Infection Prevention Isolation Precautions Toolkit

Transcription

1 Infection Prevention Isolation Precautions Toolkit The toolkit provides: Link(s) to revised Isolation Policy on The Point Link to ICON training video and key changes to policy (NEW) Quick Review Chart for education of staff (NEW) Available upon request from PHE ext FAQs on Multi-drug resistant organisms Q&A on Isolation Precautions

2 HOW TO FIND THE POLICY - Go the The Point and select Policies. 1. From the below screen select UI Hospitals and Clinics Policies and Procedures. 2. From the Policy Libraries select Infection Prevention and Control. 3. Select the Infection Control Manual. 4. Next select folder 03 Isolation Precautions and Precautions Needed for Resistant Organisms 5. Select Isolation Precautions IC and Isolation Precautions Requirements Table IC-03.00C. 2

3 Link to Isolation Training Video (NEW): Standard and Isolation Precautions - YouTube Key Changes to Isolation Policy: 3

4 Examples: C.Diff, MRSA, VRE Examples: Influenza, Respiratory Infections Examples: TB, Chicken Pox, Measles *Gown and gloves for any with patient and environment, or cleaning *Remove PPE before leaving room *Surgical mask for those within 3*6 feet *Remove PPE before leaving room *N95 or PAPR respirator for all entering room *Remove N95 or PAPR after leaving room * Staff notifies receiving dept. of isolation status *Patient wears clean hospital gown or robe and washes hands * If using cart/chair or Peds pt Use a clean sheet or blanket to cover patient *Staff does not use PPE outside of room *Staff notifies receiving dept. of isolation status *Patient wears surgical mask *Staff does not use PPE outside of room *Staff notifies receiving dept. of isolation status *Patient wears surgical mask *Staff does not use PPE outside of room *Clean room with bleach wipes *Private room *Routine cleaning *Private room *Routine cleaning *Private, negative air pressure room 4

5 FACTS on Multi-Drug Resistant Organisms (MDRO) and Additional Triggers used during an Outbreak MDROs are defined as microorganisms, predominantly bacteria, that are resistant to one or more classes of antimicrobial agents. Although the names of certain MDROs describe resistance to only one agent (e.g., MRSA, VRE), these pathogens are frequently resistant to most available antimicrobial agents. In addition to MRSA and VRE, certain GNB, including those producing extended spectrum beta*lactamases (ESBLs) and others that are resistant to multiple classes of antimicrobial agents, are of particular concern. In addition to Escherichia coli and Klebsiella pneumoniae, these include strains of Acinetobacter baumannii resistant to all antimicrobial agents, or all except imipenem. MDRO infections have clinical manifestations that are similar to infections caused by susceptible pathogens. However, options for treating patients with these infections are often extremely limited. Despite some evidence that MDRO burden is greatest in adult hospital patients, MDRO require similar control efforts in pediatric populations as well. vulnerable to colonization and infection include those with severe disease, especially those with compromised host defenses from underlying medical conditions; recent surgery; or indwelling medical devices (e.g., urinary catheters or endotracheal tubes. There is epidemiologic evidence to suggest that MDROs are carried from one person to another via the hands. Hands are easily contaminated during the process of care-giving or from with environmental surfaces in close proximity to the patient. The latter is especially important when patients have diarrhea and the reservoir of the MDRO is the gastrointestinal tract. Enhanced environmental measures for increased transmission and/or outbreaks (These are used after consultation with Infection Preventionists) o Intensify and reinforce training of environmental staff who work in areas targeted for intensified MDRO control and monitor adherence to environmental cleaning policies. o Monitor (i.e., supervise and inspect) cleaning performance to ensure consistent cleaning and disinfection of surfaces in close proximity to the patient and those likely to be touched by the patient and HCP (e.g., bedrails, carts, bedside commodes, doorknobs, faucet handles). o Obtain environmental cultures (e.g., surfaces, shared medical equipment) when there is epidemiologic evidence that an environmental source is associated with ongoing transmission of the targeted MDRO. 5

