ISOLATION TABLE OF CONTENTS STANDARD PRECAUTIONS... 2 BARRIERS INDICATED IN STANDARD PRECAUTIONS... 2 PERSONAL PROTECTIVE EQUIPMENT... 3 CONTACT PRECAUTIONS... 4 RESIDENT PLACEMENT... 4 RESIDENT TRANSPORT... 5 RESIDENT CARE EQUIPMENT... 5 DROPLET PRECAUTIONS... 6 BARRIERS INDICATED FOR DROPLET PRECAUTIONS... 6 RESIDENT PLACEMENT... 6 TRANSPORT... 6 ISOLATION PROCEDURES... 7 LAUNDRY... 7 GARBAGE... 7 CLEANING THE ISOLATION UNIT... 8 CARE OF CLIENT WITH COMMUNICABLE DISEASE... 9 HANDLING AND/OR DISPOSING... 10 EQUIPMENT AND SUPPLIES... 10 SAFETY PRECAUTIONS... 10 USING GLOVES... 11 Revised 1/2007 1
STANDARD PRECAUTIONS Purpose: It is the intent of this facility that: 1) all client blood, body fluids, excretions and secretions other than sweat will be considered potentially infectious; 2) Standard Precautions are indicated for all clients. BARRIERS INDICATED IN STANDARD PRECAUTIONS 1. Gloves - gloves should be worn whenever exposure to the following is planned or anticipated. Gloves will be kept in designated areas of the nurse s office, kitchen, classroom, and in all first-aid kits. 2. Blood/blood products/body fluids with visible blood Urine Feces Saliva Mucous membranes Wound drainage Non-intact skin Performing venipuncture or invasive procedures 3. Masks and eyewear (or face shields) - should be worn during procedures that are likely to generate droplets/splashing of blood/body fluids. Supplies of disposal masks are to be kept in the nursing office. 4. Gowns/Aprons - should be worn when there is potential for soiling clothing with blood/body fluids. 5. Private Room - consider when client hygiene is poor or in cases where blood/body fluids cannot be contained. 6. Handwashing/hand hygiene refer to procedure on handwashing/hand hygiene. 7. Resuscitation Equipment mouthpieces or other ventilation devices should be available as alternatives for mouth to mouth resuscitation. 8. Sharps Precautions safety engineered sharps should be used and used sharps should be placed in an appropriately labeled puncture resistant container. Revised 1/2007 2
9. Lab Specimens should be placed in a container which prevents leakage during collection, handling, processing, storage, transport, or shipping. If outside contamination of the primary container occurs, it should be placed within a second container. 10. Blood Spills spills of blood or other body fluids should be removed and the area decontaminated using the facility-approved blood spill kit. Gloves should be worn during cleaning and decontamination. The manufacturer s directions will be followed for use of the product in cleaning and decontaminating spills. 11. Linen soiled linen should be handled as little as possible. Gloves should be worn to handle linen wet with blood or body fluids. 12. Waste waste should be bagged in impervious bags. PERSONAL PROTECTIVE EQUIPMENT (PPE) 1. PPE is provided to all employees. Each employee is responsible for knowing where the equipment is kept in the department. 2. The type of protective barrier(s) should be appropriate for the procedure being performed and the type of exposure anticipated. 3. PPE available includes gloves, gowns or aprons, masks and eye protection (or face shields), and resuscitation devices. Reference: Department of Labor Occupational Safety and Health Administration, Occupational Exposure to Bloodborne Pathogens, Needlestick and Other Sharps Injuries; Final Rule. 66:5317-5325. January 18, 2001. Department of Labor Occupational Safety and Health Administration, Occupational Exposure to Bloodborne Pathogens: Final Rule 29 CFR Part. 1910-1030. December 6, 1991. HICPAC, Guideline for Isolation Precautions in Hospitals, Infection Control and Hospital Epidemiology, January, 1996. Revised 1/2007 3
CONTACT PRECAUTIONS Purpose: It is the intent of this facility to use contact precautions for clients known or suspected to have infectious diseases or epidemiologically significant pathogens transmitted by direct client contact or by contact with items in the client s environment. BARRIERS INDICATED FOR CONTACT PRECAUTIONS Contact Precautions shall be used in addition to Standard Precautions for clients with specific infections that can be transmitted by direct and indirect contact. 1. RESIDENT PLACEMENT A. Client may be placed in a private room. If a private room is not needed/not available, the client may be placed in a room with a client(s) who has active infection with the same organism but with no other infection (cohorting). B. When a private room is not available and cohorting is not an option, consider the organism and client population when determining placement. A decision will be made on a case by case basis regarding the safety of placing the client in a room with another client. Examples of clients that may require a private room include clients with resistant organisms who have copious drainage from a wound. 2. GLOVES AND HANDWASHING A. Gloves should be worn when entering the room and while providing care for a client. B. Gloves should be changed after having contact with infective material (e.g. fecal material and wound drainage). C. Gloves should be removed before leaving the client s room and hand hygiene should be performed immediately. D. After glove removal and hand hygiene, hands should not touch potentially contaminated environmental surfaces or items. 3. GOWNS Revised 1/2007 4
