Download THE CENTRAL HOSPITAL, COLOMBO, SRI LANKA

THE CENTRAL HOSPITAL,
COLOMBO, SRI LANKA
PREPARED BY:
NAME: DR. DR.PHILOMENA
CHANDRASIRI,
SIGNATURE:
STAMP:
REVIEWED BY:
DESIGNATION: CONSULTANT
MICROBIOLGIST
DATE:
NAME: DR. RUWAN SENATILLEKE
SIGNATURE:
DESIGNATION: CHAIRPERSON,
ASIRI HOSPITALS POLICY REVIEW
COMMITTEE
APPROVED BY:
NAME: DR. MANJULA
KARUNARATNE
STAMP:
DATE:
SIGNATURE:
STAMP:
DESIGNATION: DEPUTY CHIEF
EXECUTIVE OFFICER
JCI ACCREDITATION
STANDARDS FOR
HOSPITALS – 5TH
EDITION
SECTION III:
HEALTHCARE
MANAGEMENT
STANDARDS
CHAPTER: PREVENTION AND
CONTROL OF INFECTIONS (PCI)
DOCUMENT TITLE:
Policies and Procedures for Barrier
Precautions and Isolations
DATE:
REVISION NO: 0
DATE OF REVISION: NA
ISSUE NO: 1
DATE OF ISSUE: 15 DECEMBER
2014
DOCUMENT IDENTIFICATION NO:
CHL/HP/PCI 06
NO OF PAGES:7
STANDARDS REFERENCE: PCI.8 /
PCI.8.1
CHL/HP/PCI 06
Page 1 of 7
A.PURPOSE
To provide isolation and barrier precautions for patients with communicable diseases in
order to protect other patients, staff and visitors. To provide isolation facilities to patients
who are immunosuppressed in order to protect them from acquiring infections.
B. DEFINITION
Communicable Diseases- Infections that are transferable from one person to another.
Contact Precautions – precautions that should be practiced when handling patients infected
with diseases transmitted by contact.
Respiratory Precautions- precautions that should be practiced when handling patients
infected with diseases transmitted by respiratory route.
Standard Precautions- A set of practices that should be practiced by all healthcare workers
at all time
Airborne Precautions- precautions that should be taken to prevent transmission of
infectious agents that remains suspended in air for a long time (particles < 5µ)
Droplet Precautions –precautions that should be taken to prevent transmission of
infectious agents that are transmitted by droplet particles (> 5µ)
C. SCOPE
Out patients department and clinical areas including isolation rooms
D. JCI RELATED STANDARD
PCI 8 – The hospital provides barrier precautions and isolation procedures that protect
patients, visitors, and staff from communicable diseases and protects immunosuppressed
patients from acquiring infections to which they are uniquely prone
PCI 8 .1– The hospital develops and implements a process to manage a sudden influx of
patients with airborne infections and when negative-pressure rooms are not available
CHL/HP/PCI 06
Page 2 of 7
E. RESPONSIBILITY

