Contact Precautions. On this page: l3~ckgrounq Re.comm~ndations. Attachment C. Background. ons in Hospitals I C... Page 1 of 4

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1 Contact Precautions excerpt Attachment C ons in Hospitals I C... Page 1 of 4 Contact Precautions Excerpt from the f'~gulcjelio~jq(isolation Pre.~autions:Pr~venting Tr.ansmission of ldfecjious..a~!jts-.-i.nhealthcare Settings.2.Q07. PDF (1.33MB I 219 pages) On this page: l3~ckgrounq Re.comm~ndations Background rr..~~._ III.B. Transmission-Based Precautions There are three categories of Transmission-Based Precautions: Contact Precautions, Droplet Precautions, and Airborne Precautions.,. Transmission-Based Precautions are used when the route(s) ~. of transmission is (are) not completely interrupted using It< Standard Precautions alone. For some diseases that have multiple routes of transmission (e.g., SARS), more than one Transmission-Based Precautions category may be used. When used either singly or in combination, they are always used in addition to Standard Precautions. See Appendix A of the!::ttcpacj.gpc i~q'atiqnj~yjdelin?for recommended!. f'",.,. precautions for specific infections. When Transmission-Based Precautions are indicated, efforts must be made to counteract possible adverse effects on patients (i.e., anxiety, depression and other mood disturbances, perceptions of stigma, reduced contact with clinical staff, and increases in preventable adverse events) in order to improve acceptance by the patients and adherence by healthcare personnel (Heps). III.B.1. Contact Precautions Contact Precautions are intended to-prevent transmission of infectious agents, including epidemioiogically important microorganisms, which are spread by direct or indirect contact with the patient or the patient's environment as described in LB.3.a. The application of Contact Precautions for patients infected or colonized with MOROs is described in thet~ ~Q!t~HJCi?_ACICO~M.oRQ_g.uig~Un~ (PDF 234KB/74 pages). Contact Precautions also apply where the presence of excessive wound drainage, fecal incontinence, or other discharges from the body suggest an increased potential for extensive environmental contamination and risk of transmission. A single patient room is preferred for patients who require Contact Precautions. When a singlepatient room is not available, consultation with infection control personnel is recommended to assess the various risks associated with other patient placement dhqp/ gtisolation _ contact.html 8113/2009

2 ._-_.. ~- Contact Precautions excerpt from the Guideline for Isolation Precautions in Hospitals I c... Page 2 of 4 options (e.g., cohorting, keeping the patient with an existing roommate). In multipatient rooms, >3 feet spatial separation between beds is advised to reduce the opportunities for inadvertent sharing of items between the infected/colonized patient and other patients. Healthcare personnel caring for patients on Contact Precautions should wear a gown and gloves for all interactions that may involve contact with the patient or potentially contaminated areas in the patient's environment. Donning PPE before room entry and discarding before exiting the patient room is done to contain pathogens, especially those that have been implicated in transmission through environmental contamination (e.g., VRE, C. difficile, noroviruses and other intestinal tract pathogens; RSV). Recommendations V. Transmission-Based Precautions V.A. General principles V.A.1. In addition to Standard Precautions, use Transmission-Based Precautions for patients with documented or suspected infection or colonization with highly transmissible or epidemiologically-important pathogens for which additional precautions are needed to prevent transmission (See Appendix A of the ttlcpaclcqclsolation ~uigj~jine). V.B. Contact Precautions V.B.1. Use Contact Precautions as recommended in Appendix A of the liicf'aclcqc_'solatio!1_gyid~_lirl~ for patients with known or suspected infections or evidence of syndromes that represent an increased risk for contact transmission. For specific recommendations for use of Contact Precautions for colonization or infection with MOROs, go to the MDRO guidejin~ (PDF 234KB/74 pages) V.B.2. Patient placement V.B.2.a. In acute care hospitals, place patients who require Contact Precautions in a single-patient room when available When singlepatient rooms are in short supply, apply the following principles for making decisions on patient placement: Prioritize patients with conditions that may facilitate transmission (e.g., uncontained drainage, stool incontinence) for single-patient room placement. Place together in the same room (cohort) patients who are infected or colonized with the same pathogen and are suitable roommates. If it becomes necessary to place a patient who requires Contact Precautions in a room with a patient who is not infected or colonized with the same infectious agent: o Avoid placing patients on Contact Precautions in the same room with patients who have conditions that may increase the risk of adverse outcome from infection or that may facilitate transmission (e.g., those who are immunocompromised, have open wounds, or have anticipated prolonged lengths of stay). o Ensure that patients are physically separated (i.e., >3 feet apart) from each other. Draw the privacy curtain dhqpl gt isolation_contact.html 8113/2009

