Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Isolation Precautions
Document related concepts
Transcript
IsolationPrecautions: AmultiͲsitestandardizationproject InfectionPreventionandControl MayoClinic September2012 Copyright2012MayoFoundationforMedicalEducationandResearch.Allrightsreserved. Keycomponents • Followaclearpurpose – Haveaninfrastructure • Interpretationoftheguidelines – Applythemconsistentlyandwith flexibility • Createcommonproductsandtools – Signage,policy,educationand communication Followaclearpurpose Thebestinterestofthe patientistheonlyinterestto beconsidered,andinorder thatthesickmaybenefitof advancingknowledge,unionof forces isnecessary. ~WilliamJ.Mayo,M.D.(1910) Establishaninfrastructure • CreateOversightTeam m – Policy – Education – Communication • • • • Identifyrepsfromeachregion Establishatimelinewithdeadlines Setuponlinecollaboration(Launchpad) Defineafuturereviewschedule Roadmap:Interpretationof theguidelines Interpretationoftheguidelines Adults StandardPrecautions CDCGuidelines AppendixAp.109 CDCGuidelines AppendixAp.109 Inimmunocompromised patients,extendtheduration ofContactPrecautionsduetoprolongedshedding ContactPrecautions. WearmaskaccordingtoStandardPrecautions. Respiratoryinfectious disease,acute(ifnot coveredelsewhere) DCGuidelinesAppendixAp.109 Respiratorysynctial virusinfection,in infants,youngchildrenand immunocompromised adults CDCGuidelinesAppendixAp.109 CDCGuidelinesAppendixAp.109 Infantsandyoung children ContactPrecautions Alsoseesyndromesor conditionslistedinTable2 CDCGuidelinesAppendixAp.109 CDCGuidelinesAppendixAp.109 Respiratoryinfections,particularlybronchiolitis andpneumonia,ininfantsandyoungchildren (RSV,parainfluenza,adenovirus,influenza) CDCGuidelinesTable2p.121 ContactplusDropletPrecautions. DropletPrecautionsmaybediscontinuedwhen adenovirusandinfluenzahavebeenruledout CDCGuidelinesTable2p.121 "...itisbettertothinkand sometimesthinkwrong thannottothinkatall." ~WilliamJ.Mayo,M.D. Stopsalongtheway: Applicationofthe guidelines • • • • Categories SignageInstructions Icons Colors PitStop:Isolation PrecautionCategories e • Airborne tiv nt c e t Strict ro nme bo • Contact P r i A iro v n • Droplet E ac t t n • ProtectiveEnvironment* Sto Co rne p D et ropl Neutrop e ni c Modified Droplet Enteric Speci al Agen t Airbo rne *AlsoreferencedGuidelinesforEnvironmentalInfectionControlinHealthͲCareFacilities,2003 FlexibilityfromCDC Detour1 Gasstop:Healthcareworker Instructions Handhygiene? • Handhygienerequired Mask? • Surgicalmaskvs.maskwithfaceshield Gownandgloves? Otherresources? Gasstop:Visitor Instructions Handhygiene? Mask? Gownandgloves? • Requiredforpatientcarevs.patientcontact Restrictionsandotherinstructions? Flexibilityforinstructions acrosssites Detour2 Restarea:Icons Flexibilitywithinicons • Standardhandhygieneicon • ModifiedContacthand hygieneicon • Standardhealthcareworker maskicon • Masksuppliedforhealthcare workersatsomesites Detour3 CommonColors • Sometimesthemostunexpected detoursarethemostmemorable eventsonaroadtrip. CommonColors • • • • • • • Blue =DropletPrecautions Brown =ModifiedContactPrecautions Pink =AirbornePrecautions Turquoise =ProtectiveEnvironment Orange =ModifiedDropletPrecautions Yellow =ContactPrecautions Red =NegativeAirPrecautions Detour4 Ifindthegreatthinginthis worldisnotsomuchwhere westand,asinwhatdirection wearemoving. ~OliverWendellHolmes Standardizedproductsand tools • • • • Policy,Education&Communication DoorCards TransportCards QuickReference Commoninfrastructure • Oneisolationprecautionspolicy – Tailoredproceduresforeachisolation precautionateachsite • Oneeducationtemplateandquick referencesheetsforhospital, ambulatoryandlongͲtermcare • Formalcommunicationsdraftedand sharedacrosssites CommonDoorCards CommonTransportCards Common referencetools • • • • InfectionswithIsolationPrecautions Hospitalquickreference Ambulatoryquickreference LongͲtermcarequickreference InfectionswithIsolationPrecautions Expectations StandardPrecautionsarefollowedforallpatients,regardlessofisolationstatus *IndicatesdiseasesthatarevaccineͲpreventable.Individualswhoarenotimmune(eitherbyvaccinationorpriorinfection)shouldnotenterthe roomorcareforthepatient.Thisalsoappliestolocalizedzosterforwhichstandardprecautionsarerecommended. Inanoutbreaksituation,InfectionPreventionandControlmaymodifytherecommendationsbelow AirbornePrecautions Tuberculosis(suspectedorconfirmedpulmonaryorlaryngeal) ExtrapulmonaryTB(onlywhenperformingaerosolizingproceduresatthesiteofinfection) ContactPrecautions Skinorwoundinfection Uncontaineddrainage Resistantgrampositivebacteria MRSA(MethicillinͲresistant Staphylococcusaureus) VRE(VancomycinͲresistant Enterococcus) Epidemiologicallysignificant resistantgramnegativebacteria ‡ (GNB) Acinetobacter E.coli Enterobacter Klebsiella Proteus Pseudomonasaeruginosa Stenotrophomonas ModifiedContactPrecautions Suspectedorconfirmedinfection withoneofthefollowingin fecallyincontinentpatients Campylobacter Cholera(Vibriocholerae) Cryptosporidium Enteroviruses E.coli(0157:H7andothershiga toxinͲproducingstrains) Giardialamblia HepatitisA HepatitisE Salmonella Shigella Staphylococcusaureus (enterocolitis) Vibrioparahaemolyticus Yersiniaenterocolitica Otherpathogensandconditions Burkholderiacepacia (incysticfibrosispatients) Congenitalrubella Conjunctivitis (acuteviralhemorrhagic) Diphtheria(cutaneous) Herpessimplex(disseminatedor severemucocutaneous,or neonatalinfection) Impetigo Lice Parainfluenza (infantsandyoungchildren) Poliomyelitis Scabies Scaldedskinsyndrome Meningitisuntil24hrsof effectivetherapy Otherpathogensandconditions Diphtheria(pharyngeal) Epiglottitis (infantsandyoungchildren) Influenza,seasonal(adults) Mumps* Mycoplasma ParvovirusB19 Pertussis Plague(pneumonic) Rubella(Germanmeasles)* Streptococcus(GroupA) - Pharyngitis (infantsandyoungchildren) - Pneumonia - Scarletfever (infantsandyoungchildren) Clostridiumdifficile Norovirus Rotavirus Contact+NegativeAir§ Herpeszoster,disseminated (shingles)* Measles(Rubeola)* Varicellazoster(chickenpox)* Contact+DropletPrecautions Adenoviruspneumonia Bronchiolitis,bronchitis,croup (infantsandyoungchildren) Influenza,seasonal (infantsandyoungchildren) RSV Streptococcus,GroupA (extensiveskininfection) ModifiedDropletPrecautions DropletPrecautions Respiratorysymptoms Suspectedinfectiousetiology untildiagnosismadeand conditionrequiringDroplet Precautionshasbeenruledout Haemophilusinfluenzae Neisseriameningitidis Pneumoniauntil24hrsof effectivetherapy Haemophilusinfluenzae (infantsandyoungchildren) Neisseriameningitidis Streptococcus(GroupA) Novelinfluenza Respiratoryinfectionoutbreaks (asdirectedbyInfection PreventionandControl) Recommendationsabovearebasedonthe2007CDCGuidelineforIsolationPrecautions.Exceptionsincludemeasles(ContactPrecautionsaddedto CDCrecommendations)andRSV(DropletPrecautionsaddedtoCDCrecommendations) ‡ § Refertodiseaseindexfordefinitionofresistanceforeachorganism AirbornePrecautionsareanacceptablealternativetoNegativeAirPrecautionsifstaffing/suppliesallow Hospital Quick Reference Card for Isolation Precautions ExpectationsforIsolationPrecautions xStandardPrecautionsarefollowedforallpatients,regardlessofisolationstatus xHandhygieneisrequiredusingalcoholͲbasedhandruborsoapandwater(followsiteͲspecificprocedures) xPersonalProtectiveEquipment(PPE)iswornforroomentryandremovedbeforeexitingthepatientroom xUsededicatedpatientcareequipmentanddisinfectanyequipment usedbetweenpatientsorremovedfromanisolationroom xInanoutbreaksituation,InfectionPreventionandControlmaymodifytherecommendationsbelow Type DiseaseRequiringIsolation (thisisnotanexhaustivelist) RoomType Gloves Gown Maskor Respirator Environmental Services PatientRequirements Airborne Tuberculosis Negativeair Doorto remainclosed atalltimes No No FitͲtestedN95 respiratororPAPR Doortoremainclosed for60minutespriorto standardterminal roomcleaning Limittransporttoessentialpurposesonly Patientsarediscouragedfromambulatingoutof theirroomͲ Patientmustperformhandhygieneand wearasurgicalmaskbeforeleavingroom Contact MRSA,VRE,RSV*,resistantgramͲ negatives,scabies,diarrhea Private Doormay remainopen Yes Yes No Routinedailyand terminalroom cleaning Patientmustperformhandhygiene,wearaclean gownandhavecleandressingsbeforeleavingroom foressentialpurposesoratherapeuticwalk Modified Contact Suspectedorconfirmed C.difficile ornorovirus infections Private Doormay remainopen Yes Yes No Routinedailyand terminalroom cleaningwithbleach wipes Patientmustperformhandhygiene,wearaclean gownandhavecleandressingsbeforeleavingroom foressentialpurposesoratherapeuticwalk Droplet Pertussis,RSV*,parvovirus, influenza(seasonal),Neisseria meningitidis,mumps^,rubella^ Private Doormay remainopen Yes No Mask Routinedailyand terminalroom cleaning Patientmustperformhandhygieneandweara surgicalmaskbeforeleavingroomforessential purposesoratherapeuticwalk Modified Droplet Novelinfluenza,respiratory infectionoutbreaks(asdirected byInfectionPreventionand Control) Private Doorto remainclosed duringaerosol generating procedures and60 minutesafter Yes Yes Maskwitheye protection PAPR(orfitͲtested N95respiratorplus eyeprotection)for aerosolgenerating procedures Routinedailyand terminalroom cleaning Limittransporttoessentialpurposesonly Patientsarediscouragedfromambulatingoutof theirroomͲ Patientmustperformhandhygiene, wearacleangownandsurgicalmaskbeforeleaving room Note:PatientactivitiesmaybelimitedbyInfection PreventionandControlbasedonseverityofillness Protective Environment Absoluteneutrophil count<500 cells/dl,poststemcelltransplant Private No No No Routinedailyand terminalroom cleaning PatientmustwearasurgicalmaskorN95respirator whenoutofroom,andwhenroomisbeingcleaned andfor30minutesaftercleaning NegativeAir# (mustbe orderedwith Contact Precautions) Disseminatedzoster^, chickenpox^,measles^ Yes Yes No Doortoremainclosed for60minutespriorto standardterminal roomcleaning Limittransporttoessentialpurposesonly Patientsarediscouragedfromambulatingoutof theirroomͲ Patientmustwearasurgicalmask beforeleavingroom Doorto remainclosed atalltimes Negativeair Doorto remainclosed atalltimes * Some respiratory diseases require both Droplet and Contact Precautions (e.g. RSV) ^ Non-immune staff and visitors should not enter this room # Airborne Precautions are an acceptable alternative to Negative Air Precautions if staffing/supplies allow Ambulatory Quick Reference for Outpatients with selected Infectious Agents ForhospitalpatientsonIsolationPrecautionsseeninambulatoryareas,followinstructionsonTransportCard StandardPrecautionstobeusedforallpatientsatalltimes,includinghandhygiene Category Room Requirements PatientRequirements StaffPPERequirements SpecialInstructions Chickenpox [Varicella] or DisseminatedHerpes Zoster[Shingles] Promptlyroompatient Wearsurgicalmaskatdesk UseNegativeAirroom checkin,duringtransport, (ifavailable) andwheninpublic Glovesforcontactwithlesions NonͲimmunestaffshouldnotentertheroom Closeexamroomfor60minutesfollowing appointment LocalizedHerpes Zoster[Shingles] Promptlyroompatient Coverlesionswhengoing betweenappointments Glovesforcontactwithlesions NonͲimmunestaffshouldnotentertheroom Generalexamroomturnover Liceor Scabies Promptlyroompatient None Glovesforpatientcontact Vacuumupholsteredfurniture Delayfurtherappointmentsuntilscabies/lice treated,ifpossible.Ifthisisnotfeasible,notify receivingareasaboutpatient’sstatus. Measles Promptlyroompatient