Isolation Categories of Transmission-Based Precautions

Transcription

1 Isolation Categories of Transmission-Based Highlights Policy Statement Standard shall be used when caring for residents at all times regardless of their suspected or confirmed infection status. Transmission-Based shall be used when caring for residents who are documented or suspected to have communicable diseases or infections that can be transmitted to others. The facility shall make every effort to use the least restrictive approach to managing individuals with potentially communicable infections. Transmission-Based shall only be used when transmission cannot be reasonably prevented by less restrictive measures. Transmission-Based Isolation Types of Transmission- Based Isolation Airborne Policy Interpretation and Implementation 1. Transmission-Based will be used whenever measures more stringent than Standard are needed to prevent or control the spread of infection. 2. Based on CDC definitions, three types of Transmission-Based (airborne, droplet and contact) have been established. Airborne In addition to Standard, implement Airborne for anyone who is documented or suspected to be infected with microorganisms transmitted by airborne droplet nuclei (small-particle residue [5 microns or smaller in size] of evaporated droplets containing microorganisms that remain suspended in the air and can be widely dispersed by air currents within a room or over a long distance). Requiring Airborne Airborne a. Examples of infections requiring Airborne include, but are not (1) Measles (2) Varicella (including disseminated zoster) (3) Tuberculosis (1) If necessary and if such a room is available, place the resident in a private room that meets the following criteria: (a) (b) (c) Monitored negative air pressure in relation to the surrounding areas; Six (6) to twelve (12) air changes per hour; Appropriate discharge of air outdoors or monitored high efficiency filtration of room air before the air is circulated to other areas of the facility. (2) Keep the room door closed and the resident in the room. (3) If there is not a room in the facility that meets these criteria, then cohort the individual with someone else who is infected with the same microorganism. (4) If neither is possible and isolation is necessary, place the individual in a private room (a room with no one else in it). (5) If isolation in a negative pressure room is essential to prevent transmission of the illness (for example, with active TB), transfer the individual to a setting that can provide the appropriate kind of isolation room.

2 Respiratory Protection During Airborne Resident Transport During Airborne Resident-Care Equipment During Airborne Signs to Use to Alert Staff of Airborne c. Respiratory Protection (1) All individuals must wear approved respiratory protection when entering the room. (2) Anyone who is susceptible (i.e., not immune) to measles (rubeola) or varicella (chickenpox) may not enter the room of someone who has, or is suspected of having, these infections. d. Resident Transport (1) The resident should only leave an isolation room when absolutely essential. (2) Someone who is on Airborne, should wear a mask when leaving the room or coming into contact with others. Depending on the organism, a special filtration mask may be necessary. (3) If the resident is transported to another unit within the facility or to another e. Resident-Care Equipment (4) When possible, dedicate the use of non-critical resident-care equipment (5) If use of common items is unavoidable, then adequately clean and f. Signs - Color coded signs will be used to alert staff of the implementation of airborne precautions, while respecting the resident s privacy. Blue is the color code for Airborne. (1) Place a blue sign at the doorway instructing visitors to report to the nurses station before entering the room. (2) Place a blue sticker indicating Airborne on the head of the Contact Contact In addition to Standard, implement Contact for residents known or suspected to be infected or colonized with microorganisms that can be transmitted by direct contact with the resident or indirect contact with environmental surfaces or resident-care items in the resident s environment. Requiring Contact a. Examples of infections requiring Contact include, but are not (1) Gastrointestinal, respiratory, skin, or wound infections or colonization with multi-drug resistant organisms (e.g., MRSA, VISA, VRSA, VRE); (2) Diarrhea associated with Clostridium difficile; (3) Enterohemorrhagic Escherichia coli 0157:H7; (4) Shigella; (5) Hepatitis A;

