Isolation precautions. Patama Suttha M.D. 16 Dec 2014 Bamrasnaradura Infectious diseases Institute

Transcription

1 Isolation precautions Patama Suttha M.D. 16 Dec 2014 Bamrasnaradura Infectious diseases Institute

2 Precautions to Prevent Transmission of Infectious Agents Standard precautions 1990s Recommended in care of all hospitalized patients Apply when contact with blood, other body fluids, nonintact skin, mucous membranes and secretions and excretions except sweat Transmission based precautions - Contact Precaution Direct contact Indirect contact - Droplets Precaution - Airborne Precautions

3 Isolation precautions 3 different types : Contact Isolation Precautions used for infections, diseases, or germs that are spread by touching the patient or items in the room (ex: MRSA, VRE, diarrheal illnesses, open wounds, RSV). Droplet Isolation Precautions used for diseases or germs that are spread in tiny droplets caused by coughing and sneezing (ex: pneumonia, influenza, Pertussis, Meningococcemia). Airborne Isolation Precautions used for diseases or very small germs that are spread through the air from one person to another (ex: TB, measles, chickenpox

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5 Hand hygiene PPE (personal protective equipment ) Prevention of needle stick and injuries from other sharp instruments Respiratory hygiene and cough etiquette Environmental cleaning Linens Waste disposal Patient care equipment

6 Contact precaution Direct contact Indirect contact

7 Direct contact Norwegian scabies Herpetic Whitlow Common:Children, Dentists, Med care providers

8 Contaminated Surfaces tested positive for VRE (+) in patient environment. Hayden M. ICAAC,2001, Chicago, IL

9 Contact Precautions Apply to patients with any of the following conditions and/or disease: Presence of stool incontinence (may include patients with norovirus, rotavirus, or Clostridium difficile) Draining wounds, uncontrolled secretions, pressure ulcers, or presence of ostomy tubes and/or bags draining body fluids Presence of generalized rash or exanthems

10 Contact Precautions Colonization of with MDR bacteria Enteric infections( C.diff,entero virus,e.coli Respiratory virus ( RSV, Rhinovirus, Influenza etc) Ebola viral diseases Skin infection: Scabies,Noncontained abcesses or decubitus ulcers

11 Contact Precautions Perform hand hygiene PPE use: Wear gloves / gown when touching the patient and the patient s environment or belongings Use separate bathroom in patients with infectious diarrhea, if available Clean/disinfect the bathroom before it can be used again

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13 Droplet Precautions Apply to patients known / suspected to be infected with a pathogen that can be transmitted by droplet route ( > 5 micron) Respiratory virus Bordetella pertusis, pharyngeal diphtheria For first 24 hrs of Rx : Neisseria meningitides, group A streptococcus, Scarlet fever Mumps Parvovirus B19, Rubellla Plague( Pneumonic), Mycoplasma pneumoniae

14 Droplet Precautions Place the patient in an exam room with a closed door if an exam room is not available,patient is provided a facemask and placed in a separate area as far from other pts PPE use: Wear a facemask, such as a procedure or surgical mask, for close contact with the patient

15 Droplet Precautions Perform hand hygiene before and after touching the patient Instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients, and practice respiratory hygiene and cough etiquette Clean and disinfect the exam room accordingly

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17 Airborne Precautions Apply to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route Tuberculosis Measles Chickenpox (until lesions are crusted) Localized (in immunocompromised pt) or diss. herpes zoster (until lesions are crusted over) Patient enter through a separate entrance to the facility if available, to avoid the reception and registration area

18 Airborne Precautions Place the pt immedialty in airborne infection isolation room (AIIR) If an AIIR is not available: For patients Provide a surgical mask to the pt and place the pt in an exam room with a closed door Instruct pt to keep facemask on while in the exam room, if possible, and to change the mask if it becomes wet

19 Airborne Precautions PPE use for HCW: Wear a fit-tested N-95 or higher level disposable respirator,when caring for pt; the respirator should be donned prior to room entry and removed after exiting room If substantial spraying of respiratory fluids is anticipated, gloves and gown as well as goggles or face shield should be worn Perform hand hygiene

20 Airborne Precautions Once the patient leaves, the exam room should remain vacant for generally 1 hour before anyone enters; however, adequate wait time may vary depending on the ventilation rate of the room If staff must enter the room during the wait time, they are required to use respiratory protection

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24 AIIR Single-occupancy patient-care room used to isolate persons with a suspected or confirmed airborne infectious disease Negative pressure in the room air flow rate of 6-12 ACH Direct exhaust of air from the room to the outside or recirculation of air through a HEPA filter before returning to circulation

25 Fit check

26 Transmission - based Precautions for Hospitalized Patients Category of single room masks gown Gloves Precautions Air borne Yes, with negative Yes No No air pressure ( Particulate mask) ventilation Droplet Yes* Yes No No (surgical mask) Contact Yes* No Yes Yes * prefered but not required, cohorting patients with the same disease are acceptable

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