UseNegativeAirroom (ifavailable) Wearsurgicalmaskatdesk checkin,duringtransport, andwheninpublic Glovesforcontactwith respiratorysecretions NonͲimmunestaffshouldnotentertheroom ImmediatelynotifyInfectionPreventionand Control Closeexamroomfor60minutesfollowing appointment MultiͲDrugResistant Organisms Promptlyroompatient Coveropenwoundswhen goingbetweenappointments Standardprecautions Generalexamroomturnover Mumps Promptlyroompatient Wearsurgicalmaskatdesk checkin,duringtransport, andwheninpublic Glovesforcontactwith respiratorysecretions NonͲimmunestaffshouldnotentertheroom ImmediatelynotifyInfectionPreventionand Control Generalexamroomturnover Pulmonary Mycobacterium Tuberculosis[TB] Promptlyroompatient UseNegativeAirroom (ifavailable) Wearsurgicalmaskatdesk checkin,duringtransport, andwheninpublic FittestedN95respiratoror PAPRifpatientcannottolerate asurgicalmask Notifyreceivingarea(s)ofpatient'sTBstatus Closeexamroomfor60minutesfollowing patientappointment UpperRespiratory Infections [e.g.Pertussis, Influenza,RSV] Promptlyroompatient Wearsurgicalmaskatdesk checkin,duringtransport, andwheninpublic Glovesforcontactwith respiratorysecretions Maskifpatient’smaskis removed(e.g.duringculturing) Generalexamroomturnover Long Term Care Quick Reference Card for Infectious Agents Standard Precautions to be used for all residents at all times Category Room Requirements Close Door Transmission Route Resident Requirements Staff PPE & Hand Hygiene Requirements Special Instructions Conjunctivitis No special room requirements Not required Contact with eye drainage Instruct resident to perform frequent hand hygiene Avoid sharing personal items Gloves for contact with eye drainage or contaminated items Perform hand hygiene Avoid use of multi-dose medication vials Disinfect patient care equipment after each use General room cleaning Wipe down contaminated equipment and surfaces with hospital grade disinfectant Clostridium difficile (C. diff) Single resident room Not required Fecal to oral Contact with surfaces or items that are contaminated Instruct resident to perform frequent hand hygiene Gloves for all contact Gown for contact if incontinent or diapered Wipe down contaminated surfaces with bleach during daily cleaning Disinfect all patient care equipment after each use (check manufactures guidelines prior to use of bleach) Herpes Zoster (Shingles) Disseminated OR Localized in immunocompromised patient until disseminated infection ruled out (if lesions have not spread in past 24 hours consider localized zoster) Use Negative Air room (if available) Yes Contact with fluid from lesions Contact with articles soiled with discharge from vesicles or mucous membranes Cover lesions (when localized) until dry and crusted Wear surgical mask when out of room Gloves for skin contact with lesions Perform hand hygiene Susceptible staff should not enter the room General room cleaning Wipe down contaminated equipment and surfaces with hospital grade disinfectant Not required Contact with fluid from lesions. Contact with articles soiled with discharge from vesicles or mucous membranes. Cover lesions until lesions dry and crusted Gloves for skin contact with lesions Perform hand hygiene Susceptible staff should not enter the room General room cleaning Herpes Zoster localized [Shingles] in patient with intact immune systems Wipe down contaminated equipment and surfaces with hospital grade disinfectant nce e i r e p oex fwhere y a M o gthe gardless Mayo n i k s Ma mere ceive e a r s t e . th atien care thep Clinic Otherconsiderations • Challenges – Computerissues – Standardizationdrift – StandardPrecautionseducation • Aimforstandardization,butallowfor flexibilityanddeviations,asneeded Tripsummary… Copyright2012MayoFoundationforMedicalEducationandResearch.Allrightsreserved.
