him wear a surgical mask.
Contact precautions
♦ Add these steps to standard precautions.
♦ Place the patient in a private room.
♦ If a private room isn’t available, consult with infection control personnel. As an alternative, the patient may share a room with a patient who has an active infection with the same microorganism. (See Diseases requiring contact precautions, pages 388 and 389.)
♦ Wear gloves whenever you enter the patient’s room.
♦ Wear a gown when entering the patient’s room and remove it before leaving the patient’s room.
♦ Wear a mask if there’s a risk of splashing of body fluids.
♦ Always change gloves after contact with infected material. Remove them before leaving the room and perform hand hygiene.
♦ Limit the patient’s movement from the room. If the patient must be transported to another location, contain or cover the infected or colonized areas on the patient’s body. Remove contaminated personal protective equipment (PPE) and perform hand hygiene before transporting the patient. After arriving at the destination, don new PPE.
Reportable diseases
♦ The CDC, OSHA, The Joint Commission, and the American Hospital Association all require health care facilities to document and report certain diseases acquired in the community or in hospitals and other health care facilities.
(See Reportable diseases and infections, page 390.)
(See Reportable diseases and infections, page 390.)
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