Download CDC Guidelines for Isolation Precautions

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!