Medical Director

Nursing Director

Maintenance Engineer

Hospital Management

Infection Control Team

Chief Nursing Officer / Asst. Chief Nursing Officer

Sisters In- charge

Medical Officers
F. POLICY
1. Our hospital policy is to provide maximum isolation & barrier precautions when handling
patients with
- Communicable diseases -eg SARS ,Influenza, chicken pox
- Severe immunosuppression.
2. Our hospital policy is not to accept patients with communicable diseases on elective
admissions basis. The hospital has designed a plan of action in case of sudden influx of
patient with communicable diseases arrives for treatment.
G. PROCEDURE
1.
2.
Patients infected with communicable diseases that are transmitted by respiratory route
and needs isolation should not be admitted to the hospital unless he/she was admitted
before developing the symptoms. If such patient is taken in to the emergency unit he /
she will be taken to a separate clinical room with adequate ventilation and away from
other patients/visitors areas. Patient will be provided with surgical mask. Once the
patient leaves the room it should be left vacant for one hour.
The following infections / conditions indicate that the patient should be under air borne
precautions / isolation:
- Chicken Pox
- Disseminated zoster ion any patient or localized zoster in immunocompremised
patients
- Measles (Rubella)
CHL/HP/PCI 06
Page 3 of 7
3.
4.
5.
6.
7.
8.
9.
- Extra pulmonary tuberculosis, draining lesion (including scrofula)
- Pulmonary or laryngeal tuberculosis, confirmed
- Pulmonary or laryngeal tuberculosis , suspected
Once admitted the patient shall be isolated in an isolation room with negative pressure
ventilation (12 air exchanges /hour). The expelled air should not be directed to
patient/visitors area or air handling units. ( Refer Annexure 2 – Infection Control and
Ventilation Requirements for PE Rooms)
Once the patient is admitted the airflow direction (i.e negative pressure) will be
monitored using a log sheet on a daily basis. The record shall be maintained in a
retrievable format ideally near the entry to the room.
After the patient vacate the room terminal cleaning is done according to the guidelines(
Refer Annexure1- Checklist for Terminal Cleaning of Isolation rooms)
If there is a sudden influx of patients who are suspected of having contagious diseases
they shall be taken in from a dedicated entrance to a separate clinical room with hand
washing facilities for examination by a medical officer wearing appropriate PPE. The
patients shall be provided with a surgical mask.
The staff will be educated periodically regarding management of patients with
infectious diseases and proper use of personal care equipment.
Regular auditing will be done on barrier precaution practices and terminal cleaning
Immunosuppressed patients need to be isolated to protect them from acquiring
infections. As the hospital does not having severely immunosuppressed patients who
are undergoing stem cell transplants, rooms with positive pressure ventilation are not
necessary. It is not an essential requirement for patients undergoing solid organ
transplantation or chemotherapy. These patients are isolated in a single room. The staff
should practice contact precautions and aseptic precautions.
10. Managing Patients with Suspected or Confirmed Airborne Diseases / TB Accident &
Emergency Unit
a) The amount of time patients with suspected or confirmed airborne infections /
infectious TB disease spend in A&E should be minimized. Such patients should be
promptly identified, evaluated, and separated from other patients.
b) Ideally, such patients should be placed in an Airborne Infection Isolation room.
c) When an AII room is not available, use a room with effective general ventilation, and
use air cleaning technologies (e.g., a portable HEPA filtration system or Mobile
Plasmair unit), if available, or transfer the patient to a setting or area with
recommended infection control capacity.
CHL/HP/PCI 06
Page 4 of 7
d) A&E should have at least one Airborne Infection Isolation room. Air-cleaning
technologies (e.g., HEPA filtration) can be used to increase equivalent air changes
per hour (ACH) in waiting areas.
e) HCWs entering an Airborne Infection Isolation room or any room with a patient with
airborne infections / infectious TB disease should wear an N95 mask.
f) After a patient exits a room, allow adequate time (60 minutes) to elapse to ensure
removal of infection / M. tuberculosis-contaminated room air before allowing entry
by staff or another patient.
g) Before a patient leaves an Airborne Infection Isolation room, perform an assessment
of 1) the patient's need to discontinue airborne precautions, 2) the risk for
transmission and the patient's ability to observe strict respiratory hygiene, and 3)
cough etiquette procedures (see the standard precautions policy).
h) Patients with suspected or confirmed airborne / infectious TB who are outside an