3 (6) Diarrhea associated with Rotavirus; (7) Abscesses, cellulitis, or decubiti with noncontained drainage; (8) Pediculosis; (9) Scabies; (10) Cutaneous Zoster; (11) Viral/Hemorrhagic Conjunctivitis; and (12) Viral Hemorrhagic Infections (Ebola, Lassa, Marburg). Contact (1) Place the individual in a private room if it is not feasible to contain drainage, excretions, blood or body fluids (e.g., the individual is incontinent on the floor, or wanders and touches others). (2) If a private room is not available, the Infection Control Coordinator will assess various risks associated with other resident placement options (e.g., cohorting). Gloves and Handwashing During Contact Gowns During Contact Resident Transport During Contact c. Gloves and Handwashing (1) In addition to wearing gloves as outlined under Standard, wear gloves (clean, non-sterile) when entering the room. (2) While caring for a resident, change gloves after having contact with infective material (for example, fecal material and wound drainage). (3) Remove gloves before leaving the room and wash hands immediately with an antimicrobial agent or a waterless antiseptic agent. (4) After removing gloves and washing hands, do not touch potentially contaminated environmental surfaces or items in the resident s room. d. Gown (1) In addition to wearing a gown as outlined under Standard, wear a gown (clean, nonsterile) for all interactions that may involve contact with the resident or potentially contaminated items in the resident s environment. Remove the gown and perform hand hygiene before leaving the resident s environment. (2) After removing the gown, do not allow clothing to contact potentially contaminated environmental surfaces. e. Resident Transport (1) For individuals with skin lesions, excretions, secretions, or drainage that is difficult to contain, maintain precautions to minimize the risk of transmission to other residents and contamination of environmental surfaces or equipment. (2) If the resident is transported to another unit within the facility or to another

4 Resident-Care Equipment During Contact Signs Used to Alert Staff of Contact f. Resident-Care Equipment (1) When possible, dedicate the use of non-critical resident-care equipment (2) If use of common items is unavoidable, then adequately clean and g. Signs - Use color coded signs and/or other measures to alert staff of the implementation of Transmission-Based, while respecting the privacy of the resident. Orange is the color code for Contact. (1) Place an orange sign at the doorway instructing visitors to report to the nurses station before entering the room. (2) Place an orange sticker indicating Contact on the head of the Droplet Droplet In addition to Standard, implement Droplet for an individual documented or suspected to be infected with microorganisms transmitted by droplets (large-particle droplets [larger than 5 microns in size] that can be generated by the individual coughing, sneezing, talking, or by the performance of procedures such as suctioning). Requiring Droplet Droplet Masks During Droplet a. Examples of infections requiring Droplet include, but are not (1) Invasive Haemophilus influenzae type B disease including meningitis, pneumonia, epiglottitis and sepsis; (2) Invasive Neisseria meningitidis disease, including meningitis, pneumonia, and sepsis; (3) Mycoplasma pneumonia; (4) B. Pertussis; (5) Influenza; (6) Mumps; (7) Rubella. (1) Place the resident in a private room. (2) When a private room is not available, residents with the same infection with the same microorganism but with no other infection may be cohorted. (3) When a private room is not available and cohorting is not achievable, use a curtain and maintain at least 3 feet of space between the infected resident and other residents and visitors. (4) Special air handling and ventilation are unnecessary and the door to the room may remain open. c. Masks (1) In addition to Standard, wear a mask when working within 3 feet of the resident.

5 Resident Transport During Droplet Resident-Care Equipment During Droplet Signs Used to Alert Staff of Droplet d. Resident Transport (1) Limit movement of resident from the room to essential purposes only. (2) If transport or movement from the room is necessary, place a mask on the infected individual and encourage the resident to follow respiratory hygiene/cough etiquette to minimize dispersal of droplets. (3) If the resident is transported to another unit within the facility or to another e. Resident-Care Equipment (1) When possible, dedicate the use of non-critical resident-care equipment (2) If use of common items is unavoidable, then adequately clean and f. Signs Use color coded signs and/or other measures to alert staff of the implementation of Isolation or Droplet, while protecting the privacy of the resident. Yellow is the color code for Droplet. (1) Place a yellow sign at the doorway instructing visitors to report to the nurses station before entering the room. (2) Place a yellow sticker indicating Droplet on the head of the OBRA Regulatory Reference Numbers Survey Tag Numbers Related Documents Policy Revised References (b); CDC Guideline for Isolation (See Centers for Disease Control and Prevention s websites at: F442 Isolation Initiating Transmission-Based Isolation Notices of Transmission-Based Date: