Transcript Hospital Epidemiology/ Infection Control

ISOLATION UPDATE FOR
NURSES
Department of Hospital Epidemiology and
Infection Control
5-8384
Osler 425
www.hopkins-heic.org
Updated 4/28/03
Infection epidemic carves deadly path
Poor hygiene, overwhelmed workers
contribute to thousands of deaths
First of three parts.
By Michael J. Berens
Tribune staff reporter
July 21, 2002
A hidden epidemic of life-threatening infections is
contaminating America's hospitals, needlessly killing tens of
thousands of patients each year.
Prevent infections by:
 Practicing good hand
hygiene
 Following Standard
Precautions and
isolation instructions
 Receiving
vaccinations
Important Terms
Colonization is the presence of a pathogen in a
body site without any clinical signs and
symptoms. Different organisms prefer different
body sites, e.g. MRSA prefers nares, VRE prefers
GI tract.
An infection occurs when there are clinical signs
and symptoms (fever, erythema, edema, purulent
drainage, etc.)
STANDARD PRECAUTIONS
 Practiced for all
patients
– Keep a barrier between
the HCW and the
blood and/or body
fluids of ALL patients
•
•
•
•
GLOVES
GOWNS
MASKS
EYEWEAR
Prevent Infections…
ISOLATION
Isolation
 Isolation guidelines
are based on the ways
that specific organisms
are spread
 In order to protect
patients and staff,
additional isolation
categories are needed
to supplement
Standard Precautions
Follow Isolation Directions
 Follow the
isolation sign on
patient door/bed
space
 Check patient’s
chart for isolation
sticker
What’s New for 2003?
 Nurses now have the authority to initiate
isolation through a nursing order
 Strict Isolation has been discontinued
– Patients previously placed in Strict Isolation
will now require Airborne & Contact
Precautions
• Examples: Chickenpox, Disseminated Herpes
Zoster, Smallpox, SARS
What Else is New?
 Airborne Isolation room requirements
– Negative pressure vented to the outside
(suitable for TB)
– Negative pressure room not vented to outside
but with HEPA Filter may be used if no “TB”
rooms are available
 Initiation of Airborne Isolation requires ID
approval (not new but now encompasses
more diseases)
Still More New Information
 Airborne Isolation requires the use of PAPR
by HCW
– HCW known to be immune to chickenpox, or
measles do not need to wear PAPR when caring
for patients with those diseases or disseminated
Zoster
– PAPR must be worn by all HCW when caring
for patient with TB, Smallpox, SARS
Airborne Precautions
Airborne precautions are required for:
– Tuberculosis (TB), Smallpox, Chickenpox,
Measles, SARS
Requirements:
– ID physician approval
– Negative pressure room
– Staff must wear Powered-Air Purifying
Respirators (PAPRs) and close door behind them
– Staff remove PAPR prior to exiting ante-room
– Sanitize hands after leaving room
PAPRs
 PAPRs are obtainable




from Central Supply at
x 5-8357
Hoods can be reused by
the same HCW
Be sure to obtain more
than one or two
Call HSE at x 5-5918 to
pick up units when no
longer needed
HSE will also provide
training about how to
use the PAPR
Contact Precautions
Contact isolation is required for:
– MRSA, C. diff, Adenovirus, conjunctivitis,
decubitus ulcer infection, etc.
Requirements:
– Gown and gloves for contact with patient in
room
– Remove gown and gloves prior to leaving
room
– Sanitize hands after leaving room
Special Precautions
 Special Precautions are required for:
– VRE, VISA
 Requirements:
– Private room
– Visitors and Healthcare Worker (HCW) must
don a gown and gloves before entering patient
room
– Sanitize hands after leaving room
– Dispose of gown and gloves before leaving the
room
Fingers and Fomites: VRE
VRE (E faecium) can be recovered from gloved
and ungloved fingertips for at least 60 minutes
after inoculation
VRE recovered from bedrails (Up to 24 Hours),
telephones, and stethoscopes (Up to 60 Minutes)
VRE recovered from countertops for up to 7 days
after inoculation
Noskin, ICHE: 1995;16:577-581.
VISA/VRSA
VISA (Vancomycin Intermediate Staphylococcus aureus)
– 1999- now 20 cases worldwide
– Has not demonstrated transmission to health care
workers
VRSA (Vancomycin Resistant Staphylococcus aureus)
– 2002- 2 cases in the United States
– In both cases, patients were co-infected with
MRSA/VRE
Droplet Precautions
Droplet precautions are required for:
– Influenza, (adult) RSV, Parvovirus, Croup,
Mumps, Pertussis, Strept throat, etc
Requirements:
– Mask, gown, gloves when within 3-6 feet of
patient
– Sanitize hands after leaving room
Pediatric Droplet
 Specifically for the pediatric patient with
Respiratory Syncytial Virus (RSV)
– Private room preferred
– Gowns and masks are required for contact
– Protective attire must be removed before
leaving the room
– Hand hygiene must be performed after leaving
the room
Transport of Patients
Requiring Isolation
 Should be limited to essential needs
 Masking of patient with standard surgical mask if
droplet or airborne transmission and the patient
can tolerate
 Notify receiving department of appropriate
precautions
– Make sure chart is appropriately labeled
What’s wrong with this picture?
JHH Coding Procedures
 If a patient presents for admission to your unit,
check his magenta plate to ensure isolation is not
required.
 ICO1
VRE “Special”
 ICO2
MRSA “Contact”
 ICO4
Varicella “Airborne, Contact”
 ICO7
Both MRSA and VRE “Special”
 ICO8
“Contact” for any Cystic Fibrosis
patient with Burkholderia cepacia
(will not be on the same floor as
other cystic fibrosis patients)
Isolation Summary
 Sometimes “Standard Precautions” are not
enough
 “Isolation Precautions” protects patients
and staff from spreading communicable
diseases
 Follow isolation signs and instructions
posted on patients doors
 Isolation policy is available on-line at
www.hopkins-heic.org for further
information
Hand Hygiene: Best way to
Prevent Infection