Download Management of Patients with Transmissible Diseases (Isolation) Policy

MANAGEMENT OF PATIENTS WITH
TRANSMISSIBLE DISEASES
(ISOLATION) POLICY
PURPOSE: To prevent transmission of microorganisms from patients suspected or confirmed to
have diseases requiring transmission-based precautions; transmission-based precautions are used
in addition to Standard Precautions
POLICY: The facility will implement preventive strategies to minimize the risk of transmission of
infections. Standard Precautions apply to all patients and all situations, regardless of diagnosis or
presumed infection status. Because all patients can serve as reservoirs for infectious agents,
adhering to Standard Precautions during the care of ALL patients is essential to interrupting the
transmission of microorganisms. In addition to Standard Precautions, Transmission-based
Precautions are initiated when specific diseases/infections are suspected in an ASC patient.
Whenever possible, patients who require Contact Precautions should postpone their procedures
until they are no longer contagious or be referred to an inpatient facility. ASCs are typically not able
to provide care to patients in Airborne or Droplet Precautions.
Patient Scheduling

Patients will be screened to determine if they have symptoms of active infections, such as a
fever, rash, or new onset of diarrheal illness. Patients known to have a fever, rash or new
onset of a diarrheal illness not related to the underlying diagnosis and indication for the
surgical procedure will be rescheduled for the surgery or procedure. Patients with an acute
infection will be rescheduled for the surgery or procedure unless the surgery is deemed
emergent.

Patients will be asked if they have a history of Methicillin Resistant Staph Aureus (MRSA) or
another type of Multi-drug Resistant Organism (MDRO). Surgeons of patients identified
with an acute, active MRSA or MDRO infection will be consulted to determine if they would
like to have the surgical procedure rescheduled until the active infection has cleared. It is
not necessary to schedule patients with MDROs as the last case of the day.
Triage of Patients

Reception room staff will be educated to triage patients and be alert to patients presenting
with symptoms of infection

Reception staff will notify the clinical staff of their observations to enable rapid placement
into a designated exam room or room with a closable door until the physician and/or
clinical staff can further evaluate the situation. Patients suspected of having any of the
following diseases will be given a mask and placed in a room with the door closed until
transfer for additional treatment at a receiving facility or discharge to home can be done:
o
Tuberculosis: airborne, wait an hour after the patient has left the room before
reusing the room
o
Chickenpox: airborne, use Contact Precautions if contact with active lesions is
anticipated or to handle used linens
o
Measles: airborne, do not place another patient in the room for two hours after the
patient has left the area
o
Mumps: droplet
2.06 MANAGEMENT OF PATIENTS WITH TRANSMISSIBLE DISEASES (ISOLATION) POLICY
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o
Rubella: droplet
o
Bacterial meningitis: droplet
Refer to the CDC’s Guideline for Isolation Precautions: Preventing Transmission of Infectious
Agents in Health Care Settings for further information on isolation category requirements.

Staff will notify any receiving facility of the potential infectious disease so that appropriate
precautions may be implemented

Staff will implement appropriate barriers specific to the situation prior to transport (e.g.,
mask on patient, wound covered) and advise the persons doing the transport of these
precautions

The ASC shall follow respiratory hygiene/cough etiquette as recommended by the CDC and
shall post visual alert posters in the waiting area during the flu season and if other
outbreaks of respiratory illness are present in the community

Supplies for respiratory hygiene (tissues, hand sanitizers, masks) shall be kept at the
reception desk and will be available for patient use as needed

Patients with potential transmissible illnesses spread by contact or droplet routes will be
segregated (at least three feet away) in the waiting area if an exam room is unavailable

All patients will have any open wounds covered with an impermeable dressing that is clean
and dry

All patient lab cultures and sensitivities, if available, should be monitored pre- and postprocedure for evidence of MDROs and appropriate antimicrobial agent treatment.
Physicians should be notified of positive lab results or concerns regarding appropriate
treatment. Referring or receiving facilities should be notified of positive patient lab results.
Management of Patients with MRSA or Other MDROs in an ASC

Patients identified as having active or recent infections with MRSA or other MDROs will
have such noted on their pre-surgical health history form. [Note: Make notation of MRSA or
MDRO status using identification system established for your ASC (e.g., placed in the
electronic medical record, MDRO noted on the chart, laminated card with MDRO placed on
the patient chart, MDRO written by patients name on surgery white board the day of
surgery).]

Use Standard Precautions at all times for patients known to be infected or colonized with
target MDROs, making sure that gloves and gowns are used for contact with uncontrolled
secretions, pressure ulcers, draining wounds, stool incontinence and ostomy tubes and bags

Masks are indicated only when performing splash generating procedures

If possible, consider a private room or spatial separation of patients with potentially active
MDROs

Shared patient care equipment and surfaces (e.g., gurney, BP cuffs, oximeters) should be
cleaned and disinfected with an approved agent before reuse. Note: A hypochlorite-based
germicidal agent should be used to disinfect items used by incontinent patients with known
or suspected C. difficile infections. Before use, care should be taken to assure disinfected
equipment is compatible with the bleach solution.

Patients and families of patients with MDROs shall be provided with written educational
materials to inform them about the MDRO and control measures
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REFERENCES
Bennett, G. & Kassai, M. (2011). Infection Prevention Manual for Ambulatory Surgery Centers. ICP
Associates: Rome, Georgia.
Siegel, J. D., Rhinehart, E., Jackson, M., Chiarello, L. & the Healthcare Infection Control Practices
Advisory Committee. (2006). Management of Multidrug-Resistant Organisms in Healthcare Settings,
2006. Atlanta, Georgia: Centers for Disease Control and Prevention; Washington, D.C.: U.S.
Department of Health & Human Services.
Siegel, J. D., Rhinehart, E., Jackson, M., Chiarello, L., & the Healthcare Infection Control Practices
Advisory Committee. (2007). 2007 Guideline for Isolation Precautions: Preventing Transmission of
Infectious Agents in Healthcare Settings. Atlanta, Georgia: Centers for Disease Control and
Prevention.
Muto, C. A., Jernigan, J. A., Ostrowsky, B. E., Richet, H. M., Jarvis, W. R., Boyce, J. M., Farr, B. M. (2003).
SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of
Staphylococcus aureus and Enterococcus. Infection Prevention & Hospital Epidemiology, 24, 362–
386.
DISCLAIMER: All data and information provided by the Oregon Patient Safety Commission is for informational
purposes only. The Oregon Patient Safety Commission makes no representations that the patient safety
recommendations will protect you from litigation or regulatory action if the recommendations are
followed. The Oregon Patient Safety Commission is not liable for any errors, omissions, losses, injuries, or
damages arising from the use of these recommendations.
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