3 - ---_..._..- Contact Precautions excerpt from the Guideline for Isolation Precautions in Hospitals I C... Page 3 of 4 between beds to minimize opportunities for direct contact.) o Change protective attire and perform hand hygiene between contact with patients in the same room, regardless of whether one or both patients are on Contact Precautions. V.B.2.b. In long-term care and other residential settings, make decisions regarding patient placement on a case-by-case basis, balancing infection risks to other patients in the room, the presence of risk factors that increase the likelihood of transmission, and the potential adverse psychological impact on the infected or colonized patient. V.B.2.c. In ambulatory settings, place patients who require Contact Precautions in an examination room or cubicle as soon as possible. V.B.3. Use of personal protective equipment V.B.3.a. Gloves Wear gloves whenever touching the patient's intact skin or surfaces and articles in close proximity to the patient (e.g., medical equipment, bed rails). Don gloves upon entry into the room or cubicle. V.B.3.b. Gowns V.B.3.b.i. Don gown upon entry into the room or cubicle. Remove gown and observe hand hygiene before leaving the patient-care environment. V.B.3.bji. After gown removal, ensure that clothing and skin do not contact potentially contaminated environmental surfaces that could result in possible transfer of microorganism to other patients or environmental surfaces. V.B.4. Patient transport V.B.4.a. In acute care hospitals and long-term care and other residential settings, limit transport and movement of patients outside of the room to medically-necessary purposes. V.B.4.b. When transport or movement in any healthcare setting is necessary, ensure that infected or colonized areas of the patient's body are contained and covered. V.B.4.c. Remove and dispose of contaminated PPE and perform hand hygiene prior to transporting patients on Contact Precautions. V.B.4.d. Don clean PPE to handle the patient at the transport destination. Category /I V.B.S. Patient-care equipment and instruments/devices V.B.S.a. Handle patient-care equipment and instruments/devices according to Standard Precautions. V.B.S.b. In acute care hospitals and long-term care and other residential settings, use disposable noncritical patient-care equipment (e.g., blood pressure cuffs) or implement patientdedicated use of such equipment. If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient. V.B.5.c. In home care settings V.B.S.c.i. Limit the amount of non-disposable patient-care equipment brought into the home of patients on Contact Precautions. Whenever possible, leave patient-care equipment gl_isolation _ contact.html 8/13/2009

4 Contact Precautions excerpt from the Guideline for Isolation Precautions in Hospitals' c... Page 4 of 4 in the home until discharge from home care services. V.8.5.c.ii. If noncritical patient-care equipment (e.g., stethoscope) cannot remain in the home, clean and disinfect items before taking them from the home using a low- to intermediate-level disinfectant. Alternatively, place contaminated reusable items in a plastic bag for transport and subsequent cleaning and disinfection. V.8.5.d. In ambulatory settings, place contaminated reusable noncritical patient-care equipment in a plastic bag for transport to a soiled utility area for reprocessing. V.B.G. Environmental measures Ensure that rooms of patients on Contact Precautions are prioritized for frequent cleaning and disinfection (e.g., at least daily) with a focus on frequently-touched surfaces (e.q., bed rails, overbed table, bedside commode, lavatory surfaces in patient bathrooms, doorknobs) and equipment in the immediate vicinity of the patient. V.B.7. Discontinue Contact Precautions after signs and symptoms of the infection have resolved or according to pathogen-specific recommendations in Appendix A of thehicpaclcdc I$Qlati~D Guideline Please note: Some of these publications are available for download only as *.pdf files. These files require Adobe Acrobat Reader in order to be viewed. Please review the l!1iojjrcljio(h>np.jlw.oj9.jldingjind usil19 AcrobatRead~r softwa(~-, Date last modified: October 12, 2007 Content source: Divjsion Ql.H~talthcaleQYalih'-PrpJJlotiPnJ.DHQP} National Center for Preparedness, Detection, and Control of Infectious Diseases...- DEPARTMENT OF HEA1..TH AND HUMAN SE.RVICES CENTERS FOR DiSEASE CONTROL ANn F'REVENTfON SAFER' HEALTHIER PEoPLE gov /ncidod/ dhqp/ gljsolation _contact.html 8/13/2009