A. For extra precaution, a gown should be worn when entering the room if it is anticipated that clothing will have substantial contact with the client, environmental surfaces, or items in the client s room, or wound drainage is not contained by a dressing. B. If a gown is worn, it should be removed before leaving the client s room. C. After removal of the gown, clothing should not contact potentially contaminated environmental surfaces. B. RESIDENT TRANSPORT A. Activities of the client may need to be limited. This will be determined on a case by case basis. B. If the client leaves the room, precautions should be maintained to minimize the risk of transmission of microorganisms to other clients and contamination of environmental surfaces or equipment. C. RESIDENT CARE EQUIPMENT A. Dedicated client-care equipment should be considered for the client. B. If use of common equipment or items is unavoidable, the items should be adequately cleaned and/or disinfected before use for another client. CONTACT PRECAUTIONS MAY BE CONSIDERED FOR (EXAMPLES): Scabies Pediculosis Varicella Impetigo Herpes Simplex Virus Revised 1/2007 5
DROPLET PRECAUTIONS Purpose: It is the intent of this facility to use droplet precautions to decrease the risk of droplet transmission of infectious agents. BARRIERS INDICATED FOR DROPLET PRECAUTIONS Droplet Precautions shall be used in addition to Standard Precautions for clients with infections that can be transmitted by droplets. Droplet transmission involves contact of the conjunctiva or mucous membranes of the nose or mouth of a susceptible person with large-particle droplets containing microorganisms generated from a person who has a clinical disease or who is a carrier of the microorganism. Droplets may be generated by the client's coughing, sneezing, talking, or during the performance of procedures, e.g. suctioning. 1. RESIDENT PLACEMENT A. Client may be placed in a private room. If a private room is not necessary/not available, the client may be placed in a room with a client(s) who has active infection with the same organism but with no other infection (cohorting). B. When a private room is not available and cohorting is not an option, maintain spatial separation of at least 3 feet between the infected client and other clients and visitors. Special air handling and ventilation are not necessary and the door may remain open. 2. MASKS A mask is recommended when within 3 feet of the client who is in the contagious stage of the disease process. 3. TRANSPORT Limit the movement and transport of the client. If transport is necessary, masking the client may minimize dispersal of droplets. DROPLET PRECAUTIONS MAY BE CONSIDERED FOR (EXAMPLES): Influenza Mycoplasma pneumonia Strep pharyngitis or pneumonia Revised 1/2007 6
ISOLATION PROCEDURES LAUNDRY consists of all linens, gown, and clothing worn by client on isolation and by visitors and staff caring for client. Procedures: 1. Nursing will clearly mark and label all isolation linen. Linen will be double bagged in room, using first, a water-soluble laundry bag and second, a regular clear plastic bag. 2. Linen will be held in a designated, isolated area for immediate pick-up by Housekeeping. Nursing will call for pick-up. 3. Linen is to be removed from the plastic bag and washed separately from other facility linen inside the water soluble bag. The hottest water temperature should be used along with a detergent and a germicidal solution. 4. Soiled linen is to be handled as little as possible. Laundry personnel will wear gloves when handling isolation linen or any linen visibly contaminated with blood. 5. The washing machine will be run a full cycle on empty with disinfecting solution/germicidal solution to cleanse the machine. 6. The isolation client s personal laundry will be cared for in the facility. Family will be asked not to take home any personal laundry while the client is in isolation. Personal laundry will be handled the same as facility linen. GARBAGE consists of all garbage and disposal items in a room assigned to an isolation client. Procedures: 1. Garbage is to be double-bagged. 2. Housekeeping will remove the garbage in a timely manner and dispose of as regulated medical waste if indicated (Refer to Patient Care Policy on Infectious Waste Management). Revised 1/2007 7
