IC CONTACT and CONTACT PLUS PRECAUTIONS REV. JULY 2017

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1 IC CONTACT and CONTACT PLUS PRECAUTIONS REV. JULY 2017 Standard In addition to Routine Practices, Contact Precautions or Contact Plus Precautions will be used for patients known or suspected to have a microorganism that is spread by direct contact with the patient or by indirect contact with environmental surfaces or patient care equipment. A physician's order is not required to initiate Contact or Contact Plus Precautions. Contact or Contact Plus Precautions will be discontinued only in consultation with the Infection Prevention and Control Service (IPACS). Examples of conditions and microorganism that are spread by the contact route include: Scabies, Pediculosis (lice), Antibiotic Resistant Organisms such as Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin resistant enterococcus (VRE); and Rotavirus. Example of microorganism that requires Contact Plus precautions: Clostridium difficile. Note: Some microorganisms may also be transmitted by more that one route and will require Droplet & Contact Precautions or Airborne & Contact Precautions. Refer to the table in Section 5 for Infection Control Precautions on specific infectious diseases, conditions and/or microorganisms for children, adult and maternal-infant population. Description of Contact Transmission Contact transmission is the most common route of transmission of infectious agents. There are two types of contact transmission: Direct contact is the transfer of microorganisms via direct physical contact between an infected or colonized individual and a susceptible host (body surface to body surface). Transmission may result in infection. Indirect contact is a passive transfer of microorganisms to a susceptible host via an intermediate object, such as contaminated hands that are not cleaned between episodes of patient care, contaminated instruments that are not cleaned between patients/uses or other contaminated objects in the patient s immediate environment. INTERVENTIONS FOR CONTACT PRECAUTIONS Routine Practices are used by all Health care workers (HCW) for all patients. The following additional precautions will be used for all patients on Contact Precautions Accommodation or Patient Placement Acute Care o Single room with patient sink and toilet, bathing facilities, and dedicated staff hand washing sink is preferred. o If a private bathroom is not available, then a commode must be dedicated to the patient during the entire stay. o Negative pressure is not required. o Door may remain open. o Pass-through cupboards will remain unlocked when Contact or Contact Plus Precautions are put in place. o If a single room is not possible, consult IPACS. IC Infection Prevention & Control Manual Page 1 of 5

2 o Patients should not wait in a common area/waiting room. o Patients should be placed into an examining room as soon as possible. Signage A Contact Precautions Sign must be placed at the entrance of the patient room that is visible to all those who enter the room. Personal Protective Equipment (Note: please refer to IC Personal Protective Equipment for more information) Acute Care: Gloves Always perform hand hygiene before donning gloves and after removal. Gloves must be worn on entering the patient s room or bed space. Change gloves during care to prevent cross-contamination of sites. Gowns A gown must be worn when entering room. Remove gown before leaving the room and discard in the laundry hamper or garbage if disposable. Do not re-use gown. After gown removal, ensure clothes do not contact contaminated surfaces. A gown and gloves must be worn on entry to room. Other Personal Protective equipment such as face protection may be used based on the risk assessment (e.g., nature of interaction, status of patient). Please refer to IC Routine Practices Risk Assessment. Equipment Environmental Cleaning Dishes, Glasses, Cups and Eating Utensils Patient Transport/Transfer/Discharge Avoid transfer within and between facilities if possible unless medically necessary. Receiving department must be notified of the precautions in place, prior to transport, and make a notation of precautions required when preparing requisition. It is not appropriate for the patient to wear gloves or isolation gowns while outside their room. HCW should wear gloves and gowns for direct contact with patient during transport. On discontinuation of Additional Precautions and discharge: o All disposable patient equipment and supplies must be disposed of and not returned to general stock, Supplies may be sent with patients who are transferred. IC Infection Prevention & Control Manual Page 2 of 5