5 Airborne Precautions exc rutions in Hospitals I C... Page 1 of 4 Airborne Precautions Excerpt from the:: ~uic:lelille Lor.Isolation.pLe~a utions :J?reveoting TransmJ sjqrlqj Infe~ti9U$ Agents!1l_He_~ltbcaJe_Settings 2PQ7. PDF (1.33MB I 219 pages) On this page: 6aclmrQ.\.HJ.Q BecQmnwn~<;itiQns. Background III.B. Transmission-Based Precautions There are three categories of Transmission-Based Precautions: Contact Precautions, Droplet Precautions, and Airborne Precautions. Transmission-Based Precautions are used when the route(s) of transmission is (are) not completely interrupted using Standard Precautions alone. For some diseases that have multiple routes of transmission (e.g., SARS), more than one Transmission-Based Precautions category may be used. When used either singly or in combination, they are always used in addition to Standard Precautions. See Appendix A of the HICPAC/CQC lsolatlon Guideline for recommended precautions for specific infections. When Transmission-Based Precautions are indicated, efforts must be made to counteract possible adverse effects on patients (e.g., anxiety, depression and other mood disturbances, perceptions of stigma, reduced contact with clinical staff, and increases in preventable adverse events) in order to improve acceptance by the patients and adherence by healthcare personnel (Heps). III.B.3rAirborne Precautions Airborne Precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air (e.g., rubeola virus [measles], varicella virus [chickenpox], Mycobacterium. tuberculosis, and possibly SARS-CoV) as described in I.B.3.c and Appendix A of the HJ~PAClCDC lsplaliqil Guidelin~. The preferred placement for patients who require Airborne Precautions is in an airborne infection isolation room (AIIR). An AIIR is a single-patient room that is equipped with special air handling and ventilation capacity that meet the American Institute of Architects/Facility Guidelines Institute (AIAlFGI) standards for AIiRs (Le., monitored negative pressure relative to the surrounding area, 12 air exchanges per hour for new construction and renovation and 6 air exchanges per hour for existing facilities, air exhausted directly to the outside or recirculated through HEPA filtration before return). Some states require the availability of such rooms in hospitals, emergency departments, and nursing homes that care for patients with M. tuberculosis. A respiratory protection program that

6 _.. _._---..._- _.- -- Airborne Precautions excerpt from the Guideline for Isolation Precautions in Hospitals I C... Page 2 of 4 includes education about use of respirators, fit-testing, and user seal checks is required in any facility with AIIRs. In settings where Airborne Precautions cannot be implemented due to limited engineering resources (e.g., physician offices), masking the patient, placing the patient in a private room (e.g., office examination room) with the door closed, and providing N95 or higher level respirators or masks if respirators are not available for healthcare personnel will reduce the likelihood of airborne transmission until the patient is either transferred to a facility with an AIIR or returned to the home environment, as deemed medically appropriate. Healthcare personnel caring for patients on Airborne Precautions wear a mask or respirator, depending on the disease-specific recommendations (Respiratory Protection II.EA, and Appendix A of the tiigp~_clcqcjsqjaj19n GJ.Jideline), that is donned prior to room entry. Whenever possible, non-immune HeWs should not care for patients with vaccinepreventable airborne diseases (e.g., measles, chickenpox, and smallpox). Recommendations V. Transmission-Based Precautions V.A. General principles V.A.1. In addition to Standard Precautions, use Transmission-Based Precautions for patients with documented or suspected infection or colonization with highly transmissible or epidemiologically-important pathogens for which additional precautions are needed to prevent transmission (see Appendix A of the I:ilCe.AC/C.D<:;.I~ol~tjgll Guld(~Jjfle). V.D. Airborne Precautions V.D.1. Use Airborne Precautions as recommended in Appendix A of the HIGPACLCIlC_ls_Q!afion..Gujde!.ine for patients known or suspected to be infected with infectious agents transmitted person-to-person by the airborne route (e.g., M tuberculosis, measles, chickenpox, disseminated herpes zoster. V.D.2. Patient placement V.D.2.a. In acute care hospitals and long-term care settings, place patients who require Airborne Precautions in an AIIR that has been constructed in accordance with current guidelines. V.D.2.a.i. Provide at least six (existing facility) or (new construction/renovation) air changes per hour. V.D.2.a.ii. Direct exhaust of air to the outside. If it is not possible to exhaust air from an AIIR directly to the outside, the air may be returned to the air-handling system or adjacent spaces if all air is directed through HEPA filters. V.D.2.a.iii. Whenever an AIIR is in use for a patient on Airborne Precautions, monitor air pressure daily with visual indicators (e.g., smoke tubes, flutter strips), regardless of the presence of differential pressure sensing devices (e.g., manometers). V.D.2.a,iv. Keep the AIIR door closed when not required for entry and exit. V.D.2.b. When an AIIR is not available, transfer the patient to a facility that has an available AIIR. V.D.2.c. In the event of an outbreak or exposure involving large numbers of patients who require Airborne Precautions: 8/13/2009