3. Isolation garbage must be kept in a separate container from other garbage. Container will be clearly labeled. CLEANING THE ISOLATION UNIT Procedures: 1. Thorough isolation unit cleaning will be done upon discharge or at any time deemed necessary. 2. The type of cleaning will depend on the organisms involved and will be determined by the nurse and housekeeping at each site. 3. Laundry and Garbage Isolation procedures will be followed. 4. Housekeeping will strip all linens from the unit and beds. 5. Housekeeping will be notified to clean the unit soon after client discharge. 6. The walls, ceiling, floor, closets, and all bedroom furniture and room fixtures will be sprayed and scrubbed with a germicidal solution. 7. Bathroom fixtures, walls, ceiling, and the sink area will be sprayed and scrubbed with germicidal solution. 8. Isolation laundry procedures will be followed for all curtains and linens after removing them from the unit. Revised 1/2007 8
CARE OF CLIENT WITH COMMUNICABLE DISEASE PURPOSE: Containment of potentially infectious diseases PROCEDURE: Clients will be placed in the infirmary or medically separated from other residents if deemed necessary until they are determined to be non-contagious by the physician or Advanced Nurse Practitioner for the conditions listed below but not limited to: 1. Diarrhea 2. Vomiting 3. Purulent Conjunctivitis 4. Strep (specifically for 24 hours after initiation of antibiotic therapy) 5. Fever above 101 degree F. 6. Childhood Diseases such as Varicella, Mumps, etc. 7. Influenza/Upper Respiratory Infections 8. Scabies 9. Infectious Mononucleosis 10. Tuberculosis 11. Active Pediculosis Any client who exhibits any of the above must be assessed by an RN or LPN prior to departing for school. If no nurse is present, the child is to be held back until one arrives to assess him. Following diagnosis by a physician, care must be taken to assure the safety of other clients, staff, families, and visitors from the transmission of organisms that cause disease and/or illness: 1. The Nurse will issue a medical alert to staff. 2. Precautions will be taken to prevent transmission to other clients. 3. Staff will be in-serviced by Nursing on precautions to be taken based on CDC recommendations found on the Control of Communicable Disease Manual 4. Nursing will contact any family member with visitation privileges on the nature of the child s illness, treatment, and prevention of transmission. Revised 1/2007 9
HANDLING AND/OR DISPOSING OF USED NEEDLES PURPOSE: To provide guidelines for the safe handling and disposal of used needles. 1. EQUIPMENT AND SUPPLIES A. Safer sharps devices; B. Sharps container; C. Gloves (as indicated); and D. Other as necessary or appropriate. 2. SAFETY PRECAUTIONS A. After use, discard the needle after activating the safety feature and without recapping by hand, into the sharps container. B. Used needles must be placed in the sharps container. Do not bend, break, or cut needles. When the sharps container is ¾ filled, the container must be stored until picked up by a licensed vendor for proper disposal. C. Needles, used or unused, may not be discarded into trash receptacles. D. In the event of a needlestick injury, the employee should: 1. Immediately wash the wound with soap and running water; 2. Cause the injured site to bleed; 3. If desired, apply alcohol or hydrogen peroxide to the wound; and 4. Notify the NURSE of the incident immediately. Revised 1/2007 10
USING GLOVES PURPOSE: To provide guidelines for the use of gloves for client and employee protection. 1. When gloves are indicated, disposable single-use gloves should be worn. 2. Used gloves should be discarded into the waste receptacle inside the room. 3. Gloves should be used primarily to prevent the contamination of the employee's hands when providing treatment or services to the client and when cleaning contaminated surfaces. 4. Perform hand hygiene after removing gloves. Gloves do not replace hand hygiene. 5. Disposable (single-use) gloves must be replaced as soon as practical when contaminated, torn, punctured, they exhibit signs of deterioration, or when their ability to function as a barrier is compromised. 6. If hypersensitivity to latex occurs, employee will be provided with an alternative. WHEN TO USE GLOVES Gloves should be used: 1. When touching excretions, secretions, blood, body fluids, mucous membranes or non-intact skin; 2. When the employee's hands have any cuts, scrapes, wounds, chapped skin, dermatitis, etc.; 3. When cleaning up spills or splashes of blood or body fluids; 4. When handling potentially contaminated items; 5. When it is likely that hands will come in contact with blood, body fluids, or other potentially infectious material; 6. When performing phlebotomy. Revised 1/2007 11