Isolation Precautions 1 Explain the rationale for isolation

Isolation Precautions

1. Explain the rationale for isolation precautions. 2. Outline the types and indications of isolation precautions. 3. List the types of personal protective equipment used in isolation precautions. December 1, 2013 Learning objectives 2

• 35 minutes December 1, 2013 Time involved 3

• Microorganisms can be spread from patients to patients and patients to staff • Isolation precautions can reduce transmission decreasing the spread of microbes • Components: hand hygiene, personal protective equipment, single rooms, ventilation, and restriction of movement • Must be applied according to signs and symptoms December 1, 2013 Key points 4

• Infection results from an interaction between an infectious agent and susceptible host • The interaction occurs by means of contact between the agent and the host and is affected by the environment • Breaking the chain of infection by interrupting transmission is generally the best way to prevent infections December 1, 2013 Chain of Infection 5

• Contact spread • Direct: from one person to another • Indirect: contaminated equipment or surfaces • Droplet December 1, 2013 Transmission of Infections - 1 • Expelled when sneezing or coughing; less than 2 m from the source 6

• Airborne spread • Small particles (≤ 5μm in size) can remain airborne • Transferred more than 2 m from the source December 1, 2013 Transmission of Infections - 2 • Vehicle spread • Vector-borne 7

• Understand what is to be achieved through isolation • Know the route of transmission of an infectious agent • Reduce risks • Emphasise the use of protective barriers December 1, 2013 Principles of Isolation 8

• Universal Precautions created in 1985 due to AIDS epidemic • Objective was to prevent infections transmitted by blood and body fluids December 1, 2013 Background • Concept of Body Substance Isolation published in 1987 • All fluids from patients handled using gloves 9

• Standard Precautions • Transmission-based Precautions December 1, 2013 Isolation Precautions 10

• Basic precautions recommended for all patients • Also called Routine Practices • Based in the fact that unsuspected agents may be present in body fluids, non-intact skin and mucous membranes of all patients December 1, 2013 Standard Precautions - 1 11

• Hand hygiene • Disposable gloves on contact with secretions, excretions, or body fluids • Protective apron or gown for body contact with patient or patient’s bed • Appropriate handling of equipment and linen • Environmental cleaning and spills-management • No cap, mask, or shoe covers December 1, 2013 Standard Precautions - 1 12

December 1, 2013 Structural Elements 13

• Contact precautions • Droplet precautions • Airborne Isolation • Protective Isolation December 1, 2013 Additional transmission-based precautions 14

• PPE when likely to be in contact with environment contaminated with agents such VRE, MRSA or Clostridium difficile • Single room or room with another patient infected by the same pathogen • Clean gloves when entering the room • Clean gown/apron if substantial contact with the patient or environment is anticipated December 1, 2013 Contact Precautions 15

• Single room or in a room with another patient infected by the same pathogen • Face protection when working within 1 -2 metres of the patient • Mask on the patient if transport is necessary • Indications: Respiratory diseases (RSV, Influenza) December 1, 2013 Droplet Precautions 16

• Single room most important • Mask or respirator when entering room • Mask on patient if transport necessary • Recommended December 1, 2013 Airborne Isolation • Negative air pressure relative to corridors • Air exhausted directly to the outside or recirculated through HEPA filtration (6 12 air changes per hour) • Indications: Tuberculosis, rubeola 17

• Recommended only for allogeneic hematopoietic stem cell transplant patients • Positive room air pressure relative to corridors, along with HEPA filtration of incoming air at ≥ 12 air changes per hour • Appropriate engineering controls • Consider: • Single rooms with negative or positive pressure very difficult to maintain • Rooms with anterooms have less air movement December 1, 2013 Protective Isolation 18

• Hand hygiene • Especially important after contact with patients and contaminated equipment or surfaces • Staff equipment and surfaces December 1, 2013 Essential Components - 1 • Keep clean • Handle patient equipment with care • Ensure all reusable equipment is reprocessed • Linen • Handle, transport, and process with care 19

