Updated 4/28/03

ISOLATION UPDATE FOR NURSES

Department of Hospital Epidemiology and Infection Control

5-8384

Osler 425

www.hopkins-heic.org

Infection epidemic carves deadly pathPoor hygiene, overwhelmed workers contribute to thousands of deaths First of three parts.By Michael J. BerensTribune 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 are required for:– Tuberculosis (TB), Smallpox, Chickenpox,

Measles, SARSRequirements:– 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

Airborne Precautions

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 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

Contact 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

Special Precautions

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 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

Droplet Precautions

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