3 o All re-usable equipment must be cleaned and reprocessed as per established guidelines o Contact Environmental Services for room cleaning. Visitors Visitors of patients on Additional Precautions in health care facilities should be kept to a minimum. HCW must inform patients and visitors about the reason for implementing Contact Precautions and should provide instruction on how to enter and leave the room safely, hand hygiene, respiratory etiquette, and a demonstration in putting on, taking off and disposing of PPE, if required. Household members may choose to wear PPE. Visitors, other than household members, should wear required PPE. Instruct visitors and family to visit patient only and not go to other shared patient care areas of the hospital (e.g., playroom, teen lounge, school room, patient kitchen). Documentation In progress notes, enter date and time that Contact Precautions were started and discontinued. INTERVENTIONS FOR CONTACT PLUS PRECAUTIONS For additional information, please refer to IC Clostridium Difficile (C.difficile). Routine Practices are used by all Health care workers (HCW) for all patients. The following additional precautions will be used for all patients on Contact Plus Precautions. Accommodation or Patient Placement Acute Care o Same as interventions for Contact Precautions. Please see above. o In addition: if a private bathroom is not available, then a commode must be dedicated to the patient during the entire stay. Signage A Contact Plus Precautions Sign must be placed at the entrance of the patient room that is visible to all those who enter the room. Personal Protective Equipment (Note: please refer to IC Personal Protective Equipment for more information) Acute Care: Gloves Always perform hand hygiene before donning gloves and after removal. Gloves must be worn on entering the patient s room or bed space. Change gloves during care to prevent cross-contamination of sites. Gowns A gown must be worn when entering room. Remove gown before leaving the room and discard in the laundry hamper or garbage if disposable. Do not re-use gown. After gown removal, ensure clothes do not contact contaminated surfaces. A gown and gloves must be worn on entry to room. IC Infection Prevention & Control Manual Page 3 of 5

4 Other Personal Protective equipment such as face protection may be used based on the risk assessment (e.g., nature of interaction, status of patient). Please refer to IC Routine Practices Risk Assessment. Equipment In addition, please ensure adequate cleaning and disinfection with a sporicidal agent (e.g., bleach disinfectant wipes). Environmental Cleaning Notify Environmental Services that enhanced cleaning with a sporicidal disinfectant is required. IPACS can assist during regular business hours. Enhanced cleaning of the patient s environment and disinfection with a sporicidal agent must be done when Contact Plus Precautions are discontinued or when the patient is transferred or discharged. UV-C room disinfection should be completed after transfer or discharge cleaning. For additional information, please refer IC Environmental Cleaning. IPACS will notify Environmental Services if additional cleaning is required on the unit or in other patient care areas, (e.g., kitchen, hallway, lounges, etc.). Dishes, Glasses, Cups and Eating Utensils Patient Transport/Transfer/Discharge Transport of patients on Contact Plus Precautions is usually limited unless medically necessary for diagnostic purposes or as part of rehabilitation process or in consultation with IPACS. Avoid transfer within and between facilities if possible. It is not appropriate for the patient to wear gloves or isolation gowns while outside their room. HCW should wear gloves and gowns for direct contact with patient during transport. Notify receiving department of the precautions in place, prior to transport. Make a notation of precautions required when preparing requisition. On discontinuation of Additional Precautions and discharge: o All disposable patient equipment and supplies must be disposed of and not returned to general stock, Supplies may be sent with patients who are transferred. o All re-usable equipment must be cleaned and reprocessed as per established guidelines, o Contact Environmental Services for room cleaning. Visitors Visitors of patients on Additional Precautions in health care facilities should be kept to a minimum. HCW must inform patients and visitors about the reason for implementing Contact Precautions and should provide instruction on how to enter and leave the room safely, hand hygiene, respiratory etiquette, and a demonstration in putting on, taking off and disposing of PPE, if required. Advise family and visitors to practice diligent hand hygiene before and following visits. Provide education and patient pamphlet on Clostridium difficile to patients and families as required. Household members may choose to wear PPE. Visitors, other than household members, should wear required PPE. Instruct visitors and family to visit patient only and not go to other shared patient care areas of the hospital (e.g., playroom, teen lounge, school room, patient kitchen). Documentation Enter date and time in progress notes that Contact Plus Precautions were started and discontinued. IC Infection Prevention & Control Manual Page 4 of 5

5 Resources: Contact Precaution Sign PHSA342 available through Print Shop. Contact Plus Precaution Sign PHSA345 available through Print Shop. REFERENCES Association for Professionals in Infection Control and Epidemiology (APIC). Chapter 29: Isolation Precautions. APIC Text of Infection Control and Epidemiology. October, Provincial Infectious Diseases Advisory Committee (PIDAC). Routine Practices and Additional Precautions in All HealthCare Settings. 3rd edition. Ontario Agency for Health Protection and Promotion. Toronto, ON, November Public Health Agency of Canada (PHAC). Routine Practices and Additional Precautions for Preventing the Transmission of Infection in HealthCare Settings. Ontario, Reviewed July IC Infection Prevention & Control Manual Page 5 of 5