• Personal protective equipment • Gloves • Change between patients • Remove immediately after use • Do not reuse December 1, 2013 Essential Components - 2 • Clothes • Remove if soiled or wet as soon as possible • Masks, goggles, visors, respirators • Protect against blood/ body fluid splashes • Disinfect as needed 20

• Family members providing care to patients MUST be educated • Practice good hygiene • Use appropriate precautions to prevent spread of infections • Precautions for family members should be the same as those used by staff December 1, 2013 Essential Components - 3 21

• In most cases, Standard Precautions are sufficient • Base on clinical signs and symptoms • Consider: • Single room when gross contamination of the environment is likely (e. g. , wounds, diarrhoea, bleeding) • Door closed when contact transfer is likely (e. g. , injured skin) • Ventilate to the outside when airborne transfer is likely (e. g. , tuberculosis) • Use airlock when massive airborne transfer is likely (e. g. , varicella) December 1, 2013 Considerations about Isolation Precautions 22

• Isolation Precautions is associated with adverse psychological effects • Discontinued as soon as possible • Fluids of all patients are potentially infectious • Hand Hygiene is a key component • Use a no-touch technique when possible December 1, 2013 General Recommendations - 1 23

• Dispose of faeces, urine, and secretions via designated sinks, and clean and disinfect containers • Clean up spills promptly • Ensure that patient-care equipment, supplies, and linen is cleaned and/or disinfected between each use • For tuberculosis patients – develop a protocol December 1, 2013 General Recommendations - 2 24

• Australian Guidelines for the Prevention and Control of Infection in Healthcare, 2010. http: //www. nhmrc. gov. au/node/30290 • Hospital infection control guidance (SARS), Health Protection Agency, UK, 2005. http: //www. hpa. org. uk/web/HPAweb. File/HPAweb_ C/1194947350823 • Routine Practices and Additional Precautions in All Health Care Settings, 2012, Canada http: //www. publichealthontario. ca/en/e. Repository/RPA P_All_Health. Care_Settings_Eng 2012. pdf December 1, 2013 Guidelines 25

• Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care. Interim WHO Guidelines, June 2007. http: //whqlibdoc. who. int/hq/2007/WHO_CDS_EPR_ 2007. 6_eng. pdf • CDC Guideline for isolation precautions: Preventing transmission of infectious agents in healthcare settings. (HICPAC), 2007. http: //www. cdc. gov/hicpac/pdf/isolation/Isolation 2007. pdf • Practical Guidelines for Infection Control in Health Care Facilities. WHO. 2004. http: //www. searo. who. int/entity/emergencies/docume nts/infectioncontrolfullmanual. pdf December 1, 2013 References 26

• Global alert and response: infection prevention and control in healthcare. WHO. 2011. http: //www. who. int/csr/bioriskreduction/ infection_control/en/ • WHO Interim Infection control recommendations for care of patients with suspected or confirmed filovirus (Ebola, Marburg, haemorrhagic fever. ), 2008 http: //www. who. int/csr/bioriskreduction/filovir us_ infection_control/en/index. html December 1, 2013 Further Reading 27

1. 2. In general, Standard Precautions are sufficient to prevent spread of microorganisms. T/F? Which of the following is NOT a key component of isolation precautions: a) b) c) d) 3. Hand Hygiene Separation of beds Surveillance Personal protective equipment December 1, 2013 Quiz In a case of tuberculosis you should use: a) b) c) d) Contact isolation Airborne isolation Droplet isolation Protective isolation 28

• IFIC’s mission is to facilitate international networking in order to improve the prevention and control of healthcare associated infections worldwide. It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe. • The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication, consensus building, education and sharing expertise. • For more information go to http: //theific. org/ December 1, 2013 International Federation of Infection Control 29