Airborne Infection Isolation room should wear a surgical mask, if possible. Patients
who cannot tolerate masks because of medical conditions should observe strict
respiratory hygiene and cough etiquette procedures.
11. Environmental Controls
General Ventilation:
Airborne Infection Isolation (AII) rooms in of healthcare settings should be designed so that
aII rooms achieve an airflow of >12 ACH. The system minimum set point must be adequate
to maintain the recommended ACH and a negative pressure > - 0.01 inch of water gauge
compared with adjacent areas.
AII rooms should be checked for negative pressure by using visual indicators (e.g., flutter
strips) regardless of the presence of differential pressure sensing devices (e.g., manometers)
before occupancy, and these rooms should be checked daily when occupied by a patient
with suspected or confirmed TB disease.
Design, construct, and maintain general ventilation systems so that air flows from clean to
less clean (more contaminated) areas. In addition, design general ventilation systems to
provide optimal airflow patterns within rooms and to prevent air stagnation or shortcircuiting of air from the supply area to the exhaust area.
High-Efficiency Particulate Air (HEPA) Filters:
To ensure adequate functioning, install HEPA filters carefully and maintain the filters
according to the instructions of the manufacturer. Maintain written records of all pre-filter
and HEPA maintenance and monitoring. Manufacturers of room-air recirculation units
CHL/HP/PCI 06
Page 5 of 7
should provide installation instructions and documentation of the filtration efficiency and of
the overall efficiency of the unit in removing airborne particles from a space of a given size.
Maintenance and Engineering Issues:
Maintenance personnel should notify infection control personnel before performing
maintenance on ventilation systems servicing TB patient-care areas.
Maintenance personnel should schedule routine preventive maintenance for all
components of the ventilation systems (e.g., fans, filters, ducts, supply diffusers, and
exhaust grills) and air-cleaning devices. Quality control (QC) checks should be conducted to
verify that environmental controls are operating as designed and that records are current.
Provisions for emergency electrical power should be made so that the performance of
essential environmental controls is not interrupted during a power failure.
12.
Respiratory Protection:
The availability of Airborne Infection Isolation rooms minimizes the number of areas in
which exposure to M. tuberculosis might occur. But staff entering AII rooms and dealing
with cough-inducing or aerosol-generating procedures are at risk of exposures. Therefore,
they should use respiratory protective equipment in these situations. N95 or TB mask is
used for this purpose
13. Managing Patients with Suspected or Confirmed Airborne Diseases / TB Disease in
Emergency Medical Transport Situations / Ambulances
a) EMT / Ambulance personnel should be included in a comprehensive screening program
to test for M. tuberculosis infection and provide baseline screening and follow-up testing.
b) Patients with suspected or confirmed air borne infections / infectious TB disease who are
transported in an ambulance should wear a surgical mask, if possible, and drivers, HCWs,
and other staff who are transporting the patient might consider wearing an N95 mask.
c) The ambulance ventilation system should be operated in the non-recirculating mode,
and the maximum amount of outdoor air should be provided to facilitate dilution. If the
vehicle has a rear exhaust fan, use this fan during transport. If the vehicle is equipped
with a supplemental recirculating ventilation unit that passes air through HEPA filters
before returning it to the vehicle, use this unit to increase the number of ACH. Air should
flow from the cab (front of vehicle), over the patient, and out the rear exhaust fan. If an
ambulance is not used, the ventilation system for the vehicle should bring in as much
outdoor air as possible, and the system should be set to non-recirculating. If possible,
physically isolate the cab from the rest of the vehicle, and place the patient in the rear
seat.
d) EMT / Ambulance personnel should be included in the follow-up contact investigations of
patients with airborne infections / infectious TB disease.
CHL/HP/PCI 06
Page 6 of 7
H.
IMPLEMENTATION
1.
2.
3.
4.
Consultant Microbiologist and Head – Infection Control Team
All Consultants
All Physicians / Medical Officers
All Nursing Supervisors / Nurses / Staff in all departments
I. REFERENCES
1.
2.
3.
Sri Lanka College of Microbiologists ; 2005; Hospital Infection Control manual
CDC guidelines on Isolation precautions -2007
JCI ACCREDITATION STANDARDS FOR HOSPITALS – 5TH EDITION
J. POLICIES CROSS-LINKAGES
1.
ACC 6
K. ATTACHMENTS
1. Checklist for Terminal Cleaning of Airborne Infection Isolation Rooms
2. Infection Control and Ventilation Requirements for PE Rooms
CHL/HP/PCI 06
Page 7 of 7