6 Q&A Isolation Precautions and MDROs Does colonization and infection with germs such as MRSA and VRE, mean the same thing? Colonization means that the germ is in or on a host with growth and multiplication, but without attacking the body or causing harm. In the case of MRSA, the body site most often colonized is the nose, while VRE colonization is mostly in the stool. MRSA or VRE colonization can serve as a reservoir for the spread of these germs to others, and can lead to infection in the host. Infection is when a person has a germ attack their body, and it causes them to be ill. Infection is often identified by a fever or rise in white blood cells. How should patients with MRSA be handled in the emergency department? Should they be isolated? Is isolation with a curtain enough? Can these patients use a shared bathroom? MRSA is being seen at an increasing rate in emergency departments (EDs). It is most often the cause of purulent skin and soft*tissue infections among patients presenting to EDs. Contact precautions for MRSA patients were designed for private room settings, a need that cannot always be met in the ED. When the ED is not able to put a patient in their own room, the principles of precautions can still be used in places split only by curtains. Note that the main route of transmission of MRSA between patients is on the contaminated hands of healthcare workers. While most EDs may not be able to give MRSA patients their own bathrooms, it makes the most sense to focus on the things that you can do to avoid transmission of MRSA, such as hand hygiene, wearing gloves and gowns for, and proper disinfection of the room after the patient leaves. should be taught how to stop further transmission of their germ, e.g., keeping wounds or lesions covered with clean, dry bandages; practicing good hand hygiene; and avoiding the sharing of contaminated items. What is the best way to transport a patient in Isolation Precautions (i.e. Contact)? If a single caregiver is transporting the patient, gown and gloves are worn until the patient is on the stretcher or wheelchair, and then gloves and gowns are removed and hands are washed. The caregiver then transports the patient without having any direct patient. A clean gown must be used for the patient or a clean cover sheet if transported by bed. For Pediatric patients, use a clean blanket to swaddle the child or a clean sheet if transported by crib. If the patient might need some hands*on support during the transport, the safest tactic is to have 2 people transport the patient. One wears gown and gloves and is in charge of touching the patient, if needed, during the transport. The other person, without gloves, handles the doors and elevator buttons. A mask is needed only if the patient is on droplet precautions as recommended by the CDC. Contact Isolation patients may leave their rooms. They have access to the hallway vending machines, cafeteria, etc. Doesn't this cause the germs to get into the environment, especially if patients don't follow the precautions? The HICPAC 2006 guideline, Management of Multidrug Resistant Organisms in Healthcare Settings, says that, if MRSA colonized or infected patients do not have draining wounds, diarrhea, or uncontrolled secretions, healthcare organizations should set up areas for permitted movement within the unit, socialization and use of shared areas based on their risk to other patients whether the colonized or infected patients can use proper hand hygiene and other recommended precautions to contain secretions and excretions. Noncompliant patients should be confined to their rooms. Can Pediatric patients in Contact or Droplet precautions use the playroom and/or the Child Life room? Pediatric patients should be given toys and games that are cleanable in their room and not use the shared playroom or Child Life room. 6

7 What is the best way to manage a patient with MDRO on a behavioral health unit? The best way to stop the transmission of MDRO on the behavioral health unit or any unit is: Teach patients and staff members to practice good hand hygiene Do not let patients share personal items, such as towels, soap, or razors. Give family and visitors education on the MDRO being treated. Patient Fact Sheets on The Point If a patient has an actively draining wound infected or colonized with an MDRO, wounds should be covered with clean, dry dressings. Gloves and gowns are worn by caregivers if they need to touch the wound as part of Standard Precautions. Talk with an Infection Preventionist for patient instruction as needed ext What is the best way to teach family and visitors on use of the kitchen/food areas? and their families should ask staff for items from the unit kitchen. *If family does use the kitchen, the units should have plastic silverware they can use in the patient s room and then throw away when done. The family should be taught hand hygiene. The kitchen should have signage to point out the need to use proper hand hygiene before getting silverware, dishes etc. There should also be signage on the refrigerator indicating the need for hand hygiene when placing or retrieving items by families. Note: For patients in or droplet precautions, food that has been in the patient s room cannot be returned to the shared kitchen refrigerator. Should Nursing strip down an empty bed in a double room when the other bed was in isolation? Yes, the cubicle curtain most likely will not stop the patient s germs. The best thing would be to remove the extra bed from the room as soon as the isolation order is placed. Wipe down the bed rails and head/foot board with disinfectant wipe when taking the bed out of the room. The bedding will not need to be redone. Why has the use of Reverse Isolation been stopped on the Pediatric Units? Reverse Isolation is not an evidence-based practice. What are the recommendations for a new mom who is colonized with MRSA and visits to the NICU? Pending What should I do if the patient needs isolation precautions and the physician will not place a Contact Precaution order? The nurse can put the patient in isolation precautions per protocol. In some social medicine countries the use of precautions are not used due to financial reasons. The Infection Preventionist can help the staff as needed. Staff should always use Standard Precautions which empowers them to choose personal protective equipment as needed for their protection. I am confused by the need to isolate a patient who was found with MRSA in a wound years ago. The wound is healed and gone and there are no signs of active infection. Do we really need to isolate these patients? People who become colonized with MRSA tend to stay colonized for months or even years. People colonized with MRSA can serve as reservoirs for MRSA and pass it to others, just like those infected with MRSA. UIHC assumes that patients who were once colonized with MRSA are likely to still be colonized with MRSA. Their medical records are flagged so that precautions can be resumed right away if these patients return. 7

8 Policy IC* A Selected information: Duration of Precautions with MRSA must be placed in precautions. Contact precautions may be discontinued for one month after the following criteria are met: No clinical signs of MRSA infection at least two cultures have been obtained from the nares and any other colonized or infected site (taken 24 hrs apart) and are negative for MRSA. For patients who have been treated with intra*nasal mupirocin, cultures of the nares and previous infection sites must be taken at least 24 hours after treatment. VRE must be precautions. Contact precautions may be discontinued for one month after the following criteria are met: No clinical signs of VRE infection at least three cultures have been obtained from the rectum and any other colonized or infected site (taken one week apart) and are negative for VRE. VISA must be precautions and will remain on precautions until discharged. These precautions will be instituted each time the patient is readmitted. Criteria for discontinuing isolation have not been developed. VRSA must be precautions and will remain on precautions until discharged. These precautions will be instituted each time the patient is readmitted. Criteria for discontinuing isolation have not been developed. PRSP must be precautions and will remain on precautions until discharged unless precautions are discontinued with the approval of PHE. ESBLs must be precautions and will remain on precautions until discharged unless precautions are discontinued with the approval of PHE. 8