7 Airborne Precautions excerpt from the Guideline for Isolation Precautions in Hospitals, C... Page 3 of 4 Consult infection control professionals before patient placement to determine the safety of alternative room that do not meet engineering requirements for an AIIR. Place together (cohort) patients who are presumed to have the same infection( based on clinical presentation and diagnosis when known) in areas of the facility that are away from other patients, especially patients who are at increased risk for infection (e.g., immunocompromised patients). Use temporary portable solutions (e.g., exhaust fan) to create a negative pressure environment in the converted area of the facility. Discharge air directly to the outside, away from people and air intakes, or direct all the air through HEPA filters before it is introduced to other air spaces V.D.2.d. In ambulatory settings: V.D.2.d.i. Develop systems (e.g., triage, signage) to identify patients with known or suspected infections that require Airborne Precautions upon entry into ambulatory settings. V.D.2.d.ii. Place the patient in an AIIR as soon as possible. If an AIIR is not available, place a surgical mask on the patient and place him/her in an examination room. Once the patient leaves, the room should remain vacant for the appropriate time, generally one hour, to allow for a full exchange of air. V.D.2.d.iii. Instruct patients with a known or suspected airborne infection to wear a surgical mask and observe Respiratory Hygiene/Cough Etiquette. Once in an AIIR, the mask may be removed; the mask should remain on if the patient is not in an AIIR. V.D.3. Personnel restrictions Restrict susceptible healthcare personnel from entering the rooms of patients known or suspected to have measles (rubeola), varicella (chickenpox), disseminated zoster, or smallpox if other immune healthcare personnel are available. V.D.4. Use of PPE V.D.4.a. Wear a fit-tested NIOSH-approved N95 or higher level respirator for respiratory protection when entering the room or home of a patient when the following diseases are suspected or confirmed: Infectious pulmonary or laryngeal tuberculosis or when infectious tuberculosis skin lesions are present and procedures that would aerosolize viable organisms (e.g., irrigation, incision and drainage, whirlpool treatments) are performed. Smallpox (vaccinated and unvaccinated). Respiratory protection is recommended for all healthcare personnel, including those with a documented "take" after smallpox vaccination due to the risk of a genetically engineered virus against which the vaccine may not provide protection, or of exposure to a very large viral load (e.g., from high-risk aerosolgenerating procedures, immunocompromised patients, hemorrhagic or flat smallpox. V.D.4.b. No recommendation is made regarding the use of PPE by healthcare personnel who are presumed to be immune to measles 8/13/2009

8 Airborne Precautions excerpt from the Guideline for Isolation Precautions in Hospitals' c... Page 4 of 4 (rubeola) or varicella-zoster based on history of disease, vaccine, or serologic testing when caring for an individual with known or suspected measles, chickenpox or disseminated zoster, due to difficulties in establishing definite immunity. V.D.4.c. No recommendation is made regarding the type of personal protective equipment (i.e., surgical mask or respiratory protection with a N95 or higher respirator) to be worn by susceptible health care personnel who must have contact with patients with known or suspected measles, chickenpox or disseminated herpes zoster. ~:,.Please note: Some of these publications are available for download only as *.pdf files. These files require Adobe Acrobat Reader in order to be viewed. Please review the ilj.tqsm~jiq!1qildownl~~1iing ~rtdj,.i~ing_agr~tbat Be_ad~Lsoftware. Date last modified: October 12,2007 Content source: Qjvi~j90_9f tlq~it.flcar~ QuaUty.-Pr()mQtiof1JQHQe) National Center for Preparedness, Detection, and Control of Infectious Diseases HQmel?olicies and Re--f)l.IlatiQI1$ Disclaimer e-_goy~rnment FOIA ContClci Us Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA 800-COC-INFO ( ) TTY: (888) ,24 Hours/Every Day - ~dcintq@cd.c-,g_cl'l(tty) dhqp/si.isolation_airborne.html 8113/2009