Transcript Document
Isolation Precautions *CDC 2007 Toney Thomas Lecturer / Course Coordinator, Assistant Director of Nursing Infection Prevention & Control Department RCSI / Beaumont Hospital A quick recap how isolation precautions evolved over time HISTORY OF GUIDELINES FOR ISOLATION PRECAUTIONS IN HOSPITALS Isolation 1970 Techniques, 1st edtn. -Introduced seven isolation precaution categories with color-coded cards: Strict, Respiratory, Protective, Enteric, Wound and Skin, Discharge, and Blood - No user decision-making required - Simplicity a strength; over isolation prescribed for some infections 1975 Isolation Techniques, 2nd edtn. Same conceptual framework as 1st edition 1983 CDC Guideline for Isolation Precautions in Hospitals -Provided two systems for isolation: category-specific and disease specific - Protective Isolation eliminated; Blood Precautions expanded to include Body Fluids - Categories included Strict, Contact, Respiratory, AFB, Enteric, Drainage/Secretion, Blood and Body Fluids - Emphasized decision-making by users HISTORY OF GUIDELINES FOR ISOLATION PRECAUTIONS IN HOSPITALS contd-19851988 Universal precautions Developed in response to HIV/AIDS epidemic - Blood and Body Fluid precautions to all patients, regardless of infection status - Did not apply to feaces, nasal secretions, sputum, sweat, tears, urine, or vomitus unless contaminated by visible blood - Added personal protective equipment to protect HCWs from mucous membrane exposures - Handwashing recommended immediately after glove removal - Added specific recommendations for handling needles and other sharp devices; 1987 Body substance isolation - Emphasized avoiding contact with all moist and potentially infectious body substances except sweat even if blood not present - Shared some features with Universal Precautions - Weak on infections transmitted by large droplets or by contact with dry surfaces - Did not emphasize need for special ventilation to contain airborne infections - Handwashing after glove removal not specified in the absence of visible soiling 1996 Guideline for Isolation Precautions in Hospitals Prepared by the Healthcare Infection Control Practices Advisory Committee (HICPAC) - Melded major features of Universal Precautions and Body Substance Isolation into Standard Precautions to be used with all patients at all times - Included three transmission-based precaution categories: contact, droplet & airborne - Listed clinical syndromes that should dictate use of empiric isolation until an etiological diagnosis “Standard Precautions include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered” The application of Standard Precautions during patient care is determined by the nature of the HCW-patient interaction and the extent of anticipated blood, body fluid, or pathogen exposure Standard precautions* CDC 1996 1. Hand hygiene 2. PPE: Gloves, Gowns, Face & Eye protection 3. Patient placement 4. C&D of patient care equipment 5. Environmental hygiene 6. Textiles & laundry 7. Safe injection practices Revision of 1996 guidelines, why? 1. Transition of health care delivery 2. Emergence of new pathogens 3. Successful experience & reaffirmation of Standard precautions *1996 4. Environmental controls – Protective environment 5. Organisational characteristics 6. HAI & MDROs – surveillance & control New additions to Standard precautions – Respiratory hygiene – Safe injection practices – Use of mask when performing spinal or epidural procedures Respiratory Hygiene/Cough Etiquette The elements include 1) Education of healthcare staff, patients, & visitors 2) Posted signs, in language(s) appropriate 3) Source control measures (e.g. covering the mouth/nose with a tissue when coughing & prompt disposal of used tissues, using surgical masks on the coughing person when tolerated and appropriate 4) Hand hygiene after contact with respiratory secretions 5) Spatial separation, ideally >3 feet, Safe injection practices • Large outbreaks of HBV and HCV among patients in the United States • The primary breaches – 1) reinsertion of used needles into a multiple-dose vial or solution container (e.g.saline bag) – 2) use of a single needle/syringe to administer intravenous medication to multiple patients. Spinal canal punctures & Infection prevention • Bacterial meningitis following myelogram and other spinal procedures • Face masks are effective in limiting the dispersal of oro-pharyngeal droplets & are recommended for the placement of central venous catheters. • HICPAC recommendation 2005 – use of a face mask when placing a catheter or injection to epidural space. Transmission based precautions • Three categories – Contact • Direct • Indirect – Droplet – Airborne An important change! Don PPE upon entry into patients room for patients who are in contact / Droplet precautions Change is often painful, but we are quick to forget the pain once we taste the fruits of change!